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Home My WebLink About20111051 Ver 1_401 Application_20111211 � �� • � • TIMMONS GROUP 2 � � 1 1 0 5 1 YOUR VISION ACHIEVED THROUGH OURS TRANSMITTAL TO NCDENR Division of Water Qualitv Date 11/30/11 Job # 27037-102 Attn Amv Chapman Pro�ect CHCCS ES #11 1650 Mail Service Center Reference Raleiah, NC 27699 1650 Copies Sent To ❑ ENCLOSED PLEASE FIND ^ 0 ❑ WE ARE SENDING UNDER SEPARATE COVER � � N U M Z � COPIES DATE NUMBER DESCRIPTION � 2 11/30/11 PCN Form � � 2 11/30/11 Stream Determination � � 2 11/30/11 Site lans showin im acts N � 1 11/30/11 CD- Di ital F�les ^ LL v � � � � � � o a, � � � � c 1O THESE ITEMS ARE TRANSMITTED o0 If enclosures are not as noted please notify us at once � ��n o � Cl�� COMMENTS D "' ~ °E� � r 201� T � � O DENR WAT ° v �r(ANGSAIypSrpR�R�WNCH L � Amy � � � _ �, Please review the attached documents and let me know if you have any questions or if � 3 you need any additional information ; 3 � �. � Sincerely � � Blake Hall � �. 919-866 4933 � � � v � � SIGNED /�� E a 0 a, > ar � ar «, �n � � ENGINEERING DEPARTMENT STORMWATER MANAGEMENT � 405 Marnn Luther I�ng Jr Blvd Chapel Htll NC 27514 5705 Telephone(919) 969 7246 Fax(919) 9G9 7276 D �� www townofchapellvll org October 31 2008 D David Arnoid ��C m � 2�„ 5410 Trinity Road DENR WATERGUALITY Suite 112 �VETLANDSANDSTORMWATER9RANC�6 Raleigh NC 27607 RE Stream determination PIN 978818 1797 TMBL 7 84 J 3 Dear Mr Arnold As requested the Town Engineenng Depar�ment has performed a stream determination on the property identified below This determination provides important information regard�ng different types of streams (perenniai intermittent and/or ephemeral) and whether or not any such streams are present on or ad�acent to the property in question Based on this stream determmation and charactenstics such as elevation and location this property may�nclude a Resource Conservation Distnct(RCD}area Specific land use regulat�ons and restnctions apply w�thin the boundary of the RCD We pertormed a s�te inspection of this property Tax Map # 7 84 J 3 Parcel ID#9788 18- 1797 Orange County Mental Health (north of Caldwell Street) on October 30 2008 We determined thaf fhe property does contain a perenrnal stream (Tanyard Branch) We have not identified any other streams an ad�acent properties that may affect the location of the Resource Conservation Distnct boundary on your property Comments and findings regarding our site inspection can be found on the attached stream determination form and map NOTE THIS IS A STREAM DETERMINATION ONLY It is intended to assist the requestor in identrFy�ng whether or not the property in quest�on mcludes a Resource Conservation Distnct and rF so where it is located depending on which ordinance(s) are applicable Please provide a copy of this information to a registered Land Surveyor for use m the preparation of your parcel plan or plat which must be submitted with the permit application documents for review and approval by the Town it is the responsibdity of the Surveyor to rev�ew the stream determination information in association with information avadable in Article 3 6 3 of the Land Use Management Ordinance (LUMO) to identify the applicable RCD criteria The Surveyor must certify whether or not a Resource Conservation Distnct exists on the property m question and �f so where the RCD boundary is located The fol�owrnct lanauaqe must be provided verbat�m on the application alan or plat and must be certified bv a reqistered Land Survevor No additional or alternafive wordinq,_or caveats are acceptable 1 ?his parcel is not located �nnthin the Resource Conservation District as defined in the Chapel Hdl Development Ordinance/Land Use Management Ordinance Or 2 All or a portion of this parcel is located within the Resource Conservation Distnct as defined in the Chapel Hdl Development Ordinance/Land Use Management Ordinance and as shown hereon If you have questions regarding stream determinations please contact me at (919) 969 7202 If you have questions regarding the Town s Land Use Management Ordinance or Resource Conservation Distncts please contact the Planning Department at (919) 968- 2728 or view a copy oniine at http//www townofchapelhdl org/index asp�N/D=149 R rds atricia Arc nte tormwa r E gineering Technician cc Planning Department . Stream Determination Area Ma Perennial Stream � Culverts --- Intermittent Stream 2-foot contours Address: Orange Co Mental Health, N/S Caldwell -•-• Ephemeral Stream 10-foot contours TMBL: 7.84.J.3 ---- Stream -Unknown Flow � Buildings parcel ID: Waterbodies Parcels 9788-18-1797 0 Swamp/Marsh Q Site visited 0 50 100 200 Feet Approximate location of origin or breakpoint: i � � � i � � � � � staked � flagged onty 1 inch=200 feet and flagged Stream locations are approximate and must be verified by survey. . . . . � � _ � t � \ �� , ` . :�� , , � -� � , .� ' ' • � ��s • � • , � `� • ` � M�M � ` : �ti p� � �'� G� � �y � . . � � � � �o�� GP � CP��w�`� • a � _ • � � t -�� N . � • t .� F��s .� � • .� ' � �/ � i . � � �oM NS � � .. • � � � �y � y � C�y � �O� ♦ < � � � < �Z • �i • • �aP�� Town o ape�Engineerin rtme - ormwat ana me Div --10 0� M North Carol�na Divis�on of Water Quality—Stream Ident�fication Form Version 31 Date �V '�� 0'$ ProJect Latitude Evaluator �`�Q.�,�n(' �'�ite � �� Longitude Total Points Other Stream is atleast lntem►tttent 3 3 County e if>_19 or erennial if z 30 g Quad Name A Geomor ho(o Subtotal= , S Absent Weak Moderate Strong 18 Cont�nuous bed and bank 0 1 2 2 Sinuosity 0 1 2 3 in channel sfructure nffle-pool sequence 0 1 2 3 4 Sod texture or stream substrate sortmg 0 1 3 5 Active/relic floodplain 0 1 2 3 6 Depositional bars or benches 0 1 3 7 Braided channel 1 2 3 8 Recent alluvial deposits 0 1 2� 3 9 8 Natural levees � 2 3 10 Headcuts 1 2 3 1'1 Grade controls 0 5 1 5 92 Natural vallsy or drainageway 0 Q 5 1 5 13 Second or greater order channei on existino USGS or NRCS map or other documented o=0 Yes=3 ewdence Man-made ditches are not rated see discussions in manual / B H drolo Subtotal= �5 14 Groundwater flow/discharge 0 1 2 3 15 Water in channel and>48 hrs smce rain Qr 0 1 2 3 Water in channel—d or rowin season 16 Leaflitter 1 5 1 0 5 0 17 Sediment on plants or debris 5 1 1 5 18 Organic debns Gnes or p�les(Wrack lines) 0 0 5 1 1 5 19 Hydnc sods(redoximorphic features)present? No=0 Yes=1 5 C Biology (Subtotal=_�) 20 Fibrous roots m channel 2 1 0 21 Rooted plants fn channel 2 1 0 22 Crayfish 0 5 1 9 5 23 Bivalves -p 2 g 24 Fish 0 0 1 1 5 25 Amphibians 0 0 5 1 1 5 26 Macrobenthos(note diversity and abundance) 0 1 1 5 27 Fdamentous algae penphyton 0 2 31 28 Iron oxidizmg bacteria/fungus 0 5 1 � 5 29° Wetland plants in streambed FAC=0 5 FACW= 75 OBL=1 5 SAV=2 0 Other=0 Items 20 and 21 focus on the presence of upland plants Item 29 focuses on the presence of aqua4c or wedand plants Notes (use back side of this form for addtional notes) Sketch � .a F S��11�S � � �'�..� ��\�� £ �� *,� '��, � w�z � �� `��`�Z�` 7 z�� '� p �W � j/ � �� r`` �x O �� r 1 � .�s � \ �1\\\�\�\ '��\ � ` � � /� � / 4kjF \�� \ \�� \� �� ro f � `� f ��` Q ,� ��` ` `� ) � � .. � �, � l, � � / r_ �\��.�i �� ''` L � �� ,�� '.`!, ` / � ¢�� t 0� �J `��\ � j � � ` t y �'::\ � � . �. � + � ,�*t.� �� I � � �,�ir tz - �\�� '�ir------ �c .� / \�\��\\� � � � ,� /�� f �(` ��1 `� 4 �` � � `� i� N � -�� /�"" � � / Y- /�3j � � � ' r� � ' ` �� / � " � ^ � t �� / ' '�� ,s ��'`� � �� / � � �� - f � �� ` �. �,� !� �� '�� ''f � ( � a � ��, � � �11 `oy �_ � J �, �// f� � � � 5�r n �` , � �.:r �•�� l��j � � � \\ � � � I � b � �` �.. �, \� � � �� , � �� !� s � � . _/� � I+ , �t ,�[� � � � OO°'� }, � �=f� ,a+;h ; o �� `\�� r / ` � � �•` tr ' + / ` �\\\ ~\ �� y� � 1 � 1 � \�� . ? � � r� � � � \�� ` � � N � � 4 ` / t �` � � � �,�f C) �� l� ��, � � ` t V O��y <\ , � ` w`� � (R,? � � � � \ �� \ 11 1 ` \ r �� C ,� � p.� \ . ' r �-r' `�`� � ��N�J � / � � ` \ a `� � , �N \� � � e J H t ` � � �� \ .J� � � • ti \ k �,, �. ��.. � t � u � � ' x�« � � �� `�� .�w� 1 \ � ` \( o Lis � ,�� /1 � ■ ■ � � � ❑y � � � � ��e ' 1 I n i n I I� E Qr„j ' I I c0 I I r � 0 � m m� NVVVV � � � � y� c� m m o �u m C � � ooC » � 3 m < � -' ^� tn �D r-r .-t -� Li _ � � � � axt o � � �p � Q �' � (a N r�„a, -� > > > aoa33 �- " �' �` " � � � � o � � = �� Q � � � � ; �, � g � � r+- � m > > > �Cxxxov $ £ �. � m ' '° � '° � o � oa � � `° � A n �n' � C � iU o � d � Q � a � o � a � mmaWC� o G. N � � doim 'o � � me cn :: � m � m � md ' � ° o � m v �, m $ — 39 < 3 � f Cma — � .. Rc � s � � � p � m m C � � � N � � la 0- o c 0) N f� > — N f� Ol c �� m m ro � s 3 y �° �, v Sa co o�i d 3 m � � � d �0=� — � � � � � ; � � 3 N rp N o O �m� � (� ff� � � y A A � 3�Q �� j � � 0 � d m 2 0 1 1 1 0 5 1 pF W ArF9 `� pG Office Use Only � � � '� Corps action ID no � �.� � p < DWQ pro�ect no Form Version 1 4 January 2009 Pre-Construction Notification (PCN) Form A Appl�cant Information 1 Processing 1 a Type(s)of approval sought from the Corps ❑ Section 404 Permit ❑ Section 10 Permit 1 b Specify Nationwide Permit(NWP)number or General Permit(GP)number 1 c Has the NWP or GP number been venfied 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 Junsdictionai General Permit ❑ 401 Water Quality Certification—Express �X Riparian Buffer Authorization 1 e Is this notification solely for the record For the record only for DWQ For the record on(y for Corps Permit because wntten approval is not required? 401 Cert�fication ❑Yes ❑ No ❑Yes ❑ No 1 f !s payment mto a mit�gation bank or�n lieu fee program proposed for mitigation of�mpacts� If so attach the acceptance letter from mitigation bank ❑ Yes OX No or in lieu fee program 1 g Is the pro�ect located in any of NC s twenty coastal counties If yes answer 1 h � Yes �X No below 1 h Is the pro�ect located within a NC DCM Area of Environmental Concern (AEC)� ❑ Yes �X No 2 Pro�ect Information 2a Name of pro�ect Chapel Hdl Elementary School#11 2b Counry Orange D 2c Nearest muniapality/town Chapel Hdl 2d Subdiwsion name NA 2e NCDOT only T I P or state pro�ect no �' 3 Owner Information gyF ry��, 3a Name(s)on Recorded Deed Orange County �� 3b Deed Book and Page No 262/1058 3c Responsible Party{for LLC if NA applicable) 3d Street address 20Q South Cameron Street 3e City state zip Hdisborough NC 27278 3f Telephone no 919 732 8181 3g Fax no 3h Email address Page 1 of 10 PCN Form—Version 1 4 January 2009 4 Applicant Information(if different from owner) 4a Appiicant is ❑ Agent ❑X Other specify Chapel Hdl Carrboro City Schools 4b Name Mr Wdliam Mullin 4c Busmess name Chapei Hdl Carrboro City Schools (if applicable) 4d Street address 750 South Merritt Mitl Road 4e City state zip Chapel Hdl NC 27516 4f Telephone no 919 967 8211 4g Fax no 919 933 4560 4h Emad address BMuliin@chccs k12 nc us 5 AgenUConsultant Information(if appl�cable) 5a Name Blake Hall 5b Busmess name Timmons Group (if applicable) 5c Street address 5410 Trmity Road Swte 112 5d City state zip Ra�eigh NC 27607 5e Telephone no 919 866-4933 5f Fax no 919 859 5663 5g Emad address blake hall@timmons com Page 2 of 10 B Pro�ect Information and Pricr Pro�ect History 1 Property Identi�cation 1a Property identification no (tax PIN or parcel ID) 9788181797 1 b Site coordmates(m decimal degrees) Latitude 35 9174 Longitude 79 0611 1 c Property size acres 'j ,� 2 Surface Waters 2a Name of nearest body of water to proposed pro�ect Tanbark Branch 2b Water Qualiry Classification of nearest receiwng water WS 5 NSW 2c Rwer basin Cape Fear 3 Pro�ect Description 3a Descnbe the existing conditions on the site and the general land use m the vicinity of the pro�ect at the time of this application The exishng site is developed contairnng four exis6ng buildmg and assoc�ated infrasWcture The existing facdity is abandoned but had previously been used as an educa6onal facdity The ad�acent land use pnmanly consists of single famdy residenbal 3b List the total estimated acreage of all existing wettands on the property 3c List the total estimated Imear feet of all existmg streams(intermittent and perenrnal)on the property 450 3d Explain the purpose of the proposed pro�ect The proposed scope of work includes demolition of the exis6ng on sde infrastructure and the construction of a new three story 100 000 sf elementary 3e Descnbe the overall pro�ect m detad including the type of equipment to be used The overall construcUon of this pro�ect wdl mclude the use of heavy eqwpment The work vinthin the Jordan Lake buffer wdl be accomplished by hand 4 Junsdictional Determinations 4a Have�unsdictional wetland or stream determmations by the QX Yes ❑ No ❑ Unknown Corps or State been requested or obtained for this property/ ro ect includin all rior hases in the ast� Comments No weUands only stream determinahon 4b If the Corps made the�unsdictional determination what type � prelimmary ❑ Final of determmation was made� 4c If yes who delineated the�unsdictional areas� Agency/Consultant Company Name(if knownj 7own of Chape�kd� Other 4d if yes list the dates of the Corps�unsdictional determinations or State determinations and attach documentation 10l28/2009 Town of Chapel Hdl Stream Detertnination 5 Pro�ect H�story 5a Have permits or certifications been requested or obtained for �Yes ❑No �X Unknown this pro�ect(mcluding all pnor phases)m the past� 5b If yes explain in detad according to help file instrucUons 6 Future Pro�ect Plans 6a Is this a phased pro�ect� X� Yes ❑ No 6b If yes explain Phase I wo�ic wdl wnsist of demolition and bulk gradmg Energy disslpater InstailaUon wdl be the only buffer disturbance associated with Phase I work (120s� Phase II wdl consist of bwtdmg partang and uhlity�nstalla6on whrch wdl requ+re a new samtary sewer connection wdhin the buffer(350 s� Page 3 of 10 PCN Form—Version 1 4 January 2009 C Proposed Impacts Inventory 1 Impacts Summary 1 a Which sections were completed below for your pro�ect(check all that apply) ❑ Wetlands ❑ Streams—tributanes �X Buffers ❑ Open Waters ❑ Pond Construction 2 Wetland Impacts If there are wetland impacts proposed on the s�te then complete this question for each wetland area impacted 2a 2b 2c 2d 2e 2f Wetland impact Type of impact Type of wetland Forested Type of�urisdiction Area of number Corps (404 10)or impact Permanent(P)or DWQ(401 other) (acres) Tem ora T W1 Choose one Choose one Yes/No W2 Choose one Choose one Yes/No W3 Choose one Choose one Yes/No W4 Choose one Choose one Yes/No WS Choose one Choose one YesMo W6 Choose one Choose one Yes/IYo 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 Perenrnal(PER)or Type of Average Impact number mtermittent(INT)� �unsdiction stream length Permanent(P)or width (linear Temporary(� (feet) feet) S1 Choose one S2 Choose one S3 Choose one S4 Choose one S5 Choose one S6 Choose one 3h Total stream and tributary�mpacts 3i Comments Page 4 of 10 PCN Form—Version 1 4 January 2009 4 Open Water Impacts If there are proposed+mpacts to lakes ponds estuanes tnbutanes sounds the Atlantic Ocean or any other open water of the U S then indiwduall list all o en water im acts below 4a 4b 4c 4d 4e Open water Name of waterbody impact number (if applicable) Type of impact Waterbody Area of impact(acres) Permanent(P)or type Tem ora T p� Choose one Choose 02 Choose one Choose �, 03 Choose one Choose 04 Choose one Choose 4f Total open water impacts 4g Comments ' I 5 Pond or Lake Construction I If ond or lake construction ro osed then com lete the chart below 5a 5b 5c Sd 5e Pond ID number Proposed use or Wetland Impacts(acres) Stream Impacts(feet) �Upland purpose of pond I,{acres) Flooded Fdled Excavated Fiooded Fdled Excavated � P1 Choose one P2 Choose one 5f Total 5g Comments 5h Is a dam high hazard permd reqwred� ❑ Yes ❑ No If yes permit ID no 5i Expected pond surface area(acres) 5� Size of pond watershed(acres) 5k Method of construction 6 BufFer tmpacts(for DWQ) If pro�ect wdl impact a p�otected npanan buffer then complete the chart below �f yes then mdividually list all buffer impacts below If an im acts re uire miti ation then ou MUST fill out Section D of this form � I 6a Pro�ect is in which protected basin� ❑Neuse � Tar Pamhco ❑ Catawba � Randleman ❑Other � 6b 6c 6d 6e 6f 6g Buffer Impact Reason for impact Stream name Buffer Zone 1 �Zone 2 number— mitigatwn impact I impact Permanent(P)or required� (square (square Tem ora T feet feet B1 P Energy Dissipator Unnamed Tnbutary No 120 B2 P Sarntary Sewer Replace Unnamed Tnbutary No 100 325 B3 Yes/No B4 Yes/No B5 Yes/No 66 Yes/No 6h Total Buffer Impacts 220 325 6i Comments Page 5 of 10 D Impact Justi�cation and Mitigat�on 1 Avo�dance and Mimm�zation 1a Specifically descnbe measures taken to avoid or mirnmize the proposed impacts in designing pro�ect Storm sewer is bemg discharged through exis�ng in place storm sewer system�nnthin the buffer at retes lower than existing Energy dissipaters have been added per the request of The Town of Chapel Hdl Dissipater�nnll be mstalled wdhout mechanical eqwpment to help mirnmize disturbance The disturbance assoaated with the sanitary sewer replacement is a precau6onary measure An on site inspection of the condidons of the existing sewer wdl take place pnor to any disturbance If it is found that the ewsdng sewer is(n good working condihon impads may not be needed 1 b Speafically describe measures taken to avoid or minimize the proposed impacts through construction techniques Storm sewer is being discharged through exisdng m place stortn sewer system uvithin the buffer at rates lower than ewsbng Energy dissipaters have been added per the request of The Town of Chapel Hdl Dissipater�nnll be mstalled�nnthout mechan�cal eqwpment to help minimize disturbance The d�sturbance assoaated�nnth the sarntary sewer repiacement is a precaut�onary measure An on sde inspection of the condiUons of the existing sewer wdl take place pnor to any disturbance If d is found that the exisdng sewer is in good working condition impacts may not be needed 2 Com ensato Mit� ation for im acts to Waters of the U S or Waters of the State 2a Does the pro�ect reqwre Compensatory Mitigation for ❑ Yes ❑ No impacts to Waters of the U S or Waters of the State� 2b If yes mitigation is reqwred by(check all that apply) ❑ DWQ ❑Corps ❑ Mitigation bank 2c If yes which mitigation option wdl be used for this ❑ payment to in lieu fee program pro�ect� ❑Permittee Responsible Mitigation 3 Com lete if Usm a Miti at�on Bank 3a Name of Mitigation Bank Type Choose one Quantity 3b Credits Purchased(attach receipt and letter) Type Choose one Quantity Type Choose one Quantity 3c Comments 4 Com lete if Makin a Pa ment to In lieu Fee Pro ram 4a Approval letter from in lieu fee program is attached ❑ Yes 4b Stream mitigation requested Imear feet 4c If using stream mitigation stream temperature Choose one 4d Buffer mitigation requested(DWQ only) square feet 4e Ripanan wetland mitigation requested acres 4f Non npanan wetland mitigation requested acres 4g Coastal(tidal)wetiand mitigation requested acres 4h Comments 5 Complete if Using a Permittee Responsible M�t�gation Plan 5a If using a perm►ttee responsible mitigabon plan provide a description of the proposed mitigation plan Page 6 of 10 PCN Form—Version 1 4 January 2009 6 Buffer Mitigat�on(State Regulated R�par�an Buffer Rules)—reqwred by DWQ 6a Wdl the pro�ect result in an impact within a protected ripanan buffer that requires � Yes OX No buffer mitigation� 6b If yes then identify the square feet of impact to each zone of the npanan buffer that requires mitigation Calculate the amount of mitigation required 6c 6d 6e Zone Reason for impact Total impact Multiplier Reqwred mitigation (square feet) (square feet) Zone 1 3(2 for Catawba) Zone 2 1 5 6f Totai buffer mitigat�on required 6g If buffer mit�gation is required discuss what type of mitigation is proposed(e g payment to pnvate mitigation bank permittee responsible npanan buffer restoration payment into an approved in lieu fee fund) 6h Comments Page 7 of 10 E Stormwater Management and D�ffuse Flow Plan(reqwred by DWQ) 1 Diffuse Flow Plan 1 a Does the pro�ect include or is it adJacent to protected nparian buffers identified �Yes 0 No within one of the NC Ri anan Buffer Protection Rules� 1 b If yes then is a diffuse flow plan�ncluded�If no explam why ❑Yes ❑ No 2 Stormwater Mana ement Plan 2a What is the overall percent imperviousness of this pro�ect� a�o 2b Does this ro ect re uire a Stormwater Mana ement Plan� ❑Yes ❑ No 2c If this pro�ect DOES NOT reqwre a Stormwater Management Plan explam why 2d if this pro�ect DOES reqwre a Stormwater Management Plan then provide a bnef narrative descnption of the plan 2e Who wdl be responsible for the review of the StoRnwater Management Plan� 3 Certified Local Government Stormwater Review 3a In which local overnment s unsdict�on is this ro ect� ❑Phase il 3b Which of the following locally implemented stormwater management programs ❑ NSW apply(check all that apply) � USMP �Water Suppiy Watershed �Other 3c Has the approved Stormwater Management Pian with proof of approval been ❑Yes ❑No attached� 4 DWQ Stormwater Pro ram Review �Coastal counties ❑HQW 4a Which of the followmg state�mplemented stormwater management programs appiy �ORW (check all that apply) ❑Session Law 2006 246 ❑Other 4b Has the approved Stormwater Management Plan with proof of approvai been ❑Yes ❑No attached� 5 DWQ 401 Un�t Stormwater Review 5a Does the Stormwater Management Pian meet the appropnate reqwrements� ❑Yes � No 5b Have all of the 401 Urnt submittal requirements been met� ❑Yes ❑No Page 8 of 10 PCN Form—Version 1 4 January 2009 F Supplementary Informat+on 1 Environmental Documentation(DWQ Requ�rement) 1 a Does the pro�ect invotve 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 pro�ect reqwre preparaUon of an environmental document pursuant to the requirements of the National or State ❑Yes ❑No (North Carolina)Environmentai Policy Act(NEPA/SEPA)� 1 c If you answered"yes to the above has the document rev�ew been finalized by the State Cleanng House� (If so attach a copy of the NEPA or SEPA final approval letter) ❑Yes ❑No Comments 2 Violations(DWQ Reqwrement) 2a Is the site in violation of DWQ Wetland Rules(15A NCAC 2H 0500) Isotated Wetland Rules(15A NCAC 2H 1300) DWQ Surface Water or Wetland Standards ❑Yes �X No or Ripanan Buffer Rules(15A NCAC 26 0200)� 2b is this an after the fact permit application� ❑Yes OX No 2c If you answered yes to one or both of the above questions provide an explanation of the violat�on(s) 3 Cumulative Impacts(DWQ Reqwrement) 3a Wdl this pro�ect(based on past and reasonably anticipated future�mpacts)result in �Yes OX No additional development which could impact nearby downstream water quality� 3b If you answered'yes to the above submit a qual�tative or quantitaUve cumulative impact analysis in accordance with the most recent DWQ policy if you answered no provide a short narrative descnption 4 Sewage Disposal(DWQ Requirement) 4a Clearly detad the ultimate treatment methods and disposition(non discharge or discharge)of wastewater generated from the proposed proJect or ava+lable capac�ty of the sub�ed fac�lity Page 9 of 10 PCN Form—Version 1 4 January 2009 i I 5 Endangered Species and Designated Critical Habitat Corps Requirement) 5a Wdl th�s project occur in or near an area with federally p tected species or �Yes ❑No habitat� 5b Have you checked wrth the USFWS concemmg Endange ed Species Act �Yes ❑No impacts? 5c ff yes mdipte the USFWS Field Office you have contact 5d What data sources d�d you use to determine whether you sde would�mpad Endangered Spec�es or Designated Cntical Habitat� 6 Essential F"�sh Habitat(Corps Requirement) 6a Wili this proiect occur�n or near an area designated as e erdiai fish hab�tat� ❑Yes ❑ No 6b What data sources d�d you use to determine wrhether you s�te wouid impact Essendal Fish Habitat� 7 Historlc or Preh�storic Culturai Resources(Ccrps Re uirement) 7a wll th�s pro)ect occur m or near an area that tF�state fe erai or tribal govemments have designated as having tustonc or cultu I preservation � Yes ❑No status(e g Nahonal H�stonc Trust designahon or prope es sigrnfiqnt�n North CaroUna h�story and archaeology)? 7b What data souroes d�d you use to cktermine whether you site wouid impact histonc or archeological resourc�s� 8 Fiood Zone Designabon(Corp�s Requirement) 8a Will this project ocxur�n a FEMA-designated 100-year ft plam? ❑Yes ❑No 8b If yes expiain how pro�ect meets FEMA requ�rements � 8c What source(s)did you use to make the floodpiain determ natron� Wdham Mulhn ` 11 29 2411 ApplicarrtlAgenYs Printed Name Appl c AgenYs S�gnature Date (AgenYs sig ls valid only if an autho►iza6o� letter am the a hcarrt�s rovided I i Page 10 of 10