20060216 Ver 1_COMPLETE FILE_20060210

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Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
March 22, 2006
Mr. Jerry Hyland
2240 Danridge Drive
York, PA 17403-4518
Subject Property:
Jerry Hyland
Lake Tillery [030708,13-(1), B, WSIV B, CA]
Approval of 401 Water Quality Certification with Additional Conditions
Dear Mr. Hyland:
Alan W. Klimek, P.E. Director
Division of Water Quality
DWQ Project # 06-0216
Montgomery County
You have our approval, in accordance with the attached conditions and those listed below, to place fill
within or otherwise impact 68 feet of shoreline of waters (Lake Tilllery) for the purpose of constructing a
68-foot (by 2-foot wide) bulkhead along the existing shoreline at the subject property, as described
within your application dated February 6, 2006 and received by the N.C. Division of Water Quality
(DWQ) on March 9, 2006. After reviewing your application, we have decided that the impacts are
covered by General Water Quality Certification Number(s) 3495 (GC3495). The Certification(s) allows
you to use Nationwide Permit(s) NW80 when issued by the US Army Corps of Engineers (USACE). In
addition, you should obtain or otherwise comply with any other required federal, state or local permits
before you go ahead with your project including (but not limited to) Erosion and Sediment Control, Non-
discharge, and water supply regulations. Also, 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 or CAMA Permit.
This approval is for the purpose and design that you described in your application. If you change your
project, you must notify us and you may be required to send us a new application. If the property is sold,
the new owner must be given a copy of this Certification and approval letter and is thereby responsible for
complying with all conditions. If total fills for this project (now or in the future) exceed one acre of
wetland or 150 linear feet of stream, compensatory mitigation may be required as described in 15A
NCAC 21-1 .0506 (h). This approval requires you to follow the conditions listed in the attached
certification and any additional conditions listed below.
The Additional Conditions of the Certification are:
1. Impacts Approved
The following impacts are hereby approved as long as all of the other specific and general
conditions of this Certification (or Isolated Wetland Permit) are met. No other impacts are
approved including incidental impacts:
- I
E Amount Approved (Units) Plan Location or Reference
-
Waters (shoreline Lake TilleEy) 0.0031 (acres) Attached ma and plan
401 Oversight / Express Review Permitting Unit
1650 Mail Scrvice Center, Raleigh, Noah Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27603
Phone: [phone] / FAX [phone] / Internet: http /ih2o.enr.state.nc.tislncs%ctl inkis
NorthCarolina
Naturally
An Equal Opportunity/Affirmative Action Employer- 50°o Recycled/10% Post Consumer Paper
Mr. Jerry Hyland
Page 2 of 3
March 22, 2006
2. Erosion & Sediment Control Practices
Erosion and sediment control practices must be in full compliance with all specifications
governing the proper design, installation and operation and maintenance of such Best
Management Practices in order to protect surface waters standards:
a. The erosion and sediment control measures for the project must be designed, installed,
operated, and maintained in accordance with the most recent version of the North Carolina
Sediment and Erosion Control Planning and Design Manual.
b. The design, installation, operation, and maintenance of the sediment and erosion control
measures must be such that they equal, or exceed, the requirements specified in the most
recent version of the North Carolina Sediment and Erosion Control Manual. The devices
shall be maintained on all construction sites, borrow sites, and waste pile (spoil) projects,
including contractor-owned or leased borrow pits associated with the project.
c., For borrow pit sites, the erosion and sediment control measures must be designed, installed,
operated, and maintained in accordance with the most recent version of the North Carolina
Surface Mining Manual.
d. The reclamation measures and implementation must comply with the reclamation in
accordance with the requirements of the Sedimentation Pollution Control Act.
3. No Waste, Spoil, Solids, or Fill of Any Kind
No waste, spoil, solids, or fill of any kind shall occur in wetlands, waters, or riparian areas beyond
the footprint of the impacts depicted in the Pre-Construction Notification. All construction
activities, including the design, installation, operation, and maintenance of sediment and erosion
control Best Management Practices, shall be performed so that no violations of state water quality
standards, statutes, or rules occur.
4. No Sediment & Erosion Control Measures w/n Wetlands or Waters
Sediment and erosion control measures shall not be placed in wetlands or waters to the maximum
extent practicable. If placement of sediment and erosion control devices in wetlands and waters
is unavoidable, they shall be removed and the natural grade restored within six months of the date
that the Division of Land Resources has released the project.
5. Bulkhead Construction
The bulkhead may be no longer than 120 feet in length (along the existing shoreline) and may be
no wider than two feet in width and must follow the existing shoreline geomorphology.
6. Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable
Buffer Rules, and any subsequent modifications, the applicant is required to return the attached
certificate of completion to the 401 Oversiglit/Express Review Permitting Unit, North Carolina
Division of Water Quality, 1650 Mail Service Center, Raleigh, NC, 27699-1650.
Violations of any condition herein set forth may result in revocation of this Certification and may result in
criminal and/or civil penalties. The authorization to proceed with your proposed impacts or to conduct
impacts to waters as depicted in your application and as authorized by this Certification, shall expire upon
expiration of the 404 or CAMA Permit.
Mr. Jerry Hyland
Page 3 of 3
March 22, 2006
If you do not accept any of the conditions of this Certification (associated with the approved wetland or
stream impacts), you may ask for an adjudicatory hearing. You must act within 60 days of the date that
you receive this letter. To ask for a hearing, send a written petition, which conforms to Chapter 150B of
the North Carolina General Statutes to the Office of Administrative Hearings, 6714 Mail Service Center,
Raleigh, N.C. 27699-6714. This certification and its conditions are final and binding unless you ask for a
hearing.
Any disputes over determinations regarding this Authorization Certificate (associated with the approved
buffer impacts) shall be referred in writing to the Director for a decision. The Director's decision is
subject to review as provided in Articles 3 and 4 of G.S. 150B.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water
Act. If you have any questions, please telephone Cyndi Karoly or Ian McMillan in the Central Office in
Raleigh at 919-733-1786 or Eric Kulz at 919-791-4200.
incerely,
A`VKlijm
Enclosures: GC3495
Certificate of Completion
cc: USACE Wilmington Regulatory Field Office
Ken Averitte, DWQ Fayetteville Regional Office
DLR Fayetteville Regional Office
File Copy
Central Files
^ Alan W. Klimek, P.E.
Filcname: 060216JerryHyland(Montgomery)401
..u cv-cuu..r o?•.?o rrt?r?.uwt.-v:CtLt4YUJ 717fJJbL77J
0fidca Utsa Only:
. 'USACE Actions ID No.
(IF any partieulzr item is not applietble to this
?. a rocesgitte
[ U: `J1`l3F9?f.iy13t3k r: b' l
o c? 0
- --- ParutVersionMny?002• .
DENR - WATER QUALITY
WETUNDSMiD STCR.'RATER ER/JJCH (p 0 ?
VrQ lvo.
please enicr "Not Applicabl_' or "N/A".)
1. Check all of the approval (s) requested for tl-ds project:
? Section 404 Permit ? Riparian or Watershed Buffer Rules
? Section 10 Pe mit ? Isolated Wetland Permit from DWQ
? 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested:
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (verify availability with NCWRP prior to submittal of PCN), complete
section VIII and check here: ?
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina DiAsion of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here: ?
Il.. Applicant Information
1. Owner/Applicant Information
Name:
Mailing Address:
Telephone Number:! ~I- ?i' Fax Number:
E-mail Address:
2. Agent'Consultant Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has signatory authority for the owneriapplicant.)
Name: l3u%Cti Ord
Company Affiliation:
Mailing Address:
BO
t? R
Tele bone Numbe-: 11
p , !fi L? 8' / t5 Fax Number: /4V 3 !
E-mail Address: rn,, p fB ('nd yh ra ,,a 1?__._C!' t - -
Page 5 of 12
SEP-26-2005 09:37 FRO1:CWQ-WETLRHDS 9197336693 T0:919104391394 P:7-113
1<"x I. ?reject Information
At,aeh a vicinity m.ap C1=1 Y showing the location of the pxopcrty with respect to local
landinarRs such as towns, rivers, and roads. Also provide a detailed site plan showing property
bow:daries and development plans in relation to surrounding properties. L'otli the vicinity map
and site plan must include a scale and north arrow. The specific footprint-i of all buildings,
impervious surfaces, or.other facilities must be included. If possible, the maps and plans should
include tic appropriate USGS Topographic' Quad Map and NRCS Soil Survey with the proparty
boundaries outlined. Plait drawings, or other maps may be included at the. applicant's discretion,
so long as the oxoperty is clearly defined. For administrative and distribution purposes, tho
USACE requires information to be submitted on she: is no lamer than 1.1 by 17-inch format;
however, DWQ may accept pape..nvork of any size. D%VQ prefers full-size construction
dravings rather than a sequential sheet version of the Full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant 1v-ill b= informed that
the project has been placed on hold until deeiphCrabls maps are provided.
1. Name of project:
2. T.I.P. Project Number or State Project Number (NCDOT Only): k/A
3. Property Identification Number (Tax PLN):, lif6}
r
4. location ,
Counri: fi3) :V f r; Nearest Tow.a:
Subdivision narn??(include Phase/lot number); IJz,!? si a '?
Directions to site (include road numbers, landmarks, etc.)
5. Site coordinates, if available (UTM or Lat/Long):
kNt ote - If prpject is linear, such as a road or utility line, attacla a sheet that separately lists the
coordinates for cash crossing of a distinct waterbody.)
Y
6. Properly size (acres): g,' ?- c'
7I . Nearest body of water (stream/river/sound/occaMakc): ??'/t??'J{ r;!
S. River Basin:
(Note - this must be one of North Carolina's sevcntecn designated major river basins. The
River Basin neap is available at ligp:/lh2o.enr.statc.nc.uVadmin/mapsl.}
°. Describe the existing conditions on the site and?cneral land use in the vicinity of the project
at the time of this application:
Pap 6 of 12
sER-26-2ew 09:37 FROM:DWQ-WETLFiNDS 9197336893
10. Describe ttheoveral project in detail, includin; the type of
C'! •. 'r'd'c
T0:919104391384 P:8'13
ipment to bra us d-
r

11. Explain the purpose of the proposed work:
IT,7. prior, Project History
if jurisdictional determinations andior permits have been requested and/or obtained for this
prgjcct (including all prior phases of the same subdivision) iti the past, please explain. Include
the USAGE Action ID /dumber, DWQ Project Number, application date, and date permits and
ceItif'ications were issued or withdrawn. FroFido photocopies of previously issued pcrttuty,
certifications or other useful infomiation. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable).' If this is aNCDOT projeel,
list and describe permits issued for prior segments of the same T.Z.P. project, along with
construction schedules.
V. kfuture Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
mid provide justification for the exclusion of this work from the current application.
VI. Proposed Irnpacti to Waters of the United Statcs/Watcrs of Me Stato
ft is the applicant's (or agent's) responsibility to determine, delineate and map all impacts-to
wetlands, open water, and strcam channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be lasted herein, and must be clearly ldeotiftable on an accompanying site
plan. All wetlands and waters, and all streams (intermitient and perennial) must be shown on a
delineation map, whether or mot impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may,:be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.

Page 7 of 12
SEp-26-2005 09:33 FRQMIDWQ-142TI-RNQS 91973368'?3 70:919104391384 P:9.113
1. Provide a lvritten descxiption of the proposed impacts:
2, Individually list wetland impacts below:
%Victland Imp=
Site Number
ittdicato on ma
Type of brpact4 Area Of
Impact
a=) Located yritbin
too-ye r Ploodplai.-1s°
cs/no) Distance to
Nearest Stream
linear tcet r-"
Type of Wetland to
/vZ /J
I

._? . i. :. 1 e•lAnrinn rmclinrt. fill.
A list etch im>;cct separately and idcnaty tempo y impaeu. nllpucu mcluuc, Vu. W%; i,V.
excavotior.. flooding, ditchirgidrainagc, ctc. For dams, separately list impacts ducto both structluc and llocditi,,.
4A 10C-YCtr 000dplains arc identified through the Federal EmerOencp Mancgoment Agency's (FE-MA) Flood Insumncr Tinto Maps
(Yl tM), or rF_MA•tp;.rovcd '•ncai 9oodplain mars. %4ap3 um avril*lc througb the FF.MA Map Scrvice Canter at I-500.353.961 G, or
ontlnc at Fltr:!lonvw.f naluy•
tb' i.ist a Y/C:llnd IyTc that bast d--icribcs wotlond to be impacted (e g, fr-,shwa:e:lstlhcatcr marsh, forrst:4 «'ctland, b?t?C.r pond,
Cuelinn I3ay, bog, cta) :ndi cite if win', and is isolated (dcamtination of isokaim to be made by USACE only).
List the total acreage (estimated) of till exlsting walands on the property:
'T'otal area of wetland impact proposed: --
3. Lidividually list all intermittent and perannial streun impacts below:
strc= Tmpact
Sitz Number
indicate en ma
Typo of linpact" Length of
Impact
linear feet
Smam Name" I Ave.age Width
f o`5tr=
before Im act P4rcDmiai or
Tntcrrtittcut?
Icase s ee'
e t

{

LINE Caen nrip:t;1 npraateiy anc icenury temporary IntpBetS, lmpac; S inclUde, but arc nut limited to: culverts :end zwocIgIN rip-rap,
dams (scpurilcly list impacts due to bcth stracturc and flooding), relocaian (include linear feet bcforc and after, and nct IossJgaln).
stthilirtion activities (ccmenL wall, rip-rzp, crib wall, ;,.biom, ctc.), c-==anon, dttching/straigb1ming, etc. tf strn.am relocation is
proposed. pl: ru and p-ohl:s sb.owing ih_- linear footprint for bosh th-. original and relacatcd strcwms must be ineiudct.
StraLn nams can ba Icund on USGS topogtophic maps. If a Sttrorn ha•¢ ro nw=, list rs UT (unnnmcd tributziy) to the n=est
downstnum named virzam into which it flows. USGS mops are available Uuougb tite USGS at 1 30t) 3511-9GiG,. or oalitie at
w.y? ys +• several internet sites also ollow direct download and printing of USGS maps (e g., m ? .tcLrummnr m_.
my+v,m7pgucrtc0m, ctc.).
Cumulative impacts (linear distance in feet) to all streams on site:
Fa c3cf12
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlal11"t0
Ocean and any other Nutter of the U.S.) below:

Area of
Water impact '
Open
Site Number Type of llnpacr • Impact
Indicate ?n mu (acres

Namc of R'atcrbody
ilcable

(?4AP )
ofll?ateibndg
T}T'
nice =d, Mary, sound,
p=d
? - '
bay, ace2r, etc.)
Cep ? •4?/?/+'nr.Ylo?>?'•? ?%«".?' ,r?,?= ?? ^' ,'`r _?? =.,
.F

...w.. L... r .. r.4 I: c nanrl fn• fill. CYL'1Vdlla`3. df:.Cj.°,II1P
List cscl impact 9cpalately at'.C IOea i'rv rCMPVr4ry ;Mpacu. SII:p::Gl: U1%Jauc, DU W. uu. .«•u
f ood6rlc, draiange, bolkhenis, etc.
5. Pond Creation
If construction of a potu is proposed, associated wetland and stream impacts should 'be
included above in .Ile wetland and stream impact sections. Also, the proposed pond should
ba described here and illustrated on any mans included with this application.
Pond to be created iii (check all that apply): ? uplands D stream ? wetlands
Dcscriba the ;neulod of constructioii (e.g., damlemban1cmeni, excavation, installation of
draNa'-down valve or spillway, etc.): - - -
/611
Proposed use or purpose of pond (e.g., Lives ck'watering, irrigation, aesthetic, trout pond,
local stormwater rcouircment, etc.):
Size o-f watersbed draining to pond: Expected pond surface area:
jrII. Impact Justifhmtion (Avoidwicc nd Minim atiou)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information rata-fed to site c:onstr nts such as topography, building ordtnarces, accessibility,. and
financial Viability of the project. The applicant may attach drawings of alternative, lover-impact
site layouts, and explai7 why these design options were not feasible. Also discuss how impacts
NY= minimized once the desired site plan was doweloped. If applicable, discuss construction
techniques to b:, followed during construction to redpce impacts.
VIff. Mifigntion
DWQ - Ir accordance tivith 15A NCAC 2H .0500, mitigation may be inquired by the NC
Division. of Water Quality for projects involving greater that or equal to One acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
strCarns.
Pago 9 of 12
SEP-26-2065 09:39 FROM:01.40-NEi1ANDS 9197335893 70:919104391384 P:11-113
U,,'-.ACE - In accordance with the Final Notice of Issumce and Modification of Nationwide
Permits, published in tho Feder^..1 Register on March 9,'21000, mitigation will be required Wk-en
accessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of tea impacted
aquatic resource will be considered in detcmdming acceptability of appropriate and practicable
mitigation as proposed. E,cantples of mitigation that may be appropriate and practicable include,
but are not limited to, reducing the si7z of the project; establishing and maintaining, wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
:unctions and values, prey"erab!c is the same wetershcd.
If mitigation is required for this project, a copy of tine widnati.on plan must be attacbcd in order
for 1`'SACE or DWQ to consider the application complete for proeessuig. Any application
laekin- a required mit-.gation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration.
in DWQ's Daft Technical Guide for Stream Work in North Carolina, available at
littTxWh2o enr s1 ate nc.us/ncwetlands/s'urm idg e.html.
1. Providc a brief description of the proposed mitigation plan. The description should provide
as much information as possible, includutg, but not limited to: site location (attach directions
and/or -tap, if offsite), a5acted stream and titer basin, type and amount (acrca,e/li'.necr fact)
of mitigation proposed (restoration, crinancefracnt, creation, or preservation), a plan view,
preservation mechamusm (e.g., deed restrictions, conservation casement, etc.), and a
description of the current site conditions and proposed method of construction. Please att?zh
a separate sheet if more space is needed.
t
2. Mitigation may also be made by payment into the North Carolina Wetl ands Restoration
Program (NCWRP). Please note it is the applicrnt's responsibility to contact the NC`rv'RI' at
[phone] to determine availability and to request written approval of mitigation prior
to submittal of a PCIV. For additional information regarding the application process for the
or
NCWY, check the NGWRP wcbsite at http;//h2o.cnz.state.nc.us/wxp/index.htm. If use
the NCWRP is proposed, please check the appropriate box on page thrce and provide the
fo.llowine information: WA
Amount of'stream mitigation requested (linear feet : _
Amount of buf;ermitigation requested (square feet): it
.A.mount of Riparian wetland mitigation requested (acres):
Amount of Nor:-riparian wetland mitigation requested (acres):
Amount of. Coastal wetland mitigation requested (acres):
Pane 10 of 12
SEP-26-2005 09:40 FROM:CWQ-WETLANDS 9197336993
III.
T?•
,ek.
,nvirournental Dodti>utentation (rCC;tr?rcd ley I9 R1Q)
T0:919104391394 P:12/13
Does the project involve an expenditure of public (federal/state) funds or the use of public
(fedcrallstate) land?
Yes 0 No
If yes, does the project require preparation of an environm.ntal document purSutant to the
requirements of the National or North Carolina Enviro=nmental Policy Act (NFPA/SEPA)?
Note: if you are not $urc whether a NEPAISEPA document is required, call the SEPA
coordinator at [phone] to review cturcuttlur-sholds for environmcntal documentation.
Ycs ? No ?
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NiEPA or SEPA final approval letter.
Yes ? No ?
Proposed Impacts on Mparinu axtd Watcr.-311ed Euaf rv (required by DVIQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The appiicaut must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identir'lable ou tl:v accomp raying site plan. All buffers must be shown on a
trap, tyhctbur or not impacts = proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicants discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neusc), 15A NCAC 2B .0259 (Tar-Palriico), 15A NCAC 2B .0250 (Rand!oman Rules -,Md
Wiper Supply Buffer Requirements), or other (please identify )?
Yes ? No ? if you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buff-or
mit;gat.ion is required calculate the required amount of mitigation by applying the buffer
multipliers.
zone" (s rr.paceet Multiplicr I Mitt anon
I 3
2 1.5
Totiv1
7_ono 1 cxt.hds out 30 fc:t pcrp-.ndieulzr from near banl: of channel; Zone 2 extends an
additional 20 fact from the edge of Zono t.
Page 1 t of 12
SEP-26-2005 09:41 FROM:0WQ-1,ETL:NM 9197336893 T0:919104391364 P:13-1 13
if buffer mitigation is required, please discuss what type of mitigation is proposed (Le., Donation
of Property, Conservation Easement, Riparian Buffer Restorratioa / Erdianc mT ua o m lion as
Payment into the Riparian. Buffer Rc3tOrati0tl Fund). Please attach J1 appropriate
idcntined within 15A NCAC 2B .0242 .0260.
/,a

,i A. storm-, ater (mgti:ed by DWQ)
Describe unpcrvious acreaue (Until existizag and proposed) versus total t:crcagc on the site.
Discuss storrnwater controls proposed in order- to protect surface. waters and wetIvAds
do,vmstream from the property.
v-1T. Sc=t•nga Disposal (required by DVIQ)
ClerrIy detail the ultimate treattucat methods Vmd disposition (non-discharge or discharge) of
wasteNvater generated from th.e proposed project, or available capacity of the subject facility.
XTH. Violations (required by DWQ)
Ts this site .in violation of DWQ Wetland Rules (15 A I\TCAC 2H .0500) or asy Buffer Rules?
Yes ? No
Ts this an after-the-fact permit application?
Yes ? No
UV. Omer Circu=tanees (Optional):
It is the applicant's responsibility to submit the application sufficiQia0y in zdvanee of desired
construction dates to allow processing time for thcs:. permits. However, an applicant rrp y
choose to list constraints associated with construction or sequencing that may impose linuts on
work schedules (e.g., draw-down schedules for lalces, dates associated vrith Endangered Wd
Threatened Species, accessibility problems, or other issues outside oft_he applicant's control).
104 DOGWOOD LANE
MT. GILEAD NC 27306
PHONE [phone]
Applicunt/AgenVs Sign, pare - Date
(Agent's signature is valid only if an authorization letter frorn the applimnt is provided)
Page 12 of 12
1 of 1 Brown's Construction 1-24-06
104 Dogwood Lane
Mt Gilead N.C. 27306
910-439-1384
To whom it may concern
I Jerry Hyland give Butch B. Brown of Brown's Construction my permission to act as my
agent in securing the permits and permissions required, and the construction of the sea
wall and the boathouse. The sea wall and boathouse is to be constructed at my dwelling
at 426 Deerfield Road Mt Gilead N.C.
Verry Date Hyl nd
Brown's Construction
104 Dogwood Lane
Mt. Gilead N.C. 27306
910-439-1384
Pre-Construction Request.
Owner Name
Jerry Hyland
2240 Dandridge Drive
York, P.A. 17403-4518
H- 717-741-1161
C- 717-309-2615
Location of construction
Tilllery Park Development
426 Deerfield Road
Mt Gilead N.C. 27306
2-06-06
Propose construction.
The construction that is proposed at this location is to sea wall approximately 70
ft long and 4 ft high. The sea wall is to be constructed of treated lumber and is to
be backfilled with 2-inch stone and riff raff on the lakeside of the sea wall.
The boathouse is to be constructed of treated lumber, as per plan 1 and plan 3
Attached.
All construction is to meet N.C. building codes, Progress Energy and U.S. Army
Corps of Engineers specifications.
Butch Brown
Brown's Construction
104 Dogwood Lane
Mt Gilead N.C. 273206
910-439-1384
- 'BUTCH BROWN CONSTRUCTION
104 DOGWOOD LANE
MT. GILEAD NC 27306
PHONE [phone]

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1 --_ _
luil?((
MAR 9 2006
DENR - OVATE R QUALITYl ,
oGEcc U;sc only:
• USACE Action ID No.
(If any partia
is not applicable to

Fann Version Moy 2002• .
N o• 0 Lo -- C) to
enter iJot Appiicabl?' or' t'1'!e??".)
1. Check all of the approval (s) requested for this proiect:
? Section 404 Permit M Riparian or Watershed Buffer Rules
? Section .10 Permit Isolated Wetland Permit from DWQ
? 401 Watcr Quality Certification
2. Nationwide, Regional or General Pemit Number(s) Requested: . ---
3. If this notification is solely a courtesy copy because written approval for the 401 Ccrtilicadon
is not requircd, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (verify availability with NUIRP prior to submittal of PCN), complete
section V HI and check here: ?
5. If your proiect is lotxited in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina DiNision of Coastal Management Area of
Environmental Co-Rcern (see the top ofpage 2 for further details), check here:
11, Applicant informnflon
1. owier/Applicant Information
Nance:
Mailipg Address:
Telephone Number: 7/_7- 7 .71- Fax Number:
E-mail Address:
2. AgentlConsultant Information (A signed and dated copy of the Agent Autborimtion letter
must be attached if the Agent bas signatory authority for the owizeriapplicant.)
Name: X3u /Gh ' &"t111
Company Affiliation:
Mailing Address:
-rnn^
Telephone NTumbar:
E-mail Address: k
Fax Number: 7/C,' - Y
;!!,„a'- n.(7, n';I
Page 5 of 12 0
SE?-26-2005 09:37 FR0l9:1)WQ-WETLRNDS 9197336333 T0:919104391384 P: 7-113
M. ?roject linforn'Q ion
Amch a vicinity m.ap clearly shoRfing the location of the property with respect to locul
landmarks such as towns, rivers, and roads. Also provide a detailed sit z plin showinv property
bow darics and development plans in relation to surrounding properties. Botlt the vicinity map
and site plan must include a scalc and north arrow. The spccifrc footprints of all buildings,
impervious surfaces, or.other facilities must be included. If possible, the maps and plans sbould
include the appropriate USGS Topographic' Quad Map and NRCS Soil Survey with the propertY
boundaries outlined. Platt drawings, or other maps may be included at the applicant's discretion,
so tong as the property is clearly defined. For admirristrative?and distributioi? u ores, ho
USACE requires information to be submi.red on shc..t., no lar,,er than 1.1 by format;
however, DWQ racy accept paperwork of any size. DNVQ prefers full-size construction
drawings rather than a sequential sheet version of the gull-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will b: informed that
the project has been placed on hold until deeipherabla maps = provided.
I . Namc of project: I
2. T.I.P. Project Number or State: Project Number (NCDOT Only): 6
3. ?roperty Identification Number (Tax PL l):, AW --
4. i ouation
CGt'.,rj: f/)7pl i.." %'r :•( Nearest Town: ?.? .4f?f.`
Subdivision naraV?(include l hase/lotnumber'): VV2/ 1, y
Directions to site (include road numbers, landmarks etc.) ? -6 lit 01't-_
5. Site coordinates, if available (UTM or Lat/Long):
ltgote - If prpiect is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct watcrbody.)
6. Property size (acres): ter ',) A(.; /
7. Nearest body of water (stream/river/soundlocenn/lakc):?f ?'rl???'1<' e?
i •?
S. River Basin:
(Note. - this must be one of North. Carolina's seventeen designated major rivet basins. The
River Basin ntap is available at httn:/(h7o.enr.statc.ne.us/cdmin/maps/.)
°. Describe the existing conditions on the site and general land use is the vicinity of the project
at the tim.e of this application: f' -- ° ."
Pcgo 6 of 12
SEP-26-2005 09:37 FROi"MO-WETLANDS 9197336993
10. Describe the overall project in detail, izncludiuj the t
70:919104391384 P=8-1 13
of cauipmcut to I= used:

11. Explain the purpose of the proposed work:
!17. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
praicct (including alt prior phases of the same subdivision) ba the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
cm-tifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Desctibe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable).* If this is aNTCDOT project,
list and describe permits issued for prior segments of the same T.Z.P. project, Jon, with
construction schedules.
V. Future Project Plans
Arc any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work- from the current application.
V1. Proposcd iinpaeta to Wnters of the United States[Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts-to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and wa_ers, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs inay :be
included at the applicant's discretion. If this proposed impact is stzictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
lasting or description, please attach a separate sheet.
Pap 7 of 12
SED-26-2005 09:33 FROM:OWQ-14ETLANDS 919733689.3 70:919104391384 P:9/13
1. PrOVide a Nvritten dcscxiption of the proposed impacts:
2. Individually list victiand impacts below:
%Vatlanci lmpazt
Site Number
indicate on ma
Type of Iznpact2 Area of
Impact
acres) Located }rithin Distance to
100-year Fioodplains Nearest Stream
cs/no linear reet
Typc of ZrJctland¢ u
r
i

u'-cl clc,:rin grading. fill,
mec t? !~
l,ltt each impact separately and idcn:ify tempora.-y impacts. impacts tndude, bur arc not ltm;tcd o, ,.r
oxcavAun, ncoding, ditchir.FJdrainagc, cw. For darns, separately list imposts due to butts strucntrc cnd rlocdin,.
qa ioo-Year noodplains = identified through the Federal E1;urSenr.,y I?Sancgcment .4g ry's (? } Flood Insurnnc? Rate iilp5
(Y1;L'vi), or FE?7A•ap,-roticd '.nca :loodpl;tin maps. Nfaps ara availab)c through the FE-,%k Map Service Canter at 1400.353.4616, or
online at 1;11r:!lonvw.r??taat u?:.
"?• List a w;,O;md t)Tc that b.st describes NvctlHttd to be impacted (e.&, fr-.shwac.IsaltxWer marsh, forrst d Avctland, brmvet pond,
C.-juHnn I1ay, bog ctc.) indicate if ctland is isolxcd (d ?rsinrtion of isointion to be made by USACE only).
List the total acreage (estimated) of all existing wotlands on the property:
Total area of wetland impact proposed.
3. hidividually list all intermittent and percnaial stream impacts below:
Strr-= Impact
Sit: Number
indicata cn ma
Type of impact1 Lcnoth of
Impact
li+tear feet
smaro Nlamc" i AveraSe Width
i o`5trc m
Before Em pact Ft;rcnniai or ?
intermlacnt?

cc
sPccifY)
t

i

List each impact seprsately and identify Temporary impacts. Impacts ineiudw but arc nut limited to: culverts and ra;cckU4 rip•,ap,
dams (scp: ratcly list impact,: dua to both stricture and flooding), relocation (include linear feet before and after, and net IOSSIGWn).
smbili=tion actlvlUcs (cemcnl wall, rip-rzp, crib %yall, b Mans, etc.), excavation, dltehlnQ/straigbtcnin9, etc. irnn;am relocation is
proposed, plwls and profil:s showing tha linear feotprint for bosh the original and relnea:cd streams must be inch:dcd.
Strc;Ln names can be Ntind on USGS topogtephic :raps. If U Sitcom ha$ ro n;an;, list rs UT (unnnined tributray) to the nearest
downs,r:am munad ,q=,n into which it flows. USGS mops are available tluough the USGS at 1-8ON353-9616, or online to
w?v?ys . mt. Several internet sites also allow direct download and printing of USGS maps (e.g, . qc m?
-vlv.marjuc.:t.ccm, ctc.).
C=ulative impacts (linear distance in feet) to all streams on site:
FHgc 8 car 12
4. Individually list all open water impacts (including lalccs, ponds: estuaries, Sounds, Atlatlt'sc
Ocean and any other vmtcr of the U.S.) below:

open
Site Warr tNumbempact I Type of T,npact
?r..dicate an mu

lriprea
(ace; s 'I tT?_ or ?ViA;1VLJU;

Name of Waterbody (sake, pond, estuary, sound,

(if:.pplicable)
bo ?, ocean, etc.)

? i
?'
' cd • fiU etea??tfoa, dyed^int:
List cacao impact separately and identify tctnpurpry Impacts. lmpacts include, but are not .tmlt to. , o
f ood'.ac, drainage, butkhea3.;, etc.
Pond Creation
if construction of a pond is proposed, associated wetland and stream impacts should •Iue
included above in he wetland and stream impact sections. r%ho, the proposed pond should
ba described }sere and illustrated on any maps included ivith this application.
Pond to be created ui (check at.I that apply): ? uplands ? stream ? wetlands
Dcscri:oe the method of constructioii (e.g., damlembanianent, excavation, ins-LWIation of
drarw-do,xm tiah e or spillway, etc.): -
Proposed use or purpose of pond (e.g., Hvest&k'watering, irrigation, aesthetic, trout pond,
local storm water requirement, etc.):
Sizc ofwatersbed draining to pond: Expected pond surface area:
191. Impact Justification (Avoidance, nrid Minimization)
Specifically describe measures taken to avoid the proposed impacts. It ntay be useful to provide
information rat ated to site constraints such as topography, building ordinances, accessibilit??, and
financial viability of the project. The applicant may attach drawings of alternative, loaner-impact
site layouts, and explain why these design options N ert: not feasible. Also discuss how impacts
ivere. minimized once the desired site plane was developed. If applicable, discuss construction
techniques to b;. followed during construction to reduce _impacts.
VIM Mitigation
DWQ - In accordance with 15A NCAC ZH .0500, mitigation may be required by the NC
Division. of Water Quality for projects involving greater than or equal to one acre of impacts to
freshw-atcr wetlands or greater than or equal to 150 Iincy r feet of total impacts to pcrennial
strzsms.
Pago 9 of 12
SEP-26-2eZ5 09:39 FROMiDWO-14Ei DS 9197336893 TO:9191043913e4 P:11?13
US ACE - In accordance with the Final I110tice of Issuance and Ilrlodification of Nationwide
Permits, published in tho Federal Register on March 4, 2000, mitigation Will be required when
iieccssary to ensure that adverse of rccts to the aquatic environmcut are minimal. Factors
including 5izc and type of proposed impact and function and relative valua of the imparted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriatc and practicable include,
but are not limited to, reducing the si= of tltt: project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by crcafw- restoring, enhancing, or preserving siuailar
:unctions and values, preierab!e hi the same watershed.
If mitigation is required for this project, a copy of Lne znitigati_on plan must be attach d in order
for uSACE or DWQ to consider the application complete for processing. Any application
lacking, a required mirgation plan or NCVeRP eoacurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DW Q's Draft Technical Guide for Stream Work in North Carolina, available at
l?ttn:r%h?o pnr.state.nc.us/ncwetlandsls=p,ide.ht:ml.
1. Provide a brief description of the proposed mitigation plan. Tile description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), afieeted stream and rimer basin, type and amount (am-ca edline r ftnct)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plate view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.); and a
description of the current site conditions and proposed method of construction. Please attzxh
a separate sheet if more space is needed, p
2. Mitigation may also be made by payment into the North Carolina 'Wetlands Restoration
Program (NCNrRP). Pleasc note it is the applicant's responsibility to contact the NCWRI? at
(919) 7733-5208 to determine availability and to request written approval of mitigation prior
to submittal of a PCN. For additional information regarding the application process for the
NCNVRP, check the 1vCWRP website at http:!/h2o.enr.state.nc.u??wxp/index.htm. If use of
the NCWRP is proposed, please check the appropriate box on page three and provide the
following information:
Amount of stream mitigation requested (linear feet
Amount o£bui ermitigation requested. (square feet): i+
.Amount of Riparian wetland mitigation requested (acres):
Amount of Nor.-riparian wetland mitigation requested (acres):
Amount of. Coastal w.-tland mitigation requested (acres):
Paac 10 of 12
SEP-26-2035 09:40 FROM:CWQ-WETLANDS 9197336993 TO:9191(34391394 P:12/13
lea. CJrivirournental Documentation, (required by DN-VQ)
Doe • the project involve an expenditure of public (federal/state) funds or the use of public
(fadcrallstate) land?
Yes ? No 1
If yes, does the project require preparation of an environmerItal document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: if you are not sure whether a NEPA/SEPA document is required, call the SEM
coordinator at [phone] to review mu enttlu=holds for environmental documentation.
YCs D No ?
If yes, has the document review been finalized by the State Clearinghouse? If so, plcase attach a
copy of theNEPA or SEPA final approval letter.
Yes ? INa ?
nroposed Impacts on Rlparina attd Watcr.-shed aff:rv (required by VIQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffirs associated with the project. The applicant must also provide
justification for these impacts in Section V11 above. All proposed impacts must be listed herein,
and rntlst be clearly identinable ou tLv accompanying site plan. All buffers must be shown on a
map, %vhcth:r or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Once may be included as appropriate. Photograpbs may also b:. included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neusc), 13A NCAC 2B .0259 (Tax-Pamlico), 15A NCAC 2B .0230 (Rand-lernan Rules gtd
LVater Supply buffer Requirerner.ts), or other (please identify.,,. )?
Ycs ? No ? if you answer "yes". provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
7_onc" (square Trr.pect feet AZultiplicr 'M'tir Rcquimd
I 3
2 1.5
Total
Zone t cxtcnds out 30 fc:t pcrpvtdiculcr from near bznlt of cht nn0; Zonc 2 extends an
additional 20 feet from tho edge of Zono 1.
Page 11 of 12
'CEP-26-E@05 09:41 FROM:0WQ-1kE7LFNDS 9197336893 T0:919104391364 P:13'13
If buffer mitigation is required, pl=e discuss what type of nlitigati;on is proposed (i.e., Donation
of property, Conservation Easement, Riparian Buffer Resto?atiota / Enhanc omnte infior aorz
Payment into the Riparian Buffer Restoration Fund). Please attach all apps P
idcntitled within ISA NCAC 2B .0242 or..02 0. -

Via, 3toi mwarcr (requited bY I2DVVQ)
Describe bnpervious acreage (both existing and proposed) versus total acreage on the site.
Discuss storm,,N?ater controls proposed in order. to protect surfNec watcra and vrctlestds
dwNmstream ft m the property.
IiT,,. Sc-wnge Dispasnl (required by DV;IQ)
Clearly detail the ultimate treatluent methods Find disposition (non-discharge or discharge) of
wastewater generated Croon the proposed projectfo? avo6ble capacity of the subject facility.

XTU. Violations (required by 3DWQ)
Ts this site in violation of DWQ Wetland Rules (15A 1?TCAC 2H .0500) or any Buffer Rules?
Yes ? No
is this an after-the-fact permit application?
Yes ? No X
.KIV. Other Circurnst;- ncea (Optional):
It is the applicant's responsibility to submit the application sufficiently in zdvance of desired
construction dates to allow processing time for these permits. Blow-wer, an applicant igay
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of'the applica&s control).
104 DOGWOOD LANE
_ MT. GILEAD NC 27306
PHONE [phone]
? r ®?
ApplicanttAgent's 5ignmture jDate
(Agent's signature is valid only if an authoriaciioa letter front the cpplicmt is provided.)
Pagc 12 of 12
1 of 1 Brown's Construction 1-24-06
104 Dogwood Lane
Mt Gilead N.C. 27306
910-439-1384
To whom it may concern
I Jerry Hyland give Butch B. Brown of Brown's Construction my permission to act as my
agent in securing the permits and permissions required, and the construction of the sea
wall and the boathouse. The sea wall and boathouse is to be constructed at my dwelling
at 426 Deerfield Road Mt Gilead N.C.
? Date
Verry ay d
Hyl nd
Brown's Construction
104 Dogwood Lane
Mt. Gilead N.C. 27306
910-439-1384
Pre-Construction Request.
Owner Name
Jerry Hyland
2240 Dandridge Drive
York, P.A. 17403-4518
H- 717-741-1161
C- 717-309-2615
Location of construction
Tilllery Park Development
426 Deerfield Road
Mt Gilead N.C. 27306
2-06-06
Propose construction.
The construction that is proposed at this location is to sea wall approximately 70
ft long and 4 ft high. The sea wall is to be constructed of treated lumber and is to
be backfilled with 2-inch stone and riff raff on the lakeside of the sea wall.
The boathouse is to be constructed of treated lumber, as per plan 1 and plan 3
Attached.
All construction is to meet N.C. building codes, Progress Energy and U.S. Army
Corps of Engineers specifications.
Butch Brown
Brown's Construction
104 Dogwood Lane
Mt Gilead N.C. 273206
910-439-1384
'BUTCH BROWN CONSTRUCTION
104 DOGWOOD LANE
MT. GILEAD NC 27306
PHONE [phone]
3?169d 2 20 2 <? 4 8 icI3G1 nc
?t 'd'SCL 'a•a'd?.,`d tstzc:c

r{ ? ` ?? ?+• ^ ?"`- r 'ISBN G911 .?f
4 ~?? ~ •6lLU?'? W 9 tl'?r g 4
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flog,
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WAIF Michael F. Easley, Governor
Q 9
Q? William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
\
wa: Alan W. Klimek, P.E., Du
--q ty
Division of Water Qualiali
0 .? Coleen H. Sullins, Deputy Director
Division of Water Quality
February 10, 2006
Montgomery County
DWQ # 06-0216
CERTIFIED MAIL
Jerry Hyland
2240 Danridge Drive
York, PA 174034518
Subject: Hyland Property at Lake Tillery
Application and Fee Payment
Dear Mr. Hyland:
On February 10, 2006 the Wetlands/401 Unit of the Division of Water Quality received your paperwork
pertaining to the property at Lake Tillery. Your project has been place on hold for the following reasons:
1. Please submit four (4) more complete application copies
2. Include the appropriate fee
3. Indicate the type of approval requested as well as the Nationwide, Regional or General Permit number
sought
Please note that beginning January 1, 1999, the N.C. General Assembly passed legislation requiring payment of a
fee for all 401 applications. The fee for applications is $200 for projects impacting less than an acre of wetland
and less than 150 linear feet of streams. For projects impacting one or more acres of wetland or 150 or more feet
of streams, the fee is $475. In order for DWQ to begin review and process your request, you must send the
application sets and a check in the appropriate amount made payable to the N.C. Division of Water Quality.
If you have any questions regarding this letter please do not hesitate to call Ian McMillan or me at (919)
733-1786.
p incerely,
< /Cyndi Karoly
Wetlands/401 Unit
CBK/ jd
cc: Butch Brown Construction, 104 Dogwood Lane, Mt Gilead NC 27306
File copy
Central Files
060216 JHyland (Montgomery)_GP30_copies_fee _
7
N. C. Division of Water Quality, 401 Wetlands Certification Unit, PdCUEt;it
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
[phone] (phone), 919-733-6893 (fax), (http://h2o.enr. state.nc.us/newetlands)
Customer Service N: 1-877-623-6748

1 of 1
Brown's Construction
104 Dogwood Lane
Mt Gilead N.C. 27306
910-439-1384
2-17-06
MAR 9 2006
Division of Water Quality
1650 Crabtree Blvd. i DENR VdATER ???AUTY
ERB
r'?'ETtAt1DSF?rDSTa,.dr;?T;l{`??CN
Raleigh N.C. 27604-2260
Subject; Hyland Property at Lake Tillery. 0 LP (-0
Dear Ms. Karoly
Enclosed you will find the additional copies of the applications that you requested. I will
try in the to do better on my applications. In addition, I am enclosing the $200.00 fee for
this application.
I am very sorry that the application was not correct the first time, and I will do better.
If you have any question or if I can be of any further assistance please call me.
Thank You.
Butch Brown.
i
UNITED STATES POSTAL SERVICE

• Sender: Please print your name, address, and ZIP+4 in this box •
NC DENR Division of Water Quality
401 Oversight/Express Unit
2321 Crabtree Boulevard, Suite 250
Raleigh, NC 27604
First-Class Mail
Postage & Fees Paid
USPS
Permit No. G-10
cot,
17 Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
v Print your name and address on the reverse
so that we can return the card to you.
13 Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
Jerry Hyland
2240 Danridge Drive
York,PA 17403-4518
DWQ9 06-0216-Montgomery
A. Si nature
X ', V ?a' U ` 13 Agent
? Addressee
Re eivedby(Pnnf " N e C. Date
?. t( )(?(c2 (a a?) G
D. Is delivery address diffe nt from item 17 0
If YES, enter delivery address below: ? No
3. Se o Typo
Certified Mail ? Express Mail
? Registered ?ff Return Receipt for Merchandise
? Insured Mail ? C.O.D.
14. Restricted Delivery? (Extra Fee) ? Yes
2. Article Number 7005 1160 0000 9954 9208
(rransfer from servlco laboo
PS Form 3811, February 2004 Domestic Return Receipt