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Home My WebLink About20120723 Ver 1_401 Application_2012071220120723 @McGM A S S O C I A T E S July 27 2012 Ms Annette Lucas PE IDENR ^ � �� North Carolina Department of l�•` Environment and Natural Resources Division of Water Quality L 3 0 2012 Wetlands and Stormwater Branch 512 N Salisbury St wATER QUAL,TY waW &anch Raleigh North Carolina 27604 RE Pre Construction Notification Application (PCN) 404/401 Village Point Lake Greenway Village of Clemmons Forsyth County North Carolinas II �7 Dear Ms Lucas On behalf of the Village of Clemmons we hereby make application for the proposed Greenway project at Village Point Lake Please find enclosed five (5) copies of the properly executed Preconstruction Notification five copies (5) of DWQ Stream Classification Map two (2) full size design plans three (3) reduced size (11 x 17) design plans and a check in the amount of $240 Also enclosed are two copies of the Stormwater Low Density Supplement the storm drainage areas maps are located in the plansets As always please do not hesitate to call with any questions or comments Sincerely Mc fA ill ASSOCIATES P A MI HAE J NORRIS ASLA Project Manager MJN cdb Enclosures cc Megan Ledbetter Planning Director Village of Clemmons E n g i n e e r i n g P l a n n i n g . F i n a n c e McGill Aso(, rate P A P O Box 1136 Hit koi t NC ?W3 1240 19th St Lane NW H1cAoi t NC 78601 Office 828 3?8 W4 Far 8?8 3?8 3870 2® 1 2072 3 Permit No (to be provided by DWQ) State of North Carolina Department of Environment and Natural Resources Division of Water Quality STORMWATER MANAGEMENT PERMIT APPLICATION FORM LOW DENSITY SUPPLEMENT This form may be photocopied for use as an original A low density project is one that meets the appropriate criteria for built upon area and transports stormwater runoff primarily through vegetated conveyances Low density projects should not have a discrete stormwater collection system as defined by 15A NCAC 2H 1002(18) Low density requirements and density factors can be found in Session Law 2008 211 15A NCAC 2H 1000 Session Law 2006 246 and the DWQ BMP Manual Curb and gutter systems are allowed provided they meet the requirements in 15A NCAC 2H 1008(g) PROJECT INFORMATION Project Name Village Point Lake GreenwaVillage of Clemmons Contact Person Mike Norris Phone Number ( 828 )328 2024 Number of Lots N/A Allowable Built Upon Area (BUA) Per Lot* Number of Dwelling Units Per Acre* Low Density Development (check one) ® without curb & gutter ❑ with curb & gutter outlets to (check one) ❑ Swales ❑ Vegetated Area *If lot sizes are not uniform, attach a table indicating the number of lots, lot sizes and allowable built upon area for each lot The attachment must include the protect name phase, page numbers and provide area subtotals and totals BUA shall be shown in units of square feet * *(Phase II Post Construction (non SA) only) II BUILT UPON AREA Refer to DWQ s forms and applications websrte for specific language that must be recorded in the deed restrictions for all subdivided projects (http //h2o enr state nc us /su/bmp_forms htm) Complete the following calculation in the space provided below where SA Site Area the total project area above Mean High Water DF Density Factor the appropriate percent built upon area divided by 100 JUG 3 0 20, RA Road Area the total impervious surface occupied by roadways dv NR wd� OA Other Area the total area of impervious surfaces such as clubhouses, tennis No of Lots the total number of lots in the subdivision BUA per Lot the computed allowable built upon area for each lot including driveways and impervious surfaces located between the front lot line and the edge of pavement Total allowable lot BUA the computed allowable built upon area for all lots combined Total BUA from lot listing the sum of built upon area allocated for each lot on the list of non - uniform lots Form SW401 Low Density Rev 3 2/10/09 Page 1 of 4 Calculation For uniform lot sizes (SA ft2 x DF ) — (RA ft2 )-(OA ft2) = BUA per Lot = ft2 (No of Lots ) For non - uniform lot sizes a (SA ft2 x DF ) — (RA ft2) — (OA ft2) = Total allowable lot BUA = ft2 b Total BUA from lot listing sf b must be :5 a III DESIGN INFORMATION Complete the following table If additional space is needed the information should be provided in the same format as Table 1 and attached to this form Rainfall intensity data can be found in Appendix 8 03 of the State of North Carolina Erosion and Sediment Control Planning and Design Manual or at http //hdsc nws noaa gov/hdsc /pfds/ Table 1 Swale design information based on the 10 -vear storm Swale No Drainage Area ac Impervious Area ac Grassed Area (ac) C Q (cfs) Slope %) Vallow (fps) Vactual (fps) Flow Depth (ft) 1 6 0 6 3 13 225 55 26 41 2 4 0 4 3 9 5 55 31 30 3 sheet flom 3 sheet flo 4 10 0 10 3 21 150 55 25 53 5 10 0 10 3 21 200 55 28 50 6 4 0 4 3 10 300 55 5 78 7 16 0 16 3 33 100 55 24 68 8 9 10 11 12 13 14 15 16 17 18 19 20 Form SW401 Low Density Rev 3 2/10/09 Page 2 of 4 IV REQUIRED ITEMS CHECKLIST The following checklist outlines design requirements per the North Carolina Administrative Code Section 15A NCAC 211 1000, NCDENR BMP Manual (2007), Session Law 2006 246, and Session Law 2008 211 Please indicate the page or plan sheet numbers where the supporting documentation can be found An incomplete submittal package will result in a request for additional information This will delay final review and approval of the project Initial in the space provided to indicate that the following requirements have been met and supporting documentation is provided as necessary If the applicant has designated an agent on the Stormwater Management Permit Application Form the agent may initial below If any item is not met, then justification must be attached Only complete items n through p for projects with curb outlets Page/Plan Initials Sheet No N/A a tFor projects in the 20 coastal counties Per NCAC 2H 1005, a 50 foot wide vegetative buffer is provided adjacent to surface waters For Redevelopment projects a 30 wide vegetative buffer adjacent surface waters is provided N/A b tFor HQW or ORW projects outside the 20 coastal counties A 30 foot wide vegetative buffer is provided adjacent to surface waters e -10:k c t For Phase II Post Construction projects All built upon area is located at least 30 feet C 103 landward of all perennial and intermittent surface waters N/A d Deed restriction language as required on form SWU 101 shall be recorded as a restrictive covenant A copy of the recorded document shall be provided to DWQ within 30 days of P platting and prior to the sale of any lots -rK!s Al a Built upon area calculations are provided for the overall protect and all lots N/A f Project conforms to low density requirements within the ORW AEC (if applicable per 15A NCAC 2H 1007) a 1 g Side slopes of swales are no steeper than 3 1, or no steeper than 5 1 for curb outlet swales P a h Longitudinal slope of swales is no greater than 5% for non curb outlet projects, calculations 1 Th�3 Ap�O for shear stress and velocity are provided if slope is greater than 5% i At a minimum, swales are designed to carry the 10 year storm velocity at a non erosive rate N/A j Swales discharging to wetlands are designed to flow into and through the wetlands at a non C -501 erosive velocity (for this flow requirement into wetlands non erosive is velocity :5 2 ft/s) f� C -'50,)- k Swale detail and permanent vegetation is specified on the plans c- &2Z 1 Swale detail provided on plans includes grass type(s) for permanent vegetative cover 1' N/A m Swales are located in recorded drainage easements _ n tt Length of swale or vegetated area is at least 100 feet for each curb outlet o tt The system takes into account the run off at ultimate built out potential from all surfaces draining to the system (delineate drainage area for each swale) P tt Curb outlets direct flow to a swale or vegetated area t Protects in the Neuse, Tar Pamlico, Catawba River basms, and Randleman Lake may require additional buffers tt Only complete these items for protects with curb outlets Form SW401 Low Density Rev 3 2/10/09 Page 3 of 4 V �SWALE SYSTEM MAINTENANCE REQUIREMENTS Mowing will be accomplished as needed according to the season Grass height will not exceed six inches at any time and grass will not be mowed too close to the ground or scalped 2 Swales will be inspected monthly or after every runoff producing rainfall event for sediment build up erosion, and trash accumulation 3 Accumulated sediment and trash will be removed as necessary Swales will be reseeded or sodded following sediment removal 4 Eroded areas of the swales will be repaired and reseeded Swales will be revegetated as needed and in a timely manner based on the monthly inspections Side slopes must be maintained at the permitted slope 5 Catch basins curb cuts velocity reduction devices and piping will be inspected monthly or after every significant runoff producing rainfall event Trash and debris will be cleared away from grates, curb cuts, velocity reduction devices and piping 6 Swales will not be altered piped or filled in without approval from NCDENR Division of Water Quality I acknowledge and agree by my signature below that I am responsible for the performance of the six maintenance procedures listed above I agree to notify DWQ of any problems with the system or prior to any changes to the system or responsible party 9 uF VAG Print Name and Title LgM Kirby Director of Public Works J Address PO Box 1710 Clemmons North Carolina 27012 OR Phone 336 66 7511 Date Z �� 1VCOR886�T�' w Signature �, /Q�.� .. ,� Ek - RK`' O Note The legally responsible party should not be a homeowners association unless more than 50% of the lots have been sold and a resident of the subdivision has been named the president 1 4— A. F1 E E a Notary Public for the State of C County of F(p2Sj TIC do hereby certify that LR RAS [3 A`f Q F P-1 gy _personally appeared before me this day of ` (,«y 1 3 ao I a , and acknowledge the due execution of the forgoing swale maintenance requirements Witness my hand and official seal �� a)&" Notary signature PATRICIA A. FIFE LV My commission expires b (' Form SW401 Low Density Rev 3 2/10/09 Page 4 of 4 201 20723 \ot W ATE9 o� OG h > 1 o < Office Use Only Corps action ID no DWQ project no Form Version 13 Dec 10 2008 Page 1 of 11 PCN Form — Version 1 3 December 10 2008 Version Pre - Construction Notification PCN Form A Apphcant Information 1 Processing 1a Type(s) of approval sought from the Corps WW N Section 404 Permit El Section '10 Permit 1b Specify Nationwide Permit (NWP) number 42 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 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 Village Point Lake Greenway Village of Clemmons 2b County Forsyth 11k7 P% 2c Nearest municipality / town Village of Clemmons 2d Subdivision name 3 0 2012 2e NCDOT only T I P or state project no _ W�NR GV1-- ITY 3 Owner Information rand, 3a Name(s) on Recorded Deed Winston Salem /Forsyth County Board of Education The Village of Clemmons 3b Deed Book and Page No BK RE 3001 PG 3994 BK RE 3012 PG 1432 3c Responsible Party (for LLC if applicable) The Village of Clemmons 3d Street address 3715 Clemmons Road PO Box 1710 3e City state zip Clemmons North Carolina 27012 3f Telephone no (336) 766 7511 3g Fax no 3h Email address Ikirby @clemmons org Page 1 of 11 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 Mike Norris LSA 5b Business name (if applicable) McGill Associates 5c Street address 1240 19th Street Lane NW 5d City state zip Hickory NC 28601 5e Telephone no (828) 328 2024 5f Fax no (828) 328 3870 5g Email address mike norns @mcgdlengmeers com Page 2 of 11 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) 5883 73 3262 00 5883 83 7743 00 Latitude 36 032167 Longitude 1b Site coordinates (in decimal degrees) 80 392464 (DD DDDDDD) ( DD DDDDDD) 1c Property size 15 05 16 39 acres 2 Surface Waters 2a Name of nearest body of water (stream river etc ) to Village Point Lake proposed project 2b Water Quality Classification of nearest receiving water WS IV 2c River basin Yadkin River 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 Lake for the 7743 parcel School building parking and wet detention pond for 3262 parcel 3b List the total estimated acreage of all existing wetlands on the property 33 738 sf 3c List the total estimated linear feet of all existing streams (intermittent and perennial) on the property 496 Linear Feet 3d Explain the purpose of the proposed project 10 wide paved greenway trail including a bridge and boardwalks for public use 3e Describe the overall project in detail including the type of equipment to be used The project consists of the development of a 10 wide multi use greenway trail for public use The proposed paved greenway will be located along a portion of Village Point Lake The portion along the lake is approximately 2 600 If and will cross three (3) tributaries of the lake Two (2) of the crossings will be boardwalks and one will consist of a 10 wide bridge Minimal impact will be necessary in order to construct the greenway trail Anticpated equipment that will be used for the construction of the greenway will include bulldozer excavator dump truck compactor crane asphalt equipment 4 Jurisdictional Determinations 4a Have jurisdictional wetland or stream determinations by the Corps or State been requested or obtained for this property / ®Yes El No El Unknown project (including all prior phases) in the pasty Comments Wetland Delineation by private consultant ECS 4b If the Corps made the jurisdictional determination what type ❑ Preliminary El Final ry of determination was made? 4c If yes who delineated the jurisdictional areas? Agency /Consultant Company ECS Carolinas LLP Name (if known) ECS Carolinas LLP 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 ❑ Yes ® No ❑ Unknown this project (including all prior phases) in the past? 5b If yes explain in detail according to help file instructions Page 3 of 11 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 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 10 wide boardwalk El Yes El Corps 0156 ®No ❑DWQ greenway W2 ®P ❑ T 10 wide asphalt ❑ Yes ❑ Corps 0032 greenway ® No ❑ DWQ W3 ®P ❑ T 10 wide asphalt ❑ Yes ❑ Corps 0379 greenway ® No ❑ DWQ W4 ®P ❑ T 10 wide asphalt ❑ Yes ❑ Corps 0011 greenway ® No ❑ DWQ W5 ❑ P ❑ T ❑ Yes ❑ Corps El No El DWQ W6 ❑ P ❑ T ❑ Yes ❑ Corps ❑ No ❑ DWQ 2g Total wetland impacts 0578 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) other) (feet) feet) S1 ❑ P ®T pipe for temporary road crossing unnamed ® PER ❑ INT ® Corps ® DWQ unknown 10 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 10 31 Comments Page 5 of 11 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 4f Total open water impacts 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 I Filled I Excavated Flooded F Filled I 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) 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 Project is in which protected basin? 6b 6c 6d Buffer impact number — Reason Permanent (P) or for Temporary T impact 61 ❑P ❑T B2 ❑P ❑T B3 ❑ PEI T 61 Comments ❑ Neuse ❑ Tar Pamlico ❑ Other ❑ Catawba ❑ Randleman 6e I 6f I 6g Buffer Zone 1 impact Zone 2 impact Stream name mitigation (square feet) (square feet) required? ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No 6h Total buffer impacts Page 6 of 11 PCN Form — Version 1 3 December 10 2008 Version J D Impact Justification and Mitigation 1 Avoidance and Minimization 1a Specifically describe measures taken to avoid or minimize the proposed impacts in designing project The greenway has been designed to minimize any impacts along the project area The trail is located at areas the would result in the least distrubed areas Boardwalks and abridge are alos located in order to minimize impacts 1b Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques swales along the trail will be v shape and 2 1 to minimize width of clearing and slope impacts 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 mitigation 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 7 of 11 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 8 of 11 PCN Form — Version 1 3 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 ❑ 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 El No Comments 2 Stormwater Management Plan 2a What is the overall percent imperviousness of this project? 57% 2b Does this project require a Stormwater Management Plan? ® Yes ❑ No 2c If this project DOES NOT require a Stormwater Management Plan explain why 2d If this project DOES require a Stormwater Management Plan then provide a brief narrative description of the plan Low density Stormwater Project See attached Supplement ❑ 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? Clemmons (but public funds) ® 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 reviewed by State because public funded 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 9 of 11 PCN Form — Version 1 3 December 10 2008 Version F Supplementary Information 1 Environmental Documentation (DWQ Requirement) 1a 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 El 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 NA Page 10 of 11 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 ❑ Yes ® No habitat? 5b Have you checked with the USFWS concerning Endangered Species Act ❑ Yes ® No impacts? El Raleigh 5c If yes indicate the USFWS Field Office you have contacted ❑ Asheville 5d What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat? USFWS North Carolina website http / /ecos fws gov 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 Habitat Conservation website http / /www habitat noaa gov /protection /efh /efhmapper 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'? http / /www hpo dcr state nc us 8 Flood Zone Designation (Corps Requirement) 8a Will this project occur in a FEMA designated 100 year floodplain? —T- ❑ Yes ® No 8b If yes explain how project meets FEMA requirements 8c What source(s) did you use to make the floodplain determination? Forsyth County GIS �J� iCl�y , /lam og �li�Ir�ua7tt��is.� /c. ��J Ss A I e Signature Applicant/Agent s Printed Name Date ture is valid only if an authorization letter from the applicant is provided Page 11 of 11 PCN Form — Version 1 3 December 10 2008 Version �0 J O D N � d LL o O > Cl) �Z W U) J H Z W Z IY Z W U z F— Z D 0 U 2 'U) C. 0 U— a r 8 .o 0- g g o E N h @ fn N € y �3 N N$ 3 3 a a 3 a ag a r 1i jig' �8E$$ '9 p N3 °° w w O r r N Ng ° A .-.' a� 9.R$ 'fi g 84Ei L' B t O ' E aE n E ° o L" u 8€ E O '• '• >? E O1 w w z z 6 �3§�8$ 8� z z o x 3� 3� s8�a�� LLJI 0 � t 0 7 r / t 1� r iy { ° � � r 03 I� 0 j i ("j LOLJ J �0 J O D N � d LL o O > Cl) �Z W U) J H Z W Z IY Z W U z F— Z D 0 U 2 'U) C. 0 U— a r 8 .o 0- g g o E N h @ fn N € y �3 N N$ 3 3 a a 3 a ag a r 1i jig' �8E$$ '9 p N3 °° w w O r r N Ng ° A .-.' a� 9.R$ 'fi g 84Ei L' B t O ' E aE n E ° o L" u 8€ E O '• '• >? E O1 w w z z 6 �3§�8$ 8� z z o x 3� 3� s8�a�� LLJI 0 � t 0 7 r / t 1� r iy { ° � � r 03 ,e