20051059 Ver 2_Application_20070316

- ~ Martin Marietta Aggregates
Charlotte District
P.O. Box 7446
Charlotte, NC 28241-7446
Telephone [phone]
Fax [phone]
March 13, 2007
Mr. Steve Chapin
United States Corp of Engineers
151 Patton Ave., Room 143
Asheville, NC 28801-5006
Re: PCN Application for a Proposed Fresh Water Pond
Martin Marietta's Denver Quarry
Dear Mr. Chapin:

~~.
';:
CERTIFIED MAIL
RETURN RECEIl'T REQUESTED
7005 1820 0000 0465 1281
PAYMENT
RECEIVED
Based on the requirements for 404/401 permits, aPre-Construction Notification application
requesting approval for a proposed fresh water pond in a tributary of Killian Creek is being
requested for Martin Marietta's Denver Quarry. As you may remember, a request was made a
year or so ago to flood this stream while a new access was constructed across the tributary.
Due to the potential EEP mitigation costs, this project was reduced to only an access, less than
150' of hard impact. Since that time, we have determined that due to the potential for the lack
of fresh water to operate our quarry, this pond is needed to continue the availability of crushed
stone to the surrounding community.
This quarry is located off of Highway 16 South, just south of NC Highway 150 near the
Catawba and Lincoln County line. The attached drawings and maps outline the proposed
location, layout and mitigation activities required by your Department. Due to the nature of
this project, the proposed fresh water pond will have a surface area of approximately 1.56 acres
and flood a distance of 540' of stream channel. Since on-site mitigation is not available, our
only option is to make payment into the North Carolina Ecosystem Enhancement Program
(NCEEP). Included in this application, you will find a letter dated March 9, 2007 that was sent
to Mr. Bill Gillmore with the NC EEP requesting approval into this program. It is requested
that a stream impact amount can be agreed upon, based on the poor quality of this tributary and
the minimal impact this proposed pond will have.
By copy of this letter, the NC Wetlands Group is officially notified for Section 401
Certification approval using Certified Mail # 7005 1820 0000 0465 1274.
Qr~c~~od~~
MAR 1 6 207
yyFTtANDS AND ST EORM~N ~ BRANCN

If you have any questions, please contact me at [phone] or a-mail me at
brian. north(c~ martinmarietta. com.
Sincerely,
MARTIN MARIETTA MATERIALS, INC.
Brian K. orth, PE
Manager, Engineering Services
cc: 401 Wetlands Group
6301PCNcvr&natT

MARTIN MARIETTA MATREIALS, INC.
FRESH WATER IMPOUNDMENT
ON A TRIBUTARY OF KILLIAN CREED
DENVER QUARRY
NARRATIVE
Martin Marietta proposes to construct a new fresh water pond within the 165-acre boundary of
Martin Marietta's Denver Quarry. This pond will serve as a water supply for aggregate
production and for the operation of the quarry. The proposed impoundment will have a surface
area of approximately 1.56 acres and impound against an existing roadway crossing over a
tributary of Killian Creek.
A distance of 540' of tributary channel is proposed for flooding with this submittal. Upon
completion of the proposed flooding, a 50' undisturbed buffer will also be maintained around
the perimeter of the proposed pond, as required by the NC Mining Permit requirements for this
project. In lieu of on-site mitigation and due to the inability to construct or perform such
mitigation, Martin Marietta agrees to make payment into the North Carolina Ecosystem
Enhancement Program (NCEEP), based on a letter dated March 9, 2007 to the NCEEP
requesting acceptance into this program. Upon approval from the NCEEP, a copy of this
acceptance will be forwarded to the Corp and to NCDWQ. As always, the Corp of Engineers
and the North Carolina Water Quality Section are invited to inspect the project during and after
construction is completed.
A $475.00 application fee is attached to this PCN application for NC 401 Certification and
approval.
630~PCNcvr&nazr

Martin Marietta Materials
P. O. Box 30013
Raleigh. North Carolina 27622-0013
Telephone: [phone]
March 9, 2007
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
7005 1820 0000 0465 1571
Mr. Bill Gillmore
North Carolina Ecosystem Enhancement Program
2728 Capitol Blvd., Suite 1H-103
Raleigh, NC 27604
Re: EEP Request for a Proposed Impoundment of Killian Creek
Martin Marietta's Denver Quarry
Dear Mr. Gillmore:
Martin Marietta is in the process of permitting a 1.56-acre impoundment, which will impact 540'
of a small tributary of Killian Creek at our Denver Quarry operation. This quarry is located off
of Highway 16 South, just south of NC Highway 150 near the Catawba and Lincoln County line.
Prior to the issuance of the 401 Certification for this project, it is our understanding that this
proposed impact will require mitigation in the form of a stream restoration plan or payment into
the North Carolina Ecosystem Enhancement Program. (NCEEP). In review of the proposed
project, on-site mitigation or stream restoration will not be possible. Therefore, our only option
is to make payment into the NCEEP.
Please find enclosed a copy of our PCN application that describes the proposed project and an
aerial of the proposed impoundment. Written authorization of your acceptance of this proposal
is requested so that official submittal of this PCN can be completed.
If you have any questions, please contact Brain North at [phone] or via
brian.north(a~martirunarietta. com.
Sincerely,
~ j/
Daniel Shephard
Executive Vice President
MARTIN MARIETTA MATERIALS, INC.
630\EEP Request

Office Use Only: Form Version March 05
USACE Action ID No. DWQ No. V a. ~ 5' ~ ~ S q
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
I. Processing PAYMENT
1. Check all of the approval(s) requested for this project: RECEIVED
® Section 404 Permit ^ Riparian or Watershed Buffer Rules
^ Section 10 Permit ^ Isolated Wetland Permit from DWQ
® 401 Water Quality Certification ^ Express 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: NWP 39
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 Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts, attach the acceptance letter from NCEEP, complete section VIII,
and check here:
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), the O ~~~(]~ 4
II. Applicant Information 6 2007
MAR 1
1. Owner/Applicant Information pENR - WA7F,Ft pUAl11Y
Name: Martin Marietta Materials, Inc. WETIAND3 ANO STORI1WATfdt BRANCN
Mailing Address: P.O. Box 7446
Charlotte. NC 28241
Telephone Number: 919-781-4550 Fax Number: 919-783-4695
E-mail Address: dan.shephard~u,martinmarietta.com
2. Agent/Consultant 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 5 of 13

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: Proposed Fresh Water fond of tributary to Killian Creek at Denver
Quarry Denver NC
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): 368604506002
4. Location
County: Lincoln Nearest Town: Denver. NC
Subdivision name (include phase/lot number):
Directions to site (include road numbers/names, landmarks, etc.): From Denver, NC,
proceed north on Hi~hway 16 approximately 3 miles to Martin Marietta's Denver Quarry
located on the left The site is located approximately 1.5 miles south of Highway 16 and NC
Highway 150 Intersection.
Site coordinates (For linear projects, such as a road or utility line, attach a sheet that
separately lists the coordinates for each crossing of a distinct waterbody.)
Decimal Degrees (6 digits minimum): N35°-32.86' °N E81°-03.98' °W
6. Property size (acres): 164.68
7. Name of nearest receiving body of water: Killian Creek
8. River Basin: Catawba
(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/.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: Site is presently used for mining of native granite and is
Page 6 of 13

generally located in a rural area consisting- of farm land and residential, with minor
commercial areas.
10. Describe the overall project in detail, including the type of equipment to be used: A new
fresh water pond is proposed to provide make-up water for the crushing_plant operation.
Pans and bulldozers will be used as needed to clear the proposed impoundment area for the
pond This project will require approval from the NC Land Quality Section for compliance
with the NC Minim Act.
11. Explain the purpose of the proposed work: To construct a new fresh water (1.56 acre
surface area) for the plant operation. The previously inatalled roadway access recently
permitted wil be used as the dam to form the new fresh water impoundment.
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. Action ID# 200532512, No 401 Certification required for piping less
than 150' of stream Application dated May 25, 2005, 404 permit issued August 8, 2005
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.
Future plans may include a creek relocation project on property that is being investigated for
purchase at this time, but is not currently under the control of Martin Marietta.
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. Each impact must be
listed separately in the tables below (e.g., culvert installation should be listed separately from
riprap dissipater pads). Be sure to indicate if an impact is temporary. All proposed impacts,
permanent and temporary, must be listed, and must be labeled and clearly identifiable on an
accompanying site plan. All wetlands and waters, and all streams (intermittent and perennial)
should 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.
Page 7 of 13

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.
1. Provide a written description of the proposed impacts: The proposed impact of
approximately 540' of stream channel consisting. of flooding a tributary of Killina Creek..
The surface area of the pond will be approximately 1.56 acres. A 50' buffer is being
proposed around the future pond, as required by the NC mining_permit for this quarry.
2. Individually list wetland impacts. Types of 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.
Wetland Impact
Site Number
(indicate on map)
Type of Impact Type of Wetland
(e.g., forested, marsh,
herbaceous, bog, etc.) Located within
100-year
Floodplain
( es/no) Distance to
Nearest
Stream
(linear feet) Area of
Impact
(acres)

Total Wetland Impact (acres)
3. List the total acreage (estimated) of all existing wetlands on the property:2 ac.
4. Individually list all intermittent and perennial stream impacts. Be sure to identify temporary
impacts. Stream impacts include, but are not limited to placement of fill or culverts, dam
construction, flooding, relocation, stabilization activities (e.g., cement walls, rip-rap, crib
walls, 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. To calculate acreage, multiply length X width, then divide by 43,560.
Stream Impact
Number
(indicate on ma)
Stream Name
Type of Impact Perennial or
Intermittent? Average
Stream Width
Before Im act Impact
Length
(linear feet) Area of
Impact
(acres)
#1 Trib of Killian Ck. Flooding Perennial 5' 540' 0.0620

Total Stream Impact (by length and acreage) 540' 0.0620
Page 8 of 13

5. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.). Open water impacts include, but are not limited to
fill, excavation, dredging, flooding, drainage, bulkheads, etc.
Open Water Impact

Site Number
(indicate on ma)
Name of Waterbody
(if applicable)

Type of Impact Type of Waterbody

(lake, pond, estuary, sound, bay,
ocean, etc.) Area of

Impact
(acres)

Total Open Water Impact (acres)
6. List the cumulative impact to all Waters of the U.S. resulting from the project;
Stream Impact (acres): 0.0620
Wetland Impact (acres):
Open Water Impact (acres):
Total Impact to Waters of the U.S. (acres)
Total Stream Impact (linear feet): 540'
7. Isolated Waters
Do any isolated waters exist on the property? ^ Yes ®No
Describe all impacts to isolated waters, and include the type of water (wetland or stream) and
the size of the proposed impact (acres or linear feet). Please note that this section only
applies to waters that have specifically been determined to be isolated by the USACE.
8. 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.): Use existing roadway crossing for impoundment
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): Fresh water pond for quarryprocess
Current land use in the vicinity of the pond: Minim
Size of watershed draining to pond: 475 Ac.
Expected pond surface area: 1.56 ac.
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
Page 9 of 13

were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
Denver Quarry serves the local area with construction aggregate and building materials. This
product is vital to the surrounding community. Water is scarce in the summer months as the
tributary of Killian creek is reduced to minimal flow The stream channel proposed for the new
pond is limited in length and will provide a sufficient volume of water to allow for minim
operations A 50' natural existing buffer is also proposed around the surface area of the pond to
protect the habitat in the area The portion of the stream channel selected for the impact will be
minimized to provide for a sufficient amount of water volume to be available for the quarr~g
process. Also the~proposed impact will be monitored by the NC land Quality Section and
regulated by the NC mining Act. Adequate erosion and sediment control will be designed and
provided during the construction of this pond.
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 January 15, 2002, 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 NCEEP 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/ncwetlands/stnn~ide.html.
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.
Page 10 of 13

The proposed miti atg ion plan will include the stabilization of the existing embankment
with a permanent ground cover sufficient to restrain erosion. The embankment will have a
2:1 front slope and a 2:1 back slope. A natural vegetated buffer will remain around the
proposed distrubance and will be maintained at a minimum distance of 50' undisturbed. This
buffer will aid in the natural setting for the existing habitat on the property. Martin Marietta
proposes to plant wetland species riparian trees around the surface line of the proposed pond,
consisting of Swamp Chestnut Oak, Water Tupelo, Southern Waxmyrtle, Hazel Alder, Red
maple Roughleaf Dogwood, Swamp Blackgum, Bald Cyprus, and Willow Oak. These
plantings will be obtained from the NC Division of Forest Resources, Edwards Nursery,
located in Morganton, NC. These plantings will be 10' on-center and staggered 3' up the
bank along the normal flood elevation of the embankment. In addition, Martin Marietta
proposes to pay into the Ecosystem Enhancement Prog, am (EEP) with $232/ft of stream
impact.
2. Mitigation may also be made by payment into the North Carolina Ecosystem Enhancement
Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at
[phone] to determine availability, and written approval from the NCEEP indicating
that they are will to accept payment for the mitigation must be attached to this form. For
additional information regarding the application process for the NCEEP, check the NCEEP
website at http://h2o.enr.state.nc.us/wrp/index.htm. If use of the NCEEP is proposed, please
check the appropriate box on page five and provide the following information:
Amount of stream mitigation requested (linear feet): 540'
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount ofNon-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
IX. Environmental Documentation (required by DWQ)
1. Does the project involve an expenditure of public (federal/state/local) funds or the use of
public (federal/state) land? Yes ^ No
2. If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ^ No ^
If yes, has the document review been finalized by the State Clearinghouse? If so, please
attach a copy of the NEPA or SEPA final approval letter. Yes ^ No ^
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
Page 11 of 13

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.
1. Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 02B .0243 (Catawba) 1 SA NCAC
2B .0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please
identify )? Yes ^ No
2. If "yes", 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 Multi lier Required
1 3 (2 for Catawba)
2 1.5
Total
* Zone 1 extends out 30 feet perpendicular from the top of the near bank of channel; Zone 2 extends an
additiona120 feet from the edge of Zone 1.
3. If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e.,
Donation of Property, Riparian Buffer Restoration /Enhancement, or Payment into the
Riparian Buffer Restoration Fund). Please attach all appropriate information as identified
within 15A NCAC 2B .0242 or .0244, or .0260.
XI. Stormwater (required by DWQ)
Describe impervious acreage (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. If percent impervious surface exceeds 20%, please provide calculations
demonstrating total proposed impervious level. N/A
XII. Sewage Disposal (required by DWQ)
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.
N/A
Page 12 of 13

XIII. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ^ No
Is this anafter-the-fact permit application? Yes ^ No
XIV. Cumulative Impacts (required by DWQ)
Will this project (based on past and reasonably anticipated future impacts) result in additional
development, which could impact nearby downstream water quality? Yes ^ No
If yes, please submit a qualitative or quantitative cumulative impact analysis in accordance with
the most recent North Carolina Division of Water Quality policy posted on our website at
http://h2o.enr.state.nc.us/ncwetlands. If no, please provide a short narrative description:
XV. 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).
Applicant/Agent's Signature / Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 13 of 13

Personal Account Information Redacted
^ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
^ Print your name and address on the reverse
so that we can return the card to you.
^ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
Mr. Steve Chapin
United States Corp of Engineers
151 Patton Avenue, Room 143
Asheville, NC 28801-5006
4. Restricted Delivery? (Extra Fee) ^ Yes
2. Article Number
(Transfer from service fabe!) 7 0 5 18 2 D o o ~ a X 4 6 5 12 81,
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540'
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A. Signature
X ^ Agent
^ Addressee
B. Received by (Printed Name) C. Date of Delivery
D. Is delivery address different from item 1? ^ Yes
If YES, enter delivery address below: ^ No
3. Se a Type
Certffied Mail ^ Express Mail
^ Registered ^ Return Receipt for Merchandise
^ Insured Mail ^ C.O.D.
Postmark
Here
Total P~ ~ Steve Chapin
a o Sent To United States Corp of Engineers -
~ ~ Street,,Aj 151 Patton Avenue, Room 143 ------
orpoeo Asheville, NC 28801-5006
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^ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
^ Print your name and address on the reverse
so that we can return the card to you.
^ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
A. Signature
X ^ Agent
^ Addressee
B. Received by (Printed Name) C. Date of Delivery
D. Is delivery address different from item 17 ^ Yes ';
If YES, enter delivery address below: ^ No
NC Division of Water Quality
401/Wetlands Unit -DWQ
1650 Mail Service Center s. sere Type
Raleigh, NC 27699-1650 t~aert'rfied Mail ^ impress Mail ~,
^ Registered ^ Retum Receipt for Merchandise
^ Insured Mail ^ C.O.D.
4. Restricted Delivery? (Extra Fee) ^ Yes ~
2. Article Number 7pp5 1,82 ~~0~ X465 1274
(transfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540 ~~
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