20221197 Ver 2_Submitted IP Permit Application_20230302

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U.S. Army Corps of Engineers (USAGE)
Form Approved -
APPLICATION FOR DEPARTMENT OF THE ARMY PERMIT
OMB No. 0710-0003
For use of this form, see 33 CFR 325. The proponent agency is CECW-CO-R.
Expires: 08-31-2023
The public reporting burden for this collection of information, OMB Control Number 0710-0003, 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 the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services,
at . 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 APPLICATION TO THE ABOVE EMAIL.
PRIVACY ACT STATEMENT
Authorities: Rivers and Harbors Act, Section 10, 33 USC 403; 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 Justice 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 is 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 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. System of Record Notice (SORN). The information received is entered Into our permit tracking database and a SORN has been completed (SORN
#A1145b) and may be accessed at the following website:
(ITEMS 1 THRU 4 TO BE FILLED BY THE CORPS)
1. APPLICATION NO.
2. FIELD OFFICE CODE
3. DATE RECEIVED
14. DATE APPLICATION COMPLETE
(ITEMS BELOW TO BE
FILLED BY APPLICANT)
8. AUTHORIZED AGENTS NAME AND TITLE (agent is not required)
5. APPLICANTS NAME
First - Joel Middle-C. Last- Albea
First - Jonathan Middle -D. Last - Hinkle
Company - Embrey Partners, LLC
Company - Greenman -Pedersen Inc.
E-mail Address [e-mail]
E-mail Address [e-mail]
6. APPLICANTS ADDRESS:
9. AGENTS ADDRESS:
Address- 7600 Broadway, Suite 300
Address- 1308 US - 258 N
City - San Antonio State - TX Zip - 78209 Country -US
City - Kinston State - NC Zip - 28504 Country YS
10. AGENTS PHONE NOs. w1AREA CODE
7. APPLICANTS PHONE NOs. WAREA CODE
a. Residence b. Business c. Fax
a. Residence b. Business c. Fax
979.517.0647 210.824.6044 da
910.250.5290 910.596.1003 n/a
STATEMENT OF AUTHORIZATION
11. 1 hereby authorize, Jonathan D. Hidde to act in my behalf as m agent in the processing of this application and to furnish, upon request,
supplemental information in support of this permit application.
4�-_ 2023-01-20
rGrtlkfiklRE 04EW PrL 1 ANT DATE
NAME, LOCATION, AND DESCRIPTION OF PROJECT OR ACTIVITY
12. PROJECT NAME OR TITLE (see instructions)
3027 North Tryon St. Development and Stream Realignment/Restoration
13. NAME OF WATERBODY, IF KNOWN (if applicable)
14. PROJECT STREET ADDRESS (if applicable)
UT to Derta Branch
Address 3017 North Tryon St
15. LOCATION OF PROJECT
Latitude: -N 35,252464 Longitude: -W-80.810705
city - Charlotte State- NC Zip- 28206
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16. OTHER LOCATION DESCRIPTIONS, IF KNOWN (see instructions)
State Tax Parcel ID 08502101, 08502102, 08502103 Municipality Mecklenburg County
Section - Township - Range -
17. DIRECTIONS TO THE SITE
Starting at the Mecklenburg County Court House, travel northwest on E 4th Street approximately 0.2 miles. Turn right on to S Davidson
Street and proceed approximately 0.5 miles. take the second exit at the traffic circle onto N Davidson Street and proceed approximately 2.2
miles. Turn left onto E 36th Street and proceed approximately 0.4 miles. Turn left onto N Tryon Street and the Project Site will be on the right
in approximately 0.2 miles at 3027 N Tryon Street. The site consist of 4 parcels (PID:08502101, 08502102, 08502103, 08502104) and is
bound by the B&N Grading / McCarthy Tire Service property to the north, Atando Ave to the east, N Tryon Street to the south and the
Norfolk Souther Railway to the west.
18. Nature of Activity (Description of project, include all features)
Please see attached IP Application Response Supplement document.
19. Project Purpose (Describe the reason or purpose of the project, see instructions)
Please see attached IP Application Response Supplement document.
USE BLOCKS 20-23 IF DREDGED AND/OR FILL MATERIAL IS TO BE DISCHARGED
20. Reason(s) for Discharge
Please see attached IP Application Response Supplement document.
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
1.200 cy or suitable material
22. Surface Area in Acres of Wetlands or Other Waters Filled (see instructions)
Acres n/a
or
Linear Feet 650
23. Description of Avoidance, Minimization, and Compensation see instructions
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Please see attached IP Application Response Supplement document.
24. Is Any Portion of the Work Already Complete? QYes O No IF YES, DESCRIBE THE COMPLETED WORK
25. Addresses of Adjoining Property Owners, Lessees, Etc., Whose Properly Adjoins the Waterbody (d more than can be entered here, please attach a supplemental list)
a. Address -GMT Property Group LLC - 340 Kidder St.
City - Wilkes Barre State - PA Zip -18702
b. Address -City of Charlotte (for Atando Ave) - 1213 W Morehead St, Suite 500
city - Charlotte State - NC Zip - 28208
c. Address -
City - state - Zip -
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
See Attached Document
" 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.
I
2023-01-20 //
2023-01-20
SIGNATURE AP P ICANT DATE SIGNATURE OF AGENT DATE
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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 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
statements or entry, shall be fined not more than $10,000 or imprisoned not more than five years or both.
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