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HomeMy WebLinkAbout20140957 Ver 1_01_PCN_Form_North Carolina_20170227E3 0� VJA �<G o -r Office Use Only: Corps action ID no. DWQ project no. Form Version 1.4 January 2009 Page 1 of 10 PCN Form — Version 1.4 January 2009 Pre -Construction Notification (PCN) Form A. Applicant Information 1. Processing 1 a. Type(s) of approval sought from the Corps: ❑X Section 404 Permit Section 10 0 rmit 1 b. Specify Nationwide Permit (NWP) number: 12 or General Permit (GP) number: 1c. Has the NWP or GP number been verified by the Corps? ❑X Yes ❑ No 1 d. Type(s) of approval sought from the DWQ (check all that apply): ❑X 401 Water Quality Certification — Regular ❑ Non -404 Jurisdictional General Permit ❑ 401 Water Quality Certification — Express ❑X Riparian Buffer Authorization 1 e. Is this notification solely for the record because written approval is not required? For the record only for DWQ 401 Certification: ❑ Yes ❑X No For the record only for Corps Permit: ❑ Yes ❑X No 1f. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts? If so, attach the acceptance letter from mitigation bank or in -lieu fee program. ❑ Yes ❑ No 1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h below. ❑ Yes ❑X No 1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ❑ Yes ❑X No 2. Project Information 2a. Name of project: Atlantic Coast Pipeline 2b. County: Northampton, Halifax, Nash, Wilson, Johnston, Sampson, Cumberland, Robeson 2c. Nearest municipality / town: Not Applicable - linear project, See Appendix A - Figures 1 and 2 2d. Subdivision name: Not Applicable 2e. NCDOT only, T.I.P. or state project no: Not Applicable 3. Owner Information 3a. Name(s) on Recorded Deed: Atlantic Coast Pipeline, LLC 3b. Deed Book and Page No. N/A 3c. Responsible Party (for LLC if applicable): Leslie Hartz 3d. Street address: 707 E Main Street, 19th Floor 3e. City, state, zip: Richmond, VA 23219 3f. Telephone no.: (804) 771-4468 3g. Fax no.: 3h. Email address: leslie.hartz@dom.com Page 1 of 10 PCN Form — Version 1.4 January 2009 4. Applicant Information (if different from owner) 4a. Applicant is: ❑ Agent Q Other, specify: Atlantic Coast Pipeline, LLC 4b. Name: Leslie Hartz 4c. Business name (if applicable): 4d. Street address: 707 E Main Street, 19th Floor 4e. City, state, zip: Richmond, VA 23219 4f. Telephone no.: (804) 771-4468 4g. Fax no.: 4h. Email address: leslie.hartz@dom.com 5. Agent/Consultant Information (if applicable) 5a. Name: Richard Gangle 5b. Business name (if applicable): Dominion Resources Services, Inc. 5c. Street address: 5000 Dominion Blvd 5d. City, state, zip: Glen Allen, Virginia 23060 5e. Telephone no.: (804) 273-2814 5f. Fax no.: 5g. Email address: richard.b.gangle@dom.com Page 2 of 10 B. Project Information and Prior Project History 1. Property Identification 1a. Property identification no. (tax PIN or parcel ID): Not Applicable 1 b. Site coordinates (in decimal degrees): Latitude: Longitude: 1c. Property size: 3,023 acres 2. Surface Waters 2a. Name of nearest body of water to proposed project: See Appendix C 2b. Water Quality Classification of nearest receiving water: See Appendix C 2c. River basin: See Appendix C 3. Project Description 3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this application: See Section B3a of the attached supplemental information 3b. List the total estimated acreage of all existing wetlands on the property: 558 3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 31,700 3d. See Explain the purpose of the proposed project: Section 133d of the attached supplemental information 3e. See Describe the overall project in detail, including the type of equipment to be used: Section B3e of the attached supplemental information 4. Jurisdictional Determinations 4a. Have jurisdictional wetland or stream determinations by the Corps or State been requested or obtained for this property / project (includingall prior phases in the past? ❑ Yes ❑X No ❑ Unknown Comments: See Section 64a of supplemental information pp 4b. If the Corps made the jurisdictional determination, what type of determination was made? ❑ Preliminary ❑ Final 4c. If yes, who delineated the jurisdictional areas? Name (If known): See Section 134c of supplemental information Agency/Consultant Company: Other: 4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation. See Section B4 of supplemental information 5. Project History 5a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past? ❑X Yes ❑ No ❑ Unknown 5b. If yes, explain in detail according to "help file" instructions. See Section B5 of supplemental information 6. Future Project Plans 6a. Is this a phased project? ❑ Yes ❑X No 6b. If yes, explain. Page 3 of 10 PCN Form — Version 1.4 January 2009 C. Proposed Impacts Inventory 1. Impacts Summary 1 a. Which sections were completed below for your project (check all that apply): ❑X Wetlands Strea X — tributaries Buffers Open \❑X ters P❑d Construction ❑ 2. Wetland Impacts If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted. 2a. Wetland impact number Permanent (P) or Temporary T 2b. Type of impact 2c. Type of wetland 2d. Forested 2e. Type of jurisdiction Corps (404,10) or DWQ (401, other) 2f. Area of impact (acres) W1 - Choose one Choose one Yes/No - W2 - Choose one Choose one Yes/No W3 - Choose one Choose one Yes/No W4 - Choose one Choose one Yes/No W5 - Choose one Choose one Yes/No W6 - Choose one Choose one Yes/No 2g. Total Wetland Impacts: 2h. Comments: See Appendix C and Appendix A - Figure A-4 of the Supplemental Information for wetland impacts summaries for the pipeline facilities. 3. Stream Impacts If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this question for all stream sites impacted. 3a. Stream impact number Permanent (P) or Temporary (T) 3b. Type of impact 3c. Stream name 3d. Perennial (PER) or intermittent (INT)? 3e. Type of jurisdiction 3f. Average stream width (feet) 3g. Impact length (linear feet) S1 - Choose one S2 - Choose one S3 - Choose one - S4 - Choose one - - S5 - Choose one - S6 - Choose one - 3h. Total stream and tributary impacts 3i. Comments: See Section C, Appendix C and Appendix A - Figure A-4 of the Supplemental Information for waterbody impacts summaries for the pipeline facilities. Page 4 of 10 PCN Form — Version 1.4 January 2009 4. Open Water Impacts If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of the U.S. then indivi ually list all open water impacts below. 4a. Open water impact number Permanent (P) or Temporary T 4b. Name of waterbody (if applicable) 4c. Type of impact 4d. Waterbody type 4e. Area of impact (acres) 01 Choose one Choose 02 - Choose one Choose 03 - Choose one Choose O4 - Choose one Choose 4f. Total open water impacts 4g. Comments: See bection U, Appendix U and Appendix A - Hgure A-4 ot the 6upplemental Information tor wetland mpac s summaries or e pipeline facilities. 5. Pond or Lake Construction If pond or lake construction proposed, the complete the chart below. 5a. Pond ID number 5b. Proposed use or purpose of pond 5c. Wetland Impacts (acres) 5d. Stream Impacts (feet) 5e. Upland (acres) Flooded Filled Excavated Flooded Filled Excavated P1 Choose one P2 Choose one 5f. Total: 5g. Comments: Not applicable 5h. Is a dam high hazard permit required? ❑ Yes ❑ No If yes, permit ID no: 5i. Expected pond surface area (acres): 5j. Size of pond watershed (acres): 5k. Method of construction: Not applicable 6. Buffer Impacts (for DWQ) If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts below. If any impacts require mitigation, then you MUST fill out Section D of this form. 6a. Project is in which protected basin? X❑ Neuse ❑X Tar -Pamlico Dawba C]ndleman Other 6b. Buffer Impact number - Permanent (P) or Temporary T 6c. Reason for impact 6d. Stream name 6e. Buffer mitigation required? 6f. Zone 1 impact (square feet) 6g. Zone 2 impact (square feet B1 - Yes/No B2 - Yes/No B3 - Yes/No B4 - Yes/No B5 - Yes/No B6 - Yes/No 6h. Total Buffer Impacts: 6i. Comments: See Section C6 of the attached supplemental information, Table 5. Page 5 of 10 D. Impact Justification and Mitigation 1. Avoidance and Minimization 1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project. See Section Mal and D1a2 of the attached supplemental information 1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques. See Section D1 b1 and D1 b2 of the attached supplemental information 2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State 2a. Does the project require Compensatory Mitigation for impacts to Waters of the U.S. or Waters of the State? ❑ Yes ❑ No 2b. If yes, mitigation is required by (check all that apply): ❑ DWQ ❑ Corps 2c. If yes, which mitigation option will be used for this project? ❑ Mitigation bank El Payment to in -lieu fee program ❑ Permittee Responsible Mitigation 3. Complete if Using a Mitigation Bank 3a. Name of Mitigation Bank: 3b. Credits Purchased (attach receipt and letter) Type: Choose one Type: Choose one Type: Choose one Quantity: Quantity: Quantity: 3c. Evaluation of bank credits available is currently underway and a plan will be submitted with the final application. Comments: 4. Complete if Making a Payment to In -lieu Fee Program 4a. Approval letter from in -lieu fee program is attached. ❑ Yes 4b. Stream mitigation requested: linear feet 4c. If using stream mitigation, stream temperature: Choose one 4d. Buffer mitigation requested (DWQ only): square feet 4e. Riparian wetland mitigation requested: acres 4f. Non -riparian wetland mitigation requested: acres 4g. Coastal (tidal) wetland mitigation requested: acres 4h. Comments: 5. Complete if Using a Permittee Responsible Mitigation Plan 5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan. Atlantic is evaluating the need for permittee responsible mitigation based on available credits from banks in appropriate service areas/watersheds. A plan for mitigating impacts will be provided with the final application. Page 6 of 10 PCN Form — Version 1.4 January 2009 6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ 6a. Will the project result in an impact within a protected riparian buffer that requires ❑X Yes ❑ No buffer mitigation? 6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the amount of mitigation required. 6c. 6d. 6e. Zone Reason for impact Total impact Multiplier Required mitigation (square feet) (square feet) Zone 1 3 (2 for Catawba) Zone 2 1.5 6f. Total buffer mitigation required: 6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank, permittee responsible riparian buffer restoration, payment into an approved in -lieu fee fund). See Section D6 of the attached supplemental information See Section D6 of the attached supplemental information 6h. Comments: Page 7 of 10 E. Stormwater Management and Diffuse Flow Plan (required by DWQ) 1. Diffuse Flow Plan 1 a. Does the project include or is it adjacent to protected riparian buffers identified ❑X Yes ❑ No within one of the NC Riparian Buffer Protection Rules? 1 b. If yes, then is a diffuse flow plan included? If no, explain why. An Erosion and Sediment Control Plan is being developed and will be submitted once completed, an for diffuse is the development E&S ❑ Yes ❑X No evaluation of need a plan part of of plans. 2. Stormwater Management Plan 2a. What is the overall percent imperviousness of this project? 2b. Does this project require a Stormwater Management Plan? ❑ Yes 0 No 2c. If this project DOES NOT require a Stormwater Management Plan, explain why: This is a linear project and impervious surfaces are expected to be significantly less than 24%. 2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan: 2e. Who will be responsible for the review of the Stormwater Management Plan? 3. Certified Local Government Stormwater Review 3a. In which localgovernment's jurisdiction is thisproject? TBD ❑ Phase II ❑ NSW 3b. Which of the following locally -implemented stormwater management programs ❑ USMP apply (check all that apply): ❑ Water Supply Watershed ❑ Other: 3c. Has the approved Stormwater Management Plan with proof of approval been ❑ Yes ❑ No attached? 4. DWQ Stormwater Program Review ❑Coastal counties ❑ HQW 4a. Which of the following state -implemented stormwater management programs apply ❑ORW (check all that apply): ❑Session Law 2006-246 ❑ Other: 4b. Has the approved Stormwater Management Plan with proof of approval been ❑ Yes ❑ No attached? 5. DWQ 401 Unit Stormwater Review 5a. Does the Stormwater Management Plan meet the appropriate requirements? ❑ Yes ❑ No 5b. Have all of the 401 Unit submittal requirements been met? ❑ Yes ❑ No Page 8 of 10 PCN Form — Version 1.4 January 2009 F. Supplementary Information 1. Environmental Documentation (DWQ Requirement) 1 a. Does the project involve an expenditure of public (federal/state/local) funds or the Yes ❑ No use of public (federal/state) land? 1 b. If you answered "yes" to the above, does the project require preparation of an environmental document pursuant to the requirements of the National or State ❑X Yes ❑ No (North Carolina) Environmental Policy Act (NEPA/SEPA)? 1 c. If you answered "yes" to the above, has the document review been finalized by the State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval ❑ Yes ❑X No letter.) Atlantic Coast Pipeline, LLC is submitting an application to FERC, FERC will be Comments: writing an EIS. See Supplemental Information Section F.1. 2. Violations (DWQ Requirement) 2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards, E] Yes ❑X No or Riparian Buffer Rules (15A NCAC 2B .0200)? 2b. Is this an after -the -fact permit application? El Yes ❑X No 2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s): Not Applicable 3. Cumulative Impacts (DWQ Requirement) 3a. Will this project (based on past and reasonably anticipated future impacts) result in El Yes ❑X No additional development, which could impact nearby downstream water quality? 3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the most recent DWQ policy. If you answered "no," provide a short narrative description. See Section F3 of the attached supplemental information 4. Sewage Disposal (DWQ Requirement) 4a. 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. Not applicable Page 9 of 10 PCN Form — Version 1.4 January 2009 5. Endangered Species and Designated Critical Habitat (Corps Requirement) 5a. Will this project occur in or near an area with federally protected species or Yes ❑ No habitat? 5b. Have you checked with the USFWS concerning Endangered Species Act ❑X Yes ❑ No impacts? 5c. If yes, indicate the USFWS Field Office you have contacted. Raleigh 5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat? See Section F5 of the attached supplemental information 6. Essential Fish Habitat (Corps Requirement) 6a. Will this project occur in or near an area designated as essential fish habitat? ❑ Yes ❑X No 6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat? See Section F6a of the attached supplemental information 7. Historic or Prehistoric Cultural Resources (Corps Requirement) 7a. Will this project occur in or near an area that the state, federal or tribal governments have designated as having historic or cultural preservation ❑ Yes ❑ No status (e.g., National Historic Trust designation or properties significant in North Carolina history and archaeology)? 7b. What data sources did you use to determine whether your site would impact historic or archeological resources? See Section F7 of the attached supplemental information 8. Flood Zone Designation (Corps Requirement) 8a. Will this project occur in a FEMA -designated 100 -year floodplain? ❑X Yes ❑ No 8b. If yes, explain how project meets FEMA requirements: See Section F9 of the attached supplemental information and Figure 5 of Appendix A 8c. What source(s) did you use to make the floodplain determination? FEMA Flood Map Service Center Applicant/Agent's Printed Name Date Applicant/Agent's Signature (Agent's signature is valid only if an authorization letter from the applicant is provided. Page 10 of 10