20140659 Ver 1_401 Application_20140614

•
*iw
CONE HEALTH
The Network for Exceptional Care
June 23, 2014
Ms. Karen Higgins
NC DWR, 401 /Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699 -1650
Subject: Pre - Construction Notification Application
Request for 401 Water Quality Certification and Buffer Authorization
Moses Cone Healing Gardens
Greensboro, Guilford County, North Carolina
Dear Ms. Higgins:
Please find five copies of the Pre - Construction Notification Application for the above referenced site. The
site contains undeveloped grass covered land with scattered trees. The overall project consists of
utilization of the site as an open green space walking/sitting greenway (healing garden) for hospital
patients. To utilize the site as a healing garden, elevated walkways and concrete sidewalks must be
constructed, a portion of the stream will be stabilized /enhanced and native vegetation will be planted in
the disturbance areas. Two grade control devices will be installed in a portion of the stream and boulders
will be placed in the vicinity of the stream bed /banks to provide stream bank and proposed device
stabilization.
The proposed project will temporarily impact 75 linear feet of stream channel and permanently impact
less than 0.01 acres of wetland. Additionally, the proposed streambank stabilization will temporarily
impact 5,207 square feet of riparian buffer. A No Practical Alternative Letter has been submitted to the
City of Greensboro, independent of this application, for the proposed permanent impacts to riparian
buffers associated with the proposed elevated/concrete greenway. The temporary impacts to streams and
buffers will be re- planted with native vegetation.
1 am requesting that a 401 Water Quality Certification and Riparian Buffer Authorization to
authorize the temporary impact (streambank stabilization) to 65 linear feet stream channel, the permanent
impact (fill) to less than 0.01 acres of wetland, and the temporary impact to 5,207 square feet of riparian
buffers. There are no additional wetland or stream impacts proposed at this time.
Please feel free to contact me at (336)832 -7851 if you have any questions concerning this request or if
additional information is required. Thank you in advance for your timely consideration of this matter.
4S' erely,
�7 aji,
Ronald E. Gallo ay, PE HFM
Director- Construc ion Management
Cone Health
Attachments: Pre - Construction Notification Application
401 Water Quality Certification Fee - $240.00
Cone Construction Management
1200 N Elm Street • Greensboro, NC 27401
Phone [phone] • Fax [phone]

PAID
�OF W A'r'
o OG
2 0 1 4 0 6 5 9
o �
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Page 1 of 13
PCN Form — Version 1.3 December 10, 2008 Version
Pre - Construction Notification PCN Form
A. Applicant Information
1.
Processing
1 a.
Type(s) of approval sought from the
Corps:
®Section 404 Permit El Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: NWP 27 or General Permit (GP) number:
1c.
Has the NWP or GP number been verified by the Corps?
® Yes
❑ 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
1 e.
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
❑ Yes
for Corps Permit:
® 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 1h
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:
Moses Cone Healing Gardens
2b.
County:
Guilford
2c.
Nearest municipality / town.
Greensboro
fill
2d.
Subdivision name:
I%,
JUN
h J 214
N
2e.
NCDOT only, T.I.P. or state
project no:
R - Wq QUALITY
3.
Owner Information
°f
3a.
Name(s) on Recorded Deed:
Moses H. Cone Memorial Hospital
3b.
Deed Book and Page No.
Book 001714, Page 00085
3c.
Responsible Party (for LLC if
applicable):
Mr. Ronald Galloway
3d.
Street address.
1200 North Elm Street
3e.
City, state, zip:
Greensboro, NC 27401 -1020
3f.
Telephone no.:
336- 832 -7851
3g.
Fax no.:
3h.
Email address:
ron.galloway @conehealth.com
Page 1 of 13
PCN Form — Version 1.3 December 10, 2008 Version

4. Applicant Information (if different from,owner)
4a Applicant,is
❑ 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/Cons ultant.Information (if applicable)
"5a Name
5b Business name
(if'applicable)
5c Street address
5d City, state, zip
5e Telephone no
5f Fax no
5g, Email address
Page 2, of 13
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) 7855509356
1 b Site,coordinates (in decimal degrees) Latitude 36 08515 Longitude - 79 82709
(DD DDDDDD) ( -DD DDDDDD)
1c Property size 0 50 acre portion of a 24 18 acre parcel acres
2. Surface Waters
2a Name of nearest body of water,(stream, river, etc ) to
North Buffalo Creek
proposed project
2b Water Quality, Classification of nearest receiving water
WS -V, NSW
2c River basin
Cape Fear
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
The site contains open green space /undeveloped grass covered land with scattered trees, located on the Moses Cone
Memorial Hospital Campus in Greensboro, NC Parking garages /lots, access roads and hospital buildings adjoin the site
to the north, east and south Wooded land and the Louis Daniel Greenway adjoin the site to the west The hospital is
located in a commercial /residential, area of Greensboro
3b List the total estimated acreage of all existing wetlands on the property
0 26 acres +/-
3c List the total estimated linear feet of all existing streams (intermittent and perennial) on the property
235 feet +/-
3d Explaintthe purpose of the proposed project
The purpose of,the project is to.ycreate,a greenway for hospital patients (Healing Garden) The greenway has been
designed in a manner that will improve stream quality, function and aesthetics through stream stablization and the
installation of`two grade control devices Moses Cone patients, specifically cancer patients (situated in the budding
adjacent to the site) will utilize the greenway
3e Descnbe,the overall project in detail, including the type of equipment to be used
The overall project consists of constructing a greenway and utilize the site for an open green space walking /sitting
greenway (healing garden) for hospital patients To utilize the site as a healing garden elevated walkways and concrete
sidewalks will be constructed, a portion of the stream must be stabilized /enhanced and native vegetation will be planted in
the disturbance areas Two grade control devices will be installed in a portion of the stream and boulders will be placed
in the vicinity of the stream bed /banks to provide stream bank and ^proposed device stabilization Excavators and,other
machinery will be used during the construction of the walkways and stream stabilization portions of -the proposed project
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 past?
❑ Yes ® No ❑ Unknown
Comments- Craig Brown (USACE) and Sue Homewood
(DWR)'Site'Visit,in December'2013
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
Name (if known)
Other
4d If yes, list the dates of the Corps jurisdictional determinations or State, determinations and attach documentation
Jurisdictional Determinations and /or State Determinations have not been issued However, Mr Craig Brown (USACE)
and Ms Sue Homewood (NCDENR -DWR) visited the site prior to the delineation in December 2013
Page 3 of 13
PCN Form — Version 1 3 December 10, 2008 Version

S. 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
Additional stream or wetland impacts, outside of those proposed in this application, are not anticiapted at this time
Page 4 of 13
PCN Form — Version 1, 3 December 10, 2008 Version

C Proposed Impacts Inventory
1 Impacts Summary
la 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, the_ n 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 [:1 T
Fill
El
Cops
<0 01
® No
❑ DWQ
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 1
2h Comments A total of 60 square feet (0 001 acres) of wetlands will be permanently impacted by fill associated with the
utilization of stone /boulders for stream stablization
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
Stablization
Unnamed
❑ PER
® INT
® Corps
❑ DWQ
3
75
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
❑ Cor "ps
[:11 NT
❑ DWQ
3h Total stream and tributary impacts
75
31 Comments A total of 75 linear feet of'intermittent stream channel will be impacted by the fill of rip -rap at the discharge
points of three culverts located up- gradient of the stream, the installation of a rock cross -vein, grade control structure, the
installation of a'log drop grade control structure and placement of larger stone %boulders (See Sheets C2 3, C3 1, C3'2, C3 3)
Disturbed stream banks will be matted, staked and replanted with live stake /herbaceous vegetation seed mix See Sheet
Page 5 of 13
PCN Form — Version 1 3 December 10, 2008 Version

C3 4)
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 them individually list,all open water impacts below
4a
Open water
impact number
— Permanent
(P), or
Temporary T
4b
Name of waterbody
(if applicable)
4c
Type of impact
4d
Waterbody type
4e
Area of`impact (acres)
01 ❑P ❑T
02 ❑P ❑T'
03 ❑ RE] T
04 ❑P ❑T
4E Total open water impacts
4g Comments No open water impacts are proposed
5. Pond or Lake Construction
If pond or lake construction proposed, then complete the chart below
5a
Pond ID
number
5b
Proposed use or purpose of
pond
5c
Wetland Impacts (acres)
5d
Stream Impacts (feet)
5e
Upland
(acres)
Flooded
Filled
Excavated
,Flooded
Filled
Excavated
Flooded
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)
5j Size of pond watershed (acres)
5k Method of construction
Page 6 of 13
PCN Form — Version 1 3 December 10, 2008 Version

y
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 ® Other Jordan Lake
Project is in which protected basin?
❑ Catawba 0 Randleman
6b
6c
6d
6e
6f
6g
Buffer impact
number —
Reason for
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P)
impact
Stream name
mitigation
(square feet)
(square feet)
or Temporary
required?
B1 ❑ P ®T
Stream
Stabl za on
Unnamed
® Nos
5,207
0
B2 ®P [:IT
Elevated
Greenway
Unnamed
❑ Yes
® No
1 „492
1,019
B3 ®P ❑ T
Sidewalk
Greenway
Unnamed
❑ Yes
® No
958
1,538
6h, Total buffer impacts
7,657
2,557
61 Comments The site is located within the Cape Fear River Basin in an area that has been designated as WS -IV, NSW In
addition, the,(site is located within the Lake Jordan Watershed The stream ehancement will temporarily "impact 5,207 square
feet of Zone 1 buffer, in accordance with "allowable" activities with the NCDENR -DWR Lake Jordan Riparian Buffer Rules
The stream buffer will,be'immediately re- vegetated following installation of grade control and streambank stablization
measures The attached planting list provides a list of plant species that will be used to re- vegetate the stream buffers
Additionally, the construction of the elevated and concrete green ways will unavoidably permanently impact 2,450 square feet
of Zone 1 buffers and 2,557 sqaure feet -of Zone.2 buffers,'in accordance'with "allowable with restriction” activity A No
Practical Alternative's for the proposed impacts to riparian buffers associated with the construction of the green ways has
been submitted'to the City of,Greensboro, separate of'this application
Construction offhe proposed greenway`elevated and non - elevated walk -ways an&the proposed stream bank stablzation has
been designed to avoid removal of existing trees within and outside the limits of the riparian buffers (See Sheet 2 2 for existing
treelocation)
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 stream is being enhanced by streambank stabilization and installation of grade control structures The elevated and
concrete greenways have been designed to reduce the number oftrees1hat will need to be removed The elevated greenway
Was designed to be used in wetland areas to avoid and reduce permanent impacts to wetlands Additionally; the use,of,
slotted wood,decking on the elevated ,deck has been designed to be a minimum of 3 ft aboveground surfaces, which will -allow
for vegetation to exist below the,elevated greenway The greenways have been °designed to the minimum width possible (six
feet) in the vicinity of stream crossings, wetland areas and riparian buffers to still allow,access by patients with mobility issues
(wheelchairs)
The placement of stone /boulders has been designed to be minimum amount necessary to provide stabilization to the steam
channel and banks The stone placed at °the outlet of the culverts (up- gradient of stream) will provide more efficient energy
dissipation than the existing conditions, thus, reducing the erosive capacity and velocity of flow to down - gradient water bodies
Additionally, the7mstallation of,two grade control structureswill also reduce the erosive capacity /velocity,of down - gradient
water bodies while enhancement of the riffle -pool complex of the stream will greatly improve aquatic habitat/quality of the
stream
1 b Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
A temporary coffer dam'will be installed up- gradient of the streambank stabilization area During construction, waterwill be
pumped around the disturbance area All impacts associated with the pump- around system will take place within the limits of
the streambank, stabilization Upon completion of the streambank stabilization, including the re- vegetation of disturbed stream
banks, the temporary sand bag coffer dams will be removed and stream flow will be diverted into the stream channel
Following construction, disturbed,slo es will be stabilized with permanent seeding, matting and live stakes Best management
Page 7 of 13
PCN Form — Version 1 3 December 10, 2008 Version

practices will be implemented during disturbance activities to,avoid sediment discharge into down - gradient water bodies (See
Sheets C3 1 and C3 4)
2. Compensatory Mitigation for Impacts to Waters of,the U.S. or Waters of1he 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
❑ 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
linearfeet
4c If using stream mitigation, stream temperature_
❑ warm ❑ cool ❑cold
4d Buffer mitigation requested (DWQ only)
square feet
4e Ripanan`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,usmg a permittee responsible mitigation plan, provide a description of the proposed mitigation plan
Page 8 of 13
PCN Form —Version 1 3 December 10, 2008 Version

6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a Wtll'the project result in an impact within a protected riparian 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 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'm -lieu fee fund)
6h Comments Buffer mitigation should not be required due'to the proposed acitvities'Within the riparian buffers being
"allowable" by the NCDENR -DWR and "allowable with restrictions" by the,City of Greensboro
Page 9 of 13
PCN Form— Version 1 3 December 1'0, 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?
lb
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?
77%
2b
Does this project require a Stormwater Management Plan?
❑ Yes ® No
2c
Ifthis project DOES NOT require a Stormwater � Management Plan, explain,why The project does not require a
stormwater management plan because site development activities are being limited to less than an acre in size
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?
Greensboro
® 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
❑ 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.
DWQ401 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 10 of 13
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 tothe, 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
❑ Yes ® No
letter)
Comments A NEPA or SEPXis not required as part of this project
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 Ripanan Buffer Rules (15A NCAC 2B 0200)?
2b Is this an after - the -fact permit applications
❑ Yes ® No
2c Ifyou answered "'yes" to one or'both of the above questions, provide an explanation ofthe 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
We are not aware of additional development that will result which will impact nearby downstream water quality
4. Sewage Disposal (DWQ Requirement)
4a Clearly detail the ultimate treatment methods and disposition (non - discharge ordischarge) of wastewater,generated from
the proposed project, or available capacity of the subject facility
Wastewater will not be generated by the proposed project
Page 11 of 13
PCN Form — Version 1 3 December 10, 2008 Version

S. Endangered Species and Designated Critical Habitat (Corps Requirement)
Page 12 of 13
PCN Form — Version 1 3 December 10, 2008 Version
5a Will this project occur in or near an area with federally protected species or
El Yes ®No
habitat?
5b Have you checked with the USFWS concerning Endangered Species Act
❑ Yes ® No
impacts?
5c If yes, indicate the USFWS Field Office you have contacted
E:1 Raleigh
❑ Asheville
5d What data sources did you use to determine whether your site would impact Endangered Species•or Designated Critical
Habitat?
ECS consulted the Natural Heritage Program Website to determine if federally protected, endangered or threatened
species inhabit the Greensboro, NC Quadrangle (the quadrangle that contains the site) There are no federally listed
protected endangered or threatened species! that,have been„ identified on this quadrangle
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 =pact, Essential Fish Habitat?
Based on our knowledge of the site, the site is not located in or near an area designated as essential fish habitat We did
not observe fish inhabiting the stream during our site visits Best management practices and the,constructiomof stormwater
ponds will prevent sediment from entering down gradient waterbodies which may contain fish
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
[:1 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?
We reviewed the SHPO Map (http Hgisuncdcr- gov /hpowebn to identify historic and /or archaeological resources of the site
The SHPO map did not identify historic and /or cultural resources on the site or in the immediate vicinity of the site A copy
of, the map is included as an attachment
8. Flood Zone Designation (Corps Requirement)
8a Will this project occur in a FEMA - designated 100 -year floodplain? 7Z
Yes ❑ No
8b If yes, explain how projectrmeets FEMA requirements The project has been designed to be in compliance with FEMA
requirements
8c. What source(s) did you use to make the floodplain determination? FEMA FIRM Map Number 3710885500J, dated June
18, 2007
Ronald E. Galloway, PE, CHFM
//rl,
ivy
June 23, 2014
Applicant/Agent's Printed Name
Applicant/A tn nt's Sl nature
Date
(Agent's signature is valid only if aut hon tion letter om the applicant
is pr
Page 12 of 13
PCN Form — Version 1 3 December 10, 2008 Version

Page 13 of 13
PCN Form — Version 1 3 December 10, 2008 Version

woosiappnq )Pewpuel mmm 1000Z'49L 9£E 'd
L%LZ ON 'waleS- uo3suiM I pnoo pep! OZSE I siapng �jewpue-j
•aouepyuo3 piing aM
VX7A- 7TTATd'T k TV77
ltLlV -W lAL r t,
\\\ N f�
%
SLZ6L o
o
o
s
/—I
III'
Go
!M-N�,V
H
N O
1�J �
r � N
�Ql
I CL
O
Q O
:2O
N
� II
Z_
U
VNIIONVO H.LNON ONOUSN39NO '3AV WV'13'N 10S
NHCF VD NI'-IVHH
"IV.LIdSOH A.LlNAMOD DNO-1 ATIS3M
W91SAS Hl -lV3H 3NO3 S3SOW
N
J
U�
�z
o D-o
VEST RRytjEvARIE A
n
'r>Kos wu .o P+.n +v h rw v rl i
4M.I
ws nl yYVbl,)uvLrSa31Y111 .grMlwl rW2 0
T
c
V
wU
u�
M T-
V)
O
Q
� w
O LM 10
C
N
Sz
Z
� d)
_a
z ,�Q -
°z� ffi
(y iz <lu
QOp�<
00-N 0-6

WOO sJappngVBwpuel nrowH OOOZ 79L 9££ d
LOILZ ON 'wales- uojsuiM I ynoo peul OZS£ I siappng �jewpue-j
aouappo3ping oM -
V17FI�AT�L L V I
liuvyu%al�v �
��I1111111 //�
Nx�
_2 9LZ6 L I
11111��`'
Q < z
0 Q i::
ILI
z °o °
_ _ U—
�o
I� I
■ �I° d
I � I
Ir
■ 1= I
■ ZO
I► I
II
I`
Vt4llO IV0 H.LNON ONOBSN99'dD `9AV NV-19 N 109
R(IX D DI lJVaH
lV.LIdSOH A.LIN lWW00 DNO`°I A91SSIM
IN91SAS H.L"IV3H 9PI00 S3SOW
= Y
� J
a
z w
O l7 A
Z 0 >
Q Ne W
Q � J U J
LLJ 0 Q Z W
N A 3 U W
LLI C3
A W W N
A J
Z
J W > W
F- tY W 0 O,
3 (~i� w o ¢m �
w I II
Xx L6 II
II
a
z
F II
� II
X
u
W
` era anu .0 n ..ran smaxn ��a 0
Nb`1d - i1b`�I�O
Z,
08 �
/,
� r
° � yC���1;���1�►` -�`�� vim, '_��� ���a1� � ,�►'(i� `._ - • •
bb
0 PIE
NOW I
• '��* `l
0
O
N
0
6
NICV
II
U
AD

woo sjaplinq >peuipuel Awwn 1000Z,V9L 9£E d
ON weleS-uolswM j'pnoOpeulOZ9E I siappng,�jewpue-1
aouapguoo Pling'aM
NJUVTATCF k TF7rT
Llll'V 9V lLtlliL V 1 oil
ti1/9I/9 \` \ \ \ \g 111311 / / //�i /'i
8
- 5LZ61 = _
lllll
0
0
0
Z
F--
U)
X
W
,------------ - -- - -- - --
VNI10AVO HDION ON09SN99 -80 `9AV WV'13 N 105
X9MlVD NI'-IVHH
lVlIdSOH AIIN-nWWOD DNO'I,A�I ISFIM
WTLSAS HJAV9H 9NO3 SgSOW
-� -,� ,
,
1 - -�M
1
,
,
I 1
J
I \\
`U
\ lool
0
E• \
W
W
V)
f
O
F—
W
0
u p ei M wv >ivjo< vsn p W >w M >I >
p�dm s W>•'WAV� +V+V W iw sl wv vl Fwl M P sWIV r+apol fo Ai++OeE +W sl
_ �a avim w � s+mluu ,wn
Nb`1d - lib`ai3A0
,oz ° 11i
N ..
u
O �
N JWIWIL_
b
69 �L
f-
__
aR
.J
iL
n e•
rt; i
m
F- ~
z z
O O
.� V
J
0 �
O' O OO
M�
Z
'Q `R UO
zoo ' ' o'o
NN sN ;NN
S
LLJ
U-
V J
U
z
Y
H
Z
Z
F=
Z
Z
'q�y
=
J
�
_o
I—
\
O
a
Q
W
L i
Q
LL_
Z
3
u
�
Z
G
0 ® ®OO(5
Z
l7
W
Q
F—
z
>
Z
Q'
Y
U
F-
Fl
J
p
Q
J
1-4
O3
Q
ZZ
V)
�
W
F-
W
�
W
3
U
A
A
Q
tY
Q.
0�
W
M
C3
LLJ
O
A
W
A
O
Q
J
J
F-
Z
M:
F-
Q
m
LL-
W
Z
Z
J
W
i

woo s,appnq>pewpuej`n -n I OoOZ b8Ly9££ d
LOI.LZ ON 'waIeS -ua-'M I pnoo peul OZg£ tsAeppng >ijewpue-i
a3uopquo:) piing aM -
ZN'VItATff,PLTFTrT ■ ■■
!iu v y Uul,AL v 1
4l /ST /4
001111
9LZ -6 l g = o
MUM
,Z
lQ
V
,Q
m
�a
�m
~;W
d
zo
W _
x�
W
o
0
z
ahnliau n vm�re w
VNIIOIIVO,HIIION O'IOSSN99'dD `3AVMV"I9'N 10S
XH�XIVD DNIIVHH lr LaaHS S- IIVIlaa
]' .DdSOH A.LIKnWWOD DKO'I Ad'ISdM
WO.LSAS HIIV,,dH 9NOD SdSOW
lul
0
0
Z
5I..L "JI
J
H
H
V�
N
�
m
Z
�
�
►+�
fY+
O
+
V
lul
0
0
Z
5I..L "JI

woo siappngVewpuel mmm 1000t 49L 9EE d
LULZ ON 'waleS-u0)su'M I Unoo peul 0Z9E I stapling miewpue-I
aouapguo3 ppng aM -
V1TF7TATlTPLTF7rT ■ ■■
liuvy�ulV V I
�I1111111 /�
.
Nm .N
4 C /7AL 8
litum
4= E
V1 a
s
wW, .o w�w.a+,°�+o n� >a m .� .•+f.a ,.p. . e wM 4 .i .w y .i ym y < +w v
H w. �>•q wl,t wp � •,4n M.W.1 Je 4,.ma •w M E.'.; •W
�i avuu'w n vmn� ae.inxn .wz 0
VNI"I021V0 HEWN 02I0HSNHH'1'J `HAV WV'IH N 105 v
NaCMVJ NIIVHH V16
I l��HS s�ibl�Q
d.LIdSOH A.LINNIWWO3- b -N-O"I IS9-M
IN91SAS H,L"IVHH 3NO:j S9s- 0-W
N
E Y �,
Ga lSs
E�
I VI
cn
�
O a
V I
e �
/ a
z
0
I
CL
a�
N
� a
O `
L
•1i
R
C 1
c
o
�z
� f
G
. F
s
wW, .o w�w.a+,°�+o n� >a m .� .•+f.a ,.p. . e wM 4 .i .w y .i ym y < +w v
H w. �>•q wl,t wp � •,4n M.W.1 Je 4,.ma •w M E.'.; •W
�i avuu'w n vmn� ae.inxn .wz 0
VNI"I021V0 HEWN 02I0HSNHH'1'J `HAV WV'IH N 105 v
NaCMVJ NIIVHH V16
I l��HS s�ibl�Q
d.LIdSOH A.LINNIWWO3- b -N-O"I IS9-M
IN91SAS H,L"IVHH 3NO:j S9s- 0-W
N
E Y �,
Ga lSs
E�
I VI
cn
�
O a
V I
e �
/ a
z
0
I
CL
a�
N
� a
O `
L
.0
a
js Lo
o a
E
v
O
O �O
+p
O
Ln
N
O
O
r
+E
r �
U
LO
to rli
'A
•1i
u
z
c
o
�z
� f
G
. F
5a
i
cc
m
c`d
a
Y
3
�'
w.
d
d
f
ac
0a o'
.0
a
js Lo
o a
E
v
O
O �O
+p
O
Ln
N
O
O
r
+E
r �
U
LO
to rli
'A
4
u
z
c
o
�z
� f
. F
5a
i
cc
m
c`d
a
Y
3
Y
C
,m
�E
z
M¢
W
z
D
ED LL
p q 0
Ch
d OWSWW
N�z a
�W;�~
x U
W
W
W S W
LU
F= —UQ�}
J
Q � 0
0 Lou .,,� �
u W 0 � U w
6� OR LL W 4Lu=Q
.2 N Vu 0.,U
W z "W
vi 'm mm
Z
z 5-,' o�
�
o.M- is < d�j 0. W�QDj�
o�W
o ea�gopzW,
O_R_ F=
IM � pac it
fA 2 g '-" 1 Lu uj Y
oo.7iI��'LLr�n��'
Z- N

woo siaplinqVewpuel wnnn I OOOZ bSL S££ d
L06LZ ON 'LialeS- uol-]M I Unoo Peul OZS£' I 'siappng >ljewpue-1,
aouapl;uo:) pling aM
VITFITATIT K, TWrT
lJL u v y ILulX v IL ■■■
�111111111,/��
41/91/9 \\\ - - 3
5LZ6L $ -_
S
I o
s
1I,I1I11O
V
W
,0
W � W
o ,U- d
Q�
Q <
w 1L U-
pppp Z W
wm3 lu
IN
2415
0-IS
>N`d9 GN0,GG
eal dN3UC:l
P.poi a P.yWd.� q Plil�N we 'vl PN,I +W Jo s+iPf r,vWVl fo H,.OUdi+a!
ai aNnl x�J n wmvna x
VNIIO'IVD HINON ONOGSN9321D '3AV WV'I3 N 105
NA(l VD Jl a -IVHH U
- iviIdSOH AiIIqfIW W00 9NO I AIR ISEIM
W91SAS HLlVgH ANOD,SgSOW
i
I
O-. Z
!
N N
� 11
U-
o Q
)0
00� o I 'op
0 000 i 0
�- � 0
OC
o
o
) 0 Q0
0
j� CJ a
i
0 0 � (510o j
0 00 - �
0 I 00 O{
01
I
O
I
U-
110-19 T,
I
Z
g
a
�= v
J �
w Z"
q w 5-
y
I
L
•
r_•
Q
0
a
m
"!I
W
O

woo slapllnq>pewpuel / OOOZ 08L 9£E d wro• w�a�, q' d w• an o, , •yo anu•iu n wn i :mx 9'
LOLLZ ON 'wajeS- uolswM I ynoo peul OZSE I siappng Miewpue-1 -- -
VwI0xV0 H.L 'dou 0x0gSN99WD '3AV WVla N109 Co
aauapguoo pling,aM
VU7- 7lAT"kTV7rf NaQFdVD DNIgVaH £a l��NS S'll'c7`l3a _
�1u v y %Lt11�1 r a ■ l "IV.LI'dSOH it. INFIN 03 ONO-1 A9'IS3M
INgf SAS H.L'IHiH 9NOD SgSON Q
%��� // o a
3 N"b
9LZ6 l
s. Cal
,W O
1111111V��� � � V ,
Ck O
3pN uj
D
3�Q
~
c0 v e e
N ►- LL N m Ln p
o Y��o Z
��
LU
szoz �o
i
e
o
ml Q
o �u
zQ
LU
m� �
tu
lu
Q=
,Z
u Q'
W�
�Z
LU
o -o,
4u ;
v o il,
;
Z Z
a

woo sJappngWewpueI ,wvsn I OOOZ 68L 9EE d
LOLLZ ON 'wales- uoyswM I unoo peul OZSE I siappns Njewpue-,l
aouapguoo ping aM -
XFATff tiTFTT
l Mill iu v,y AL',
ul� v I
11111111// '
_t
9LZ6 L $$
uu>M
itl Wlbl Nlr9 SMLVM i!
VNI'10XV3 HINON ONOUSN332IO `3AV WV'13 N 109
NH(INVO 1JNIIVHH- 1�3HS s1�b`1�a
' IVIIdSOH,,kIINnWK0D rDN0 I A3'IS3M
W3.LSAS HL'lVgH'3PIO0 S3SOW
0
z
z = uj
Lu
= �? zqv
O�>O
F
pY ZJ <�� `�uN
v �Q Q U QQ13 IV 5 � e
NQ Qv O� O �4 Z —71!_
O �w O z 0 Y�z
'd� �t(l! Wd� w�3
Ow
lL
Lu
HJ
O
O
� z
,II
�I

. U (jr. ll
0f
M GS
u 3 4"e3dc
D M
J { Wesllan� ;x
2 � �
15 P� tad silnW WIMb ro
er�yDi � n Jeffbrson Jed
^ \�djuow f'lonitcajlo St
iC] L7 ytipPUaF1 ibl11e
tr � 414
���
2 'G
um nl`rC xp 3
0� e Dr 3 a
u`-
rytc�r
y n
coo ,o o N ° S
o
a Pj $ t ciu�a}t a
t
A �e 3
v 'o AS eh slyc !
hS 3 M O
m a M ash
9 P8
to
Q
fF`°r rr 1,61 Forest Hill pr
Hold-h, Rd Greenwood Dr
it3 may
�^ Op Jz.
St fit - 4'
Q "edgedale Ave
or
. ac
ma W p� Pj =2 ? D uojfic4ea� Qrl�
K
°agate Dr 0
,•
H fi '4vondate Dr C� ppp'�,40
W ewpod Aye O� T N }O �f j(I
Northridge St
a Scott Ave 0
S EI.:.
ton St
n St
Ito ! a t
3
431 Nt
n
3 C�
CD
G)
N 0 ■_ r c'
a 2 0
CD
cD 0
Om m r
c° n i x
Z N �■ ■� i5
3 -p � � ■ X
A-- P;u
n' �N ■ K■ M
m
zt
EL x v
n z
■.4
m
■
_ m m D
az 3 O
** � N Be ,-h St
1? @ n]eY St t
= r�
O � T
G1i Boyd
T m� M
aw
(n
.t N ;a , a
v N �
n�:i H�rkerSt ��
egiall St
r 'OspieSt
rn 5 Lw St
•m v m
2 ro
t X
0
c y -4
n s,3
K v_ I
Huffman St
r
or Fairfield
0
autl y,a��tla
%5
'� and aUe,te ;e�
4eburne St c
I �
t
PH allIALIC,
^p apOOMW13
1
n
cost
Co �
tden C 2
(� V7
w .T
i
z
m
�
�-
pi
3 J
3.
-
Wall
cn
F a !;/ i evr S t
E3 ©c -r t S =
z
x
v)
C
ro
t ■
0 !{ t
O
3'rm
° Simnkt
m 8atl5tj

'
A hi
Jlr-
Iq-
Ftl
If
OR