20001039 Ver 1_COMPLETE FILE_20000807

State of North Carolina
Department of Environment I'W
and Natural Resources AT4 • or
Division of Water Quality Admbmdmbmdm
James B. Hunt, Jr., Governor D E N R
Bill Holman, Secretary Kerr T. Stevens, Director
August 11, 2000
DWQ# 00-1039
Davidson County
Rodge Parish, Gilbert Powell, Richard Willard. Robin Craven, J. Michael Leatherwood and
Lexington District United Methodist Church
138 Sunset Place
Lexington, NC, 27292
APPROVAL of 401 Water Quality Certification
Dear Messrs. Parish, Powell, Willard, Craven and Leatherwood:
You have our approval, in accordance with the attached conditions, to excavate 0.10 acre of accumulated silt from High
Rock Lake, adjacent to lots 154, 155, 156, 157, 160. 161, 162, 163 and 157A, as you described in your application received by
the Division of Water Quality on August 7, 1999. After reviewing your application, we have decided that this fill is covered by
General Water Quality Certification Number 3280. This. Certification allows you to use Regional Permit Number 198200030
when the Corps of Engineers issues it. In addition, you should get any other federal, state or local permits before you go ahead
with your project including (but not limited to) Sediment and Erosion Control, Coastal Stormwater, Non-Discharge and Water
Supply Watershed regulations. Also this approval will expire when the accompanying 404 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 you may be required to send us a new application for a new certification. If the property is sold, the new
owner must be given a copy of the 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 Dorney at 919-733-9646 or Cyndi Karoly at 919-733-9721
Sincerely,
LKerr T. Stevens { d?q Attachment
cc: Corps of Engineers Raleigh Regulatory Field Office
Winston-Salem DWQ Regional Office
Central Files
File Copy 001037
Non-Discharge Branch 1621 Mail Service Center Raleigh, North Carolina 27699-1621
Telephone [phone] FAX # [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/10% post consumer paper

L GROUP
001039 ,
DEN I D : CORPS ACT X y I D ^ TIpr
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT t4):
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
1) NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATION FOR SECTION 401 CERTIFICATION
3) COORDINATION WITH THE NC DIVISION OF COASTAL HAXAGEMENT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE
FIELD OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN
(7) COPIES SHOULD BE SENT TO THE N.C. DXVISION OF ENVIRONMENTAL MANAGEMENT
(SEE AGENCY ADDRESSES SHEET;. PLEASE PRINT.
?b N ?P?1? G 19 r. a rl - jQp?R i S??..t- -
0 ERS NAME: T L(??LL- icu/Mwr') ???¢RD- DaiJ?
LENG7ov 9iST'ri?T UNIT D .U v??Sc/?JtiG(Yjic?7/?
2. MAILING ADDRESS: 139 IS v iU sE G
SUBDIVISION NAME:
CITY: i Ex % NG _7o r/ STATE : NC
r Lwv&D 6,!5 RE 5
ZIP CODE: 4 r7?-
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
S A M ?,s
3. TELEPHONE NUMBER (HOME) (WORK) : fyo -
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER:

n
m
C fTl
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAP?IY WITH SCALE) : /
COUNTY: ?a 1 Dg h/ NEAREST TOWN OR CITY: L
Hato 5 wd r? Ps - ?,?i o ? ?
I

SPECIFIC LOCATION (INCLUDE ROAD
NUMBERS, LANDMARKS, ETC.) : SU u•T/4 FgoM e>uT1 M )NT
j?RNIEf-? Ow CSI`-l<uJo6D BIyv'ga 14 mile 7-uAwl-fFTOrv
SU 05E 7- P1 ,
LoTS'' 1J_7-r41&3-167_
-l?l? /Lo IS7- fsG - iss rr?P vq-Go9- l7-Ooy-O- /63`
Qg_pv9-,?-Cay-o-1GZ 09-Ue9-,D=ooy?0162 (? ?-da?^d-UD?f-b ?LIj?9-p -..pay-0.157,
-?v-D-vay 6' EGG U YGo9-1?-ooy-a-is'7 aq-ov9 D-vvy-o-IS6 o9-ov9-D-oeSl-o- rSs
5. IMPACTED OR NEAREST STREAM/RIVER: - I ff-R I VT ... ,?-U U -I? Uv y !' ° 1SY
RIVER BASIN: I'7ICj H ?a?K ,L-!gt<L
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER
(SA), HIGH QUALITY WATERS (HOW), OUTSTANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WS-1 OR WS-II)? YES j ) NO rX IF YES, EXPLAIN:
7b. IS THE PROJECT LOCATED WITHIN A NORTH CARO.,INA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES NO
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?
/Y ly'
Ba. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON
THIS PROPERTY? YES ( ) NO (k IF YES, PROVIDE ACTION I.D. NUMBER OF
PREVIOUS PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
CERT157CATION):
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
FUTURE? YES ( ] NQ (X IF YES, DESCRIBE ANTICIPATED WORK:
98. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND: Vo A R t
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
?CL
2

10a. NUMBER OF ACRES OF WETLANDS IMPACTED BY HE PROPOSED PROJECT BY:
FILLING: 1 62: EXCAVATION.
FLOODING: OTHER:
DRAINAGE:: ' TOTAL ACRES TO BE IMPACTED:
10b. (1) STREAM CHP-NNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF
RELOCATED, PROVIDE D_rS/TANCE BOTH BEFORE AND AFTER. RELOCpAlTION)
LENGTH BEFORE: IY fi FT AFTER: l 19 FT
WIDTH BEFORE (based on normal high water Contours): N -it FT
WIDTH AFTER: N ?q
AVERAGE DEPTH BEFORE: N I? FT AFTER: (V !9 FT
(2) STREAM CHAN-NFL IMP CTS WILL RE50LI FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION: _ Np •,_- PWACEMENT OF PIPE IN CHANNEL:
CHANNEL EXCAVATION: N p CONSTRUCTION OF A DAM/FLOODING: ,_,-- JY-L_
OTHER:
11. IF CONS'T'RUCTION OF A POND IS PROPOSED, VIHAT IS THE SIZE OF THE
WATERSHED DRAINING TO THE POND? _ ^ N W
WHAT IS THE EXPECTED POND SURFACE AREA? N a
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF
MECHANICAL EQUIPMENT TO _BE USED (ATTACH PLANS: 8 1/2" X 11" DRAWINGS
ONLY) . -7-o r,?W eLt7- f--r-0 IV) T to F{1T OF /- ez0 M Lr4T-ES $ IL?
fD ne-EALZ To korit ?s?' lSS-ISG- 1S7- -;'15714-TIC n PA'rlor?
t.v 11 0k Do rv f W -7B It TR A C K 4 j4 i) t ({ AW D 943 rrf T-B U C K S _
.C'XGRVftf 0 In if rI 14 L WiLl gE L? APUS?U UFRY PR-V0- 1-
a f? r+ c 0w A- y ±C -0 in ,c, AKA E
13. PURPOSE OF PROPOSED WORK: V I M - j'0 N L-
Rorf/ Pte FSS

14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED
OUT IN WETLANDS. (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND
IMPACTS):
tKv ro,Sk u k: -xcJ9 yA7-i o r/ 6,j;4 1. Nor
IM pAGT LVETL n, ND
1S. YO:J•ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SERVICE
(USFWS) AND/OR._NATIONP.L MARINE FISHER--ES SERVICE (NM FS) (SEE AGENCY ;€?.ll
ADDRESSES SHEET) REGARDING THE PRESENCE OF ANY FEDERALLY LISTED OR
PROPOSED FOR LISTING ENDMGERED OR THREATENED SPECIES OR CRITICAL, HABITAT
IN THE PERMIT AREA THAT'MAY'•BE-AF ETED BY THE PROPOSED PROJECT. DATE
CONTACTED: (ATTACH RESPONSES
FROM THESE AGENCIES.)
16. YOU ARE'AEQUIREJ-TO-CONT.ACT THE STATE HISTORT•C__p..AESERVAT,=a-OFFICER pocr
(SHPO) (SEE AGENCY UpRE,SSE&__SHEET) -REGARDING THE PRESENCE OF HISTORIC ?j
PROPERTIES. -3N-V PERMIT AREA WHICH MA); BE AFFECTED BY THE "PROPOSED
PRO,7ECT. DATE CONTACTED: ? N '
17. DOES THE PROJECT :WVCLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF
PUBLIC (STATE) LAND?
YES () NO DQ (IF NO, GO TO 18)
a. IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TC THE REQUIREVENTS OF THE NORTH CAROLINA ENVIRONMENTAL
POLICY ACT?
YES (I NO () w ft
t
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE?
YES ( ) NO ( ) r
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTA'T'ION FROM THE
STATE CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT REGARDING
COMPLIANCE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
4

18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICAT ON IF
PROPOSED ACTIVITY INVOLVES THE CISCHARGE OF EXCAVATED OR FILL MATERIAL
INTO WETLANDS:
a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES
AND PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 25,
29, AND 38). ALL STREAMS (INTERMITTENT AND PERMANENT) ON THE PROPERTY
MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET OR
INCH EQUALS 100 FEET OR THEIR EQLIVALENT.
b. IF AVAILABLE, REPRESENTATIVE PPOTOGRAPH OF WETLANDS TO BE
IMPACTED BY PROJECT.
C. IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA
SHEETS RELEVANT TO THE PLACEMENT OF THE DELINEATION TINE.
d. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
c. WHAT IS LAND USE OF SURROUNDING PROPERTY?
/ Y
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
1
9. SIGNSD PVD DATED AGSNT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE U.S. MAY NOT HE IMPACTED PRIOR TO:
1) ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT,
2) EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF
ENVIRONMENTAL MANAGEMENT (WATER QUALITY) CERTIFICATION, AND
3) (IN THE TWENTY COASTAL COUNTIES ONLY), A LETTER FROM THE
NORTH CAROLINA. DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED
ACTIVITY IS CONSISTENT WITH THE NORTH CAROLINA COASTAL MANAGEMENT
a
PROGRAD; . f /[?//?/// CA _ '; ' /L" Q1rl'F'1? tI,- '-
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OWNER'S/AGENT'S SIGNATURE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDEC (189.) )
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DEM ID:
00 1039
.. 3
m
CORPS ACTION TD:
.
R T

NATIONWIDE PERMIT REOVESTED (PROVIDE NATIONWIDE PERMIT 4): J ? 1 t, t'
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
i.... 1 .. f._A
r... f
1) NOTIFICA'T'ION TO THE CORPS OF ENGINEER."
2) APPLICATION FOR SECTION 401 CERTIFICATION - l
3) COORDINATION WITH THE NC DIVISION OF COASTAL HARAGEMENT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE
FIELD OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN
(7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT
(SEE AGENCY ADDRESSES SHEET;. PLEASE PRINT.
p
OWNERS NAME: ?`'?-?f R T /!/?LIJ?l.•.i?'?f/r??to1 1?1" 1 ?°jG??ji?h,?t?_.
L 7rrNCs7v0 a; rjri4rC1?V?tt'1a
2. MAILING ADDRESS; S? .5 y IV 51=,`> - 1. rar f'
SUBDIVISION NAME: L,5 C)GP 19Cr15
CITY: 1 T 3=; NG i c? ri' STATE: l ?,r ? ' 7
.L ZIP CODE: J 4--,_
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF D=FFERENT FROM
M]P,ILING ADDRESS ABOVE) :
e_ ,q hi
3. TELEPHONE NUMBER (HOME) : x334° (WORK) . 1y1
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER:
t 0
5. LOCATION OF WORK (PROVIDE R MAP, PREFERABLY A CO?Y OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: "L tit! I -lp v hl NEAREST TOWN OR CITY:
k10 r"d 5 4 w) s * tt ? C,_ wGl G v 1-_'P
1

SPECIFIC LOCATION (INCLUDE ROAD
NUMBERS, LANDMARKS, ETC.) :

f(r on'
,5uoo jA';r 1"/'
LO is td D IGS-lG2-lGl? f.5"G - /sS ?4if>?' Ga 9-
?D9-aa?_??r?y-o-IGZ O?-?a9-D-c?oy?oi?z ?y_oa?,r>-von-b~/`??G?_U -??ay~L"•?s?
Y
?-G? ?-•?-UO?? a-l Gv ? y?o9-,p-c?ny???-Is?-a??-???r-t?-ot?y_1?.. ?.. ,
5. IMPACTED OR NEAREST STREAM/RIVER: Y? / ) tv R I V kK, c' RIVER BASIN: wo A-l ?_ f f L
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED A$ TROUT, TIDAL
(SA), HIGH QUALITY WATERS (HOW), OUTSTANDING RESOURCE WATERS
SUPPLY (WS-I OR WS-II)? YES ( ) NO rX IF YES, EXPLAIN:
SALTWATER
(ORW), WATER
7b. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA D.V'ISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES ] NO (X]
7c. IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR
LIST OF COASTAL COUNTIES), WHATIS THE LAND USE PLAN (LUP) DESIGNATION?
A/ 12.
Ba. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON
THIS PROPERTY? YES [ ] NO rk IF YES, PROVIDE ACTION I.D. NUMBER OF
PREVIOUS PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
CERTIFICATION):
8b. ARE ADDITIONAL, PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
FUTURE? YES ( ) NO ()() IF YES, DESCRIBE A27TICIPATED WORK:
9u. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND: ?cq #cF.,i
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
2

10a. NUMBER OF ACRES OF WETLANDS IMPFCT:D BY THE PROPOSED PROJECT BY:
FILLING: - EXCAVATION: - ?
FLCODING: -&
OTHER:
DRAINAGE: TOTAL ACRES TO BE IMPACTED: _F ?A
10b. (1) STREAM CHP.4NEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF
RELOCATED, PROVIDE DISTANCE BOTH BEFORE AND AFTER. RELOCATION)
LENGTH BEFORE: wo FT AFTER: n !V i FT
WIDTH BEFORE (based on normal high water contours) : h,FT
WIDTH AFTER: W FT
AVERAGE DEPTH BEFORE: FT AFTER: (Vi`? FT
(2) STREAK CHAN_NFL IMP CTS WILL REQLT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION: _.- I? w •-„- PLACEMENT OF PIPE IN CHANNEL: _.,.,N l?
CHANNEL EXCAVATION: CONSTRUCTION OF A DAM/FLOODING: ,?IV 11-
OTHER:
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE
WATERSHED DRAINING TO THE POND? ,' 14 WHAT IS THE EXPECTED POND SURFACE AREA? U)t

12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF
MECHANICAL EQUIPMENT TO BE USED (ATTACH PLANS: 8 1/2" X 11" DRAWI:7GS
ONLY) . `Y"b V e ?4 v T k F'r ? n, r o f? f4 ? 0 M t n 7'k
&4?tE (y7' ? ortt?S?-?5S_15G 715719-?'kC ?? U ri©??
_813 C, K 6
L'awrftr??T-0 wA-y EL0 T t 't 14K (Z -
13. PURPOSE OF PROPOSED WCRK: -r& M JPR t0 F 6M -ri a /f 1
3

14. STATE REASONS
OUT IN WETLANDS,
xMPACTS):
f!x,
WHY IT IS BELIEVED -h AT THIS ACTIVITY MUST EE CARRIED
(INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND
Fri A
I rn P A 6, b 7 -L g tv U
15. YOU•ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SERVICE go
(USFWS) AND/OR•_t?ATIONP.L MARINE FISHER-ES SERVICE (NMF'S) (SEE AGENCY a) ?6
ADDRESSES SHEET) REGARDING THE PRESENCE OF ANY FEDERALLY LISTED OR
PROPOSED FOR LISTING END,-,NGERED OR THREATENED SPECIES OR CRITICAL HABITAT
IN THE PERMIT AREA THAT 'MAY'BE- ALF? E,yCTED BY THE PROPOSED PROJECT. DATE
CONTACTED: (ATTACH RESPONSES
FROM THESE AGENCIES.)
16. YOU ARE'?iEC?UIREJ-R`O-tipNT1?CT THE STATE HISTORI.9 _R ESERVAT,ZON_O.FFICER ? ?
(SHPO) (SEE AGENCY ADDRESSSES_.SHEET) -REGARDING THE PRESENCE OF HISTORIC ?j 19 CIO
PROPERTIES.-IN-V PERMIT AREA WHICH MP. BE AFFECTED BY THZ-PROPOSED 7?
PROJECT. DATE CONTACTED:. N ft'
17. DOES THE PROJECT :WVCLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF
PUBLIC (STATE) LAND?
YES () NO X (IF NO, GO TO 18)
a. IF YES, DOES THE PROJECT REQUIRE PRIPARATION OF AN ENVIRONMENTAL,
DOCUMENT PURSUANT TO THE REQUIREN,ENTS OF THE NORTH CAROLINA ENVIRONMENTAL
POLICY ACT?
YES ( ] NO ( ] Iv ft
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE?
YES ( ) NO () rt I i
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRXATE DOCUMENTATION FROM THE
STATE CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT REGARDING
COMPLIANCE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRYS SAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27503-8003, TELEPHONE [phone].
4

18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF
PROPOSED ACTIVITY INVOLVES THE CISCHARGE OF EXCAVATED OR FILL MATERIAL
INTO WETLANDS:
a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREPMS, LAKES
MD PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 19, 18, 21, 26,
29, AND 38). ALL STREAMS (INTERMITTENT AND PERMANENT) ON THE PROPERTY
MUST BE SHOWN ON THE MAP. MA? SCALES SHOULD BE 1 INCH EQUALS 50 FEET OR 1
INCH EQUALS 100 FEET OR THEIR EQCIVALENT.
a. IF AVA::,ABLE, REPRESENTATIVE PPO OGRAPH OF WETLANDS TO BE
IMPACTED BY PROJECT.
C. IF DEL_NEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA
SHEETS RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
d. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
e. WHAT IS LAND USE OF SURROUNDING PROPERTY?
Y ...
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
g. SIGNED AND DATED AGENT AUTHORIZATION LETTER, I:' APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE U.S. MAY NOT BE IMPACTED PRIOR TO:
1) ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT,
2) EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF
ENVIRONMENTAL MANAGEMENT (WATER QUALITY) CERTIFICATION, AND
3) (IN THE T;MNTY COASTAL COUNTZES ONLY), A LETTER FROM THE
NORTH CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED
ACTIVITY IS CONSISTENT WITH THE NORTH CAROLINA COASTAL MANAGEMENT
PROGRAM
.
- _._ .,
OWNER'S/AGENT'S SIGNATURE U DAT
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED (18g.) )
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