19970554 Ver 1_Complete File_19970710

State of North Carolina
Department of Environment, +
Health and Natural Resources
Division of Water Quality
James Hunt, Governor [D E
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
August 1, 1997
Madison County
WQC 401 Project #970554
APPROVAL of 401 Water Quality Certification
Mr. K.A. Wilson
N.C. Dept. of Transportation
P.O. Box 3279
Asheville, NC 28802
Dear Mr. Wilson:
You have our approval, in accordance with the attached conditions, to excavate & fill in
0.05 acres of wetlands or waters for the purpose of paving at SR 1301, as you described in your
application dated 7 July 1997. After reviewing your application, we have decided that this fill is
covered by General Water Quality Certification Number 3103. This Certification allows you to
use Nationwide Permit Number 14 when it is issued by the Corpstof Engineers. 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-
exrrels nnle s othAlso this erwise approval in the expire when n the
Discharge and Water Supply Watershed
accompanying 404 or CAMA permit expires
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 and you may be required to send
us a new application. 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.
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 150B of the NoRaleigh,
Carolina General Statutes to the Office of Administrative Hearings,
N.C. 27611-7447. This certification and its conditions are final and binding unless you ask for
a hearing.
This letter completes the review n S? Division please telephone John Domey at 919- ?3-1786e
questions,
Clean Water Act. If you have any
Sincerely,
Rn?Howar , Jr. P .
Attachment
cc: Wilmington District Corps of Engineers
Corps of Engineers Asheville Field Office
Asheville DWQ Regional Office
Mr. John Domey
Central Files 970554.1tr
Division of Water Qualffy • Environmental Sciences Branch
Environmental Sciences Branch, 4401 RAY Creek Rd., Raleigh, NC 2760;?eP 919-733-1786 3-1786 FAX # [phone]
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An Equal Opportunity Affirmative Action Employer • 50 /o recyded/
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P.O. Box 3279 .
Asheville, N.C.
Juy 7, 1997
'0¢564
Mr. David Baker
U.S. Army Corp of Engineers
Regulatory Field Office
151 Patton Ave. Rm. 143
Asheville, NC. 28801-5006
Subject: S.R. 1301, Madison Co.
Dear Mr. Baker:
We are providing a package of design sketches concerning wetlands that
will be impacted by this project. We have enclosed a completed N. C. D. E. M.
application for your use.
. We are planning on replacing one pipe in an unknown tributary flowing
into Clover Branch and one proposed channel change in Clover Branch. This
stream is not a trout stream nor high quality water.
If you have any comments or questions concerning this project, please
contact J.N. Jarrett or myself of this office at 704-298-2741.
Thank you for your cooperation and assistance in this matter.
Sincerely yours,
K. A W
District Engineer
KAW:JNJ:jnj
cc: Mr. Eric Galamb, Div. of Environmental Management
Mr. Mark S. Davis, Western Mt. Region Coordinator
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DEM ID: CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #):
PRE-CONSTRUCTION NQT'IFICATION 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 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 SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT
(SEE AGENCY ADDRESSES SHEET). PLEASE PRINT.
1. OWNERS NAME : P. C. DCP7, GF TRAKSPCR7A7'7Q 4
2. MAILING ADDRESS: F, O- (OK 3z7
SUBDIVISION NAME:
CITY: A6f-fr=V(LLE STATE: Nc ZIP CODE: Z860Z
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
SR 13 01 , C-LGVr- R,_>ANCN 'RD, ? M(MISN Co'
3. TELEPHONE NUMBER (HOME):
(WORK) : Z78-Z74-1
4.. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER:
_k. A. WLSW , ( D IST EN R) 7_78 - 7_74- (
P.o. BOY, K77 l-SREWLLE, NC 086()Z
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: MA-0150Q NEAREST TOWN OR CITY: NOI SfRit-je
s ?-
1

?e
NUMBERS, LANDMARKS, ETC.):

SPECIFIC LOCATION (INCLUDE ROAD
?R I301 CLOVER PRPNCH 2D F'ROm 5R_1300
UNNiNG ?OUTllEPSTERLq -qN'D SOUiNWESTERLY
Falb O- W M)LES TD E.0, rn.
6. IMPACTED OR NEAREST STREAM/RIVER: CLOVES 'B Rr?,\iCl-A
RIVER BASIN: FRENCH 9RGA'D ?iVER
7a. 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 [?1 IF YES, EXPLAIN:
7b. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES [ ] NO [A
7c. 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?
N /A
8a. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON
THIS PROPERTY? YES [ ] NO (A IF YES, PROVIDE ACTION.I.D. NUMBER OF
PREVIOUS PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
CERTIFICATION):
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
FUTURE? YES [ ] NO [?f IF YES, DESCRIBE ANTICIPATED WORK:
9a. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND: 3•`J
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
0.12 Rc
2
a
10a. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: 0.02 AC.. EXCAVATION:
l' V ? n C
FLOODING:
DRAINAGE:
OTHER: /1? /?
TOTAL ACRES TO BE IMPACTED: 0.0 5 A C
10b. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF
RELOCATED, PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION):
LENGTH BEFORE: 110 FT AFTER: - 130 FT
WIDTH BEFORE (based on normal high water contours): 5 FT
WIDTH AFTER: 5 FT
AVERAGE DEPTH BEFORE: 2 FT AFTER: 2 FT
(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 qq WHAT IS THE SIZE OF THE
WATERSHED DRAINING TO THE POND? N!(-)
WHAT IS THE EXPECTED POND SURFACE AREA? N / q
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF
MECHANICAL EQUIPMENT TO BE USED (ATTACH PLANS: 8 1/2" X 11" DRAWINGS
ONLY) :
ONE P)'PE TO '[3E REPLACED IN AN UNWWY)EJ TRIBUTARY
CROSSING SR 130) a ONE FROPOSQ CHANNEL CNAMGE
IN CLOVER 3Rr4NCH OF 140 FT
13. PURPOSE OF PROPOSED WORK: TO FACILITATE THE W IDEN i N G
AN`D FqV I NG OF SR 1301 , CLOVER 'L-?RRNCLH 1;ZD.
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3

14. STATE REASONS
OUT IN WETLANDS.
IMPACTS):
WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED
(INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND
(sEE lad ALL ROU INE (AND NECtSSR)?Y MEOSURES TO
C O?JiROL ERS)Oty RNQ _EjD) F"TR i 10x1 WILL BE
U T) L17E-0 ?1LT 1=ENCE5 , 1,0Ck SILT CtI CI S RNA
BASit?S 1N T)I CHES_
15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SERVICE
(USFWS) AND/OR NATIONAL MARINE FISHERIES SERVICE (NMFS) (SEE AGENCY
ADDRESSES SHEET) 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: CO?Y TO N.C.I. R.C• (ATTACH RESPONSES
FROM THESE AGENCIES.)
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) (SEE AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC
PROPERTIES IN THE PERMIT AREA WHICH MAY BE AFFECTED BY THE PROPOSED.
PROJECT. DATE CONTACTED: N /P?
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF
PUBLIC (STATE) LAND?
YES [ J NO [v]? (IF NO, GO TO 18)
a. IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA ENVIRONMENTAL
POLICY ACT?
YES [I NO [ J
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE?
YES [ J NO [)
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE
STATE CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT REGARDING
COMPLIANCE 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 ?.,
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
4

18. THE FOLLOWING ITEMS SHOULD. BE INCLUDEh WITH THIS APPLICATION IF
PROPOSED ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL
INTO WETLANDS:
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 STREAMS (INTERMITTENT AND PERMANENT) ON THE PROPERTY
MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET OR 1
INCH EQUALS 100 FEET OR THEIR EQUIVALENT.
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. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
e. WHAT IS LAND USE OF SURROUNDING PROPERTY?-
4GR I CULTURE /`RE31 DENT) FO-
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
g. SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE U.S. 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
ENVIRONMENTAL MANAGEMENT (WATER QUALITY) CERTIFICATION, AND
3) (IN'TRE TWENTY COASTAL COUNTIES ONLY), A LETTER FROM THE
NORTH CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED
ACTIVITY IS CONSISTENT WITH THE NORTH CAROLINA COASTAL MANAGEMENT
PROGRAM.
k• A • W,6, C D(st' Ewq R) .
OWNER'S/AGENT'S SIGNATURE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED (18g.))
7- 07- 77
DATE
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N.C. DEPARTMENT OF TRANSPORTATION
D IV) SON OF-HIGHWAYS
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SECONDARY ROAD SURVEY
sR r 3l b ( CLOD E? BR R©.
-OCATION FROM SR 1300 TO E.0. M,
WOR I< TYPE GPA-DE BASE Pl?-vE DRpff t
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COUNTY MAVsdu TOWNSHIP HQT 5MU6S
DATE -7-0z-97 SCALE /
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EROSION CONTROL
DETAILS AND
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Std. 1;1r'.
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245.03 Temporary Silt Ditch
245.05 Temporary Diversion .._-------.-•---------------- TSD --- VI - 2

893.01 -----------------•-----------
Temporary Silt Fence T --- VI - 4

890.05

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Silt Check Type-B
892.01 ............ )IN - ------------ VI -16
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892.02
897
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IX
1
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N.C. DEPARTMENT OF TRANSPORTATION
D IVI SON of - H IG HWAYS
SLCONDARY ROAD SURVEY
9'0554
SLEJECT ?R (2,3( CLOVER BR. Rp.
-OCATIO N FROM SR i-oo To E.O. M,
WOR I< TYPE GRA13E LIAStE PPvE D?P(u
WORK F PRIORI 9F
COUNTY MA--Msow TOWNSI I I P HOT 5PRIU65-
[jATE -7-oz-9-7
SCALE "..<-o '
NOTES
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DEM 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
2) APPLICATION FOR SECTION 401 CERTIFICATION
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 SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT
(SEE AGENCY ADDRESSES SHEET). PLEASE PRINT.
1. OWNERS NAME: M. C. DCP7; GF- TRAKSPCRTAT7064
2. MAILING ADDRESS: 1 0• BCX 3Z77
SUBDIVISION NAME:
CITY: 106ffEVfLLE STATE: Nc ZIP CODE: Z8??Z
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE)/:
I?301 CLOVE=P, 'B)?_ANCN ''RD, M(MS0tJ CO.
3. TELEPHONE NUMBER (HOME) : (WORK): z?a-z74-f
4_ IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER:
K. A. W Sog , ( D 15T E14 R) Z98 - Z74- f
P.0 . BOY, K7 9 ASKED f LLE, NC ZB?Z
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE): H07 S pR)N S S
COUNTY: mfl01'5Gy'j NEAREST TOWN OR CITY: H01
1
1.

PECIFIC LOCATION (INCLUDE ROAD
NUMBERS, LANDMARKS, ETC.):
1301 , CLOVER pANC-H RD IFROrn sR u300
l-,)UtJNING SOU TllEPSTERLq -AND 'EJOUTHWE51-ERLY
FOR O- GA m ) LES TD E.0, rn.
6. IMPACTED OR NEAREST STREAM/RIVER: CLOVER BRF)NCH
RIVER BASIN: FRENCH GRQI:D "?iVE'R_
7a. 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 [?J IF YES, EXPLAIN:
7b. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES [ ) NO [;/]
7c. 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?
N /A
8a. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON
THIS PROPERTY? YES [ ] NO (A IF YES, PROVIDE ACTION I.D. NUMBER OF
PREVIOUS PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
CERTIFICATION):
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
FUTURE? YES [ ] NO [Vf IF YES, DESCRIBE ANTICIPATED WORK:
9a. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND: 3.5
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE: 411
0.12 Rc
2
10a. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: 0.02 AC EXCAVATION s l' • 0 A C
,.y
FLOODING: OTHER:
DRAINAGE: TOTAL ACRES TO BE IMPACTED: 0'05 A C
h
10b. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF
RELOCATED, PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION):
LENGTH BEFORE: M o FT AFTER: - ISO FT
WIDTH BEFORE (based on normal high water contours): 5 FT
WIDTH AFTER: 5 FT
AVERAGE DEPTH BEFORE: 2 FT AFTER: 2 FT
(2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION: J 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? N/A
WHAT IS THE EXPECTED POND SURFACE AREA? N /A
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF
MECHANICAL EQUIPMENT TO BE USED (ATTACH PLANS: 8 1/2" X 11" DRAWINGS
ONLY) :
ONE P)PE 0 'BE 'RE`PLACED IN f?N UNNArDED T RSUTA)RY
C20SSI+?G SR 1301 ONF PROROSFD CHRNQEL C-HAtiGE
IN CLOYER 2R/4NCN OF 140 FT
13. PURPOSE OF PROPOSED WORK: TO 'FACILITATE THE W 1`DFN j N G
AN`D PAv I NG OF SR 1301 CLOVER BRANCH `l
{h
3

14. STATE REASONS WHY IT IS BELIEVEDTTHAT THIS ACTIVITY MUST BE CARRIED
OUT IN WETLANDS. (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND
IMPACTS):
(SEE ?2> (ALL ?) OUi IME. (AND NEUQSA?N MEn-SURFS TO
COJ ROL EROSION (?N?? S??irn1=Ni (?i 10N WILL BE
U 11_IZE-D ` i!L 1=ENCES , SOCK 31T Ci1?Cl?S AND
15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SERVICE
(USFWS) AND/OR NATIONAL MARINE FISHERIES SERVICE (NMFS) (SEE AGENCY
ADDRESSES SHEET) 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: COPY 17) N.C.Iw. I`?,C.• 1-?- ?1 (ATTACH RESPONSES
FROM THESE AGENCIES.)
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) (SEE AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC
PROPERTIES IN THE PERMIT AREA WHICH MAY BE AFFECTED BY THE PROPOSED.
PROJECT. DATE CONTACTED: J /p?
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF
PUBLIC (STATE) LAND?
YES [] NO [v (IF NO, GO TO 18)
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 []
b., IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE?
YES [ ] NO [ ]
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE
STATE CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT REGARDING
COMPLIANCE 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
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].

4
18. THE FOLLOWING ITEMS SHOULD. BE INCLUDED WITH THIS APPLICATION IF
PROPOSED ACTIVITY INVOLVES THE DISCHARGE OF-EXCAVATED OR FILL MATERIAL
INTO WETLANDS:
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 STREAMS (INTERMITTENT AND PERMANENT) ON THE PROPERTY
MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET OR 1
INCH EQUALS 100 FEET OR THEIR EQUIVALENT.
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. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
e. WHAT IS LAND USE OF SURROUNDING PROPERTY?-
AGR i CULTURE / RESIDEN I h5l-
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
g. SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE U.S. 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
ENVIRONMENTAL MANAGEMENT (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 CAROLINA COASTAL MANAGEM8NT
PROGRAM..
• A • W'?lscm D(5T' tCR) 7- 07- 7 7
OWNER'S/AGENT'S SIGNATURE DATE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED (18g.))
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