20041132 Ver 1_COMPLETE FILE_20040712

MEMORANDUM
TO: John Dorney
Non-Discharge Branch
Regional Contact: Barnett, Kevin
WO Supervisor: Forrest Wesstall
Date:
SUBJECT: WETLAND STAFF REPORT AND RECOMMENDATIONS
Facility Name John T. Mize
Project Number 04 1132
Recvd From APP
Received Date 7/12/04 Recvd By Region
Project Type pond construction
County Polk
County2
Region Asheville
Certificates Stream
Permit Wetland Wetland Wetland Stream Class Acres Feet
Type Type Impact Score Index Prim. Supp. Basin Req. Req.
39 Stream O Y OO N ? 9-23 ?? 30,802. F__ 140.0(
F- P7 ON F_ f I_F_ F- I-F-
Mitigation Wetland
MitigationType Type Acres Feet

Is Wetland Rating Sheet Attached? O Y #N Did you request more Info? O Y *N
Have Project Changes/Conditions Been Discussed With Applicant? 0 Y0 N
Is Mitigation required? 0 Y0 N Recommendation: 0 Issue Op Issue/fond 0 Deny
Provided by Region: Latitude (ddmmss) 351438 Longitude (ddmmss) 805840
Comments:
issued by ARO on Aug 13, 2004 - khb
cc: Regional Office
Central Office Page Number 1
Triage Check List
Date: Project Name: 7
DWQ#:
County:
To: ARO Kevin B ? WaRO Tom Steffens
? FRO Ken Averitte ? WiRO Noelle Lutheran
? MRO Alan Johnson ?' WSRO Daryl Lamb
? RRO Mike Horan
From: Telephone : (919) G7?
The file attached is being forwarded tokpur for your evaluation.
Please call if you need assistance.
? Stream length impacted
? Stream determination
? Wetland determination and distance to blue-line surface waters on USFW topo maps
-inimization/avoidance issues
? Buffer Rules (Meuse, Tar-Pamlico, Catawba, Randleman)
? Pond fill
Mitigation Ratios
,51 ? Ditching
? Are the stream and or wetland mitigation sites available and viable?
? Check drawings for accuracy
? Is the application consistent with pre-application meetings?
? Cumulative impact concern
Comments: Jl 4 16 1

15
USDA, Natural Resources Conservation Service
Courthouse Annex
P. O. Box 236, Columbus, N.C. 28722
[phone]
August 11, 2004
WETLANDS/ 401 GROUP
AUG 13 2004
John Dorney
NCDENR
Division of Water Quality
401 Wetlands Certification Unit
1650 Mail Service Center
Raleigh, North Carolina 27699-1650
Dear Mr. Dorney,
WATER QUALITY SECTION
This refers to DWQ Project # 04-1132, Polk County and 401 permit applicant John T.
Mize. I am assisting Mr. Mize in this project.
As requested the additional information has been included on page 8 of the PCN form.
A check for $475 for the application fee is enclosed.
Sincerely,
f ,
Gerald Harbinson
District Conservationist
Cc: Kevin Barnett, DWQ Asheville Regional Office
John Mize
Office Use Only: Form Version May 2002
USACE Action ID No. DWQ No. Il"?
to any paracuiar item is not appucabte to this project. please enter "Not Applicable" or
1.
H.
Processing
1. Ch ck all of the approval(s) requested for this project:
[Section 404 Permit ? Riparian or Watershed Buffer Rules
? Section 10 Permit ? Isolated Wetland Permit from DWQ
2'*'401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested:
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (verify availability with NCWRP prior to submittal ofPCN), complete
section VIII and check here: ?
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here: ?
Applicant Information

1. Owner/Applicant Information WETL4NDS/401 GROUP
Name: To k n 22 g „H I
Mailing Address: P O. box 0/ J ZU04
c lw Nc aB?,2L
sECDO-,
Telephone Number: - 963- 1?o'L3 Fax Number:
E-mail Address:
2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has siQnatorv authority for the owner/applicant.)
Name: /d y Ar,b,?1so
Company Affiliation:
Mailing Address:
- ?,L/?. 1,jaf-wiot esovAceS
x 1_Z 3 !4
Vnb(.s /VG a87 2, S¢t

Telephone Number: ?}$ - r4??
E-mail Address: o / ?r3 3 Fax Number: 60,1
oh KSdk
14ENT
RECEIVED
Page 5 of 5
III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: __,To o k-.x Pon c
2. T.I.P. Project Number or State Project Number (NCDOT Only):
' •Z
3. Property Identification Number (Tax PIN): 130
4. Location /
County: -Po I K Nearest Town: Co 1 U,-, 6 t?S
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.):
6f `Ik ;1 4e,SeGt o-P Lee, C,dd 16(SR, 135,6) s

r' •n c!e be `f+e ?ac?ti ?S¢.r. 's ;n k-oLs-e- 6.e
5 ?e?., ro es . Pe?. s : : S d *+
Site coordinates, if available (UTM or Lat/Long): 35701Y"3 8 " 010-5-8 y0
(Note - If project is linear, such as a road or utility line, attach a sh et that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Property size (acres): S
7. Nearest body of water (stream/river/sound/ocean/lake): 14" So ns C ree K
S. River Basin: 16 Ko ad
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/maps/.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: .8e/ackJ 5W. *!,j -d `f? c re 'I u--\S 0-F a
ox l' W Do-nd of X J GCA95 `lave.
?,? Tease e? ?-?e s'd-es ?3 bra,,, 7'?-? cue s,?, ,gees/ s?nti.
o+?? 7?re d n
Page 6 of 6
10. Describe the overall project in de
Doted KJ:11 be c wrfe?
Lo 11ecf
7'"e vJaZ, c,); I I be c?: I ;
a 4rac. K be Al.d b l?u clc
including the type of equipment to be used: 'A O, C vie.
?v s'7o v-?- a. rlwisal c
caA 'ci dir
// .
w'.1 I be se,
11. Expllain/ the purpose of the proposed work: 7 r?
CIG?NC ?'4 ?ti rD`C T t, J M l?-t. ?-fi Q 5 Cw, f,
C.J
o-r, d W4
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USAGE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
con?s/truction schedules.
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
rovide justification for the exclusion of this work from the current application.
anWO
VI
. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
Pate 7 of 7
Provide a written description of the proposed impacts:
Gem ?l ?u c?? -/, C/V_ O C' 2 /70,

Individually list wetland impacts below:
Wetland Impact I
Site Number I Type of Impact*
(indicate on mar)) I Area of
( Impact
I (acres) Located "'ithin
I00-year FIoodplain**
yes'no Distance to
Nearest Stream
linear feet
Type of Wetland***
I I I
I I I . I I
I I i I
t I i l i i

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditchins/drainase, etc. For darts, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Emer_zencv Management .Agency's (FENLA) Flood Insurance Rate Maps
(FIR ), or FELLA-approved local tloodplain maps. Maps are available through the FEJ LA Map Service Center at I-800-3=3-9616. or
online at htto•lh',ly%V.fema.gov.
:** List a wetland ripe that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.) Indicate if wetland is isolated (de;emaination of isolation to be made by USACE only).
List the total acreage (estimated) of all existing wetlands on the property:
Total area of wetland impact proposed:
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact
Site Number
(indicate on ma) I
1 Type of Impact*
I Length of
Impact
(linear feet)
Stream Name** Average Width
of Stream
Before IT pact Perennial or
Intermittent').
:
(pleases ecif)
f cla c w? /go I (,Cr f± ems' I
Z I/o K ;.s5 a I S" I U7" o,• S GtQ, I<
?FIOOWD- boo' I a- r(
l I t I I

I I ( !
List each impact separately and identifv temporary impacts. Impacts include. but are not limited to: culverts and associated rip-rap.
dams (separate!- list impacts due to both structure and flooding). relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement %%all, rip-rap. crib ?%all, gabions. etc.), excavation, ditcling/straightening, etc. If stream relocation is
proposed, plans and profiles shoving the linear footprint for both the original and relocated streams must be included.
Stream names can be tound on USGS topographic neaps. If a stream has no name, list as UT (unnamed tributary) to the nearest
dov.nstream named stream into which it flows. LSGS maps are available through the L'SGS at 1-300-3:8-9616, or online at
t •«?.usgs.guc. Seve-at intemct sites also ailo,.v direct do,.xnlcad and printing of LSGS maps (c.o., a .tily.tocozcne.am.
«"%ivy.maoaticst.com. etc.).
Cumulative impacts (linear distance in feet) to all streams on site:
Prise S of 8
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Open Water Impact
Site Number

(indicate on map)
Type of Impact* Area of
Impact

(acres)
Name of Wa y
(if applicable) Type of Waterbodv

(lake. pond, estuary. sound
bav. ocean, etc.)

List eacn unpact separately and identity temporan_• impacts. Impacts include, but are not limited to: fill, excavation, dredging,
floodins, drainase, bulkheads, etc.
Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands Z stream ? wetlands
Describe the method of construction (e.g., dam/ embankment, excavation, installation of
draw-down valve or spillway, etc.): e. d a-? / / e't ba-„kw'?'?
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):_ i r - qoa- t,Jaj!Zt G c, ,
e of watershed draining to pond: Yz. S Expected pond surface area: Q- q
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
_?:ez
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
Nee 9 of 9
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http://hl-o.enr.state.nc.us/ncwetlands/strmszide.html.
Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP). Please note it is the applicant's responsibility to contact the NCWRP at
[phone] to determine availability and to request written approval of mitigation prior
to submittal of a PCN. For additional information reaarding the application process for the
NCWRP, check the NCWRP website at http://h2o.enr.state.nc.us/wrp/index.htm. If use of
the NCWRP is proposed, please check the appropriate box on page three and provide the
following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
Page 10 of 10
LY. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public federa tate) funds or the use of public
(federal/state) land?
Yes t?Q No ?
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes (4 No ?
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B ..0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ? No If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
L I Zone* Impact Multiplier Required
(square feet) I Nlitiaation
f
2 1.5
Total I
* Zone 1 extends out 10 feet perpendicular from near thank of channel: Zone 2 extends an
additional 20 feet from the edae of Zone 1.
Page 11 of 11
LY. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public federa tate) funds or the use of public
(federal/state) land?
Yes '4 No ?
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes (4 No ?
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B ..0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ? No ?C] If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact Multiplier Required
(square feet) Miti-ation
1 3
2 1.5
Total
c uuc i emcnus out ?u sect perpenuicular from near MnK of channel: Gone 2 extends an
additional 20 feet from the edse of Lone 1.
Page I1 of 1 1
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or.0260.
XI. Stormwater (required by DWQ)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
3A4Azc. a^e. ?,k???e??s ?inRa,.Lth.ses d Avd?u,,. F:P4J;II b4
U11P.pW 'h p/vpose, o o,& (? ?d " ZXS-knr :-, r, (4 .
XII. Sewage Disposal (required by DWQ)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
XHL Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No
Is this an after-the-fact permit application?
Yes ? No?
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).

0 Applicant/*ent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 12 of 12
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NCDENR
North Carolina Department of Environment and Natural Resources
Michael F. Easley, Governor
Division of Water Quality
William G. Ross, Jr., Secretary
Alan W. Klimek, P.E., Director
July 27, 2004
CERTIFIED MAIL: RETURN RECEIPT REQUESTED
John T. Mize
Post Office Box 691
Columbus, NC 28722
REQUEST FOR MORE INFORMATION
Dear Mr. Mize:
DWQ Project # 04-1132
Polk County
On Jul 12, 2004, the Division of Water
y Quality (DWQ) received your application dated May
20, 2004 to impact 140 feet of streams to construct the proposed pond. The DWQ has determined
that your application was incomplete and/or provided inaccurate information as discussed below.
The DWQ will require additional information in order to process your application to impact
protected wetlands and/or streams on the subject property. Therefore, unless we receive the
additional information requested below, we will have to move toward denial of your application
as required by 15A NCAC 211.0506 and will place this project on hold as incomplete until we
receive this additional information. Please provide the following information so that we may
continue to review your project.
Additional Information Requested:
1. Plan Details
Please show and list on page 8 of the PCN form all stream impacts including all fill slopes,
dissipaters and bank stabilization spillways, and flooded areas on the site plan
2. Application Fee
Please provide the revised application fee as discussed in the PCN Form.
Please respond within three weeks of the date of this letter by sending this information to me in
writing and Kevin Barnett of the DWQ Asheville Regional Office. If we do not hear from you
within three weeks, we will assume that you no longer want to pursue this project and we will
consider the project as withdrawn.
401 Wetlands Certification Unit
1650 Mail Service Center, Raleigh, North Carolina 27699.1650 One
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604 NofthCarohna
Phone: [phone] / FAX [phone] / Internet: httr)://h2o.enr.state.nc.us/ncwetiands ;Vatmrally
An Equal Opportunity/Affirmative Action Employer - 50% Recycled/10% Post Consumer Paper
John Mize
Page 2 of 2
July 27, 2004
This letter only addresses the application review and does not authorize any impacts to wetlands,
waters or protected buffers. Please be aware that any impacts requested within your application
are not authorized (at this time) by the DWQ. Please call Cyndi Karoly or Mr. John Dorney at
919-733-1786 if you have any questions regarding or would like to set up a meeting to discuss
this matter.
Sincerely,
C44-
John Dorney,
DWQ, Wetlands / 401 Unit
JRD/bs
cc; Kevin Barnett, DWQ Asheville Regional Office
USACE Asheville Regulatory Field Office
File Copy
Central Files
USDA, Natural Resources Conservation Services, Post Office Box 236 Columbus, NC
28722
Filename: 04-1132 - John Mize (Polk) on hold
USDA, Natural Resources Conservation Service
Courthouse Annex
P. O. Box 236, Columbus, N.C. 28722
[phone]
July 9, 2004
John Dorney
Division of Water Quality
401 Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Dear Mr. Dorney,
n411 3t,
WETLANDS/ 401 GROUP
JUL 12 1004
WATER QUALITY SECTION
I am assisting Mr. John Mize to construct an impoundment to capture potential
nutrient and pesticide runoff from his nursery operation here in Polk County. This is
being done though the USDA Environmental Quality Incentives Program (EQIP).
Enclosed are 7 copies of the PCN and the General Permit Verification from the
USACOE. Also enclosed are location maps and design information.
If you have any questions please give me a call.
Sincerely,
S4
Gerald Harbinson
District Conservationist
U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id. 200430991 County P_cdk Quad FINCTFRVILLF FAST
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Property owner: John T. Mize
Address: P.O. Box 691, Columbus, NC 28722
Telephone No:
Zone: 44 UTM or LAT/LONG: North: 3898957 East: 588959
Size and Location of project (water body, road name/number, town, etc.): Pond project located on the Mize
greenhouse property on Tanner Road (SR 1357); north of Sandy Springs
Description of Activity: Construct a 0.9 acre water quality pond on an intermittent, unnamed tributary to
Hensons Creek. The pond will impact approx. 350 LF of stream channel by dam fill and inundation.
Applicable Law: _X Section 404 (Clean Water Act, 33 U.S.C. 1344)
(check all that apply) Section 10 (River and Harbors Act of 1899)
Authorization: NW39 Nationwide Permit Number
Your work is authorized by this Regional General (RGP) or Nationwide Permit (NWP) provided it is accomplished in
strict accordance with the attached conditions and your submitted plans. If your activity is subject to Section 404 (if
Section 404 block above is checked), before beginning work you must also receive a Section 401 water quality
certification from the N.C. Division of Water Quality, telephone [phone]. For any activity within the twenty
coastal counties, before beginning work you must contact the N.C. Division of Coastal Management, telephone (919)
733-2293.
Please read and carefully comply with the attached conditions of the RGP or NWP. Any violation of the conditions of
the RGP or the NWP referenced above may subject the perrrrittee to a stop work order, a restoration order, and/or
appropriate legal action.
This Department of the Army RGP or NWP verification does not relieve the permittee of the responsibility to obtain any
other required Federal, State, or local approvals/permits. The permittee may need to contact appropriate State and local
agencies before beginning work.
If there are any questions regarding this authorization or any of the conditions of the General Permit or Nationwide
Permit, please contact the Corps Regulatory Official specified below.
Date: June 9, 2004
Corps Regulatory Official: Stephen D. Chapin
Expiration Date of Verification: June 29, 2006
Telephone No.: [phone] x 224
cc: USDA-NRCS (Gerald Harbinson)
CESAW Form 591
Revised July 1995
Office Use Only: Form Version Mav 2002
USACE Action ID No. DWQ No
(If any particular item is not applicable to this project. please enter "Not Applicable" or "N/A".)
I. Processing
1. Check all of the approval(s) requested for this project:
?Section 404 Permit ? Riparian or Watershed Buffer Rules
? Section 10 Permit ? Isolated Wetland Permit from DWQ
[401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested:
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (verify availability with NCWRP prior to submittal of PCN), complete
section VIII and check here: ?
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here: ?
II. Applicant Information
1. Owner/Applicant Information
Name: o
Mailing Address: . O. 6
Co Nc C?B??L

Telephone Number: - 963 ' O ? Fax Number:
E-mail Address:
2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has signatory authority for the owner/applicant.)
Name: 6eAcld ay-?;,150
Company Affiliation: No,?wjok e,SovAGeS kl
Mailing Address: F D . o X
Telephone Number: 69 - 8qY -8g-2,3 Fax Number:
E-mail Address: freta/cs. Nu,4);,1Son r2 nc . KSJd. G o
Page J of 5
III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USAGE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: ,) vv ?n M Z P hors
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): 13 V " -?
4. Location
County: od Nearest Town: ?0 1 (?
Subdivision name (include phase/lot number):
Directions to site (include road numbers, lapnJdmarks, etc.): 400rox;
a,(T g,
?' n c1 r. be *i-e r2g n J4vdes . 'S ;n ko in.se_ he el
y ?-We es . Pew s s cl Y+- ?
Site coordinates, if available (UTM or Lat/Long): 35 ° / Y ` $ " O 1 o S Y0
(Note - If project is linear, such as a road or utility line, attach a sh et that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Property size (acres):
7. Nearest body of water (stream river/sound/ocean/1ake): n"So n-s C ree K
River Basin: 6 r-o Q a
(Note - this must be one of North Carolina's seventeen designated major river basins. The
/.)
River Basin map is available at http://h2o.enr.state.nc.us/admin/maps
Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: Bel c-i re o-F C..
S ? o44w ptncl -fne % s? aG+es have 4k- 91?? in, a
b ?1ea? e? ??e S.?es sue

Page 6 of 6
10. Describe the overall project in detail, including the type of equipment to be used: 74 O, `j6 vie
D u1nd PJ: P be CR-W ?c-i?P-cl (?Jwln 570,ap_ )-Sr 2 YLUA-'aA v o XA czt e^- 4-n
-01 lect ea., ,+a4 ru.y,OA'T' ?n11 c n. T a p-t ean,?.,,, a-nd ' aes71(-;c i d es ,
le ")Z, U) ; I I b t cJ : 1; -Jz ? , f ' acz'; &,, . ?4ea V U eq u1,D tl,K k a S
a
11. Explain the purpose of the proposed work: T rGduce, `f
aic,-4 4-4 ; -F,r o ^- ?? ?. 4 r? ohs ?,, ?l N-41 c.; d es
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
L- f
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and _provide justification for the exclusion of this work from the current application.
/U o
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
Pave 7 of 7
Provide a written description of the proposed impacts:-
Individually list wetland impacts below:
Wetland Impact Area of
II Site Number I Type of Impact* Impact
(indicate on map) ("acres) Located "tiithin
100-year FIoodpfain**
(yes/no) Distance to
Nearest Stream
(linear feet)
Type of wetland***

List each impact separately and identity temporary. impacts. Impacts include, but are not limited to: mechanized clearing, grading. till,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and tooding.
100-Year floodplains are identified through the Federal Emergency Management Agency's (FEvLA) Flood Insurance Rate Maps
(FIRM), or FENL4-approved local tloodplain maps. Nlaps are available through the FENLA yfap Service Center at 1-360-353-9616, or
online at httc ;i/wwlv.fema.gov.
List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond.
Carolina Bay. bog, etc.) Indicate if wetland is isolated (deternunation of isolation to be made by USACE only).
List the total acreage (estimated) of all existing wetlands on the property:
Total area of wetland impact proposed:
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact Length of
Site Number J Type of Impact* Impact
("indicate on ma) I (linear feet I Averaze Width
+ Stream Name** of Stream

Before Impact Perennial or
Intermittent?

(pleases ecrfi-)
f I C(a eWIL", o f 1 (,tT' Cruz 3 ?n--ef M i-H-

*
List each impact separately and identity temporary impacts. Impacts include. but are not limited to: culverts and associated rip-rap.
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after. and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.). excavation, ditching/straightening. etc. If stream relocation is
proposed. plans and profiles showing the linear footprint for both the original and relocated streams must be included.
Stream names can be found on USGS topographic maps. If a stream has no name. list as UT (unnamed tributary) to the nearest
downstream named stream into which it tlo%vs. USGS maps are available through the USGS at I-300-»3-9616. or online at
I'll V-11%* Several intemet sites also alloys direct dovmload and printing of USGS maps %y,.%-w.torozone.com.
%»%w.mapque>t com. etc. ).
Cumulative impacts (linear distance in feet) to all streams on site: /4'o '
Page S of 8
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Open Water impact

Site Number
(indicate on ma)

Type of Impact* Area of

Impact
(acres)
Name of Waterbodv
(if applicable) Type of Waterbody

(lake. pond. estuary, sound,
bav, ocean, etc.)
I

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dred_ina.
floodins, drainase, bulkheads, etc.
5. Pond Creation
if construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ®, stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.): ec?`(1 ?a_? e,_1 ba -.? -
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local storm+ater requirement, etc.): i rr; ola / Ca o eJa q UA.Q?
S e of watershed draining to pond: Y2. S Expected pond surface area: Q. q
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
VIII. Mitigation
DWQ - In accordance with I5A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or Greater than or equal to 150 linear feet of total impacts to perennial
streams.
Pate 9 of 9
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http://hl-o.enr.state.nc.us/ncwetlands/str-m2ide.html.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation),va plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP). Please note it is the applicant's responsibility to contact the NCWRP at
[phone] to determine availability and to request written approval of mitigation prior
to submittal of a PCN. For additional information regarding the application process for the
NCWRP, check the NCWRP website at http://h2o.enr.state.nc.us/wrp/index.htm. If use of
the NCWRP is proposed, please check the appropriate box on page three and provide the
following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
Page 10 of 10
LN. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public oedera tate) funds or the use of public
(federal/state) land?
Yes '4 No ?
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes X No ?
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )''
Yes ? No 0 If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet) Multiplier Required
Mitigation
1 3
2 1.5
Total
Zone 1 extends out 30 feet perpendicular from near bank of channel: Gone 1 extends an
additional 20 feet from the edue of Zone 1.
Page I I of 1 I
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or.0260.
XI. Stormwater (required by DWQ)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
47-A)Y...w,YS -4 ", n, Q.tunp.-.L-cx.sef 4v,'t?
r . ICel,b- r? n'" n os e, d (.?w? cL ?+-?fy _ `f'?1 ?X S din G ;7 d h d .
XH. Sewage Disposal (required by DWQ)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
XM. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No Z
Is this an after-the-fact permit application?
Yes ? No?
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
2-6 - `
Applicant/Rent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 12 of 12
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John Mize Pond Site
Location Map

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John Mize "Water Quality Pond"
Polk County, NC
Approximately 8 acres of nursery area and greenhouses will drain into the proposed
pond.
Summary of Design
Top of Dam - 995
Emergency Spillway - 992
Normal Pool 990.6
Total Storage - 9.9 acre feet
Storage - 4.9 acre feet
= 1,596,000 gallons
Top of Dam width - 12 feet
Emergency Spillway width - 30 feet
All side slopes of embankment - 3:1
Side slopes of emergency spillway - 2:1
Embankment Fill - 5,130 cubic yards
+ 5% - 256
5,386 cubic yards
Rough Estimate Cutoff Treanch - 600 cubic yards
Samuel C. Bingham
Civil Engineer
USDA, NRCS
U. S. DEPART11ENT OF AGRICULTURE
SOIL CONSERVATION SERVICE
Pond Owner Address
County Telephone No.
POND DESIGN - WORK SHEET
(Not Flood Routed)
NC-ENG-16
10-85
Location Code
DETERMINATION OF RUNOFF CURVE NUMBER FOR ANTECEDENT SOIL MOISTURE CONDITION II
(Chanter 7 - Engineerine Field Manual)
Land Use Or
Cover Treatment Or
Practice Hydrologic
Condition Hydrologic
Soil Group Acres Curve
No. Curve No.
x Acres
S c tna
-A n e 4 O e ck L-
t
Rcat »,
8s

e G't Y?tf's1

I Sum of Acres Sum of Product =
Weighted Curve No. = Sum of Curve No. x Acres = = Use CN = ?D 3
Sum of Total No. Acres
GENERAL DATA
Hazard Class - cX" (NEM •520.21(e))
01
Drainage Area - 2,.5 Ac.
Average Watershed Slope - _ 12?_ %
Slope Interpolating (Correction)
(EFM Page 2-8.1) Factor -
Normal Pool Surface Area - -b-, Ct_ Ac.
Effective Height - :Z j Ft. (NEM 520.21(d)
Storage - '7, Z Ac. Ft. (NEM 520.2141b))
Effective Height x Storage - 1- 5-7
Engineering Job Class - (NEM NC 501.09
SUMMARY
Normal Water Level Elev.ielc-(¢
Required Storage (Ft.) c+:?e -eod + z, z
174.1 7
Crest Emergency Spillway Elev. q 9 Z, £?
Emergency Spillway Stage ( p) (Ft.) + Z
Design High Water Elev. 99y,
o
Freeboard (Ft.) + 160
Settled Top of Dam Elev. 9457x:
Est. Storage to Top of Dam esq. q Ac Ft
Overall Height (NEM 520.21(c)) 7-5- Ft.
Dam Safety JV ,, inventory Size k o
(NEM NC 501.09) (NEM 520.21(f))
REQUIRED DETENTION STORAGE (PS-378) (EFM - Chapter 2, Rainfall Data Maps)
Yr - j Day = .7.57 Inches Rainfall Inches Runoff (EFM - Page 2-51a)
Required ( In. Runoff)( Ac. DA) _ Ac.Ft. ,5f'P? r?kF
Storage 12 In./Ft. Ac.Ft. Ac.(Pool) Ft. Use Z.L Ft.
EMERGENCY SPILLWAY DESIGN (PS-378) (EFM - Chapters 2 & 11)
Yr - I_ Day = 70- Inches Rainfall = ( CFS)( ^) = Q = CFS
(EFM 11-53 to 11-54h) Retardance: Maximum Velocity: fps Length Control Section: Ft
Discharge (q) = CFS/ft. Stage (lip) = ft. Outlet Slopeange Min Max
Bottom Width = Q _ q = - = Ft. Use Ft.Use Outl4ettSlope Z
Computed By Date
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DWQ# 09-)1 3? Date Who Reviewed: i
Plan Detail Incomplete
? Please provide a location map for the project. 1 p _ / /' cam. `r ?- / Cam/ Td
lease sho4alf stream impacts tncludig all fill slopes, dissipaters, and bank stabiliz4tion the site plan.
? Please show all wetland impacts including fill slopes on the site plan.
? Please indicate all buffer impacts on the site plan.
? Please indicate proposed lot layout as overlays on the site plan.
? Please indicate the location of the protected buffers as overlays on the site plan.
? Please locate all isolated or non-isolated wetlands, streams and other waters of the State as overlays on the site plan.
? Please provide cross section details showing the provisions for aquatic life passage.
? Please locate any planned sewer lines on the site plan.
? Please provide the location of any proposed stormwater management practices as required by GC
? Please provide detail for the stormwater management practices as required by GC
? Please specify the percent of project imperviousness area based on the estimated built-out conditions.
? Please indicate all stormwater outfalls on the site plan.
? Please indicate the diffuse flow provision measures on the site plan.
? Please indicate whether or not the proposed impacts already been conducted.
Avoidance and/or Minimization Not Provided
? The labeled as on the plans does not appear to be necessary. Please eliminate the or provide additional
information as to why it is necessary for this project.
? This Office believes that the labeled on the plans as can be moved or reconfigured to avoid the impacts to the
Please revise the plans to avoid the impacts.
? This Office believes that the labeled on the plans as can be moved or reconfigured to minimize the impacts to the
Please revise the plans to minimize the impacts.
? The stormwater discharges at the location on the plans labeled will not provide diffuse flow through the buffer because
Please revise the plans and provide calculations to show that diffuse flow will be achieved through the entire buffer. If it
is not possible to achieve diffuse flow through the entire buffer then it may be necessary to provide stormwater management
practices that remove nutrients before the stormwater can be discharged through the buffer.
Othe vl ?/ -4 6 4-1 r e C-, f
Ila
? The application fee was insufficient because over 150 feet of stream and/or over 1 acre of wetland impacts were requested. Please
provide $ . This additional fee must be received before your application can be reviewed.
? Please complete Section(s) on the application.
? Please provide a signed copy of the application.
? Please provide
Mitigation
copies of the application, copies of the site plans and other supporting information.
? of compensatory mitigation is required for this project. Please provide a compensatory mitigation plan. The
plan must conform to the requirements in 15 A NCAC 2H .0500 and must be appropriate to the type of impacts proposed.
? Please indicate which 404 Permit the USACE would use to authorize this project.
¦ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
¦ Print your name and address on the reverse
so that we can return the card to you.
¦ Attach this cans to the back of the mallpiece,
or on the front if space permits.
1. Article Addressed to:
John T. Mize
Post Office Box 691
Columbus, NC 28722
DWQ# 04-1132 - Polk
A. Signs /
X ? Agent
? Addressei
B. Racal ?ed b (Prin''ttned,,, Name) C. Date of Dellvetn
_V 74
VV1\
D. Is delivery address differe 1? Yes
If YES, enter delivery a slow:
V 1n
fn cfl 3
W%% I AF
3. Service Type ' /Q0
181 Certified Mail ? Express
? Registered [$ Return Receipt for Merchandlst
? Insured Mail ? C.O.D.
4. Restricted Delivery? (Extra Fee) ? Yes
2. Article Number 7001 2510 0009 0250 7335
(ftnsfer from service /abeq
n Form 3811, August 2001 Domestic Return Receipt 102596-02-M- i
UNITED STATES POSTAL SERVICE

• Sender: Please print your name, address, and ZIP+4 in this box •
NC DENR Division of Water Quality
Wetlands/401 Certification Unit
2321 Crabtree Boulevard, Suite 250
Raleigh, NC 27604
First-Class Mail
Postage & Fees Paid
USPS
Permit No. G-10