20060318 Ver 1_COMPLETE FILE_20060227

of war F
O? 9QC Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
bwa,)
Alan W. Klimek, P.E. Director
Division of Water Quality
April 18, 2006
DWQ Project # 06-0318
Macon County
Brian Sanders
194 Crestview Drive
Otto, NC 28763
Subject Property: Brian Sanders Property
Macon County
Approval of 401 Water Quality Certification with Additional
Conditions
Dear Mr. Sanders:
You have our approval, in accordance with the attached conditions and those listed below, to
place fill within or otherwise impact 20 linear feet of streams for the purpose of property
development at the subject property, as described within your application received by the N.C.
Division of Water Quality (DWQ) on February 27, 2006 and subsequent additional information.
After reviewing your application, we have decided that the impacts are covered by General
Water Quality Certification Number(s) 3402 (GC3402). The Certification(s) allows you to use
Nationwide Permit(s) 39 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, stormwater, and buffer 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 culverting / damming activities 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 2H .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:
401 Wetlands Certification Unit
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] /FAX [phone] / Internet www.ncwateraualitv.orn
N?oi?`l,Carolina
dvaturallU
An Equal Opportunity/Affirmative Action Employer- 50% Recycled/10% Post Consumer Paper
Brian Sanders Property
Page 2 of 8
April 18, 2006
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:
Amount Approved Plan Location or Reference
(Units)
UT to North Fork Little 20 (feet) Dam for Impoundment
Tennessee
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.
Brian Sanders Property
Page 3 of 8
April 18, 2006
5. 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/Wetlands Unit, North Carolina
Division of Water Quality, 1650 Mail Service Center, Raleigh, NC, 27699-1650.
6. Stream Stabilization (Final Plan Needed)
Before any of the impacts authorized in this Certification are to be completed, you must
provide and receive written approval from this Office for a final stream restoration plan
for the stream segments above and below the impoundment. The plan must include
designs and specifications that meet the definition of stream restoration (or enhancement
if no relocation is proposed) according to the latest version of the Internal Technical
Guide for Stream Work in North Carolina (available at
http://h2o.ehnr.state.nc.us/ncwctlands/stnngide.html). The stream and buffer relocation
must be constructed, maintained, and monitored according to the plans approved by this
Office. Any repairs or adjustments to the site must be made according to the approved
plans or must receive written approval from this Office to make the repairs or
adjustments. All streams on the subject property must be preserved in perpetuity by use
of a conservation easement or other similar mechanism as part of the approved plans.
A. Deed Restrictions - Deed restrictions or similar mechanisms shall be placed on
the lot to assure compliance with the conditions of this variance approval. These
mechanisms shall be put in place prior to impacting any waters or buffers. The
Deed Restrictions shall include the following paragraph.
"The areas shown on the recorded plat as Riparian Buffer Protection Areas shall
be maintained in perpetuity in their natural or mitigated condition. No person or
entity shall fill, grade, excavate, or perform any other land disturbing activities;
nor cut, remove, or harm any vegetation; nor construct any structures or add any
additional impervious surfaces, on such protected areas without written
authorization from the Division of Water Quality (DWQ). This covenant is
intended to ensure continued compliance with authorizations issued by the State
of North Carolina, Division of Water Quality, DWQ Project Number 03-1030,
and therefore may be enforced by the State of North Carolina. This restriction is
to run with the land, and shall be binding on the Owner, and all parties claiming
under it."
B. Riparian Buffer Protection Areas - The "Riparian Buffer Protection Areas" shall
include all retained riparian buffers as proposed within you application. (25 linear
feet from top of bank on both sides of all jurisdictional streams).
Brian Sanders Property
Page 4 of 8
April 18, 2006
7. Diffuse Flow
All constructed stormwater conveyance outlets shall be directed and maintained as
diffuse flow at non-erosive velocities through the protected stream buffers such that it
will not re-concentrate before discharging into a stream. If this is not possible, it may be
necessary to provide stormwater facilities that are considered to remove nitrogen. This
may require additional approval from this Office.
8. Protective Fencing
The outside buffer, wetland or water boundary and along the construction corridor within
these boundaries approved under this authorization shall be clearly marked with orange
warning fencing (or similar high visibility material) for the areas that have been approved
to infringe within the buffer, wetland or water prior to any land disturbing activities.
9. Turbidity Standard
The turbidity standard of 10 NTUs (Nephelometric Turbidity Units) shall not be
exceeded as described in 15 A NCAC 213. .0200. Appropriate sediment and erosion
control practices must be used to meet this standard. Continuous monitoring by onsite,
calibrated, continuous recording, equipment must be performed both upstream and
downstream of any instream work. The results of this monitoring must be submitted
along with the below required stability monitoring. Additionally, should the results
indicate a violation of the turbidity standard, all work shall cease until such a point the
measures are implemented to protect surface waters form further violations.
10. No Sediment and Erosion Control Measures in Wetlands
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 or locally delegated
program has released the project.
11. Construction Stormwater Permit NCGO10000
Upon the approval of an Erosion and Sedimentation Control Plan issued by the Division
of Land Resources (DLR) or a DLR delegated local erosion and sedimentation control
program, an NPDES General stormwater permit (NCGO10000) administered by DWQ is
automatically issued to the project. This General Permit allows stormwater to be
discharged during land disturbing construction activities as stipulated by conditions in the
permit. If your project is covered by this permit [applicable to construction projects that
disturb one (1) or more acres], full compliance with permit conditions including the
sedimentation control plan, self-monitoring, record keeping and reporting requirements
are required. A copy of this permit and monitoring report forms may be found at
htt12: //h2o. enr. state. nc. us/su/Forms_Docuinents. htm.
Brian Sanders Property
Page 5 of 8
April 18, 2006
12. Deed Restrictions
Deed restrictions or similar mechanisms shall be placed on all retained jurisdictional
wetlands, waters and protective buffers in order to assure compliance for future wetland,
water and buffer impact. These mechanisms shall be put in place prior to impacting any
wetlands, waters and/or buffers approved for impact under this Certification Approval
and Authorization Certificate.
13. Temporary Fills
All temporary fill and culverts shall be removed and the impacted area returned to the
original grade, including each stream's original cross sectional dimensions, planform
pattern, and longitudinal bed and bed profile after construction is complete or within 6
months of the establishment of the crossing, which ever is sooner, and the various sites
shall be stabilized with natural woody vegetation (except for the maintenance areas of
permanent utility crossings) and restored to prevent erosion. If the crossings are not
completely removed and restored as described above within the specified time above,
additional written approval from this Office must be obtained to modify this condition.
14. Culvert Installation
Culverts required for this project shall be installed in such a manner that the original stream
profiles are not altered. Existing stream dimensions (including the cross section
dimensions, pattern, and longitudinal profile) must be maintained above and below
locations of each culvert. Culverts shall be designed and installed to allow for aquatic life
movement as well as to prevent head cutting of the streams. If any of the existing pipes are
or become perched, the appropriate stream grade shall be re-established or, if the pipes
installed in a perched manner, the pipes shall be removed and re-installed correctly.
Culvert(s) shall not be installed in such a manner that will cause aggradation or erosion of
the stream up or down stream of the culvert(s). Existing stream dimensions (including the
cross section dimensions, pattern and longitudinal profile) shall be maintained above and
below locations of each culvert. Therefore, you must provide plans with adequate details
that indicate that the current stability of the stream will be maintained or enhanced. You
must receive written approval from this Office for the above plans before the culvert(s) is
installed. Culvert(s) must be installed according to approved plans.
The establishment of native, woody vegetation and other soft stream bank stabilization
techniques must be used where practicable instead of rip rap or other bank hardening
methods. If rip-rap is necessary, it shall not be placed in the stream bed, unless
specifically approved by the Division of Water Quality.
Brian Sanders Property
Page 6 of 8
April 18, 2006
15. Riparian Zone Replanting
Replanting of vegetation within disturbed areas located within 25 feet of each streambank
associated with any land disturbing activity, repair, replacement and/or maintenance must be
done in a manner consistant with the Guidelines for Riparian Buffer Restoration
immediately following construction. (Please see attached.)
17. In stream construction and disturbance shall be prohibited within 25 feet of the top of banks
except where permitted impacts will occur.
16. Culverts that are less than 48 inches in diameter should be installed with 20% of the diameter
of the culvert placed below the level of the stream bottom to allow the accumulation of
stream bed materials and to facilitate aquatic life passage during periods of low stream flow.
Larger diameter culverts should be placed 1 foot below the stream bottom. Culverts should
be placed in the main flow channel (i.e. thalweg). Partial burial of culverts in this manner
also may require increasing their size to accommodate flow requirements.
17. If concrete is used during construction (e.g., headwalls), a dry work area must be maintained
to prevent direct contact between curing concrete and stream water. Water that inadvertently
contacts live concrete should not be discharged to surface waters due to the potential for
water chemistry change and a fish kill.
18. Rock, sand, or other materials should not be dredged from the stream channels except in the
immediate vicinity of the crossings. Instream dredging has severe effects on aquatic life and
disturbance of the natural form of the channel can cause downstream erosion problems. The
natural dimension, pattern, and profile of the channels adjacent to the crossings should not be
modified by widening or changing their depths.
19. Sandbags, flexible pipe, or other diversion structures should be used to avoid excavation in
flowing water. Materials used for flow diversions should be removed from the stream bed
after completing the construction work. Any diversion channels must be lined with fabric
and/or rock.
20. Storm water from roads should be directed to vegetated buffer areas (e.g. level spreaders) or
retention basins and not routed directly to streams. Drop inlets on streams must not be
constructed.
21. Any riprap placed for inlet or outlet stabilization should be clean and limited to the stream
bank below the high water mark and vegetation should be used above. Rip rap must not be
placed in stream channels in a manner that obstructs fish passage.
22. All crossings should be constructed as close to perpendicular to the stream channels as
possible to minimize stream and buffer disturbance. Road and utility alignments should be
set-back as far as possible from stream channels to minimize sedimentation and buffer
disturbance.
23. Riparian vegetation, especially trees and shrubs, should be preserved as much as possible.
Native woody vegetation (e.g., rhododendron, dog hobble, silky dogwood, sycamore, river
birch, red maple) should be reestablished upstream and downstream of the stream crossings if
it is removed during construction to provide bank stability and shading. We encourage the
use of native plants that must be removed from permanently disturbed areas.
Brian Sanders Property
Page 7 of 8
April 18, 2006
24. All mechanized equipment operated near surface waters should be inspected and maintained
regularly to prevent contamination of stream waters from fuels, lubricants, hydraulic fluids or
other toxic materials.
25. Discharging hydroseed mixtures and washing out hydroseeders and other equipment in or
adjacent to surface waters is prohibited.
26. The remaining lengths of streams and riparian areas on the tract should be protected in either
their existing or improved state (i.e. with native vegetation reestablished where absent) in
perpetuity from fill, vegetation removal, and other forms of disturbance with deed restrictions
or similar instrument. A riparian buffer width of 25 feet is minimally consistent with the
"trout buffer rule", but wider buffers are recommended to provide more water quality and
habitat functions.
27. All jurisdictional waters on the site shall be inspected weekly for stability (longitudinal
profile, cross sectional dimension, and pattern) and a monthly report submitted to the
Asheville Regional Office within 15 days of the end of each month.
28. Bottomless Culverts must span from high bank to high bank. The digging of footers which
change the flow of the stream, or otherwise impact the natural course on the stream are
prohibited.
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.
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.
Brian Sanders Property
Page 8 of 8
April 18, 2006
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 in the Central Office in
Raleigh at 919-733-9721 or Kevin Barnett in the DWQ Asheville Regional Office at either
Kevin. Barnett(2ncmail.net or at 828-296-4657.
Sincerely,
Alan W. Klimek, P.E., Director
Division of Water Quality
AWK/khb
Enclosures: GC 3402
Certificate of Completion utt
APR 2 4 2006
cc: USACE Asheville Regulatory Field Office DENR - WATER QUALITY
DWQ 401 Central Office lM1'ETIA111 1,11DSTr?R• AMRBRMcH
David McHenry, NC Wildlife Resources Commission
Macon County Building Inspections Office
File Copy
Central Files
Filename: 06-0318.BrianSandersProperty.approval
Triage Check List
Date: 2/28/06
Kevin Barnett, Asheville Regional Office
To:
60-day Processing Time: 2/24/06 to 4/24/06
From: Cyndi Karoly Telephone: [phone]
Project Name: Brian Sanders
DWQ #:06-0318
County: Macon
rr _
The file attached is being forwarded to you for your evaluation.
Please call if you need assistance.
? Stream length impacted
? Stream determination
Wetland determination and distance to blue-line surface waters on USFW topo maps
? Minimization/avoidance issues
? Buffer Rules (Neuse, Tar-Pamlico, Catawba, Randleman)
? Pond fill
Mitigation Ratios
? Ditching
? Are the stream and or wetland mitigation sites available and viable?
? Check drawings for accuracy
Is the application consistent with pre-application meetings?
? Cumulative impact concern
Comments: As per our discussion regarding revision of the triage and delegation processes,
please review the attached file. Note that you are the first reviewer, so this file will need to be
reviewed for administrative as well as technical details. If you elect to place this project on hold,
please ask the applicant to provide your requested information to both the Central Office in
Raleigh as well as the Asheville Regional Office. As we discussed, this is an experimental, interim
procedure as we slowly transition to electronic applications. Please apprise me of any
complications you encounter, whether related to workload, processing times, or lack of a "second
reviewer" as the triage process in Central had previously provided. Also, if you think of ways to
improve this process, especially so that we can plan for the electronic applications, let me know.
Thanks!
FEB 2 7 2006
Office Use Only: DENR-VVil ,c .
1'JETLPNDSAtJDSTGi?Ff?`:Afi??uary 2004
USACE Action ID No. DWQ No. 17 6 0 3 1 8
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
I. Processing
1. Check all of the approval(s) requested for this project:
® Section 404 Permit ? Riparian or Watershed Buffer Rules
? Section 10 Permit ? Isolated Wetland Permit from DWQ
Q/ 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: 14W (L
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 Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts (verify availability with NCEEP 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 Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here: ?
II. Applicant Information
Y 1. Owner/Applicant Information
/w Name:_ .._ r-i - N - S
Mailing Address: r& 2 T?6 3
Telephone Number: 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 owner/applicant.)
Name:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Page 5 of 12

III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers frill-size construction
drawings rather than a sequential sheet version of the full-size plans. If firll-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: l r+??,? ct ?1?' (?'
2. T.I.P. Project Number, NCMA or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): 6 Lf -?- Oki
4. Location
County: o(\ Aco Nearest Town: 0Mb
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.): Lf 1H S ffi"OM F/'7?t k `.-
al j t
f l fill rc? q 6 ?0 C It A D ? 5' 1'1 d? (_ ?` tq ..l st S
i ii f5 c r -st,, 1, c-,5 17r? , o.i PA i w
'o I it A- el
Site coordinates (Lat/Long; D/M/S format):
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Property size (acres):
T , -) 3 .4c /,&S
7. Nearest body of water (streairdriver/sound/ocean/lake): i??yr?l1 I e r ?\ -`5 I r&(W1 t
?. l? i;rrr
8. River Basin: lz ??Nnl`,SS,-?
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.stite.nc.us/admin/maps/.)
X 9. Describe the existing conditions on the site and general land use in the vicinit of the project
at the time of this application: Ho W (- + Marc' S h74k I ; r'c'•t?( w ; k,
Page 6 of 12
10. Describe the overall project in detail, including the type of equipment to be used:
t3 ls'
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Explain the purpose of the roposed work: r JA ,?r 0 (?? a'lit
10 tlii?' Ctddt?vjFr 10 1-0r a61Gi??D,1c??)
A rrt n l' t a A N n? .9 c? _ vI G1 ?l (f
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IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
?C the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued pennits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
-A cr; dr r?T?v1i1' - C Cr ` ? COf(V1
n
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
X and provide justification for the exclusion of this work from the current application.
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VI. Proposed Impacts to Waters 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 waters, 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 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.
X15,
Pagc 7 of 12
1. Provide a written description of the proposed impacts: 1 ?. Gl(
I Individually list wetland impacts below:
N
Wetland Impact
Site Number
(indicate on ma)
Type of Impact* Area of
Impact
(acres) Located within
100-year Floodplain**
(yes/no) Distance to
Nearest Stream
(linear feet)
Type of Wetland***

List Oac uupact acpawiuty and iucnury Temporary impacts. impacts include, but are not limited to: mechanized clearing, grading, 611,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEN1A) Flood Insurance Rate Maps
(FIRM), or FENIA-app roved local tloodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http://www.fema.gov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.) Indicate if wetland is isolated (determination of isolation to be made by USACE only).
List the total acreage (estimated) of all existing wetlands on the property:
Total area of wetland impact proposed:
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact
Site Number
(indicate on map) '
Type of Impact* Length of
Impact
(linear feet)
Stream Name** Average Width
of Stream
Before Impact ! Perennial or
Intermittent?
(please specify)
))
1Gl ? 1 r
IV l w?? I•NOVN/A(i

List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.us,s.eov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
www.mapqucst.corn, etc.).
f., 1
Cumulative impacts (linear distance in feet) to all streams on site: .L (J
Page 8 of 12
4. Individually list all open water impacts (including lakes, pond, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Open Water Impact Area of Type of Waterbod
Site Number Type of Impact* Impact Name of Waterbody Y
(indicate on ma) (if applicable) (lake, pond, estuary, sound,
(acres) bay, ocean, etc.)
* List each impact separately and identity temporary impacts. Impacts include, but are not limited to: till, excavation, dredgir
flooding, drainage, bulkheads, etc.
5. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock w t n '(Tation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
}< information related to site constraints such as topography, building ordinances, accessibility, and
/ financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during const tc ion to reduce im acts.
r t.t< <l I' U F S ?I ?v t c L-1 l? c-r
1 J S' i iJt\C U C j 41 Ll G CA
LI !.\ (,1 YI (? i^1 o l? n„ L3 c17`Lf n,f L 1- T 4-'
i 2
VIII. Mitibation
S r?-q ?1
DWQ - In accordance with 15A NCAC 2H .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
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
Page 9 of 12
. `A
A.
USACE - In accordance with the Final Notice of Issuance and Nlodification of Nationwide
Permits. published in the Federal Register on March 9, 2000, mitigation will be required when
necessary 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 the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size 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
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCEEP concurrence shall be placed on hold as incomplete.
An applicant may also choose to review the current guidelines for stream restoration in DWQ's
Draft Technical Guide for Stream Work in North Carolina, available at
http:/ih2o.ciir.state.ne.us/iicwetiands/sti-mgide.hti-nl.
Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
2. Mitigation may also be made by payment into the North Carolina Ecosystem Enhancement
Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at
[phone] 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
NCEEP, check the NCEEP website at http://www.nceep.net . If use of the NCEEP is
proposed, please check the appropriate box on page three and provide the following
information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres): _
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
Page 10 of 12
IX. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federal/state) funds or the use of public
(federal/state) land?
Yes ? No
If yes, does the project require preparation of an environmental 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 SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No ?
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
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 applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers mast be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 213 .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify 1,4
Yes ? No ? If you answered "yes", )
y provide t e 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.
Zone* Impact
(s uare feet /acres)
Multiplier Required

Mitit,ation
1 3
1/1 1.5
Total
-11c ' -Eenas out su tcet perpendicular from rear bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone I.
Page I t of 12

If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement. Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0212 or .0260.
XI. Stormwater (required by DWQ)
X Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the propert
Ci? Gi 5 ., i Z Fc G1.5 ?ti_ v? ?I r&Cf 1, 0,15 1-0 J
?? Y.1 i ci C , o n 0 -- i` tl 4 10 Ci `I + A
XII. Sewage Disposal (required by DWQ)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
XIII. Violations (required by DWQ)
Is this site in. v Iation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes j? No ?
Is this an aft r- he-fact permit application?
Yes No ?
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
r' work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
„{- W at 1, G, LU d / f 'T l W h 1 i W ?k Y?'I'1 n ai G,'i C7 ; t,1 c di
r1( C ?(G1+?1 3, 00
rp;
Applicant/Agent's Signature ate
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 12 of 12
ID 1????
r
FEB 2 7 2006
1
[04R - WATER QUALITY
i',,ETLtJZ3 tJ M gopI ?ti IATER BRM"CH
Office Use Only:
Form Version February 2004
iISACE Action ID No. DbVQ No " , 0 3 ' 8
No. (If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
I. Processing
1. Check all of the approval(s) requested for this project:
® Section 404 Permit ? Riparian or Watershed Buffer Rules
? Section 10 Permit ? Isolated Wetland Permit from DWQ
401 Water Quality Certification
571 P-J
2. Nationwide, Regional or General Permit Number(s) Requested: ,T W ( Z
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 Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts (verify availability with NCEEP 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 Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here: ?
II. Applicant Information
1. Owner/Applicant Information
Name:_ f_? /'i ck6 t;'O,0
Mailing Address: 1911-
* ? 63
Telephone Number: 3 - G .Z 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 owner/applicant.)
Name:
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
Fax Number:
Page 5 of 12
III. Project Information
Attach a vicinity map clearly slowing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Nlap and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers fiill-size construction
drawings rather than a sequential sheet version of the full-size plans. If fiill-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
`( 1. Name of project:__ S _A,- (_-e ?l
2. T.I.P. Project Number, NCMA or State Project Number (NCDOT Only):
X 3. Property Identification Number (Tax PIN): 0P1 l 0, ,c( ) 110
4. Location
County: (V`A(_0 A) Nearest Town: O T M
Subdivision naive (include phase/lot number): _
X Directions to site (include road numbers, landmarks, etc.):
t 0,1 s ?14112 6 Pill g 0 f-0 4?-°t_A 6P f4l ".s
i o hi c 9 t 5 f `C 0 Un , 11 o t s (- o ?i itt w &_V1 ytiiolJ CFcf
5. Site coordinates (Lat/Long; D/Nl/S format):
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Property size (acres): 1 3 +ic 1-4-S
7. Nearest body of water (streacn/river/sound/ocean/lake): i? orf l1 T a (?\ Ar&A,n +0
8. River Basin: _ yqz 1zN?1`,ssZt
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/maps/.)
X 9. Describe the existing conditions on the site and general land use in the vicinit of the project
at the time of this application: ?>!U G{S (- ,t ?Ic1ft? S iwA ?? ??d3.,?? u ; t! l?
4-,,
Page 6 of 12
i
10. Describe the overall project in detail, including the type of equipment to be used:
l '\ ' r j{ U L L1 ti f-l ! .S A 6 No
, d
`1 vi1 l% i ' cl I l L b t? 6"lt ,-,: L b
J
It. Explain the purpose of the roposed work: P J AJ
1 0 ??9tt c L4 L? r t'1 1'J! f c( G1 G i I1 e,?c? ?J ?I ct i c1
J. c? L1 o f t G? v1 1 JL? Cl vI q ?1 F p d
IV. Prior Project History
If jurisdictional detenninations and/or pen-nits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
jC the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules. LL
of 0.1? lillp„? o i- Ck4r, dr r-/-"I?"? ? rr f% C i cc??r b,?
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
x and provide justification for the exclusion of this work from the current application.
VI. Proposed Impacts to Waters 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 mast be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation snap, whether or not 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.
ths,
Pagc 7 of 12
X 1. Provide a written description of the proposed impacts;
2. Individually list wetland impacts below:
Wetland Impact
Site Number
(indicate on ma)
Type of Impact* Area of
Impact
(acres) Located within
100-year Floodplain**
(yes/no) Distance to
Nearest Stream
(linear feet)
Type of Wetland***

* . : _I-
-13 ,..,,,.l -IPUu t acPataiciy and iucnury temporary impacts. impacts include, but are not limited to: mechanized clearing, grading, till,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEivIA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http://www. fema.oov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.) Indicate if wetland is isolated (determination of isolation to be made by USACE only).
List the total acreage (estimated) of all existing wetlands on the property:_
Total area of wetland impact proposed:
3. Individually list all intermittent and perennial stream impacts below:
N
Stream Impact
Site Number
(indicate on map) '
Type of Impact* Length of
Impact
(linear feet)
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
(pleasespecify)
`f- 6- -i b •1G 1?1 d t V i vwX Y " I'Q6NNIA6,

List each impact separately and identity temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.usgs.eov. Several internet sites also allow direct download and printing of USGS maps www.topozone.com,
www.mapduest.corn, etc.).
20
Cumulative impacts (linear distance in feet) to all streams on site:
Page 8 of 12

4. Individually list all open water impacts (including lakes, ponc_, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Upon water Impact
Site Number Type of impact*
(indicate on ma) Area of
impact
(acres)
Name of lVaterbody
(it applicable) ,

* r:
- - -- r?-• P-1 y u„u iucnury icmporary impacts. Impacts include, but are not limi
Hooding, drainage, bulkheads, etc.
Type of waterbody
(lake, pond, estuary, sound,
bav, ocean, etc.)
to: till, excavation, dredging,
5. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dan-Vembankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock w t in 'gation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
/ financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during const J,on to reduce impacts.
W r t.u 6k I ' v - f' Fl(cl ?i '1r' v 14 t C C-1 I ? c-f
s n V t l ct ?, C CA
,
?'1 L,/ n L f i `r' L d t L')
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .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
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
Page 9 of 12

USACE - In accordance with the Final Notice of Issuance and Nlodification of Nationwide
Permits, published in the Federal Re27ister on ivlarch 9, 2000, mitigation will be required when
necessary 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 the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacin- losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCEEP concurrence shall be placed on hold as incomplete.
An applicant may also choose to review the current guidelines for stream restoration in DWQ's
Draft Technical Guide for Stream Work in North Carolina, available at
http://h2o.eiir.state.nc.tis/iicwetlands/stimRide.html.
Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
2. Mitigation may also be made by payment into the North Carolina Ecosystem Enhancement
Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at
[phone] 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
NCEEP, check the NCEEP website at http://www.nceep.net . If use of the NCEEP is
proposed, please check the appropriate box on page three and provide the following
information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
Page 10 of 12
IX. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federal/state) fiends or the use of public
(federal/state) land?
Yes ? No
If yes, does the project require preparation of an environmental 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 SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No ?
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
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 applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .02 - (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify p
Yes ? No ? If you answered "yes", provide t e 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.
Zone* Impact
(s uare feet /acres) Multiplier Required
Mitigation
1 3
2
IAT

1.5
Total

?- enw Gu. w rcet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
Page I t of 12
I
t
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement. Riparian Buffer Restoration / Enhancement, Preservation or
Pa,vnent into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .022 or .0260.
XI. Stormwater (required by DWQ)
X Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property. )
c; c ti 1 S +f\ C E _'Q n 0 `f _ `!` 6 r'_ 10( G Gl ?I ?.. (t o a- , } a
XII. Sewage Disposal (required by DWQ)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
VIII. Violations (required by DWQ)
Is this site in 'olation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
YesX No ?
Is this an aft r- he-fact permit application?
Yes No ?
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
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 &cies,? accessibility problems, or other issues outside of the applicant's control).
ctV«c1t T 1w\ FfM,
w' t? o l ( r ' l(A ?1 00 5 '4? ,(-
/"9 r
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 12 of 12