20190860 Ver 1_401 Application_20190423

Water Resources
Environmental Quality
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02H .0506(b)(4) Water Quality Certification,
Notification of Work in Trout Watersheds
FORM: TroutWS 11-2017
Notification of Work in Trout Watersheds Form
A.
Applicant Information
1.
Processing
1a.
Specify Nationwide Permit (NWP) number: 13 or General Permit (GP) number:
1 b.
Has the NWP or GP number been verified by the Corps?
❑ Yes 21 No
1c.
Does the project meet all the Conditions of the applicable Water Quality
Certification
r7f Yes ❑ No
Please note that your project may be subject to the Sediment and Erosion Control Program and/or Trout Buffers
implemented by the Division of Energy, Mineral, and Land Resources. Find more info at:
https://deq.nc.gov/about/d ivisions/energy-mineral-land-resources/erosion-sed iment-control
2.
Project Information
2a.
Name of project:
%fjp o
2b.
County:
SUrr
2c.
Nearest municipality / town:
D Ob SUN
3.
Owner Information
3a.
Name(s) on Recorded Deed:
T C L C
3b.
Responsible Party (for LLC if
applicable):
I
ff o
3c.
'Street address:
° 16 v a ; d r, E 54 a IJ
3d.
City, state, zip:
�ob5o�� , N c- 'q-70 I "
3e.
Telephone no.:
33 �}'� f - �(pp a
3f.
Email address:
n o 0.11 re o 5 C AbL. C�
4.
Agent/Consultant Information (if applicable)
4a.
Name:
j�Gtn 0 Le p 11
4b.
Business nameC
(if applicable):
�Ce �0��N 9 w L �1�(�0 n►'�'l�l , LL C
4c. Telephone no.:
331p ^ 344, 69i40
4d.
Email address:
QC2 9 ra( ���1 t 1 C 1Q SUM
B.
Project Information
1.
Property WentHication
la.
Property identification no. (tax PIN or parcel ID):
V38 00 /L./ Z(9 /S1-
1b.
Site coordinates (in decimal degrees):
Latitude: 3(P . y3?b/ot Longitude: - qi). q48 I10i
(DD.DDDDDD) (-DD.DDDDDD)

Z Proyect Description.
2a. Explain the purpose of the proposed project (continue on back):
/C) f e_p Q� � 5- ;� I � z e- C_i e K boo 1c ,
2b. Describe theoverall project in detail, including the -type .of equipment to be.used: d
e�JLJ S��'Qan� L4XJ-C W i 44 /,66-f-Gt)adj 4 b�o2 Ltodod ;
&-,1J
02 b c� n k I I be��1, e S w +h Ste'. II a<,-� C ac 2 -F% 134, mei >J9
ReSeed 4- p64- 1-'r ear;n V"e-Fob-iGN « �cjtt<<D�nen'% L� �I �`NC� ltc�2
e5 Cgvoo6r- Qc)oi comjoac4- 16ctde2 -
C. Stream Impacts: Please list all proposed impacts to the stream
1 a. Stream Name: -T oinP--5on IS Brt i7 o—C
1 b.
Type of impact
Average stream
width (linear feet)
Impact length
(linear feet)
19 Bank Stabilization - Sloping and Revegetating
o�v F�
aC)U Ffi
❑ Bank Stabilization --Sloping and Riprap/Armoring
❑ Bank Stabilization - Gabion Baskets / Retaining Wall
❑ Culvert Installation
Cut rt Diameter.
❑ Temporary Impacts for required dewatering activities
❑ Other (describe):
1c. Comments:
Owner/Agent's,Pdrited-Name
Date
Own exYAgentsl Signature
(Agent's signature is valid only if an authorization letter from the owner is
provided.)

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