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Pre Construction Notification (PCN) Form Instructions
The PCN form is required for applicants seeking the following approvals Corps 404 or Section 10 Permit or
DWQ 401 Certification Buffer Authorization Isolated/non 404 Wetlands Permit
PURPOSE
The PCN — Pre Construction Notification form helps regulators from the state and federal agencies m North
Carolina better understand and evaluate the impacts of activities that you propose to do in or around streams
wetlands or other waters that may affect water quality the health of the aquatic ecosystem or water access or
flow in the immediate or nearby drainage area
The PCN is a combined effort by the US Army Corps of Engmeers (USACE known as the Corps ) and the
NC Division of Water Quality (DWQ) to coordinate regulatory requirements for work m(or affecting)
wetlands streams ripanan buffers and waters within North Carolma By accurately compieting the PCN
form we can determme if you meet reqwrements to proceed with your pro�ect as proposed We can
evaluate the measures you propose to take to avoid or mitigate for any damage to the environment Our
review of your completed form will provide us with necessary information about your pro�ect to determine if
we can allow you to begin your pro�ect without the time expense or uncertainty involved in going through a
ma�or permit process
Many Corps Nationwide permits and some general permits require the applicant to complete and submit a
PCN form before starting any work in an area that may impact streams wetlands or other waters Activities
that reqwre a NC General Water Quality Certification a stormwater permit or a buffer permit within
protected watersheds use the PCN form The responsible state or federal agencies wdl review your
application for completeness within 30 days of receipt We wdi notify you if we need additional information to
process your request You may not begin work until your application is complete Once your application is
complete the Corps will process it within 45 days for a Nationwide or General Permit and the NC DWQ will
process your 401 Certification within 60 days
Note Do not use the PCN form if you are requesting a Corps Individual Permit or NC DWQ Individual Water
Quality Certification The Corps Individual Permit application form is available online at
www saw usace army mil/wetlands/Permits html
INFORMATION WE NEED TO KNOW
We need to know details about who you are where you propose to work what you will be domg and how you
will compensate for impacts to streams wetlands or other waters as a result of your work Ali information is
required unless otherwise stated as optional Incomplete applications cannot be accepted for review and will be
returned to the applicant You can obtain help in completing each question on the form through the instructions
m th�s document
FEES
DWQ Water Qualitv Certifications North Carolina requires fees for processmg water quality certifications
and buffer permits The reqwred fees are as follows
i�or water quality applications Greater than or equal to $570 00
e acre of wetlands/waters AND/OR Greater than or equal
150 feet of streams (whether intermittent or qerenrnal)
nor water quality applications Less than one acre of
�tlands/waters AND Less than 150 feet of streams
hether intermittent or perennial)
$240 00
Checks should be made out to the NC Divis�on of Water Quality with the specific name of the pro�ect or
appl�cant identified on the check Piease sta le your check to the front of the application package
Version 1 2 PCN Heip File Page 1 of 26
12/29/2008
For more information on the required NC DWQ fees see the DWQ Application Fees document at
http //h2o enr state nc us/ncwetlands/documentslApplicationFees doc
Note If the pro�ect is sponsored by a federal agency the DWQ requires the name of pro�ect pnnted on the
US Treasury check and the pro�ect application fee mailed to NC DWQ 401/Wetlands Unit 1650 Mad
Service Center Raleigh NC 27699 1650
DWQ Buffer Permits If written approval is sought solely for Buffer Rules (Ripanan Buffer Authorization) the
application fee does not apply and the applicant should clearly state (in a cover letter) that o� Buffer Rule
approval is sought in wnting
Corps Permits There is no fee for Nationwide or General Permits processed by the Corps of Engineers
WHERE TO SEND YOUR COMPLETED PCN FORM
Copies of your completed PCN with all required attachments must be sent to the Corps or to DWQ or both
agencies depending on the approval sought Additionally review the specific reporting reqwrements for
your pro�ect as some conditions of approval require you to send a copy of your PCN to coordinating
agencies
DWQ Certifications All PCN Forms processed by NC DWQ must be sent to
NC DWQ 401/Wetlands Unit
1650 Mad Service Center
Raleigh NC 27699 1650
Number of Copies Required for DWQ Provide five (5) complete and collated copies of the PCN
Application and supporting documentation (instead of providmg 5 copies of the full size plans (usually
approximately 24x36 mches) you may provide two copies of full size plans along with three copies of 11 x17
plans)
Corps Permits — PCN Forms are processed at each Corps
Field Office for the counties in which the activity is proposed
The map and list shows the counties that are served by each
Corps field office
Field Office
Ashevdle Regulatory Field Office
US Army Corps of Engineers
151 Patton Avenue
Room 208
Ashevdle NC 28801 5006
Telephone (828) 271 7980
Fax (828) 281 8120
Raleigh Regulatory Field Office
US Army Corps Of Engineers
�3331 Hentage Trade Drive
Swte 105
Wake Forest NC 27587
Telephone (919) 554 4884
Fax (919) 562 0421
Washington Regulatory Field O�ce
US Army Corps of Engineers
Post Office Box 1000
Counties by Field Office
0 Asheville Field Office
0 Raleigh Field �ffice
� Washington Field Office
� Wdmington Field �ffice
Counties Served
Alexander Caldwell
Alleghany Catawba
Ashe Cherokee
Avery Clay
Buncombe Cleveland
Burke Gaston
Cabarrus Graham
Alamance
Caswell
Chatham
Davidson
Davie
Durham
Edgecombe
Beaufort
Bertie
Camden
Franklin
Forsyth
Granville
Guilford
Halifax
Johnston
Lee
Haywood
Henderson
Iredell
Jackson
Lincoln
Macon
Madison
Nash
Northampton
Orange
Person
Randolph
Rockingham
Stokes
Curntuck Jones
Dare Lenoir
Gates Martin
Corps Field affices
■
McDowell Swain
Mecklenburg Transylvania
Mitchell Urnon
Polk Watauga
Rowan Yancey
Rutherford
Stanley
Surry
Vance
Wake
Warren
Wilkes
Wilson
Yadkm
Pitt
Tyrrell
Washington
Version 1 3 PCN Help File Page 2 of 26 12/29/2008
�
Washmgton NC 27889 1000
Telephone (252) 975 1616
Fax (252) 975 1399
Carteret Green Pamlico
Chowan Hertford Pasquotank
Craven Hyde Perquimans
Wilmmgton Regulatory Field Office Anson Duplm Onslow
US Army Corps of Engineers Bladen Harnett Pender
69 Darlington Avenue Brunswick Hoke Richmond
Wilmington NC 28403 1343 Carteret Montgomery Robeson
Telephone (910) 251 4511 Columbus Moore Sampson
Fax (910) 251 4025 Cumberland New Hanover Scotland
Wayne
Croatan National Forest
Only
Number of Copies Reauired for Coras Provide one complete PCN Application and supporting
documentation (all plans must be no greater in size than 11 X 17 sheets )
Diqital document attachments for Coras The Corps encourages appiicants to begin to submit plan map
and survey attachments in digital format Specific guidance will be provided in 2009 on the Corps web s�te
concerning format and method the goal of which wdl be to eventually allow users to submit electronically in
lieu of paper copies At this time however di4ital attachments cannot replace the paper copv and
attachments but the Corps would apprec�ate receiving a digital copy of all attachments in addition to the
required paper copy The digital copy must be saved to a CD or DVD ROM and must be clearly labeled and
in PDF format that can be legibly pnnted for viewing at no larger than 11 x 17
Specific Renortinp Requirements There are specific reporting requirements for pro�ects located in counties
that have trout waters coastal counties and western NC counties as well as specific drainage basms covered
by state riparian buffer rules
Counties with Trout Waters
The NC Wildlife Resources Commission can help determine if your pro�ect may impact trout waters If
your pro�ect is within a trout county listed below you must send a copy of your PCN to WRC to assess
potential impacts to trout waters
If your pro�ect is in any of the following counties Alleghany Ashe Avery Burke Caldwell Mitchell
Stokes Surry Watauga or Wilkes send a copy of your PCN to
Western Piedmont Region Coordinator
3855 Idlewild Road
Kernersvdle NC 27284 9180
Telephone (336) 769 9453
If your pro�ect is m Buncombe Cherokee Clay Graham Haywood Henderson Jackson Macon
Madison McDowell Polk Rutherford Swain Transylvania or Yancey counties send a copy of your
PCN to
Mountain Region Coordinator
20830 Great Smoky Mtn Expressway
Waynesville NC 28786
Telephone (828) 452 2546
Fax (828) 452 7772
Coastal Counties
If your proposed pro�ect is in a coastal county you need to check to see if the work is m an Area of
Environmental Concern and requires a CAMA permit If the pro�ect occurs in any of North Carolina s
twenty coastal counties Beaufort Bertie Brunswick Camden Carteret Chowan Curntuck Craven
Dare Gates Hertford Hyde New Hanover Onslow Pamlico Pasquotank Pender Perquimans Tyrrell
or Washington counties you need to determine if a CAMA permit is required for your pro�ect
Contact the North Carolina Division of Coastal Management (DCM) for help DCM will determine if the
pro�ect is within a designated Area of Environmental Concern in which case you must apply directly to
Version 1 3 PCN Help File Page 3 of 26
12/29/2008
DCM for a CAMA permit DCM and the Corps share a �oint permit application for CAMA permits Many
CAMA permits do not require completing a PCN
NC Division of Coastal Management Telephone (252) 808 2808
400 Commerce Avenue Fax (252) 247 3330
Morehead City NC 28557 3421
Pro�ects within nver basins with NC Ripanan Buffer protection
If your pro�ect is located within the Neuse Tar Pamlico Catawba or Randleman River Basins you must
ensure you are meeting the requirements for diffuse flow provisions set out in the North Carolina
Administrative Code Specific requirements for each river basin are set out in the Red Rule Book
which is located at the following website
http //h2o enr state nc us/admin/rules/documents/Redbook2007 pdf
Western counties with US FWS desiqnated cntical apuatic watersheds
All Corps permits reqwre you to check to ensure that no state or federally protected plant animal or
ecological commurnty is adversely impacted by your proposed pro�ect
If your pro�ect is in the following counties Avery Cherokee Forsyth Graham Haywood Henderson
Jackson Macon Mecklenburg Mitchell Stokes Surry Swain Transylvarna Union and Yancey you
must send an advance copy of your PCN to the Asheville Field Office of the US Fish and Wildlife Center
for review to ensure there will be no adverse impacts to cntical aquatic habitats as a result of your
pro�ect
Send your PCN package to
The US Fish and Wildlife Service
160 Zillicoa Street
Asheville North Carolina 28805
Telephone (828) 258 3939
SECTION A APPLICANT INFORMATION INSTRUCTIONS
A1 Processing — By completmg these fields accurately we can determine how your application wdl be
reviewed
A1a Type(s) of approval soughtfrom the Corps
Section 404 Permit the discharge of dredged or fill material into all waters of the United States including
wetlands as regulated under the Clean Water Act Typical activities requiring Section 404 permits are
Depositing of fill or dredged material in waters of the US or ad�acent wetlands site development fill for
residential commerciai or recreational developments construction of revetments culvert piacement
groins breakwaters levees dams dikes and weirs or placement of nprap and road fills
Section 10 Permit the construction of any structure in or over any navigable water of the United States as
regulated under the Rivers and Harbors Act Activities such as dredging construction of docks and
bulkheads and pfacing navigation aides require review under Section 10 to ensure that they will not cause
an obstruction to navigation Typical activities reqwnng Section 10 permits are construction of piers
wharves bulkheads dolphins marinas ramps floats intake structures and cable or pipeline crossings or
dredging and excavation
Need more information about federal water regulations under Corps authority�
http //www saw usace armv miI/WETLANDS/authontv html
How do 1 know if my parcel has wetlands or waters on �t that are �egulated by the Corps�
Not all waters or wetlands are regulated by the Corps To find out how this process is done and to learn
about how to survey your property for waters and wetlands visit the Corps web site section on Junsdictional
Determinations http //www saw usace armv md/wetlands/JDs
How do ! know if 1 need to complete a PCN�
Version 1 3 PCN Help File Page 4 of 26 12/29/2008
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20111112
Office Use Only
Corps action ID no
DWQ pro�ect no
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 Section 404 Permit ❑ Section 10 Permit
1 b Specify Nationwide Permit (NWP) number ���' or General Permit (GP) number
1 c Has the NWP or GP number been venfied by the Corps� ��s es ❑ No
1 d Type(s of approval sought from the DWQ (check all that apply)
401 Water Quality Certification - Regular ❑ Non 404 Jurisdictional General Permit
❑ 401 Water Quality Certification - Express ❑ Riparian Buffer Authonzation
1 e Is this notification solely for the record For the record only for DWQ For the record only for Corps Permit
because wntten ap roval is not required� 401 Certification
�� ❑ Yes lo ❑ Yes lo
1f Is payment into a mitigation bank or m lieu fee program proposed for
mitigation of impacts� If so attach the acceptance letter from mitigation bank � Yes lo
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 o
below
1 h Is the pro�ect located withm a NC DCM Area of Environmental Concern (AEC)� ❑ Yes o
2 Pro�ect Information
2a Name of pro�ect � C c �a �,.� c�
2b County � u� f��-� Cou�•-►
2c Nearest municipality / town �� j� � d Q ��
2d Subdiwsion name ENR WqrERQ���n,
2e NCDOT only T I P or state pro�ect no ATERBFtANCH
3 Owner Information
3a Name(s) on Recorded Deed �.�-�Ve� (_ c�- r� �,�0. («
3b Deed Book and Page No D �� Q,r
3c Responsible Party (for LLC if
applicable)
3d Street address � 3 Q �/.( � r va C�
3e City state zip � � f e C. �. / O
3f Telephone no 3 3(o _� C� ,' I S-
3g Fax no
3h Emailaddress S i"ICE� � D C
Page 1 of 10
PCN Form - Version 1 4 January 2009
Page 2 of 10
�
B Pro�ect Information and Prior Pro�ect History
1 Property Identification
1a Property identification no (tax PIN or parcel ID) (�� s ,3
1 b Site coordinates (in decimal degrees) Latitude Longitude
1 c Property size �Z �, c � e s acres
2 Surface Waters
2a Name of nearest body of water to proposed pro�ect �-/��..� iC,� V�
2b Water Quality Classification of nearest receiving water S'
2c River basm �'ct � 1-e � ✓
3 Pro�ect Description
3a Describe the existmg conditions on the site and the general land use in the v�cinity of the pro�ect at the time of this
application (� �
ttiPS � �c v► f 'i �.
3b List the total estimated acreage of ail existing wetlands on the property
3c List the total estimated Imear feet of all existing streams (intermittent and perennial) on the property
3d Explain the purpose of the proposed pro�ect
%rs�r✓�y ���
3e Descnbe the overall pro�ect in detad includmg the type of eqwpment to be used �i vr�,c�E'.. q r� � G, v� �•�.
s��F�-,.�` ca,��. ��2�. �.f dA.�.. , bu� �� daw,, #- �.Gk h��e �- 1��� ��
�, �e ,��
4 Jurisdictional Determinations
4a Have �unsdictional wetland or stream determinations by the Yes ❑ No ❑ Unknown
Corps or State been requested or obtained for this property / Comments
ro ect includin all rior hases in the ast�
4b If the Corps made the �urisdictional determination what type � Preliminary ❑ Final
of determination was made�
4c If yes who delmeated the �unsdictional areas� Agency/Consultant Company
Name (if known) ��A � � ��,, z,,v �� � Other
4d if yes list the dates of the Corps �unsdictional determinations or State determinations and attach documentat�on
�'v� �.�.,.,,, b �-- '-�. (�, �o t I
5 Pro�ect History
5a Have permits or certifications been requested or obtained for � Yes o ❑ Unknown
this pro�ect (including all pnor phases) m the past�
5b If yes explain m detad accordmg to help file instructions
6 Future Pro�ect Plans
6a Is this a phased pro�ect� ❑ Yes No
6b If yes explam
Page 3 of 10
PCN Form — Version 1 4 January 2009
C Proposed Impacts Inventory
1 Impacts Summary
1 a Which sections were comp ted below for your pro�ect (check all that apply)
❑ Wetlands Streams — tributanes ❑ Buffers ❑ Open Waters ❑ Pond Construction
2 Wetland Impacts
If there are wetland impacts proposed on the site then complete this question for each wetland area impacted
2a 2b 2c 2d 2e 2f
Wetland impact Type of impact Type of wetland Forested Type of�unsdiction Area of
number Corps (404 10) or impact
Permanent (P) or DWQ (401 other) (acres)
Tem ora
W1 Choose one Choose one Yes/No
W2 Choose one Choose one Yes/No
�1/3 Choose one Choose one Yes/No
�/�/4 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
3 Stream Impacts
If there are perennial or intermittent stream impacts (mcluding temporary impacts) proposed on the site then complete this
question for all stream sites impacted
3a 3b 3c 3d 3e 3f 39
Stream impact Type of impact Stream name Perennial (PER) or Type of Average Impact
number intermittent (INT)� �urisdiction stream length
Permanent (P) or width (linear
Temporary (T) (feet) feet)
S1 Choose one �,, c.� �,,,,., � z.- t' �' �i vt n��( U �v � r ��
S2 Choose one
S3 Choose one
S4 Choose one
S5 Choose one
S6 Choose one
3h Total stream and tributary impacts �
3i Comments
Page 4 of 10
PCN Form — Version 1 4 January 2009
4 Open Water Impacts
If there are proposed impacts to lakes ponds estuaries tnbutanes sounds the Atlantic Ocean or any other open water of
the U S then mdividuall list all o en water im acts below
4a 4b 4c 4d 4e
Open water Name of waterbody
impact number (if applicable) Type of impact Waterbody Area of impact (acres)
Permanent (P) or type
Tem ora
01 Choose one Choose
02 Choose one Choose
03 Choose one Choose
04 Choose one Choose
4f Total open water impacts
4g Comments
5 Pond or Lake Construction
If ond or lake construction ro osed then com lete the chart below
5a 5b 5c 5d 5e
Pond ID number Proposed use or Wetland Impacts (acres) Stream Impacts (feet) Upland
purpose of pond (acres)
Flooded Filled Excavated Flooded Filled Excavated
P1 Chooseone �r(�rQq�r,y S'(�
P2 Choose one
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 construction
6 Buffer Impacts (for DWQ)
If pro�ect will impact a protected riparian buffer then complete the chart below If yes then individually list all buffer impacts
below If an im acts re uire miti ation then ou MUST fill out Section D of this form
6a Pro�ect is in which protected basin� ❑ Neuse ❑ Tar Pamlico � Catawba � Randleman ❑ Other
6b 6c 6d 6e 6f 6g
Buffer Impact Reason for impact Stream name Buffer Zone 1 Zone 2
number — mitigation impact impact
Permanent (P) or required� (square (square
Tem ora feet feet
B � Yes/No
B2 Yes/No
63 Yes/No
64 Yes/No
B5 Yes/No
B6 Yes/No
6h Total Buffer Impacts
6i Comments
Page 5 of 10
D Impact Justification and Mitigation
1 Avoidance and Mirnmization
1 a Specifically descnbe measures taken to avoid or minimize the proposed impacts in designing pro�ect
' " � � 1/� Y �Y� f �,� ,S ( Z, 2 U � � U ✓�,�
1 b Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
NI�
2 Com ensato Miti ation for im acts to Waters of the U S or Waters of the State
2a Does the pro�ect reqwre Compensatory Mitigation for ❑ Yes o
impacts to Waters of the U S or Waters of the State�
2b If yes mitigation is required by (check all that apply) ❑ DWQ ❑ Corps
❑ Mitigation bank
2c If yes which mitigation option will be used for this � payment to in lieu fee program
pro�ect�
❑ Permittee Responsible Mitigation
3 Com lete if Usin a Miti at�on Bank
3a Name of Mitigation Bank
Type Choose one Quantity
3b Credits Purchased (attach receipt and letter) Type Choose one Quantity
Type Choose one Quantity
3c Comments
4 Com lete if Makin a Pa ment to In lieu Fee Pro ram
4a Approval letter from in lieu fee program is attached ❑ Yes
4b Stream mitigation requested linear feet
4c If usmg stream mitigation stream temperature Choose one
4d Buffer mitigation requested (DWQ only) square feet
4e Riparian wetland mitigation requested acres
4f Non ripanan wetland mitigation requested acres
4g Coastal (tidal) wetland mitigation requested acres
4h Comments
5 Compiete if Usmg a Permittee Responsible Mitigation Plan
5a If usmg a permittee responsible mitigation plan provide a description of the proposed mitigation plan
Page 6 of 10
PCN Form — Version 1 4 January 2009
6 Buffer Mitigation (State Regulated R�par�an Buffer Rules) — required by DWQ
6a Will the pro�ect result in an impact within a protected nparian buffer that requires � Yes ❑ No
buffer mitigation�
6b If yes then identify the square feet of impact to each zone of the riparian buffer that reqwres mitigation Calculate the
amount of mitigation required
6c 6d 6e
Zone Reason for impact Total impact Multiplier Reqwred 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)
6h Comments
Page 7 of 10
E Stormwater Management and Diffuse Flow Plan (required by DWQ)
1 Diffuse Flow Plan
1 a Does the pro�ect include or is it ad�acent to protected npanan buffers identified Yes ❑ No
within one of the NC Ri arian Buffer Protection Rules�
1 b If yes then is a diffuse flow plan included� If no explain why
N� h�t.J 1v�... �.rJ-lc2N.S SC�v ���e. ❑Yes No
P
2 Stormwater Mana ement Plan
2a What is the overall percent imperviousness of this pro�ect� � %
2b Does this ro ect re wre a Stormwater Mana ement Plan� ❑ Yes ❑ No
2c If this pro�ect DOES NOT require a Stormwater Management Plan explain why
2d if this pro�ect DOES require a Stormwater Management Plan then provide a brief narrative description of the plan
2e Who wdl be responsible for the review of the Stormwater Management Plan�
3 Certified Locai Government Stormwater Review
3a In which local overnment s unsdiction is this ro ect�
❑ Phase II
3b Which of the followmg locally implemented stormwater management programs ❑ NSW
apply (check all that apply) � USMP
� Water Suppiy Watershed
� Other
3c Has the approved Stormwater Management Plan with proof of approval been ❑Yes ❑ No
attached�
4 DWQ Stormwater Pro ram 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 Urnt Stormwater Review
5a Does the Stormwater Management Plan meet the appropnate reqwrements� � Yes � No
5b Have all of the 401 Unit submittal reqwrements been met� ❑ Yes ❑ No
Page 8 of 10
PCN Form — Version 1 4 January 2009
F Supplementary Information
1 Env�ronmental Documentation (DWQ Requirement)
1 a Does the pro�ect �nvolve 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 pro�ect require preparation of an
environmental document pursuant to the reqwrements of the National or State ❑ 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 finaf approva!
letter ) ❑ Yes ❑ No
Comments
2 Violat�ons (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 es ❑ No
or Ripanan Buffer Rules (15A NCAC 2B 0200)�
2b Is this an after the fact permit application� es ❑ No
2c If you answered yes to one or both of the above questions provide an explanation of the violation(s)
C/(, n c� w��e �-� ►��j c�, �a� �v. s'
3 Cumulative Impacts (DWQ Reqwrement)
3a Will this pro�ect (based on past and reasonably anticipated future impacts) result in �Yes o
additional development which couid impact nearby downstream water quality�
3b If you answered yes to the above submit a qualitat�ve or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy If you answered no provide a short narrative description
4 Sewage Disposal (DWQ Requirement)
4a Clearly detad the ultimate treatment methods and disposition (non discharge or discharge) of wastewater generated from
the proposed pro�ect or avadable capaaty of the subJect facdity
Page 9 of 10
PCN Form — Version 1 4 January 2009
5 Endangered Species and Designated Critical Habitat (Corps Requirement)
5a Will this pro�ect occur m or near an area with federally protected speaes or � Yes No
habitat�
5b Have you checked with the USFWS concerning Endangered Species Act � Yes o
impacts�
5c If yes indicate the USFWS Field Office you have contacted
5d What data sources did you use to determine whether your site would impact Endangered Species or Designated Cntical
Habitat�
6 Essential F�sh Habitat (Corps Requirement)
6a Will this proJect occur m or near an area designated as essential fish habitat� ❑ Yes No
6b What data sources did you use to determine whether your site would impact Essential Fish Habitat�
7 Historic or Prehistoric Cultural Resources (Corps Requirement)
7a Will this pro�ect occur m or near an area that the state federal or tnbal
governments have designated as having histonc or cultural preservation � Yes ❑ No
status (e g National Historic Trust designation or properties significant in
North Carolina history and archaeology)� �� K� � w`
7b What data sources did you use to determme whether your site would impact histonc or archeological resources�
8 Flood Zone Designation (Corps Reqwrement)
8a Will this pro�ect occur in a FEMA designated 100 year floodplam� ❑ Yes o
8b If yes explam how pro�ect meets FEMA requirements
8c What source(s) did you use to make the floodplain determmation�
5�-ev�," 1_ R► c e ��--i �- L�--�-- 12 --1 l� �l �
Applicant/Agent s Printed Name ApplicanUAgent s Signature Date
(Agent s signature is valid only if an authonzation
tetter from the a licant is rovided
Page 10 of 10
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GUIL,FORD COUNTY
PLANNlNG AA1D DEVELOPMENT DEPARTMENT
December 12 20l t
A9r Sbaven R�ce and Mrs Angela Rice
8b33 Haw River Road
Oak Ridge, NC 27310
Sub�� Stream Bui%r Restorahon Atan
Nov ioo3ao� i
8633 Haw Rtver Road
Oak Ridg� NC 2731 Q
Dear Mr and Mrs Rice
Th�s letter is to adv�se that ihe strEam buffer restorahon plan for the sub,�ect property which the L,ahe Jordan sh�ain
buiier violst�on notificaaon was issued on Ociober 3 2011 was subm�tted on December 5 2Q11 The st�+eam buffer
rest�oradon ptan has been approved as submittal A copy af the approved plan �s bemg retumed i�o the engtneenng
firm of eecord Anderson & Associates, Inc for their eise and further handlmg
In accordance w�th the Cktober 3 2011 Norce of Violatron upon �mpletion of the �+estoretion of thc buffer this
o�ae must recerve the followu�g rtems�
By Mamch, 2012, you must present a detatfed wntten report and digital photagtanhs to the Gmlford County Piannmg
and Development Depaztment that ctearly depicts that the npanan buffer has been r�estored if th�s infomlation is not
pr+esented v�nthm this t�me frame, addihonal penalty r�commendahons may be forwarded for c�vil penalty
assessment
In addrttan an annuai repott, mciuding a wntten account and dtgitat p6otographs, must be submttted to tf�e Gudford
County Plann�ng and Development by De�ember i st of each year for a perrod of three years after the resioraUon is
compieteci Thts report must dep�ct whether trees that ��ere planted have surv�ved and that d�fiuse storrnwater flow
thrnugh the npanan bnfi'er has been achreved [f your monrtoruig et%rts r+eveal dead or dymg planhngs and/or
fadures to maintam d�ffitse stormwater flow you must noUfy Ga�lforrl County Plannmg and Development staff
w�thm 20 days and cornect the failw+es
Please be aware that the strearn buffer restorapon �s performance based and a follow up �nspect�on wili be performed
to ensure the plantmgs ate healthy and bvmg Any desd or diseased piants wili have to be replaca! Also note that
you are st�l1 required to get appropnate USACE 444 and DWQ 40 i permits
Post Office Box 3427 Greensboro I�orth Carolula 27402
Telephone (336) 373-3334
� ��
If the ripanan buffer is not mstw�ed by the re�uirBd date above the o�`mer w�ll be sub,�ect to civil �nahy assessment
of up to twenty five thousand dollars ($25 000 OQ) per violabon If you have any questions rEgard�ng thus matter
please contact Franlc Park or myself at (33� 641 5564
Sincerely
,. � ;�/ //.
Matt Wtll�ams, P E
cc Betty Garett, Guilford County P dt D Depi
Earl Dav�s, Gailford County P� D Dept
Theon dackson Gudfivrd County P& D Dept
Bruce Oakley, Town of 4akr�dge
Sue Hamewood, DWQ W-S Reg�onal Offtce
Amy Chapman, DWQ W S Regional Qffice
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