19990216 Ver 1_Complete File_19990308

State of North Carolina -
Department of Environment `
and Natural Resources °?` ti
Division of Water Quality

James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
Kerr T. Stevens, Director
Mr. George Teague
APPROVAL of 401 Water Quality Certification
Bridge Maintenance Supt.
515 Camp Road
Salisbury, NC 28147
Dear Mr. Teague:
( - [E
DIE
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
May 8, 2000
Stokes County
DWQ Project # 990216
You have our approval, in accordance with the attached conditions, to place fill material in 52 linear feet of streams
f6r the purpose of improving Bridge 122 on SRI 619 over Crooked Creek, as you described in your application dated
March 8, 2000. After reviewing your application, we have decided that this till is covered by General Water Quality
Certification Number 3102. This Certification allows you to use Nationwide Permit Number 14 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 or CAMA 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 and send us a new application. If the property is sold, the new owner must be given a copy of
this 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. This
approval shall expire when the corresponding Nationwide Permit expires or as otherwise provided in the General
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 North Carolina General Statutes to the Office of Administrative Hearings, P.O. Box 27447, Raleigh,
N.C. 276 1 1-7447. 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 John Domey at 919-733-1786.
Attachment
cc: Wilmington District Corps of Engineers
Corps of Engineers Raleigh Field Office
Winston-Salem DWQ Regional Office
File Copy
Central Files
Sir c •ly,
I
f
T Stevens
J
Division of Water Quality • Environmental Sciences Branch
Environmental Sciences Branch, 4401 Reedy Creek Rd, Raleigh, NC 27607
Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer
50% recycled/10% post consumer paper

DEM ID:
CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #):
PRE-CONSTRUCTION NOTIFICATIONS APPLI
FOR NATIONWIDE PERMITS THAT REQUIRE:

1) NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATIONS FOR SECTION 101 CERTIFICATION
e
i'_; 79
V 1
3) COORDINATION WITH THE N. C. DIVISION OF COASTAL MANAGEME`iI T'`; ~''-,,
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: NORTH CAROLINA DEPARTMENT OF TRANSPORTATION
2. MAILING ADDRESS: BRIDGE MAINTENANCE UNIT
51 S CAMP RD.
SALISBURY, N.C. 28147
PROJECT LOCATION ADDRESS, (INCLUDING SUBDIVISION NAME) Stokes County, near
Stuart,VA: on SR 1619
3. TELEPHONE NUMBER (HOME)_N/A
(WORK) 704-639-7555
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
AND PHONE NO.
GEORGE L. TEAGUE
BRIDGE MAINTENANCE SUPERINTENDENT
515 CAMP RD.
SALISBURY, N.C. 28147
704-639-7555
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: _STOKES NEAREST TOWN OR CITY:STUART, VA.
SPECIFIC LOCATION, (INCLUDING ROAD NUMBERS, NAMES, LANDMARKS, ETC.):_0.4
MILES NORTH OF JCT. OF SR 1615 OVER CROOKED CREEK ON SR 1619.

6. IMPACTED OR NEAREST STREAM/MVER: BUFFALO CREEK
RIVER BASIN: ROANOKE
2.
7a. IS PROJECT LOCATED NEAR WATER CLASSIFED AS TROUT, TIDAL SALTWATER (SA),
HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WS-I OR WS-II)? YES ( ) NO (X) IF YES, EXPLAIN:
7b. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES ( ) NO (X)
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
Sa. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROPERTY? YES (X) NO( ) IF YES, PROVIDE ACTION I.D. NUMBER OF THE
PREVIOUS PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF
301 CERTIFICATION):
Sb. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
FUTURE? YES O NO (X) IF YES, DESCRIBE ANTICIPATED WORK:
9a. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND:-4.5 SQUARE MILES
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
0 ACRES
10a. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: 0
FLOODING: 0
DRAINAGE: 0
EXCAVATION: 0
OTHER: 0
TOTAL ACRES TO BE IMPACTED: NONE
10b. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED
PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION):
LENGTH BEFORE: N/A FT. AFTER: N/A FT.
WIDTH BEFORE (BASED ON NORMAL HIGH WATER
CONTOURS):_N/A FT.
WIDTH AFTER: N/A FT.
AVERAGE DEPTH BEFORE: N/A FT. AFTER: N/A FT.
3.
10b. (2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION: PLACEMENT OF PIPE IN CHANNEL:
CHANNEL EXCAVATION: X CONSTRUCTION OF A DAM/FLOODING:
OTHERS:
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 'i/2" X 1 I" DRAWINGS ONLY):_TO
REPLACE OLD 40'6" TIMBER BRIDGE WITH NEW 3 BARREL REINFORCED CONCRETE
BOXED CULVERT L? 9'x 8' \\
(??v? o??? p? CU?VC (?\Oh?i eY? tc? i ?? 0? C?n1 V L?? it S ll Q II
w,a?? pc c.u?vc.r? \ \ I,?.t ?? ??a?w?v ;s ag' ? ??
?t13. PURPOSE OF WORK:-TO REPLACE OLD TIMBER BRIDGE WITH A NEW BOX
CULVERT.
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS. (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS):
N/A
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:-NO (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 HISTIRIC
PROPERTIES IN THE PERMIT AREA WHICH MAY BE AFFECTED BY THE PROPOSED
PROJECT. DATE CONTACTED: NO
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF
PUBLIC (STATE) LAND? YES ( ) NO (X) (IF NO, GO TO 18)
17. 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 ( )
17. 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 ADIMINSTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE NO. 919-733-6369.
18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF
PROPOSED ACTIVITIES INVOLVES THE DISCHARGE OF EXCAVATED MATERIALS
INTO WETLANDS:
a. WETLANDS 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" = 50'
OR 1" = 100' OR THEIR EQUIVALENT.
b. IF AVAILABLE, REPRESENTIVE PHOTOGRAPH OF WETLANDS TO BE IMPACTED
BY PROJECT.
c. IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA
SHEETS RELEVANT TO PLACEMENT OF THE DELINEATION LINE.
d. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
e. WHAT IS LAND USE OF SURROUNDING
PROPERTY? FARMLAND
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
N/A
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 101 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
MANAGEMENT PROGRAM.
OWNS / A S GNA DATE
(AGENT'S SIGNATURE VALID ONLY IF AUTHORIZATION
LETTER FROM THE OWNER IS PROVIDED (18g.) )
5.
AGENCY ADDRESSES
ENDANGERED SPECIES
U.S. FISH AND WILDLIFE SERVICE
RALEIGH FIELD OFFICE
P.O. BOX 33726
RALEIGH, N.C. 27636-3726
TELEPHONE [phone]
NATIONAL MARINE FISHERIES SERVICE
HABITAT CONSERVATION DIVISION
PIVERS ISLAND
BEAUFORT. N.C. 28516
TELEPHONE [phone]
U.S. FISH AND WILDLIFE SERVICE
ASHVILLE FIELD OFFICE
160 ZILLICOA STREET
ASHVILLE, N.C. 25801
TELEPHONE [phone]
HISTORIC RESOURCES
STATE HISTORIC PRESERVATION OFFICE
N.C. DIVISION OF ARCHIVES AND HISTORY
109 EAST JONES STREET
RALEIGH, N.C. 27601
TELEPHONE [phone]
STATE REGULATORY AGENCIES
MR. JOHN DORNEY MR. STEVE BENTON
DIV. OF ENVIRONMENTAL MANAGEMENT DIV.OF COASTAL MANAGEMENT
N.C. DEPARTMENT OF ENVIRONMENT,
HEALTH, AND NATURAL RESOURCES
4401 REEDY CREEK ROAD
RALEIGH, N.C. 27607
TELEPHONE [phone]
6.
CORPS OF ENGINEERS FIELD OFFICES:
RALEIGH REGULATORY FIELD OFFICE
U.S. ARMY CORPS OF ENGINEERS
6512 FALLS OF THE NEUSE ROAD
RALEIGH, N.C. 27615
TELEPHONE [phone]
ASHEVILLE REGULATORY FIELD OFFICE
U.S. ARMY CORPS OF ENGINEERS
151 PATTON AVE. ROOM 133
ASHEVILLE. N.C. 28801-5006
TELEPHONE [phone]
WASHINGTON REGULATORY FIELD OFFICE
U.S. ARMY CORPS OF ENGINEERS
P.O. BOX 1000
WASHINGTON, N.C. 27889-1000
TELEPHONE [phone]
WILMINGTON REGULATORY FIELD OFFICE
U.S. ARMY CORPS OF ENGINEERS
P.O. BOX 1890
WILMINGTON, N.C. 28302-1890
TELEPHONE [phone]
N.C. DEPARTMENT OF
ENVIRONMENT, HEALTH, AND
NATURAL RESOURCES
P.O. BOX 27687
RALEIGH, N.C. 27611-7687
TELEPHONE [phone]
FAX [phone]
MAR 4,1999
515 Camp Rd.
Salisbury, N. C. 28147
Mr. KEN JOLLY
U. S. ARMY CORPS OF ENGINEERS
RALEIGH REGULATORY FIELD OFFICE
6512 FALLS OF THE NEUSE ROAD, SUITE 105
RALIEGH, N.C. 27615
Dear Mr. JOLLY,
The North Carolina Department of Transportation Bridge Maintenance Unit, proposes the following
project for your review. We believe this project can be accomplislied under Nationwide # 3.
COUNTY : STOKES COUNTY; BRIDGE # 122
ROUTE : S. R. 1619
STREAM : CROOKED CREEK
DESCRIPTION : Bridge # 64-122 Replaced with 3 BARRELS OF RCBC 0` 9' X 8'
Not located in wetlands.
Less than 0.02 Acres of Rip Rap fill in Waters.
Drainage Area = 4.5 sq. miles. Average Daily Flow = 5.4 C.F.S.
We have attached a site location map , and a sketch of planned activities. A stringent erosion and
sedimentation control program will be implemented during the project constriction and every effort will
be made to complete work in a timely manner.
Our personnel arc available to assist with your evaluation of this project , if necessary. Should you
have any questions, please call me at 704- 639-7555.
Sincerely,
Gcorge? .Teague
Bridge Maintenance Supt.
Attachments.
GLT/des
a + STA7[ o
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•^• ar d'
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
JAMES B. HUNT. JR DIVISION OF HIGHWAYS SAM HUNT
GOVERNOR SECRETARY
-`:11AR-y? I°l5?
515 Camp Rd.
Salisbury, N. C. 28147
Mr. Joe Mickey, Jr.
N. C. Wildlife Resources Commission
Rt. 2 Box 278
State Road, N. C. 28676
Dear Mr. Mickey:
The following is a project of the N.C. Dept. of
Transportation, Bridge Mte. Unit which involves a designated
trout stream county:
County :
Route 5R Ib 15
Stream Ccook??-ceck `` 1
Description
N111 W 3 ® ), 8' R,C ?o? c.v?`V e, Na vJc?la?dr L?r? hq?0?c?1 mCr?
tl`p-CAP ?A Dfca?c\NL a?e? 4.Sg?.w". q?c. ????k \ow ° 5? CIrS
Attached is a location map and sketch showing the work
involved. All necessary erosion and sediment control measures
will be utilized per N.C. D.O.T. Guidelines for Control of
Erosion & Sediment, Bridge Maintenance Construction.
We are requesting you review this project as part of our
procedure to obtain a Corps of Engineers 404 Permit to do this
work. Please contact Mr. Ronnie Joyce, Bridge Mainteance
Supervisor, at 919-593-8325, Stokes County, who will be happy to
discuss this work and/or visit the site at your convience.
Your help in reviewing this work and obtaining the permit
for this work will be appreciated.
Sincerely,
Attachment: George L. Teague
Bridge Maint. Supt.
704-639-7555 work

M?K' 4 J m
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:
The North Carolina Department of Transportation Bridge Maintenance Unit, proposes the following proj-
ect for your review. We believe this project can be accomplished under Nationwide # 14.
COUNTY : Stokes County ; Bridge # 122
ROUTE : S.R. 1619
STREAM: Crooked Creek
DESCRIPTION: Bridge # 64-122 Replaced with a 3 @ 9'x 8' R.C. Box Culvert.
Not located in Wetlands.
Less than 0.02 Acre Rip Rap fill in waters.
Drainage Area= 4.5 Sq. Miles. Ave. Daily Flow= 5.4 C.F.S.
We have attached a site location map, and a sketch of planned activities. A stringent erosion and sedi-
mentation control program will be implemented during the project construction and every effort will be
made to complete work in a timely mariner.
Our personnel are available to assist with your evaluation of this project, if necessary. Should you have
any questions, please call me at 704-639-7555.
Sincerely,
George L. Teague
Bridge Maintenance Supt.
GLT/des
attach.
e w. SUI[ s
_y p°iA n
STATE OF NORTH CAROLINA
DEPARTMENT OF TkANSPORTATION
JAMES B. HUNT JR. DIVISION OF HIGHWAYS GARLAND B. GARRETT JR.
GOVERNOR SECRETARY
m R4 J vq`1Ct
515 Camp Rd.
Salisbury, N. C. 23147
Ms. Stephanie Goudreau
N. C. Wildlife Resources Commission
320 S. Garden St.
Marion, N. C. 23752
Dear Ms. Goudreau :
The following is a project of the N. C. Dept. Of Transportation , Bridge Maintenance
Unit which involves a designated trout stream county:
County : Stokes , Bridge # 122
Route : S. R. 1619
Stream : Crooked Creek
Description : Bridge 964 - 122 Replaced With 3 @ 9' x S' R. C. Box Culvert.
Not Located In Wetlands .
Less Than 0.02 Acre Rip Rap Fill In Waters. Drainage Area = 4.5
Sq. Miles. Ave Daily Flow= 5.4 C.F.S.
We have attached a site location map , and a sketch of planned activities. A stringent
erosion and sedimentation control program will be implemented during the project construction
and every effort will be made to complete the work in a timely manner .
Our personnel are available to assist with your evaluation of this project , if necessary .
Should you have any questions , please call me at 704 -639 -7555 .
Sincerely ,
-6-? /?24 '
George L. Teague
Bridge Maint. Supt.
Attachments.
GLT/des

DEM ID:
ACTION ID:
JOINT APPLICATION FORM FOR
NATIONWIDE PERMITS THAT REQUIRE NOTIFICATION TO THE DISTRICT ENGINEER
NATIONWIDE PERMITS THAT REQUIRE SECTION 1401 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 KANAGEMENT
NC DEPARTMENT OF ENVIRONMENT, HEALTH,
AND NATURAL RESOURCES
P.O. BOX 29535
RALEIGH, NC 27626-0535
ATTN: MR. JOHN DORNEY
Telephone [phone]
ONE (1) COPY OF THIS COMPLETED APPLICATION S'H'OULD BE SE.1MT TO = CORPS OF
ENGINEERS. SEVEN (7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF
ENVIRONMENTAL MANAGEMENT. PLEASE PRINT.
1. OWNERS NAM : C
2. OWNERS ADDRESS: S I ,? Ca rw P ?c Y
3. OWNERS PHONE NUMBER (HOME) : (14412-? - 9 SSS (WORN) : CWA) 0 S - ? S SS
4. IF APPLICArLE: AGENT'S NAME' OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER: (•?e.?ra?, ?., ?ea9?Ae
SR??sbury 'N C,
(?? ,?3?a- '1SS S
5. LOCATION OF PLANNED WOFJ{ (ATTACH MAP).
COUNTY : S i o k -P-s
NEAREST TOWN OR CITY: S-? LA CX Vfl .
SPECIFIC LOCATION (INCLUDE ROAD NU143ERS, LANDMARKS, ETC.): 0'?1 et
Nac??. a? ?c? sR t(, I5 o`re r ??ek?? ?r? ,k ?? SCZ 1 1?
6. NAME OF CLOSEST STREAM/RIVER:
7. RIVER BASIN: k% A 0 ?k.?, ?a < n
8. IS THIS PROJECT LOCATED IN A WATERSHED CLASSIFIED AS TROUT, SA, HQW, ORW,
WS I, OR WS II? YES C ] NO [
9. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROPERTY? YES M NO [ ]
IF YES, EXPLAIN. QA A, h.?,14 -Vv 1c\ o\A • CA& P-rm"A j-x'a" ftA .
10. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
N13 J6
2/3/92
-2-
11. NUMBER OF ACRES OF WETLAND IMPACTED BY THE PROPOSED PROJECT:
FILLED:
DRAINED:
FLOODED: O
EXCAVATED: 0
TOTAL IMPACTED : W) N ?.
1 `s P c
12. DESCRIPTION OF PROPOSED WORK (ATTACH PLANS) : -[a mow, a GY; '?)jd
rN j_ 405 '.5 .? ? 9 `-t 4 ` " w ?. r ? ?nC 3 b 1 \ (t C ? vl ? i e _r?
13. PURPOSE OF PROPOSED WORK:
14. STATE REASONS WHY THE APPLICANT BELIEVES THAT THIS ACTIVITY MUST BE
CARRIED OUT IN WETLANDS. ALSO, NOTE MEASURES TAKEN TO MINIMIZE WETLAND
IMPACTS. N I (a
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 [Ilyl
RESPONSES FROM THE USFWS AND/OR NM ES 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 (jq
RESPONSE FROM THE SHPO SHOULD BE ATTACHED.
17. ADDITIONAL INFORMATION REQUIRED BY DEM:
A. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAYS, AND LAKES ON
THE PROPERTY.
B. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE IMPACTED BY
PROJECT.
C. IF DELINEAT=ON 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? For ad ow 1A
F. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
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