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HomeMy WebLinkAbout19931049 Ver 1_Complete File_19931222State of North Carolina Department of Environment, Health and Natural Resources 4 Division of Environmental Management, James B. Hunt, Jr., Governor Jonathan B. Howes, Secretary A. Preston Howard, Jr., P.E., Director December 22, 1993 Mr. George L. Teague Bridge Maintenance Supt. N.C. Dept. of Transportation 515 Camp Road Salisbury, N.C. 28147 Dear Mr. Teague: Subject: Proposed fill in Wetlands or Waters Bridge replacement, #60-047 on SR 1515 Davidson County DEM Project #931049 Upon review of your request for 401 Water Quality Certification to place fill material in waters which are tributary to Fryes Creek for bridge replacement located at SR 1515 in Davidson County as described in your submittal dated 15 December 1993, we have determined that the proposed fill can be covered by General Water Quality Certification No. 2745. A copy of the General Certification is attached. This Certification may be used in qualifying for coverage under Corps of Engineers' Nationwide Permit No. 3. If this Certification is unacceptable to you, you have the right to an adjudicatory hearing upon written request within thirty (30) days following receipt of this Certification. This request must be in the form of a written petition conforming to Chapter 150B of the North Carolina General Statutes and filed with the Office of Administrative Hearings, P.O. Box 27447, Raleigh, N.C. 27611-7447. Unless such demands are made, this Certification shall be final and binding. If you have any questions, please contact John Dorney at 919-733- 1786. Sincerely, 41estop oward, Jr. P.E. 931049.1tr Attachment cc: Wilmington District Corps of Engineers Corps of Engineers Raleigh Field Office Winston-Salem DEM Regional Office Mr. John Dorney Central Files P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone 919-733-7015 FAX 919-733-2496 An Equal Opportunity Affirmative Action Employer 50% recycled/ 101 post-consumer paper e . STATE o W STATE OF NORTH CAROLINA DEPARTMENT OF TRANSPORTATION JAMES B. HUNT. JR DIVISION OF HIGHWAYS GOVERNOR December 15, 1993 SAM HUNT SECRETARY 515 Camp Rd. Salisbury, N.C. 28147 Mr. Eric Galamb W Q Certification Unit P. O. Box 29535 Raleigh, N. C. 27626-0535 Dear Mr. Galamb : ETLAT"DS R ULAR S'- The North Carolina Department of Transportation, Bridge Maintenance Unit, proposes the following project for your review. We believe this project can be accomplished under Nationwide ff3. COUNTY Davidson County Bridge 047 ROUTE SR 1515 STREAM Fryes Creek DESCRIPTION Bridge 60-047 Replaced with Bridge. Not located in wetlands. No fill in waters. Drainage Area = 7.3 sq. mi. Average daily flow = 6.9 cfs. We have attached a site location map, planned activities. A stringent erosion a control program will be implemented during construction and every effort will be made timely manner. Our personnel are available to assist of this project, if necessary. Should you please call me at 704-639-7555. attachment. 0 R22 OWN [SEC 1 61993 and a sketch of nd sedimentation the project to complete work in a with your evaluation have any questions, Sincerely, George L. Te gue Bridge Maintenance Supt. Kg? r SID `'o DE114 ID . ? ACTIOti" III: JOINT' APPLICATION FORM7. FOR: NATIONWIDE. PERMITS THAT REQUIRE: NOTIFICATION TO THE: DISTRICT7ENGINEEII NATIONWIDE PERN.ITS° THAT-REQUIRE'SECTION 401 CERTIFICATIO11: CONCURRENCE= NATIONWIDE PE'RMITS' THAT- REQUIRE:' INDIVIDUAL SECTION 40.1 CERTIFICATIOU WILMINGTON DISTRICT E_ NGI1=T CORPS OF- ENGINEE-I S DEPARTI-.''IT OF- TF- ARMY P.0-_ Box 1890 WTILMINGTON, NC 28402-1890 ATTN'= CESAW-CO-c.. Telephone (919) 251-4511 WATER QUALIT2" PLANNING: DIVISION OF" ENVIR01 -'I7 NC. DEPART"=71, OF- ENVit AND NATURAL RESO P":0_ BOg 29535 RAT-EIGT,. NC: 27626-0 ? A=: MR*- JOHN" DO Telephone (919) 733= OF f C(; J ? as t;;1TER (LA1f NDI?iyyGcc?3 ONE: (1 ) COPY OF- THIS. COMPLETE APPLICATIONL SHOULD_ BE: SE!rr T TFtt"IC0 RP?6 ENGINE:"-.1.S_ SEVER (7) CC?!= SHOULIl BE- SrIT• TO THE N.C_ DIVISION OF- F- IRONMENTA - MANAGam-217. PLEASE`. PRINT. 1. OWNERS NAME:: N. G, /J a 7`f,-z,,,s o, ?c ?fdr ? 2_ OWNERS ADDRESS: S15- Ca 3. OWNERS PHONE NUMBER (HOt) : 705- 3 9. 7555 (WORK) 7a'/ 639- 7SSS- 4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE. CORPORATE` OFFICIAL:. ADDRESS PHONE 5. 6-_ NAIL OE CLOSEST' STP.EAMlRIVE.Rr M ?-d cI ?/ G? e?k 7-_ RIVE-1 BASIN= - 4x J k , r! - 8 _ IS THIS PROJE='LCCATED: IN- A WATERSHn'"II CLASSIFIED. AS: TROUTr SA,. HQFL',_.ORW,. } WS: rp- OR. WS III Y-71-- NO. ?.,9 HAVE ANY SECTIOU 404-2E.=ZT BEar PREVIOUSLY REQUESir.Il: FOEFUSF. OK. THIS PROPERTY? YES C I --- NO UCI _ _ _ IF- YES, EXPLAIN_ 10.. ESTIMATED TOTAL NUMBER OF- ACRES OF WETLANDS LOCATED ON PROJECT SITH: Na H.0- 2/3/92 LOCATION OF"PLANNED WORK (ATTACH MAP). COUNTY: fc? 7j .5m., NEAREST? TOWIT OR CITY: re -10, SPECIFIC: LOCATIONL (INCL F- ROAD. NUMBEHS,. LANDMARKS,.. ETC_) : O. 7 /49; e- ? _lor A ?___ ?G , k S. ? /S/-j '0"" S, ? /S/S /9c??SS ?f 1 1 . NUMBER OF' ACRES OF W'F:TTLAND IMPACTED" BY T'rE- PROPOSED' PROJc C; : FILLED: DRAINED": FLOODED: EXCAVATED: TOTAL Ile ACTED 12. DESCRIPTION OF' PROPOSED WORK (ATTACH PLANS) : / 13. PURPOSE= OF" PROPOS? 1rORK: A,,;?/arm d cam: 14. STATE: REASCNS WHY T'r.tT?.. APPLICANT PELI.'V"rs• THAT THIS ACTIVIT`T MUST BE: CARRIED OUT- III- WETLANDS. ALSO, NOTE M-.ASURES TAK=`L TO MINIMIZE:' W'Z.L NU IMPACTS'_ 15. YOU ARE REQUIRED TO CONTACT- THEE U.S. FISH AND WILDLIFE SERVICE (USF'r7S) AND/OR NATIOt1AL uARL'1r.: ISiiERIEs SERVICE (N2 S) 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 TIC PROPOSED PROJECT. HAVE YOU DONE SO? YES [ ] NO EX ]. RESPONSES FROM TH USFWS AND/OR NMFS SHOULD BE ATTACH D. 16. YOU ARE REQUIRED TO CONTACT irr' STAT HISTORIC PRESERVATION OFFICER (SHPO) REGARDING- THE.. PRESENCE OF HISTORIC PROPERTIES IN Tir" PERMIT AREA WHICH MAY BE. AFFECTED BY THE. PROPOSED. PROJECT? HAVE-YOU DONE SO? YES [. ] NO [X] RESPONSE. FROM TIRE SHPO. SHOULD- BE_ ATTACHED 17. ADDITIONAL INFORMATION REQUIRED BY DEM: A. WETLAND DEL TNEATiOPi MAP SHOWING. ALL WETLANDS, S-.REA?S, AND LAKES- ON THE-- PROPERTY`. B- IF' AVAILABLE r RE2.RZSl_-2LTATLVE= PHOTOGRAP:i OF" WETLANDS TO BE ImpACTEIX_ BY PROJECT- C _ IF- DEL_T.NZAT='0N WAS PERFORMED- BY A. CONSULTANT', INCLUDE ALL. DATA. S=- S7 RELEVANT" TCi TFiE PLACL'?1T" OF" THE DELINEATICIL LINE- D. IF" A STORMWATER MANAGL'= PLAN. IS: REQUI.REE FOR THIS PROJECT, ATTACH' COPY- / F:_ WHAT IS LAND- USE OF- SURROUNDINGPROPERTY?- GtJd?ds /Tz:aIt" F". IF- APPLICABLE, WHAT` IS PROPOSED METHOD OF SEWAGL DISPOSAL.T II k2 It? a OWNn, ' S SlG2 A J DATE z6K \IJ V- " I...? Jr. \ •\'? ?i ,??? 1 r i% a `.???0?•`i ? ?? ,?l ?i `,. U?,i. _.r-. ,: J??ti?-/ ??.??'?\? ??--. ? ..? ,I ?nj; Nz_ Rll? A .. /""ice., / /.h ?\ ,- ? ? ? r ?.` ? •h =-, /'. _ ? ? 1 ?I?I fir' ?? ?? 1 ?: ?1 ?-? ??? ? ? 900 r ? 1;_/`/ ?-/ J?_•? ?l ???k - ?_? ?1?,. ?????- __?? ?v I i.? ?? ivi ?U ?/?I}'J?N ?'?, .? _,? -v.v 11,wu ? ? ?/? 1! Cc3,u ?? ? ?i li ' ??\.A ? ??`'i Lw???; ?',?.?'? ?V 1???? 'l?`? i? it i l! ? `?? 1'?'?^ ?,-?i?? ??- ,??% rt ??? ?? l ? r',??U???• ?, / ,? ? ?\J,r' ?(?I?JI\/i 1?? ? Jao°? 'ir-.?flr'??? ?JI?? i i ;r ?-. r ?r?1> ?; ? _ ? ?? _- • ? ! it ;, 2j ?IFT n? . a -ul o? ?r r- !.r \ V\`\. `-??? \j 1_L.Il o? a >~ y K w ° O .? LI - ? a z io p. U F? ^^ Iii a 1 rh 7 r? 1 v . I It 4 ? i f 1 ? f l? I 7 1 1 I .. I I c 3 ?l 1 L^ ,U v ?t • 1 _ r 'a ? -{{ T , {?.? 4 ? f t? ( _j Jr .- ?- '- }- ? 74 ;.. 7 • 1 ) r f _ I .i r ~ ?., ?? 11 1 r ' . . j -7 ? ? j ? ? :a l- J?` {. ?;, ? '? ?? 1. .?,. ? '.?^? . ?: ?. 2( ?: '-jy,?l. , .?• i ?.tti t?f.? I ? ..1?.? „ : ?eJ . L ? ` ? .{.. }.y I? _„}.) °: -7. ? . + ?- ?r. l. r ;? ? .1'•1-,y 1 '3131 '• t?' ? :`{ ? r x , ?- ?•? 7?' , :? ?- ?-• !} }. f •1 '_7? I •?j?l f ?? ?? -h[?_ ; ? i 7 f '?-1 '?'( , amt ?? jj •? ? 1 r ..1: ? ? ? ? "Y ? • ? ? ' I t-? L? J? ? i ? ?,- ? ? j ?.. ; ? 1't -I I i i •.; ?? ?? lI P.L ii . { J 1: ? ? I ? - ? ' i;,' ?:;i {+ !1 1 ' ? i•1i q:??U ????i ??-•??: ' !?: `:?" i! iil ?!!! I ?'i ll; . 1 I J:? :j-? •,iI II ?`? ; ?? i?;.' '++i !1,? I ? I 71 * 7 4 1 .4 1.1 11 -41 I f i .1 - r? Q V `O V d d ? ? i ? ,A ? as ? u ? 0 0 Q ? V ? L U u aJ ^ N C-4 u z E Z' E p° zQ n 1 h N / oE,I: q5' iLM ACTION' III JOINT' APPLICATION FOR2t. FOR- NATIONWIDE. PERMITS THAT" REQUIRE: NOTIFICATION TO THE: DISTRICT-ENGINEEE NATIONWIDE PERMITS THAT-REQUIRE`'SECTION 401 CERTIFICATION C011CURRENC17- NATIONWIDE PERMITS: THAT- REQUIRE`' INDIVIDUAL_ SECTION 401 CERTIFICATION' WILMINGTON D IS'iRIC'L. MGINE- CORPS. OF ENGINEERS: DEPARTM-ENT OF' = ARMY P . a'_ Box 1890 WTMMINGTON, NC. 28402-1890- A=: CESAW-CO-E: Telephone (919) 251-4571 3 - ? 11493 e -? ane (9 9) 73??00 a tVr:TL',i;L'S G;a?;?_ E'.;1TEi10111ALITY uu. WATER QUALITY' PLANNI11 DIVISION. OF ENVIROMM;1n NC-DEPARTY...NT• OE" ENV AND NATURAL_RESO P-.O- BOg 29535- RA L IGE,. NC 27626-0 i ATT:T: Mff. JOHK DORN`f T lA h 1 ?" E ONE: (1 ) COPY OF- THIS. COMPLP"T.. APPLICATICtT SHOULM BE S= TM THE' CORPS b-F ENGINE 3S_ SZMT (7) COP= SHOULD. 3E7 ScE!rr TO TFF N.C_ D=ZON OF- ENVIRONMENTAL N.ANAM01M. PLEASE- PRINT. / 1. OWNERS: NAME: /?/.G, ?e d T 7`fi?.?s,oa,•?`jo?-I 2.. OWNERS ADDRESS: T Ca 3. OWNERS PHONE NUMBER (HCtE) : 7011- 639, 7555 (WORK) 7,1 /- 639-7SSS 4. IF APPLICABLE AGM'S NAME OR RESPONSIBLE CORPORA=- OFFICIAL., ADDRESS-, PHON 5. e 6-_ NAME= OE- CLCS= STREAM/RZj z /y/ e-',- I ? 7 - RIVE-117 BASIt1? ?ac! ki ,•t _ 8 _ IS: THIS: PROJECT' LOCATED: IK A WATERSHED: CLASSIFIED:. AS. TROUT, SA,. HQW`,. ORW,. I WS Lr OR. WS: IL? YE -1: G ]_ NO. (XL --- ? _....... . 9. HAVE ANY SECTION 404- PERMITS BEE.*I PREVIOUSLY REQUESTM.:Mm- USE`. OT`L: THIS: PROPERTY? YES [ ] NO [)(] IE YES` EYPLAIN_ 10.. ESTIMATED TOTAL NUMBER OF- ACRES OF- WETLAPIDS LOCATED ON PROJECT SITE: Na rG2. 2/3/92 LOCATION OF PLANNED WORK. (ATTACH MAP). COUNTY : /Dd., ; j s m., NEAREST" TOWN OR CITY: Yc ; q SPECIFIC/LCCATIOtL (INCL ROAD. NUMBERS, LANDMARKS,.. ETC-) O_ 7 14.1' e- SG?E- e ? -S• ? ?S/`/ aN S, ?, /S/S .9cc?ss ,xt 1 1. NUMBER OF ACRES OF WETLANI ` IMPACTED' BY TIM- PROPOSED' PROJECT": FILLED : DRAINED": FLOODED: EXCAVATED: TOTAL I11T ACTED: c•z2 12. DEppSCRIPTIOPI OF /P//,R/O?POSED WOR?K/ (ATTACH PLANS) : ?y 1ax ' 13. PURPOSE" OF PROPOS WORK: 7o t?J i 14. STAT.= REASONS WrriY TP.:I APPLICANT BELI."Tc T THAT- THIS. ACTT-=-- MUST BE: CARRIED OUT- III' WETLANDS. ALSO, NOTE 2m--ASURES TAK I TO MINIMIZE: WE.= IMPACTS- N 15. YOU ARE REQUIRED TO CONTACT TI-' U.S. FISH AND WILDLIFE SERVIC-7 (UScriS) AND/OR NATIONAL u.ARINF. FISHERIES SERVICE (NIB'S) REGARDING THE PRES'E'NCE OR ANY FEDERALLY LISTED OR PROPOSED FOR LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL HABITAT IN THE PERMIT AREA THAT MAY BE. AF-EECTED 3Y THE' PROPOSED PROJECT. HAVE YOU DONE SO? YES ( ] NO ?X RESPONSES FROM THE USF'riS AND/OR NMFS SHOULD BE ATTACHED. 16. YOU ARE REQUIRED TO CONTACT THEE STATE HISTORIC PRESERVATION OFFICER (SHPO) REGARDING- THE.. PRESENCE OF HISTORIC PROPERTIES IN THE PE' RMIT-AREA WHICH MAY BE AFFECTED BY Thy PROPOSED. PROJECT7 HAVE: YOU. DONE SO? YES [ ] NO ?(] RESPONSE-- FROM T' r7-- SHPO. SHOULD BE_ ATTACHED 17. ADDITIONAL INFORMATION REQUIRED BY DEM: A. W LAND DELINEATION MAP SHOWING. ALL WETLANDS, STREAMS, AND LAK S. ON THE PROPERTY. B _ IF AVAILABLE T REP.R°M== PHOTOGRAPH: OF- WETLANDS- TG BE: IMPACT- BT P ROJEC:T'_ C-_ IF DEL.INEAT=ON WAS PEP.FORMED- BY A. CONSULTANT', INCLUDE: ALL DATA- SF?""".-.1S: REI VANT TO i"F.- PLAC Z?E!dT OF" =DELINE 11CN L=- D. IF A STORMWATER MANAG'E"'=Z PLAIL IS: REQUIRED. FOR THIS- PROJECT", ATTACH- COPY- / E- WHAT- IS LAND- USE" OF SURROUNDING:. PROPERTY'- G!)d?ds ? '?+? ??'? F. Ir' APPLICABLE, WHA IS PROPOSED METHOD OF SEWAGE DISPOSALT t2 [? ? DWR'ffR' S SI-GNA DATE 'r VIP '\?\1`!? I? If \/ `?- •,?,j jt ?\? ?/)1?\ \ ..?..,V ., ? ? .C j . ? - / C\i VJ iv. J'J?/\ \ ? =J `?!`J? II ?1I?? r'??'\\?'V +•'r??wJl(??? ?? ? ? ? ?-?? ?i, v ??? / ???c??.. ? ? il:_? --fir- ?? r () EMI \ ---- YR l``? -/ I? I .?- ?? n\ ?G^?? ??.._ \\ ?\ ? ?'iJ X11 •.\?\\\ ,` 1_ ?i-^-?^_ ? asr \\\? \ \ ``? ?- 41, ?-- v ? ? .-hpam; ?-^ ? I ?v ,?v ,.., ? ?,, ..??, •,?i ? ?;?- i N '?/`-?^, ? ?`vv, A' / ?._ %% ti ?? ti'- v/\ \\? ?,,.\ ?//\ ^'''?? n$? l.' ?rJ ??\rl . ?_. 1 !?- \ J ? /rte ?i ?C yr, ~ ?? ?//?'? V;j I I ? ? r N.??y?\?? ? ?i.??^?i??.?'•/. \\ ? r'/, \ ?i? ice. ? I I'--? ? a ? \\ ?I ) ? ? ?, ? 1 a J .?.'? `•-v 5'f t \? I \\ \ui# \ \I Ji-.1?, \?i/..,.?'" I ?^?1-v ? ??/ / i ; \ `\ \/ "y . r - / ? I'??\\\`I ?..J ?•? III ? ? ?, _ /? dli???.l?j?1 '•i w? \\.,?p ,_? ? i ?\??r??,??1 ? ? ,ti?l?? /?A. Ali ?iy !? .AI A' ?o A?\V?V?\\? ?? \;" 9V( 'v\? q0 ?\1 1 II N -Ir ? ''n o V O J ? v Q cz? - .. tee`'^r?=? S Y•??4?`S.zc?, ?? rn oa CS ? •y F u ,o z as v1 N \??:.?f 1 1 . r I ! ? I I , ? f I I? i 1 I 3 1 ! Jl ! c cr- i ' L~ ,G lj wJ- ?a t.= { 0 I b Id, . 4 1 I t N - C . ?T ] •? ? ? .. ? ' ? • ? 111 ?J JI • j? ..{{•' 3 -.. t 1 *? : . 999 ? ? . ? ? ? T ("? ? _ _ ? ? ? I f- ? l f, j i: .. 1 LiLJ ? ,? ' ? ? • ? ?I ? E 4 ?? - ? ? ? • z ? {? • ' M ? i? 1 _..? j> ? '?? 1 1 ? ?' ! t . }h ? l Yt . ? I : 1 ' - ' j ? ? • ! ) . - ? , I -'"• I V ? q t ? 1? 1 `i=? ?-,•? -?.1 {' ? a 1 ,.i I ? .?.3 4,j, i^? ? d IIi ? '_.? ." ?tcrrjt`u??' "l: i ? ? ? ;? .? j .? , ? ? ?.? ,p.. tit ; • , 41 f l l r ? ; ? ? ?? t - ? ` ?? ; ? i 1 i i I ! j j { + i -i .•? i ? II ? ' ? . • ? ??? ? '' ? _ s ?--1 . { ? ? ?? ? j -?' ? -• l i ?. i { ; 1 I ' .i ? 1 t ? i ? l ' 1 ?' i 1 -i ,,,r•I 1... ?,? i• .- . ; ?_i i '' i K ? ? ? ? ` ?? 1 ?,,? ;;I i!!! I• i- ?•,i . ?,:?•? .? '?:#? };', •??: ;=; fill {! -I I t i j 1 a .1. i I A li- I [J , 1 t . 4 V Q i d d !` h a P CS L 'y K o ? p O o ci wl ^ N _L ?? zQ U ? 1\ A / DEM ID: . V ? 1 o? ACTION ID: 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, NO 28402-1890 ATTN: CESAW-CO-E Telephone (919) 251-4511 WATER QUALITY PLANNING DIVISION OF ENVIRONMENTAL MANAGEMENT NC DEPARTMENT OF ENVI N ,uXAr qH, AND NATURAL RESOD P.O. BOX 29535 RALEIGH, NC 27626-0 ATTN: MR. JOHN DO Telephone ONE (1) COPY OF THIS COMPLETED APPLICATION SHOULD BE SENT 170" ?' SrtiQ;_ ENGINEERS. SEVEN (7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL.MANAGEMENT. PLEASE PRINT. 1 . OWNERS NAME : 2. OWNERS ADDRESS: 3• OWNERS PHONE NUMBER (HOME) : 7S r (WORK) : 7G?f- 63LZ---'u"s 4. IF APPLICABLE: PHONE 5. 6. NAME: OF CLOSEST STREAM/RIVER: ya?cJ ??i 7. RIVER BASIN:. ra-c? k;?p 8. IS THIS PROJECT LOCATED IN A WATERSHED CLASSIFIED AS-TROUT, SA, HQW, ORW, WS I, OR WS II? YES [.J NO [j 9. HAVE ANY SECTION 404 PERMITS'BEEN PREVIOUSLY REQUESTED FOR USE ON THIS PROPERTY? YES [ J NO ?(] IF YES, EXPLAIN. AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS, 10. ESTIMATED .TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE: MAO- 2/3/92 LOCATION OF PLANNF,D WORK (ATTACH MAP). COUNTY : Q•,., %J saN NEAREST TOWN OR CITY: 6uo-1 cc' s SPECIFI LOCATION (INCLU E ROAD NUMBERS, LANDMARKS, ETC_): d,/ 14 EaS Q P ?'c7L • c ? /?.G. 15ZT GN S, 141-W it- isr?- p e v ipr, _t -2- 12. DESCRIPTION OF PR( 50' r? c.. cr 13. PURPOSE OF PROPOS! WO (ATTACH PLANS) : GJ ; A at 3 eo WORK: e- . ?. 3 11. NUMBER OF ACRES OF WETLAND IMPACTED BY THE PROPOSED PROJECT: 11 . FILLED: DRAINED: FLOODED: EXCAVATED: TOTAL IMPACTED : w 10- 14. STATE REASONS WHY THE APPLICANT BELIEVES THAT THIS ACTIVITY MUST BE CARRIED OUT IN WETLANDS. ALSO, NOTE MEASURES TAKEN TO MINIMIZE: WETLAND IMPACTS. /1/ 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 ]. RESPONSES FROM THE USFWS AND/OR NMFS SHOULD BE ATTACHED. 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? HAVE YOU DONE SO? YES [ ] NO [XI 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 AVAILABL. ,. REPRESEUTATIVE.PHOTOGRAPH OF WETLANDS TO BE IMPACTED BY PROJECT. C. IF DELINEAT=ON WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA SHEETS RELEVANT TO THE PLACEMINT' 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? P0.s?wa.?' Ci'a? Z-4,W F IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL? N/i4 &? W"--f 7;6?'--? / z ?4 9 OTWN S" RE DATE "III ? \J ,,?????1, ?-? ?~`?f l•'/-? ? ^ \ \??5..?-?! `? JI%S\ I {?J ??(\ (? i L ?' °? \ lei J? l f` •?? ? ,? /' ??V _ ?(( ?1: /? J ?? ? 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