20240357 Ver 2_Barons Drive_Eng_Form_4345 (1) SIGNED_20240507

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U.S. Army Corps of Engineers (USACE)
Form Approved -
APPLICATION FOR DEPARTMENT OF THE ARMY PERMIT
OMB No. 0710-0003
33 CFR 325. The proponent agency is CECW-CO-R.
Expires: 01-08-2018
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 whs.mc-alex.esd.mbx.dd-dod-information-collections(a-)mail.mil. 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: http://dpcld.defense.gov/Privacy/SORNslndex/DOD-wide-SORN-Article-View/Article/570115/al l45b-ce.aspxx
(ITEMS 1 THRU 4 TO BE FILLED BY THE CORPS)
1. APPLICATION NO.
2. FIELD OFFICE CODE
3. DATE RECEIVED
4. DATE APPLICATION COMPLETE
(ITEMS BELOW TO BE FILLED BYAPPLICANT)
5. APPLICANT'S NAME
8. AUTHORIZED AGENT'S NAME AND TITLE (agent is not required)
First - Lance Middle -C Last - Smith
First - Samuel Middle -Adam Last - Carter
Company -
Company - Wetland Solutions LLC
E-mail Address-lancesmith926(&,gmail.com
E-mail [e-mail]
6. APPLICANT'S ADDRESS:
9. AGENT'S ADDRESS:
Address- 4337 Johnson Avenue
Address- PO Box 244
City - Western Springs State - IL Zip - 60558 Country -USA
City - Bunnlevel State - NC Zip - 28323 Country -USA
7. APPLICANT'S PHONE NOs. w/AREA CODE
10. AGENTS PHONE NOs. w/AREA CODE
a. Residence b. Business c. Fax
a. Residence b. Business c. Fax
312-343-2161
910-890-2779
STATEMENT OF AUTHORIZATION
11. 1 hereby authorize, Adam Carter to act in my behalf as my agent in the processing of this application and to furnish, upon request,
supplemental information in support of this permit application.
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DATE
NAME, LOCATION, AND DESCRIPTION OF PROJECT OR ACTIVITY
12. PROJECT NAME OR TITLE (see instructions)
Barons Drive
13. NAME OF WATERBODY, IF KNOWN (if applicable)
14. PROJECT STREET ADDRESS (if applicable)
Deep Creek (Tributary)
Address 20 Barons Drive
15. LOCATION OF PROJECT
City - Pinehurst State- NC Zip- 28374
Latitude: -N 35.203889 Longitude: -W-79.518530
16. OTHER LOCATION DESCRIPTIONS, IF KNOWN (see instructions)
State Tax Parcel ID 854207591376 Municipality Pinehurst
Section - Township - Range -
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17. DIRECTIONS TO THE SITE
Turning left off of Abbottsford Drive south onto Barons Drive continue straight until you approach a roundabout in line with the utility
easement. The site is straight ahead as the road turns right under the utility easement. There is a small cul-de-sac at the front of the property.
18. Nature of Activity (Description of project, include all features)
Property owner is seeking to install a culvert and road in order to access across the wetlands onto the site where they intend to build a single
family residence. The width of the impact is about 23 feet wide and will impact approximately 0.016 acres of adjoining wetlands.
19. Project Purpose (Describe the reason or purpose of the project, see instructions)
The purpose of the impact is to allow the property owner to access the property via vehicle for the purpose of constructing and residing in a
single family structure.
USE BLOCKS 20-23 IF DREDGED AND/OR FILL MATERIAL IS TO BE DISCHARGED
20. Reason(s) for Discharge
Culverted crossing is the most cost effective way to access the property as the wetland crosses the entirety of the road frontage for the parcel.
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
22. Surface Area in Acres of Wetlands or Other Waters Filled (see instructions)
Acres .016
or
Linear Feet
23. Description of Avoidance, Minimization, and Compensation (see instructions)
The crossing will be the minimal width with sediment fencing in place on both sides as the side slopes naturalize with grass and other
vegetation.
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24. Is Any Portion of the Work Already Complete? Yes ❑X No IF YES, DESCRIBE THE COMPLETED WORK
25. Addresses of Adjoining Property Owners, Lessees, Etc., Whose Property Adjoins the Waterbody (if more than can be entered here, please attach a supplemental list).
a. Address- 16 Barons Drive
City - Pinehurst State - NC Zip - 28374
b. Address- 24 Barons Drive
City - Pinehurst State - NC Zip - 28374
c. Address- 31 Northam Court
City - Pinehurst State - NC Zip - 28374
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
USACE WITHDRAWN SAW-2024-00442 2024-02-27 2024-03-22
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
a
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SIGNATURE 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 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.
ENG FORM 4345, MAY 2018 Page 3 of 3