20201607 Ver 1_ePCN Application_20201210

DWR
mrlslon of Water Resources
Pre -Construction Notification (PCN) Form
October 26, 2020 Ver 3.3
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?*
C Yes r No
Change only if needed.
BIMS # Assigned
20201607
Is a payment required for this project?*
r No payment required
r Fee received
r Fee needed - send electronic notification
Reviewing Office *
Mooresville Regional Office - [phone]
Information for Initial Review
1a. Name of project:
Ranson Rosedale Park
1a. Who is the Primary Contact?
Richard K. Mogensen
1b. Primary Contact Email:*
[e-mail]
Date Submitted
12/10/2020
Nearest Body of Water
McDowell Creek
Basin
Catawba
Water Classification
WS-IV
Site Coordinates
Latitude: Longitude:
35.410691-80.867162
Pre -Filing Meeting Information
ID#
20201607
Pre -fling Meeting or Request Date*
12/31 /2020
Attach documentation of Pre -Filing Meeting Request here:*
DWR Pre -Filing Meeting Request Form.pdf
Version#*
1
What amout is owed?*
IT $240.00
r $570.00
Select Project Reviewer*
Alan Johnson:eads\adjohnson1
1c. Primary Contact Phone:*
[phone]
Version
1
51.84KB
A. Processing Information C^U
County (or Counties) where the project is located:
Mecklenburg

Is this a NCDMS Project
r Yes r No
Is this project a public transportation project?*
r Yes r No
la. Type(s) of approval sought from the Corps:
* Section 404 Permit (wetlands, streams and waters, Clean Water Act)
r Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
Has this PCN previously been submitted?*
r Yes
r No
1b. What type(s) of permit(s) do you wish to seek authorization?
W Nationwide Permit (NWP)
r Regional General Permit (RGP)
r Standard (IP)
1c. Has the NWP or GP number been verified by the Corps?
r Yes r No
Nationwide Permit (NWP) Number: 12 - Utility Lines
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
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:
r 401 Water Quality Certification - E)press
r Riparian Buffer Authorization
1f. Is this an after -the -fact permit application?*
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
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. Is the 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 r No
B. Applicant Information
1d. Who is applying for the permit?
W Owner r 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:
Town of Huntersville, NC
2b. Deed book and page no.:
L1 M35-611
2c. Responsible party:
Michael Jaycocks
2d.Address
*
r Yes r No
r Yes r No

Street Address
101 Huntersville-Concord Road
Address tine 2
City
Huntersville
Postal / Zip Code
28078
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Richard K. Mogensen
4b. Business Name:
SynTerra Corporation, INc.
4c.Address
Street Address
10430 Harris Oaks Blvd.
Address tine 2
Suite H
City
Charlotte
Postal / Zip Code
28269
4d. Telephone Number:
[phone]
4f. Email Address:*
[e-mail]
Agent Authorization Letter*
Agent Authorization Form.pdf
State / Rovince / Rion
NC
Country
USA
2f. Fax Number:
State / Rmince / Rion
NC
Country
USA
4e. Fax Number:
479.95KB
C. Project Information and Prior Project History O
1. Project Information
1b. Subdivision name:
(if appropriate)
N/A
1c. Nearest municipality/ town:
Huntersville
2. Project Identification
2a. Property Identification Number:
2b. Property size:
01715220
13
2c. Project Address
Street Address
9519 Rosewood Lane
Address Line 2
city
State / Rmince / Region
Huntersville
NC
Postal / Zip Code
Country
28078
USA
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
McDowell Creek
3b. Water Resources Classification of nearest receiving water:*
WS-N

3c. What river basin(s) is your project located in?*
Catawba
3d. Please provide the 12-digit HUC in which the project is located.
030501011401
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 surrounding land use is a mixture of single-family residences, apartments and forested land. The south property boundary is Rosewood Meadow Lane. The site is mostly immature
upland forest, bottomland hardwood wetlands, some cleared areas and a tributary to McDowell Creek. The project is a sanitary sewer pipe line to support the development of a small
public park and associated bathroom facilities. The sanitary sewer ties into an eAsting sewer that runs parallel to the unnamed tributary to McDowell Creek. The sewer will be installed
perpendicular to a forested wetland. All impacts Will be temporary and the applicant will conform to the attached Permittee Responsible Mitigation Plan. The wetland areas will be
restored to the original grades and stabilized with temporary annual rye and permanent native grass and\or wildflower mixes within 30 days after construction.
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)
Fig02_Site _Qu ad_Ma p. pdf
3.11 MB
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)
Fig04_NRCS_Soils _Map.pdf 1.43MB
4f. List the total estimated acreage of all existing wetlands on the property:
2.06
4g. List the total estimated linear feet of all existing streams on the property:
899
4h. Explain the purpose of the proposed project:*
Public park for the people and their pets.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
This project will involve all the standard heavy equipment for clearing, grading, paving, bathroom facilities and maintained lawns. Dump trucks, gradall, front-end loader, sheeps foot,
paving equipment and equipment to install playground facilities. The sewer will be installed using conventional techniques which include excavators, bobcat, welders for tie-in.
4j. Please upload project drawings for the proposed project.
Ranson Rosedale —Site Plan with Wetlands.pdf 462.29KB
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes r No 6 Unknown
Comments:
Done by prior consultant. Maps attached.
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: Terracon
Other:
5d1. Jurisdictional determination upload
AquaticResources_JDfeaturesOnly_4.pdf 1.78MB
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?
D. Proposed Impacts Inventory
1. Impacts Summary
la. Where are the impacts associated with your project? (check all that apply):

W Wetlands r Streams -tributaries G Buffers
r Open Waters r Pond Construction
2. Wetland Impacts
2a. Site #* (?) 2a1 Reason (?) 2b. Impact type * (?) 2c. Type of W.* 2d. W. name * 2e. Forested * 2f. Type of 2g. Impact
Jurisdicition*(?) area*
1 Sewer T Bottomland Hardwood Forest W-1 Yes Corps 0.024
(acres)
2g. Total Temporary Wetland Impact
0.024
2g. Total Wetland Impact
0.024
2g. Total Permanent Wetland Impact
0.000
2h. Comments:
Wetlands will be restored after sewer installation.
E. Impact Justification and Mitigation u
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
Due to the location of the wasting sewer line and the bathroom facilities for the new park the sewer had to cross the wetlands.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
The new sewer alignment crosses perpendicular to the forested wetlands to minimize impacts. The site will be restored per the attached PRIM.
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:
The impacts are below the mitigation thresholds and the impacted area will be restored to pre-eAsting conditions to greatest extent practicable. Areas outside the permanently
maintained corridor will be replanting with native bottomland hardwood trees and the permanent Right of Way will seeded with native grass seed and wildflower mixes.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
1a. 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:
Not along the main stem of the Catawba River.
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 15A NCAC 02H .1003(2)?
r Yes r No
Comments:
The project does not require a SMP as it is low density (12 % BUA threshold) per Mecklenburg County PCSO.
G. Supplementary Information
u
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
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 (North Carolina)
Environmental Policy Act (NEPA/SEPA)?*
r Yes r No
Comments:
This is a small municipal park and is using public funds and public lands but at the local level. It is under SEPA thresholds. It is not a federal project.

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 2H .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.
A small public park to service existing neighborhoods and apartments.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
r Yes r Nor N/A
4b. Describe, in detail, the treatment methods and dispositions (non -discharge or discharge) of wastewater generated from the proposed project. If the wastewater will be treated
at a treatment plant, list the capacity available at that plant.
Project is tying in to exsting public sanitary sewer pipe line.
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?
IPAC
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?*
Web resources
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?*
Site Inspection State Database
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
8b. If yes, explain how project meets FEMA requirements:
No elevation changes within the FEMA flood plain will result from this project.
8c. What source(s) did you use to make the floodplain determination?*
Meek. County Polaris GIS
Miscellaneous
Comments
Additional Uploads: ACE JD Request Form Ranson Rosedale Park, PJD Appendix 2, Vicinity Map, Aerial Photo, NNI Map, Corps ORM Form
Miscellaneous attachments not previously requested.
ACE JD Request Form Ranson Rosedale Park 12-9-20.pdf
194.77KB
PJD Appendix2 Ranson Rosedale Park.pdf
141.3KB
Fig01_Site_Vicinity_Map.pdf
1.41 MB
Fig03_Aerial _Location_Map.pdf
1.46MB
Fig05_NWI_Soils _Map.pdf
1.58MB
Preliminary ORM Data Entry Fields Ranso Rosedale Park.pdf
33.13KB
Signature
U
*
W By checking the box and signing below, I certify that:
• The project proponent hereby certifies that all information contained herein is true, accurate, and complete to the best of my knowledge and belief; and
The project proponent hereby requests that the certifying authority review and take action on this CWA 401 certification request within the applicable reasonable period of time.
• 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:
Richard K. Mogensen
Signature
Date
12/10/2020

41P
synTerra
AGENT A17HORIZATION FORIM
PROPERFY LEGAL DESCRIPTION:
LOT NO. PLAN NO. PARIML ID: 01 / j xe?
.70
STREET ADDRESS: _
q 5) °f'�Aa,� rnat�� tL�
PROPERTY OWNER:
Wyi OP PPAfPy(w&j Nt l
The undersigned, registered property owners of the above noted property, do hereby aud-iu
of (Contractor? Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing. issuance and acceptance of this permit
of certiGca6on and any :red all standard and special conditions atracbad
By Signing below. I authorize representstivcs of the Wilmington District, U-S. Army Corps of Engmers
(Corps) to enter upon the property herein described for the purpose of conducting on -site investigations, if
nccessuy. tatd issuing a jurisdictional deterrninntioa Pursuant to Section 404 of the Clean Waters Act
andlor Section I0 of the Rivers and Harbors Act of 1999. 1, the w Ide rsigned mu the duly authorized owner
of record of the property identified herein.
PROPERTY OWNERS ADDRESS (if different than property above),
PROPEIRIY OWNER CONTACT:
We hereby certiiv the alwve igform[
mrbmitkd in this application is true Dad cvrrtWe m the best of uur .
[mowledgc.
Authorized Si$agme Atrthotized Signanrre
Date:_ Date: /6 l ? G/a D--;�o

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tersville
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NOTES:
1. ROPERTY BOUNDARY OBTAINED FROM NC ONE MAP rCq v
(hftps://www.nconemap.gov/pages/parcels) ON DECEMBER 4, 2020.
2. ALL BOUNDARIES ARE APPROXIMATE. LEGEND \
3.2019 USGS TOPOGRAPHIC MAP, CORNELIUS, NC
QUADRANGLE, OBTAINED FROM USGS THE NATIONAL PARCEL BOUNDARY -
GEOLOGICAL MAP DATABASE AThftps://ngmdb.usgs.gov/.
FIGURE 1
vNnston-Salem VICINITY MAP (USGS)
Asheville RANSON ROSEDALE PARK
synTerra • HUNTERSVILLE, NORTH CAROLINA
• charlotte PARCEL ID: 01715220
10430 HARRIS OAKS BOULEVARD, SUITE H
CHARLOTTE, NORTH CAROLINA 28269 MECKLENBURG DRAWNBY-C.CURRIER DATE: 12/04/2020 GRAPHIC SCALE
NORTH CAROLINA REVISED BY: C. CURRIER DATE 12/04/2020 500 0 500 1,000
PHONE: [phone] COUNTY PROJECT MANAGER: R. MOGENSEN
www.synterracorp.com G:\CHASE\Rich Mogensen\GIS TEMPLATES\Fig01_Site_Vicini7y7p.mxd (IN FEET)

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SITE LOCATION
± 13-ACRES -------�
J l T RgHAME
�23Y
1
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726 f
r rI %
30
NOTES � -
1. PROPERTY BOUNDARY OBTAINED FROM INC ONE
(https://www.nconemap.gov/pages/parcels) ON DECEMBER 4, 2020. 2. ALL BOUNDARIES ARE APPROXIMATE. LEGEND f
3.1993 USGS TOPOGRAPHIC MAP, CORNELIUS, NC ,
QUADRANGLE, OBTAINED FROM USGS THE NATIONAL PARCEL BOUNDARY
GEOLOGICAL MAP DATABASE AThttps://ngmdb.usgs.gov/.
FIGURE 2
Winston-Salem. QUAD MAP (USGS)
•
Asheville RANSON ROSEDALE PARK
synTerra • HUNTERSVILLE, NORTH CAROLINA
• charlotte PARCEL ID: 01715220
:CHAR
0 HARRIS OAKS BOULEVARD, SUITE H
LOTTE, NORTH CAROLINA 28269 MECKLENBURG DRAWN BY: C.CURRIER DATe12/04/2020 GRAPHiCSCALE
NORTH CAROLINA REVISED BY: C. CURRIER DATE: 12/04/2020 500 0 500 1,000
E: 980-312-5999 COUNTY PROJECT MANAGER: R. MOGENSEN
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NOTES:
1. PROPERTY BOUNDARY OBTAINED FROM NC ONE MAP
(https://www.nconemap.gov/pages/parcels) ON DECEMBER 4, 2020. r
2. ALL BOUNDARIES ARE APPROXIMATE. LEGEND
3. 2019 AERIAL IMAGERY OBTAINED FROM ESRI ONLINE
BASEMAP SERVICE ON DECEMBER 4, 2020. AERIAL DATED PARCEL BOUNDARY
FEBRUARY 1, 2019.
�� FIGURE 3
Winston-Salem. AERIAL PHOTO MAP
Asheville RANSON ROSEDALE PARK
synTerra • HUNTERSVILLE, NORTH CAROLINA
• Charlotte PARCEL ID: 01715220
10430 HARRIS OAKS BOULEVARD, SUITE H
CHARLOTTE, NORTH CAROLINA 28269 MECKLENBURG DRAWN sv: C.CURRIERIE DATE:12/04/2020 GRAPHicscA E
NORTH CAROLINA REV BED sv: C. CURRIER DATE: 12/04/2020 ioo o ioo zoo
PHONE: [phone] COUNTY PROJECT MANAGER: R. MOGENSEN
www.synterracorp.corn G:\CHASE\Rich Mogensen\GIS TEMPLATES\Fig03_Aerial_Location_Map.mxd (A FEET)

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NOTES:
1. SOILS DATA OBTAINED FROM THE USDA WEB SOIL SURVEY
(https://websoilsurvey.sc.egov.usda.gov) ON DECEMBER 4, 2020. LEGEND
2. ALL BOUNDARIES ARE APPROXIMATE.
3. PROPERTY BOUNDARY OBTAINED FROM NC ONE MAP O CECIL SANDY CLAY LOAM, 2-8% SLOPES, MODERATELY ERODED
(https://www.nconemap.gov/pages/parcels) ON DECEMBER 4, 2020. O CECIL SANDY CLAY LOAM, 8-15% SLOPES, MODERATELY ERODED
4. 2019 AERIAL IMAGERY OBTAINED FROM ESRI ONLINE MONACAN LOAM, 0-2% SLOPES, FREQUENTLY FLOODED
BASEMAP SERVICE ON DECEMBER 4, 2020. AERIAL DATED
FEBRUARY 1, 2019. PARCEL BOUNDARY
FIGURE 4
Winston-Salem SOILS MAP (USDA)
Asheville RANSON ROSEDALE PARK
synTerra • HUNTERSVILLE, NORTH CAROLINA
• Charlotte PARCEL ID: 01715220
10430 HARRIS OAKS BOULEVARD, SUITE H
CHARLOTTE, NORTH CAROLINA 28269 MECKLENBURG DRC.CURRIER DATE: 12/04/2020 GRAPHIC SCALE
NORTH CAROLINA REVISEDVISED BY: C. CURRIER DATE: 12/04/2020 100 0 100 200
PHONE: [phone] COUNTY PROJECT MANAGER: R. MOGENSEN
www.synterracorp.com G:\CHASE\Rich Mogensen\GIS TEMPLATES\Fig04_NRCS_$oils_Map.mxd I
(IN FEET)

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SITE LOCATION
± 13-ACRES
PSS1
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NOTES:
1. POTENTIAL WETLANDS OBTAINED FROM THE NATIONAL
WETLANDS INVENTORY (NWI) ON DECEMBER 4, 2020.E
2. ALL BO U NDARI ES ARE APPROXI MATE.
-
LEGEND
3. PROPERTY BOUNDARY OBTAINED FROM NC ONE MAP
(https://www.nconemap.gov/pages/parcels) ON DECEMBER 4, 2020.
,
k.^'
A- FRESHWATER FORESTED/SHRUB WETLAND
4. 2019 AERIAL IMAGERY OBTAINED FROM ESRI ONLINE
RIVERINE
BASEMAP SERVICE ON DECEMBER 4, 2020. AERIAL DATED
FEBRUARY 1, 2019.
PARCEL BOUNDARY
FIGURE 5
��
wlnston-Salem
NATIONAL WETLANDS INVENTORY (NWI) MAP
RANSON ROSEDALE PARK
Asheville
synTerra
•
HUNTERSVILLE, NORTH CAROLINA
Charlotte
•
PARCEL ID: 01715220
10430 HARRIS OAKS BOULEVARD, SUITE H
CHARLOTTE, NORTH CAROLINA 28269
MECKLENBURG
NORTH CAROLINA
DATE: 12/04/2020 GRAPHIC SCALE
DRAWNBYCC. CURRIER
REVISED BY: C. CURRIER DATE: 12/04/2020 100 0 100 200
PHONE: [phone]
COUNTY
PROJECT MANAGER: R. MOGENSEN
www.synterracorp.com
G:\CHASE\Rich Mogensen\GIS TEMPLATES\Fig05_NWI_$oils_Map.mxd (IN FEET)

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SS EXISTING SANITARY SEWER
SS PROPOSED SANITARY SEWER
LID LIMIT OF DISTURBANCE
AREA OF WETLAND IMPACT =
±1,050 SF
UNNAMED TRIBUTARY
TO TORRENCE CREEK
EXIST. SANITARY
I SEWER OUTFALL
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GRAPHIC SCALE
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DATE: 12-3-20
PROJECT: RR-001
SHEET NO:
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is
Wetland 1:-1.26 Acres e..'Joe.
Wetland 2:-0.13 Acres ' AA}
Wetland 3: —0.003 Acres
Wetland4:—0.005Acres �� W2
Wetland 5: —0.14 Acres
Wetland 6:—4.130Acres
Wetland 7: —0.04 Acres
Wetland 8: —0.80 Acres t
Wetland 9: —4.13 Acres
Intermittent / Perennial Features
RPW 1: —116 LF 0.023 AC
RPW 2: —304 LF 0.038 AC a
RPW 3 (Torrence Creek): 3187 LF 0.99 AC*
I^ 5 I
* Torrence Creek digitized based on aerial imagery.
The approximate wetlands and non -wetlands lines depicted on
this drawing were flagged and collected with a Trimble Geo7x
GPS with GNSS receiver in the field by Terracon Consultants,
Inc. on Jan 3, 2020.
Total Project Area = - 63.74 Acres
Total Approximate Non -wetlands Waters = -3,607 Linear Feet
1--1.051 Acres
Total Approximate Wetlands = -11.04 Acres
Total Approximate Non jurisdictional Features = -367 Linear
+rn eki%Kann ryn:
NC 15 I �
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0 150 300 600 fl
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Disclaimer: The information depicted in this file is for o
QSite Boundary ORPW
(Intermittent / Perennial) • Data Points
Latest High -Resolution NC Statewide
Orihoinnagery, NC OneMap Server; Site
informational purposes only and was not prepared for and is o�
Wetland
Boundary Based on Mecklenburg County Parcel
not suitable for legal or engineering purposes. This
6
information presented is not for regulatory review and is o�
Data.
intended for use only by a Professional Land Surveyor prior to 0
regulatory review.
Project No.:
71197707
Date:
Feb 2020
Drawn By:
KT
Reviewed By:
JCW

x
RPW 3 (Torrence Creek):
`
—37 LF
,s
,
—0.011 AC
WETLAND 5:
WETLAND 7:
culvert
-
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' culvert
Upland Data Point
Wetland Data Point
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IL 16
::., ..IW
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.
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UplaData
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*
'
nd Point
_-.�-. _
^ 3150 LF
Data Point Upland Data Point
Wetland Data Point Upland Data Point
• .1
Upland Data Point Upland Data Point
� S
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Upland Data Point
iL
•
.. WETLAND 6:
�4.13 AC
Feet
y
0
50 100 200
Legend
DATA SOURCES: Disclaimer: The information
depicted in this file is for
.:. a .:.
rrng1�4�5
f
tKannaryn:��
QSite Boundary
- RPW (Intermittent / Data Points
Latest High -Resolution INC Statewide informational purposes only and was not prepared for and is
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Boundary Based on Mecklenburg County Parcel 6S
information is for is
Wetland
Perennial)
presented not regulatory review and o
Data. intended for use only by a Professional Land Surveyor prior to 0
- -
NC 15
}
�
regulatory review.
N
H o f tnlie
,I rn.
Project No.: 7707
Depiction of Aquatic Resources
p' q
m
Exhibit
Nsrtlku a
Date:
Feb 2020
Drawn By:
Irerracon
Torrence Creek Project
z
9
o
(35.41312,-80.86510)
4A
J�..re HQll� IUSi1
—
;-}
cEW
Reviewed By:
2701 Westport Road Charlotte, NC 28208
Huntersville, Mecklenburg County, NC
9 Y
1tS
JCW
PH. [phone] terracon.com

L +
Q
. ►2.
WETLAND 4:
—0.005 AC
WETLAND 3:
WETLAND 5:
~ 1'I�
fl
�0.003 AC
�0.14 AC
6
I
F
Wetland Data Point
%
Upland Data Point
5'S
�` �� ' Wetland Data Point.
RPW13 (Torrence Creek):
Wetland
` {{ —3150 LF
Upland Data Point Data Point
AC
Upland Data Point
Upland Data'Point
iftl
�116 LF
WETLAND'2:
Wetland Data Poir t
•' u .� .r',
�0.13 AC
WETLAND 6:
Upland Data Point
�4.13AC
+ 4
WETLAND 9:
'
t
Upland Data Point
Feet
Mafchpage C
0
50 100 200
Legend
DATA SOURCES: Disclaimer: The information
depicted in this file is for
I. + Kann n:,�
[prrgl Pik ry
Site Boundary
- RPW (Intermittent / Data Points
Perennial)
Latest High -Resolution INC Statewide informational purposes only and was not prepared for and is
Orlhoimagery, NC One Map Server; Site not suitable for legal or engineering purposes. This
Boundary Based on Mecklenburg County Parcel nformation presented is not for regulatory review and is o
Data.
y
14C 15 I f�
7I
Wetland
intended for use only by a Professional
regulatory review.
Land Surveyor prior to 0
H to:r v lle (n,l rn.
Project No.: 7707
Depiction of Aquatic Resources
p' q
m
Exhibit
Nsrrlku'4
Date:
Feb 2020
Drawn By:
Irerracon
Torrence Creek Project
o
(35.41312,-80.86510)
46
J.ire HQll� I ;- }
US'21
—_ _
cEW
Reviewed By:
2701 Westport Road Charlotte, NC 28208
Htille, MklenbCounty, NC
unersvMecklenburg
9 Y
1tS
JCW I
PH. [phone] terracon.com

Match
Clow
page g N
Wetland Data Point
Culvert
�_.-.
WETLAND 9:
?
c3.65 AC
4 _ WETLAND 1:
_
C1.26 AC
F
�'
Upland Data Point
Wetland Data Point �,
`�
w,
�
� y Upland Data Point
��
�'�
;r
Wetland Data Point
r
co"
_ _
`
-
r
j +t
Culvert
b
OE AC
- �
RPW 3 (Torrence Creek):
�.
�0.98 AC
Feet
'•.••• 0
50 100 200
Legend
DATA SOURCES: Disclaimer: The information
depicted in this file is for
I.
+ Kann n:,�
[ Pik
prrgl ry
Site Boundary
- RPW (Intermittent / Data Points
Perennial)
High -Resolution NC Statewide informational purposes only and was not prepared for and is
LatesServer;
Orlhoinnagery, NC OneMap Site not suitable for legal or engineering purposes. This
Boundary Based on Mecklenburg County Parcel 6S
information presented is not for regulatory review and is o
Data.
y
Wetland
intended for use only by a
regulatory review.
Professional Land Surveyor prior to 0
NC 15
N
H to:r v,lle (0'I rn.
Project No.: 7707
Depiction of Aquatic Resources
p' q
m
Exhibit
Nsrrlku a
Date:
Feb 2020
Drawn By:
erracon
Torrence Creek Project
(35.41312,-80.86510)
z
o
4C
J�.�re HQll�
177
I ;-}
USit
—
cEW
Reviewed By:
2701 Westport Road Charlotte, NC 28208
unersvMecklenburg
9 Y Htille, MklenbCounty, NC
1tS
JCW
PH. [phone] terracon.com

PERMITTEE RESPONSIBLE MITIGATION PLAN
RANSOM ROSEDALE PARK SANITARY SEWER
1) Stakeout limits of grading and disturbance
2) Finish clearing area to be excavated for sewer installation
3) Remove all debris to an upland disposal site
4) Install any additional erosion control measures such as silt fence
5) Excavate trench and dewater to a stabilized erosion control device such as hay bales or
silt bag
6) Install new sanitary sewer and hookup to existing public sanitary sewer
7) Apply temporary seed mix (annual rye grass) per the erosion control plan in all disturbed
areas
8) Once sewer installation and tie-in has been completed, re-establish existing grades in
wetland and surrounding areas
9) Install jute matting in areas that are bare soil and are within any disturbed wetlands
10) Plant native trees and shrubs in any forested wetlands that were cleared for sewer
construction that are outside the permanent sewer easement at a density of 400 trees
per acre
11) Plant herbaceous sprigs and/or broadcast temporary annual rye and permanent native,
riparian grass and\or wetland wildflower seed mixes within wetland areas disturbed for
sewer construction that are inside the permanent sewer easement
12) Remove any excess materials, debris or other undesirable items such as brush and
stumps
13) Demobilize all equipment
14) All of the above activities must be completed within one month after sewer
construction has been completed
15) Applicant will submit a snapshot report to the Corps of Engineers with pictures of the
wetland restoration once during the following growing season. If site is fully
revegetated monitoring will cease. If the area is not fully revegetated applicant will
repair and monitor site for the following year.

urisdictional Determination Reauest
US Army Corps
of Engineers.
Wilmington District
This form is intended for use by anyone requesting a jurisdictional determination (JD) from the
U.S. Army Corps of Engineers, Wilmington District (Corps). Please include all supporting
information, as described within each category, with your request. You may submit your request
via mail, electronic mail, or facsimile. Requests should be sent to the appropriate project
manager of the county in which the property is located. A current list of project managers by
assigned counties can be found on-line at:
http://www.saw.usace.aimy.mil/Missions/Re ul�atoiyPermitProi4ram/Contact/CountyLocator.aspx,
by calling 910-251-4633, or by contacting any of the field offices listed below. Once your
request is received you will be contacted by a Corps project manager.
ASHEVILLE & CHARLOTTE REGULATORY
FIELD OFFICES
US Army Corps of Engineers
151 Patton Avenue, Room 208
Asheville, North Carolina 28801-5006
General Number: [phone]
Fax Number: [phone]
RALEIGH REGULATORY FIELD OFFICE
US Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
General Number: [phone]
Fax Number: [phone]
INSTRUCTIONS:
WASHINGTON REGULATORY FIELD OFFICE
US Army Corps of Engineers
2407 West Fifth Street
Washington, North Carolina 27889
General Number: [phone]
Fax Number: [phone]
WILMINGTON REGULATORY FIELD OFFICE
US Army Corps of Engineers
69 Darlington Avenue
Wilmington, North Carolina 28403
General Number: 910-251-4633
Fax Number: [phone]
All requestors must complete Parts A, B, C, D, E, F and G.
NOTE TO CONSULTANTS AND AGENCIES: If you are requesting a JD on behalf of a
paying client or your agency, please note the specific submittal requirements in Part H.
NOTE ON PART D — PROPERTY OWNER AUTHORIZATION: Please be aware that
all JD requests must include the current property owner authorization for the Corps to
proceed with the determination, which may include inspection of the property when
necessary. This form must be signed by the current property owner(s) or the owner(s)
authorized agent to be considered a complete request.
NOTE ON PART D - NCDOT REQUESTS: Property owner authorization/notification for
JD requests associated with North Carolina Department of Transportation (NCDOT)
projects will be conducted according to the current NCDOT/USACE protocols.
NOTE TO USDA PROGRAM PARTICIPANTS: A Corps approved or preliminary JD
may not be valid for the wetland conservation provisions of the Food Security Act of
1985. If you or your tenant are USDA Program participants, or anticipate participation in
USDA programs, you should also request a certified wetland determination from the local
office of the Natural Resources Conservation Service, prior to starting work.
Version: May 2017 Page 1

Jurisdictional Determination Request
A. PARCEL INFORMATION
Street Address: 9519 Rosewood Meadow Lane
City, State:
Huntersville, NC
County: Mecklenburg
Parcel Index Number(s) (PIN): 01715220
B. REQUESTOR INFORMATION
Name: Richard K. Moaensen
Mailing Address: PO Box 690429
Telephone Number:
Electronic Mail Address
Select one:
Charlotte, NC 28227
704 576-1111
[e-mail]
I am the current property owner.
I am an Authorized Agent or Environmental Consultanti
Interested Buyer or Under Contract to Purchase
Other, please explain.
C. PROPERTY OWNER INFORMATION
Name: Town of Huntersville
Mailing Address: PO Box 664
Huntersville, NC 28078
Telephone Number: [phone] c\o Dan Dodd
Electronic Mail Address: [e-mail]
1 Must provide completed Agent Authorization Form/Letter.
2 Documentation of ownership also needs to be provided with request (copy of Deed, County GIS/Parcel/Tax Record).
Version: May 2017 Page 2

Jurisdictional Determination Request
D. PROPERTY ACCESS CERTIFICATION',4
By signing below, I authorize representatives of the Wilmington District, U.S. Army Corps of
Engineers (Corps) to enter upon the property herein described for the purpose of conducting on -
site investigations, if necessary, and issuing a jurisdictional determination pursuant to Section
404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of 1899. I, the
undersigned, am either a duly authorized owner of record of the property identified herein, or
acting as the duly authorized agent of the owner of record of the property.
Richard K. Mogensen
Print Name
Capacity: ❑ Owner Z Authorized Agent'
12-9-20
Date
Richard K. Mogensen
Signature
E. REASON FOR JD REQUEST: (Check as many as applicable)
❑ I intend to construct/develop a projector perform activities on this parcel which would be
designed to avoid all aquatic resources.
❑ I intend to construct/develop a projector perform activities on this parcel which would be
designed to avoid all jurisdictional aquatic resources under Corps authority.
I intend to construct/develop a projector perform activities on this parcel which may
require authorization from the Corps, and the JD would be used to avoid and minimize
impacts to jurisdictional aquatic resources and as an initial step in a future permitting
process.
❑✓ I intend to construct/develop a projector perform activities on this parcel which may
require authorization from the Corps; this request is accompanied by my permit application
and the JD is to be used in the permitting process.
❑ I intend to construct/develop a project or perform activities in a navigable water of the
U.S. which is included on the district Section 10 list and/or is subject to the ebb and flow of
the tide.
A Corps JD is required in order obtain my local/state authorization.
I intend to contest jurisdiction over a particular aquatic resource and request the Corps
confirm that jurisdiction does/does not exist over the aquatic resource on the parcel.
❑ I believe that the site may be comprised entirely of dry land.
❑ Other:
s For NCDOT requests following the current NCDOT/USACE protocols, skip to Part E.
a If there are multiple parcels owned by different parties, please provide the following for each additional parcel on a
continuation sheet.
s Must provide agent authorization form/letter signed by owner(s).
Version: May 2017 Page 3

Jurisdictional Determination Request
F. JURISDICTIONAL DETERNIINATION (JD) TYPE (Select One)
0 I am requesting that the Corps provide a preliminM JD for the property identified herein.
A Preliminary Jurisdictional Determination (PJD) provides an indication that there may
be "waters of the United States" or "navigable waters of the United States"on a property.
PJDs are sufficient as the basis for permit decisions. For the purposes of permitting, all
waters and wetlands on the property will be treated as if they are jurisdictional "waters of
the United States". PJDs cannot be appealed (33 C.F.R. 331.2); however, a PJD is
"preliminary" in the sense that an approved JD can be requested at any time. PJDs do
not expire.
❑ I am requesting that the Corps provide an approved JD for the property identified herein.
An Approved Jurisdictional Determination (AJD) is a determination that
jurisdictional "waters of the United States" or "navigable waters of the United
States" are either present or absent on a site. An approved JD identifies the limits of
waters on a site determined to be jurisdictional under the Clean Water Act and/or
Rivers and Harbors Act. Approved JDs are sufficient as the basis for permit
decisions. AJDs are appealable (33 C.F.R. 331.2). The results of the AJD will be
posted on the Corps website. A landowner, permit applicant, or other "affected
party" (33 C.F.R. 331.2) who receives an AJD may rely upon the AJD for five years
(subject to certain limited exceptions explained in Regulatory Guidance Letter 05-
02).
❑ I am unclear as to which JD I would like to request and require additional information
to inform my decision.
G. ALL REQUESTS
Map of Property or Project Area. This Map must clearly depict the boundaries of the
review area.
✓� Size of Property or Review Area 13 acres.
❑✓ The property boundary (or review area boundary) is clearly physically marked on the site.
Version: May 2017 Page 4

Jurisdictional Determination Request
H. REQUESTS FROM CONSULTANTS
Project Coordinates (Decimal Degrees): Latitude:
35.410691
Longitude:-80.867162
A legible delineation map depicting the aquatic resources and the property/review area.
Delineation maps must be no larger than I Ix 17 and should contain the following: (Corps
signature of submitted survey plats will occur after the submitted delineation map has been
reviewed and approved).6
■ North Arrow
■ Graphical Scale
■ Boundary of Review Area
■ Date
■ Location of data points for each Wetland Determination Data Form or tributary
assessment reach.
For Approved Jurisdictional Determinations:
■ Jurisdictional wetland features should be labeled as Wetland Waters of the US, 404
wetlands, etc. Please include the acreage of these features.
■ Jurisdictional non -wetland features (i.e. tidal/navigable waters, tributaries,
impoundments) should be labeled as Non -Wetland Waters of the US, stream, tributary,
open water, relatively permanent water, pond, etc. Please include the acreage or linear
length of each of these features as appropriate.
■ Isolated waters, waters that lack a significant nexus to navigable waters, or non -
jurisdictional upland features should be identified as Non -Jurisdictional. Please
include a justification in the label regarding why the feature is non jurisdictional (i.e.
"Isolated", "No Significant Nexus", or "Upland Feature"). Please include the acreage
or linear length of these features as appropriate.
For Preliminary Jurisdictional Determinations:
Wetland and non -wetland features should not be identified as Jurisdictional, 404,
Waters of the United States, or anything that implies jurisdiction. These features can be
identified as Potential Waters of the United States, Potential Non -wetland Waters of
the United States, wetland, stream, open water, etc. Please include the acreage and
linear length of these features as appropriate.
F] Completed Wetland Determination Data Forms for appropriate region
(at least one wetland and one upland form needs to be completed for each wetland type)
6 Please refer to the guidance document titled "Survey Standards for Jurisdictional Determinations" to ensure that the
supplied map meets the necessary mapping standards. hM2://www.saw.usace.4rmy.mil/Missions/Regulatoly-Permit-
Pro gram/Jurisdiction/
Version: May 2017 Page 5

Jurisdictional Determination Request
F4Completed appropriate Jurisdictional Determination form
• PJDs, please complete a Preliminary Jurisdictional Determination Form' and include the
Aquatic Resource Table
• AJDS• please complete an Approved Jurisdictional Determination Form'.
Vicinity Map
Aerial Photograph
F4 USGS Topographic Map
0 Soil Survey Map
Other Maps, as appropriate (e.g. National Wetland Inventory Map, Proposed Site
Plan, previous delineation maps, LIDAR maps, FEMA floodplain maps)
Landscape Photos (if taken)
NCSAM and/or NCWAM Assessment Forms and Rating Sheets
❑ NC Division of Water Resources Stream Identification Forms
hJ Other Assessment Forms
' www.saw.usace.4rmy.mil/Portals/59/docs/regulatory/readocs/JD/RGL 08-02_App A Prelim _JD_Form fillable.pdf
8 Please see hM2://www.saw.usace.4M.mil/Missions/Regulatory-Permit-Program/Jurisdiction/
Principal Purpose: The information that you provide will be used in evaluating your request to determine
whether there are any aquatic resources within the project area subject to federaljurisdiction under the regulatory
authorities referenced above.
Routine Uses: This information may be shared with the Department of Justice and other federal, state, and local
government agencies, and the public, and may be made available as part of a public notice as required by federal
law. Your name and property location where federal jurisdiction is to be determined will be included in the
approved jurisdictional determination (AJD), which will be made available to the public on the District's website
and on the Headquarters USAGE website.
Disclosure: Submission of requested information is voluntary; however, if information is not provided, the
request for an AJD cannot be evaluated nor can an AJD be issued.
Version: May 2017 Page 6

Appendix 2 - PRELIMINARY JURISDICTIONAL DETERMINATION (PJD) FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PJD: 1 2-9-20
B. NAME AND ADDRESS OF PERSON REQUESTING PJD: Richard K. Mogensen
C. DISTRICT OFFICE, FILE NAME, AND NUMBER: Charlotte Field Office
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION:
(USE THE TABLE BELOW TO DOCUMENT MULTIPLE AQUATIC RESOURCES AND/OR
AQUATIC RESOURCES AT DIFFERENT SITES)
State: NC county/parish/borough: Mecklenburg city: Huntersville
Center coordinates of site (lat/long in degree decimal format):
Lat.: 35.410691 Long.:-80.867162
Universal Transverse Mercator:
Name of nearest waterbody: MCDoWell Creek
E. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
❑ Office (Desk) Determination. Date:
❑ Field Determination. Date(s):
TABLE OF AQUATIC RESOURCES IN REVIEW AREA WHICH "MAY BE" SUBJECT TO REGULATORY
JURISDICTION.
Site
number
Latitude
(decimal
degrees)
Longitude
(decimal
degrees)
Estimated amount
of aquatic resource
in review area
(acreage and linear
feet, if applicable)
Type of aquatic
resource (i.e., wetland
vs. non -wetland
waters)
Geographic authority
to which the aquatic
resource "may be"
subject (i.e., Section
404 or Section 10/404)
1
35.410691
-80.867162
2.06 ac
wetland
Section 404
2
35.410691
-80.867162
595 If
perennial stream
Section 404
3
35.410691
-80.867162
304
intermittent stream
Section 404

1) The Corps of Engineers believes that there may be jurisdictional aquatic resources in
the review area, and the requestor of this PJD is hereby advised of his or her option
to request and obtain an approved JD (AJD) for that review area based on an
informed decision after having discussed the various types of JDs and their
characteristics and circumstances when they may be appropriate.
2) In any circumstance where a permit applicant obtains an individual permit, or a
Nationwide General Permit (NWP) or other general permit verification requiring "pre -
construction notification" (PCN), or requests verification for a non -reporting NWP or
other general permit, and the permit applicant has not requested an AJD for the
activity, the permit applicant is hereby made aware that: (1) the permit applicant has
elected to seek a permit authorization based on a PJD, which does not make an
official determination of jurisdictional aquatic resources; (2) the applicant has the
option to request an AJD before accepting the terms and conditions of the permit
authorization, and that basing a permit authorization on an AJD could possibly result
in less compensatory mitigation being required or different special conditions; (3) the
applicant has the right to request an individual permit rather than accepting the terms
and conditions of the NWP or other general permit authorization; (4) the applicant can
accept a permit authorization and thereby agree to comply with all the terms and
conditions of that permit, including whatever mitigation requirements the Corps has
determined to be necessary; (5) undertaking any activity in reliance upon the subject
permit authorization without requesting an AJD constitutes the applicant's acceptance
of the use of the PJD; (6) accepting a permit authorization (e.g., signing a proffered
individual permit) or undertaking any activity in reliance on any form of Corps permit
authorization based on a PJD constitutes agreement that all aquatic resources in the
review area affected in any way by that activity will be treated as jurisdictional, and
waives any challenge to such jurisdiction in any administrative or judicial compliance
or enforcement action, or in any administrative appeal or in any Federal court; and (7)
whether the applicant elects to use either an AJD or a PJD, the JD will be processed
as soon as practicable. Further, an AJD, a proffered individual permit (and all terms
and conditions contained therein), or individual permit denial can be administratively
appealed pursuant to 33 C.F.R. Part 331. If, during an administrative appeal, it
becomes appropriate to make an official determination whether geographic
jurisdiction exists over aquatic resources in the review area, or to provide an official
delineation of jurisdictional aquatic resources in the review area, the Corps will
provide an AJD to accomplish that result, as soon as is practicable. This PJD finds
that there "may be" waters of the U.S. and/or that there "may be" navigable waters of
the U.S. on the subject review area, and identifies all aquatic features in the review
area that could be affected by the proposed activity, based on the following
information:

SUPPORTING DATA. Data reviewed for PJD (check all that apply)
Checked items should be included in subject file. Appropriately reference sources
below where indicated for all checked items:
■❑ Maps, plans, plots or plat submitted by or on behalf of the PJD requestor:
Map:Site Plan, Vicinity Map, USGS Quad map, Soil Survey, NWI, Aerial photo map
❑ Data sheets prepared/submitted by or on behalf of the PJD requestor.
❑ Office concurs with data sheets/delineation report.
❑ Office does not concur with data sheets/delineation report. Rationale:
❑ Data sheets prepared by the Corps:
❑ Corps navigable waters' study:
❑ U.S. Geological Survey Hydrologic Atlas:
❑ USGS NHD data.
❑ USGS 8 and 12 digit HUC maps.
■❑ U.S. Geological Survey map(s). Cite scale & quad name:
■❑ Natural Resources Conservation Service Soil Survey. Citation:
■❑ National wetlands inventory map(s). Cite name:
❑ State/local wetland inventory map(s):
❑ FEMA/FIRM maps:
❑ 100-year Floodplain Elevation is: .(National Geodetic Vertical Datum of 1929)
■❑ Photographs: ■❑ Aerial (Name & Date):
or ❑ Other (Name & Date):
❑ Previous determination(s). File no. and date of response letter:
❑ Other information (please specify):
IMPORTANT NOTE: The information recorded on this form has not necessarily
been verified by the Corps and should not be relied upon for later jurisdictional
determinations.
Signature and date of
Regulatory staff member
completing PJD
Signature and date of
person requesting PJD
(REQUIRED, unless obtaining
the signature is impracticable)'
' Districts may establish timeframes for requestor to return signed PJD forms. If the requestor does not respond
within the established time frame, the district may presume concurrence and no additional follow up is
necessary prior to finalizing an action.

Preliminary ORM Data Entry Fields for New Actions
ACTION ID 9: SAW- Begin Date (Date Received):
Prepare file folder ❑ Assign Action ID Number in ORM ❑
1. Project Name [PCN Form A2a]: Ranson Rosedale Park
2. Work Type: ❑Private ❑Institutional ❑✓ Government ❑ Commercial
3. Project Description / Purpose [PCN Form 133d and B3e]:
Small public park for people and their pets. This project is a sanitary sewer for new bathroom facilities at the park.
4. Property Owner / Applicant [PCN Form A3 or A4]: Town of Huntersville
5. Agent / Consultant [PNC Form A5 — or ORM Consultant ID Number]:
Riachrd K. Mogensen, SynTerra Corp.
6. Related Action ID Number(s) [PCN Form B5b]:
7. Project Location —Coordinates, Street Address, and/or Location Description [PCN Form Blb]:
9519 Rosewood Meadow Lane, Huntersville, NC 28078
8. Project Location —Tax Parcel ID [PCN Form Bla]: 01715220
9. Project Location —County [PCN Form A2b]: Mecklenburg
10. Project Location —Nearest Municipality or Town [PCN Form A2c]: Huntersville
11. Project Information —Nearest Waterbody [PCN Form 132a]: McDowell Creek
12. Watershed / 8-Digit Hydrologic Unit Code [PCN Form 132c]: 03050101
Authorization: Section 10 ❑ Section 404 ✓❑
Regulatory Action Type:
Standard Permit
✓ Nationwide Permit 9
Regional General Permit 9
Jurisdictional Determination Request
Section 10 and 404 ❑
Pre -Application Request
Unauthorized Activity
Compliance
No Permit Required
Revised 20150602

ID#* 20201607 Version* 1
Regional Office * Mooresville Regional Office - [phone]
Reviewer List* Alan Johnson
Pre -Filing Meeting Request submitted 10/26/2020
...............................................................................................................................................................................................................
Contact Name* Richard Mogensen
Contact Email Address* [e-mail]
Project Name* Ranson Rosedale park
Project Owner* The Dodd Studio on behalf of the Town of Huntersville
Project County* Mecklenburg
Owner Address: Street Address
Rosewood Meadow Lane
Address Line 2
aty
State / Rovince / Pegion
Huntersville
NC
Fbstal / Zip axle
Country
28078
USA
Is this a transportation project?* r Yes r No
Type(s) of approval sought from the DWR:
* 401 Water Quality Certification - F 401 Water Quality Certification -
Regular Express
* Individual Permit F Modification
F Shoreline Stabilization
Does this project have an existing project ID#?*
C Yes (-- No
Do you know the name of the staff member you would like to request a meeting with?
Please give a brief project description below.*
Sewer line installation to support an outdoor dog park. all impacts wil be
temporary.
Please give a couple of dates you are available for a meeting.

11 /8/2020
Please attach the documentation you would like to have the meeting about.
C500.pdf
pdf only
711.49KB
By digitally signing below, I certify that I have read and understood that per the Federal Clean Water Act Section
401 Certification Rule the following statements:
This form completes the requirement of the Pre -Filing Meeting Request in the Clean Water Act Section 401 Certification
Rule.
1 understand by signing this form that I cannot submit my application until 30 calendar days after this pre -filing
meeting request.
1 also understand that DWR is not required to respond or grant the meeting request.
Your project's thirty -day clock started upon receipt of this application. You will receive notification regarding meeting location
and time if a meeting is necessary. You will receive notification when the thirty -day clock has expired, and you can submit an
application.
Signature
Submittal Date 10/26/2020