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Home My WebLink About20120409 Ver 1_Application_20120424�-� 60 5 0fWATF9 FM�? r 0 � �r v4 �►� 2L 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 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 3 or General Permit (GP) number 1 c 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 1g 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 Maintenance activity at pipe structure conveying UT to Harris Creek on SR 2929 (Peebles Road) in Wake County 2b County Wake 2c Nearest municipality / town Rolesville 2d Subdivision name 2e NCDOT only T I P or state project no 3 Owner Information 3a Name(s) on Recorded Deed NCDOT 3b Deed Book and Page No 3c Responsible Party (for LLC if applicable) 3d Street address 3e City state zip 3f Telephone no 3g Fax no 3h Email address Page 1 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 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 ❑P ❑T 04 ❑P ❑T 417 Total open water impacts 00 4g Comments 5 Pond or Lake Construction If pond or lake construction proposed then 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 517 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) 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 El Tar Pamlico El 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? 61 ®P ❑ T Stabilize UT to Harris Creek ® Yes s 2 000 sf F-1 Yes B2 ❑P ❑T ❑ No B3 ❑P ❑T ❑Yes ❑ No 6h Total buffer impacts 2 000 sf 61 Comments Buffer impact is only for constuction access Linear impact to buffer is 36 linear feet Page 5 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 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 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 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 ❑ Yes No Comments Project serves to stabilize fill slope and re attach pipe segment 2 Stormwater Management Plan 2a What is the overall percent imperviousness of this project? 0% 2b Does this project require a Stormwater Management Plan? ❑ Yes ® No 2c If this project DOES NOT require a Stormwater Management Plan explain why Impacts are only to stabilize fill slope re attach pipe segment and install rip rap streambank protection 2d If this project DOES require a Stormwater Management Plan then provide a brief narrative description of the plan Construction of this project WILL NOT add any additional impervioius surface at the project ❑ 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? N/A ❑ 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 ❑ 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 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 ❑ Yes ❑ No letter ) 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 Project will not generate sewage disposal Page 9 of 10 PCN Form — Version 1 3 December 10 2008 Version r 1 +S r V - • • 1 , >V -'r Z- N oNa � TCunjQ .- Fac�� }� 1-x,5t Try �ac l r / 6/_ � r l� � 11.1 � a %' �j ° � �1 � '�`'�f � `� /f�`�s+r� � � �� - � \ �� Ej / r`� ) -i' )/(� �' tytrCaty\arrl( ��yC�� \� ✓�r+,v�(rF t Ilyd t TC emh i�� ft -- - r� 1r �t i t r� � �`, C `~`� I` `x �� / \�•"`I „` t��-'' 1: 21 fh� k,-,t ✓f % -- rA 111 irt�tw� �s --`l i .Jr/ ~�Ir� k�' �\� i 1i 147 1 � 1 7, ... / v4 `� 1 t ' ti 1 '4' "�- .- ._..�'t �' � ,� '��t t •,, vv`��i �1� t ti� r 1 � ��L /'" ti'"�1� ' f r r ^4 F � it ''�4�{ r� ��!� j” ) 4� \ �.� %�� 1� �i; �l v �c 7.�r 1 �� i `\ Cem } �� 'i.I/0'lo9 T �\,� ' \� t �.A '��/ \rte ]i�\ ♦ ! 1 ,R \ \� _.i +� /i / 1% 1 �t �\ �.. i. 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