20120178 Ver 1_More Info Received_20120320

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AND STORWATE,� ALP WK
LET 'T'gR OF TRANSMITTAL DICKSON
community infrastructure consultants
720 Corporate Center Dave Raleigh North Carolina 27607 919 782 0495 tel [phone] fax
TO
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ATTENTION G(ySt�Crl �'►`lSC% Pr'
DATE r.(b ?c2( Z
RE (/ tick`"t,(v rt lrcc 7bn
We are sending via ❑ Overnight Regular Mail ❑ Pick up ❑ Hand Delivered
The following items ❑ Correspondence ❑ Plans ❑ Specifications ❑ Other as listed below
COPIES
DATE
NO
DESCRIPTION
I PA Vlal
�D 14ir T-5 �� r
(it G (/ G 1 `cry //� �'l`s✓ l
/-
THESE ARE TRANSMITTED as checked below
❑ For Approval bQ"As Requested ❑ Approved as Submitted ❑ Returned for Corrections
❑ For Your Use ❑ For Review and Comment ❑ Approved as Noted ❑ Forward to Subcontractor
REMARKS
P&I"Y' L
i
COPY TO ..��� / �� 11(111 all /v(QI/�� SIGNED
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WD
ICKSON
co —unlly inlrostructure consultants
Buckhead Creek
Figure 8
Buckhead Creek Watershed
Stormwater Infrastructure Improvement
Raeford Road Project Map
Feet
0 75 150 300
1 in = 150 feet
1� i k
Wetland Impact
(0.97 acres)
Raeford Rd Project Limits
Roads
Wetland Impact/Alteration
® Existing Wetlands
_ Wetland Creation
_ Unnamed Tributary
Parcel Boundaries

Stream Impact to
Unnamed Tributary
(100 LF)
Wetland Impact
(0.34 acres)
WD
ICKSON
communlly Infrastructure consultants
Buckhead Creek
Figure 7
Buckhead Creek Watershed
Stormwater Infrastructure Improvement
Coventry Road Project Map
Feet
125 250 500
1 in = 250 feet
- Roads
Coventry Rd Project Limits
_ Streams
Wetland Impacts /Alteration
® Existing Wetlands
- Wetland Creation
Parcel Boundaries

APPLICATION FOR DEPARTMENT OF THE ARMY PERMIT
OMB APPROVAL NO 0710-0003
(33 CFR 325)
EXPIRES 31 Au ust 2012
Public reporting burden for this collection of information is estimated to average 11 hours per response Including the time for reviewing Instructions searching
exlstinj data sources gathering and maintaining the data needed and completing and reviewing the collection of Information Send comments regarding this
urden estimate or any other aspect of this 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
Popenrork 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 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 junsdction over the location of the proposed actvity
PRIVACY ACT STATEMENT
Aithontles Rivers and Harbors Act Section 10 33 USC403 Clean Water Act Section 404 33 USC 1344 Marine 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 this
form will be used In evaluating the application for a permit Routine Uses This Information may be shared with the Department of Ustice and other federal
state and local government agencies and the public and may be made available as part of a public notice as required by Federal law Submission of
requested information Is voluntary however if information 1s not 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 ttached to this application (see sample
drawings and 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
OTEMS 1 THRU 4 TO BE FILLED BY THE CORPS)
I APPLICATION NO
2 FIELD OFFICE CODE
3 DATE RECEIVED
4 DATE APPLICATION COMPLETE
(ITEMS BELOW TO BE FILLED BYAPPLICANT)
5 APPLICANT'S NAME
8 AUTHORIZEDAGENTS NAME ANDTITLE (an agent 1s not required)
First Mary Middle Last- D P
First Middle Last -
Company - Cdy r Fayetter Ile
Company -
E mail Address -
E mall Address -
6 APPLICANTS ADDRESS
9 AGENT S ADDRESS
Address 433 Hay Street
Address
QIY - Fayeriavfl State - NC ZIP - 28301 Country - us
Qty - State - Zip - Country -
7 APPLICANTS PHONE NOS WIAREA CODE
10 AGENTS PHONE NOs W /AREA CODE
I Residence b Business c Pa(
a Residence b Business c Fax
(910) 433 -1656 (910) 433 -1058
STATEMENT OF AUTHORIZATION
11 1 hereby authonze 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
APPLICANT S SIGNATURE DATE
NAME LOCATION AND DESCRIPTION OF PROJECT OR ACTIVITY
12 PROJECT NAME OR TITLE (see rest d s)
Buckhead Creek Watershed Strormwater Infrastructure Improvement Projects at Coventry Road and Raeford Road
13 NAME OF WATERBODY I F KNOWN (f appi We)
14 PROJECT STREET ADDRESS (f appicable)
Buckhead Creek
Address
15 LOCAII ON OF PROJECT
Latitude N Caento35C0528RaefodRoad35041919
Longitude 'W cowNry 78.95 6841 Ra*WRoad 78050.392
Qty St ZIp
rn
16 OTHER LOCATION DESCRIPTIONS IF KNOWN (see structions)
State Tax Parcel ID S- AllaetedShed 0lockts Munlclpahty
Section - Township - Range - ALITY
17 DIRECTIONS TO THE SITE
from Raleiyhtat 140es$(M8 01 195Stovad Ben9wfa)ztteNYQ59m)Tef d32UbaeWato495Slovwd BenaonfeyMemie q jagN atl 95 Buss(dgp trwo SA1Sm1# }etteAbfatemovope tFe)(72 0
Tum gilt merge orkloticerokmaIN(12m1) Tat 4iio4trRoba2m Sbedto%ard US40181b S(- Um) Tu I tat US401 BUSNiRobeson5tred(18 ) Tun let d Raeford Road(I 7mt)RaetxdR adP�I%0n taking
Budihead Cre IcWpatl e4nJI)r a Fa Cme"Rom Prolecl Tv Mail almel Dr&a Tak WftfigY4ad CveertryRoad(09m0 DestnoonvJlbem,4m0on8reletalfgS ckNWCm k
ENG FORM 4345 SEPT 2009 EDITION of OCT 2004 IS OBSOLETE Proponent CEC 4-OR

18 1` 1801`eOf Activity m cnph fp f t c de Ire tures)
See Attached Sheet Block 18
19 Project Purpose (De crib the so or p pose f the prop I see nsbucoons)
See Attached Sheet Block 19
USE BLOCKS 20 23 IF DREDGED AND /OR FILL MATERIAL IS TO BE DISCHARGED
20 Reason(s) for Discharge
21 Type(s) of Matenad Being Dischaged and the Amount of Each Type in Cubic Yards
Type Type Type
Amount In Cubic Yards Amount in Cubic Yards Amount in Cubic Yards
22 Surface Area in A res U Wefland, or Other Waters Filled (eee instruction )
Acres
Or
Liner Feet
23 Description of Avoidance Minimization and Compensation (see mvruct o s)
24 Is Any Portion of the Work Already Complete? Yes El N01:Z1 IF YES DESCRIBE THE COMPLETED WORK
25 Addresses of Ac)ctinmg Property Owners Lessees Etc Whose Property Adjoins the Waterbody of more the c b tered he pl se each a suppiem tal I st) t
Address —
Ctty — State — Zip —
26 list of Other CerUfiLations or Approval sfDeni als Received from other Federal State or Local Agencies for Work Described in This Appllcabon
AGENCY TYPE APPROVAL IDENTIFICATION NUMBER DATE APPLIED DATE APPROVED DATE DENIED
Would Include but Is not resincted to zoning building and flood plain permits
27 Application Is hereby made for a permit or permits to authorize the work described In this application I certify that the Information In this application Is
complete and accurate I further cerbfy that I possess the authontyto undertake the work described herein or am acting as the duly authorized agent of the
applicant
�j _ _ 1014 It __
SI N�pU E OF APPLICANT DATE SIGNATURE OF AGENT DATE
The applicabon llmust 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 to 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 wlllfufly
falsifies conceals or covers up any trick 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 some to contain any false fictitious or fraudulent statements or entry shall be fined not more than
$10 000 or impnsoned not more than five years orboth
EMG FORM 4345 SEPT 2009

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