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HomeMy WebLinkAbout20110422 Ver 1_401 Application_20110511201 1042 2 OF W Tp 0 Office Use Only: 3 Corps action ID no. DWQ project no. Form Version 1.3 Dec 10 2008 Pre-Construction Notification PCN Form A. Applicant Information 1. Processing la. Type(s) of approval sought from the Corps: Section 404 Permit Section 10 Permit 1 b. Specify Nationwide Permit (NWP) number: 29 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 1 e. Is this notification solely for the record For the record only for DWQ 401 For the record only for Corps Permit: because written approval is not required? Certification: Yes No Yes No 1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation Yes No of impacts. If so, attach the acceptance letter from mitigation bank or in-lieu fee program. . 1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h Yes below. 1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ; Yes No 2. Project Information -r 2a. Name of project: 2b. County: ?? e Ar?d-e r 2c. Nearest municipality / town_ 2d. Subdivision name: 2e. NCDOT only, T I.P. or state project no: 3. Owner Information ffrr 3a. Name(s) on Recorded Deed: ?1r?a'hOn? Q.. lA?hnun ?- S-C12[r' a-(1 ?p?r1 3b. Deed Book and Page No. ? _ni Z , No L 14. 1?c7.Wc.-$3__? _ 5137 R IX* 1.040 . 3c. Responsible Party (for LLC if applicable): N 3d. Street address: I'? g GO, ' 6vn uf ; Vf- 3e. City, state, zip: 3f. Telephone no -- - ---- -- - 3g. Fax no.: ?-- 3h. Email address: 6SSr0.CKco, i, V\UU. Coe?l MAY I 1011 4. Applicant Information (if different from owner) DENIM 4a. Applicant is: Agent Other, specify: nYA7EH QU'AL 4b. Name: O - --- &andy 4c. Business name (if applicable): 4d. Street address: - Page 1 of 9 PCN Form - Version 1.3 December 10, 2008 Version 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 1 of 9 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 arcel I--- 1 b. Site coordinates (in decimal degrees): 1c. Property size: -- -----------_------------- 2. Surface Waters 2a. Name of nearest body of water (stream, river, etc.) to proposed project: 2b. Water Quality Classification of nearest receiving water: 2c. River basin: -00 ILA (,SI Odo3lo`I7 Latitude: Longitude: - _ ___-__ (DD•DDDDDD)___- - (-DD.DDDDDD) x.14 acres 15 . - -- 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: - - -UV-LK-OaOLW0 , ? }? -- - 3b. List the total estimated acreage of all existing wetlands o the property: NSA -- -_ _-- ---- ------- -_ _------ - - - 3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 300 3d. Explain the purpose of the proposed project: -- -1-0 51 fir, -? CA- --roa_ ke-_ywt-- wLiArA - - - 3e. Describe the overall project in detail, including the type of equipment to be used: ---------- 4. Jurisdictional Determinations 4a. Have jurisdictional wetland or stream determinations by the Corps or State been requested or obtained for this property / project (including all prior phases) in the past? Yes No Unknown 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 this project (including all__priorphases) in the past? Yes No 5b. If yes, explain in detail according to "help file" instructions. 6. Future Project Plans_ 6a. Is this a phased project? 6b. If yes, explain. Unknown Yes No Page 2 of 9 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 (check all that apply): Wetlands treams - tributaries Buffers 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 j 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) Temporary (T) - - - ---+ - . -- - --------r - - --- -- - W1 P T Yes Corps } No DWQ W2 P T --- -- --- -- --- Yes ----- Corps ---------- W3 P T W4 P T W5 P T W6 P T No -- --- - -, -...Yes - - 4No Yes ----- + NO - --- Yes No Yes No DWQ. Corps Corps DWQ --- - - Corps - DWQ Corps 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 i Type of jurisdiction Average Impact number -Permanent (P) or (PER) or intermittent (Corps - 404, 10 stream DWQ - non-404 ! width length I I (linear Temporary (T) ---------- -- ! (INT _)_ -; other feet feet ) S1 (?T CEO> INT I Corps DWQ 499-L jq - 10S S2 P T PER - Corps - -- S3 P T S4 P T S5 P T INT PER INT PER INT PER INT DWQ j Corps DWQ Corps DWQ Corps - --- -- ----- ---- --- DWQ S6 P T PER Corps - _ ; INT DWQ 3h. Total stream and tributary impacts i 3i. Comments: -- -- - ------- _ Q S 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. Page 3 of 9 PCN Form -Version 1.3 December 10, 2008 Version 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 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. 15e. Pond Wetland Impacts (acres) Stream Impacts (feet) Upland use number D Propose of pond purpose ---- - --- - - - (acres) ------------ Flooded Filled j Excavated Flooded i Filled Excavated Flooded i 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 any impacts require mitigation, then you MUST fill out Section D of this form. 6a. Neuse Tar-Pamlico Other: Project is in which protected basin? 16Catawba 6f Randleman 6g. ? -I 6b. 6c. 6d. Buffer impact number - Reason j 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 Yes I _ No I - - --- ----- - - - 1- - -?- - --- ----- B2 P T Yes B3 P T Yes - - ---- ? -------6h. Total buffer impacts i. Comments: D. Impact Justification and Mitigation 1. Avoidance and Minimization a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project. - ----- Q?4-n_.L?rc,SS_- Page 4 of 9 PCN Form - Version 1.3 December 10, 2008 Version I b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques. 2. Compensatory Mitigation_for Impacts to Waters of the U.S. or Waters of the State 2a. Does the project require Compensatory Mitigation for Yes No impacts to Waters of the U.S. or Waters of the State? 2b. If yes, mitigation is required by (check all that apply) DWQ Corps Mitigation bank 2c. If yes, which mitigation option will be used for this Payment to in-lieu fee program project? Permittee Responsible Mitigation 3. Complete if Using a Mitigation Bank 3a. Name of Mitigation Bank: 3b. Credits Purchased (attach receipt and letter) Type ?Quant 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 --- --- ---- ----------- -- - -r ---- -- 4e. Riparian wetland mitigation requested acres 4f. Non-riparian wetland mitigation requested: acres 4g. Coastal (tidal) wetland mitigation requested: acres 4h. Comments: 5. Complete if Using a Permittee Responsible Mitigation Plan 5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan. 6. Buffer Mitigation (State Regulated Riparian Buffer Rules) - required y 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 re uired. _ c. 6d. 6e Zone Reason for impact Total impact Multiplier Required mitigation (square feet) (square feet) Zone 1 Zone 2 3 (2 for Catawba) 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 5 of 9 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 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 3b. Which of the following locally-implemented stormwater management programs NSW apply (check all that apply): USMP 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 4a. Which of the following state-implemented stormwater management programs apply O W (check all that apply): R Session Law 2006-246 - - - - ---- -- - Other: 4b. Has the approved Stormwater Management Plan with proof of approval been attached? Yes No 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 re uirements been met? Yes No F. Supplementary Information 1. Environmental Documentation DWQ Reguirementj--_ 1 a. Does the project involve an expenditure of public (federal/state/local) funds or the p use of ublic_ federal/stat - e land? Yes No 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)? Page 6 of 9 PCN Form - Version 1.3 December 10, 2008 Version 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 letter.) Yes No 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 ©o or Riparian Buffer Rules (15A NCAC 2B.0200)? 2b. Is this an after-the-fact permit application?_ es No 2c. If you answered "yes" to one or both of the above questions, provide-an explanation_of the violation(s): n A-YIAO 0 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 7 of 9 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 Yes habitat? ---------------------------------- 5b. Have you checked with the USFWS concerning Endangered Species Act Yes impacts? 5c. If yes, indicate the USFWS Field Office you have contacted. Raleigh No No 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 Yes No status (e.g., National Historic Trust designation or properties significant in North Carolina history and archaeology)?__ _ 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: c. What source(s) did you use to make the floodplain determination? A,4-bony D. 6,4 5_ 3_ p I i Applicant/Agent's Printed Name A licant/Agent's Signature Date II (Agent's signature is valid only if an authorization letter from the applicant - --- - --- - i - - -- - -_--is provided.),--- Page8 of 9 PCN Form -Version 1.3 December 10, 2008 Version 0zz z0-? _rrl w°-? 22 o? z C) r- >>K>: xxaxanx <rA: > ...cnz ?mp -o ? ?(-,? z?z? ozzz°o0 >2z -30 _mv a=tea a-?m-:3cn!)m v p a.?z0T-0o 30-Oar cm?o=c?om?' cn -c :v m v cam?mm7om <mz?vNm crn <pp?p 0?3mrCn Ocano000r znz Oov.?' mLn0av'yma AcnzzCavr ? -3 '-? v r -l cn or,av z?z=o=r-0 --mcn ma -d 'o m w0a? zz-? °a -c 0-3zm00 v' n -n m 0 >a00a.z.3m ?_z ocz ZCA-n > C4 > C C4 z cn ?m ° m z ul O D V) 1 D (D X Q) a (D I O c z C) -0 g; m 3 cn U n d (D _r H o 0 D v , O n m Ln a G) m Z 0 ai N tJ N O (V) W V Q U C) U z .? 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