19920628 Ver 1_Complete File_19930105

State of North Carolina
Department of Environment, Health, and Natural Resources
. Division of Environmental Management
512 North Salisbury Street • Raleigh, North Carolina 27604
James G. Martin, Governor A. Preston Howard, Jr., P.E.
William W. Cobey, Jr., Secretary January 5, 1993 Acting Director
David J. Savage
NC DOT - Right of Way
190 Marshburn Hill Road
Marshall, North Carolina 28753
Dear Mr. Savage:
Subject: Proposed Fill in Wetlands or Waters
Road improvement
Madison County
DEM Project # 92628
Upon review of your request for Water Quality certification
to place fill material in 0.12 acres of wetlands or waters for
widening and realigning SR 1565 located at SR 1565A in Madison
County, we have determined that the proposed fill can be covered
by General Water Quality Certification No. 2732 issued January
21, 1992. A copy of the General Certification is attached. This
Certification may be used in qualifying for coverage under Corps
of Engineers' Nationwide Permit No. 14.
If you have any questions, please contact John Dorney at
919/733-1786.
Sincerely,
reston oward, P.E.
APH:JD
Attachment
cc: Wilmington District Corps of Engineers
Corps of Engineers Asheville Field Office
Asheville DEM Regional Office
Mr. John Dorney
Central Files
REGIONAL OFFICES
Asheville Fayetteville Mooresville Raleigh Washington Wilmington Winston-Salem
704/251-6208 919/486-1541 704/663-1699 919/571-4700 9191946-6481 919/395-3900 919/896-7007
Pollution Prevention Pays
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone]
An Equal Opportunity Afrumative Action Employer

1
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DEM ID:
JOINT REQUIRE APPLICATION NOTIFIICATI O R
NATIONWIDE PERMITS THAT
ON.TOTHE DISTRICT ENGINEER
NATIONWIDE PERMITS T14AT REQUIRE SECTION 401 CERTIFICATION CONCURRENCE
NATIONWIDE PERMITS THAT REQUIRE INDIVIDUAL SECTION 401 CERTIFICATION
WILMINGTON DISTRICT ENGINEER
CORPS OF ENGINEERS
DEPARTMENT OF THE ARMY
P.O. BOX 1890
WILMINGTON, NC 28402-1890
ATTN: CESAW-CO-E
Telephone [phone]
WATER QUALITY PLANNING
DIVISION OF ENVIRONMENTAL MANAGEMENT
NC DEPARTMENT OF ENVIRONMENT, HEALTH,
AND NATURAL RESOU Fna? P.o. BOX 29535
RALEIGH, NC 27626
ATTN: MR. JOHN DO Telephone (919) 73 3 OCT 2 z i?r'?
ONE (1) COPY OF THIS COMPLETED APPLICATION SHOULD BE SEN TOITH 3, ,
EjDb
ENGINEERS. SEVEN (7) COPIES SHOULD BE SENT TO THE N.C. D VISI?fiYOF
ENVIRONMENTAL MANAGEMENT. PLEASE PRINT. "
1. OWNERS NAME:
2. OWNERS ADDRESS:
3. OWNERS PHONE NUMBER (HOME):
0/q/,/ -

(WORK)•

If. IF APPLICABLE/,') AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL; ` AOL111?SS,`?
PHONE NUMBER: 21,;/ ?7- , -,- -- ,c)c-
'1 '7
7
5. LOCATION OF PLANNED WORK (ATTACH MAP).
COUNTY: 1M&11Jo.7
NEAREST TOWN OR CITY : / ,¢,S ,'
SPECIFIC LOCATION (INCLUDE ROAD NU
\. ? \?ry ??ie ? s .X'fr oa? ,Eat s?
Iti LAN] ARKS, ETC.):
6. NAME OF CLOSEST STREAM/RIVER: ?i??-
7. RIVER BASIN: "x
8. IS THIS PROJECT LOCATED IN WATERSH
WS I, OR WS II? YES EJI?PLASSIFIED AS TROUT, SA,
NO [
1(QW, ORW,
9. HAVE ANY SECTION 404 PERMITS BEoEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROPERTY? YES IF YES, EXPLAIN.

G'
CC1
10. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS L&ATED ON PROJECT SITE: O 2 v Ac?Ps

N

DEM ID: 262,,?
WATER QUALITY PLANNING
DIVISION OF ENVIRONMENTAL MANAGEMENT
NC DEPARTMENT OF ENVIR UMpr?T ,1-EA?4j , -?---- -
AND NATURAL RESOUR
P.O. BOX 29535
ATTNIGNMR. JO IN6DORNEY OCT 2 Z 199Z
Telephone [phone]
JOINT APPLICATION FORM FOR
NATIONWIDE PERMITS THAT REQUIRE NOTIFICATION TO THE DISTRICT ENGINEER
NATIONWIDE PERMITS THAT REQUIRE SECTION 401 CERTIFICATION CONCURRENCE
NATIONWIDE PERMITS THAT REQUIRE INDIVIDUAL SECTION 401 CERTIFICATION
WILMINGTON DISTRICT ENGINEER
CORPS OF ENGINEERS
DEPARTMENT OF THE ARMY
P.O. BOX 1890
WILMINGTON, NC 28402-1890
ATTN: CESAW-CO-E
Telephone [phone]
ONE (1) COPY OF THIS COMPLETED APPLICATION SHOULD BE SENT TO ?HE
ENGINEERS. SEVEN (7) COPIES SHOULD BE SENT TO THE N.C. DIVISION
ENVIRONMENTAL MANAGEMENT. PLEASE PRINT.
1. OWNERS NAME: A/c.
2. OWNERS ADDRESS:

ACTION ID:
3. OWNERS PHONE NUMBER (HOME):
4. IF APPLICABLE.: AGENT'S NAME
PHONE NUMBER: Z-k"w '7- <
(WORK) :
RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
5. LOCATION OF PLANNED WORK (ATTACH MAP).
COUNTY: li)wall'101
NEAREST TOWN OR CITY:
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS LANDMARKS, ETC.):
6. NAME OF CLOSEST STREAM/RIVER: ?veY ?i??
7. RIVER BASIN: X
8. IS THIS PROJECT LOCATED iN A WATERSHE
•? ?ASSIFIED AS TROUT, SA, HQW, ORW,
WS I, OR WS II? YES [ NO [
9. HAVE ANY SECTION 4011 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROPERTY? YES [ ] NO [ y?
IF YES, EXPLAIN.
10. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS L&ATED ON PROJECT SITE: O 20 AcfP5
• J
-2-
11. NUMBER OF ACRES OF WETLAND IMPACTED BY THE PROPOSED PROJECT:
-FILLED: o./2
DRAINED:
FLOODED:
EXCAVATED:
TOTAL IMPACTED: b.
12. DESCRI TION OF PROVO D WORK (ATTACH PLANS): ?77?ee C/I)/? ?•???p???y
v o a
13 . PURPOSE OF PROPOSED WORK: ,•,,,
i v
111. STATE REASONS WHY THE APPLICANT BELIEVES THAT THIS ACTIVITY MUST BE
CARRIED OUT IN WETLANDS. ALS NOTE MEASURES TAKEN TO MINIMIZE WETLAND
IMPACTS. See ft ?yr• =- J$ /o ?i?? ??C°SS1p+ ?1°.9surPc
15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SERVICE
(USFWS) AND/OR NATIONAL MARINE FISHERIES SERVICE (NMFS) REGARDING THE PRESENCE
OR 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. HAVE YOU DONE SO? YES [ ). NO [\,r
RESPONSES FROM THE USFWS AND/OR NMFS SHOULD BE ATTACHE.
16. YOU ARE REQUIRED TO C014TACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE PERMIT AREA WHICH
MAY BE AFFECTED BY THE PROPOSED PROJECT?
HAVE YOU DONE SO? YES [ ] NO [?Q
RESPONSE FROM THE SHPO SHOULD BE ATTACHED.
17. ADDITIONAL INFORMATION REQUIRED BY DEM:
A. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, AND LAKES ON
THE PROPERTY.
B. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE IMPACTED BY
PROJECT.
C. IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA SHEETS
RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
D. IF A STORMWATER MANAGEMENT PLAN IS REQUIRED FOR THIS PROJECT, ATTACH
COPY.
E. WHAT IS LAND USE OF SURROUNDING PROPERTY?
F. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
OWNER'S SIGNATURE
-/Z/-
DATE

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N.C. DEPARTMENT OF TRANSPOR1ATION
DIVISION OF HIGHWAYS
SECONDARY ROAD SURVEY

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