Little River Bank Restoration

NC Department of
Enviro Received uality
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Winston-Salem
o_. ;nnnl office
.braze Or Norm laronna
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:
-IF Has the NWP or -GP
number been verified by the
Corps?
-
Yes No
-
1c. Does the project meet all
the Conditions of the
applicable Water Quality
Certification
V Yes No
y�
Please note that your project may be subject to the Sediment and Erosion Control Program
implemented by the Division of Energy, Mineral, and Land Resources. Find more info at:
https://deq.nc.gov/about/divisions/energy-mineral-land-resources/erosion-sediment-control
and/or Trout Buffers
2. Project Information
2a: Name of project:
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2b. County:
2c. Nearest municipality /
town:
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Owner Information
3a. Name(s) on Recorded
Deed:
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3b. Responsible Party (for
LLC if applicable):
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3c. Street address:
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3d. City, state, zip:
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3e. Telephone no.:
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3f. Email address:
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4. Agent/Consultant Information (if applicable)
4a. Name:
4b. Business name
(if applicable):
4c. Telephone no.:
4d. Email address:
B. Project Information
-
1. Property Identification W_0 k --'u- r`( AvbQes��'. -39� ��JQ(Siae �(Z
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1 a. Property identification no.
(tax PIN or parcel ID):
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1b. Site coordinates (in
decimal degrees):
Latitude:y�, Longitude:-85,4(D76o3
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2. ProjectDescription
2a. Explain the purpose of the proposed project (continue on back):
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2b --Describe ttie overall project in detail, including the type of equipment to be used:
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C. Stream Impacts: Please list all proposed impacts to the stream
1a. Stream Name: L( � 2( U C=�-
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Type of impact
Average stream
width (linear feet)
Impact length
(linear feet)
Bank Stabilization - Sloping and Revegetating
❑ Bank Stabilization - Sloping and Riprap/Armoring
❑ Bank Stabilization - Gabion Baskets / Retaining Wall
Culvert Installation
Culvert Diameter: �D "
❑ Temporary Impacts for required dewatering activities
❑ Other (describe):
1c. Comments:,
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Owner/Agents Signature
(Agents signature is valid only if an authorization letter from the owner is
Owner/Agents Printed Name
Date
provided.)

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