19990765 Ver 1_COMPLETE FILE_19990712

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
e??
James B. Hunt, Jr., Governor NCDENR
Bill Holman, Secretary NORTH CAROLINA DEPARTMENT OF
Kerr T. Stevens, Director ENVIRONMENT AND NATURAL RESOURCES
October 5, 1999
Wake County
DWQ Project # 990765
APPROVAL OF 40I.Quality Certification and ADDITIONAL CONDITIONS and Neuse River Buffer Rules
John Matthews
7625 Lake Wheeler
Raleigh NC 27603
Dear Mr. Matthews:
You have our approval, in accordance with the attached conditions and those listed below, to place fill material in 356 linear
feet of streams for the purpose of developing Laneridge subdivision at SR 2723, as you described in your revised application
dated August 26, 199 with a site plan revision dated August 23, 1999. After reviewing your application, we have decided that this
fill is covered by General Water Quality Certification Number 3103. This certification allows you to use Nationwide Permit
Number 14 when the Corps of Engineers issues it. This approval is also valid for the Neuse River buffer rules (15A NCAC 2B
.033). 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.. 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). This approval shall expire when the corresponding Nationwide Permit
expires or as otherwise provided in the General Certification. For this approval to be valid, you must follow the conditions listed
in the attached certification and any additional conditions listed below.
1. Deed notifications or similar mechanisms shall be placed on all lots with remaining jurisdictional wetlands and waters or
areas within 50 feet of all streams and ponds to notify the state in order to assure compliance for future wetland and/or water
impact. These mechanisms shall be put in place within 30 days of the date of this letter or the issuance of the 404 Permit
(whichever is later).
2. An additional condition is that stormwater shall be directed to sheetflow at nonerosive velocities through the protected
stream buffers and that sediment and erosion control measures shall be outside the 50-foot wide buffer zone.
3. Applicant must contact US Army Corps of Engineers to determine which Nationwide Permit is required for this project.
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 Dorney at 919-733-9646.
ice 1,
err to en
Attachment
cc: Corps of Engineers Raleigh Field Office
Raleigh DWQ Regional Office
,h1eRCbP9
Central Files
Raleigh Division of Land Resources
Mike Stewart; Stewart-Proctor PLLC
990765.1tr
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
http://h2o.enr.state.nc.us/wetiandc.htmi
MEMORANDUM
TO: John Dorney Regional Contact: Steve Mitchell
Non-Discharge Branch WQ Supervisor: Ken Schilster
Date:
SUBJECT: WETLAND STAFF REPORT AND RECOMMENDATIONS
Facility Name John Matthews/Lane Ridge Developement County Wake
Project Number 99 0765 County2
Recvd From APP Region Raleigh
Received Date 7/12/99 Recvd By Region
Project Type
Certificates Stream
Permit Wetland Wetland Wetland Stream Class Acres Feet
Type Type Impact Score Index Prim. Supp. Basin Req. Req.
NBR O Y O N F- 27 (36) wsv Nsw 30,402. F- F_
Mitigation Wetland
MitigationType Type Acres Feet
Is Wetland Rating Sheet Attached? 0 Y (0 N Did you request more info? 0 Y (0 N
Have Project Changes/Conditions Been Discussed With Applicant? DQ Y 0 N
Is Mitigation required? 0 Y O N Recommendation: 0 Issue 0 Issue/COnd 0 Deny
Provided by Region: Latitude (ddmmss) Longitude (ddmmss)
Comments:
Engineer made the Yecomended changes and tthe project meets the NRR requirements. Lay out
looks good
cc: Regional Office
Central Office Page Number 1
Transmittal
S'TEWART - PROCTOR PLLC
ENGINEERING & SURVEYING
(, 19) 854-2080
Fax : [phone]
4628 TRYON RD.
RALEIGH, NC 27606
d //--- 6 L
Date:
J ZIVZAJ6?\Xje-M'? I -1k
Attention:
From:
Number of pages (including this cover):
Comment(s):
je:
zd +a
I--`
?-

Reply requested- ? Yes ? No
State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
Kerr T. Stevens, Director
Mr. John Matthews
7625 Lake Wheeler Road
Raleigh NC 27603
Dear Mr. Matthews:
1, 1 L11?1WA •
NC ENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
July 26, 1999
DWQ # 990765
Wake County
On 8 July, 1999 the Division of Water Quality (DWQ) was notified by receipt of your
applications regarding your plan to fill wetland for the purpose of constructing Lanshire
subdivision in Wake County. Approval from DWQ is required to disturb these wetlands. Please
show a site plan of suitable scale (for instance 1" = 100 feet) so we can begin to determine your
projects' compliance with 15A NCAC 2H .0500. `
Please call me at 919-733-1786 if you have any questions or would require copies of our
rules or procedural materials.
cc: Raleigh DWQ Regional Office
Wilmington Corps of Engineers
John Dorney
Central Files
Mike Stewart; Stewart- Proctor, P.L.L.C
990765.pnd
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
4.7
67771
To:
FAY#
Remarks:
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From:
10
Date: 7/67/9I
Number of Pages:
Phone: [phone]
Fax: [phone]
FAX TRANSWTAL SHEET
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DWQ ID• CORPS ACTION ID: -
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #) _
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
1) NOTIFICATION TO THE, CORPS OF ENGINEERS
2) APPLTCATTON+ FOR STC llON 401 CERTIFCATION
3) COORDLNATION WI'T-H THE NC DIVISION OF COASTAL MANAGEM-ENIT
SEND THE ORIGINAL AND (I) COPY OP THIS COMPLETED FORM TO THE APPROPRAIM
FIELD OFFICE OF THE COPY'S OF ENGINEERS (SEE AGENCY ADDRESSI=S S.:-ME-I). SEVEN
(7) COPIES MUST BE SENT TO THE NC DIVISION OV WATER
QUALITY, ATTN: JOHN DORNEY, 4401 REEDY CREED RQAD,
RALEIGH, NC 27607. PLEASE PRINT OR TYPE.
1. OWNER'S NAME: 52 d HV M ATTff eV.5
2. MATLLNG ADDPMS: _ Ili Z1- GA'kE LagZ5FLEl2 ,2 p A10
RA1" SLBDTV'ISION NAME _1i EJSI? ?/e?
CITY: 041-cQ4f1 STATE- A?. G - ZIP CODE- Z 71, V-7
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFF.,RE-ST FROM
MAILING ADDRESS ABOVE): I- AL cAPetf_ SE /Q L1 cA,1
9Sao 6ftlAlY BfoL?? gD. AA1,. t?G z?Go,?
3. TELEPHONE NUMBER: (HOME) _854- 2Ddd (WORK) B S4-2t
,6Tl? _
4, IF APPLICABLE: AGENT'S NAINM OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER:
4 G ZY 7-2yoj/ 210942 RA-GEi6ht 19.E z ?/ 0 4
r64: (91Z_ 994-Zo610
/yJ m S T ?f}?T C ST Et???t2T ? PQDGTd/e ,Cl??! L
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USES TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY W'1171E SCALE):
COUNTY: _?? JC - NEAREST TOWN:
'S'00 ?.?yrJY 990WAI g2 ),
f . ! .
SPECIFIC LOCATION (INCLUDE ROAD NVIMP15, LANDMARKS, FCT.)
?C? F,JG?t?S?l7 pLf??tJ.S -
6. MCPA" I'ED OR NEknST SnaQNRIVEP- t1 e y- 6 9109A
RIN'ERBASIN• fagj,&E
7e. IS PROJECT LOCATFM NEAR. W, TER C-ASSiFIED AS TRAUT, IIDAi SALT` 'A -' R (S?.),
F rJH QUALITY WATERS (HQW), OUTSTANDING RESOURSE WATERS (ORW), WATER
SUT'I'LY (WS-1 OR WS-H}? YES ( ?) NO '( ) IF YES. EXrL.AIN:
9C2-eae 21 VE,2 Q ASA,cI
7b. IS THE PROSECT LOCATED Y TrHw A NORTH CAROLINA DIVISION CF COASTAL
I.A.- AGE-ME:rNT AREA OF FN VIRONaWAL CON(MM (AEC)? YES ( ) NO { ?( }
7;,. IFTHIPROJE' i IS LOCATED WITHIN .A. COASTAL COUNTY (SEEPAGE ?FOR LIST OF
COASTAL COUN=), WHAT NS THE LAND USE PLAIN (LUP) DESIGNATION?
Ufa
Si HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON 1-flIS
PROJECT? YHS ( ) NO {X ? IF YES, PROVIDE ACTION I.D. NUMBER CF MEVIOUS
PEP-V= AND ANY ADDIT O NAL YW-OR4A7ION (INCLUDE PHOTOCOPY OF 401
CERTIFiCATION):
8b. ARR ADLITIONA-1 PERIZT REQUEST S LrXPECTED FOR THJS PROPERTY IN THE
FUTURE!: YES ( ) NO (X) IF YES, DESCRIBE ANTTCIPXMD WORK: _
9a. ESTIMATED TOT AL NUMBERS OF ACRES IN TRACT OF LAND: Ill.] G .
9b. FZMEAT.ED TOTAL NUMBER OF ACRES OF WEIZI+NDS LOCATED ON PROJECT SITE:
1-n Qff
toe. NUMBER OF ACRES OF WETLA.*IDS WACTED BY THE PROPOSED PROTECT BY:
c • J i.1.jQC'-7r cc . Q,a nnr
-V,

F1LI.IIdG: EXCAVATION:
?z ooDnrO: OTHER :
DRAINAGE : TOTAL ACRES TO BE MPACTED:.`._
IOb_ (1) STREAM CHAINNT-L TO BE IMPACTM BY THE PROPOSED PROJECT (IF
Fja,OCATM, PROVIDE 0TSTANCB BOTH BEFORE AND -A z- ER RELOCATION;
LENCy f;.I;PE1?0?-E: 3SG FT AMER. __Fr
WIDTH BEFORE. (based on Eoz:mal high water coasoun): Fr
AvERACM DEPTH BEFORE: AFTER. -?. S' / Fr
(2) snmvM CHAN. NFL IMPACTS WILL RESULT FROM. (CHECK ALL THAT APPLY j
OPEN CIF-ANNEL RELOCATION: PLACEMENT OP PIPE W CFiANA'EL:
CHANNM EXCAVATION: COONMUGTION OF A DAIyVF LOODING:
OTHER:
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT iS THE SIZE OF THE WATERSAM
DRAIND40 TO THE POND?
WHAT 1S IMF. E)aECTED
POND SURFACE AREA?
12, D3,-CFI IP,'ION OF PROPOSED WORK INC_r LMING DISCUS110N OF TYPE OF MECHANICAL
EQUIPMENT TO BE USED? (ATTACH PLANS: 8112 BY 1 I DRAWINGS C.NLY)
LnAQ" -
13. PUP-POSIT OF PROPOSED WORK-
STATE REASONS WHY iT IS BELIEVED THAT MS ACTIVITY MUST BE CARRIED OUT IN
14,
WETLANDS (WCLUDE ANY MEASURES TAKEN TO I'd.TNMIM WMAND 2,4PACTS)
IS. YOU ARE REQUIRED TO CONTACT THE US FISH AND WJLOLTFE SERVICE ANDIOR
NATIONAL MARINE FISHERIES SERIVE REGARDING THE PRESENCE OF ANY FEDER.AI.Y
LISTED OR PROPOSED FOR LISTING ENDANGERED OR THREATENED SPECIES OR
CRITICAL I3ABITAT IN THE PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED
PROD EC71. DATE CONTACTED: g1A
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 TIC PROPOSED PROJECT. DATE CONTACTED
17. DOES THE PROTECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OT THE 13SE OF
PUBLIC (STATE) LAND? YES ( ) NO. ( ?f (IF NO, GO TO 16)
L IF YES, DOES THE PROJECT REQUIRE PREP ERATION OF AN LNVIRONMBNT?Z
DOCUMENT PURUANT TO THE REQUIR.E1,=S OF THE NORTH CAROLINA
ENVMONMF_NTAL POLICY ACT? YES ( ) NO( )
b. IF YES. HAS THE DOCUMENTi BEEN REFMWED THROUGH TIM NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE YES ( ) NO ( }
IF ANSWER 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENT ATIONFROM THE STATE
CLF.ARDIGHOUSE 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 X7603-8003, TELEPHONE [phone].
18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WTI'H THIS APPLICATION IF PROPOSED
ACTIVITY INVOLVES-THE DISCHARGE OF EXCAVATED OF FILL MATERIAL. INTO
WE'T',:.ANDS:
s. WETLAND DE.LUNF.ATION 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 SO FEET
OF I INCH EQUALS 100 FEET OF THEIR EQUNALENT.
b. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE IMPACTED
BY PRODUCT.
a. L DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA
SHEETS RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
d. ATTACH A COPY OF THE STOXMWATER MANAGEMENT PLAN IF REQUIRED.
a WHAT IS LAND USE OF SURROUNDING PROPOERTY?
RE-s140A,'r,aL Ao%eln
11
,ucc•?r cc_ on -Irr

f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
E TIL
?. S13NED AND DATED AGENT AUTHORIZATION L.ETPER. IF AMICABLE.
NOTE: WTL4NDS OR WATERS OF THE US MAY NOT BE IlvIPACTED PRIOR TO:
I) ISSUANCE OF A SEC-00N 404 CORPS OF ENGINEERS PERMIT,
2) EITI ER THE ISSUANCE OR WAIVER OF A 4CI DIVISION OF WATER QUALI'T'Y
CERTIFICATION, AND
3) (IN THE TWENTY COASTAL COUNTIES ONLY), A LETTER FROM THE NORTH
CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED
ACTIVI'T?i IS CONSISTENT WITH THE `FORTH CAROLINA COASTAL
MANAGEMENT PROGRAK
OW SP ! EI?r SIGNATURE DATE
(AGENT'$ SIGNA-LURE VALID ONLY
IF AUTHOR2ATION LETTER FROM
THE OW TR IS PROVIDED).

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s UNITED STATES
DEPARTMENT OF THE INTERIOR
GEOLOGICAL SURVEY
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1000 _0-- IOCO 1 MILE
_--- = - 2000 3000 4000 5000
5 6000 7000 FEET
0
1 KILOMETER
CCr:TOUR INTERVAL 10 FEET
NATIONAL GEODETIC VERTICAL DATUM_ OF 1929 17 ) -1W
s UNITED STATES
DEPARTMENT OF THE INTERIOR
OIOLOGICAL SURVEY
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SCALE 1:24 000 /11 40 712
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looo - ---- s_=?
?f'.v00 2000 3000 q? 1 MILE
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-- 1 KILOMETER
CowOUR INTERVAL 10 FEET
"''TONAL GEODETIC VERTICAL DATUM OF 1929
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7S* 4J
JUL 08 199 01:46PM
DWQ ID:
CORPS A'CUON ID:
NATIONWIDE PERM11* REQU-ESTLD (PROVIDE NATIONWIDE PERMIT #)
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
I) NOTIFICATION TO THE CORPS OF ENC,x;.NEERS
2) APPLICATION FOR SECTION 401 CERTIFCATION
3) COORDINATION WITH TfIE NC DIVISION OF COASTAL MANAGEMENT
SEND THE ORIGINAL AN'+J' (1) COPY OF THIS COMPLETED FORM TO TIIE APPROPR:ATI's
FIELD OFFICE OF THE COP.PS OF ENGMERS (SEE AGENCY ADDRESSES S.-MET). SEVEN
7 COPIES MUST BE SENT TO THEN SIGN OF WATER
UALITY, ATTN_:.JOHN DORNE'Y, 4441 REEDY CREEK RQA
R.ALEIGI3, N C ?7607. PLEASE PRINT OR TYPE,
1. OWNER'S NA_NlE: a -t?,S
P.2
2. MAILLNG ADDRESS. 1-/YKJ5 c?W"LE2 ,20.4 p
QA1' • $UBDTV3SION NAME _?..i}!?S? /??
CITY. QA l-E/6N . _ STATE: L • ZIP CODE: -2--'7/. a,3
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF Dff T'ERZN-r FROM
MAILING ADDRESS ABOVE): [, Aa a4L,,rf_ S8Qpt4A _1_o 1
'VS 0 MA41,y BKou?
3. TELEPHONE NUMBER: (HOME) Z,04?0 (WORK) B Sq-7_ y ?
4, IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADIIR-SS,
PHONE NUMBER:
Alk? sTE??,eT' C s-r64?AeY-P2oGTb2
3. LOCATION OF WORK (PROVIDE A MAP; PREFERABLY A COPY OF USCS TOPOGRA713IC
MAP OR AERIAL PHOTOGRAPHY %TrH SCALE):
COUNTY: -NEAREST TOWN: ApJ45 d _
?s'd0 ?AyrJY Bjeow4l X240, -
SPECIFIC LOCATION (INCLUDE ROAD NtrV3RRS, LANDMARKS, FCd'.)
LZ's EGG c? G .S
b. wPAC ED 0R NAAnST STREAM/R.NSR: a-f4' X wgfe
P07It BASIN: .? -a 6
7a. IS PROJECT LOCATED NEAR WATER, C . ASSIMP-D AS TRt3U T, 7 fDAI, S,sLT` 'A' ETt, (SA),
HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURSE WATERS (OPM. WATER
StyppL!t(WS"ORWS-TD? YES,(,"") NO '( ) tFYES.EXPLAIN:., SA-l
7b. IS THE PROJECT' LOCATED WTTI3TN' A NORTH CAROLINA DIVISION OF COASTAL
&3AINAGEMENT ARE, OF ENVMol%oI.EN'TAL. CONCERN (AEC)? YES ( ;s NO (?( }
7C. IF'THE PRO.JE;C-A r$ LOCATED WITHIN A COASTAL COL"N N (SEE PAGE 7 FOR LIS T OF
COASTAL COUN 71FA), WHAT IS THE LAND USE PLAN (LL"P) DESIGNA'T'ION?
8a HAVE ANY SECTION 404 PERMITS BEEN PREV 0USL Y REQLM$TED FOR USE ON THUS
PROJECT? YES ( ) NO (X) T YBS, PROVIDE ACTION I.D. NUMBER OF PREVIOUS
PERIVUT AND ANY ADDI'T OVAL INFOR131ATION (INCLUDE PHOTOCOPY OF 401
CERTMCATION):
8b, ARE ADDITIONAL PERT GT REQUESTS E"ECT"ED FOR THIS PROPERTY IN THE
FUTURE? YES( ) NO (f) OF YES, DESCRIBE ANTICIPATED WORK
9a. ETITMATED TOTAL NUMBERS OF ACRES IN TRACT OF LkND. 1191AG
9b. ES'IUi.,+nD TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
To dL?__ D 7-,OQAW4
toe. NU.?GE,R OF ASS OF WETLANDS IMPACTED BY THE PROPOSED PRO.IRCT BY:
:? 14dBE:2T 66, ao -inr
FIII..II ri.: _ EXCAVATION;
FIOOIANG: OTM
DRAINAGE ; TOTAL ACRES TO BE LMPACTED :._.._
IOb. (1) STREAM CHANNEL. TO BE WPACrED BY TM PROPOSED PROJECT (IF
KELOCATED, PROVIDE DISTANCE BOTH BEFORE AND A.7-MR RELOCATION;
LENGTH EEFORE: ...,3" PT AF rER-. _ -_FT
wmvi REFQRRE (baser] on nomal high water contours): Z Z FT
AVERAGE r)MYM BEFORE: _ ?' AFTER: ?• .? / FT
(2) STREA-14 CHANNEL IMPACPS WA.L RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CI3ANNEL RELOCATION: PLACRM ENT OF ME IN CHANNEL: ?
CHANNL L EXCAVATION: - COONSTRUC ON OF A DAN1,7LOODWO:
O'S"I-IER:
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THP- WATERSHED
DRA M40 TO THE POND?
WHAT IS I.'HE E.aECTED
POND SURFACE A-R-FA?
12. D35E'I1P ITON OF PROPOSED WORK INCLUDING DISCU$-tiON OF 1`YPF. OF MEr-HA_NICAL
EQUIPM'P.YdT TO BE -TSED? (ATTACH PLAINS; 8112 BY 11 DRAWINOS ONLY)
if P h? S„£IA14 --jej?9_040,4 egg 1 o? r- -
b2A Q"
13. PURPOSE. OF PROPOSED WORK- , -SVQ,,,Q Wzaez --
14, STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (1NCI,UUE ANY MEASURES TAKEN TO MINIM US WETLAXI) rMPAC'TS?
17 "i w-?6F :?Z 66, so -inr
IS. YOU ARE REQUIRED TO CONTACT THE US FISH AND W)LIDLIFE SERVICE AIN-DIOR
- NATIONAL MARINE FISMRIES SSRTVE REGARDING THE PRESENCE OF ANY FEDERALY
LISTED OR PROPOSED FOR LISTING ENDANGERED OR THREATENED SPECIES OR
CRPI`ICAL H1%BITAT IN THE PERMIT AREA TI- T MAY BE AFFECTED BY THE PROPOSFI7
PROM "T. DATE. CONTACTED: 141A
16. YOU ARE REQUIRED TO CONTACT THE STATE HIS'T'ORIC PRESERVATION OFFICER
(SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN TIM PERMIT AREA
WHICH MAYBE AFFECTED BY THE PROPOSED PROTECT. DATE CONTACTED
17. DOES TIC PROTECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (STATE) LAND? YES { ) NO. ( ?f (IF NO, GO TO 16)
a. IF YES, DOES THE PROTECT REQUIRE pREpERATION OF AN ENVIRONMENT?.L
DOCUMENT PUMLrANT TO THE REQUIREMENTS OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT? YES( ) NO( If
b. IF YES. HAS THE DOCUMENT BEEN REFMWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE YES ( ) NO ( )
IF ANSWER 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATIONFROM THE STATE
CLEARIINGHOUSE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS kEGAkDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OF ADMIMSTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
18. THE'FOLLOWING ITENIS SHOULD BE INCLUDED WITH THIS APPLICATION IF PROPOSED
ACTIVITY INVOLVES TIM DISCHARGE OF EXCAVATED OF FILL MATERIAL INTO
WE'I1.ANDS;
a. WETLAND DFLTNF_ATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES, AND
PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18.21, 26, 29,
AND 38). ALL STREAM (D- TERMITT) NT AND PERMANE.-M ON THE PROPERTY
MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS SO FEET
OF I INCH EQUALS 100 FEET OF TIMM EQUIVALENT.
b. U: AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE IMPACTED
BY PRODUCT.
c. 11 DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA
SHEETS RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE,
d. ATTACH A COPY OF THE STOR.MWATER MANAGEMENT PLAN IF REQUIRED.
a WHAT IS LAND USE OF SURROUNDING PROPOERTY?
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c IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL? ... --
+ g, SIGNED AND DATED AGENT AU ORI ATION LETTER. ff APPLICABLE.
NOTE: WTLANDS OR WATERS OF TKE US MAY NOT BE DAPACTED PRIOR TO:
1) ISSUANCE OF A SECnON 404 CORPS OF ENGINEERS PERMIT,
2) En'HER 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
A&rvirk' I5 CONSISTENT WITH THE NOR-M4 CAROLINA COASTAL
MANAGEMENT PROGRAM,
DATE
OWNSR S! ENT'S SIGNATURE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED).
9'd
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