20110800 Ver 1_401 Application_20110811

20110 8 0 0
of WAr?4¢ Office Use Only:
Corps action ID no.
o c 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
1b. Specify Nationwide Permit (NWP) number: 29 or General Permit (GP) number:
1 c. 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
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 mitigation bank or in-lieu
fee program. ? Yes ® No
1g. Is the project located in any of NC's twenty coastal counties. if yes, answer 1 h
below. ? Yes ® No
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ? Yes ® No
2. Project Information
2a. Name of project: Ruth Morgans single family residential driveway
2b. County: Chatham
2c. Nearest municipality /town: Pittsboro D s
2d. Subdivision name: NA
2e. NCDOT only, T. I. P. or state
project no: NA f`a i) (a a D
3. Owner Information

VE71
uENR • WATER QUALITY
ANDS AND qTORMWER BRANCH
3a. Name(s) on Recorded Deed: Leif Diamant
3b. Deed Book and Page No. parcel ID 60085
3c. Responsible Party (for LLC if
applicable):
3d. Street address: 183 Box Turtle Rd.
3e. City, state, zip: Pittsboro, NC 27312
3f. Telephone no.: 919-542-4134
3g. Fax no.:
3h. Email address:
Page 1 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: Ruth Morgans
4c. Business name
(if applicable):
4d. Street address: 1771 Henderson Tanyard Rd mailing address is POB 67 Pittsboro NC 27312
4e. City, state, zip: Pittsboro NC 27312
4f. Telephone no.: 919 337 3947
4g. Fax no.: 919-928-5496
4h. Email address: [e-mail]
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 2of10
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): 10673
1 b. Site coordinates (in decimal degrees): Latitude: Longitude: -
(DD.DDDDDD) (-DD.DDDDDD)
1 c. Property size: 5 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to Terrells Creek
proposed project:
2b. Water Quality Classification of nearest receiving water:
2c. River basin: Cape Fear
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 and agricultural
3b. List the total estimated acreage of all existing wetlands on the property:
1/2 acre
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:
Single-family residential driveway crossing.
3e. Describe the overall project in detail, including the type of equipment to be used:
See attached plans.
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: AWT Engineers and Soil
Name (if known): Jeff Vaugn Scientists
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" instructions.
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
1 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.
Wetland impact Type of jurisdiction
number - Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWQ - non-404, other) (acres)
Temporary T
W1 ? P ? T ? Yes ? Corps
? No ? DWQ
W2 ? P ? T ? Yes ? Corps
? No ? DWQ
W3 ? P ? T ? Yes ? Corps
? No ? DWQ
W4 ? P ? T ? Yes ? Corps
? No ? DWQ
W5 ? P ? T ? Yes ? Corps
? No ? DWQ
W6 ? P ? T ? Yes ? Corps
? 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 Impact
number - (PER) or (Corps - 404, 10 stream length
Permanent (P) or intermittent DWQ - non-404, width (linear
Temporary (T) (INT)? other) (feet) feet)
S1 ®P ? T P UT to Terrells ® PER ® Corps 10 47
Creek ? INT ? DWQ
S2 ? P ? T ? PER ? Corps
? INT ? DWQ
S3 ? P ? T ? PER ? Corps
? INT ? DWQ
S4 ? P ? T ? PER ? Corps
? INT ? DWQ
S5 ? P ? T ? PER ? Corps
? INT ? DWQ
S6 ? P ? T ? PER ? Corps
? INT ? DWQ
3h. Total stream and tributary impacts 47 ft
3i. 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 water impacts below.
4a.
Open water
impact number -
Permanent (P)
or Temporary
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
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If and or lake construction proposed, then complete the chart below.
5a.

Pond ID 5b.

Proposed use or purpose 5c.
Wetland Impacts (acres) 5d.
Stream Impacts (feet) 5e.
Upland
(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:
Page 5 of 10
PCN Form - Version 1.3 December 10, 2008 Version
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: Jordan
Project is in which protected basin? ? Catawba ? Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number - Reason Buffer Zone 1 impact Zone 2 impact
Permanent (P) for Stream name mitigation (square feet) (square feet)
or Temporary impact required?
T
B1 ®P ? T Driveway UT to Terrells creek ® Nos 960 640
B2 ? P ? T ? Yes
? No
B3 ? P ? T ? Yes
? No
6h. Total buffer impacts 960 640
6i. Comments:
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Minimum amount of impact for single-family residential driveway crossing.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Minimum amount of impact for single-family residential driveway crossing.
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
El 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 Quantity
Page 6of10
PCN Form - Version 1.3 December 10, 2008 Version
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:
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 by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation? ? Yes ® No
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
(square feet)
Multiplier 6e.
Required mitigation
(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 7of10
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.
Comments: No ditches or piping will be installed. Runoff will sheet flow through the ? Yes ® No
fo rest.
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project? <24 %
2b. Does this project require a Stormwater Management Plan? ? Yes ® No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: Minimal single family residential property.
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
? 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

4a.
Which of the following state-implemented stormwater management programs apply ? HQW
? ORW
(check all that apply):
? 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 8 of 10
PCN Form -Version 1.3 December 10, 2008 Version
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1a. 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
l
? Yes
? No
etter.)
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards, ? Yes ® No
or Riparian Buffer Rules (15A NCAC 2B.0200)?
2b. Is this an after-the-fact permit application? ? Yes ® No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in ? Yes ® No
additional development, which could impact nearby downstream water quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
Single family residential sub-surface septic system.
Page 9of10
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 ® No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act ? Yes ® No
impacts?
E] Raleigh
5c. If yes, indicate the USFWS Field Office you have contacted. ? 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:
8c. What source(s) did you use to make the floodplain determination?

RUTH MORGANS C? 8/16/11
Applicant/Agent's Printed Name Applicant/Agent's Sign ure Date
(Agents signature is valid only if an authorization letter from the applicant
is provided.)
Page 10 of 10
PCN Form -Version 1.3 December 10, 2008 Version
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C Is ~R~DIN~~DRIU€~f~rs!rAttC~NnNUfuNTrtct~Mt OR 21 CALENDAR DAYS (WHICHEVER IS SHORTER), FOLtOWI,~G COMPLETION O~ ANY PHASE (1F ONTTNUEUNTTLCDMPLFT_FD. ~
GRADING. THE CONTRACTOR Sl~lll INSTALL PERMANENT GROUND COVER FOR Alt DISTURBED AREAS 16. 9ASECDJIRS€cDV€RINT~EAREAASD€frN€DarDE$r~ AASDEfINEDBYDfSIGNPLANSHAtt 8f b"ABC.
WITHIN 15 WORKING DAYS OR 90 CALENDAR DAYS (WHICHEVER tS SHORTER) FOLLOWING COMf'LETTON 11. BASECDURSECY?UfRf)UfS/DETHfA~At'DVERfttBYi dfA~hCOVERED8Y7NEDfSfGNPtANSHAiL~4°, '~~r~tr++i ~f tr~r~~r
aF eDNSTRUGnDI~
9 UPON COMPLETION OF THE PROJECT STABILIZE ALL DISTURBED AREAS AND REQUEST INSPECTION ti ID ,4d~ {
FROM ENGINEER OF RECORD. CLEAN AND CONVERT SEDIMENT BASINS TO PERMANENT STORMWATER ~-~~s MANAGEMENT DEVICES UPON ENG6NEER'S APPROVAL 1. P1~dANDPRDfJifOFDRfffIFWAYDUTS}DESiREAM$fi YOUTS}DESiREAMBUffERAREAARENDTBINDiNG. TNfCONTRACTORSHALLBUILDDRIVABEEDRIVE6V~YINTHEAREAOUTSPDESFREAMaBUfffRTOOINNER = a ~ ~ p7.g6. ~.3
l0. CONTRACTOR IS RESPONSIBLE FOR All INSTALLATION, MAINTENANCE AND REMOVAL OF 1HE SATfSfACFlDN
EROSION CONTROL SYSTEMS 2. CDNTRACTDRSNAifAVO/DUs~REMDVABtfRDCKD~ 16941 n ~o- crcm: tEMDVABtERDCKDUTCROPANDDRSKIRTTHESURfACEINAREASOfSUSPEi7fDR(XCKBED {
ll. EROSION CONTROL MEASURES SHOULD STAY IN .PLACE UNr~L ENTIRE SUBJECT DRAINAGE AREA IS 3. ~tEC~NTRACTDRSh'Att Ex~~AT~trttCATTREaEGIJ~ 9TEfJfiLATTfIfBfGINNIN'BOFDRP~'Ede'AYTOQ?fATEDRIVABtECONDTftONSANDSE~IRfENOU1~DtRFf4Rftlt#NGGfDIb'YE~UAYdNN~DfBUffftt ~ ' ; r ~~~m~°~' SW8 SW8
PFRMANFtdTt Y .STA8RI7ED TD A DF(;RFF ADE(IUATE TlI PREVFNl DEESITE SEDIMENT AND. EROSION A /'ICaDIR!/'lAITUf[TOCAAADfIC[CDADCACCfA7! OCIfAAf •nanreeunrrnrrrearrenrnruenaxrrrrer~nairnmrrrrnernrrtaurreievierrer_rerrn~rrnn~ur_ unnrure~xeavt '`i_~d.~~ .t~.t° ~
. ff, ucrtnrtvv yr rrs,rrnrrorr uvrrurrman.n rnu. ur. urra. aantatn.nrnttuturraeturvva rrrrnartrna.e,rtaarrtutrevervrvtuxsxxnr ~.avuvwttrfosstt+utxvxxruatrtvtritunf ~I~~~IZj w T S{W17
EROSION & SEDIMENT CONTROL MEASURES MAINTENANCE DURING CON57RUC7lON SHEET. 'fv
12. INSPECT ALL EROSION & SEDIMENT CONTROL DEVICES ON A WEEKLY BASIS AND FOLLOWING OF
RAINFALL AS A MINIMUM, REMOVE SILT FROM BEHIND SILT FENCE, CLEAN TEMPORARY DRAINAGE DITCHES AND OTHER SEDIMENT & EROSION CONTROL DEVICES WHEN THEY ARE HALF FULL REMOVED CAD -FILE.*
SEDIMENT SHALL BE DEPOSITED ON-SfTE AND PROTECTED BY SILT FENCING. RUTH
PROJECT NO:
2011.701