20220744 Ver 1_1 - ORM Form_20220525

Preliminary ORM Data Entry Fields for New Actions
ACTION ID #: SAW- Begin Date (Date Received):
Prepare file folder n Assign Action ID Number in ORM n
1. Project Name [PCN Form A2a]: Washington Street Residential Project
2. Work Type: FlPrivate Institutional Government [1 Commercial
3. Project Description / Purpose [PCN Form B3d and B3e]:
The site is located at 948 Washington Street in Durham, Durham County, North Carolina. The site consists of four parcels totaling
approximately 1.02 acres. According to the Durham County GIS Database website, the Parcel Identification Numbers (PINs) is
0822-92-71-8637, 0822-92-91-6882, 0832-02-01-4888, and 0832-02-11-3913 (1.03 acres). The site consists of remnants of a
demolished buildings and undeveloped wooded land. Surrounding land uses include residential and commercial uses. The project is a
residential development.
4. Property Owner / Applicant [PCN Form A3 or A4]: Copernica Properties, LLC
5. Agent / Consultant [PNC Form A5 — or ORM Consultant ID Number]:
Michelle Measday / ECS
6. Related Action ID Number(s) [PCN Form B5b]: NA
7. Project Location — Coordinates, Street Address, and/or Location Description [PCN Form Blb]:
The site is located at 948 Washington Street in Durham, Durham County, North Carolina.
36.008863, -78.899624
8. Project Location — Tax Parcel ID [PCN Form B 1 a] : 0822-92-71-8637, 0822-92-91-6882, 0832-02-01-46
9. Project Location — County [PCN Form A2b]: Durham County
10. Project Location — Nearest Municipality or Town [PCN Form A2c]: Durham County
11. Project Information — Nearest Waterbody [PCN Form B2a]: Ellerbe Creek
12. Watershed / 8-Digit Hydrologic Unit Code [PCN Form B2c]: 03020201
Authorization: Section 10 [1 Section 404 [1 Section 10 and 404 pi
Regulatory Action Type:
_ Standard Permit
✓ Nationwide Permit # 18
Regional General Permit #
✓ Jurisdictional Determination Request
RPre -Application Request
Unauthorized Activity
RCompliance
No Permit Required
Revised 20150602