20010448 Ver 1_COMPLETE FILE_20010326

O?O?WAT?9pG
r
Michael F. Easley
Governor
William G. Ross, Jr., Secretary
Department of Environment and Natural Resources
Kerr T. Stevens
Division of Water Quality
April 3, 2001
DWQ# 01-0448
Alexander County
Wilson & Peggy Hulick
756 North Shore Drive
Hickory, NC 28601
APPROVAL of 401 Water Quality Certification
Dear Mr. & Ms. Hulick:
You have our approval, in accordance with the attached conditions, to place fill in 0.046 acre of waters in order to
stabilize the shoreline and pier on your property on Lake Hickory in Alexander County, as you described in your application
materials received by the Division of Water Quality on March 26, 2001. 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.
Sincerely,
0 . St v s
Attachment
cc: Corps of Engineers Asheville Regulatory Field Office
Mooresville DWQ Regional Office
Central Files
File Copy
North Carolina Division of Water Quality, 401 Wetlands Certification Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
P. Duke
(Power.
A Uuke Energy eu,np,,,y
X440
Duke Power
C" 526 South Church Sheet
?i V0. Box 1006
DUKE POWER Charlotte, NC 28201-1006
LAKE MANAGEMENT, EC12-Q
P O BOX 1006
CHARLOTTE, NC 28201-1006
704-382-1567 OR TOLL FREE 1-800-443-5193
APPLICATION FOR PERMIT TO STABILIZE THE SHORELINE
IN NORTH CAROLINA
Please type or print and fill in all blanks. If information is not applicable, so indicate by placing
N/A in blank. PLEASE SUBMIT APPLICATION AND APPROPRIATE FILING FEE,
PAYABLE TO DUKE POWER, TO ABOVE ADDRESS.
1. Applicant Information
A. Name
B. Mailing Address
e- kmrul.
C. Telephone: Y-?,P
`f s" " 3 5r•2
H. Location of Proposed Project
A. Street Address ?' ( ?r`i `7,??J1^mr i??
B. County tqf?? y)dip r
C. City, town, community or landmark z4 ['k- h . -M e n,nl,mw-A 0 `; v? r `5
D. Lake
E. Section I Lots rte2 5
F. Direction to property byroad l_e h o n W ; \Ava' ccA??
re Y7r
M;&-5 406'-s tt Get F ?yrr:? ?n ris;ht
III. Description of Project
A. Length of wall 6Q
?
B. Material r; n Ncs i?
C. Distance from property line/shorel ne t4j- f,Qre.1 n
IV. Intended Use of Project Area
A. Private
B. Commercial
V. Applicant Signatures Date-
PLEASE SUBMIT COPY OF APPLICATION TO:
US ARMY CORPS OF ENGINEERS
151 PATTON AVE. - ROOM 143
ASHEVILLE, NC 28801-5006
?Rha\' -n
Rev.03/08/00ssb
i
Form 398576 (R9-85) SHORELINE MANAGEMENT PROGRAM Previously Form 06940
PERMIT APPLICATION FORM
NC 1 SC 2 I.D. No. Permit No.
Co. No. Grid Sect.
Lake r,k e? r r Utility Co. Ownership?leed 2 Lease
`
APPLICANT
Name: n 1_t. I ? - i l

Address: First Middle Last
Street or Box
t'r.K?r??? N 'C-
C state Zip
Telephone: 93? -
Area Code Number Ext.
Signature:
Circle the appropriate number below
Ramp &
Marine Shoreline
Pier Railway Boathouse Stabilization Other
USE:
1. Individual Ci> 1
C 2
2. Common 2
STATUS:
1. Existing 1 1 1 1
2. Proposed Q? 2
MATERIALS:
1. Concrete 4. Treated wood 1 4 1 1 4 1 4
2. Masonry 5. Untreated wood 2 5 3 2 5 2 5
3. Metal 6. Other 3 6 6 3 6 3 ock
FLOTATION:
1. Plastic cylinders
2. Styrofoam 2 2
3. Other 3 3
TYPE OF FACILITY:
1. Permanent 1 1 1
2. Floating
3. Combination & <?p
T
?I i--
Fig. 1
Fig. 2

T
?b
-I y'I-
Fig. 3
?l 1-- --I I--
Fig. 4 Fig. 5 Fig. 6 (other)
Pier surface area sq. ft.
Float surface area sq. ft.
Pier Dimensions: See Figure Above
Condition of Pier: ? Good ? Fair ? Poor
Permitted: ? Yes ? No Date:
Additional information:
By:
COMMON USE PERMIT
If this application is for the common use of a facility, those parties using the facility appoint the individual listed in the
applicant section of this form as the agent applying for the permit. All parties using the facility must sign below.
Date Address
Ali ??Pl??
•rf-
Q?®44?
DWQ ID: _ CORPS ACTION ID: _
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT ff) _
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 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
1707. PLri ASE PRINT OR TYPE.
CV 1. OWNER'S NAME: _ VW' i ISOn
Q, 111.
2. MAILING ADDRESS: _ I
SUBDIVISION NAME - tl 1 -r z5 tit c?• Y)
P 1,c kc'5 f^ )\) c 2 a? o f
CITY: _STA E: - ZIP CODE:
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
TELEPHONE NUMBER: (HOME) - (WORK)
4. IF APPLICABLE: AGENTS NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER:
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP
OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: _ - NEAREST TOWN: _
? Qx ih Yl cl a c- ' C L0 r
,SVE,CIFIC LOCA1 SON (INCLUDE ROAD NUMBERS, LANDMARK ECT. 4k-/
?• T ? (?
j t ors l ?' Id ! ' Flc ?z? c% ? C4 on crir.,
Lan f ? e•?. q n .161i C= S•, . ?l L? L.
Lrc3Nor? o -S 1? V ,'>7 sn '?
6. IMPACTED OR NEsl.AREST TRE?fvl/RIER: RIVER AS[N:
7. (a) IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER, (SA),
F- C] HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER
W ?w SUPPLY (WS-I OR WS-II)? YES E] NOIF YES, EXPLAIN: _
U (b) IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES El NO U-
(c) IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF
COASTAL COUNTIES), WHAT IS TI4E LAND USE PLAN (LUP) DESIGNATION? _
Include the Appropriate Fee.
Beginning January 1, 1999, the North Carolina General Assembly adopted fees for the 401
Water Quality Certification Program. Ptease read the fee memorandum discussing this legislation prior
to writing your check. In brief, a fee dit 00 i?) required if the project impacts are less than one acre
wetland fill and less than 150 feet pere-hi ial'stream impact. If wetland or water impacts equal or exceed
one acre, or if stream impacts equal or exceed 150 feet of stream impact, then a fee of $475 is
required. Checks are to be made payable to the NC Division of Water Qualit Any application received
without the necessary fee payment will be returned to the applicant.
What to expect following submittal of your application
You may choose to read the full text of the 401 Wetland Rules governing review of 401 Water
Quality Certifications. In summary, once your complete application is received by the DWQ Central
Office, then we have 60 days to prepare a response (a Certification, an On-Hold letter, or other request
for additional information). Please note that if your application is determined to be incomplete by DWQ,
then the 60-day clock has not begun ticking. For example, if you did not attach a check, provide a map,
or if your PCN form does not provide sufficient information, we will inform you in writing that we cannot
begin processing your application until we receive the required material. Many applications are
forwarded to the appropriate DWQ Regional Office for site-specific review. Once a staff report is
submitted, we will either issue the 401 Certification or request more information from you, based upon
the recommendations of Regional Office staff.
How to Track the Status of Your Application
DWQ plans to have portions of the project database available for public access later in 1999. In
the meantime, inquiries about specific projects can be directed to Cyndi Bell at [phone]. Please
allow one month for your application to be mailed and initially reviewed prior to making calls. We also
ask that you remember the 60-day clock when budgeting time for project construction. Due to the high
number of applications received and staff-time limitations, we cannot prioritize projects based on your
construction schedule. All applications will be reviewed in the order received.
The Wetlands/401 Water Quality Certification Unit of the Division of Water Quality - North Carolina
Department of Environment and Natural Resources. For more information please call [phone] or
write NC DENR/Division of Water Quality, Wetlands Unit, 1621 Mail Service Center, Raleigh, NC 27699-
1621. For information or comments on this Web Site please email Todd St. John -
"[e-mail]"
8. (a) HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT? YES [] NO [2 IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND
ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401 CERTIFICATION): _
Co
t? (b) ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE?
J'IF YES, DESCRIBE ANTICIPATED WORK:
YES ? NO [-
9. (a) ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND: Js s s 7?ta r„
(b) ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE: A )p
to. (a) NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY: N' iq
FILLING: _ EXCAVATION:
FLOODING: _ OTHER : -
DRAINAGE : TOTAL ACRES TO BE IMPACTED: _
(b) (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED,
PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION: f ty?
LENGTH BEFORE: _ FT AFTER: _ FT
WIDTH BEFORE (based on normal high water contours): _ FT
AVERAGE DEPTH BEFORE: - FT AFTER: _ FT
(b) (2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY) 'k )A
OPEN CHANNEL RELOCATION: - PLACEMENT OF PIPE IN CHANNEL: _
CHANNEL EXCAVATION: ` CONSTRUCTION OF A DAM/FLOODING: _
OTHER:
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED N f)
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; 81/2 BY I I DRAWINGS ONLY)
13. PURPOSE OF PROPOSED WORK: 5<3-4. 0 1? 6 1 r
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS) IyA
15. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE AND/OR
NATIONAL MARINE FISHERIES SERVICE REGARDING THE PRESENCE OF ANY FEDERALLY
LISTED OR PROPOSED FOR LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL
HABITAT M THE PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED PROJECT.
DATE CONTACTED: _ Al lI
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE PERMIT AREA
WHICH MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE CONTACTED - /1,1A
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (STATE) LAND? YES E] NO PTIF NO, GO TO 16)
(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 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE STATE
CLEARINGHOUSE 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].
18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF PROPOSED
ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OF 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, 26, 29, AND 38).
ALL STREAM (INTERMITTENT AND PERMANENT) ON THE PROPERTY MUST BE SHOWN ON
THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET OF 1 INCH EQUALS 100 FEET
OF THEIR EQUIVALENT.
(b) IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE IMPACTED BY
PRODUCT.
(c) IF DELINEATION 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? _
(f) IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL? _
SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS 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,
6\NiA S/AGENTS SIGNATURE DATE
(AGENTS SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
TIiEOWNER IS PROVIDED).
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DWQ ID: - CORPS ACTION ID: _
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT 11) _
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 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 (71
COPIES MUST BE SENT TO THE NC DIVISION OF WATER QUALITY,
ATTN: JOIN DORNEY 4401 REEDY CREED ROAD RALEIGIi NC
27607. PLEASE PRINT OR TYPE.
1. OWNER'S NAME: _ w f, ISO rL ? Pojc,.) 14 k-L 't C, k-
2. MAILING ADDRESS: _ "75& O o rtl ,
SUBDIVISION NAME k;L H J r7?
CITY: -STATE: _ ZIP CODE: _
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
Sd? ?f•9s_ `13112.
TELEPHONE NUMBER: (HOME) _ (WORK) -
4. IF APPLICABLE: AGENTS NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER:
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP
OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: _ - NEAREST TOWN: _
Alexander.- 14''c,kor
ECIFIC LOCAUON (INCLUDE ROAD NUMBERS, LANDMAIV ECT. Ak"7 N,-! ?/-
4--,' (? ?? rJn ??hh. 16.6 ?, de ?) on I ?i ld l; Olc eess d?d?? Lc44 on Clv,..w?* ? Loop
?
1 - 1LxO Nor ??.o K? ?'? 7"
W 7 G. IMPACTED OR NEAREST STREXWI I_VER: - RIVER ,ASIN: _ L u?? w lII'a ? c, 't'
lctl?. ?t c ?C p r
U I (a) IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER, (SA),
ad. HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WS-I OR WS-II)? YES ? Nolpfw YES, EXPLAIN: _
(b) IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES E] NO LA-
(c) IF TliE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEL' PAGE 7 FOR LIST OF
COASTAL COUNTIES), WI1AT IS THE LAND USE PLAN (LUP) DESIGNATION? -
40
r
Include V?t Appropriate Fee.
Beginning January 1, 1999, the North Carolina General Assembly adopted fees for the 401
Water Quality Certification Program. Please read the fee memorandum discussing this legislation prior
to writing your check. In brief, a fee $200)required if the project impacts are less than one acre
wetland fill and less than 150 feet perennlat stream impact. If wetland or water impacts equal or exceed
one acre, or if stream impacts equal or exceed 150 feet of stream impact, then a fee of $475 is
required. Checks are to be made payable to the NC Division of Water Quality. Any application received
without the necessary fee payment will be returned to the applicant.
What to expect following submittal of your application
You may choose to read the full text of the 401 Wetland Rules governing review of 401 Water
Quality Certifications. In summary, once your complete application is received by the DWQ Central
Office, then we have 60 days to prepare a response (a Certification, an On-Hold letter, or other request
for additional information). Please note that if your application is determined to be incomplete by DWQ,
then the 60-day clock has not begun ticking. For example, if you did not attach a check, provide a map,
or if your PCN form does not provide sufficient information, we will inform you in writing that we cannot
begin processing your application until we receive the required material. Many applications are
forwarded to the appropriate DWQ Regional Office for site-specific review. Once a staff report is
submitted, we will either issue the 401 Certification or request more information from you, based upon
the recommendations of Regional Office staff.
How to Track the Status of Your Application
DWQ plans to have portions of the project database available for public access later in 1999. In
the meantime, inquiries about specific projects can be directed to Cyndi Bell at [phone]. Please
allow one month for your application to be mailed and initially reviewed prior to making calls. We also
ask that you remember the 60-day clock when budgeting time for project construction. Due to the high
number of applications received and staff-time limitations, we cannot prioritize projects based on your
construction schedule. All applications will be reviewed in the order received.
The Wetlands/401 Water Quality Certification Unit of the Division of Water Quality - North Carolina
Department of Environment and Natural Resources. For more information please call [phone] or
write NC DENR/Division of Water Quality, Wetlands Unit, 1621 Mail Service Center, Raleigh, NC 27699-
1621. For information or comments on this Web Site please email Todd St. John -
"[e-mail]"
8. (a) HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT? YES E] NO []' IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND
ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401 CERTIFICATION): _
(b) ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE?
YES [] NO []'IF YES, DESCRIBE ANTICIPATED WORK: _
(a) ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND: Le s s Lta n- it
(b) ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE: 11118
to. (a) NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY: N
FILLING: _ EXCAVATION: -
FLOODING: _ OTHER : _
DRAINAGE : TOTAL ACRES TO BE IMPACTED: _
(b) (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED,
PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION:
LENGTH BEFORE: _ FT AFTER: - FT
WIDTH BEFORE (based on normal high water contours): - FT
AVERAGE DEPTH BEFORE: - FT AFTER: _ FT
(b) (2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY) k )p
OPEN CHANNEL RELOCATION: _ PLACEMENT OF PIPE IN CHANNEL: _
CHANNEL EXCAVATION: - CONSTRUCTION OF A DAM/FLOODING: _
OTHER:
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED N A
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; 81/2 BY I I DRAWINGS ONLY)
13. PURPOSE OF PROPOSED WORK: b'r \ ` Z- e 50 T+ °' S? sk,am I r ro-
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS) IVI)
15. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE AND/OR
NATIONAL MARINE FISHERIES SERVICE REGARDING THE PRESENCE OF ANY FEDERALLY
LISTED OR PROPOSED FOR LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL
HABITAT IN THE PERMIT AREA TliAT MAY BE AFFECTED BY THE PROPOSED PROJECT.
DATE CONTACTED: _ A 1,q
IG. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE PERMIT AREA
WHICH MAY BE AFFECTED 13Y THE PROPOSED PROJECT. DATE CONTACTED _ &I A
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (STATE) LAND? YES E] NO EKIF NO, GO TO 16)
(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 Q NO
IF ANSWER 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE STATE
CLEARINGHOUSE 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].
l8. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF PROPOSED
ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OF 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, 26, 29, AND 38).
ALL STREAM (INTERMITTENT AND PERMANENT) ON THE PROPERTY MUST BE SHOWN ON
THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET OF I INCH EQUALS 100 FEET
OF THEIR EQUIVALENT.
(b) IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE IMPACTED BY
PRODUCT.
(c) IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA SHEE'T'S
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? -
(f) IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL? _
SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE US MAY NOT BE IMPACTED PRIOR TO:
I. 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,
O S/AGENTS SIGNATURE DATE
(AGENTS SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER PROM
THE OWNER IS PROVIDED).
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