19960139 Ver 1_COMPLETE FILE_19960208

State of North Carolina IT
Department of Environment,
Health and Natural Resources ` N1.5?FA
Division of Environmental Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary ED C H N F1
A. Preston Howard, Jr., P.E., Director
February 19, 1996
Forsyth County
DEM Project # 960139
APPROVAL of 401 Water Quality Certification
Mr. William Widener
P.O. Box 408
Clemmons, NC 27012
Dear Mr. Widener:
You have our approval to place fill material in 0.0014 acres of wetlands or waters for the purpose
of fillin an area for a yard at your home (lot 17), as you described in your application dated 8
February 1996. After reviewing your application, we have decided that this fill is covered by General
Water Quality Certification Number 2733. This certification allows you to use Nationwide Permit
Number 18 when it is issued by the Corps of Engineers.
This approval is only valid 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.
For this approval to be valid, you must follow the conditions listed in the attached certification. In
addition, you should get any other federal, state or local permits before you go ahead with your
project.
If you do not accept any of the conditions of this certification, 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 SUILUMS to the
Office of Administrative Hearings, P.O. Box 27447, Raleigh, N.C. 27611-744-. This certification and
its conditions are final and binding unless you ask for a hearing.
This letter completes the review of the Division of Environmental Management under Section
401 of the Clean Water Act. If you have any questions, please telephone John Dorney at 919-733-
1786.
Sincerely,
ston Howard, lr. P.E
Attachment
cc: Wilmington District Corps of Engineers
Corps of Engineers Raleigh Field Office
Winston-Salem DEM Regional Office
Mr. John Dorney
Central Files
960139.1tr
Environmental Sciences Branch, 4401 Reedy Creek Rd., Raleigh, NC 27607 Telephone [phone] FAX # [phone]
An Equal Opportunity Affirmative Action Employer • 50% recycled/10% post consumer paper
FEB 0 8 1996
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DEM ID:
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ACTION ID:
JOINT APPLICATION FORM FOR
NATIONWIDE PERMITS THAT REQUIRE NOTIFICATION TO THE DISTRICT ENGINEER
NATIONWIDE PERMITS THAT REQUIRE SECTION 401 CERTIFICATION CONCURRENCE
NATIONWIDE PERMITS THAT REQUIRE INDIVIDUAL SECTION 401 CERTIFICATION
WILMINGTON DISTRICT ENGINEER WATER QUALITY PLANNING
CORPS OF ENGINEERS DIVISION OF ENVIRONMENTAL MANAGEMENT
DEPARTMENT OF THE ARMY NC DEPARTMENT OF ENVIRONMENT, EALTH,
P.O. BOX 1890 AND NATURAL RESOURCES
WILMINGTON, NC 28402-1890 P.O. BOX 29535 7
ATTN: CESAW-CO-E RALEIGH, NC 27626-0535
Telephone [phone] ATTN : MR . JOHN DORNEY
Telephone [phone]
ONE (1) COPY OF THIS COMPLETED APPLICATION SHOULD BE SENT TO THE CO"S OF
ENGINEERS. SEVEN (7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF
ENVIRONMENTAL MANAGEMENT. PLEASE PRINT.
1. OWNERS NAME: L % /? /???
,o-
2. OWNERS ADDRESS : Pd. ? _
r'LPoN.
'/ 2-
3. OWNERS PHONE NUMBER (HOME): '7/0 .' 2C r, / 7 F(WORK): 4. IF APPLICABLE:
PHONE NUMBER: _
5. LOCATION OF PLANNED WORK (ATTACH MAP).
COUNTY : )--u X, j- Y T71
NEAREST TOWN OR 'CITY: C L, 2 mm a i?
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS ETC.):
t z -7 ai
6. NAME OF CLOSEST STREAM/RIVER:
r
7 RIVER BASIN:
t:
IS THIS PROJECT LOCATED IN A WATERSHED CLASSIFIED AS TROUT, SA, HQW, ORW,
WS I, OR WS II? YES [ ] NO [ 4
9. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROPERTY? YES [ ] NO [ ?•j'
IF YES, EXPLAIN.
10. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
2/3/92
AGENT'S NAME OR'RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,

-2-
11. NUMBER OF ACRES OF WETLAND IMPACTED BY THE PROPOSED PROJECT:
FILLED: o p l ?/ AG 2e
DRAINED:
FLOODED:
EXCAVATED:
TOTAL IMPACTED:
12. DESCRIPTION OF PROPOSED WORK (ATTACH PLANS):,c t- i.r/ AnJ
/ -i1" FT i >//)e '4" yo I?PQr LoNa /.y/i,-y r,<< v
13.
m(1
PURPOSE OF PROPOSED WORK:
oN
14. STATE REASONS WHY THE APPLICANT BELIEVES THAT THIS ACTIVITY MUST BE
CARRIED OUT IN WETLANDS. ALSO, NOTE MEASURES TAKEN TO MINIMIZE WETLAND
IMPACTS. / cl• Av T t- r 1,9 << 1 , r f
OC T?F} r./ Ar/ 'zcA ,tee r 17 ewe_e, l /N o 72,77.71' 1A) z* , rcr,?.??777 P
?Fr.ecr 1-/A -1;?Le , ? /YI??Lcri9l',?ir? c>? Nc?,Q iT?/'"lq r C, /=
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 [ ] NO [v]"'
RESPONSES FROM THE USFWS AND/OR NMFS SHOULD BE ATTACHED.
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 [ ] NO [
RESPONSE FROM THE SHPO SHOULD BE ATTACHED.
.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.
r
,•'D., IF A STORMWATER MANAGEMENT PLAN IS REQUIRED FOR THIS PROJECT, ATTACH
! .COPY.
E. WHAT IS LAND USE OF SURROUNDING PROPERTY? P r
F. IF APPLICABLE, W01AT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
OWNER'S SIGNATURE-'DATE
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