HomeMy WebLinkAbout20140375 Ver 1_401 Application_20140414Page 1 of 10
PCN Form — Version 1 3 December 10, 2008 Version
Pre - Construction Notification (PCN) Form
A.
Applicant Information
1
Processing
la
Type(s) of approval sought from the
Corps
Fx, Section 404 Permit ❑Section 10 Permit
1b
Specify Nationwide Permit (NWP) number 0711 or General Permit (GP) number
1 c
Has the NWP or GP number been verified by the Corps?
❑ Yes
X No
id
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 ❑ 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
❑ Yes
for Corps Permit
X No
if
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
X No
1g
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
Shepherds Way Farm - Piney Branch Stream Restoration
2b
County
Ashe
2c
Nearest municipality / town
Laurel Springs
2d
Subdivision name
NA
2e
NCDOT only, T I P or state
project no
N/A
— —
3
Owner Information
D
3a
Name(s) on Recorded Deed
Shepherds Way Farm, LLC
IM
F
3b
Deed Book and Page No
417/370
APR 1 5
3c
Responsible Party (for LLC if
applicable)
Jarvis Dickens
6114ft - WA R MALITY
I
3d
Street address
540 George Shepherd Road
3e
City, state, zip
Laurel Springs, NC 28644
3f
Telephone no
704- 437 -4554
3g
Fax no
N/A
3h
Email address
N/A
Page 1 of 10
PCN Form — Version 1 3 December 10, 2008 Version
4.
Applicant Information (if different from owner)
4a
Applicant is
X Agent ❑ Other, specify
4b
Name
4c
Business name
(if applicable)
4d
Street address
4e
City, state, zip
4f
Telephone no
4g
Fax no
4h
Email address
5
Agent/Consultant Information (if applicable)
5a
Name
Derek Goddard
5b
Business name
(if applicable)
Blue Ridge Environmental Consultants, P A
5c
Street address
1305 S Collegiate Drive
5d
City, state, zip
Wilkesboro, NC 28697
5e
Telephone no
336 - 844 -4088
5f
Fax no
N/A
5g
Email address
derek@brec biz
Page 2 of 10
B Project Information and Prior Project History
1 Property Identification
is Property identification no (tax PIN or parcel ID)
14421 -085
1 b Site coordinates (in decimal degrees)
Latitude 36 440213 Longitude - 81 287006
(DD DDDDDD) ( -DD DDDDDD)
1 c Property size
67 acres
2 Surface Waters
2a Name of nearest body of water (stream, river, etc ) to
proposed project
Piney Branch
2b Water Quality Classification of nearest receiving water
2c River basin
New
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
Agricultural and Forrest
3b List the total estimated acreage of all existing wetlands on the property
0
3c List the total estimated linear feet of all existing streams (intermittent and perennial) on the property
4800' Perennial
3d Explain the purpose of the proposed project
To restore stream function and prevent erosion of Piney Branch
3e Describe the overall project in detail, including the type of equipment to be used
The project will The project will utilize a track loader
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 prior phases) in the past9
Comments
❑ Yes X No ❑ Unknown
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) Unknown
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
this project (including all prior phases) in the past?
❑ Yes X No ❑ Unknown
5b If yes, explain in detail according to "help file" instructions
6 Future Project Plans
6a Is this a phased projects
❑ Yes X No
6b If yes, explain
Page 3 of 10
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 X 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)
Tem orar T
❑ Yes
Corps
W1 P T
No
❑ DWQ
W2 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W3 ❑ P FIT
❑ 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
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
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)
Si X P ❑ T
Restoration
Piney Branch
X INT X
DWQs
8
1,868
S2 P FIT
PER
❑ INT
Corps
DWQ
S3 ❑ P ❑ T
❑ PER
❑ INT
❑ Corps
❑ DWQ
S4 ❑ P ❑ T
❑ PER
❑ INT
❑ Corps
❑ DWQ
❑ PER
❑ Corps
S5 ❑ P ❑ T
❑ INT
❑ DWQ
❑ PER
❑ Corps
S6 ❑ P ❑ T
❑ INT
❑ DWQ
3h Total stream and tributary impacts
1,868
31 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, 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 ❑P ❑T
02 ❑P ❑T
03 ❑P ❑T
04 ❑P ❑T
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)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
number
of pond
P1
P2
5f Total
5g Comments
5h Is a dam high hazard permit required
❑ Yes ❑ No If yes, permit ID no
51 Expected pond surface area (acres)
51 Size of pond watershed (acres)
5k Method of construction
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
❑ Neuse ❑Tar- Pamlico El Other
Project is in which protected basin? NA
❑ 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
mitigation
(square feet)
(square feet)
Temporary T
impact
—required
El Yes
B1 ❑P
❑ No
El Yes
B2 ❑P
❑ No
❑ Yes
B3 ❑ P ❑ T
❑ No
6h Total buffer impacts
61 Comments
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
The only practical alternative to preventing erosion and restoring stream function is a holistic restoration
1 b Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
Stringent erosion control standards for sensitive water sheds will be adhered too All disturbances will be stabilized at the
end of each days work
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 X 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
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 6 of 10
PCN Form — Version 1 3 December 10, 2008 Version
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWO
6a Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation?
❑ Yes X 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
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
❑ Yes X 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?
0 %
2b
Does this project require a Stormwater Management Plan?
❑ Yes X No
2c
If this project DOES NOT require a Stormwater Management Plan, explain why Project is in forested, rural setting All
stormwater is diffuse flow over vegetated surfaces
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
❑ 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 El 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 3 December 10, 2008 Version
F
Supplementary Information
1.
Environmental Documentation (DWQ Requirement)
la
Does the project involve an expenditure of public (federal /state /local) funds or the
❑ Yes
® No
use of public (federal /state) land?
lb
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 Houses (If so, attach a copy of the NEPA or SEPA final approval
❑ Yes
® No
letter )
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)9
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
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
N/A
Page 9 of 10
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
® Yes ❑ No
impacts?
E] Raleigh
5c If yes, Indicate the USFWS Field Office you have contacted
® Asheville
5d What data sources did you use to determine whether your site would Impact Endangered Species or Designated Critical
Habitat?
http / /www ncnhp org - http //www saw usace army mil/WETLAND /esa - http //www fws gov /nc- es /es /es html
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 flondamarine org /efh_ coral /ims /viewer htm
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?
http / /www hpo ncdcr gov
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 No rise to the flood way will occur
8c What source(s) did you use to make the floodplain determination? http / /www ncfloodmaps com
Derek Goddard
4/11/14
Applicant /Agent's Printed Name
Applicant /Agent's Signature
Date
(Agent's signature is valid only if an authorization letter from the applicant
is provided
Page 10 of 10
AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION
Book 417
Page 0370 & 0372
PIN: 3928 -77- 0358 -81 and 3928 -76- 1201 -50 Ashe County, NC
STREET ADDRESS: 540 George Shepherd Road, Laurel Springs, NC 28644
Property Owner: Shepherds Way Farm LLC —Jarvis Dickens
The undersigned, registered property owners of the above noted property, do hereby authorize
Derek Goddard of BREC PA
(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 all standard and special conditions attached
Property Owner's Address (if different than property above):
Shepherds Way Farm, LLC
Jarvis Dickens
540 George Shepherd Road
Laurel Springs, NC 28644
We hereby certify the above information submitted to this application is true and accurate to
the best of our knowledge
i
Authorized Signature
Date.
Shepherds Way Farm, LLC — Jarvis Dickens
NA
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Soil Map —Ashe County, North Carolina
Map Unit Legend
SHEPHERDS WAY FARM SOIL MAP
Ashe County, North Carolina (NC009)
Map Unit Symbol
Map Unit Name
Acres in AOI
Percent of AOI
EvE
Evard loam, 15 to 25 percent 10.1
6.3%
slopes
FnD
Fannin loam, 8 to 15 percent 6.1
3.9%
slopes
Fannin loam, 15 to 25 percent 3.9
2.4%
FnE
slopes
Tusquitee loam, 8 to 15 percent 15.4
9.7%
TsD
slopes
WaD
Watauga loam, 8 to 15 percent
20.5
12.9%
slopes
Watauga loam, 15 to 25 percent
8.6%
WaE
13.7
slopes
56.2%
WaF
Watauga loam, 25 to 45 percent
89.5
slopes
100.0 °A.
Totals for Area of Interest
159.2
usa,, Natural Resources Web Soil Survey 8/5/2013
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