19981062 Ver 1_COMPLETE FILE_19981026

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
December 2, 1998
Wake County
WQC 401 Project #981062
APPROVAL of 401 Water Quality Certification and Neuse River Buffer Rules
City of Wendell
PO Box 828
Wendell, NC 27591
Dear Sirs:
You have our approval, in accordance with the attached conditions, to construct the Meadowbrook Phase 4A sewer
line in the City of Wendell, as you described in your application dated October 26, 1998. After reviewing your
application, we have decided that this fill is covered by General Water Quality Certification Number 3101. This
Certification allows you to use Nationwide Permit Number 12 when the Corps of Engineers issues it. This approval is
also valid for the Neuse River buffer rules (15A NCAC 2B .0233). 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. Also 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. 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 .0506 (h). 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 which conforms 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.
Attachment
cc: Wilmington District Corps of Engineers
Corps of Engineers Raleigh Field Office
Raleigh DWQ Regional Office
Mr. John Dorney
Central Files
Blackburn Engineering
Since ly,
ton Howard, r. P.E.
981062.1tr
Division of Water Quality - Environmental Sciences Branch
Environmental Sciences Branch, 4401 Reedy Creek Rd., Raleigh, NC 27607 Telephone [phone] FAX # 733-
9959
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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
City of Wendell
PO Box 828
Wendell, NC 27591
Dear Sirs:
NC ENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
November 4, 1998
Re: City of Wendell - Meadowbrook subdivision sewer line
Wake County
DWQ # 981062
The Division of Water Quality has reviewed your submittal for a 404/401
Permit for a sewer line near Meadowbrook subdivision in Wake County. Your
application was not complete since a location map not included. Please provide
information regarding the location of your project. This information is needed by DWQ
in order for us to decide whether this project is approvable.
I can be reached at 919-733-1786 if you have any questions. Until this
information is received, I will request (by copy of this letter) that the Corps of Engineers
place this project on hold. Also, the project will be placed on hold for our processing due
to incomplete information (15A NCAC 2H .0507(a)(4)).
Sincerely,
Jo R. Dorney
W er Quality Certificati Program
L
Attachment
cc: Raleigh DWQ Regional Office
Wilmington District of Corps of Engineers
Raleigh Field Office Corps of Engineers
John Dorney
Central Files
Keith Roberts; Blackburn Consulting Engineering
981062.hld
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

DWQ ID:
CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #)
PRE-, NSTRUCTION NOTIFICATION APPLICATION
PERMITS THAT REQUIRE: .9
1TC1 ON TO THE CORPS OF ENGINEERS
PLI TI FOR SECTION 401 CERTIFCATION
nC,? 3) C INA N WITH THE NC DIVISION OF COASTAL MANAGEMENT
,. ?, . ?elS e4C
AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE
%; -tCE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN
7) COPIES MUST BE SENT TO THE NC DIVISION OF WATER
QUALITY, ATTN: JOHN DORNEY, 4401 REEDY CREEK ROAD,
RALEIGH, NC 27607. PLEASE PRINT OR TYPE.
1. OWNER'S NAME:
2. MAILINGADDRESS:_ Ao; 2?bPr X2_9 (r, r„?P ll1 /UC
SUBDIVISION NAME
CITY: // STATE: /V C ZIP CODE: ,),9 Sj (
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE): , An lYl.• k
At if ,J f /71-4ir k( C? I' 1- _t
TAN Or c?z??L=?,c
3. TELEPHONE NUMBER: (HOME) (WORK)
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER:
?z c.F &FIX
?2 -',2: gcll f m n fI'Pc' f
&A
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: AA? ke ; NEAREST TOWN:

SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ECT.)

6. IMPACTED OR NEAREST STREAM/RIVER: && /,' (-)-er k
RIM BASIN:
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER, (SA),
HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURSE WATERS (ORW), WATER
SUPPLY (WS.I OR WS-In? YES ( ) NO ( )( ) IF YES, EXPLAIN: ,.,
7b. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION NO F COASTAL
MANAGEMENT AREA OF ENVIROMENTAL CONCERN (AEC)? YES ( )
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?
S& HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT?
ERMTT AND ANY ADDITIONAL INFORMATIOPROVIDE INCL REVIOUS
UDE PHOTOCOPY OF 401
P
CERTIFICATION):
8b. ARE ADDITIONAL (ON NO PERMIT X tIT IREQUESTS F YES, DESCRIBE ANTICIPATED WORK: IN THE
FUTURE?
9a ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND: y
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WE'T'LANDS LOCATED ON PROJECT SITE:
O
10s. NUMBER OF ACRES OrzwE'TLANDS IMPACTED BY THE PRC)POSEP.PROJECT BY: IVIA

t
.IM.4
A
FU.UNO; r,d%v* V.4% a avill:
FLOODING: OTHER :
DRAINAGE : TOTAL ACRES TO BE IMPACTED:
lOb. (1) STREAM CHANNEL. TO BE IMPACTED BY THE PROPOSED PROJECT (IF
RELOCATED, PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION:
LENGTH BEFORE: -FT AFTER: Fr
WIDTH BEFORE (based on normal high wator contours): FT
AVERAGE DEPTH BEFORE: , FT AFTER:
(2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION: _ PLACEMENT OF PIPE IN CHANNEL:
CHANNEL EXCAVATION: COONSTRUCTION OF A DAMXLOODING:
OTHER: C'R? w
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. DISCTIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL
EQUIPMENT TO BE USED? (ATTACH PLANS: 81/2 BY 11 DRAWINGS ONLY)
nE41 -SL-1.J..k ,<n,j` GU /",= Ttivi1L`0 l-ui 'i ,..w Cif>L? So4
TO /l :W M H // 'f? n U,t > J !n rE C)`;?? i/ /1N ?.
I NCK
13. PURPOSE OF PROPOSED WORK: i rr ,d -l f f¢-a
RN ktZ?E-I: T/1(= ?Vlh L? iC?i l/?7? ?y57F7n r/.j d- /?/h1 r'Xi?TS . ///r I=KiSTNG .I
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETL.AND IMPACTS)
j rT .E'c:? K'cT/? D r C r/ • ?;YUI•? /1c i(tc,i1JY1 i ?c i "d Gu U ti:?u'
7-!/4?7- C'i4LFK, sr?/tirT G?tLC rv?/n r/(? S??c?f%rST
TO
T//N/- to C(- / c u"? S?>J? rr? f?/t l' ji r ?
?jS.C? gC? /'1/ua ce /9? f ui ( C'?'c 2

15. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE AND/OR
- NATIONAL MARINE FISHERIES SERIVE REGARDING THE PRESENCE OF ANY FEDERALY
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:
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. DATE CONTACTED
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (STATE) LAND? YES Gk') NO ( ) (IF NO, GO TO 16)
a IF YES, DOES THE PROJECT REQUIRE PREPERATION OF AN ENVIRONMENTAL
DOCUMENT PURUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT? YES( ) NO( )
b. IF YES, HAS THE DOCUMENT BEEN REFIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE YES ( ) NO (q')
IF ANSWER 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATIONFROM THE STATE
CLEARINGHOUSE 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 OF FILL MATERIAL INTO
WETLANDS: All fA?-
a WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES, AND
PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, l8, 21, 26, 29,
AND 38). ALL STREAM (INTERMITTENT AND PERMANENT) ON THE PROPERTY
MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET
OF 1 INCH EQUALS 100 FEET OF THEIR EQUIVALENT.
b. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE IMPACTED
BY PRODUCT.
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 PROPOERTY?

f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
S. SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WTLANDS OR WATERS OF THE US 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 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 WGRAM,
OWNER'S/AG S SIGNATURE DATE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM '
THE OWNER IS PROVIDED).
ps:;
f i.4
!r,

K, +
DWQ ID: CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #) _
O? -CONSTRUCTION NOTIFICATION APPLICATION
%
?FO NWIDL pERMITS THAT REQUIRE: a .a
T
?G? kTCATION TO THE CORPS OF ENGINEERS
PLCATION FOR SECTION 401 CERTIFCATION
.??? 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 MUST BE SENT TO THE NC DIVISION OF WATER
QUALITY. ATTN: JOHN DORNEY, 4401 REEDY CREEK ROAD,
RALEIGH. NC 27607. PLEASE PRINT OR TYPE.
1. OWNER'S NAME: C; fv C'1/= &irl loll . IJL)4'? ?z17?1•'n«
2. MAILING ADDRESS: moo: !?pr X 2-e SUBDIVISION NAME

CITY: &?PIvii /I STATE: A) C ZIP CODE: 0 Sj (
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE): ?? ' C P . t E fr r /Yl (? rL,?; ?rn: ?/n x.71 1 U '
3. TELEPHONE NUMBER: (HOME) (WORK)' 4444-
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER:
ti &A
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: CUR r NEAREST TOWN:
Y Awf
r SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS ECT.)
71
6. IMPAMD OR NEAREST STREAM/RIVER:
RIVER BASIN:
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, 71DAL SALTWATER, (SA),
HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURSE WATERS (ORW), WATER
SUPPLY (WS•I OR WS-II)? YES ( ) NO ( )( ) IF YES. EXPLAIN:
7b. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIROMENTAL 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?
ga. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUES'T'ED FOR USE ON THIS
PROJECT? YES ( ) NO (X) IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS
PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
CERTIFICATION):
FUTURARE E?FS ( ON NO (?X ) IF YES. DESCRIBE ANTICIPATED WORK: PROPERTY IN THE
?y
9a. ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND:
9b. ESMIATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
0
10a. NUMBER OF ACRES OR WETLANDS IMPACTED BY THE PRP"SA.P. PROJECT BY: NIA
r,k
R•
r
z3?d
4t
r
f, +r?,
bE.LiNG• EXCAVATION:

FLOODING. OTHER :
--774
DRAINAGE : TOTAL ACRES TO BE IMPACTED:
lOb. (1) STREAM CHANNEL. TO BE IMPACTED BY THE PROPOSED PROJECT (IF
RELOCATED, PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION:
LENGTH BEFORE: - --YT AFTER: FT
WIDTH BEFORE (based on normal high water contours): FT
AVERAGE DEPTH BEFORE: AFTER FT -Yr
(2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION: - PLACEMENT OF PIPE IN CHANNEL:
CHANNEL EXCAVATION: -? COONSTRUC17ON 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. DISCTIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL
EQUIPMENT TO BE USED? (ATTACH PLANS: 81/2 BY 11 DRAWINGS ONLY)
'i
>'UW6 5 r lt-t-
W M r f l n C/r ) "Pig c? '? /YI fl ?.

?r

13. PURPOSE OF PROPOSED WORK:
'
C-XiST-LNC? ;.
{
Y)Q L /'c-phi i/Ua- T C'/Irfl[ i'

IN
STATE REASONS WHY IT IS BELIEVED THAT ACTIVITY MUST
14
.
Ti.AND IMPACTS)
WBTANDS (INCLUDE ANY MEASURES
tT a`- _, ,? - c >f u/til 1??(?<;NYt 1/c d Gv Un/y?t '
jf/? C.QL?r?, ?r/tk f G?i (C_ /;C m/ "v rn lG t'? ?'Y 7Hr" /V ` 1'Xe S/AK%6ST
`XSCi gCc= /9iu6 cc` /9C o?sl Z °-'c t K 11719T iu, LC lquOw SYS/l-m TO fury c T? GV? , W .
`a

15. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE AND/OR
- NATIONAL MARINE FISHERIES SERIVE REGARDING THE PRESENCE OF ANY FEDERALY
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:
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. DATE CONTACTED
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (STATE) LAND? YES (,?') NO ( ) (IF NO, GO TO 16)
a IF YES, DOES THE PROJECT REQUIRE PREPERATION OF AN ENVIRONMENTAL
DOCUMENT PURUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT? YES( ) NO( )
b. IF YES, HAS THE DOCUMENT BEEN REFIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE YES ( ) NO (-f')
IF ANSWER 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATIONFROM THE STATE
CLEARINGHOUSE 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 OF FILL MATERIAL INTO
WETLANDS: /V/ f?-
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 STREAM (INTERMITTENT AND PERMANENT) ON THE PROPERTY
MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET
OF 1 INCH EQUALS 100 FEET OF THEIR EQUIVALENT.
b. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE IMPACTED
BY PRODUCT.
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 PROPOERTY?

• 'o J I N,,
t s. f
it

f. IF APPLICABLE, WHAT I$ PROPOSED METHOD OF SEWAGE DISPOSAL.
g. SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WTLANDS OR WATERS OF THE US 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 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
DWQ ID: CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #)
? % v - Pf CONSTRUCTION NOTIFICATION APPLICATION
114 ATIONWIDE PERMITS THAT REQUIRE:
OG 061,
c/ v
NOTIFICATION TO THE CORPS OF ENGINEERS
APPLICATION FOR SECTION 401 CERTIFCATION
f 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
M_COPIES MUST BE SENT TO THE NC DIVISION OF WATER
QUALITY, ATTN: JOHN DORNEY, 4401 REEDY CREEK ROAD,
RALEIGH, NC 27607. PLEASE PRINT OR TYPE.
1. OWNERS NAME: Y r). I:- t' /?C-)41, (22, u/"no'
11 + /(i C 9 S`P /
2. MAM NG ADDRESS: Zo, ?Pc X2-e 4 ,1 e,- r.P e
SUBDIVISION NAME
CITY: &L,)Pne-ir l l STATE: /V C ZIP CODE: ,0 S'l (
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE): /J?al ' i c c . fr, lYl ?•/??: <:? :,: F s/? ?: ?? o nL 2! y '
3GS-
3. TELEPHONE NUMBER: (HOME) (WORK) ? a j)
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER:
I'P f
?2 Lr-2 S f 422c2/-l
C l'a 4 t'n A, /Q L212) SS L-Z`/0 U
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: ZL-e ke - NEAREST TOWN GtJP? , l ,

SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ECT.) _
U 5 f 7 7( , 14 C"',)J-F
ri-L
6. IMPACTED OR NURPST STREAM/RIVER: C1'=&
RIVER BASIN'
7a. IS PROJECT LOCATED NEAR WATER
CLASSIFIED AS TROUT, TIDAL ?1G RESOUR.SE WATERS 0 W), WATER SALTWATER, (SA),
HIGH QUALITY WATERS (HQW), OUTS
SUPPLY (WS•I OR WS-In? YES ( ) NO ( )( ) IF YES. EXPLAIN:
7b IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIROMENTAL CONCERN (AEC)? YES ( ) NO ( X )
7c. IF THE PROTECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF
COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION? _/L//A
8a, HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT?
ERMTT AND ANY ADDITIONAL INFORMATION( INCLUDE PHOTOCOPY OF 440 PREVIOUS
P
CERTIFICATION):
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
FUTURE? YES ( ) NO (X) IF YES. DESCRIBE ANTICIPATED WORK: -
„1b:,.
11 ? 1
{ ,yJI
1i .
9a. ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND:
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
101. NUMBER OF ACRES OR WETLANDS IMPACTED BY THE PROPOSEQ,PROJECT BY: N//4
1 ?w
Y '
OTHER : (/ /
FLOODING:
-774 f % 67
DRAINAGE : 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
FT AFITR
AVERAGE DEPTH BEFORE:
(2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION: PLACEMENT OF PIPE IN CHANNEL:
CHANNEL EXCAVATION: ! COONSTRUCTION OF A DAM/FLOODING:
OTHER: C'?2u iv
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
DRAINING TO THE POND? , 1411A WHAT IS THE EXPECTED
POND SURFACE AREA? /1,?A- ,
12, DISCTIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL
EQUIPMENT TO BE USED? (ATTACH PLANS; 8112 BY 11 DRAWINGS ONLY) ,
nEt.J -S[ k' C .v" Cu < / r= <'un STiz?c /r`? ??c ??i s'tilt' ._ rIH Cl j1 4 ?i t_` nL
l0 w mH // %m n cn --e ?xist>u? c`<--i;k TQ /nµ /y ct P 0_,_lu?M0 f.

UVI/S7/?r/CT r r< / S , T -Yn "rYZ?%?? -
13. PURPOSE OF PROPOSED WORK: • D 64 + - 5"1 f
AAA k?2r??e L_,r?r? Over r? Jam= ?Ys E M Th., f i7c i kr 1 s ri%? c- x?sTING
)e_ _ cuh r/U aT
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WET'IAND IMPACTS)
j T o?,?jk C l) ALT t=ftC C iC / OX4_ 1* a-?<yyetm c [? a Gy Uwr??
w S/?cKTtS'T
%!/? CQG?K. sry/7cT ICC ?? ?rliv?pi;ZrQ ??' 7Hr"N? P
/?ss?sc? /9%?acC ry?o?i, C?'c? Tff?r w•cc flcc?w syS7?-m To f??cT
r
6
fl
M5'
Ire-
1
13. YOU ARE REQUIRED TO CONTACT THE US FISH .AND WILDLIFE SERVICE AND/OR
- NATIONAL MARINE FISHERIES SERIVE REGARDING THE PRESENCE OF ANY FEDERALY
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:
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. DATE CONTACTED
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (STATE) LAND? YES (-,r) NO ( ) (IF NO, GO TO 16)
a IF YES, DOES THE PROJECT REQUIRE PREPERATION OF AN ENVIRONMENTAL
DOCUMENT PURUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT? YES( ) NO( )
b. IF YES, HAS THE DOCUMENT BEEN REFIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE YES ( ) NO (-f")
IF ANSWER 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATIONFROM THE STATE
CLEARINGHOUSE 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 OF FILL MATERIAL INTO
WETLANDS: /1// f -
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 STREAM (INTERMITTENT AND PERMANENT) ON THE PROPERTY
MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET
OF 1 INCH EQUALS 100 FEET OF THEIR EQUIVALENT.
b. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE IMPACTED
BY PRODUCT.
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 PROPOERTY?

r
/A h; ,

E IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL? ////-V
S. SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: W`71 ANDS OR WATERS OF THE US 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 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
MANAG ROGRAM,
2 OWNERTAG 'S SIGNATURE DATE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED).

DWQ ID: CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #) _

CTION NOTIFICATION APPLICATION
THAT REQUIRE:

=10'C
CATION
TO THE CORPS OF ENGINEERS
ATION FOR SECTION 401 CERTIFCATION
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 MUST BE SENT TO THE NC DIVISION OF WATER
QUALITY, ATTN: JOHN DORNEY, 4401 REEDY CREEK ROAD,
RALEIGH, NC 27607. PLEASE PRINT OR TYPE.
1. OWNER'S NAME: __ ?? ty ?l!= GcJPn?E'// /Iu?-f? ?2; yl n«
2. MAILING ADDRESS: /o. A X2-g ,1c Pal' (l /f/L Z/I ct l
SUBDIVISION NAME
CITY: &1Pne-Qr /I STATE: /U C ZIP CODE: ;,9 Sj
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAMING ADDRESS ABOVE): In Mr ;?/, s/; U'
3. TELEPHONE NUMBER: (HOME) (WORK)
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER:
CFA &n /L)C 29 s<.z o L212) Ss- ? -Z20 0
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: AA? Le NEAREST TOWN: Gt/P?v(?? l l
'1u
6
SPECIFIC LOCATION (INCLUDE ROAD NUI GERS, LANDMARKS, ECT.) /1 r?47'w
V / r crtl? . ?C
6. IMPACTED OR NEAREST STREAM/RIVER: _ L& L CrP k
RIVER BASIN: °
7a. IS PROJECT LOCATED NEAR WA OUTSTANDING RESOURSE WATERS O V?? WATER SALTWATER, (SA),
HIGH QUALITY WATERS (HQW), SUPPLY (WS-1 OR WS-II)? YES ( ) NO ( )' ) IF YES, EXPLAIN:
7b. 1S THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA Of ENVIROMENTAL CONCERN (AEC)? YES ( ) NO ( A' )
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? _.AJZA
HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON PHIS
8a.
REVIOUS
P
I.D. NUMBER OF
??Qm ? ???
PROJECT? YES ( ) NO ()
O
R
HOTOCOPY OF 4
P
PERMIT AND ANY ADDITIONAL
CERTIFICATION):
RE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE ;
8b. A
FUTURE? YES ( ) NO (X) IF YES, DESCRIBE ANTICIPATED WORK:

9a. ESTIMATED TOTAL NUMBERS OP ACRES IN TRACT OF LAND:
OTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
9b. ESTD ATED T

OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED. PROJECT BY: IVIA
109. NUMBER

. r
A.
I" i
FLLING: EXCAVATION:
FLOODING: OTHER :
DRAINAGE : TOTAL ACRES TO BE IMPACTED:
Job. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF
RELOCATED, PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION:
LENGTH BEFORE -- F'I' AF MR; FT
WIDTH BEFORE (based on normal high water contours):
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: ?_ COONSTRUCTION OF A DAMNLOODING:
OTHER: l Ru
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
DRAINING TO THE POND? A-//A WHAT 1S THE EXPECTED
POND SURFACE AREA? /PIKA-
12, DISCTIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL
EQUIPMENT TO BE USED? (ATTACH PLANS: 8112 BY 11 DRAWINGS ONLY)
11E4I
_ja w MH // •(-1/) 70 /„u /0 c?•?_? n :lq ?'_nN ?.

?Url/S71C?CLc /S Yyr?'?Y" I-'a
5"tf¢IL
13. PURPOSE OF PROPOSED WORK: iy TLi= Flc-w/ fRv /!z, tyltl old
ki r,S .
?Z 'Iw //L OVC:
Z-1rvu T C'/ri9C %
14. STATE REASONS WHY IT IS BELIEVED THAT ACTIVITY MUST BE CARRIED OUT IN
WB'1'LANDS (INCLUDE ANY MEASURES
% rT
orn
cC ?? °?sI z?yc ? T/1?r ku.cc. jr[cuw syS7??? 70
fiscc= /9?u6
I a-
1S. YOU ARE REQUIRED TO CONTACT THE US FISH .AND WILDLIFE SERVICE AND/OR
NATIONAL MARINE FISHERIES SERIVE REGARDING THE PRESENCE OF ANY FEDERALY
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:
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. DATE CONTACTED
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (STATE) LAND? YES (,?') NO ( ) (IF NO, GO T016)
a IF YES, DOES THE PROJECT REQUIRE PREPERATION OF AN ENVIRONMENTAL
DOCUMENT PURUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT? YES( ) NO( )
b. IF YES, HAS THE DOCUMENT BEEN REFIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE YES ( ) NO (4')
IF ANSWER 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATIONFROM THE STATE
CLEARINGHOUSE 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 OF FILL MATERIAL INTO
WETLANDS: ?V ltf -
a WEI LAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES, AND
PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26, 29,
AND 38). ALL STREAM (INTERMITTENT AND PERMANENT) ON THE PROPERTY
MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET
OF 1 INCH EQUALS 100 FEET OF THEIR EQUIVALENT,
b. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE IMPACTED
BY PRODUCT.
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 PROPOERTY?
t

r?
K,, F
r' .
• f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL? /VIA-
j, SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WTLANDS OR WATERS OF THE US MAY NOT BE IMPACTED PRIOR TO:
I) ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT,
2) EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF 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 PJ"RAM,
S SIGNATURE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED).
DATE

}
DwQ ID: CORPS ACTION ID:
E PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #) _
C? -CONSTRUCTION NOTIFICATION APPLIPA 6 -?
16'i0
1 Fo %p bE PERMITS THAT REQUIRE:
NOTIFICATION TO THE CORPS OF ENGINEERSd ,
?;??R 2) APPLICATION FOR SECTION 401 CERTIFCATION
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 MUST BE SENT TO THE NC DIVISION OF WATER
OUALITY, ATTN: JOHN DORNEY, 4401 REEDY CREEK ROAD,
RALEIGH, NC 27607. PLEASE PRINT OR TYPE.
1. OWNER'S NAME: ?fY <J/- GcJP?,r?(P// 12o4l,
?tti C,l %?C?
2. MAILING ADDRESS: ?JA" X2_9 /l/ C
SUBDIVISION NAME
CITY: C?JPAr'l e /I STATE: _JV C ZIP CODE: -k'9 Sl
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
I3. TELEPHONE NUMBER: (HOME) (WORK) -yam-
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER:
?,+Z? ?flPrf' '} .
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: 4y NEAREST TOWN:
t
?Y
-to
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ECT.) _ d,421- ,
CFPek
?< r
6. IMPACTED OR NEAREST STREAM/RIVER: &?L /, ?T PPS --
RIVER BASIN:
SALTWATER, (SA),
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED
RESOURSE WATERS 0 W), WATER
HIGH QUALITY WATERS (HQW), OUTSTANDING
SUPPLY (WS•I OR WS-In? YES ( ) NO ( )( ) IF YES. EXPLAIN:
7b. IS THE PROJECT SATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIROMENTAL 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? A/
ga, HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT?
UDE PHOTOCOPY OF 401
ERMTT AND ANY ADDITIONAL INFORMATION( INCL PREVIOUS
P
CERTIFICATION):
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
FUTURE? YES( ) NO (X) EYES, DESCRIBE ANTICIPATED WORK: ?_..--
1_IC.p t f
9a ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND:
9b. ES'T'IMATED TOTAL NUMBER OF ACRES OF WE'T'LANDS LOCATED ON PROJECT SITE:
lOt. NUMBER OF ACRES OF-WETLANDS IMPACTED BY THE PROPOSED PROJECT BY. N//4
6
FLOODING: _... 741 IA- OTHER : Tk
•w
DRAINAGE : TOTAL. ACRES TO A IMPACTED: ? : .
i
10b. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF
RELOCATED, PROVIDE DISTANCE BOTH BEFORE AND AFI ER RELOCATION:
LENGTH BEFORE: --FT AFTER; FT
r
WIDTH BEFORE (based on normal high water contours): FT
AVERAGE DEPTH BEFORE: IT AFTER:- Fr
(2) ST" CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION: - PLACEMENT OF PIPE IN CHANNEL:
CHANNEL EXCAVATION: COONSTRUCTION OF A DAM/FLOODING:
OTHER: N
11, IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
DRAINING TO THE POND? 1 WHAT IS THE EXPECTED
POND SURFACE AREA? , /v;?A- ---
12, DISCTIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL
EQUIPMENT TO BE USED? (ATTACH PLANS: 8112 BY 11 DRAWINGS ONLY)
nSTr??c I? U lrz ?/. /?N C-SIY1 St 4
nE4l 5?ttii <,L?' iu L< 66
Nf .
C/Vl/STRc/CTL i1 ? S 7 YyL r?i'!2A?'"I a ??.??••??
13. PURPOSE OF PROPOSED WORK: _. i CPC ,' Iif? t- c f'?" "'' ft 7d .Si 1,?'a
7Z/c-- CV?X 6uLC.7e l /?'? ?I?S7E7>1 AX,i -/71?i1 raL rS f/E GKi1T?/v?
?)c /14. STATE REASONS WHY 1T IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (INCLUDE ANY MEASURAS TAKEN TO MINIMIZE WETLAND IMPACTS)
7d Cer ti"? •LL?'c ? Gv?rc+Cc T%/ /uw /?Ci(s?rtlYt i?c i' -u G? Uivy?? '
j,rl? CRE LK. ??`/ T wi(? ?? ?r?iNi?Y? l?C? /9,Y 7Hr." niu TAP 5?1?LC%rST
r/5Cc /9rudCr /?c?uSl ?r'C?Lc jflNT wC? /9CCut,/ SyS7ln^ TU ?c//1CjiGw
>?ILOF? /176 cY _ _ . _ _
10
Y
6

,r,Fy?
15. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE AND/OR
NATIONAL MARINE FISHERIES SERIVE REGARDING THE PRESENCE OF ANY FEDERALY
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:
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. DATE CONTACTED
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (STATE) LAND? YES (?') NO ( ) (IF NO, GO TO 16)
a. IF YES, DOES THE PROJECT REQUIRE PREPERATION OF AN ENVIRONMENTAL
DOCUMENT PURUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT? YES( ) NO( )
b. IF YES, HAS THE DOCUMENT BEEN REFIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE YES ( ) NO (-'')
IF ANSWER 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATIONFROM THE STATE
CLEARINGHOUSE 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 OF FILL MATERIAL INTO
WETLANDS: %Vl tf -
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 STREAM (INTERMITTENT AND PERMANENT) ON THE PROPERTY
MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET
OF 1 INCH EQUALS 100 FEET OF THEIR EQUIVALENT.
b. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE IMPACTED
BY PRODUCT.
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 PROPOERTY?

f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL? /V/A
P
g. SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WTLANDS OR WATERS OF THE US 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 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
MANAG ROGRAM,
26
'S/AG 'S SIGNATURE DATE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED).
p
•

y?
?I• f
• E
• ,, e11 1
' .j
-ry'i

DWQ IDs CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #)
?' - \W-CONSTRUCTION NOTIFICATION APPLICATION
ti ATIONWIDE PERMITS THAT REQUIRE:
NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATION FOR SECTION 401 CERTIFCATION
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 MUST BE SENT TO THE NC DIVISION OF WATER
QUALITY, ATTN: JOHN DORNEY, 4401 REEDY CREEK ROAD,
RALEIGH, NC 27607. PLEASE PRINT OR TYPE.
1. OWNER'S NAME: F4 <)1= Gc/t'lvko /9041, G'.'& /'"Icy

2. MAILING ADDRESS: moo; 2Q--)Pr X2-9 A/C ?9S`ll
SUBDIVISION NAME
CITY: CcJPn? Pr l ! STATE: !U C ZIP CODE:
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
3. TELEPHONE NUMBER: (HOME) (WORK) -44-
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER:
/h:?" ? frPc'
?-r
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: &/ r NEAREST TOWN: (4g l l

' SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ECL) I one r- . --luyu- -
crpeak
6. IMPACTED OR NEAREST STREAMfi"M' -&& /a ?JPPt?
RIVER BASIN: 'o7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER- (SA), ;
HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURSE WATERS (ORW), WATER
SUPPLY (WS-I OR WS-In? YES ( ) NO (X) IF YES. EXPLAIN:
7b. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIROMENTAL CONCERN (AEC)? YES ( ) NO ( X )
7c. IF THE PROJECT T5 LOCATED WITHIN A C P1. DF.ySiG(SEE NATIONPACE ?'_LFOR L?,ST OF
?/.?-
COASTAL COUNTIES), WHAT IS THE LAND USE (LUP)
8a. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROTECT? YES ( ) NO (X) IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS
PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
w.vM ' ? "" 11T\.
%.C^ t Ara%.^ a av6-1-
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
FUTURE? YES ( ) NO (X ) IF YES- DESCRIBE ANTICIPATED WORK:

9a. ESTIMATED TOTAL. NUMBERS OF ACRES IN TRACT OF LAND: t y .
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
4
10a. NUMBER OF ACRES OR WETLANDS IMPACTED BY THE PROPOSED,PROJECT BY: NIA
..F
r• f`.r

I` jiM`, dyl, L,
y
t'
I
;41 IA- OOTHER: Z ( /
FLOODING: _„
% 67
DRAINAGE : 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
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: COONSTRUCTION OF A DAM/FLOODING:
OTHER: 04-4-6
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? . /YEA
12. DISCTHMON OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL
EQUIPMENT TO BE USED? (ATTACH PLANS. 81/2 BY 11 DRAWINGS ONLY)
A64i Qt'? ,Lt C? L< e'si" ?vn sl2?c 1 c- !, c?:? % tivc._ I'?H c-' STY; St 4
TD /?cW MH // Tt vn C`xicr, c l ?u2K TJ in,µ A) 6'er i 0.-) A MN !5-•
13. PURPOSE OF PROPOSED WORK: Qu., t
A102 XUtllg1^= r//L OVki? f-x%sT/1/G
SN??>e ,Li ryC / S J /'c%??t i i/li e- i4 T C'i?rf?c
14. STATE REASONS WHY rr IS BELIEVED THAT TEES ACTIVITY MUST BE CARRIED OUT IN
WMI.ANDS (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS)
rT I'?.a-ilty? il?r/ff?C /?Li(t;/t/Y1j1,/c '-- /-C) 6?'?)ulW-:?e
-Xe
7CJ j//c= C.Q??K. /fhT w?? • J?iNir•??2?;0 ?' it
.
:U,(,c" Nccow Sy?I?n? To /r-. v/lcr?a'? . .
i,
Y
6
r w
a0
15. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE AND/OR
- NA77ONAL MARINE FISHERIES SERIVE REGARDING THE PRESENCE OF ANY FEDERALY
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:
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. DATE CONTACTED
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (STATE) LAND? YES (?') NO ( ) (IF NO, GO TO 16)
L IF YES, DOES THE PROJECT REQUIRE PREPERATION OF AN ENVIRONMENTAL
DOCUMENT PURUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT? YES( ) NO( )
b. IF YES, HAS THE DOCUMENT BEEN REFIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE YES ( ) NO (4-)
IF ANSWER 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATIONFROM THE STATE
CLEARINGHOUSE 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 OF FILL MATERIAL INTO
WETLANDS: %V/ A-
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 STREAM (INTERMITTENT AND PERMANENT) ON THE PROPERTY
MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET
OF 1 INCH EQUALS 100 FEET OF THEIR EQUIVALENT.
b. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE IMPACTED
BY PRODUCT.
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 PROPOERTY?
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
S. SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WTLANDS OR WATERS OF THE US MAY NOT BE IMPACTED PRIOR TO:
I ) ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT,
2) EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF 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
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED).
DATE

r
CORPS ACTION ID:
REQUESTED (PROVIDE NATIONWIDE PERMIT #) _
10,01% v

UCTION NOTIFICATION APPLICAT 1062
PERMITS THAT REQUIRE:
1) NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATION FOR SECTION 401 CERTIFCATION
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 MUST BE SENT TO THE NC DIVISION OF WATER
QUALITY, ATTN: JOHN DORNEY, 4401 REEDY CREEK ROAD,
RALEIGH, NC 27607. PLEASE PRINT OR TYPE.
1. OWNER'S NAME: 041, a2 yl 'nay
2. MAILING ADDRESS: X2-e?
SUBDIVISION NAME
CITY: C?JPn, ?r // STATE: A) C ZIP CODE: ,0 6'? (
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE): Ar:ii `i cr. /- An 3. TELEPHONE NUMBER: (HOME)

/-0-N Or WCA ii :,6C
(WORK) _ 0,I) 1c ?
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER:
/
?i tom,. Svc ??s?o C-2612 s5-3-2,2o&
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: AIL? ?r ,- NEAREST TOWN: G?/,9 ?g / /

SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ECT.) /i on,'r ?x CGG _
reek ,
6. IMPACTED OR NEAREST STREAM/RIVER: _ &/?f /a C-
RIVER BASIN: lIZ-oil
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER, (SA),
HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURSE WATERS (ORW), WATER
SUPPLY (WS-I OR WS-In? YES ( ) NO ( )( ) IF YES, EXPLAIN: -
7b. 1S THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIROMENTAL CONCERN (AEC)? YES ( ) NO ( :1' )
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? Iv
&a. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT? YES ( ) NO (X) IF YES, PERMIT AND ANY ADDITIONAL INFORMATION( (INCLUDE PHOTOCOPY PREVIOUS
OF 401
CERTIFICATION):
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
FUTURE? YES( ) NO (X ) IF YES, DESCRIBE ANTICIPATED WORK:
r .
9a. ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND:
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
lOt. NUMBER OF ACRES OR WETLANDS IMPACTED BY THE PROPOSED. PROJECT BY: N/t4 i
k
4t- 1.
t
FILLING:
FLOODING:
DRAINAGE :
OTHER:
TOTAL ACRES TO BE IMPACTED:
lOb. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF
RELOCATED, PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION:
LENGTH BEFORE FT AF17ER: FT
WIDTH BEFORE (based on nomW high water contours):
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: , COONSTRUCTION OF A DAMIFLOODING:
OTHER: CPU N
t 1. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
DRAINING TO THE POND? , A11A WHAT IS THE EXPECTED
POND SURFACE AREA? ?A-
12, DISCTIP'I'i0N OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL
EQUIPMENT TO BE USED? (ATTACH PLANS; 81/2 BY 11 DRAWINGS ONLY)
J C ?S
E '{.V 'i/ll Ci/ C V ?I 5//?. y/ -V - L ._ 7 I
l4 /1 'W ?H /? 'r, n c n??, e "h/sr?vc ?-k JJ in /l /CU c1,\ P '().?%?N f•
?uvUS7l??c7? ? ? ? <
13. PURPOSE OF PROPOSED WORK:
AIV /?CZI\E 1n: r//L ??C iu iC?J =r?/?'? ??57 ?7+ ?/ y f 7 F? TS . %% G X<ST?N?

14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS)
ill CeZ A3010e( &"lTI/ -d G? Uivi?e
/f/t, SRC K? /n/??% 4?l? ?L INI/?i jrt'? ?'Y THr /v
?is.ci5c? 111L,6cr 19LXVsd C'?-'c am 111191 iurcc //CWw s/?II?Y• To fvi?cT/fYv

r

15. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE AND/OR
- NATIONAL MARINE FISHERIES SERIVE REGARDING THE PRESENCE OF ANY FEDERALY
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:
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. DATE CONTACTED
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (STATE) LAND? YES (,t-) NO ( ) (IF NO, GO TO 16)
a IF YES, DOES THE PROJECT REQUIRE PREPERATION OF AN ENVIRONMENTAL
DOCUMENT PURUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT? YES( ) NO( )
b. IF YES, HAS THE DOCUMENT BEEN REFIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE YES ( ) NO (4')
IF ANSWER 17b IS YES, THEN SUBMIT APPROPRIATE DOCUIVIENTATIONFROM THE STATE
CLEARINGHOUSE 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 OF FILL MATERIAL INTO
WETLANDS:
l1//ft- 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 STREAM (INTERMITTENT AND PERMANENT) ON THE PROPERTY
MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET
OF 1 INCH EQUALS 100 FEET OF THEIR EQUIVALENT.
b. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE IMPACTED
BY PRODUCT.
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 PROPOERTY?

1. f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAUJ: UlbrUbALa ? % %x
S. SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WTLANDS OR WATERS OF THE US MAY NOT BE IMPACTED PRIOR TO:
I ) ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT,
2) EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF 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
MANAG ROGRAM,
MNER'TlAG 'S SIGNATURE DATE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED).
it

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° o _ 64 WENDELL,IN C
SITE DATA Tract Area - 23.1 ac
Zoning - R-12
Minimum Lot Size - 12,000 sf
Average Lot Size - 15,650 sf Linear Feet of Street - 2960 if
MEADOWBAOOH nm SUBDIVISIONS / V\ Number of Lots - 59(rosqL IN 1`01,64AA4B)
E 1 / / / \ / pO Minimum Lot Width - 60' (70' typical)
p RD e Minimum Lot Depth - 125' Minimum Setbacks
l~I 07EA00w4Q00 k FIIAgE 3 Front - 25'
Rear - 20'
23 Side - 10'
Corner Side - 25' Owner
Lucius Jones
i PO Box 128
Wendell NC 27591 1 919-365-7196
VICINITY MAP
\ / f 1, 0,0
NOTE
~40! ,lam/ J l/'\l qD ) All construction shall be in accordance with
Town of Wendell Standards.
4
fte
Z B B CSAcS~
Ile 3L . 1 94'
Z ^ II 1 , pM M~ ,~a / IGZ,
` o 31 I
rjo 31
36 . ewzo t Gu1rEfL &"Me It 1 yi 1-2
173 ° r75' X33 PDBCC 5~1')ZlceLANP 1 ° a / Zf 04
CA Nof6: ND%.-(N 51P6 OG 12AUUA DR-IUE (DfF51>I~) SHALL
rr~ 0 v y,' \ / / / / / 1?AJ~ RarpI~LED 5NoWu28F- wa?TJ of 6' TD
ter- / / quDrnor~OhTE S~oPEs (,~i~{~N t~-xi'7TiA36- f-(L..N-
/ /
/ 4~, ` m -7 / Zq / D
/ 4 \ 3~w - J 71 h 40
V
76, SITE DATA BY PHASE
Phase 4A Phase 48
0E42'615 (3001L 1=ULLEF Tract Area 14.3 ac. 9.7 ac.
.5, D7 ZDNE IZA Zoning R-12 R-12
JAI sal o y2 ~Ij ^M
/ ~A ~lJ y Minima Lot Size 12,000 SF 12,000 SF
Aver IS SF
?z I I ,M 4e Ire I
3zP r a ° _ Q Linear L>~ f 960 LF y
Number of Lots 35 1 24
Afg 13 I 12" Sewer 2,153 LF _
8" Sewer 1,207 LF
6" Water 2,130 LF
,VIP
- /
/i r5V as b - r 1001#v 146~r
>?b~lE 2q ~476R -~2y°
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7s-
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M ~A PNAML)U FNAs9 4A
q9 CARO
?~~tn i s
S qe j = BLACKBURN CONSULTING ENGINEERING
,•~F~ ' ~pc,,.~ PH. [phone] FAX [phone]
0 fo too too 400 234 EAST MAIN STREET ;p CLAYTON, NC 27520
1= IDO z!~~9$
1-303 I of 1D