20120404 Ver 1_401 Application_20120412

20120404
5outkern Environmental Group, Inc
5315 Soutk College 1Zoacl Suite E Wilmington Nortk Carolina 25+12
Prone 910+52271, Fax 910+52Z899 Email o{fice@segi us
www segl us
April 19 2012
Attn Mr Ian McMillan
RE D'Alessandro Sewer Line Project
Please find the requested changes have been made to the (4) attached PCNs from your Request for
Additional Information received in our office on April 13 2012
I have also attached an email from Emily Hughes at the Corps giving verbal pernussion to proceed with
the proposed temporary impacts associated with Mr D Alessandro s project
Please feel free to contact me if you should have any questions
7cerel
(111-)
David Scibetta
kt�:)
APR 202012

David Scibetta
From Hughes Emily B SAW [Emily B Hughes @usace army mil]
Sent Tuesday April 17 2012 4 46 PM
To danodebo @gmail com
Cc David Scibetta
Subject D Alessandro Sewer Line Work (UNCLASSIFIED)
Classification UNCLASSIFIED
Caveats NONE
Good day
You have our verbal permission to move forward with your sewer line protect located at 7910 Market Street on the north side of
Marsh Oaks Drive for the purpose of serving a new restaurant/bar establishment on Market Street to the north You are
authorized to temporarily impact 446 sq ft of Section 404 jurisdictional wetlands with the notion that all wetland areas will be
returned to original grade once the project is complete
Please refer to Nationwide Permit 12 for further information
http / /www saw usace army mil / Wetlands /permits/NWP/NWP2012/NWP12 3 23 pdf
If you have questions /concerns please do not hesitate to call
Emily
U S Army Corps of Engineers
Wilmington Regulatory Field Office
69 Darlington Avenue
Wilmington North Carolina 28403
Office (910) 251 -4635
Fax [phone]
The Wilmington District is committed to providing the highest level of support to the public To help us ensure we continue to
do so please complete the Customer Satisfaction Survey at hqp / /per2 nwp usace army mil /survey html
U S Army Corps of Engineers
Wilmington Regulatory Field Office
69 Darlington Avenue
Wilmington North Carolina 28403
Office (910) 251 -4635
Fax [phone]
The Wilmington District is committed to providing the highest level of support to the public To help us ensure we continue to
do so please complete the Customer Satisfaction Survey at http / /per2 nwp usace army mil /survey html
Classification UNCLASSIFIED
Caveats NONE

R
5outkern Environmental Group, Inc
5315 South College Road Suite 1_ Wilmington North Carolina 7-8-+12
Phone 5`10+52271, Pax 910+522899 Fmail o{fice@segus
www sep us
March 23 2012
Hand Dehvery
Ms Emily Hughes
Regulatory Specialist
U S Army Corps of Engineers
Wilmington District Regulatory Division Office
69 Darlington Avenue
Wilmington N C 28403
Mr Chad Coburn
Senior Environmental Specialist
NCDENR Division of Water Quality
127 Cardinal Drive Extension
Wilmington N C 28405 3845
[SEGi Project # 012 -010 011
APR��10 :�
DENR
Yuet1! R YATL-k Qj LITY
RE Nationwide Pernut 12 — Dan D'Alessandro Sewer Line Project
Wilmington, New Hanover County, N C
Dear Ms Hughes and Mr Coburn
APR 2 0 2012
DENR
'etlands 8 aA1�R QU 17V !
Southern Environmental Group Inc (SEGm) on behalf of Dan D Alessandro the Applicant is
submitting this request for Department of the Army (DA) authorization to temporarily impact 0 01 acre
(446 s f ) of 404 jurisdictional wetlands The proposed impacts are requested along the north side of
Marsh Oaks Drive approximately 240 feet from Market Street in Wilmington New Hanover County
North Carolina
The Applicant is proposing construct 438 1 f of 8 sewer line from his new bar /restaurant facility on
Market Street to tie in at Marsh Oaks Drive The applicant requests Department of the Army (DA)
approval to temporarily impact 0 01 acre (446 s f ) of non riparian forested as part of this project The
Applicant has mmmmmzed his work to remain in the established utility right of way Sedimentation and
erosion control BMPs will be utilized during the construction process No mitigation is proposed for this
temporary impact as the site will be restored to original grade and contour and stabilized No trees are
proposed to be replanted because only on large black willow seedlings and small sapling trees and
shrubs will be impacted This area was mowed about 6 years ago and has revegetated well on its own,
and will do so after this construction activity
In summary SEGm is requesting DA authorization to utilize Nationwide Permit 12 to temporarily impact
0 01 acre (446 s f ) of non riparian forested wetland for the purpose of construction of 4381 f of 8 sewer
line from a new bar /restaurant facility on Market Street to tie in at Marsh Oaks Drive

If you have any question or concerns please call me at [phone] Thank you in advance for your
time and assistance with this project
Sincerely
i
� J
David Scibetta
Project Manager
Enclosures Attachment 1 — Pre Construction Notification and Accompanying Appendices

Attachment 1
Pre- Construchon Notification
And Accompanying Appendices

:m
W A TF9oG
O �
20120404
Office Use Only
Corps action ID no
DWQ project no
Form Version 13 Dec 10 2008
Wed ode $ ERR QUAI ?y
Page 1 of 11
PCN Form — Version 13 December 10 2008 Version
Pre - Construction Notification PC F ran
A Applicant Information
1
Processing
la
Type(s) of approval sought from the
Corps
® Section 404 Permit ❑ Section 1 ermit
1b Specify Nationwide Permit (NWP) number 12 or General Permit (GP) number
1c
Has the NWP or GP number been venfied by the Corps?
® Yes ❑ No
1 d
Type(s) of approval sought from the DWQ (check all that apply)
❑ 401 Water Quality Certification — Regular ❑ Non -404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
1 e
Is this notification solely for the record
because written approval is not required?
For the record only for DWQ 401
Certification
❑ Yes ® No
For the record only for Corps Permit
❑ Yes ® No
1f
Is payment into a mitigation bank or in lieu fee program proposed for mitigation
of impacts? If so attach the acceptance letter from mitigation bank or in lieu
fee program
❑ Yes ® No
1g
Is the project located in any of NC s twenty coastal counties If yes answer 1 h
below
® Yes ❑ No
-1h Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes ® No
2
Project Information
2a
Name of project
D Alessandro Sewer Line Project _
2b
County
New Hanover �r 1 al
2c
Nearest municipality / town
Wilmington
2d
Subdivision name
Marsh Oaks
2e
NCDOT only T I P or state
project no
NA
3
Owner Information ` s•r�a 8a
3a
Name(s) on Recorded Deed
Bayshore Estates Inc
3b
Deed Book and Page No
5524/0734
3c
Responsible Party (for LLC if
applicable)
Bayshore Estates Inc (see Appendix 1 Business Corporation Annual Report)
3d
Street address
1201 Glen Meade Road
3e
City state zip
Wilmington NC 28401
3f
Telephone no
910 762 2676
3g
Fax no
3h
Email address
Wed ode $ ERR QUAI ?y
Page 1 of 11
PCN Form — Version 13 December 10 2008 Version

4
Applicant Information (if different from owner)
4a
Applicant is
❑ Agent ® Other specify Adjacent Property Owner
4b
Name
Dan D Alessandro
4c
Business name
(if applicable)
4d
Street address
230 Bradley Drive
4e
City state zip
Wilmington NC 28409
4f
Telephone no
910 616 7335
4g
Fax no
4h
Email address
danodebo @gmad com
5
Agent/Consultant Information (if applicable)
5a
Name
David Scibetta
5b
Business name
(if applicable)
Southern Environmental Group Inc (See Appendix 2 Agent Authorization Form)
5c
Street address
5315 South College Road Suite E
5d
City state zip
Wilmington NC 28412
5e
Telephone no
910 -452 2711
5f
Fax no
910 -452 2899
5g
Email address
dscibetta @segi us
Page 2 of 11
PCN Form — Version 13 December 10 2008 Version

B Project Information and Prior Project History
1 Property Identification
1a Property identification no (tax PIN or parcel ID)
R03600 005 020 000
1 b Site coordinates (in decimal degrees)
Latitude 34 2903 Longitude 777994
(DD DDDDDD) ( DD DDDDDD)
Property size
9 2 acres
-1c
2 Surface Waters
2a Name of nearest body of water (stream river etc ) to
UT to Pages Creek
proposed project
2b Water Quality Classification of nearest receiving water
SA HQW
2c River basin
New 03020302
3 Project Description
3a Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application
The site is along the entrance road to Marsh Oaks and was mowed approximately 6 years ago and has grown back with
small trees shrubs and herbaceous vegetation
3b List the total estimated acreage of all existing wetlands on the property
001
3c List the total estimated linear feet of all existing streams (intermittent and perennial) on the property
0
3d Explain the purpose of the proposed project
To install sewer line to serve a new restaurant and bar on Market Street tied into sewer along Marsh Oaks Drive
3e Describe the overall project in detail including the type of equipment to be used
New sewer line will be installed from the new facility along an existing powerline easement then following the road
easement to tie into sewer along Marsh Oaks Drive Backhoes and other excavating equipment will be used The limits
of disturbance will be encased by silt fence After work is completed the site will be returned to original grade and
contour and stabilized (see Appendix 3 Proposed Sewer Line Plan)
4 Jurisdictional Determinations
4a Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (including all pnor phases) in the past
Yes ❑ No El Unknown
Comments A JD package has been submitted concurrently
with NWP application to secure a site visit to confirm wetland
delineation
4b If the Corps made the jurisdictional determination what type
El Preliminary ❑ Final
of determination was made
4c If yes who delineated the jurisdictional areas?
Agency /Consultant Company SEGi
Name (if known) David Scibefta
Other
4d If yes list the dates of the Corps jurisdictional determinations or State determinations and attach documentation
5 Project History
5a Have permits or certifications been requested or obtained for
❑ Yes ® No ® Unknown
this project (including all prior phases) in the past
5b If yes explain in detail according to help file instructions
Page 3 of 11
PCN Form — Version 13 December 10 2008 Version

6 Future Project Plans
6a Is this a phased project? ❑ Yes ® No
6b If yes explain
Page 4 of 11
PCN Form — Version 1 3 December 10 2008 Version

C Proposed Impacts Inventory
1 Impacts Summary
la Which sections were completed below for your project (check all that apply)
® Wetlands ❑ Streams tributaries ❑ Buffers
❑ Open Waters ❑ Pond Construction
2 Wetland Impacts
If there are wetland impacts proposed on the site then complete this question for each wetland area impacted
2a
2b
2c
2d
2e
2f
Wetland impact
Type of jurisdiction
number —
Type of impact
Type of wetland
Forested
(Corps 404 10
Area of impact
Permanent (P) or
(if known)
DWQ — non -404 other)
(acres)
Temporary T
W1 ❑ P ®T
Fill
Basin wetland
® Yes
❑ No
® Corps
® DWQ
446 s f (0 01)
W2 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W3 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W4 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W5 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W6 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
2g Total wetland impacts
446 s f (0 01)
2h Comments
3 Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site then complete this
question for all stream sites impacted
3a
3b
3c
3d
3e
3f
3g
Stream impact
Type of impact
Stream name
Perennial
Type of jurisdiction
Average
Impact
number
(PER) or
(Corps 404 10
stream
length
Permanent (P) or
intermittent
DWQ — non -404
width
(linear
Temporary (T)
(INT)?
other)
(feet)
feet)
S1 ❑ P [:IT
NA
❑ PER
❑ Corps
❑ INT
❑ DWQ
S2 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S3 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S4 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S5 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S6 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
3h Total stream and
tributary impacts
31 Comments
Page 5 of 11
PCN Form — Version 13 December 10 2008 Version

4 Open Water Impacts
If there are proposed impacts to lakes ponds estuaries tributaries sounds the Atlantic Ocean or any other open water of
the U S then individually list all open water impacts below
4a
4b
4c
4d
4e
Open water
Name of waterbody
impact number —
(if applicable)
Type of impact
Waterbody type
Area of impact (acres)
Permanent (P) or
Temporary T
01 ❑P ❑T
NA
02 ❑P ❑T
03 ❑P ❑T
04 ❑P ❑T
41' Total open water impacts
4g Comments
5 Pond or Lake Construction
If pond or lake construction proposed then complete the chart below
5a
5b
5c
5d
5e
Wetland Impacts (acres)
Stream Impacts (feet)
Upland
Pond ID
Proposed use or purpose
(acres)
number
of pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
NA
P2
517 Total
5g Comments
5h Is a dam high hazard permit required
❑ Yes ❑ No If yes permit ID no
51 Expected pond surface area (acres)
5I Size of pond watershed (acres)
5k Method of construction
6 Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer then complete the chart below If yes then individually list all buffer impacts
below If any impacts require mitigation then you MUST fill out Section D of this form
6a
❑ Neuse ❑ Tar Pamlico ❑ Other
Project is in which protected basin?
❑ Catawba ❑ Randleman
6b
6c
6d
6e
6f
6g
Buffer impact
number —
Reason
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P) or
for
Stream name
mitigation
(square feet)
(square feet)
Temporary T
impact
required?
61 ❑P[IT
NA
El Yes
❑ No
B2 ❑P❑T
❑Yes
❑ No
B3 ❑P ❑T
El Yes
❑ No
6h Total buffer impacts
6i Comments
Page 6 of 11
PCN Form — Version 1 3 December 10 2008 Version

D Impact Justification and Mitigation
1 Avoidance and Minimization
1 a Specifically describe measures taken to avoid or minimize the proposed impacts in designing project
The work will be confined to the designated utility line right of way
1 b Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
Only the area to be excavated and a small work area will be disturbed during utility line installation within existing right of way
2 Compensatory Mitigation for Impacts to Waters of the U S or Waters of the State
2a Does the project require Compensatory Mitigation for
impacts to Waters of the U S or Waters of the State?
❑ Yes ® No
2b If yes mitigation is required by (check all that apply)
❑ DWQ ❑ Corps
2c If yes which mitigation option will be used for this
project?
❑ Mitigation bank
❑ Payment to in lieu fee program
❑ Permittee Responsible Mitigation
3 Complete if Using a Mitigation Bank
3a Name of Mitigation Bank NA
3b Credits Purchased (attach receipt and letter) TType
Quantity
3c Comments
4 Complete if Making a Payment to In lieu Fee Program
4a Approval letter from in lieu fee program is attached
❑ Yes
4b Stream mitigation requested
NA linear feet
4c If using stream mitigation stream temperature
❑ warm ❑ cool ❑cold
4d Buffer mitigation requested (DWQ only)
NA square feet
4e Riparian wetland mitigation requested
NA acres
4f Non riparian wetland mitigation requested
NA acres
4g Coastal (tidal) wetland mitigation requested
NA acres
4h Comments
5 Complete if Using a Permittee Responsible Mitigation Plan
5a If using a permittee responsible mitigation plan provide a description of the proposed mitigation plan
NA
Page 7 of 11
PCN Form — Version 13 December 10 2008 Version

6 Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation?
❑ Yes ❑ No
6b If yes then identify the square feet of impact to each zone of the riparian buffer that requires mitigation Calculate the
amount of mitigation required
Zone
6c
Reason for impact
6d
Total impact
(square feet)
Multiplier
6e
Required mitigation
(square feet)
Zone 1
NA
3 (2 for Catawba)
Zone 2
15
6f Total buffer mitigation required
6g If buffer mitigation is required discuss what type of mitigation is proposed (e g payment to private mitigation bank
permittee responsible riparian buffer restoration payment into an approved in lieu fee fund)
6h Comments
Page 8 of 11
PCN Form — Version 13 December 10 2008 Version

E
Stormwater Management and Diffuse Flow Plan (required by DWQ)
1
Diffuse Flow Plan
1 a
Does the project include or is it adjacent to protected riparian buffers identified
❑ Yes ® No
within one of the NC Riparian Buffer Protection Rules?
1 b
If yes then is a diffuse flow plan included? If no explain why
❑ Yes ❑ No
Comments
2
Stormwater Management Plan
2a
What is the overall percent imperviousness of this projecO
0%
2b
Does this project require a Stormwater Management Plan?
❑ Yes ® No
2c
If this project DOES NOT require a Stormwater Management Plan explain why It is a temporary impact associated with
a utlity line installation There will be no impervious surface associated with the project
2d
If this project DOES require a Stormwater Management Plan then provide a brief narrative description of the plan
NA
❑ Certified Local Government
2e
Who will be responsible for the review of the Stormwater Management Plans
❑ DWQ Stormwater Program
❑ DWQ 401 Unit
3
Certified Local Government Stormwater Review
3a
In which local government s jurisdiction is this project?
NA
❑ Phase II
3b
Which of the following locally implemented stormwater management programs
❑ NSW
❑ USMP
apply (check all that apply)
❑ Water Supply Watershed
® Other NA
3c
Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached9
4
DWQ Stormwater Program Review
® Coastal counties
4a
Which of the following state implemented stormwater management programs apply
❑ HOW
❑ ORW
(check all that apply)
❑ Session Law 2006 246
❑ Other
4b
Has the approved Stormwater Management Plan with proof of approval been
attached?
❑ Yes ® No
5
DWQ 401 Unit Stormwater Review
5a
Does the Stormwater Management Plan meet the appropriate requirements?
❑ Yes ❑ No
5b Have all of the 401 Unit submittal requirements been met?
® Yes ❑ No
Page 9 of 11
PCN Form — Version 13 December 10 2008 Version

F
Supplementary Information
1
Environmental Documentation (DWQ Requirement)
la
Does the project involve an expenditure of public (federal /state /local) funds or the
❑ Yes
® No
use of public (federal /state) lands
lb
If you answered yes to the above does the project require preparation of an
environmental document pursuant to the requirements of the National or State
❑ Yes
❑ No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1c
If you answered yes to the above has the document review been finalized by the
State Clearing House? (If so attach a copy of the NEPA or SEPA final approval
letter )
❑ Yes
❑ No
Comments
2
Violations (DWQ Requirement)
2a
Is the site in violation of DWQ Wetland Rules (15A NCAC 2H 0500) Isolated
Wetland Rules (15A NCAC 2H 1300) DWQ Surface Water or Wetland Standards
❑ Yes
® No
or Riparian Buffer Rules (15A NCAC 2B 0200)?
2b
Is this an after the fact permit application?
❑ Yes
® No
2c
If you answered yes to one or both of the above questions provide an explanation of the violation(s)
3
Cumulative Impacts (DWQ Requirement)
3a
Will this project (based on past and reasonably anticipated future impacts) result in
❑Yes
No
additional development which could impact nearby downstream water quality
3b
If you answered yes to the above submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy If you answered no provide a short narrative description
4
Sewage Disposal (DWQ Requirement)
4a
Clearly detail the ultimate treatment methods and disposition (non - discharge or discharge) of wastewater generated from
the proposed project or available capacity of the subject facility
NA
Page 10 of 11
PCN Form — Version 13 December 10 2008 Version

5 Endangered Species and Designated Critical Habitat (Corps Requirement)
5a Will this project occur in or near an area with federally protected species or
❑ Yes ® No
habitat?
5b Have you checked with the USFWS concerning Endangered Species Act
® Yes ❑ No
impacts?
® Raleigh
5c If yes indicate the USFWS Field Office you have contacted
❑ Asheville
5d What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
The North Carolina Natural Heritage Program database
6 Essential Fish Habitat (Corps Requirement)
6a Will this project occur in or near an area designated as essential fish habitat'?
❑ Yes ® No
6b What data sources did you use to determine whether your site would impact Essential Fish Habitat
NOAA Fisheries Essential Fish Habitat Mapper
7 Historic or Prehistoric Cultural Resources (Corps Requirement)
7a Will this project occur in or near an area that the state federal or tribal
governments have designated as having historic or cultural preservation
❑ Yes ® No
status (e g National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b What data sources did you use to determine whether your site would impact historic or archeological resources?
National Historic Trust National Park Service and NC Historic Places websites
8 Flood Zone Designation (Corps Requirement)
8a Will this project occur in a FEMA- designated 100 year floodplain? —713
Yes ® No
8b If yes explain how project meets FEMA requirements NA
8c What source(s) did you use to make the floodplam determination? The NC Floodplain Mapping Information System
oaz�
;�
- I9 -12-
Applicant/Agents Printed Name
Date
Applicant/Agent s Signature
(Agents signature is valid only d an authorization letter from the applicant
is provided
Page 11 of 11
PCN Form – Version 1 3 December 10 2008 Version

Appendix 1 Business
Corporation Annual Report
° ►' BUSINESS CORPORATION ANNUAL REPORT
NAME OF BUSINESS CORPORATION Bayshore Estates Inc.
SECRETARY OF STATE ID NUMBER 0011138 STATE OF FORMATION NC
REPORT FOR THE FISCAL YEAR END 2012
SECTION A REGISTERED AGENTS INFORMATION
1 NAME OF REGISTERED AGENT William H Cameron
2 SIGNATURE OF THE NEW REGISTERED AGENT
Bing OIGce Use O ty
r Changes
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3 REGISTERED OFFICE STREET ADDRESS & COUNTY 4 REGISTERED OFFICE MAILING ADDRESS
1201 Glen Meade Rd P 0 Box 3649
Wilmington NC 28401 NEW HANOVER
Wilmington NC 28406
SECTION B PRINCIPAL OFFICE INFORMATION
1 DESCRIPTION OF NATURE OF BUSINESS Real Estate Developer
2 PRINCIPAL OFFICE PHONE NUMBER [phone] 3 PRINCIPAL OFFICE EMAIL
4 PRINCIPAL OFFICE STREET ADDRESS & COUNTY
1201 Glen Meade Rd
Wilmington NC 28401 NEW HANOVER
SECTION C OFFICERS (Enter additional Officers in Section E )
5 PRINCIPAL OFFICE MAILING ADDRESS
PO Box 3649
Wilmington NC 28406 0649
NAME William H Cameron NAME Alexander B Koonce
TITLE President TITLE Vice President/Treasurer
ADDRESS ADDRESS
PO Box 3649 PO Box 3649
Wilmingtnn Nr 7R4nA Wllminntnn mr jaAna
NAME Jabe V Hardee
TITLE Vice President/Secretary
ADDRESS
PO Box 3649
Wilmington NC 28406
SECTION D CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a person/business entity
SIGNATURE
Form must be signed by an officer listed under Section C of this form.
Print or Type Name of Officer
SUBMIT THIS ANNUAL REPORT WITH THE REQUIRED FILIN - FEE OF 925
MAIL TO• Secretary of State Corporations Division Post Office Box 29525 Raleigh NC 27626-0525
DATE
TITLE

SEG!
AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION _ Q 65 ACRES) 16 AC ALEX & SOUTHERLAND
LOT NO PLAN NO _PARCEL I D R03600 005 020 003
STREET ADDRESS 7976 Market Street
Property Owner (please print) Daniel L D Alessandro
The undersigned registered property owner of the above noted property does hereby authorize
Southern Environmental Group, Inc (SEGO to act on my behalf in matters regarding areas of
environmental concern
Property Owner's Address (if different than property above)
230 Bradley Drive
Wilmington, NC 28409
Telephone
Dan D Alessandro [phone]
We hereby rtify the above info anon submitted in this a placation is true and accurate to the best of
our kno ge
erty Ow r Authorized Signature SEGi Authorized Signature
Date
Date
I - 13 - /-,;? --

m�/ jV/ Auvo W. .
85/30/2086 15 07 9104522899 SEGI PAGE 02/04
Appendix 2 Agent
Authorization Form
SEGO
5outkern F nvironmental Group, Inc
Environmental, pevolopment, and Conservation Advisors
www ISCO us
i etter ofAgencc
1, hereby
rant
(46-w0m, Name)
jou4mm Er,v,ronmental Group Inc., (SEGO the right to
represent
.M=D-)a + � � in matters regarding environmental consulting
(C"1
serv,ces on real Property owned by C�Aye -
at r u�A.�.e lv� 1.L�i! -L in .....�..1L IN A4-K
9h@ �� County, jvorth Carolina
La
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/jAgent
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5319 50uth College Koad 5u,w E, • Wdomngton, North Carolina 2&tf 2
910+52.X71 r Fax. [phone] QMcsQ*eg, us

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