20010597 Ver 1_COMPLETE FILE_20010418

o?0 WA7- 9p Michael F. Easley
Governor
r William G. Ross, Jr., Secretary
Department of Environment and Natural Resources
Kerr T. Stevens
Division of Water Quality
May 14, 2001
DWQ# 01-0597
Iredell County
Tommy Baldwin
140 Windy Knoll Lane
Mooresville, NC, 28117
APPROVAL of 401 Water Quality Certification
Dear Mr. Baldwin:
You have our approval, in accordance with the attached conditions, to place fill in 0.006 acre of waters in order to
construct a seawall on your property on Lake Norman in Iredell County, as you described in your application received by the
Division of Water Quality on April 18, 2001 and in additional information received May 4, 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,
Stev
ens
s
0rr1
Attachment
cc: Corps of Engineers Asheville Regulatory Field Office
Mooresville DWQ Regional Office
Central Files
File Copy
Bill Clawson, 9201 Magnolia Estates Drive, Cornelius, NC, 28031
010597
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)
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WATER QUALITY PLANNING Fax:919-(15-t)b6(
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
May 2 "U1 1b:U4 r. Ui/UZ
1?•
M000-ftowoft ;I
N.C ENR
NORTH CAROLINA Der'ARYMMNT OF
VIRO PSI?N T AND NATURAL REsc)u RCes
ay 1, JOJ
DWQ # 010597
iredell County
Clawson
9201 olia Estatcs Dr W 1 N (D k.1 N
Cornelius, 031
%5lo W / ??? y 1?ivd?.c. L ??
Dear Mr. Clawson: M00 f,' V I c c- F
On April 18, 2001 the Division of Water Quality (DWQ) was notified by receipt of your
applications regarding your plan to fill the lake shoreline of Lake Norman for the purpose of
shoreline stabilization in Iredell County. Approval from DWQ is required to disturb these waters.
Please provide seven copies of the following information and refer to the DWQ # listed above in
your reply. In particular as described in 15A NCAC 2B .0502, we will require you to provide a
map showing where the shoreline stabilization will occur and the area of water to be filled
property. Please show these on maps of suitable scale (for instance 1" = 100 feet) so we can begin
to detemune your projects' coinpliance with 15A NCAC 2H .0500.
Please call me at [phone] if you have any questions or would require copies of ottr
:rules or procedural materials. This project will remain on hold as incomplete in accordance with
15A. NCA.C 21-J .0505(c)_ The processing tiixle for this application will begin when this
infonnation is received. If we do not hear from you by writing within three (3) weeps we w ll
assume you no longer want to pursue the project and will consider it withdrawn.
4 in erel
R. o y
Cc: Mooresville DWQ Regional Office
AsUville Corps of Engitieers
File Copy
Central Piles
ATT ' c. Nay
Wetlands/401 Unit • 4401 Reedy Creek Road • Raleigh, North Carolina 27607
Telephone [phone] FAX # [phone]
An rquul Oppurwnil7 Afrinltntive Action rknploysr
SOYo iCrycled/10% post consumerp;iper
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
Bill Clawson
9201 Magnolia Estates Dr
Cornelius, NC 28031
Dear Mr. Clawson:
e??
NCDENR
NORTH CAROLINA DEPARTMENT OF
0 NVIRONMENT AND NATURAL RESOURCES
ay 1, 2001
DWQ # 010597
Iredell County
On April 18, 2001 the Division of Water Quality (DWQ) was notified by receipt of your
applications regarding your plan to fill the lake shoreline of Lake Norman for the purpose of
shoreline stabilization in Iredell County. Approval from DWQ is required to disturb these waters.
Please provide seven copies of the following information and refer to the DWQ # listed above in
your reply. In particular as described in 15A NCAC 213 .0502, we will require you to provide a
map showing where the shoreline stabilization will occur and the area of water to be filled
property. Please show these on maps of suitable scale (for instance 1" = 100 feet) so we can begin
to determine your projects' compliance with 15A NCAC 2H .0500.
Please call me at [phone] if you have any questions or would require copies of our
rules or procedural materials. This project will remain on hold as incomplete in accordance witlf
15A NCAC 2H .0505(c). The processing time for this application will begin when this
information is received. If we do not hear from you by writing within three (3) weeks we will
assume you no longer want to pursue the project and will consider it withdrawn.
PiR. Cc: Mooresville DWQ Regional Office
Asheville Corps of Engineers
File Copy
Central Files
Wetlands/401 Unit • 4401 Reedy Creek Road • Raleigh, North Carolina 27607
Telephone [phone] FAX # [phone]
An Equal Opportunity Affirmative Action Employer
50% recycle3'10% post consumer paper
State of North Carolina
Department of Environment
and Natural Resources ?•/
Division of Water Quality 1
James B. Hunt, Jr., Governor NCDENR
Bill Holman, Secretary NORTH CAROLINA DEPARTMENT OF
Kerr T. Stevens, Director ENVIRONMENT AND NATURAL RESOURCES
Ai l 6 , 2001
wQ # 017
Cot?nty
Dear Mr. - -
- 101
On tdt1-gYOLII- the Division of WI r Quality (DWQ) was no ' ?ed b ccci{{??t of your
applications hegplan to fill w z, for the purpose of _ i? L\_County.
Approval from DWQ is required to disturb these V?Ot_. Please provide seven copies of the
following information and refer to the DWQ # listed above in your reply. In particular as
described in 15A NCAC 213 .0502, xve will require y0U to gemtk aalstre?tng Mid n aL the
property. Please show these on maps of suitable scale instance 1" = 100 feet) so we can
begin to determine your pro.1cets' compliance with 15A NCA ' 2f1 .0500.
Please call me at [phone] if you have any q iestions or would require copies of
our rules or procedural materials. This project will remain o hold as incomplete in accordance
with 15A NCAC 21-1 .0505(c). The processing time for thi application will begin when this
information is received. Its we do not hear from you by writ no within three (3) weeks we will
assume you no longer want to pursue the project and will con, ider it withdrawn.
C _ DWQ Regional Office
?r'I ?I C Corps of Engineers
rile copy
Central Files
Sincerely,
1
John R. Dorncy C (-VK OP
1 ? 5
St A, It.
L/
Wctlands1401 Unit • 4401 Reedy Crcek Road • lUeivh. North Carolina 27607
Telcphone 919-733-1756 1-AX tl 733-9959
An k1tial Opportunil? AfllrmatiNe Action hnplo?er
50"', rec\rlekI/I0°o host consumer paper
A I

DWQ ID: -. CORPS ACTION ID: _
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #)
._!.
082001
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• JOHN DORNEY, 4401 REEDY CREEK ROAD RALEIGH NC
27607. PLEASE PRINT OR TYPE.
1. OWNER'S NAME: _rn ?n?' LOW !?7 -?
F-T
2. MAILING ADDRESS: - ?qp l?/) l'Dy /N(!LL L r`1r?6} 17ov C --
r i-i
SUBDIVISION NAME _ [f??o????b ?}1 K? )U pi2rvl g n? rT?
CITY: -STATE: - ZIP CODE: _ /$'loo,Q?s Z/l G(,<J/ /?'+
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
3. TELEPHONE NUMBER: (HOME) _ (WORK) -
336 7194SA? 336- g87?
4. IF APPLICABLE: AGENTS NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER: /?
wiL. ? i am 0L.10wso Al 7a el- W l 4;o
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP
OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: NEAREST TOWN: -
t,eA,D6t-(, In00k&? Ylbl,6
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ECT.) _
IL10 l?l/lNOy lemoLc- !-An/i?; AQeE: 1110deMAAI
6. IMPACTED OR NEAREST STREAM/RIVC t: _ RIVER BASIN:
4.AKE 1yokm-n-
7. (a) IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER, (SA),
HIGH QUALITY WATERS (HQW), O TANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WS-I OR WS-II)? YES J'NIF YES, EXPLAIN:
(b) IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF ASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES ? NOW
(c) IF "11IE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF
COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION? -
FA
Include the 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 of $200 is required if the project impacts are less than one acre
wetland fill and less than 150 feet perennial 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]"
S. (a) HAVE ANY SE UT 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT? YES Q NO51 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 E] NO IF YES, DESCRIBE ANTICIPATED WORK:
9. (a) ESTIMATED TOTAL 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:
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)
OPEN CHANNEL RELOCATION: _ PLACEMENT OF PIPE IN CHANNEL:
CHANNEL EXCAVATION: - CONSTRUCTION OF A DAMIFLOODING: -
OTHER:
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
DRAINING TO THE POND? - WI4AT 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 1 DRAWINGS ONLY)
13. PURPOSE OF PROPOSED WORK: _
:S 4Vp-r LINE STq ?31 LI ZA?'J Ur?
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (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 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: -
16. YOU ARE REQUIRED TO CONTACT 1-11E STATE HISTORIC PRESERVATION OFFICER
(SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE PERMIT AREA
WI I ICII MAY 13E AFFECTED BY THE PROPOSED PROJECT. DATE CONTACTED -
17. DOES THE PROJECT INVOLVE N EXPENDITURE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (STATE) LAND? YES ? 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 Q
(b) IF YES, HAS.THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE YES [] NO E]
IF ANSWER 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE STATE
CLEARINGHOUSE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGIOUSE 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].
t8. 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 (FORNATIONWIDE 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 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? _
(1) 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
OWNER'SIAGEN SIGNATURE DATE
(AGENTS SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
TIM OWNER IS PROVIDED).
01 0 5-9-7 - s

DWQ ID: _ CORPS ACTION ID: -
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT 9) _
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
27607. PLEASE PRINT OR TYPE.
1. OWNER'S NAME: - ? fY.? ?/' / t-OLt/i?11 ?+
2. MAILING ADDRESS: _ /qo j/)j jyhy /CNdG jl G.r%r?6 } r '°h'-6 ' y? L } ??` ,
SUBDIVISION NAME L-A Kr, )vop_ly) fa ref
--TD
CITY: -STATE: - ZIP CODE: G[b,
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM <= r Ti
MAILING ADDRESS ABOVE): FTC -
C7 -1
3. TELEPHONE NUMBER: (HOME) _ (WORK) _
3 6 7 F?3 - 6? ? 336-• 887.
4. IF APPLICABLE: AGENTS NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER:
if/1c.L I q/" C Al 74?? 0201 ,9
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP
OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: NEAREST TOWN: -
t?AOEC c, mvok&, ti'1m-6
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ECT.)
/,,/o a/l i?o y K rio L? ?XR/d ,01e6 /1/00210 ,AA/
G_ IMPACTED OR NEAREST STREAM/RIVI?R: _ RIVER BASIN: _
4-AKC, fi 0k,inflY
7. (a) IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER, (SA),
HIGH QUALITY WATERS (HQW), O TANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WS-I OR WS-II)? YES jrN IF YES, EXPLAIN: _,
(b) IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF OASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES ? NO
(c) IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF
COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION? __
Include the 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 of $200 is required if the project impacts are less than one acre
wetland fill and less than 150 feet perennial 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] NOIF 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: -
9. (a) ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND: LN6
(b) ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
to. (a) NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
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: _ F'I' 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)
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
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 11 DRAWINGS ONLY)
CAN!' ? ?L?: /-_A ;e. S,Eiafek, . , r?G 574) 61 L 12A7"l0 V
5?i0 GC7A0gk 7b /"lovE 1S'e_0 _,C 7o Sl7E.
13. PURPOSE OF PROPOSED WORK: -
? ?Z72 LiN? ;-rA j9 l L lZjqi" I O l/
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (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 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: _
IC6. 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
17. DOES THE PROJECT INVOLVE N EXPENDITURE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (STATE) LAND? YES ? NOC,(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 ACTT YES ? NO ?
(b) IF YES, HAS.THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE YES ? NO Q
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 I 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 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:
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
OWNER'S/AGENI)t SIGNATURE DATE
(AGENTS SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED).

o •l 1069 7

DWQ ID: _, CORPS ACTION ID: _
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT If) _
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 RALEIGIi NC
27607. PLEASE PRINT OR TYPE.
1. OWNER'S NAME: _\?_?n,'? ?'?-0L1/??11
2. MAILING ADDRESS: _ / ow-6" XK e_
SUBDIVISION NAME bI KF M OR_M iQ ?'j
CITY: !STATE: - ZIP CODE:
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
3. TELEPHONE NUMBER: (HOME) _ (WORK) _
134 336-° 88 7• 9-
4. IF APPLICABLE: AGENTS NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER:
tT/1?.G. I r; Irl (,"U4'Lf?sa.-?? 707 ? 0?0 / • rl ???' v
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP
OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: _ - NEAREST TOWN:
1RA,DEt' - moor-ma-'4
?? ROAD NUMBERS, LANDMARKS, ECT.)
SPECIFIC LOCATION (INCLUDE
c/o 1?1r?oy KrioL? 1A-g e6 /]10621)7)0A1
6. IMPACTED OR NEAREST STREAM/RIVr : _ RIVER BASIN: _
LAKE /vokln;i
7. (a) IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER, (SA),
HIGH QUALITY WATERS (HQW), O TANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WS-I OR WS-II)? YES W"XIIF YES, EXPLAIN: _
(b) IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF OASTAL
MANAGEMENTAREA OF ENVIRONMENTAL CONCERN (AEC)? YES ? NO
C)
(c) IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF
COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION? _

Include the 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 of $200 is required if the project impacts are less than one acre
wetland fill and less than 150 feet perennial 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 -
"todd.st. [e-mail]"
8. (a) HAVE ANY SE TION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT? YES ? NON 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: - ?}
9. (a) ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND: iNg
(b) ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
to. (a) NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
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: _ IT
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)
OPEN CHANNEL RELOCATION: - PLACEMENT OF PIPE IN CHANNEL: -
CHANNEL EXCAVATION: - CONSTRUCTION OF A DAM/FLOODING: _
OTHER:
11. IF CONSTRUCTION OF A POND IS PROPOSED, WIIAT 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; 81/2 BY I I DRAWINGS ONLY)
??f? Go100?? 7? ^' OvE /sGn!JC ro S!7'6
13. PURPOSE OF PROPOSED WORK: _
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (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 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: _
IG. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE PERMIT AREA
WHICH MAY 13E AFFECTED BY THE PROPOSED PROJECT. DATE CONTACTED __
17. DOES THE PROJECT INVOLVE N EXPENDITURE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (STATE) LAND? YES ? NO M(IF NO, GO TO 16)
(a) IF YES, DOGS 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].
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 I 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.
(c) 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
OWNER'S/AGENTPS SIGNATURE DATE
(AGENTS SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED).
. 1.
DWQ ID: _ CORPS ACTION ID: _
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT 9) _
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 RALEIGII NC
27607. PLEASE PRINT OR TYPE.
OWNER'S NAME: - i?7 '?LOw Aj
MAILING ADDRESS: - ? l?p (?Jv 1Ybyl )e; ©n . 10r16 -7D -v
SUBDIVISION NAME- C?iplv°??i?l? IV p2 m g rlJt
CITY: !STATE: -ZIP CODE: _ /' &0eA6 j/1 e a,
^r f'Yl
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM V
MAILING ADDRESS ABOVE):
3. TELEPHONE NUMBER: (HOME) _ (WORK) _
?3 ? - 7 4? -•6? a? 336- 88'7_. ?--
4. IF APPLICABLE: AGENTS NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER: n
Gd1 LL I 'q /n ("44wt?s, ?r/ 7O`?-
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP
OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: _ - NEAREST TOWN: -
fRA'4E1.(_ lio0ki% YYIM,6
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ECT.) _
/yo alIdoy lerioLL tAW-4 110&6 1V00emAA1
6. IMPACTED OR NEAREST STREAWRIV r,? : RIVER BASIN:
L.Akc, /rok,n?Y
7. (a) IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER, (SA),
HIGH QUALITY WATERS (HQW), O TANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WS-I OR WS-II)? YES JrN IF YES, EXPLAIN:
(b) IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF OASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES E] NO
(c) IF THE PROJECT IS LOCATED WITHIN A COASTAL. COUNTY (SEE PAGE 7 FOR LIST OF
COASTAL COUNTIES), WIAAT IS THE 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. Please read the fee memorandum discussing this legislation prior
to writing your check. In brief, a fee of $200 is required if the project impacts are less than one acre
wetland fill and less than 150 feet perennial 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 -
"todd.st. [e-mail]"
8. (a) HAVE ANY SE TION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT? YES 0 NON 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: - ?}
9. (a) ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND: L
(b) ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
to. (a) NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
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)
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
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 11 DRAWINGS ONLY)
C?NP.-&-EZ'F 61-011"k- Fae 54102-C-iv-6 57061LIZArl0n/0
5 k / b Gpli 0g f, 7`? Ali 0 ?E / 40e,C y"o S! 7'E
13. PURPOSE OF PROPOSED WORK: _
5kvRP-i-iNE '?;T'gi9"-1Zfl7.jvh/
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (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 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: _
I(,. 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 .
17. DOES THE PROJECT INVOLVE N EXPENDITURE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (STATE) LAND? YES ? 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 THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE YES ? NO El
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
OWNER'SIAGENIrS SIGNATURE DATE
(AGENTS SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
T14C OWNER IS PROVIDED).
i A-1
w
DWQ ID: ` CORPS ACTION ID: _
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT ft) _
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
27607. PLEASE PRINT OR TYPE.
1. OWNER'S NAME: _\ .?-? r'Y??' /t ixL IAJ
2. MAILING ADDRESS:
fqo
SUBDIVISION NAME rn
_ f iP?°??l`1Z r )? p/2 )nr? g M? r
ri ,=.
FTJ
r--r j
CITY: -STATE: _ ZIP CODE: _ oCh? y! L(,Fj r? l?
rT-l
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
3. TELEPHONE NUMBER: (HOME) - (WORK)
X36. 74?-•6??? 336_S87•?--
4. IF APPLICABLE: AGENTS NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER:
?dJ?L yam L"?'?r?svi? 70? aof -•v?(v
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP
OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: - NEAREST TOWN: -
IRA,D E c,(. in o oQ615 y1 ?1t-E
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ECT.)
6. IMPACTED OR NEAREST STREAM/RIVc,R : _ RIVER BASIN: _
I-AKC, f?rIkln-
7. (a) IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER, (SA),
HIGH QUALITY WATERS (HQW), O TANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WS-I OR WS-II)? YES O)d IF YES, EXPLAIN: _
lp-
(b) IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF OASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES E] NO
(c) IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF
COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION? __
161

Include the 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 of $200 is required if the project impacts are less than one acre
wetland fill and less than 150 feet perennial 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 SE TION 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): _
(b) ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE?
YES p NO IF YES, DESCRIBE ANTICIPATED WORK: -
9. (a) ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND: Y6
(b) ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
to. (a) NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
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: - [T AFTER: -1T
WIDTH BEFORE (based on nonnal high water contours): ^ FT
AVERAGE DEPTH BEFORE: _ FT AFTER: _ FT
(b) (2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT 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 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; 81/2 BY 1 I DRAWINGS ONLY)
C-?NC?'ti-F ?L?C ?- Fa,e. ,S?bI?E?,?,rv? 57'+OBiLlzA7''i0??u .mac. ?i :.. ? ,t ? r!ti?.
r D Gc?l? 0?? 7"h I"10 V15 144a!...,C 7"0
S! y'E
13. PURPOSE OF PROPOSED WORK: _
S ?Z72?L?NE ?'-I`Jy?l t l ?T"jJd?
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (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 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: -
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 ___.
?tl
17. DOES THE PROJECT INVOLVE N EXPENDITURE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (STATE) LAND? YES ? NO a(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 E]
(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].
t8. 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 I 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:
L 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 W?IT14 THE NORTH CAROLINA COASTAL MANAGEMENT
OWNER'S/AGENIto SIGNATURE DATE
(AGENTS SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED).
10597

DWQ ID: _ CORPS ACTION ID: -
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT I) _
PRE-CONSTRUCTION NOTIFICATION APPLICATION
.s.
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 TIDE NC DIVISION OF WATER QUALITY,
ATTN: JOHN DORNEY 4401 REEDY CREEK ROAD RALEIGH NC
27607. PLEASE PRINT OR TYPE.
1. OWNER'SNAME:_ ?rv>>'Y>?'?t-OLI?rN
2. MAILING ADDRESS:
SUBDIVISION NAME _ tAle-g )V Co mAAl T7
CITY: -STATE: - ZIP CODE:
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM r j ..'_
MAILING ADDRESS ABOVE): _:) --?
3. TELEPHONE NUMBER: (HOME) _ (WORK) _
X' 7 14 _49 a? 336- 88 7. ,2?-7-
4. IF APPLICABLE: AGENTS NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER: n
W/trt- yam C,"?'?r?5v?/ 70?/? ?o f -• v??v
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP
OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: _ - NEAREST TOWN: -
"eA'iEL'(. / o&keS6 YjjA, i
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ECT.)
'i./o a//o?o y KrlO LL !Aprg ,.400e 6 111ORMAW
6. IMPACTED OR NEAREST STREAM/RIVE: _ RIVER BASIN:
7. (a) IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER, (SA),
HIGH QUALITY WATERS (HQW), O TANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WS-I OR WS-11)? YES WNO)id IF YES, EXPLAIN: _
(b) IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF OASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES ? NOA
(c) IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 I-OR LIST OF
COASTAL COUNTIES), WHAT IS THE 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. Please read the fee memorandum discussing this legislation prior
to writing your check. In brief, a fee of $200 is required if the project impacts are less than one acre
wetland fill and less than 150 feet perennial 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 SE TION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT? YES ? NOIN IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND
ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401 CERTIFICATION): _
(b) ARE AD ITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE?
YES ? NO IF YES, DESCRIBE ANTICIPATED WORK: -
9. (a) ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND: f6,
(b) ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
to. (a) NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
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)
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
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)
f-0NC??-f? ,?jL?? e?n? S?ia2E? ?rv? 57?g1L/?4i lOi?? ?i3.t i ????.
'SKi Go/g0?? 7`r r`?avE /?'/?!?C Sr7 E
13. PURPOSE OF PROPOSED WORK: _
$ ?fZ7/? ?. L/NE ST13 $ i L ? ?J?' I l? Jy?
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (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 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:
16. YOU ARE REQUIRED TO CONTACT TliC STATE HISTORIC PRESERVATION OFFICER
(SIiPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE PERMIT AREA
WHICH MAY BE AFFECTED BY THC PROPOSED PROJECT. DATE CONTACTED __
17. DOES THE PROJECT INVOLVE N EXPENDITURE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (STATE) LAND? YES E] NOM (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 THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE YES Q NO Q
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 I 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:
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
OWNER'S/AGEN SIGNATURE DATE
(AGENTS SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED).

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 (71
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: _\r?7 fY??' /L4Lt?i?
2. MAILING ADDRESS: _ /qo tl)j,Vby /?:j'?oLi 2011116 1OR-6" )II,
L _A gr. ??pR M yet
SUBDIVISION NAME_ iP?,g?l?? r
CITY: -STATE: - ZIP CODE: `eaciP..L,S o l'a,
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
3. TELEPHONE NUMBER: (HOME) _ (WORK) __
33 b - y 4? -•6,? a? 336- 88'7_. ?-
4. IF APPLICABLE: AGENTS NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER:
1_ ao f - v Wv
u/?trL j am C 'vr?5o.?/ 70e
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP
OR AERIAL. PHOTOGRAPHY WITH SCALE):
COUNTY: - NEAREST TOWN: _
,RA',EUC- Ino k6 Y1?'h
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ECT.) _
jyo /Needy /CRio1LL rr? , 0,e6 1J/0oe1)7)qn1
6. IMPACTED OR NEAREST STREAM/RIV RIVER BASIN: _
t-AKKE /YCI ?p,??
7. (a) IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER, (SA),
HIGH QUALITY WATERS (HQW), O TANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WS-I OR WS-II)? YES WOyj YES, EXPLAIN: _
(b) IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF OASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES ? NO

FT-1
QD ----1
(c) IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF
COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION? __

Include the 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 of $200 is required if the project impacts are less than one acre
wetland fill and less than 150 feet perennial 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 -
"todd.st. [e-mail]"

8. (a) HAVE ANY SE TION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT? YES E] NON 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: _ ?}
9. (a) ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND: 6X15
(b) ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
to. (a) NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
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)
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
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) F?e- s,?v2,E? ,?? 57?grL lzAr rc7:?? 2 bi ; ?t, ?.
?SkrD 1-0r909-k Ito ^.ov6 /sGnr?C yo Sr7E.
13. PURPOSE OF PROPOSED WORK: _
S it-p/z+Er ??iv6 ?T? $ i c. t ZA?' i v 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)
Is. 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 THAT MAY BE AFFECTED BY THE PROPOSED PROJECT.
DATE CONTACTED: -
I(,. 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

17. DOES THE PROJECT INVOLVE N EXPENDITURE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (STATE) LAND? YES ? NOM,(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 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 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 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? _
(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
OWNER'S/AGENI)t SIGNATURE DATE
(AGENTS SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED).
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