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Home My WebLink About20041246 Ver 1_Other Agency Comments_20040721APPLICATION FOR DEPARTMENT OF THE ARMY PERMIT I OMB APPROVAL N0.0710-003 (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 applications should require 5 hours or less. This includes 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 this burden estimate or any other aspect of this collection 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 22202-4302; 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 control 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 activity. PRIVACY ACT STATEMENT Authority: Rivers and Harbors Act, Section 10, 33 USC 403: Clean Water Act, Section 404, 33 USC 1344; Marine Protection, Research and Sanctuaries Act, 33 USC 1413, Section 103. 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. 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 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. ITEMS 1 THRU 4 TO BE /LLED BY THE CORPS 1. APPLICATION NO. 2. FIELD OFFICE CODE 3. DATE RECEIVED 4. DATE APPLICATION COMPLETED ITEMS BELOW TO BE F LLED BY APPLICAN 5. APPLICANTS NAME 8. AUTHORIZED AGENTS NAME AND TITLE (an agent is not required) North Carolina Department of Transportation Project Development & Environmental Analysis 6. APPLICANTS ADDRESS 9. AGENTS ADDRESS 1548 Mail Service Center Raleigh, NC 27699 7. APPLICANTS PHONE NOs. W/AREA CODE 10. AGENTS PHONE NOs. W/AREA 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 furnish, 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 inswdions US 32l Widening from SR 1370 (Kirby Mountain Road) to SR 1500 (Blackberry Road) in Bailey Camp, just north of Patterson, Caldwell Coun , NC 13. NAME OF WATERBODY, IF KNOWN (if appiicabie) 14. PROJECT STREET ADDRESS (ff appiicabie) Rocky Cove Creek, Greenfield Branch, UT to Puncheon Camp Creek, UT to Right Fork Mulberry Creek, UT to Left Fork Mulberry Creek 15. LOCATION OF PROJECT Caldwell NC COUNTY STATE 16. OTHER LOCATION DESCRIPTIONS, IF KNOWN (see inswaions) Section, Township, Range, LaHLon, andlorAccessors's Parcel Numbsr, forezarr~le. 17. DIRECTIONS TO THE SITE US 321-from SR 1370, go north 6.5 miles to SR 1500 in Bailey Camp ENG FORM 4345, Jul 97 EDITION OF FEB 94 IS OBSOLETE (Proponent: CECW-OR) 18. Nature Of ACtlVlty (Description of project, include all features) Widening of US 321 from atwo-lane facility to a four-lane roadway. The project is 6.5 miles long and will provide four 12-foot lanes with afour- foot painted median and 10-foot shoulders (13 feet with guardrail). ). The proposed right-of--way varies throughout the project, ranging from approximately l 10 to 885 feet. Section B of the project will impact five streams through seven stream crossings, impacting 1,080 linear feet of jurisdictional perennial streams and 600 linear feet of intermittent streams. The project will also impact 0.16 acre of wetlands and 0.13 acre of surface waters. 19. PfOJBCt PUrpOSe (Describe the reason or purpose of the project, see instructions) Public transportation. The purpose of the project is to increase traffic capacity and safety by widening the roadway. US 321 is listed in the draft 2004-2010 North Carolina Transportation Improvement Program USE BLOCKS 20-22 IF DREDGED AND/OR FILL MATERIAL IS TO BE DISCHARGED 20. Reason(s) for Discharge Needed in order to provide a wider road base for the highway widening. 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) 1,6801inear feet of stream channel, 0.13 ac of surface water, and 0.16 acre of wetland 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 25. List of Other Certifications or Approvals/Denials 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 inGude 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 appliption. 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. _~ ~,~ -1 I t I C+~ SIGNAT RE OF APPLICANT DAT SIGNATURE OF AGENT DATE The application must lie 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. Jul 97 EDITION OF FEB 94 IS OBSOLETE (Proponent CECW-OR)