19930049 Ver 1_COMPLETE FILE_19930320

STA7Z
• A,? ?• sir ??
State of North Carolina
Department of Environment, Health, and Natural Resources
512 North Salisbury Street * Raleigh, North Carolina 27604
James B. Hunt, Jr., Governor Jonathan R Howes, Secretary
DIVISION OF COASTAL MANAGEMENT
27 April 1993
Mr. Mike Ackroyd
United States Cellular Corporation
6701 Baum Drive
Suite 260
Knoxville, TN 37919
REFERENCE: DEM 93-049 Nationwide Permit Application for an activity located irj
Hertford County, North Carolina: Fill Wetlands for Telephone Towe
and Associated Facilities
Dear Mr. Ackroyd:
The North Carolina Division of Coastal Management has reviewed the above
referenced application for a Nationwide Permit dated 31 December 1992 pursuant
to Section 307 of the Coastal Zone Management Act of 1972 as amended. Based upon
our review, we have determined that the proposed activity is consistent with the
North Carolina Coastal Management Program provided the following conditions are
met.
1. The activity described in the above application qualifies to receive
one of the Nationwide Permits described in 33 CRF Part 330 with the
exception of numbers 17, 21, 24, and 34 which were found
inconsistent with the North Carolina Coastal Management Program.
2. A 401 Water Quality Certification is received, where required, from
the North Carolina Division of Environmental Management.
This letter does not relieve you of the responsibility to insure that all
other State authorization and/or permit requirements are met prior to
implementation of the project. Please feel free to contact Mr. Steve Benton at
[phone] if you have any questions or need further assistance.
Sincerely,
erry E. Moore
District Manager
Division of Coastal Management
Washington Regional office
cc: (.°ohn Dorney - NC Division of Environmental Management, Raleigh
Steve Benton - NO Division of Coastal Management, Raleigh
Wilmington District Engineer
ATTN: CESAW-CO-E
P.O. Box 27687, Raleigh, North Carolina 27611-7687 Telephone [phone] Fax # [phone]
An Equal Opportunity Affirmative Action Employer
K d ??
OMM
State of North Carolina
Department of Environment, Health and Natural Resources
Division of Environmental Management
512 North Salisbury Street • Raleigh, North Carolina 27604
James B. Hunt, Jr., Governor A. Preston Howard, Jr., P.E.
Jonathan B. Howes, Secretary Director
March 30, 1993
United States Cellular Corporation
Attention: Mr. Mike Ackroyd
6701 Baum Drive, Suite 260
Knoxville, Tennessee 37919
Dear Mr. Ackroyd:
Subject: Proposed Fill in Wetlands or Waters
Telephone Tower Construction
Hertford County
DEM Project # 93049, COE# 199300886
Upon review of your request for Water Quality certification to place fill
material in 0.77 acres of wetlands or waters (and clear 2.19 acres of wetlands)
which are tributary to Horse Swamp for tower construction located at SR 1411 and
US 13 in Hertford County, we have determined that the proposed fill can be
covered by General Water Quality Certification No. 2671 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. 26.
If you have any questions, please contact John Dorney at 919/733-1786.
Sincerely, j?
eston Howard, r. P.E.
AP11: JD
l 1
Attachment i
cc: Wilmington District Corps. of Engineers
Corps of Engineers Washington Field office
Washington DEM Regional Office
Mr. John Dorneyi
Central Files
J. S. Janowski, J.S. Janowski & Assoc.
Peter West; Custom Building Company
Regional Offices
Asheville Fayetteville Mooresville Raleigh Washington Wilmington
704/251-6208 919/486-1541 704/663-1699 919/571-4700 919/946-6481 919/395-3900
Pollution Prevention Pays
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone]
An Equal Opportunity Affirmative Action Employer
Winston-Salem
919/896-7007
DEPARTMENT OF THE ARMY
WILMINGTON DISTRICT, CORPS OF ENGINEERS
P.O. BOX 1890
WILMINGTON, NORTH CAROLINA 28402-1890
IN REPLY REFER TO
Regulatory Branch
March 17, 1993
Rim-
Action ID. 199300886 and Nationwide Permit No. 26 (Headwaters and Isolated
Waters)
United States Cellular Corporation
Att: Mr. Mike Ackroyd
6701 Baum Drive
Suite 260
Knoxville, TN 37919
Dear Mr. Ackroyd:
Please reference your application received January 26, 1993, for
Department of the Army authorization to construct a 400-foot-tall cellular
telephone tower, and associated guy wire anchors, equipment building, and
access road within approximately 3.0 acres of wetlands, located on your
property approximately 0.25 miles east of the intersection of US 13 and S.R.
1411, adjacent to Horse Swamp, north of Ahoskie, in Hertford County, North
Carolina.
For the purposes of the U.S. Army Corps of Engineers' Regulatory Program,
Title 33, Code of Federal Regulations (CFR), Part 330.6, published in the
Federal Register on November 22, 1991, lists nationwide permits.
Authorization was provided, pursuant to Section 404 of the Clean Water Act,
for discharges of dredged or fill material into headwaters and isolated waters
provided:
a. the discharge does not cause the loss of more than 10 acres of waters
of the United States;
b. the permittee notifies the District Engineer if the discharge would
cause the loss of waters of the United States greater than one acre in
accordance with the "Notification" general condition. For discharges in
special aquatic sites, including wetlands, the notification must also include
a delineation of affected specific aquatic sites, including wetlands; and
c. the discharge, including all attendant features, both temporary and
permanent, is part of a single and complete project.
Your work is authorized by this nationwide permit provided it is
accomplished in strict accordance with the enclosed conditions. This
nationwide permit does not relieve you of the responsibility to obtain any
required State or local approval.
r
-2-
This verification will be valid for 2 years from the date of this letter
unless the nationwide authorization is modified, reissued, or revoked. Also,
this verification will remain valid for the 2 years if, during that period,
the nationwide permit authorization is reissued without modification or the
activity complies with any subsequent modification of the nationwide permit
authorization. If during the 2 years, the nationwide permit authorization
expires or is suspended or revoked, or is modified, such that the activity
would no longer 'comply with the terms and conditions of the nationwide permit,
activities which have commenced (i.e., are under construction) or are under
contract to commence in reliance upon the nationwide permit will remain
authorized provided the activity is completed within 12 months of the date of
the nationwide permit's expiration, modification or revocation, unless
discretionary authority has been exercised on a case-by-case basis to modify,
suspend, or revoke the authorization.
As discussed, you should contact the following state agencies to obtain
the required State authorizations prior to starting work: Mr. John Dorney,
North Carolina Division of Environmental Management, telephone [phone],
and Mr. Steve Benton, North Carolina Division of Coastal Management, telephone
[phone].
Thank you for your time and cooperation. If you have any questions,
please contact Mrs. Fogo, at the Washington Regulatory Field office, telephone
[phone].
Sincerely,
G. Wayne Wright
Chief, Regulatory Branch

-2-
Copy Furnished with enclosure:
J. S. Janowski & Associates
302 Sycamore Branches Close
Winterville, North Carolina 28590
Copies Furnished (without enclosure):
Mr. John Parker
North Carolina Department of
Environment, Health and
Natural Resources
Post office Box 27687
Raleigh, North Carolina 27611-7687
VMr. John Dorney
Water Quality Section
Division of Environmental Management
North Carolina Department of
Environment, Health and
Natural Resources
Post Office Box 27687
Raleigh, North Carolina 27611-7687
Mr. Richard Peed
Land Quality Section
North Carolina Department of Environment,
Health, and Natural Resources
Post Office Box 2188
Washington, North Carolina 27889
Mr. Terry Moore
North Carolina Department of Environment,
Health, and Natural Resources
Division of Coastal Management
Post Office Box 2188
Washington, North Carolina 27889
{7
MEVIORJ?9DUM ((???, RR M INITIAL-',:
'; Reviewer:
l?7 LS D U
TO: John Dorney Q WQ Supv : 7/ k?T
Planning Branch Date: y3
MAR 181993
SUBJECT: WETLAND STAFF REPORT AND RE > ENDATIONS
***EACH ITEM MUST BE ANSWERED (N/A-NO APIg7`
PERMIT _YR: 93 PERMIT NO: 0000049 COUNTY: HERTFORD
APPLICANT NAME: U.S. CELLULAR CO.
PROJECT TYPE: TOWER PERMIT-TYPE: NW26
COE_#: 199300886 DOT _#:
CDA:
FROM
RCD APP CDA:
DATE
FP.M 01/22%9:
_
_
REG OFFICE: WARD _
_
RIVER_AND_SUB_BASIN_#: 4f 1416
STREAM CLASS:
STR__INDEX_NO :
WL_IMPACT?: C?N
L REC<T4ESTE-,
HYDRO_CNECT? • OY N
MITIGATION?: Y,0
MITIGATION SIZE:
WL TYPE:
WL_ACR_E,= 1' :: Y / N
WL_S C{>I' E (#) :
MITIGATION.-TYPE
`) WETLAI.,,TD RATING SHEET ATTACHED? : Y/N
RECOMMENDATION (Circle One) : ISSUE SSTTF./COND DENY
A
COMMENTS..
cc

Central File-
0
-? f
1-3-0/S-7-
RECOMMENDED CONDITIONS OR PERMIT RESTRICTIONS :
75- x '7s-
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3sa'X3D
I Gv,'cs G G X /D
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77
j

?73 --013 Vim-
MEMORANDUM
TO: John Dorney
Planning Branch
SUBJECT: WETLAND STAFF REPORT AND RECOMMENDATIONS
***EACH ITEM MUST BE ANSWERED (N/A-NOT APPLICABLE)***
INITIALS:
Reviewer:
WQ Supv:
Date : 9.3
?J
PERMIT_YR: 93 PERMIT-NO: 0000049 COUNTY: HE 1F Q
Q ? E
R
APPLICANT NAME: U.S. CELLULAR CO. ?
PROJECT_TYPE: TOWER PERMIT-TYPE: NW 6
COE_#: 199300886 DOT_#: 4NA
RCD
FROM
CDA: APP DATE
FRM
CDA: 22/93
01
/

_
_
REG_OFFICE:
WARO
_
_
RIVER_AND_SUB_BASIN #: ?
/
/
e-_96
??or5e. spa ,M-?
STREAM CLASS:
STR INDEX N0:
WL_IMPACT?: ON WL_TYPE:
WL_REQUESTED: oq,9 6 ?- WL_ACR_EST?: YIN
HYDRO_CNECT?:6 N WL_SCORE(#):
MITIGATION?: Y,® MITIGATION-TYPE:
MITIGATION SIZE:
!6
WETLU?!?S 377,'66
TER QUAL!
IS WETLAND RATING SHEET ATTACHED?: YIN
RECOMMENDATION (Circle One): ISSUE ISSUE/COND DENY Z?o / pt/-
-6 A
COMMENTS:
,'I A

cc:
Central Files
AV -
j3ogf
WETLAND DETERMINATION FORM
-V /`7 ! C>('VIL o y
COORDINATOR' TIME: 0 DATE: Io2/ l / COUNTY:
NEAREST TOW _ W TERWAY:
QUAD: LOCATION'
PR PERTY OW AME/ DRESS) PARTY G WORK:(NAME/A DRESS) ,? ,?Ff?1C
Id AIA
PHONE : ((,??) &2
OTHER INDIVIDUALS PRESENT:
PHONE :
IS PROPERTY UNIFORM_ZOR SEPARATE DISCRETE VEGETATIVE UNITS
VEGETATION:4(IN ORDER OF DOMINANCE, DRAW LINE ABOVE NON-DOMINANT SPECIES)
TR % COVEh--INDICATOR
IP: SPECta
& GROUND COV R: SPECIES-% COVER-INDICATOR
W
:
1. / l At"A FAe„ .26z
-
- 1. OJL * i. 4 FNC
CIp-di
6%
?A? 5
3.
4 3.
4
. .
5.
1A PO,6 7. K::
2. 8•

3 .
4 .
WOODY
n
VINES :
_
?
5. 2. ?
% OF DOMINANT SPECIES (OBL.- FAC.)/OQ?fpOTHER INDICATORS:
HYDROPHYTIC VEGETATION: YES(NO BASIS: :72 !5pz OO ALA-t? 9MAM
M .A0/1I O-A (iii D CJAP_uI - L"n A- L.? .,r4- Y1ew: e. !A/IA /A. f/I
TYPICAL:_(COMPLETE BELOW)
SOIL:
SERIES: yt4 Ally
MOTTLED:J YES NO MATRIX COLOR:
BASIS: JlLA) L)m iu
ATYPICAL:? (COMPLETE BACK)
ON HYDRIC SOILS LIST: YE ?NO
HYDRIC SOILS: YESjt/-NO
V
HYDROLOGY: „
INUNDATED: YES ?l1 DEPTH OF WATER:
SATURATED SOILS: YE§ZNO DEPTH TO SATURATION/WATER TA LE
OTHER ,I1PICATp?tS:
rl U/ Ll n-I?I? IhJ: . Ann 41 64 1 - A. A A
WETLAND HYDROLOGY: YES_jeW BASIS: v
ATYPICAL SITUATION: YES NO t,/ NORMAL 'CONDITIONS: YES P NO
WETLAND DETERMINATION: WETLAND:izNON-WETLAND:
NONE
PHOTOS TAKEN: YES N0 AUTHqRITY: 10 404 10/4LP#
JURISDICTION: ABOVE HEADWATERS v/ ISOLATED ADJACENT DETERMINED BY:
ATYPICAL SITUATIONS
','VEGETATION:
TYPE OF ALTERATION:
EFFECT ON VEGETATION: v s•
PREVIOUS VEGETATION:
HYDROPHYTIC VEGETATION. YES ? 0 `
SOILS:
TYPE OF ALTERATION:
EFFECT ON SOIL
PREVIOUS SOILS
HYDRIC SOILS: YES NO
HYDROLOGY:
TYPE OF ALTERATION: ti Afl-L
EFFECT ON HYDROLOGY:- ki
PREVIOUS HYDROLOGY:
WETLAND HYDROLOGY: /
AUTHORITY: AECTION 10 404 v0/404 NONE
JURISDICTION:'ABOVE HEADWATERS ISOLATED ADJACENT
NATIONWIDE ? YES_V'NO IF YES, # X& PHOTOS TAKEN ? YES No
ATTACH DRAWING W/PHOTO ANGLES AND DIMENSIONS:
,oa ly . A^"
r ,
December 30, 1992
N 21993
IAwra M. Fogo
U.S. Artny Corps ofFa?gineers
KWATER ?
Regulatory Branch `UALLITYGROUP
!
P.O. Box 1000
Washington, N. C. 27889
Re: United States Cellular Company site in Hertford County offNCSR 1411
Dear Laura.
I have enclosed the eight (8) copies of the following for your review:
a. Nationwide Permit No. 26 application
b. Narrative
C. Site plan
d. Vicinity map
As a part of this permit process I have contacted the following on December 31, 1992 and
notified them that this application is to be submitted in Jauuary of 1993.
U.S. Fish and Wildlife Service
Raleigh Field Office
David Bell
919-856-4520
State Historic Preservation Office
N.C. Division of Archives and History
Renee Gledhill-Earley
919-733-4763
Please review this application for approval. It is my understanding that this process should
take 30 days from the time of receipt of a complete application. Please contact me
immediately if this Application is incomplete.
If you have any questions please feel free to call.
z
Sincerely,
J.S. Janowski and Associates
J.S. anowski, P.E.
302 Svcamore Branches Close 0 Winterville. NC 28590 • (919) 756$918
J.S. Janowski& Associates
NATION WIDE PERMIT 26 REQUEST
UNITED STATES CELLULAR SITE
Hertford County
NCSR .1411
The project is located in Hertford County north of Ahoskie. The eastern property line is
approximately 0.25 miles east on NCSR 1411 from the intersection of US 13 and NCSR
1411. The property contains 9.18 acres of cut-over timber land on the north side of NCSR
1411. The property does not front the state road but is located 300 feet north and will be
accessed by a 30 foot easement. The property has been observed by a representative of the
US Army Corps of Engineers and the entire property is classified as a wetland The
property is located above the headwaters on Horse Swamp and drains to the Chowan
River basin by way of Wiccacon River.
The purpose of this project is to construct a 400 foot tower for the United States Cellular
Corporation. The tower will serve a rural service area as link for portable telephone
service in eastern North Carolina. The purpose for clearing and grubbing 2.96 acres of
land is to provide an area where trees damaged during storms would not fall and disrupt
service by causing damage to the tower, guys or equipment building.
This work will consist of constructing a 400 foot tower, an equipment building and guy
wire anchors for the tower. The site will be served with a 30 foot access easement 800
feet long. It will be cleared and grubbed to a width of 30 feet to construct a 12 foot gravel
access road The access road will be built up with 2 feet of fill and will cover a width of
approximately 20 feet The three guy wire lines will be cleared and grubbed to a width of
60 feet and will total approximately 1,050 feet in length. The debris from the clearing and
grubbing operation will be windrowed in a 30 foot width paralleling the guy wire lines. It
is anticipated that a minor amount of fill will be used along the gay wire lines for access by
construction equipment Where the three guy wire lines intersect an area approximately 100
feet by 100 feet will be cleared and grubbed to construct a 12 foot by 20 foot equipment
building. This is the area that the tower will be located and constructed.
302 Sycamore Branches Close • Winterville, NC 28590 • [phone]
U.S. ARMY CORPS OF ENGINEERS
Wilmington District
Action ID: County: E
Chu-
Notification of Jurisdictional Determination
Property owner Authorized Agent
Address
Telephone Number '??,1 J?5 () 76
Size and Location f Property waterbod , Highwa name/number, town, etc.)
?a
hea ?i Drse.
44k i & tAS 3 A CS /411.
Indicate Which of the following apply: So", Ali ski e Touansh i p , fJ ) N e,
• There are wetlands on the above described property which we strongly suggest should be delineated and
surveyed. The surveyed wetland lines must be verified by our staff before the Corps will make a final
jurisdictional determination on your property.
• Because of the size of your property and our present workload, our identification and delineation of your
wetlands cannot be accomplished in a timely manner. You may wish to employ a consultant to obtain a
more timely delineation of the wetlands. Once your consultant has flagged a wetland line on the property,
Corps staff will review it, and, if it is accurate, we strongly recommend that you have the line surveyed for
final approval by the Corps. The Corps will not make a final jurisdictional determination on your property
without an approved survey.
?y?l?Q• The wetlands on your lot have been delineated, and the limits of Corps jurisdiction have been explained
to you. Unless there is a change in the law or our published regulations, this determination may be relied
upon for a period not to exceed three years from the date of this notification.
• There are no wetlands present on the above described property which are subject to the permit
requirements of Section 404 of the Clean Water Act (33 USC 1344). Unless there is a change in the law
or our published regulations, this determination may be relied upon for a period not to exceed three years
from the date of this notification.
The project is located in one of the 20 Coastal Counties. You sho ld contact the nearest tate Office of
Coastal Management to determine their requirements. q1g-y6 -& f V
Placement of dredged or fill material in wetlands on this property without a Department of the Army
permit is in most cases a violation of Section 301 of the Clean Water Act (33 USC 1311). A permit is
not required for work on the property restricted entirely to existing high ground. If you have any
questions regarding the Corps of Engineers regulatory program, please contact
-AUfPr M, F O &O at AcI ri _ 7S- _ ' ,
Property
Project Mana er Si nature en(jAkIUC /
Date piration Date ?.
SURVEY PLA OR FIELD SKETCH OF DESCRIBED PROPER AND THE WETLAND
DELINEATION FORM MUST BE ATTACHED TO THE YELLOW (FILE) COPY OF THIS FORM.
CESAW Fom 566
1 OCr 92
DEM ID: ACTION ID: 19iq3o o -%
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT 0°): 26
JOINT FORM FOR
NATIONWIDE PERMITS THAT REQUIRE NOTIFICATION TO THE CORPS OF ENGINEERS
NATIONWIDE PERMITS THAT REQUIRE APPLICATION FOR SECTION 401 CERTIFICATION
WILMINGTON DISTRfCT 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 ENVIRONMENT, HEALTH,
AND NATURAL RESOURCES
P.O. BOX 29535
RALEIGH, NC 27626-0535
ATTN: MR. JOHN DORNEY
Telephone [phone]
ONE (1) COPY OF THIS COMPLETED APPLICATION SHOULD BE SENT TO THE CORPS OF
ENGINEERS. SEVEN (7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF
ENVIRONMENTAL MANAGEMENT. PLEASE PRINT.
1. OWNERS NAME: lJrited States G:ellnlar GbrInration
2. OWNERS ADDRESS: Attn: Mr. Mike Ackroyd, 6701 Baum Drive, Suite 260,
Knoxville. 1N 37919
3. OWNERS PHONE NUMBER (HOME): NSA (WORK):
4. IF APPLICABLE:
PHONE NUMBER:
Custom Building Co.
P.O. Box 781
Greenville, NC 27835 919-752-4220
5.
LOCATION OF WORK (MUST ATTACH MAP). COUNTY: Hertford
NEAREST TOWN OR CITY: Ahoskie
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ETC.):
0.25 miles east of the intersection of US 13 and NCSR 1411 north of SR 1411
6. NAME OF CLOSEST STREAM/RIVER: Horse Swam
7. RIVER BASIN:
Chowan (Wiccacon)
8. IS THIS PROJECT LOCATED IN A WATERSHED CLASSIFIED AS TROUT, SA, HQW, ORW,
WS I, OR WS II? YES [ j NO [Xj
9. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROPERTY? YES [ j NO [Xj
IF YES, EXPLAIN.
10. ESTIMATED TOTAL NUMBER OF ACRES OF WATERS OF THE U.S., INCLUDING
WETLANDS, LOCATED ON PROJECT SITE: 9.18 acres
615-558-6375
AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
Peter E. West
7/8/92
-2-
11. NUMBER OF ACRES OF WATERS OF THE U.S., INCLUDING WETLANDS, IMPACTED BY
THE PROPOSED PROJECT:
FILLED: 2.96 Acres
s 2.96 Acres
12. DESCRIPTION OF PROPOSED WORK (ATTACH PLANS-8 1/2" X 11" DRAWINGS ONLY):
See attached Narrative
13. PURPOSE OF PROPOSED WORK: See attached Narrative
14. STATE REASONS WHY THE APPLICANT BELIEVES THAT THIS ACTIVITY MUST BE
CARRIED OUT IN WETLANDS. ALSO, NOTE MEASURES TAKEN TO MINIMIZE WETLAND
IMPACTS. Property is MA wetlands. Fill utilizing offsite material will be limited to the access
road, equipment building, and minor areas on guy wires for construction access. A majority of the
e areas will maintain ;;pprnximare existing
grades and wetland vegetation will grow bac .
15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SERVICE
(USFWS) AND/OR NATIONAL MARINE FISHERIES SERVICE (NMFS) REGARDING THE PRESENCE
OR ANY FEDERALLY LISTED OR PROPOSED FOR LISTING ENDANGERED OR THREATENED
SPECIES OR CRITICAL HABITAT IN THE PERMIT AREA THAT MAY BE AFFECTED BY THE
PROPOSED PROJECT. HAVE YOU DONE SO? YES [XJ NO [ )
RESPONSES FROM THE USFWS AND/OR NMFS SHOULD BE FORWARDED TO CORPS.
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE PERMIT AREA WHICH
MAY BE AFFECTED BY THE PROPOSED PROJECT?
HAVE YOU DONE SO? YES [X1 NO [ )
RESPONSE FROM THE SHPO SHOULD BE FORWARDED TO CORPS.
17. ADDITIONAL INFORMATION REQUIRED BY DEM:
A. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, AND LAKES ON
THE PROPERTY.
B. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE IMPACTED BY
PROJECT.
C. IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA SHEETS
RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
D. IF A STORMWATER MANAGEMENT PLAN IS REQUIRED FOR THIS PROJECT, ATTACH
COPY.
E. WHAT IS LAND USE OF SURROUNDING PROPERTY? Agricultural, Fnrresr", Residential
F. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
N/A
OWNER'S SIGNATURE DATE
DRAINED:
FLOODED:
EXCAVATED: _
TOTAL IMPACTED:
04
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