20040175 Ver 1_COMPLETE FILE_20040206

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Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
September 9, 2004
Kenneth Foster
835 Breezy Shore Road
Bath, NC 27808
Subject Property:
Approval of 401 Water Quality Certification and Authorization Certificate per the Tar-Pamlico
River Buffer Protection Rules (15A NCAC 2B .0259) with Additional Conditions
Dear Mr. Foster:
You have our approval, in accordance with the attached conditions and those listed below, to place fill
within or otherwise impact 0.16 acres of wetlands, 36 feet of streams and 3,400 square feet (ft ) of
protected riparian buffers for the purpose of constructing a road\.at the subject property, as described
within your application dated July 13, 2004 and received by the N C. Division of Water Quality (DWQ)
on July 19, 2004. After reviewing your application, we have decided that the impacts are covered by
General Water Quality Certification Number(s) 3404 (GC3404). The Certification(s) allows you to use
Nationwide Permit(s) 14 when issued by the US Army Corps of Engineers (USACE). This letter shall
also act as your approved Authorization Certificate for impacts to the protected riparian buffers per 15A'
NCAC 2B .0259. 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, and Non-discharge 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 purpose and design that you 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:
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)
Alan W. Klimek, P.E. Director
Division of Water Quality
DWQ Project # 04-0175
Beaufort County
Page 1 of 3
Breezy Shores S/D, Breezy Shores Road, Bath, NC
Gar Gut tributary to Pamlico River [03-03-07, 29-22, SB NSW]
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: http://h2o.enr.state.nc.us/ncwetiands
None hCarolina
Naturally

Kenneth Foster
Page 2 of 3
September 9, 2004
Stream 36 (feet)
404 Wetlands 0.16 (acres)
Buffers 3,400 (square ft.)
2. Deed Notifications - Deed notifications 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. A sample deed notification can be downloaded from the 40l/Wetlands Unit
web site at http://h2o.enr.state.nc.us/ncwetlands. The text of the sample deed notification may be
modified as appropriate to suit to this project.
3. 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 as identified within 15A NCAC 2B .0259 (5). 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.
4. 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.
5. 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.
6. 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.
7. 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
Kenneth Foster
Page 3 of 3
September 9, 2004
required. A copy of this permit and monitoring report forms may be found at
http://`h2o.enr.state.nc.uslsulForrns Documents.htm.
8. 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.
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.
Any disputes over determinations regarding this Authorization Certificate (associated with the approved
buffer impacts) shall be referred in writing to the Director fora decision. The Director's decision is
subject to review as provided in Articles 3 and 4 of G.S. 150B. `
This letter completes the review of the Division of Water Quality under Section 401 of the Clean. Water
Act and the Tar-Pamlico riparian buffer protection rule as described within 15A NCAC 2B .0259. If you
have any questions, please telephone John Dorney at 919-733-9646 or Bob Zarzecki at 919-733-9726.
Sincerely,
J
Alan W. Klimek, P.E.
AWK/bz
Enclosures: GC 3404
Certificate of Completion
cc: Jay Johnson, PO Box 1601, Nags Head, NC 27959
USACE Washington Regulatory Field Office
DWQ Washington Regional Office
File Copy
Central Files
Filename: 040175
Jay Johnson
P.O. Box 1601
Nags Head, N.C. 27959
[phone]
71
Mr. John Dorney
N.C. Division of Water Quality
401 Wetlands Certification Unit =
2321 Crabtree Blvd.
Raleigh, N.C. 27604 - 2260 WETLANDS/401 GROUP
Subject: DWQ # 04-0175 Beaufort County JUL
2004
Dear Mr. Dorney, WATER
(QUALITY SECTION
Please find enclosed a revised PCN application and drawing for DWQ # 04-0175
Beaufort County. In response to your February 12, 04 letter (attached) I will address each
numbered item as follows:
#1. All impacts are shown for streams subject to the buffer rules including all fill areas on
the revised drawing and in the revised PCN. All fill slopes will be seeded.
#2. All buffer impacts are shown on the site plan and included in the revised PCN.
#3. There is no lot lay out. The owner only wants to be able to access the back portion of
his property.
#4. The impacted stream and its buffers are located on the revised drawing. I have
included USGS topo info and County soil maps to identify the subject feature being
impacted.
#5. I have included USGS topo and County soil maps to identify the subject feature being
impacted.
#6. No sewer systems are proposed. The owner only wants to access the back portion of
his property.
#7. The gravel road proposed will be 870' long by 18' wide (15,660-sq. ft.). The tract size
is 23.79 acres. The percent of project imperviousness is 1.51 %.
#8. There are no stormwater outfalls. Everything will sheet flow onto adjacent vegetated
uplands and wetlands and not discharging directly into any stream. The silt fence will
filter runoff from the fill section until vegetation can be established on the slopes.
#9. Sheet flow is indicated on the site plan.
#10. An agent authorization letter is included with the revisions.
Should you have any questions please call me at 252 341 9802. Thank you for your time
in this matter.
Sincerely,
Jay o n
Office Use Only: Form Version April 2001
USACE Action ID No. DWQ No.
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
1. Processing
1. Check all of the approval(s) requested for this project:
® Section 404 Permit
? Section 10 Permit
® 401 Water Quality Certification
? Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested: NWP 14
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 Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here: ?
H. Applicant Information
1. Owner/Applicant Information
Name: Kenneth Foster
Mailing Address: 835 Breezy Shore Rd.
Bath. N.C. 27808
Telephone Number: 252 923 0222 Fax Number:
E-mail Address:
2. Agent 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: Jav Johnson
Company
Affiliation: Consultant
MailingAddress: P.O. Box 1601. NagsHead N.C. 27959
Telephone Number: 252 341 9802 Fax Number:
E-mail Address:
Page 3 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 full-size construction
drawings rather than a sequential sheet version of the fi l-size plans. If full-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: Breezy Shores
2. T.I.P. Project Number (NCDOT Only): N/A
3. Property Identification Number (Tax PIN): Deed Book 1022 Pa. 306
4. Location
County: Beaufort Nearest Town: Bath
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.):_ From Washington 264 E. to 92
E. through Bath take a right on SR 1745 Breezy Shores Rd Site is on left side of road
before the mini storage site.
5. Site coordinates, if available (UTM or Lat/Long): UTM 18 336447E 3923609N Dec.
Degrees: 35.443N 76.8020W Lat/Long: 35 26' 41" N 7648103"
6.
(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.) Bath Quad
7. Describe the existing land use or condition of the site at the time of this application:Ezisting
forest
8. Property size (acres): 23.79 acre parcel
9. Nearest body of water (stream/river/sound/ocean/lake): Gar Gut trib. to Pamlico River
Page 4 of 12
10. River Basin: Tar-Pam
(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/.)
11. Describe the purpose of the proposed work: Provide access to back portion of property
12. List the type of equipment to be used to construct the project: Typical -construction
equipment.
13. Describe the land use in the vicinity of this project: Residential, Forest
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
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.
No previous permits have been issued. Have already been issued nw1D14 permit from
USACE on this project from original application. March 29, 04 Attached
V. Future Project Plans
Are any additional permit requests anticipated for this project in the future? If so, describe the
anticipated work, and provide justification for the exclusion of this work from the current
application: Road access to the property is the only known permit request at this time
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
Page 5 of 12
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.
1. Wetland Impacts Fill in 404 wetlands
Wetland Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Located within
100-year Floodplain**
es/no Distance to
Nearest Stream
linear feet
Type of Wetland***
Area 1 Fill .02 No > 500' freshwater
Area 2 Fill .14 No > 500' freshwater

List each impact separately and identity temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditching/&ainage, 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 FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http://www.fern&pov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property: N/A
Total area of wetland impact proposed: 7.171 sq. ft. or.16 acres
2. Stream Impacts, including all intermittent and perennial streams = < 40'
Stream Impact
Site Number
indicate on ma
Type of Impact* Length of
Impact
linear feet
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
leases eci
1 culvert 36' UT 24" intermittent

* 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
Page 6 of 12
www.usgs.gov. Several intemet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
www.maRguest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 36'
3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S. N/A
Open Water Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Name
(if applicable) Wat) Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean, etc.

List each impact separately and identity temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
4. Pond Creation N/A
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 watering, irrigation, 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 construction to reduce impacts.
The fill area has been designed for a minimal amount of fill to allow for standard
construction for an access road. Only the wetland areas indicated will be impacted and the
new road requires adequate cover over the proposed culvert. Any runoff from this road
will be constructed to sheet flow onto adjacent vegetated uplands and wetlands and not
directly discharging into any stream. The silt fence will filter runoff from the fill until
vegetation can be established on the slopes.
Page 7 of 12
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.
USACE - In accordance with the Final Notice of Issuance and Modification 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 NCWRP 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.enr.state.nc.us/ncwetlands/strmgide.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.
,16 acres of Mitigation area (1:1) is proposed onsite at this time. Refer to man Upland
area will be graded to wetland elevation and allowed to revegetate naturally. The
USACE conditioned their NWP 14 permit to require an approved mitigation plan prior
to beginning work onsite.
Page 8 of 12
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP) with the NCWRP's written agreement. Check the box indicating that
you would like to pay into the NCWRP. Please note that payment into the NCWRP must be
reviewed and approved before it can be used to satisfy mitigation requirements. Applicants
will be notified early in the review process by the 401/Wetlands Unit if payment into the
NCWRP is available as an option. For additional information regarding the application
process for the NCWRP, check the NCWRP website at htt-p://h2o.enr.state.nc.uslwm/index.htm. If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following information: N/A
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):
IX. Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
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 (DWQ Only)
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.
Page 9 of 12
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 identifyTar-Pamlico
Yes ® No ? If you answered "yes", provide the 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. *Stream Impacts are less than 40'
Zone* s Impact
feet
Multiplier
Mitig t on
1 2,040 3 N/A
2 1,360 1.5 N/A
Total 0 N/A
'Lone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
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.0242 or.0260.
XI. Stormwater (DWQ Only)
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.
There currently is no impervious acreaae on this tract. New impervious acreage would
comprise of the proposed aravel access road. Most to all stormwater will infiltrate or sheet
flow to adiacent vegetated uplands and wetlands and not directly discharging into anv
stream. The silt fence will filter runoff from the fill section until ve etation can be
established on the slopes.
XII. Sewage Disposal (DWQ Only)
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.
No Sewage disposal is proposed at this time.
Page 10 of 12
XHL Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No
Is this an after-the-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 Species, accessibility problems, or other issues outside of the applicant's control).
o `-
Applicant/ en Signatur Dat
(Agent's si ature is valid only if an authorization letter from the applicant is provided.)
US Army Corps Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Cherokee Iredell Mitchell
US Army Corps of Engineers Avery Clay Jackson Polk
151 Patton Avenue ' Buncombe Cleveland Lincoln Rowan
Room 208 Burke Gaston Macon Rutherford
Asheville, NC 28801-5006 Cabarrus Graham Madison Stanley
Telephone: [phone] Caldwell Haywood McDowell Swain
Fax: [phone] Catawba Henderson Mecklenburg Transylvania
Raleigh Regulatory Field Office Alamance Durham Johnston Rockingham
US Army Corps Of Engineers Alleghany Edgecombe Lee Stokes
6508 Falls of the Neuse Road Ashe Franklin Nash Surry
Suite 120 Caswell Forsyth Northampton Vance
Raleigh, NC 27615 Chatham Granville Orange Wake
Telephone: [phone] Davidson Guilford Person Warren
Fax: [phone] Davie Halifax Randolph Wilkes
Washington Regulatory Field Office Beaufort Currituck Jones Pitt
US Army Corps Of Engineers Bertie Dare Lenoir Tyrrell
Post Office Box 1000 Camden Gates Martin Washington
Union
Watauga
Yancey
Wilson
Yadkin
Page 11 of 12
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7F9 Michael F. Easley, Governor
?O+ , QG William G. Ross Jr., Secretary
? y North Carolina Department of Environment and Natural Resources
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O Y Alan Klimek, P.E., Director
Division of Water Quality
Coleen H. Sullins, Deputy Director
Division of Water Quality
February 12, 2004
DWQ # 04-0175
CERTIFIED MAIL -RETURN RECEIPT REQUESTED Beaufort County
Kenneth Foster
835 Breezy Shore Road
Bath, NC 27808
Subject Property: Breezy Shores
Dear Mr. Foster:
On February 6, 2004 the Division of Water Quality (DWQ) was notified by receipt of your application regarding your plan to
fill wetlands or waters for the purpose of providing access to property in Beaufort County. Approval from DWQ is required
to disturb these areas. Please provide 7 copies of the following information and refer to the DWQ # listed above in your
reply. Please show these on maps of suitable scale (for instance V = 100 feet) so we can begin to determine your projects'
compliance with 15A NCAC 2H.0500.
1. Please show all impacts on streams subject to the buffer rules including all fill slopes, dissipaters, and bank
stabilization on the site plan.
2. Please indicate all buffer impacts on the site plan.
3. Please indicate proposed lot layout as overlays on the site plan for the entire site.
4. Please indicate the location of the protected buffers as overlays on the site plan. Please provide legible copies of the
USGS Top@ and County Soil Survey so we can determine which features are subject to the buffer rules.
5. Please locate all isolated or non-isolated wetlands, streams and other waters of the State as overlays on the site plan.
6. Please locate any planned sewer lines on the site plan.
7. Please specify the percent of project imperviousness area based on the estimated built-out conditions.
8. Please indicate all stormwater outfalls on the site plan.
9. Please indicate the diffuse flow provision measures on the site plan.
10. Please provide an agent authorization letter which permits Mr. Johnson to apply for your approvals.
Please telephone John Dorney at 919-733-9646 if you have any questions or would require copies of our rules or procedural
materials. This project will remain on hold as incomplete in accordance with 15A NCAC 2H .0505(c). The processing time
for this application will begin when this information is received. If we do not hear from you by writing or by fax at (919)
733-6893 within three (3) weeks we will assume you no longer want to pursue the project and will consider it withdrawn.
Sincerely,
John R. Dorney
401 Water Quality Certification Program
JRD/bs
cc: Washington DWQ Regional Office
Washington Corps of Engineers
Central Files
File Copy
Jay Johnson, Post Office Box 1601, Nags Head, NC 27959
N. C. Division of Water Quality, 401 Wetlands Certification Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 276042260 (Location)
[phone] (phone), 919-733-6893 (fax), (bttp:/lh2o.erLrstate.nc.us/ncwedands)
Customer Service #: 1-877-623-6748
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DATA FORM
ROUTINE WETLAND DETERMINATION
(1987 COE Wetlands Delineation Manual)
Project/Site: Date: -31 3

Applicant/Owner: Ke,?h N•_t_?o e' -ems ??--?___ _
County:
Investigator: ----- State:
Do Normal Circumstances exist on the site? No Community ID:

Is the site significantly disturbed (Atypical Situation)? e No _
Transect ID:
Is the area a potential Problem Area? es No Plot ID:
If needed, ex lain on reverse.) I
--
VEGETATION
Dominant Plant Soecies Stratum Indicator Dominant Plant Soecies Stratum Indicator
1 L c
2 -2
10.
3. Jlo - _ v d)e 'r 3_0
11.-
-
5 .A-yst Jdl.--- 5??. 3-° ---_
13.-- - -- -
---
I
8.-A-y'nar-ia
O{f1C?-ZL_a C 16.-- ---- ---- --- --
Percent of Dominant Species that are 08L, FACW or FAC
t
i
l
d
j
(exc
ng FAC-).
ud
o
Remarks: ` r J2T + a^'Lµ t1Q q G 5 ?? °L? Qiv?1
HYDROLOGY
- Recorded Data (Describe in Remarks):
- Stre4m, Lake, or Tide Gauge
- Aerial Photographs
Other
Recorded Data Available Wetland Hydrology Indicators:
Primary Indicators:
_ Inundated
'ISaturated in Upper 12 Inches
ater Marks
rift Lines

Field Observations: Sediment Deposits
- ?::rainage Patterns in Wetlands
Secondary Indicators (2 or more required):
Depth of Surface Water: (in.) Oxidized Root Channels in Upper 12 Inches
ter-Stained Leaves
Depth to Free Water in Pit: a (in.) _itcrcal Soil Survey Data
• _ FAC-Neutral Test
Depth to Saturated Soil: /
?
(in.) _ Other (Explain in Remarks)
Remarks: we llcA. d yyd,dI oy y (S
B2 Appendix B Blank and Example Data Forms
1 U"'J 7 I.J
SOILS
Map Unit Name
(Series and Phase): al jr ---- Drainage Class:
Taxonomy (Subgroup): `2;eAfjC_ Field Observations
Confirm Mapped Type? Yes No
Profl . Description. Depth Matrix Color Mottle Colors Mottle Abundance/ Texture, Concretions,
(inches) Horizon (Munsell Moist) (Munsell Moist) Size/Contrast Structure. etc
Hydric Soil Indicators:
Histosol Concretions
Histic Epipedon High Organic Content in Surface Layer in Sandy Soils
- Sulfidic Odor _ Or anic Streaking in Sandy Soils
_ Aquic Moisture Regime _ fisted on Local Hydric Soils List
Reducing Conditions fisted on National Hydric Soils List
!Gleyed or LowChroma Colors - Other (Explain in Remarks)
Remarks: wt>// s
WETLAND DETERMINATION
Hydrophytic Vegetation Present? No (Circle) (Circle)
Wetland Hydrology Present? a No
Hydric Soils Present? es No Is this Sampling Point Within a Wetland? Q-. No
Remarks: ?? - `' b ?'r?'?'- t Ct,y-t. ?v'eL?2t-t.l
Approved by HQUSACE 3192
Appendix B Blank and Example Data Forms B3
N19h ?.VP
DATA FORM
ROUTINE WETLAND DETERMINATION
(1987 COE Wetlands Delineation Manual)
Project/Site:Pei 7d?•..{_°v??l?/ Date: 3 03
Applicant/Owner: xg_,2,,? *hY. _+ ____
Investigator: County: _f-
State:
Do Normal Circumstances exist on the site? es No Community ID:
Is the site significantly disturbed (Atypical Situation)? a No Transect ID:
Is the area a potential Problem Area? a No Plot ID:
If needed, explain on reverse.
VEGETATION
Dominant Plant Soeda
1
G
?
' Stratum Indicator Dominant Plant Specio
Stratum Indicator
. }?JL.
r, '
e
ia " 9._ ??t?.?s C?i?.?dr/.•
"
10.E

jU
S.?JJ a ? y rr,.n? -- S?S ?37.TaG 3-e 13. - - -- --
-----
6.??pJy_Q?S? _ i?
Aff/F mac ;, a
- - -
14.
?
S
7.f
ri s??s?v/r1? - _i7° ?G? S?v 1S. -_ -_? ----
?
[
?
8./K?/ 16. - ----- - -- -
Percent of Dominant Species that are OBL, FACW or FAC
(excluding FAC-). `

-------------------

--
Remarks:
(,?'..,/.lca?tiG( !/?2.9? t•5 ???L.°
HYDROLOGY
- Recorded Data (Describe in Remarks):
- Stream, Lake, or Tide Gauge
- Aerial Photographs
Other
_,"?ecorded Data Available Wetland Hydrology Indicators:
Primary Indicators:
- Inundated
_ Saturated in Upper 12 Inches
_ Water Marks
Drift Lines
-
- Sediment Deposits
Field Observations: - Drainage Patterns in Wetlands
Secondary Indicators (2 or more required):
Depth of Surface Water: (in.) - Oxidized Root Channels in Upper 12 Inches
- Water-Stained Leaves
Depth to Free Water in Pit: (in.) - Local Soil Survey Data

Depth to Saturated Soil: (in.) - FAG-Neutral Test
- Other (Explain in Remarks)
Remarks: (AT ?a.,.?? f yG?va ?oo y f S 'Vo ? tai' U?'4
B2 Appendix B Blank and Example Data Forms
at ? h 7,?P
SOILS
Map Unit Name
(Series and Phase): ?p?a Drainage Class:
3 -- Field Observations
Taxonomy (Subgroup): Confirm Mapped Type? Yes No
Profile Descriotiom
Depth Matrix Color Mottle Colors Mottle Abundance/ Texture, Concretions,
(inches) Horizon (Munsell Moist) (Munsell Moist) Size/Contrast Structure. etc.
0( -Z?7,r
Hydric Soil Indicators:
Histosol _ Concretions
Histic Epipedon _ High Organic Content in Surface Layer in Sandy Soils
Sulfidic Odor _ Organic Streaking in Sandy Soils
Aquic Moisture Regime Listed on Local Hydric Soils List
Reducing Conditions Listed on National Hydric Soils List
- Gleyed or Low-Chroma Colors _ Other (Explain in Remarks)
Remarks: S`R 5 c%4,-e. /Jo{
WETLAND DETERMINATION
Hydrophytic Vegetation Present? es No (Circle) (Circle)
Wetland Hydrology Present? Yes
Hydric Soils Present? Yes Is this Sampling Point Within a Wetland? Yes No
Remarks: VA4- ? t 4-LS a,?• ?. /C!eIL-
Approved by HQUSACE 3/92
Appendix B Blank and Example Data Forms B3
835 Breezy Shores Road
Bath, NC 27808
February 20, 2004
The Army Corps of Engineers and
NCDENR, Division of Water Quality
REF: Property Surrounding 835 Breezy Shores Road, Bath, NC
To Whom It May Concern:
I hereby give permission to Jay Johnson to act on any wetland permitting issues for the
above referenced property.
Sincerely,
Kenneth Foster
t

U.S.ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action ID. 200411260 County Beaufort
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Property Owner: Mr. Kenneth Foster c/o Mr. Jay Johnson
Address: P. O. Box 1601
Nags Head, NC 27959
Telephone No.: 252-341-9802
Size and location of project (water body, road name/number, town, etc.) Linear project located
within a 23.8 acre parcel located on the east side of NCSR 1745 (Breezy Shores Road)
approximately 0.5 miles south of the intersection with N C Highway 92 east of Bath in
Beaufort County, North Carolina.
Description of activity Applicant proposes to install two wetland crossings for the
construction of an access road. Work to be accomplished using roadway construction
equipment including bulldozers, graders and backhoes Total wetland impacts = 0.16
acres.
Applicable Law: X Section 404 (Clean Water Act, 33 USC 1344)
_ Section 10 (Rivers and Harbors Act, 33 USC 403)
Authorization: Regional General Permit Number
Nationwide Permit Number 14
Your work is authorized by the above referenced permit provided it is accomplished in strict
accordance with the attached conditions and your submitted plans. If your activity is subject to
Section 404 of the Clean Water Act (as indicated above), before beginning work you must receive
a Section 401 water quality certification from the N.C. Division of Water Quality (telephone
[phone]). For any activity within the twenty coastal counties subject to regulation under
the Coastal Area Management Act (CAMA), prior to beginning work you must contact the N.C.
Division of Coastal Management (telephone [phone].
Please read and comply with the attached conditions. Any violation of these conditions may
subject the permittee to a stop work order, a restoration order and/or appropriate legal action.
This Department of the Army verification does not relieve the permittee of the responsibility
to obtain any other required Federal, State or local approvals/permits.
If there are any questions regarding this verification, any of the conditions of the Permit, or
The Corps of Engineers regulatory program, please contact Scott Jones at 252-975-1616 ext. 27.
Corps Regulatory Official C?A' Date 29 MAR 2004
Expiration Date of Verification 29 M 2006
SURVEY PLATS, FIELD SKETCH, WETLAND DELINEATION FORMS, PROJECT
PLANS, ETC., MUST BE ATTACHED TO THE FILE COPY OF THIS FORM, IF
REQUIRED OR AVAILABLE.

Special Conditions for Action I.D. 200411260
March 29, 2004
A. The Permitee will submit a final compensatory mitigation plan within 60 days of the date of
this permit. If the plan is not approved by the Corps of Engineers within 90 days of the
date of this permit, the permittee shall cease all work within wetlands associated with this
permit action. The Permitee shall implement the final approved plan as specified in the
plan.
B. The mitigation property will be maintained by the Permitee in its natural condition, as
altered by the implementation of the mitigation plan, in perpetuity. Prohibited activities
within the mitigation area specifically include, but are not limited to, the construction or
placement of buildings, signs, or any other structures; the discharge of dredged or fill
material, or any debris, waste or garbage; excavation; grading; dredging; leveling or any
other earth moving activity; cutting, removal or damage of any vegetation; any activity
which would impact the drainage or water quality on the site; except as required by the
implementation of the mitigation plan, described in condition A, above.
C. The Permitee shall not sell, lease, or otherwise convey any interest in the property without
first providing sixty (60) days written notice to the Corps of Engineers of the proposed
conveyance. The instrument effecting such conveyance shall include legally binding
restrictions on the use of the mitigation property as described in condition B above, to be
enforceable by the Permitee as well as the U.S. Army Corps of Engineers, Wilmington
District. The instrument establishing such restrictions shall be subject to the approval of
the Corps of Engineers. The Permitee shall enforce the terms of the required restrictions.
D. The compensatory mitigation work associated with the Breezy Shores project pursuant to
plan entitled "Boundary Survey and Wetland Crossing Map for Kenneth A. Foster" off
NCSR 1745 east of Bath in Beaufort County, North Carolina," dated November 25, 2003,
must be completed to provide 0.16 acres of wetland creation.

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FILE COPY
Office Use Only: 040175 Form Version April 2001
USACE Action ID No. DWQ No.
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
1. Processing
WETLANDS 1401 GROUP
1. Check all of the approval(s) requested for this project:
® Section 404 Permit FEB 0 6 2004
? Section 10 Permit
® 401 Water Quality Certification WATER QUALITY SECTION
? Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested: NWP 39
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 Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here: ?
II. Applicant Information
1. Owner/Applicant Information
Name: Kenneth Foster
Mailing Address: 835 Breezy Shore Rd.
Bath, N.C. 27808
Telephone Number: 252 923 0222 Fax Number:
E-mail Address:
2. Agent 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: Jav Johnson
Company
Affiliation: Consultant
MailingAddress: P.O. Box 1601, NagsHead N.C. 27959
Telephone Number: 252 3419802 Fax Number:
E-mail Address:
Page 3 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 full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-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: Breezy Shores
2. T.I.P. Project Number (NCDOT Only): N/A
3. Property Identification Number (Tax PIN): Deed Book 1022 Pg. 306
4. Location
County: Beaufort Nearest Town: Bath
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.): From Washington 264 E. to 92
E. through Bath take a right on SR 1745 Breezy Shores Rd. Site is on left side of road
before the mini storage site.
5. Site coordinates, if available (UTM or Lat/Long): UTM 18 336447E 3923609N Dec.
Degrees: 35.443N 76.8020W Lat/Long: 35 26' 41" N 764810311
6.
(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.) Bath Quad
7. Describe the existing land use or condition of the site at the time of this application:Existin
forest
8. Property size (acres): 23.79 acre parcel
9. Nearest body of water (stream/river/sound/ocean/lake): Gar Gut trib. to Pamlico River
Page 4 of 12
10. River Basin: Tar-Pam
(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/.)
11. Describe the purpose of the proposed work: Provide access to property
12. List the type of equipment to be used to construct the project: Typical -construction
equipment.
13. Describe the land use in the vicinity of this project: Residential. Forest
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
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.
No previous permits have been issued.
V. Future Project Plans
Are any additional permit requests anticipated for this project in the future? If so, describe the
anticipated work, and provide justification for the exclusion of this work from the current
application: Road access to the property is the only known permit request at this time.
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
Page 5 of 12
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.
1. Wetland Impacts Fill in 404 wetlands
Wetland Impact
Site Number
indicate on ma)
Type of Impact* Area of
Impact
(acres) Located within
100-year Floodplain**
es/no Distance to
Nearest Stream
linear feet
Type of Wetland***
Area 1 Fill .02 No > 500' freshwater
Area 2 Fill .14 No > 500' freshwater

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
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 FEMA-approved local floodplain 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.)
List the total acreage (estimated) of existing wetlands on the property: N/A
Total area of wetland impact proposed:7,171 sq. ft. or.16 acres
2. Stream Impacts, including all intermittent and perennial streams N/A
Stream Impact
Site Number
indicate on ma
Type of Impact* Length of
Impact
linear feet
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
leasespecify)

* 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
Page 6 of 12
www.uses.aov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.tonozone.com,
www.mapquest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site:
3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S. N/A
Open Water Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Name of Waterbody

(if applicable) Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean, etc.

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
4. Pond Creation N/A
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 watering, irrigation, 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 construction to reduce impacts.
The fill area has been desiened for a minimal amount of fill to allow for standard
construction for an access road. Only the wetland areas indicated will be impacted and the
new road requires adequate cover over the proposed culvert. Side ditches from this road
will be constructed to flow into wetlands and not directly discharging into any streams.
Page 7 of 12
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.
USACE - In accordance with the Final Notice of Issuance and Modification 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 NCWRP 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
ham://h2o. enr. state.nc.us/ncwetlands/strmaide. 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.
.16 acres of Mitigation area (1:1) is proposed onsite at this time. Refer to map Upland
area will be graded to wetland elevation and allowed to revezetate naturally if
mitigation is required by the review agencies.
Page 8 of 12
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP) with the NCWRP's written agreement. Check the box indicating that
you would like to pay into the NCWRP. Please note that payment into the NCWRP must be
reviewed and approved before it can be used to satisfy mitigation requirements. Applicants
will be notified early in the review process by the 401/Wetlands Unit if payment into the
NCWRP is available as an option. For additional information regarding the application
process for the NCWRP, check the NCWRP website at httv://h2o.enr.state.nc.us/M/index.htm. If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following information: N/A
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):
IX. Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
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 (DWQ Only)
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.
Page 9 of 12
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identifyNo )?
Yes ? No ® If you answered "yes", provide the 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
(square feet) Multiplier Required
Mitigation
1 0 3 N/A
2 0 1.5 N/A
Total 0 N/A
* Zone I extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
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 .0242 or.0260.
XI. Stormwater (DWQ Only)
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.
There currently is no impervious acreage on this tract. New impervious acreage would
comprise of the proposed eravel access road. Most to all stormwater will infiltrate or sheet
flow to side ditches and swales that will discharee to existing wetland areas onsite.
XII. Sewage Disposal (DWQ Only)
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.
No Sewage disposal is proposed at this time.
Page 10 of 12
XIII. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No N
Is this an after-the-fact permit application?
Yes ? No N
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 Species, accessibility problems, or other issues outside of the applicant's control).
Applicant/Age S' e Date
(Agent's signat a is aid only if an authorization letter from the applicant is provided.)
US Army Corps Of Engineers Field Offic es and County Coverage
Asheville Regulatory Field Office Alexander Cherokee Iredell Mitchell
US Army Corps of Engineers Avery Clay Jackson Polk
151 Patton Avenue Buncombe Cleveland Lincoln Rowan
Room 208 Burke Gaston Macon Rutherford
Asheville, NC 28801-5006 Cabarrus Graham Madison Stanley
Telephone: [phone] Caldwell Haywood McDowell Swain
Fax: [phone] Catawba Henderson Mecklenburg Transylvania
Union
Watauga
Yancey
Raleigh Regulatory Field Office Alamance Durham Johnston Rockingham Wilson
US Army Corps Of Engineers Alleghany Edgecombe Lee Stokes Yadkin
6508 Falls of the Neuse Road Ashe Franklin Nash Surry
Suite 120 Caswell Forsyth Northampton Vance
Raleigh, NC 27615 Chatham Granville Orange Wake
Telephone: [phone] Davidson Guilford Person Warren
Fax: [phone] Davie Halifax Randolph Wilkes
Washington Regulatory Field Office Beaufort Currituck Jones Pitt
US Army Corps Of Engineers Bertie Dare Lenoir Tyrrell
Post Office Box 1000 Camden Gates Martin Washington
Washington, NC 27889-1000 Carteret* Green Pamlico Wayne
Page 11 of 12
Q m U

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lopoLone - "111e Web's "Copographic Map
wysiwyg:// 11/http://Www.topozone.com/print.asp?z=18&rr-=3923609&e=336447&s=25&u=1
1 of 1 3/14/03 9:12 AM
L '-.? 9 ,-P
DATA FORM
ROUTINE WETLAND DETERMINATION
(1987 COE Wetlands Delineation Manual)
Project/Site: &f,;.,JZA317`TIQgr-- ?1 7 ?/or.-,het N ?• Date:
Applicant/Owner: Ke v1? f11 ;5 ___ County:
.
Investigator: State:
Do Normal Circumstances exist on the site? No Community ID:
Is the site significantly disturbed (Atypical Situation)? e No Transect ID: _ -

Is the area a potential Problem Area? es No ---
Plot ID:

If needed, explain on reverse. -
VEGETATION
Dominant Plant Species Stratum Indicator Dominant Plant Soecies Stratum Indicator
1 fer_?'+frsr?9 Lr'?''b?zcc_3 °

o
9.414
Q/??itli?_s^a-'6
2
.?f? °
.

S.yst 1'1L/?Sl?Jdl.- Sy?3?°_IoLs ° 13.------- -- --- ----
7.c..' --- ° ?i c. 3. °
'? 15.-----------

8.?y??i, n. r-i? Gi3?iiC? 22??
±?'d ?'.LP .??1?e?. 0 -- ----
16.
Percent of Dominant Species that are OBL, FACW or FAC
(excluding FAC-). erg

------------------------------------------------
Remarks: we"1 1-d ???t L S ?? °L
HYDROLOGY
- Recorded Data (Describe in Remarks):
_ Stream, Lake, or rde Gauge
_ Aerial Photographs
Other
Recorded Data Available Wetland Hydrology Indicators:
Primary Indicators:
_ Inundated
_?SS turated in Upper 12 Inches
= N/ater Marks
-gift Lines
Sediment Deposits
Field Observations: ainage Patterns in Wetlands
Secondary Indicators (2 or more required):
Depth of Surface Water: (in.) Oxidized Root Channels in Upper 12 Inches
Ater-Stained Leaves
Depth to Free Water in Pit: (in.) _lacal Soil Survey Data
_ FAC-Neutral Test
Depth to Saturated Soil: 0-(in.) - Other (Explain in Remarks)
Remarks: w,+4c.,d ?r?w? oyv is
E32 Appendix B Blank and Example Data Forms
1 Ov'j T I.J
SOILS
Map Unit Name
(Series and Phase):?a?V?i?[O _r1L?f?jl2?j Drainage Class: -_-_---
7- Field Observations
Taxonomy (Subgroup): Confirm Mapped Type? Yes No
Profile Descriotiow ,r
Depth Matrix Color Mottle Colors Mottle Abundance/ Texture, Concretions,
(inches) Horizon (Munsell Moist) (Munsell Moist) Size./Contrast Structure, etc,
Hydric Soil Indicators:
Histosol - Concretions
Histic Epipedon High Organic Content in Surface Layer in Sandy Soils
- Sulfidic Odor Organic Streaking in Sandy Soils
Aquic Moisture Regime meted on Local Hydric Soils List
-,,,Reducing Conditions fisted on National Hydric Soils List
!Gleyed or Low-Chroma Colors - Other (Explain in Remarks)
Remarks: lirn?u ts?? `
WETLAND DETERMINATION
Hydrophytic Vegetation Present? No (Circle) (Circle)
Wetland Hydrology Present? a No
Hydric Soils Present? es No Is this Sampling Point Within a Wetland? Yes No
Remarks: W\Q 9 a,,"d -
L Pam-.?-w? a-t73 a v-t- p?.-?e se?,?
Approved by HQUSACE 3/92
Appendix B Blank and Example Data Forms B3
f4y
DATA FORM
ROUTINE WETLAND DETERMINATION
(1987 COE Wetlands Delineation Manual)
Project/Site&,-fee"-,? I?_?__j,,._.( ?iQLf_?va,w.? AC Date:
Applicant/Owner: xe,2,2 -ge-ho??- _ County: _feswfg,,.-f-
Investigator: _J,Ik__` State: ,L-Q,
Do Normal Circumstances exist on the site? es No Community ID:
Is the site significantly disturbed (Atypical Situation)? e No Transect ID:
Is the area a potential Problem Area? a No Plot ID:
If needed, ex lain on reverse.) I
VEGETATION
Dominant Plant Soecies Stratum Indicator Dominant Plant Soecies Stratum Indicator
1.L4Sy?i_P3[L?
T
! ?1^!!Li? 0 9.-Gvr?.,a r?.,_/_.b /1{??_ xt?J•°
2.?Lt
4
SLS
--
3. QoeYSuS «ct --- -?? ?D? ?acu y'' 11.--
4.i?-GerS /^W IF /OT jiLaky p -
----- -

--

Percent of Dominant Species that are OBL, FACW or FAC
(excluding FAC-).
Remarks: r,?'??G?L?GI (??.Q• r 5 ,/J?
HYDROLOGY
- Recorded Data (Describe in Remarks):
_ Stream, Lake, or Tide Gauge
- Aerial Photographs
Other
o Recorded Data Available Wetland Hydrology Indicators:
Primary Indicators:
- Inundated
- Saturated in Upper 12 Inches
- Water Marks
Drift Lines
-
- Sediment Deposits
Field Observations: - Drainage Patterns in Wetlands
Secondary Indicators (2 or more required):
Depth of Surface Water: (in.) _ Oxidized Root Channels in Upper 12 Inches
- Water-Stained Leaves
Depth to Free Water in Pit: (in.) - Local Soil Survey Data
_ FAC-Neutral Test
Depth to Saturated Soil:
l ?(in.) - Other (Explain in Remarks)
/
Remarks: Wekt.__? 14,yd- I°c3v j,5 'U6 f t4r'C-5 ?
B2 Appendix B Blank and Example Data Forms
141 ti T'd
SOILS
Map Unit Name --------
(Series and Phase): Al" - Drainage Class:
1 Field Obse vations
Taxonomy (Subgroup):-(?? 9 -_--__ Confirm Mapped Type? Yes No
Profile Descriotiow
Depth Matrix Color Mottle Colors Mottle Abundance/ Texture, Concretions,
(inches) Horizon (Munsell Moist) (Munsell Moist) Size/Contrast Structure, etc,
Qom" _, Y 3 - ------ ---- - --- ?
?,r ---- -1_ ------ ------ - s.r -
Hydric Soil Indicators:
Histosol - Concretions
Histic Epipedon High Organic Content in Surface Layer in Sandy Soils
Sulfidic Odor Organic Streaking in Sandy Soils
Aquic Moisture Regime - Listed on Local Hydric Soils List
Reducing Conditions Listed on National Hydric Soils List
Gleyed or Low-Chroma Colors - Other (EVIain in Remarks)
Remarks: I /)Q'f ja4,' S`R IS dW'e /ub //1YE.?rt l
WETLAND DETERMINATION
Hydrophytic Vegetation Present? es No (Circle) (Circle)
Wetland Hydrology Present? Yes
Hydric Soils Present? Yes Is this Sampling Point Within a Wetland? Yes No
Remarks: 1),.,n (/(f`Q/
>?`?? ---a-- *// ?O?tfirvrn t ?-w3 -m4" Approved by HQUSACE 3/92

Appendix B Blank and Example Data Forms B3
81 9 18'
1"/FT. CROWN 1/4":1
6 6
TH WALL
27;:;ED 5' CABC
PLASTIC PIPE
GRAVEL ROAD
TYPICAL CROSS SECTION
N.T.S.
23.792 ACRES

S 61'33'53
47.22'
404 WETLANDS
S 52'38'51" E
126.52'(TOT)
MORGAN, III
4, PG 970
1022,
)LINA
ED: MWB
11/25/03
1 " = 100'
mf10,4 s
y
m
m z
p
c '
v
u,

? g
cn © 17
° o
c
o -o

S 67'46'15" W S 70'34'27" W
34.28' 65.30'
S 32.24'25" W
' AREA TO BE FILLED
32.01 6,156 SF
Av-e a 2
-At W- -^ ELINE
O
T
W- D
A
I
N
W-n5 PROPOSED 36" SMOOTH WALL
(TIE) CORRUGATE D PLASTIC PIPE
N 30'03'26" W
\, I 84.31'
N \?
LIMITS OF
DELINEATION w-s
(11.53')-
(22.03') -
N 53'52'17" E- J
33.56'(TOT)
N 06'20'30" E
10.38'

,171 S.I
W-1 EIP CONTROL
?"--N 32'32'31" E CORNER
\ 63.14'
"E 359,g?
?w-z p3,?9
N 41. I
EIP W=3
O?
O

2
lS?
ro??
?o
kSa
'G -so'
SII
N
W
PROPOSED MITIGATION AREA 1:1
I
N
(A
ZEFFIE E. JONES EIP
DB 1150, PG 680
r4 \ N .6307 .
(TIE) ?0 F
N 69'42'40" W !`? I \ 0
22.77'
S 05'03'20" W
87.39' ° I ELWOOD R. JEFFERSON
DB 1137, PG 257 \
i
WP-138
WP-130
WP-137-N 00'04'52" E /
81.18' I
P-13 WP-131 LIMITS OF ( 2 )
wP_1--DELINEATION /
N 30'25'57" E I
36.41 KENNETI
wP-' 33 REA TO BE FILLED
26.71') 1,015 SF KENNETH A. FOSTER
??. N 04'48' 11 " W DB 1022, PG 306
EIP EIP 36.68' I /
N 58'22 50' E LEIP - -"
67.77'
N 81'34 18". EJ c1'-
31.77' 0
o ? sue.
0-
l
S 05'51'07" W ??
/ 33.50'
S 12'22'24" W
/ 34.48'
MYRTLE G. SLADE
DB 454, PG 527 S 10'18'41" W?
37.31 ' (TOT)
wP-1z
404 WETLANDS (17'27 )
(20.04')--
WP-1
Av-eo, ' (19.14'
R/W N 42'37'50" E
45.85' (TOT) NCSR 1745 (6
RARY 2)
??F Vd A TE9q Michael F. Easley, Governor
William G. Ross Jr., Secretary
?O Gy North Carolina Department of Environment and Natural Resources
-i Alan Klimek, P.E., Director
Y Division of Water Quality
Coleen H. Sullins, Deputy Director
Division of Water Quality
February 12, 2004
DWQ # 04-0175
Beaufort County
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
Kenneth Foster
835 Breezy Shore Road
Bath, NC 27808
Subject Property:
Dear Mr. Foster:
Breezy Shores
On February 6, 2004 the Division of Water Quality (DWQ) was notified by receipt of your application regarding your plan to
fill wetlands or waters for the purpose of providing access to property in Beaufort County. Approval from DWQ is required
to disturb these areas. Please provide 7 copies of the following information and refer to the DWQ # listed above in your
reply. 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.
1. Please show all impacts on streams subject to the buffer rules including all fill slopes, dissipaters, and bank
stabilization on the site plan.
2. Please indicate all buffer impacts on the site plan.
3. Please indicate proposed lot layout as overlays on the site plan for the entire site.
4. Please indicate the location of the protected buffers as overlays on the site plan. Please provide legible copies of the
USGS Tope and County Soil Survey so we can determine which features are subject to the buffer rules.
5. Please locate all isolated or non-isolated wetlands, streams and other waters of the State as overlays on the site plan.
6. Please locate any planned sewer lines on the site plan.
7. Please specify the percent of project imperviousness area based on the estimated built-out conditions.
8. Please indicate all stormwater outfalls on the site plan.
9. Please indicate the diffuse flow provision measures on the site plan.
10. Please provide an agent authorization letter which permits Mr. Johnson to apply for your approvals.
Please telephone John Dorney at 919-733-9646 if you have any questions or would require copies of our rules or procedural
materials. This project will remain on hold as incomplete in accordance with 15A NCAC 2H .0505(c). The processing time
for this application will begin when this information is received. If we do not hear from you by writing or by fax at (919)
733-6893 within three (3) weeks we will assume you no longer want to pursue the project and will consider it withdrawn.
Sincerely,
John R. Dorney
401 Water Quality Certification Program
JRD/bs
cc: Washington DWQ Regional Office
Washington Corps of Engineers
Central Files
File Copy
Jay Johnson, Post Office Box 1601, Nags Head, NC 27959
IN AN
N. C. Division of Water Quality, 401 Wetlands Certification Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
[phone] (phone), 919-733-6893 (fax), (hUR://h2o.enr.state.nc.us/ncwetlands)
Customer Service #: 1-877-623-6748
DWQ# 0 q - n I ` 5-
plan Detail Incomplete
Date ` 2, 1'tq q Who Reviewed:

t] PleasUrovide a location map for the project ] ra (?S
Please show all stream impacts`m uding all fill slopes, dissipaters, and bank stabilization on the site plan.
? Please show all wetland impacts including fill slopes on the site plan.
Please indicate all buffer impacts on the site plan. p 1.
.S! ,
Please indicate proposed lot layout as overlays on the site plan.( I i
I? iYJI'2 f S
Please indicate the location of the protected buffers as overlays on the site plan. [,ems ,ems 0-
?' •? Ups C 5
Please locate all isolated or non-isolated wetlands, streams and other waters of the State as overlays on the:site plan. A (?
? Please provide cross section details showing the provisions for aquatic life passage.
Please locate any planned sewer lines on the site. plan.
? Please provide the location of any proposed stormwater management practices as required by GC
? ' Please provide detail for the stormwater•menagement practices as required by GC
Please specify the percent of project imperviousness area based on the estimated built-out conditions.
Please indicate all stormwater outfalls on the site plan.
Please indicate the dif Use flow provision measures on the site plan.
? Please indicate whether or not the proposed impacts already been conducted
Avoidance and/or Minimization Not Provided
CO "
sVJ I
d ear ??-e
arc ?h?.o?--?
? The labeled as on the plans does not appear to be necessary. Please eliminate the or provide additional
information as to why it is necessary for this project.
? This Office believes that the labeled on the plans as can be moved or reconfigured to avoid the impacts to the
Please revise the plans to avoid the impacts.
? This Office believes that the - labeled on the plans as can be moved or reconfigured to minimize the impacts to the
Please revise the plans to minimize the impacts.
? The stormwater discharges at the location on the plans labeled will not provide diffuse flow through the buffer because
Please revise the plans and provide calculations to show that diffuse flow.will be achieved through the entire buffer. If it
is not possible to achieve diffuse flow through the entire buffer then it may be necessary to provide stormwater management
,
practices that remove'nutrients before the stormwater can be discharged through the.buffer.
Other
? The application fee was insufficient because over 150 feet of stream and/or over 1 acre of wetland impacts were requested. Please
provide $ . This additional fee must be received before your application can be reviewed
? Please complete Section(s) on the application.
? Please provide a signed copy of the application.
? Please provide copies of the application, copies of the site plans and other supporting information.
D
Mitigation
? of compensatory mitigation is required for this project. Please provide a compensatory mitigation plan. The
plan must conform to the requirements in 15 A NCAC 2H,0500 and must be appropriate to the type of impacts proposed.
? Please indicate which 404 Permit the USACE would use to authorize this project.
dy?
/V\ 0
UNITED STATES POSTAL SERVICE lass Mail
epT P & Fees Paid
US S
Permit No'
• Sender: Please print your name, address, *d FS4in$hiNx •
NC DENR Division of Water Quality
Wetlands/401 Certification Unit
2321 Crabtree Boulevard, Suite 250
Raleigh, NC 27604

¦ Complete items 1, 2, and 3. Also complete
item 4 if, t?Wdoted Delivery Is desired.
¦ Print your name and address on the, reverse
so that we can return the card to ybu.
¦ Attach this card to the back of the mailplece,
or on the front i 'space permits.
1. Article Addressed to:
Kenneth Foster
835 Breezy Shore Road
Bath, NC 27808
DWQ# 04-0175 - Beaufort
A. Slg atu
E3 X r Agent
? Addre
.. by nted Name) C?. Date of Del
D. Is delivery add from Item 1? ? Yes
es below: ? No
If YES, enter del
S% 1% a
I
3.
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Registered ,Return Receipt for Merchandlsi
? Insured Mail ? C.O.D. .
4. Restricted Delivery? (Extra Pbe) ? Yes
2. Article Number 7002 2410 0003 0275 4070
01ansfer from servrce /abso
Ps Form 3811, August 2001 Domestic Return Receipt 102595.02•M-140