HomeMy WebLinkAbout20120886 Ver 1_Complete File_20121005�0F w Ar f.,
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Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.4 January 2009
Page 1 of 10
PCN 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
1d.
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
1e.
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
1 g.
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:
MC D006f{ LL_ H M I TE,
2b.
County:
� R A F_ 0
2c.
Nearest municipality / town:
HA A L 0 W E I Hkl E L0C;, ,
2d.
Subdivision name:
COACHES cR e la i`
2e.
NCDOT only, T.I.P. or state project no:
3.
Owner Information
3a.
Name(s) on Recorded Deed:
I D G. M c ®OV &Au AN 1) W I-FE, SANDRP 8. CP0V trALL
3b.
Deed Book and Page No.
�e, 2. 1"T I F PA ,5 E 3 H 9
3c.
Responsible Party (for LLC if
applicable):
3d.
Street address:
10 C) 3 N N W C 4 E S TEK C O Vt
3e.
City, state, zip:
ADEN N G 2_1 502
3f.
Telephone no.:
q dq ig ® — 3 D ( $ A
3g.
Fax no.:
3h.
Email address:
305C.0 i 9 ci L4 Q (a AA I L, Co iA
Page 1 of 10
PCN Form — Version 1.4 January 2009
4. Applicant Information (if different from owner)
4a. Applicant is:
Agent ❑ Other, specify:
4b. Name:
C H R I S
4c. Business name
(if applicable):
-T r 01i WA rj EA L E 5°71�TE-- I PI C_
4d. Street address:
Z Z.- d, j�j C HV %j V 5,5"
4e. City, state, zip:
OR I EN TA L IV C IF 5 7)
4f. Telephone no.:
C2 5 2..) 7—H 0 0
4g. Fax no.:
25 7-) 9 9
4h. Email address:
CH915 69 ii IDF—W 7 rR C0 V N TR �{ , �L?Al
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
1 a. Property identification no. (tax PIN or parcel ID):
5 - D
1 b. Site coordinates (in decimal degrees):
I Latitude: 3 2.1. 3 3 3 A Longitude: 7 6, 7 13 2- 3 `? >/
1c. Property size:
, �( acres t
2. Surface Waters
2a. Name of nearest body of water to proposed project:
N E V S E 1 f�
2b. Water Quality Classification of nearest receiving water:
2c. River basin:
N EU 5 E RN V Ir F.
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: Tp't 1 ()T'5 $VILDA6LE f PE2 l a S LARL�tj_-V CLEARE`ot &9p >t. ?) A N 0
R >V ► t�r� Alei } E 'LZOEAV�5:� +aa' A YEVr)Cp! wpo , t., fi:rjs«t :
3b. List the total estimated acreage of all existing wetlands on the property: ,j 4-
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 17,00 ±
3d. Explain the purpose of the proposed project:
C®NS°rpvcn'DN or A S1r44,L r - FAMILY 1UL-nSI DENCE 440 APPVR'TC- Pr) ; PAAK INL-
AND 0 R I V 1 wti `%
3e. Describe the overall project in detail, including the type of equipment to be used:
As 47-AT F9 )N PARA�rRAPFI 3d, A6ovE,
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 ❑ No ❑ Unknown
Comments:
4b. If the Corps made the jurisdictional determination, what type
of determination was made?
El Preliminary ❑Final
4c. If yes, who delineated the jurisdictional areas?
Name (if known): C-AMA
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 ❑ No [Unknown
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project?
❑ Yes No
6b. If yes, explain.
Page 3of10
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):
El Wetlands El Streams —tributaries u 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
Temporary T
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
1/x/4
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 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 T
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
C.
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:
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no:
5i. 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?
M Neuse ❑ Tar - Pamlico ❑ Catawba ❑ Randleman ❑ Other:
6b.
Buffer Impact
number–
Permanent (P) or
Temporary T
6c.
Reason for impact
6d.
Stream name
6e.
Buffer
mitigation
required?
6f.
Zone 1
impact
(square
feet )
6g.
Zone 2
impact
(square
feet
B1
14t)ME COpi� -Jpvnp'l
J1j US
Yes/@0)
9 0 a
I b �b
B2 P
DRIV �M'f lWx IN
YesO o;
'S S- q ?
97-7
B3
Yes /No
B4
Yes /No
B5
Yes /No
B6
Yes /No
6h. Total Buffer Impacts:
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.
ALL. wo&14 54ALL 8f_ EN r- PSVLATE121 s Cie CENF -0 AT &�0VND '_;LV _� ?„ ° 11),
w5 l"LNf) Arc -A
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
6L-I WUl'.4PlO'�ILD1N(r SPPY ��&1�'taTt94, L�✓Kl°f> ' �7ti5,'"'it�
,gAhiAS To Tt4E F_wc -r)-r POSEWLE. 9ES`i' !�Ff_rAf5 °fp V5I IRIS_ST METPD -3 To
IMptq CT ,S
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 [y 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?
Yes [f 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
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 ❑ 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?
❑ Phase II
❑ NSW
3b.
Which of the following locally - implemented stormwater management programs
❑ USMP
apply (check all that apply):
❑ Water Supply Watershed
❑ Other:
3c.
Has the approved Stormwater Management Plan with proof of approval been
El Yes ❑ No
attached?
4.
DWQ Stormwater Program Review
❑Coastal counties
❑HOW
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 1.4 January 2009
F.
Supplementary Information
1.
Environmental Documentation (DWQ Requirement)
1a.
Does the project involve an expenditure of public (federal /state /local) funds or the
❑ Yes
dNo
use of public (federal /state) land?
1 b.
If you answered "yes" to the above, does the project require preparation of an
❑
❑ No
environmental document pursuant to the requirements of the National or State
Yes
(North Carolina) Environmental Policy Act (NEPA /SEPA)?
1 c.
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,
F-1 Yes
[2f No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b.
Is this an after - the -fact permit application?
El 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
MNo
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.
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{�ALI- yFROM
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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?
CHRIS 11-'AC�t . i
Applicant/Agent's Printed Name
!
q° 1) I.
Date
Applicant/Agent's Signature
(Agent's signature is valid only if an authorization
letter from the applicant is provided.)
Page 10 of 10
SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT N0. I 1 PLAN NO. PARCEL ID: - D
STREET ADDRESS: 3 ! 1 13 E Grt oYV i) 11 V E - - C Z $ S 3
Please print:
Property Owner: av, 7 o u' .,,t L
Property Owner: 3A 4IXIA
The undersigned, registered property owners of the above noted property, do hereby authorize
AgCHLE of Tior -w4 TEr
(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):
101' i h'k= 3 "4Ct ICsk Cr f40CJv, X ,I Ieo2
Telephone: `if q -w (' 1 6 �b I
We hereby certify the above Information submitted in this application Is true and accurate to the
best of our knowledge,
Authorized Signature
Date: 9'yf) ' to#Z
Avuf"R tltl
Authorized Signature
Date:
Re: McDougall Homesite application
Lot 11, Coaches Creek Subdivision
977 Becton Road
Havelock, NC
To Whom It May Concern,
This is to clarify that only written DWQ Riparian Buffer Authorization
approval is being sought in this application.
Signed,
Chris C. Machle
Applicant and Agent for Owner
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Date 02/02/2005 Tim 14:215:05 7 of 7 P9S
No'. 2005- 00119142
Bank ,LV Page 1
EXHIBIT "A"
All those certain tracts or parcels of land lying and being in
Number Five (5) Township, Craven County, State of North Carolina,
and being more particularly described as follows:
BEING all of Lot No. Ten (10) and Ten -A (10 -A) and Lot No. Eleven
(11) and Eleven -A (11A) as the same are shown on that map of
record in the Office of the Register of Deeds of Craven County in
Plat Cabinet E, Slides 203 -204. The map herein referred to was
prepared by Floyd L. Suitt, Jr., Registered Land Surveyor, and is
dated June 10, 1988, and is identified by the following legend:
"Final Plan of Coaches Creek ". Further reference is made to said
map for a more complete and accurate description of this property.
There is also conveyed a non - exclusive, permanent and perpetual
easement over and upon the roads shown on the map heretofore
referred to for the purpose of placing and maintaining a sewer
line to run to and from Lot Ten (10 ) to Lot Ten -A (10-A) and to
and from Lot Ten -A (10 -A) to Lot Ten (10) .
There is also conveyed a non - exclusive, permanent and
perpetual easement over and upon the roads shown on the map
heretofore referred to for the purpose of placing and maintaining
a sewer line to run to and from Lot Eleven (11) to Lot Eleven -A
(11 -A) and to and from Lot Eleven -A (11 -A) to Lot Eleven (11)
Further reference is made to that deed dated May 8, 1992
and recorded in Book 1324, Page 83 of the Craven County Registry.