Loading...
HomeMy WebLinkAbout20120581 Ver 2_401 Application_20120912� t I2, -1) SS.t U a- 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 1 a. Type(s) of approval sought from the Corps: ❑ Section 404 Permit ❑ Section 10 Permit 1b. Specify Nationwide Permit (NWP) number: 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 ❑X Riparian Buffer Authorization le. 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 ❑X No 1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h below. ❑Yes ❑ No 1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ❑ Yes ❑ No 2. Project Information 2a. Name of project: 641 Sagamore Boat Slip Repair 2b. County: Franklin 2c. Nearest municipality / town: Bunn 2d. Subdivision name: Lake Royale 2e. NCDOT only, T.I.P. or state project no: 3. Owner Information 3a. Name(s) on Recorded Deed: David N & Vicki A Nizen 3b. Deed Book and Page No. 1453, 707 3c. Responsible Party (for LLC if applicable): sro �19A/ 3d. Street address: 641 Sagamore Dr 6 3e. City, state, zip: Louisburg, NC 27549 Wei HR . 3f. Telephone no.: (919) 662 -8525 w nk 3g. Fax no.: n/a 8ncri 3h. Email address: nizenfamily @nc.rr.com Page 1 of 10 PCN Form —Version 1.4 January 2009 4. Applicant Information (if different from owner) 4a. Applicant is: ❑ Agent Q Other, specify: Mailing address for owner 4b. Name: David & Vicki Nizen 4c. Business name (if applicable): 4d. Street address: 1425 Perrimor Ct 4e.. City, state, zip: Raleigh, NC 27603 4f. Telephone no.: (919) 662 -8525 4g. Fax no.: n/a 4h. Email address: nizenfamily @nc.rr.com 5. Agent/Consultant Information (if applicable) 5a. Name: 5b. Business name (if applicable): 5c. Street address: 5d. City, state, zip: 5e. Telephone no.: 5f. Fax no.: 5g. Email address: Page 2 of 10 B. Project Information and Prior Project History 1. Property Identification 1a. Property identification no. (tax PIN or parcel ID): PIN 2830 -84 -9777 1 b. Site coordinates (in decimal degrees): Latitude: 35.958568 Longitude: - 78.192489 1c. Property size: 0.76 acres 2. Surface Waters 2a. Name of nearest body of water to proposed project: Lake Royale 2b. Water Quality Classification of nearest receiving water: 2c. River basin: Tar River Basin 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: Developed single - family lot with a 10'dx11'w boat slip. 3b. List the total estimated acreage of all existing wetlands on the property: 3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 0 3d. Explain the purpose of the proposed project: Damaged and non - square bulkhead wall on one side of existing boat slip will be replaced and straightened 3e. Describe the overall project in detail, including the type of equipment to be used: Small tracked excavator and hand tools will remove several inches of backfill to straighten existing boat slip wall. Wall will be rebuilt with pressure treat 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 past? ❑ Yes Z No ❑ Unknown Comments: 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 past? ❑ Yes ❑X No ❑ Unknown 5b. If yes, explain in detail according to "help file" instructions. 6. Future Project Plans 6a. Is this a phased project? ❑ Yes ❑X No 6b. If yes, explain. Page 3 of 10 PCN Form - Version 1.4 January 2009 C. Proposed Impacts Inventory 1. Impacts Summary 1 a. Which sections were completed below for your project (check all that apply): ❑ Wetlands ❑ Streams — tributaries ❑X 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. Wetland impact number Permanent (P) or Tem ora 2b. Type of impact 2c. Type of wetland 2d. Forested 2e. Type of jurisdiction Corps (404,10) or DWQ (401, other) 2f. Area of impact (acres) W1 - Choose one Choose one Yes/No - W2 - Choose one Choose one Yes/No - W3 - Choose one Choose one Yes/No - W4 - Choose one Choose one Yes/No - W5 - Choose one Choose one Yes/No - W6 - Choose one Choose one Yes/No 2g. Total Wetland Impacts: 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. Stream impact number Permanent (P) or Temporary (T) 3b. Type of impact 3c. Stream name 3d. Perennial (PER) or intermittent (INT)? 3e. Type of jurisdiction 3f. Average stream width (feet) 3g. Impact length (linear feet) S1 Choose one S2 - Choose one S3 Choose one S4 - Choose one S5 - Choose one S6 - Choose one 3h. Total stream and tributary impacts 3i. Comments: Page 4 of 10 PCN Form — Version 1.4 January 2009 4. Open Water Impacts If there are proposed impacts Ito lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of the U.S. then indiv" uallv list all open water impacts below. 4a. Open water impact number Permanent (P) or Tem ora 4b. Name of waterbody (if applicable) 4c. Type of impact 4d. Waterbody type 4e. Area of impact (acres) 01 - Choose one Choose 02 - Choose one Choose 03 - Choose one Choose 04 - Choose one Choose 4f. Total open water impacts 4g. Comments: 5. Pond or Lake Construction If pond or lake construction proposed, the 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 P1 Choose one P2 Choose one 5f. Total: 5g. Comments: Sh. Is a dam high hazard permit required? ❑ Yes ❑ No If yes, permit ID no: Si. 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? ❑ Neuse ❑ Tar - Pamlico ❑ Catawba ❑ Randleman ❑ Other: 6b. Buffer Impact number— Permanent (P) or Temporary 6c. Reason for impact 6d. Stream name 6e. Buffer mitigation required? 6f. Zone 1 impact (square feet ) 6g. Zone 2 impact (square feet 61 P Repair bulkhead wall No 10 B2 - Yes/No B3 - Yes/No B4 - Yes /No B5 - Yes/No B6 - Yes /No 6h. Total Buffer Impacts: 10 6i. Comments: Page 5 of 10 D. Impact Justification and Mitigation 1. Avoidance and Minimization 1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project. There should be no measures necessary. 1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques. There should be no measures necessary. 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: Choose one Type: Choose one Type: Choose one Quantity: Quantity: 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: Choose one 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 1.4 January 2009 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? El 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 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 within one of the NC Riparian Buffer Protection Rules? ❑ Yes ❑X No 1 b. If yes, then is a diffuse flow plan included? If no, explain why. ❑ Yes ❑ No 2. Stormwater Management Plan 2a. What is the overall percent imperviousness of this project? 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:' 2e. Who will be responsible for the review of the Stormwater Management Plan? 3. Certified Local Government Stormwater Review 3a. In which local government's jurisdiction is this project? 3b. Which of the following locally - implemented stormwater management programs apply (check all that apply): ❑ Phase II ❑ NSW ❑ USMP ❑ Water Supply Watershed ❑ Other: 3c. Has the approved Stormwater Management Plan with proof of approval been attached? ❑ Yes ❑ No 4. DWQ Stormwater Program Review 4a. Which of the following state - implemented stormwater management programs apply (check all that apply): []Coastal counties ❑HQW ❑ORW []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 1.4 January 2009 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? 1b. 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 ❑X No or Riparian Buffer Rules (15A NCAC 2B .0200)? 2b. Is this an after- the -fact permit application? ❑Yes ❑X 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 Q 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. Page 9 of 10 PCN Form — Version 1.4 January 2009 5. Endangered Species and Designated Critical Habitat (Corps Requirement) 5a. Will this project occur in or near an area with federally protected species or habitat? ❑ Yes ❑ No 5b. Have you checked with the USFWS concerning Endangered Species Act impacts? ❑ Yes ❑ No 5c. If yes, indicate the USFWS Field Office you have contacted. - 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? 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 status (e.g., National Historic Trust designation or properties significant in North Carolina history and archaeology)? ❑ Yes ❑ No 7b. What data sources did you use to determine whether your site would impact historic or archeological resources? 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: 8c. What source(s) did you use to make the floodplain determination? O fv �, �rzFni Applicant/Agent's Printed Name Date Applicant/Agent's Signa ure (Agent's signature is valid only if an authorization letter from the applicant is provided.) Page 10 of 10 Repairing right- hand bulkhead /slip wall to make it square and effect other repairs to it.