19930586 Ver 1_Complete File_19930313

DEPARTMENT OF THE ARMY
WILMINGTON DISTRICT, CORPS OF ENGINEERS
P.O. BOX 1890
WILMINGTON, NORTH CAROLINA 28402-1890
IN REPLY REFER TO September 20, 1993
Regulatory Branch

Action ID. 199303166 and Nationwide Permit No. 14 (Road Crossing)
Mr. George Grantham
3222 Stevens Mill Road
Goldsboro, North Carolina 27530
Dear Mr. Gratham:
Reference your application of June 28, 1993, for Department of the Army
authorization to place fill material into 2,000 square feet (.05 acre) of
wetlands adjacent to an unnamed tributary to the Neuse River to relocate an
access road. The propose project is located off S.R. 1008, near the community
of Stevens Mill, in Wayne County, North Carolina.
For the purposes of the Corps of Engineers' Regulatory Program, Title 33,
Code of Federal Regulations (CFR), Part 330.6, published in the Federal
Register on November 22, 1991, lists nationwide permits. Authorization,
pursuant to Section 10 of the Rivers and Harbors Act of 1899 and Section 404
of the Clean Water Act, was provided for fills for roads crossing waters of
the United States (including wetlands and other special aquatic sites)
provided:
.a. The width of the fill is limited to the minimum necessary for the
actual crossing;
b. The fill placed in waters of the United States is limited to a filled
area of no more than one-third acre. Furthermore, no more than a total of 200
linear feet of the fill for the roadway can occur in special aquatic sites,
including wetlands;
C. The crossing is culverted, bridged or otherwise designed to prevent
the restriction of, and to withstand, expected highflows and the movement of
aquatic organisms;
d. The crossing, including all attendant features, both temporary and
permanent, is part of a single and complete project for crossing of a water of
the United States; and
e. For fills in special aquatic sites, including wetlands, the permittee
notifies the District Engineer in accordance with the "Notification" general
condition.
Your work is authorized by-this nationwide permit provided it is
accomplished in strict accordance with the enclosed conditions. This
nationwide permit does not relieve you of the responsibility to obtain any
required State or local approval.
This verification will be valid for 2 years from the date of this letter
unless the nationwide authorization is modified, reissued, or revoked. Also,
this verification will remain valid for the 2 years if, during that period,
the nationwide permit authorization is reissued without modification or the
activity complies with any subsequent modification of the nationwide permit
authorization. If during the 2 years, the nationwide permit authorization
expires or is suspended or revoked, or is modified, such that the activity
would no longer comply with the terms and conditions of the nationwide permit,
activities which have commenced (i.e., are under construction) or are under
contract to commence in reliance upon the nationwide permit will remain
authorized provided the activity is completed within 12 months of the date of
the nationwide permit's expiration, modification or revocation, unless
discretionary authority has been exercised on a case-by-case basis to modify,
suspend, or revoke the authorization.
As discussed, you should contact the following State agency to obtain the
required State authorizations prior to starting work: Mr. John Dorney, North
Carolina Division of Environmental Management, telephone [phone].
Thank you for your time and cooperation. Questions or comments may be
addressed to Mr. Norm Sanders of our Washington Regulatory Field Office,
telephone [phone].
Sincerely,
G. Wayne Wright
Chief, Regulatory Branch
Enclosure
Copies Furnished (without enclosure):
,M-f' John Dorney
Water Quality Section
Division of Environmental Management
North Carolina Department of
Environment, Health and
Natural Resources
Post Office Box 29535
Raleigh, North Carolina 27626-0535
Mrs. Deborah Sawyer
Division of Environmental Management
North Carolina Department of
Environment, Health and
Natural Resources
Post Office Box 2188
Washington, North Carolina 27889
Ms. Patricia Gabriel
U.S. Soil Conservation Service
Wayne Center Room 104
208 W. Chestnut Street
Goldsboro, North Carolina 27530
State of North Carolina
Department of Environment,
Health and Natural Resources A14 tr-ow Division of Environmental Management
wow
James B. Hunt, Jr., Governor
Howes, Secretary
Jonathan ;: F=?L
A. Preston Howard, Jr., P.E., Director
August 9, 1993
George Grantham
3222 Stevens Mill Road
Stevens Mill, N.C. 27533
Dear Mr. Grantham:
Subject: Proposed fill in Wetlands or Waters
Path/road construction
Wayne County
DEM Project # 93586
Upon review of your request for 401 Water Quality
Certification to place fill material in 0.2 acres of wetlands or
waters which are tributary to Neuse River for construction of a
road or path located at SR 1008 in Wayne County as described in
your submittal dated 7 July 1993, we have determined that the
proposed fill can be covered by General Water Quality
Certification No. 2732 issued January 21, 1992. A copy of the
General Certification is attached. This Certification may be
used in qualifying for coverage under Corps of Engineers'
Nationwide Permit No. 14.
If this Certification is unacceptable to you, you have the
right to an adjudicatory hearing upon written request within
thirty (30) days following receipt of this Certification. This
request must be in the form of a written petition conforming to
Chapter 150B of the North Carolina General Statutes and filed
with the Office of Administrative Hearings, P.O. Box 27447,
Raleigh, N.C. 27611-7447. Unless such demands are made, this
Certification shall be final and binding.
If you have any questions, please contact John Dorney at
919-733-1786.
Sincerely,
rest d Jr. P.E.
93586.1tr
Attachment
cc: Wilmington District Corps of Engineers
Corps of Engineers Washington Field Office
Washington DEM Regional Office
Mr. John Dorney
Central Files
RO. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post-consumer paper
State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Environmental Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
July 30, 1993
George Granthan
3222 Stevens Mill Road
Stevens Mill, N.C. 27533
Dear Mr. Granthan:
Re: Application for 401 Certification
Wayne County
E:) FE r****J F1.0
On 7 July 1993, DEM received an application for
certification for wetland fill to construct a path for your farm.
Your application did not list the acres of wetlands to be
filled or the width of the crossing of the wetlands. Please se
send seven copies this imformation. Until we receive this
information, I will place this project on hold.
I can be reached at 919-733-1786 if you have any questions.
Sincerely,
Jo R.D ey
inapp.ltr
Attachment
cc: Wilmington District Corps of Engineers
Central Files
. cr,s0
TI
?J I
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post-consumer paper
DEM ID: /35 ACTION D:
Nationwide Permit Requested (Provide Nationwide Permit ft 1
JOINT FORM FOR
Nationwide permits that require notification to the Corps of Engineers
Nationwide permits that require application for Section 401 certification
WILMINGTON DISTRICT ENGINEER
CORPS OF ENGINEERS
DEPARTMENT OF THE ARMY
P.O. Box 1890
Wilmington, NC 28402-1890
ATTN: CESAW-CO-E
Telephone [phone]
WATER QUALITY PLANNING
DIVISION OF ENVIRONMENTAL MAN.
NC DEPARTMENT OF ENVIRONMENT,
AND NATURAL RESOURCES
P.O. Boy. 29535
Raleigh, NC 27626-0535
ATTN: MR..i OHN DORNEY
Telephone [phone]
ONE (1) COPY OF THIS COMPLETED APPLICATION SHOULD BE SENT TO THE CCSE$
SEVEN (7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL
PLEASE PRINT.
?a
7
f9
1. Owners Name: G%-o;-4 S G H ti
2. Owners Address: 2 2 2 ? Y h S M, r/l /Y
3. Owners Phone Number (Home): h S 5 2 8" ?23 (Work): 4 R 9 '- 2 5 3
4. If Applicable: Agent's name or responsible corporate official, address, phone number:
5. Location of work (MUST ATTACH MAP). County: I410r-
Nearest Town or City: C a/, s? O Y a
Specific Location (Include road numbers, landmarks, etc.):
a,k- 5-f-4,7C r /00 9
6. Name of Closest Stream/River: At - s e
7. River Basin: t? - s z
8. Is this project located in a watershed classified as Trout, SA, HQW, ORW, WS I, or WS II? YES [ ] NO [`]--
9. Have any Section 404 permits been previously requested for use on this property? YES [ ] NO ?,J-
If yes, explain.
10. Estimated total number of acres of waters of the U.S., including wetlands, located on project site: L2
11. Number of acres of waters of the U.S., including wetlands, impacted by the proposed project:
Filled:
Drained:
Flooded:
Excavated:
Total Impacted:
- .. ? }.
12. Description of proposed work (Attach PLANS-8 1/2" X 11" drawings only):
13. Purpose of proposed work: e-- A 7e> o yr. ?4 -e- A2 vu V
)5?rI- YY-
14. State reasons why the applicant believes that this activity fmust be carried out in wetlands. Also, note measures
taken to minimize wetland impacts. Ile- cg e s -e- 7' `- 3 -7' le 41C ' Gv, -e-
5 5
?rm15. You are required to contact the U.S. Fish and Wildlife Service (USFWS) and/or National Marine Fisheries Service
(NMFS) regarding the presence or any Federally listed or proposed for listing endangered'or threatened species or critical
habitat in the permit area that may be affected by the proposed project. Have you done so? YES [ ] NO [ ]
RESPONSES FROM THE USFWS AND/OR NMFS SHOULD BE FORWARDED TO CORPS
16. You are required to contact the State Historic Preservation Officer (SHPO) regarding the presence of historic
properties in the permit area which may be affected by the proposed project? Have you done so? YES [ ] NO [ ]
RESPONSE FROM THE SHPO SHOULD BE FORWARDED TO CORPS.
17. Additional information required by DEM:
A. Wetland delineation map showing all wetlands, streams, and lakes on the property.
B. If available, representative photograph of wetlands to be impacted by project.
C. If delineation was performed by a consultant, include all data sheets relevant to the placement of the
delineation line.
D. If a stormwater management plan is required for this project, attach copy.
E. What is land use of surrounding property? -/?" & F* N wt-
F. If applicable, what is proposed method of sewage disposal?
Own 's Signature Date
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L E N O u t
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MEMO
DATE:
TO:

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MnY ?O. In
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SUBJECT:
pr ?01

From:
North Carolina Department of
Health, and Natural Resources
Environment,
9 Printed on Regcied Paper
_r r
DEM ID: ACTION D:
Nationwide Permit Requested (Provide Nationwide Permit ft
JOINT FORM FOR
Nationwide permits that require notification to the Corps of Engineers
Nationwide permits that require application for Section 401 certification
WILMINGTON DISTRICT ENGINEER
CORPS OF ENGINEERS
DEPARTMENT OF THE ARMY
P.O. Box 1890
Wilmington, NC 28402-1890
ATTN: CESAW-CO-E
Telephone [phone]
WATER QUALITY PLANNING
DIVISION OF ENVIRONMENTAL MAN,
NC DEPARTMENT OF ENVIRONMENT,
AND NATURAL RESOURCES
P.O. Boy. 29535
Raleigh, NC 27626-0535
ATTN: MR. S OHN DORNEY
Telephone [phone]
ONE (1) COPY OF THIS COMPLETED APPLICATION SHOULD BE SENT TO THE CO
SEVEN (7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT.
PLEASE PRINT.
1. Owners Name: G a z (5;4 ti /t-l ;4-t
2. Owners Address: 2 2 2 S? 6a y h S M, r/l /Y h
3. Owners Phone Number (Home): 8 5- 2 Q ? 7 3 (Work): R 2 5;7 3
4. If Applicable: Agent's name or responsible corporate official, address, phone number:
5. Location of work (MUST ATTACH MAP). County: w?
Nearest Town or City: C& /a? s ? D y a
Specific Location (Include road numbers, landmarks, etc.): in; f !? S 7? a t.e S JLc v ?S ?L. ??
,r A- 5- 7C4,7Cr /009
6. Name of Closest Stream/River: Aye ze s r-
7. River Basin: /1 -r- k. s % --
8. Is this project located in a watershed classified as Trout, SA, HQW, ORW, WS I, or WS II? YES [ ] NO
9. Have any Section 404 permits been previously requested for use on this property? YES [ ] NO [-]?"
If yes, explain.
10. Estimated total number of acres of waters of the U.S., including wetlands, located on project site:
11. Number of acres of waters of the U.S., including wetlands, impacted by the proposed project:
Filled:
Drained:
Flooded:
Excavated:
Total Impacted:
,r?
12. Description of proposed work (Attach PLANS-8 1/2" X 11" drawings only):
13. Purpose of proposed work: f v „( i-L f 7?`> i2C
6? Y rY -
14. State reasons why the applicant believes that this activity must be carried out in wetlands. Also, note measures
taken to minimize wetland impacts. l? c Q ti s { 7 7-n , If ; s -2r to l Gv? U
-Aa C- r s S
15. You are required to contact the U.S. Fish and Wildlife Service (USFWS) and/or National Marine Fisheries Service
(NMFS) regarding the presence or any Federally listed or proposed for listing endangered or threatened species or critical
habitat in the permit area that may be affected by the proposed project. Have you done so? YES[ ] INTO [ ]
RESPONSES FROM THE USFWS AND/OR NMFS SHOULD BE FORWARDED TO CORPS.
16. You are required to contact the State Historic Preservation Officer (SHPO) regarding the presence of historic
properties in the permit area which may be affected by the proposed project? Have you done so? YES ( J NO [ )
RESPONSE FROM THE SHPO SHOULD BE FORWARDED TO CORPS.
17. Additional information required by DEM:
A. Wetland delineation map showing all wetlands, streams, and lakes on the property.
B. If available, representative photograph of wetlands to be impacted by project.
C. If delineation was performed by a consultant, include all data sheets relevant to the placement of the
delineation line.
D. If a stormwater management plan is required for this project, attach copy.
E. What is land use of surrounding property? -?" c, t-, -- 4-%-
F. If applicable, what is proposed method of sewage disposal?
Own 's Signature Date
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DEM ID: ACTION D:
Nationwide Permit Requested (Provide Nationwide Permit #): 14
JOINT FORM FOR
Nationwide permits that require notification to the Corps of Engineers
Nationwide permits that require application for Section 401 certification
WILMINGTON DISTRICT ENGINEER
CORPS OF ENGINEERS
DEPARTMENT OF THE ARMY
P.O. Box 1890
Wilmington, NC 28402-1890
ATTN: CESAW-CO-E
Telephone [phone]
WATER QUALITY PLANNING
DIVISION OF ENVIRONMENTAL
NC DEPARTMENT OF ENVIROND
AND NATURAL RESOURCES
P.O. Bop 29535
Raleigh, NC 27626-0535
A=: MR. SOHN DORNEY
Telephone [phone]

ONE (1) COPY OF THIS COMPLETED APPLICATION SHOULD BE SENT TO
SEVEN (7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIR
PLEASE PRINT.
1. Owners Name: G o N G H h lt-e- 14,t
2. Owners Address: 2 2 2 tic y h ??,??? h
3. Owners Phone Number (Home): h 9'7' - 2 Q' ?23 (Work): 4 5? 9 -2 5 ?23
4. If Applicable: Agent's name or responsible corporate official, address, phone number:
5. Location of work (MUST ATTACH MAP). County: wnr-It 4
Nearest Town or City: Cc, l a? S 1 o L O
Specific Location (Include road numbers, landmarks, etc.): M s f a S f?Y ?s ?2, ??
6. Name of Closest Stream/River. Aye - s e-
7. River Basin: f'1_ec4. s r
8. Is this project located in a watershed classified as Trout, SA, HQW, ORW, WS I, or WS H? YES [ ] NO [- }--
9. Have any Section 404 permits been previously requested for use on this property? YES [ ] NO H-
If yes, explain.
10. Estimated total number of acres of waters of the U.S., including wetlands, located on project site: 11. Number'of acres of waters of the U.S., including wetlands, impacted by the proposed project:

Filled:
Drained:
Flooded:
Excavated:
Total Impacted:

12. Description of proposed work (Attach PLANS-8 1/2" X 11" drawings only):
13. Purpose of proposed work: » el" L J e> ,?( s t r? G f A? ;,Lc V (7 1
u v- rl't_
14. State reasons why the applicant believes that this activi
taken to minimize wetland impacts. dG c? J { 7
4- GroSS
be carried out in wetlands. /Also, note measures
r 3 ? ? '-- a !* / v e" max- v
15. You are required to contact the U.S. Fish and Wildlife Service (USFWS) and/or National Marine Fisheries Service
(NMFS) regarding the presence or any Federally listed orproposed for listing endangered orthreatened species or critical
habitat in the permit area that may be affected by the proposed project. Have you done so? YES [ ] NO [ ]
RESPONSES FROM THE USFWS AND/OR NMFS SHOULD BE FORWARDED TO CORPS.
16. You are required to contact the State Historic Preservation Officer (SHPO) regarding the presence of historic
properties in the permit area which may be affected by the proposed project? Have you done so? YES [ ] NO [ ]
RESPONSE FROM THE SHPO SHOULD BE FORWARDED TO CORPS.
17. Additional information required by DEM:
A. Wetland delineation map showing all wetlands, streams, and lakes on the property.
B. If available, representative photograph of wetlands to be impacted by project.
C. If delineation was performed by a consultant, include all data sheets relevant to the placement of the
delineation line.
D. If a stormwater management plan is required for this project, attach copy.
E. What is land use of surrounding property? -/?- c F* N- wl-
F. If applicable, what is proposed method of sewage disposal?
Own 's Signature Date

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r DEM ID:
ACTION P:
Nationwide Permit Requested (Provide Nationwide Permit ft L
JOINT FORM FOR
Nationwide permits that require notification to the Corps of Engineers
Nationwide permits that require application for Section 401 certification
WILMINGTON DISTRICT ENGINEER
CORPS OF ENGINEERS
DEPARTMENT OF THE ARMY
P.O. Box 1890
Wilmington, NC 28402-1890
ATTN: CESAW-CO-E
Telephone [phone]
WATER QUALITY PLANNING
DIVISION OF ENVIRONMENTAL MANAGEMENT
--n R
NC DEPARTMENT OF ENVIRONME
AND NATURAL RESOURCES D (U" I? U l5
P.O. Bop 29535
Raleigh, NC 27626-0535
ATTN: MR. SOHN DORNEY ° 719M
Telephone [phone]
ONE (1) COPY OF THIS COMPLETED APPLICATION SHOULD BE SENT TO
SEVEN (7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIR
PLEASE PRINT.
1. Owners Name: G a N S G H h 1'?2
2. Owners Address: b
3. Owners Phone Number (Home): 3'7- - 2223 (Work): 4 R 9- 251 3
4. If Applicable: Agent's name or responsible corporate official, address, phone number:
5. Location of work (MUST ATTACH MAP). County: WC.
Nearest Town or City: G a I Z s ,l D&- a
Specific Location (Include road numbers, landmarks, etc.): m, I-e f s f a S 1??v o is A I1
4A 5- 75*L Z?!V? /009
6. Name of Closest Stream/River: Aye te s e
7. River Basin: tl e c4- S t
8. Is this project located in a watershed classified as Trout, SA, HQW, ORW, WS I, or WS H? YES [ ] NO ?]--
9. Have any Section 404 permits been previously requested for use on this property? YES [ ] NO H-
If yes, explain.
10. Estimated total number of acres of waters of the U.S., including wetlands, located on project site: 0
11. Number of acres of waters of the U.S., including wetlands, impacted by the proposed project:
Filled:
Drained:
Flooded:
Excavated:
Total Impacted:

12. Description of proposed work (Attach PLANS-8 1/2" X 11" drawings only):
13. Purpose of proposed work: `{ ?? y v yt f 7' ;Oe y
F-a c^ rye.
14. State reasons why the applicant believes that this activity must be carried out in wetlands. Also, note measures
taken to minimize wetland impacts. 12 G c-e V- s -e- tk, r s 41 -e- :,- tc 4'k-- ?
-A- C- roS5
15. You are required to contact the U.S. Fish and Wildlife Service (USFWS) and/or National Marine Fisheries Service
(NMFS) regarding the presence or any Federally listed or proposed for listing endangered or threatened species or critical
habitat in the permit area that may be affected by the proposed project. Have you done so? YES [ ] NO [ J
RESPONSES FROM THE USFWS AND/OR NMFS SHOULD BE FORWARDED TO CORPS.
16. You are required to contact the State Historic Preservation Officer (SHPO) regarding the presence of historic
properties in the permit area which may be affected by the proposed project? Have you done so? YES [ ] NO [ ]
RESPONSE FROM THE SHPO SHOULD BE FORWARDED TO CORPS.
17. Additional information required by DEM:
A. Wetland delineation map showing all wetlands, streams, and lakes on the property.
B. If available, representative photograph of wetlands to be impacted by project.
C. If delineation was performed by a consultant, include all data sheets relevant to the placement of the
delineation line.
D. If a stormwater management plan is required for this project, attach copy.
E. What is land use of surrounding property? -/?- c, F* N w-
F. If applicable, what is proposed method of sewage disposal?
Own6('s Signature Date

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DEM ID: ACTION D:
Nationwide Permit Requested (Provide Nationwide Permit #):
JOINT FORM FOR
Nationwide permits that require notification to the Corps of Engineers
Nationwide permits that require application for Section 401 certification
WILMINGTON DISTRICT ENGINEER
CORPS OF ENGINEERS
DEPARTMENT OF THE ARMY
P.O. Box 1890
Wilmington, NC 28402-1890
ATTN: CESAW-CO-E
Telephone [phone]
WATER QUALITY PLANNING
DIVISION OF ENVIRONMENTAL
NC DEPARTMENT OF ENVIRONA
AND NATURAL RESOURCES
P.O. Bop 29535
Raleigh, NC 27626-0535
ATTN: MR .i OHN DORNEY
U' ?l ? U v r?? ? `
Telephone [phone]
ONE (1) COPY OF THIS COMPLETED APPLICATION SHOULD BE SENT TO THE
SEVEN (7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONM
PLEASE PRINT.
1. Owners Name: G o o P 4 G H h At-e, x'12
2. Owners Address: ! 2 2 2 S ? y r- h S ??'! • ???
3. Owners Phone Number (Home): 8 5- 2 223 (Work): 4 8 9_ 2 ?7 3
4. If Applicable: Agent's name or responsible corporate official, address, phone number:
5. Location of work (MUST ATTACH MAP). County: 1 /c.
Nearest Town or City: C& L5, h o L a
Specific Location (Include road numbers, landmarks, etc.): / m ; ?? ?° 9 S f a S f?Y G us yh, ??
a A. 5- z? 7Cr /009
r
6. Name of Closest Stream/River: Ate. t s e-
7. River Basin: /I -e k s r -
8. Is this project located in a watershed classified as Trout, SA, HQW, ORW, WS I, or WS H? YES [ ] NO [•-]-
9. Have any Section 404 permits been previously requested for use on this property? YES [ ] NO -]-
If yes, explain.
10. Estimated total number of acres of waters of the U.S., including wetlands, located on project site: -
11. Number of acres of waters of the U.S., including wetlands, impacted by the proposed project:
Filled:
Drained:
Flooded:
Excavated:
Total Impacted:

12. Description of proposed work (Attach PLANS-8 1/2" X 11" drawings only):
7C? iiLL ti
13. Purpose of proposed work: 1-2, id --e- 7'
e ry1_
14. State reasons why the applicant believes that this activity must be carried out in wetlands. Also, note measures
taken to minimize wetland impacts. de- G'eti s -e- Z'W , tC r 3 '-11 --- k /,,t c. 4.>,
-f -a ? J+ 0 5 S
15. You are required to contact the U.S. Fish and Wildlife Service (USFWS) and/or National Marine Fisheries Service
(NMFS) regarding the presence or any Federally listed or proposed for listing endangered or threatened species or critical
habitat in the permit area that may be affected by the proposed project. Have you done so? YES[ ] NO [ ]
RESPONSES FROM THE USFWS AND/OR NMFS SHOULD BE FORWARDED TO CORPS.
16. You are required to contact the State Historic Preservation Officer (SHPO) regarding the presence of historic
properties in the permit area which may be affected by the proposed project? Have you done so? YES [ ] NO [ ]
RESPONSE FROM THE SHPO SHOULD BE FORWARDED TO CORPS.
17. Additional information required by DEM:
A. Wetland delineation map showing all wetlands, streams, and lakes on the property.
B. If available, representative photograph of wetlands to be impacted by project.
C. If delineation was performed by a consultant, include all data sheets relevant to the placement of the
delineation line.
D. If a stormwater management plan is required for this project, attach copy.
E. What is land use of surrounding property? - "- c, t,, N. i+ -
F If applicable, what is proposed method of sewage disposal?
'Z
Own 's Signature Date
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DEM ID: ?-,J ACTION D:
Nationwide Permit Requested (Provide Nationwide Permit ft
JOINT FORM FOR
Nationwide permits that require notification to the Corps of Engineers
Nationwide permits that require application for Section 401 certification
WILMINGTON DISTRICT ENGINEER
CORPS OF ENGINEERS
DEPARTMENT OF THE ARMY
P.O. Box 1890
Wilmington, NC 28402-1890
ATTN: CESAW-CO-E
Telephone [phone]
WATER QUALITY PLANNING M E
DIVISION OF ENVIRONMENTAL MAN U b
NC DEPARTMENT OF ENVIRONMENT,
AND NATURAL RESOURCES 7 19
P.O. Bor. 29535
Raleigh, NC 27626-0535
ATTN: MR SOHN DORNEY WETLANDS GROUP
Telephone [phone] WATER UALITY SECTI01? m
ONE (1) COPY OF THIS COMPLETED APPLICATION SHOULD BE SENT TO THE CORPS OF ENGINEERS.
SEVEN (7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT.
PLEASE PRINT.
1. Owners Name: 6't- a j?4 s G N N 74'ke-
2. Owners Address: 7 2 2 2 7 vt? PL S b
3. Owners Phone Number (Home): H S 5 - 2 S" ?2 3 (Work): 4 5' 9 " 2 S,7
4. If Applicable: Agent's name or responsible corporate official, address, phone number:
5. Location of work (MUST ATTACH MAP). County: wor-1/. 4
Nearest Town or City: Go /?r z o p d
Specific Location (Include road numbers, landmarks, etc.): M; Ae- -f S f a 1E S
TA- 5- 6*7cr /DG$
6. Name of Closest Stream/River: ASE - s e
7. River Basin: t? ?-- r4. c r-
8. Is this project located in a watershed classified as Trout, SA, HQW, ORW, WS I, or WS II? YES [ ] NO [•-]-
9. Have any Section 404 permits been previously requested for use on this property? YES [ ] NO j-]'"
If yes, explain.
10. Estimated total number of acres of waters of the U.S., including wetlands, located on project site: CI -
11. Number of acres of waters of the U.S., including wetlands, impacted by the proposed project:
Filled:
Drained:
Flooded:
Excavated:
Total Impacted:

12. Description of proposed work (Attach PLANS-8 1/2" X 11" drawings only):
13. Purpose of proposed work: ,/1 t2
a ? nz
14. State reasons why the applicant believes that this activity must be carried out in wetlands. Also, note measures
taken to minimize wetland impacts. de- ce ti s 7`? f e s -/r le
T a C'
15. You are required to contact the U.S. Fish and Wildlife Service (USFWS) and/or National Marine Fisheries Service
(NMFS) regarding the presence or any Federally listed or proposed for listing endangered or threatened species or critical
habitat in the permit area that may be affected by the proposed project. Have you done so? YES [ ] INTO [ ]
RESPONSES FROM THE USFWS AND/OR NMFS SHOULD BE FORWARDED TO CORPS.
16. You are required to contact the State Historic Preservation Officer (SHPO) regarding the presence of historic
properties in the permit area which may be affected by the proposed project? Have you done so? YES [ ] NO [ ]
RESPONSE FROM THE SHPO SHOULD BE FORWARDED TO CORPS.
17. Additional information required by DEM:
A. Wetland delineation map showing all wetlands, streams, and lakes on the property.
B. If available, representative photograph of wetlands to be impacted by project.
C. If delineation was performed by a consultant, include all data sheets relevant to the placement of the
delineation line.
D. If a stormwater management plan is required for this project, attach copy.
E. What is land use of surrounding property? - "- e? F-, e "-
F. If applicable, what is proposed method of sewage disposal?
??AJ -
Own 's Signature Date

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DEM ID: ACTION D:
Nationwide Permit Requested (Provide Nationwide Permit #): j
JOINT FORM FOR
Nationwide permits that require notification to the Corps of Engineers
Nationwide permits that require application for Section 401 certification
WILMINGTON DISTRICT ENGINEER
CORPS OF ENGINEERS
DEPARTMENT OF THE ARMY
P.O. Box 1890
Wilmington, NC 28402-1890
ATTN: CESAW-CO-E
Telephone [phone]
WATER QUALITY PLANNING
DIVISION OF ENVIRONMENTAL
NC DEPARTMENT OF ENVIROM
AND NATURAL RESOURCES
P.O. Box 29535
Raleigh, NC 27626-0535
ATTN: MR. SOHN DORNEY
f )
wE? sEC? o?
????iIlV??1Z5•
MANAGEMENT.
Telephone [phone]
ONE (1) COPY OF THIS COMPLETED APPLICATION SHOULD BE SENT TO THE
SEVEN (7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONM
PLEASE PRINT.
1. Owners Name: G o S G H h fke- Wt.
2. Owners Address: 2 2 Z 5:4a y r, h- S
3. Owners Phone Number (Home): h S 5 2 Q ?73 (Work): 4 R 9 -- 2 ?7
4. If Applicable: Agent's name or responsible corporate official, address, phone number:
5. Location of work (MUST ATTACH MAP). County: li1/c?
Nearest Town or City: C& /zlr h o t a
S f?v G us 1h, ??
Specific Location (Include road numbers, landmarks, etc.): 0,k45
-, G- 5- 7S* 7cr /009
6. Name of Closest Stream/River: Ac te s e
7. River Basin: /1 .e c4 s t - -
8. Is this project located in a watershed classified as Trout, SA, HQW, ORW, WS I, or WS H? YES [ ] NO [?---
9. Have any Section 404 permits been previously requested for use on this property? YES [ ] NO j-]-
If yes, explain.
10. Estimated total number of acres of waters of the U.S., including wetlands, located on project site: lad---
11. Number of acres of waters of the U.S., including wetlands, impacted by the proposed project:
Filled:
Drained:
Flooded:
Excavated:
Total Impacted:
A
12. Description of proposed work (Attach PLANS-8 1/2" X 11" drawings only):
13. Purpose of proposed work: '-rc, _1 » el,2k y v ,? ? o s ? r? G 7' i vu y
?4NYYi,
14. State reasons why the applicant believes that this activity must be carried out in wetlands. Also, note measures
taken to minimize wetland impacts. de- c e s 717- 1 f r ? 4 ?- --- a- & / r. e-- -
15. You are required to contact the U.S. Fish and Wildlife Service (USFWS) and/or National Marine Fisheries Service
(NMFS) regarding the presence or any Federally listed or proposed for listing endangered or threatened species or critical
habitat in the permit area that may be affected by the proposed project. Have you done so? YES[ ] NO [ ]
RESPONSES FROM THE USFWS AND/OR NMFS SHOULD BE FORWARDED TO CORPS.
16. You are required to contact the State Historic Preservation Officer (SHPO) regarding the presence of historic
properties in the permit area which may be affected by the proposed project? Have you done so? YES [ ] NO [ ]
RESPONSE FROM THE SHPO SHOULD BE FORWARDED TO CORPS.
17. Additional information required by DEM:
A. Wetland delineation map showing all wetlands, streams, and lakes on the property.
B. If available, representative photograph of wetlands to be impacted by project.
C. If delineation was performed by a consultant, include all data sheets relevant to the placement of the
delineation line.
D. If a stormwater management plan is required for this project, attach copy.
E. What is land use of surrounding property? -'- c, F* r i+ -
F. If applicable, what is proposed method of sewage disposal?
-2 7 -7
Own 's Signature Date
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