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Home My WebLink About20120215 Ver 1_401 Application_2012021220 1202 15 CITY OF MOUNT AIRY E N G I N E E R I N G D I V I S I O N Post Office Box 70 Mount Airy North Carolina 27030 Phone 336 786 3580 Fax 336 719 7540 www mountairy org February 20 2012 NC DENR Division of Water Quality Wetland / 401 Unit 2321 Crabtree Blvd Ste 250 Raleigh NC 27604 2260 RE 401 Water Certification To Whom It May Concern mwilliams @mountairy org COURTESY cOpY Please find enclosed a copy of the PCN Form for a proposed sewer line project in Mount Airy NC If you need additional information please let me know Respectfully Mitchell R Williams P E City Engineer enc FES 2 7 2012 wS71AN5'*DSTORMWA TE BRANCH O�pF WATF9QG r `-i O Y 20120215 Office Use Only Corps action ID no DWQ project no Form Version 1 3 Dec 10 2008 Page 1 of 10 PCN Form — Version 1 3 December 10 2008 Version Pre Construction Notification (PCN) Form A Applicant Information COURTEST 1 Processing 1 a Type(s) of approval sought from the Corps ®Section 404 Permit E] Section 10 Permit 1b Specify Nationwide Permit (NWP) number 12 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 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 1 g Is the project located in any of NC s twenty coastal counties If yes answer 1 h below ❑ Yes ® No 1h Is the project located within a NC DCM Area of Environmental Concern (AEC)? ❑ Yes ® No 2 Project Information 2a Name of project Veterans Park Sewer Line Extension 2b County Surry 2c Nearest municipality / town Mount Airy 2d Subdivision name N/A 2e NCDOT only T I P or state project no N/A 3 Owner Information 3a Name(s) on Recorded Deed City of Mount Airy nn 3b Deed Book and Page No N/A 3c a Responsible le Parry (for LLC if PP Barbara Jones City Manager FEg 2 7 201 3d Street address PO Box 70 DENR WAT 3e City state zip Mount Airy NC 27030 1i AND STORINATERBRANCH 3 Telephone no 336 786 3501 3g Fax no 336 7197506 3h Email address bajones @ mountairy org 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 4c Business name (if applicable) 4d Street address 4e City state zip 4f Telephone no 4g Fax no 4h Email address 5 Agent/Consultant Information (if applicable) 5a Name Mitch Williams PE 5b Business name (if applicable) City of Mount Airy Engineering Department 5c Street address PO Box 70 5d City state zip Mount Airy NC 27030 5e Telephone no 3367863580 5f Fax no 3367197540 5g Email address mwilliams @mountairy org Page 2 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) 5020 06 36 4254 1 b Site coordinates (in decimal degrees) Latitude 36 5125 Longitude 806206 (DD DDDDDD) ( DD DDDDDD) 1c Property size 29 acres 2 Surface Waters 2a Name of nearest body of water (stream river etc ) to proposed project Lovill Creek 2b Water Quality Classification of nearest receiving water Class C 2c River basin Yadkin 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 Wooded flood plain adjacent to Lovill Creek Adjoining parcels are commercial /industrial /institutional 3b List the total estimated acreage of all existing wetlands on the property 05 3c List the total estimated linear feet of all existing streams (intermittent and perennial) on the property 2000 3d Explain the purpose of the proposed project Sewer line extension camp sites and public restroomas at Veterans Memorial Park 3e Describe the overall project in detail including the type of equipment to be used Project includes the installation of approximately 700 feet of sewer line Sewer line will be installed by trench excavation 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 pasty Comments El Yes ®No El Unknown 4b If the Corps made the jurisdictional determination what type of determination was made? ❑ Preliminary ❑ Final 4c If yes who delineated the jurisdictional areas? Name (if known) Agency /Consultant Company 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 this project (including all prior phases) in the pasty ❑ Yes ® No ❑ Unknown 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 la 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 Possible Wetland ® Yes ❑ Corps 10 Excavation ❑ 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 10 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)2 other) (feet) feet) S1 ❑ P ❑ T ❑ PER ❑ Corps ❑ 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 31 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 6 Buffer Impacts (for DWQ) 02 ❑P below If any impacts require mitigation then you MUST fill out Section D of this form 6a 03 ❑P Project is in which protected basing ❑ Catawba ❑ Randleman 6b 04 ❑P ❑T 6d 6e 6f 4f Total open water impacts Buffer impact 4g Comments 5 Pond or Lake Construction If pond or lake construction proposed then complete the chart below 5a Pond ID number 5b Proposed use or purpose of pond 5c Wetland Impacts (acres) 5d Stream Impacts (feet) 5e Upland (acres) Flooded Filled Excavated Flooded Filled Excavated Flooded P1 Stream name mitigation (square feet) (square feet) Temporary T impact P2 B1 ❑P ❑T El Yes 5f Total ❑ No 5g Comments 5h Is a dam high hazard permit required? 51 Expected pond surface area (acres) 51 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 any impacts require mitigation then you MUST fill out Section D of this form 6a ❑ Neuse ❑ Tar Pamlico ❑ Other Project is in which protected basing ❑ 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 ❑T El Yes ❑ No B2 ❑P ❑T El Yes ❑ No B3 ❑P ❑T El Yes ❑ No 6h Total buffer impacts 61 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 1 b Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques 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 nutigation is required by (check all that apply) ❑ DWQ ❑ Corps 2c If yes which mitigation option will be used for this project ❑ Mitigation bank ❑ Payment to in lieu fee program ❑ Permittee Responsible Mitigation 3 Complete if Using a Mitigation Bank 3a Name of Mitigation Bank 3b Credits Purchased (attach receipt and letter) Type Quantity 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 Page 6 of 10 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 buffer mitigation9 ❑ Yes Z 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 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 la Does the project include or is it adjacent to protected riparian buffers identified ❑ Yes ® No within one of the NC Riparian Buffer Protection Rules? lb 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? 0 /o J 2b Does this project require a Stormwater Management Plan? ❑ Yes ❑ No 2c If this project DOES NOT require a Stormwater Management Plan explain why The project involves sewer lines installed below grade so there will be no impact to stormwater volume Short term impacts due to construction disturbance to be addressed by implementation of an E& S Control Plan 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 governments 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) la Does the project involve an expenditure of public (federal /state /local) funds or the ® Yes ❑ No use of public (federal /state) land? lb 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 213 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 All sewer will be treated at the City of Mount Airy WWTP NC 0021121 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 El Yes ® No habitat' 5b Have you checked with the USFWS concerning Endangered Species Act El Yes ® No impacts'? 5c If yes indicate the USFWS Field Office you have contacted El Raleigh ❑ Asheville 5d What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat? NCDENR Office of Conservation Planning and Community Affairs Interactive Mapper 6 Essential Fish Habitat (Corps Requirement) 6a Will this project occur in or near an area designated as essential fish habitats Yes ® No 6b What data sources did you use to determine whether your site would impact Essential Fish Habitat? NOAA Web Page for Essential Fish Habitat Mapper 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 USACE link to NC State Historic Preservation Office 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 No fill placed within floodway /floodplain 8c What source(s) did you use to make the floodplam determination? NC Floodplam Mapping A- 3m6 —s- Z1j7 /20 z Applicant/Agent s Printed Name Applicant/Age s Signature Date (Agent s 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 >- •. - - y t -;� � � • °' - !'��"punt'r'fC'I °ub'Ku'- ,.. -,. .T •,. � . -. ..�- n.� {, Vii., ,�.� �. ., � `"•. �+ - 4 � 1. ale 5� !(GRn }PVC ve. go G} Hayr� Op I Mc gn ir k -.• g ma S T �+ Mlt Ai ry . « p de- ♦ A , �� . A \� ��, � j, 4 Tecn nalogies 36',30'30.57' N 80'36�58I36" W ele'v 1056 It Eye all ! 11'5�4$t`-e- I�a 04 cm z 4 � 0 z 09 n D� O� D�o MM� 111 z z 0 N \\ o I � s io E O :a � 0' jfi' J/ i/. Veo o �� /y �/a / ill �• —• � !• ^I VSO Veo o �� /y z ill �• —• � PHOTOGRAPHS Looking toward beginning of project Looking toward Lovill Creek Looking toward Veterans Park