The URL can be used to link to this page

Home My WebLink About20130022 Ver 1_401 Application_2013011320130022' Office Use Only Corps action ID no DVVQ project no. Form Version 14 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 1b. Specify Nationwide Pernd (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)* 9 401 Water Quality Certification - Regular ❑ Non404 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 0040 1g Is the project located in any of NC's twenty coastal counties. If yes, answer 1h below ❑Yes ,�No 1h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ❑ Yes KNo 2. Project Information 2a Name of project: & La7 2b County- 2c. Nearest municipality / town. bu j 2d Subdiftionimm: 3. Owner Information 3a Name(s) on Recorded Deed. 3b. Deed Book and Page No. /.3 6 3c. Responsible Party (for LLC if applicable): 3d Street address P? O 464S W- 14-AA-291"S 120 . 3e City, state, zip: NL Z8 Z 3f Telephone no.: X28 2GS-J/92 >D T,M46 LluF 3g. Fax no.. 8 Z 8 2 &T- OS-08' 3h Email address: STupleY Q i»PR./N'rs /NC tart EE Wetlan ` _ ds S mwaty Branch — -- - -- Page 1 of 10 PCN Form - Version 14 January 2009 [ � ., `' 1 � .: J �^ - - --'"`: 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 plicable) 5a Name. 5b. Business name (i applicable): ' ,- 5c. Street address:, f " 5d. Cdy, 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). 1pip 21917- 34.5894 SD 0'70 21 ZZ_ lb Site coordinates (in decimal degrees) Latitude: Longitude: 1c Property size / . 7. acres 2. Surface Waters 2a. Name of nearest body of water to proposed project: 2b Water Quality Cla"cation of nearest receiving water. 2c River basin reclk-1 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 - 3b List the total estimated acreage of all existing wetlands on the property. Nt\ 3c List the total estimated linear feet of all existing streams (intermittent and perenniaQ on the property: 3d Explain the purpose of the proposed project. RECREA-nwAL FAQnn PoiJb - 3e. Describe the overall project in detail, including the type of equipment to be used: 'b IG FARrX Pea b r-01Z P ZI VAsZ RECk447 #0A1C- LA 5 ar (A 51 -)4. '17R-Ac Hot AVB A ULL Do 4. Jurisdictional Determinations 4a. Have jurisdictional wetland or stream determinations by the Corps or State been requested or obtained for this property ! ro'ect indudin all ases in the Yes ❑ No ❑ Unknown Comments: 4b If the Corps made the jurisdictional determination, what type mi of determination was made? Preliminary ❑Final 4c. If yes, who delineated the jurisdictional areas? Name (d known). f jl le_ i'pr v- vj 0L>4— Agency/Consultant Company: Other. T)L -. 4d If yes, list the dates of the Corps jurisd cUonal determinations or State determinations and attach documentation 1Z'2��tZ S. 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. Lions. 6. Futuna Project Plans 6a. Is this a phased project? ❑ Yes MNo 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 ❑ Buffers ❑ Open Waters ❑ Pond Construction 2. Wetland Impacts If there are wetland impacts proposed on the site, then complete this questi each wetland area impacted. 2a Wetland impact number Permanent (P) or Temporary T impact 2c. Type of nd 2d Forested 2e Type of jurisdiction Corps (404,10) or DWO (401, other) Zf Area of impact (acres) W1 - Choose one j Yes/No - W2 - Choose one - Choose one Yes/No - W3 - 06se one Choose one Yes/No W4 - Choose one Choose one Yes/No - W5 - Choose one Choose one esMo We - 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) 39 Impact length prnear fit) S1 - Choose one ]. OT - - k VN 1 LAI r S2 - dose one - S3 - Choose one S4 - Choose one - S5 - Choose one - - S6 - Choose one 3h. Total stream and tributary impacts LA el 1 31 Comments: Page 4 of 10 PCN Form — Version 14 January 2009 4. Open Water I�Wcts If there are proposed i ftacts to lakes, ponds, estuanes, to es, sounds, the Atlantic Ocean, or any other open water of the U.S then individuallylistall open water imiacts cm -acts bel 4a. Open water impact number Permanent (P) or Temporary 4b. % Name waterbody�� (rf a �� 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 5a Wetland Impacts (acres) 5d. Stream Impacts (feet) 5e. Upland (acres) Flooded Filled Excavated Flooded I Filled Excavated P1 Choose one l LV C P2 Choose one 5f. Total: 1 5g. Comments. 5h Is a dam high hazard permit required? ❑ Yes No If yes, permit ID no. 5i Expected pond surface area (acres)- *z r 2 RCRt` 5j Size of pond watershed (acres): 5k Method of construction I f y-eA VA-rt CO l Tµ Jr.40r,K de p 6. Butter Impacts (for DWO) If project will impact a protected riparian buffer, then complete the chart below Af yes, then individually list all buffer impacts w if belo - an im ds miti . then you MUST fill out Section D of this form. 6a. Project is in which protected basin? r ❑ Neuse ❑ Tar-Parrigpd ❑ Catawba ❑ Randleman ❑ Other. 6b. Buffer Impact number — Permanent (P) or Temporary 6c. Reason for il;� 6d. // S"m name 6e Buffer mitigation required? 6f. Zone 1 impact (square 6g Zone 2 impact (square feet B1 - Yes/No B2 - Yes/No 63 - YesMo 84 - Yw4No 65 - Yes/No B6 - Yes/No 6h Total Buffer Impacts; 6i Comments- Page 5 of 10 D. Impact Justification and Mitigation 1. Avoidance and Minimization 1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project. "- i��v►�r-.�1 <<v- .P4�t -� fit✓ wi�'i' . 1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques 2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State 2a. Does the project require Compensatory Mitigation for ❑ Yes P(No impacts to Waters of the U.S. or Waters of the State? 2b If yes, mitigation is required by (check all that apply): ❑ DWQ ❑ Corps ❑ - gation bank 2c If yes, which miQrtion option will be used for this Payment to in -lieu fee program project' `..� � / ❑ Permittee Responsible Mitigation 3. Complete if Using a !!! n Bank 3a Name of Mitigation Bank Type;/'Choose one Quantity: 3b Credits Purchased (attach receipt and Mier) TO: Choose one Quantity: T, : Choose one Quantity: 3c Comments: 4. Complete if Making a Payment to In4le Fee Pro ram 4a Approval letter from in -lieu fee program ' attached. ❑ Yes 4b Stream mitigation requested: linear feet 4c. If using stream mitigation, stream to perature: C 4d. Buffer mitigation requested (D /only): square feet 4e Riparian wetland mitigation req ed: 4f Non- ripanan wetland mfiga ' requested: 49 Coastal (tidal) wetland m' lion requested- acres 4h. Comments 5. Complete if Using a FArrnfte Responsible Mitigation Plan 5a. If using a permittee ponsible mitigation plan, provide a description of the proposed midge ' plan. Page 6 of 10 PCN Form — Version 14 January 2009 6. Buffer MitigatioW(State Regulated Riparian Buffer Rules) - required by DWQ 6a. Will the project result in an impact within a protected riparian buffer that requires es ❑ No buffer mitigation? 6b. If yes, then identify the square feet ohlygMct to each zone of the riparian that requires mitigation Calculate the amount of mitigation required. ``� , 6c. 6d. 6e. Zone for impact Total im d ultipGer Required mitigation (square fee (square feet) Zone 1 X(2 for Catawba) Zone 2 - — - - - - 6---- - - - - - --- - - - 6f Total buffer mitigation re fired: fag. If buffer m Ration is required, d' what type of mitigation is proposed (e.. yment to private mitigation bank, permittee responsible dpariarbuffer restoration, payment into an approved iM fund). 6h. Comments: Page 7 of 10 E. Stormwater Management and Diffuse Flow Plan (required by DWQ) 1. Diffuse Flow Plan la Does the project include or is it adjacent to protected riparian buffers identified O Yes ,b�Vo 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? 0% 2b Does this project require a Stomhwater Management Plan? O Yes No 2c. If this project DOES NOT require a Stormwater Management Plan, explain wiry: 2d. If this project IDES require a Stormwater Management Plan, then provide a brief, na ive description of the plan 2e Who will be responsible for the revi of the Stornw ater Managemen n? 3. Certified Local Government Stormwa Review 3a In which local ovemmenYs " risdicdon is this ect? ❑ Phase II ❑ NSW 3b Whicth of the following locally - implemented stomnaat nagement programs USMP apply (check all that apply). Water Supply Watershed ❑ Other. 3c Has the approved Stormwater Management n with proof of a 1 been []Yes O No attached? 4. DWQ Stortnwater Program Review OCoastal counties 48 Which of the following state -ir *emented stomhwater management programs (check all that apply): OHQW ❑ORW n Law 2006 -246 �/ []� 4b Has the approved ormwater Management Plan with proof of approval been ❑ Yes ❑ No attached? 5. DWQ 401 Unit Stirmwater Review 5a Does the Stormwater Management Plan meet the appropriate requirements? ❑ . Q No 5b Have all of the 401 Unit submittal requirements been met? ❑ Yes ❑ No Page 8 of 10 PCN Form — Version 14 January 2009 F. Supplementary Information 1. Environmental Documentation (DWQ Requirement) la. Does the project involve an expenditure of public (federallstateliocal) funds or the Yes JKNo use of public (federallstate) 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 Ad (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 ❑ No letter.) Comments. 2. Violations (DWQ Requirement) 2a. Is the site in violation of DWQ Weiland Rules (15A NCAC 21-1.0500), Isolated Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Weiland Standards, XYes ❑ No or Riparian Buffer Rules (15A NCAC 213 0200)? 2b Is this an after- the -fact permit application? )KYes ❑ No 2c If you answered 'yes' to one or both of the above questions, provide an explanation of the violations) 'EGA#�j c*o& RKe-„eN ax pwb w /T"v"-r S6erro--J 11 o N P6901 S I - NA t To 4 4Cfe of X.#J oW LfAGE 001C ABdvE W 4rz4opUb RItt.GS AND NLGLiSi OF SLCT -1011 44041 Peon I'r. 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's 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 I Y • . . , 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's ❑ 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 probed occur in or near an area that the state, federal or tribal governments have designated as having historic or ailtural preservation status (e.g., National Historic Trot designation or properties significant in North Carolina history and archaeology)? 0 Yes ❑ No 7b What data sources did you use to determine whether your site would impact historic or archeological resources? B. Flood Zone Designation (Corps Requirement' 8a Will this project occur in a FEMA- designated 100 -year floodplam? ❑ Yes ❑ No 8b If yes, explain how project meets FEMA requirements: 8c. What source(s) did you use to make the floodplain determination? -SAM CS — 5rU0X'r / r &W,"fik Applicant/Agent's Printed Name p icant/Agent's Sig (Agenrs signature is valid only if an aftenafton letter from the awlicant is provided ) —1 Date Page 10 of 10 Q 3 l�