19961158 Ver 1_401 Application_19961203

961158
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DEM ID: ACTION ID:
~iation~n ode pertnit Requested (Provide Nationwide Permit #): ~ - -
JOINT FORM FOR
Nationwide permits that require notification to the Corps of Engineers
Nationwide permits that require application for Section 401 certification
WILMINGTON DISTRICT ENGINEER
CORPS OF ENGINEERS
' °EPARTMENT OF THE ARMY
i':O. Box 1890
-~''ilmington, NC 28402-1890
~TTN: CESAW-CO-E
"Telephone [phone]
WATER QUALITY PLANNING
DIVISION GF ENVIROIv'MEN'I'AL ~~'~tAGEMENT
NC DEPARTMENT OF EIv'VIRONMENT, HEALTH,
AND NATUR~'~L, RESOURCES
P.O. Box 29535
Raleigh, NC 2?626-0535
ATTN: MR JOHN DORNEY
Telephone [phone]
OI~iE (~Ij COPY OF T'rIIS COMPLETED APPLICATION SHOULD BE SENT TO THE CORPS OF ENGINEERS.
SL~ (7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT.
P 'SE PRINT. ; J ,~ j ~ .. ~~ .
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1. Owners Name: I , "~~ l r %'"i' = . ~' ~" I' ~ !^ c.-~ ~~; ~,
2. Owners Address: ~'~ ~ ~.'; -; ;~ ~.~ ; "; "~ /; ~; ~ +~'!~ ~ /, ~ ~'. ~ ~'
,, .
3. Owners Phone Number (Home): ~~ "•• -- '~~~'~ - `~~ .; `~ ~ (Work): _"~'f ~. - - ` - /'~~'
4. If Applicable: Agent's name or responsible corporate official, address, phone number.
r,~` ~, ,
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5. Location of work (MUST ATTACH MAP). County: -. r;~ ` ' _ ~ '
Nearest Town or City: /.~~' r.I=-: _' ~ ' ~~ J
Specific Locatio/n (Include road numbers, landmazks, etc.):
6. Name of Closest Stream/River~ ~!%'~!~i/%~~,
7. River Basin: /t ~; - ."~--. ~ . ~~~ ;'
;,
8. Is this project located in a watershed classified as Trout, SA, HQW, ORW, WS I, or WS II? YES [) NO ,
9. Have any Section 404 permits been previously requested for use on this property? YES [) NO [:~
If yes, explain.
3~ Estimated total number of acres of waters of the U.S., including wetlands, located on project site:
11. Number of acres of waters of the U.S., including wetlands, impacted by the proposed project:
.~ , . ~ ,
Filled. . ~ " - -:~ `:;
Drained:
Flooded:
Excavated:
.~
Total Impacted: ~,~ ~, ~LJ':~J

12. Description of pi-oposed work (Attach PL.KNS-8 1r2' X 11" drawings only):
13. se of ro osed work: `- ~ ` ' %~~~ ~! h' = `, /,' ` .'} : ~ "'
Purpo P P ~ %' ~,ti.. ~., ~ ~%,~.~
I'4. State reasons why the applicant believes that this activity must be carried out in wetlands. Also, note measures
taken to minimize wetland impacts.
35. 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 orproposed 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 FORWARDED TO CORPS.
i~G. You are required to contact the State Historic Preservation Officer (SHPO) regarding the presence of historic
properties ir. Lhe penrit area v~hich may be affeciPd by the prorosrd project? Nave you done so? YES [ ] NO [ ]
RESPONSE FROM THE SHPO SHOULD BE FORWARDID TO CORPS.
.~ ,
>/'~. 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 sutr~unding property?
F. If applicable, what is proposed method of sewage disposal?
-~~ G~~~x ~ ~d ~~-~
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wn-r's Signature Date

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DECEMBER 16,1996
A NeW Access Road for
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THIS DOCUMENT WAS PREPARED FOR
and remains the Property of
James H. Franklin, Grading Contractor
139 Jaynes Cove Road
Waynesville North Carolina ©1996

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DECEMBER 16,1996
THIS DOCUMENT WAS PREPARED FOR
and remains the Property of
James H. Franklin, Grading Contractor
139 Jaynes Cove Road
Waynesville North Carolina
©1996
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