WQ0045766_Application (FTSE)_20241016

Initial submission received on Aug 28, 2024 (Check Bounced)
New Check came on Sep 11, 2024. Additional Infor Came on Oct 16, 2024 State of North Carolina
31 Q taltt, Department of Environmental Quality
Division of Water Resources
OCT 16 FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 10-23&SUPPORTING DOCUMENTATION
Application Number: WQ0045766 (Po be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Johnston County(company,municipality,HOA,utility,etc.)
2. Applicant type: Individual Corporahon Q General Partnership Privately-Owned Public Utility
Federal State County Zr Municipal Other
3. Signature authority's name: Chandra C. Farmer,P.E, per 15A NCAC 02T.0106(b)
Title:Director of Utilities
4. Applicant's mailing address: 309 E. Market Street P.O. Box 2263
City: Smithfield State: NC Zip: 27577-
5. Applicant's contact information:
Phone number:[phone] Email Address: mike.keena-iohnsonnc.com
11. PROJECT INFORMATION:
I. Project name: Wilson's Mills High School (Public)
2. Application/Project status: j Proposed(New Permit) Existing Permit/Project ARPA funded
If a modification,provide the existing permit number: WQOO and issued date:
For modifications,also attach a detailed narrative description as described in Item G of the checklist.
If new construction,but part of a master plan,provide the existing permit number:WQ00
3. County where project is located:Johnston County
4. Approximate Coordinates(Decimal Degrees):Latitude: 35.575 Longitude: -78.326
5. Parcel ID(if applicable): 17KO8028A(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Kennard Trowbridge.PE License Number: 054445
Firm:The John R. McAdams Company
Mailing address: 621_Hillsborough Street,Suite 500
City: Raleigh State: NC Zip: 27603-
Phone number: (9t2)23 0-73 34 Email Address: trowbrid ze(ebmcadamsco.ccom
IV. WASTEWATER TREATMENT FACILITY(WWTF) INFORMATION:
1. Facility Name:Central Johnston County.Regional Wastewater Facilit Permit Number: NCO030716
Owner Name:Johnston County
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ0034975
2. Downstream(Receiving)Sewer Information: 8 inch ® Gravity LJ Force Main
3. System Wide Collection System Permit Number(s)(if applicable):WQCS00060
Owner Name(s): Johnston County
FORM: FTA 10-23 Pagel of 5

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately-Owned Public Utility,has a Certificate of Public Convenience and Necessity been attached?
Yes No ❑ N/A
2. If the Applicant is a Developer of lots to be sold,has a Developer's Operational Agreement(FORM: DEV)been attached?
Yes ❑ No [A-'] N A
3. If the Applicant is a Home/Property Owners'Association,has an HOA/POA Operational Agreement(FORM: HOA)and
supplementary documentation as required by 15A NCAC 02T.0115(c) been attached?
I Yes ❑No ❑ N/A
4. Origin of wastewater:(check all that apply):
❑Residential(Individually Owned) ,_J Retail(stores,centers,malls) Car Wash
❑Residential(Leased) ❑ Retail with food preparationlservice ]Hotel and/or Motels
School, preschool day care ❑ Medical/dental veterinary facilities ]Swimming Pool:Clubhouse
❑Food and drink facilities ❑Church ❑Swimming Pool/Filter Backwash
❑Businesses 'offices factories ❑Nursing Home ❑Other(Explain in Attachment)
5. Nature of wastewater: °o Domestic 100%Commercial 0,6 Industrial(See 15A NCAC 02T.0103(20))
If Industrial, is there a Pretreatment Program in effect? Yes 1 No
6. Hasa flow reduction been approved under 15A NCAC 02T.0114(f)? ❑Yes No
r If yes,provide a copy of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type(see 02T.0I14(f)) Daily Design Flow j° No.of units Flow
gala 0 GPD
gal GPD
gal.' GPD
gal. GPD
gal/ GPD
gal. GPD
Total 0 GPD
a See 15A NCAC 02T .01 14(b),(d),(e)(l)and(e)t2) for caveats to wastewater design flow rates(i.e. proposed unknown
non-residential development uses; public access facilities located near high public use areas; and residential property
located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined in G.S.42A-4).
b Per 15A NCAC 02T.0114(c),design flow rates for establishments not identified [in table 15A NCAC 02T.01 14]shall be
determined using available flow data,water using fixtures,occupancy or operation patterns,and other measured data.
8. Wastewater generated by project: 0 GPD(per 15A NCAC 02T.0114 and G.S. 143-215.l)
r Do not include future flows or previously permitted allocations
If permitted flow is zero,please indicate why:
Pump Station/Force Main or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line.
Please provide supplementary information indicating the approximate timeframe for permitting upstream sewers with flow.
C[Flow has already been allocated in Permit Number: Issuance Date:
[l Rehabilitation or replacement of existing sewers with no new flow expected
Other(Explain). flow allocated_iD_prjyate application currently under review
FORM: FTA 10-23 Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA(If Applicable)-02T.0305& MDC(Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size(inches) Length(feet) Material
8 301 PVC
Z Section II&III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
Z Section III contains information related to minimum slopes for gravity sewer(s)
L Oversizing lines to meet minimum slope requirements is not allowed and a violation of the MDC
Vlll. PUMP STATION DESIGN CRITERIA(If Applicable)—02T.0305&MDC(Pump Stations/Force Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PRQJF.CT
1. Pump station number or name:
2. Approximate Coordinates(Decimal Degrees): Latitude: Longitude: -
3. Total number of pumps at the pump station:
3. Design flow of the pump station: millions gallons per day(firm capacity)
r This should reflect the total GPM for the pump station with the largest pump out of service.
4. Operational point(s)per pump(s): gallons per minute(GPM)at feet total dynamic head(TDH)
5. Summarize the force main to be permitted(for this Pump Station):
Size(inches) Length(feet) Material
If any portion of the force main is less than 4-inches in diameter,please identify the method of solids reduction per
MDCPSFM Section 2.01C.l.b. Grinder Pump Mechanical Bar Screen Other(please specify)
b. Power reliability in accordance with 15 A NCAC 02T.0305(h X t):
Standby power source or Standby pump
Must have automatic activation and telemetry- 15A NCAC 02T.0305(h)(1)(B):
Z Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
'r Must be permanent to facility and may not be portable
Or if the pump station has an average daily flow less than 15,000 gallons per day 15A NCACO2T.0305(h)(1)(C):
Portable power source with manual activation,quick-connection receptacle and telemetry-
or
Portable pumping unit with plugged emergency pump connection and telemetry:
L Include documentation that the portable source is owned or contracted by the applicant and is compatible with the station.
If the portable power source or pump is dedicated to multiple pump stations,an evaluation of all the pump stations'storage
capacities and the rotation schedule of the portable power source or pump,including travel timeframes,shall be provided
as part of this permit application in the case of a multiple station power outage.
FORM: FTA 10-23 Page 3 of 5

IX. SETBACKS&SEPARATIONS -(02B.0200& 15A NCAC 02T.0305(f)):
I. Does the project comply with all separations/alternatives found in 15A NCAC 02T.03050)&(g)? Yes No
15A NCAC 02T.0305(f)contains minimum separations that shall be provided for sewer systems:
Setback Parameter* Separation Required
Storm sewers and other utilities not listed below(vertical) 18 inches
'Water mains(vertical-water over sewer preferred, including in benched trenches) 18 inches
'Water mains(horizontal) 10 feet
Reclaimed water lines(vertical-reclaimed over sewer) 18 inches
Reclaimed water lines(horizontal-reclaimed over sewer) 2 feet
"Any private or public water supply source,including any wells,WS-1 waters of Class I or
Class I1 impounded reservoirs used as a source of drinking water,and associated wetlands. 100 feet
"Waters classified WS(except WS-1 or WS-V),B,SA,ORW,HQW,or SB from normal
high water(or tide elevation)and wetlands associated with these waters(see item IX.2) 50 feet
"Any other stream, lake, impoundment,or ground water lowering and surface drainage
ditches,as well as wetlands associated with these waters or classified as WL. 10 feet
Any building foundation(horizontal) 5 feet
Any basement(horizontal) 10 feet
Top slope of embankment or cuts of 2 feet or more vertical height 10 feet
Drainage systems and interceptor drains 5 feet
Any swimming pools 10 feet
Final earth grade(vertical) -4 36 inches
Z If noncompliance with 02T.0305(f)or . see Section X.1 of this application
*15A NCAC 02T.0305W contains alternatives where separations in 02T.0305(f)cannot be achieved. Please check"yes"
above if these alternatives are used and provide narrative information to explain.
**Stream classifications can be identified using the Division's NC Surface Water Classifications webpage
2. Does this project comply with the minimum separation requirements for water mains? Yes ❑No N A
i If no,please refer to 15A NCAC 18C.0906(f) for documentation requirements and submit a separate document,
signed/sealed by an NC licensed PE,verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? Yes No N A
Z Please provide supplementary information identifying the areas of non-conformance.
Z See the Division's draft separation requirements for situations where separation cannot be met.
r No variance is required if the alternative design criteria specified is utilized in design and construction.
4. Is the project located in a river basin subject to any State buffer rules? ; , Yes Basin name:Neuse No
If yes,does the project comply with setbacks found in the river basin rules per 15A NCAC 02B.0200? Yes No
,01 This includes Trout Buffered Streams per 15A NCAC 2B.0202
5. Does the project require coverage authorization under a 404 Nationwide/individual permits Yes No
or 401 Water Quality Certifications?
L Please provide the permit number permitting status in the cover letter if coverage,authorization is required.
6. Does project comply with 15A NCAC 02T.0105(c)t6)(additional permits:'certifications)? Yes No
Per 15A NCAC 0270105(c)(6),directly related environmental permits or certification applications must be being prepared,
have been applied for,or have been obtained. Issuance of this permit is contingent on issuance of dependent permits(erosion
and sedimentation control plans,stormwater management plans,etc.).
7. Does this project include any sewer collection lines that are deemed"high-priority?" Yes � No
Per 15A NCAC 02T.0402,"high-priority sewer"means any aerial sewer,sewer contacting surface waters,
siphon,or sewers positioned parallel to streambanks that are subject to erosion that undermines or deteriorates the sewer_
Siphons and sewers suspended through interferencelconflict boxes require a variance approval.
Y If yes, include an attachment with details for each line, including type(aerial line,size,material,and location).
High priority lines shall be inspected by the permittee or its representative at least once every six-months and
inspections documented per 15A NCAC 02T.0403(a)(5)or the permittee's individual System-Wide Collection permit.
FORM: FTA 10-23 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T,the Minimum Design Criteria for the Permitting of rump Sta_ lions
and Force Mains[latest varaign).and the Gravtty Sower Minim=Design Criteria(latest version)as applicable?
® Yes ❑No
If no, for projects requiring a single variance, complete and submit the Variance/Alternative Design Request application
(VADC 10-14) and supporting documents for review to the Central office. Approval of the request will be Issued
conemmuft with the approval of the permit. and g fro acts Etguirina a yAdancce anorovai maybe subject to longer
review times.For protects mulrintg two or more variances or where The he vgdance Is determined by the Divlaloxt to be a
slain 0ont portion of the protect,the full techof cat review is required,
2. Professional Engineer's Certification:
� /, .(So
f Mitts
f f #kkv,61
I, 1 h 1 Ti attest that this application for 6J,1�ViS ,-`ibis
(Professional En&aer'a twee ftrkApplication Item III I ) iProject Name fmtn Application Nem 11.1)
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans,
specifications,engineering calculations, and all other supporting documentation to the best of my knowledge. I further
attest that to the best of my knowledge the proposed design has been prepared in accordance with the applicable regulations,
Minimum Design Criteria for Gravity Sowm(latest version).and the MWmum Design Criteria fgr the Fast-7mck
of Pump Stations and Force Mains(latest version), Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that I have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.613, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed$10,000,as well as civil penalties up to$25,000 per violation.Misrepresentation of the application
information,including failure to disclose any design non-compliance with the applicable Rules and design criteria,may subject
the North Carolina-licensed Professional Engineer to referral to the licensing board.(21 NCAC 56.0701)
North Carolina Professional Engineer's seal,signature,and date: ,11 Ci�' /������
j
054445
3, Applicant's Certification per 15A NCAC 02T.0106(b):
1, l_,�Vl 1\V0_ �- &L (y Z ,attest that this application for VAIV-1m 1l�S 4'1 oo
(Signature Aulhonity Namefrom Application Item 1.3.) (Project Name fe6m Application I(effi 1-1.1)
attest that this application has been reviewed by me and is accurate and complete to the best of my knowledge.
I understand that if all required parts of this application are not completed and that if all required supporting documentation
and attachments are not included,this application package is subject to being returned as incomplete. I understand that any
discharge of wastewater from this non-discharge system to surface waters or the land will result in an immediate enforcement
action that may include civil penalties,injunctive relief,and/or criminal prosecution. 1 will make no claim against the Division
of Water Resources should a condition of this permit be violated. I also understand that if all required parts of this application
package are not completed and that if all required supporting information and attachments are not included, this application
package will be rehired to me as incomplete.
MOTE In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed S 10,000 as well as civil penalties up to$25,000 per violation.
Signature: Date: I Ot
FORM: FTA 10-23 Page 5 of 5

0
MCADAMS FAST TRACK APPLICATION > SPEC22626
October 15, 2024
NCDEQ
Raleigh Regional Office
3800 Barrett Drive OCT 16 2024
Raleigh, NC 27609
Ra?n1 g1l1 f Eb:t?n f>ii2C0
RE: Wilson's Mills High School
Fast Track Application for Gravity Sewer—Cover Letter
SPEC22626
We are proposing a gravity sewer system as part of the Wilson's Mills High School development which is intended to
convey the flow from the private system (separate application) serving the 2,000-student high school.This
application pertains only to the public portion of the sanitary sewer system which includes the connection to the
existing sewer system in Clearwater Dr. and (1) upstream manhole extending public gravity sewer into the project
site.The proposed sewer main included with this application will be under public ownership. All other upstream
proposed sewer mains for this project will be owned and operated by Johnston County Public Schools and are
included in a separate application for the private portion of the system.The project requires authorization under a
404 Nationwide permit and 401 Water Quality Certification (SAW-2023-00680/DWR#20240625), both of which
have been approved and are attached to the application.
Thank you for taking the time to review our application. If you have any questions, please feel free to contact me at
912-230-7334 or [e-mail]
Sincerely,
MCADAMSS ZZL,
Kennard Trowbridge, PE
Project Manager, Education and Healthcare
crest ng experiences through experience 621 Hillsborough Street,Suite 500,Raleigh,NC 27603/919.361.5000

" r621 Hillsborough street "ICDCP#o al"!rcd,,..`,.
Suite 500
Raleigh,NC 27603
MCADAMS 919.36t.5000
OCT 16 2024
'Ral�t.�, �
Letter of Transmittal -- F1011laj lcr, j�
Date: October 16,2024 HAND DELIVER
To: NCDEQ Re: Johnston County Schools, Bond Program
Water Quality Regional Operations Public Fast Track Gravity Sewer Application
3800 Barrett Drive
Raleigh,North Carolina 27609 Job#: SPEC22626
❑ Drawings ❑ Letter ❑ Statement of Qualifications
❑ Specifications ® Submittal ❑ Other
❑ Plans ❑ Check
Quantity Unit Description
1 Each Cover Letter
1 Each FTA
1 Each Sewer Approval
1 Each 401 Approval
1 Each 404 Approval
1 Each Site Aerial Map
1 Each USGS Topo Map
Transmitted as checked below:
❑ For approval ® For review+comment
CO Foryouruse ❑ Other
❑ As requested ❑ Other
Remarks:
Copy to: Signature:
Printed Name: Kody Trowbridge,PE
Title: Project Manager
Date: October 16,2024
to`t

DEPARTMENT OF PUBLIC UTILITIES
PO BOX 2263
SMITHFIELD, NC 27577
Jw-
July 17, 2024
Kody Trowbridge, PE �•'�,.,
McAdams orj�
T
Re: Sewer Collection Facilities to Serve Wilson's Mills High School
1C Project No: 24-030-P
Plan Approval
Dear Mr.Trowbridge:
This letter is to confirm that Johnston County Public Utilities has reviewed the plans and technical specifications
for the sewer facilities to serve Wilson's Mills High School (JC Project No. 24-030-P)and found them to meet the
minimum design and construction standards for Johnston County Public Utilities. Please find attached the Fast
Tract Application and Flow Tracking Form for your submittal to NCDEQ—DWR.
Upon completion of the construction or modification,and prior to placing the new construction or modification
into service,the following information must be received and approved by the Johnston County Department of
Utilities:
1. Engineer's sewer certification (signed by Engineer,Johnston County and submitted to NCDEQ-DWR)
2. As-Built drawings sealed by the Engineer
3. Lien wavier from the utility contractor
4. Recorded plat indicating any necessary utility easements
Please find enclosed the "Flow Tracking for Sewer Extension Applications"executed by Johnston County for your
submittal to NCDEQ with the permit for the private sewer system extension.
Please have the utility contractor schedule a pre-construction conference with this office prior to the installation
of the sewer collection facilities. Please be advised that other necessary permits must be received by this office
prior to construction. Please contact me at(919) 209-8334 or rudy.wells2iohnstonnc.com if you have any
questions or need additional information.
Sincerely,
Rudy Wells, PE
Civil Engineer
Cc:
Mike Keen—Utilities Manager
Shannon Stanley—Engineering and Environmental Technician
Richard Denning—Construction Inspector

DocuSign Envelope ID:95842C68-EB36-4900-BE24-EA1591C2CA79
10 Sri a,
ROY COOPER
covema 1 ° �
ELIZABETH S.BISER d 0 ,
Secretary �(s
RiCHARD E.ROCERS,JR. NORTH CAROLINA �C
Director EnNronnun WQuony,
1
O
June 19,2024 ;,
fly
DWR#20240625
J ;. Johnston County
Johnston County Board of Education Yc
Attn: Brooks Moore
PO Box 1335
Smithfield, NC 27577 1336
Delivered via email to: [e-mail]
Subject: Approval of Individual 401 Water Quality Certification
Wilson's Mills High School
USACE Action ID. No. SAW-2023-00680
Dear Brooks Moore:
Attached hereto is a copy of Certification No. WQC006951 issued to Brooks Moore and The Johnston
County Board of Education, dated June 19,2024. This approval is for the purpose and design described
in your application.The plans and specifications for this project are incorporated by reference as part of
this Water Quality Certification. If you change your project, you must notify the Division and you may be
required to submit a new application package with the appropriate fee. If the property is sold, the new
owner must be given a copy of this Certification and is responsible for complying with all conditions.
[15A NCAC 02H .0507(d)(2)].
This Water Quality Certification does not relieve the permittee of the responsibility to obtain all other
required Federal, State, or Local approvals before proceeding with the project, including those required
by, but not limited to,Sediment and Erosion Control, Non-Discharge, Water Supply Watershed,and
Trout Buffer regulations.
This Water Quality Certification neither grants nor affirms any property right, license, or privilege in any
lands or waters, or any right of use in any waters. This Water Quality Certification does not authorize
any person to interfere with the riparian rights, littoral rights, or water use rights of any other person
and does not create any prescriptive right or any right of priority regarding any usage of water. This
Water Quality Certification shall not be interposed as a defense in any action respecting the
determination of riparian or littoral rights or other rights to water use. No consumptive user is deemed
by virtue of this Water Quality Certification to possess any prescriptive or other right of priority with
respect to any other consumptive user.
Upon the presentation of proper credentials,the Division may inspect the property.

DocuSign Envelope ID:95842C6a-EB36-49D0-BE24-EA1591C2CA79
Wilson's Mills High School
DWR#20240625
Individual Certification#WQC006951
Page 2 of 11
This Water Quality Certification shall expire on the same day as the expiration date of the corresponding
Section 404 Permit. The conditions shall remain in effect for the life of the project, regardless of the
expiration date of this Water Quality Certification.
Non-compliance with or violation of the conditions herein set forth may result in revocation of this
Water Quality Certification for the project and may also result in criminal and/or civil penalties.
If you are unable to comply with any of the conditions of this Water Quality Certification you must notify
the Raleigh Regional Office within 24 hours(or the next business day if a weekend or holiday)from the
time the permittee becomes aware of the circumstances.
The permittee shall report to the Raleigh Regional Office any noncompliance with, and/or any violation
of, stream or wetland standards[15A NCAC 02B .02001 including but not limited to sediment impacts to
streams or wetlands. Information shall be provided orally within 24 hours(or the next business day if a
weekend or holiday) from the time the permittee became aware of the non-compliance circumstances.
This approval and its conditions are final and binding unless contested [G.S. 143-215.5].
This Certification can be contested as provided in Chapter 150E of the North Carolina General Statutes by
filing a Petition for a Contested Case Hearing (Petition) with the North Carolina Office of Administrative
Hearings(OAH)within sixty(60)calendar days. Requirements for filing a Petition are set forth in Chapter
150E of the North Carolina General Statutes and Title 26 of the North Carolina Administrative Code.
Additional information regarding requirements for filing a Petition and Petition forms may be accessed at
http:/Iwww.ncoah.com or by calling the OAH Clerk's Office at(919)431-3000.
A party filing a Petition must serve a copy of the Petition on:
William F. Lane, General Counsel
Department of Environmental Quality
1601 Mail Service Center
Raleigh, NC 27699-1601
If the party filing the Petition is not the permittee, then the party must also serve the recipient of the
Certification in accordance with N.C.G.S 1508-23(a).
This letter completes the Division's review under section 401 of the Clean Water Act and 15A NCAC 02H
.0500. Please contact Joe Myers at 919-791-4256 or [e-mail] if you have any
questions or concerns.
Sincerely,
CN(6dDocuSgd b
ney ita
3 2DC6CW1EE4A8
Michael Hall
Regional Supervisor, Raleigh Regional Office
Water Quality Regional Operations Section
Division of Water Resources, NCDEQ
D Ewa
� Vunh Caru:ma Department of Lm'aronrtnntal Quality Ih�•rsinn of Wain Resources
Raleigh Regional OIli.a 3800 Saab[Drive Raleigh.North Carolina'_'609
4, - �a �/ 919'91.1:fr1

DocuSign1Envelope ID:95842C68-ES36-49D0-BE24-EA1591C2CA79
Wilson's Mills High School
DWR#F 20240625
Individual Certification##WQC006951
Page 3 of 11
Electronic cc: Wyatt Brown, Brown's Environmental Group, Inc
Matthew Martin, USACE Raleigh Regulatory Field Office
Gabriella Garrison, NCWRC
DWR 401& Buffer Permitting Branch Electronic file
Filename: 20240625_WiIson's Mills High School_IP39_Johnston_401.docx
D`�� North Carolina Department of I m tronmental Quality Dig uwn of Hater Resources
Raleigh Regional Office 3800 Barrett Drive Raleigh.North Carolina 27609
919.791 4200

DocuSign Envelope ID:95642C68-EB36-49D0-BE24-EA1591C2CA79
Wilson's Mills High School
DWR#20240625
Individual Certification#WQC006951
Page 4 of 11
NORTH CAROLINA 401 WATER QUALITY CERTIFICATION
CERTIFICATION#WQC006951 is issued in conformity with the requirements of Section 401, Public Laws
92-500 and 95-217 of the United States and subject to North Carolina's Regulations in 15 NCAC 02H .0500
and 15A NCAC 02B .0200,to Brooks Moore and The Johnston County Board of Education,who have
authorization for the impacts listed below,as described within your application received by the N.C.
Division of Water Resources(Division) on April 24, 2024, and by Public Notice issued by the Division on Aril
30, 2024, and within the Reasonable Period of Time pursuant to 40 CFR Part 121.6.
The State of North Carolina certifies that this activity will comply with water quality requirements and
the applicable portions of Sections 301, 302, 303, 306, 307 of the Public Laws 92-500 and Pl.95-217 if
conducted in accordance with the application,the supporting documentation,and conditions
hereinafter set forth.
The following impacts are hereby approved. No other impacts are approved, including incidental
impacts. [15A NCAC 02H .0506(b))
Type of Impact Amount Approved Amount Approved Mitigation Amount
Permanent Temporary Required
Riparian Wetlands
W1: Culvert— 0.010 acres 0 acres 0 credits
Wetland B
Totals: 0.010 acres 1 0 acres 1 0 credits
This approval requires you to follow the conditions listed in the certification below.
ACTIVITY SPECIFIC CONDITIONS
1. The Permittee shall secure an approved Buffer Authorization from Johnston County prior to
commencement of any impacts authorized by this Certification.
Citation: 15A NCAC 02H.0506(b),15A NCAC 02H.0507(c)
2. If this Water Quality Certification is used to access residential,commercial,or industrial building
sites,then all parcels owned by the permittee that are part of the single and complete project
authorized by this Certification must be buildable without additional impacts to streams or
wetlands.
Citation:15A NCAC 02H.0502(a);15A NCAC 02H.0506(b);15A NCAC 02H.0507(c)
3. For road construction purposes,this Certification shall only be utilized from natural high ground to
natural high ground.
Citation:15A NCAC 02H.0502(a);15A NCAC 02H.0506(b);15A NCAC 02H.0507(c)
4. Deed notifications or similar mechanisms shall be placed on all lots/parcels with retained
jurisdictional wetlands,waters, and state regulated riparian buffers within the project boundaries
in order to assure compliance with NC Water Quality Certification Rules(15A NCAC 02H .0500), NC
D_E Q North Carohna Deputment of Gns ironmcntal Quality tsion of Water Resources
45;' Raleigh RcgaroaI 011-wc 3800 Hama Drive RA,gh.North Caroltna 27609

DocuSign Envelope ID:95842C68-EB36-49D0-BE24-EA159iC2CA79
Wilson's Mills High School
DWRii 20240625
Individual Certification#WQC006951
Page 5 of 11
Isolated Wetland Rules(15A NCAC 02H .1300), and/or State Regulated Riparian Buffer Rules(15A
NCAC 02B .0200). These mechanisms shall be put in place at the time of recording of the property
or individual parcels, whichever is appropriate.
Citation: 15A NCAC 02H.0502(a),15A NCAC 02H.0506(b); 15A NCAC 02H.0507(c)
5. If this Water Quality Certification is used for utility related impacts,then the following Activity
Specific Conditions shall apply to those impacts.
a. All sewer lines shall be designed, constructed and maintained in accordance with Title 15A NCAC
Chapter 02T, applicable Minimum Design Criteria (MDC), and/or Alternative Design Criteria.
Citation: 15A NCAC 02H.0506(b);15A NCAC 02H.0507(c)
b. Any utility construction corridor that is parallel to a stream or open water shall not be closer than
10 feet to the top of bank or ordinary high-water mark.
Citation: 15A NCAC 02H.0506(b);15A NCAC 02H.0507(c)
c. Where there are temporary or permanent impacts from stream crossings, utility lines shall cross
the stream channel at a near-perpendicular direction (i.e., between 75 degrees and 105 degrees
to the stream bank).
Citation: 15A NCAC 02H.0506(b);15A NCAC 02H.0507(c)
d. Construction corridors in wetlands and/or across stream channels shall be minimized to the
maximum extent practicable and shall not exceed 40 feet wide for utility lines.
For construction corridors in wetlands and across stream channels, stumps shall be grubbed
only as needed to install the utility and remaining stumps shall be cut off at grade level. The
general stripping of topsoil within wetlands along the construction corridor is prohibited.
Citation: 15A NCAC 02H.0506(b);15A NCAC 02H.0507(c)
e. Permanent maintained access corridors in wetlands and across stream channels shall be
restricted to the minimum width practicable and shall not exceed 30 feet wide except at manhole
locations.
Citation: 15A NCAC 02H.0506(b);15A NCAC 02H.0507(c)
f. For all utility lines constructed within wetlands, an anti-seep collar shall be placed at the
downstream (utility line gradient) wetland boundary and every 150 feet up the gradient until the
utility exits the wetland. Anti-seep collars may be constructed with class B concrete,compacted
clay, PVC pipe, or metal collars. Wetland crossings that are directionally drilled, and
perpendicular wetland crossings that are open cut and less than 150 feet long do not require
anti-seep collars. The compacted clay shall have a specific infiltration of 1 X 10` cm/sec or less.
A section and plan view diagram is attached for the anti-seep collars.
The following specifications shall apply to class B concrete:
i. Minimum cement content, sacks per cubic yard with rounded coarse aggregate 5.0
ii. Minimum cement content, sacks per cubic yard with angular coarse aggregate 5.5
iii. Maximum water-cement ratio gallons per sack 6.8
D North Carolina Ihpartment of I nvtronatental Quality Division of Water Resources
Raleigh Regional Office 3800 Barrett Drive Raleigh.North Carolina 27609

DocuSign Envelope ID:95842C68-EB36-49D0-BE24-EA1591 C2CA79
Wilson's Mills High School
DWR##20240625
Individual Certification#WQC006951
Page 6 of 11
iv. Slump range 2"to 4"
v. Minimum strength - 28-day psi 2,500
Citation: 15A NCAC 02H.0506(b);15A NCAC 02H.0507(c)
g. The permittee shall have a specific plan for restoring wetland contours to pre-construction
conditions. Any excess material will be removed to a high ground disposal area.
The mixing of topsoil and subsoils within the wetlands along utility corridors shall be minimized
to the greatest extent practical. During excavation,the soils shall be placed on fabric to
minimize impacts whenever possible.Topsoil excavated from utility trenches will be piled
separately from subsoils and will be backfilled into the trench only after the subsoils have been
placed and compacted.
Citation: 15A NCAC 02H.0506(b);15A NCAC 02H.0507(c)
6. The Permittee shall secure an approved stormwater management plan (SMP)from Johnston
County before any impacts authorized in this certification occur.The applicable portion of the
approved SMP shall be constructed and operational before any permanent building or other
permanent structure is occupied at the site. If any of the SCMs are used as an Erosion and
Sediment Control device, it must be restored to the approved stormwater design condition
within 30 days of close-out of the Erosion and Sediment Control Plan.
GENERAL CONDITIONS
7. The permittee shall report to the DWR Raleigh Regional Office any noncompliance with,and/or
any violation of,stream or wetland standards [15A NCAC 02B .0200], including but not limited to
sediment impacts to streams or wetlands. Information shall be provided orally within 24 hours(or
the next business day if a weekend or holiday)from the time the permittee became aware of the
non-compliance circumstances_
Citation: 15A NCAC 02H.0506(b);15A NCAC 02H.0507(c)
8. No waste,spoil,solids,or fill of any kind shall occur in wetlands or waters beyond the footprint
of the approved impacts(including temporary impacts).
Citation: 15A NCAC 02H.0506; 15A NCAC 02H.0507(c)
9. All activities shall be in compliance with any applicable State Regulated Riparian Buffer Rules in
Chapter 2B of Title 15A in the North Carolina Administrative Code.
Citation: 15A NCAC 02H.0506(b);15A NCAC 02H.0507(c)
10. When applicable,all construction activities shall be performed and maintained in full
compliance with G.S. Chapter 113A Article 4(Sediment and Pollution Control Act of 1973).
Regardless of applicability of the Sediment and Pollution Control Act,all projects shall
incorporate appropriate Best Management Practices for the control of sediment and erosion so
that no violations of state water quality standards, statutes,or rules occur.
Design,installation,operation, and maintenance of all sediment and erosion control measures
shall be equal to or exceed the requirements specified in the most recent version of the North
D E�� �Ioph i arohra Departmcnl of I m•uonmeinal Qualih Ihc�sion of Racer Resource.
Rakigh Regional ollicc Mo Harrell Drive Raleigh North Carolina"604
v � �/ 919 ")I a2i70

DocuSign Envelope ID 95842C68-EB88-49DO-BE24-EA1591C2CA79
Wilson's Mills High School
DWRii 20240625
Individual Certification#WQC006951
Page 7 of 11
Carolina Sediment and Erosion Control Manual,or for linear transportation projects, the North
Caroline Department of Transportation Sediment and Erosion Control Manual.
All devices shall be maintained on all construction sites, borrow sites, and waste pile (spoil)sites,
including contractor-owned or leased borrow pits associated with the project. Sufficient
materials required for stabilization and/or repair of erosion control measures and stormwater
routing and treatment shall be on site at all times.
For borrow pit sites,the erosion and sediment control measures shall be designed, installed,
operated, and maintained in accordance with the most recent version of the North Carolina
Surface Mining Manual. Reclamation measures and implementation shall comply with the
reclamation in accordance with the requirements of the Sedimentation Pollution Control Act
and the Mining Act of 1971.
If the project occurs in waters or watersheds classified as Primary Nursery Areas(PNAs),SA, WS-
I, WS-II, High Quality Waters(HQW), or Outstanding Resource Waters (ORW),then the
sedimentation and erosion control designs shall comply with the requirements set forth in 15A
NCAC 04B .0124, Design Standards in Sensitive Watersheds.
Citation: 15A NCAC 02H.0506(b); 15A NCAC 02H.0507(c);ISA NCACO28.0200,15A NCAC 02B
.0231
11. Sediment and erosion control measures shall not be installed in wetland or waters except within
the footprint of temporary or permanent impacts otherwise authorized by this Certification. If
placed within authorized impact areas,then placement of such measures shall not be conducted
in a manner that results in dis-equilibrium of any wetlands,streambeds, or streambanks. Any
silt fence installed within wetlands shall be removed from wetlands and the natural grade
restored within two(2) months of the date that DEMLR or locally delegated program has
released the specific area within the project to ensure wetland standards are maintained upon
completion of the project.
Citation: 15A NCAC 02H.0506(b); 15A NCAC 02H.0507(c);15A NCAC 028.0200,15A NCAC 028
.0231
12. Erosion control matting that incorporates plastic mesh and/or plastic twine shall not be used
along streambanks or within wetlands.
Citation: 15A NCAC 02H.0506(b); 15A NCAC 02H.0507(c)
13. If the project is covered by NPDES Construction Stormwater Permit Number NCGO10000 or
NPDES Construction Stormwater Permit Number NCG250000,full compliance with permit
conditions including the erosion & sedimentation control plan, inspections and maintenance,
self-monitoring, record keeping and reporting requirements is required.
Citation: 15A NCAC 02H.0506(b); 15A NCAC 02H.0507(c); 15A NCAC 028.0200;15A NCAC 028
.0231
14. All work in or adjacent to streams shall be conducted so that the flowing stream does not come
in contact with the disturbed area. Approved best management practices from the most current
version of the NC Sediment and Erosion Control Manual, or the NC Department of
North Carolina Department of Ltrwonmcntal Quahty Division or Water Resources
15' Raleigh Regional 01 ice 3900 Ban-cu Drive Raleigh.North Carolina 27609
y 4 E
Q
919.791 4200

DocuSign Envelope ID:95842C68-EB36-49D0-BE24-EA1591C2CA79
Wilson's Mills High School
DWR#20240625
Individual Certification#WQC006951
Page 8 of 11
Transportation Construction and Maintenance Activities Manual, such as sandbags, rock berms,
cofferdams,and other diversion structures shall be used to minimize excavation in flowing
water.
Citation: 15A NCAC 02H.0506(b);15A NCAC 02H.0507(c);15A NCAC 028.0200
15. Culverts shall be designed and installed in such a manner that the original stream profiles are
not altered and allow for aquatic life movement during low flows. The dimension, pattern,and
profile of the stream above and below a pipe or culvert shall not be modified by widening the
stream channel or by reducing the depth of the stream in connection with the construction
activity. The width, height,and gradient of a proposed culvert shall be such as to pass the
average historical low flow and spring flow without adversely altering flow velocity. If the width
of the culvert is wider than the stream channel,the culvert shall include multiple boxes/pipes,
baffles, benches and/or sills to maintain the natural width of the stream channel. If multiple
culverts/pipes/barrels are used,low flows shall be accommodated in one culvert/pipe and
additional culverts/pipes shall be installed such that they receive only flows above bankfull.
Placement of culverts and other structures in streams shall be below the elevation of the
streambed by one foot for all culverts with a diameter greater than 48 inches, and 20%of the
culvert diameter for culverts having a diameter less than or equal to 48 inches,to allow low flow
passage of water and aquatic life. If the culvert outlet is submerged within a pool or scour hole
and designed to provide for aquatic passage, then culvert burial into the streambed is not
required.
For structures less than 72" in diameter/width,and topographic constraints indicate culvert
slopes of greater than 2.5%culvert burial is not required, provided that all alternative options
for flattening the slope have been investigated and aquatic life movement/connectivity has
been provided when possible (e.g. rock ladders,cross-vanes,sills, baffles etc.). Notification,
including supporting documentation to include a location map of the culvert,culvert profile
drawings, and slope calculations,shall be provided to DWR 30 calendar days prior to the
installation of the culvert.
When bedrock is present in culvert locations, culvert burial is not required, provided that there
is sufficient documentation of the presence of bedrock. Notification, including supporting
documentation such as a location map of the culvert,geotechnical reports, photographs,etc.
shall be provided to DWR a minimum of 30 calendar days prior to the installation of the culvert.
If bedrock is discovered during construction,then DWR shall be notified by phone or email
within 24 hours of discovery.
Installation of culverts in wetlands shall ensure continuity of water movement and be designed
to adequately accommodate high water or flood conditions. When roadways, causeways,or
other fill projects are constructed across FEMA-designated floodways or wetlands,openings
such as culverts or bridges shall be provided to maintain the natural hydrology of the system as
well as prevent constriction of the floodway that may result in destabilization of streams or
wetlands.
The establishment of native woody vegetation and other soft stream bank stabilization
techniques shall be used where practicable instead of rip-rap or other bank hardening methods.
Citation: 15A NCAC 02H.0506(b), 15A NCAC 02H.0507(c)
D ,Ie nh Car.hna Dcpartmem of l nt tronment<I Quality Division of Water Resources
Raleigh Regional Ovice 331+t Barret)Drive Riletgh.North C arolma 27609
'..r� _X 919 '91 4'_DO

DocuSign'Envelope ID:95842C68-EB36-49D0-BE24-EA1591C2CA79
Wilson's Mills High School
DWRii 20240625
Individual Certification#WQC006951
Page 9 of 11
16. Application of fertilizer to establish planted/seeded vegetation within disturbed riparian areas
and/or wetlands shall be conducted at agronomic rates and shall comply with all other Federal,
State and Local regulations. Fertilizer application shall be accomplished in a manner that
minimizes the risk of contact between the fertilizer and surface waters.
Citation: 15A 02H.0506(b); ISA NCAC 02H.0507(c); 15A NCAC 02B.0200,15A NCAC 02B.0231
17. If concrete is used during construction,then all necessary measures shall be taken to prevent
direct contact between uncured or curing concrete and waters of the state. Water that
inadvertently contacts uncured concrete shall not be discharged to waters of the state.
Citation: 15A 02H.0506(b); 15A NCAC 02H.0507(c);15A NCAC 02B.0200, 15A NCAC 02B.0231
18. All proposed and approved temporary fill and culverts shall be removed and the impacted area
shall be returned to natural conditions within 60 calendar days after the temporary impact is no
longer necessary. The impacted areas shall be restored to original grade, including each
stream's original cross-sectional dimensions, planform pattern, and longitudinal bed profile_ All
temporarily impacted sites shall be restored and stabilized with native vegetation.
Citation: 15A NCAC 02H.0506(b);15A NCAC 02H.0507(c)
19. All proposed and approved temporary pipes/culverts/rip-rap pads etc. in streams or wetlands
shall be installed as outlined in the most recent edition of the North Carolina Sediment and
Erosion Control Planning and Design Manual or the North Carolina Surface Mining Manual or
the North Carolina Department of Transportation Best Management Practices for Construction
and Maintenance Activities so as not to restrict stream flow or cause dis-equilibrium during use
of this Certification.
Citation: 15A NCAC 02H.0506(b); 15A NCAC 02H.0507(c)
20. Any rip-rap required for proper culvert placement, stream stabilization,or restoration of
temporarily disturbed areas shall be restricted to the area directly impacted by the approved
construction activity. All rip-rap shall be placed such that the original streambed elevation and
streambank contours are restored and maintained and shall consist of clean rock or masonry
material free of debris or toxic pollutants. Placement of rip-rap or other approved materials
shall not result in de-stabilization of the stream bed or banks upstream or downstream of the
area or be installed in a manner that precludes aquatic life passage.
Citation: 15A NCAC 02H.0506(b); 15A NCAC 02H.0507(c)
21. Any rip-rap used for stream or shoreline stabilization shall be of a size and density to prevent
movement by wave, current action,or stream flows, and shall consist of clean rock or masonry
material free of debris or toxic pollutants. Rip-rap shall not be installed in the streambed except
in specific areas required for velocity control and to ensure structural integrity of bank
stabilization measures.
Citation: 15A NCAC 02H.0506(b);15A NCAC 02H.0507(c);15A NCAC 02B.0201
22. All mechanized equipment operated near surface waters shall be inspected and maintained
regularly to prevent contamination of surface waters from fuels, lubricants, hydraulic fluids, or
other toxic materials. Construction shall be staged in order to minimize the exposure of
D`�Q'i
North Carolina Dcpanment of linvironmen[al Qaility Drviswn of Water Resources
011
Raleigh Regiomal Office 3800 Barrell Drive Raleigh.North C arohna 27609

DocuSign Envelope ID:95842C68-EB36-49D0-BE24-EA1591C2CA79
Wilson's Mills High School
DWR#20240625
Individual Certification#WQC006951
Page 10 of 11
equipment to surface waters to the maximum extent practicable. Fueling, lubrication,and
general equipment maintenance shall be performed in a manner to prevent,to the maximum
extent practicable,contamination of surface waters by fuels and oils.
Citation: 15A NCAC 02H.0506(b);15A NCAC 02H.0507(c);15A NCAC 028.0200,15A NCAC 02B
.0231
23. Heavy equipment working in wetlands shall be placed on mats or other measures shall be taken
to minimize soil disturbance and compaction.
Citation: 15A NCAC 02H.0506(b);15A NCAC 02H.0507(c);15A NCAC 02B.0231
24. In accordance with 143-215.85(b),the permittee shall report any petroleum spill of 25 gallons or
more; any spill regardless of amount that causes a sheen on surface waters;any petroleum spill
regardless of amount occurring within 100 feet of surface waters; and any petroleum spill less
than 25 gallons that cannot be cleaned up within 24 hours.
Citation: 15A NCAC 02H.0507(c);N.C.G.S 143-215.85(b)
25. The permittee and their authorized agents shall conduct all activities in a manner consistent
with State water quality standards (including any requirements resulting from compliance with
§303(d)of the Clean Water Act),and any other appropriate requirements of State and Federal
Law.
Citation: 15A NCAC 02H.0506(b);15A NCAC 02H.0507(c)
26. The permittee shall require its contractors and/or agents to comply with the terms and
conditions of this certification in the construction and maintenance of this project, and shall
provide each of its contractors and/or agents associated with the construction or maintenance
of this project with a copy of this Water Quality Certification. A copy of this Water Quality
Certification shall be available at the project site during the construction and maintenance of
this project.
Citation:15A NCAC 02H.0506(b),15A NCAC 02H.0507(c)
D� � Vonh Carnhtta Depanmem of knatrcmmental Quality Division of Wairr Resources
Raleigh Regional Qllicc 3800 Barren Drive Raleigh.North Carolina 27609
919 '91 4200

DocuSign Envelope ID 95842C68-EB36-49D0-BE24-EA1591C2CA79
Wilson's Mills High School
DWR#20240625
Individual Certification#WQC006951
Page 11 of 11
This approval to proceed with your proposed impacts or to conduct impacts to waters as depicted in
your application shall expire upon expiration of the 404 Permit. The conditions in effect on the date of
issuance shall remain in effect for the life of the project, regardless of the expiration date of this
Certification. [15A NCAC 02H .0507(c)}
This,the 19th day of June 2024
Ooer J uSlpneA by
�atf
ANA
37217CBC861MA8
Michael Hall
Regional Supervisor, Raleigh Regional Office
Water Quality Regional Operations Section
Division of Water Resources, NCDEQ
D North Carolina Department of Fin nronmenial Quakily Din ision of%atcr Resources
Raleigh Regional Office 3800 Barrett Drive Ralcigh.North Carolina 21609
919.791 4200

DEPARTMENT OF THE ARMY
R U.S.ARMY CORPS OF ENGINEERS,WILMINGTON DISTRICT
July 1 2024 f�
Regulatory Division D �
SAW-2023-00680 ;�,• �'� �-
Sent Via email: [e-mail] �o
a:.
Brooks Moore
Johnston County Board of Education
PO Box 1336
Smithfield, NC 27577
Dear Mr. Moore:
This letter is in response to the Pre-Construction Notification (PCN) you submitted to
the Wilmington District, Raleigh Field Office on April 24, 2024, for a Department of the
Army Nationwide permit (NWP) verification. This project has been assigned the file
number SAW-2023-00680 and is known as Wilson's Mills High School. This file number
should be referenced in all correspondence concerning this project.
A review of the information provided indicates that the proposed work would include
the permanent discharge of fill material into 0.010 acre of wetland waters. The
project area for this determination includes the area which is illustrated on the enclosed
site plans/maps. The project is located approximately 0.8 miles northeast of the
intersection of Talton Farm Road and US-70 Highway, at Parcel number 260600-05-
3156 in Johnston County, North Carolina.
We have determined that the proposed work is authorized by NWP 39 pursuant to
authorities under Section 404 of the Clean Water Act (33 U.S.0 § 1344). The proposed
work must be accomplished in strict accordance with the general permit conditions, any
regional conditions, the special conditions listed in this letter, the application materials,
and the enclosed plans. If the extent of the project area and/or nature of the authorized
impacts to waters are modified, a revised PCN must be submitted to this office for
written approval before work is initiated. Any violation of permit conditions or deviation
from your submitted plans may subject the permittee to enforcement action.
This verification is valid until March 14, 2026, unless prior to this date the subject
NWP(s) is suspended, revoked, or is modified such that the activity no longer complies
with the terms and conditions of this NWP. If you commence or are under contract to
commence this activity before the date that the relevant NWP is modified or revoked,
you will have 12 months from the date of the modification or revocation of the NWP to
complete the activity under the present terms and conditions of this NWP.

Project Specific Special Conditions:
Special condition 1:
1. Suitable habitat for tricolored bat (Perimyotis subflavus) may be present at the
site. On September 14, 2022, the USFWS published a proposal in the Federal
Register to list the tricolored bat as endangered under the Endangered Species
Act (ESA). The permittee understands and agrees that all work associated with
the clearing and removal of trees and removal or modification of culverts must be
completed prior to the effective date of the final listing of this species in the
Federal Register. Work associated with the aforementioned activities not
completed by that time must cease and the permittee must contact Matthew
Martin of the Corps at [phone] or [e-mail] to
determine if additional coordination with the United States Fish and Wildlife
Service is required under Section 7 of the Endangered Species Act prior to
continuing work.
This NWP verification does not preclude the necessity to obtain any other Federal,
State, or local permits, licenses, and/or certifications, which may be required.
If you have any questions related to this verification or have issues accessing
documents referenced in this letter, please contact Matthew Martin, Regulatory
Specialist of the Raleigh Field Office at [phone], by mail at the above address,
or by email at [e-mail]. Please take a moment to complete
our customer satisfaction survey located at
https://regulatory.ops.usace.army.mil/customer-service-survey/.
Sincerely,
Matthew K. Martin
Regulatory Specialist
Enclosures
Cc (w/enclosures)
Wyatt Brown, Brown Environmental Group (via [e-mail])

Compliance Certification Form
File Number: SAW-2023-00680 County: Johnston
Permittee: Johnston County Board of Education, Brooks Moore
Project Name: Wilson's Mills High School
Date Verification Issued: 7/1/2024
Project Manager: Matthew Martin
Upon completion of the activity authorized by this permit and any mitigation required by
the permit, sign this certification and return it to the following address:
US ARMY CORPS OF ENGINEERS
Wilmington District
Attn: Matthew Martin
Raleigh Field Office
3331 Heritage Trade Drive Suite 105
Wake Forest, North Carolina 27587
or
[e-mail]
Please note that your permitted activity is subject to a compliance inspection by a U. S.
Army Corps of Engineers representative. Failure to comply with any terms or conditions
of this authorization may result in the Corps suspending, modifying or revoking the
authorization and/or issuing a Class I administrative penalty, or initiating other
appropriate legal action.
I hereby certify that the work, and mitigation (if applicable), authorized by the above
referenced permit has been completed in accordance with the terms and conditions of
the said permit including any general or specific conditions.
Date Authorized Work Started: Completed:
Describe any deviations from permit (attach drawing(s) depicting the deviations):
"Note: The description of any deviations on this form does not constitute approval by the Corps.
Signature of Permittee Date

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