HomeMy WebLinkAbout20131304 Ver 1_401 Application_20131213O�0��.t4 A T f,9
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DEC 1 R 2013
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
1 b. Specify Nationwide Permit (NWP) number: or General Permit (GP) number:
1 c. Has the NWP or GP number been verified by the Corps? 7_11
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 N 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 ❑ 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
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes No
2. Project Information
2a. Name of project:
2b. County:
U.)G Ve-
2c. Nearest municipality/ town:
2d. Subdivision name:
vSQn G/l'e' Ai
2e. NCDOT only, T.I.P. or state project no:
3. Owner Information
3a. Name(s) on Recorded Deed:
o�Tncrs
3b. Deed Book and Page No.
I �q ) ) 79
3c. Responsible Parry (for LLC if
applicable):
�/-
Jv�inA C..
3d. Street address:
5-12 S. 4un >6 5y.
3e. City, state, zip:
/YG 27(003
3f. Telephone no.:
94 _ 9,0 - 600
3g. Fax no.:
3h. Email address:
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
4c
Business name
(if applicable)
4d
Street address
4e
City, state, zip
S ri
S Ale, %S 0
4f
Telephone no
—341
/2 Z7
4g
Fax no
4h
Email address
J ti San S rC /'4
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.
I
Project information and Prior Project History
1
Property Identification 5-13 &Ee e.14ew
�, yG 74.0 3
1a
Property identification no (tax PIN or parcel ID)
j 703 Ye ,'Z. 7 -7 0
1b
Site coordinates (in decimal degrees)
Latitude S 7
(p Longitude — 78 6 yes
1c
Property size 0( G,rS
Q (� acres
2
Surface Waters
2a
Name of nearest body of water to proposed project
T .),o o /'4 ,iG
2b
Water Quality Classification of nearest receiving water
�S S f✓ .$L�%
2c
River basin
Reuse ,fir DSi n
3.
Project Description
3a Describe the a istmg conditions on the sit and t e eneral land yse i the vicinity of the project at the time f this
applicati n greet i4 'A � -A1% � 6.4 1Sn+ '74 44� fo7�, e.reA f®r. /k. 19 /'i. �� �'S 4
$r«,,�� .� -k �,. Rte- v'ee- 4(-14 AA "Aw A y �•�.sf���•�0
ho 1`- 64 /e'44 741 s 'r i's ;,i 2oi►G ba1Wler o- `ethos 6-Q 00.07
an On 1�l I'ok1lQ /o�
3b
List the to al 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
3d Explain the purpose of the proposed project /J
6ws4ris C / 43'-.e S It -�G.f► . A� ES i��r�L 8
3e
Describe the overall project in detail, including the type of equipment to be used
a e, �0 6 a � l � 4 �o�! G
(/
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 nor phases) in the past?
❑ Yes ❑ No RfJnknown
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
I 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 lnknown
5b
If yes, explain in detail according to "help file" instructions
6.
Future Project Plans �.G s
.M!� Y 4S.1,26'eic e,
6a
Is this a phased project?
❑ Yes RLNo
6b
If yes, explain
Page 3 of 10
PCN Form — Version 14 January 2009
C Proposed Impacts Inventory
1 Impacts Summary
la Which sections were completed below for your project (check all that apply)
❑ Wetlands ❑ Streams — tributaries � Buffers [:1 Open Waters El 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
-
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
31 Comments
Page 4 of 10
PCN Form — Version 14 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 indivi ually 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
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
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 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 Protect is in which protected basin?
6tNeuse ❑ 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
B1 Qty -
4.--we.
Y N
/70
B2 O►lX�4'a
J 0494 k S
B3 T �4
,
P/(%
B4 -
Yes/No
B5 -
Yes/No
B6 -
Yes/No
6h Total Buffer Impacts
3 /P
61 Comments s'AX0Q& AA/
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
`rk3 �ne4(y propvsoa� j,.�n� �: /l s. -�'.� � A�w�y - Ore.r, 5 �.•� �
tome '//
lb Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
,0
W#// A" ;T- 41Ver ;*f cA 4_,% d riegs Gee are re if o q
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
El 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 - npanan wetland mitigation requested
acres
4g Coastal (tidal) wetland mitigation requested
acres
4h Comments
5 Complete if Using a Permrttee 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
Yes G40
buffer mitigation?
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
6c
6d
6e
Zone
Reason for impact
Total impact
Multiplier
Required mitigation
(square feet)
(square feet)
Zone 1
3 (2 for Catawba)
Zone 2
15
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
la
Does the project include or is it adjacent to protected riparian buffers identified
Yes ❑ No
within one of the NC Riparian Buffer Protection Rules?
lb If es, then is a diffuse flow plan included ??/1 If no, explain why
()C-ck hers Aal �L 114.) "'140 ��
Yes No
d
YO
❑ ❑
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)
B Water Supply Watershed
❑ Other
3c
Has the approved Stormwater Management Plan with proof of approval been
❑Yes ❑ No
attached?
4
DWQ Stormwater Program Review
❑Coastal counties
❑HQW
4a
Which of the following state - implemented stormwater management programs apply
ORW
(check all that apply)
RSession 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 S 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 (federal /state/local) funds or the
❑ Yes ❑ No
use of public (federal /state) land?
1 b
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)?
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,
❑Yes &<O
or Riparian Buffer Rules (15A NCAC 2B 0200)?
2b
Is this an after - the -fact permit application?
❑Yes E3<o
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 protect (based on past and reasonably anticipated future impacts) result in
El Yes o
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 14 January 2009
5 Endangered Species and Designated Cntical Habitat (Corps Requirement)
5a Will this project occur in or near an area with federally protected species or
habitat?
Ye; []No
i
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 Histonc 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?
44Sor7 Zfow0--.,
Applicant/Agent's Printed Name
1 Z lG f3
i�
Date
Applicant/Agent's Signature
gents signature is valid only if an authorization
letter from the applicant is provided
Page 10 of 10
W. CABARRUS ST.
NOTES
LEGEND
AREA BY COORDINATES.
EIP
— EXISTING IRON PIPE
THIS LOT IS NOT LOCATED IN A FEMA
R/W
— RIGHT OF WAY
_
MAPPED FLOOD HAZARD AREA. FEMA MAP
# ISS
— IRON STAKE SET
STAKE
3720170300J; ZONE X; EFF. DATE
EIS
— EXISTING IRON
04
SITE j
5/2/2006.
D.B.
— DEED BOOK
a
B.M.
— BOOK OF MAPS
oy ALA
S.F.
— SQUARE FEET
Ln
a
;INITY MAP (no scalel
50' NEUSE RIVER
m
VARIANCE GRANTED
j' RIPARIAN BUFFER
BUILDING SETBACKS
i
FRONT PORCH — 10'
/
SIDE — 5'
NEUSE RIVER BUFFER
# 1
REAR — 20'
CORNER SIDE — 10'
�'� NEUSE RIVER
BUFFER #
2
/.
/ co 4 El
%
/
�JV o \� S
PROPOSED PLAN FOR
STARCWT BUILDERS, INC.
513 ROSENGARTEN ALLEY, RALEIGH, NC
LOT 16 ALEX ROSENGARTEN PROP.
BOOK OF MAPS 1918 PAGE 50
DEED BK. 14635 PG. 829 i
PIN # 1703462770
CITY OF RALEIGH — WAKE COUNTY
=NORTH CAROLINA
SCALE : 1 = 30 — DECEMBER 12, 2013
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0 15 30 60
BENTON DEWAR & ASSOCIATES
PROFESSIONAL LAND SURVEYOR
5920 HONEYCUTT ROAD
HOLLY SPRINGS, NC 27540
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ISS I, BENTON W. DEWAR CERTIFY THAT THIS PLAT WAS DRAWN UNDER
7p001 8 ?J EIS MY SUPERVlS10N FROM AN ACTUAL SURVEY MADE UNDER MY
PROPOSED H 6. 10.1' S 21'23'S5'YII 1 i
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CONC. RIVE 2Q `��.. PORCH 1 6 '— 18.95' 7 THAT THE BOUNDARIES NOT SURVEYED ARE SHOWN AS BRRO/KK "Es
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2, 3 $„ (! .571 TH4T TT+!S °tAT D4E5 NOT HFfT SIZE PFOUIREMFNiS
ISS N D.B. 14696 PG. 2149 FOR RECORDING IN THE OF DEPs. PER G.S. 47 -30 AS AM MENDED.
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PROFESSIOWLL. uuu0 I.RVEYOR L-
THIS PLAT S OF A BOUNDARY SURVEY OF AN EXISTING
.3_3075 PARCEL OF LAND THAT IS REGULATED &f A COUNTY OR
MUNICIPALITY OP.DINANCE THAT REGULATES PARCELS OF IAND.
ROSENG \12 \600