HomeMy WebLinkAbout20011760 Ver 1_COMPLETE FILE_20011203? N1 A rF
u R Michael F. Easley, Governor
G
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Willi
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ot
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.
am
oss
ecre
ary
North Carolina Department of Environment and Natural Resources
\
r Gregory J. Thorpe, Ph.D.
> y Acting Director
.? Division of Water Quality
December 14, 2001
DWQ # 01-17.60
Davidson County
Ray C. Turbyfill
154 Ervin Drive
Lexington, NC 27292
APPROVAL of 401 Water Quality Certification
Dear Mr. Turbyfill:
You have our approval, in accordance with the ached condfiiiorz, to impact 0.1 acres of the Yadkin River for the
purpose of excavation and shoreline stabini ation on vaur property in DzvvJson County as described in your application
materials received by the Division of Water Quality (r= member 3 200- After reviewing your application, we have
decided that this fill is covered by Genera! Water Qc-aiiiy Certification Number 3280, which can be downloaded from our
web site at http://h2o.enr.state.nc.us/ncweFL?nds. Tiri_- Certification albtr?s the use Regional Permit Number 198200030
when the US Army Corps of Engineers (U!S CE) issues t- In addmon, you should get any other federal, state or local
permits before you go ahead with your project induidhg Abut not Gnitad'io) Sediment and Erosion Control, Coastal
Stormwater, Non-Discharge, State Stormy sees and Wstar Sup* hNalea.sned regulations- Also this approval will expire
when the accompanying 404 permit expires unless r&,termse speaffied. in the General CerI flcation.
This approval is only valid for the purpose and dim that yv_: bas=. iied in your application. If you change your
project, you must notify us in writing, and you may t-e Wired to sand Ls a new applicaation for a new certification. If the
property is sold, the new owner must be giver copynf f t-e CeT?tic;atian and approval I&Uer and is thereby responsible for
complying with all conditions. If total wetand Nis fcc this Droject (row or in the future) exceed one acre, compensatory
mitigation may be required as described in 15A NCAC 2 .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 condttiors of tzEss ne-ffication, you ray ask for an aaudcatory hearing. You must act
within 60 days of the date that you receives ti•tis letter To ask for a tearr, g, send a written petition which conforms to
Chapter 1506 of the North Carolina General Statutes tD t-e Office of Aanin_ iee Hearings, 6714 Mail Service Center,
Raleigh, NC 27699-6714. This certification and its conditcm are imai a7d binding unless you ask for a hearing.
This letter completes the re•Aew of ti-.eDtvisk)n 1 r VV=-er Q witty L naar Sac ion 401 cdi the Clean Water Act. If you have
any questions, please telephone Jennifer in tie DWQ W instart-Salyn Ftegbnal Offibe at 336-771-4600 or Todd St.
John at 919-733-1786.
Sm.
Actirtg Dimae
Attachment
cc: USACE Raleigh Regulatory Field Otfrit?r_--
Winston-Salem DWQ Regional Otfirz
File Copy
Central Files
N. C. Division of Water Quality 1650 Mail SerjCx SenW fif: ,. JV__Z75%1_1 =_JD J'r9j 733-7015
01-1760
??
Customer Service
1 800 623-7748
17 60
CORPS 7ION TD:
DEN ID:
NATIONWIDE PERHIT REQUESTED (PROVID
N):
NATIONWIDE PERMIT
i
OTIVICATION APPLIGATIC?14
pRE-CONSTRUCTION
F'OR NATIONWIDE PERMITS THAT QUIRE:
NOTIVZCa1TIoN TO T? C
1) S OF ENGINEERS
401 CER'T'IFICATION
y) APPLICATION FOR 3ECTZ
TES
C DIVISION or COASTAL *okj4A0F_MFNT
3) COORDINATION WITH
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE
. SEVEN
ADDRESSES
AGLjjCY
FIELD OFFICE OF CORPS THE
Z EERS (SEE C
ENVIRONMENTAL
DIVISION
TO THE
(7) COPIES SHOULD D B BE SENT .
-
ASE PUNT.
.
(SEE. AGENCY ADDRESSES SHEET)-
1. OWNERS NAME:
2. MAILING ADDRESS:
'SUBDIVISION NAME: R??/EQ [??JOQt?
- •
DE: 77a 7a?
STAT
?/1/?
Y ?/ ZIP CO
..
CIT G SUBDIVISION NAME (IF DIFFERENT FROM
PROJECT LOCATION ADDRESS, INCLUD
MAILING ADDRESS- ABOVE):
.... _. 7G?- ? 33 6 - ?? 7 ?
(WORK):
3
3- TELEPHONE NUMBER (HOME):
' RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
S NAME O
4. IF APPLICABLE: AGENT
PHONE NUMBER:
5- LOCATION OF WORK (PROVIDE A r P, PREFERABLY A COPY OF USGS TOPOGRAPHIC
HjkP OR AERIAL PHOTOGRAPHY WITH S ALE): NEARESx TOWN OR CITY: b V--- T ?aN
COUNTY : Q 411d s0/?
PAYM ENT
1 ??CEIVED
' a, p•t 1
SPECIFIC LOCATION (INCLUDE ROAD
IPo a c1t- ? o T °N W
NUMBERS, LANDtARKS, ETC.):
C X21 UE?t too L NF
L J
o Al v?
6. IMPACTED OR NEAREST STREAM/RI R:
RIVER BASIN: FIED AS
TROUT TIDAL ?a. IS PROJECT LOCATED NEAR WATE CLASSIDING RESOURCEFWATERS (ORW)ASWATER
(SA), HIGH QUALITY WATERS (HOW). IF YES, EXPLAIN:
SUPPLY (WS-I OR WS-II) ? YES ( ) NO Yr'
7b_ IS THE PROJECT LOCATED WITHI A, NORTH CO'INYES.[I)IpNo•r?/)OASTALy
ONCERN
' tgi XGEMSNT AREA OF ENVIRONMEtJTAL '
PAG
'COASTAL .(S
7c. -IF. THE PROJECT IS LOCATED W HTHEALAAND USE PLANT (LUP)EDESIGNAT ON?
LIST OF COASTAL COUNTIES), WHAT S T
NUMBER OF
da. HAb RNY SECTICIN 404 p R?tl? BEEN pRSVZpUSLYRovIDE ACTION'REQUESTED"I.D•
"FOR 'USE THIS PROPERTY? YES ( ) NO IF YES,
PREVIOUS. PERMIT AND ANY ADDITION INFORMATION (INCLUDE.PHOT000PY OF- 401
CERTIFXCATION)
8b_ ARE ADDITIONAL PERMIT REQUE TS EXPECTED FOR THISDPROPERTY IN THE
FUTURE? YES NO [ ) IF YES DESCRIBE
_31
, O (!?
ga. ESTIMATED TOTAL NUMBER OF A RES IN TFACT OF LAND:
9b_ ESTIMATED TOTAL NUMBER OF A RES OF WETLANDS LOCATED ON PROJECT SITE:
/JA A/C
2
FS?
3 04.1
108. NuMsER OF ACRES OF WETLANDS
FILLING:
FLOODING:
DRAINAGE:
IMPACTED BY THE PROPOSED PROJECT BY: N/-A
XCAVA
THEP
nT.xL ACRES TO BE XMPACTED:
lob. (1) STREAK! CHANNEL TO BE X ACTED BY THE PROPOSED PROJECT (IF
EFORE AND AFTER RELOCATION).
RELOCATED, PROVIDE DXSTANCE BOTH
:
AFTER
LENGTH BEFORE:
based on normal hi
WZD7'H BEFORE
water ntours): ---
1 FT
WIDTH AFTER: rAr
AFTER:
AVERAGE DEPTH BEFORE:
MP CTS LL RES T OM: (CHECK ALL THAT APPLY)
42). E AN L.
PLACISMENT OF 'PIPE T --r-'-r
OPEN CttMNEI, RE CATION:
NSTRUCTION OF A WU4/FLOODING:-
CHANNEL tTATION:
OTH
`
I F -CONSTRUCTION. OF A -POND IS
I... PROPOSED,,1!HE SjZE..,QF. THE.,
WATERSHED DRAINING TO THE POND?
WHAT IS THE EXPECTED POND SURFAC AREA?
DESCRIPTION OF PROPOSED WORK
12 E OF
SCUSSI N OFIlYPDRAwINGS
INCLUDING D
.
}SECHANICA7i, EQUIPMENT TO SFs USED I
uGIG
A 7 6u?` No u
ONLY) : Ro?as? t 2r.r?1 t A L
,
W crL Lg_,A? /. s ?? w 2
A A o 62(CNVro IrV-
S SLoP?.
J'
r? $ ...
1 ti
L
'04 A%U,x)c AT !-('A c
13. PURPOSE•OF PROPOSED WORK:
A cG r?S_S
L o W f L ?./? T' o tj f 1 L
3
//OF Y
14. STATE REASONS WHY IT IS BEL
OUT IN WETLANDS; /INCLUDE ANY M
IMPACTS).
15. YOU'-ARE.REQUIRED TO CONTACT
(USFWS) AND/OR--NATIONAL MARINE F
ADDRESSES SHEET) REGARDING THE P
PROPOSED FOR LISTING ENDANGERED
J N THE PERMIT AREA THAT •'MAY'`BE-A
CONTACTED:
FROM THESE AGENCIES.)
16.: YOU ARE?EQU3RD'`O-CONY'
(SHPO) (SEE 'AGENCY-' ADL2B a-ES
PROPERTIES-,411-ME PERMIT. AREA
QROJECT, DATE CONTACTED:
_17.? DOES THE PROJECT INVOLVE
PUBLIC (STATE) LAND?
ED THAT THIS ACTIVITY MUST BE CARRIED
URES TAKEN TO MINIMIZE WETLAND
THE U.S. FISH AND WILDLIFE SERVICE, g' ul4g
SHERIES SERVICE (NMFS) (SEE AGENCY
ESENCE OF ANY FEDERALLY LISTED OR
R THREATENED SPECIES OR CRITICAL HABITAT
FECTED BY THE PROPOSED PROJECT. DATE.,
(ATTACH RESPONSES
SERVA•TZON-.,OFFICER
THE STATE HISTORIC _-EBE
?
T)-.. REGARDING; THE PRFi?ENCE OF -HISTORIC'--.
CH MAY BE AFFECTED BY. ift--PROPOSED
AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF
YES [ J NO ' t/ (IF NO,
a. IF YES, DOES THE PROJE
DOCUMENT PURSUANT TO THE REQUIR
POLICY ACT?
YES [) NO ()
TO 18)
REQUIRE PREPARATION OF AN ENVIRONMENTAI!
NTS OF THE NORTH CAROLINA ENv'IRONHENTAL
b. IF YES, HAS THE DOCUt9EN BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STA E CLEARINGHOUSE?
YES ( ) NO ( ]
IF ANSWER TO 17b IS YES, THEN SU MIT APPROPRIATE DOCUMENTATION FROM THE
STATE CLEARINGHOUSE TO DIVISION F ENVIRONMENTAL MANAGEMENT REGARDING
COMPLIANCE WITH THE NORTH CAROLI A ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CL
DIRECTED TO MS. CHRYS BAGGETT, D
CAROLINA'DEPARTMENT OF A6MIN191S
NORTH CAROLINA 27603-8003, TELEV
ARINGHOUSE REVIEW PROCESS SHOULD BE
RECTOR STATE CLEARINGHOUSE, NORRTjEIG#i,
TION, 116 WEST.JONES STREET,- I
ONE (919) 733-6369.
•4
5 of 9
ION IF
EXCAVATED ORPFILLxMATERIAL
IS. THE
ACTIVWZNG NVOLVESHOUE D INCLUDED
PROPOSED
INTO WETLANDS
a. WETL DELINEATION MAP SHOWING ALL WETLANDS, ST 14, EMS, , L KES26,
.AND PONDS HE PROPERTY (FOR N TIONWIOE PERM
29, AND 39). ALL STREAMS (INTE ITTENT AND PERMANENT) ON THE PROPERTY
MUU BE SHOWN ON THE MAP. MAP S ES SHOOLD BE 1 INCH EQUALS 50 FEET OR 1
INCH EQUALS 100 FEET OR THEIR EQ IVALENT,
b. IF AVAILABLE, REPRESENT TIVE PHOTOGRAPH OF WETLANDS TO BE
IMPACTED BY PROJECT.
C. IF DELINEATION WAS PER RMED BY A CONSULTANT, INCLUDE ALL DATA
SHEETS RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
_ d. ATTACH A COPY OF THE ST RMWATER MANAGEMENT PLAN IF REQUIRED.
e_ WHAT IS LAND USE OF SUR OUNDING PROPERTY?
f_ -IF APPLZ BLE, WHAT IS ROPOSED METHOD OF SEWAGE DISPOSAL?
,g. SIGNED AND DATED lAGEN7`.
NOTE:. SrET7,*aIDS.OR HATERS -OF
1) ISSUANCE' OF A SECTI'Ot
2) EITHER THE ISSUANCE c
ENVIRONMENTAL MANAGEMENT (WA'
3) ('2W THE TWEyTY CCIAST.
NORTH CAROLINA DXVI5ION OF Cl
ACTIVITY 19 CONSISTENT WITH '
PROGSRPJ 4.,.
OWNER'®/AGENT' S' -9Y?INATURE
(AGENT'S SIGNATURE VALID O Y
-IF-AUTHORIZATION LETTER FR-
THE OWNER IS PROVIDED (18g )
5
UTHORtZATION't8TTZlkr- IF APPLXCABLE.
-HE U . S . MAY NOT BE IMPACTED. PRIOR' TO
404 CORPS OF ENGINEERS PERMIT',
t WAIVER OF A 401 DIVISION OF
;R QUALITY) CERTIFICATION, AND
G COUNTIES ONLY), A LETTER FROM THE
TpI, IjANAGEMENT STATING THE PROPOSED
E NORTH CAROLINA COASTAL MANAGEMENT
?Va v_J_4 Avb l -
DATE
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01176Q
CORPS 'L'ION TD:
DEN ID:
NATIONWIDE FERNIT REQUESTED (PRO?/TD NATIONWIDE PERMT'f U):
PRE--CONSTRUCTION
FOR NATIONWIDE PERMITS THAT
1) NOTIFICATION TO THE CC
Z) APPLICATION FOR SECTIC
3) COORDINATYON WITS THE
SEND THE ORIGINAL AND (1) COPY OF
FIELD OFFICE OF THE CORPS OF ENGI
(7)'COPIES SHOULD BE SENT TO THE
(SEE. AGENCY ADDRESSES SHEET) -
i . OWNERS ! NAME : 6.?
?L?---
2. MAILING ADDRESS:
CITY: STA;
PROJECT LOCATION ADDRESS, INCLEY
MAILING ADDRESS ABOVE):
3- TELEPHONE NUMBER (HOME):
4. IF APPLICABLE: AGENT'S NAME
PHONE NUMBER: A A --
OTIFICATION APPLICATION
SQUIRE:
,PS OF ENGINEERS
401 CERTIrICATION
fC D2VISION OF COASTAL 14ANAGEtMENT
THIS COt4PLETZD FORM TO THE APPROPRIATE
EERS (SEE AGENCY ADDRESSES SHEET). SEVEN
.C. DIVISION OF ENVIRONMENTAL MANAGEMENT
ASE PRINT.
''SUBDIVISION NAME: iZ/bE ?OQ? p
,CZIP CODE: a??a 7d?
G SUBDIVISION NAMs (IF DIFFERENT FROM
7G?-ql (WORK)
RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
5_ VOCATION OF WORK (PROVJlAt PREt:ERABLY A COPY or USGS TOPOGRAPHIC
5o V?I?l da/V `
HAP OR AERIAL PHOTOGRAPHY E) NEAREST TOWN OR CITY:
COUNTY : O? '
PAYMENT
1 RECEIVED
.
NUMBERS, LANDMARKS, ETC.
a? q
_SPECIFIC LOCATION (INCLUDE ROAD
k
.2.d..J jejvc.k 4y QA/ 7,
(L
v/ •
I T' T ;¢N o Al
q /1? .I lA
6. IMPACTED OR NEAREST STREAM/RI R:
RIVER BASIN:
7a. 15 PROJECT LOCATED NEAR WATE CLASSIFIED AS TROUT, TIDAL SALTWATER
(SA), HIGH QUALITY WATERS (HOW), IJTSTANDING RESOURCE WATERS (ORW), WATER
-------
NO IF YES, EXPLAIN
SUPPLY (WS-I OR WS-II)? YES
7b- IS THE* PROJECT LOCATED WITHI A, NORTH CAROLINA DI `I S IONO NCOASTAL
'HKNAGEHENT AREA OF ENVIRONMENTAL ONCERN (C) YES. -
7c_ IF. THE PgO4ECT IS LOCATED W HIN A 'COAST E COUNT (I,UPEEDESIGNAT ON7
LIST OF COASTAL COUNTIES), WHAT S THE LAN
b$ AkY' SECTI6N 404- PERMIT I F BEEN PREVIOUSLY 'REQUESTED --.I DR UUSS '0R .'
THIS IPA YES, PRO
THIS PROPERTY? YES [ )
PREVIOUS PERMIT AND ANY ADDITION INFORMATION (INCLUDE. PHOTOCOPY. OF 40
CERTIMCATION) :
b. ARE ADDITIONAL PERMIT REQUE TS EXPECTED FOR THIS PROPERTY IN THE
8
FUTURE? YES NO [ ) IF YES DESCRIBE ANTICIP)kTED
. ?, , O Cfl
9a. ESTIMATED 'T'OTAL NUMBER OF A RES IN TRACT OE LAND=
gb. ESIIMATED TOTAL NUMBER OF A RES OF WETY,ANDS LOCATED ON PROJECT SITE:
D e,
N/-A
10a. NUMBER OF ACRES OF WETLAND IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: XCAVA
FLOODING: THER:
OTAL ACRES To BE XHPACTED:
DRAINAGE:
10b. (1) STREAM CHANNEL TO BE I ACTED BY THE PROPOSED PROJECT (IF
EFORE AND AFTER RELOCATION :
RELOCATED, PROVIDE DISTANCE BOTH
AFTER: .
LENGTH BEFORE:
WIDTH BEFORE (based o.n normal hi --•-?
.water ntours):
' FT
WIDTH AFTER:
FT
'
AFTER:
^
AVERAGE DEPTH BEFORE:
AN L Mp CTS LL RES T OM: (CHECK ALL THAT APPLY)
(2) E _
FLACIEMENT Off' -PIPE IN"Cf1ANNEL: _ ,-, ,-
OPEN cAmsEL RE CATION:
•' NSTRUCTION OF A DM/FLOODING: -
VA
CHANNEL 7'I ON:
0TH
11-IF-CONSTRUCTION OF A .POND IS PROPOSED, w ,•I$, T14E ;szZE•QF, THE„
WATERSHED DRAINING TO THE POND?
WHAT IS THE EXPECTED POND. SURFAC AREA?
DESCRIPTION OF PROPOSED WORK
12 E OF
ISCUSSION OFIIYPDRAWINGS
INCLUDING
,
MECHANIC EQUIPMENT TO 8 USED D
uGIG
ATTACH 6u?` fV0 v
ONLY) : r o r t
W >. c12 L•_Je; L 19 A a o 6XA'A VA v
Llo?2???N t? p OF $ ...
13. 'PURPOSE' OF PROPOSED WORK:
A ?? mss
L0W. 1 L Pohs 15IItCLam.
3
7 v-F !
19. STATE REASONS WHY IT IS B
OUT IN WETLANDS./ (INCLUDE ANY
IMPACTS)
VED THAT THIS ACTIVITY MUST.' BE CARRIED
SORES TAKEN TO MINIMIZE WETLAND
15. YOU"ARE.REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SERVICE, A O
P ESENCES (NMFS) (LISTEDSEE
S) AD7SEETiARREGARDEGARD MARINE
ADDRESSES SHHEET) ING THE
PROPOSED FOR LISTING ENDANGERED R THREATENED SPECIES OR CRITICAL HABITAT
'.IN THE PERMIT AREA THAT•'MAY-"BE-A FECTED BY THE PROPOSED PROJECT, RDATE ESPONSES
CONTACTED:— (ATTACH
FROM THESE AGENCIES.)
O?
16 .: YOU ARE- QQ3?ED-••`??ONTACT: THE SPATE HISTORIC -P_AE SERVATI,ON-0EFICER
(SHPO) ($EE•'AGENCY' • D EASES-.SHE T')-REGARDING; THE PRE.PSNbE OF HISTORIC'—
PROPERTIES =IN . E- PERMIT AREA 'WH CH MAY BE AFFECTED BY. Tff57PRO1POSED
PROJECT. DATE CONTACTED:
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF
•
PUBLIC (STATE) LAND?
YES ( ) NO (IF NO, G TO 18)
a. ZF YES, DOES TEE PROTC
DOCUMENT PURSUANT TO THE REQUIR ENTS
POLICY ACT?
YES [) NO ()
b. IF YES, HAS THE DOCUIEN BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION ST E CLEARINGHOUSE?
YES (] NO ()
IF ANSWER TO 17b IS YES, THEN SO MIT APPROPRIATE DOCUMENTATION FROM THE
STATE CLEARINGHOUSE TO DIVISION F ENVIRONMENTAL tiMAGEHENT REGARDING
COMPLIANCE WITH THE NORTH CAROLI A ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE C
DIRECTED TO MS. CHRYS BAGGETT,
CAROLINA'DEPARTMENT Or AOMINZST
NORTH CAROLINA 21603-8003, TELE
;ARINGHOUSE REVIEW PROCESS SHOULD BE
RECTOR STATE CLEARINGHOUSE, NORRIT?EIGH,
TION, 116 V4E$T.JONES STREET,'
NONE (919) 733-6369.
S o+ 7
E D SCHARGE INCLUDED OF EXCAVATED ORPFILLx
PROP MATERIAL
18. THE PROPOSED ACTIVITtNG NITEMS VOLVE SHOO
PR ?
INTO WETLANDS- \"
a. WETL DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES
21, 26,
AND PONDS HE PROPERTY (FOR N TIONWIDE PERMIT NUMBERS 14, 18,
29, AND 38). ALL STREAMS (INTE ITTENT AND PERMANENT) ON THE PROPERTY
MVST BE SHOWN ON THE MAP• MAP S I?E SHOULD BE 1 INCH EQUALS 50 FEET OR 1
INCH EQUALS 100 FEET OR THEIR EQ
b. IF AVAILABLE, REPRESENT TIVE PHOTOGRAPH OF WETLANDS TO BE
IMPACTED BY PROJECT.
C. IF DELINEATION WAS PER RMED BY A CONSULTANT, INCLUDE ALL DATA
SHEETS RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
USE OFE5UST RMWATER R O LADING MANAGEMENT PLAN IF REQUIRED-
. d. AT•ICISALANDCOPY
WHAT f' 'IF APPLI BI,E WHAT IS ROPOSED METHOD OF SEWAGE DISPOSAL?
. . . . . .. .: ,
g. SIGNEb AND DATED AGENT
'NOTE:. WETI- MS .OR HATERS -OF
1) ISSUANCE' OF A SECTM
2) EITHER THE ISSUANCE
ENVIRONMENTAL MANAGEMENT (WA
3) (IN THE' TWENTY COAST
NORTH CAROLINA DIVISION OF C
ACTIVITY IS CONSISTENT WITH
PROGRAM..
7THORI ZAT I ON 'I,ETTElk: • IF AfPPLXCABLE.
HE U.S. MAY NOT HE IMPACTED. PRIOR' TO
404 CORPS OF ENGINEERS PERMIT",
WAIVER OF A 401 DIVISION OF
R QUALITY) CERTIFICATION, AND
COUNTXES ONLY) , A LETTER FROM THE
,STAL MANAGEMENT STATING THE PROPOSED
fE NORTH CAROLINA COASTAL MAN""'GEMSNT
OWNER'/AGENT' S' lYi?NATURE
(AGENT'S SIGNATURE VALID O Y
-IF-AUTHORIZATION LETTER FR
THE OWNER IS PROVIDED (189_ )
?Ioy, 1q
DATE
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CORPS TION ID:
®? ®
DEM I D
NATIONWIDE PERMIT REQUESTED (PROvID NATIONWIDE PERMXT N):
PRE--CONSTRUCTION OTIVICATION APPLICATION
FOR NATIONWIDE PERMITS THAT QUIRE: .°
ERS
1) NvTZF'IC]1TI0l7 To 'rte C g or TENGINE 40X CER'riIFICATION
y) APPLICATION FOR 3ECTY
31 COORDINATION RITE TEE C DIVISION OF COASTAL mAXXGEHEHT THE APPROP SEND THE oRIGINAt. AND (1) COPY
OF TH3:S EER9 (g?LAG?IC?AApRE3SES SHEET)?SEVEN
FIELD OP'FICI; OF THE CORPS OF ENGZ -C- DIVISION OF ENVIRONMENTAL MANAGEMENT
(7)?COPIES SHOULD BE SENT TO THE PRINT
(SEE. AGENCY ADDRESSES SHEET) - ASE
?. OWNERS 'NAME:
? v/N •DrC'? v
2. MAILING ADDRESS:
'-SUBDIVISION NAME: ?Z/VE2 uJ04t?
CITY: STA
PROJECT LOCATION ADDRESS, INCLU
MAILING ADDRESS- ABOVE):
3- TELEPHONE NUMBER (HOME) : 3,
4- IF APPLICABLE: AGENT'S NAME
PHONE NUMBER:
ZIP CODE: 7a SUBDIVISION NAME (IF DIrFEitXNT E'ROM
74 y- (woRK)
RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
5- LOCATION OF WORK (PROVIDE A r P, PREFERABLY A COPY of USGS TOPOGRAPHIC
.'?O tJT hfQN
MkP OR AERIAL PHOTOGRAPHY WITH S ALE) NEAREST TOWN OR CITY:
COUNTY: C?
--------------
• PAYMENT
1 ?ECE?UED
NUMBERS, LANDMARKS, ETC.) = ?:L
0? ZI?WOn9`SotJ1`1{?+s
L
_SPECIFIC LOCATION (INCLUDE ROAD
---V f- , 1lh10 '81 eN/ MO)y Q ,- -
L) ki
s 2.tJJ mvctj4y. QN -r
Al 7T
6. IMPACTED OR NEAREST STREAM/RI R:
RIVER BASIN:
?a. IS PROJECT LOCATED NEAR WATE CLASSIFIED AS TROUT,WTIDAL ALT ATWATER
-----------
(SA), HIGH QUALITY WATERS (HOW), UTSTAN IF yE5, EXPLAIN:
SUPPLY (WS-1 OR WS-II) ? YES [ ) NO ¢(l
7b. IS THE PROJECT LOCATED WITHI A; NORTH CAROLINA DI [I) IONO • R/] COASTAL
- ' KHNAGEMENT AREA OF ENVIRONMENTAL, ONCERN (AE ) - -••- • • •-7 FO 7c- YF• THE PROJECT IS LOCATED W HYN A'COASTAL
E PLANT (I,(SEEDPAIGNAT ON?
LIST OF COASTAL, COUNTIES), WHAT S THE LAN U
b ANY- SECTIdN 404 PERMIT BEEN PREVIOUSLY 'QUESTED-.1 OR UNt1tiB '
HA
THIS OF
THIS PROPERTY? YES NO IF YES, PR
[ )
pRgtTIOUS -PERMIT AND ANY ADDITION INFORMATION (INCLUDE, PHOTOCOPY OF- 403,
CERTIFICATION):
8b- ARE ADDITIONAL PERMIT REQUE TS EXPECTED FOR THISFPROPERTY IN THE
FUTURE? YES NO [ ) IF YES DESCRIBE ANTICIPATE:
9a. ESTIMATED TOTAL NUMrsER OF A RES IN TRACT OE LAND:
gb, ESTIMATED TOTAL NUMBER OF A RES OF WETLANDS LOCATED ON PROJECT SITE=
2
108. NUMBER OF ACRES OF WETLAND
FILLING:
FLOODING:
DRAINAGE:
?oay
IMPACTED 13Y THE PROPOSED PROJECT BY* XCAVA
THEP:
oTAL ACRES TO BE IMPACTED:
10b. (1) STREAM CHANNEL TO BE I ACTED BY THE PROPOSED
EFORE AND AFTER RELOCATION CT (IF
RELOCATED, PROVIDE DISTANCE
:.
AFTER
LENGTH BEFORE:
WIDTH BEFORE (based on normal hi -??
.water ntours):
• 1 FT
WIDTH AFTER:
F-
'
AFTER : -=
AVERAGE DEPTH BEFORE:
T OM : (CHECK ALL'THAT APPLY)
FZ), E L MP CTS LL RES
FLAC$MENT OF-PIPE TN"CHANNEL: -,-
OPEN CHANNEL RE CATION:
' HSTRUCTION OF A DAM/FLOODING:
CHANNEL NATION:
OTH
.]I...IF•CONSTRUCTION. OF A-POND IS PROPOSED,,WHA .1p THE SIZE QF,THE„
WATERSHED DRAINING TO THE POND?
WHAT IS THE EXPECTED POND SURFAC AREA?
DESCRIPTION OF PROPOSED WORK
12 INCLUDING DISCUSSION OF1TYPEDOWING3
8 1/2"'X 1"
.
HECHANIC EQL)IFMENT TO 8 USED
ACH PLANS:
uclL
ATT
6u?-L /VQ
ONLY) :
• - ?? 1.1 orz ? 1-c
13. PURPOSE•OF PROPOSED WORK:
J, 1' s' SLof',.
F. $ U.S.
3
y v? 1
14. STATE REASONS WHY IT IS BEL
OUT IN WETLANDS. (INCLUDE ANY H
IMPACTS) :
EVER THAT THIS ACTIVITY MUST BE CARRIED
RSURES TAKEN TO MINIMIZE WETLAND
15. YOU_'ARE.REQUIRED TO CONTACT
(USFWS) AND/OR-..NATIONAL MARINE F
ADDRESSES SHEET) REGARDING THE P
PROPOSED FOR LISTING ENDANGERED
'.IN THE PERMIT AREA THAT-,MAY`BE-A
CONTACTED:
FROM THESE AGENCIES.)
16.-.- YOU ARE- -REQU3-RE` -V0--CONTACT
(SHPO) (8EE 'AGENCY' D _ESsES__SHE
PROPERTIES.=IN E PERMIT AREA 'WIH
TE CONeACTED:
THE U - S - FISH AND WILDLIFE SERVICE. *l_
SHERIES SERVICE (NMFS) (SEE AGENCY /`
ESENCE O£ ANY FEDERALLY LISTED OR
R THREATENED SPECIES OR CRITICAL HABITAT
FECTED BY THE PROPOSED PROJECT. DATE.
(ATTACH RESPONSES
ERVAT-ION-.dFFICER
THE SPATE 1-1ISTORT,C PRES
T)-- EGARDING; THE PRE$ENtE OF HISTORIC',, •
CH MAY BE AFFECTED BY. WIS `PROPOSED
PROJECT. UA -
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR 'THE USE OF
PUBLIC (STATE) LAND?
YES [] NO 'f (IF NO, G TO 18)
- a. IF YES, DOES THE PROJEC PREPARATION OF. AN ENVIRONMENTA14
ENVIROLdPiENTAL
DOCUMENT PURSUANT TO THE REQUIR
POLICY ACT?
YES [] NO []
b. IF YES, HAS THE DOCUr9EN BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STA E CLE)kRINGHOUSE? „
YES [ ) NO 0
IF ANSWER TO 17b IS YES, THEN 50MIl APPROPRIATE DOCUMENTATION FROM THE
STATE CLEARINGHOUSE TO DIVISION F ENVIRONMENTAL l4ANAGEHENT REGARDING
COMPLIANCE WITH THE NORTH CAROLI A ENVXRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE C
DIRECTED TO MS. CHRYS BAGGETT,
CAROLINA'DEPARTMENT OF A6MIN19t
NORTH CAROLINA 27603-8003, TELE
ARINGHOUSE REVIEW PROCESS S14OULD BE
RECTOR STATE CLEARINGHOUSE, NORTH
TION, 116 WEST .JONES STREET,- RALEIGH,
ONE (919) 733-6369.
4-
? of 7
18. THE IV'ITNG ITEMS SHOV E D SCHARGE INCLUDED OF EXCAVATED APPLICATION IF
PR MATERIAL
PROPOSED ACT
INTO WETLANDS :
a. WETL DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES
21 26
AND PONDS PROPERTY (
(rFOR INTEN ITTENTpANDEPEIRMANENT) ONITHEIPROPERTY
29, AND 38). ALL STR ES SHOUTED BE 1 INCH EQUALS 50 FEET OR 1
ML7ST BE SHOWN ON THE MAP - IMMAZ' S
INCH EQUALS 100 FEET OR THEIR EQ IVALENT.
b. IF AVAILABLE, REPRESENT TIVE PHOTOGRAPH OF WETLANDS TO BE
IMPACTED BY PROJECT,
c. IF DELINEATION WAS PER RMED BY A CONSULTANT, INCLUDE ALL DATA
SHEETS RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
d. ATTACH ALACOPY OF ND USE OFE5UST RMWATER R O LADING pMANAGEMENT PLAN IF REQUIRED.
e_ WHAT IS
f _ IF Ap
WHAT IS ROPOSED METHOD OF SEWAGE DISPOSAL? .,
g. SIGNED AND DATED AGENT
N02'E:. v4ETLA2TDS OR HATERS 'OF
1) ISSUANCE' OF A SECTION
2) EITHER THE ISSUANCE C
ENVIRONMENTAL MANAGEt-MNT (WA'
3) (IN THE TWENTY COAST.
NORTH CAROLINA DIVISION OF C(
ACTIVITY IS CONSISTENT WITH '
PROGRAM-.
UTHORtZATION't8TTZA;' IF APPLXCABLE.'
'FIE U.S. MAY NOT BE IMPACTED • PRIOR' TO:
404 CORPS OF ENGINEERS PERMIT,,
WAIVER OF A 401 DIVISION OF
;R QUALITY) CERTIFICATION,
FROM THE
COUNTXES ONLY),
TAL KhNAGEMENT STATING THE PROPOOSED
E NORTH CAROLINA COASTAL MANAGEMZNT
OWNER' /A.GENT' S' ?dNATURE
(AGENT'S SIGNATURE VALID O Y
-IF'AUTHORZZAIION LETTER FR
THE OWNER IS PROVIDED (189. )
AlP y
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