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HomeMy WebLinkAbout20161176 Ver 1_Pipe #2123 Application_20161123� � � � ` �r - - � � � _. _ _ � � . .:_� � � � ,� � . �_ 4 �, � : : e � � :.� � : � � . # �� '#: � �� � _ � •• _ � ��� �#��; # . � � . _ . . � � . . . € �`�c�������r ��.b����a ��.��c����d� ������ #� ����.��� ��p� �2 � 23 �� ���� ��.���� � ��.d �� �Y�dk������� ��.dki� ���.��y, ����h ��.�°�1���. ���j��t ���.�b��°� 1 ���� 11 m�85 { � � � ��°� � it ��� ���4� � � � ` � ���� i • ` � `: I � i`' � • ! i ' � !' �' � � �` ; � �. � � � � : # ; � a • ` i �'` . ' . ` ! . # - - s i' •= i^i!; �, � � , ; --� �; � °�. . � s "! ` ' :i ii S` .: ` i • ` i i f ' � �' ! . i !" '� ` �� -. �. l� ' ; , � . : , , _`- � . .� , � , . _ i . . . � 5� -.c .� : _ �. � :� _ _ � � � � � '_ ' , ' � �.. ' �: � � � `, `- ; .. ' . : . � I � ': , ; I i • � � � � : � s � f ,, � �, i 4 � �, � � � • � f i i � if ` !, ` � i �, •! ! �; ! ` � • ��� .,� #• � � ; . � ` �., f'# i 'i i' S :'. ' I � � The repla��me�t �f �he e�ist�n� pipe wi�h the prop�sed new p�p� �vill requi�� temp�rary devvate�ing, An imper�ious sandbag di�e �vil� be construc�ed approx�ma�ely 10 feet upstream af �he existing structure t� create a small po�l. Cle�.n water �vill temporar�l� be pumped around the constru.ctio� area and will be discharg�d dawnstream. Any di�iy water lacated inside the construct�on area v�ill be pumped in�o a silt bag if necessary. �'�a�h�n� ���pares s..�-�...�.._ State of Narth Carolina � Department of Transportation � Division Eleven 801 Statesville Road j PO Bc�x 250 � North Wilkesboro, N� 28659-0250 336 667 9111 T � �°. ����� �����s�� ���� �� � �� �� ��� �p�:���� ��.�, ����� �� ��� ��� ��, �� �. � . .�� � � .. .� ��� �✓� �� �� � �� ��8l�� � �� � � � . � � ������5.3 �.C.8.1�� .. ��� �� . . T � � � . r � �������� ���� �� � i3��� � � �� � . � � ����8� � � ��� � � 8 ������ � � n. � ����� ����� �. . . . � �� � � ��� ��� � . . ��� �. � . . ���� �� � ����� �� �. . . �� �� ����� � � ������ � . �. � � � � � � . $��� � ��� s � � � ��1�����. �. . .�.� �. � �✓� ��� � �� � � � iJ�� � � ��. ���/� � � ��+��s � �a � { �� �� � ������ � �s ������ ��� �.�� �.� ������ c� �.�y ����°�.��y ����� ��. �. ���� ��. � �� �. � �� � ����� �� �s �� �.���� � �.� � � � � �� ���i ���s ��c�r�� �.�� �� � � �� . ��� �. �1 ���� ��°���� ����.�° � � � y �.�s iss���� e �� ��� � � � �.�r�s �f ����.�� � �� � � � � ��� � i �� "; , �. . . , ; � . , � . . �� _ , , - s. - -, � , � ' . a. ' �. ` � ' � ' �s, s, , �; • s s ; s ! # '� , s �� _ � f� � � � .. ���. � ,.► '� �� �'�s"���;_ � ;�' #������i"�:# r`. � � � � � � � � � ,� � � . � s: � ! i: . # # ; � ` � . _ ` !: . i ' # ! � . ! :.: f` # s . � s i . s ` .l;. � # � s f ' s 1t i °i � � � �, � ��. ' -. re :- . : � . � a s : - � = , � s # a � �` " � , ; -a :�, , ` ... � _ �, ; s r,.. , �r� a. �... ... a, ' _ ,. ;. . : _ . . 'E i _ _ , ... -� ,_ ��' e � �` '` • ! ` ` s�i if s'� !' �" �' � f f � ` � ; �: � # . . �: _ _ � , _. �' � _, � �; . � � . � . ,� . , � ; # : rt , � _ �: � � ,:� � � �,� � ` i �` � � : ; .� ir z � s � � _ .�, � � �; J�: �� � � ...- � . .. , �- : :. ' i ; : � . : ' � � � :. �� i � i��_ ` � !�� ��' � '_ �� � ����� ! , -� � -� i '. �- "� ` � � .�� '� " s` � � t' .' # � i` .� ���i '� .'`i�; 5����r�1�� �a�h S1a�gh��r �ivisi�� ���iro ental ff ��r cc: Amy �h�.pman, I�i��s�on of ��ater Resources Dave �Uanu�ha, Div3sio� of ��a��� R�sour�es David �ayne, PE, I�ivisian Bridge ��aintenance �ngineer Jam� �r�.ynn, I)ivision Bridge Pragram l��Ianager �eath Slaughter, Divis�on En�ironmental �ff�cer �ac1� Souther, Roadside Env�ro�m�ntal �'ield �pera�ions �'�c�.nician fvt�r�� �.� I � I r,t .,fr s�{t ;� �f '� r � ,tf 1 f P. . � �. ,t' i� 'f��J 1' '� �; .. .. Il` j. . !r{ .. 3 -� . � -'-'-. `rF � ' f - ` ' t� f i=:it. �� �• fr#:i a,.` � .''. �"; »;�- �,: -;'�£<. �;r f� ; � ,, �r�;. :;�;; � Jf ` � fY` �` S l,>� . f f L '• �!r � xs'/�. fr`�f .t f d= f�? t, f t' �r�'.r.:>� t✓::�:.f;�.�; EF..�`r.�'�='. ��� � �i� n ��� ������ � ��_ ������ ��. �� �'�� � � ,� �� � � . . . . . . . . . . . g � � � i 1 . . . . .. . � . . . . � . . . . � �F # � � . � � � . . . . g � � . �"� { } � � � � �� �� � � ��` �. � ����� 4 �� �� �� ��� � �r �� � . � �� �� � i r �� � � �� r; 3 �r ������ �r �� � } ��� �r: � �e �� ��� �� �� ��� �� ����f� �� ��� ����� �� � � . �'�����} �� p� ��I � �� �r� �� {����k I� �h�� ������� � � r � ��� �f � �� � � �� r ❑ ��� �r�� ���i r��� ��r I r �� �� ���r ��I�ty r�if� �i�� � � r��� ❑ � �ri r� � �r u����i���i�� 1 �. I� ���� r���if ���i � ��I��y ��r ��� r���r F�r t�� r���rd ���y ��r 1 F�r �h� r���r �r��y f�r r � �r ��e ���a�s� ri���r� �ppr���� is ��� r�q�ir�d� �er�ifi�ati��: � �es � �� � 1�. �� payn�en� i��� � nni�ig�t6�� bar�k �r i�-lie� ��� pr�gram pr�po�ed ��r r�i�ig�ti�� �,e� �� �� it�pacis� I� ��, �t#�ch the a��epi�r�ce ��t��r �fr�r� mi�igati�n bar�k �r i�-lie� t�� pro�ram. 1g, Is the pr�jec� [o�a��d in any of �'s t�enty ca�st�1 cc��n�i�s. If yes, ar�s�nrer 1h � Yes � o �e1�w. 1�. Is the pr�j�ct �oc�ted within a��� Area �f En�iro���ntai Concern (��C)`? ❑�es �o . r�ject 1r�fe�r afii� 2�. �iarne of �rc�ject: R�pl�ce F�ip� #�2123 or� Pir�e Valley F��ad 2b, �o�r�ty: i�adkir� 2c. Rlearest municipality / town: Yadkinville 2d. Subdivision r�ame: ��. iV��OI" �r��y, �".�.�. �� ����� 17BP.11.�.5 project no: 3. Owner Information 3a. Name{s) �n Recarded Deed: �1CDQT 3b. Deed Book and Page �lo. 3c. Responsible F'arty {for LL� i f �pplicable}: 3d. S�reet address. 8�1 Sfatesville Road 3e. City, sta#e, zip. North Wiikesk�oro, NC 28�59 3f. Telephone na.: 33G-9�3-9202 3g. F��c r�o.; 33�-��7-4549 3h. Email address; hsla�gh�er{�r�cdo�.gov Page I af 10 P�N Form — Version 1.3 December 10, 2008 Version . � � � � � � � � . ��� ��������� ��: �� ���� � ����, ����� . � � � � . . _ � �. � �� � � � � � ��� ��������: � � ► � � a �� � � ��: � � 4�, ���y, ��at�, z�pa � �. �������� � . o � ��. a 4�. ��� �� � � : � $ ��� ��� �� �� ��f r ��i�� ��� � ���� ��� ��. ����: 5be ���r���s � ��� �pp�i��b��): 5�. �ree� �dd����: ��. i�y, ���t�, zi . ��. �"��eph��� � .: 5f. ��� r�c�.: 5g, �ail �d�r��s: Page 2 of 10 P�N Form — Version 1.3 December 10, 2�08 Version � � � � � � � � , ` � �� � � g £ � ` � � . � � ����� �� � , � � � �� � � • � � � � �° � � � �. ���� ������������ �i� ������� ��g�����o � �� ���� . � � � � �� � ��� ��� � : � . � � � � ���.��[������ �-��.������} 1 �. ������� ����: � �.� ����� � � � � 2�. ���� c�f ������� ��d� �� ����� {��r��r�, r����, ���.� �� � � ���po��� prc��e��: �� �� ����� ���� �r��k 2b. �����r ������y �����if���i�� �� ���r��� ����i��r�� ��t�r: � � � 2�, i��r ��. � ���k�r� . r ° � i 3�. e�crib� ��� �i�tir� ��� i�i��� �c� ��� ���e �r� ��� ������ ��r�d ��� ir� ��� �i�ir�i�y �f �h �����t �� t�� �i �f �h�� �pp�ic�����: �b�ta�d�rd pip� �� b� r�pia�ed Y�dkir���ll�. re� i� f�r���ed i�h ��� ��� ��� rby. 3b. �ist �he ����I �stim���d ��re�ge �f �II exi��i�g �nre�l��d� �r� ��e pr�per��: 0 a�r�� 3c. Li�t th� t�ta� ���ir����d lin�ar fe�� �f ali e�istir�g �trear�� {i�ter�itt��� �r�d perer�r�ial� �� �h� praper#�: 15{� linear fee� 3d. �p���� �h� ��rp��� �� �h� p��p���d �r�j���: Upgrade substandard stream crossir�g 3e. Describe the overall projec� in defiail, including the type of eq�ip�nen� to be c�sed: �ee a�tached cover letter. � urisdict�on�l eter ��ati�n 4a. �ave juri�dic�ional wetland or s�ream d�termina�ic�ns by �he Corps Qr Sta�e been reques�ed �r �b�ained for this property I project �incl�di�g ali prior phases) in �he past? � Yes ��1� � Unkno�r� Comments: 4b. ���%� �arp� r��d� �he j�risdic�i���l de��rminati�n, what type of determina�ion was made� ❑ Prelim�nary � F�nal 4c. if yes, who defineated the jurisdictiar�al areas? AgencylConsul�a�t Company: Narne {if knownje Other: 4d. If yes, lis� the dates of �he Corps jurisdictional determinations or Siate determi�atior�s and at�ach documentati�n. 5, Project History 5a. Have permi�s a� certifica#ions been req�ested or obta�r�ed fc�r � Yes � Na ❑ Unknown th�s pro�ec� {�nclud�ng all pr�or phases} �n �he pas�? 5b, If yes, explain in detail accflrding ta "help file" instructions. 6, Fut��ure Project Plans 6a. �� this a phased project? [� Yes �j �lo �b. If yes, explain. Page 3 of � 0 PCR] Form — Version �.3 December � 0, 2008 Version � � a � � � �� � �� 3 � , � �� � � I } � , ���� ��� � � � � � � � �� � � � ��� � �� �� � � �: � �� � �� � �� � ��� �� �� � � � � ��� ����� � ��� ����������� � 2. �'������d ��p���� � � £ �� �h��� �r� �����d i� ���� ���p���d �� �h� ����, ���� ��� ���� ��i ����i�� f�� � �� ����� r � ����m �. � �d. � �e_ �, ���r�� i � �� � � �Y� f j�r��d���i � � �����r — f i �� �"y � �� � � � ��� �� r - � � � �� �f i ��� � � i � �rr�����t { j �r � ��f k����� � ��V� � ���-4�4, �t��r} {������ �'� �� r � i � 1 � � ` � ��� � ���p� � � �� V�2 � �' � �" � ��� � ���p� � � �� � [��� 3 ❑�❑°T � �e� � ��rp� ❑ c� � C�WC� 4 ❑ �j� � ��� [] �orp� � � � ❑ ��� 5 ��[�T ❑ ��� ❑ ��rp� � 1�� ❑ C�W� W� ❑ P � � [.� �es ❑ ��rp� ❑ � o ❑ D11VQ 2g. T���1 vvetla� � ����s 2h, �omments: o tr�� Ir�p��t� i� �here are pere�ni�l �r ir��ermit�e�t str��rn imp�c�s {including �emp�r�r� impacts) pr-opo�ed or� ihe si�e, th�n complete �hi� quesiion �or ai1 s��eam �ites impacted. 3a. 3b. 3c. 3d. 3e. 3f. 3g. Stream impac� Type Q� impac� Strear� name Perer�niai Type of j�ar�sdic�i�n Average lmpac� number - {PER} or {�o�ps - 4�4, 10 str�am leng�l� Permanent (P} or intermittent DWt� — non-404, widtl� {linear �empQrarY �T) {I�iT}� other) (feet� fe�t} Fiil, Riprap, Piping UT ta South Deep � PER � Corps �1 � P� T & Dewaterin Creek 11�1T 3 88 9 ❑ � DWQ � PER ❑ Corps S2 0 P� T I NT ❑ ❑ DWQ ❑ PER ❑ Carps S3 ❑ P ❑ T 1 �1T ❑ ❑ C�WQ ❑ PER ❑ C�rps S4 ❑ P❑ T 1 NT ❑ ❑ DWQ ❑ PER �] Corps S5 � P ❑ T � NT 0 ❑ aWQ ❑ PER ❑ G�rps S� Q P� T I NT i� ❑ [�WQ 3h. Total stream and tributary impacts 88 3i. Comr�en�s: 31' fi�l, 21' riprap, 16' piping & 2Q linear feet of dewatering Page 4 of 10 P�N Farm — Version 1.3 December 10, 2008 Version � � � � � ���� � ��� ��� �� � � � � � � �� � � � ` � � � s , , �� r� , �r� �� r� , �n � �� ��I ���� � �, �� �� � � � _ � � . � � �� . . �� �� ��� � �� �� � �� � � � � �� � , � � . � . � �. � �. � � � ��� � � � � ; � � � � � � � � # � � �� �� � � ��� ��� � � � � � � �� � � � � � � � �� � �� � � � r ��� �3 � � �� � � � � �� ��� � � � � � ( t � � �� � � � � � � �. �� � � i �� ���� a � � �� � � � -�- � � � . ���� � � ��� � ��� � � �����: . � � ; If ��� �r I�k� ��r�s�r���i�� r� ���d, �h�� �c�� ���� �h� �h�� b�[��. 5�. 5b. ��. �d_ ��. �e���r�d ���a��� {�cr�s} �tre�r� Ir�p��t� {feet) �Jp1a�d ��r�d I� �r�p��ed �s� �r p�rp��� {a�res} r��r�ber o� po�d FIaQd�d Fil[�d E����a#ed Flca�d�d F�II�� ����v�ted F�o�d�d �1 P2 � 5f. �'�tal � 5g. �omrt�ten�s: /A 5h. 1� a da� high haz�rd p�rmit required� ��es � N� �f yes, perrnit ID no: 5i. Expec�ed pand surface area {acres): 5j. Size ot pond watersh�d {acres}: 5k. Meth�d Qf cvns�r�ction: fi. �ff�� � pa��s ���r C�� If project vvilf impact a protected riparian buffer, then complete fine chart below. If yes, �hen individually list al1 bc�ffer impacts below. 1f an impacts require miti ation, then ou MUST fill out Section D of this form. Ga. ❑ Neuse � �ar-Pamli�� ❑ C3�her: Project is in which protected basin? ❑ Catawba � Randleman �b. ��. �d. �e. 6f. 6g. Suffer impac# number — Reason �uff�r Zone 1 impact Z�ne 2 impact Perr�nanent �P} or for Stream r�ame mitigation (square fee�� (square feet) Tem ora T im act re uired? B 1 P T ❑ Yes ❑ ❑ Cj No ❑ Yes 82 �P❑T Nc� ❑ B3 � P T ❑ Yes ❑ ❑ No bh. Tatal buffer impacts �i. Commer�ts: Page 5 of 10 PCN Form — Version 1.3 December 10, 2008 Ver�ion . ■ � . . .�. .� � . i . . � �� � � # � 9 ��.� . � � � � � . �� � . � . . � • ��SY�/ ��y ���� � � � � � � � � ��� �� Rn� � �/ i� �N� �i $ � ���. � � ��s � � � � �� �� �� ��� � � � � � � � �y � � i ��� �� �. � � � ��� ��� � ��� � � � r . � � � . ��f�� ��� ��� �� � � � � � � � � �� � i �� � � � � ������ � � �� � , � ��� �p��������� � ���� �� ���� ����� ���������i�� � � � , 4 � ������� � . .��� ��� � i ��� � � . ���� �� . . ����� � . .� �� S � C �� ����� �� ��� ��lf� � � �a ��� ��� �r����t ��q��r� �� ������� i�i��ti�� ��� � ��� � � . i� ���� �� ����� � ��� . , � ���r� �� �h� ��� � 2b, �fy�s, ��tig��ic�� is r�qa��red by �check ��� ���� �.�p�Y)o � � � �� � � i�ig��i�� �a�k 2�. I� ���, ����� ���ig�� �o� �pt�o� i�� � �� � f�r th�� � ��� �� i��i��� f�� �� r r�� �c�� � � r��t � e p�� ��� i�i ti � e � � ��� � 3a. arn� �f i�ig��io� ��k; 3b. redii� �r�ha��d {�t���h receip� �r�d let��r) i'�pe �an�i�y 3c. �or�ment�: . ���� �f �ki� �n� t ��-���� �� r r 4a. Approv�l le�ter fr�m �r�-1i�� fee program is a��ached. ��es �b. Stream mitigatian reques�ed: 4�7 linear feei 4��. If usir�g stream mitigation, strear� temperature: � vvarm c�ol �c�ld 4d. �uffer �itiga�i�� requested {�WC� or�ly}: square fee� 4e, Riparian vvetland mi�igation requested: �cre� 4f. �]on-riparian we�land mitigation requested: acres 4g. Coastal {tidai) wetland mitigation requested: acres 4h. Comments: 5. Compiete �f Using a Permit#ee �esponsibie Mitigation Plan �a. If using a permittee responsible mi�igation plan, provide a description of the proposed mitigati�n plan, Page6afi14 PCN Forr� — Version 1.3 December 10, 2aQ8 Version I � r ��� #� � � � � � �� �� � � � � � � � � � � ° � , , � ��a ��� ��� ������� r����� �� �� � ��� ����� � ������� �� �r��� ����� ���� �������� � � � � � � ����� ����g��i��� � � _ � . �� y �� � �� � ��i �� � r f � � � �� � � � f �� �� �� � � � �� � � ��r ��� �� �3 ���� � � � ��� � ��� �� � �° ���� . � � �. � �, � � � f r � �� �� � � ��� � ��������� � � ��r ��� ���� ��q���� ����� ; �� � r� ����� � � � � � � � � � � ��� �� ��� ��� 2 � a� � , �f. r � � � � �re a �g, �f b�fi��� ����g�t��r� �� r�q��r��, d������ ��a� �y�� c�f ����c�����r� �� pr�p���� ��.c� ., p�yr���t �� p������ ������iic�� ba�k, perr�i��e� resp���ib�e rip�r��r� b��f�� r��t�r�ti��, ��yrr��r�t �r��� �� �ppr���d �n-li�� f�� f�r�d). �h. or��ent�: Page � of 10 PCN Form —�tersior� 1.3 December � 0, 20�8 �lersion � � � � � � � � � � �� � $ � ��� � � � �. ��� ��� ������� �����a�� � �� �� �������� �� �������� �������� � ��� ��������� � ��� � ������ ��� �� ��� � � ����� ��f�� �����t��� ����� �� � � � � � �b. �� y��, ��e� �� � di���� �4� p��r� i����d��� �� ��, �x����� ���, � � �����: � ��� � �� a � � 2�. V���� i� ��� �����I� p����r�t �rrr�p���������� �f ��i� �������� ' °I� b. �e� �h�� pr�j��� r� �ir� i�r ��r �� ��� ��r�� �� 2�. If fihis pr�j��t �' ��q�ire �t�rm��ter an�g���n� la�, ��plain �%y; r�� ch�� e i� imp�rvi��� ��rfa�� �r�� 2 , �f ihi� ��j��� r�q�ire � ��r ���r ���g� ��t �a�, �h�� r��id� � br��f, ��rr��i�� ���ripti�� �f t�� � n: � �er�ified L���� �vern�e�� 2ee h� �i�� � r��p�r��ible for �h� re�ie �f �h� t�r���ter �r�� err���� lar��? a C� Q���rr��nra�er �r�gr� � � 401 r�it . ertifie� ����1 �v�rr��en� tear��nra�er ��rie�nr 3a. In vvhich lo�al government's j�risdiction is �his pr�ject'? � Phase I � 3b. VVl�hich o� �he follo�in I�caN -in� le�en�ed ���rri��ra#er rt�ana er�er�t r� rarns 0 NSW g � p 9 � 9 � �Si�� �pp[y �ch�ck �11 th�� app1Y): 0 �ater Supply Watershed ❑ �ther; 3c. Has the appr�ved S�ormw��er M�nagerr�en� Plar� �ri�h proof af �ppr�val been ❑ Yes ❑�o attached? 4. DWQ Stormwater Pro ram Review � �oastai counties ❑ Hc�w 4a. Which af the following state-impfemented s�ormwater management programs a�ply � pR� {check all tha� apply}: � Session Law 20��-2�� ❑ C3ther: 4b. Has �he approved StQrmwater Man�gemer�t Plan with praof of approvai been attached? ❑ Yes � No �. DWQ 40� Unit Stormwater Review 5�. D��s ��e ��orrnwa�er �lar�agemen� P1�n r�ee� tl�e �ppr�pri��e r�quirer�er��s� � Yes ❑ No 5b. Have all of the 401 Unit sc�bmittal req�irements been me#? ❑ Yes � No Page 8 af 10 P�N Form — Version 1.3 December 10, 2008 Version � � � � �� � � � � �� � � �� � �� � � �a � � � � �� ��� ��� ���j��� ������� �� ��p�������� �#� ������ ��������1������������ ����� �r t�� � � ��� � � ��� �f p����� ��������1�����} ����� � � � � � 1 . �f � � �� ���� "y �" � �� ��, ��� ��� ������� ������� � �� �i � � n , � �������e���� ������r�� ������� t� ��� ��q��r������ �f �� ������� � ���� � � � � � � �� ������ } ��ir � ����� ���y �� { }� } � � �. �°� y � ����e�� "�� " � ��� ����, ��� ��� ���� ��� ����� ��� �� ����d by �� � ���e le�r�� ����� �� ��, ������ � �� �� t�e �� fir��� � �o��� � � � Y �� � �����r.} ��� � ���e���: � . i � � � � 2�. �� �h� �it� i� �i�l��i�� �f �VVC� VV�tl��d ��1�� �15� ���� 2� .�5��}, ���I�ted �V����r�d ����� {� 5A ���� 2� . � 30�), �VUC� ���`��� �V'���r �r 11������d ����c��rd�g �j ��� � �� or �ipari�n �u�fer �ule� �� �� ���� 2� .�2�0�? 2b. I� �hi� �� ��t�r-�he�f��� p�rr�i� appli��ti�r�'? � l�e� ��� 2c. If y�u �r��wer�d "ye�" t� c�r�� or b��h c�� ��e �b�ve que�ti���, prc�vid� �r� expia�a�i�� �� �h� �i41at���t{s): 3. ��r�ul����� �rnp��t� �D1lV� �eq��rem�r��} 3�. 11�1i�� thi� pr�j�c� {b��ed �� p��� ��d r��s���b�y a�����pat�d ��#��� ��p����� ��s��� ir� Ye� Ri �dditi�nal devel� men�, �nrhich could im ac� nearb d4wnstrear� wafier ualit ? � �� p � Y q Y 3b. �� you ar�s�rered "y��" �c� �he �b�ve, ��br�i� � quali���ive �r qu���ita�iv� cu�nulative impac� ar�alysis ir� �ccordan�� �rith �h� r�as� recent C�i�lC� policy. If you answered iino,,, provide a s�orfi narra�i�e description. A�a �V�vag� C%e�pVsa� �D.*t� /l�q��rV���t� 4a. �learly detail the uitimate treatmen� methods and disp�sition {n�r�-discharge o� discharge) of wastewater g�nera�ed #ram the proposed projec�, c�r available capaci#y of the subject f�cility. N/A Page 9 of 1 Q PCN Form — Version 1.3 December 10, 2008 Version � � � � �� � �� � ��° � $ ���s ��� ��� � � � � � ����� ����� �� �� ���� �� ���� ���� ��������� ��������� ������� �� ��� � � � ���3����� � . �� l� �� ��� ��� �� � �� ��1�� � � �" �� �� � � � ����� ������1 �. �� y��, �� ����� �� ���d ��� y � � � � �� ��� . ���i�l � . h�f �t� ������ �i y�� ��� � ������r�� �����r ���r ��� ��� � ��� �r���r� �r� ��i�� �r ��i � � r���� � ������� � �r� �i�� � �� ��� �. �q����i� ���� ��� ��p� ���rd����e F r���rdi�� ��� ����a�� i� �e������y. . � i � ir � . i�l �hi� ��� �� ���r i� r �� r � r�� ��ig���� � ����r�t��fi ��h h�bit��� �j � � � �b. h�� d��� ���r��� did ��� u�e �� d���r�i�� �r�e�her y��r site ��uld irr�pact �s��nti�l Fi�h �bi�a�� . �st r�� r r� i�t r�� I��ral e�� rc� � r ��r� � tj 7�. �II �h�� �r��e�� ����r �� �r ��a� �� �r�� ���� �h� �����, f�d�r�� �r �r�b�� governments have designated as having histor�c �r cu[tural preservation ��� � sta��s �e. ., ational �listoric Trus� desi nati�n ar ro er�ie� �i nificant in � � 9 9 p � 9 �fiorth �arolina historr� and archaeolagy}? 7b. hat dat� ��urc�s did �o� use to determine �rh�ther your site �o�1d impact historic or arche�logical r�so�r�es� A��ivit� i� ��empt d�e to �m�ll scale �ithir� existing righ�-�f-�vay. 8. Flc��d �or�e ��s�gr��tion {Carps ��quirem�n�) ��. �l�1� �h�� pr����� �cc�r �n � ���A�d��ig��t�d � Q�@���r ����d��ai�� [� ��� � �c� 8b. if yes, explain how project mee#s FEMA requirer�ents; 8c. What source(s} did you use �o make �he floodplain de�erminafii�n? r�cfloodmaps J. I�eat1� Slaughter 11 /23i� � Applicant/Agent's Prin�ed Name Applican�lAgent's � nat�re Date {Ageni's gnature is valid oniy if an aut a zati�n letter from the applicant is provided.} Page 10 af 10 PCRI Form — Version 1.3 December 10, 2008 Version