20130183 Ver 1_401 Application_20130213

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f Office Use Only:
4
AR Corps action ID no.
2 0 1 3 0 18 3 DWQ project no.
11� Fonn Version 1.4 January 2009
Pre - Construction Notification (PCN) Fo
A. Applicant Information
r'•
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: NW29 or General Permit (GP) number.
1 c. Has the NWP or GP number been verified by the Corps?
❑ Yes [JX, No
1d. 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
le. 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 recd 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 prograrn.
❑ 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 Concem (AEC)?
❑ Yes ® No
2. Project Information
2a. Name of project:
Benson Property Impoundment Reconstruction
2b. County:
Transylvania
2c. *Nearest municipality / town:
Rosman
2d. Subdivision name:
2e. NCDOT only, T.I.P. or state project no:
3. owner Information
38. Name(s) on Recorded Deed:
R. Douglas Benson
3b. Deed Book and Page No.
Deed Book: 00277 Pg: 0726
3c. Responsible Party (for LLC if
applicable):
3d. Street address:
Post Office BOX 7280
3e. City, state, zip:
Pensacola, Florida 32634
3f. Telephone no.:
— 0 _ -- 39 15
3g. Fax no.;
5 '
31h. Email address:
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PCN Form —Version 1.4 January 2009
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4. Applicant Info tion (if different from owner)
4a. Applicant is:
PWAgent ❑ Other, speCify:
4b. Name:
4c• Business name
Cif applicable):
_
4d. Street address:
4e. City, state; zip:
4f. Telephone no.:
49. Fax no.:
4h. Email address:
5. Agent(Consultant Information (if applicable)
5a. Name:
Matt Cantrell
5b. Business name
if applicable).
Cantrell ConsWction Co.
5c. Street address:
6776 Greenville Highway
5d. City, state, sip:
Brevard, North Carolina 28712,
5e. Telephone no.:
828 -884 -6157
$f. Fax no.:
5g. Email address:
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B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel IDj:
PID#: 8582 -52- 3269 -000
1b. Site coordinates on decimal degrees): I Latitude: Longitude:
1c. Property size: 4.76 acres
2. Surface Waters
29. Name of nearest body of water to proposed project:
2b. Water Quality Classification of nearest receiving water.
UT East Fork Frendh Broad
B. Tr, HOW
2c. River basin:
French Broad
3. Project Description eA � 2 to
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: 8ro►5,5 frel� wA1kW'r6 f
3b. List the total estimated acreage of all existing wetlands on the property; • NA
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
3d. Explain the purpose of the proposed project:
Toev% 000*wpdol 5120- 4pw.
3e. Describe the overall project in detail, including the typg¢ of equipme t t�pp be used: ` '
Ocft +0 �e ew w� a-4 '1 -"0iv. aS ri,42. �o bwl ol� i; jbb,®,,., N9AA4,t - ex&V A*.-
&.,P 44rw , N6 ►04 +o be M" 1W lOc- wAt, &"W06 . HOLFvj jibe
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (including all riot phases) in the past?
❑ Yes R No ❑ Unknown
Comments:
4b. N the Corps made the jurisdictional determination, what type
of determination was made?
❑ Preliminary ❑ Fjnal
4c. If yes, who delineated the jurisdictional areas?
Name (if known):
Agency /Consultant Company:
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5. Project History
5a. Have permits or certifications been requested or obtained for
thin project (including all prior phases) In the past?
❑Yes ONO ❑Unknown
5b. If yes, explain in detail according to 'help tile" instructions.
6. Future Project Plans _
Be. Is this a phased project?
❑ Yes 19 No
6b. If yes, explain.
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C. Proposed Impacts Inventory
1. Impacts Summary
1a. Which sections were completed below for your project (check all that apply);
❑ Wetlands Streams — tributaries 0 Suffers ❑ 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 jurisdiction Area of
number Corps (404,10) or impact
Permanent (P) or DWQ (401, other) (acres)
Temporary
W1 -
Choose one
Goose one
YesMo
W2 -
Choose one
Choose one
Yes/No
W3 -
Choose one
Choose one
YOWNO
W4 -
Choose one
Choose one
U Mo
W5
Choose one
Choose one
YesINO
We -
Choose one
Choose one
YesiNo
2g. Total
Wetland Impadta:
2h. Comments:
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
Beet)
S1 - —r
Choose am .__..
n.
- ?d'Ernn p
ID of
Zino
S2 -
Choose one
N
140,
83 -
Choose one
S4 -
Choose one
S5 -
Choose bne
so -
Choose one
3h. Total stream and tributary
impacts
aiH 0'
31. Comments:
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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.
. Open water
impact number
Permanent (P) or
Tem ora
4b.
Name of waterbody
0f 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
04 -
Choose one
choose
4f. Total open water impacts
4g. Comments:
6. Pond or Lake Construction
If pond or lake construction iDr000sed. the complete the chart below.,
58.
Pond ID number
P1
5b.
Proposed use or -
purpose of pond
Choose one
5c.
Wetland Impacts (acres)
5d.
Stream Impacts (feet)
5e.
Upland
acres
Flooded
Filled
Excavated
Flooded
aoo
Filled
0
Excavated
QXD�
P2
Choose one
5f. Total:
a o o
5g. Comments:
5h. Is a dam high hazard permit required?
❑ Yes No If yes, permit ID no:
51. Expected pond surface area (acres):
3
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWG)
If project wUl Impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If env Impacts require miti ation then you MUST fill out Section D of this form.
6a. Project is in which protected basin?
❑ Neuse ❑ Tar - Pamlico (3 Catawba [] Randleman ❑ Other:
eb.
Buffer Impact
number -
Permanent (P) or
Temporary
6c.
Reason for impact
tad.
Stream name
6s.
Buffer
mitigation
required?
6f.
Zone 1
impact
(square
feet
fig.
Zone 2
impact
(square
feet
B1 -
Yes/No
82 -
Yes/N0
B3 -
Yes/No
B4 -
Yes/No
65 -
Yes/No
86 -
Yes/No
6h. Total Buffer Impacts:
61. Comments:
F
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D. Impact Justification and Mitigation
1.' Avoidance and Minimization
1a. Specifically describe mea ures taken to avol o minimiz the p po impacts in d@8igningproje
o�cr M R� t-2. 4; l�ed.l�i
rQ 1.4«� .
Sal!fw.�.4 svraw � � *weW� V Sa bk
OR a.. Ski V06t e
1 b. Specifically describe measures taken to avoid or minimize the propoked Impacts through construction techniques.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for
D Yes No
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
Q payment to in -Ifeu tee
project?
program
Permittee Responsible Mitigation
3. Complete If Using a Mitigation Bank
3a. Name of Mitigation sank:
Type: Choose one
Quantity:
3b. Credits Purchased (attach receipt and letter)
Type: Choose one
Quantity:
Type: Choose one
Quantity:
3c. Comments:
4. Complete it Making a Pa meet to in -lieu Fee Program
4a. Approval letter from in -lieu fee program is attached.
0 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:
ages
4h. Comments:
& Complete if Using a Permittee Responsible Mitigation Plan
6a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
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6. Buffer Mitigation (State Regulated Riparian Suffer Rules) — required by DWQ
6e. Will the project result in an impact within a protected riparian butter that requires
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).
be
6h. Comments: nla
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E. Stormwater Milinagement 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
within one of the NC Riparian Buffer Protection Rules?
Yes © No
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
•
Yes ❑ No
i
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project?
5%
2b. Does this Project require a Stormwater Management Plan?
❑ Yes ® No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: a�
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 local ovemment's urisdiction Is this project?
3b. Which of the following locally - implemented stormwater management programs
apply (check all that apply):
❑ Phase II
❑ NSW
USMP
Water Syppty Watershed
❑ Other.
3c. Has the approved Stormwater Management Plan with proof of approval been
attached?
Cyes [] No
4. DWQ Stormwater Pro ram Review
4a. Which of the following state - implemented
ented stormwater management programs apply
(check all that apply):
OCoastal counties
HQW
ORW
Session Law 2006 -246
[]Other,
4b. Has the approved Stormwater Management Plan with proof of approval been
attached?
❑ Yes ® No
S. gn 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
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F. Supplementary Information
I. Environmental Documentation (DWQ Requirement)
1a. Does the project involve an expenditure of public (federallstate/local) funds or the
use of public (federal/state) land?
❑ Yes • © No
11b. 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
Oyes ❑ No
(North Carolina) Environmental Policy Ad (NEPA/SEPA)?
1c. 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 26.0200)?
2b. Is this an after -the -fad permit application?
®Yes ❑ No
2c. If you answered "yes" to one or-both of the a ve questions,, provide an expla ation of the violation(s):
Project in process. P;." "vq g "6'JJ bio r- k'v �l l
J
an-� 5� Fww. wng. NI�Q a 6 rain jrne tlo. -t'U. aia4,�"ty,riy;th�ne.va5 r+o
Q v�risa•+u GL�, ,�P �i e(?s�c �' '�^b P^°S ee�'�re.- too . 94rr r.r► d�,l .�e� .
3. Cumulative Impacts (DWQ Requirement)
3a. Wit this project (based on past and reasonably anticipated future impacts) result in
Yea No
additional development, which could impact nearby downstream water quality?
/'CM
3b. If you answered ayes" 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.
I* &" ' .
4. Sewage Disposal (DWQ Requiremenh
4a. Clearly detail the ultimate treatmerit methods and disposition (non - discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility
no wastewater creased by this project
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5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or
habitat?
❑ Yes 14 No
5b. Have you checked with the (1SFWS'conceming Endangered Species Act
impacts?
❑ Yes ML No
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 Critical
Habitat?
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat?
❑ Yes C4 No
•6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
7. Histk ric 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
status (e.g., National Historic Trust designation or properties significant in
❑ Yes ® No
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA- designated I00 -year floodplain?
❑ Yes CR No
8b. If yes, explain how project meets FEMA requirements:
8a What source(s) did you use to make the floodplain determination?
Applicant/Agenfs Printed Name
Applicant/Agent's Signature
Date
(toms Signature Is VSIW only if an authorization
lifter from the WHOM is ed.
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Authorization Letter for PCN
The owner herby gives authorization to the agent/ consultant to fill out preconstruction
notification form and submit it to all agencies that it pertains to.
Owner Signature j Date 2 —0— 1,3
Agent/ Consultant Signature AA; Date
Y