20120967 Ver 1_401 Application_20121012

20120967
OF W ATF9
oa qG Office Use Only:
r Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre - Construction Notification PCN Form
A. AppUcant Information
_—Z1. Processing
x '
1a. Type(s) of approval sought from the
Corps:
® Section 404 Permit ❑ Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: 14 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps?
❑ Yes
® 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 Authorization
1e. Is this notification solely for the record
because written approval is not required?
For the record only for DWQ 401
Certification:
® Yes ❑ No
For the record only for Corps Permit:
❑ Yes ❑ 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.
El Yes
®No
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below.
❑ Yes
® No
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
® No
2. Project Information
2a. Name of project:
Garrett driveway
2b. County:
Durham
2c. Nearest municipality / town:
Rougemont D
2d. Subdivision name:
n/a
2e. NCDOT only, T.I.P. or state
project no:
O
OCT
3. Owner Information pF
3a. Name(s) on Recorded Deed:
Garrett, William E Jr
Book 001323, Page 000897
�qV
' Ora►
3b. Deed Book and Page No.
3c. Responsible Parry (for LLC if
applicable):
3d. Street address:
821 Hopkins Rd
3e. City, state, zip:
Bahama NC 27503
3f. Telephone no.:
n/a
3g. Fax no.:
n/a
3h. Email address:
n/a
Page 1 of 11
PCN Form — Version 1.3 December 10, 2008 Version

4. Applicant Information (if different from owner)
4a. Applicant is:
❑ Agent ® Other, specify: new property owner
4b. Name:
David Garrett
4c. Business name
(if applicable):
4d. Street address:
625 Hutton St. Suite 104
4e. City, state, zip:
Raleigh, NC 27606
4f. Telephone no.:
919 7301409
4g. Fax no.:
n/a
4h. Email address:
[e-mail]
5. Agent/Consultant Information (if applicable)
5a. Name:
Charles S. Johnston
5b. Business name
(if applicable):
Environmental Services, Inc.
5c. Street address:
524 S. New Hope Road
5d. City, state, zip:
Raleigh, NC, 27541
5e. Telephone no.:
(919) 212 -1760
5f. Fax no.:
(919) 212 -1707
5g. Email address:
cjohnston @esinc.cc
Page 2 of 11
PCN Form — Version 1.3 December 10, 2008 Version

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
0828 -03 -23 -7925
1 b. Site coordinates (in decimal degrees):
Latitude: 36.17920 Longitude: - - 78.92313
(DD.DDDDDD) (- DD.DDDDDD)
1c. Property size:
10.1 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
Mountain Creek
proposed project:
2b. Water Quality Classification of nearest receiving water:
WS-11; HOW, NSW
2c. River basin:
Neuse
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:
Site is currently a mixture of Pasture and Mixed Deciduous - Coniferous Forest. An unnamed tributary (UT) to Mountain
Creek bisects the property, flowing from the southwestern corner to the central north property line. Beaver activity has
caused much of the area upstream from the driveway crossing to be inundated as Non -Tidal Freshwater Marsh.
Surrounding land use is a mixture of Agriculture and single - family Residential.
3b. List the total estimated acreage of all existing wetlands on the property:
1.8 acres
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
1,300 LF including that length currently inundated - within beaver impoundment
3d. Explain the purpose of the proposed project:
Improvements to existing culverted stream crossing
3e. Describe the overall project in detail, including the type of equipment to be used:
The two existing culverts are undersized and frequently occluded by beaver activity resulting in occasional overwash and
erosion of the gravel roadbed. These will be replaced by four (4) pipes of larger diameter with concrete headwalls at both
sides and a riprap energy dissipation pad on the downstream side. The roadbed will be widened from the existing 12'
(approximate) to 18'. Standard heavy equipment and construction methods will be used. Flow in the stream will be
temporarily blocked on the upstream side during pipe replacement to facilitate work in the dry and prevent water contact
with curing concrete. Silt fencing and all other applicable sedimentation and erosion control measures will be employed
in compliance with state and local regulations.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
® Yes ❑ No ❑ Unknown
project (including all prior phases) in the past?
Comments: JDR request via email sent 3/26/2012.
4b. If the Corps made the jurisdictional determination, what type
❑ Preliminary ❑ Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas?
Agency /Consultant Company: Environmental Services
Name (if known): Charles Johnston
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Page 3 of 11
PCN Form — Version 1.3 December 10, 2008 Version

5. Project History
5a. Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
❑ Yes ® No ❑ Unknown
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project?
❑ Yes ® No
6b. If yes, explain.
Page 4 of 11
PCN Form — Version 1.3 December 10, 2008 Version

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
® Wetlands ® Streams - tributaries ® 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 jurisdiction
number —
Type of impact
Type of wetland
Forested
(Corps - 404, 10
Area of impact
Permanent (P) or
(if known)
DWQ — non -404, other)
(acres)
Temporary T
W1 ®P ❑ T
culvert
non -tidal fw marsh
❑ Yes
® No
® Corps
El DWQ
0.006
W2 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W3 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W4 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W5 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W6 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
2g. Total wetland impacts
0.006
2h. Comments: Wetland impact totals 241 square feet.
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.
3b.
3c.
3d.
3e.
3f.
3g.
Stream impact
Type of impact
Stream name
Perennial
Type of jurisdiction
Average
Impact
number -
(PER) ) or
(Corps - 404, 10
stream
length
Permanent (P) or
intermittent
DWQ — non -404,
width
(linear
Temporary (T)
(INT)?
other)
(feet)
feet)
S1 ®P ❑ T
culvert
UT to Mountain
❑ PER
® Corps
2
65
Creek
® INT
❑ DWQ
S2 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S3 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S4 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S5 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S6 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
3h. Total stream and tributary impacts
65
3i. Comments: Scored 25.5 on DWQ Stream ID Form. Scored 54 (out of 100) on Stream Quality Assessment Worksheet.
Page 5 of 11
PCN Form — Version 1.3 December 10, 2008 Version

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 individually list all open water impacts below.
4a.
4b.
4c.
4d.
4e.
Open water
Name of waterbody
impact number -
(if applicable)
Type of impact
Waterbody type
Area of impact (acres)
Permanent (P) or
Temporary T
01 ❑ PEI T
02 ❑P ❑T
03 ❑P ❑T
04 ❑ PEI
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If pond or lake construction proposed, the complete the chart below.
5a.
5b.
5c.
5d.
5e.
Wetland Impacts (acres)
Stream Impacts (feet)
Upland
Pond ID
Proposed use or purpose
(acres)
number
of pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
K Total
5g. Comments:
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:
6. Buffer Impacts (for DWO)
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.
ED Neuse ❑ Tar-Pamlico F-1 Other:
Project is in which protected basin?
❑ Catawba Randleman
❑ Randleman
6b.
6c.
6d.
6e.
6f.
6g.
Buffer impact
number -
Reason
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P) or
for
Stream name
mitigation
(square feet
(square feet)
Temporary T
impact
required?
61 ®P ❑ T
driveway
crossing
UT to Mountain Creek
❑ Yes
® No
1,950
1,300
B2 ❑ P ❑ T
❑ Yes
❑ No
B3 ❑P ❑T
❑Yes
❑ No
6h. Total buffer impacts
1,950
1,300
6i. Comments:
Page 6 of 11
PCN Form - Version 1.3 December 10, 2008 Version

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Headwalls have been used to minimize impact. Drive has been slightly realigned to be more perpendicular to stream.
Culverts are sized to the minimum size required to meet FEMA floodplain requirements. Riprap pad is of the minimum size
necessary to provide adequate erosion protecton.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Water in the beaver impoundment will be drawn down prior to construction. Flow will then be blocked to allow work 'in the dry'
and to prevent water contact with curing concrete. Placement of riprap pad will be done from the crossing itself as much as
practical to minimize disturbance of the riparian buffer zone.
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
E:1 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
Quantity
3c. 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:
❑ warm ❑ cool ❑cold
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.
Page 7 of 11
PCN Form — Version 1.3 December 10, 2008 Version

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
buffer mitigation?
❑ Yes ® No
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.
Zone
6c.
Reason for impact
6d.
Total impact
(square feet)
Multiplier
6e.
Required mitigation
(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: Driveway crossing of this extent is an "Allowable" activity per 15A NCAC 026.0233.
Page 8 of 11
PCN Form — Version 1.3 December 10, 2008 Version

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
❑ 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.
❑ Yes No
❑
Comments:
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project?
3.4%
2b. Does this project require a Stormwater Management Plan?
❑ Yes ® No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: Driveway itself will be gravel. No
individual drainage area on the tract will contain 24% or greater impervious area. The whole -tract calculation above
assumes cumulative impervious at build -out of 15,000 sq. ft to account for roof tops, paved parking area, and all other
reasonably anticipated impervious surfaces or structures.
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
❑ Certified Local Government
2e. Who will be responsible for the review of the Stormwater Management Plan?
❑ DWQ Stormwater Program
❑ DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a In which local government's jurisdiction is this project
❑ Phase II
3b. Which of the following locally - implemented stormwater management programs
❑ NSW
❑ 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
4a. Which of the following state - implemented stormwater management programs apply
❑ HQW
❑ ORW
(check all that apply):
❑ Session Law 2006 -246
❑ Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
attached?
❑ Yes ❑ No
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 9 of 11
PCN Form — Version 1.3 December 10, 2008 Version

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1a. Does the project involve an expenditure of public (federal /state /local) funds or the
El 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
❑ 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
letter.)
❑ Yes ❑ No
Comments:
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,
❑ Yes ® No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after - the -fact permit application?
❑ Yes ® No
2c If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in
❑ Yes 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.
Improvement of this crossing is for a single residence only and will not result in any anticipated increases in development.
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.
Any wastewater generated from the single residence planned for this site will be treated using an onsite septic system.
The location of the house and septic field have not yet been finalized.
Page 10 of 11
PCN Form — Version 1.3 December 10, 2008 Version

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
El Yes ®No
impacts?
5c. If yes, indicate the USFWS Field Office you have contacted.
El Raleigh
❑ Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
A search of the NC Natural Heritage Program shows no federally endangered species occurences within a 2 -mile radius.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in 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?
http: / /ocean.floridamarine.org
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?
hftp://gis.ncdcr.gov/hpoweb/
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA- designated 100 -year floodplain?
® Yes ❑ No
8b. If yes, explain how project meets FEMA requirements: A flood study was performed to show that there will be "no rise" to
the FEMA floodplain.
8c. What source(s) did you use to make the floodplain determination? The FEMA map and data tables as published in the
Flood Insurance Study Report for Durham County, NC; also the HEC Ras base flood study model for the river basin
(Mountain Creek Tributary 4) along with the field- surveyed topographic mapping for the crossing.
Charles S. Johnston, Environmental
October 4,
Services Inc.
2012
Applicant/Agent's Printed Name
Date
Applican Ag nt's Signature
(Agent's signature is valid onl if an authorization letter from the applicant
is provided.)
Page 11 of 11
PCN Form — Version 1.3 December 10, 2008 Version

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. PLAN NO. PARCEL ID: d ,�" ' • G �' �' c
STREET ADDRESS: Ib�t:'( �,�• �0�i_t^li rl, !`',� iy�SCt ��I('
Please print: N
Property Owner: : f/. V 0
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby alAhorize
Of p
(Contractor / Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
X70 Z Cwt Od L., "Vxk NC z -,-7.5 4') 3
Telephone: "230 - /yO 9
We hereby certify the above information submitted in this application is true and accural -a to the
best of our knowledge.
-k -�'*
Authorized Signature
Date: .3 —Z4 l
Authorized Signature
Date: —

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