20120653 Ver 1_More Info Received_20120712

Strickland, Bev
From:
Sent:
To:
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Attachments
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Mcmillan, Ian
Thursday, July 12, 2012 3:04 PM
Dennison, Laurie; Strickland, Bev
FW: PCN Page 1 revision
D00071212- 07122012124725. pdf
E -mail correspondence to and from this address may be subject to the
North Carolina Public Records La-,i- and may he disclosed to third parties.
From: sissonh(a)aol.com [mailto:sissonh(a)aol.com]
Sent: Thursday, July 12, 2012 12:56 PM
To: Mcmillan, Ian
Subject: PCN Page 1 revision
Ian,
See attached. Let me know if this is not what you want. m

Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.4 January 2009
Pre- Construction Notification (PCN) Form
A. Applicant Information
1. Processing
1a.. 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 verified by the Corps? .0 Yes ❑X No
1d. Type(s) of approval sought from the DWQ (check ali that apply):
❑ 401 Water Quality Certification — Regular ❑X 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 Certificatio0,:
For the record only for Corps Permit:
❑ Yes 0 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 ❑X No
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1h
below.
❑ Yes ❑X No
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes ❑X No
2. Project Information
2a. Name of project:
Little Dismal Restoration
2b. County:
Richmond
2c. Nearest municipality 1 town:
Dobbins Heights
2d. Subdivision name:
NA
2e. NCDOT only, T.I.P. or state project no:
NA
3. Owner Information
3a. Name(s) on Recorded Deed:
State of North Carolina, Wildlife Resources Commission
3b. Deed Book and Page No.
0,0
3c. Responsible Party (for LLC if
applicable):
NA
3d. Street address:
2995 N. US HWY 1
3e. City, state, zip:
Hoffman, NC 28347
3f. Telephone no.:
910- 281 -3917
3g. Fax no.:
910 -281 -4184
3h. Email address:
Mark.Hamlett @ncwildlifb.org
Page 1 of 10
PCN Form — Version 1.4 January 2009