20011369 Ver 1_COMPLETE FILE_20010912

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North Carolina Department of Environment and Natural Resourc,
Gregory J. Thorpe, Ph.D.
Acting Director
Division of Water Quality
September 27, 2001
DWQ# 01-1369
Stanley County
Bill Hildredeh
Rt. 2 Box 61
Wadesboro, NC 28710
APPROVAL of 401 Water Quality Certification
Dear Mr. Hildredeh:
You have our approval, in accordance with the attached conditions, to construct 75 feet of seawall on your property in
Lake Side subdivision, Section 4 in Stanley County, as described in your application received by the Division of Water
Quality on September 12, 2001. After reviewing your application, we have decided that this fill is covered by General Water
Quality Certification Number 3280, which can be downloaded from our web site at htti)://h2o.enr.state.nc.us/ncwetlands .
This Certification allows you to use Regional Permit Number 198200030 when the US Army Corps of Engineers (USACE)
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, 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 in writing 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 acopy 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, 6714 Mail Service Center,
Raleigh, N.C. 27699-6714. 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 Pete Colwell in the Mooresville Regional Office at 704-663-6040 or John Dorney in Raleigh
at 919-733-9646.
Attachment
cc: USACE Asheville Regulatory Field Office
Mooresville DWQ Regional Office
Central Files
File Copy
011369
AMA
WNW
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 [phone] Customer Service
1 800 623-7748
Sincerely,
OF WATF9
OCR QG Michael F. Easley
y Governor
j r
-i William G. Ross,Jr.Secretary
Department of Environment and Natural Resources
Kerr T. Stevens
Division of Water Quality
Division of Water Quality
Department of Environmental and Natural Resources
. Wetlands/401 Unit
Location: 2321 Crabtree Boulevard, Suite 250 Raleigh, NC 27604-2260
Mailing Address: 1650 Mail Service Center Raleigh, NC 27699-1650
Contact Information: General 919-733-1786 Fax: [phone]
Fax To _,1 ,?ZYCrc?c?t, Fax Number:
Company:
From:
No. Of Pa4es including cover sheet:
Date: _ i2s(b C
Phone:
-2-1
Notes or special instructions:
A,A
NCDENR
Division of Water Quality
Wetlands/401 Unit: [phone]
Fax- Ml q) 733-FiRgl
2321 Crabtree Blvd, Ste 250 Raleigh, NC 27604-2260
40 1, 1S E---,Q? 169;'
APPLICATION FOR PIMMI'f TO STABILIZE !6 ORLLINg
Please typc or print toad an is all blatrils.
1. Applhrwt lntormsll"
A. na. erPItUPERTV 0WIVgF: 1i L r/ i( ?y 1?eG / ?,
8, Mailing nddreu ,? j : ? c3o X ks ?
C. Chy,SW*, zip: ?.?. ;..U' `ode , r? ?? , 81 0
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C.ri'A& c??. - ---- ^ --
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H. Tdepileee:N?? _ ?JS-- c7$'? 8 °FF
11. Locs0m e1 Frv*vtd Proiett
A. CotaMy Project Is Ia•
tf. Nearest (.11y, Town. or Coeanavnlty:
C. Lek* projeelIsa:_..?14 l(E l P/f? _ - - - ---- D. Dlratlems torroperty Dy road: /•¢kr6 5-2_ %o l.tD[•4w I?oua l? ??? uRv?
nV3
9. SUBMIT A LOCAT101% MAP WJTH APPLICATION TO CORPS OP ENGINglt",
111. Dwriptloa of Project
A. tAosita efwstl - ` - X J /Ye!
11. Matorlat to ee Msrd: ?/?SSu Zn.?l x "? [,'?x ?`,-.--F???S ?`' .2xCO'
C. 111dseoe Orwell wsterword or property l1weberclise: --,,A??'???'`? 2 n
IV, laat?wt#aa tiec atP?njerct Ara (('h?ek one)
A. Privels:
a. Cooaaardai:
pP
PLFANZ SUBMIT (` tV Aff LIC:ATJON TO:
VS ARMV CORPS OW ENGINRFRa
1s1 rco roN Avg. ROOM 143
ASHEVILL& N(' 2590140116
_l
Office Use Only: Form Version April 2001
USACE Action ID No. DWQ No. 011369
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
I. Processing
1. Check all of the approval(s) requested for this project:
? Section 404 Permit
? Section 10 Permit
401 Water Quality Certification
? Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested: rill JA
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here: ?
H. Applicant Information
1. Owner/Applicant Information
Mailing Address: 1,.*.2 ao
?,C. 2,R /-7,
Telephone Number: 7o4 - 60- 36 39 Fax Number: /V4
E-mail Address:
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be
_attached if the Agent has signatory authority-for the owner/applicant.)
Name: R
Company Affi iation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Page 5 of 13
M. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed- on hold until decipherable maps are provided.
1.Name of project:
2.T.I.P. Project Number (NCDOT Only):
3.Property Identification Number (Tax PIN): A)
4.Location
County: J'r v Nearest Town: c J (\J . C -
Subdivision name (i clude phase/lot number): ? -_C_- Se- c:- t L)
Directions to site (include road numbers,
l?k ?+e S landmarks, etc.):
iQ rrq CiQ_l d ?lc? L ?U o d L
-h c L P E -E 7? o ti <-fi?
5. Site coordinates, if available (UTM or Lat/Long):
(Note - If project is linear, such as a road or utility line, tach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6.Describe the existing land use or condition of the site at the time of this application:
7.Property size (acres): D. S /?ere-
8.Nearest body of water (stream/river/sound/ocean/lake):_ Pe /?o c% rer.
9.River Basin: ?e e De-e L_? 45
?y2
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http-.//h2o.enr.state.nc.us/4dmin/mgj2s/.)
Page 6 of 13
10. Describe the purpose of the proposed work: -???,,O 1. r?- J ?rr(G ????
IV.
V.
VI.
11. List the type of equipment to be used to construct the project:- S (c J5 c
r-A?•l5 2'x(0 ?. 14 'XGTa w?ec? g? w -kQ.?S ?-??I
12. Describe the land use in the vicinity of this project: &O -v e (LIP CIJ j. vu X10 ??e C
Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
ru I A,
Future Project Plans
Are any additional permit requests anticipated for this project in the future? If so, describe the
anticipated work, and provide justification for the exclusion of this work from the current
application: /1i Id
Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
Page 7 of 13

L
Cumulative impacts (linear distance in feet) to all streams on site: ^1 S G.??1g 3 K{?,
3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U. S.
Open Water
Impact
Site Number
(indicate on
ma
*
Type of Impact
ofa
Impact
(acres)
Name of Waterbody
(if applicable)
Type of Waterbody
(lake, pond, estuary,
sound, bay, ocean, etc.)

r-C &J. ? L'. q ((
'151 "c '' 11
a k e
C e Oe e Q t vc'oe e.- t

List each unpact separately and mcmrify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
4. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.): y, 1
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):_ 11 J (14
Size of watershed draining to pond: 42 id Expected pond surface area:- lyk2
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
/9 ka,1q Jt 3 ' 1n l? F.t/ed
Page 9 of 13
/ ; f 1 VIII. Mitigation

DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
hiip://h2o.enr.state.nc.us/ncwetlands/stnngide.html.
Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
Page 10 of 13
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP) with the NCWRP's written agreement: Check the box indicating that
you would like to pay into the NCWRP. Please note that payment into the NCWRP must be
reviewed and approved before it can be used to satisfy mitigation requirements. Applicants
will be notified early in the review process by the 401/Wetlands Unit if payment into the
NCWRP is available as an option. For additional information regarding the application
process for the NCWRP, check the NCWRP website at
http://h2o.enr.state.nc us/wrp/index htm. If use of the NCWRP is proposed, please check the
appropriate box on page three and provide the following information:
Amount of stream mitigation requested (linear feet): 75- 3' l(e-i jlar
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
• Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
land?
.r,> N Yes ? No ?
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
\? Yes ? No ?
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
?A Yes ? No ?
IX. Proposed Impacts on Riparian and Watershed Buffers (DWQ Only)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ? No El If you answered "yes", provide the following information:
Page I 1 of 13
XIL Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
Work schedules (e.g., draw down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
f
Applicant/'s Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
L0
Page 13 of 13
DEM ID: CORPS ACTION I' :
NATIC^NWIDE PERMIT REQUESTED (PRU'.VInE NA'^,C)WIDE PERMIT 0) :
PRE--CONSTRUCTION NOTIFICATION-APPLICATION
FOR NATION'6 -rDE PERMITS THAT REQUIRE :
i.) NOTIF'XCATION TO TAE CORPS Or ENGINRXW
2) "PLICAT.ION 7 SLCTXOIl 401 C'BikTY1''IC..ATxoN
S) C OCIRDrNATTION WXTH 'i= NC 'JIVISZON OF COA.VTAL 14ANAG CNT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETM FORM TO THE "P'ROPRIATE
F'IEW OFFICE OF THE COMPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN
(7) COPIES SHOULD HE SENT TO THE N.C. DIVISICN OF ENVIRONMENTAL MANAGEMENT
(SEF AGENCY ADDRESSE . ::;HEET) PLUS _ _P- RYNT.
OWNERS NAPE : ? :. ??'?. ? ? ?G? r'?C?7F f1
2. MAILING ADDRESS :
- _?..
eSo6V >c'.1C-%(,
CITY: '`SATE: _ NJ, C ZIP CODE: - --
PROJECT LOCATOTON ADDRESS, IINC-LeIDING SUBDIVISION -NAME f TF DjFrr.Afir-!* rpOM
MAILING ADDRESS A$Ot'E l
?!)P1?rAtnn h Alr
3. TELEi"s.IUNE f41.'/S R (HOME'r - ''?'?/ b`t -. b3S (WORK). 4. IF APPLICABLE; ACENIT' S NAME OR RESPONSIBLE. CORPORATL OFFICIAL; ADDRESS,
PHONE NUMEFR!
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOJ `1F2?.?;iZC'
MAP OR AERIAL PHOTOGRAP14Y WI:'H SCALE)
COUNTY: S7 P,) I- V ITEAREST TCYAN OR CITY: /Uo'ewDv
1.
--- - SPECIFIC LOCATION (INCLUDE ROAD
NUMBERS, LANDMARKS, ETC.); /l-O1 Arv mo" n d k d
0 ICs •-lt3 Q,a,1 to s- Fe,-, Q d i K Z ?r ort >e ?? +?
- 1

6. IMPACTED OR NEAREST STREAM/RIVER: ?r/v1?C r • C.Lr<C } 1Q? L 4)L l= kl vtik
RIVER BASIN:
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER
(SA), HIGH QUALITY WATERS (HOW), OUTSTAND G RESOURCE WATERS (ORW), WATER
SUPPLY (WS-I OR WS-II)? YES [ j NO Iti-li YES, EXPLAIN:
7b. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF ASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES 1 NO [ J
7G. rF THE PROJECT IS LOCATLI: kiI'.HIN A 'COASTAL COUNTY (SEE PAGE 7 FOR
LIST OF COASTAL COUNT!):'_'), WHAT :a HE LAND USE PL-301 (LVP) DESIGNATION?
aa. HAVE ANY SECTION 404 PERMITS ?8EEN PREVIOUSLY REQUESTED FOR USE ON
THIS PROPERTY? YES [ J NO [ IF YES, PROVIDE ACTION I.D. NUMBER OF
PREVIOUS PERMIT AND ANY ADDITIONAL INFORMATION '.INCLUDE PHOTOCOPY OF 401
CERTX VICA°TION) •- - ----- ,.M- __ -- _
Sb. ARE ADDITIONAL PE WT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
FUTURE? YES [ J NO [ If YES, DESCRIBE ANTICIPATED WORK:
9a. ESTIMATED lOTAL NUMBER OF ACRES IN OF LAND:
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
2
10a. NUMBER )E ACRE'S OF WETLANDS IMPACTED BY THE: PROPOSED PROJECT BY:
FILLING: EXCAVATION:
FLOODING: ._ Y OTHER:
DRAINAGE : TOTAL ACRES TO Z tE IMpACTED.
?-
1 Qb • (1) STR SAM CHANNEL TO BE IMPACTED BY THE PIOPOSED PROJECT (IF '
RELOCATED, PFOVIDE DrSTANCE BOTH BEFORE AArD AFTL.7 RELOCATION)
LENGTH BEFORE: FT . AFTER: T
WIDTH BEFORE (based on normal high water con ou.r.;):
r? FT
WIDTH AFTER : \ ??.
AVERAGE DEPTE BEFORE : FT AFT ?",R:
(2) STF E? CHA2JI3EL IMPACTS WILL R&U.- T TROD (CHECK AL'a TW.T r.PPY f)
OPEN CHANNEL RELOCATION: PLACEMENT OF PIPE 2N C_f-i WVfEI;:
CHANNEL EXCAI 'A'PRON. ' ?
••CONSTRUCTION OF A DAM/FLOODING:
OTHER: '
11. IF CONSTItU(CTION OF A POND IS PROPOSED, WHAT ,:S THE SIZE OF TI?F.
WATERSHED DRIdNING TO THE POND?
WHAT IS THE EXPECTED POND SURFACE AREA?
12. DESCRIPT:COF OF PROPOSED WORK. INCLUD
MECHANICAL EA?U!7iN N USED ONLY) :
ING Dt3CC'SSION OF TYPE OF
vT.arI c• t 1/29' X 11" DRAWINGS
U U t'gc 7" r? q L 4-
13. PURPOSE OF PROPOSED WORK: A,E?,jw Vr h a7?C1?t?
3
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTT; _:! ; MUS7 3E :l1?RIrT;
OUT IN WE1 :.ADDS _ (-TN'-'.T'UDE ANY MEASURES TAKEN TO MINIMIZ WE'L'LAY. )
IMPACTS): _
?* ,S TA i ?? c3?4 /??t' A iv fl ??: ur.v O S 1'e) A/. ?.. _
IS. YOU ARE; REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SERVICE
(USFWS) A1\D/OR NATIONAL. MARINE FISHERIES SERVICE (NMFS) (SEE AGENCY
ADDRESSES SHEET) REGARDING THE PRESENCE OF AN'.P FEDERALLY LISTED OR
PROPOSED 1:OFt LISTING ENDANGERED OR THREATENED SPcCIES OR C?LTICAL HABITAT
IN THE PEx M]:T AREA THAT MAY BE AFFECTED BY TH : VRCF,%;L4 FRCJD7 7'. IA?7E
CONTACTED: (ATTACH RESPONSES
FROM THESE'. AGENCIES.)
16. YOU FRIS REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFElCE:<
(SHPO) (Srt AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC
PROPERTIE: ::N THE PERMIT AREA WHICH MAY BE AFFECTED BY T141 PRr°;aSED
PROJECT. UX E CONTACTED:
17. DOES T14E PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF
PUBLIC w.'ATE) LAND?
YE'> () NO M (IF NO, GO TO 18)
a. EF YES, DOES THE PROJECT REQUIRE PRE;PT i.ATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA ENVIRONMENTAL
POLICY AC'C?
YES ( ] NO f j
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE?
YES ( ] NO ( ]
::F !s?ISWEA TO 17b IS YES, THEN SUBMIT APPROPAIATI,: O(X;'UMENIATION FROM THE
STA'L'E CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT REGARDING
COMPLIANCE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
4
18. THE FOLL014INC STU45 sHUOLD 6L 1NGLUVED WI'Xti ''HIS
PROPOSED ACTIV :TY INVOLVES THE DISCHARGE OF FXCAVLTED OR Fll.;, iKATER-AL
INTO WETLANDS:
a. WETLATE DELINEATION MAP SHOWILIG ALL WETLI,NDS, STREAMS, LAKES
AND PONDS ON TiE PROPERTY (FOR NATIONWIDE PERMIT ZVMBERS 14, 18, 21, 26,
29, AND 38). UL STREAMS (INTERMITTENT AND PERMAVENT) ON THE PROPERTY
MUST BE SHOWN )N THE MAP. MAP SCALES SHOULD BE I INCH 50 FEET OR 1
INCH EQUALS 10) FEET OR THEIR EQUIVALENT.
b. IF AN'%ILABLE, REPRESENTATIVE PHOTOGRAPH OF WETIANDS TO .rL
IMPACTED BY PRDZECT.
c. IF DELINEATION WAS PERFORMED BY A CONSUL"ANT, INCLUDE ALL DATA
SHEETS RELEVANC TO THE PLACEMENT OF THE DELINEATION LINE,
d. ATTAC3 A COPY OF THE STOMWATER MANAGEM&IT PLAN IF REQUIRED.
e. ,sWHAAT IS LAND USE OF SURROUNDING PROPERTY'?
--
- rs?`, Ullv i'.1
f. IF ArPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
9. SYGNID AND DATED AGENT AUTHORIZATION LEZTER, IF AP LIC.,ABY,F.
NOTE: WETLA4ES OR WATERS OF THE U.S. MAY NCT HE IMPACTED PRIOR TO:
1) ISSUANCE OF A SECTION 404 COMPS OF ENGINEERS PERMIT,
2) EITH.P. THE ISSUANCE OR WAIVER OF A 401 DIVISION OF
ENVIRONMENTAL MANAGEMENT (WATER QUALITY) CEF71FICATION, AND
3) (IX VX TWENTY COASTAL COUNTIES ONLIJ , A LETTER FRD?K THE
NORTH CAROLINk DIVISION OF COASTAL MANAGEMENT STATINVG THE uROi-017ED
ACTIVITY IS CONSISTENT WITH THE NORTH CAROL].NP_ COASTAL MANAGEMENT
PROGRAM.
OWNER' S/AGF-* S SIGN TURF r
DATE
(AGENT'S SIGNATURE VALID ONLY
TF 11UTHORIZATTON LETTER FROM
THE OWITE I IS PROVIDED (18g.))
5

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