20130135 Ver 1_401 Application_20130213

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Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.4 January 2009
Pre - Construction Notification (PCN) Fo o
A. Applicant Information
1. Processing
1a. 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 Q No
1d. Type(s) of approval sought from the DWQ (check all that @pply):
® 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 ❑X 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 Q No
1Ih. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes © No
2. Project Information
2a. Name of project:
Jeffrey Myers Golf Cart Bridge °
2b. County:
Alamance °
2c. Nearest municipality / town:
Burlington
2d. Subdivision name:
Spring Forest
2e. NCDOT only, T.I.P. or state project no:
3. Owner Information
3a. Name(s) on Recorded Deed:
Jeffrey Todd Myers
3b. Deed Book and Page No.
1374, 660
LM
3c. Responsible Party (for LLC if
applicable):
Jeffrey Todd Myers
FEB
3d. Street address:
1402 Cherry Drive
81NR .
3e. City, state, zip:
Burlington, NC 27215
3f. Telephone no.:
336 - 260 -7232 ,
3g. Fax no.:
3h. Email address:
JMyers7 @tdad.rr.com
Page 1 of 10
PCN Form — Version 1.4 January 2009
1/
0

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:
S. Agent/Consultant Information (if applicable)
5a. Name:
Jack Harman/Daren Cox
5b. Business name
(if applicable):
5c. Street address:
7027 Yarbrough Rd
5d. City, state, zip:
Mebane, NC 27302
5e. Telephone no.:
919 -818 -2077 / 336 -669 -7297
5f. Fax no.:
5g. Email address:
jackharman53 @gmail.com / NCSUCEEBAE @aol.com
Page 2of10

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
116821 (Alamance County)
1b. Site coordinates (in decimal degrees):
Latitude: 36.100833 Longitude: 79.476667
1c. Property size:
0.47 acres
2. Surface Waters
2a. Name of nearest body of water to proposed project:
Little Alamance Creek
2b. Water Quality Classification of nearest receiving water:
WS-IV, NSW
2c. River basin:
Haw
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:
Residential Use. Undergrowth of Briars and poison oak with some 6-14 inch caliber hardwoods with approximately 49 AGL canopy.
Little Alamance Creek Bank Rip- Rapped on East Side and sporadic natural low growth on West Creek Bank.
3b. List the total estimated acreage of all existing wetlands on the property: 0
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 70
3d. Explain the purpose of the proposed project:
Access approximately 4200 square foot of the owners property on the West Side of the Creek for summer shade for grilling and cookouts
3e. Describe the overall project in detail, including the type of equipment to be used:
Remove undergrowth, construct bridge across Little Alamance Creek, Rip -Rap west bank to match East Bank for aesthetics. Hand tools, backhoe
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project includin all prior phases) in the past?
❑ Yes 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?
Cl Yes 0 No ❑ Unknown
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project?
❑ Yes 0 No
6b. If yes, explain.
Page 3 of 10
PCN Form — Version 1.4 January 2009

C. Proposed Impacts Inventory
1. Impacts Summary
1a. 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.
Wetland impact
number
Permanent (P) or
Temporary
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
YesM0
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)
3g.
Impact
length
(linear
feet)
S1 P
Type In (Other)
Little Alamance Creek
PER
DWQ
15
70
S2 -
Choose one
S3 -
Choose one
S4 -
Choose one
-
-
S5 -
Choose one
S6 -
Choose one
-
3h. Total stream and tributary impacts
3i. Comments:
Rip -Rap Creek Bank, Installation of Bridge Abutments
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.
4b.
4c.
4d.
4e.
Open water
Name of waterbody
impact number
(if applicable)
Type of impact
Waterbody
Area of impact (acres)
Permanent (P) or
type
Temporary
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.
5b.
5c.
5d.
5e.
Pond ID number
Proposed use or
Wetland Impacts (acres)
Stream Impacts (feet)
Upland
purpose of pond
(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:
51. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWO)
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 0 Tar - Pamlico [] Catawba [:] Randleman © Other:
6b.
6c.
6d.
6e.
6f.
6g.
Buffer Impact
Reason for impact
Stream name
Buffer
Zone 1
Zone 2
number —
Permanent (P) or
mitigation
impact
impact
Temporary
required?
(square
(square
feet )
feet
131 P
property accesslabutments
Little Alamance Creek
No
140
B2 P
rip -rap west bank
Little Aiamance Creek
No
770
B3 -
YesMo
B4 -
Yes/No
B5 -
Yes/No
B6
Yes/No
6h. Total Buffer Impacts:
910
6i. Comments:
rage o or i o

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Activity to take place during Dry Season.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Temp seeding of area where undergrowth has been removed. Silt fence along west stream bank
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 Pennittee 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?
0 Yes Q 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
within one of the NC Riparian Buffer Protection Rules?
❑ Yes © 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?
0
2b. Does this project require a Stormwater Management Plan?
❑ Yes ❑X 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?
City Of Burlington, NC
3b. Which of the following locally- implemented stormwater management programs
apply (check all that apply):
❑ Phase 11
❑ NSW
❑ USMP
❑ Water Supply Watershed
❑ Other:
3c. Has the approved Stormwater Management Plan with proof of approval been
attached?
❑ Yes ❑ No
4. DWQ Stormwater Pro ram Review
4a. Which of the following state - implemented stormwater management programs apply
(check all that apply):
❑Coastal counties
❑HQW
HSession ORW
Law 2006 -246
❑Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
attached?
❑ Yes ❑ No
S. 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 Q No
use of public (federallstate) 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
❑ 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,
©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):
Failure to Secure a 401 Water Quality Certification. Owner was unaware of permitting requirements.
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in
❑Yes ❑X 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

S. 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 ❑X 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?
-3 %/"-Ye "s
Applicant/Agent's Printed Name
t\v v r-4 '/'
"Xb��
plicant/Agent's 5 ature
14")nt;Ignature is valid only if an authorization
lr from the applicant is provided.)
a,_ 7 -/3
Date
Page 10 of 10

City of Burlington
a ^ Stormwater Division
0 1103 Mebane Street
Burlington, NC 27215
(336) 222 -5140
Pre - Construction Notification (PCN) Form
0 1, gf13urlington Ripariwt Bifffier Prulection Ordinance [for Lands within the Jordan Watershed]
RIPARIAN BUFFER PROTECTION ORDINANCE IO.A
1. Ownerand Property Information
1. Namc(s) on Recorded Deed _Jeffrey Todd Myers
2. Deed Book 1374 Page No.
3. Property Identification No. Tax PIN or Parcel ID 116821 (Alamance Co.)
4. Property Size (acres) 0 .4 7
S. Site Coordinates (Decimal Degrees) Latitude 36d06' 03 "N and Longitude 79d28' 36 "W
6. Responsible Party (for LLC if applicable) --
7. Property Owner Name Jeffery To yers
Street Mailing Address 1402 Cherry Drive Email Address ]ffyers@tr—lad.rr—.com
City Burlington Telephone Number 336.260.7232
State _worth Ca rnl i na Fax Number
Zip 97,215
11. Project Information
I. Project Name Minor Stream Modification w/ Aerial Stream Crosse 1a _
2. County Alamance -- .
3. Is project located in the City of Burlington or F.TJ? Yes
4. Subdivision Name (if applicable) Spring Forest
3. Nance of nearest body of water (river, stream. etc.) to proposed project Little Alamance_ Creek
6. Water Quality Classification of Nearest Receiving Water WS-IV. NSW
7. Subwatershed Little Alamance Creek
Ill. Project Description
1. Describe the existing conditions of the site and the general land use in the vicinity ofthe project at the time of
this application (include maps, diu rants or plans as needed)
Developed residential subdivision since year 2000. Approximate
average lot size =/- 0.5 ac. See attached Google Earth photo.
3 List the total estimated linear feet of all cxistin$ streams intermittent and perennial) on the property
Approximately 80'
Sturm Water Di%-ision Website I %%-w %%,.Berlin totg�iNC.I!o% /Stortm%*ttter

0
City of Burlington
Stormwater Division
1103 Mebane Street
Burlington, NC 27215
[phone]
111. Protect Description (Cont'd)
3. Explain the purpose or the proposed project
To provide stream flow conveyance improvements, including slight
widening of stream bottom, armoring stream banks, and to instal]
an aerial stream crossing to provide access of maintenance equil
ment to opposite side of stream.
d Describe the overall pro ect in detail including the type of equipment to be used
Heavy Rough Sawn Timber Bridge approximately 11' 10" wide and
!spanning the brook 1413. Timber will be 18" square decked with 3'
heavy rough sawn boards. The timber will be bolted down to two
4 "x 6" dry sills on each end. The Abutments will be a gravity
design made of solid precast Concrete blocks,stacked two high an
unree ong on geo -piers of washed stone.Small backhoe /hand tools.
3. Have iurisdictional wetland or stream determinations by the US Army Corps of Engineers or NC Division of Water
Quality been requested or obtained for this property in the asf? (attach any supporting documentation)
To my knowledge and belief, any information on Wetlands has
not been requested to be obtained.
6. Have any permits been obtained from the NC Division of Water Quality or lice US Army Corps of Engineers? if so attach
permits to this application. Yes or NO No.
IV. Certification
A certilj under penalty of law that this document and all attachments were prepared under ni) direction or supervision in accordance
with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my
inquiry of the person or persons directly responsible for gathering the information. the information submitted is. to the best of my
knowledbe and belief. true. accurate. and complete. ( ani aware that there are significant penalties for submitting false information.
including the possibilit) of fine and imprisonment for knowing violations."
"In addition. 1 understand that b) submitting this I CN that I am not authorized to work in cite Rilhirian Butter without receiving an
approved Huffer Authorization Certificate**
Typed or Printed Name
Signature:
Jeffrey Todd Myers Title. Property Owner
Date:
Storm Water Division Website nNC•.�or /Stonmwater

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Tole: (338) 227 -8723 E —Mail: surveyormnstpath.not
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