20111032 Ver 1_401 Application_20111129

201 1 1032
OF W AT�e,9
�O� QG Office Use Onty
� � � � Corps adion ID no
� ,�� � o < DWQ pro�ed no
Form Version 1 3 Dec 10 2008 0�
Pre-Construchon Nohficahon C Form
A A Lcant Informahon
1 Processing � �^� �� r� �— �
1 a Type(s)of approval sought from the `�'' ��'� '=
Corps � Secbon 404 Perm�t ❑Secaon'�0 Permit �-�_��
1 b Specify Natiornnnde Permit(NWP)number 18 or General Permd(GP)number
1 c Has the NWP or GP number been venfied by the Corps� �Yes ❑ No
1 d Type(s)of approvai sought from the DWQ(check all that apply)
❑401 Water Quality Cerdficat�on—Regular ❑Non-404 Junsdictional Generai PeRnit
❑401 Water Quality Cert�fication—Express ❑ Ripanan Buffer Authorizafion
1 e Is this not�ficafion solely for the record For the record only for DWQ 401 For the record only for Corps Permit
because wntten approval is not required? Certifica�on
�Yes No ❑Yes �No
1f is payment into a mit�gation bank or m lieu fee program proposed for mfigabon �Yes � No
of impacts? if so attach the acceptance letter from mingat�on bank or in-lieu
fee program
1 g is the pro�ect located in any of NC s twenty coastal counties If yes answer 1 h �Yes ❑ No
below
1 h Is the pro�ect located within a MC DCM Area of Env�ronmental Concem(AEC)? ❑Yas �No
2 Project Information
2a Name of pro�ect Tim Noble Mobde Home Park Access Dnve
2b County Onslow
2c Nearest murncipality/town Jacksonv�lle
2d Subdivision name ►V��
2e NCDOT only T I P or state
pro�ect no �FNR
3 Owner Information $ �e�TY
3a Name(s)on Recorded Deed Timothy A noble
3b Deed Book and Page No
3c Responsibie Party(for LLC�f
applicable)
3d Street address 2436 Dawson Cabm Road
3e City state z�p Jacksonvdle NC 28540
3f Telephone no 910-455-0723
3g Fa�c no
3h Emad address
Page 1 of 10
PCN Fortn—Version 1 3 December 10 2008 Version

4 Appl�cant InfoRnation(if d�fferent from owner)
4a Applicant is ❑Agent ❑Other specdy �_
4b Name
4c Business name
(�f applicabie)
4d Street address
4e City state z�p
4f Telephone no
4g Fax no
4h Emad address
5 AgenUConsultant Information(ff applicable)
5a Name
5b Busmess name
(if appiicabie)
5c Street address
5d City state zip
5e Telephone no
5f Fax no
5g Emad address
Page 2 of 10
PCN Form—Version 1 3 December 10 2008 Version

B Pro�ect Informat�on and Pnor Project History
1 Property Identification
1a Property ident�fication no (tax PIN or parcel ID) Tax ID 739-991
1 b S�te coordmates(m decimai degrees) La�tude 34 68860 Longitude 77 501287
(DD DDDDDD) (DD DDDDDD)
1c Property size —2 acres
2 Surface Waters
2a Name of nearest body of water(stream nver etc)to
proposed pro�ect UT to Haws Run
2b Water Quality ClassficaUon of nearest receiv�ng water C NSW
2c River basm Whde Oak 03030001
3 Pro�ect Description
3a Descnbe the existing cond�ons on the site and the general land use m the v�c�nity of the pro�ect at the 6me of this
,�r� application
/\ �-� v / a PQ {
3b List the totai esfimated acreage of all exi t�ng wetlands on he property
02
3c List the total esbmated linear feet of ail existing streams(intermittent and perenroal)on the property
350
3d Explain the purpose of the p posed pro�ect
Mob� !Q oyrP �a r K �' r��c �. r�5g.
e Descnbe the overall pro�ect m detad induding the type of ipment to be
0 0 � —t'��c a a b �
4 Jurisdictional Determmations
4a Have�unsdic�onal wetland or stream determmat�ons by the
Corps or State been requested or obtained for this property/
pro�ect(including all pnor phases)m the past� �Yes ❑ No ❑Unknown
Comments Delineated as part of unauthonzed acbvity mvest
4b If the Corps made the�unsdictional determmaUon what type
of determinaUon was made� ❑ Preliminary � Finai
4c If yes who delineated the�unsdictional areas� Agency/Consultant Companr
Name(if known) David E Badey(USACE) Other
4d if yes I�st the dates of the Corps�unsdicfional determina�ons or State detennmaUons and attach documenta�on
10h 9/2011
5 Project History
5a Have permits or cerfificafions been requested or obtained for �Yes �No ❑Unknown
this pro�ect(includmg all pnor phases)m the past�
5b If yes expiain m detail according to heip file instrucbons
6 Future Pro�ect Plans
6a Is this a phased pro�ect� ❑Yes � No
6b If yes expiain
Page 3 of 10
PCN Form—Version 1 3 December 10 2008 Version

C Proposed Impacts Inventory
1 impacts Summary °-
1 a Which secGons were compieted below for your pro�ect(check all that appiy)
�Wetlands „�Streams tnbutanes ❑Buffers
❑Open Waters ❑ Pond Construction
2 Wetland Impacts
If there are wetland�mpacts proposed on the site then compiete this quesbon for each wetland area impacted
2a 2b 2c 2d 2e 2f
Wetiand impact Type of�unsdict�on
number— Type of impact Type of wetland Forested (Corps 404 10 Area of impact
Permanent(P)or (if known) DWQ—non�404 other) (acres)
Tem ra
W1 P[]T Permanent Ripanan ❑Yes � Corps
�, ,,, �No ❑ DWQ � �
� �P❑T ❑Yes ❑Corps
❑No ❑DWQ
W3 ❑P�T ❑Yes ❑Corps
❑No ❑DWQ
W4 �P 0 T ❑Yes ❑Corps
❑No ❑ DWQ
W5 ❑ P 0 T ❑Yes ❑ Corps
❑No ❑DWQ
W6 �P 0.� ❑Yes ❑Corps
❑No ❑DWQ
2g.Total wetland impacts N'�0 S .
2h Comments
3 Strearrllmpacts
If there are perenrnal or intermittent stream impacts(inGud�ng temporary impacts)proposed on the s�te then complete this
question for all stream sdes impacted
3a 3b 3c 3d 3e 3f 3g
Stream impact Type of impact Stream name Perenrnal Type of�unsdictian Average Impact
number (PER)or (Corps 404 10 stream length
Permanent(P)or mtermittent DWQ—non-404 w�dth (linear
Temporary(i� (INI�� other) (feet) feet)
S1 � P 0 T Pertnanen UT to Haws Run �PER �Cotps / /
� INT ❑ DWQ �''� eZd
S2 ❑P�T ❑PER ❑Corps
❑tNT ❑DWQ
S3 ❑P�T ❑PER ❑Corps
❑ INT ❑ DWQ
� � P�T ❑PER ❑Corps
❑ INT ❑ DWQ
S5 ❑P�T ❑PER ❑Corps
❑tNT ❑DWQ
S6 ❑ P❑T ❑PER ❑Corps
❑ INT ❑ DWQ
3h Total stream and tnbutary impacts �x fj �— p < <
3i Comments
Page 4 of 10
PCN Form—Version 1 3 December 10 2008 Version

4 Open Water impacts
If there are proposed impacts to lakes ponds estuanes tnbutanes sounds the Atlarrtic Ocean or any other open water of
the U S then individualiy list all open water impacts below e -
4a 4b 4c 4d 4e
Open water Name of waterbody
impact number— (d appl�cable) Type of impact Waterbody type Area of impact(acres)
Permanent(P)or
Tem ora
01 ❑P❑T
02 ❑ P❑T
03 ❑ P�T
04 ❑ P�T
4f Total open water�mpacts
4g Comments
5 Pond or l.ake Constructfon
if ond or lake construction ro osed then com lete the chart below
5a 5b 5c 5d 5e
Wetland Impacts(acres) Stream Impacts(feet) Upiand
Pond ID Proposed use or purpose (acres)
number of pond
Flooded Fdled Excavated Flooded Fdled Excavated Flooded
P1
P2
5f Total
5g Comments -
5h Is a dam high hazard permit reqwred�
❑Yes ❑ No If yes permit ID no
5i Expected pond surface area(acres)
5� Size of pond watershed(acres)
5k Method of construcfion
6 Buffer Impacts(for DWQ)
If pro�ect vinll impact a protected npanan buffer then complete the chart below If yes then indiv�dually list all buffer impacts
below If an im acts re wre miU abon then ou MUST fill out Secfion D of this form
6a
❑Neuse ❑Tar Pamlico ❑Other
Pro�ect�s in which protected basin� ❑Catawba ❑Randleman
6b 6c 6d 6e 6f 6g
Buffer impact
number— Reason Buffer Zone 1 impact Zone 2 impact
Permanent(P)or for Stream name mi�garon (square feet) (square feet)
Tem ora im act r wred�
B1 ❑ POT ❑Yes
❑ No
B2 ❑P�T ❑Yes
❑ No
B3 ❑ P�T ❑Yes
❑ No
6h Total buffer impacts
6i Comments
Page 5 of 10
PCN Form—Vers�on 1 3 December 10 2008 Version
^

D Impact Justification and MrtigaUon
1 Avoidance and Mlnimization
� 1 a Specfically descnbe measures taken to avoid or minimize the proposed impacts in desigrnng pro�ect ° �'
� � � 'f" � b I
1 b Specfically descnbe me s re taken to avoid or i ize the roposed impa throug cons on techrn ues
r , ' • k �-,�ns 11,'
2 Compensatory Mitigation for Impacts to Waters of the U S or Waters o e State '������ f'�'P t r wr��a �3
2a Does the pro�ect require Compensatory Mr�gabon for ❑Yes � No
impacts to Waters of the U S or Waters of the State?
2b If yes mingat�on is reqwred by(check all that apply) ❑ DWQ ❑Corps
❑ MitigaUon bank
2c If yes which miUgabon opt�on�nnll be used for this
pro�ect� ❑ Payment to in-lieu fee program
❑ PeRnittee Responsible Mit�gat�on
3 Complete if Using a Mitigation Bank
3a Name of Mit�gation Bank
3b Cred�ts Purchased(attach receipt and letter) Type Quanbty
3c Comments
4 Complete if Making a Payment to In Ileu Fee Program
4a Approval letter from in-lieu fee p�ogram is attached ❑Yes
4b Stream mit�gafion requested Imear feet
4c If usmg stream midgat�on stream temperature ❑warm ❑cooi ❑cold
4d Buffer mittgabon requested(DWQ only) square feet
4e Ripanan wetiand mit�ga�on requested acres
4f Non nparian wetland mitigabon requested acres
4g Coastal(bdal)weUand mit�gafion requested acres
4h Comments
5 Complete if Using a Permittee Responsible Mitigation Plan
5a If using a peRn�ttee responsibie mit�gahon pian prov�de a descnp�on of the proposed mfigabon plan
Page 6 of 10
PCN Form—Version 1 3 December 10 2008 Version

6 Buffer Mitigation (State Regulated Riparian Buffer Rules)—required by DWQ
6a Will the pro�ect result in an impact vinthm a protected npanan buffer that requ�res ❑Yes �No o _
buffer mitigat�on�
6b if yes then identify the square feet of impact to each zone of the npanan buffer that requires mfigabon Caiculate the
amount of mifigabon required
6c 6d 6e
Zone Reason for impact Totai impact Mulbplier Required mit�gat�on
(square feet) (square feet)
Zone 1 3(2 for Catawba)
Zone 2 1 5
6f Total buffer mitlgat�on required
6g If buffer mitigabon is required discuss what type of m�gabon is proposed(e g payment to pnvate mfigat�on bank
permittee responsible npanan buffer restora�on payment mto an approved in-lieu fee fund)
6h Comments
Page 7 of 10
PCN Form—Version 1 3 December 10 2008 Vers�on

E Stormwater Management and Diffuse Flow Plao(required by DWQ)
1 Diffuse Flow Plan
1a Does the pro�ect�nclude or is d ad�acent to protected npanan buffers idenbfied �Yes � No
wnthm one of the NC Ripanan Buffer ProtecGon Rules?
1 b If yes then is a drffuse flow plan induded�If no expiam why
Comments ❑Yes ❑No
2 Stormwater Mana ement Plan
2a What is the overall percent imperviousness of this pro�ect� �%
2b Does this pro�ect reqwre a Stormwater Management Plan? ❑Yes ($No
2c If this pro�ect DOES NOT require a Stormwater Management Plan explam why /� � k�� �oI+P �'�ipA
2d if this pro�ect DOES require a Stormwater Managemerrt Plan then prowde a bnef narrative descnpdon of the plan
❑Cefified Local Govemment
2e Who vinll be respons�ble for the rewew of the Stormwater Management Plan? ❑ DWQ Stonnwater Program
❑DWQ 401 Unit
3 Certffied Local Government Stormwater Review
3a In which local govemment s�unsdiction is this pro�ect�
❑ Phase II
3b Which of the follo�nnng locally implemented stormwater management programs ❑ NSW
apply(check all that appiy) ❑ USMP
❑Water Supply Watershed
❑Other
3c Has the approved Stormwater Management Plan vinth proof of approval been ❑Yes ❑No
attached?
4 DWQ Stormwater Pro ram Review
Coastal counUes
HQW
4a Which of the follov�nng state-�mplemented stormwater management programs apply � ORW
(check all that apply) ❑ Sess�on Law 2006-246
❑ Other
4b Has the approved Stormwate�Management Plan�nnth proof of approval been
attached� ❑Yes �'jVo
5 DWQ 401 Unit Stormwater Review
5a Does the Stormwater Management Plan meet e appropnate requirements? �Yes ❑No
5b Have all of the 401 Urnt submittai reqwrements been met? ❑Yes ❑No
Page 8 of 10
PCN Form—Version 1 3 December 10 2008 Version

F Suppiementary Informat�on
1 Environmental Documentation(DWQ Requirement) e-
1 a Does the proJect mvolve an expend�ture of public(federaUstate/iocal)funds or the �Yes �lo
use of publ�c(federaUstate)land�
1 b If you answered°yes to the above does the pro�ect require preparabon of an
env�ronmental document pursuant to the requirements of the Nafionai or State ❑Yes ❑No
(North Caroima)Env�ronmental Policy Act(NEPA/SEPA)?
1 c If you answered"yes to the above has the document rewew been finalized by the
State Cleanng House� (If so attach a copy of the NEPA or SEPA final approval
letter) ❑Yes ❑No
Comments
2 Violatlons(DWQ Reqwrement)
2a is the s�te in wolation of DWQ We�and Rules(15A NCAC 2H 0500) Isolated
Wetland Rules(15A NCAC 2H 1300) DWQ Surtace Water or Wetiand Standards �Yes ❑ No
or Ripanan Buffer Rules(15A NCAC 2B 0200)?
2b Is this an after the-fact permit applica�on� �Yes ❑ No
2c If you answered yes to one or both of the above quest�ons prov�de an explanation of the v�olat�on(s) Fdl matenal placed
in wetlands without a perm�t Fdi matenai was placed as a dnveway crossing
3 Cumutahve Impacts(DWQ Requirement)
3a Will this pro�ect(based on past and reasonably ant�Gpated future impacts)result in �Yes f�No
addit�ohai development which could impact neatby downstream water quality'�
3b If you answered yes to the above submit a qualitat�ve or quant�tahve cumulatnre impact analysis m accordance w�the
most recent DWQ policy If you answered no prov�de a short narraUve descnp�on
� 4 Sewage D�sposal(DWQ Requirement)
.
4a Clearly detad the ulbmate treatment methods and d�sposit�on(non-discharge or discharge)of wastewater generated from
the proposed pro�ect or available capacity of the sub�ect fac�lity
Page9of10
PCN Form—Vers�on 1 3 Decembe�70 2008 Version

5 Endangered Species and Designated Cntical babitat(Corps Requirement) �
5a Will this pro�ect occur in or near an area wdh federally protected spec.�es or �Yes �No
habitat�
5b Have you checked with the USFWS concemmg Endangered Species Act
�mpacts? ❑Yes � No
5c if yes �ndicate the USFWS Field Office you have contacted ❑ Rale�gh
❑ Ashev�lle
5d What data sources did you use to determine whether your site wouid impact Endangered Species or Designated Cntical
Habdat�
NC Natural Hentage Database
6 Essential Fish Habitat(Corps Reqwrement)
6a Will this proJect occur�n or near an area des�gnated as essenbal fish habitat? ❑Yes �No
6b What data sources did you use to determ�ne whether your site would impact Essen�ai Fish Habitat�
vt.e I P
7 HistoNc or Prehistonc Cultural Resources(Corps Reqwrement)
7a Will this pro�ect occur m or near an area that the state federal or fibal
govemments have designated as havmg histonc or cuitural preservat�on �Yes �No
�status(e� Nabonat Histon�firust designafion�rpraperhes signficant in
North Carolma history and archaeology)�
7b What data sources did you use to determine whether your s�te would impact histonc or archeological resources�
8 Flood one Designation(Corps Requirement)
8a Wilt this project occur in a FEMA-designated 100-year floodplain? ❑Yes ,�No
8b If yes explain how pro�ect meets FEMA reqwrements
8c What source(s)did you use to make the floodpla�n determination?
j i rv►o-�I� � !1>0�1C
� !
� ` '��'Il r�(�l/'
T
ApplicanUAgent's Pnnted Name n AgenYs S�gnature Date
(I\qenYs signature�s va onty d an authonzaUon letter from the appucant
is rovuled
,
Page 10 of 10
PCN Form—Vers�on 1 3 December 10 2008 Version

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