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Home My WebLink About20111112 Ver 1_401 Application_20111211i y�O� W AT �909 � r 1 O < Pre Construction Notification (PCN) Form Instructions The PCN form is required for applicants seeking the following approvals Corps 404 or Section 10 Permit or DWQ 401 Certification Buffer Authorization Isolated/non 404 Wetlands Permit PURPOSE The PCN — Pre Construction Notification form helps regulators from the state and federal agencies m North Carolina better understand and evaluate the impacts of activities that you propose to do in or around streams wetlands or other waters that may affect water quality the health of the aquatic ecosystem or water access or flow in the immediate or nearby drainage area The PCN is a combined effort by the US Army Corps of Engmeers (USACE known as the Corps ) and the NC Division of Water Quality (DWQ) to coordinate regulatory requirements for work m(or affecting) wetlands streams ripanan buffers and waters within North Carolma By accurately compieting the PCN form we can determme if you meet reqwrements to proceed with your pro�ect as proposed We can evaluate the measures you propose to take to avoid or mitigate for any damage to the environment Our review of your completed form will provide us with necessary information about your pro�ect to determine if we can allow you to begin your pro�ect without the time expense or uncertainty involved in going through a ma�or permit process Many Corps Nationwide permits and some general permits require the applicant to complete and submit a PCN form before starting any work in an area that may impact streams wetlands or other waters Activities that reqwre a NC General Water Quality Certification a stormwater permit or a buffer permit within protected watersheds use the PCN form The responsible state or federal agencies wdl review your application for completeness within 30 days of receipt We wdi notify you if we need additional information to process your request You may not begin work until your application is complete Once your application is complete the Corps will process it within 45 days for a Nationwide or General Permit and the NC DWQ will process your 401 Certification within 60 days Note Do not use the PCN form if you are requesting a Corps Individual Permit or NC DWQ Individual Water Quality Certification The Corps Individual Permit application form is available online at www saw usace army mil/wetlands/Permits html INFORMATION WE NEED TO KNOW We need to know details about who you are where you propose to work what you will be domg and how you will compensate for impacts to streams wetlands or other waters as a result of your work Ali information is required unless otherwise stated as optional Incomplete applications cannot be accepted for review and will be returned to the applicant You can obtain help in completing each question on the form through the instructions m th�s document FEES DWQ Water Qualitv Certifications North Carolina requires fees for processmg water quality certifications and buffer permits The reqwred fees are as follows i�or water quality applications Greater than or equal to $570 00 e acre of wetlands/waters AND/OR Greater than or equal 150 feet of streams (whether intermittent or qerenrnal) nor water quality applications Less than one acre of �tlands/waters AND Less than 150 feet of streams hether intermittent or perennial) $240 00 Checks should be made out to the NC Divis�on of Water Quality with the specific name of the pro�ect or appl�cant identified on the check Piease sta le your check to the front of the application package Version 1 2 PCN Heip File Page 1 of 26 12/29/2008 For more information on the required NC DWQ fees see the DWQ Application Fees document at http //h2o enr state nc us/ncwetlands/documentslApplicationFees doc Note If the pro�ect is sponsored by a federal agency the DWQ requires the name of pro�ect pnnted on the US Treasury check and the pro�ect application fee mailed to NC DWQ 401/Wetlands Unit 1650 Mad Service Center Raleigh NC 27699 1650 DWQ Buffer Permits If written approval is sought solely for Buffer Rules (Ripanan Buffer Authorization) the application fee does not apply and the applicant should clearly state (in a cover letter) that o� Buffer Rule approval is sought in wnting Corps Permits There is no fee for Nationwide or General Permits processed by the Corps of Engineers WHERE TO SEND YOUR COMPLETED PCN FORM Copies of your completed PCN with all required attachments must be sent to the Corps or to DWQ or both agencies depending on the approval sought Additionally review the specific reporting reqwrements for your pro�ect as some conditions of approval require you to send a copy of your PCN to coordinating agencies DWQ Certifications All PCN Forms processed by NC DWQ must be sent to NC DWQ 401/Wetlands Unit 1650 Mad Service Center Raleigh NC 27699 1650 Number of Copies Required for DWQ Provide five (5) complete and collated copies of the PCN Application and supporting documentation (instead of providmg 5 copies of the full size plans (usually approximately 24x36 mches) you may provide two copies of full size plans along with three copies of 11 x17 plans) Corps Permits — PCN Forms are processed at each Corps Field Office for the counties in which the activity is proposed The map and list shows the counties that are served by each Corps field office Field Office Ashevdle Regulatory Field Office US Army Corps of Engineers 151 Patton Avenue Room 208 Ashevdle NC 28801 5006 Telephone (828) 271 7980 Fax (828) 281 8120 Raleigh Regulatory Field Office US Army Corps Of Engineers �3331 Hentage Trade Drive Swte 105 Wake Forest NC 27587 Telephone (919) 554 4884 Fax (919) 562 0421 Washington Regulatory Field O�ce US Army Corps of Engineers Post Office Box 1000 Counties by Field Office 0 Asheville Field Office 0 Raleigh Field �ffice � Washington Field Office � Wdmington Field �ffice Counties Served Alexander Caldwell Alleghany Catawba Ashe Cherokee Avery Clay Buncombe Cleveland Burke Gaston Cabarrus Graham Alamance Caswell Chatham Davidson Davie Durham Edgecombe Beaufort Bertie Camden Franklin Forsyth Granville Guilford Halifax Johnston Lee Haywood Henderson Iredell Jackson Lincoln Macon Madison Nash Northampton Orange Person Randolph Rockingham Stokes Curntuck Jones Dare Lenoir Gates Martin Corps Field affices ■ McDowell Swain Mecklenburg Transylvania Mitchell Urnon Polk Watauga Rowan Yancey Rutherford Stanley Surry Vance Wake Warren Wilkes Wilson Yadkm Pitt Tyrrell Washington Version 1 3 PCN Help File Page 2 of 26 12/29/2008 � Washmgton NC 27889 1000 Telephone (252) 975 1616 Fax (252) 975 1399 Carteret Green Pamlico Chowan Hertford Pasquotank Craven Hyde Perquimans Wilmmgton Regulatory Field Office Anson Duplm Onslow US Army Corps of Engineers Bladen Harnett Pender 69 Darlington Avenue Brunswick Hoke Richmond Wilmington NC 28403 1343 Carteret Montgomery Robeson Telephone (910) 251 4511 Columbus Moore Sampson Fax (910) 251 4025 Cumberland New Hanover Scotland Wayne Croatan National Forest Only Number of Copies Reauired for Coras Provide one complete PCN Application and supporting documentation (all plans must be no greater in size than 11 X 17 sheets ) Diqital document attachments for Coras The Corps encourages appiicants to begin to submit plan map and survey attachments in digital format Specific guidance will be provided in 2009 on the Corps web s�te concerning format and method the goal of which wdl be to eventually allow users to submit electronically in lieu of paper copies At this time however di4ital attachments cannot replace the paper copv and attachments but the Corps would apprec�ate receiving a digital copy of all attachments in addition to the required paper copy The digital copy must be saved to a CD or DVD ROM and must be clearly labeled and in PDF format that can be legibly pnnted for viewing at no larger than 11 x 17 Specific Renortinp Requirements There are specific reporting requirements for pro�ects located in counties that have trout waters coastal counties and western NC counties as well as specific drainage basms covered by state riparian buffer rules Counties with Trout Waters The NC Wildlife Resources Commission can help determine if your pro�ect may impact trout waters If your pro�ect is within a trout county listed below you must send a copy of your PCN to WRC to assess potential impacts to trout waters If your pro�ect is in any of the following counties Alleghany Ashe Avery Burke Caldwell Mitchell Stokes Surry Watauga or Wilkes send a copy of your PCN to Western Piedmont Region Coordinator 3855 Idlewild Road Kernersvdle NC 27284 9180 Telephone (336) 769 9453 If your pro�ect is m Buncombe Cherokee Clay Graham Haywood Henderson Jackson Macon Madison McDowell Polk Rutherford Swain Transylvania or Yancey counties send a copy of your PCN to Mountain Region Coordinator 20830 Great Smoky Mtn Expressway Waynesville NC 28786 Telephone (828) 452 2546 Fax (828) 452 7772 Coastal Counties If your proposed pro�ect is in a coastal county you need to check to see if the work is m an Area of Environmental Concern and requires a CAMA permit If the pro�ect occurs in any of North Carolina s twenty coastal counties Beaufort Bertie Brunswick Camden Carteret Chowan Curntuck Craven Dare Gates Hertford Hyde New Hanover Onslow Pamlico Pasquotank Pender Perquimans Tyrrell or Washington counties you need to determine if a CAMA permit is required for your pro�ect Contact the North Carolina Division of Coastal Management (DCM) for help DCM will determine if the pro�ect is within a designated Area of Environmental Concern in which case you must apply directly to Version 1 3 PCN Help File Page 3 of 26 12/29/2008 DCM for a CAMA permit DCM and the Corps share a �oint permit application for CAMA permits Many CAMA permits do not require completing a PCN NC Division of Coastal Management Telephone (252) 808 2808 400 Commerce Avenue Fax (252) 247 3330 Morehead City NC 28557 3421 Pro�ects within nver basins with NC Ripanan Buffer protection If your pro�ect is located within the Neuse Tar Pamlico Catawba or Randleman River Basins you must ensure you are meeting the requirements for diffuse flow provisions set out in the North Carolina Administrative Code Specific requirements for each river basin are set out in the Red Rule Book which is located at the following website http //h2o enr state nc us/admin/rules/documents/Redbook2007 pdf Western counties with US FWS desiqnated cntical apuatic watersheds All Corps permits reqwre you to check to ensure that no state or federally protected plant animal or ecological commurnty is adversely impacted by your proposed pro�ect If your pro�ect is in the following counties Avery Cherokee Forsyth Graham Haywood Henderson Jackson Macon Mecklenburg Mitchell Stokes Surry Swain Transylvarna Union and Yancey you must send an advance copy of your PCN to the Asheville Field Office of the US Fish and Wildlife Center for review to ensure there will be no adverse impacts to cntical aquatic habitats as a result of your pro�ect Send your PCN package to The US Fish and Wildlife Service 160 Zillicoa Street Asheville North Carolina 28805 Telephone (828) 258 3939 SECTION A APPLICANT INFORMATION INSTRUCTIONS A1 Processing — By completmg these fields accurately we can determine how your application wdl be reviewed A1a Type(s) of approval soughtfrom the Corps Section 404 Permit the discharge of dredged or fill material into all waters of the United States including wetlands as regulated under the Clean Water Act Typical activities requiring Section 404 permits are Depositing of fill or dredged material in waters of the US or ad�acent wetlands site development fill for residential commerciai or recreational developments construction of revetments culvert piacement groins breakwaters levees dams dikes and weirs or placement of nprap and road fills Section 10 Permit the construction of any structure in or over any navigable water of the United States as regulated under the Rivers and Harbors Act Activities such as dredging construction of docks and bulkheads and pfacing navigation aides require review under Section 10 to ensure that they will not cause an obstruction to navigation Typical activities reqwnng Section 10 permits are construction of piers wharves bulkheads dolphins marinas ramps floats intake structures and cable or pipeline crossings or dredging and excavation Need more information about federal water regulations under Corps authority� http //www saw usace armv miI/WETLANDS/authontv html How do 1 know if my parcel has wetlands or waters on �t that are �egulated by the Corps� Not all waters or wetlands are regulated by the Corps To find out how this process is done and to learn about how to survey your property for waters and wetlands visit the Corps web site section on Junsdictional Determinations http //www saw usace armv md/wetlands/JDs How do ! know if 1 need to complete a PCN� Version 1 3 PCN Help File Page 4 of 26 12/29/2008 ��0� W AT �g�G � r ti O -C 20111112 Office Use Only Corps action ID no DWQ pro�ect no Form Version 1 4 January 2009 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 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� ��s es ❑ No 1 d 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 Authonzation 1 e Is this notification solely for the record For the record only for DWQ For the record only for Corps Permit because wntten ap roval is not required� 401 Certification �� ❑ Yes lo ❑ Yes lo 1f Is payment into a mitigation bank or m lieu fee program proposed for mitigation of impacts� If so attach the acceptance letter from mitigation bank � Yes lo 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 o below 1 h Is the pro�ect located withm a NC DCM Area of Environmental Concern (AEC)� ❑ Yes o 2 Pro�ect Information 2a Name of pro�ect � C c �a �,.� c� 2b County � u� f��-� Cou�•-► 2c Nearest municipality / town �� j� � d Q �� 2d Subdiwsion name ENR WqrERQ��n, 2e NCDOT only T I P or state pro�ect no ATERBFtANCH 3 Owner Information 3a Name(s) on Recorded Deed �.�-�Ve� (_ c�- r� �,�0. (« 3b Deed Book and Page No D �� Q,r 3c Responsible Party (for LLC if applicable) 3d Street address � 3 Q �/.( � r va C� 3e City state zip � � f e C. �. / O 3f Telephone no 3 3(o _� C� ,' I S- 3g Fax no 3h Emailaddress S i"ICE� � D C Page 1 of 10 PCN Form - Version 1 4 January 2009 Page 2 of 10 � B Pro�ect Information and Prior Pro�ect History 1 Property Identification 1a Property identification no (tax PIN or parcel ID) (�� s ,3 1 b Site coordinates (in decimal degrees) Latitude Longitude 1 c Property size �Z �, c � e s acres 2 Surface Waters 2a Name of nearest body of water to proposed pro�ect �-/��..� iC,� V� 2b Water Quality Classification of nearest receiving water S' 2c River basm �'ct � 1-e � ✓ 3 Pro�ect Description 3a Describe the existmg conditions on the site and the general land use in the v�cinity of the pro�ect at the time of this application (� � ttiPS � �c v► f 'i �. 3b List the total estimated acreage of ail existing wetlands on the property 3c List the total estimated Imear feet of all existing streams (intermittent and perennial) on the property 3d Explain the purpose of the proposed pro�ect %rs�r✓�y �� 3e Descnbe the overall pro�ect in detad includmg the type of eqwpment to be used �i vr�,c�E'.. q r� � G, v� �•�. s��F�-,.�` ca,��. ��2�. �.f dA.�.. , bu� �� daw,, #- �.Gk h��e �- 1�� , �e ,�� 4 Jurisdictional Determinations 4a Have �unsdictional wetland or stream determinations by the Yes ❑ No ❑ Unknown Corps or State been requested or obtained for this property / Comments ro ect includin all rior hases in the ast� 4b If the Corps made the �urisdictional determination what type � Preliminary ❑ Final of determination was made� 4c If yes who delmeated the �unsdictional areas� Agency/Consultant Company Name (if known) ��A � � ��,, z,,v �� Other 4d if yes list the dates of the Corps �unsdictional determinations or State determinations and attach documentat�on �'v� �.�.,.,,, b �-- '-�. (�, �o t I 5 Pro�ect History 5a Have permits or certifications been requested or obtained for � Yes o ❑ Unknown this pro�ect (including all pnor phases) m the past� 5b If yes explain m detad accordmg to help file instructions 6 Future Pro�ect Plans 6a Is this a phased pro�ect� ❑ Yes No 6b If yes explam Page 3 of 10 PCN Form — Version 1 4 January 2009 C Proposed Impacts Inventory 1 Impacts Summary 1 a Which sections were comp ted below for your pro�ect (check all that apply) ❑ Wetlands Streams — tributanes ❑ 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 impact Type of wetland Forested Type of�unsdiction Area of number Corps (404 10) or impact Permanent (P) or DWQ (401 other) (acres) Tem ora W1 Choose one Choose one Yes/No W2 Choose one Choose one Yes/No �1/3 Choose one Choose one Yes/No �/�/4 Choose one Choose one Yes/No W5 Choose one Choose one Yes/No W6 Choose one Choose one Yes/No 2g Total Wetland Impacts 2h Comments 3 Stream Impacts If there are perennial or intermittent stream impacts (mcluding temporary impacts) proposed on the site then complete this question for all stream sites impacted 3a 3b 3c 3d 3e 3f 39 Stream impact Type of impact Stream name Perennial (PER) or Type of Average Impact number intermittent (INT)� �urisdiction stream length Permanent (P) or width (linear Temporary (T) (feet) feet) S1 Choose one �,, c.� �,,,,., � z.- t' �' �i vt n��( U �v � r �� S2 Choose one S3 Choose one S4 Choose one S5 Choose one S6 Choose one 3h Total stream and tributary impacts � 3i Comments Page 4 of 10 PCN Form — Version 1 4 January 2009 4 Open Water Impacts If there are proposed impacts to lakes ponds estuaries tnbutanes sounds the Atlantic Ocean or any other open water of the U S then mdividuall 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 01 Choose one Choose 02 Choose one Choose 03 Choose one Choose 04 Choose one Choose 4f Total open water impacts 4g Comments 5 Pond or Lake Construction If ond or lake construction ro osed then com lete the chart below 5a 5b 5c 5d 5e Pond ID number Proposed use or Wetland Impacts (acres) Stream Impacts (feet) Upland purpose of pond (acres) Flooded Filled Excavated Flooded Filled Excavated P1 Chooseone �r(�rQq�r,y S'(� P2 Choose one 5f Total 5g Comments 5h Is a dam high hazard permit 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 Impacts (for DWQ) If pro�ect will impact a protected riparian buffer then complete the chart below If yes then individually list all buffer impacts below If an im acts re uire miti ation then ou MUST fill out Section D of this form 6a Pro�ect is in which protected basin� ❑ Neuse ❑ Tar Pamlico � Catawba � Randleman ❑ Other 6b 6c 6d 6e 6f 6g Buffer Impact Reason for impact Stream name Buffer Zone 1 Zone 2 number — mitigation impact impact Permanent (P) or required� (square (square Tem ora feet feet B � Yes/No B2 Yes/No 63 Yes/No 64 Yes/No B5 Yes/No B6 Yes/No 6h Total Buffer Impacts 6i Comments Page 5 of 10 D Impact Justification and Mitigation 1 Avoidance and Mirnmization 1 a Specifically descnbe measures taken to avoid or minimize the proposed impacts in designing pro�ect ' " � � 1/� Y �Y� f �,� ,S ( Z, 2 U � � U ✓�,� 1 b Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques NI� 2 Com ensato Miti 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 o 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 pro�ect� ❑ Permittee Responsible Mitigation 3 Com lete if Usin 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 linear feet 4c If usmg stream mitigation stream temperature Choose one 4d Buffer mitigation requested (DWQ only) square feet 4e Riparian wetland mitigation requested acres 4f Non ripanan wetland mitigation requested acres 4g Coastal (tidal) wetland mitigation requested acres 4h Comments 5 Compiete if Usmg a Permittee Responsible Mitigation Plan 5a If usmg a permittee responsible mitigation plan provide a description of the proposed mitigation plan Page 6 of 10 PCN Form — Version 1 4 January 2009 6 Buffer Mitigation (State Regulated R�par�an Buffer Rules) — required by DWQ 6a Will the pro�ect result in an impact within a protected nparian 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 reqwres 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 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 E Stormwater Management and Diffuse Flow Plan (required by DWQ) 1 Diffuse Flow Plan 1 a Does the pro�ect include or is it ad�acent to protected npanan buffers identified Yes ❑ No within one of the NC Ri arian Buffer Protection Rules� 1 b If yes then is a diffuse flow plan included� If no explain why N� h�t.J 1v�... �.rJ-lc2N.S SC�v ��e. ❑Yes No P 2 Stormwater Mana ement Plan 2a What is the overall percent imperviousness of this pro�ect� � % 2b Does this ro ect re wre a Stormwater Mana ement Plan� ❑ Yes ❑ No 2c If this pro�ect DOES NOT require a Stormwater Management Plan explain why 2d if this pro�ect DOES require a Stormwater Management Plan then provide a brief narrative description of the plan 2e Who wdl be responsible for the review of the Stormwater Management Plan� 3 Certified Locai Government Stormwater Review 3a In which local overnment s unsdiction is this ro ect� ❑ Phase II 3b Which of the followmg locally implemented stormwater management programs ❑ NSW apply (check all that apply) � USMP � Water Suppiy Watershed � Other 3c Has the approved Stormwater Management Plan with proof of approval been ❑Yes ❑ No attached� 4 DWQ Stormwater Pro ram Review �Coastal counties ❑HQW 4a Which of the following state implemented stormwater management programs apply �ORW (check all that apply) ❑Session Law 2006 246 ❑Other 4b Has the approved Stormwater Management Plan with proof of approval been � Yes ❑ No attached� 5 DWQ 401 Urnt Stormwater Review 5a Does the Stormwater Management Plan meet the appropnate reqwrements� � Yes � No 5b Have all of the 401 Unit submittal reqwrements been met� ❑ Yes ❑ No Page 8 of 10 PCN Form — Version 1 4 January 2009 F Supplementary Information 1 Env�ronmental Documentation (DWQ Requirement) 1 a Does the pro�ect �nvolve 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 require preparation of an environmental document pursuant to the reqwrements 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 finaf approva! letter ) ❑ Yes ❑ No Comments 2 Violat�ons (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 es ❑ No or Ripanan 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) C/(, n c� w��e �-� ►��j c�, �a� �v. s' 3 Cumulative Impacts (DWQ Reqwrement) 3a Will this pro�ect (based on past and reasonably anticipated future impacts) result in �Yes o additional development which couid impact nearby downstream water quality� 3b If you answered yes to the above submit a qualitat�ve 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 detad the ultimate treatment methods and disposition (non discharge or discharge) of wastewater generated from the proposed pro�ect or avadable capaaty of the subJect facdity Page 9 of 10 PCN Form — Version 1 4 January 2009 5 Endangered Species and Designated Critical Habitat (Corps Requirement) 5a Will this pro�ect occur m or near an area with federally protected speaes or � Yes No habitat� 5b Have you checked with the USFWS concerning Endangered Species Act � Yes o impacts� 5c If yes indicate the USFWS Field Office you have contacted 5d What data sources did you use to determine whether your site would impact Endangered Species or Designated Cntical Habitat� 6 Essential F�sh Habitat (Corps Requirement) 6a Will this proJect occur m 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 pro�ect occur m or near an area that the state federal or tnbal governments have designated as having histonc or cultural preservation � Yes ❑ No status (e g National Historic Trust designation or properties significant in North Carolina history and archaeology)� �� K� � w` 7b What data sources did you use to determme whether your site would impact histonc or archeological resources� 8 Flood Zone Designation (Corps Reqwrement) 8a Will this pro�ect occur in a FEMA designated 100 year floodplam� ❑ Yes o 8b If yes explam how pro�ect meets FEMA requirements 8c What source(s) did you use to make the floodplain determmation� 5�-ev�," 1_ R► c e ��--i �- L�--�-- 12 --1 l� �l � Applicant/Agent s Printed Name ApplicanUAgent s Signature Date (Agent s signature is valid only if an authonzation tetter from the a licant is rovided Page 10 of 10 � � � � � GUIL,FORD COUNTY PLANNlNG AA1D DEVELOPMENT DEPARTMENT December 12 20l t A9r Sbaven R�ce and Mrs Angela Rice 8b33 Haw River Road Oak Ridge, NC 27310 Sub�� Stream Bui%r Restorahon Atan Nov ioo3ao� i 8633 Haw Rtver Road Oak Ridg� NC 2731 Q Dear Mr and Mrs Rice Th�s letter is to adv�se that ihe strEam buffer restorahon plan for the sub,�ect property which the L,ahe Jordan sh�ain buiier violst�on notificaaon was issued on Ociober 3 2011 was subm�tted on December 5 2Q11 The st�+eam buffer rest�oradon ptan has been approved as submittal A copy af the approved plan �s bemg retumed i�o the engtneenng firm of eecord Anderson & Associates, Inc for their eise and further handlmg In accordance w�th the Cktober 3 2011 Norce of Violatron upon �mpletion of the �+estoretion of thc buffer this o�ae must recerve the followu�g rtems� By Mamch, 2012, you must present a detatfed wntten report and digital photagtanhs to the Gmlford County Piannmg and Development Depaztment that ctearly depicts that the npanan buffer has been r�estored if th�s infomlation is not pr+esented v�nthm this t�me frame, addihonal penalty r�commendahons may be forwarded for c�vil penalty assessment In addrttan an annuai repott, mciuding a wntten account and dtgitat p6otographs, must be submttted to tf�e Gudford County Plann�ng and Development by De�ember i st of each year for a perrod of three years after the resioraUon is compieteci Thts report must dep�ct whether trees that ��ere planted have surv�ved and that d�fiuse storrnwater flow thrnugh the npanan bnfi'er has been achreved [f your monrtoruig et%rts r+eveal dead or dymg planhngs and/or fadures to maintam d�ffitse stormwater flow you must noUfy Ga�lforrl County Plannmg and Development staff w�thm 20 days and cornect the failw+es Please be aware that the strearn buffer restorapon �s performance based and a follow up �nspect�on wili be performed to ensure the plantmgs ate healthy and bvmg Any desd or diseased piants wili have to be replaca! Also note that you are st�l1 required to get appropnate USACE 444 and DWQ 40 i permits Post Office Box 3427 Greensboro I�orth Carolula 27402 Telephone (336) 373-3334 � �� If the ripanan buffer is not mstw�ed by the re�uirBd date above the o�`mer w�ll be sub,�ect to civil �nahy assessment of up to twenty five thousand dollars ($25 000 OQ) per violabon If you have any questions rEgard�ng thus matter please contact Franlc Park or myself at (33� 641 5564 Sincerely ,. � ;�/ //. Matt Wtll�ams, P E cc Betty Garett, Guilford County P dt D Depi Earl Dav�s, Gailford County P� D Dept Theon dackson Gudfivrd County P& D Dept Bruce Oakley, Town of 4akr�dge Sue Hamewood, DWQ W-S Reg�onal Offtce Amy Chapman, DWQ W S Regional Qffice k�r ��..2 ��,�,� 9 �� N � � � � � � ��a � � � �� P � ° � �g ° _ � tl � g�d� �� L � � s � � � � �� t �� '�� 6 D� � ��6 � �� a � s � ' �� e ��,� �2 E � a�$� ak��@�� e�� i r � � w � �! ... �' � � �. r �!' ►��^"�� ____ �� r �' �� .o'� _- __ _- = �' � � Bp �� F Yg � B � � fi� �� r b � 8 �� g �g s � � �� a� �� § �� $ � � � �� g � � ��! �� p�f� 9! S X � � 4�� a � � 3�� 4 $e !�� € � g � � � �� €7 � � �� c � � � � �a� � � � �� g�� P�� d � e � � "g�� g °� � E�� 3 �� gap�� g �� aq�� 3 8 6� Y�� S�� @� � 7E�� a�d �� / �� 5Ef �, � ��A� � P �'�►�$ ,� R � � �� Z � 3 .� . - `. '�� ` � ; � `♦ �� ` . _ � �� L� � � �� o� s G � n � � �� d K� � �� K ��