19870368 Ver 1_Complete File_19870903

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MEMORANDUM
DIVISION OF ENVIRONMENTAL MANAGEMENT
August 31, 1987
RECEIVED
DATE:
TO:
FROM:
THROUGH:
Bill Mills
Operations Branch
David H. Cotton
Wilmington Regional O ce
A. Preston Howard, Jr.
Wilmington Regional Office
SE° 03 1987
WATER QUALITY SECTIOpq
OPERATIONS BRANCH
SUBJECT: Regional Office Review & Recommendations
Application for Permit for Excavation and/or Fill
Grove Point Subdivision
New Hanover County
The applicant is proposing to place drainage pipe into and fill
existing drainage ditches and to fill up to 3.7 acres of isolated
wetlands. The project will require a 401 Water Quality
Certification for the filling of the wetlands. The 401
Certification should contain the following conditions.
1. That the fill dirt be from an upland source and free from
toxic materials.
2. That all erosion control measures be implemented prior to
the placement of the fill material.
3. That all side slops be stabilized with vegetation
immediately upon completion.
This office has no objection to the project provided the above
conditions are adhered to.
DHC:kc
cc: DCM - Steve Benton
CF, WiRO
SITEWORKS
Design Group
June 24, 1987
Mr. Bill Mills
Water Quality Section
Division Of Environmental Management
PO Box 27687
Raleigh, NC 27611-7687
RE: 401 Water Quality Certification
Grove Point Subdivision
New Hanover County, NC
File # 86014-12
Dear Mr. Mills:
JUN 2 o 1987
*71mington Regional Office
DFht
Submitted for your review are two copies of the required
"Application for Water Quaity Certification" and plans for the
project. By copy of this letter, this information is being sent
to Dave Cotton in the Wilmington regional office.
The project consists of the construction of a single family
subdivision. Work within 404 wetland areas will consist of
filling existing dewatering ditches, installation of drain pipe,
and fill to accommodate streets and houses. Up to 3.7 acres
along. the fringe of a 38 acre wetland will be affected by this
project.
The groundwater dewatering system will discharge into an
existing ditch, tributary to Cedar Drain, tributary to Myrtle
Grove Sound. One street catchbasin will discharge- into the
groundwater dewatering system. All other surface drainage will
discharge through grassed swales to the remaining wetland areas.
A sedimentation basin has been constructed near the discharge of
Cedar Drain from the site. All disturbed areas will be graded
and vegetation established.
Please contact our office if additional information is
required. Your expedient review and approval will be
appreciated.
Sincerely,
SITEWORKS DESIGN GROUP
C. Lawrence Sneeden, Jr. PE
cc: Dave Cotton
Wilmington Properties
Post Office Box 3988 0 Wilmington, North Carolina 28406-3988
+ APPLICATION ,
FOR
PERMIT TO EXCAVATE AND/OR FILL WATER QUALITY CERTIFiiCAT10N -
EASEMENT IN LANDS COVERED BY WATER CAMA PERMIT FOR MAJOR DEVELOPMENT
Department of Administration State of North Carolina Department of the Army
(GS 146.12) Department of Natural Resources and Community Development Corps of Engineers, Wilmington District
(GS 113-229, 143.215.3(a)(1), 143-215.3(c), 113A-118 (33 CFR 209.320.329)
Please type or print and fill in all blanks. If information is not applicable, so indicate by placing N/A in blank.
1. Applicant Information
A. Name Wilmington Properties
Last First Middle
B. Address - - P0.-Box-.-7276 --
Street, P. 0. Box or Route
Wilmington NC 28406 [phone]
City or Town State Zip Code Phone
II. Location of Proposed Project:
A. County New Hanover
B. 1. City, town, community or-landmark Federal Point Township
2. Is proposed work within city limits? Yes No X
C. Creek, river, sound or bay upon-which project is located or nearest named body of water to project Near rprl.%r rr _
a Tributary to Myrtle Grove Sound
111. Description of Project
A. 1. Maintenance of existing project 2. New work Residential Subdivision
B. Purpose of excavation or fill
1. Access channel N A length width depth
2. Boat basin A --- length width - depth
3. Fill area Street & Houses length width depth See Plan
4. Other length width depth
C. 1. Bulkhead length N/A Average distance waterward of MHW (shoreline)
2. Type of bulkhead construction (material)
D. Excavated material (total for project)
1. Cubic yards None 2. Type of material
E. Fill material to be placed below MHW (see also V1. A)
1. Cubic yards None 2. Type of material
IV. Land Type, Disposal Area, and Construction Equipment: 424
A. Dues the area to be excavated include any marshland, swamps or other wetland? Yes No
B. Does the disposal area include any marshland, swamps or other wetland? Yes No ar
C. Disposal Area
1. Location Borrow pit. on site
2. Do you claim title to disposal area? Yes
D: Fill material source if fill is to be trucked in Borrow pit on site
L. How will excavated material be entrapped and erosion controlled? All disturbed areas Fraded & grassed,
Vegetative buffer at watercourse, & sedimentation basin at outlet.
1 . I ype of equipment to be used F.Yrflt a±.nrQ & pans
G. Will marshland be crossed in transporting equipment to project site? If yes, explain No
C
V. Intended Use of Project Area (Describe) t
A. 1. Private
2. Commercial
3. Housing Development or Industrial Residential Housing Development
4. Other
B. I. lot size(s) - J 5 . nnn a f nr 1;;r-
2. Elevation of lot(s) above mean high water m3.nlmum elevation 14
3. Soil type and texture sand & sandy loam
4. Type of building facilities or structures Single.. family brick or frame hnn
S. Sewage disposal and/or waste water treatment A. Existing Planned _ Private
B. Describe Individual Septic Tanks
6. 'Land Classification' (circle one) DEVELOPED TRANSITIONAL COMMUNITY RURAL
CONSERVATION OTHER Resour .. OnS .r_ (See CAMA Local Land Use Plan Synopsis)
VI. Pertaining to Fill and Water Quality:
A. Does the proposed project involve the placement of fill materials below mean high water? Yes No
B. 1. Will any runoff or discharge enter adjacent waters as a result of project activity or planned use of the
area following project completion? Yes X No
2. Type of discharge Groundwater dewatering system & minor- surface water discharge
3.- Location of discharge_ ni+.rh tri h utary to C Aar nra
VI I. Present rate of shoreline erosion (if known): NIA
Vlll. List permit numbers and issue dates of pre
work in project area, if applicable: NIA
Department of Army Corps of Engineers or State permits for
IX. Length of time required to complete project: Two -years
X. In addition to the completed application form, the following items must be provided:
A. Attach a copy of the deed (with State application only) or other instrument under which applicant
N/A claims title to the affected property. OR if applicant is not claiming to be the owner of said property,
then forward a copy of the deed or other instrument under which the owner claims title plus written
permission from the owner to carry out the project on his land.
B. Attach an accurate work plat drawn to scale on 8%s X 11" white paper (see instruction booklet for
details). Note: Original drawings preferred - only high quality copies accepted.
C. A copy of the application and plat must be served upon adjacent riparian landowners by registered or
N/A certified mail or by publication (G.S. 113-229 (d))Enter date served
D. List names and complete addresses of the riparian landowners with property adjoining applicant's.
N/A Such owners have 30 days in which to submit comments to agencies listed below.
X1. Certification requirement: I certify that to the best of my knowledge, the proposed activity complies
with the State of North Carolina's approved coastal management program and will be conducted in a
manner consistent with such program.
X11. Any permit issued pursuant to this application will allow only the development described in this appli-.
cation and plat. Applicants should therefore describe in the application and plat all anticipated devel-
opment activities, including construction, excavation, filling, and land clearing.
DATE
?_ .... _._,_ ... __ _Applicant's Signature
D& F-8 2
Rcv. 10/78 . SEE REVERSE SIDE FOR MAILING INST•RUC'TIOW
UU4%
State of North Carolina
Department of Natural Resources and Community Development
Division of Environmental Management
512 North Salisbury Street • Raleigh, North Carolina 27611
James G. Martin, Governor
S. Thomas Rhodes, Secretary
Septgnber 1, 1987
R. Paul Wilms
Director
Mr. Frank D. Carter
Wilmington Properties
P.O. Box 7276
Wilmington, NC 28406
Dear Mr. Carter:
Subject: Certification Pursuant to Section
401 of the Federal Clean Water Act,
Proposed Subdivision Project
Wilmington Properties
Grove Point Subdivision
Cedar Drain
New Hanover County
Attached hereto are two (2) copies of Certification No. 2141
issued to Wilmington Properties dated September 1, 1987.
If we can be of further assistance, do not hesitate to contact us.
Sincerely yours,
Original Signed B1
William C. Mill
Fnr -
R. Paul Wilms
cc: Wilmington District Corps of Engineers
W jton Regional Office
William Mills
Jortavid Owens
?qw . Lawrence Sneeden, Jr.
Pollution Prevention Pays
P.O Box 27687, Raleigh, North Carolina 27611-7687 Telephone [phone]
1 . J
NORTH CAROLINA
New Hanover County
CERTIFICATION
THIS CERTIFICATION is issued in conformity with the requirements of
Section 401 Public Laws 92-500 and 95-217 of the United States and
subject to the North Carolina Division of Environmental Management
Regulations in 15 NCAC 2H, Section .0500 to Wilmington Properties
pursuant to an application filed on the 25th day of June, 1987 to fill
wetland areas for construction of road and dwellings in Grove Point
Subdivision.
The Application provides adequate assurance that the discharge of
fill material into a wetlands area adjacent to the waters of Cedar Drain
in conjunction with the proposed subdivision construction in New Hanover
County will not result in a violation of applicable Water Quality
Standards and discharge guidelines. Therefore, the State of North
Carolina certifies that this activity will not violate Sections 301,
302, 303, 306, 307 of PL 92-500 and PL 95-217 if conducted in accordance
with the application and conditions hereinafter set forth.
Condition(s) of Certification:
1. That the activity be conducted in such a manner
as to prevent significant increase in turbidity
outside the area of construction or construction
related discharge (increases such that the
turbidity in the Stream is 25 NTU's or less
are not considered significant).
2. That all fill areas be seeded after completion of
final grading to establish a vegetative cover.
3. That appropriate sedimentation and erosion control
measures be employed to minimize turbidity and
siltation.
Violations of any condition herein set forth shall result in
revocation of this Certification.
This Certification shall beccme null and void unless the above
conditions are made conditions of the Federal Permit.
This the 1st day of September, 1987.
DIVISION OF ENVIRONMENTAL MANAGEMENT
Original Signed By
William C. Mills
F°r R. Paul Wilms, Director
WQC# 2141
T
State of North Carolina
Department of Natural Resources and Community Development
Division of Environmental Management
512 North Salisbury Street • Raleigh, North Carolina 27611
James G. Martin, Governor R. Paul Wilms
S. Thomas Rhodes, Secretary Septanber 1 1987 Director
Mr. Frank D. Carter
Wilmington Properties
P.O. Box 7276
Wilmington, NC 28406
Subject: Certification Pursuant to Section
401 of the Federal Clean Water Act,
Proposed Subdivision Project
Wilmington Properties
Grove Point Subdivision
Cedar Drain
New Hanover County
Dear Mr. Carter:
Attached hereto are two (2) copies of Certification No. 2141
issued to Wilmington Properties dated September 1, 1987.
If we can be of further assistance, do not hesitate to contact us.
Sincerely yours,
Original Signed Bye
William C. Mills
For
R. Paul Wilms
cc: Wilmington District Corps of Engineers
•
Wi ' gton Regional Office
William Mills
Mr. David Owens
Mr. Lawrence Sneeden, Jr.
Pollution Prevention Pays
P.O. Box 27687, Raleigh, North Carolina 27611-7687 Telephone [phone]

NORTH CAROLINA
New Hanover County
CERTIFICATION
THIS CERTIFTCATION is issued in conformity with the requirements of
Section 401 Public Laws 92-500 and 95-217 of the United States and
subject to the North Carolina Division of Environmental Management
Regulations in 15 NCAC 2H, Section .0500 to Wilmington Properties
pursuant to an application filed on the 25th day of June, 1987 to fill
wetland areas for construction of road and dwellings in Grove Point
Subdivision.
The Application provides adequate assurance that the discharge of
fill material into a wetlands area adjacent to the waters of Cedar Drain
in conjunction with the proposed subdivision construction in New Hanover
County will not result in a violation of applicable Water Quality
Standards and discharge guidelines. Therefore, the State of North
Carolina certifies that this activity will not violate Sections 301,
302, 303, 306, 307 of PL 92-500 and PL 95-217 if conducted in accordance
with the application and canditions hereinafter set forth.
Condition(s) of Certification:
1. That the activity be conducted in such a manner
as to prevent significant increase in turbidity
outside the area of construction or construction
related discharge (increases such that the
turbidity in the Stream is 25 NTU's or less
are not considered significant).
2. That all fill areas be seeded after completion of
final grading to establish a vegetative cover.
3. That appropriate sedimentation and erosion control
measures be employed to minimize turbidity and
siltation.
Violations of any condition herein set forth shall result in
revocation of this Certification.
This Certification shall became null and void unless the above
conditions are made conditions of the Federal Permit.
This the 1st day of September, 1987.
DIVISION OF ENVERONMENTAL MANAMVIENT
Original Signed By
Wd!1 am C-Mills
R. Paul Wilms, Director
WQC# 2141
SITEW RF%%-,7 ?
Design Group ?
919/799-6808
June 24, 1987
Mr. Bill Mills
Water Quality Section
Division Of Environmental Management E
PO Box 27687 C E r V
Raleigh, NC 27611-768'7 JUN 2 5
RE: 401 Water Quality Certification 3987
Grove Point Subdivision WATER QUALITY SECTION
New Hanover County, NC OPERATIONS BRANCH
File # 86014-12
Dear Mr. Mills:
Submitted for your review are two copies of the required
"Application for Water Quality Certification" and plans for the
project. By copy of this letter, this information is being sent
to Dave Cotton in the Wilmington regional office.
The project consists of the construction of a single family
subdivision. Work within 404 wetland areas will consist of
filling existing dewatering ditches, installation of drain pipe,
and fill to accommodate streets and houses. Up to 3.7 acres
along the fringe of a 38 acre wetland will be affected by this
project.
The groundwater dewatering system will discharge into an
existing ditch, tributary to Cedar Drain, tributary to Myrtle
Grove Sound. One street catchbasin will discharge into the
groundwater dewatering system. All other surface drainage will
discharge through grassed swales to the remaining wetland areas.
A sedimentation basin has been constructed near the discharge of
Cedar Drain from the site. All disturbed areas will be graded
and vegetation established.
Please contact our office if additional information is
required. Your expedient review and approval will be
appreciated.
Sincerely,
SITEWORKS DESIGN GROUP
C. Zawrence Sneeden, Jr. PE
cc: Dave Cotton
Wilmington Properties
Post Office Box 3988 Wilmington, North Carolina 28406-3988
.4 .+. ?'
s ?
PERMIT TO EXCAVATE AND/liR FILL
EASEMENT IN LANDS COVERED BY WATER
APPLICATION
FOR
WATER QUALITY CERTIFICATION
CAMA PERMIT FOR MAJOR DEVELOPMENT
Department of Administration State of North Carolina Department of the Army
(GS 146.12) Department of Natural Resources and Community Development CorpLof Engine ers Wilmington District
(GS 113-229,143-215.3(a)(1), 143-215.3(c), 113A-118 (33 Lti- p[G?j V E
Please type or print and fill in all blanks. If information is not applicable, so indicate by placing N/A in bladiUN 2 5 1987
WATER QUALITY SECTION
OPERATIONS BRANCH
1. Applicant Information
A. Name Wilm neton Properties --
Last First Middle
B. Address PO Box 7276
Street, P. O. Box or Route
Wilmington NC 28406 [phone]
City or Town State Zip Code Phone
11. Location of Proposed Project:
A. County New Hanover
B. 1. City, town, community or landmark Federal Point Township
2. Is proposed work within city limits? Yes No X
C. Creek, river, sound or bay upon which project is located or nearest named body of water to project N-ar radAr. n__ 8i r,
a Tributary to Myrtle Grove Sound
Ill. Description of Project.
A. 1. Maintenance of existing project 2. New work Residential Subdivision
B. Purpose of excavation or fill
1. Access channel N A length width depth
2. Boat basin N/A length width depth
3. Fill area Street & Houses length width depth See Plan
4. Other length width depth
C. 1. Bulkhead length N/A Average distance waterward of MHW (shoreline)
2. type of bulkhead construction (material)
D. Excavated material (total for project)
1. Cubic yards None 2. Type of material
E. Fill material to be placed below MHW (see also VI. A)
1. Cubic yards None 2. Type of material
IV. Land Type, Disposal Area, and Construction Equipment: 424
A. Dues the area to be excavated include any marshland, swamps or other wetland? Yes - No
B. Does the disposal area include any marshland, swamps or other wetland? Yes No .%
C. Disposal Area
1. Location Borrow if..an si-s
2. Do you claim title to disposal area? Yes
D. Fill material source if fill is to be trucked in Borrow pit on site
E. How will excavated material be entrapped and erosion controlled? All disturbed areas graded & grassed.
Vegetative buffer at watercourse, & sedimentation basin at outlet.
I . I ype of equipment to be used Fxr-avat.nrs & :any
G. Will marshland be crossed in transporting equipment to project site? If yes, explain
F- E 1
V' - . `iR
V. Intended Use of Project Area (gibe)
A. 1. Private
- 2. Commercial
3. Housing Development or Industrial Residential Housing Development
4. Other
B. I. Lot size(s)-__ 15,00t) -,-f- nr 7 arger
2. Elevation of lot(s) above mean high water minimum elevation 14
3. Soil type and texture sand & sandy loam
4. Type of building facilities or structures Single family brick or frame houses
5. Sewage disposal and/or waste water treatment A. Existing Planned Private
B. Describe Individual Septic Tanks
6. 'Land Classification'(circle one) DEVELOPED TRANSITIONAL COMMUNITY RURAL
CONSERVATION OTHER Resource Conser_ (See CAMA Local Land Use Plan Synopsis)
VI. Pertaining to Fill and Water Quality:
A. Does the proposed project involve the placement of fill materials below mean high water? Yes No
B. 1. Will any runoff or discharge enter adjacent waters as a result of project activity or planned use of the
area following project completion? Yes A No
2. Type of discharge Groundwater dewatering system & minor surface water discharge
3.- Location of discharge ni +.Ph tributary to Cedar nrai n
VII. Present rate of shoreline erosion (if known): N/A
VIII. List permit numbers and issue dates of previous Department of Army Corps of Engineers or State permits for
work in project area, if applicable: NIA
IX. Length of time required to complete project: - Two -years
X. In addition to the completed application form, the following items must be provided:
A. Attach a copy of the deed (with State application only) or other instrument under which applicant
N/A claims title to the affected property. OR if applicant is not claiming to be the owner of said property,
then forward a copy of the deed or other instrument under which the owner claims title plus written
permission from the owner to carry out the project on his land.
B. Attach an accurate work plat drawn to scale on 8%z X 11" white paper (see instruction booklet for
details). Note: Original drawings preferred - only high quality copies accepted.
C. A copy of the application and plat must be served upon adjacent riparian landowners by registered or
NIA certified mail or by publication (G.S. 113-229 (d))Enter date served
D. List names and complete addresses of the riparian landowners with property adjoining applicant's.
N/A Such owners have 30 days in which to submit comments to agencies listed below.
XI. Certification requirement: 1 certify that to the best of my knowledge, the proposed activity complies
with the State of North Carolina's approved coastal management program and will be conducted in a
manner consistent with such program.
XII. Any permit issued pursuant to this application will allow only the development described in this appli-
cation and plat. Applicants should therefore describe in the application and plat all anticipated devel-
opment activities, including construction, excavation, filling, and land clearing.
DATE G /z¢-le? ?-^n C,?, 0-1 ej?__7_
Applicant's Signature
O&.-BZ
Rev. 10/78 SEE REVERSE SIDE FOR MAILING INSTRUCTIONS
40 APPLICATION
FOR
PERMIT TO EXCAVATE AND/OR FILL WATER QUALITY CERTIFICATION
EASEMENT IN LANDS COVERED BY WATER CAMA PERMIT FOR MAJOR DEVELOPMENT
Department of Administration State of North Carolina Department of the Army
(GS 14612) Department of Natural Resources and Community Development Corps of Engineers, Wilmington District
(GS 113-229, 143-215.3(a)(1), 143-215.3(c), 113A-118 (33 CFR 209.320-329)
Please type or print and fill in all blanks. If information is not applicable, so indicate by placing N/A in blank.
1. Applicant Information
A. Name Wilmington Properties -
Last First Middle
B. Address P-0 Bo-x 7-2-6
Street, P. O. Box or Route
Wilmington NC 28406 [phone]
City or Town State Zip Code Phone
11. Location of Proposed Project:
A. County New Hanover
- -B.-1.- City,-town; community or 4andmark Federal Point Township
2. Is proposed work within city limits? Yes No X
C. Creek, river, sound or bay upon which project is located or nearest named body of water to project Near ('.Pricer rrni N -
a Tributary to Myrtle Grove Sound
III. Description of Project
A. 1. Maintenance of existing project 2. New work Residential Subdivision
B. Purpose of excavation or fill
I. /access channel N LA length width depth
A_.
2. Boat basin -N_ -- -- _ length width depth
3. Fill area Street & Houses length width depth See Plan
4. Other - -- length width depth
C. 1. Bulkhead length N/A Average distance waterward of MHW (shoreline)
2. (ype of bulkhead construction (material)
D. Excavated material (total for project)
1. Cubic yards None 2. Type of material
E. Fill material to be placed below MHW (see also V1. A)
1. Cubic yards None 2. Type of material
IV. Land Type, Disposal Area, and Construction Equipment: 494
A. Dues the area to be excavated include any marshland, swamps or other wetland? Yes No
B. Does the disposal area include any marshland, swamps or other wetland? Yes No Y
C. Disposal Area
1. Location Borrow ;zit. on site
2. Do you claim title to disposal area? Yes
D. Fill material source if fill is to be trucked in Borrow pit on site
L. How will excavated material be entrapped and erosion controlled? All disturbed areas graded & grassed.
Vegetative buffer at watercourse, & sedimentation basin at outlet.
----
I . I ype of equipment to be used 'FXt-.gyg nrR A pang
G. Will marshland be crossed in transporting equipment to project site? If yes, explain No
F- 1
V. Intended Use of Project Area (Describe)
A. 1. Private
2. Commercial
3. Housing Development or Industrial Residential Housing Development
4. Other
B. 1. Lot size(s) -L4__n()(1 g - f - nr 1 a rgeor
2. Elevation of lot(s) above mean high water minimum elevation 14
3. Soil type and texture sand & sandy loam
4. Type of building facilities or structures Single family brick or frame houses
5. Sewage disposal and/or waste water treatment A. Existing Planned - Pri vato-
1B.' Describe Individual Septic Tanks
6. 'Land Classification'(circle one) DEVELOPED TRANSITIONAL COMMUNITY RURAL
CONSERVATION OTHER Resource Cons r. (See CAMA Local Land Use Plan Synopsis)
VI. Pertaining to Fill and Water Quality:
A. Does the proposed project involve the placement of fill materials below mean high water? Yes No
B. 1. Will any runoff or discharge enter adjacent waters as a result of project activity or planned use of the
area following project completion? Yes A No
2. Type of discharge Groundwater dewatering system & minor surface water discharge
3.- Location of discharge ni +.e h tributary to ..rear nrai n
VII. Present rate of shoreline erosion (if known): N/A
Vill. List permit numbers and issue dates of previous Department of Army Corps of Engineers or State permits for
work in project area, if applicable: N/A
IX. Length of time required to complete project: Two years
X. In addition to the completed application form, the following items must be provided:
A. Attach a copy of the deed (with State application only) or other instrument under which applicant
N/A claims title to the affected property. OR if applicant is not claiming to be the owner of said property,
then forward a copy of the deed or other instrument under which the owner claims title plus written
permission from the owner to carry out the project on his land.
B. Attach an accurate work plat drawn to scale on 8%z X 11" white paper (see instruction booklet for
details). Note: Original drawings preferred - only high quality copies accepted.
C. A copy of the application and plat must be served upon adjacent riparian landowners by registered or
NIA certified mail or by publication (G.S. 113-229 (d))Enter date served
D. List names and complete addresses of the riparian landowners with property adjoining applicant's.
NIA Such owners have 30 days in which to submit comments to agencies listed below.
XI. Certification requirement: I certify that to the best of my knowledge, the proposed activity complies
with the State of North Carolina's approved coastal management program and will be conducted in a
manner consistent with such program.
X11. Any permit issued pursuant to this application will allow only the development described in this appli-
cation and plat. Applicants should therefore describe in the application and plat all anticipated devel-
opment activities, including construction, excavation, filling, and land clearing.
DATE G /94'-/97 Applicant's Signature

Rev. . TO/
o 10/78 SEE REVERSE SIDE FOR MAILING INSTRUCTIONS