20141089 Ver 1_More Info Received_20141015

From. 5hen�,A,Montalvo shen montalvo(ncdenr gov
Subject- 118 Teufen project
Data October 15, 2014 at 9 11 AM
To. Rick Young ryoung 60p Ca con)
Good morning,
We received the PCN and .fee for the above project: Page 10 of 10 of the application was ,not
signed. Please sign that page. Also, if you, Rick, are going to be signing it then we will need
the attached agent authorization form to be filled out and sent in as well authorizing your
signature. Bdth of`therequested�can either be emailed to me at sheri,[e-mail] or
mailed to:
Sheri Montalvo
401 & Buffer Permitting ,Unit
,NCDENR= Division of Water Resources
1617 Mail Service Center, Raleigh, 'NC 27699 -161'7
This project will be placed on hold until recipt of these two items. Thank you for your help!
Sheri
Phone: [phone]
Email:,sheri montalvo6ncdenr.gov
E -mail correspondence to and from,this address may be subject to public records laws and
may be disclosed to third parties.

5. Endangered Species and Designated Critical Habitat,(Corps Requirement)
5a Will this project occur rotor near an area with federally protected species or
habitat?
Yes MX No .
5b Have you checked with the, USFWS,concerning Endangered Species Act
impacts?
Yes ❑X No
5c if yes, indicate the USFWS Field Office you have contacted
-
5d What data sources did you use to determine whether your site would, impact Endangered Species or Designated Critical
Habitat?
6, Essential Fish' Habitat (Corps Requirement)
6a Will this project occur, in or near an area designated as essential fish habitat?
❑ Yes QX No
6b What data sources did you use to determine whether your'site,wouid impact Essential' Fish Habitat?
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 oracultural preservation
status (e g , National Historic Trust-designation or properties significant in
North Carolina.history and archaeology)?
Yes ONO
7b What data sources did you use to determine whether your site would impact historic,or archeological resources?
NA
8. Flood Zone Designation (Corps Requirement)
8a Will this project occur in a FEMA - designated 100 -year fl6odpla_in?
❑ Yes Q No
8b If yes, explain how project meets FEMA requirements
I
8c What source(s) did you use to make the floodplain determination?
Local Board MLS
Applicant/Agent's Printed Name
kx
Date
Applicant/A nt's Sign re
(Agents signature is slid only4 authorization
letter from the,applicant is provided
Page 10 of 10

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION•
LOT NO 3�3 PLAN iNO.
PARCEL ID- 7- Sob " "s" 373
STREET ADDRESS: 119 T ttt {rl TCL- eMq
Please print.
Property Owner: UP -s4e- r L Ehcon,
Property Owner, [)A-0 J Eb ray-1 -
The undersigned, registered property owners of the above, noted property, do hereby authorize
W1 G{` )t a rl_(2I of C, e_v 4V
(Contractor / Ag t) (Name of consulting fir )
Lo act on my behalf and take all actions,necessary for the processing, issuance and acceptance of
this pernut or certification and, any and all standard and special conditions, attached
Property Owner's Address (if different than property above)
Pd 130-X 3549 /V b , -a 1-7 0s"-
Telephone:
We hereby certify the above information submitted in this application, is true and accurate to the
best of our knowledge.
Signature
Date h2