20120173 Ver 1_More Info Received_20120222

ENVIRONMENTAL PROFESSIONALS, INC
Planning for a Better Environment
P O Box 3368
Kill Devil HMIs NC 27948
Telephone [phone]
Fax [phone]
Email obxwood @yahoo com
TO North Carolina Division of Water Quality
401 Wetlands Unit
Attn Ms Karen Higgins
1650 Mad Service Center
Raleigh NC 27699 1650
A ATTACHED
Ia -o193
DATE February 20 2012
JOB NO 011 044
RE Richard Edsall — 912 Lighthouse
Drive— Whalehead Club
COPIES
DATE
DESCRIPTION OF DOCUMENTS
5
1 23 12
ENG FORM 4345
1
1 18 12
24 x 36 plat
5
1 18 12
8 '/Z x 11 plat
1
$240 00 Application Fee
1
CD with Copy of Plat in PDF Format
THESE ARE SUBMITTED AS CHECKED BELOW
For your approval
L For your use
U As requested
REMARKS
COPY TO Project File
9t" Review & Comment
D
U Other FE
2012
DENR VM , ,dUALITY
6 IDSMD STORMWATER BRANCH
SIGNED /1" 7, /
rge Wood CEP PWS
Environmental Professionals Inc

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U S ARMY CORPS OF ENGINEERS
APPLICATION FOR DEPARTMENT OF THE ARMY PERMIT
OMB APPROVAL NO 0710-0003
EXPIRES 31 AUGUST 2012
33 CFR 325
Public reporting for this collection of information is estimated to average 11 hours per response including the time for reviewing instructions searching
existing data sources gathering and maintaining the data needed and completing and reviewing the collection of information Send comments regarding
this burden estimate or any other aspect of the collection of information including suggestions for reducing this burden to Department of Defense
Washington Headquarters Executive Services and Communications Directorate Information Management Division and to the Office of Management and
Budget Paperwork Reduction Project (0710-0003) Respondents should be aware that notwithstanding any other provision of law no person shall be
subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number Please DO NOT
RETURN your form to either of those addresses Completed applications must be submitted to the District Engineer having jurisdiction over the location of
the proposed acbvity
PRIVACY ACT STATEMENT
Authorities Rivers and Harbors Act Section 10 33 USC 403 Clean Water Act Section 404 33 USC 1344 Maine Protection Research and Sanctuaries
Act Section 103 33 USC 1413 Regulatory Programs of the Corps of Engineers Final Rule 33 CFR 320 -332 Principal Purpose Information provided on
On form will be used in evaluating the application for a permit Routine Uses This information may be shared with the Department of Jusbce and other
federal state and local government agencies and the pub) c and may be made available as part of a pub/ c notice as required by Federal law Submission
of requested Information is voluntary however if information is riot provided the permit application cannot be evaluated nor can a permit be issued One set
of original drawings or good reproducible copies which show the location and character of the proposed activity must be attached to this application (see
sample drawings and/or instructions) and be submitted to the District Engineer having jurisdiction over the location of the proposed activity An application
that is not completed in full will be returned
(ITEMS 1 THRU 4 TO BE FILLED BY THE CORPS)
1 APPLICATION NO
2 FIELD OFFICE CODE
3 DATE RECEIVED
4 DATE APPLICATION COMPLETE
(ITEMS BELOW TO BE FILLED BY APPLICANT)
5 APPLICANTS NAME
8 AUTHORIZED AGENTS NAME AND TITLE (agent is not required)
First Richard Middle Last Edsall
First Crcorge Middle H Last Wood
Company
Company hnrnronincntal Professionals Inc
E-mail Address redsall(Wchubb coin
E mail Address obxwood(a)yahoo corn
6 APPLICANTS ADDRESS
9 AGENTS ADDRESS
Address 375 Grist Mill Drive
Address P U Box 3368 1404 S Virginia Dare Trail
City Baskmg Ridgi. State NJ Zip 07920 Country USA
City Kill D Lvd Hills State NC Zip 27948 Country USA
7 APPLICANTS PHONE NOs w/AREA CODE
10 AGENTS PHONE NOs WAREA CODE
a Residence b Business c Fax
a Residence b Business c Fax
908 247 2948 1
252 441 0219 252 -441 0721
STATEMENT OF AUTHORIZATION
11 I hereby authorize George H Wood to act in my behalf as my agent in the processing of this application and to furnish upon request
supplemental information in support of this permit application
oginqa r dbyW drmw
DFI
Richard Edsall .A
fLt� MI} Al ]� IMq {a d5yp'
SIGNATURE OF APPLICANT DATE
NAME LOCATION AND DESCRIPTION OF PROJECT OR ACTIVITY
12 PROJECT NAME OR TITLE (see instructions)
Lighthouse Drive
13 NAME OF WATERSODY IF KNOWN (if applicable)
14 PROJECT STREET ADDRESS (d applicable)
Atlanta Ocean
Address 912 Lighthouse Dnvc
15 LOCATION OF PROJECT
Latitude N 16 341628 Longitude W 75 816653
City C i n lid State NC Zip- 27917
16 OTHER LOCATION DESCRIPTIONS IF KNOWN (see instructions)
State Tax Parcel ID 1Dk 115AO(X)00200010 Mun cipality, Corolla NC (Pin 49935 79 4062)
Section 10 Township Poplar Branch Range
ENG FORM 4345 OCT 2010
EDITION OF OCT 200415 OBSOLETE
Propo M CECW OR
FEB 2 2 2012
DENR WATER QUALITY
WEWDSAND STORMWATER BRANCH

17 DIRECTIONS TO THE SITE
North on NC 12 Cumtuck Outer Banks Turn eatt on Coral Drive and proceed to Lighthouse Drive Turn north and proceed 1/2 block
Property on west side of Lighthouse Drive
18 Nature of Activity (Description of project include all features)
To fill wetlands to provide adequate setbacks for sewage disposal system for a residential structure and parking to be constructed
19 Project Purpose (Describe the reason or purpose of the project see instructions)
Residential construction to commence April 2012 and completed July 2012
USE BLOCKS 20 23 IF DREDGED AND /OR FILL MATERIAL IS TO BE DISCHARGED
20 Reason(s) for Discharge
Fill in wetlands to provide adequate setbacks for sewage disposal system
21 Type(s) of Material Being Discharged and the Amount of Each Type in Cubic Yards
Type Type Type
Amount in Cubic Yards Amount in Cubic Yards Amount in Cubic Yards
Sand 762 cubic yards
22 Surface Area in Acres of Wetlands or Other Waters Filled (see instructions)
Acres 16 Acres
or
Linear Feet
23 Description of Avoidance Minimization and Compensation (see instructions)
Only the areas needed to provide setbacks mandated by State Health Regulations will be filled
ENG FORM 4345 OCT 2010

24 is Any Portion of the Work Already Complete? []Yes X[]No IF YES DESCRIBE THE COMPLETED WORK
25 Addresses of Adjoining Property Owners Lessees Etc Whose Property Adjoins the Waterbody (it mo th ca b tered her pi ase ttach supplemental lot)
a Address Suzanne Diennger 825 Kmgs Reheat Drive
City Davidsonville State MD Zip 21035
b Address- Peter & Sandra Day 73 Woodbridge Road
City Bristol State CT Zip 06010
c Address Michael J Levin 1781 Fernwood Lane
City Plainfield State NJ Zip 07060
d Address -
City State Zip
e Address
City State Zip
26 List of Other Certificates or Approvals/Denials received from other Federal State or Local Agencies for Work Described in This Application
AGENCY TYPE APPROVAL IDENTIFICATION DATE APPLIED DATE APPROVED DATE DENIED
NUMBER
NCDWQ Section 401 Pending Pending
Curntuck County Sewage Improvement Pending Pending
Health Department Permit
Would include but is not restricted to zoning building and flood plain permits
27 Application is hereby made for permit or permits to authorize the work described in this application I certify that this information in this application is
complete and accurate I further certify that I possess the authority to undertake the work described herein or am acting as the duly authorized agent of the
applicant
SIGNATURE OF APPLICANT DATE S G ATURE F AGENT DATE
The Application must be signed by the person who desires to undertake the proposed activity (applicant) or it may be signed by a duly
authorized agent if the statement in block 11 has been filled out and signed
18 U S C Section 1001 provides that Whoever in any manner within the jurisdiction of any department or agency of the United States
knowingly and willfully falsifies conceals or covers up any tuck scheme or disguises a material fact or makes any false fictitious or
fraudulent statements or representations or makes or uses any false writing or document knowing same to contain any false fictitious or
fraudulent statements or entry shall be fined not more than $10 000 or imprisoned not more than five years or both
ENG FORM 4345 OCT 2010

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