19961135 Ver 1_COMPLETE FILE_19961210

State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Wafter Quality
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
10 f b(d e Mi A&
Dear Mr.
D"EHNF1
3 , 1997
#97" OE #1
(ant g , you requested a 401 a W e Q;t? Certification
from the vi$ion f Water Quality or yo roject ( C6 t ?h IT ) located
near in County. We wrote to you on
discu sing concerns that we have regarding the design of the
project and p acing it on hod until those concerns are addressed. As of today, we have not
received at response to our earlier letter. Unless we receive a response from you by
q ?ec ew?b tir (V we will consider that you have witl awn this application and are
not interested in pursuing the project at, this time. uril7)I"
Please call me at 919-733-1786 if you have any questions or would like to discuss this
matter.
Sincerely,
John R. Dorney.
Water Quality Certification Program
cc: DWQ Regional Office.
Wilmington strict Corps of Engineers
Central Files
clr
Division of Water Quality - Environmental Sciences Branch -
4401 Reedy Creek Rd., Raleigh, NC 27626-0535 - Telephone [phone] - FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post-consumer paper -
State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
Mr. Scott E. Thomas
6010 Forest Creek Circle
Wilmington, NC 28403
Dear Mr. Thomas:
Re: Proposed land clearing of wetlands
New Hanover County
WQC Project #961135
A ??
E NR ?
December 19, 1996
On 12 December 1996 the Division of Water Quality (DWQ) was notified by mail
regarding your plan to fill wetlands for the purpose of constructing a home in New
Hanover County . Approval from DWQ is required to disturb these wetlands. Although
we received seven copies of the application, maps were not included Please send us 7
copies of supporting maps and documentation. In particular as described in 15A NCAC
2B .0502, we will require you to locate all streams and ponds on the property. Please
show these on maps of suitable scale (for instance 1" =100 feet) so we can begin to
determine your projects' compliance with 15A NCAC 2H.0500.
Please call me at 919-733-1786 if you have any questions or would require copies of
our rules or procedural materials.
cc: Wilmington DWQ Regional Office
Wilmington Corps of Engineers
Central Files.
Sincerely,
?. J'o 1R.:Dorney
ter Quality Certifi ' n Program,
961135.app
Division of Water Quality - Environmental Sciences Branch
Environmental Sciences Branch, 4401 Reedy Creek Rd., Raleigh, NC 27607 Telephone [phone] FAX # [phone]
An Equal Opportunity Affirmative Action Employer - 50% recycled/10% post consumer paper
961135
DEM ID: CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #):
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
1) NOTIrICATION TO TSZ CORPS or ZNCnaZRs
2) PPLICATION rOR SZCTION 401 CZRTZrICATION
A
bammamT
3) COORDINATION WITH THE NC DIVISION or COASTAL
SEND TSE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE
FIELD OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET) . SEVEN
(7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT r;•_r
(SEE AGENCY ADDRESSES SHEET). PLEASE PRINT.
1. OWNERS NAME: - '
/ ortST &Cek ` irC C"
2 . MAILING ADDRESS:
SUBDIVISION NAME: j o_c
CITY: STATE: f 0c ZIP CODE: A8403
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISIO NAME (IF DIF RENT FROM
MAILING ADDRESS ABOVE) : <am t.- LrcvZ- j°l °? '? p e"?
Sia
3. TELEPHONE NUMBER (HOME) C910,35D '3(03!0 (WORK) :
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER:
S. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: /Vec.? /;am0L)e A NEAREST TOWN OR CITY:
1
. \
IMPACTED OR NEAREST STREAM/RIVER: zxjaps ove'k
RIVER BASIN: NIlq
?. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER
;A), HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER
1PPLY (WS-I OR WS-II) ? YES [ ] NO IF YES, EXPLAIN:
). IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISI.N OF COASTAL
1NAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES [NO [ ]
IF THE PROJECT IS LOCATED WITHIN A COASTAL, COUNTY (SEE PAGE 7 FOR
:ST OF COASTAL COUNTIES.),\ WHAT IS THE LAND USE PLAN (LUP) DESIGNATION?
-15 - : ty ?rs?'c?e.rfi?
3. HAVE ANY SECTION 404 PERMITS B PREVIOUSLY REQUESTED FOR USE ON
3IS PROPERTY? YES [ ] NO [ IF YES, PROVIDE ACTION 1. D. NUMBER OF
IEVIOUS PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
ZRTIFICATION):
a. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
7TURE? YES [ ] NO [?F YES, DESCRIBE ANTICIPATED WORK:
a. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND: • 3 3 4e.
'b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
. 101 ac.
?.1 a sy
1 4.JJ''!!({.?r

2
SPECIFIC LOCATION (INCLUDE ROAD
MBERS, LANDMARKS, ETC.): / ?OOg ysmA l &e-k- cle-c-/`e-

.f.
Oa. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
ILLING: • 0 0.C • EXCAVATION:
LOODING: /1)? OTHER: N /
RAINAGE : N TOTAL ACRES TO BE IWACTED : • O O.c
Ob. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF
ZLOCATED, PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION :
ZNGTS BEFORE: (004 FT AFTER: /0/4 FT
rTDTH BEFORE (based on normal high water contours): ? L1 FT
7IDTH AFTER : M /11 FT
\VERAGE DEPTH BEFORE: NIA- FT AFTER: FT
(2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY) )PEN CHANNEL RELOCATION: A PLACEMENT OF PIPE IN CHANNEL: AVA
::HANNEL EXCAVATION: CONSTRUCTION OF A DAM/FLOODING: ro/A
OTHER:
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE
WATERSHED DRAINING TO THE POND? &
WHAT IS THE EXPECTED POND SURFACE AREA?

13. PURPOSE OF PROPOSED WORK:

3
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF
MECHANICAL EQUIPMENT TO BE USED (ATTACH PLANS: 8 1/2" X 11" DRAWINGS
ONLY):

14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED
OUT IN WETLANDS. (INCLU74le- Y MEASURES TAKEN TO INIMIZE WETLAND
IMPACTS) : . S' i2 e ? . co n_ 1- _ • . a
/cs,47tj?u ?s cc vs c. ie Aevse 76 /N4?e- f.` k
,--J /cli ll ,'cl r car vaa(.? Cyr_
15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SERVICE
(USFWS) AND/OR NATIONAL MARINE FISHERIES SERVICE (NMFS) (SEE AGENCY
ADDRESSES SHEET) REGARDING THE PRESENCE OF ANY FEDERALLY LISTED OR
PROPOSED FOR LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL HABITAT
IN THE PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE
CONTACTED: (ATTACH RESPONSES
FROM THESE AGENCIES.)
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) (SEE AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC
PROPERTIES IN THE PERMIT AREA WHICH MAY BE AFFECTED BY THE PROPOSED
PROJECT. DATE CONTACTED:-
. ?
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF
PUBLIC (STATE) LAND?
YES (I NO lam!" ( IF NO, GO TO 18)
a. IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA ENVIRONMENTAL
POLICY ACT?
YES [ ] NO [ ]
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE?
YES (I NO [ J
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE
STATE CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT REGARDING
COMPLIANCE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].

4

18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF
PROPOSED ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL
INTO WETLANDS:
a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES
AND PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26,
29, AND 38). ALL STREAMS (INTERMITTENT AND PERMANENT) ON THE PROPERTY
MAST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS SO FEET OR 1
INCH EQUALS 100 FEET OR THEIR EQUIVALENT.
b. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE
IMPACTED BY PROJECT.
c. IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA
SHEETS RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
d. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
e. WHAT IS LAND USE OF SURROUNDING PROPERTY?
-? iS.
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
g. SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE U.S. MAY NOT BE IMPACTED PRIOR TO:
1) ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT,
2) EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF
ENVIRONMENTAL MANAGEMENT (WATER QUALITY) CERTIFICATION, AND
3) (IN T1-0 TWENTY COASTAL COUNTIES OnY) , A LETTER FROM THE
NORTH CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED
ACTIVITY IS CONSISTENT WITH THE NORTH CAROLINA COASTAL MANAGEMENT
PROGRAM.
O R'S/AGENT'S SIGNATURE
? i
14,
DATE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED (18g.))
5

DEM ID: 6113 5 CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #):
PRE-CONSTRUCTION NOTIFICATION APPLICATION ?.;'
FOR NATIONWIDE PERMITS THAT REQUIRE:

,1) NOTIa'ICATION TO TBZ coRps or manumm
2) APPLICATION rOR SZCTION 401 CZP-TXrICATION
3) COORDINATION WITH TSS NC DIVISION or COASTAL HpjNAGlbccNT
SEND THE ORIGINAL AND (1) COPY OF THIS COLLETED FORM TO THE APPROPRIATE ?,-.:•,rKr:•• ' k
FIELD OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET) . SEVEN
(7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT r;'•`
(SEE AGENCY ADDRESSES SHEET). PLEASE PRINT.
1. OWNERS NAME : ?-
2. MAILING ADDRESS:
X 01 Fore-sl &eek C'-rd-
SUBDIVISION NAME:
CITY: .I STATE: /U01 ZIP CODE: "?28'4c)
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAM (IFQDIFFERENT FROM
MAILING ADDRESS ABOVE) : <? c - d ? P?se11
?lj 3. TELEPHONE NUMBER (HOME) (9 - DSO '3?D31? (WORK)
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER:
S. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC I
MAP OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: Nei 3 powoae'. NEAREST TOWN OR CITY:
1
{
f
' ?e1?
IMPACTED OR NEAREST STREAM/RIVER:
RIVER BASIN: N14
. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER
A), HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER
PPLY (WS-I OR WS-II)? YES [ ] NO IF YES, EXPLAIN:
). IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISI.N OF COASTAL
iNAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES [NO [ ]
IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR
:ST OF COASTAL COUNTIES.);, WHAT ISM THE LAND USE PLAN (LUP) DESIGNATION?
1. HAVE ANY SECTION 404 PERMITS B PREVIOUSLY REQUESTED FOR USE ON
iIS PROPERTY? YES [ ] NO (IF YES, PROVIDE ACTION I.D. NUMBER OF
ZEVIOUS PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
71RTIFICATION):
:). ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
7TURE? YES [ ] NO [?F YES, DESCRIBE ANTICIPATED WORK:

a. ESTnIATED TOTAL NUMBER OF ACRES IN TRACT OF LAND: • 3 3 4C• ?II
1
b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
2
/ SPECIFIC LOCATION (INCLUDE ROAD
MBERS, LANDMARKS, ETC.): 6009 i&-t& l C ek- Clr-4e
r
.r..
Oa. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
ILLING: • 0 1 GLQ • EXCAVATION:
LOODING: /U1 OTHER: Nr "
RAINAGE • TOTAL ACRES TO BE IIKPACTED : .01 Oleo
Ob. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF
IELOCATED, PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION)
,ENGTR BEFORE: FT AFTER: /^^v1, FT
rZDTH BEFORE (based on normal high water contours): FT
fIDTH AFTER: FT
kVERAGE DEPTH BEFORE: ET AFTER: N?/T FT
(2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION: PLACEMENT OF PIPE IN CHANNEL: ri/A
--HANNEL EXCAVATION: CONSTRUCTION OF A DAM/FLOODING: AV A
OTHER : -jFy
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE
WATERSHED DRAINING TO THE POND?
WHAT IS THE EXPECTED POND SURFACE AREA?
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF
MECHANICAL EQUIPMENT TO BE USED (ATTACH PLANS: 8 1/2" X 11" DRAWINGS

13. PURPOSE OF PROPOSED WORK: ?•e

S?ReYYt ? ?
ty/.? ? ite ? .
r.oejj
3

14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED
OUT IN WETLANDS. (INCLUDE Y MEASURES TAKEN TO
' INI ZE WETLAND
IMPACTS): 7A e- i
CL%
/-as47 t 'o) S cc vs e
? ;
4
6
---
io?se V
/
C-
77
N ?? l1 1 ?CtC-
f-C Cyr
76

15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SERVICE
(USFWS) AND/OR NATIONAL MARINE FISHERIES SERVICE (NMFS) (SEE AGENCY
ADDRESSES SHEET) REGARDING THE PRESENCE OF ANY FEDERALLY LISTED OR
PROPOSED FOR LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL HABITAT
IN THE PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE
CONTACTED: (ATTACH RESPONSES
FROM THESE AGENCIES.)
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) (SEE AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC
PROPERTIES IN THE PERMIT AREA WHICH MAY BE AFFECTED BY THE PROPOSED
PROJECT. DATE CONTACTED:.
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF
PUBLIC (STATE) LAND?
YES [I NO P ( I F NO, GO TO 18)
a. IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA ENVIRONMENTAL
POLICY ACT?
YES [ ] NO [ ]
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE?
YES (I NO [ ]
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE
STATE CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT REGARDING
COMPLIANCE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
4

18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF
PROPOSED ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL
INTO WETLANDS:
a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES
AND PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26,
29, AND 38). ALL STREAMS (INTERMITTENT AND PERMANENT) ON THE PROPERTY
MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET OR 1
INCH EQUALS 100 FEET OR THEIR EQUIVALENT.
b. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE
IMPACTED BY PROJECT.
c. IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA
SHEETS RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
d. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
e. WHAT IS LAND USE OF SURROUNDING PROPERTY? '""? 't _Vzol-.1
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?

g. SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE U.S. MAY NOT BE IMPACTED PRIOR TO:
1) ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT,
2) EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF
ENVIRONMENTAL MANAGEMENT (WATER QUALITY) CERTIFICATION, AND
3) (2N T 71E TWENTY COASTAL COUNTIES ONLY) , A LETTER FROM THE
NORTH CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED
ACTIVITY IS CONSISTENT WITH THE NORTH CAROLINA COASTAL MANAGEMENT
PROGRAM.

OW MR'S/AGENT'S SIGNATURE
DATE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED (18g.))
5
t
DEM ID: 9 6 1 1 3 5 CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #):
PRE-CONSTRUCTION NOTIFICATION APPLICATION
2?yy
FOR NATIONWIDE PERMITS THAT REQUIRE:

'1) NOTIrICATION TO TRZ CORPS or lNGIuRS
2) APPLICATION rOR SZCTION 401 CZRTI!'IC7?TION XS t
lcouwommT
3) COORDINATION WITH TSS NC DIVISION OZ COASTAL
OF THIS COMPLETED FORM TO THE APPROPRIATE
SEND THE ORIGINAL AND (1) COPY
FIELD OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN
(7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT
(SEE AGENCY ADDRESSES SHEET). PLEASE PRINT.
/'? • •'•I 'HN
1. OWNERS NAME: ? Amm
2. MAILING ADDRESS: FOrGS` &C"" C-rd e"
SUBDIVISION NAME:
CITY: 1')s*lmL STATE: J )Q ZIP CODE: nZ8?o3
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISIO NAME (IF DIF RENT FROM
MAILING ADDRESS ABOVE) :5u-200 ?- 'N 4 d °? p`iaSe.3
3. TELEPHONE NUMBER (HOME) 0910) 35D -3(03( (WORK)
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER:
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE): r
COUNTY : Ne -1 dowcu "- NEAREST TOWN OR CITY :
1
?,

IMPACTED OR NEAREST STREAM/RIVER: ?pP.S
RIVER BASIN: M14
?. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER
;A), HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER
TPPLY (WS-I OR WS-II) ? YES [ ] NO (kl'IF YES, EXPLAIN:
). IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISI.N OF COASTAL
,NAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES [NO [ ]
IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR
:ST OF COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION?

. L 'r .
1. HAVE ANY SECTION 404 PERMITS BFZW PREVIOUSLY REQUESTED FOR USE ON
iIS PROPERTY? YES [ ) NO [ IF YES, PROVIDE ACTION I.D. NUMBER OF
2EVIOUS PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
RTIFICATION):
:). ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
7TQRE? YES [ J NO [?F YES, DESCRIBE ANTICIPATED WORK:
a. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND: • 3 3 4e.
b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
1'* ac..
. ,. r
,w
rY
2
/ SPECIFIC LOCATION (INCLUDE ROAD
MBERS, LANDMARKS, ETC.): 6009 L T O e k- c1l-ctf-

.r.,
Oa. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
ILLING. • 0 QC • EXCAVATION:
LOODING: NIA OTHER: N / 4
RAINAGE• TOTAL ACRES TO BE IIWACTED: ae
Ob. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF
'ELOCATED, PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION
.ENGTH BEFORE: FT AFTER: //.4 FT
rIDTH BEFORE (based on normal high water contours) : FT
rIDTH AFTER : 14 FT
kvERAGE DEPTH BEFORE: N/AFT AFTER: FT
(2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
)PEN CHANNEL RELOCATION: PLACEMENT OF PIPE IN CHANNEL: f1jjA
:HANNEL EXCAVATION: CONSTRUCTION OF A DAM/FLOODING: Iv ?r
OTHER:
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE
WATERSHED DRAINING TO THE POND? 411
WHAT IS THE EXPECTED POND SURFACE AREA? . 44
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF
MECHANICAL EQUIPMENT TO BE USED (ATTACH PLANS: 8 1/2" X 11" DRAWINGS
w?1T V \

13. PURPOSE OF PROPOSED WORK: =S!7NAe_ If

:',; 3{
r``K ?•i3!??
3
r
r
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED
OUT IN WETLANDS. (INCLUDE _4#Y MEASURES TAKEN TO INI ZE WETLAND
IMPACTS): i
CL%
?iO
/c5 c
JS ??
?5 e (;
4
.
•? .
e Tia?se V
776 -
c/q-
f

15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SERVICE
(USFWS) AND/OR NATIONAL MARINE FISHERIES SERVICE (NMFS) (SEE AGENCY
ADDRESSES SHEET) REGARDING THE PRESENCE OF ANY FEDERALLY LISTED OR
PROPOSED FOR LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL HABITAT
IN THE PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE
CONTACTED: (ATTACH RESPONSES
FROM THESE AGENCIES.)
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) (SEE AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC
PROPERTIES IN THE PERMIT AREA WHICH MAY BE AFFECTED BY THE PROPOSED
PROJECT. DATE CONTACTED:.
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF
PUBLIC (STATE) LAND?
YES H NO IF NO, GO TO 18)
a. IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA ENVIRONMENTAL
POLICY ACT?
YES C ] NO C ]
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE?
YES C ] NO C ]
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE
STATE CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT REGARDING
COMPLIANCE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
4

18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF
PROPOSED ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL
INTO WETLANDS:
a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES
AND PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26,
29, AND 38). ALL STREAMS (INTERMITTENT AND PERMANENT) ON THE PROPERTY
MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET OR
INCH EQUALS 100 FEET OR THEIR EQUIVALENT.
b. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE
IMPACTED BY PROJECT.
c. IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA
SHEETS RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
d. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
e. WHAT IS LAND USE OF SURROUNDING PROPERTY?
f?WHAT /IS PROPOSED METHOD OF SEWAGE DISPOSAL?
f. IF APPLICABLE,
g. SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE U.S. MAY NOT BE IMPACTED PRIOR TO:
1) ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT,
2) EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF
ENVIRONMENTAL MANAGEMENT (WATER QUALITY) CERTIFICATION, AND
3) (ZN TIC TWENTY COASTAL COUNTIES ONLY), A LETTER FROM THE
NORTH CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED
ACTIVITY IS CONSISTENT WITH THE NORTH CAROLINA COASTAL MANAGEMENT
PROGRAM.
O R'S/AGENT'S SIGNATURE
DATE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED (18g.))
1
5
i

DEM ID: 9 6 1 1 3 5 CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #):
PRE-CONSTRUCTION NOTIFICATION APPLICATION y;
FOR NATIONWIDE PERMITS THAT REQUIRE:
'1) NOTIFICATION TO THE CORPS O! ZNGINZERS
2) APPLICATION FOR SZCTION 401 CZRTIFICATION
3) COORDIIMTION WITH TES NC DIVISION 08 COASTAL baN71GlbaNT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE
FIELD OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN
(7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT
(SEE AGENCY ADDRESSES SHEET). PLEASE PRINT.
1. OWNERS NAME : '4/v- s-- 1-rZ.q,s
2. MAILING ADDRESS: clo0 l y / ores &eG-k C'ed e .
^SUBDIVISION NAME: N Q,(,e
CITY: 1L STATE: ZIP CODE: n?8'7C)3
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISIO NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE) : e- L ca f oL# a Roe 3-C
3. TELEPHONE NUMBER (HOME)C9 10) ZSO -3(C3( (WORK) :
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER:
n:! Xr
S. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE): f y
COUNTY : Nec I dowaLk N NEAREST TOWN OR CITY :

1
1

SPECIFIC LOCATION (INCLUDE ROAD
MBERS, LANDMARKS, ETC.) : 6OOg FMST 6 Gk- cll-ctc
// /
6c IMPACTED OR NEAREST STREAM/RIVER: Zeap ek
RIVER BASIN: Nhq
IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER
?A), HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER
'PPLY (WS-I OR WS-11)? YES [ ] NO (i<'IF YES, EXPLAIN:
i. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISI.N OF COASTAL
?NAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES [NO ( ]
IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR
_ST OF COASTAL COUNTIES.) ,\ WHAT IS THE LAND USE PLAN (LUP) DESIGNATION?
-1S (Z11
• /. . .
1. HAVE ANY SECTION 404 PERMITS B PREVIOUSLY REQUESTED FOR USE ON
ilS PROPERTY? YES [ ] NO [ IF YES, PROVIDE ACTION I.D. NUMBER OF
IEVIOUS PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
'RTIFICATION):

:3. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
7TURE? YES [ J NO [?F YES, DESCRIBE ANTICIPATED WORK:
a. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND: • 3 3 4e•
b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
. 1OZ oC..
2

.41
Oa. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
ILLING: .01 0.0a. EXCAVATION:
LOODING: NIA OTHER: N r
RAINAGE• N TOTAL ACRES TO BE II PACTED: • C?C
Ob. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF
'ELOCATED, PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION):
ZNGTH BEFORE: INA FT AFTER: N/,4 FT
rzDTR BEFORE (based on normal high water contours) : too, ' FT
7IDTH AFTER: FT
AVERAGE DEPTH BEFORE: 1y/?!7 FT AFTER: A)J/T FT
(2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
)PEN CHANNEL RELOCATION: N A PLACEMENT OF PIPE IN CHANNEL: 44
--HANNEL EXCAVATION: --/rT CONSTRUCTION OF A DAM/FLOODING: N14
ETHER:
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE
WATERSHED DRAINING TO THE POND? N1,4
WHAT IS THE EXPECTED POND SURFACE AREA?
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF
MECHANICAL EQUIPMENT TO BE USED (ATTACH PLANS: 8 1/2" X 11" DRAWINGS
ONLY) :

13. PURPOSE OF PROPOSED WORK:
3 M
ix4l
3
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED
OUT IN WETLANDS. (INCLUDE _MY MEASURES TAKEN TO
' INI ZE WETLAND
IMPACTS) : 7A e- i

/ts c?O•?S ?S e
C?
? ;
4
6 k
.
ie
io?se /
0
-7
e . 1 ?l
cl?j iN ACIV #411 f._/
?jl r ?_
/ n-ma :0 `l.L4.L7v [
15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SERVICE
(USFWS) AND/OR NATIONAL MARINE FISHERIES SERVICE (NMFS) (SEE AGENCY
ADDRESSES SHEET) REGARDING THE PRESENCE OF ANY FEDERALLY LISTED OR
PROPOSED FOR LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL HABITAT
IN THE PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE
CONTACTED: (ATTACH RESPONSES
FROM THESE AGENCIES.)
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) (SEE AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC
PROPERTIES IN THE PERMIT AREA WHICH MAY BE AFFECTED BY THE PROPOSED
PROJECT. DATE CONTACTED:-
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF
PUBLIC (STATE) LAND?
YES (I NOI F NO, GO TO 18)
a. IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA ENVIRONMENTAL
POLICY ACT?
YES ( ] NO ( ]
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE?
YES [ ] NO ( ]
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE
STATE CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT REGARDING
COMPLIANCE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
4
18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF
PROPOSED ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL
INTO WETLANDS:
a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES
AND PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26,
29, AND 38). ALL STREAMS (INTERMITTENT AND PERMANENT) ON THE PROPERTY
MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET OR
INCH EQUALS 100 FEET OR THEIR EQUIVALENT.
b. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE
IMPACTED BY PROJECT.
c. IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA
SHEETS RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
d. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
e. WHAT IS LAND USE OF SURROUNDING PROPERTY?
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?

g. SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE U.S. MAY NOT BE IMPACTED PRIOR TO:
1) ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT,
2) EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF
ENVIRONMENTAL MANAGEMENT (WATER QUALITY) CERTIFICATION, AND
3) (ZIT T71E TWENTY COASTAL COUNT=S CM4 , A LETTER FROM THE
NORTH CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED
ACTIVITY IS CONSISTENT WITH THE NORTH CAROLINA COASTAL MANAGEMENT
PROGRAM.
EENT SIGNATURE
O R'S/AGENT' S SIGNATURE
DATE
E
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED (18g.))
1
5
c
34
DEM ID: CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #):
PRE-CONSTRUCTION NOTIFICATION APPLICATION ti;M ,1
2'y
FOR NATIONWIDE PERMITS THAT REQUIRE: nr^. ass"
'1) NOTIBICATION TO TSZ CORPS or ZNGINZZRS
2) APPLICATION a`OR SZCTION 401 CZRT282CATION?
MANAGZbGCNT
3) COOpMrKATION WITH THE NC DIVISION or COASTAL
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE
FIELD OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN
(7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT
SEE AGENCY ADDRESSES SHEET). PLEASE PRINT.
1. OWNERS NAME:
2. MAILING ADDRESS: CO? I v / oresl c-'eGk Cede-
SUBDIVISION NAME: N O-C
CITY: STATE: NC ZIP CODE: q8'fo3
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISIO NAME (IF DIFTERENT FROM
MAILING ADDRESS ABOVE) : e_ L,,c.A -0 o? ## ,a .7 P?iASC.?
S?'a
3. TELEPHONE NUMBER (HOME) (910),35D -.3(cZD (WORK):
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER:
r?
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC '
MAP OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY : we • I 140-wou - NEAREST TOWN OR CITY :
1
0
/ SPECIFIC LOCATION (INCLUDE ROAD
MBERS, LANDMARKS, ETC.) : 6008 ?ITrS1 6?ek- CjIT-te-
IMPACTED OR NEAREST STREAM/RIVER: eje.S ocek
RIVER BASIN: 621f4
IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER
A), HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER
'PPLY (WS-I OR WS-II)? YES [ ] NO [ d IF YES, EXPLAIN:
). IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISI.N OF COASTAL
SAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES [NO [ ]
IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR
_ST OF COASTAL COUNTIES),% WHAT IS THE LAND USE PLAN (LUP) DESIGNATION?
/---.) .mil
.
3. HAVE ANY SECTION 404 PERMITS B PREVIOUSLY REQUESTED FOR USE ON
3IS PROPERTY? YES [ ] NO CLT' IF YES, PROVIDE ACTION I.D. NUMBER OF
2EVIOUS PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
:,RTIFICATION) :
:3. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
7TURE? YES [ ] NO [?F YES, DESCRIBE ANTICIPATED WORK:
a. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND: • .33 ae,
b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
. 0 aC,•

2

Oa. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
ILLING. .01 QC • EXCAVATION:
LOODING: A) OTHER: N r 14
RAINAGE • TOTAL ACRES TO BE IIeACTED : O I ac
Ob. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF
'ELOCATED, PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION):
M4GTH BEFORE: M/fi FT AFTER: FT
rIDTH BEFORE (based on normal high water contours): L? FT
;TDTH AFTER: 11)1,4- FT
AVERAGE DEPTH BEFORE: NIA- FT AFTER: FT
(2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
)PEN CHANNEL RELOCATION: PLACEMENT OF PIPE IN CHANNEL: 44
;HANNEL EXCAVATION: /fIr CONSTRUCTION OF A DAM/FLOODING: NIA
ETHER :
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE
WATERSHED DRAINING TO THE POND? 411
WHAT IS THE EXPECTED POND SURFACE AREA? -4#,
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF
MECHANICAL EQUIPMENT TO BE USED (ATTACH PLANS: 8 1/2" X 11" DRAWINGS
ONLY):
13. PURPOSE OF PROPOSED WORK: sf? •z1)` /a'
.r..

3

14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED
OUT IN WETLANDS. (INCLUDE Y MEASURES TAKEN TOIINIM?ZE WETLAND
IMPACTS) : -A e- e- ra? f{?' hn ,co l? 1? _ _ . y
Anv.Sf. 776
zrepraw. %D ac-Lf-? .
15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SERVICE
(USFWS) AND/OR NATIONAL MARINE FISHERIES SERVICE (NMFS) (SEE AGENCY
ADDRESSES SHEET) REGARDING THE PRESENCE OF ANY FEDERALLY LISTED OR
PROPOSED FOR LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL HABITAT
IN THE PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE
CONTACTED: (ATTACH RESPONSES
FROM THESE AGENCIES.)
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) (SEE AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC
PROPERTIES IN THE PERMIT AREA WHICH MAY BE AFFECTED BY THE PROPOSED
PROJECT. DATE CONTACTED:.
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF
PUBLIC (STATE) LAND?
YES (I NO k (IF NO, GO TO 18)
a. IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA ENVIRONMENTAL
POLICY ACT?
YES [ J NO [
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE?
YES [ ] NO [ ]
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE
STATE CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGE14ENT REGARDING
COMPLIANCE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
4

18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF
PROPOSED ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL
INTO WETLANDS:
a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES
AND PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26,
29, AND 38). ALL STREAMS (INTERMITTENT AND PERMANENT) ON THE PROPERTY
MOST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET OR 1
INCH EQUALS 100 FEET OR THEIR EQUIVALENT.
b. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE
IMPACTED BY PROJECT.
c. IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA
SHEETS RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
d. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
e. WHAT IS LAND USE OF SURROUNDING PROPERTY?
1ao•: l se Assl'403 ?c..(
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
g. SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE U.S. MAY NOT BE IMPACTED PRIOR TO:
1) ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT,
2) EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF
ENVIRONMENTAL MANAGEMENT (WATER QUALITY) CERTIFICATION, AND
3) (IN THE TWENTY COASTAL COUNTIES ONZY), A LETTER FROM THE
NORTH CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED
ACTIVITY IS CONSISTENT WITH THE NORTH CAROLINA COASTAL MANAGEMENT
PROGRAM.
ell
OWIMR'S/AGENT'S SIGNATURE
DATE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED (18g.))
5

9611 35
DEM ID: CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #):
PRE-CONSTRUCTION NOTIFICATION APPLICATION :;.. FOR NATIONWIDE PERMITS THAT REQUIRE:
'1) NOTIBZCATION TO TSE CORPS or ENGINELRS
2) APPLICATION TOR -SECTION 401 CSRT28ICATION
xkNAGzbizNT
3) COORDINATION WITH TSb NC DIVISION or COASTAL
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE
FZELD OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN '?''.•
(7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT r..?.
(SEE AGENCY ADDRESSES SHEET). PLEASE PRINT.
1. OWNERS NAME:
2. MAILING ADDRESS : COO ?v Fore-$i G-eek (21-rGre.
SUBDIVISION NAME: N fie.
CITY: STATE: A )Q ZIP CODE: ?8?103
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISIOJp NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE) : _ - .I* c- ?oCat?'o?? ?? °? p e'?
ge'osi'v4v"Q?
3. TELEPHONE NUMBER (HOME) ?qb? LSD '3(03 (WORK).
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER:
r
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE): -''
COUNTY: NeU3 PaAX ? NEAREST TOWN OR CITY:
1
r-
SPECIFIC LOCATION (INCLUDE ROAD
MBERS, LANDMARKS, ETC.): / ?Oog sra l Ovek- Clete-
IMPACTED OR NEAREST STREAM/RIVER: ZeesS Orel`
RIVER BASIN: Nyfi
IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER
A), HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER
'PPLY (WS-I OR WS-11)? YES [ J NO (ij-' IF YES, EXPLAIN:
). IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISI.N OF COASTAL
1NAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES [NO [ J
IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR
:ST OF COASTAL COUNTIES.),N WHAT IS THE LAND USE PLAN (LUP) DESIGNATION?
-/J 1%$
• If. / .
1. HAVE ANY SECTION 404 PERMITS BFZW PREVIOUSLY REQUESTED FOR USE ON
iIS PROPERTY? YES [ ] NO [ IF YES, PROVIDE ACTION I.D. NUMBER OF
2EVIOUS PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
:RTIFICATION) :
3. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
7TURE? YES [ ] NO [?F YES, DESCRIBE ANTICIPATED WORK:
a. MIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND: • 3 3 4e.

b. ESTIIKATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE: '
101 mc..
2

.6.
Oa. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
ILLING: .01 aQ • EXCAVATION:
LOODING: AA OTHER: N
RAINAGE • /0 TOTAL ACRES TO BE IIeACTED : O??'
Ob. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF
'ELOCATED, PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION :
M4GTH BEFORE: (D/,q FT AFTER: iul-4 FT
rlDTH BEFORE (based on normal high water contours): FT
TIDTH AFTER: jam + FT
\VERAGE DEPTH BEFORE: FT AFTER: FT
(2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
)PEN CHANNEL RELOCATION: N PLACEMENT OF PIPE IN CHANNEL: N/A
:HANNEL EXCAVATION: N? CONSTRUCTION OF A DAM/FLOODING: 1014
DTHER
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE
1
WATERSHED DRAINING TO THE POND? 411
WHAT IS THE EXPECTED POND SURFACE AREA?
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF
MECHANICAL EQUIPMENT TO BE USED (ATTACH PLANS: 8 1/2" X 11" DRAWINGS
ONLY) :
13. PURPOSE OF PROPOSED WORK:

3

14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED
OUT IN WETLANDS. (INCLUDE Y MEASURES TAKEN TO
l INI ZE WETLAND
IMPACTS): Z
e .

/cs41r o'vs Cc
L's c ?
A ;
4
A k
,
ie
&jse -
v
/
, e_ 4
,AI Ac-j l'cf f- cam'

15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SERVICE
(USFWS) AND/OR NATIONAL MARINE FISHERIES SERVICE (NMFS) (SEE AGENCY
ADDRESSES SHEET) REGARDING THE PRESENCE OF ANY FEDERALLY LISTED OR
PROPOSED FOR LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL HABITAT
IN THE PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE
CONTACTED: (ATTACH RESPONSES
FROM THESE AGENCIES.)
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) (SEE AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC
PROPERTIES IN THE PERMIT AREA WHICH MAY BE AFFECTED BY THE PROPOSED
PROJECT. DATE CONTACTED:.
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF
PUBLIC (STATE) LAND?
YES (I NO lK ( I F NO, GO TO 18)
a. IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA ENVIRONMENTAL
POLICY ACT?
YES [ ] NO [ ]
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE?
YES [I NO [ ]
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE
STATE CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT REGARDING
COMPLIANCE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
4

18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF
PROPOSED ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL
INTO WETLANDS:
a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES
AND PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26,
29, AND 38). ALL STREAMS (INTERMITTENT AND PERMANENT) ON THE PROPERTY
MOST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET OR 1
INCH EQUALS 100 FEET OR THEIR EQUIVALENT.
b. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE
IMPACTED BY PROJECT.
c. IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA
SHEETS RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
d. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
e. WHAT IS LAND USE OF SURROUNDING PROPERTY?
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?

g. SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE U.S. MAY NOT BE IMPACTED PRIOR TO:
1) ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT,
2) EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF
ENVIRONblENTAL MANAGEMENT (WATER QUALITY) CERTIFICATION, AND
3) (IN = TWENTY COASTAL COUNTIES MY), A LETTER FROM THE
NORTH CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED
ACTIVITY IS CONSISTENT WITH THE NORTH CAROLINA COASTAL MANAGEMENT
PROGRAM.
O R'S/AGENT'S SIGNATURE
DATE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED (18g.))
5
t
r
DEM ID:
CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #):
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
0,91135
11 35
1) NOTIa'IcATION TO THZ CORPS or zxanmERB
2) APPLICATION !OR SZCTION 401 CSItTIlICATION
3) CooRDINATION WITS TEE Nc DIVISION or COASTAL m"mm =T

SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE
FIELD OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN
(7) COPIES SHOULD BE-SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT
(SEE AGENCY ADDRESSES SHEET). PLEASE PRINT.
1. OWNERS NAME : 5C )/V- , 7O"4,s
2. MAILING ADDRESS:
?o l l=oresi C-«k O?det-
SUBDIVISION NAME : _ e'N ? 7 cLLe
CITY: STATE: f-00-- ZIP CODE: nZNca
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISIO?t NAME (IF D/IF RENT FROM
MAILING ADDRESS ABOVE) : ? - c- 4,nC:T-Vl & 40 'Ili
3. TELEPHONE NUMBER (HOME) (910),35D-30(n (WORK) :
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER:

?E.
S. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: we?.I 140LV0Lle-&- NEAREST TOWN OR CITY:
1

IV,
/ SPECIFIC LOCATION (INCLUDE ROAD
MBERS, LANDMARKS, ETC.): 6008 ismA1 Ocek- lffrcte,
IMPACTED OR NEAREST STREAM/RIVER: ?pPS drek
RIVER BASIN: A)M
. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER
A), HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER
'PPLY (WS-I OR WS-11)? YES [ J NO (ij-'IF YES, EXPLAIN:
). IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISI.N OF COASTAL
?NAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES [NO [
.. IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR
:ST OF COASTAL COUNTIES.),\ WHAT IS THE LAND USE PLAN (LUP) DESIGNATION?
ja,.,:ly lcesl'dWh;r--
a. HAVE ANY SECTION 404 PERMITS B PREVIOUSLY REQUESTED FOR USE ON
iIS PROPERTY? YES [ ] NO [ IF YES, PROVIDE ACTION I.D. NUMBER OF
1EVIOUS PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
:RTIFICATION) :
:). ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
ITURE? YES [ ] NO [ F YES, DESCRIBE ANTICIPATED WORK:
a. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND: • 3 3 ax- -
b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
. la ac.
2

f?41

J p-

.to
Oa. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
ILLING: .01 ac. EXCAVATION:
LOODING: /2/,4 OTHER: N! 14
RAINAGE• N? TOTAL ACRES TO BE IIwACTED: • ae
Ob. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF
ZLOCATED, PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION :
M;GTH BEFORE: FT AFTER: Nl-4 FT
rzDTH BEFORE (based on normal high water contours): L? FT
;IDTH AFTER : 6 F
kVERAGE DEPTH BEFORE: NIA- FT AFTER: Nl?- FT
(2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION: IT PLACEMENT OF PIPE IN CHANNEL: /WA
OHANNEL EXCAVATION: CONSTRUCTION OF A DAM/FLOODING: IU
JTHER:
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE
1
WATERSHED DRAINING TO THE POND? 411
WHAT IS THE EXPECTED POND SURFACE AREA?

13. PURPOSE OF PROPOSED WORK:
,_ &-
t' ? f
3
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF
MECHANICAL EQUIPMENT TO BE USED (ATTACH PLANS: 8 1/2" X 11" DRAWINGS
ONLY) :

14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED
OUT IN WETLANDS. (INCLUDE Ale- MEASURES TAKEN TO INIM?ZE WETLAND
IMPACTS): A Q .S 4e np '- ^ ,co 'o
res4;:Ao•?s C'?.?SG lie douse 776
15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SERVICE
(USFWS) AND/OR NATIONAL MARINE FISHERIES SERVICE (NMFS) (SEE AGENCY
ADDRESSES SHEET) REGARDING THE PRESENCE OF ANY FEDERALLY LISTED OR
PROPOSED FOR LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL HABITAT
IN THE PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE
CONTACTED: (ATTACH RESPONSES
FROM THESE AGENCIES.)
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) (SEE AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC
PROPERTIES IN THE PERMIT AREA WHICH MAY BE AFFECTED BY THE PROPOSED
PROJECT. DATE CONTACTED:
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF
PUBLIC (STATE) LAND?
YES N NO P--'(A7,F NO, GO TO 18)
a. IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA ENVIRONMENTAL
POLICY ACT?
YES [J NO CI
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE?
YES [I NO [ ]
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE
STATE CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT REGARDING
COMPLIANCE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].

4

18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF
PROPOSED ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL
INTO WETLANDS:
a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES
AND PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26,
29, AND 38). ALL STREAMS (INTERMITTENT AND PERMANENT) ON THE PROPERTY
MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET OR 1
INCH EQUALS 100 FEET OR THEIR EQUIVALENT.
b. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE
IMPACTED BY PROJECT.
c. IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA
SHEETS RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
d. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
e. WHAT IS LAND USE OF SURROUNDING PROPERTY?
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?

g. SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE U.S. MAY NOT BE IMPACTED PRIOR TO:
1) ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT,
2) EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF
ENVIRONMENTAL MANAGEMENT (WATER QUALITY) CERTIFICATION, AND
3) (IN THE TWENTY COASTAL COUNTIES ONLY), A LETTER FROM THE
NORTH CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED
ACTIVITY IS CONSISTENT WITH THE NORTH CAROLINA COASTAL MANAGEMENT
PROGRAM.
O R'S/AGENT'S SIGNATURE
DATE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED (18g.))
5