20010593 Ver 1_COMPLETE FILE_20010418

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
Mr. E. J. Temple, Jr.
Post Office Box 4186
Hickory, NC 28601
Dear Mr. Temple:
LT?WAA
NCDENR
NORTH CAROLINA DEPARTMENT OF
May 1, 2001 T AND NATURAL RESOURCES
DWQ # 010593
Catawba County
On April 18, 2001 the Division of Water Quality (DWQ) was notified by receipt of your
applications regarding your plan to fill waters for the purpose of stabilizing a shoreline on Lake
Hickory in Catawba 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 1) a
location map and 2) a site plan showing the location of the proposed fill as well as it's area.
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 with
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assume you no longer want to pursue the project and will consider it withdrawn.
Cc: Mooresville DWQ Regional Office
Asheville Corps of Engineers
- - - - - - - File Co
Central Files
Wetlanda1401 Unit • 4401 Reedy Creek Road • Raleigh, North Carolina 27607
Telephone [phone] FAX # [phone]
An Equal Opportunity Affirmative Action Employer
50% recycled'10% post consumer paper
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
?b
ll , 2001
DWQ#010
C--. County
Y? ` w
D
d-g6
Dear Mr. 2 'c7? v,jd,
qq•? 7iv v
On the Division of ater Quality (DWQ) was notified by r cei t of your
applications regarding your plan to fill ds for the purpose of in County.
Approval from DWQ is required to disturb these R/ . 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. 1 n the
property. Please show these on maps of suitable scale (fo instance 1" = 100 feet) so we can
begin to determine your projects' compliance with 15A NCA 21-1.0500.
Please call me at [phone] if you have any q estions or would require copies of
our rules or procedural materials. This project will remain n hold as incomplete in accordance
with 15A NCAC 2H .0505(c). The processing time for t is application will begin when this
information is received. If we do not hear from you by wr ting within three (3) weeks we will
assume you no longer want to pursue the project and will co cider it withdrawn.
Sincerely,
John R. Dorney ? Z ct--
awl
. x,11 ?? ? Sk
Ce. DWQ Regional Office wap
d 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% recycled/ 10% post consumer paper
/--A 1 1 T \- 11.- %......- " i

n` w
010593
DWQ ID: _ CORPS ACTION ID: _
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT ##) _
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
1. NOTIFICATION TO THE CORPS OF ENGINEERS
APPLICATION FOR SECTION 401 CERTIFICATION
2
.
COORDINATION WITH TIC NC DIVISION OF COASTAL MANAGEMENT
;
.
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE FIELD
CE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN (71
OFFI
COPIES MUST BE SENT TO THE NC DT'VISiON OF WATER QUALITY,
ATTN: JOHN DORNEY 440112EDY CREEK ROAD RALEIGH NC
27607. PLEASE PRINT OR TYPE.
._ 1
1. OWNER'S NAME:
2. MAILING ADDRESS: r1 = t, ?"
SUBDIVISIONNAME= r?i-? D

CITY: _STATE:.._ ZIP CODE: m
INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
DDRESS m -?- I
,
PROJECT LOCATION A
MAILING ADDRESS ABOVE):

3.' TELEPHONE NUMBER. (HOME)_ (WORK),
AGENTS NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
4. IF APPLICABLE:
PHONE NUMBER: /`l! A
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP
OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: _ - NEAREST TOWN:
?4-?awSa N?, t
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMAIriCS, ECT.)
6. IMPACTED OR NEAREST STREAMIRIVER: _ RIVER BASIN: Qv e
T, (a) IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER, (SA),
HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WS-I OR WS-II)? YES ? NO ? IF YES, EXPLAIN: _
(b) IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES E] NO Ea'
(c) IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF
COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LvP) DGSIGNA T ION? _ ? f
t- C
8. (a) HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON. TRIS
PROJECT? YES ? NO 0-IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND
ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401 CERTIFICATION):
(b) ARE ADDIT NAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE?
YES RfNO IF YES, DESCRIBE ANTICIPATED WORK:
9. (a) ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND: r '.
(b) ESTIMATED TOTAL NUMBER OF ACRES bF WETLANDS LOCATED ON PROJECT SITE:
?onG
10. (a) NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: ` EXCAVATION: _ Non z.
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 RELOCA TION. j
LENGTH BEFORE: - FT AFTER: _ FT !
WIDTH BEFORE (based on nonnai uig'a wafer wa.ours): ^ 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? h/?f}
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL
EQUIPMENT TO BE / /YSED? (ATTACH PLANS; SV2' BY 1 I DRAWINGS ONLY)
1'? r ?r'n r
JGG " 4l 14.1 d. EX Ccauct 4>- f o, ® f
13. PURPOSE OF P(((ROPOSED WORK: _ sh ot? 1' eve- ??a? a ? •? ? ?? o v?
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS)
i\j/ 14
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: _ N14
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE PERMIT AREA
WIAIC14 MAYBE AFFECTED BY THE PROPOSED PROJECT. DATE CONTACTED_. /J/iq
L

17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (STATE) LAND? YES ? NO QV NO, GO Tb 16)
(a) IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO T'HE REQUIREMENTS OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT? YES ? NO
(b) IF YES, I-IAS THE DOC Uu-SENT BEEN REVMWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE YES ? NO
IF ANSWER 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE STATE
CLEARINGHOUSE WITI- THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STAT CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH
C-AROLDUIL DEPART MENT nF A DMINISTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
Ig. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF PROPOSED
ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OF FILL MATERIAL INTO
WETLANDS: I41 9
(a) WETLAND DELINEATION O NATIONWIDE PERMIT NUMBERS 14, 18, STREAMS, 1 2LAKES, ?
PONDS ON THE PROPERTY (F 9,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 PER ALIT,
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 CAROLI?A COASTAL MANAGEMENT
PROGRAM
OWNER'S/AGENTS SIGNATUfUP, DATE/
r
f --
(AGENTS SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED).

00593
DWQ ID: ` CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT ff) _
PRE-CONSTRUCTION NOTIFICATION APPLICATION 7U D
FOR NATIONWIDE PERMITS THAT REQUIRE: c3
1. NOTIFICATION TO THE CORPS OF ENGINEERS ..C m
2. APPLICATION FOR SECTION 401 CERTIFICATION m ;a
a 3. COORDR.ATION1 `IMI-I THE NC DIVISION O. CO. STAL MA.. A GEMENT
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: JOAN DORNEY 4401 REEDY CREEK ROAD RALEIGH NC
27607. PLEASE PRINT OR TYPE.
1. OWNER'S NAME._ tr :`f 1-42
2. MAILING ADDRESS:
SUBDIVISION NAME
CITY: _STATE: _ ZIP CODE:
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
J ?
3. TELEPHONE NUMBER: (HOME) - (WORK)
4. IF APPLICABLE: AGENTS NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER: 1`l1A
S. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP
OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: _ - NEAREST TOWN:
?--
Q-c4at4l , cJ?[ s-, `l
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ECT.)
_ ?a?atv?4 - as ? ?' u
6. IMPACTED OR NEAREST STREAMIRIVER: _ RIVER BASIN: 4
7. (a) IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER, (SA),
HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER.
SUPPLY (WS-I OR WS-II)? YES ? NO ? IF YES, EXPLAIN: _
(b) IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
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 (LUi') DESIGNATION? - l"114

g. (a) HAVE ANY SECTION 404 PERMITS BEEN PREV40USLY REQUESTED FOR USE ON. THIS
PROJECT? YES ? NO ErIF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND
ANY A DDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401 CER rIFICATION): _
(b) ARE ADDIT NAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE?
YES ffNO IF YES, DESCRIBE ANTICIPATED WORK: - =
9. (a) ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND:
(b) ESTIMATED TOTAL NUMBER OF ACRES bF WETLANDS LOCATED ON PROJECT SITE:
oorLr_
10. (a) NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: _ EXCAVATION: -°"
FLOODING: _ OTHER :
DRAINAGE TOTAL ACRES TO BE IMPACTED:
(b) (I) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED,
PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION: lV r
LENGTH BEFORE: - FT AFTER: _ FT
WIDTH BEFORE (based on nonuai Iugl? 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: N
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? WHAT IS THE EXPECTED POND SURFACE AREA? ;//f{
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL
EQUIPMENT TO BE USED? (ATTACH PLANS; 91/2 BY I I DRAWINGS ONLY)
ScG ?a f f??c?. E4cacja' o - Fr Ors llct,1s
13. PURPOSE OF PROPOSED WORK: _ s? oCc 1' n e?a?? ar o?
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (INCLUDE ANY MEASURES TAKEN TO MINIMIZB WETLAND IMPACTS)
\J/ 14
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 CON ACIED:_ N1A
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE PERMIT AREA
WHICH MAYBE AFFECTED BY THE PROPOSED PROJECT. DATE CONTACTED /,J/,4
..

17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (STATE) LAND? -f ES (J NO Er(IF 1.10, (30 TM 16)
(a) IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO TTY .EQUIREMENTS OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT? YES ? NO [j
(b) IF YES, HAS 111E DOCUMENT REEN REV IP-WED 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 «;TM'THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATF., CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRYS BAGGETT, D Ibit-s m-ei T
CAROLINA DEP:LRTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
IS THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF PROPOSED
ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OF FILL MATERIAL INTO
WE RANDS: t4 /t9
(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? _
(I) 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 PEIU IIT,
2_ EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF WATER QUALITY
CERTIFICATION, AND
3. (IN THE TWENTY COASTAL COUNTIES ONLY), A LET T ER FROr.1 THE NORTH
CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED
ACTIVITY IS CONSISTENT-:WITH THE NORTH CA)IOLIi A COASTAL MANAGEMENT
PROGRAM,
OWNEWS/AGENTS SIGMA-fp DATE:?`
f _
(AGENTS SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED)-
/-A I I T_\? I%•-% " ;
,\ 0b°a3
©Q?
cb,
ti
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 MAMAGEMENT
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: L= r_
2. MAILING ADDRESS: ^ - JI,
SUBDIVISION NAME _ f i < e, jr c L ." rf ? ?7 -t7
n
CITY: _STATE: _ ZIP CODE: _ fT1
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM r- {
MAILING ADDRESS ABOVE):
3.' TELEPHONE NUMBER: (HOME) - (WORK)
4. IF APPLICABLE: AGENTS NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER: 1,,,113-
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP
OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY- _ - NEAREST TOWN'
c'a4awS1h N(!z_k d V r
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ECT.)
6. IMPACTED OR NEAREST STREAMIRIVER: _ RIVER BASIN: _ ea4awSq ?-?
7. (a) IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER, (SA),
HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WS-I OR WS-II)? YES ? NO E] IF YES, EXPLAIN: _
(b) IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES Q 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 (L' ) DESIGNATION? _ t'11
8. (a) HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON. THIS
PROJECT? YES ? NO all YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND
ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401 CERTIFICATION): _
WORK: R THIS PROPERTY IN THE FUTURE?
(b) ARE ADDITIF A DESCRIBE ANT EXPECTED
YES ffNO , D
9. (a) ESTIMATED TOTAL NUMBERS OF 0,CRES IN TRACT OF LAND: ? `f
(b) ESTIMATED TOTAL NUMBER OF ACRES bF WETLANDS LOCATED ON PROJECT SITE:
None
10. (a) NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: EXCAVATION: _ NO r% e.
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: IV //'T
LENGTH BEFORE: - FT AFTER: _. FT
WIDTH BEFORE (based on normal Itig'u 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:
I I. 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? _ hl/f}
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL
EQUIPMENT/ T/O?BE SED? (ATTACH PLANS; 81/2 BY I I DRAWINGS ONLY)
s? " / AJ-1 .?. EX CaLla40r ('tit- 0r, 1 L'ns
13. PURPOSE OF PROPOSED WORK: _ Sh c,, J n e S4a14 bZ,4, °,
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (INCLUDE AMY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS)
J\//,q
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 CONTAC CED: _ N11)
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE PERMIT AREA
WHICH MAYBE AFFECTED BY THE PROPOSED PROJECT. DATE CONTACTED-. /,J /h

17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (STATE) LAIv'D7 Y Es Q ?;c) Erp NO, GO TO 16)
(a) IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUA711T TO THEI; REQUIREMENTS OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT? YES ? NO f-I
(b) IF YES, I;AS 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 c'?!ITII 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].
I8 THE FOLLOWINGTITEMS SHOULD BE INCLUDED WIT14 THIS APPLICATION IF PROPOSED
ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OF FILL MATERIAL INTO
WETLANDS: rf A
(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? _
(fl 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 FRON'. THE NTOPTH
CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED
ACTIVITY IS CONSISTEN WITH THE NORTH CARPLII A COASTAL MANAGEMENT
PROGRAM,
cam..--' OWNERS/AGENTS SIGNATPBIF, DATE.' J
f` f(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED).
le-_ x 1 1 T \_I %. %- „ i
0'ba'3
S

0 DWQ ID: ' CORPS ACTION ID: _
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #t) _
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS TIIAT P.EQUIRE:
1. NOTIFICATION TO THE CORPS OF ENGINEERS
2. APPLICATION FOR SECTION 401 LERTIFICATION
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 CREED R )Ab RALEIGH NC
27607. PLEASE PRINT OR TYPE.
I. OWNER'S NAME-
e 4'`?W? j J` t t
2. MAILING ADDRESS:.
SUBDIVISION NAME ! r / `
CITY: -STATE: ZIP CODE: _ t-'
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
3.' TELEPHONE NUMBER: (HOME) _ (WORK)
4. IF APPLICABLE: AGENTS NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER
7:10 -0
n
rri F?
rn
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP
OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY- NEAREST TOWN:
////--,,
0qd4y?S cl f ?tC.Ll v l
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ECT.)
6. IMPACTED OR NEAREST STREAMIRIVER _ RIVER BASIN: _ ea4arvS? 4 ?'v e
7. (a) IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER, (SA),
HIGH QUALITY WATERS (RQW), OUTSTANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WS-I OR WS-II)? YES ? NO ? IF YES, EXPLAIN: _
(b) IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES Q NO Eq`
(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? - t?'1114
8. (a) HAVE ANY SECTION 404 PERMITS BEEN pREVjOUSLY REQUESTED FOR USE ON.TRIS
PROJECT? YES ? NO 0IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND
ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401 CERTIFICATION):
(b) ARE ADDITJONAL
YES DESCRIBE QUEST ANTICIPATED WORK: R THIS PROPERTY IN THE FUTURE?
YES RNO }r ,
9. (a) ESTIMATED TOTAL NUMBERS OF AACRES IN TRACT OF LAND: f /V ' 4
(b) ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
/4oe-G
14. (a) NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
on c-
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 Aiv`D A ER P,.;,,OCAV.ON:
LENGTH BEFORE: _» AFTER _ FT
WIDTH BEFORE (based on noznal high rater ccatcurs): 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: /Ik)
OTHER:
I I. 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? _ ; //lq
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL
EQUIPMENT TO BE SED? (ATTACH PLANS; 81/2 BY I I DRAWINGS ONLY)
11 PURPOSE OF PROPOSED WORK:_ Sh OCa l r +1 e S??t Q 1 Z ? °'?
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS)
\/1, rj
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 CONCAC:"f ED: - IV ! ")
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) REGARDING THE PRESENCE O HISTORIC PROPERTIES IN THE PERMIT AREA
WHICH MAYBE AFFECTED BY THE PROPOSED PROJECT. DATE CONTACTED ?,Jdl

17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (STATE) LAND? x ES ? NO ZqF 210, GO TO I6)
(a) IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT T TO THIS I'EQUIREI.fE NTS OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT? YES [CIO E]
(b) IF YES, HAS THE DOCUMENT BEEN REV rr--WED 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
CA ROLL: L.: DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
I8. THE FOLLOWING: ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF PROPOSED
ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OF FILL MATERIAL INTO
WETLANDS: /V
(a) WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES, AND
AND 38).
PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21,2 ,
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? _
(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 CONSISTENTxWITH THE NORTH CAROL Ii A COASTAL MANAGEMENT
PROGRAM C'
OWNEWS/AGENTS SIGNATURE DATE/ ! v '
(AGENTS SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED).

?v2
010593
DWQ ID: CORPS ACTION ID: _
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS TEAT REQUIRE:
1. NOTIFICATION TO THE CORPS OF, ENGINEERS
2. APPLICATION FOR SECTION 401 CERTIFICATION
3. COORDINATION lTH 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 RALEIGI3 NC
27607. PLEASE PRINT OR TYPE.
1. OWNER'S NAME:
2. MAILING ADDRESS:
{F
5U01jIVISION NAME _ "'`-`
CITY: -STATE: - ZIP CODE:
G?
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
I
3.' TELEPHONE NUMBER: (HOME) - (WORK) _
4. IF APPLICABLE: AGENTS NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER: 1\11A
77 --p
n _<
M Ez
m
m?2!
C7 ---i
LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP
OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY- - - NEAREST TOWN: ?--
?'q-?aws? Na y
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ECT.) _
6. IMPACTED OR NEAREST STREAM/RIVER: _ RIVER BASIN:
7. (a) IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER, (SA),
HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER
4 SUPPLY (WS-I OR WS-II)? YESE] NO E] IF YES, EXPLAIN: -
(b) IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL C UNCERN (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 P LAN (LUl l D SIGNA T ION^ - ?,/??

8, (a) HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON. TKIS
PROJECT"? YES ? NO 0IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND
ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401 CER FIFICATION): -
(b) ARE ADD1T NAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE?
YES 07NO TF YES, DESCRIBE ANTICIPATED WORK:
f
9, (a) ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND:'; `-
(b) ESTIMATED TOTAL NUMBER OF ACRES bF WETLANDS LOCATED ON PROJECT SITE:
/4OnG
10. (a) NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
Non e.
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: / V /q
LENGTH BEFORE: _ FT AFTER: _ FT
WIDTH BEFORE (based on normal higli Neater 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: , IX)
OTHER:
I T. 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? _ hV/lq
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL
EQUIPMENT T,OnB714-1d. SED? (ATTACH PLANS; 8112 BY 11 DRAWINGS ONLY)
s? "4t Ex Catja4o, F r
13. PURPOSE OF PROPOSED WORK: _ Sh O, 'q e S4q?Gll 2,,4,
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS)
1\J/Ig
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
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE PERMIT AREA
WHICH MAYBE AFFECTED BY THE PROPOSED PROJECT. DATE CONTACTED-. !`1/il

17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OT THE USE OF
{{-?? `
PUBLIC (5`i'A'i E) LANu`? Y ES D NO r-?/ YLiIF 140, GO TO 161
(a) IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT Plii?SUAI-,7 TO TIC REQUIREI.?MNTS OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT? YES ? NO Q
(b) IF YES, HAS THE DOCUMENT BEEN REV I'F-WED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE YES ? NO ?
IF ANSWER 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE STATE
CLEARINGHOUSE NYIT1I THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATEt 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].
3Q THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF PROPOSED
ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OF FILL MATERIAL INTO
WETLANDS: J-11t9
(a) WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES, AND 38).
,
PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26,9AND
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? _
(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:
I. ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PEr'MIT,
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 CAROLUJA COASTAL MANAGEMENT
PROGRAM,
Iv-
OWNETSIAGENTS SIGNATyI ? DATE/ 1
f
+t -
(AGENTS SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED).
/4-V I I *Z?-- I I •- lk li ; I -
t,
DWQ ID: CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT ft) _
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMI'T'S THAT REQUIRE:
1. NOTIFICATION TO THE CORPS OF ENGINEERS
2. APPLICATION FOR SECTION 401 CERTIFICATION
3. COORDINATION IVTTH THE INC 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 DUALITY,
ATTN: JOHN DOPY 4401 REEDY CREEK ROAD RALEIGI3 NC
27607. PLEASE PRINT OR TYPE.
1. OWNER'S NAME:
P , ? t irk Y.., ? •' rj . 1 ? i L t .,r }
2. MAILING ADDRESS:
_ f
j
SUSDIVISIONNAhiE_fi'=""=_
CITY: -STATE: -ZIP CODE: _ r1 ? . r %?`_> # F " ? ' L? f• -? ; ?" ? t?T1 ?
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM m
MAILING ADDRESS ABOVE): U --I
...-
(
3.' TELEPHONE NUMBER: (HOME) _ (WORK) _
4. IF APPLICABLE: AGENTS NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER: 1' l1'4
LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP
OR AERIAL PHOTOGRAPHY WITH SCALE):
?--
COUNTY- _ - NEAREST TOWN:
C'altrl? 10 /1rcLid?
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ECT.)
6. IMPACTED OR NEAREST STREAMIRIVER: _ RIVER BASIN:
7. (a) IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER, (SA),
HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WS-I OR WS-II)? YES ? NO [] IF YES, EXPLAIN: _
(b) IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)7 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? _ 1\1l4
8. (a) HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON. TIdIS
PROJECT? YES ? NO 0I1' YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND
ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401 CERTIFICATION): _
(b) ARE ADDIT NAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE?
YES jTNO 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:
to. (a) NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: _ EXCAVATION: ^ Non e
FLOODING: OTHER :
DRAINAGE : -. TOTAL ACRES TO BE IMPACTED:
(b) (I) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED,
PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION: //-T
LENGTH BEFORE: - FT AFTER _ FT
WIDTH BEFORE (based on noraiat f:ig!a 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 DAMNLOODING: _
OTHER: _
I I. 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 TOABE/VSE{D? (ATTACH PLANS; SU2 BY I II }DRAWINGS ONLY)
SCG l.LJa(?' / ry•?c?. Ever la?vrtt Foi- Vr; 1lrr'?S
13. PURPOSE OF PROPOSED WORK: _ ,SF? otG I r +1 e .S?a? Q Zt o v?
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS)
iv
?
r
15. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE AND/OR
NAT IONAL MARINIE 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:- 1\11A
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE PERMIT AREA
WHICH MAYBE AFFECTED BY THE PROPOSED PROJECT. DATE CONTACTED-. 1j /il
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (SPATE) LAND i - ES ? Id0 0(IF NO, GO TO 16)
(a) IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO TITLE ?IEQUIREMENTS OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT? YES ? NO (]
(b)'IF YES, HAS THE DOCUMENT BEEN RFVMWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE YES ? NO
IF ANSWER 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE STATE
CLEARINGHOUSE LuIT II THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STAT? CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINT A DEIP RTIMENT OF ADMINISTRATION. 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
ROPOSED
.8 THE FOLLOWING ITEMS SHOULD BE OFF EXCA ATED WITH TIS OF FILL MATERIAL INTO
ACTIVITY INVOLVES THE DISCHARGE
WETLANDS: rf ??
(a) WETLAND DELINEATION MAP SHOWING ALLVv'ETLANDS, STREAMS, LAKES AND
AND 38).
PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26, 29,
ALL STREAM E MAP. MAPS ALES SHOULD D AND PERMANENT) ON THE PROPERTY MUST BE B 1 INCH EQUALS 50 FEET OF 1 INCH EQUALS 00FE T
TH
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? _
(I) 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 E-14GINEERS 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 I THE NORTH
CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED
ACTIVITY IS CONSIST NT,WITH THE NORTH CAROLINA COASTAL MANAGEMENT
PROGRAM, ` ?•
f Y'
t ?~l f
OWNEWSIAGENTS SIGNATURE DATE/ J =? '
(AGENTS SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED)-
frC I I r---- I % - - %- -
. ~

010593
DWQ ID: _ CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT iff) _
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT ItEQUIRE:
1. NOTIFICATION TO THE CORPS OF, ENGINEERS
2. APPLICATION FOR SECTION 401 CERTIFICATION
3. COORDINATI ON 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
2. MAILING ADDRESS:
SUBDIVISION NAME
F i-/v L! t ?`;
CITY: -STATE: -ZIP CODE:_
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
3.' TELEPHONE NUMBER: (HOME) _ (WORK)
4. IF APPLICABLE: AGENTS NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER: /'M4
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5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP
OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY - NEAREST TOWN:
c'jawSq N,?y y
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ECT.) _
6. IMPACTED OR NEAREST STREAMIRIVER: - RIVER BASIN:
7. (a) IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER, (SA),
HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WS-I OR WS-II)? YES E] NO ? IF YES, EXPLAIN: _
(b) IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES Q 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 (LL'i') DESIGNATION? - W4
L, .. .
g, (a) HAVE ANY SECTION 404 PERMITS BEEN PREWOUSLY REQUESTED FOR USE ON. THIS
PROJECT? YES ? NO 1F YES, PROVIDE ACTION LD. NUMBER OF PREVIOUS PERMIT AND
ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401 CERTIFICATION): -
(b) ARE ADDITIONAL PERMIT REQUESTS QAUUEST EXPECTED TED WORK R THIS PROPERTY IN THE FUTURE?
YES ffNO IF YES,
9, A a) ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND:
(b) ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
No ? C,
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 nol-Mal I.ig'u .,i-it-' coutour'): _ 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? _ ?Iq
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL
EQUIPMENT JTO n BE YSEfD? (ATTACH PLANS; 8I//22 BY I I DRAWINGS ONLY)
SCG WaY/ / f?•?G(. Eycat ct4o, f t?1• ?r' 11"-'3 r
13_ PURPOSE OF PROPOSED WORK: _ ,S?y otG 1r rte ??a? 41 t Z? o s?
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS)
1\11,q
15. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE AND/OR
NATIONAL ; .ARINE 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 CON TAC UL;D: - 141A
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE PERMIT AREA
WHICH MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE CONTACTED . /1 //I
, .

17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (STAI E) LkRER YES Q NO 01P 240, GO TQ 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, I-L&S THE DOCUMENT BEEN RF.Vd---WED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE YES Q NO ?
IF ANSWER 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE STATE
CLEARINGHOUSE VJITI i T_N_E NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATF CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAR{,LI; IA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF PROPOSED
ACTIVITY INVOLVES `THE DISCHARGE OF EXCAVATED OF FILL MATERIAL INTO
WETLANDS: ? 19
(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.
(e) WHAT IS LAND USE OF SURROUNDING PROPERTY? _
(I) 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 CONSISTFNT,WITH THE NORTH CARPLI?A COASTAL MANAGEMENT
PROGRAM, ce' % f
OWNERS/AGENT'S SIGNATPRk DATE! ' '
;f
(AGENTS SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED)-
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