19980609 Ver 1_COMPLETE FILE_19980707

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 ENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
July 30, 1998
Wake County
DWQ Project # 980609
APPROVAL of 401 Water Quality Certification and ADDITIONAL CONDITIONS
Greystone Homeowners Association
c/o Charleston Management
PO Box 97243
Raleigh, NC 27624
Dear Sirs:
You have our approval, in accordance with the attached conditions and those listed below, to impact
0.94 acres of water for the purpose of dredging an existing lake, as you described in your application dated
July 7, 1998. After reviewing your application, we have decided that this fill is covered by General Water
Quality Certification Number 3108. This certification allows you to use Nationwide Permit Number 26
when the Corps of Engineers issues it. In addition, you should get any other federal, state or local permits
before you go ahead with your project including (but not limited to) Sediment and Erosion Control,
Coastal Stormwater, Non-Discharge and Water Supply Watershed regulations. This approval will expire
when the accompanying 404 or CAMA permit expires unless otherwise specified in the General
Certification.
This approval is only valid for the purpose and design that you described in your new application except
as modified below. If you change your project, you must notify us and send us a new application. If the
property is sold, the new owner must be given a copy of this Certification and approval letter and is thereby
responsible for complying with all conditions. If total wetland fills for this project (now or in the future) exceed
one acre, compensatory mitigation may be required as described in 15A NCAC 2H 00506(h) (6) and (7). For
this approval to be valid, you must follow the conditions listed in the attached certification and any additional
conditions listed below.
1. Applicant shall contract the City of Raleigh to obtain a Sediment and Erosion Control Permit.
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory
hearing. You must act within 60 days of the date that you receive this letter. To ask for a hearing, send a
written petition, which conforms to Chapter 150B of the North Carolina General Statutes to the Office of
Administrative Hearings, P.O. Box 27447, Raleigh, N.C. 276 1 1-7447. This certification and its conditions
are final and binding unless you ask for a hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean
Water Act. If you have any questions, please telephone John Dorney at 919-733-1786.
Attachment
cc: Wilmington District Corps of Engineers
Corps of Engineers Raleigh Field Office
Raleigh DWQ Regional Office
John Domey
Central Files
S' rely,
r ton Howa , Jr. PV
980609.1tr
Wetlands/401 Unit 4401 Reedy Creek Road Raleigh, North Carolina 27607
Telephone [phone] FAX # [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/10% post consumer paper
EMORANDUM
O: " John Dorney
Non-Discharge Branch
Regional Contact:!
WO Supervisor:
Date:
SUBJECT: WETLAND STAFF REPORT AND RECOMMENDATIONS
Facility Name Greystone HOA County Wake
Project Number 98 0609 County2
Recvd From APP Region Raleigh
Received Date 7/7/98 Recvd By Region
Project Type lake dredging
Certificates Stream
Permit Wetland Wetland Wetland Stream Class Acres Feet
Type Type Impact Score Index Prim. Supp. Basin Req. Req.
26 FMO Y _0N [--27-33-14 r C NSW 030402 0.94 F_-
Mitigation
MitigationType
Wetland
Type Acres Feet

Is Mitigation required? Q Y O N l
S y
z3s
Did you request more info? Q Y 10 N d
Is Wetland Rating Sheet Attached? Q Y @ N
Have Project Changes/Conditions Been Discussed With Applicant? Q Y ON
Comments: Recomm;ndation: Q Issue ® Issue/Cond
r' O Deny
cc: Regional Office
Central Office Page Number 1
Greystone- Proposed to dredge 0.94 acres of the headwaters of a pond. The pond is (shallow)
open wate (not wetlands)r. The spoil is proposed to be place near the dredging area. The
locations did not have forest vegetation and the placement of this spoil would not violate NBR (as
proposed)..
I recommended that to the Mr. Marxen (Home Owner Ass. representative) that they may wish to
consider reducing their dredging to provide suitable breeding habitat for bedding fish and thereby
reducing the amount of spoil that they had to handle.
Anyway, the RRO recommends issuance of the 401 Certification with the stipulation that HOA
contact the City of Raleigh and acquire a sedimentation and Erosion Control Plan, as per the
Control Authority's requirements.
' A
1
DEM ID
) 09
.• ` CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #):

STRUCTION NOTIFICATION APPLICATION
DE,PERMITS THAT REQUIRE:
FICATION TO THE CORPS OF ENGINEERS
ICATION FOR SECTION 401 CERTIFICATION
DINATION WITH THE NC DIVISION OF COASTAL MANAGEMENT
SEND'' E?RIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE
FIELD OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN
(7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT
(SEE AGENCY ADDRESSES SHEET). PLEASE PRINT.
1. OWNERS NAME: G?r¢•?7'??'.t/? /f'`d./l?Ot/?Y/sF' ?ssdciyriO?
2. MAILING ADDRESS:
P, ?, /3vx 97 a v -i
????.tcsrow ^c/.4?r/.s=Gcr?r?
SUBDIVISION NAME:
CITY: STATE: ?G ZIP CODE: ???oZ y

PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (zF DIFFERENT FROM
MAILING ADDRESS ABOVE) : o?e-
3. TELEPHONE NUMBER (HOME):
(WORK) :
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER: G/yT?r ??/2 ?wiF/R,r/?4hy?/ -
/j'?.c??Lc //7ihL'X?'? / 7g%l. h'.¢n'.dd R .??1/yc? ? ?/,t.CG=?G?!? /l/G
5 / (9?sJ - 5y7,Zss:Z
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: Gr?k <' NEAREST TOWN OR CITY: .dam f d ?? CI.dtv'g-t > Ctl ??C t sue/ / 4-0 0-44 41-t,!i ?Goc?Tc ?

1
r l9k
SPECIFIC LOCATION (INCLUDE ROAD
NUMBERS, LANDMARKS, ETC.) : ol/dR.rN o% AyAllf Zov'o Gt/&.f o?
YyIIf-G ¢ y eC141 241"'_ 6. IMPACTED OR NEAREST STREAM/RIVER:

RIVER BASIN: ,/li'F_1i,
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER
(SA), HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WS-I OR WS-II)? YES [ ] NO A IF YES, EXPLAIN:
7b. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES [ ] NO [X
7c. IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR
LIST OF COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION?
8a. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON
THIS PROPERTY? YES [ J NO X IF YES, PROVIDE ACTION I.D. NUMBER OF
PREVIOUS PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
CERTIFICATION):
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
FUTURE? YES [ ] NO [XI IF YES, DESCRIBE ANTICIPATED WORK:
17 If-- 4
9a. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND: cl
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
2

10a. NUMBER OF ACRES OF WETLANDS-IMPACTED BY THE PROPOSED PROJECT BY:
FILLING:
FLOODING:
DRAINAGE:
EXCAVATION: 4 - '457-5"e 'Oe;e d-:5
OTHER:
TOTAL ACRES TO BE IMPACTED : er- ?F5"-
10b. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF
RELOCATED, PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION)
LENGTH BEFORE: FT AFTER: FT
WIDTH BEFORE (based on.normal high water contours): FT
WIDTH AFTER: FT
AVERAGE DEPTH BEFORE: ?2 FT AFTER: FT
(2) STREAM;CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION: PLACEMENT OF PIPE IN CHANNEL:
CHANNEL EXCAVATION: CONSTRUCTION OF A DAM/FLOODING:
OTHER:
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE
WATERSHED DRAINING TO THE POND?
WHAT IS THE EXPECTED POND SURFACE AREA?
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF
MECHANICAL EQUIPMENT TO BE USED (ATTACH PLANS: 8 1/2" X 11" DRAWINGS
ONLY) : ?? ?.0 6i?vG yi= CO wS12v c Teo ?v 6r47- fa20wi ?[is!'7.vG "Ite _
4000--'o c d Y.yil /? S .t--1y5 tirr? b :?A069iit-
rs2 4'03firfS .?. J•Nkri ? l?J. ??6 T/Lsc rip ,a
,L'?Cc.Ff/?Q.TO/L / ?tJ6?I''r2 /.L y,c*L Sri' L?k1r ?/?tL 8? ?Gok/t ?l !/si.f/G ?1i5?'ir?6
,r?r?r! ?/? w'.eTTS, ? M'?? 5 yv??. ? /,? c fit ? c'a ry ? rq ? ? ?v y? o >• ? r-
13. PURPOSE OF PROPOSED WORK: Ty d2/6/U/r/?L
TU C2C1 4--r-I rY
3

14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED
OUT IN WETLANDS. (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND
IMPACTS)
7-0 ?3?'/?vG. T'Y? 4??c? ?3?c?c in
??, i G i v •ci ? ,y ? Br"N f"o ? .e?= <?z ?-?i a<v?c P?i?,?3 ? S y. ,? q 7?
mr W//Yil ? ? L f?fi ? `'r0/L !!///frJU
15. NOT REQUIRED
16. NOT REQUIRED
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF
PUBLIC (STATE) LAND?
YES (I NO X (IF NO, GO TO 18)
a. IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA ENVIRONMENTAL
POLICY ACT?
YES [ ] NO [I
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE?
A
YES [I NO [ ]
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE
STATE CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT REGARDING
COMPLIANCE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
4
I

18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF
PROPOSED ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL
INTO WETLANDS:
a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES
AND PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 19, 18, 21, 26,
29, AND 38). ALL STREAMS (INTERMITTENT AND PERMANENT) ON THE PROPERTY
MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET OR 1
INCH EQUALS 100 FEET OR THEIR EQUIVALENT.
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. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
e. WHAT IS LAND USE OF SURROUNDING PROPERTY? ?(
./ r1,1• M -6
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
g. SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE U.S. MAY NOT BE IMPACTED PRIOR TO:
1) ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT,
2) EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF
ENVIRONMENTAL MANAGEMENT (WATER QUALITY) CERTIFICATION, AND
3) (IN THE TWENTY COASTAL COUNTIES ONLY), A LETTER FROM THE
NORTH CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED
ACTIVITY IS CONSISTENT WITH THE NORTH CAROLINA COASTAL MANAGEMENT
PROGRAM.
N
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AG q
SAG SGNATURE ?IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED (18g.))
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SHEET 323
MAP DATE 1981
I V?
GO: John Dorney Regional Contact:
Non-Discharge Branch WO Supervisor:
Date:
SUBJECT: WETLAND STAFF REPORT AND RECOMMENDATIONS
Facility Name Greystone HOA County Wake
Project Number 98 0609 County2
Recvd From APP Region Raleigh
Received Date 7/7/98 Recvd By Region
Project Type lake dredging
Certificates Stream
Permit Wetland Wetland Wetland Stream Class Acres Feet
Type Type Impact Score Index Prim. Supp. Basin Req. Req.
it 26 - EM O Y O N r- ?7-: 3-14 r- c 030402 0.94
f -1-'-' O Y _0N r__?-i--i--(-'-?
lei
/
Is Mitigation required? 0 Y O N Sl 2- 'z 3 S?
Did you request more info? 0 Y 0 N
Is Wetland Rating Sheet Attached? 0 Y 0 N
Have Project Changes/Conditions Been Discussed With Applicant? 0 Y 0 N
Comments: Recommendation: 0 Issue 0 Issue/fond 0 Deny
cc: Regional Office Page Number 1
Central Office
ttigation Wetland
MitigationType Type Acres Feet
41k, - -
U
Greystone- Proposed to dredge 0.94 acres of the headwaters of a pond. The pond is (shallow)
open wate (not wetlands)r. The spoil is proposed to be place near the dredging area. The
locations did not have forest vegetation and the placement of this spoil would not violate NBR (as
proposed)..
I recommended that to the Mr. Marxen (Home Owner Ass. representative) that they may wish to
consider reducing their dredging to provide suitable breeding habitat for bedding fish and thereby
reducing the amount of spoil that they had to handle.
Anyway, the RRO recommends issuance of the 401 Certification with the stipulation that HOA
contact the City of Raleigh and acquire a sedimentation and Erosion Control Plan, as per the
Control Authority's requirements.

i TRIAGE CHECKLIST
Cumulative impact concerns.
Project Name: V 9 f OlL (C)
Project Number: l O 0 &0 1
County: %_j J l ?t?7 _
The attached project has been sent to you for review for the following reasons. Please consider whether a
site visit is needed to determine the impacts. Particular attention should focus on the below checked items.
Please feel free to call the central office staff; member assigned to your region if you need assistance.
- Stream length impacted.
Stream determination (i.e. intermittent or perennial, or any channel present).
Wetland impact and distance to blue-line surface waters on USGS topo map.
Niiinimization/avoidance options.
NW 14. (is access to highground or wetlands)?
LI_ Meuse buffer rules.
Pond (water) fill (i.e. is the pond drained or holding water)?
Pond creadon (i.e. in uplands, in a drained channel, or in wetlands). Please locate streams and
channels (if any) so that the central office can determine.
Midsadon ratios.
Stormwater pond placed in wetlands.
Ditchin; in wetlands.
Is the applicant's proposed stream/wedand mitigation site available and viable?
Applicant/consultant has a history of non-compliance (check drawings and application for
accuracy).
- Has project been split from previous work to avoid mitigation requirements?
- Consistent with pre-application meetings?
OTHER-
ibs?

DEM ID: CORPS ACTION ID:
NA fONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #):
l), PR?t- ? 8TRUCTION NOTIFICATION APPLICATION
v3
F& N,` `IDE PERMITS THAT REQUIRE:
7I) NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATION FOR SECTION 401 CERTIFICATION
3) COORDINATION WITH THE NC DIVISION OF COASTAL MANAGEMENT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE
FIELD OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN
(7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT
(SEE AGENCY ADDRESSES SHEET). PLEASE PRINT.
1. OWNERS NAME :
2. MAILING ADDRESS:
Pd, /2eX 979 v-25'

SUBDIVISION NAME:
CITY: ,e A4`74-1 STATE: ZIP CODE: r7;fl 2Y

PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (;F DIFFERENT FROM
MAILING ADDRESS ABOVE) : GRrI'-?/g?F ?'??'??'yl?'?// ???6 y gv-'G'
3. TELEPHONE NUMBER (HOME):
(WORK) :
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER: GeyrkT /</2 /w/F/R,a?4l?y'?
/1'?.Fecc` ?y?.X?ir/?? 7S/G si'.t,?,dd ? .?/f.?L=?G'>
a/ ( 9Z-?F J- 5-V7,7ss_z
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: wi?r NEAREST TOWN OR CITY: fVit/'o CG+aw'd 2) wifkC ,?I //V& 0--462<t???UG?%r?

1

C
`5?0 y,N SPECIFIC LOCATION (INCLUDE ROAD
NUMBERS, LANDMARKS, ETC.) : yO'?f? off' AYj1* ?O'1?•? G1/?Ji o?
e(141 041k2ef_
/ol
6. IMPACTED OR NEAREST STREAM/RIVER:
RIVER BASIN:
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER
(SA), HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER.
SUPPLY (WS-I OR WS-II)? YES [ ] NO A IF YES, EXPLAIN:
7b. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES [ ] NO [X
7c. IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR
LIST OF COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION?
8a. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON
THIS PROPERTY? YES [ ] NO X IF YES, PROVIDE ACTION I.D. NUMBER OF
PREVIOUS PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
CERTIFICATION):
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
FUTURE? YES [ ] NO [X] IF YES, DESCRIBE ANTICIPATED WORK:
1 __4
9a. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND: ,7
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
1
2

10a. NUMBER OF ACRES OF WETLANDS-IMPACTED BY THE PROPOSED PROJECT BY:
FILLING:
FLOODING:
DRAINAGE:
EXCAVATION: :51' - 9 y
OTHER:
TOTAL ACRES TO BE IMPACTED :
10b. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF
RELOCATED, PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION):
LENGTH BEFORE: FT AFTER:
WIDTH BEFORE (based on.normal high water contours): 4Y4d e-Y*VG A FT
WIDTH AFTER: FT
AVERAGE DEPTH BEFORE: ?2 FT AFTER: FT
(2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION:
CHANNEL EXCAVATION:
OTHER:
PLACEMENT OF PIPE IN CHANNEL:
CONSTRUCTION OF A DAM/FLOODING:
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE
WATERSHED DRAINING TO THE POND?
WHAT IS THE EXPECTED POND SURFACE AREA?
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF
MECHANICAL EQUIPMENT TO BE USED (ATTACH PLANS: 8 1/2" X 11" DRAWINGS
ONLY) : Of 2_> 4,-WeZ 0s= CO w/sr2v c r a w 5r4- T WoO X /sr/.yG L. 4 k'?
Cd
?G2 ?1.53rd 151?L e"A T/LR'c'rb' ;
?'X?iF{/iZTO/Z / ?tlsll'c'2 i(L li,C?'L /?V' G.!'k? Wrt? 8,c- SO/d? 2 !/si.t/G ?jl?'ir?6
,1 ??/?, /?? ko.FT/i a 0?A1 J Lf/?Lt- /? L'l J?/6L G d IV ? T-J of t 444 P.A L Vi LT
13. PURPOSE OF PROPOSED WORK: A4rfC Ty dQ/6/U/y/?L
z ?!'?Y' Tv i M d rc: w 17
Q d ? ?Y
3

14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED
OUT IN WETLANDS. (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND
IMPACTS) : T?YA-
wG . rh'? 4 ?4-L Qc ?c i?
f..4?CLc , /rf? ?,3 d c : 5 TO -OF/
X12. i G i v ni ? .U ? b'rry fo ? .??_ <iL ??i asv?c Pdi?A3 ? S ,?. ,v q TD
15. NOT REQUIRED
16. NOT REQUIRED
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF
PUBLIC (STATE) LAND?
YES (I NO X (IF NO, GO TO 18)
a. IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA ENVIRONMENTAL
POLICY ACT?
YES [ ] NO [I
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE?
YES [ ] NO [ ]
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE
STATE CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT REGARDING
COMPLIANCE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
4

18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF
PROPOSED ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL
INTO WETLANDS:
a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES
AND PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26,
29, AND 38). ALL STREAMS (INTERMITTENT AND PERMANENT) ON THE PROPERTY
MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET OR 1
INCH EQUALS 100 FEET OR THEIR EQUIVALENT.
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. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
e. WHAT IS LAND USE OF SURROUNDING PROPERTY?
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
g. SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE U.S. MAY NOT BE IMPACTED PRIOR TO:
1) ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT,
2) EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF
ENVIRONMENTAL MANAGEMENT (WATER QUALITY) CERTIFICATION, AND
3) (IN THE TWENTY COASTAL COUNTIES ONLY), A LETTER FROM THE
NORTH CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED
ACTIVITY IS CONSISTENT WITH THE NORTH CAROLINA COASTAL MANAGEMENT
PROGRAM.
?e
'S/A?;ENT'S/-?IGNA E DAT
`(AGENTUS-SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED (18g.))
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TOPOGRAPHIC MAP
EGG 200 400 600
Emmi
SHEET 323
MAP DATE 1981