20231361 Ver 1_10 SGWASA agent authorization form_9_25_2023_20230929

Agent Authorization

Property/Site: SGWASA I-85 Sewer System Improvements
Address of Site: Lift Station (LS) sites are 1230 E. Middleton Drive (East Middleton LS),
West of Ledge Creek/Joe Peed Rd (Joe Peed LS), and near 2531 E. Lyon
Station Rd, plus easements for pipelines. Work is in Granville County, NC
Parcel Identification Number (PIN): 088603009324 (E. Middleton LS), 088604537023 and
088603422613 (Joe Peed LS), 088703019291 (I-85 LS);
plus pipelines
Owner Information:
Name: SGWASA (in process of acquiring easements)
Address: 415 Central Avenue, Suite B
Butner, NC 27509
Telephone Number: 919-575-3367 ext. 312
Fax Number: 919-575-4547
E-mail Address: [e-mail]
Property Owner Certification:
I, the undersigned, a duly authorized owner of record of the property/properties identified herein,
do authorize representatives of the Wilmington District, U.S. Army Corps of Engineers (USACE)
and/ or the North Carolina Division of Water Resources (NCDWR) to enter upon the property
herein described for the purpose of conducting on-site investigations and issuing a
determination associated with Waters of the U.S. subject to Federal/State jurisdiction under
Section 404 and 401 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of
1899. I also authorize CDM Smith to act in my behalf in the processing of this request and to
furnish supplemental information in support of this request, including stream/wetland matters in
coordination with the USACE and the NCDWR field verification and permit application:
Property Owner Signature:
Date:
DocuSign Envelope ID: 66DB409A-6764-4FD8-9261-B00B2A6E3871
9/25/2023