19980775 Ver 1_COMPLETE FILE_19980818

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
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
August 18, 1998
Columbus County
DWQ Project 980775
APPROVAL of 401 Water Quality Certification
Nicky Fowler
1680 Sandy Plains Church Road
Tabor City NC 28463
Dear Mr. Fowler:
You have our approval, in accordance with the attached conditions and those listed below, to impact 0.90
acres of wetlands or waters for the purpose of consructing a pond in Tabor City, as you described in your
application dated August 18, 1998. After reviewing your application, we have decided that this impact is
covered by General Water Quality Certification Number 3108. This Certification allows you to use
Nationwide Permit Number 26 when it is issued by the Corps of Engineers. 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 application except as
modified below. If you change your project, you must notify us and you may be required to send us a new
application for a new certification. 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.0506 (h) (6) and (7). For this approval to be valid, you must follow the
conditions listed in the attached certification.
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 conforming to Chapter 150B of the North Carolina General Statutes to the Office of Administrative
Hearings, P.O. Box 27447, Raleigh, N.C. 27611-7447. 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 Domey at 919-733-1786.
Pc
aYr
on Howard, Jr.
Attachment
cc: Wilmington District Corps of Engineers
Corps of Engineers Wilmington Field Office
Wilmington DWQ Regional Office
Mr. John Dorney
Central Files
980775.1tr
Division of Water Quality • Non-Discharge Branch
4401 Reedy Creek Rd., Raleigh, NC 27607 Telephone [phone] FAX # [phone]
An Equal Opportunity Affirmative Action Employer • 50% recycled/10% post consumer paper
SENT BY:Wilmington District ; 8-24-98 ; 14:27 USACE-Reg. Branch-4 919 733 99594 2
ITEM ID: CORPS ACTIO14 ID: 100?1?h ? `6 LR
IIATIOWOIDE PERMIT REQUES'T'ED (PROVIDE NA,rIGNWIDE PERMI,r P): A\o W&
W1 m
PRE-CONSTRUCTION NOTIFICATION APAELpty
EV
FOR NATIONWIDE PERMITS THAT REQUIRE:
AUG 7 1998
1) NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATION FOR SECTION 401 CERTIFICATION REGULATORY
3) COORDINATION W.ZTH THE NC DIVISION OF COASTAL T+ hftk ON FIELD OFFICE
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLZ TTu0 FORM TO THE APPROPRIATE
FIELD OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN
1,I) COPIES SHOULD BE SENT TO THE N.CI. DIVISION OF ENVIRONMENTAL MANAGEMENT
(SEE -AGENCY ADDRESSES S1T)• Ei) PLEASk PRINT.
L, OWNERS NAME: Nicky & Britty Fowler
?. MAT LING ADDRESS: 1680 Sandy Plains Church Rd.
SUBDIVISION NAME:
:.:TTY: Tabor City STATE: NI! ZIP CODE: 99463
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT E'ROM
MAILING ADDRE33 ABOVE): _
at 1680 Sandy Plains Church Road
3. TELEPHONE NUMBER (HOME) : [phone] (WORT)-
2. IF APPLICABLE: AGENT'S NAME 09 RESPONSIBLE CORPORATE OFFICIAL, AUD RESS,
PHONE NUMBER: I-
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COY OF USGS TOPOGRAPHIC
MAP.,OR AERIAL PHOTOGRAPHY WITH SCALE):
COUAITY: Columbus NEAREST TOWN d CITY: Tabor City -
NUMBERS, LANDMARKS, ETC.
Sandy Plain Community.
SPEciric LOCA ION (INCLUDE ROAD
West of SRI' 105 & South Of 904 in the
i
r ?`
SENT BY:Wilmington District ; 8-24-98 ; 14:28 USACE-Reg. Branch-4 919 733 99594 3
6. IMPACTED OR NEAREST STREAW RIVER: __T_oms Foxl? - -
RTVER BASTN! Lumber River Basin
7e. TS PROJECT LOCATED NEAR WATER CLASSIrTED AS TROUT, TIDAL SALTWATER
(SA), HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WS-I OR WS-II)? YES [ ) NO [X] IF YES, EXPLAIN:
7b, IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC) ? YES [ ) NO IX)
7c, IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST
STGNA'PTDN?
OF COASTAL COUNTIES) , WHAT IS THE LAND USE PLAN (T,UP) Dp
Ba, HAVE ANY SECTION 409 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROPERTY? YES ( ) NO [X1 IF YES, PROVIDE ACTION I.D. NUMBER OF
PREVIOUS PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
CERTIFICATION) ;
ft. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
FUTURE? YES [ ) NO [)4 IF YES, DESCRIBE ANTICIPATED WORK;
9a, ESTIMATED TOTAL NUMBER Of ACRES IN TRACT OF LAND: _z j.5_ acres
Sb, ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
1 ,?r *10a. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING; .6 EXCAVATION: .3
FLOODING:
DRAINAGE:
OTHER:
TOTAL ACRES TO BE IMPACTED:
10b, (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF
RELOCATED P.ROVrOE DISTANCE BOTH BEFORE AND AFTER RELOCATION) :
LtNGTH BEFORE: FT AFTER: FT
WIDTH BEFORE (boned on normal high water contours);
- ------ -----
FT
SENT BY:Wilmington District 8-24-98 : 14:28 USACE-Reg. Branch-4 919 733 9959: 4
WIDTH AEVER: FT
AVERAGE DEPTH BEFORE: 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 I$ THE SIZE OF THE
WATERSHED DRAINING TO THE POND? 1 acre
WHAT IS THE EXPECTED POND SURFACE AREA? 2nn' x fin'
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION Off' TYPE OF MECHANICAL
EQUIPMENT TO BE USED (ATTACH PLANS: B 112" X 11" DRAWINGS ONLY):
Construct a pond using a backhoe and bulldozer.
13, PURPOSE OF PROPOSED WORK: Wildlife/Recreation
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED
OUT IN WETLANDS. (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS):
Best Suited Place
15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIVE SERVICE (USFWS)
AND/OR NATIONAL MARINE FISHERIES SERVICE (NMFS) (SEE AGENCY ADDRESSES
SHEET) REGARDING THE PRESENCE OF 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. DATE CONTACTED: 8/14/9$
(ATTACH RESPONSES FROM THESE AGENCIES.)
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) (SEE AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC
SENT BY;Wilmington District ; 8-24-98 ; 14;28 ; USAGE-Reg. Branch-4 919 733 9959; 5
PROPERTIES IN THE PERMIT AREA WHICH MAY BE AFFECTED DY THE PROPOSED
PROJECT. DATE CONTACTED: 8/14/91 _
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF
PUBLIC (STATE) LAND?
YES [l NO 9Q (IF NO, 00 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 II
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 APPROPRTATF 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, OTRECTOR STATE CLP:ARTNGHOUSE, 14ORTH CAROLINA
DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH, NORTH
CAROLINA 21603-800$, TELEPHONE [phone].
18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF
PROPOSED ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OR PILL 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 36). 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 Y-A CONSULTANT, INCLUDE, ALL DATA
SHEETS RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
d. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN TF REQUIRED.
8. WHAT IS LAND USE OF SURROUNDING PROPERTY? Woodland(Cro2land
f. IF APPLICABLE, WHAT 13 PROPOSED METHOD OF SEWAGE DISPOSAL? N/A
SENT BY;Wilmington District ; 8-24-98 ; 14:29 ; USACE-Reg. Branch-4
919 733 99594 6
g. SICNED AND DATED AGENT AUTHORIZATION LETTER, IF AQPI,ICA9LE.
NOTE: WETLANDS OR WATERS OF THE U_S_ MAY NOT HE IMPACTED PRIOR TO:
1) ISSUANCE OF A SECTION 404 COMPS 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.
OWNER`/AGENT'S SIGNATURR
rr r
ATE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LSTTER FROM
THE OWNER IS PROVIDED (189.))
P
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SENT BY;Wilmington LDistrict ; B-24-98 ; 14;29 ; USACE-Reg. Branch-4 919 733 99594 7
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SENT BY:Wilmington District : B-24-98 : 14:32 : USAGE-Reg. Branch-+
DATA FORM
ROUTINE WETLAND DETEPIMINATION
(1987 COE Wetlands Delineation Manual)
919 733 9959:9 9
`T 41"7 2

Prnjact/site: T zt'i 7 2.
Applicant/Owner: iC'j?tf >? ?t ? 0?•+??Q? Date: 8 jr/9
Cnunty: tWokbhPS
Investigator; -f State: North Carolina
Do Normal Circumstances exist on the site? -40Yes () No Community ID:
Is the site significantly disturbed (Atypical Situation)? ( )Yew No Transect ID:
ID,
la the area a potential Problem Arco? ( )Yes-44 No Plot
S:k
(It needed, explain on reverse.)
YGmG MI IVIT - Low"JI.-,
COMMON NAME
SCIENTIFIC NAME Stratum
Indicator
? r... is -

3 - ....... ........ itt ..S F01 c f r)VI I

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'

k
0,2 L
,
4
_?a.?.._ ?.Q^.? n c......,?_ ?..._......., ,
B. { Q' _.S...I.rY^

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P/?yyI •,. ur ? „ ?.?d/a?.. ., ,.
67 m Jhd0. I'(2MQ) is
J
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G
F11 G
I`f1C 11J
7. „

..10.

13.

Percent of Dominant Species that are 08L, FACW or FAC
(excluding Q).
Remarks:
'.}`1'-tR y' G.?.T ' ?q,o S S`?
?(?, i..?.•4C. C ?Crl`'-..t lv' R c', ? r

Recorded Data (Describe In Remarks): Wetland Hydrology Indicators:
-Stream, Lake or Tide Gouge Primary Indicators:
Aerial Photographs In ndated
-
Other ?turated in Upper 12 Inches
-
No Recorded Data Available -Water Marks
-Drift Linea
Field Observations: Sediment Deposits
-
Depth of Surface Water: (in.) -Drainage Patterns in Wetlands
i Secondary Indicators (2 or more required):
Depth to Free Water in Pit: _(in.) Oxidized Root Chnnneig in Upper 12 Inches
-
Water-Stained Loaves
Depth to Saturated Soil; - (in,) Local Soil Surey Data
-Local
Test
(Other (explain in Remarks)
Remarks:

SENT 6Y:Wilmin ton District 8-24-98 : 14:34 USACE-Re . Branch-4 919 733 9959#11
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IEM ID:9AQ 7 CORPS ACTION ID:
04 041 IT"!N
bpytaj
;IATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PE
PRE-CONSTRUCTION NOTIFICATIO ATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
. ,
1) NOTIFICATION TO THE CORPS OF ENGINEERS AUG I g 1998
2) APPLICATION FOR SECTION 401 CERTIFICATION' y?1?Dp?}?$?7,B?R{?O ,y 11
3) COORDINATION WITH THE NC DIVISION OF COAS?AL I
16t A TO0biTtccUP nI f
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: Nicky & Britty Fowler
?. MAILING ADDRESS: 1680 Sandy Plains Church Rd.
SUBDIVISION NAME:
'ITY: Tabor City STATE: NC ZIP CODE: 28463
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE) : Sandy Plain Road behind brickhollse 1 nr-atpH
at 1680 Sandy Plains Church Road
3. TELEPHONE NUMBER (HOME) : [phone] (WORK) :
1. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER:
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE) :
COUNTY: Columbus NEAREST TOWN OR CITY: Tabor City
SPECIFIC LOCATION (INCLUDE ROAD
;NUMBERS, LANDMARKS, ETC.): North West of SR 1135 & South of 904 in the
Sandy Plain Community
6. IMPACTED OR NEAREST STREAM/RIVER: ms Fork
RIVER BASIN: Lumber 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 [X] IF YES, EXPLAIN:
7b. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES [ ) NO [XI
7c. IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST
OF COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (t,UP) DESIGNA'T'ION?
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:
9a. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND: 2.65 acres
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
10a. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: .6 EXCAVATION: .3
FLOODING:
DRAINAGE:
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: FT
WIDTH BEFORE (based on normal high water contours): FT
WIDTH AFTER:
FT
AVERAGE DEPTH BEFORE: 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? 1 acre
WHAT IS THE EXPECTED POND SURFACE AREA? 200' x 60'
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL
EQUIPMENT TO BE USED (ATTACH PLANS: 8 1/2" X 11" DRAWINGS ONLY):
Construct a pond using a backhoe and bulldozer.
13. PURPOSE OF PROPOSED WORK: Wildlife/Recreation
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED
OUT IN WETLANDS. (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS):
Best Suited Place
15. YOU ARE REQUIRED TO CONTACT
AND/OR NATIONAL MARINE FISHERIES
SHEET) REGARDING THE PRESENCE OF
LISTING ENDANGERED OR THREATENED
AREA THAT MAY BE AFFECTED BY THE
THE U.S. FISH AND WILDLIFE SERVICE (USFWS)
SERVICE (NMFS) (SEE AGENCY ADDRESSES
ANY FEDERALLY LISTED OR PROPOSED FOR
SPECIES OR CRITICAL HABITAT IN THE PERMIT
PROPOSED PROJECT. DATE CONTACTED: 8/14/98
(ATTACH RESPONSES FROM THESE AGENCIES.)
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) (SEE AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC
PROPERTIES IN THE PERMIT AREA WHICH MAY BE AFFECTED BY THE PROPOSED
PROJECT. DATE CONTACTED: 8/14/98
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF
PUBLIC (STATE) LAND?
YES [I NO Pq (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 [ J NO [I
. b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE?
YES [] NO [l
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].
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? Woodland/Cropland
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL? N/A
g. SIGNED AND DATED AGENT AUTHORIZAT=ON 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.
OWNER' /AGENT'S S GNATURE
0 / o
I r)
ATE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED (18g.))
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7 Li z 2
DATA FORM
ROUTINE WETLAND DETERMINATION ' I I?+
(1987 COE Wetlands Delineation Manual)
Project/Site: T 11'1 7 2-
Applicant/Owner: N C {??, 3'r' 44 ?Q f. Date: 8 /ll9(?
County: Col bt..1M, bVS
Investigator I. ?e ;sir a State: North Carolina

Do Normal Circumstances exist on the site? ---{+)Yes () No Community ID:
Is the site significantly disturbed (Atypical Situation)? ( )Yes-44 No Transect ID:
Is the area a potential Problem Area? ( )Yes-4) No Plot ID:
(If needed, explain on reverse.)
VEGETATION - DOMINANT PLANT SPECIES
ON NAME
M
M
CO SCIENTIFIC NAME Stratum Indicator
`
1
'
_1 . W ter DA ?. Qv\ ?1.1?5 NJ I Y-ck
J yT F A c-
2. FI0.? S.Q? c
S? _
_. \
?ypPruS I I?iCi'1VS I-F 02 L.,

4. ?? r U - -- J.LdCI/rY?jjpr S?yrclCi-?IucL T G
_5. :._..P=nom ------.- P! ?l?S -FCXtd - T FAc
?L ?Zrrr PR_ ao J rr FA C_ U,

8.
_9..._..
10.

13.
14.
15.
Percent of Dominant Species that are OBL, FACW or FAC
5-
(excluding E AC-).
Remarks: + 1
HYDROLOGY
-Recorded Data (Describe in Remarks): Wetland Hydrology Indicators:
-Stream, Lake or Tide Gauge Primary Indicators:
Aerial Photographs Inundated
-
-Other ?turated in Upper 12 Inches
No Recorded Data Available -Water Marks
-Drift Lines
Field Observations: -Sediment Deposits
Depth of Surface Water: (in.) -Drainage Patterns in Wetlands
Secondary Indicators (2 or more required):
Depth to Free Water in Pit: _(in.) -Oxidized Root Channels in Upper 12 Inches
-Water-Stained Leaves
Depth to Saturated Soil: ?- (in.) -Local Soil Surey Data
_FAC-Neutral Test
Other (explain in Remarks)
Remarks:

SOILS
Map Unit Name
(Series and Phase): Ury
Drainage Class: V
Field Observations
Taxonomy (Subgroup): Confirm Mapped Type? (des (_) No
Profile Description:
Depth Matrix Color Mottle Colors Mottle Texture, Concretions,
(inches) Horizon (Munsell Moist) (Munsell Moist) Abundance/Contrast Structures, etc.

0 2,
3-G ?, ?o? ? ?l6
s

u t 1011Y2 Z/1 ' FS

Hydric Soil Indicators:
_Histosol
_Histic Epipedon -Concretions
?Aligh Organic Content in Surface Layer in Sandy Soils
Sulfidic Odor -Organic Streaking in Sandy Soils
_
_Aquic Moisture Regime ?Listed on Local Hydric Soils List
-Reducing Conditions -Listed on National Hydric Soils List
_Gleyed or Lo-Chroma Colors -Other (Explain in Remarks)
Remarks:
WETLAND DETERMINATION

Hydrophytic Vegetation Present? `*N Yes () No (Circle) (Circle)
Wetland Hydrology Present? _'(r) Yes (_) Po
Hydric Soils Present? -N) Yes (_) No Is this Sampling Point Within a Wetland?
`4)Yes (_)No
Remarks:

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