20120150 Ver 1_401 Application_20120213

20� W aT SRO
201 20 1 50
Office Use Only
Corps action ID no
DWQ project no
Form Version 13 Dec 10 2008
Page 1 of 10
PCN Form - Version 13 December 10 2008 Version
Pre - Construction Nohi ication PC Form
1
A Applicant Information 1
Processing
1a
Type(s) of approval sought from the
Corps
®Section 404 Permit C3 Section 10 Permit
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
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
le
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
If
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 1h
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
Lot 28, Section Seven, Stately Pines Subdivision
2b
County
Craven ( No 6 Township)
2c
Nearest municipality / town
Havelock
2d
Subdivision name
—P
Section Seven, Stately Pines
p
R21
M53
99*
n
2e
NCDOT only T I or state
project no
IKN L--J U
3
Owner Information 3 2012
3a
Name(s) on Recorded Deed
Stately Pines Partnership DENR WATER QUALITY
3b
Deed Book and Page No
Deed Book 932, Page 720 645A D"MMERIMIe
3c
Responsible Party (for LLC if
applicable)
Lonnie E Pridgen, Jr
3d
Street address
233 Middle Street, Suite 107 -A, P 0 Box 907
3e
City state zip
New Bern N C 28560
3f
Telephone no
252 637 -3115
3g
Fax no
( 252) 637 -3117
3h
Email address
pridgen @pamlico net
Page 1 of 10
PCN Form - Version 13 December 10 2008 Version

4
Applicant Information (if different from owner)
4a
Applicant is
❑ Agent ❑ Other specify
4b
Name
4c
Business name
(if applicable)
4d
Street address
4e
City state zip
0
Telephone no
4g
Fax no
4h
Email address
5
AgentlConsultant Information (if applicable)
5a
Name
Edward B Latham, P E, P L S
5b
Business name
(if applicable)
Edward B Latham, P A
5c
Street address
3412 Windsor Drive
5d
City state zip
New Bern N C 28562
5e
Telephone no
( 252) 637 -4265
5f
Fax no
( 252) 637 -4265
5g
Email address
edwardlathamhsd@embargmall com
Page 2 of 10
PCN Form - Version 13 December 10 2008 Vernon

B Project Information and Prior Project History
1 Property Identification
1a Property identification no (tax PIN or parcel ID)
6- 213 -1 -128
1b Site coordinates (in decimal degrees)
Latitude 34 968422' Longitude 76 948753
(DD DDDDDD) ( DD DDDDDD)
1c Property size 16,793 2 sq ft
acres 0 386
2 Surface Waters
2a Name of nearest body of water (stream river etc ) to
proposed project
Neuse River
2b Water Quality Classification of nearest receiving water
SB Sw, NSW
2c River basin Lower Neuse
3 Project Description
3a Describe the existing conditions on the Bite and the general land use in the viciV of the yro ect at the time of this
Mixed Deciduous - Coniferous land
application orest (44) Spe i 1ca 1 , Oak -Pine Forest(441)
The adjoining lots have existing dwellings with establ1 ed lawns The ad3oini
lots in the subdivision meet the maximum impervious requirements in the restrictive
3b List the total estimated acreage of all existing wetlands on the property
11,822 19 sq ft. = 0 271 Acres
3c List the total estimated linear feet of all existing streams (intermittent and perennial) on the property
None
3d Explain the purpose of the proposed pprofect� To decrease the area of wetland woods by 0 4G99 acres
the 25 %maximum
r
10 o er Q increase allowable impervious area to accomoaate a minimum
size ing
3e D�scnbe the o�er�Ilpro)ect in detail incl iinVhe ty$e of e�ui ntient o bQ used Doze and /or backkhoes to
clear t e we i.ng area & a ea ump
yar r c s o au away ie c earing deipris
Excavation eciulDment for constructing footings and foundations Landscape Equipment
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 Shown on subdivision plat and attached
site plan
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) Scott Jones
Other USACE
4d if yes list the dates of the Corps jurisdictional determinations or State determinations and attach documentation
USACE Action ID 200511127, dated 05/23/2005 (Copy Attached )
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 USACE Nationwide 14 Permit No 200511836
DWQ Wastewater Collection Permit No WQ 0030343
6 Future Project Plans
6a Is this a phased project?
❑ Yes No
[6b If yes explain
Page 3 of 10
PCN Form - Version 13 December 10 2008 Version

C Proposed Impacts Inventory
1 Impacts Summary
1a 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
number -
Type of impact
Type of wetland
Forested
Type of jurisdiction
(Corps - 404 10
Area of impact
Permanent (P) or
(d known)
DWQ - non -404 other)
(acres)
Temporary
W1 ®P ❑ T
Vegetation
clearing & ar
Hardwood-
ial pine Flats
® Yes
❑ No
® Corps -404
1:1 DWQ
0 0999
❑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
2g. Total wetland impacts
0 0999
2h Comments other than the im2grvious area the balance of the wetland reduction will rema
3 Stream Impacts wco a awn
then this
If there are perennial orQnlermdtent stream impacts (including temporary impacts) proposed on the site complete
question for all stream sites impacted
3a
3b
3c
3d
3e
3f
39
Stream impact
Type of impact
Stream name
Perennial
Type of jurisdiction
Average
Impact
length
number
(PER) or
(Corps 404 10
stream
(linear
Permanent (P) or
Temporary (T)
intermittent
(INT)?
DWQ - non-404
other)
width
(feet)
feet)
❑ PER
❑ Corps
S1 ❑ P ❑ T
None
❑INT
❑ DWQ
❑ PER
❑ Corps
S2 ❑ P ❑ T
❑ INT
❑ DWQ
❑ PER
❑ Corps
S3 []POT
❑ INT
❑ DWQ
❑ PER
❑ Corps
S4 ❑ P ❑ T
❑ INT
❑ DWQ
❑ PER
❑ Corps
S5 ❑ P ❑ T
❑ INT
I ❑ DWQ
❑ PER
❑ Corps
S6 ❑ P ❑ T
❑ INT
❑DWQ
3h Total stream and tributary impacts
31 Comments
Page 4 of 10
PCN Form - Version 13 December 10 2008 Version
1 as

4 Open Water Impacts None
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
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 []POT
04 ❑P ❑T
4f Total open water impacts None
4g Comments
5 Pond or Lake Construction None
If pond or lake construction proposed th en complete the chart below
5a
5b
5c
5d
5e
Wetland Impacts (acres)
Stream Impacts (feet)
Upland
Pond ID
Proposed use or purpose
(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
51 Expected pond surface area (acres)
5j Size of pond watershed (acres)
5k Method of construction
6 Buffer Impacts (for DWQ) None
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?
❑ Catawba ❑ Randleman
6b
6c
6d
6e
6f
6g
Buffer impact
number —
Reason
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P) or
for
Stream name
mitigation
(square feet)
(square feet)
Temporary T
impact
required?
B1 ❑P [IT
❑Yes
❑ No
B2 ❑P ❑T
El Yes
❑ No
B3 ❑P ❑T
❑Yes
❑ No
6h Total buffer impacts
61 Comments
Page 5 of 10
PCN Form — Version 13 December 10 2008 Version

D Impact Justification and Mitigation
1 Avoidance and Minimization
1a Specifically describe measures taken to avoid or minimize the proposed impacts in designing project
Thy m }nimum siz foot r�nti for the ro osed dwellin will be located as close to the ft
1b Spec cally describe measures taken to avoid or minimize the proposed impacts through construction tachrn ues
The use of wooden decks & minimum width walks and drives Pervious concrete if needed
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, nvhgation is required by (check all that apply)
❑ DWQ ❑ Corps
2c If yes which mitigation option will be used for this
project?
❑ Mibgabon bank
❑ payment to in lieu fee program
❑ Permittee Responsible Mitigation
3 Complete if Using a Mitigation Bank N A
3a Name of Mitgabon Bank
3b Credits Purchased (attach receipt and letter)
Type
Quantity
3c Comments
4 Complete if Making a Payment to In -lieu Fee Program N A
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 Ripanan 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 Pennittee Responsible Mitigation Plan N A
5a If using a permittee responsible mitigation plan provide a description of the proposed mitigation plan
* structural integrity of the dwelling
Page 6 of 10
PCN Form — Version 13 December 10 2008 Version
ont
they

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
15
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 13 December 10 2008 Version

E
Stormwater Management and Diffuse Flow Plan (required by DWQ)
1
Diffuse Flow Plan
1a
Does the project include or is it adjacent to protected riparian buffers identified
within one of the NC Riparian Buffer Protection Rules?
❑ Yes ® No
lb
If yes then is a diffuse flow plan included? If no explain why
Comments
❑ Yes ❑ No
2
Stonrnvater Management Plan
2a
What is the overall percent imperviousness of this project?
25%
2b
Does this project require a Stormwater Management Plan?
❑ Yes ® No
2c
The
ermi�ojegiQ,OEp MOTs reu�r�e �etormyvater Management Plan explain why the
tai 1 d disturbanc s
�iresho�� requirement or
2d
If this project DOES require a Stormwater Management Plan then provide a brief narrative description of the plan
2e
Who will be responsible for the review of the Stormwater Management Plan?
❑ Certified Local Government
❑ DWQ Stormwater Program
❑ DWQ 401 Unit
3
Certified Local Government Stormwater Review N A
3a
In which local government s jurisdiction is this project?
3b
Which of the following locally implemented stormwater management programs
apply (check all that apply)
❑ Phase 11
❑ NSW
❑ USMP
❑ Water Supply Watershed
❑ Other
3c Has the approved Stormwater Management Plan with proof of approval been
attached?
❑ Yes ❑ No
4
DWQ Stormwater Program Review
4a
Which of the following state - implemented stormwater management programs apply
(check all that apply)
® Coastal counties
❑ 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 N A
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 13 December 10 2008 Version
eloG
a

F Supplementary Information
1 Environmental Documentation (DWQ Requirement)
1a Does the project involve an expenditure of public (federal/state/local) funds or the
0 Yes ® No
use of public (federal/state) land?
1b 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)?
1c 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 ® No
or Riparian Buffer Rules (15A NCAC 26 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 The City of New Bern Sanitary Sewer
Service is available for tapping to serve all lots in the subdivision
Page 9of10
PCN Form — Version 13 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?
® Raleigh
5c If yes indicate the USFWS Field Office you have contacted
El Asheville
5d What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
USFWS review prior to subdivision approval
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?
Maps show that the site does not have or border any water areas
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
El 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?
Site review prior to subdivision approval
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? FEMA Flood Map No 3720640400J,dated07
72./,9 /,,F�
Lonnie E Pridgen, Jr
Applicant/Agenrs Printed Name
Applicant/Agent's Signatu
(Agent's signature is valid only if an authorization letter from the applicant
Date
is provided
Page 10 of 10
PCN Form — Version 13 December 10 2008 Version
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