19920433 Ver 1_COMPLETE FILE_19920903

State of North Carolina
Department of' Environment, Health, and Natural Resources
Division of Environmental Management
512 North Salisbury Street • Raleigh, North Carolina 27004
James G. Martin, Governor September 10, 1992 A. Preston Howard, Jr., P.E.
William W. Cobey, Jr., Secretary Acting Director
Bromley Plastics Corporation
Mr. David Katterman, President
29 Apple Tree Way
Asheville, North Carolina 28805
Dear Mr. Katterman:
Subject: Proposed Fill in Headwaters or Isolated Wetlands
Henderson County
DEM Project # 92433
Upon review of your request for Water Quality Certification
to place fill material. in 0.001 acres of wetlands for utility
crossing of a stream located in Henderson County, we have
determined that the proposed fill can be covered by General Water
Quality Certification No. 2664 issued January 21, 1992. A copy
of the General Certification is attached, This Certification may
be used in qualifying for coverage under Corps of Engineers'
Nationwide Permit No. 12.
If you have any questions, please contact John Dorney at
919/733-1786 or 919/733-1787.
Sincerely,
Y.r-Aerston ?iowa , Jr. P . E .
APH:JD
Attachment
cc: Wilmington District Corps of Engineers
Corps of Engineers Asheville Regional Office
Asheville DEM Regional Office
Mr. John Dorney
Central Files
David R. Day, Day Environmental Services
RF,GIONAL 0MCI--S
Asheville Fayetteville Mooresville Raleigh Washington Wilmington Winston-Salem
704/251-6208 9 19/486-154 1 704/663-1699 9 19/57 1-4700 919/946-6481 9 19/395 -3900 9 19/896 -7007
Pollution Prevention Pays
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone]
Air Equal Oplx>rtunity Affirmative Action Employer

EXORANDUM
O: John Dor
Planning
UBJECT: WETLAND
***EACH ITEM MUST
1 ?
PERMIT_YR: 92
APPLICANT NAME: BRI
PROJECT-TYPE: SE!
COE_#: 19'
RCD_FROM_CDA: AP:
REG_OFFICE: AR(
PN/?,
STREAM-CLASS: ( ,S -I'- " 7_"CZ;r_1
STR_INDEX_NO:
(_,-S-7-10
WL_IMPACT?: Y40
? WL_R.EQUESTED : 0-0 a l A? k s
HYDRO_CNECT?: /N
MITIGATION?: Y?
ITIGATION SIZE: '`_/'d
WL_TYPE : /V/14
WL_ACR_EST?: YN
WL_SCORE(#): /v
T I GAT I ON_TYPE :
IS WETLAND RATING SHEET ATTACHED?:ON
RECOMMENDATION (Circle One): SS ISSUE/COND DENY
COMMENTS : /,_/
S:
v:
o
c: Regional Office
Central Files
2819?
WEI LANDS GROUP'

WETLAND RATING: SYSTEM WORKSHEET
Project No. or description
Location
County Nearest road or town e fc 1 f/ C
River Basin
,,r„r g,¢,dAd
Nearest stream ,ppwv_u- -C .and classification _I-VS
Evaluator
Agency and address
Date and time evaluated -"&
Major Wetland Type
Approximate size of wetland system. acres
Approximate extent of wetlands in area acres
within / miles
Three most common plant species (in order):
1.
2.
3.
Soil Series (if known)
Hydrologic indicators
Direct surface hydrologic connection?
Existing Conditions
YES NO
Drainage ?,,.-•"•,oT
Disturbance
Restoration potential
Restoration value 6Z,.,, 2' 2no urQ JG p- ?__ _
Is site known to provide habitat for rare, endangered or threatened
species? If so, list species observed or recorded.
Item Number
I. Location/Landscape
1 Natural area buffer
2 Sensitive watershed
3 Dispersal corridor system
II. Ecological Values
4 Special ecological attributes
5 Wildlife habitat
6 Aquatic life
7 Water storage
8 Streambank stabilization
9 Removal of pollutants
III. Human Values
10 Outdoor recreation/education
11 Economic value
Total. Snore
Score (circle one)
5
5
4
2
1
0

5 4 3 2 0
5 4 3 2 1 0
5 4 3 2 Q 0
5 4 3 2 1
5 4 3 2 1 0
5 4 3 2 0
5 4 3 2 1 0
5 4 3 (0 ) 0
5 4 3 2 & 0

Site description and notes:
..M ...
-. ,( Idw-:I uoq?\1 •?nnrui,glV Am m -hiO 1-1, 1 ,V
VIOL EtL61(, •nunld;)JJJ, 5E50'()E9LZ euyO-Ic_) i{>JON 1 ?St?6Z ofl C)?,I
sAed uo!WA )Jd uo!inllod
LOOC968/610 (MPSW616 1869'WV616 OOLV ILS/616 66914991h)L 1651 )RV/616 80i9-1SUVW
waleS-uwsulM uO)Yunull/1V U0JJI yn:A\ IlMalv'f IJJIASJ10014 a!linana,W.l all!AaLJs
SIDIiK) IVN(?IJJ2I
AOUJOU • d UgOf "JW
aoTJJO TPUOTbad WSQ :oo
z4T•oTTddv
gwPTPO OTJH
'AT030OUTS
'98LT-EEL-6T6 -412
Aau-TOQ Uuor -JW 30 aw TTPO asPaTd 'suOTgsanb Aup aAPq noA jI
• pa4PT4TUT aq upo gsanba.z .znoA go MaTA@J
aqq geuq os (saTdoo uanas go Tegoq P) saTdoo TPuOTgTppe xTs pugs
pup (9T pup ST suoTgTpuoo jog gdaoxa) wJOJ p0u3P4ge au4 0q@Tdwoo
asPOTd asTM.zaug0 • aoua.zanouoo UOggTJM uTpggo oq paaTnba.z -}ou eap
noA a.zop up go (EST) p.zTu4-au0 uPug ssaT zo oq Tenba ST AgT11TgDP
TTT3 .znoA pup 9Z # gTw.zad apTMuOTgPN buTZTTTgn a'zp noA 41
'PTTpn ST gTWJ@d ap-rMUOTJeN auq a3ogaq
uoTsTnTQ auq wo.z3 aouejanouoo uaggTjm a.ZTnba.z su0Tge3TJTgJ03
T2.zaua0 au4 3o Te.zanas 'zanaMOu 'sgTwjDd apTMUOTgPN
auq Jo gsow 0J uoTsTnTQ Oqq Aq anssT uaaq anpq su0TgP3TJTg383
TPaauaO 'uoTsTnTQ aqq Aq panssT uaaq seq uoTgeoT3Tq.za3
A4TTpno aageM TOb P TT-4un pTTPn qOU ST 4Twaad apTMUOTgPN OT44 gPT44
pasTnpp aq asPaTd •4Tw.zad apTMuOTgeN P jog paTgTTpnb goaCoid
.anoA qPT44 buTgPgR (HOD) s.zaauTbua Jo sd.zo0 auq woag je-4gaT
P paATODE)a (WSQ) quawabPuPW TPquawUOJTAUE Jo uoTsTnTQ aqJ
OZAZOZ??) # -40a10.Td 900 'A-4unoO }r, ???'I
N0I,IV3IaLL'dHO XII`IVnO 'dHIVM TO6 ' ZO9.CenS
:wPpPW 10 aTS JPOG
SOS Z
? P J1N
IOJJa11CJ
,a-gd 'nalany l J310aY)
4 / I '5Z tieaalaaS ,.a f 'AagoJ -A we!II!/X\
D J0U1an0I)'uialew •-
') Sawe(
'y,'l!aled .lamas tings!les T1oN Z15
ti09GZ euilole? L11-10N
aUaLUaiJeUew IeauawU01!nU] JO UOIS!ni(J
saDanosa-d lLanjLN pue '41IL'aH 'JLlaWU0-IInu3 30 iuawj.iedaCI
U1110JUD 41.JON 40 aIpIS

pue swaaq agq gqTM ATdwoo aa6uoT ou pTnoM A4TAT40e aqq gegg Bons 'paT;Tpow
ST ao 'pa%onaa ao papuadsns sT ao saaTdxa UOT4PzTaoggnv dMN aqq 'saveA Z agq
6uTanp ;I •UOTgszTaoggna dMN aqg ;O UOtgeOT;Tpow guenbesgns Cue gqTM saTTdwoo
dgTATgOe aqq ao UOTgeOT;Tpow gnoggTM penssTea sT UoTgvzTaogqne dMN aqq
'pOTaad gsgq 6uTanp '3T salad Z aqg ao; pTTPA uTPwaa IITM uOTgeOT;TaaA sTgg
'osTy •paxonaa ao 'penssTea 'paT;Tpow BT UOTgezTaoggne apTMuoTgeu aqq ssaTun
aaggaT sTgg ;O agep aqg woa; saROA Z ao; pTTeA aq IITM uOTgeOT;TaaA sTgl
•uOTgeOT;TgaaO ao aaATeM aqg ;o gdTaoaa uodn aATgoa;;a ST gTwaad
sTgg •xaoM pasodoad aqq ao; UOTgeOT;TgaaO A4TTenb a84VM JO aaATeM a uTsggo
og '98LT-££L (6T6) euogdeTeq '4u9w96eueyq TequawuoaTAua ;o uosTATa eUTToaea
ggaoN 'Aeuaoa ugor •aw gosquoo aseald •Tenoadde TeooT ao agegS paaTnbea
due uTEggo og A4TTTgTsuodsea aqq ;o noA OABTTaa qOU saop gTwied apTMUOTgeU
sTgl •suOTgTpuoO pasOTOua aqq gqTM 83uepao00e 4OT248 UT pagsTTdwooov
BT qT papTAoad gTwied apTMuoTgeu sTgq Aq pazTaoggne BT XaoM anox
•sanoguoo uoTgonagsuoo
-aid UT 86uegO oU ST aaagq papTAoid 'seangonags axequT pue TIP;qno 6u7pnTOUT
'sauTT AgTTTgn ao; 6uTppaq ao TTTjNovq ao; TeTaagew 3O 96a8gOaTp aqg JO;
papTAOad seM 'qoV aageM ueaTO aqq ;o v0V uoTgoes oq queneand 'UOTgezTaoggnv
-sgTwaad epTMuoTgeu sgsTT 'T66I 'ZZ aagwanoN UO a948T68H Teaapa3
aqg uT PagsTTgnd '9'0££ gaed '(HaD) suO74eTn6ag Teaepej 3o aPoO '££ 914TI
'weaboad AaogvlnbaH ,saaeuT6u3 ;o sdaoo Away •S•n aqg ;o sesodand aqq ao3
•saag2M gnoaq oq sgoedwT asaeApe TETquagod RUe
ao; (02IM) UoTssTwwoa saoinosag a;TIPITM 'a'N aqq dq paMaTAaa ueeq seq goa?oad
eqs •euTToaea ggaoN 'Agunoa equwo 'aagogaT3 uT xaaaa euea oq AaegngTaq
paweuun UP ssoaoe uTEw aaMas AaegTues OAd 4OUT-8 Us TTsgsuT oq uoTgszTaog4n8
Away aqq ;o quawgaedau ao3 'Z66T IS AEN ;o uoTgeoTTdde anoA aouaae;ag
: Ava ' aw aeaa
S088Z PUTTOaea ggaON 'OTTTAaLIOV
deM eeas etddli 6Z
'3'd 'APa -d PTAeQ •aN
uoTgvaodaoa sOTgsgTd A8Twoa9
(6uTppeg
PUP ITT;XOP8 aUTq A4TMfl) S'E'A"ON gTwaad apTMUOTgeN PUP OZVZOZ66T -aI UOTgOV
gousag AaogPTn6ag
Z66T 'ST aunt 01H313HAld3WN1
069VZOV9Z VNI108VO H1HON NOIDNIWIIM
069 L X08 'Od
SN33NION3 :10 Sdd00 `laldlSla N0IONIWIIM
AWad 3Hl JO 1N3W1ddd3a
y f, r?
11
L89L-TT9LZ EuTTOaED ggaoN 'g6TaTEg
L89LZ xog aoT;;O gsod
saoanosag TvangvN
puE 441EOH 'guewuoaTnuH
;o guawgavdea vuTToavo ggaoN
gu8w86EUEW TvguawuoaTeuH ;o uOTsTnTQ
uoTgoaS AgTTvno aagvM
Aouaoa ugor • 9
L89L-TT9LZ EuTTOaEO ggaON 'g6T8TEg
L89LZ xog aoT;;O gsod
saoanosag TvangeN
puE g4TEaH 'guawuoaTnuN
;o guewgaedea EuTToaRD ggaoN
aaxaed ugor • aye
:(eansoToue gnoggTm) pagsTuana saTdoo
eansoTouH
gouvag Aa04vTn6ag ';eTgO
4g6TaM auAvM •O
' AleaaouTg
•9S80-6SZ (VOL) gv aoT;;O AaogvTn6eg
aTTTeagsV ano UT aai{vg PTnva •aH og pesseappv aq Avw sguewwoo ao suoTgseno
•uoTgvzTaoggnv egg eXonea ao 'puedsns
'd;Tpow og sTsvq asvo-dq-asvo v uo posToaaxe ueeq svg A4Taoggnv dxvuOTgaaosTp
sseTun 'uoTgvoonaa ao uoTgvoT;TPOw 'uOTgvaTdxe s,dMN agg ;o egvp egg ;o
sgguow ZT uTg4Tm pegaTdwoo ST AITnTgov egg P8PTnoad pezTaoggnv uTvwea TTTm dMN
egg uodn 80UVTTOI UT eouewwoo og govaguoo aepun eav ao (uoTgonagsuoo aepun eav
'•a•T) Peouewwoo anvq goTgm OBTITATgov 'uOTgvzTaoggnv dMN agg ;o suoTgTpuOo
-
Z-4 44 •

DEM ID: 12-43
NATIONWIDE PERMIT APPLIED FOR (PROVIDE NATIONWIDE PERMIT 0):
JOINT APPLICATION FORM FOR
NATIONWIDE PERMITS THAT REQUIRE NOTIFICATION TO CORPS OF ENGINEERS
NATIONWIDE PERMITS THAT REQUIRE SECTION 401 CERTIFICATION CONCURRENCE
NATIONWIDE PERMITS THAT REQUIRE INDIVIDUAL SECTION 401 CERTIFICATION
WILMINGTON DISTRICT ENGINEER
CORPS OF ENGINEERS
DEPARTMENT OF THE ARMY
P.O. BOX 1890
WILMINGTON, NC 28402-1890
ATTN: CESAW-CO-E
Telephone [phone]
WATER QUALITY PLANNING
DIVISION OF ENVIRONMENTAL MANAGEMENT
NC DEPARTMENT OF ENVI -
AND NATURAL RESOD
P.O. BOX 29535
RALEIGH, NC 27626-05
ATTN: MR. JOHN DORNE
Telephone [phone] a
ONE (1) COPY OF THIS COMPLETED APPLICATION SHOULD BE SENT T.LN"MW
ENGINEERS. SEVEN (7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF
ENVIRONMENTAL MANAGEMENT. pLEASE PRINT.
1. OWNERS NAME:
2. OWNERS ADDRESSt
A Of &b!(- 'a SZ 37
a
hors t& , /v
3- OWNERS PHONE NUMBER (HOME):
I??I ZS Z?9s'O ?. (WORK): 72y ^ Z ] (1..s Z S-,
4. IF APPLICABLE: AGENV5 NAME OR RESPONSIBLE CORPORATE OFFICIAL,
PHONE NUMBER: D?1/ ) /Z. D'4V . P .W C'" N'a" zr.. -- ADDRESS,
7
-
U L4 -
5 • LOCATION OF PLANNED WORK (ATTACH MAP). COUNTY: tt?'IVG?/SGtJ
NEAREST TOWN OR CITY: ?tG/L --
SPEC?FIC LOCATION (IN LI,%ROAD U BERS, LANDMARKS, ETC.):
6. NAME OF CLOSEST STREAM/RIVER: eigf/ &wa.(-
n
7. RIVER BASIN:
k-
8. IS THIS PROJECT LOCATED N A WATERSHED CLASSIFIED AS TROUT, SA, HQW, ORW,
WS I, OR WS II? YES ( NO ( )
9. HAVE ANY SECTION 404 PERMITS BEEN PRE}GIOUSLY REQUESTED FOR USE ON THIS
PROPERTY? YES ( ) NO
IF YES, EXPLAIN.
10. ESTIMATED TOTAL NUMBER OF ACRES OF WATERS OF THE U.S., INCLUDING
WETLANDS, LOCATED ON PROJECT SITE: i al©/ gt'e1.'c?
3/30/92
? 1a 4 Ah --/LCiv, /?rPS co?,
¦

3IYa 3HnIYNJIS S,UZNMO
=7?)/ -/77"7-
L'IYSOdSIa 3JYM3S d0 aOHI3W a3SOdOHd SI IYHM '3'ISYOIZddYUdI 'd
/ (.4fSn T d17t IXXH3dO)td JNIaNnODUnS JO 3SL: aNW7 SI LYHM '3
'xdOO
HOYIIY 'IO3roUd SIHI Hod a3HIna3H SI NY'Id IN3W3JYNYW H3::YM4HOIS Y dI 'a
3NI'I NOIIY3NI13a 3HI d0 INMOY'Id 3HI OI INYARlad
SI33$S viva `i7v 3an'IONI 'INVI'IASNOO Y As a3KHOJU3d SVM NOIIYHNI'I3a dI 'O
I A
4'IO3roHd
x8 QIZOYdWl ?? OIL f;QNY7I3M d0 HdYHOOIOHd 3AIIYIN3S3Hd3H '3'ISY'IIYAY dI '8
'xIH3dOHd 3HI
No 52*V.7- ANY l9wvau.LS 'SaMell3M 'ITV JNIMUHS dVK NOIIY3NI73a aNY7I3M 'Y
:W3a x8 a3HIn03H NOIIYWHOdNI 'IYNOIIIQaY 'LT
'SdUO0 OI a3aHYMHoa as a'MOHS OdHS 3HI WOHA
ON ) Sax ZOS 3NOa nox aAv h
LIOZMIfd a3SOdOHd 3HI AS a3I03ddY 38 xYW
HOIHN YXl ZZNHXd XHZ NI S3IIH3dOHd OIHOISIH JO 3ON3SZUd 3HI ONIaHYJ3H (Odns)
9201440 NOX&VAUXOSHd OIHOISIH 3IYIS 3HI IOYINOO OI a3HIna3H 3HY nO '97
06"00 OZ ClXq $iHOJ 38 a'InOHS s"N HO/mm SMdSn 3HI HOHd S3SNOdsfp
( 1 ON ZI ) Sax LOS 3NOa nOx 3AYH 'IO3rOHd a3S,idOdd
3I x3 QXZ0344V ail xYW Y3HY LIKHSd 3HI HI -LVXISYH 7VOIIIHO HO S3 03dS
Q3NBZVXWRZ 40 QXi30NYQN3 ONIISI7 HOd a3SOdOHd HO a3ISI7 x77"3Q3.d x, Y HO
3aN38944 XI" VNZQi(CXV (S$WN) 30IA)13S S3IH3HSId 3NIHYW ZYNOIIYN HO/aNY.(So. ISM
XDZAVXI 24l'1Q'II/I aNY HSId 'Son 3HI IOYINO0 OI a3HIn03Y 39Y nOx 'ST
- T -. , - -. - , WUT-If nrb a'/a1''lr ^wl/ Off[. n!r ' S. ;'??idWZ
MM 43W 31THINIX OS NMI SMSY3W 3ION 'OSTY ' SQNY'II3M NI IAO a dIHHYO
38 ZPAN xZIAIZOW SIHI IVHI S3AM38 INYOI'IddY 3HI AM SNOSY3H 3IYIS -VT
?(v S `
S :XWOM QIsodo'dd .d0 3S rurld *V r
o7O! ! Z, s s(SNY'Id HOYIIY) XVOM a3SOdOHd d0 NOIIdIHOS3a 'Zr.
/00- : a3IOYdWI 'IYIO,L
n-,V& /Po . 7577- k t a3IYAY0x3
aaaoo'Id
=a3NIYHa
a3'I'IId
' :I03roUd a3SOdOkid 3HI
AS a3IOYdWl 'SQNY'II3M ONIQi. T ''S'n 3ILL do SH3IY14 do S3HOY d0 H38WnN 'TT
-Z-
.tMoldw-1 uo11:YV anpeuu!NV ,Oiunlxddo lenbl uV
SIOL-££L-616 .nualdalaL S£SO-9z9LL eu110.ie:) yuON 'ykli.)Iq '5£562 XO8 Od
SAPd uouuana.,d uolinllod
LOOL9681616 006£'56£/616 IM9P6/616 00L6-IL9/616 6691-£99/WL Ib51-90/616 RON-15UboL
wales-UO1SUl/X\ UOI4ulwllm uoj9ulyse/X\ yylalP21 alllnsaUOOW alNnauatel alynaysV
SIDIJJO IVNOIDMi
AauaOQ g uu0LI ' IN
OOTJ30 TPUOTbag NEC , - :oo
? 'a-4 T•0TTddV
gw-eTPO OTJS
'ATaaaouTg
'98LT-EEL-6T6 qp
AaUJOG uuor •aW ao aw TTPO asPaTd 'suoTgsanb Aue anew noA jI
•pa?PT4TuT eq uPO qsanbaa anoA go MaTnaa
auq gpuq os (saTdoo uanas 90 TP40q P) saTdoo TPUOTgTppP xTs puss
Pup (9T Pup 9T suoTgTpuoo JOJ gdeoxa) waOJ pagOPgqe auq O4aTdwoo
asPOTd asTMaaggo •aouaaanouoo UOggTaM uTPggo oq paaTnbaa -.ou eaP
noA aaoP up go (EST) paTgq-euO uPuq sseT aO 04 TPnba ST AgTnTgoP
TTT3 anoA pup 9Z # gTwaad apTMuOT4PN bUTZTTTgn a'ze noA gI
'pTTPn ST gTwaad apTMUOTgPN auq a.zogaq
UOTSTnTQ auq woag aouaaanouoo uaggTaM aaTnbea suoTq?OTJTgaa3
TPaauaO auq JO Teaanas 'zanaMOu 'sgTwaad apTMUOT4PN
auq go gsow JOJ UOTSTnTQ aLjq Aq anssT uaaq aA?q suoTq?OTJT-4a00
TP.zaua0 •UOTsTnTQ auq Aq panssT uaaq sPu uoTgPOT9Tgaa3
AgTTPna aagPM TOb P TTqun PTTPn qOU ST gTwaad apTMuOT4PN auq gpuq
pasTnpP aq aseaTd •gTwaad apTMuOT4PN e aOJ paT9
TTenb qoaCoad
anoA gVgq buTgPgs (HOD) saaeuTbua go sdao0 auk woag as-4'4aT
P panTOOaa (WSQ) quawabPuPW TPquawuoaTnua go UOTsTnTO aqy
O?hZOZha? # -4oaCoad goo 'A-4unoO
Nozs?r?z3zs??? zsrz?rn? ??s?M Tov ?s??rans
:wepPW ao arg aeaa
Saga Z ?/??sv
ao»aala
'4'M '11aJan3 1 a??10a7
Una gas ,.i('.(a9OD A we!II!A\
D 1? aoulanoD 'uuaeW •D Sawef
b09LZ eu!IoaeJ ylaoN 'g2!;)Iq . iaawS Aangs!jeS 4JON Zl5
auawa2euew leauawuOJIAU] 40 uo!S!n!Q
s;)Djnosa-d leinI N pue 'gi[eaH '4uaWuo.zinu] Jo iuauaiieda4
euilo.zeD T-ION 40 ;)It!
Z6/C;
ONIcnioNI ' • s'n 3H,L .d0 S1inymjo S32io?t ao ua8Hf N gIZoLaHLKHI.LSS3 OT
l y
'OT
( l six NIK7dX3 'Sax Ji
yi o
sIH.L NO 3Sn 1?Od c3,LS3nb31i xasnozA'S d) N33N8 ZALHadoxd
SyIHU3d VOV NOIXOHS ANV 3AKH '6
( ) ON y1) Sax L I I SM Ho ' I SM
'muo 'MbH 'KS ',LnoMy SK 03IjISSK73 03HSH3,LK14 V N 03.LKOOZ 103r01ld SIHX SI •8

:NIsys HaAIH -L
v
7f??l/J :IiHAIH/KVTdXS LSaso'M 3o 3HKN .9
mtoli
I1ubmi) NOI,LvoOI oI3f'o3dS
r : XXIO Ho NMO,L ,ESa-dvaN
xuoM 03NNf1'Id .do NOI,L ioo'I • s
('oy3 1sX1mawi 'I 'Sum
2/
/`N? ? :XXMnoo ' (dW HOVXXV
'SE::tZi00ti ''IHIOI3J0 3lY1iOd1i00 3ZHI-," g / A-UQ Z 1n I sM3HHnN 3NOHd
3HYN S „LN3OY = 3'IHYOI'Iddv d I .11
hQZ _ (XU014) .L Off' h : (3HOH) 1138HnN 3NOHd Su3NM0 -E
b-2S'Z- O
1882 Win/ ?? ?? LEQ-5 -e 'Y?Pil ,2 Gl : ssawav sx3NMo • z
, SOW 'ry? ? LIG ?J,if Ltd s aKVN S'd3NMo • T
v
'y 3s?r3'I
30 NOISIAIC ' •,LN3H3O?(NKH ,VXU.aHN0dIAN3
o•N 3Hy py XN3S 38 QznOHS SSU03 (L) N3A3S 'S1i33NION3
?-
N01103S Aflldfl
"llyn !1 1 Z XNHS 38 GUMS NOIXVOIZddV c3X31dHOO SIH.L CIO AdOo (T) 3No
(., 4089 SaNN113M
E8 S-EEL (6T6) euogd8T8y
3NUOC NHOr *uW :NXXV TTSb-TSZ (6T6) euogd8Tey
S0-9Z9LZ ON 'HOIPAM
SES6Z X08 'O'd 3-OO-MFlS3o :NyyV
nOS311 Tt1i(lyvN QNY 068T-Z068Z ON 'NOXONIH'IIM
IAN3 30 ,LN3Hy2IYd3c ON 068T X08 'O'd
XN"? gaDVNVH 7WIN3HNOUTAN3 30 NOISIAIQ
S1is'L '33NIOd0Na 30 SJo d 1i0 'H0 0
ONINNK'Id xyI'zfrnb 1i3.LKM 0
2i33NION3 loIuxsI0 NOXONIH'IIM
NJIZYOIJI;LHZO TOb N0IZ05iS mrnQIAIQN2 2XIn6aW XvRX ssIxuad SQIMNOIX"
3=?NXHUMMO-3 NOIZYOIdIS1i23 T09 MOIW29 2xIn62V XVRX 9XrK 2d 3QIMNOIzvm
NOIZ\CJIdISOm 31IInbr2a ZKHZ slINvad 3QIMNOIxvm
1 MHOA NOIZ1foI'Idiv ZNIOL'
(f XIWdHd 3clMN0IXVN 3cIAOUd) UOJ c3I'IddK ,LIKHad 30IMNOI,LYN
'GI NOIyo c
L Z :QI HTQ
Nfwl ?`a?urr ll y{,'.. kl y:9 `l µ?L .?.?.L
1? v
-2-
11. NUMBER OF ACRES OF WATERS OF THE U.S., i, "DING WETLANDS, IMPACTED BY
THE PROPOSED PROJECT:
FILLED: /1`/e
DRAINED: to AN
FLOODED:
EXCAVATED: A 3? s,A _ .,00/ iCjC/ZP
TOTAL IMPACTED: woo/ fieyw
12. DESCRIPTION OF PROPOSED WORK (ATTACH PLANS): ylic4, _
3 3 . PURPPSE OF PROPOSED WORK: ? C rr 5 s 7 i Wr,CP Syti? ? (??
14. STATE REASONS WHY THE APPLICANT BELIEVES THAT THIS ACTIVITY MUST BE
CARRI]?D OUT IN WETLANDS. ALSO, NOTE MEASURES TAKEN TO MINIMIZE OIETLAND
IMPAr'i'S. v ormCQr {D -7~ Ouhllr 3.A o4ar l co??.r t1A
15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SERVICE
(US1'4S) AND/OR NATIONAL MARINE FISHERIES SERVICE (NMFS) REGARDING THE PRESENCE
OR A!Y FEDERALLY LISTED OR PROPOSED FOR LISTING ENDANGERED Ok THREATENED
SPEC.,ES OR CRITICAL HABITAT IN THE PERMIT AREA T MAY BE AtP'ECTED BY THE
PP.OPilSED PROJECT. HAVE YOU DONE SO? YES (7 NO ( )
i?ESPONSES FROM THE USFWS AND/OR NMFS SHOULD BE FORWARDED TO CORPS.
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SUPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE PERMIT AREA WHICH
MAY BE AFFECTED BY THE PROPOSED PROJECT?
NAVF. YOU DONE SO? YES ( J NO
FROM THE SHPO SHOULD BE FORWARDED TO CORPS.
17. ADDITIONAL INFORMATION REQUIRED BY DEM:
A. WETLAND DELINEATIOM MAP SHOWING ALL WETLANDS, STREAMS, AM "LAKES ON
THE PROPERTY.
B. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO 8E IMPACTED BY
PROJECT. „t
a
C. IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA SkEETS
RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
D. IF A STORMWA^aER MANAGEMENT PLAN IS REQUIRED FOR THIS PROJECT, ATTACH
COPY.
E. WHAT IS LAND USE OF SURROUNDING PROPERTY? Grw"2-L94' Z-", us fr» a I
F. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
?ublti?
7? z
OWNER'S SIGNATURE DATE
IMPORTANT' -[ 2 O Z
t
n
To Cl?r?? -- - -- -- -)-J - -
Date Time_-! d
Q `WHILE YOU WERE OUT
M Llt? _ _
Phone_-_ !?_ Q g q _
AREA CODE NUMBER EXTENSION
TELEPHONED PLEASE CALL
CALLED TO SEE YOU WILL CALL AGAIN
WANTS TO SEE YOU URGENT
RETURNED YOUR CALL
Mes e V by v'
? ? ?? 1 ?7I!?SvrY?- vv? // r1 Qr'
W U)

N.C. Dept. of Environment, Health, and Natural Resources
D Printed on Recycled Paper