20100485 Ver 1_401 Application_20100610

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Corps action ID no.
o < 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 from the
Corps:
404 Permit El Section 10 Permit
? Section
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
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
le. 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 for Corps Permit:

? Yes ? 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 mitigattorr bank or in=lieu fee program.
o
El Yes XN
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1h
below. ? Yes ? No
1h, Is the project located within a NC DCM Area of Environmental Concern (AEC)? ? Yes ? No
2. Project Information
2a. Name of project: 0V4 4.Le. f lb@C/-5
2b. County:

2c. Nearest municipality / town:
M 00 Ai ZI It,
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2d. Subdivision name:
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2e. NCDOT only, T.I.P. or state
project no: JUN ! 21010
3. Owner Information DENR-W.4TERMIALITY
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3a. Name(s) on Recorded Deed: *
a
AND tTMl
AYVf_ AliOA/4 ij S
3b. Deed Book and Page No,
3c. Responsible Party (for LLC if
applicable): I
3d. Street address: 3 Z ( ?'??in /t,G k IZW,
3e. City, state, zip: OOlLCS'ud1e /'U C 2
3f. Telephone no.: Z 9Z y Z p/ p L)
3g. Fax no.:
3h. Email address: C ,q ,9 T N AfL VAI/1 /7 • CO,"
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ANCH
Page t of 10
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/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):
Latitude: Longitude: -
1b. Site coordinates (In decimal degrees): (DD.DDDDDD) (-DD,DDDDDD)
1 c. Property size: acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to }?
A
C ((A
proposed project: ,
2b. Water Quality Classification of nearest receiving water:
2c. 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:
11 Not 41~s tomjkttL?e my r /leer 0 A;4le-4
3b. List the total estimated acre ge of all existing wetlands on a property:
List the total estimated linear feet of all existing streams (intermittent and perennial) on th property:
3c
.
- To 7 / l v -fee ? 1.4 /GL ??lo.?? &v De-4,A1
SbCA
41
d
pp3d. Explain the purpose of the roposed project:
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3e. Describe the overall pr )ect in detail, including the type of equipment to be d: 40 140.CS
J2 iet:
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property / 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.
5. Project History
5a. Have permits or certifications been requested or obtained for Yes ? No ? Unknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instru ions. 041V ?aOp?60Va G ?•

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6. Future Project Plans
6a. Is this a phased project? ? Yes ? No
6b. If yes, explain.
Page 3 of 10
PCN Form - Version 1.3 December 10, 2008 Version
C. Proposed Impacts Inventory
1. Impacts Summary
k all that apply):
1 a. Which sections were completed below for your project (

? Wetlands ? Streams - tributaries uffers
XB
? 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.
Wetland impact 2b. 2c. 2d. 2e.
Type of jurisdiction 2f.
number - Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWQ - non-404, other) (acres)
Tem ora T
? Yes ? Corps
W1 ? P ? T ? No ? DWQ
? Yes ? Corps
W2 ? P [] T ? No ? DWQ
? Yes ? Corps
W3 ? PEI T ? No ? DWQ
? Yes ? Corps
W4 ? P ? T ? 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. 3g.
Stream impact Type of impact Stream name Perennial Type of jurisdiction Average
t Impact
length
number -
Permanent (P) or (PER) or
intermittent (Corps - 404, 10
DWQ - non-404, s
ream
width (linear
Temporary (T) (INT)? other) (feet) feet)
? PER ? Corps
S1 ? P ? T ? INT ? DWQ
? PER ? Corps
S2 ? P ? T ? INT ? DWQ
? PER ? Corps
S3 ? P ? T ? INT ? DWQ
F1 PER El Corps
S4 ? P ? T ? INT [:1 DWQ
? PER ? Corps
S5 ? P ? T ? INT _ ? DWQ
? PER ? Corps
S6 ? P ? T ? INT ? DWQ
3h. Total stream and tributary impacts
31. Comments:
Page 4 of 10
PCN Form - Version 1.3 December 10, 2008 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 wate r impacts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number - (if applicable)
Type of impact
Waterbody type Area of impact (acres)
Permanent (P) or
Temporary T

01 ?P?T
02 ?P?T

03 ?P?T

04 ?P?T

4f. Total open water impacts

4g, Comments:

5. Pond or Lake Construction
if and or lake construction ro osed the n com lete the chart below.
5a. 5b. 5c.
Wetland Impacts (acres) 5d. 5e.
Stream Impacts (feet) Upland
Pond ID Proposed use or purpose (acres)
number of pond 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:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):

5k. Method of construction:
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 an im acts require mitigation, then you MUST fill out Section D of this form.
6a. 3o44-- )90- 91M 2 ? Neuse ? Tar-Pamlico ? Other:
AJ
Project is in which protected basin? j Catawba ? Randleman f!? 0AA
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number-
Reason
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P) or for Stream name mitigation (square feet) (square feet)
Temporary T impact required?
_
B1 []P?T pQGIG ?Nos
? Yes
B2 ? P ? T ? No
?Yes
B3 ?P?T ? No
6h. Total buffer impacts
6i. Comments: S

7'v
7?
/Lt4 Page 5 of 10 Sfi f / G ,o.,A.A/ Z* L AwAhr?a
?j PC?yN GForm - Version 1.3 December 10, 2008 Version
?'/ LCo??.t I ?!I ` T'r ? /(t"L ? ?OAN???/j' ? /w r

D. Impact Justification and Mitigation
/
1. Avoidance and Minimization - To i. ? C 7i/9 "" e? lJl?
Specifically describe}?easures taken to avoid or minim a the proposed I pacts in designing pro'ect.af li /3l ro
fee Akk'661 1 b. Specifically describe measures taken to avoid r ni a the opose impacts through const uction techn'ques. L
parck .r
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State T
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: linear feet
4c. If using stream mitigation, stream temperature: ? warm ? cool ?cold
4d. Buffer mitigation requested (DWQ only): square feet
4e. Riparian wetland mitigation requested: acres
4f. Non-riparian wetland mitigation requested: acres -
4g. Coastal (tidal) wetland mitigation requested: acres
4h. Comments:
6. Complete if Using a Permittee Responsible Mitigation Plan
5a, If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
All, -
/V/W.
LAO
GS.
Page 6 of 10
PCN Form - Version 1.3 December 10, 2008 Version
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.

Zone 6c.
Reason for impact 6d.
Total Impact
Multiplier 6e.
Required
square mitigation
( feet)
(square feet)
Zone 1 3 (2 for Catawba)

Zone 2 1.5
6f. Total buffer mitigation required:
If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
6g
.
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
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?
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
Who will be-responsible for the review of the Stormwater Management Plan?
2e ? DWQ Stormwater Program
. ? DWQ 401 Unit
3. Certified-Local Government Stormwater Review

3a. In which local government's jurisdiction is this project?
? Phase II
F] 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 th-e 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 El Yes El No
attached?
15, DWQ 401 Unit Stormwater Review
15a. Does the Stormwater Management Plan meet the appropriate requirements? I ? Yes ? No
15b. Have all of the 401 Unit submittal requirements been met? I ? 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?
1b. 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)?
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:
2. Violations (DWQ Requirement) d s?.? /11 ?CGK

2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
d
d
St ? ?w I
v,? 4, l3tl
? Yes ? No
s,
an
ar
Wetland Rules (15A NCAC 2H.1300), DWQ Surface Water or Wetland
or Riparian Buffer Rules (15A NCAC 2B.0200)? 2
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. WIII this project (based on past and reasonably anticipated future Impacts) result in
additional development, which could impact nearby downstream water quality? El Yes IiN?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative imp t analysis in accordance with the
t
JGG
n arrative d scyppjJ?
l
l

y
?
? '?
e a s
?# ,
most recent DWQ Polly.
It if y ?s?w d o-M pro
U.ye,1 't? / /
p
/M rA 10 9 L A GGl
r
4. Sewage Disposal (DWQ Requirement) , C 441-A
eta, 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.
n ,AA An
>-y?.le .
. k,P71-
fl.
OW,
Page 9 of 10
PCN Form - Version 1.3 December 10, 2008 Version
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? El 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
Ej 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 nearan 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? ? Yes ? No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did y u use to make the floodplain determine
A/ u

Applicant/Agent's Printed Name Applica Agent's S' lure
(Agent's slg a re is valid o if an auth lion letter from the applicant
Is rovide . Date
Page 10 of 10
PCN Form -Version 1.3 December 10, 2008 Version