HomeMy WebLinkAbout20120563 Ver 1_401 Application_201206121
f CONSULTING, PA
7332 Cotesworth Dnve
D Wilmington NC 28405
(910) 619 9990
PLANNING ENGINEERING PROJECT MANAGEMENT
May 31 2012
NC DWQ 401 /Wetland Unit
1650 Mad Service Center
Raleigh NC 27699 -1650
RE 401 Certification Application
Coxs Ferry Boating Access Area
Boat Ramp Repair
Wayne County NC
Dear Sirs
I am respectfully submitting the above mentioned project for 401 certification On
May 22 20121 met with representatives with DWQ (Roberto Scheller) and USACOE
(William Wescott) to discuss this project and the related permitting requirements
Based on this meeting I am offering the following
a Project Narrative - attached
b Set of plans for the project- (C 1 C2 & C3) (5 full size sets)
c The application fee has been electronically transferred in the state system
Documentation of that fee transfer is attached
d 5 sets of the PCN for the project
e An agent authorization form
I trust that the attached information is sufficient for DWQ to review and issue a
permit on this project Should you have any questions please do not hesitate to call
Sincerely yours
< A
Bradford Sedgwick PE
President
f CONSULTING, PA
D 7332 Cotesworth Dnve
ti Wilmington NC 28405
(910) 619 9990
PLANNING ENGINEERING PROJECT MANAGEMENT
May 31 2012
Coxs Ferry Boating Access Area
Ramp Repair and ADA Access
North Carolina Wildlife Resources Commission owns a 7 05 acre tract of land located
at 1048 Coxs Ferry Road In Princeton NC (Wayne County) The property currently
supports a single 12 wide boat ramp and a gravel parking area The ramp Is In very
poor shape and access to the water /ramp are not ADA compliant
At this time the property owner /operator (North Carolina Wildlife Resources
Commission) wish to replace the aged concrete boat ramp with a new 14 wide
ramp provide a floating dock an ADA compliant approach and provide a parking
spot for a handicap vehicle pulling a boat trader
The sequence of construction shall be as follows
1 Mobilize to the site
2 Remove existing ramp using front end loader Ramp will be removed In as large of
pieces as possible as not to disturbed surrounding areas
3 After ramp Is removed from the water It will be broken Into pieces loaded In
dump trucks and transported to a predetermined area of the Holly Shelter Games
Lands (Owner held property)
4 After removal of ramp the footprint of the ramp will be excavated deep enough
to achieve the proper grade ( +/- 2 125 feet deep from top of existing ramp)
5 After excavation of ramp footprint 18 layer of stone (see sheet C3 - Push Slab
Design detail
6 During the excavation process a section of the push slab wIi cc o —ea ana
poured on high ground In line with the ramp area Once curea the slab wlli be
Nu hind in "n place with a tfack hoe along the top of the gravel This proce.'s wi
occu, until the last push slab is in place (See plans for limit between push slab and
poured In place portion of the ramp)
7 Once push slabs have been put Into place the remainder of the ramp will be
c, rued and poured Into place
8 At +'^e completion of the ramp construction the floating dock abutment the ADA
s uewulk and ADA purKing spot ml be iorrnec, uri.., pouiu,.l u , e �, „ „ ,
9 After the proper cure time of the abutr -nent the f'oa' ng doc' zec{ o-
b o�gh+ onto +he site and anchored into place (Tne docK secs.,
e'.,e ,"ere ,n +1'e #ciel
10 After the above activity shore ,+ab I za+ or fu +e rna11 " be
p oject cleaned up
All work on this project will occur in the existing footprint of the site
SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION
LOT NO PLAN NO PARCEL ID Coxs Ferry Boating Access Area
STREET ADDRESS 1046 Ferry Bridge Road Princeton NC 27569
Please print
Property Owner North Carolina Wildlife Resources Commission
Property Owner
The undersigned registered property owners of the above noted property, do hereby authorize
Brad Sedgwick PE of JBS Consulting PA
(Contractor / Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing Issuance and acceptance of
this permit or certification and any and all standard and special conditions attached
Property Owner s Address (if different than property above)
Telephone (919) 707 -0150
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge
0
4
Authorized Signature Authorized Signature
r
Date May 24 2012 Date 4
O�0� W A 94
20120563
Office Use Only
Corps action ID no
DWQ project no
Form Version 13 Dec 10 2008
�c Responsible Far-1V 4iUt i`L-C it Afia,y s,yr, u rE
app,,%,ause} l i
j 3d St Pe add ecs ! 1 -72EE Mail C' r ira rentp
�C C t, -Z ofio y P3 a g !" .. 2''r 9 1'2^ f
i v Z
i 3f Telepttone no i 919L733-3155
3g Fax no � 919 -707 1720 j
13h Email address mark hamlett0ne ildlife orq
Paoe I of !
F-Cim Folini — veismi 1 3 Dectemnbei tU 2008 vCrbion
Pre - Construction Notification PC Form
A. Appheant Information
1
Processing
flo
la
Type(s) of approval sought from the
Corps
❑Section 404 Permit ®Section 10 Permit
_PV_
lb Specify Nationwide Permit (NWP) number 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 Junsdicbonal General Permit
❑ 401 Water Quality Certification - Express ❑ Riparian Buffer Authorization
le
Is this notification solely for the record For the record only for DWQ 401 i For the record only for Corps Permit
`-_
because written approval is not required" C_ --
® Yes ❑ No ® Yes
❑ No �
If
Is payment into a mitigation bank or in -lieu fee program proposed for mitigation
❑ Yes
® No
of impacts? if so attach the acceptance letter from mitigation bank or in -lieu
fee program
1g
Is the project located in any of NC s twenty coastal counties if yes answer 1h
❑ Yes
® No
below
1h
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
® No
2
Project Information
2a
Name of project
Cox Ferry Boating Access Area Ramp Repair and ADA Access
{ 2b
County
Wayne
21r
Ca CJt mites L Pa y av-- i %.3 Liu u
l
2d
Subdivision name NIA
F
2e
NCDOT only T I P or state NIA -- - - - -- -- - -
- -- -- --
project no
3
Owner Information
��
3a
Name(s) on Recorded Deed
State of North Carolina
30
D� 6v�h a� a Page ��u ; Dutd Bv1R i5o Page 435 N
,. ►
�c Responsible Far-1V 4iUt i`L-C it Afia,y s,yr, u rE
app,,%,ause} l i
j 3d St Pe add ecs ! 1 -72EE Mail C' r ira rentp
�C C t, -Z ofio y P3 a g !" .. 2''r 9 1'2^ f
i v Z
i 3f Telepttone no i 919L733-3155
3g Fax no � 919 -707 1720 j
13h Email address mark hamlett0ne ildlife orq
Paoe I of !
F-Cim Folini — veismi 1 3 Dectemnbei tU 2008 vCrbion
�, ,�''
i �� i
4� ��
4
Applican *'nforration
(if d Iferent fro— o.ane )
4a
Applicant is
❑ Agent ❑ Other specify
4b
Narne
4c
Business name
(if applicable)
4d
Street address
4e
Cily state zip
4f
Telephone no
j
4g
Fax no
4h
Email address
5
Agent(Corlsultarit information ff applicablell
5a
Name
Brad Sedgwick PE
5b
Business name
(if applicable)
j5S Conbulling Pm
5c
St eet add ess
71,32 Co+est orth D^ e
5d
City state zip
WilmingLon NC 28405
5e
Telephone no
i gi0 -619 9944 !
� a
' r !
i 51 FiAf U i vwA
i
! 5g Email address i bradsedg%mck@hotmail com
pzno 7 of 11
PCN Form — Version 1 3 December 10 2008 Version
B
Project Information and Prior Project History
Yes ®ivo ❑ unKnown
7
Property Identification
i i
1a
Property identification no (tax PIN or parcel ID)
2558752659
lb
Site coordinates (in decimal degrees)
Latitude 35 356667 Longitude
78136667
(DD DDDDDD) ( DD DDDDDD)
1 c
Property size
7 05 acres
2
Surface Waters
Agency /Consultant Company
1
2a
Name of nearest body of water (stream river etc) to
proposed project
Neuse River
2b
Water Quality Classification of nearest receiving water
WS-ry rdSvv
1 2c
River basin
Neuse River f
€ .mss
� esjcs.s Lve;.'aes gs v-
i
3a
Descrbe •t'e ex s.^g cond €e€o ^s on the site ano the genera€ land use n the v icinity of the Dro €ect at tree urne o, this €
€ app ca c-
€
€ Cite c �n ov of nn_ hn?t nn !:ir -ecc o e7 nth on ovnefinn a r+n {a :na+ an�i ncenr ntlmri ri = ni -mrk r..v+ C rr n-r nn
S nenera hr wnruted trar-ts f €
1—
€ ...✓ � o e is 6 cS a ees ac; cagc is a cF.S4i`C c GT iI5 V "'c � isisc'"
E MIA
v a esu—a cu -ea lee is a cn G.-g str ea - s a-a PC ore, }. v¢.: y f
€ €
f ora c.,ns., „ at,.. n .. _ ..� ♦s,,, .. n .,.,t ., ..a _ f
€ Rvu aL a ngec nua rap- o oriel orovioe r or ❑c.;i34 adrx nq dna dccess [o me nver OY rnedns or access smewdik and froatino
docx
€ .., esBSii ✓., cis e a Fs 0l0c e... se "Gu.. ^y fle ypsc C eyes p —,e es ase es$ces €
a ur`'''n fjEirr 'v %-ate3r A anzer w nes _-F+:t V PL .Fl Inat are PiDift:3 Can nrt115 €
1 ___ .__ �.0 �._ f_ I _ .1��LS _ Z
it Pc€ 3.t cv1 –a J f-i Ulu €J—iff Zic J ., ie`c.F v� _ i1T U' Gu –U V Z rw et v a rar=v
T un r r�nn n a.r•n n �niv �. r �.•m rr`. reran nn nrae. n nn
6 4-nine nr C vnTA ncnn —r11 �s1G�rA� �r r\r�raf• ...
P-n3 7 ^f i
PCN Form — Version 1 3 December 10 2008 Version
protect (mctudinq au prior vnases) in the past?
Yes ®ivo ❑ unKnown
Comments Proleet involvez the replacement of an existing
i i
boat ramp No wetland impacts expected
4b
If the Corps made the jurisd ctionai cteterm €nation what type
El Preliminary ❑ Final
1
of determination was rnadv'
1
4c
If yes who delineated the jurisdictional areas?
Agency /Consultant Company
1
Name (if known)
Other i
4d
i
If yes list the dates of the Corps jursdretiona' determ €natio ^s or State deferrr nations a ^d a "ach docurrertation
1
j 5
Project History
i 5a
I
Haire permits or certifications been requested or obtained fo
this protect (including all prior phases) n tl�,e past' j ❑ Yes ❑ No ® Unknown
50
if yes expiain in oetai€ according to help rile instructions
F
I
€
P-n3 7 ^f i
PCN Form — Version 1 3 December 10 2008 Version
6 Future Project Plans
6a is this a phased project? ❑ Yes ® No
6b if yes explain
Page 4 of 11
PCN Form — Version 1 3 December 10 2008 Version
C Proposed Impacts Inventory
1 question for all stream sites Imoa,• ^'?
1 Impacts Summary
❑ Corps
1 a Which sections were completed below for your project
(check all that apply)
❑ Wetlands ❑ Streams tributaries
❑ Buffers
i �''Qr�i�['1d�4
❑ Open Waters ❑ Pond Construction
�VfS q,-
I IMDclCt
2 Wetland Impacts
i i PER i or
i}
r`nmg AU_ 11-1
If there are wetland impacts proposed on the site then complete this question
for each wetland area impacted
2a 20 2c
2d
2e 2f
vdeudno impact (
'
Type of juribuic,tion
nurnbe.l - i yPe Ol illipcitA Type ui wedand Forested
r -nr,s 404 10 Area of impair
i Permanent (P) of (if mown)
S3 ❑ P ❑ T
! I
DvvQ — vie �- tit
° Tempo ar T i
i
,
W1 [I P [IT
❑ Yes
El Corps
❑ DWQ
S4 ❑ P ❑ T
❑ No
❑ DWQ
❑ Corps
W2 ❑ P ❑ T
❑ Yes
❑ Corps
❑ DWQ
S5 ❑ P [IT
❑ No
❑ DWQ
❑ Corps
W3 ❑ P [IT
❑ Yes
❑ Corps
❑ DWQ
S6 ❑ P ❑ T
❑ No
❑ DWQ
❑ Corps
W4 ❑ P ❑ T
❑ Yes
❑ Corps
❑ DWQ
31L Total stream and tributary impacts
0
❑ No
❑ DWQ
W5 ❑ P [IT
❑ Yes
[I Corps
❑ No
❑ DWQ
W6 ❑ P [IT
❑ Yes
❑ Corps
❑ No
❑ DWQ
2g Total wetland impacts
0
2h Comments No wetland impacts from this project Replacing exsibng ramp with a new ramp in same footprint
f3 Stream Impacts
u � i_� e _ „ c °• ••a!`r acicai!(!lCdilClL'� (9F`LlLLl((`� iC!(ii..'Llttt +y i'l� L �' il'VUU�CU U{" inC �FIC '{le[! S:U['ip{Cle ••7!S
1 question for all stream sites Imoa,• ^'?
❑ PER
❑ Corps
art 13e - -
-1 3t— -
� 3t3
T Pa{ii {Rfi[i.^_g('€ ! kp_g C` F€F'rFaf'F f y F €" `l i'Si'
i �''Qr�i�['1d�4
[ Vi3is of (64r[4!'{ i`tjlirF
�VfS q,-
I IMDclCt
i
filly i0eF i i
i i PER i or
i}
r`nmg AU_ 11-1
p[
9 stream-
1 length
Dermarent tPl or
i
I intermittent
f)
! DIA ' - nnn -AC-A
� width
a (i 'year
Temporary (T)
M
S3 ❑ P ❑ T
(INT)?
�nthPrl
(feet)
feet)
S1 ❑ P [IT
❑ PER
❑ Corps
❑ INT
❑ DWQ
S2 ❑ P [IT
❑ PER
❑ Corps
❑ INT
❑ DWQ
S3 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S4 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S5 ❑ P [IT
❑ PER
❑ Corps
❑ INT
❑ DWQ
S6 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
31L Total stream and tributary impacts
0
31 Comments No new stream impacts
Pa -e 5 OT 1
Pr"Uiv rul -ii i - vCibiuri 1 3 Decor ibei IU 2008 ve wo-,
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
4b
Name of waterbody
(if applicable)
4c
Type of impact
4d
Waterbody type
4e
Area of impact (acresl
01 ❑P ❑T
6c
6d
6e
6f
02 []P [IT
Buffer impact
03 ❑ PEI T
number —
Reason
04 ❑P ❑T
Zone 1 impact
Zone 2 impact
Permanent (P) or
for
4f Total open water impacts
0
4g Comments
5 Pond or Lake Construction
If pond or lake construction proposed then complete the chart below
5a
Pond ID
number
E
Pi
5b
Pr000sed use or ouroose
of pond
5c
Wetland Impacts (acres)
5d
Stream Impacts (feet)
5e
Upland
E (acres)
_
_ _ _ _
r _
Nuese River
® No
548
P2
B2 ❑P ❑T
❑Yes
51' Total
❑ No
B3 ❑P ❑T
❑Yes
5g Comments
5h Is a dam high hazard permit required
❑ Yes ❑ No If yes permit 1D no
51 Expected pond surface area (acres)
0
5) Size of pond watershed (acres)
0
5k Method of construction
0
V B..ffer Impacts (for DWQ)
o L em vii impact a protected riparian busier then complete the chart below it yes then individually +Est all buffer impacts
helo y if ar% — D--cfs ea e m t not on thap !o.! Jd.U! "I f i
6a
® d%cuba ❑ Tai Pat I111W ❑ voice
Project is in which protected basin?
❑ Catawba ❑ Randlerrar i
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
impact
required
61 ® P ❑ T
Ramp
Nuese River
® No
548
72
B2 ❑P ❑T
❑Yes
❑ No
B3 ❑P ❑T
❑Yes
❑ No
6h Total buffer impacts
61 Comments See plans for a total summary of BUA on the site
Page 6 of 11
PCN Form — 'veisiuni 3 Ni- ennit:ei EG 2008 version
D Impact Justification and Mitigation
1 Avoidance and Mimm¢abon
la Specifically describe measures taken to avoid or minimize the proposed impacts in designing project
Project was sited in the existing footprint of the existing boat ramp and access art-a
1b Specifically describe measures taken io avoid or min m ze the proposed impacts through construction techniques
nJA ftiininnzeo To meet: rieeus of puolic useage
}
f e �,u� tPe1-i°:atOT -Y t I InaTI i1" Lvi ire- 1paCTS t.o a WS Ot -e si v a M. € f fe .a asc
1 I
2a Does the project require Compensatory Mitigation for
impacts to Waters of the U S or Waters of the State?
I
+ El Yes ® No
2b If yes mibgabon is requuW by (check all that apply)
❑ DWQ ❑ Corps
2c If yes which mitigation option will be used for this
projects
❑ Mifigation bank
❑Payment to in -ilea 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 13 il"Fer Mitigation requested tDv%Q only)
square feet
4e Riparian wetland mitigation requested
acres
AF Aron -agan vetland nitigat on regLester'
i
c7nz 6 .lt 1CT i T 'ii,^.� V.. ?T :i ^!i CTi# i?_ 3tSTi r iii fiCLCR fit` isZ #
dh t`nmmenrc l
a L 9itplCtC s J$fig d r eltlei: Resp`rsILTL IIIC 9dt3 i P
tall i
5a If usi-ig a perm lee respor's ble — t# ation a- pro de a des: p . cl "'--^ cvvL " at plo-
g p F r� r :;}. .. yam..,, i.
i-age ! of If
PCKI Form — \lorsicr 2 oe.:e -ibei r =- versi_r
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 ❑ Yes ® No
buffer mitigation?
6b If yes then identrfy the square feet of impact to each zone of the riparian buffer that requires mitigation Calculate the 1
1 a- o int o rritigaLion requ red
- -- F6r - — - - -- I Rd
Zane Reason for impact { Total impact Multiplier I Required mitigation ( I (square feet) I I (square feet)
Zone 1 3 (2 for Catawba)
Zone 2 15
6f Total buffer mitigation required
6g if Duffer mitgation is regL red d sc ss L.;!!a4 type o, rnitigat o- s proposed =e g payment is p vale rri ga 0- bQ -n
pfe t uttee responsible riparian bufFe restorat,o^ payment P c an aD,, v °d , et ¢°
r
t
1 6h f nmmen*S
Dzyy � C
PCv,i Futiii — vwtaut 1 3 Dmwiiuvi tv 200o vutaturt
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 npanan buffers identified
❑ Yes ❑ No
within one of the NC Mpanan Buffer Protection Rules?
1b
If yes then is a diffuse flow plan included? If no explain why
❑Yes No
❑
Comments
2
Storrs water Management Plan
2a
What is the overall percent imperviousness of this project?
61%
2b
Does this project require a Stormwater Management Plan?
❑ Yes ® No
2c
If this project DOES NOT require a Stormwater Management Plan explain why Entire BUA (exst^g and vr000sed Belo i
247 of ine tact)
2d
if Lk s p ;-,' DOES require a Stormwater Management Plan then provide a bnef narrative descnptior• of the plan
i
i
❑ Certified Local Government
2e
Who will be responsible for the review of the Stormwater Management Plan?
i ❑ DWQ Stormwater Program i
❑ DWQ 401 Unit i
3
Certified Local Government Stormwater Review
3a
In which local government s jurisdiction is this project?
i
❑ Phase II
3b
Which of the following malty 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 Prog in 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 appropnate requirements?
❑ Yes ❑ No
5b Have all of the 401 Unit submittal requirements been met?
❑ Yes ❑ No
Page 9 of 11
PCN Form - Version 13 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
en sronmental 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 amen a copy or me 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 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 Req. nee —o"I
y
3a
Mill this project (based on past and reasonably anbc1pated future impacts) result in
❑ Yes ® No
additional development which could impact nearby downstream water oua! t,
l
p a - -tv t=u yes Lu trie above suomit a quainative or quantitative cumulative Impact analysis to accordance with the
s — t Pr.Pnt lib 0 r -t r. � si ;� �,�rFre� -G � vvl � ce ai ry t F lal vat ire fez) s ✓t vii
1 4 Sewage Disaosai tDWQ Requirement)
4a Clearly detail the ultimate treatment methods and disoosition (non- discharge or discharge) of wastewater generated from
the oroaosed oroiect or available caaacity of the subiect facilitvv
Kfo can a s ?..c —, ties a e nr,., cea n n s r lecT
PdgU I V UT ! 1
PLrt Form — Version 1 3 Decemt)er 10 2008 Ve,!.iun
&
Endangered Species and Designated Critical Habitat (Corps Requirement)
8b If yes explain how project meets FEMA requirements Water access project
5a
Will this project occur in or near an area with federally protected species or
❑ Yes
® No
Applican Agen s Signature
(Agents signature is valid only if an authorization letter from the applicant
LS provided
habitat?
5b
Have you checked with the USFWS concerning Endangered Species Act
Yes
®No
impacts
5c
if yes indicate the USFWS Field Office you have contacted
❑ Raleigh
❑ Asheville
5d
What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
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?
N/A
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)?
f 71n
t/1 fL...i .i..i.. ......���_ J_J ..___ ..__ a_ J_a_ _.__ . •• _ _ _ _
i
., —2 gel uGIG .AUUlf -=N Ulu VOU USti to uerermine wneIner vour sire wnUia imr%act niStonc or archeological resources?
i
1 NSA
8 Flood Zone Designation (Corps Requirements
8a Will this project occur in a FEMA- designated 100 -year floodplain? ® Yes ❑ No !
8b If yes explain how project meets FEMA requirements Water access project
8c What source(s) did you use to make the floodplain determination? FIRM Map
Brad Sedg%vick, APE
Applicant/Agent's Pnnted Name
Date
Applican Agen s Signature
(Agents signature is valid only if an authorization letter from the applicant
LS provided
rage i i of e i
PCN Form — Version 13 December 10 2008 Version