20010009 Ver 1_COMPLETE FILE_20010104

0/0007
North Carolina
Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor
William G. Ross Jr., Secretary
Donna D. Moffitt, Director
Mr. Rudolph Koziol, Owner or
Mr./Ms. Jodi Jobker, Buyer
C/0 Mr. M. S. Medeiros, Jr.
P. O. Box 150
Kitty Hawk, NC 27949
LUUI
;?
e' ?l i(iR,
NCDENR
January 22, 2001
COE ID Number 200110225
Permit Application for activity in
Monteray Shores Subdivision
Currituck County
Dear Mr. Koziol; Mr. and Ms. Jobker:
The North Carolina Division of Coastal Management has reviewed your
application for a Nationwide Permit pursuant to Section 307 of the Coastal Zone
Management Act of 1972, as amended. Based upon our review, we have
determined that the proposed activity is consistent with the North Carolina
Coastal Management Program subject to the following conditions:
The activity described in the above referenced application is for the
issuance of an U. S. Army Corps of Engineers Nationwide Permit
Number 18 under 33 CFR, Part 330. Any modification of your
proposed activity, or change in the Nationwide Permit Number that
you are seeking, will require an additional review for consistency
by this office.
2. Since the activity that you propose involves impacts to waters
and/or wetlands, a 401 Water Quality Certification must be
obtained from the North Carolina Division of Water Quality.
Please understand that this letter does not relieve you of the responsibility to
ensure that all other applicable State authorizations and/or permits are met prior to
the implementation of this project. Please feel free to contact me at (252) 264-
3901 if you have any questions or need further assistance
Sincerel ,
d Samph
District Manager
Division of Coastal Management
Elizabeth City District \ 1367 U.S. 17 South, Elizabeth City, North Carolina 27909
Phone: [phone] \ FAX: [phone] \ Internet: http://dcm2.enr.state.nc.us
AN EQUAL OPPORTUNITY \ AFFIRMATIVE ACTION EMPLOYER - 50% RECYCLED / 10% POST CONSUMER PAPER
Mr. Rudolph Koziol, Owner or
Mr./Ms. Jodi Jobker, Buyer
C/0 Mr. M. S. Medeiros, Jr.
January 22, 2001
Page 2
cc: Raleigh Bland, Tom Walker, USCOE, Washington, NC
Dennis W. Hawthorn, Charles Jones, DCM
Caroline Bellis, Consistency Coordinator, DCM
John Dorney, Water Quality Section, Raleigh, DWQ
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
January 5. 2001
DWQ# 01-0009
Currituck County
Rudolph B. Koziol, Jr., and Jodi Jobkar
947 Sun Burst Court
Corolla, NC, 27927
APPROVAL of 401 Water Quality Certification
Dear Mr. Koziol and %Is. Jobkar:
You have our approval, in accordance with the attached conditions, to place till in 0.05 acre of wetlands for the purpose of residential till
at Lot 130 in Monterey Shores, Corolla. Currituck County, as you described in your application received by the Division of Water Quality on
January 4, 2001. After reviewing your application. Nve have decided that this fill is covered by General Water Quality Certification Number
3106. This Certification allows you to use Nationwide Permit 18 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 tills 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 conforming to Chapter 150B of the North Carolina General
Statutes to the Office of Administrative Hearings. P.O. Box 27447, Raleigh. N.C. 27611-7447. This certification and its conditions are final
and binding unless you ask for a hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water Act. If you have any questions.
please telephone John Domey at 919-733-9646.
Attachment
cc: Corps of Engineers Washington Regulatory Field Office
Washington DWQ Regional Office
Central Files
File Copy
M.S. Medeiros, Jr., P.O. Box 150, Kitty Hawk, NC, 27949
Sinc rely,
PSt 'ns??
ee
010009
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

0.1 00 00
DEM ID: CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PElUlIT
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONOIDE PERMITS THAT REQUIRE:
1) NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATION FOR SECTION 401 CERTIFICATION
3) COORDINATION WITH THE NC DIVISION OF COASTAL MANAGEMENT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE FIELD OFi?
OF PHt CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN (7) COPIES SHOULD E
SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT (SEE AGENCY ADDRESSES SHEET)
FLEA=° PRINT / / // ///
1. Gt4IJEf:S NAME: ?dOO1 Q• Iro?i0/ Jr CJodl .JObK?r ????
2. MAILING ADDRESS: C4 LDr,?: I?•.! map- it ?•OQ V/ P• o• QOX /So
??' w? ?C- L2 9Y9 SUBDIVISION NAME: n s'
CITY: STATE: -449- ZIP CODE: I
FER-'N FPO"1
PROJECT LOCATION ADDRESS, INCLUDING SU' DIVISION/TAME (,IF DI F
MAILING ADDRESS ABOVE) : 6egur t ?lro/ll? Ivr-
/ 30 cJiT'Lt eXIS?'i a?u?Gl, n ?C°rdo rem
3. TELEPHONE NUMBER (HOME) : Z Z-.26 - /? Z (WORK) : -Z /--?OoOJCJ? ,
4. IF APPLICABLE: AGENT'S NAME MOR R bPONSIBL-E/-CORPORATE.!2FFICIAL, ('(
ADDRESS, PHONE NUMBER: I ?,• /???e?e/C`OS' n/r: ?.?L Z?/- ZODO 1
PO d ox / s0 fit'; )? 1?d w?C ,VC- 2-79q2 rye Lrz-z6l-/e?L)
:. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF U.SGS TOPOGRAPHIC MAP OR ?I
AE:'.IAL PHOTO RF.PHY WITH ,;('P.LE) .
CC-U:= : (J r r i 7 L/c GC NEAREST TOWN OR CITY: SrECIF'iC LOCATION (INCLUDE ROAD NUMBBrkS, 'LANDMARKS, ETC-)
-Pv Kt G v rs 4 Cov ?4- r o L?? /V C z 7 9Z
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4u1 lSSII
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6. =MPACTED OR NEAREST STREAM/RIVER:
RIVER BASIN: " N
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, T=DAL SALTWATER
(SA), HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER SUP
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(WS-1 OR WS-II): YES [ ) NO [?(J IF YES, EXPLAIN:

IF THE PROJECT IS LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTA:, MANAGEME
ARE OF ENVIP.ONMENTAL CONCERN (AEC)? YES [ ] NO [X)
IF TliE PROJECT IS LOCATED WITHIN A. COASTAL COUNTY (SEE PAGE 7 FOR LIST vF COA5
COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION:

Ole At ?1 Cp??re r v a) i
Imo'
HAVE ANY SECTION 904 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS PROPERT?
Y _. ( ] N0 [V1 IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT ANL AN"
`
//
RM.,IMON (INCLUDE PHOTOCOPY OF 401 CERTIFICATION) : t
ADDITIONAL IN
FO
4
of
t
ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOP. THIS PiROPLRTY IN THE FUTURE?

YES [ J C0 X) IF YES, DESCRIBE ANTICIPATED WORK: ?
f.

ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND: o Z 'L.
ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE: ? O S
NUMBER OF ?CA--S OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY: '
FILLING: • 6) s EXCAVATION: O
FLOODING: 0 OTHER: a
DRAINAGE: O TOTAL ACRES TO BE IMPACTED: D S
r.
(1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED, PROVE
E
DISTANCE BOTH pEFORE AND AFTER RELOCATION) : a?,?Jl/?Cd?le
U E
LENGTH BEFORE: FT AFTER: FT
a
,
WIDTH BEFORG (based on normal high water contours): FT
viIDTH AFTER: FT
s .i '.l *12 7 _ TICW ... 7',dcf1 . -. J .,. ?... -' ... ,•r
( L )
11
1'
13
14.
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F,
"Pp e-
AVE'RAG'E DEPTH BEFORE: FT AFTER: FT
STREAM CHF.NNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION: PLACEMENT OF PIPE IN CHANNEL:'
CONSTRUCTION OF A DAM/FLOODING:
CHANNEL ELEVATION:
?-
l /'r agle.
l/tv -4- d
"
OTHER:
IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED DRAIN,

TO THE PGND"
1
WHAT IS' THE EXPEC.^.ED POND SUREACr AREA?
=DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL EQUIFM? 11
TO BE USED (ATTACH PLANS: 81:" Y 11" DRAWINGS ONLY) : Gt?rIJ'7rUG? a
3 L x / P e r fOJJ rw,, wary-7 , - 00 ( Or of n e
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.
CURPOSE OF PROPOSED WORK:
so4vin m-64-A ?2 d 07

.STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
IMIZE WETLAND iMrACTS)
WETLANDS. (INC'LODE ANY MEASURES TAKEN TO MI
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v l h WT ' d rpnra? ?' ?
.
akt ?W?y?-?w?? ????• fee. c?LTc? Y? -S'lc?
YOU ARE REQUIRED TO COtITACT THE STATE HISTORIC PRESERVATION OFFICER (SHPO) (SE

AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE
E-
PERMIT AREA WHICH MAY BE AFFECTED BY THE PROPOSED PROJECT.
DATE CONTACTED: lc-,aak- Aee-- I T, ?Ov
DOES THE PROUECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF PUBLIC
r
r
7a
(STATE) LAND? YES [ ] NO (y] (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 AC
YES ( ] 110 ( ]
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA DEPARTME
OF ADMINISTRATION STATE CLEARINGHOUSE? YES ( ] NO [ ]
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE STATE
CLEARINGc30USE TO DIVISION OF ENVIRONMENTAL MANAGEMENT REGARDING COMPL"_AtjC WITH THi
A
NORTH CAROLINA ENVIRONM'ENTA'L POLICY ACT. [•
QUESTIONS R.GARDING :HE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE DIRECTED TO
CE• P Y-3 -•PGGE :'T, D'l KECTOR STATE CLEARINGHOUSE, NORTH CAROLINA DEPFRTM EDIT OF
ADMltN_ST'RATION, 1302 Marl Service Center, RALEIGH, NORTH CAROLINA 276?U-1302,
I'cLL=HO::E (-19) 807-2925.
17. TEE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF PROPOSED ACTIVlY
INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL INTO WETLANDS:
u. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES AND FONDS ON Tl
?FkOPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26, 29, AND 38). ALL
STREA:`:S (INTERMITTENT AND PERMANENT) ON THE PROPERTY MUST BE SHOWN ON THE M
MAP SCALES SHOULD BE 1 INCH E UP.LS 50 FEET OR 1 INCH EQUALS 100 FEET OR TH
EQUIVALE T.
were- cl?l hez-4 ?7 jq• C% C,? oic /2-43 L. T_F AVAILA°L-, RErR.SENTlTIVE PHO GRAPH OF WETLANDS TO BE IMPACTED 3Y 2Ru`JEn
c. I- DELINEATION WAS PERFORMED BY A CONSULTAN'T', INCLUDE ALL DATA SHEETS REL---Vl T
TO THE PLACEMENT OF THE DELINEATION LINE. III
d. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
1
e. WHAT IS LAND USE OF SURROUNDING PROPERTY? /?QG Ole w n
I. Ii APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
,. SIGNED AND DATED BY AGENT AUTHORIZATION LETTER, IF ArP'LICABLE.

NOTE: WETLANDS OR WATERS OF THE U.S. MAY NOT BE IMPACTED PRIOR TO:
1) ISSUANCE OF A SECTION 404 CORPS OF ENGI14EERS PERMIT, AND
2) EITFER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF ENVIRONMENTAL MANAGEMF
(WATER QUALITY) CERTIFICATION.
n
owtc S/ GENT'S S'I NATURE
(AGENT'S SIGNATURE VALID ONLY
IF =AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED (18G.))
Q 4'?" /-/ o
DATE

MEMORANDUM
DATE: November 22, 2000
FROM: Rudolph Koziol, Owner
TO: Tom Walker, A. C. E.
SUBJECT: Inspection of Lot 130, Monteray Shores
This memorandum authorizes Tom Walker to accompany Manny Medeiros on
December 13, 2000 to inspect the subject lot relative to a possible wet land area where
a prospective buyer wishes to locate a swimming pool.
Ru Iph Koziol

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THAT THIS PLAT WAS PREPARED
IN ACCORDANCE WITH GS 47-30
UNDER MY SUPERVISION FROM
AN`ACTUAL SURVEY MADE
UNDER MY SUPERVISION USING
REFERENCES SHOWN HEREON.
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12-16-88 FOUNDATION SURVEY (M.W.)
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10-31-88 SURVEY FOR:
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Eck. RUDOLPH B. KOZIOL, JR
AND VIFE
S HADEL YN:. M, KOZIDL

W30 POPLAR FRANCH TVSP. CURRITUCK CO NORM CAROLINA
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DEM ID: CORPS ACTION ID:
NATIONWIDE PEWIT REQUESTED (PROVIDE NATIONWIDE PERMIT -`)
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATION;aIDE PERMITS THRT REOUIP.E:
1) NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATION FOR SECTION 401 CERTIFICATION
?) COORDINATION WITH THE NC DIVISION OF COASTAL MANAGEMENT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE FIELD OFr?
OF fHE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN (7) COPIES SHOULD E;
SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT (SEE AGENCY ADDRESSES SHEET)6
PLEASE ?RiNT. // I / // ////
!. OWINERS NA:NIE: ?llal7j Q.?'o Jr CJOd.L JObKdr'
QOX ISM '
2. MAIL114G ADDRESS: a/0 C?gepc? • I?•, •l?Ira-p D7,4 P, a
?• "d-wk ?1/C- Z./ SUBDIVISION NAME: n
CITY: STATE: -4? ZIP CODL
rr:OJECT LOCATION ADDRESS, INCLUDING SU-DIVISIION GAME ( r v
MAILING ADDRESS ABCVE) : 9" ?'UK Ui•1'r OUT
Li o ?- 13 0
cJil?'Lt L'X.rS?'i?u3 a?u?G?r . i'?/Dn Ord -?
TELE?HONE NUMBEF (HOME) : (WORK)
IF A?PLICABLE: AGENT'S NP_ME ?OR7 RESPONSIBLE / CORPORATE -UFIC
ADDRESS, PHONE NUMBER: I? F-'-o l ras' Z? -
P 0 (a ox / 51) /[-,- 1-/ it/ C 1- 7 9 q y' (L
c FER?'N F: OM
D !? d RUC
?,p re.1
-Z G/-?oooX11.?,
IAL,
S? Z? /- ? 000
1?? L.S2-L6l-/86L
TOPOGRAPHIC MAP OR
7roll')-
3
4
S. LOCATION OF WORK (FROVIDE A MAP, PREFERABLY A COPY OF USC
AE i nL PHO^0 ftF.PH _' WT TH 31 :P.LE) .
COUNTY: m- r r JC k NEAREST TOWN OR CITY: -
5r'?CIE'it: LOCATION (INCLUDE ROA/D?NUM3ERS, LANDMARKS, ETC-)
7 q 7 -3v PL 0 v r S' ? " ?v q- y-, (-,a P o Lr% /V C z 7 9
OE
,
5. =MPACTED OR NEAREST STRERM/RIVER:
RIVER BASIN: "H(2-
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER 6
(SA), HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER SUPPI
`441lS'UC6.
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(WS-I OR WS-II)" YES ( j NO [x] IF YES, EXPLAIN:

IF THE PROJECT IS LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL MANAGEME;
ARE OF ENVIRONMENTAL CONCERN (AEC)? YES [ ] NO [xj
IF 'T'E PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF COAS
COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION:

< ?2 i ` COn.re r va A `D.Ar-
r'AVE ANY SECTION 404 PERMITS BEEN PREVIOCISL•1 REQUESTED FOR USE ON THIS P'ROPERT '
'i_. [ ) NO [ IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND ANj
i
`
t
RMATION (INCLUDE PHOTOCOPY OF 401 CERTIFICATION):
ADDITIONAL IISFO

d
ARE ADDITIONAL PERMIT P.ElUESTS E:{?EC'TED FOP THIS PROPERTY IN THE FUTURE? t.
YES [ J NO X) IF YES, DESCRIBE ANTICIPATED WORK:.

k
v
k

ESTIMrTED TOTAL NUMBER OF ACRES IN TRACT OF LAND: o Z-2- t

_ r
ESTIMATED TOTAL NUI-IBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE: • ?.S )
NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY: ¢
FILLING: 0S EXCAVATION:
FLOODING: O OTHER: a
DRAINAGE: D TOTAL ACRES TO BE IMPACTED: • mss'
(1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED, P'ROV E
-
DISTANCE BOTH BEFORE AND AFTER RELOCATION) : hD d/?p/ ?'cd-UC- I
LENGTH BEFORE: FT AFTER. FT j
l
WIDTH BEFORE (based on normal high water contours): FT
wIDT.''. AFTER: FT
a
}

(L)
11
17
13
14
?5
6
I
I
t?LO d 0' `l c ?-
F,rE'RAGS DEPTH BEFORE: FT AFTER: FT
STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL R?LOCATI?IJ: PLACEMENT OF PIPE IN CHANNEL:
CHANNEL ELEVATION: CONSTRUCTION OF A DP_M/FLOODING:
ktv ti }Pv l !,G" 9/p
OTHER:
v
PROPOSED, WHAT IS THE SIZE OF THE WATERSHED DRAIN;
IF CONSTRUCTION OF A POND IS
! cagle
? a
-
- QG
TO THE FOND" GL®
S THE EXIFECTED POND SUnFACE AREA?
WHAT T
_
i
DESCRIPTION 0: PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF,,MECHANT_?:AL EQUIP:':( '
TO BE USED (ATTACH PLANS: 81A." X 11" DRAWINGS ONLY) : ?QrlJ'7'?UG? a

32, x J'w,?VZi4-7) oo/ -par- c) n e
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[URPOS'E OF PROPOSED WORK:

s
F°
STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS. (INCLUDE ANY MEP.SURES TAKEN TO MINIMIZE WETLAND IMPACTS): f
C'_x /S'??i? GL r / S !?G /' e d- L6 Gri?`e? O /-L ! ?-d `ci-r
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C/o Ci 14`ah. -14k- f?/ wyi ?me ?• fee. c?va'1 X ez S'?2
(
YOU ASE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER (SH?O) (SEf

AGENCY ADDRESSES SHEZT) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE 4
4

PERMIT AREA WHICH MAY BE AFFECTED BY THE PROPOSED PROJECT. .
DATE CONTACTED:
DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF PUBLIC
t

r
70
.. n n.. c: - _.?7 inn. ...17

(STATE) LAND:' YES [ ] NO [Yj (IF NO, GO TO 18)
a. IF :'ES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL DOCUMENT
PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA ENVIRONMENTAL POLICY AC
YES [ j NO ( j
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA DEPARTME
OF iiDMINIiTRATIGN STATE CLEARINGHOUSE'S YES ( j NO [ ]
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE STATE
CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT REGARDING COMPL=A'NC' WITH TH
NORTI-] CAROLINA ENVIRONMENTAL POLICY ACT.
QUCSTIONS REGARDING TH'E STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE DIRECTED TO M
CERYS 'BAGGE'."T, DIRECTOR STATE CLEARINGHOUSE, NORTH CAROLINA DEPARTMENT OF
P.D2^IAS7TR.A'PIGN, 1302 Marl Service Center, RALEIGH, NORTH CAROLINA 27699-1302,
TEL''=HONE [phone].
17. T- FO'LLO'WING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF PROPOSED ACTIV
NVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL INTO WETLANDS:
u. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES AND PONDS ON T
PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26, 29, AND 36). ALL
STRE;-MS (INTERMITTENT AND PERMANENT) ON THS PROPERTY MUST BE SHOWN ON THE M
MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET OR 1 INCH EQUALS 100 FEET OR THE
EQUIVALE T.
Wet-l?tcds cvere- a????hez ?1'LY? fO??, G?d??P.?? ?}• C, C-? dyc ?Z ??
V. IF AVAILABLE, nEtRSSENTATIVE F'HO GfWFH OF WETLANDS TO BE IMPACTED BY FROjE
c. I= DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA SHEETS RELr-V,l T
TO THE PLACEMENT OF THE DELINEATION LINE. (
d. ATTACH A COPY OF THE STORMWATER MA14AGEIIENT PLAN IF REQUIRED.
1
WHAT IS LAND USE OF SURROUNDING PROPERTY? / u/Gce"V r 1'lle
e.
t. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
'? X /-s r?1? CO ?2i rte- v tit ? 1?? ?e ?? ??

q. SIGNED AND DATED BY AGENT AUTHORIZATION LETTER, IF A?PLICABLE.
(p???r e h?^ o ?,??. 12 -/ 3- o of Cm
_e. IT ,Ern oT ,,., (.- T- ....Pi
NOTE: NETLANDS OR WATERS OF THE U.S. MAY NOT BE IMPACTED PRIOR TO:
1) YSSUP.NCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT, AND
2) EITHER THE ISSUANCE OR WAIVZR OF A 401 DIVISION OF ENVIRONMENTAL MANAGE
(WATER QUALITY) CERTIFICATION.

C,rrNLR' S/ GEN1 SiNA1'URE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED (18G.))
DATE
MEMORANDUM
DATE: November 22, 2000
FROM: Rudolph Koziol, Owner
TO: Tom Walker, A. C. E.
SUBJECT: Inspection of Lot 130, Monteray Shores
This memorandum authorizes Tom Walker to accompany Manny Medeiros on
December 13, 2000 to inspect the subject lot relative to a possible wet land area where
a prospective buyer wishes to locate a swimming pool.
Ru Iph Koziol

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I JESSE S. JEWELL JR. CERTIFY
THAT THIS PLAT WAS PREPARED
IN ACCORDANCE WITH GS 47-30
UNDER MY SUPERVISION FROM
AN`ACTUAL SURVEY MADE
UNDER MY SUPERVISION USING
REFERENCES SHOWN HEREON.
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12-16-88 FOUNDATION SURVEY (M.W.)
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SURVEY FOR:
=A ECG RUDDLPH A KOII01, JR.
AND VIFE
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HADEL YN:. H. KOIIOL

3.330, POPLAR BRANCH P.
CU.2RITUCK C4 NOR TN C,tROLINA

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"4011SSUED"
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
M.S. Medeiros, Jr
Southern Shores Realty
PO Box 150
Kitty Hawk, NC 27949
Dear Mr. Medeiros:
d © o
e
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
er.
-e?er?t.b_._?0, 2000
i JAN
,I `1 9 0 ® 0
On December 18, 2000, your application for 401 Water Quality Certification on
behalf of Rudolph Koziol for a project in Currituck County was received by the N.C.
Division of Water Quality. Please note that beginning January 1, 1999, the N.C. General
Assembly passed legislation requiring payment of a fee for all 401 applications. Your
application is being returned since no payment was received with the package. The fee for
applications is $200 for projects impacting less than an acre of wetland and less than 150
linear feet of streams. For projects impacting one or more acres of wetland or 150 or
more feet of streams, the fee is $475. In order for DWQ to review and process your
request, you must send a check in the appropriate amount made payable to the N.C.
Division of Water Quality attached to your applications.
Please call Robert Ridings or Cyndi Karoly at 919-733-1786 or visit our web site
at http://h2o.enr.state.nc.us/ncwetlancis if you have any questions.
PAYMENT
RECEIVED
cc: Central Files
TJn Dorney
Wetlands/401 Unit 4401 Reedy Creek Road Raleigh, North Carolina 27607
Telephone [phone] FAX # [phone]
An Equal Opportunity Affirmative Action Employer 509o recycled/10% post consumer paper

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