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HomeMy WebLinkAbout20061237 Ver 2_401 Application_201001100LO- ( a 3 1 voti 10F W A7?ROG 603 T Office Use Only: Corps action ID no. DWQ project no. Form Version 1.3 Dec 10 2008 Pre-Construction Notification (PCN) Form A. Applicant Information 1. Processing 1a. Type(s) of approval sought frot= ection 404 Permit ? Section 10 Permit S 11 Corps: 1b. Specify Nationwide Permit (NWP) number: or General Permit (GP) number: 1c. Has the NWP or GP number been verified by the Corps? ? Yes ® No 1 d. Type(s) of approval sought from the DWQ (check all that apply): ? 401 Water Quality Certification - Regular [-I Non-404 Jurisdictional General Permit 401 Water Quality Certification -- Express ['_'f Riparian Buffer Authorization 1e is this notification solely for the record For the record only for DWQ 401 FOr the record only for Corps Permit because written approval :s not required? Certification i I I ? Yes ? No ? Yes ? No it Is payment into a mitigation bank or in-lieu fee program proposed for mitigation n Yes No of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu fee program 1 1g. ? is the protect located in any of . NC's ti,rvem,ty counties. If yo ,.s, an s+sver 1h El Yes ? No coastal below. l h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? E Yes El No 2. Project Information 1 2a Name of project: I ??C Sc/?1-Z-? tf4"J ?c>/3 --- ----- -- 2b. County: IVA/tl 2c. -- - Nearest municipality / town: 2d. Subdivision name: -.! ? ? ?3??? ?? S` ??ZU'V ???•J(? f-/ ! 2e. NCDOT only, T.I.P. or state j prefect no* 3. Owner Information (^ / 3a. 3b. 1,4arr+et5) urr Mewfueu ueeu. Deed Book and Page No. 0 3c. Responsible Party (for L LC if - applicable). - 3d. _ Street address. ; j 3e. City, state zip. / f 3f. T eiephone no.: 3g. Fax no. 3h. Em l3dd ss: i - ----- -- I. DENR - WAMR QUALM _ ---- WhILANU5 AND STOR#N14TER ORANCl1 Al C ?dC // _ ('CA 4 - Win!?) - Plop t of 10 PCN Form - Version 1.3 December 10, 2008 Version 4. Applicant Information (if different from owner) 4a. Applicant is: El Agent Other, specify: ?p oJ7,?;?}(7pIZ - 4b. Name: I?Z?LL/L / )&*,4A ° 4c. Business name (ifapplicable): 0141A-A.) Ej)11-J0J 6 L/' Djed _ 4d. Street address: VZ?6 to 4e. City, state, zip: 4f. Telephone no.: 4g. 4h. Fax no.: - Email address: --- -- ---?/ - c?-7 /" ?p/rf??/?, Z Ff 2 - --_? /?C, i /`, fd•? _ _____ 5. Agent/Consultant 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 10 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): ©79570. 9S% 1b. Site coordinates (in decimal degrees): Latitude: Longitude: - DDDDDD) (-DD.DDDDDD) (DD . 1c. Property size: acres 2. Surface Waters 2a. Name of nearest body of water (stream, river, etc.) to ?- _ proposed project: r!'--IX 2b. Water Quality Classification of nearest receiving water. I? Lc. River basin ?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: /? kJri Oj7xJ,, ?L ilo.ti9?- iv; fi G'k'•?SS ?r4 rc/ -I ?7c/ S?ri/??`n?? •?/ n? ?'/,, r-rL d. I 3b. List the total estimated acreage of all existing wetlands on the property: I 3c. List the total estimated linear feet of all existing streams, (intermittent and perennial) on the property: 19 /011' J A41 4,714, /T- a.7r 3d. Explain the purpose of the proposed project: IV f D 4,4ti4'Iv& 9?:c1 s>c s F,?v.u i`U/ P i£cvfi3 01/ Jd Zr4- J 1'v 4EXI SVILI ? 1OeA tkr ell' 1/Wl a,) /ff' O1P 3e. Describe the overall project in detail, including the type of equipment to be used: I Gl/r ?9 S S 19,-id /?(1 4Il`r? a- 1,11/ e f j ??r?4r1?r 9 /V, // /2 rlCrt? av f/? ?t} ?? -------- 4. Jurisdictional Determinations - - - 4a. Have jurisdictional wetland or stream determinations by the Corps or State been requested or obtained for this property El Yes ? No ? Unknown project (including all prior phases) in the past? Comments: 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. I 5. Project History - - 5a. Have permits or certifications been requested or obtained for 9"yes ? No ? U known hases) in the ast? all rior ct (includin thi p p p g s proje 1 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. 17 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 (chec that apply): ? Wetlands ? Streams - tributaries uffers ? 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) Temporar T ? Yes ? Corps W1 ? PEI T ? No ? DWQ v -- --- _ -- -- --- ? Yes ? Corps W2 ? P ? T ? No ? DWQ ? Yes ? Corps W3 ? P ? T ? No ? DWQ 4 ? Yes ? Corps ? P ? T W ? No ? DWQ _ ? Yes ? Corps W5 ? P ? T ? No _ ? DWQ -- - -- --- ----- ? Yes ? Corps W6 ? P ? T ? 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. Stream impact Type of impact Stream name ! Perennial Type of jurisdiction Average Impact number - ! ! (PER) or (Corps - 404, 10 stream 0 length Permanent (P) or j Temporary (T) intermittent (IN f)? DWQ - non-404, other) width (feet) (linear feet) ? PER ? Corps ! ! S1 ? P ? T ? INT ? DWQ l 82 ? P El T I I ? PER I ? INT El Corps ? DWQ S3 ? P [IT -- - -- -- - I _ EE] PER l NT D Corps O DWQ I -- ? PER _ ? Corps S4 ? P ? T i i ------- - - - ----- - ----- El INT ? PER ? DWQ - - i ? C ---- + S5 L-1 P ? T ' f ? INT orps I ? DWQ _ - r _ _---- --- -- ----- ?- - _ _---- _ __- - - - _ ? PER ? Corps S5 ? P ? T _ l ---------- -- - El INT - [J DWQ - -- s ii. "fatal stream an d tributary impacts .-_ --- --------.-----' - --- f 1------------ j 3i. Comments Page 4 of 10 PCN Form - Version 1.3 December 1 0, 0-008 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. 4e. 4b. 4c. 4d. Qa 1 . Open water Name of waterbody impact number - (if applicable) Type of impact Waterbody type Area of impact (acres) Permanent (P) or Tem orar I— 01 ? P ? T I -- 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, then complete the chart below. -- 5a. 5b. 5c. 5d. a Wetland Impacts (acres) Stream Impacts (feet) Upland (acres) j Pond ID Proposed use or purpose i number of pond Flooded Filled Excavated Flooded Filled Excavated 1 Flooded P1 j PZ I 15f "Total 5g. Comments 5h. Is a dam high hazard permit required? ? Yes I ? No If yes, permit ID no: 5i. Expected pond surface area (acres): 5f. Size of pond watershed (acres): - -`_ 5k. Method of construction: _ ---- -- - ---- - 6. Buffer Impacts (for DWQ) i 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: I Project is in which protected basin? ? Catawba ? Randleman 6b. - --? 6c. 6d. 6e. 6f. 6g. 1 Buffer impact number - I Reason Buffer Zone 1 impact Zone 2 impact Permanent (P) or r r l T T for im act? Stream name mitigation required? (square feet) (square feet) y ? a ei p ____ B1 ?P?T ? Yes ?N - -- - B2 01P ? T --- - -- I t2fl4 a CeY - o El Yes I ? No - s -- - B3 ?P?T ?No 6h. Total b uffer impacts 1_ E 6i Comments: 1 Page 5 of 10 PCN Form - Version 1.3 December 10, 2008 Version D. Impact Justification and Mitigation 1. Avoidance and Minimization 1 aa. Specifically describe measures oaken to avoid or minimize the proposed 16, Z' impacttsin designing projeAtt.. l-[ ?`[ ?.'? / i/f//iC ' rJ/-' ?(?? ?/ t V 741e _ 1b. Specifically describe measures taken to avoid or minimize thLproposed impacts through construction techniques. it !+?'ZI i;1 GJy ?.9?/d 152.1 4& 191-1,? 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 ? No 2b. If yes, mitigation is required by (check all that apply): ? DWQ ? Corps i 2c. If yes, which mitigation option will be used for this project? ? Mitigation bank ? Payment to in-lieu fee program ? Permittee Responsible Mitigation 3. 3a. Complete if Using a Mitigation Bank Name of Mitigation Bank: 3b. Credits Purchased (attach receipt and letter) I 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 (DWO only): square feet 4e. Riparian wetland mitigation requested: acres 4f 4g. Non-riparian wetland mitigation requested: Coastal (tidal) wetland mitigation requested: acres acres 4h . Comments: ?5. 5a i Complete if Using a Permittee Responsible Mitigation Plan _? _ -- . If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan. -_ Page b of 10 PCN Form -Version 1.3 Decernber 1 u, 20=11 `ve.161 n 6. Buffer Mitigation (State Regulated Riparian Buffer Rules) - required by DWQ 6a. Will 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. Gone 6c. Reason for impact 6d. Total impact Multiplier 6e. 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 in-lieu fee fund). 6h. Comments: Page 7 of 10 PCN Form - Version 1.3 December 10, 2008 Version E. Stormwater Management and Diffuse Flow Plan (required by DWQ) 1. Diffuse Flow Plan 1a. Does the project include or is it adjacent to protected riparian buffers identified ? Yes ? 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? % 2b. Does this project require a Stormwater Management Plan? ? Yes ? No 2c. If this project DOES NOT require a Stormwater Management Plan, explain why: 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 ? 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) 1 a. Does the project involve an expenditure of public (federal/state/local) funds or the ? Yes No use of public (federal/state) land? 1 b. 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)? 1c. 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: 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)? 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. Page 9 of 10 PCN Form - Version 1.3 December 10, 2008 Version 6. Endangered Species and Designated Critical Habitat (Corps Requirement) 5a. Will this project occur in or near an area with federally protected species or habitat? ? Yes No 5b. Have you checked with the USFWS concerning Endangered Species Act impacts? ? Yes ? No 5c. If yes, indicate the USFWS Field Office you have contacted. El Raleigh ? Asheville 5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat? 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? 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 (e.g., National Historic Trust designation or properties significant in North Carolina history and archaeology)? ? Yes ? No 7b. What data sources did you use to determine whether your site would impact historic or archeological resources? 8. Flood Zone Designation (Corps Requirement) 8a. Will this project occur in a FEMA-designated 100-year floodplain? J E1 Yes ? No 8b. If yes, explain how project meets FEMA requirements: 8c. What source(s) did you use to make the floodplain determination? Applicant/Agent's Printed Name T Applicant/Agent's Signature (Agent's signature is valid only if an authorization letter from the applicant is provided.) Date Page 10 of 10 PCN Form - Version 1.3 December 10, 2008 Version FLOOD CERTIFICATION Tffi3 VAL CERTIFY THAT TES SUBJECT PROPERTY (x ) IS or ( ) IS NOT located in a SPECIAL FLOOD HAZARD AREA as determined by the Department of Housing and Urban Development. or as shorn on the FLOOD INSURANCE RATE AMP. 370243 0795 1 COMMUNITY I PANEL SUFFIX PROFESSIOPML LAND SURVEYOR CITY OF RALEIGH - ZONE 2 0 APPROX. LOCATION '!t" OF 50' NEUSE \ RIVER BUFFER CHAIN LINK IMPERVIOUS AREA FENCE - HOUSE 2685 SQ.FT. PORCH 370 SQ.FT. STOOP 75 SQ.FT. DR/RETWALL 1285 SQ.FT. UTIUTY LANDING 90 SOFT POLE (T,P). TOTAL 4505 SQ.FT. 32.6% IMPERVIOUS 0.9 01041. PG 349 s3'3yz?4 TOP OF 9MK 1Y'gY 1 p8,20, ZONE` _ LOT 16, BUDG °o BARBER SECTION c 13,814 SQ.FT. vy?rs Z 0.32 ACRES PROPOSED V. 73 E NING m 10.3• SCALE I I.- 30 O 15 30 60 Q ( IN FEET) 1 inch = 30 M m PORCH 2-STORY BRICK DWELLING VV/BASEMENT (NEW CONSTRUCTION) STOOP WALL (1YP) z - O ? z DRIVE 'a* \ R LEGEND OVERHEA / X. ? 00 IN O ExIS11NG IRON PIPE LOT 17 100. 0 NEW IRON PIPE ,40 X COMPUTED CORNER 3 14 22?J NOTE THIS PROPERTY DOES NOT UE WITHIN 2000' OF A N.C.G.S. MONUMENT. THIS SURVEY IS OF AN EXISTING PARCEL t NOTTINGHAM ROAD OR PARCELS OF LAND. (50' R/lf) UTILRtES SHOWN ARE FOR REPRESENTATON ONLY AND NOT TO BE USED FOR PROPERTY LIVE LOCATION ALL CREEKSEASEMENTSBUFFERS RE TO EIP AT THE FLOOD LIMITS do SETBACKS TAKEN ORTHEAST' COVNVER OF FROM BDM 1945 PG 027 OT 41 RECORDED IN BOW 2000. PG 1794 1, Jeffrey H. Davis. PLS , certify this map was drown under my supervision from an actual survey made under my superm and that the wrar of closure as calculated by latitudes and departures is 1/ 10,000+ : that the boundaries not surva" ore shown as broken lines plotted from mfor ation found in Book - : Page - : that this map was prepared in 47-30 amended accordance with G S . . Witness my original signature, registration number and seal this 19TH day of OCTOBER 20OZ PREIANNIRY PLAT, NOT FOR Signed RECORDATION, CONVEYANCES, OR SALES TN6 PLAN MUST BE APPROVED BY ALL STATE AND LOGY. REMEMM AUTHORITIES FOR CONCURRENCE WON SITE ZONNG Seal AND CODE OF ORDINANCES PLAN LNMRMA17ON BLOCK Footprint Total Square Feet Crawl: Stab: Basement: Mean Height Stories: Facade: Impervious Surface Areo: SITE PLAN n 0p " MICHAEL L. BRUEMMER TURNING POI 2 AMANDA T. BRUEMMER o ? nor s, BARBER SECTION UD I H S URVEYING PL L ' - B LE G - 1706 NOTTINGHAM ROAD 1706 RABOTEAU WYND 4113 JOHN S RALEIGH NORTH CAROLINA . 10-19-2007 WE DWG Na RALEIGH, NORTH CAROLINA 27612 . SCALE: 1' = M. A-10105 FAX (800)948-0213 PH (919)781-0f 34 N 0 't M01 - WAfFR oununY IO UOR%MATERSIR w0 Q t a G k VICINITY MAP (NS:S.) i t c,4 a E f ? I 4 r (?) air n v cat I- 7KNI q , SAN end r' L2 0 D U S 176? Fx;51 {0 (, Poem Lcv? -r ?? OI c / i s ,e -7 0[ I'l l0,o'