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HomeMy WebLinkAbout20021335 Ver 1_COMPLETE FILE_20020821Michael P. Easley, Governor William G. Ross Jr., Secretary North Carolina Department of Environment and Natural Resources Alan W. Klimek, P.E., Director Division of Water Quality ix To: >mpany: Division of Water Quality Department of Environmental and Natural Resources Wetlands/401 Unit Street Address: Mailing Address: Contact Information: t ember of pages including cover sheet: rtes or special instructions: S Fax #: I J ? ? 5 2 3o Date: I ?a 0) 10 2321 Crabtree Boulevard, Suite 250 Raleigh, NC 27604-2260 1650 Mail Service Center Raleigh, NC 27699-1650 Phone #: 919-733-1786 Fax #: 919-733-6893 Division of Water Quality, 401 Wetlands Certification Unit, Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address) Crabtree Blvd., Raleigh, NC 27604-2260 (Location) 733-1786 (phone), 919-733-6893 (fax), (http://h2o.enr.state.nc.us/ncwctlands O?OF W AT F9pG U.S. Army XVIII Airborne Corps XVIII Airborne Corps and Fort Bragg Mr. Roderick Chisholm ATTN: AFZA-PW BC Building 3-1631 Butner Road Fort Bragg, INC, 28310 r O `r October 14, 2002 DWQ# 02-1335 Cumberland County APPROVAL of 401 Water Quality Certification with Additional Conditions Dear Mr. Chisholm: You have our approval, in accordance with the attached conditions, to place fill in 28 linear feet of streams in order to replace an existing culvert with a 202-foot culvert plus rip-rap underneath Sharp Drive on Fort Bragg, Cumberland County, as you described in your application received by the Division of Water Quality on August 21, 2002. The purpose of this project is to repair a storm drain associated with Butner Road near Varsity Road on Fort Bragg. After reviewing your application, we have decided that this fill is covered by General Water Quality Certification Number 3374, which can be viewed on our web site at http://h2o.enr.state.nc.us/ncwetlands . This Certification allows you to use Nationwide Permit Number 12 when the Corps of Engineers issues it. In addition, you should get any other federal, state or local permits before you go ahead with your project including (but not limited to) Sediment and Erosion Control, Coastal Stormwater, Non-Discharge and Water Supply Watershed regulations. Also this approval will expire when the accompanying 404 permit expires unless otherwise specified in the General Certification. This approval is only valid for the purpose and design that you described in your application. If you change your project, you must notify us 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 a copy of the Certification and approval letter and is thereby responsible for complying with all conditions. If total wetland fills for this project (now or in the future) exceed one acre, compensatory mitigation may be required as described in 15A NCAC 2H .0506 (h). For this approval to be valid, you must follow the conditions listed in the attached certification and the additional conditions listed below: 1. The culvert must be designed, constructed and placed one foot below ground level to allow aquatic life passage; 2. You are required to return the attached Certification of Completion form to notify DWQ when all work included in the 401 Certification has been completed. If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearing. You must act within 60 days of the date that you receive this letter. To ask for a hearing, send a written petition which conforms to Chapter 1508 of the North Carolina General Statutes to the Office of Administrative Hearings, 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 Ken Averitte in our Fayetteville Regional Office at (910) 486-1541 or Cyndi Karoly in our Central Office in Raleigh at 919-733-9721. Sincerely, AW Wcbk Attachments cc: Corps of Engineers Wilmington Regulatory Field Office Fayetteville DWQ Regional Office Central Files File Copy N. C. Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 (919) 733-7015 Michael F. Easley, Governor William G. Ross Jr., Secretary North Carolina Department of Environment and Natural Resources Alan W. Klimek, P.E. Director Division of Water Quality . Klime , P.E. % 021335 Customer Service 1 800 623-7748 MEMORANDUM TO: John Dorney Regional Contact: Ken Averitte Non-Discharge Branch WQ Supervisor: Paul Rawls Date: SUBJECT: WETLAND STAFF REPORT AND RECOMMENDATIONS Facility Name Butner Road Storm Drain Project Number 02 1335 Recvd From APP Received Date 8/21/02 Recvd By Region 9/10/2002 Project Type storm drain improvements County Cumberland County2 Region Fayetteville Certificates Stream Stream Impacts (ft.) Permit Wetland Wetland Wetland Stream Class Acres Feet Type Type Impact Score Index Prim. Supp. Basin Req. Req. ME 12 ?- O Y O N F_ 18-23-27-1 F -cF- 30,614. 1 230.00 1- Mitigation Wetland MitigationType Type Acres Feet Is Wetland Rating Sheet Attached? O Y (ON Did you request more Info? O Y (ON Have Project Changes/Conditions Been Discussed With Applicant? O Y 0 N Is Mitigation required? O Y O N Recommendation: O Issue 0 Issue/fond 0 Deny Provided by Region: Latitude (ddmmss) 350933 Longitude (ddmmss) 785852 Comments: Project involves replacement of deteriorating 60" CMP with 72" RCP p*pe- headwalls, and rigrap apron at discharge end. Pips is aligned with existing drainage atj?(this is not a 90 degree road crossing). Recommend approval with requirement that pipe invert be buried one foot according to standard DOT requirements, cc: Regional Office Central Office Page Number 1 Tardy Projects as of October 2, 2002 County I DWQ# Project Regional Office CO staff CO Received Date Drop Dead 7l Date Johnston 021314 Lee and Pamela Gilliam RRO Cyndi Karoly 8/19/02 10/17/02 Franklin 021275 Van G. Boathouse and Dockage/Robert W. Van Graefieland RRO Cyndi Karoly 8/12/02 10/10/02 Wake 021297 Crabtree Crossing RRO Cyndi Karoly 8/16/02 10/14/02 Cumberland 021335 Butner Road Storm Drain FRO Cyndi Karoly 8/21/02 i 10/19/02 i Rutherford 021328 Sparks Crossing ARO Dave Penrose 8/20/02 10/18/02 Beaufort 021296 Charles Thomas Poston WARO Bob Zarzecki 8/14/02 ! 10/12/02 Dare 021334 Barbara Taylor WARO Bob Zarzecki 8/21/02 10/19/02 i Variance Requests: Laura B. Barabas, Hyde Co., 02-1310, received 8/19/02 Arthur J. Wikander, Pamlico Co., 02-1278, received 8/13/02 John and Kathleen Buck, Pamlico Co., 02-1263, received 8/12/02 i Date: _Z To: ?RRO Steve Mitchell ?FRO Ken Averitte ,V []WaRO Deborah Sawyer EaWiRO Joanne Steenhuis? ?WSRO Jennifer Frye DARO Mike Parker ?MRO Pete Colwell From: •??6,n l.c Triage Chec Lis i Project Name ?y?„??,?g DWQ Project Number Dot i 3 j County u, ?N4 Telephone (919) 733- : fy The file attached is being forwarded to you for your evaluation. Please call if you need assistance. ? Stream length impacted ? Stream determination I ? Wetland determination and distance to blue-line surface waters on USGW topo maps n mization/avoidance issues ? Buffer Rules (Neuse, Tar-Pamilco, Catawba, Randleman) ? Pond fill ? Mitigation Ratios ? Ditching ? Are the stream and or wetland mitigation sites available and viable? ? Check drawings for accuracy ? Is the application consistent with pre-application meetings? [] Cumulative Impact concems - Comments { DEPARTMENT OF THE ARMY HEADQUARTERS, XVIII AIRBORNE CORPS AND FORT BRAGG FORT BRAGG, NORTH CAROLINA 28310 REPLY TO ATTENTION OF: August 14, 2002 Public Works Business Center Ms. Lillette Moore 4u Wilmington Regulatory Field Office j United States Army Corps Of Engineers t Post Office Box 1890 Wilmington, North Carolina 28402-1890. Dear Ms. Moore: AUG? ? .f ..1 Enclosed is a Pre-Construction Notification form for a Nationwide Permit Number 12 Utility Line Discharges as required by Section 404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act, and for the North Carolina Division of Water Quality's associated General 401 Water Quality Certifications. We understand the activities must comply with any regional conditions that have been added by the Corps of Engineers (COE) and with any case specific conditions added by the COE or by the State in its Section 401 water quality certification. Any condition in this certification, which is not met, requires notification to and written concurrence from North Carolina Division of Water Quality. This permit area action involves replacement of_an-existing culvert that crosses underneath Sharp Drive with a`202-fg?)t culvert, at Fort Bragg, North Carolina. Cumulative impacts include an additional 28 feet of impacts to linear stream footage involving a cement wall and rip-rap. Total cumulative impacts in linear feet are 230 feet. If you have any questions, please contact Mr. Erich Hoffman, at (910) 396-2867. Sincerely, Rjlo_? `L w1,1, GREGORY G. BEAN Colonel, U.S. Army Director of Public Works Business Center Office Use Only: Form Version October 2001 USACE Action ID No. DWQ No. If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than leaving the space blank. 1. Processing 1. Ch ck all of the approval(s) requested for this project: ?vSection 404 Permit ? Section 10 Permit 401 Water Quality Certification ? Riparian or Watershed Buffer Rules 2. Nationwide, Regional or General Permit Number(s) Requested: Nationwide 12 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: ? II. Applicant Information Owner/Applicant Information Name: U.S. Army XVIII Airborne Corps Mailing Address: XVIII Airborne Corps and Fort Bragg ATTN: AFZA-PWBC Building 3-1631 Butner Road Fort Bragg, NC 28310 Telephone Number: (910)396-4009 Fax Number: 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: Company Affiliation: Mailing Address: Telephone Number: Fax Number: E-mail Address: Page 1 of 9 III. 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: Repair Storm Drain, Butner Road near Varsity Road. 2. T.I.P. Project Number or State Project Number (NCDOT Only): 3. Property Identification Number (Tax PIN): 4. Location County: Cumberland Nearest Town: Spring Lake Subdivision name (include phase/lot number): Directions to site (include road numbers, landmarks, etc.): The project is located at the intersection of Butner Road and Varsity Road, Fort Bragg NC. 5. Site coordinates, if available (UTM or Lat/Long): UTM 83959235 (Note - If project is linear, such as a road or utility line, attach 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: Industrial 7. Property size (acres): Disturbed construction area is less than 0.5 acre, located on Fort Brae 8. Nearest body of water (stream/river/sound/ocean/lake): Young's Lake 9. River Basin: Cape Fear (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/admin/maps/.) Page 2 of 9 10. Describe the purpose of the proposed work: This project will replace approximately 200 feet of failing 48" x 60" corrugated metal storm pipe that crosses Butner and Varsity Roads with a new 72" diameter reinforced concrete pipe. 11. List the type of equipment to be used to construct the project: All typical construction equipment used for earthwork projects. 12. Describe the land use in the vicinity of this project: Developed - Military IV. 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. V. Future Project Plans Are any future permit requests anticipated for this project? If so, describe the anticipated work, and provide justification for the exclusion of this work from the current application: No additional permit requests anticipated. VI. 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 3 of 9 1. Wetland Impacts Wetland Impact Site Number (indicate on ma) Type of Impact* Area of Impact (acres) Located within 100-year Floodplain** (es/no) Distance to Nearest Stream (linear feet) Type of Wetland*** # 1 Mechanized Excavation Approx10 . <, Acre No Adjacent Riparian Forested Wetland * List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill, excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding. ** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps (FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or online at http:/hvww.fema.pov. *** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond, Carolina Bay, bog, etc.) List the total acreage (estimated) of existing wetlands on the property: 0 acres Total area of wetland impact proposed: NA 2. Stream Impacts, including all intermittent and perennial streams Stream Impact Site Number (indicate on ma) Type of Impact* Length of Impact (linear feet) Stream Name** Average Width of Stream Before Impact Perennial or Intermittent? leasespecify) #1 Culvert . 202 UT, flows into Young's Lake, which flows into Tank Creek Approximately 6 feet Perennial #2 Cement Wall 4 Same as Above Same as Above Same as Above #3 Rip-Rap 20-25 Same as Above Same as Above Same as Above * List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap, dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain), stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included. ** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at www.usgs.gov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com, www.mapquest.com, etc.). Cumulative impacts (linear distance in feet) to all streams on site: 230 feet Page 4 of 9 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* Area of Impact (acres) (if Name p Waterbody applicable) Type of Waterbody (lake, pond, estuary, sound, bay, ocean, etc.) NA * List each impact separately and identify 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.): NA Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond, local stormwater requirement, etc.): Size of watershed draining to pond: Expected pond surface area: 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. The proposed proiect will replace a failins? 48" by 60" by 200 foot lone corrueated metal nine with a 72" diameter reinforced concrete pipe. Because the pipe conveys a small [perennial?] stream under Butner and Varsity Roads to Young's Lake on Fort Bragg there is no reasonable alternative to replacing it. However, the only impact will be temporary during construction. Page 5 of 9 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 http://h2o.enr.state.nc.us/ncwetiands/strnit4ide.htm1. 1. 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. 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.tis/wrp/index.htm. If Page 6 of 9 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): 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): IX. Environmental Documentation (DWQ Only) Does the project involve an expenditure of public funds or the use of public (federal/state/local) land? Yes X 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 (919) 733-5083 to review current thresholds for environmental documentation. Yes X 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. Yes ? No ,U X. 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 (Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please identify )? Yes ? No X If you answered "yes", provide the following information: Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer mitigation is required calculate the required amount of mitigation by applying the buffer multipliers. Zone* Impact (square feet Multiplier Required Min ation 1 3 Page 7 of 9 If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as identified within 15A NCAC 2B .0242 or .0260. XI. Stormwater (DWQ Only) Describe impervious acreage (both existing and proposed) versus total acreage on the site. Discuss stormwater controls proposed in order to protect surface waters and wetlands downstream from the property. The proposed project will replace a failing 4_8" by 60" by 200 foot long corrugated metal pipe with a 72" diameter reinforced concrete pipe The pipe conveys a small [perennial?] stream under Butner and Varsity Roads to Young's Lake on Fort Bragg. The proposed method is an approximately 40 foot wide open excavation. Considering the excavation and room for equipment and access, the entire project should disturb less than a half acre Tunnelling alternatives were considered but rejected because of cost. Since the project will replace an existing pipe with a pipe of almost the same size there will be no change ipervious acreage Sediment entering the stream as a result of the construction will be minimized by 1) pumping the stream around the excavation during construction-, 2) silt fence and inlet protection where practical; 3 seeding, mulching and establishing permanent vegetation on disturbed areas as soon as possible after construction is complete; and 4) replacing the pipe as quickly as possible to minimize the time that the area is disturbed. XII. Sewage Disposal (DWQ Only) Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of wastewater generated from the proposed project, or available capacity of the subject facility. XIII. Violations (DWQ Only) Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules? Yes ? No X Page 8 of 9 Zone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an additional 20 feet from the edge of Zone 1. Is this an after-the-fact permit application? Yes ? No X XIV. 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). akly) S ,q vo? ?,2 Applicant/Agent's Signature Date (Agent's signature is valid only if an authorization letter from the applicant is provided.) Page 9 of 9 0 u IN Z Z ?wy Z W a z w = a x Q Z o o x ll_ ~ a 7 W 7 Z F co ai u z x a" a ct: z z z ?S i z U m i w Z Y? a >? 3 v o ; 0 v) x > ? d Q N J LL n ? ? ' 1 1 1 1 x `? Q iL ? o ? (D tX F] P-41 E [B C El i l l l l g `• T ? • All- 9 11