20001150 Ver 1_COMPLETE FILE_20000906

AL
State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
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NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
December 18, 2000
Johnston County
DWQ Project #: 001150
APPROVAL OF 401Quality Certification and ADDITIONAL CONDITIONS and Neuse River Buffer Rules
River Dell Company
4880 Hwy 42 E
Clayton, NC 27520
Dear Sirs:
You have our approval, in accordance with the attached conditions and those listed below, to place fill material in 149 linear
feet of streams for the purpose of constructing a road crossing for the Sumerset Place development, as you described in your
revised application dated October 16, 2000. After reviewing your application, we have decided that this fill is covered by General
Water Quality Certification Number 3289. 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 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. Stormwater shall be directed to flow at non-erosive velocities across the entire protected stream buffers.
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.
Attachment
cc: Corps of Engineers Raleigh Field Office
Raleigh DWQ Regional Office
File copy
Central Files
Raleigh Division of Land Resources
Neal Floyd
i c re
Stevens
Division of Water Quality • Wetlands/401 Unit
1621 Mail Service Center • Raleigh NC 27669-1621 •Telephone [phone] • FAX # [phone]
An Equal Opportunity Affirmative Action Employer
50% recycled/10% post consumer paper
40".
State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
DWQ Project No.: County:
Aonlicant:
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
Project Name:
Date of Issuance of 401 Water Quality Certification:
Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable
Buffer Rules, and any subsequent modifications, the applicant is required to return this certificate to
the 401/Wedands Unit, North Carolina Division of Water Quality, 1621 Mail Service Center, Raleigh,
NC, 27699-1621.This form may be returned to DWQ by the applicant, the applicant's authorized
agent, or the project engineer.It is not necessary to send certificates from all of these.
Applicant's Certification
I, , hereby state that, to the best of my abilities, due care
and diligence was used in the observation of the construction such that the construction was observed
to be built within substantial-compliance and intent of the 401 Water Quality Certification and Buffer
Rules, the approved plans and specifications, and other supporting materials.
Signature: Date:
Agent's Certification
I, , hereby state that, to the best of my abilities, due care
and diligence was used in the observation of the construction such that the construction was observed
to be built within substantial compliance and intent of the 401 Water Quality Certification and Buffer
Rules, the approved plans and specifications, and other supporting materials.
Signature: Date: .
If this project was designed by a Certified Professional
I, , as a duly registered Professional (i.e.,
Engineer, Landscape Architect, Surveyor, ect.) in the State of North Carolina, having been
authorized to observe (periodically, weekly, full time) the construction of the project, for the
Permittee hereby state that, to the best of my abilities, due care and diligence was used in the
observation of the construction such that the construction was observed to be built within substantial
compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans
and specifications, and other supporting materials.
Signature Registration No.
Date
Division of Water Quality • Wetlands/401 Unit
1621 Mail Service Center • Raleigh NC 27669-1621 .Telephone [phone] • FAX # [phone]
An Equal Opportunity Affirmative Action Employer
50% recycled/10% post consumer paper
Re: River Dell Company
Subject: Re: River Dell Company
Date: Fri, 15 Dec 2000 08:35:16 -0500
From: Steve Mitchell <[e-mail]>
To: Cyndi Karoly <[e-mail]>
I have looked at this site. The. feature that they are crossing is a stream
and therefore subject to protection. Initially I did not like the large
impact, over 150 and made them reduce it to less than that. I have no
problems now with issuance.
Cyndi Karoly wrote:
> Hey folks. I've got one tardy file that Hennessy had to drop back on me
> due to endless DOT meetings. It's the Sumerset Place Subdivision, c/o
> River Dell Company, Johnston County, 00-1150. We need to produce a
> letter by 12119100. I've looked over the file and this project appears
> to deserve a site visit - it's got buffer impacts and a road crossing,
> and it's a water supply, otherwise I'd just try to make a decision using
> the application. Please let me know if you'll be able to file a report
> on this one. If not, I may go to the site this weekend.
> Sorry to bug you and thanks for your time.
1 of 1 12/15/00 9:19 AM
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U.S.G.S. QUAD SHEET CLAYTON, N.C.
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CORPS ACTION ID:
DWQ ID.
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #)
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE 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:
2. MAILING ADDRESS: -Aaw42E -
SUBDIVISION NAME?''??
CITY: STATE: N ` C ZIP CODE: 2- - 20
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM y.
MAILING ADDRESS ABOVE):
(WORK) 8"10- 780 S <
` 3.. TELEPHONE NUMBER: (HOME)
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER:
-7 R054A.LAI-?C>A
2-7co?s -
5. LOCATION OF WORK (PROVIDE A`MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE):.
? r•.
COUNTY: ` r:4
v a?f ?f? S?oP1 - NEAREST TOWN. CAA k? On
•
10a. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING:
EXCAVATION:
5eoun?
150(
FLOODING: OTHER: Ptf e-
DRAINAGE : ' TOTAL ACRES TO BE IMPACTED : 0.07 GLC.•Ce
10b. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED
RELOCATED, PROJECT IF
PROVIDE DISTANCE BOTff BEFORE AND AFTER RELOCATION) :
LENGTH BEFORE: 1
FT AFTER: 150
FT
WIDTH BEFORE (based on normal high water contours): _
l FT
WIDTH AFTER:
AVERAGE DEPTH BEFORE: 1
AFTER:
(2) STREAM CHA NEL ACTS WILL R Srtr T
FROM; (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION: PLACEMENT OF PIPE IN CHANNEL:
CHANNEL
EXCAVATION: CONSTRUCTION OF A DAM/FLOODING:
OTHER: `? J C (fin n _ .? ..?
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. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF
MECHANICAL EQUIPMENT TO BE USED (ATTACH PLANS: 8 1/2" X 11" DRAWINGS
ONLY)
13. PURPOSE OF PROPOSED WORK: -(

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SPECIFIC LOCATION CINCLUDE ROAD NUMBERS, LANDMARKS, ECT•)
6_ IMPACTED OR NEAREST STREAM/RIVER:
RIVER 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-IT)? YES( ) NO ()( ) IF. YES, EXPLAIN:
7b. IS THE PROTECT LOCATED WITHIN A NORTH CAROLIN ( AYES ( ION OOF COQ >AL
MANAGEm NT AREA OF ENmOMENT? CONCERN
7c. IF T?M COUNTIES), OWHAT r THE LAND USE PLAN (LDP) DE.4IGNATIONE ?FOR LIST OF
COASTAL ga, HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUES'T'ED FOR USE ON 1'TIIS
PROJECT? YES ( ) NO (%( ) IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS
PERNUT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
CERTIFICATION):
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY JN THE
FUTURE? YES ( ) NO ()() IF YES, DESCRIBE ANTICIPATED WORK:
Too ?14?-#'e.S
9a. ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND: •
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
10a. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
o.0-7 ac ces (foc).a cco ss %Ks) , 15OI 5AACO-m
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14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED
OUT IN WETLANDS. (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND
IMPACTS) :

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b Dian S flGLC12.-
15. YOU'ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SERVICE
(USFWS) AND/OR--tATIONAL MARINE FISHERIES SERVICE (NMFS) (SEE AGENCY AT
?,??QU-1
ADDRESSES SHEET) REGARDING THE PRESENCE OF ANY FEDERALLY LISTED OR
PROPOSED FOR LISTING-ENDANGERED OR THREATENED SPECIES OR CRITICAL HABITAT
IN THE PERMIT AREA THAT •'MAY•-BE-AFFECTED BY THE PROPOSED PROJECT. DATE
CONTACTED: (ATTACH RESPONSES
FROM THESE AGENCIES.)
16. YOU ARE--IMQU-I-RED-TO-GONTACT._ THE STATE HISTORI•g?RESFRVAT-7AN_OFFICER der
(SHPO) (SEE AGENCY A?DRESSES_SFiEET•)-••-REGARDING THE PRESENCE OF HISTORIC
PROPERTIES.-l-N PERMIT AREA WHICH MAY BE AFFECTED BY TFtE'PROPOSED E
PROJECT. DATE CONTACTED:-
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF
PUBLIC (STATE) LAND?
YES (] NO •(] (IF NO, GO TO 18)
a. IF YES, DOES THE PROJECT' REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA ENVIRONMENTAL
POLICY ACT?
YES [] NO []
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE?
YES [] NO []
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE
STATE CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT REGARDING
COMPLIANCE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING-THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
4
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
Ofiyt 4 SQa.-?-Qf' S?aS- -y?-? '1c- t.3-6tA-r
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
MANAGEMENT PROGRAM,
OWNER'S/AGENT'S SIGNATURE DATE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS. PROVIDED).
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State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
A NOW
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
September 18, 2000
Johnston County
DWQ Project No. 001150
Neal Floyd
River Dell Company
4880 US Highway 42 East
Clayton, NC, 27520
Dear Mr. Floyd:
On September 6, 2000, the NC Division of Water Quality received your application for a 401
Water Quality Certification for the Sumerset Place subdivision in Johnston County. Before we can
proceed with reviewing your application, we need the following information:
1. Please provide details regarding stormwater discharges associated with the pre-
construction and post-construction phases of the project. For example, have any measures
been taken to ensure diffuse flow of runoff?
2. A site plan clearly showing the proposed impact areas, property boundaries, and proposed
structures, buildings, and paved surfaces. We suggest that you generate a map showing
this area on a USGS topo map, and identify the nearest surface waters. You have
provided a preliminary plat and erosion control plan, but the impact and preservation
areas are not clearly shown on a legend. It is particularly important to show all the
proposed crossings of streams, wetlands and Neuse Buffers, as well as the areas to be
preserved. These impact areas must match the impacts described in the Pre-Construction
Notification form.
3. Stream impacts should be listed in linear feet rather than acres, and each crossing
structure should be described, such as stormwater channels, intermittent and perennial
streams.
4. This project occurs within the Neuse River Basin, which has Buffer Rules in effect.
Please visit our web site at http://h2o.enr.state.nc.us/ncwetlands to learn about the buffer
rules in effect in North Carolina. You may also wish to discuss the buffer rules with Bob
Zarzecki in the 401/Wetlands Unit. He can be reached at [phone]. After you have
reviewed the rules, please provide detailed maps illustrating all buffer impacts, if any,
proposed for this project. We suggest that you use the appropriate NRCS soil surveys to
illustrate stream and buffer impacts associated with this.project.
Division of Water Quality • Non-Discharge Branch
401Metlands Unit, 1621 Mail Service Center, Raleigh, NC 27699 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer • 50% recycled/10% post consumer paper
sst (by copy of this letter) that the Corps of
)jest will be placed on hold for our processing
W(h)). Please visit the 401/Wetlands Unit
:an be reached at [phone].
NC, 27615

001150,
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) 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 APPROPRIATir `'
FIELD OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVI
O 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; m T?-
2. MAILING ADDRESS: _A (3W t ?-?Os.l 4 2E _ M
+ z
SUBDIVISION NAME m ?-r^'?'? She o -i
CITY: V\ STATE: 0; c ZIP CODE: 2- -7
5
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
' MAILING ADDRESS ABOVE):
64 We_u- e.. Rvv_plr'Po' kLz sp- it ems)
I. TELEPHONE NUMBER: (HOME) (WORK) Q -TO _ 78(D S ?}
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER: ,? ` _ _ y n • .?,? ? ?,
-7
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE):.
COUNTY: v avR S+c r\ - NEAREST TOWN: C LiMA-0n
10a. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: ECT BY.
EXCAVATION:
FLOODING: OTHER: o.© Qcce-c, _,
DRAINAGE :
TOTAL ACRES TO BE IMPACTED : ©• 0-7 a-r425
10b. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT
RELOCATED, PROVIDE DISTANCE BOTX BEFORE AND AFTER RELOCATION) : (IF
LENGTH BEFORE:
FT AFTER: --
WIDTH BEFORE (based on normal high water contours): FT
1 ?I
WIDTH AFTER:
FT
AVERAGE DEPTH BEFORE: ( l FT
' AFTER: (2) STR M H-A?rTNEL IMPA(`Ta WTT T R Gf)T T
(CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION:
PLACEMENT OF PIPE IN CHANNEL: ?
CHANNEL EXCAVATION: ?--
CONSTRUCTION OF A DAM/FLQODING:
OTHER:
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZ
WATERSHED DRAINING TO THE POND? E OF THE
WHAT IS THE EXPECTED POND SURFACE AREA?
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE
MECHANICAL EQUIPMENT TO BE USED (ATTACH PLANS: a 1/2" X 11" DRAWINGS
ONLY)
rn?
L3. PURPOSE OF PROPOSED WORK: c` lki

3

SPECIFIC LOCATION (INCLUDE ROAD NUMEERS, LANDMARKS, ECT.)
6_ IMPACTED OR NEAREST STREAMIRIVER:
RIVER BASIN:
71. 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-II)? YES ( .) NO (1C ) IF YES, EXPLAIN:
7b IS THE PROJECT. LOCATED wnsIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIROMENTAL CONCERN (AEC)? YES ( ) NO (?( )
7c. IF THE PROJECT TS LOCATED WI THIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF
COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION?
&a. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT? YES ( ) NO ("() IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS
PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
CERTIFICATION:
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
FUTURE? YES ( ) NO (X) IF YES, DESCRIBE ANTICIPATED WORK:
°7 4gr-f S
9a. ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND: fo0•
9b. EST2v1ATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
B
I.
10a. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
0.0-7 arc fes (-fa)& C-ros5 +&5)

14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED
OUT IN WETLANDS. (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND
IMPACTS):
N dvol
b D?2.?n ? ? O?..ClZ..
15. YOU'ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SERVICE
(USFWS) AND/OR-_i TIONAL MARINE FISHERIES SERVICE (NMFS) (SEE AGENCY
ADDRESSES SHEET) REGARDING THE PRESENCE OF ANY FEDERALLY LISTED OR `i
PROPOSED FOR LISTING?END2LNGERED OR THREATENED SPECIES OR CRITICAL HABITAT
IN THE PERMIT AREA THAT •'MAY'-'BE-AFFECTED BY THE PROPOSED PROJECT. DATE
CONTACTED: (ATTACH RESPONSES
FROM THESE AGENCIES.)
16. YOU ARE_ttEQUT-RE -To-GONTACT.-.THE STATE HIST_RI.g PR SF.RV.ATZON_DFFICER
(SHPO) (SEE AGENCY S_SHEET.).•.-REGARDING THE PRESENCE OF HISTORIC
PROPERT IES--3-N E PERMIT AREA WHICH MAY BE AFFECTED BY THE"PROPOSEDE
PROJECT. DATE CONTACTED:-
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF
PUBLIC (STATE) LAND?
YES (] NO -() (IF NO, GO TO 18)
a. IF YES, DOES THE PROJECT-REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA ENVIRONMENTAL
POLICY ACT?
YES (I NO O
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE?
YES H NO ( ]
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE
STATE CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT REGARDING
COMPLIANCE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING-THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
4
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
Of 1 V OJZQ Sax,-)-ter S`1 S i ' rOl L vjJ
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
MANAGEMENT PROGRAM,
'-A,JC' Cl l s i 2-oco
OWNER'S/AGENT'S SIGNATURE DATE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED).

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