20010469 Ver 1_COMPLETE FILE_20010402

OF uv H FF9
O Michael F. Easley
?O G Governor
Co William G. Ross, Jr., Secretary
-I Department of Environment and Natural Resources
Kerr T. Stevens
Division of Water Quality
April 11, 2001
DWQ# 01-0469
Catawba County
De6nis R. Anthony
840 Second Street, NE
Hickory, NC 28601
APPROVAL of 401 Water Quality Certification
Deer Mr. Anthony:
You have our approval, in accordance with the attached conditions, to place fill in 0.04 acres of waters in order to
construct shoreline stabilization on your property on Lake Hickory in Catawba County, as you described in your
application materials received by the Division of Water Quality on April 2, 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 1508 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.
Sin erely,
rr . Steve 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)
nIn 7,21 170 8 /n L.nnn\ nIn 7'11 GOn'1 /i....\ L'"-1/1.7.. -el nlr. nr - M.v „n11 ..n.1n1

DlJl:ls POWER LAKE MANA(;1 1111!:N'1', It:(:12 (1
1' O IWX 1006
roll ('1IA I(I.OTlT_', WA8201-1006
701-382-1567 ur'1 MA, 1110!:1 1-800 4.13-5193
APPLICATION FOR PERMIT 1'O STAIIILILIs'1'111: S110R LINE: IN NOI0'11 (_AIMLINA
I'Icasc 1y11c ur 111 inl unJ till ill ull blanks. IC iulul muliun is nut u11111iu1blc, su iudiuUC by pluciug tJ/A i..-
blank. AND AI'1'1tOPMATE DUKE POWlslt FILING FLll,
PAYABLE TO DllkCl- 1'OWliI(,'I'O ABOVE ADDRESS.
Applicant lufurulation
A. tl,uue p? n_I.I ?S _ _? W hbn
_ J
li mailing Add1css 9,90 j e C Ong.
Cgz?? 3??- 5z5;z
C. I cIc1111une.
11. Location of PruPwcd 1'rujccl
A. kkke / c Ko rc' //- C
D. Sheet Address &j.3/_. 7 ( ?i_ AVE.,
C. (:utility ('4fQw6,
6 cL - _-_
U. (:ily, luwn, Curlununily ur Imidniaik l G.KQC(?... . -14
--- Sulxlivlsiun 01dE'.101 _.11..k4.11d.11'1CP
1:. Secliun 1.01 11
- -- - -
I . I)irediuns lu prullCrly by 1 :1J ,S?f?---a 7 .1f.0413
r-or mc?P?
d
G. I.aliludc unJ Iun1,UuJu Cur lllu plujuul site ,cAt 35
Please submit u oral) 5110" u1g 111c Cuurdiuules or u JclulIed 111,111 (1JSGS (jtiud nrr1), city
u1a1), cIc ) showing lIle c>;acl locution of 111c project site. (NOT. LuliulJc! !ungiluJe
cuurdinalcs cull be luutid ur1 inleruel site, 1ru 1v. rrulpGl,rrr.rurn)
111. Dasc1,1111iu11 1,1' 111 uJccl 1
A. (.en 111 of Wall ,Z 1 ()( Fee+> Z? R
- -- 1'X(1 n
nC_?? e - -r e ?.... ?, t?C k; _9al 1IFJ) ? zed C.
I1. n•L:11el is 1 co --
C. Uisl.ulce fluid painterly liuc/slluleline. _ N(/A_ .
IV. lulcudcd Use of Piojcc( Area
A. ?)I ivale
Il. Cuuuuer
` 1)a (e - -Y FT I
V. APPlic:wl Sil;uulurc
1'L.liA.1'I: NO'l'L: %'Ill: l?'l)LLO11'lN(::
• A COPY OF "1'111-' COlvtl'1.C'1ED APPI.ICATI0N WITII A KOAI) MAP S110W1116 I.0X:A'I'10N 01;
'1'111:1'KOI'I:K'I'Y MUSTIW SUIIMI'I'I'IiD'I'O: (1SAKAIYCORPS OF1sNGINEERS, 151
PA %?'ONAI'L'. - XOOAI208, ASH VILLE, NC288UI-5006
A COPY 01''1'111? " I ) U K I ` POWHIt API-1.1CATI0N 11011L I'I'.KMH' I'C) 8TAII11,IZII TI I I t HIIt3It1WINI1
• IN NOKTII CAKOLINA" AND SEVEN (7) COPIES OI''I'IIF COMPLETED "NC DIVISION OF
WATER QUALITY PRE-CONST RUC I ION NOTIFICAT1011 APPLICATION" MUSTBE
s1)11MI'ITIA) WITII'I'llli DIVISION OF WA'1 EM QUALITY APPL.ICA'I-ION FIA'Tu:
W DIVISION OLD IVAILR QU,I1.11T
A771VIYON: JOUN UORNLi Y
1621 A1;IIL SL'll1'LCL' C.'L'NTI..'R
K?Il.lilGll, NC "17699-1621
919-733-1786
I I/Ill/llll:.Al

DUKE POWER DIRECTIONS BY ROAD FORM
Lake Use Permit Applicants and Contractors: Ease of locating the proposed project site can have a big
impact on permit processing time. Please complete this form and return it along with your completed
permit application to:
DUKE POWER
C/O LAKE, MANAGEMENT- EC 12 Q
1'O BOX 1006
CHARLOTTE, NC 28201-1006
1-800-443-5193
Type of Penrlit Requested
"Circle":
Private Facility
Commercial Facility
Excavation
Stabilization
Conveyance
MiscellaneoliS Uscs
Directions (from major road or highway): C N f j
Applicant's Name:_ +A U n nn//
U/ '?6 th YE', ??
Street Address (at lake): ;! F
Lake Name: l /? NI C O/ /-
Subdivision Name: __01de
Property Section: Lot tl
City: O County: C Q I Q Wl??
i
U D O l
State: zip:
Telephone: y?3
01Ui
Descriptive Structure on Property (i.e. brick garage, white fence, mobil home, ctc):
(A Cf?pIV of ?ouSe
"Note: [,lease use (lie back of this form if desired (o draw us a map (o (lie silt.
61'AIA.AKI:h16NI I-A N1I'I'MMIItI'(IIONS 1)"'
I:111.oivc D-11c. 11115/9tt

\Sc'Jt?O
010469
DNYQ lD: __ CORI'S ACTION lD:
NATIONWIDE' 1'l:ltl\11'1' Rl:Ql1L5'1'1:1) (PROVIDE' NATIONWIDE PFRMI'T fl)
P1Z1?-GUNS"I'RUC'1'lUN NOTIFICATION APPLICATION
FOR NA"fIONWII)I; I'IatMI'I'S "I'IIA'1' ItI:OIJIItI::
I. NU'I?II'ICAIION'IY)'I III: CORPS OI' I:NGINI:I:RS
2. AI'l'I,i(;A"I IUN I UR Sl:(°1101 401 CI:R'I'll'ICA'I'ION
3. COOItDINA"1'1014Wl"I'11 'I'I Ili NC IIVISION Ol' COAS'I'A1. MA1JA(;I?MIsN'I'
SEND Tllli ORIGINAL. AND (1) COPY 01"I IIIS COMPLETED ?'O?tM'?') 'IlIli. APPROPRIATE' 1 IFLD
OI'1'ICG Ol "1'111: CORPS Ol' I:NGINGI:RS (S?li AGIiNCY ADURIiSSIiS Sltla:'I"). 6- YEN_ )
COPIES MUS'IBE SL`NT TO T)J NC DIVISION Ole \'VA`I'IqR Q1JAI,I`I'Y,
ATTN: JOAN DORNEY,_4401 R1'EDY CREEK ROAD, RAI.IAGI1,_NC
27607. PLEASI? PRINT OR TYPE-
I. OWNEWS, NAh91:: __ DQ " \ ? S R. k 1-11-"ot 11
g?] O Se COfI C ,
2
MAII
IN(; ADDRI'
SS
.
.
.
: ___,
SUBDIVISION NAMI, _
OD
"
'
E:
CI
I
Y: STATE: ZIP C
PROJFC-F LOCATION ADDRESS, INCLUDING SU15DIV SIGN NAME (II' DII'I'I:I(I;N"I' I ROM
pr
?V
.,
e- • ,
MAILING ADDRESS ABOVE): (.D 13 -q( . - .
w8e K%1( LAr\4V) > H)Lkory, NC. Z?3-eol
?
7
3. 'I•I:IETiIONFNUMIJI:R:(IIOMF) (WORK) ?$2??3z8-jzJrz m0ir?l?2(gzS)(r?z?U?o

4. IN APPLICABLE: AGFNTS NAME' OR Kl'_SI'ONSllii_L' (;OI(I'UI(A'I'li OF ICIAI., ADDKliSS,
1'110141: NllMlililt: n11A
n

5. LOCATION OF WORK (PROVIDE A MAP, PREFERAULY A COPY OF USGS'TOPO(;RAI'III(; MAI' t'r7
OR AE'IUAL I'l10TOGRAPI IY WT TI I SCALE): rT-7 Z!
COUNTY: NHAR'STTOWN: Q
IiC'I
)
ANUMARKS
ROAD NUMIll R
I
11)1
INCL
CA TMN
'
'
,
.
,
.
.
,
IC; I.O
(
SI
I?CII
i
14ot' (
c.?
?t?Vlilt (IASIN
fA L
/kC
WHR
'
6
: __
,
._
:
0.
l KFAM/R
6. IMPACTED OR NI ARI;ST S
7. (a) IS PROIIiCT LOCATED NLAlt WATIiR CLASSIFIED AS TROD T, "TIDAL SALTWATER, (SA),
111G1I QUALITY WATE-KS (IIQW), OUTSTANDING RIiSOURCL WATERS (ORW), WAl'1'It
SUPPLY (WS-1 OR WS-11)7 YES n NO [] IIi YES, EXPLAIN: _-
(l,) IS THE PROJECT LOCATED WI 1.11IN A NORTH CAROLINA DIVISION OF COASTAL.
MANA(;I-'MI:N l' AI(I?A OV ENVIRONMIi1,1 I Al. CONCERN (AUC)'I YI:S (_ ] NO j f
(c) II' •TI II: I'RUJl:CT IS LOCA I 1:1) \VI'I I IIN A COAS I AL COON l'Y (Sl:l PA(;I--1 V OR I.IS'T (
COASI Al, ('01)11 ILS), WI IA I IS'I III: I.AND US1: PI AN 1)I:SI(;NA'TION?

8. (a) IIAVE 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 IN & (INCLUDE PHOTOCOPY OF 401 CERTIFICATION): _
(b) ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR TI IIS PROPERTY IN TI IE, FUTURE?
YES E] NO IF YES, DESCRIBE ANTICIPATED WORK: -
?rU?x3'?
9. (a) ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OP LAND: _
(b) ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
10. (a) NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: _ EXCAVATION: _
FLOODING: OTI IER : _
DRAINAGE: TOTAL ACRES TO BE IMPACTED:
(b) (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (I!' RELOCATED,
PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION:
LENGTI I BEFORE: _ 171- AFTER: _ FT
WIDTH BEFORE (based on normal high water contours): - FT
AVERAGE DEPTII BEFORE: FT AFTER: FT
(b) (2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION: _ PLACEMENT OF PIPE IN CHANNEL: _
ClIANNE•L EXCAVATION: _ CONSTRUCTION OFA DAM/FLOODING: _
OTI I ER:
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSIII:D
DRAINING TO THE POND? WHAT IS THE EXPECTED POND SURFACI' 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)
/i ?cc IJobca7
13. PURPOSE OF PROPOSED WORK: _ S+U? e f I ?3 ?'ti w 1 ?l S ?u w ??
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WFTLANDS (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS)
15. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE AND/OR
NATIONAL MARINE FISHERIES SERVICE REGARDING THE PRESENCE OP ANY FEDERALLY
LISTED OR PROPOSED FOR LISTING ENDANGERED OR TI IREATENED SPECIE'S OR CRITICAL
HABITAT IN THE PERMIT AREA THAT MAY BI--- AFFECTED BY THE PROPOSED PROJECT.
DATE CONTACTED:
16. YOU ARC REQUIRED TO CONTACT TIiC STATE I IISTORIC PRESFRVA'TION OFFICE- It
(S1 11'O) REGARDING TT IE PR[:SI:NCF OF I IISTORIC PROPERTIES IN -1-1 IF PERMIT AREA
WI IWI I MAY BI? AFFEC I'D 13Y Ti Ili PROPOSED PROJECT. DATE CONT'ACIT'.D
?j

17. DOES THE PROJECT INVOLVE AN EXPENDITURE OP PUBLIC FUNDS OT THE USE OF
PUBLIC (STATE) LAND? YES ? NO Q (IF NO, GO TO 16)
(a) IF YES, DOES TI IE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO THE REQUIREMENTS Ol, 'I'I IE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT? YES ? NO
(b) IF YES, I IAS THE DOCUMENT BEEN REVIEWED THROUGI I THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE YES 0 NO n
IF ANSWER 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE STATE
CLEARINGHOUSE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS RI7GAIMING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. Cl IRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTI I
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
18. THE FOLLOWING I'T'EMS SHOULD BE INCLUDED WITH THIS APPLICATION IF PROPOSED
ACTIVITY INVOLVES 11IE 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 13Y
PRODUCT.
(c) II' DELINEA'I'ION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA SHEI I'S
RELEVANT TO THE PLACEMENT OF TI IE DELINEATION LINE.
(d) ATI'ACI I A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
(c) WI IAT IS LAND USE OF SURROUNDING PROPERTY? _
(1) II- APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL? -
SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WE'T'LANDS 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 I-WEIJTY COASTAL COUNTIES ONLY), A LETTER FROM TI IE NORTI I
CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED
ACTIVIT S CONSISTENT WITH THE NORTH CAROLINA COASTAL MANAGEMENT
OWNGR'S/AGENT'S SIGNATURE DATE\
(AGENTS SIGNATURE VALID ONLY
IF AUTHORIZATION LI 1 i'ER FROM
'I'I Ili OWNIiR IS PROVIDED).

At a-,?
V\YQ ID: ___ CORPS ACTION ID: _--
NATIONWIDE PE'RI111 I' REQUE'STE'D (PROVIDE NA'T'IONWIDE 1'I?Rh11'1' !!) _-_
PRE'-CONSTRUCTION NOTIFICATION APPLICATION
NA'I'IONWIDL' 1'EltMl'I'S'lT1A'I' It1iQUlltli:
FOR
I. NU'I'II?ICA"LION "I"O'flll; CORPS OI? I:NGINIaiI(S
2. APPLICATION FOR SECTION 401 CERTIFICATIO11
3. COOItI)INA'I'ION WI'1'11'1111? NC I)IVISION OIL (_:OAS'I'Al. MANA(il-MliN'l'
SEND TIII's ORIGINAL AND (1) COPY OFT I IIS COMPLETED FORM TO' III AI'1'ROPRIATI? FIFLD
OFFICE' OF TIIE CORPS OF ENGINVEKS (Slip AGENCY ADDItI?SSES SIIL-'E'I'). S11, VL'N_(7_ )
COPIES MUST BE SENT 1'O T1110, NC D)V1SION_O WATER?H 1,
A'CI,N: JOHN DORNEY,_4401 REEDY CREEK ROAD _RALAtA(,II, NC
27607. PLEASE, PRINT OR TYPE.
1. 0W11I.IZ'S NAtvni: _ DQ- YlI\.l S fl ?1Ot 1
o n c? 5-t- ??-
2. MAILING ADDRESS. _. ?? Se
SUBDIVISION NAME'
_-_-- 010 ./V\ I (emu" I`nJ
. C'.. (D?
Ko ?S
S'l'A'I'E: 'LIT' CO1)li:
? I Cc
CITY
.
: -
)
- -
J
SIOFI NAMIi (II' UII'I'IiIZI;N'I' FROM
PROJECT LOCATION ADDRESS, BACLUDING SUIIDIV
pr
VE
J
-
fE
', f
•,
VVA A
MAILING ADDRESS Al1OVl:): (013
A(D
oWe- W1 Lnr)4to g > Hjc-kory, NC - zieo1
3. I'EI,I:I'IIUNE h1llMlJl:lt: (IIUME) (WORK) ' ?$2?) 3Z$-jzJ?z ??4?11e??zS?V'?'Z?U1dT

4. IF AI'1'I.ICABLE: AGENT'S NAtvil? Olt RESPONSIBLE CORPORATIi OFFICIAI., ADDKI:SS,
IIIIONL•' NLJNIBER: NSA
? D
5. LOCATION OF WORK (PROVIDE A MAT', PREFERABLY A COPY OF USES TOPO(ilkAPI IIC MAI, C-)
Olt AERIAL. III IOTOGItAIIlIY WITII SCALE): C m
COUNTY: NEAR `STTOWIA: I (
a W ? CN 1 C \ `a r?
(1 ^
' ?
11
.) ___
SPI?CII IC LU(:A I N (INCL. 1D1_' ROAD NUMIJI?R , I.ANDMAItKS, ECT
t,c, ,? r - p - /
/? f
tM-R IlASIN
` c4aWka
\\ c-
IVER
'
'
'
-
:
ItI:AM/R
:..-
IT?D Olt NEAREST
ST
6. IMPA(:
7. (a) IS PRO1L'(:T' LOCATED NEAR WATER CLASSIFIED AS TKOLJT, TIDAL SAI.TWATFIt, (SA),
111(;11 Ql1Al.l l'Y WA"I'EI(S (11(1W), Oll'1"S"I'ANDIN(i ItI:SOUItCIi WA'I'I:RS (OI(W), WA'I'I;R
Sul'PI.Y (WS-I (m WS-11p YIS"J ["] 14o [_] 11, YES, ISXVIAIN: _-
(t,) IS 'flll: I'RO11iC'I' LOCA"I'I:D WITHIN A NORTH CAROI.INA DIVISION OF CUAS'I'AI.
MANA(;IiMIiN'I' ARI=A OF FNVIRONMIiNTAI. CONCI?ItI4 (AFC)'? YI?S I .I 1JOX
(c) II TI IF I'I(U11:("f IS LOCATED WITI IIN A COAS I A I. ('OLIN IN (Slit: I'A(i1'. 1 FOR I.IS f OI
('OAS I AI. ('UI1tJ I II:S), WIIAI IS 'fllli I.ANI) l1Sl? PLAN (I.lll') DI:SI(iNA'fIOfJ'?

8. (a) HAVE' ANY SECT ON 404 PERMITS BEEN PREVIOUSLY REQUESTTsD FOR USE ON TATS
PROJECT? YES 0 NO IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND
ANY ADDITIONAL IN ATION (INCLUDE PHOTOCOPY OF 401 CERTIFICATION): _
(b) ARE ADDITIONAL PERMIT REQUESTS EXPECTTD FOR THIS PROPER'L'Y IN THE FUTURE?
YES E] NO?IF YES, DESCRIBE ANTICIPATED WORK: -
9. (a) ESTIMATED TOTAL NUMBERS OF ACRE'S IN TKACT OF LAND: -
(b) ESTIMATED TOTAL, NUMBER OF ACRES OF WETLANDS LOCATED ON PROJE'C'T' SI'TI?:
to. (a) NUMBSK OF ACRE'S OF WETLANDS IMPACTED BY THE PROPOSED PROJECTBY:
FILLING: EXCAVATION: _
FLOODING: OTHER:
_
DRAINAGE.: "TOTAL ACRES TO BEL IMPACTED:
(b) (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED,
PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION:
LENGTI I BE`1'01tE: _ V7 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 TIIAT APPLY)
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 WA'TERSHE'D
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? (A7TACII PLANS; 81/213Y I 1 DRAWINGS ONLY)
13. PURPOSE OF PROPOSED WORK:-.51,p e v I >tr ?, ; ??t s w ?? r!1
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE' CARRIED OUT IN
WETLANDS (INCLUDE ANY MEASURES TAKEN 1'0 MINIMIZE WETLAND IMPACTS)
15. YOU ARE REQUIRED TO CONTACT THE US FIST{ AND WILDLII'E SERVICE AND/OR
NATIONAL MARINE 14-ISIIERIES SERVICE REGARDING THE PRESENCE OF ANY FEDERALLY
LISTED OR PROPOSED FOR LISTING ENDANGERED OR TITREATENED SPECIES OR CRITICAL,
HABITAT IN THE PERMIT AREA TIIAT MAY 13E AFFECTED BY THE PROPOSED PROJECT.
DATE CONTACTED:
16. YOU ART: RL•QUIRI'D TO Cc INTACT TI31 STATE I IISTORIC PRESERVATION OFFICER
(SI11'O) REGARDING TI IE PRESENCE OF HISTORIC PROPFIRTIES IN '1'I IF PERMIT AIWA
WI 1101 MAY 13F Al 'F'ETED BY TI It, PROPOSED PROJECT. DATE CONTACL'I;D
?J
17. DOES TI IE PROJECT INVOLVE AN EXPENDITURE OI, PUBLIC FUNDS OT THE USE OF
PUBLIC (SPATE) LAND? YES Q NO [:] (IF 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 T14ROUGII THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGI [OUSE YES [j NO
IF ANSWER 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE STATE
CLEARINGI IOUSE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SI IOULD BE
DIRECTED TO MS. CHRYS BAGGETI', 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 W1TII 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 13E SHOWN ON
THE MAP. MAP SCALES SHOULD BE I INCH EQUALS 50 FEET OF 1 INCII 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.
(c) WHAT IS LAND USE OF SURROUNDING PROPERTY?
(I) IF APPLICABLE, WI TAT 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:
. ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT,
2. EITI IER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF WATER QUALITY
CERTIFICATION, AND
3. (IN THE TWENTY COASTAL COUNTIES ONLY), A LETTER FROM THE NORTI I
CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED
ACTIVITY IS CONSISTENT WITH THE NORTH CAROLINA COASTAL MANAGEMENT
O NGRZ S/AGENTS SIGNATURE DATE (AGENTS SIGNATURE VALID ONLY
II' AUTHORIZATION LE'TT'ER PROM
THE OWNFIR IS PROVIDED).

010469
DWQ 1D: _ CORPS AC'T'ION 11):
NATIONWIDE I'EltNll'l' ItEQUI,"S'1'1?D (PROVIDE NATIONWIDE PERMIT ll) -__
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NA'I'IONWIDI? I'IatMl'I'S "Ll1A'I' REQUIRE:
1. NO"1'II-'ICA'1'1ON 'I-O'l'lll: CORPS OI-'ENGINI?I?ItS
2. AI'1'I.ICA'I'ION I OI( SE(:7'TO1J 401 CEIt'1'il,ICA'I'IOIJ
3. COORDINATION WITII "1'I IE NC DIVISION OF! ;OASTA1, MANA(; L'MI`NT
SENU'I'l1E ORIGINAL AND (I) COPY OF"1'1115 COMI'L.ETIiD FORn1 'I'O'1'llli APl'1i01'KIA'1'E t'ILiLI)
OFFICE OF TIIE CORPS OF ENGINEERS (SH: AGLNCY ADDRESSES SIII:ET). SEYL;N V)
COPIEsS MUST BE SENNT `I'O T11E NC DIVISION OF WATE'R pUALI`1'Y,
ATM: J0I1N DORNEY,_4401 REEDY CREEK ROAD, RALEIGII,_M"
27607. PLEASE PRIN`h OR TYPE-
I. OWNEWS NAMIi: DQ v-I t S R.
,?d
2. h1nI1.ING ADDRESS: g'u O SQ C.a ,
SUBDIVISION NAMI.__ OI ,A 1II L?nJv r`nJ
CI'T'Y: -STATE': -_ 'Lill CODE. ^ k I c KO y-?
I I..

PROJIiCI' LOCA'T'ION ADDRESS, INCI.UDING SUIIDIVI:iION NAME (I?I'/ I)II I IiltliN l' 1 1(UM
MAILING ADDRESS ABOVE): (p 13 q(otV, AUe • ,Or•, frE'
o de. K%11 Lfir\ m > f/?c.kory NC Z,3(oDl
3. TI?LITIIONE NUMBEl(: (IIOMIi) ?• (WORK) -? ($2?? 3z8-5,252 ??o1?'r1e(?z??IZ`U1?7
4. IF APPLICABLE: AGI?N'I'S NAND Olt ltESl'ONSIIiLIi COltl'OltA'1'1? OFFICIAL, ADDRI.SS,
PHONE NUMBER: 4/A
5. LOCATION OF WOI(K (I'ROVIDI: A MAP, fill-'I'EltAIiLY A COI'Y O1--USGS'I'OI'OUItAI'III('MAP
OR AERIAL. PHOTOGRAPHY WITH SCALE):
COUNTY: _ NliAI(TS'1' "I'IOWN:
CI W F? tom. l' 1 c 1 `o -?
SI'Ii 'IFIC LOCA PION (INCI. 1D1 ROAD NUMBER , I.ANUMARKS, E(`I'.)
i
&-C`
6. IMPAC'I'IiD Olt NIiAItI.S'I' S"I'ItI:AM?I(I Vlat: ?t?Vlatr (IASIN: __ `. ct to wYJa_ `r
. (a) IS I'ROIEC'I' LOCA"I1:U NEAT( WATER CLASSII II:D AS'1'KOl1'I','t'IUAI. SA1."I'WA'I'EIt, (5A),
111(;11 QUALITY WATERS (IIQW), OUTSTANDING RESOURCE WATERS (()ItW), WATER
SIJI'I'I.Y (W5-1 UR WS-II)7 YI±S 0 NO (_] IV YVS, I!XI'I.AIN: --
(b) IS TIIIi I'ItUIEC'I' LOCA'I'131) WITHIN A NORTI I CAROLINA DIVISION OI' COAS'1'AI.
MANA(iliMliNT AI(EA OF ENVIRONMENTAI. CON(:IiKN (Ali(:)'? YIiS 140
FT I
C7 -?<
F71
?-' fTl
fT'I «?
0 -?
(c) II: 'I'l IF PROJECT IS LOCATED WITI III1 A COASTAL COUNTY (Slili I'A(;I: "? FOR ITS"T OF
CUA`i'I'AI. ('UIIIJ'I IIiS), \VIIA'I IS'I III: LAND USE PLAN (1.111') IWSI(i114A IIMP

8. (a) HAVE ANY SECT ON 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT? YE-SE] NO IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND
ANY ADDITIONAL 1N ATION (INCLUDE PHOTOCOPY OF 401 CERTIFICA'T'ION): _
(b) ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE?
YES [:] NO p F YES, DESCRIBE ANTICIPATED WORK: _
?101 A 3`,- (Y30.
9. (a) ESTIMATED TO'T'AL NUMBERS OF ACRES IN TRACT OF LAND: _
(b) ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
10. (a) NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
PILLING: _ EXCAVATION: _
FLOODING: OTI IER : _
DRAINAGE_ TOTAL ACRES TO BE IMPACTED:
(b) (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED,
PROVIDE DISTANCE BOTLI BEFORE AND AFTER RELOCATION:
LENGTI I BEFORE: _ F1, AFTER: _ PT
WIDTH BEFORE (based on normal high water contours): - FT
AVERAGE DEPTH BEFORE: - FT AFTER: - FT
(b) (2) STREAM CHANNEL IMPACTS WILL RESUL'T' FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION: _ PLACEMENT OF PIPE IN CHANNEL: _
CHANNEL EXCAVATION: _ CONSTRUC'T'ION OF A DAM/FLOODING: _
OTHER:
11. IF CONSTRUCTION OF A POND IS PROPOSED, WI IAT IS THE SIZE OF TI IE WATERSHED
DRAINING TO THE POND? WHAT IS THE EXPEC'T'ED POND SURFACE AREA?
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL
EQUIPMENTTO BE USED? (ATTACIA PLANS; 81/2 BY I I DRAWINGS ONLY)
/' ? << IJobca7
13. PURPOSE OF PROPOSED WORK: r I Q 3 Of-, w S
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE' CARRIED OUT IN
WI TLANDS (INCLUDE ANY MEASURES TAKEN 1'0 MINIMIZE WETLAND IMPACTS)
15. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE AND/Olt
NATIONAL, MARINE FISHERIES SERVICE REGARDING THE PRESENCE OF ANY FEDERALLY
LISTED OR PROPOSED FOR LISTING ENDANGERED Olt THREATENED SP'E'CIES Olt CRITICAL,
HABITAT IN TIIE PERMIT AREA THAT MAY BE AFFECTED BY TIIE PROPOSED PROJECT.
DA'I'S CON'T'ACTED:
16. YOU ARE REQUIRED TO CONTACT 1-1 If-- STATE HISTORIC PRESERVATION OFFICER
(SI1PO) REGARDING 1.111: PRESENCE OF HISTORIC PROPER'T'IES IN'TI II: PERMI'T' AREA
W111CH MAY RF AFFECTIM BY '1 HE PROPOSED PROJECT. DATE CONTAC TI)

17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OT TIIE USE OF
PUBLIC (STATE) LAND? YES (] NO E] (IF NO, GO TO 16)
(a) IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTI I CAROLINA
ENVIRONMENTAL POLICY ACT? YES ? NO E]
(b) IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE YES E] NO E]
IF ANSWER l7b IS YES, THEN SUBMIT APPROPRIA'T'E DOCUMENTATION FROM THE STATE
CLEARINGHOUSE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CIIRYS 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 13E SHOWN ON
THE MAP. MAP SCALES SHOULD BE 1 INCA EQUALS 50 FEET OF 1 INCI I EQUALS 100 FEET
OF THEIR EQUIVALENT.
(b) IF AVAILABLE, REPRESENTATIVE PHOTOGRAPII OF WETLANDS TO 131' IMPACTED 13Y
PRODUCT.
(c) IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA SHEE'T'S
RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
(d) ATTACII A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
(c) WHAT IS LAND USE OF SURROUNDING PROPERTY? _
(o 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;-ONSISTENT WITH T13E NORTH CAROLINA COASTAL MANAGEMENT
NATURE DATE'
(AGENTS SIGNATURE VALID ONLY
IF AUTI IORIZA'FION LI.'I"I'GR PROM
IHf:OWNEIt IS PROVIDED).