19980142 Ver 1_COMPLETE FILE_19980217

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
Nc';DENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
April 9,1998
DWQ Project # 980142
Wilson County
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Mr. Gerald Ellis
5371 St. Mary's Church Road
Lucama, NC 27851
Dear Mr. Ellis:
The Division of Water Quality has reviewed your plans for the discharge of fill material into 1.6 acres of
streams and/or wetlands located at 5371 St. Mary's Church Road in Wilson County for development of an irrigation
pond. Based on this review, we have identified significant uses, which would be removed or degraded by this project.
These uses are agent life and pollutant removal. Furthermore, insufficient evidence is present in our files to conclude
that your project must be built as planned in waters and/or wetlands in accordance with 15A NCAC 2H .0506.
Therefore, unless modifications of the proposal are made as described below, we will have to move toward denial of
your 401 Certification as required by 15A NCAC 2H .0507(e) and will place this project on hold as incomplete until
we receive this additional information. Until we receive additional information, we are requesting (by copy of this
letter) that the U.S. Army Corps of Engineers and/or the N.C. Division of Coastal Management place your project on
administrative hold.
Please provide us with information supporting your position that states your project must be constructed as
planned and that you-have no practicable alte native to placing fill in these waters and/or wetlands. Specifically can
you construct your irrigation pond without damming the creek or located 50 feet from the stream channel? Any
documentation such as maps and narrative that you can supply to address alternative designs for your project may be
helpful in our review of your 401 Certification. Also this project will require compensatory mitigation as described
in 15A NCAC 2H .0506(h). Your mitigation proposal is insufficient because none was provided as required for
wetland impacts greater than one acre.
. Please respond within two weeks of the date of this letter by sending a copy of this information to me and one
copy to Danny Smith Raleigh Regional Office at 3800 Barrett Drive Raleigh NC 27607. If we do not hear from you
in two weeks, we will assume that you no longer want to pursue this project and we will consider the project as
withdrawn. I can be reached at 919-733-1786 if you have any questions.
Si ce
Jo in R. Dorney
W ter Quality Certification ogram
cc: Raleigh DWQ Regional Office
Wilmington Office Corps of Engineers
Central Files
John Dorney
Raleigh Field Office Corps of Engineers
Mr. Donald Pittman; NRCS- Wilson County
980143.nty
Division of Water Quality - Non-Discharge Branch
4401 Reedy Creek Rd., Raleigh, NC 27626-0535 - Telephone [phone] - FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post-consumer paper
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United States Natural Resources Wilson Field Office
Department of Conservation 1806 Goldsboro St S/W
Agriculture Service Wilson N C 27893
[phone]
February 13, 1998
MrQ John Dorney
DW , Environmental Sciences Branch it
4401 Reedy Creek Rd
Raleigh, NC 27607
Attached, please find an application form for a section 401
certification. This application is for a waterhole on the
Gerald Ellis farm tract 506. The waterhole is requested for
irrigation purposes.
Please process as appropriate and notify this office when
the process is completed.
Donald W. Pittman
District Conservationist

le,
DEM M: 0 - " °R ACTION ID:
Nationwide Permit Requested (Provide Nationwide Permit #):
JOINT FORM FOR
Nation,%ide permits that require notification to the Corps of Engineers
Nationwide permits that require application for Section 401 certification
WHIvIINGTON DISTRICT ENGINEER
CORPS OF ENGINEERS
DEPAR71 ENT OF THE ARMY
P.O. Box 1890
Wilmington, NC 28402-1890
ATIN: CESAW CO-E
Telephone [phone]
DIVISION OF ENVIRONMENTAL MAN
NC DEPARTIENT OF ENVIRONMENT,
AND NATURAL RESOURCES
ENVIRONMENTAL SCIENCES BRANCH
4401 Reedy Creek Road
Raleigh, N.C. 27607
ATTN: MR. JOHN DORNEY
Telephone [phone]
1 7
ONE (1) COPY OF THIS COMPLETED APPLICATION SHOULD BE SENT TO THE CORPS OF ENGIN LEERS.
SEVEN (7) COPIES SHOULD BE SENT TO TIM N.C. DIVISION.OF I NWROi'? MENTAL M. NAGENIE.\Z:
PLEASE PRINT.
1. Owners Name: 6-6u,--b E 1-U-s
s?8s i
2. Owners Address: -C,37/ ST 6# -YA CE ift 40CA^a ; eJe-
3. Owners Phone Number (Home): qi 9 - Z3 9 - e i fi (Work):
4. If Applicable: Agent's name or responsible corporate official, address, phone number.
5. Location of work (MUST ATTACH MAP). County: wia.s o of
Nearest Town or City: Lu C,oM,4
Specific Location (Include road numbers, landmarks, etc.): S A /I ib a N a.A2- s ie //72
6. Name of Closest Stre-wn/River: _ Cezm
7. River Basin: NEv s e
8. Is this project located in a watershed classified as Trout, SA. HQW, ORW, WS I, or WS II? YES ( ) NO (X
9. Have any Section 404 permits been previously requested for use on this property? YES ( ] NO N
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: O'S,
Drained:
Flooded:
Excavated: ` <
Total Impacted:
12. Description of proposed work (Attach PLANS-8 X 11" drawings only):
1441ggT/oe IbO?
13. Purpose of proposed work: P? ? it? e / AA1601P a? W A-100-
14.
State reasons why the applicant believes that this a_tivity must be carried out in wetlands. Also, note measures
taken to minimize wetland impacts. o,1 c. y sd.T? E s, Tt
15. You are required to contact the U.S. Fish and Wil if a Service (USFWS) and/or National Marine Fisheries Servic
(NMFS) regarding the presence or any Federally listed or proposed for listing endangered or threatened species or critics
habitat in the permit area that may be affected by the proposed project. Have you done so? . YES( J 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 histod
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 proper -Ly.
B. If available, representative photograph of wetlands to be impacted by project.
C. If delineation was performed by a consultant, include ali 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?
R If applicable, what is proposed method of sewage disposal?
Owner's Signature Date

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980142-
09 6.
DE%1 ID: "` 4, 1
ACTION ID:
Nationwide Permit Requested (Provide Nation, ide Permit #):
JOINT FORM FOR
Nation,%lde 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
ATrN: CESAW-CO-E
Telephone [phone]
DIVISION OF ENVIRONMENTAL MANAGEMENT
RC DEPARTb NT OF ENVIRONMENT, HEALTH,
AND NATURAL RESOURCES
ENVIRONMENTAL SCIENCES BRANCH
4401 Reedy Creek Road
Raleigh, N.C. 27607
ATTN: MR. JOHN DORNEY
Telephone [phone]
ONE (1) COPY OF THIS COMPLETED APPLICATION SHOULD BE SENT TO THE CORPS OF ENGMERS.
SEVEN () COPIES SHOULD BE SEI,T!' TO 111-M N.C. DIVISION -OF NVI:'tGNIVENTAL NIANIAGEMENT
PLEASE PRINT.
1. Owners Name: _ G6a?r?? Esc ?s
2. Owners Address: -C- 37t ST MAy,?s e# oft y VG4.hA G 4%11-11
3. Owners Phone Number (Home): Z3'? - a 1-2 (Work):
4. If Applicable: Agent's name or responsible corporate official, address, phone number.
5. Location of work WST ATTACH MAP). County: W/- 56
Nearest Town or City: L u eAAAA
Specific Location (Include road numbers, landmarks, etc.): S A /i b a N 6..f- see 117-3
6. Name of Closest Saram/River. CCD ?,c -et
7. River Basin: Nev-S e
8. Is this project located in a watershed classified as Trout, SA. HQW, ORW, WS I, or WS H? YES [ ] NO 04
9. Have any Section 404 permits been previously requested for use on this property? YES [ ] NO N
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: o S
Drained:
Flooded:
Excavated:
Total Impacted: l L
12. Description of proposed work (Attach PLANS-8 !=" X I I" drawings only):
_ / /??l G,H T/e.+ Pores "
13. Purpose of proposed work: fta ato a 1RA16-i-,a! we Fig-
14. State reasons why the applicant believes that this a:tivity must be carried out in wetlands. Also, note measures
taken to minimize wetland impacts. e I- r sd,rA4t E s, rr-
15. You are required to contact the U.S. Fish and Wil '; a Service (USFWS) and/or National Marine Fisheries Servic.
(NIriFS) regarding the presence or any Federally listed c. proposed for listing endangered or threatened species or critica
habitat in the permit area that may be affected by the proposed project. Have you done so? . YES[ J 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 histori:
properties in the permit area which maybe affected by the proposed project? Have you done so? YES[ ] NO[
RESPONSE FROM THE SHP- 0 SHOULD BE FORWARDED TO CORPS.
17. Additional information required by DEM:
A. Wetland delineation map showing all wetlands, streams, and lakes on the prope may.
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 or this project, attach copy.
E. What is land use of surrounding property?
F. If applicable, what is proposed method of sewage disposal?
Owner's Signature Date

DEM M:
ACTION ID:
Nationwide Permit Requested (Provide Nationwide Permit #):
JOINT FORA FOR
Nation-Aide permits that require notification to the Corps of Engineers
Nationwide permits that require application for Section 401 certification
WILNIINGTON DISTRICT ENGINEER
CORPS OF ENGINEERS
DEPARTMENT OF THE ARMY
P. O. Box 1890
Wilmington, NC 28402-1890
ATIT1: CFSAW-CO-E
Telephone [phone]
DIVISION OF ENVIRONMENTAL MANAGEMENT
NC DEPARTtSNT OF ENVIRONMENT, HEALTH,
AND NATURAL RESOURCES
ENVIRONMENTAL SCIENCES BRANCH
4401 Reedy Creek Road
Raleigh, N.C. 27607
ATTN: MR. JOHN DORNEY
Telephone [phone]
ONE (1) COPY OF THIS COMPLETED APPLICATION SHOULD BE SENT TO THE CORPS OF ENC31NEERS.
SE'VEN' (7) COPIES SHOULD BE SENT TO 17-M N.C. DIVISION .OF .ENVIRC -MEN- AL IvL4NAGEMEXT
PLEASE PRINT.
1. Owners Name: G6e*-b E?cr-s
2. Owners Address: -C-,37t ST /yt#uvJ e # AD 4-0cAm,4 ,. ? e_ Ales i
3. Owners Phone Number (Home): 9i9 - Z3 9-6 6XI (Work):
4. If Applicable: Agent's name or responsible corporate official, address, phone number.
5. Location of work (MUST ATTACH MAP). County: wlc.s cr-1
Nearest Town or City: ?-? caMA
Specific Location (Include road numbers, landmarks, etc.): S41/06 N 6-M- s C 7-3
6. Name of Closest Stneam/River. CCAge met
7. River Basin: N?vs
8. Is this project located in a watershed classified as Trout, SA. HQW, ORW, WS I, or WS II? YES [ ) NO 04
9. Have any Section 404 permits been previously requested for use on this property? YES [ 1 NO N
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:
o,s-
Excavated:
Total lmpacted: ? ??
12. Description of proposed work (Attach PLANS-S X I1" drawings only):
?l?1GvgTin? Por-a ? .
13. Purpose of proposed work: P" -1i0 a / AA16erl"'a? EA
I4. State reasons why the applicant believes that this a_ iviry must be carried out in wetlands. Also, note measures
taken to minimize wetland impacts. e,1 c.Y Sd.-no e E sl'rt
1S. You are required to contact the U.S. Fish and Wildlife Service (USFWS) and/or National Marine Fisheries Servic
(N1riFS) regarding the presence or any Federally listed o. proposed for listing endangered or threatened species or critica
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 P:-eservation Officer (SHPO) regarding the presence of histori
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 propery.
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 ofthe
delineation line.
D. If a stormwater management plan is required or this project, attach copy.
E. What is land use of surrounding property?
F. If applicable, what is proposed method of sewage disposal?
Owner's Signature Date
DENT M. 9 8 0 1 4 -2 ACTION ID:
Nationwide Permit Requested (Provide Nationwide Permit #):
JOINT FORA FOR
Nation-Aide permits that require notification to the Corps of Engineers
Nationwide permits that require application for Section 401 certification
WILMIIdGTON DISTRICT ENGINEER
CORPS OF ENGINEERS
DEPARTMENT OF THE ARMY
P.O. Box 1890
Wilmington, NC 28402-1890
A1TN: CESAW-CO-E
Telephone [phone]
DIVISION OF ENVIRONMENTAL MANAGEMENT
NC DEPARTbENT OF ENVIRONMENT, HEALTH,
AND NATURAL RESOURCES
ENVIRONMENTAL SCIENCES BRANCH
4401 Reedy Creek Road
Raleigh, N.C. 27607
ATTN: MR. JOHN DORNEY
Telephone [phone]
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 MANZAGEME\?.
PLEASE PRINT
1. Owners Name: e,64#--b E64rs
2. Owners Address: S.3 7 t ST gm^,/-S e# AD `V CAA4 .. AJ e- a -;BS /
3. Owners Phone Number (Home): 9 - Z3 T- a LEI (Work):
4. If Applicable: Agent's name or responsible corporate official, address, phone number.
5. Location of work (MUST ATTACH MAP). County: wiv.s bra
Nearest Town or City: L v cA.,^ A
Specific Location (Include road numbers, landmarks, etc.): 5 2 // b a N e.yt s2 117-3
6. Name of Closest StreamlRiver. Cc-zm--, wee.
7. River Basin: NEv-S e
8. Is this project located in a watersbed classified as Trout, SA. HQW, ORW, WS I, or WS II? YES [ ] NO [4
9. Have any Section 404 permits been previously requested for use on this property? YES [ ] NO [}A
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: o, !5-
Drained:
Flooded:
'r I
Excavated: [
Total Itnpactcd: l
12. Description of proposed work (Anach PLANS-8 1:=" X I1" drawings only):
144, G? r/a? Pore
4g,.,
13. Purpose of proposed work: P? -/to e 1AA160ri,,a? /--&L- F
14. State reasons why the applicant believes that this a:tivity must be carried out in wetlands. Also, note measures
taken to minimize wetland impacts. o,J t-Y sd,r" t E s/rc
15. You are required to contact the U.S. Fish and Wil a Service (USFWS) and/or National Marine Fisheries Servic
(NS) regarding the presence or any Federally listed c. proposed for listing endangered or threatened species or cri6ca
habitat in the permit area that may be affected by the proposed project. Have you done so? . YES[ J NO [
RESPONSES FROM THE USFWS ARID/OR NMFS SHOULD BE FORWARDED TO CORPS.
16. You are required to contact the State Historic Peservation Officer (SHPO) regarding the presence of histod
properties in the permit area which may be affected by tine proposed project? Have you done so? YES [ J NO [
RESPONSE FROM 713E ST-1P0 SHOULD BE FORWARDED TO CORPS.
17. Additional information required by DEM:
A. Wetland delineation map showing all wetlands, streams, and lakes on the prope7zy.
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 or this project, attach copy.
E. What is land use of surrounding property?
F. If applicable, what is proposed method of sewage disposal?
Owner's Signature Date
9 0 0 ?. A
DEM ID: ACTION ID:
Nationwide Permit Requested (Provide Nationwide Permit #t):
JOINT FORA FOR
Nation-Aide permits that require notification to the Corps of Engineers
Nationwide permits that require application for Section 401 certification
W1124INGTON DISTRICT ENGINEER
CORPS OF ENGINEERS
DEPART1vlENIT OF THE ARMY
P.O. Box 1890
Wilmington, NC 28402-1894
AT N: CESAW-CO-E
Telephone [phone]
DIVISION OF ENVIRONMENTAL MANAGEMENT
NC DEPARTI NT OF ENVIRONMENT, HEALTH,
AND NATURAL RESOURCES
ENVIRONMENTAL SCIENCES BRANCH
4401 Reedy Creek Road
Raleigh, N.C. 27607
ATTN: MR. JOHN DORNEY
Telephone [phone]
ONE (1) COPY OF THIS COMPLETED APPLIrAtON SHOULD 13E SENT TO THE CORPS OF ENGIN-EEFtS.
SEVEN (T COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVRI ONIviENTA.L MANAGENIEN7
PLEASE PRINT.
1. Owners Name: 4-6egceb ill-Us
2. Owners Address: S.S 7 i ST rtaLy-'s c N 4 uc.?ng ; G s?8s i
3. Owners Phone Number (Home): qi 9 - Z3 9 - d iSi (Work):
4. If Applicable: Agent's name or responsible corporate official, address, phone number.
5. Location of work (MUST ATTACH MAP). County: w.?4.5 c r-1
Nearest Town or City: L-v caM,4
Specific Location (Include road numbers, landmarks, etc.): SA//bb N 6At sR 7_3
6. Name of Closest Stream/River. CCU c;,ceGt 4
7. River Basin: NEvs e _
8. Is this project located in a watershed classified as Trout, SA. HQW, ORW, WS L or WS H? YES [ ] NO [t14
9. Have any Section 404 permits been previously requested for use on this property? YES [ ] NO N
If yes, explain.
10. Estimated total number of acres of waters of the U.S., including wetlands, located on project site: Z.
11. Number of acres of waters of the U.S., including wetlands, impacted by the proposed project:
Filled: 0"5-
Drained:
Flooded:
Excavated: ` - `
Total Impacted:
12. Description of proposed work (Attach PLANS-8 i X I1" drawings only):
13. Purpose of proposed work: Pia ala e /!lA16.47.,ar
14. State reasons why the applicant believes that this a_tivity must be carried out in wetlands. Also, note measures
taken to minimize wetland impacts. e,,j t-Y sO,-no t E J e rr+
15. You are required to contact the U.S. Fish and Wildlife Service (USFWS) and/or National Marine Fisheries Servic
(NIrfFS) regarding the presence or any Federally listed c. proposed for listing endangered or threatened species or cridca
habitat in the permit area that maybe affected by the proposed project. Have you done so? . YES () INTO [
RESPONSES FROM THE USFWS AMID/OR NMFS SHOULD BE FORWARDED TO CORPS.
16. You are required to contact the State Historic P_-servation Officer (SHPO) regarding the presence of histori:
properties in the permit area which may be affected by the proposed project? Have you done so? YES [ ) NO
RESPONSE FROM THE SHPO SHOiJ'L.I, BE FORWPMED TO CORPS.
17. Additional information required by DEM:
A. Wetland delineation map showing all wetlands, streams, and lakes on the prope:Ly.
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. If applicable, what is proposed method of sewage disposal?
Owner's Signature Date
DEM M: ACTION ID:
Nationwide Permit Requested (Provide Nationwide Permit #):
JOINT FORA FOR
Nation-Aide 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
A=: CESAW-CO-E
Telephone [phone]
DIVISION OF ENVIRONMENTAL MANAGEMENT
NC DEPARTIENT OF ENVIRONMENT, HEALTH,
AND NATURAL RESOURCES
ENVIRONMENTAL SCIENCES BRANCH
4401 Reedy Creek Road
Raleigh, N.C. 27607
ATTN: MR. JOHN DORNEY
Telephone [phone]
ONE (1) COPY OF THIS COMPLETED APPLICATION SHOULD BE SENT TO THE CORPS OF ENGINEERS.
SEVEN (7) COPIES SHOULD BE SENT TO E N.C,. DIVISION .OF ENVIRONMENTAL MANAGEMENT.
PLEASE PRINT.
1. Owners Name: 6-6t#t-1? Eoc, s
2. Owners Address: CZ 7/ ST rta+-yJ e # oeb Ale-fl
3. Owners Phone Number (Home): 4?19 - 23 9-d IXI (Work):
4. If Applicable: Agent's name or responsible corporate official, address, phone number.
5. Location of work (MUST ATTACH MAP). County: wigs o, i
Nearest Town or City: I-u CAmA
Specific Location (Include road numbers, landmarks, etc.): S 211 o b N x.12- see 117-3
6. Name of Closest Stream/River. CLZ
7. River Basin: NEv.s e
8. Is this project located in a watershed classified as Trout, SA, HQW, ORW, WS I, or WS II? YES [ ] NO (}4
9. Have any Section 404 permits been previously requested for use on this property? YES [ ] NO [k]
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 projecl:
Filled: o, S
Drained:
Flooded:
Excavated: L
Total lmpactcd: 1 L?
12. Description of proposed work (Attach PLANS-8 is=" X I1" drawings only):
I44 1G?gT/ar? POpa
13. Purpose of proposed work: PA4 -1to 6 /AAl&?rital w,e-: Fig-- 'r--6A- Faz,•,
14. State reasons why the applicant believes that this a:tivity must be carried out in wetlands. Also, note measures
taken to minimize wetland impacts. o e-1 LY Sy,, 7" t E S? TL "
15. You are required to contact the U.S. Fish and Wil a Service (USFWS) and/or National Marine Fisheries Servic
(NhiFS) regarding the presence or any Federally listed o. proposed for listing endangered or threatened species or criticz
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 histori
properties in the permit area which may be affected by the proposed project? Have you done so? YES [ ] NO [
RESPONSE FROM THE SyPO SHOULD BE FORIJ/iRDED TO CORPS.
17. Additional information required by DEM:
A. Wetland delineation map showing all wetlands, streams, and lakes on the prope-cy.
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. If applicable, whet is proposed method of sewage disposal?
Owner's Signature Date
98 01 4
DEM ID:
ACTION ID:
Nationwide Permit Requested (Provide Nationwide Permit #):
JOINT FORA FOR
Nation-aide 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]
DIVISION OF ENVIRONMENTAL MANAGEMENT
NC DEPARTMENT OF ENVIRONMENT, HEALTH,
AND NATURAL, RESOURCES
ENVIRONMENTAL SCIENCES BRANCH
4401 Reedy Creek Road
Raleigh, N.C. 27607
ATTN: MR. JOHN DORNEY
Telephone [phone]
ONE (1) COPY OF THIS COMPLETED APPLITCATION SHOULD BE M-17 TO i HE CORPS OF ENGINEERS.
SEVEN (7) COPIES SHOULD BE SENT TO IWE N.C. DIVISION OF 1?:NWR, ONMENTAL MANAGEMENT.
PLEASE PRINT.
1. Owners Name: G6/tA?? E?trs
2. Owners Address: .-CZ 7t ST Mh-uy.S e N IUD Z-V C ^4 ., eJ G A-y8s i
3. Owners Phone Number (Home): '211-2,31-61-12 (Work):
4. If Applicable: Agent's name or responsible corporate official, address, phone number.
5. Location of work (MUST ATTACH MAP). Counry: wi?.s c r
Nearest Town or City: ?-v caM A
Specific Location (Include road numbers, landmarks, etc.): 5 2 M5 a N e5n2- 172 7-3
6. Name of Closest Sueam/River.
7. River Basin: NEvs
8. Is this project located in a watershed classified as Trout, SA, HQW, ORW, WS I, or WS II? YES [ J NO ()J
9. Have any Section 404 permits been previously requested for use on this property? YES [ ] NO N
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: 0,,5-
Drained:
Flooded:
Excavated: _ ?r
Total Impa=d: 1 /
12. Description of proposed work (Attach PLANS-8 i:=" X II" drawings only):
emT/Dr' Phi''
13. Purpose of proposed work: PxA a/a a ?llAibai,a? le F
14. State reasons why the applicant believes that this a:tivity must be carried out in wetlands. Also, note measures
taken to minimize wetland impacts. e, id cY sV,rno t E .'S, rt
15. You are required to contact the U.S. Fish and Wil a Service (USFWS) and/or National Marine Fisheries Servic
(NhiFS) regarding the presence or any Federally listed o: proposed for listing endangered or threatened species or critica
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 (SIPO) regarding the presence of histori:
properties in the permit area which may be affected by tine proposed project? Have you done so? YES [ ] NO [
RESPONSE FROM THE S l-1po SrIOUL.D BE FORIN ARDED TO CORPS.
17. Additional information required by DEM:
A. Wetland delineation map showing all wetlands, streams, and lakes on the proper.
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 ofthe
delineation line. -
D. If a stormwater management plan is required for this project, attach copy.
E. What is land use of surrounding property?
F. If applicable, what is proposed method of sewage disposal?
Owner's Signature Date