20000874_401 Application_20030213

APPLICATION FOR DEPARTMENT OF THE ARMY PERMIT I OMB APPROVAL NO. 07%-=3
(33 CFR 325) Expires December 31, 2004
Public reporting burden for this collection of information is estimated to average 10 hours per response, although the majority of applicattions should
require 5 hours or less. This includes the time for reviewing Instructions, searching existing data sources, gathering and maintaining the dlata needed,
and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this mollection of
Information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Service Directorate of Information
Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 222024302; and to the Office of Management and Budget,
Paperwork Reduction Project (0710 -0003), Washington, DC 20503. 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 cortlltrol 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 activi .
PRIVACY ACT STATEMENT
Authority: Rivers and Harbors Act, Section 10, 33 USC 403: Clean Water Act, Section 404, 33 USC 1344; Marine Protection, Research ands `Sanctuaries
Act, 33 USG 1413, Section 103. Principal Purpose: Information provided on this form will be used in evaluating the application for a pemnit. Routine
Uses: This information may be shared with the Department of Justice and other federal, state, and local government agencies. Suttanission of
requested information is voluntary, however, if information is not provided the permit application cannot be evaluated nor can a permit be Wsued.
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 instructions) and be submitted to the District Engineer having jurisdiction over the location of. tone proposed
activity. An application that is not completed in full will be returned.
I_ (ITEMS l THRU 4 TO BE fjILLED BY THE CORPS) I
1. APPLICATION NO. 1 2. FIELD OFFICE CODE 13, DATE RECEIVED 14. DATE APPLICATION COMPLETED
(ITEMS BELOW TO BE FILLED BY APPLICANT)
5. APPLICANTS NAME
North Carolina Department of Transportation
Project Development & Environmental Analysis
6. APPLICANTS ADDRESS
1548 Mail Service Center
Raleigh, NC 27699 -1548
8. AUTHORIZED AGENTS NAME AND TITLE (an agent is notregouirad)
9. AGENTS ADDRESS
7. APPLICANTS PHONE NOS. W /AREA CODE 10. AGENTS PHONE NOS. WIAREA CODE
a. Residence a. Residence
b. Business 919 - 733 -3141 b. Business
11, STATEMENT OF AUTHORIZATION
I hereby authorize, to act in my behalf as my agent in the processing of this application and to ffumish, upon
request, supplemental information in support of this permit application.
APPLICANTS SIGNATURE DATE
NAME, LOCATION, AND DESCRIPTION OR PROJECT OR ACTIVITY
12. PROJECT NAME OR TITLE (see instructions
Ellerbe Bypass
13. NAME OF WATERBODY, IF KNOWN (if applicable) 14. PROJECT STREET ADDRESS (if appticabis)
Tributaries to Yadkin and Lumber River
Basin. See attached cover letter for
detailed descriptions.
15. LOCATION OF PROJECT
Montgomery and Richmond NC
COUNTY STATE
16. OTHER LOCATION DESCRIPTIONS, IF KNOWN (see instructions) section, Township, Range, LatfLon, and/or Accessora's Parcel Number, for example-,.
The North Carolina Department of Transportation (NCDOT) proposes to cons. "truct a
four -lane, full control of access highway on new location from south of Ellerbe
(Richmond County) to Emery, south of Candor (Montgomery County) . rnter,changes
are proposed at US 220 south of Ellerbe, SR 1452, SR 1458, NC 73, SR 1:321, SR
1524, and US 220 north of Emery. The project will be approximately 19 moles in
EN FORM 4345, Jul V EDITION OF FEB 94 IS OBSOLETE (Proponent: CECWOR)

length. A connector road (R -3303) also known as the NC 73 Extension between the
existing intersection of US 220 and NC73, and the proposed Bypass will also be
constructed. UTM coordinates: Project extends from UTM 17 612364E 3878031N to
UTM 17 615716E 3905402N.
17. DIRECTIONS TO THE SITE
See Attached Vicinity maps.
18. Nature of Activity (Description of project, include all features)
Highway construction
19. Project Purpose (Desvibe the reason or purpose of the project, Sae instructions) Public transportation. The main purpose of the
proposed Ellerbe Bypass is to improve the entire US 220 corridor in the state.
US 220 is designated as part of the Interstate Corridor System and serves as a
major north -south route. The bypass is needed because the existing road in and
near Ellerbe has sharp curves, roller -- coaster grades and reduced speed zones
through towns that create safety hazards, which are increasing in severity as
the traffic volumes increase. The purpose of the Connector is to provide direct
connection between existing NC73 and the proposed Bypass without the need to
travel to downtown Ellerbe.
USE BLOCKS 20 -22 IF DREDGED AND /OR FILL MATERIAL IS TO BE DISCHARGED
20. Reason(s) for Discharge
Construction of the highway
21. Type(s) of Material Being Discharged and the Amount of Each Type in Cubic Yards
See attached permit drawings
22. Surface Area in Acres of Wetlands or Other Waters Filled (see instructions)
See attached permit drawings and covet fetter.
23, Is Any Portion of the Work Already Complete? Yes _ No x IF YES, DESCRIBE THE COMPLETED WORK
24, Addresses of Adjoining Property Owners, Lessees, Etc., Whose Property Adjoins the Waterbody (if more than can be entered here, please attach a supplemental list).
See attached list. Mailing labels included for your convenience.
25. List of Other Certifications or ApprovaWDenials Received from other Federal, State, or Local Agencies for Work Described in This Application.
AGENCY TYPE APPROVAL' IDENTIFICATION NUMBER DATE APPLIED DATE APPROVED DATE DENIED
Would include but is not restricted to zoning, building, and flood plain permits
26. 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 certify that I possess the authority to undertake the work described herein or am acting as the duly authorized agent
of the applicant.
Mmov 13 -0
SIG ATU OF APPLICANT DATE SIGNATURE OF 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 Unitd States knowingly
and willfully 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 same to contain any false, fictitious or fraudulent stateiments or entry, shall
be fined not more than $10,000 or imprisoned not more than five years or both.
ENG FORM 4345, Jul 97 EDITION OF FEB 94 IS OBSOLETE (Proponent: CECW -OR)