20200212 Ver 1_PCN Form Submission_20200206

DWR
mrlslon of Water Resources
Pre -Construction Notification (PCN) Form
September 29, 2018 Ver 3
Initial Review
Has this project met the requirements for acceptance in to the review process?*
r Yes
r No
Is this project a public transportation project?*
G Yes r No
Change only if needed.
BIMS # Assigned
20200212
Is a payment required for this project?*
r No payment required
r Fee received
r Fee needed - send electronic notification
Select Project Reviewer*
Alan Johnson:eads\adjohnson1
Information for Initial Review
1a. Name of project:
Brookline Park
1a. Who is the Primary Contact?*
Larissa Coles
1b. Primary Contact Email:*
[e-mail]
Date Submitted
2/6/2020
Nearest Body of Water
Rankin Lake
Basin
Catawba
Water Classification
C
Site Coordinates
Latitude: Longitude:
35.274874-81.220410
A. Processing Information
County (or Counties) where the project is located:
Gaston
Is this project a public transportation project?*
r Yes r No
1a. Type(s) of approval sought from the Corps:
W Section 404 Permit (wetlands, streams and waters, Clean Water Act)
r Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What type(s) of permit(s) do you wish to seek authorization?
* Nationwide Permit (NWP)
* Regional General Permit (RGP)
7 Standard (IP)
Version#*
1
Reviewing Office*
Mooresville Regional Office - [phone]
1c. Primary Contact Phone:*
[phone]
U

1c. Has the NWP or GP number been verified by the Corps?
r Yes r No
Nationwide Permit (NWP) Number:
NWP Numbers (for multiple NWPS):
1d. Type(s) of approval sought from the DWR:
W 401 Water Quality Certification - Regular
r Non-404 Jurisdictional General Permit
r Individual Permit
39 - Commercial/Institutional Developments
le. Is this notification solely for the record because written approval is not required?
For the record only for DWR401 Certification:
For the record only for Corps Permit:
F 401 Water Quality Certification - E)press
F Riparian Buffer Authorization
1f. Is this an after -the -fact permit application?*
r Yes IT No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
Acceptance Letter Attachment
1h. lathe project located in any of NC's twenty coastal counties?
r Yes r No
1j. Is the project located in a designated trout watershed?
r Yes IT No
B. Applicant Information
1d. Who is applying for the permit?
r Owner W Applicant (other than owner)
le. Is there an Agent/Consultant for this project?*
r Yes r No
2. Owner Information
2a. Name(s) on recorded deed:
Brookline Logistics II LLC
2b. Deed book and page no.:
5071/1746
2c. Responsible party:
2d.Address
Street Address
1001 Baldwin Ln
Address Line 2
City
Waxhaw
Postal / Zip Cate
28173
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
State / Province / Region
NC
Country
USA
2f. Fax Number:
r Yes r No
r Yes r No
3a. Name:
Larissa Coles

3b. Business Name:
Odom Engineering, PLLC.
3c.Address
Street Address
169 Oak St.
Address Line 2
CKY
Forest City
Postal / Zip Code
28043
3d. Telephone Number:
[phone]
3f. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Larissa Coles
4b. Business Name:
Odom Engineering, PLLC.
4c.Address
Street Address
169 Oak St.
Address Une 2
City
Forest City
Postal / Zip Code
28043
4d. Telephone Number:
[phone]
4f. Email Address:*
[e-mail]
Agent Authorization Letter*
SIGNED Agent Authorization Letter.pdf
State / Province / Region
NC
Country
USA
3e. Fax Number:
[phone]
State / Province / Region
NC
Country
USA
4e. Fax Number:
[phone]
229.75KB
C. Project Information and Prior Project History C^U
1. Project Information
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/ town:
Gastonia
2. Project Identification
2a. Property Identification Number:
201884
2c. Project Address
Street Address
Jenkins Rd.
Address Line 2
City
Gastonia
Postal / Zip lode
28052
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Rankin Lake
2b. Property size:
17.37
State / Province / Region
NC
Country
USA
3b. Water Resources Classification of nearest receiving water:*
C

3c. What river basin(s) is your project located in?*
Catawba
3d. Please provide the 12-digit HUC in which the project is located.
030501020603
4. Project Description and History
4a. 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 is currently vacant. The land use in the vicinity is Industrial.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
r Yes r No r Unknown
4d. Attach an 8 1/2 X 11 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for DWR)
USGS.pdf 6.49MB
4e. Attach an 8 1/2 X 11 excerpt from the most recent version of the published County NRCS Soil Survey map depicting the project site. (for DWR)
4f. List the total estimated acreage of all existing wetlands on the property:
None
4g. List the total estimated linear feet of all existing streams on the property:
90 LF
4h. Explain the purpose of the proposed project:*
The purpose of the project is to develop the lot into an Industrial Subdivision.
41. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
The project Will have a road traversing from Jenkins Rd. (SR 1317) to Northwest Blvd. (SR 1338) and part of it will be crossing the creek. The project will install 2-30" RCP and headwalls
at each end. The culvert will impact an unnamed tributary of Rankin Lake. The project will require the utilization of equipment such as, but not limited to, a bulldozer, backhoe, excavator,
front end loader and dump truck. Construction activities include grading, filling, installing erosion control measures, and seeding disturbed areas.
4j. Please upload project drawings for the proposed project.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes r No r Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
r Preliminary r Approved r Not Verified r Unknown r N/A
Corps AID Number:
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
5d1. Jurisdictional determination upload
6. Future Project Plans
6a. Is this a phased project?*
r Yes r No
Are any other NWP(s), regional general permit(s), or individual permits(s) used, or intended to be used, to authorize any part of the proposed project or related activity?
Proposed Impacts Inventory
1. Impacts Summary
la. Where are the impacts associated with your project? (check all that apply):
r Wetlands W Streams -tributaries r Buffers
r Open Waters r Pond Construction

3. Stream Impacts
3a. Reason for impact (?) 3b.lmpact type * 3c. Type of impact* 3d. S. name* 3e. Stream Type * 3f. Type of 3g. S. width * 3h. Impact
(?) Jurisdiction* length*
New Culvert Permanent Culvert Unnamed Tributary Intermittent Cor s 1;;;1'
i1 rY Pearfeet)
3i. Total jurisdictional ditch impact in square feet:
0
31. Total permanent stream impacts: 31. Total temporary stream impacts:
90 0
31. Total stream and ditch impacts:
90
3j. Comments:
The project Will permanently impact 90 linear feet of the stream by adding a new culvert.
E. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
To minimize impacts, erosion control measures Will be installed. construction activities will be limited to daylight hours, and adequate distance will be
maintained between stream bank and construction.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Construction techniques taken to avoid or minimize the proposed impacts include limiting the area of disturbance and using more compact equipment
when possible. Erosion Control measures will be installed to minimize impacts.
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?
r Yes r No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
la. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
r Yes r No
If no, explain why:
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
r Yes r No
2b. Does this project meet the requirements for low density projects as defined in 15ANCAC 02H .1003(2)?
r Yes r No
2c. Does this project have a stormwater management plan (SMP) reviewed and approved under a state stormwater program or state -approved local government stormwater
program?
r Yes r No
2d. Which of the following stormwater management program(s) apply:
W Local Government r State
Local Government Stormwater Programs
W Phase II F NSW F USMP r Water Supply
Please identifywhich local government stormwater programyou are using.
Gaston Natural Resources Department
Comments:
U
G. Supplementary Information

1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
r Yes r No
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15A NCAC 2H .0500), Isolated Wetland Rules (15A NCAC 21-1.1300), or DWR Surface Water or Wetland Standards or
Riparian Buffer Rules (15A NCAC 2B .0200)? *
r Yes r No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality?*
r Yes r No
3b. If you answered "no," provide a short narrative description.
The purpose of installing a culvert is to construct a new road in the middle of the property that will provide an access from Jenkins Rd. to Northwest
Blvd.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
r Yes r Nor N/A
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?*
r Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
r Yes r No
5d. Is another Federal agency involved?*
r Yes r No r Unknown
5e. Is this a DOT project located within Division's 1-8?
r Yes r No
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?
r Yes r No
5g. Does this project involve bridge maintenance or removal?
r Yes r No
5h. Does this project involve the construction/installation of a wind turbine(s)?*
r Yes r No
5i. Does this project involve (1) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhammers, mechanized pile drivers, etc.?
r Yes r No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
https://ncdenr.maps.arcgis.com/
Consultation Documentation Upload
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
r Yes r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
https://ncdenr.maps.arcgis.com/
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 status?*
r Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
https://archaeology. ncdcr. gov/get-involved/sampling-archaeological-sites
https://savingplaces.org/places#.>(hdeTshKiUk
7c. Historic or Prehistoric Information Upload

8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year flood plain?*
r^ Yes r No
8c. What source(s) did you use to make the floodplain determination?*
NC Flood Map
https://fris.nc.gov/fris/Indexaspx?FIPS=071 &ST=NC&user=General % 2OPublic#
Miscellaneous
Comments
Miscellaneous attachments not previously requested.
Signature U
W By checking the box and signing below, I certify that:
• I have given true, accurate, and complete information on this form;
• I agree that submission of this PCN form is a "transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act');
• I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act');
• I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature; AND
• I intend to electronically sign and submit the PCN form.
Full Name:
Larissa Coles
Signature
Date
2/4/2020

PRE -CONSTRUCTION NOTIFICATION FORM
AGENT AUTHORIZATION
Property Legal Description
Deed Book/Page: 5071/1746
Parcel #: 201884
Location: JENKINS RD., GASTONIA, NORTH CAROLINA 28052
Property Owner: BROOKLINE LOGISTICS II LLC
Mailing Address:1001 BALDWIN LN.. WAXHAW, NORTH CAROLINA, 28173
Contact Number: [phone]
To whom it may concern:
I authorize
LARISSA M. COLES with
ODOM ENGINEERING, PLLC.
to act as my agent for the submittal of the Pre -Construction Notification documents to NCDEQ
Division of Water Resources.
Regards, fi.7G I.L�1-\v� (��� J ;SDI C' (( L L
c�
(Signature above printed name)