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Home My WebLink About20140039 Ver 1_Application_20140110.�,�,. ,� . X k ` � p 4 M . ,+�d�` �.; � g�,�^,.�� ,L.c`� ��S1t�`� �M �� `�. �TATE t�F 1`��R:��H I�.�+�R�L,Il.'�T.A �!:��'��.�T�1��T' +►�F 3��:��P�?�.�'.�.TICJN P�.T l�I+��i�.�R�` P'. +�. �� .�4� �., 3��i,gh, 3'�� ' ?'� 1 I-��Q� T�1�3�'` T�4.T'.�►.. Cirt;��:��:��R. �'��:��: �1'�-?�� E��'��.�' ��1��.�y S� �oi� �!�r. .��.d� �"i�l�arr�� ,T. �. .A�ny l�arp� �af En�ine�rs :��I+�i�� .��ula�+�ry Fi�ld +�3��.c+� � 3 31. �-I�rita�� Trad.e �ri��, ��.ite l �►� 'VV�:I�� :�c�r�st, �.`+1�� 755�'7 �u�bj e�� : �T�tit��wide Per�nr�it � 13 1�ridg+� #� 1 �� o� �:� �� Wilk�s �c��.ty, l�T+art�i +��rc�li�.a �`roj�e+��t Nu�mb�r: ��1�52.1�1 �(1'�a :i��WW� 1'ern�it :�tequirec�� I��ar l�!�r� �t�i�liam.s: �'�.+e 1�T+C �+�pa�tment �►�` 'Tran��orta�tic��. i� p�r�pc�sir�� c► r��1�.c� B�dg+� � 193 +�n I�.�� h��t� and �lu�e I�.aad in '�'��1�� unty. t�►rd.in�� th�i� pr�jec� ��ld �'�l ur��er �the �,:�f:� pr�►�r�:� b►�.� ��.� n�vv b�.d�e is �►�. a��i��ly d�:�`�r��.�t a�i��n�t �.n�. t�+er�fca�e +��es n�t c�ua,li�y� ��►r th� �.I�R � rc�c�s�. 'T�+� ��w� bridg� is a hig� �r+�und t+� hi�h �r+��u�.d st:r�u.c�tur+�� "�.+� c��l.y e�v��ra:�r�n�e�t�.� i�pacts are 34 Iin�ar fee�t ��' b�.�� arjmc�rin a� t�� ol�. b�.dg+� l+�ca,�ic��. alc�n� v�r��th a.�b�u�t �i� l�n�ar feet of de�w�.terin �t the e+d,�� c�f th� c�.anr�el. Thes�e impact� �vi�1 o�cur �n tl�� 'Yadl�i.r� Ba��. al�ng B�ri�,r �r�ek. ��l�.�s: �). �"his prc�j�ct wa.s re��. �"�r th� pr+�s�r�+c+� c�� t�re��n+�+� an� e�.da�.;g+�red spe�� :�+�+c�m�+��r, ��►13 . Thai.� pr�j�ct �vill hav� n�o ef��t +�� ny f�d.+�ra11� list+�d enc��.n��r�d� pl�� r �:c�.m�,1 �p�ci�s. �:�.�t+�ric c+�:r.n�li�n�c�e �w�r�k has b�+�n +c�m.�►l+�ted �n�d �+� �u�r�ys �cr�r+� �r��q��r�d. i'h+� pr�►j�� i:�pacts are ��t si�n��.cant in na��.re. 1�t��n�tr��.� ��.�er c�u�.l�t� s�tar�d.ar�.s �vill �►� prc�t�ct�� by u��i�zin� a�pr+��.a,te I31��'s duri�a�g +��s�ru+cti�n. �.�tt�.c��d i� a Pr�cc��.structic�n 1�Tt�ti:�c�.�.ic�� 'c��n, p�l��. �h+�e�ts, a. m.a�`�.��. c�unt� ma.p� a r�ar�+�d. t�pc�gra�h�r �m.a:p �a�a.d phot+�,�ra�hs. �y cop�� t��" t�:s �lectrc�ni+� l�tt��, it �s reque��d t�.a�t l��r�� 11�arla, �h�:�b�r� �vvit� tl��e ��Tarth �a.rc��ina, '�ildli�e :F�.�sc��rce� ��mr��is�it�� ct�r��rne�.t dir�ctly tr� you +�c��.ce�r�.n� th+� �� 1"��.�i+�n�w�it�+e �'�rr��.�. ap�li+�atic�� v�ith a��py se�t �o me. P. C�. Box �5�, N. �'r�.�.sB��.c�, �� 8�59 Pxa;r� (33�) �66'7-9i 11 F� �(�36� �6'7-4,5�9 l��r. Andy '�"i�lia.m.s �ridge #193 v�� t �324, ��lk.es Pa.�e � ,��.nu�a�� , 2014 '�'�e �aul� ��1�� e�� n:�tructi��a as soc�n a� ��bl�. If �ii�r�her i�for�na,ti+��: is req?�ir�d, pl�� let m+e ��.€�v�r. �"t�ur earl�r r��iew �n.d +�onsid�r�tic�n �%l� be apprecia,t�d. � i�c��l�, � �_ ,�, :�3eath �1a�.�h��r Il�i�i�si�n :�n��r�anm.+�nta� �►��:�+��r :��lc�sure� cc: I1�I�,rla �h�m�+�rs, �C�V�EE�.� �!�rny �ha�m�.n, I�►i�.si�n �f'U'�at�er t�ival�ty �� pi�es� l�fi��.e P+�tt�j �ah�., F'E� Ii�iv�sic�� r�gir�+��r J�a:r�:i �uynr�, II�►ivi��c��. �rit�,�� Prc��ram ��an�a,��r I:�ea�h �Iau��i��r,l�ivi�i�n �n�vi�-+��m.�ental t��i+c+�r ��a�e "�hrell��l�d, l�oad�i�.e :�n�i�ran�m.+��.t�IT :��+�ld tC�p�rati��.� T��h��.cian �� .� :.�,�`".�mV� (�ffice Use CJnly: � � �� :... � l�•y � ��` � � �� i � , � �j .� � CQrps action I D n�. � � 1b � y .� . . ...-+ 5 " �. � �, �<$ �k 4.��.�:�� N�;��u,� .,,� C�W Q p rC7� �.'Gi li O. � � � � '..'� ��<��'� �:��. {C{y,r �� .f��"�� Form Versior� 1.3 Dec 1 C� 2�Q8 �'r�-t��.��r��t�� I"�c��ii�i�c�.��+�� {�'t�I`�) :�� A. .t�.�pl�car�� 'or�rnat�o� 1. Proces�ing 1 a. Type(s) of approvai sought from the �� : ��ection 4�n4 Permit ❑ Section 10 Permit P 1 b. Specify Nationwide Permit (NWP} number: 13 or General Permit {GP) number: 1 c. Has the !�W P or GP number been verified by the Corps? ❑ Yes � No 1 d. Type(s} c�f approval sought from the DWQ {check all that apply): ❑ 401 Water Quality Certificatian -- Regular ❑ Non-4�4 J�urisdictional General Permit ❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorizataan 1 e. Is this notification soleiy for the record For the record oniy for DWQ 401 For the r�cord only for Corps Permit: because written approval is not required? Gertification: � Yes [� Na C] Yes j� Na 1 f. Is payment into a mitigation bank or in-lieu fee program proposed for mitig�tion ��e� ��o af impacts? If so, attach the acceptance letter #rom mitigation bank or in-lieu fee program. 1 g. Is the projecfi located in any of NC's twenty coas�al countie�. lf yes, answer 1 h ❑ Yes � Nn below. 1 h. Is the project Ic�cated within a NC DCM Area of Environmental Concern (AEC)? ❑ Yes � No 2. Project lnformation 2a. Name af project: Bridge #193 on SF� 2324 2b. County: Wilkes 2c. Nearest municipality / town: Roaring River 2d. Subdivision name: 2e. NCDOT only, T.I . P. or state �p082.1.1 project no: 3. Owner Information 3a. Name(s) on Recorded Deed: NCDOT 3b. Deed Book and Page No. 3c. Responsible Party (for LLC if applicable}: 3d. Street address: 801 Statesville Road 3e. City, state, zip: Nc�rth Wilkesboro, NC 28�59 3f. Telephone nca.: 336-9�3-92�2 3g. Fax no.: 336-667-4549 3h. Email address: hslaughter� ncdot.gov Pagel�fl� PCN Form — Versian 1.3 December 10, 2�08 Version 4. �ppli�ant �nf�rm��i+�ra ��f dif�er��t �r�r� �awn�r� 4a. Applicant is: �] Agent (� C�ther, specify: 4b. Name: 4c. Business name �if applrcable}: 4d. Street address: 4e. City, state, zip: 4f. Teiephone no.: 4g. Fax na.: 4h. Email addres�: �. AgentlCQnsultarat Infc�rrr�ation tif applicabl�e� 5a. Name: 5b. Busines� name (if applicable): 5c. �treet address: 5d. City, state, zip: 5e. Telephone no.: 5�. Fax no.: 5g. Email �ddress: Page 2 of 10 PCN Form — Version 1.3 Decem ber 1 n, 20U8 Ver�ion E�. P'rc�j�c� ir�fc�rm��ion an� �'r�c�r �rc�ject �is��r� � . Pr�per��r 1d�nt�f�c��it�n �9 a. Property ider�tifica�ion na. (tax P1�1 �r parcel IL�): 1 b. �ite coordinates (in decimal degrees}: Latitude: 3�.19��1 Longitude. - 80.9��52 {afl.D��Q� �-�Q.ac��aa� 1c. Proper�y si�e: 4.5 acres �. Surface Wa#�ers 2a. Name of nearest body o� water {stream, river, etc.} to g�ia� �reek proposed project: 2b. Water Quaiity �lassification of nearest receiving water: C 2c. River ba�in: Yadkin 3. Project Des�ription 3a. Describe the exi�ting conditions on the site and the general land �ase in the vicinity of the project at the t'rme of this applicatiar�: �ubstandard bridge on a paued road with grassed shoulders in a rurai setting 3b. List the total estimated acreage of a!I existing wetlands on the property: 4 acres 3c. �ist the total estimated linear feet of al1 existing streams {ir�termittent and perennial} c�n the property; 190' 3d. Explain the purpose of the propc�sed project: Bridge Replacement 3e. Describe the overall praject in detail, incfuding the type of equipment t� be used: See attached caver fetter and plans. 4. Jurisdictit�nal Determir�ations 4a. Have jurisdictic�nal wetland or stream determinations by the Carps or State been requested or obtained for this prope�ty / project includin all prior phases) in the past? ��'�� No �j Unknown � � Comments: 4b. If the Crarps made the jurisdictional determination, what type of determination was made? ❑ Preliminary ❑ Final 4c. 1f yes, who delineated the jurisdictiona! areas? Agency/Consultant Company: Name (if knawn): C�ther: 4d. If yes, list the dates of the Corps j�risdictional determinations or State determinations and attach documentation. 5. Projec# Hisic�ry 5a. Have permits or certifications been requested or obtained fior � Yes j� �lo ❑ lJnknown this project {including a!I prior phases} in the past? 5b. If yes, explain in detail according to "help file" instructions. �. Future Project Pians 6a. Is this a phased project? ❑ Yes � No 6b. lf yes, explain. Page 3 of 10 PCN Fc�rm — Versi�n 1.3 Decem ber 1 a, 2UQ8 Version �. Proposed Impacts lnventory 1. Impacts Summary 1 a. Which sections wer� completed belc�w for yaur project {check a!I that appiY): [� Wetlands � Streams - tributaries ❑ Buffers ❑ C�pen Waters ❑ Pond Constructic►n 2. Wetland fmpacts If �here are wet�and impacts proposed on the site, then campiete this question �or each wetland area impacted. 2a. 2b. 2c. 2d. 2e. 2f. Wetland impact Typ� of jurisdiction number — Type of impact Type of wetland Forested {Corps - 404, 1� Ar�a nf impact Permanent (P) or {if knawn) DWC� -- nan-�o4, c�ther} (acres) Tem orar T ❑ Ye� ❑ Corps W1 ❑P❑T ❑No [�DWQ ❑ Yes ❑ Corps W2 [�P❑T �hlo [�pWQ� ❑ Ye� Q Corps W3 ❑P❑T ❑No ❑DWCC� �] Yes C] Corps W4 ❑P❑T C]NQ ❑DWQ ❑ Ye� ❑ Corp� W5 ❑P❑T C]No ❑DWQ [� Yes ❑ Corps W6 ❑P❑T ❑N� ❑DWC� Zg. Total wetland impacts 2h. Camments: 3. �tream Impacts If there are perennial or intermittent stream impac�s (including temporary impacts} proposed on the �ite, then compiete this question for all stream sites impacted. 3a. 3b. 3c. 3d. 3e. 3f. �� Stream impact Type of impact Stream name Perenniafi Type of jurisdiction Average Impact number - (PER) or (Corps - 404, 10 stream length Permanent {Pj or ir�termittent DW Q— non-4C�4, width (lin�ar Temporary (T) (�NT)� other) {feet} feet) Riprap & � PER (� Corps 1�-�p 54 �1 � P� T Dewaterin �r�ar Creek � �NT � �WC� g C]] PER ❑ Corps S2 ❑P❑T [�INT ❑QWC� ❑ PER ❑ Garps S3 C]P❑T [�1NT C�QWC� ❑ PER ❑ Corps S4 ❑P❑T ❑INT ❑�WC� [� PER ❑ Corps S5 ❑ P❑ T ❑ I NT ❑ DW Q ❑ P E R ❑ Corps �6 ❑P❑T ❑iNT ❑DWQ 3h. Total stream and tributary impacts �4 3i. Comments: 20 linear feet of the impacts are temporary dewatering Page 4 af 1 � PCN Form — Version 1.3 December 1�, �aC�8 Versian 4. +�pen �1!'��r �mpact� a# there are proposed impacts tca lakes, p�nds, estuarie�, tributaries, sounds, the Atlantoc fl�ean, or any c�ther �per� wa�er �f the U.�. then individually list all ope� water impacts below. 4��. 4b. 4c. 4d. 4e. C�p�n waier �lar�e c�f waterbody impact n�mber — (if a�plicable) Typ� c�f impact V1Jaterbody �ype Area of impact (acres) Permanent {�'} or iem orar T t� 1 ❑ P [_] T C�2 ❑ P ❑ T CJ3 ❑ P CJ T C�4 ❑P❑T 4f. �Cotal open water impacts 4g. Comments: �. Pond or L�k� Cc��asiructic�n If ond or lake construction ro ased, then com lete the chart below. 5a. 5b. 5c. 5d. 5e. W�tland Impac�s (acr�s) Stream lmpacts (feet) Upland Pond ID Proposed use or purpose (acres} number of pond Flooded Filled Excavated Flooded Filled Excavated Fic�c�d�d P1 P2 5f. Total 5g. Comments: N/A �h. Is a dam high hazard permit required? ❑ Yes �(�o If yes, permit I D no: 5i. Expect�d pond surface area (acres}: 5j. Size of pond watershed (acres): 5k. Methad af construction: 6. Buffer Impacts {for DWQ) If prc�ject will impact a protected riparian buffer, then complete the char� belaw. If yes, then individually list ai1 buffer impacts below. If any impacts require miti atic�n, then you MU�T fi11 out Section D of this form. �6a. ❑ �leuse [� Tar-Pamlica ❑ C�ther: Project is in which protected basin? ❑ Catawba ❑ Randleman 6b. �c. 6d. 6e. 6f. 6g. Buffer impact number — Reasan Buffer Zone 1 impact Zone 2 impact Permanent (P) or for Stream name mitigatian (square feet) (square fe�t) Tem arar T im act re uired? ❑ Yes B1 [�P❑T a�� ❑ ��? 5 B2 ❑P❑T ❑No [� Y�s B3 [�P❑T �� 6h. Total bu��'er impac�s 6i. Comments: Page 5 af 14 PCN Form — Version 1.3 December 10, 2�U8 Versian �. �rr�pac� �1us�i�i��t�c�r� �r�� i1��g�ti+�� i � e4�rc� i da r� �� ra d� i r� i rr� i�� c�� 1 a. �pecifically describe measures iak�n to avaid or mir�imi�e the propos�d imp�c;`�s in designing pr�jec�. Na impact at the new bridge. 1 b. �pecificaily describe measur�s t�ken to avoid c�r minimize th� prc�posed impacts thraug� cc�nstruction t�ch�iques. All appropriate BN1Ps will be used during cc�nstruction 2. C�mpensatary Mit�gatic�n #c�r �rrapac�s #011Vat�er� c�f the �.�. or Water� c�f �he �'��te 2a. �oes the project req�ire Cc�mpensatory Mitigatian for [� Y�s � No impacts to Waters of the U.�. or Waters of the State? 2b. If yes, mitlgatlon is required by (check a11 that apply): ❑ DWQ ❑ Corps ❑ Nlitigatian bank 2c. If yes, which mitigation option will be used for this ro�ect? ❑ Payment to in-iieu f�e pragram p 1 ❑ Permittee Res�ansible Mitigation 3. Gomplet� if Using a Mitigation Bank 3a. Name of Mitigatior� Bank: 3b. Credits �'urchased (attach receipi and letter} Type Quantity 3c. Comments: 4. Cornplet�e ifi Making a Payrr�ent to in-tieu Fee Pragram 4a. Approval letter frc�m in-lieu fee prQgram is attached. ❑ Y�s 4b. �tream mitigaiion requested: linear feet 4c. I# using stream mitiga#ion, stream temperature: [� warm C] cool ❑cold 4d. 8uffer mitigation requested {DWQ only). square feet 4e. Riparian wetfand mitigation requested: acres 4f. Non-riparian wetland mitigation requested: acres 4g. Coastal (tidal) wetland mitigation requested: acres 4h. Cc�mments: 5. Compl�e#e if Using a Permittee R�spc�r�sible Mitigatic�r� P�an 5a. If u�ing a permittee responsible mitigation plan, provide a description of the proposed mitigation plan. P�ge � of 1 � PCN Form — Version 1.3 Decem ber 1 Q, 20Q8 Version �. E�uffer �V'fi�ig�tic�� +�goui��ed �iparmar� ��f�er ��al��) -- r�:q�ir�� b� ��VV �a. Wiil the project result in an impact within a protected riparian buff�r that ��q�ir�s � Yes � No buffer mitigation? � t 6b. It yes, then ic�entify the square feet c�f impact tc► each zone of the riparian buffer that requires m�t�gat�on. Calculafie the ! �mc�unt c�f mifiigation required. � �c. 6�. �e. �� Reason for impact Total impact Nlultiplier Re�uired mitigation (square feet) (square feet) Zone 1 3(� for Catawba} �one 2 1.� 6f. T�t�i buffer rr�itig�tic�n r��ir�e�: ; �g. If buffer mitigation is required, diseuss what type c�f mitigatic�n is proposed (e.g., payment to private mitigation bank, permittee responsible rip�.rian buffer restoraiion, payment into an apprnved in-)ieu fee fund). 6h. Comments: Page 7 c�f 1 {� PCN Form — Version 1.3 �ecember 10, 2Q08 Version �E. �'��►rt�e�vaier �lla�nagement ;�r�d C3iffu�e Ficaenr Plar� �re��ir�� y �?V�J't�� 1. C�if�u�e F1ow �lara 1 a. Does the project include or is it adjacent to protected ri�arian buf�ers ider�tified � Yes � No w i t h i n o n e c� f t h e �, i� F� i p a r i a n � u f f e r P r o t e e t i o n R u l e s? 1 b. Ifi yes, then is a diffu�e ficaw plan includ�d? lf no, explain why. C] Yes [� No Comments: 2. 5tormwater M�rr�a �ement F'lara 2a. What is the ove�all percent imperviousr�ess c�f this project? % 2b. aoes this prc�ject require a Stormwater Management Plan? ❑ Y�s j� Nc� 2c. If this prc�ject DC.�E� NCC�T require a�tarmwater Management Plan, e�plain why: 2d. If this project DQES require a Stc�rmv�ater Mar�agement Plan, then provide a brief, narrative descripti�n o� the pian. ❑ Gerkified Lc�cal �overnment 2e. Whca will be respansible for the revi�w a# the ��ormwater Management F'lan? [� L�V1lQ StQrmw�ter Program ❑ DWQ 401 lJnit 3. �ertif�edl Local G+�vernmerat �torrnwa�ter Re�riew 3a. In which local government'� jurisdiction is this pr�ject? Q F'hase i I ❑ N�W 3b. Which �f the foilowing iocaliy-implemented stormwater mana�ement programs � U��, �pp�Y Ccheck all that app�Y): Q Water �upp#y Watershed C] C�ther: 3c. Has ihe approved Stormwater Management Plan with proc�f o# approval been ❑ Ye� ❑ Nc� atta�hed? 4. DWQ Stc�rmwater Pra ram Revgew ❑ Coastal caunties ❑ r�t�w' 4a. Which of the following state-implemented stormwater management programs appfy 0�R� (check all that apply): ❑ Session Law 20(�6-246 [� CJther: 4b. Has the approved Stormwater Management Plan with praof of appraval been attached? 0 �e� � �° 5. DV1/Q 401 Unit Stormwafi�r Review 5a. Does t�e Stormwater Management Plan meet the appropriate requirements? [� �e� � No 5b. Nave all t�f fihe 4�1 Unit submittal requirements been met? � Y�� fl Page $ of 1 C� PCN Form — Version 1.3 December 1�, 2C��8 Version F. S�pp��r�e�t�ry �r�fc�rr�a�i+�� . �r�virc�nrr�e�atal C9oc�m+�r�ta��on {C�WC� ��quir�rroer�t� 1 a. Do�s the project invalve ar� expenditure of public (federal/state/local} �ur�ds c�r the �,�� ❑�Q use of pub{i� (federal/state} 1and? 1 b. If you answered "yes" to the above, daes the project require preparation of an environmentai dc�cument pursuant ta the requirements of �the Na�ional or �tate ❑ Yes � No {North Carolina) Enviranmenta! Policy AGt (NEF�A/��PA}? 1 c. if you answered "ye�" to �he above, has the document review been finalized by the �tate Clearing Hause? {If so, attach a capy of the NEPA or SEP�. final approval letter.j ❑ Y�s [:� No Comments: 2. Viola�ions {DWC� Rec�uirement� 2a. Is the s�te in violation af DWQ 1Netland Rules {15A NCAC 2H .05G�}, Isolated Wetland Rules (15A NCAC 2H .13Q0), D1NQ Surface Water or Wetland Standards, ❑ Y�s �J No ar Riparian Buffer Rules {15A NCAC 2B .4200}? 2b. Is this an after-the-fact p�rmit application? ❑ Yes �) No 2c. If you answered "yes" to one or bc�th ofi the above questians, provide an explanation of t�e viofation{s): 3. Cumulative Irr�pacts (C�1Nt� Req�irement) 3a. Will this project (based on past and reasonably anticip��ed fiuture impacts} re�ult in ��,,.�5 �� additional deveic�pment, which could impact nearby downstream water qu�.lity? 3b. lf you answered "yes" to fihe above, submit a qualitative or quantitative cumulative impact analysis in ac�ardar�ce with the mosfi recent DWQ policy. If you answered "no," provide a shart narrative description. 4. Sewage aisposal {DWQ Requiremer�t) 4a. Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) af wastewater generated fr�m the proposed project, or available capacity af the subject facility. N/A Page 9 of 1 � PCN Form -- Version 1.3 December 1�, 200� Version 5, En+dar��r�d 5�ec�e�► ar�d �esign�t�c� �r��ti�a9 ��itat (t�c�rp� ��+q�air+er��r��) �a. Will this project c�ccur �r� c�r near an area wit� federaliy pr�tec�e� speci�s or Yes � f�o h i t`� � ab ta . 5b. Have you checked with �he IJ�FW� cancernir�g Endangered Sp�cies Act [� Yes � No i m pacts? ❑ Raleigh 5c. !f yes, indicate the USF1N� Field CJffice you have contacted. ❑ Ashevi{le 5d. What data sources did yQU use to determine vvhether your site would impact Endangered �pecies ar Designated Critical H�bitat? �IS and visual abservatian 6. Essential Fish H�bitat {�arps Req�ir�ment� fa. W'il! this project accur in or near an area designated as essential fish habitat? ❑ Yes ��lo 6b. What data sources did you use to determine whether your si�e would impact Essential Fi�h Habitat? WR� will comment ?. Historic or Prehistc�ric CUltur�� Re�QUrc�es {!Cc�rps Requirer�+��n�� 7a. Will this project oc�ur in or near an area that the state, federa! or tribal gov�rnments have designated as having historic or culturai pr�serva#ion ��e� ��o status {e.g., National Nistoric Trust designatian or praper�ies significant in North Carolina histc�ry and archaeology)? 7b. What data saurces did you use to determine whether your site wc�uld impact historic or archeol�gical resources? HUE reviewed the project. 8. Flr�od Zone Desigr�ati+�n (Cc�rps Requirer�en�) 8a. Will this praject accur in a FEMA-designated 144-year f{oodplain? ❑ Yes (� N� 8b. If yes, explain how project meets FEMA requi�ernents: 8c. W hat source(s) did you use to make the fioodpiain determinatic�n'? ncfloodmaps , J. I-�eath S 1 aughter 1/8I14 �. � A ficant/A ent's Printed Name Applicanfi/Agent's Signat �� p� � (Agent's r nature is valid onfy if an authorizatio tter from the applicant � is rovided. ' F'age 1Q of � 4 PCN Form — Version 1.3 �December 10, 2C�U8 Version .�,�,. ,� . X k ` � p 4 M . ,+�d�` �.; � g�,�^,.�� ,L.c`� ��S1t�`� �M �� `�. �TATE t�F 1`��R:��H I�.�+�R�L,Il.'�T.A �!:��'��.�T�1��T' +►�F 3��:��P�?�.�'.�.TICJN P�.T l�I+��i�.�R�` P'. +�. �� .�4� �., 3��i,gh, 3'�� ' ?'� 1 I-��Q� T�1�3�'` T�4.T'.�►.. Cirt;��:��:��R. �'��:��: �1'�-?�� E��'��.�' ��1��.�y S� �oi� �!�r. .��.d� �"i�l�arr�� ,T. �. .A�ny l�arp� �af En�ine�rs :��I+�i�� .��ula�+�ry Fi�ld +�3��.c+� � 3 31. �-I�rita�� Trad.e �ri��, ��.ite l �►� 'VV�:I�� :�c�r�st, �.`+1�� 755�'7 �u�bj e�� : �T�tit��wide Per�nr�it � 13 1�ridg+� #� 1 �� o� �:� �� Wilk�s �c��.ty, l�T+art�i +��rc�li�.a �`roj�e+��t Nu�mb�r: ��1�52.1�1 �(1'�a :i��WW� 1'ern�it :�tequirec�� I��ar l�!�r� �t�i�liam.s: �'�.+e 1�T+C �+�pa�tment �►�` 'Tran��orta�tic��. i� p�r�pc�sir�� c► r��1�.c� B�dg+� � 193 +�n I�.�� h��t� and �lu�e I�.aad in '�'��1�� unty. t�►rd.in�� th�i� pr�jec� ��ld �'�l ur��er �the �,:�f:� pr�►�r�:� b►�.� ��.� n�vv b�.d�e is �►�. a��i��ly d�:�`�r��.�t a�i��n�t �.n�. t�+er�fca�e +��es n�t c�ua,li�y� ��►r th� �.I�R � rc�c�s�. 'T�+� ��w� bridg� is a hig� �r+�und t+� hi�h �r+��u�.d st:r�u.c�tur+�� "�.+� c��l.y e�v��ra:�r�n�e�t�.� i�pacts are 34 Iin�ar fee�t ��' b�.�� arjmc�rin a� t�� ol�. b�.dg+� l+�ca,�ic��. alc�n� v�r��th a.�b�u�t �i� l�n�ar feet of de�w�.terin �t the e+d,�� c�f th� c�.anr�el. Thes�e impact� �vi�1 o�cur �n tl�� 'Yadl�i.r� Ba��. al�ng B�ri�,r �r�ek. ��l�.�s: �). �"his prc�j�ct wa.s re��. �"�r th� pr+�s�r�+c+� c�� t�re��n+�+� an� e�.da�.;g+�red spe�� :�+�+c�m�+��r, ��►13 . Thai.� pr�j�ct �vill hav� n�o ef��t +�� ny f�d.+�ra11� list+�d enc��.n��r�d� pl�� r �:c�.m�,1 �p�ci�s. �:�.�t+�ric c+�:r.n�li�n�c�e �w�r�k has b�+�n +c�m.�►l+�ted �n�d �+� �u�r�ys �cr�r+� �r��q��r�d. i'h+� pr�►j�� i:�pacts are ��t si�n��.cant in na��.re. 1�t��n�tr��.� ��.�er c�u�.l�t� s�tar�d.ar�.s �vill �►� prc�t�ct�� by u��i�zin� a�pr+��.a,te I31��'s duri�a�g +��s�ru+cti�n. �.�tt�.c��d i� a Pr�cc��.structic�n 1�Tt�ti:�c�.�.ic�� 'c��n, p�l��. �h+�e�ts, a. m.a�`�.��. c�unt� ma.p� a r�ar�+�d. t�pc�gra�h�r �m.a:p �a�a.d phot+�,�ra�hs. �y cop�� t��" t�:s �lectrc�ni+� l�tt��, it �s reque��d t�.a�t l��r�� 11�arla, �h�:�b�r� �vvit� tl��e ��Tarth �a.rc��ina, '�ildli�e :F�.�sc��rce� ��mr��is�it�� ct�r��rne�.t dir�ctly tr� you +�c��.ce�r�.n� th+� �� 1"��.�i+�n�w�it�+e �'�rr��.�. ap�li+�atic�� v�ith a��py se�t �o me. P. C�. Box �5�, N. �'r�.�.sB��.c�, �� 8�59 Pxa;r� (33�) �66'7-9i 11 F� �(�36� �6'7-4,5�9 l��r. Andy '�"i�lia.m.s �ridge #193 v�� t �324, ��lk.es Pa.�e � ,��.nu�a�� , 2014 '�'�e �aul� ��1�� e�� n:�tructi��a as soc�n a� ��bl�. If �ii�r�her i�for�na,ti+��: is req?�ir�d, pl�� let m+e ��.€�v�r. �"t�ur earl�r r��iew �n.d +�onsid�r�tic�n �%l� be apprecia,t�d. � i�c��l�, � �_ ,�, :�3eath �1a�.�h��r Il�i�i�si�n :�n��r�anm.+�nta� �►��:�+��r :��lc�sure� cc: I1�I�,rla �h�m�+�rs, �C�V�EE�.� �!�rny �ha�m�.n, I�►i�.si�n �f'U'�at�er t�ival�ty �� pi�es� l�fi��.e P+�tt�j �ah�., F'E� Ii�iv�sic�� r�gir�+��r J�a:r�:i �uynr�, II�►ivi��c��. �rit�,�� Prc��ram ��an�a,��r I:�ea�h �Iau��i��r,l�ivi�i�n �n�vi�-+��m.�ental t��i+c+�r ��a�e "�hrell��l�d, l�oad�i�.e :�n�i�ran�m.+��.t�IT :��+�ld tC�p�rati��.� T��h��.cian �� .� :.�,�`".�mV� (�ffice Use CJnly: � � �� :... � l�•y � ��` � � �� i � , � �j .� � CQrps action I D n�. � � 1b � y .� . . ...-+ 5 " �. � �, �<$ �k 4.��.�:�� N�;��u,� .,,� C�W Q p rC7� �.'Gi li O. � � � � '..'� ��<��'� �:��. {C{y,r �� .f��"�� Form Versior� 1.3 Dec 1 C� 2�Q8 �'r�-t��.��r��t�� I"�c��ii�i�c�.��+�� {�'t�I`�) :�� A. .t�.�pl�car�� 'or�rnat�o� 1. Proces�ing 1 a. Type(s) of approvai sought from the �� : ��ection 4�n4 Permit ❑ Section 10 Permit P 1 b. Specify Nationwide Permit (NWP} number: 13 or General Permit {GP) number: 1 c. Has the !�W P or GP number been verified by the Corps? ❑ Yes � No 1 d. Type(s} c�f approval sought from the DWQ {check all that apply): ❑ 401 Water Quality Certificatian -- Regular ❑ Non-4�4 J�urisdictional General Permit ❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorizataan 1 e. Is this notification soleiy for the record For the record oniy for DWQ 401 For the r�cord only for Corps Permit: because written approval is not required? Gertification: � Yes [� Na C] Yes j� Na 1 f. Is payment into a mitigation bank or in-lieu fee program proposed for mitig�tion ��e� ��o af impacts? If so, attach the acceptance letter #rom mitigation bank or in-lieu fee program. 1 g. Is the projecfi located in any of NC's twenty coas�al countie�. lf yes, answer 1 h ❑ Yes � Nn below. 1 h. Is the project Ic�cated within a NC DCM Area of Environmental Concern (AEC)? ❑ Yes � No 2. Project lnformation 2a. Name af project: Bridge #193 on SF� 2324 2b. County: Wilkes 2c. Nearest municipality / town: Roaring River 2d. Subdivision name: 2e. NCDOT only, T.I . P. or state �p082.1.1 project no: 3. Owner Information 3a. Name(s) on Recorded Deed: NCDOT 3b. Deed Book and Page No. 3c. Responsible Party (for LLC if applicable}: 3d. Street address: 801 Statesville Road 3e. City, state, zip: Nc�rth Wilkesboro, NC 28�59 3f. Telephone nca.: 336-9�3-92�2 3g. Fax no.: 336-667-4549 3h. Email address: hslaughter� ncdot.gov Pagel�fl� PCN Form — Versian 1.3 December 10, 2�08 Version 4. �ppli�ant �nf�rm��i+�ra ��f dif�er��t �r�r� �awn�r� 4a. Applicant is: �] Agent (� C�ther, specify: 4b. Name: 4c. Business name �if applrcable}: 4d. Street address: 4e. City, state, zip: 4f. Teiephone no.: 4g. Fax na.: 4h. Email addres�: �. AgentlCQnsultarat Infc�rrr�ation tif applicabl�e� 5a. Name: 5b. Busines� name (if applicable): 5c. �treet address: 5d. City, state, zip: 5e. Telephone no.: 5�. Fax no.: 5g. Email �ddress: Page 2 of 10 PCN Form — Version 1.3 Decem ber 1 n, 20U8 Ver�ion E�. P'rc�j�c� ir�fc�rm��ion an� �'r�c�r �rc�ject �is��r� � . Pr�per��r 1d�nt�f�c��it�n �9 a. Property ider�tifica�ion na. (tax P1�1 �r parcel IL�): 1 b. �ite coordinates (in decimal degrees}: Latitude: 3�.19��1 Longitude. - 80.9��52 {afl.D��Q� �-�Q.ac��aa� 1c. Proper�y si�e: 4.5 acres �. Surface Wa#�ers 2a. Name of nearest body o� water {stream, river, etc.} to g�ia� �reek proposed project: 2b. Water Quaiity �lassification of nearest receiving water: C 2c. River ba�in: Yadkin 3. Project Des�ription 3a. Describe the exi�ting conditions on the site and the general land �ase in the vicinity of the project at the t'rme of this applicatiar�: �ubstandard bridge on a paued road with grassed shoulders in a rurai setting 3b. List the total estimated acreage of a!I existing wetlands on the property: 4 acres 3c. �ist the total estimated linear feet of al1 existing streams {ir�termittent and perennial} c�n the property; 190' 3d. Explain the purpose of the propc�sed project: Bridge Replacement 3e. Describe the overall praject in detail, incfuding the type of equipment t� be used: See attached caver fetter and plans. 4. Jurisdictit�nal Determir�ations 4a. Have jurisdictic�nal wetland or stream determinations by the Carps or State been requested or obtained for this prope�ty / project includin all prior phases) in the past? ��'�� No �j Unknown � � Comments: 4b. If the Crarps made the jurisdictional determination, what type of determination was made? ❑ Preliminary ❑ Final 4c. 1f yes, who delineated the jurisdictiona! areas? Agency/Consultant Company: Name (if knawn): C�ther: 4d. If yes, list the dates of the Corps j�risdictional determinations or State determinations and attach documentation. 5. Projec# Hisic�ry 5a. Have permits or certifications been requested or obtained fior � Yes j� �lo ❑ lJnknown this project {including a!I prior phases} in the past? 5b. If yes, explain in detail according to "help file" instructions. �. Future Project Pians 6a. Is this a phased project? ❑ Yes � No 6b. lf yes, explain. Page 3 of 10 PCN Fc�rm — Versi�n 1.3 Decem ber 1 a, 2UQ8 Version �. Proposed Impacts lnventory 1. Impacts Summary 1 a. Which sections wer� completed belc�w for yaur project {check a!I that appiY): [� Wetlands � Streams - tributaries ❑ Buffers ❑ C�pen Waters ❑ Pond Constructic►n 2. Wetland fmpacts If �here are wet�and impacts proposed on the site, then campiete this question �or each wetland area impacted. 2a. 2b. 2c. 2d. 2e. 2f. Wetland impact Typ� of jurisdiction number — Type of impact Type of wetland Forested {Corps - 404, 1� Ar�a nf impact Permanent (P) or {if knawn) DWC� -- nan-�o4, c�ther} (acres) Tem orar T ❑ Ye� ❑ Corps W1 ❑P❑T ❑No [�DWQ ❑ Yes ❑ Corps W2 [�P❑T �hlo [�pWQ� ❑ Ye� Q Corps W3 ❑P❑T ❑No ❑DWCC� �] Yes C] Corps W4 ❑P❑T C]NQ ❑DWQ ❑ Ye� ❑ Corp� W5 ❑P❑T C]No ❑DWQ [� Yes ❑ Corps W6 ❑P❑T ❑N� ❑DWC� Zg. Total wetland impacts 2h. Camments: 3. �tream Impacts If there are perennial or intermittent stream impac�s (including temporary impacts} proposed on the �ite, then compiete this question for all stream sites impacted. 3a. 3b. 3c. 3d. 3e. 3f. �� Stream impact Type of impact Stream name Perenniafi Type of jurisdiction Average Impact number - (PER) or (Corps - 404, 10 stream length Permanent {Pj or ir�termittent DW Q— non-4C�4, width (lin�ar Temporary (T) (�NT)� other) {feet} feet) Riprap & � PER (� Corps 1�-�p 54 �1 � P� T Dewaterin �r�ar Creek � �NT � �WC� g C]] PER ❑ Corps S2 ❑P❑T [�INT ❑QWC� ❑ PER ❑ Garps S3 C]P❑T [�1NT C�QWC� ❑ PER ❑ Corps S4 ❑P❑T ❑INT ❑�WC� [� PER ❑ Corps S5 ❑ P❑ T ❑ I NT ❑ DW Q ❑ P E R ❑ Corps �6 ❑P❑T ❑iNT ❑DWQ 3h. Total stream and tributary impacts �4 3i. Comments: 20 linear feet of the impacts are temporary dewatering Page 4 af 1 � PCN Form — Version 1.3 December 1�, �aC�8 Versian 4. +�pen �1!'��r �mpact� a# there are proposed impacts tca lakes, p�nds, estuarie�, tributaries, sounds, the Atlantoc fl�ean, or any c�ther �per� wa�er �f the U.�. then individually list all ope� water impacts below. 4��. 4b. 4c. 4d. 4e. C�p�n waier �lar�e c�f waterbody impact n�mber — (if a�plicable) Typ� c�f impact V1Jaterbody �ype Area of impact (acres) Permanent {�'} or iem orar T t� 1 ❑ P [_] T C�2 ❑ P ❑ T CJ3 ❑ P CJ T C�4 ❑P❑T 4f. �Cotal open water impacts 4g. Comments: �. Pond or L�k� Cc��asiructic�n If ond or lake construction ro ased, then com lete the chart below. 5a. 5b. 5c. 5d. 5e. W�tland Impac�s (acr�s) Stream lmpacts (feet) Upland Pond ID Proposed use or purpose (acres} number of pond Flooded Filled Excavated Flooded Filled Excavated Fic�c�d�d P1 P2 5f. Total 5g. Comments: N/A �h. Is a dam high hazard permit required? ❑ Yes �(�o If yes, permit I D no: 5i. Expect�d pond surface area (acres}: 5j. Size of pond watershed (acres): 5k. Methad af construction: 6. Buffer Impacts {for DWQ) If prc�ject will impact a protected riparian buffer, then complete the char� belaw. If yes, then individually list ai1 buffer impacts below. If any impacts require miti atic�n, then you MU�T fi11 out Section D of this form. �6a. ❑ �leuse [� Tar-Pamlica ❑ C�ther: Project is in which protected basin? ❑ Catawba ❑ Randleman 6b. �c. 6d. 6e. 6f. 6g. Buffer impact number — Reasan Buffer Zone 1 impact Zone 2 impact Permanent (P) or for Stream name mitigatian (square feet) (square fe�t) Tem arar T im act re uired? ❑ Yes B1 [�P❑T a�� ❑ ��? 5 B2 ❑P❑T ❑No [� Y�s B3 [�P❑T �� 6h. Total bu��'er impac�s 6i. Comments: Page 5 af 14 PCN Form — Version 1.3 December 10, 2�U8 Versian �. �rr�pac� �1us�i�i��t�c�r� �r�� i1��g�ti+�� i � e4�rc� i da r� �� ra d� i r� i rr� i�� c�� 1 a. �pecifically describe measures iak�n to avaid or mir�imi�e the propos�d imp�c;`�s in designing pr�jec�. Na impact at the new bridge. 1 b. �pecificaily describe measur�s t�ken to avoid c�r minimize th� prc�posed impacts thraug� cc�nstruction t�ch�iques. All appropriate BN1Ps will be used during cc�nstruction 2. C�mpensatary Mit�gatic�n #c�r �rrapac�s #011Vat�er� c�f the �.�. or Water� c�f �he �'��te 2a. �oes the project req�ire Cc�mpensatory Mitigatian for [� Y�s � No impacts to Waters of the U.�. or Waters of the State? 2b. If yes, mitlgatlon is required by (check a11 that apply): ❑ DWQ ❑ Corps ❑ Nlitigatian bank 2c. If yes, which mitigation option will be used for this ro�ect? ❑ Payment to in-iieu f�e pragram p 1 ❑ Permittee Res�ansible Mitigation 3. Gomplet� if Using a Mitigation Bank 3a. Name of Mitigatior� Bank: 3b. Credits �'urchased (attach receipi and letter} Type Quantity 3c. Comments: 4. Cornplet�e ifi Making a Payrr�ent to in-tieu Fee Pragram 4a. Approval letter frc�m in-lieu fee prQgram is attached. ❑ Y�s 4b. �tream mitigaiion requested: linear feet 4c. I# using stream mitiga#ion, stream temperature: [� warm C] cool ❑cold 4d. 8uffer mitigation requested {DWQ only). square feet 4e. Riparian wetfand mitigation requested: acres 4f. Non-riparian wetland mitigation requested: acres 4g. Coastal (tidal) wetland mitigation requested: acres 4h. Cc�mments: 5. Compl�e#e if Using a Permittee R�spc�r�sible Mitigatic�r� P�an 5a. If u�ing a permittee responsible mitigation plan, provide a description of the proposed mitigation plan. P�ge � of 1 � PCN Form — Version 1.3 Decem ber 1 Q, 20Q8 Version �. E�uffer �V'fi�ig�tic�� +�goui��ed �iparmar� ��f�er ��al��) -- r�:q�ir�� b� ��VV �a. Wiil the project result in an impact within a protected riparian buff�r that ��q�ir�s � Yes � No buffer mitigation? � t 6b. It yes, then ic�entify the square feet c�f impact tc► each zone of the riparian buffer that requires m�t�gat�on. Calculafie the ! �mc�unt c�f mifiigation required. � �c. 6�. �e. �� Reason for impact Total impact Nlultiplier Re�uired mitigation (square feet) (square feet) Zone 1 3(� for Catawba} �one 2 1.� 6f. T�t�i buffer rr�itig�tic�n r��ir�e�: ; �g. If buffer mitigation is required, diseuss what type c�f mitigatic�n is proposed (e.g., payment to private mitigation bank, permittee responsible rip�.rian buffer restoraiion, payment into an apprnved in-)ieu fee fund). 6h. Comments: Page 7 c�f 1 {� PCN Form — Version 1.3 �ecember 10, 2Q08 Version �E. �'��►rt�e�vaier �lla�nagement ;�r�d C3iffu�e Ficaenr Plar� �re��ir�� y �?V�J't�� 1. C�if�u�e F1ow �lara 1 a. Does the project include or is it adjacent to protected ri�arian buf�ers ider�tified � Yes � No w i t h i n o n e c� f t h e �, i� F� i p a r i a n � u f f e r P r o t e e t i o n R u l e s? 1 b. Ifi yes, then is a diffu�e ficaw plan includ�d? lf no, explain why. C] Yes [� No Comments: 2. 5tormwater M�rr�a �ement F'lara 2a. What is the ove�all percent imperviousr�ess c�f this project? % 2b. aoes this prc�ject require a Stormwater Management Plan? ❑ Y�s j� Nc� 2c. If this prc�ject DC.�E� NCC�T require a�tarmwater Management Plan, e�plain why: 2d. If this project DQES require a Stc�rmv�ater Mar�agement Plan, then provide a brief, narrative descripti�n o� the pian. ❑ Gerkified Lc�cal �overnment 2e. Whca will be respansible for the revi�w a# the ��ormwater Management F'lan? [� L�V1lQ StQrmw�ter Program ❑ DWQ 401 lJnit 3. �ertif�edl Local G+�vernmerat �torrnwa�ter Re�riew 3a. In which local government'� jurisdiction is this pr�ject? Q F'hase i I ❑ N�W 3b. Which �f the foilowing iocaliy-implemented stormwater mana�ement programs � U��, �pp�Y Ccheck all that app�Y): Q Water �upp#y Watershed C] C�ther: 3c. Has ihe approved Stormwater Management Plan with proc�f o# approval been ❑ Ye� ❑ Nc� atta�hed? 4. DWQ Stc�rmwater Pra ram Revgew ❑ Coastal caunties ❑ r�t�w' 4a. Which of the following state-implemented stormwater management programs appfy 0�R� (check all that apply): ❑ Session Law 20(�6-246 [� CJther: 4b. Has the approved Stormwater Management Plan with praof of appraval been attached? 0 �e� � �° 5. DV1/Q 401 Unit Stormwafi�r Review 5a. Does t�e Stormwater Management Plan meet the appropriate requirements? [� �e� � No 5b. Nave all t�f fihe 4�1 Unit submittal requirements been met? � Y�� fl Page $ of 1 C� PCN Form — Version 1.3 December 1�, 2C��8 Version F. S�pp��r�e�t�ry �r�fc�rr�a�i+�� . �r�virc�nrr�e�atal C9oc�m+�r�ta��on {C�WC� ��quir�rroer�t� 1 a. Do�s the project invalve ar� expenditure of public (federal/state/local} �ur�ds c�r the �,�� ❑�Q use of pub{i� (federal/state} 1and? 1 b. If you answered "yes" to the above, daes the project require preparation of an environmentai dc�cument pursuant ta the requirements of �the Na�ional or �tate ❑ Yes � No {North Carolina) Enviranmenta! Policy AGt (NEF�A/��PA}? 1 c. if you answered "ye�" to �he above, has the document review been finalized by the �tate Clearing Hause? {If so, attach a capy of the NEPA or SEP�. final approval letter.j ❑ Y�s [:� No Comments: 2. Viola�ions {DWC� Rec�uirement� 2a. Is the s�te in violation af DWQ 1Netland Rules {15A NCAC 2H .05G�}, Isolated Wetland Rules (15A NCAC 2H .13Q0), D1NQ Surface Water or Wetland Standards, ❑ Y�s �J No ar Riparian Buffer Rules {15A NCAC 2B .4200}? 2b. Is this an after-the-fact p�rmit application? ❑ Yes �) No 2c. If you answered "yes" to one or bc�th ofi the above questians, provide an explanation of t�e viofation{s): 3. Cumulative Irr�pacts (C�1Nt� Req�irement) 3a. Will this project (based on past and reasonably anticip��ed fiuture impacts} re�ult in ��,,.�5 �� additional deveic�pment, which could impact nearby downstream water qu�.lity? 3b. lf you answered "yes" to fihe above, submit a qualitative or quantitative cumulative impact analysis in ac�ardar�ce with the mosfi recent DWQ policy. If you answered "no," provide a shart narrative description. 4. Sewage aisposal {DWQ Requiremer�t) 4a. Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) af wastewater generated fr�m the proposed project, or available capacity af the subject facility. N/A Page 9 of 1 � PCN Form -- Version 1.3 December 1�, 200� Version 5, En+dar��r�d 5�ec�e�► ar�d �esign�t�c� �r��ti�a9 ��itat (t�c�rp� ��+q�air+er��r��) �a. Will this project c�ccur �r� c�r near an area wit� federaliy pr�tec�e� speci�s or Yes � f�o h i t`� � ab ta . 5b. Have you checked with �he IJ�FW� cancernir�g Endangered Sp�cies Act [� Yes � No i m pacts? ❑ Raleigh 5c. !f yes, indicate the USF1N� Field CJffice you have contacted. ❑ Ashevi{le 5d. What data sources did yQU use to determine vvhether your site would impact Endangered �pecies ar Designated Critical H�bitat? �IS and visual abservatian 6. Essential Fish H�bitat {�arps Req�ir�ment� fa. W'il! this project accur in or near an area designated as essential fish habitat? ❑ Yes ��lo 6b. What data sources did you use to determine whether your si�e would impact Essential Fi�h Habitat? WR� will comment ?. Historic or Prehistc�ric CUltur�� Re�QUrc�es {!Cc�rps Requirer�+��n�� 7a. Will this project oc�ur in or near an area that the state, federa! or tribal gov�rnments have designated as having historic or culturai pr�serva#ion ��e� ��o status {e.g., National Nistoric Trust designatian or praper�ies significant in North Carolina histc�ry and archaeology)? 7b. What data saurces did you use to determine whether your site wc�uld impact historic or archeol�gical resources? HUE reviewed the project. 8. Flr�od Zone Desigr�ati+�n (Cc�rps Requirer�en�) 8a. Will this praject accur in a FEMA-designated 144-year f{oodplain? ❑ Yes (� N� 8b. If yes, explain how project meets FEMA requi�ernents: 8c. W hat source(s) did you use to make the fioodpiain determinatic�n'? ncfloodmaps , J. I-�eath S 1 aughter 1/8I14 �. � A ficant/A ent's Printed Name Applicanfi/Agent's Signat �� p� � (Agent's r nature is valid onfy if an authorizatio tter from the applicant � is rovided. ' F'age 1Q of � 4 PCN Form — Version 1.3 �December 10, 2C�U8 Version