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Home My WebLink About20130360 Ver 1_Application_20130405A• �aP WA�4 a O Y 20130360 Olfice Use Only: Corps action ID no. DWQ project no. Form Version 1.4 January 2008 Pro- Constructlon Noliflcatfon (PCN) Form A. Applicant Information 1. Processing 1 a. Type(s) of approval sought from the Corps: ❑ Section 404 Permit ❑ Seddon 10 Permit 1 b. Specify Nationwide Permit (NVVP) number: or General Permit (GP) number: 10. Has the NWP or GP number been verified by the Corps? ❑ Yee ❑ No id. Type(q) of approval sought from the DWQ (check all that apply): ❑ 401 Water Quality CeMcation — Regular Q Non-404 Jurisdictional General Permit ❑ 401 Water Quality Certification — Express Riparian Buffer Authorization . le. Is this notification solely for the record because written approval Is not required? For the record only for DVVO 401 CerUficmtlon: ❑ Yes ❑ No For the reoord only for Corps Permit: ❑ Yes ❑ No 11. 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 1 h. Is the project looted within a NC DCM Area of Environmental Concern (AEC)? ❑ Yes ❑ No 2. Project Information 2a. Name of project: t4ec %R 3-raffte 1Qv: l�:r 2b. County: *eo 2c. Nearest municipality / town: pit iAfivr41 2d. Subdivision name: c*,enjol-W r Sold Al -i- w 2e. NCDOT only, T.I.P. or state project no: -� 3. Owner Information 3a. Name(s) on Recorded Deed: EIWwRJ 4. f Al / %!s 3b. Deed Book and Page No. :r ?3 ISA. 3c. Responsible Party (forLLC if applicable): N/A 3d. Street address: /o.4 Wo.571044 .'.v 3e. City, state, zip: Ro o .2m I/G A V70 3f. Telephone no.: 3 i 3g. Fax no.: 3h. Email address: p�fe.IAwr /er6JCOWMYfAwk.aer — Page 1 of 10 PCN Form — Version 1.4 January 2009 13 4. Applicant Information Of different from owner) 4a. Applicant is: ❑ Agent ❑ Other, specify: 4b. Name: 40. Business name d applicable): 4d. Street address: 4e. City, state, zip: 4f. Telephone no.: 4g. Fax no.: 4h. Email address: 5. AgentlConsultant Information (If applicable) Ga. Name: 5b. Business name (d applicable): 50. Street address: 5d. City, state, zip: 5e. Telephone no.: 5f. Fax no.: 5g. Email address: Page 2 of 10 I 1* B. Project Information and Prior Project History 1. Property Identification mom 1a. Property identification no. (tax PIN c ercel ID • 1b. Site coordinates (in decimal degrees): I Latitude: 3 S. 0 ?/66 / Longitude: 7d. .4.U/86 1c. Property size: L/87 acres 2. Surface waters 2a. Name of nearest body of water to proposed project SA49 Ctev K 2b. Water Quality Classificcation of nearest receiving water. SA • al • A(Sa/ 2c, River basin: ive%se 3. Project Description 3a. Describe the existing conditions on the eke and the general land use in the vicinity of the project at the time of this application: L;yAr /r t;.ieaed w, *- Ji Revel -xpw/ /oogroestrj ;A/ 744 NOW. 3b. List the total estimated acreage of all existing wetlands on the property: 3c. List the total estimated linear feet of all existing streams (intemMtent and perennial) on the properly: 3d. Explain the purpose of the proposed project: �ea�e• ��: �d: Ns 3e. Describe the overall project in detail, including the We of equipment to be used: Q,AeRA) C00.97sver.'efi e/) el er %ji 4. Jurisdictional Determinations 4a. Have Jurisdictional wetland or stream determinations by the Corps or State been requested or obtained for this property / ro ect (Including all pdor phases) in the past? Zyes OLNo Q Unknown Comments: 4b. If the Corps made the jurisdictional determination, what type of determination was made? Rg PrelMdnmy ❑ Final 4c. if yes, who delineated the judsdk dpn I as ?o 3 _ A7 _ f i SCAM Name (if known) :Amuth, war 11 al)- t Agency /Consultant Company: Other; D m 4d. If yes, list the dates of the Corpe jurisdictional determinations or State determinations and-attach documentation. nit 5CM 130awth fiRrreJ R,008%40 SVOMA offli e3 &V03P MA Comaird aereAmesed rAe coon) .Jerland Av.j pi,>iiA/Mee! 7%, piuvlers ele /•wew7��►n N a 6A/13 5. Project History 5a. Have permits or certifications been requested or obtained for this project (including all prior phases) In the past? OYes ANo ❑ Unknown 5b. If yes, explain to detail according to "help file' instructions. 6. Future Project Plans 6a. Is this a phased project? ❑ Yes No 6b. If yes, explain. Page 3 of 10 PCN Form — Version 1.4 January 2009 4 X C. Proposed Impacts Inventory 1. Impacts Summary 1a. Which sections were completed below for your project (check all that apply): ❑ Wetlands ❑ Streams — bfttades 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 imps 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 have one YesiNa W2 - Choose one Choose o Yes/No W3 Choose one C one Yeaft W4 - Choose one Choose one Yes/No - W5 - Choose on Choose one Yes/No 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 m 3b. T Impact 3c. Stream name 3d. Perennial (PER) or Intermittent (INT)? 3e. Type of Jurisdiction 3f. Average stream width (feet) 3g- Impact length (linear feet) 31 - Choose one S2 - Choose one S3 - Choose one S4 - Choose one S6 - Choose one S6 - Choose one 3h. T stream and tributary Impacts 31. 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, tdbutades, sounds, the Atlantic Ocean, or any other open water of the U.S. then IndIvv ually list all open water Impacts below. 4a. Open water impact number Permanent (P) or Temporary 4b. Nam e�of�a+ tprbody (If applicatBl) 4c. Type of impact 4d. Waterbody type 4e. Area of Impact (acres) 01 - Choose one Choose 02 - Choose one Choose 03 - We one Choose 04 - Cho one lChowe 4f. Total open water impacts 4g. Comments: 5. Pond or Lake Construction If oond or lake construction proposed. the complete the ched below. 58. Pond ID number 6b. Proposed use or purpose of pond 6c. and Impacts (saes) 6d. Stream Impacts (feet) - ' 5e. Upland (acres) Flood Filled Excavated Flooded FIIIW "Excavated P1 Choose one P2 Choose one W. Total: 5g. Comments: 5h. Is a dam high hazard permit required? ❑ Yes ❑ No ff yes, mat 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 impede below. If any Impacts require mitigation. then you MUST fill out Section D of this form. Be. Project is In which protected basin? ❑ Nauss ❑ Ter - Pamlico ❑ Catawba ❑ Randleman ❑ Other. 6b. Buffer Impact number — Permanent (P) or Temporary 6c. Reason for Impact 8d. Stream name 6e. Buffer mitigation required? 6f. Zone 1 Impad (square feel ) 69. Zone 2 Impact (square feet B1 - P CavSrR�er+' of ,sA. cRee9 Yeaft 3SS B2 Yes/No B3 - Yes/No B4 - Yeeft 65 I Yeaft 86 1 Yes/140 6h. Total Buffer Impacts: 33s 6i. Comments: Page 5 of 10 D. Impact JusOcation and Mitigation A. Avoidance and Minimization 1a. Specifically describe measures taken to avoid or minimize the proposed Impacts In designing project. 1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques. 2. Compensatory Mitl ation for Impacts to Waters of the U.S. or Waters of the State 2a. Does project reore Compensatory Mitigation for ❑Yes ❑ No Impacts to ter$ of the U.S. or Waters of the State? 2b. If yes, mitigation i equired by (check all that apply): ❑ DWQ ❑corps 2c. If es, which mitigation y tig optio 11 be used for this project? fiigation bank ❑ Payment to in -lieu fee program ❑ Permittee Responsible Mitigation 3. Complete ff Using a Mitigation Bank 3a. Name of Mitigation Bank: 3b. Credits Purchased �rewlpt and letter) Type: oose ane Type; Ch one Type: Choose Quantity: Quantity: Quantity: 3c. Comments: 4. Com lets if Maki a Pa m ' to In4lou Fee Pro ram 4a. Approval letter from In-lieu fee p m is attached. ❑ Yes 4b. Stream mitigation requested: linear feet 40. If using stream mitigation, stream tempera C one 4d. Buffer mitigation requested (DWQ only): square feet 4e. Riparian wetland mitigation requested: acres 4f. Non- dparien wetland mitigation requested: acres 4g. Coastal (tidal) wetland mitigation requested.-'- acres 4h. Comments: 6. Complete K Using a PormItt0009ponsible Mitigation Ian So. If using a pennittee respo a Is mitigation plan, provide a de ption of the proposed mitigation plan. Page 8 of 10 PCN Fo — Version 1.4 January 2009 G. Buffer Mitigation (State Regulated Riparian Buller Rules) — required by DWQ ea. Will the protect resuh in an Impact within a protected riparian butter that requires ❑Yes No buffer mitigation? 6b. If yes, than Identify the square feet of Impact to each zone of the dparlan buffer that requires mitigation. Calculate the amount of mitigation required. ec, ed. ee. Zone Reason for impact Total impact Multiplier Required mitigation (square feet) (square feet) Zone 1 3 (2 for Catawba) Zone 2 1.6 Total buffer mitigation required: eg. If buffer mitigation is required, discuss what type a Higatlon is proposed• (e.g., payment to private mitigation bank, permittee responsible riparian buffer restoration, payt Into an.approved in•Ileu fee fund). �r 6h. Comments: Page 7 of 10 S. Endangered Species and Designated Critical Habitat (Corps Requirement) Be. Will project occur In or near an area with federally protected species or Y � 0 � No Sb. Have YOU checked with the USFWS con mp ng Endangered Species Act Yes No Sc. H yes, Indicate the USFWS Field Office you have ntacted. 5d. What data sources did you use to determine whether ur s uld Impact Endangered Species or Designated Critical Habitat? S. • Essential Fish Habitat (Corps Requirement) 8a. Will this project occur in or near an area dejg4ed as essential fish habitat? ❑ Yes [] No tab. What data sources did you use to determine whether your site would Impact Essential Fish Habitat? 7. Historic or PrehlsWc Cultural Resou es (Corps Requireme 7a. MI this project occur in or near an area that state, WOW or tribal govemments have designated as having histon r Kral preservation ❑ Yes ❑ No status (e.g., National Historic Trust designallon o parties significant in North Carolina history and archaeology)? ' 7b. What data sources did you use to date a whether your te,"uld impact historic or archeological resources? B. Flood Zone Designation (Corps Requirement) 8a. Will this project occur in a FEMA -d d 100 -year floodplain? ❑ Yes ❑ No 8b. H yes, enpiain how project meets FEMA req ments: 8c. What source(s) did you use to make the fl n dete lion? ,Ea%wARJ �. • l.11rae lea �o� �f !�►; / y� X013 Applicant/Agents Printed Name Applicant/Agent's Signature Date (Agent's stgnature is valid only K an authorisation Wderfinm the applicont is provided.1 Page 10 of 10 p 47 z � o ",5 WOpp OOCK L-4 NOTI S : SUBJE'Cl PROFIERIY I;; LOT 17 IN StJ0DIVl`�ION FOR WETLAND /BUFFSP 'FRRY CAR1 WRIGI-11 Mb ► 1, FAG 64 'PROPERTY IS LOCATED IN FLOOD ZONE AE (EL 7) FIRM PANEL 7408, JULY 2, 2004 #DAhp ROIP = EXISTING IRON PIN NOA IRONMENT Ip - SET IRON PIN T COMMISSION WATER QUALITY N /F , 20 l� s��' CHRISTOPHER R KUZI W DWQ Permit No. 011�07-1/ D8 407 PG 916 Attshl LINE 'L-3 y WOOD DECK 2 STY. D91 FRAME DWELLING WELL .�.p 38. N F 04 KENNETH L COOPER DB 213 PG 122 LOT 11 RESURVEY PREPARED FOR JOHN SHEPHARD, BLDR. FORK POINT ROAD NO. 2 TOWNSHIP, PAMLICO CO., NC; DATE=: 8 -27 -06 PROJECT 06210 SCALE: .I ' = 50' �.t LOT 13 - -- _ N 22°40'00" E 368.'69 LOT 12 N /F KENNETH L COOPER DI3 210 PG 545 44320.3 SCE. FT. 1.02 ACRES EARTH DRIVEWAY 460,37' N 18'40'00" E 1, WILLIAM E. MARLOWE, 00 HEREBY CERTIFY THAT, TO THE BEST OF MY KNOWLEDGE AND BELIEF, THIS PLAN, DRAWN UNDER MY SUPERVISION, REPRESENTS A FIELD SURVEY CONDUCTED UNDER MY SUPERVISION (REF.DEED DESCRIPTION RECORDED IN DEED BOOK 210, PAGE 545, EtC); THAT THE BOUNDARIES NOT SURV D ARE CLEARLY NOTED: THAT THE RATIO OF PRFCf$ION, AS�CALCUULt� IS i IN 45.000 f WITNF SS MY 4,IAIA // NATURf � stk:Y"WIS 90TH SAY nc Al icl icr 9AAr -'INITY MAP r/ r � r= 2w � � G 3��y oo gam. 2v'I� Z 00 �ytP ,3 /,//� (� ) V ��E�cc a etiefaoa i 01A CAR s a''s� °` SEAL 3913 ''aao ►,�ire�te`�`' LINE TABL.F L -1 N 37 "27'44" W 35.34' L -2 N 12 °39'30" W 17.25' L -3 N 23'5829" W 7.61' L -4 N 19'31'56" E 45.07' L -5 N 13'54'05" W 54.79' L -6 N 32' 17'49" W 54.47' p 47 z � o ",5 WOpp OOCK L-4 NOTI S : SUBJE'Cl PROFIERIY I;; LOT 17 IN StJ0DIVl`�ION FOR WETLAND /BUFFSP 'FRRY CAR1 WRIGI-11 Mb ► 1, FAG 64 'PROPERTY IS LOCATED IN FLOOD ZONE AE (EL 7) FIRM PANEL 7408, JULY 2, 2004 #DAhp ROIP = EXISTING IRON PIN NOA IRONMENT Ip - SET IRON PIN T COMMISSION WATER QUALITY N /F , 20 l� s��' CHRISTOPHER R KUZI W DWQ Permit No. 011�07-1/ D8 407 PG 916 Attshl LINE 'L-3 y WOOD DECK 2 STY. D91 FRAME DWELLING WELL .�.p 38. N F 04 KENNETH L COOPER DB 213 PG 122 LOT 11 RESURVEY PREPARED FOR JOHN SHEPHARD, BLDR. FORK POINT ROAD NO. 2 TOWNSHIP, PAMLICO CO., NC; DATE=: 8 -27 -06 PROJECT 06210 SCALE: .I ' = 50' �.t LOT 13 - -- _ N 22°40'00" E 368.'69 LOT 12 N /F KENNETH L COOPER DI3 210 PG 545 44320.3 SCE. FT. 1.02 ACRES EARTH DRIVEWAY 460,37' N 18'40'00" E 1, WILLIAM E. MARLOWE, 00 HEREBY CERTIFY THAT, TO THE BEST OF MY KNOWLEDGE AND BELIEF, THIS PLAN, DRAWN UNDER MY SUPERVISION, REPRESENTS A FIELD SURVEY CONDUCTED UNDER MY SUPERVISION (REF.DEED DESCRIPTION RECORDED IN DEED BOOK 210, PAGE 545, EtC); THAT THE BOUNDARIES NOT SURV D ARE CLEARLY NOTED: THAT THE RATIO OF PRFCf$ION, AS�CALCUULt� IS i IN 45.000 f WITNF SS MY 4,IAIA // NATURf � stk:Y"WIS 90TH SAY nc Al icl icr 9AAr -'INITY MAP r/ r � r= 2w � � G 3��y oo gam. 2v'I� Z 00 �ytP ,3 /,//� (� ) V ��E�cc a etiefaoa i 01A CAR s a''s� °` SEAL 3913 ''aao ►,�ire�te`�`'