20110443 Ver 1_401 Application_20110511

3 '
201 10443
OF WA7-o9
o? o? Office Use Only:
t o DU1Q Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification PCN Form
A. Applicant Information
1. Processing
1 a. Type(s) of approval sought from the
Corps: ®Section 404 Permit ? Section 10 Permit 0URT ESY
1b. Specify Nationwide Permit (NWP) number: 18 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 VVater 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
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu ?Yes ®No
fee program.
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1h ® Yes
below. ? No
1h . Is the project located within a NC DCM Area of Environmental Concern (AEC)? ? Yes
® No
2. Project Information
2a. Name of project: Dean Osborn driveway
2b. County: Onslow
2c. Nearest municipality / town: Richlands
2d. Subdivision name: Angel Haven Lane
2e. NCDOT only, T.I.P. or state da
project no:
3. Owner Information
3a. Name(s) on Recorded Deed: Jay and Rosemary Voter
3b. Deed Book and Page No. 2469, 508
3c. Responsible Party (for LLC if
applicable):
3d. Street address: 168 Angel Haven Lane
3e. City, state, zip: Richlands
3f. Telephone no.:
3g. Fax no..
3h. Email address:
Page I of 10
PCN Form - Version 1.3 December 10, 2008 Version
4. Applicant Information (if different from owner)
4a. Applicant is: ? Agent ® Other, specify: Resident
4b. Name: Dean Osborn
4c. Business name
(if applicable):
4d. Street address:

168 Angel Haven Lane
4e. City, state, zip: Richlands, NC 28574
4f. Telephone no.: 910-545-0127
4g. Fax no.:
4h. Email address:
5. Agent/Consultant information (if applicable)
Name:
5a
.
5b. Business name
(if applicable):
Street address:
state, zip:
City
5d
r
,
Telephone e no.:
.
Fax no.:
5f
.
5g. Email address:
Page 2 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)?
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)
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): Road crossing has
already been installed; further violations include mechanized clearing in jursidcitional wetlands; this violation will be restored
according to USACE instructions sent in a Notification of Unauthorized Activities letter dated 3/10/2011.
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
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?
? 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. ? Raleigh
? Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
Natural Heritage Program Element Occurances GIS shapefile
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?
SHPO website
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 you use to make the floodplain determination?
V--A, DEAN 0 -? 30 44 ' 5Na I
Applicant/Agent's Printed Name Applicant/Agent's Signature
(Agent's signature is valid only if an authorization letter from the applicant
is rovided. Date
Page 10 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):
1 b. Site coordinates (in decimal degrees):
196-12
Latitude: 34.907473
(DD DDDDDD
Longitude: - 77.62628
1c. Property size: ) (-DD.DDDDDD)
1.03 acres
2. Surface Waters
-----------------
2a. Name of nearest body of water (stream, river, etc.) to
proposed project: UT to New River
2b. Water Quality Classification of nearest receiving water: C; NSW
2c. River basin:
White Oak, 03030001
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:
Residential lot, some cleared, some forested
3b. List the total estimated acreage of all existing wetlands on the property:
-0.25
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
0
3d. Explain the purpose of the proposed project:
Driveway crossing to access uplands
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?
Comments: Middle portion of property was assessed for ®Yes ? No ? Unknown
wetland occurance
4b. If the Corps made the jurisdictional determination, what type
of determination was made? ? Preliminary ®Final
4c. If yes, who delineated the jurisdictional areas?
Agency/Consultant Company: USACE
Name (if known): David E. Bailey
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
SAW-2011-00482
5. Project History
5a. Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past? ?Yes ® No
? Unknown
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.
? Yes ® No
Page 3 of 10
PCN Form - Version 1.3 December 10, 2008 Version
C. Proposed Impacts Inventory
1. Impacts Summary
I a. Which sections were completed below for your project (check all that apply):
® Wetlands ? Streams - 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.
Type of jurisdiction
Wetland impact
number - Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact
other) (acres)
DWQ - non-404
Permanent (P) or (if known) ,
Temporary T

® Yes

Corps
®

0
05
W1 ®P ? T Fill Headwater Forest ? No ? DWQ .
El Yes ?Corps
W2 ? P ? T ? No ? DWQ
? Yes ? Corps
W3 ?P?T ?No ?DWQ
? Yes ? Corps
W4 ?P?T ?No ?DWQ
? Yes ?Corps
W5 ?P?T ?No ?DWQ
? Yes ?Corps
W6 ? P ? T ? No ? DWQ
0.05
2g. Total wetland impacts
2h. Comments:
3. Stream Impacts
l or intermittent stream impacts (including temporary impacts) proposed on the site, then com
i
plete this
a
If there are perenn
question for all stream sites impacted.
f
3g
3a. 3b. 3c.
Stream impact Type of impact Stream name 3d.
Perennial .
3e. 3
Type of jurisdiction Average
stream .
Impact
length
number - (PER) or
intermittent (Corps - 404, 10
width
DWQ - non-404 (linear
Permanent (P) or (I NT)? ,
other) (feet) feet)
Temporary (T)
El PER ?Corps
S1 ?P?T ?INT ?DWQ
? PER ? Corps
S2 ? P ? T ?INT ?DWQ
? PER ?Corps
S3 ? P ? T ? INT ? DWQ
? PER ?Corps
S4 ? P ? T ? INT ? DWQ
? PER ? Corps
S5 ? P ? T [:1 INT ? DWQ
? PER F-1 Corps
S6 [] P ? T ? INT ? DWQ
3h. Total stream and tributary impacts
31. Lommenis:
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 water impacts below.
La.
water
umber -
ent (P) or
rar T 4b.
Name of waterbody
(if applicable) 4c.

Type of impact 4d.

Waterbody type 4e.

Area of impact (acres)

01 ?P?T

02 ?P?T
03 ?P?T
04 ?P?T
df. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If and or lake construction proposed, the
n complete the chart below.
5a 5b
.

Pond ID
number .

Proposed use or purpose
of
ond 5c.
Wetland Impacts (acres) 5d.
Stream Impacts (feet) 5e.
Upland
(acres)
p 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 impacts require mitigation, then you MUST fill out Section D of this form.
6a.
? Neuse ? Tar-Pamlico ? Other:
Project is in which protected basin? ? Catawba ? Randleman
6b. 6c. 6d.
Buffer impact 6e. 6f. 6g.
number - Reason Buffer Zone 1 impact Zone 2 impact
Permanent (P) or for Stream name mitigation (square feet) (square feet)
Temporary T im act re uired?
B1 ?P?T ?Yes
? No
B2 ?P?T ?Yes
? No
B3 ?P?T ?Yes
? No
6h. Total buffer impacts
6i. Comments:
Page 5 of 10
PCN Form -Version 1.3 December 10, 2008 Version
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Only the very upper extent of wetland was impacted. Wetland extended across property, so total avoidance was not possible
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Drainaqe pipes were placed under crossing to allow water passage to wetland area downstream
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)
2c. If yes, which mitigation option will be used for this
project?
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter)
3c. Comments:
4. Complete if Making a Payment to In-lieu Fee Program
? DWQ ? Corps
? Mitigation bank
? Payment to in-lieu fee program
? Permittee Responsible Mitigation
Type
Quantity
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
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:
5. Complete if Using a Permittee Responsible Mitigation Plan
?cold
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 6of10
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.
6c. 6d. 6e.
Zone Reason for impact Total impact Multiplier 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

1 a. Does the project include or is it adjacent to protected riparian buffers identified
within one of the NC Riparian Buffer Protection Rules? ? Yes ® No
1b. 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. 1 /
Certified Local Government Stormwater Review ?V

3a. In which local government's jurisdiction is this project?
? Phase II
3b. Which of the following locally-implemented stormwater management programs ? NSW
F-1 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 A/ /A
? Coastal counties

4a.
Which of the following state-implemented stormwater management programs apply
(check all that apply): ? HQW
? ORW
? 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 requirements been met? ? Yes ? No
Page 8of10
PCN Form - Version 1.3 December 10, 2008 Version
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