20220184 Ver 1_ORM Form Stokes-Meadows_20220128

Preliminary ORM Data Entry Fields for New Actions
ACTION ID 4: SAW- Begin Date (Date Received):
Prepare file folder ❑ Assign Action ID Number in ORM ❑
1. Project Name [PCN Form A2a]: Stokes -Danbury Meadows Water System Improvements Project
2. Work Type: ZPrivate ❑Institutional ❑Government ❑ Commercial
3. Project Description / Purpose [PCN Form 133d and 133e]:
The proposed project entails improvements to an existing well, installation of a new storage tank, new pressure reducing station, a new
booster pump station and approximately 25,500 linear feet of water main. The proposed work is located in close proximity to tributaries
to the Dan River. The current plan shared with our office mainly avoids impacting tributaries, however the plan proposes two open
stream cuts for water line installation, which include a tributary to the Dan River and Flat Shoals Creek.
4. Property Owner / Applicant [PCN Form A3 or A4]: Stokes County (Applicant)
5. Agent / Consultant [PNC Form A5 — or ORM Consultant ID Number]:
Michelle Measday / ECS
6. Related Action ID Number(s) [PCN Form 135b]: NA
7. Project Location —Coordinates, Street Address, and/or Location Description [PCN Form Blb]:
Dodgetown Road, NC 8 and 89 Highway South and County Home Road, Danbury -Meadows, Stokes
County NC, 36.3935515,-80.195574
8. Project Location —Tax Parcel ID [PCN Form Bla]: n/a
9. Project Location — County [PCN Form A2b]: Stokes County
10. Project Location — Nearest Municipality or Town [PCN Form A2c]: Danbury- Meadows
11. Project Information — Nearest Waterbody [PCN Form 132a]: Upper Dan River
12. Watershed / 8-Digit Hydrologic Unit Code [PCN Form 132c]: Dan River/ 03010103
Authorization: Section 10 ❑ Section 404 ❑✓
Regulatory Action Type:
Standard Permit
Nationwide Permit 4
Regional General Permit 9
Jurisdictional Determination Request
Section 10 and 404 ❑
Pre -Application Request
Unauthorized Activity
Compliance
✓ No Permit Required
Revised 20150602