20140276 Ver 1_More Info Received_20140424

Homewood, Sue
From:
Carl von Isenburg <cvi @geotec com> -
Sent:
Thursday, April 24, 2014 12 31 PM
To:
John T JR SAW Thomas, Homewood, Sue
Cc:
Steve Causey, Jack Fitzgerald
Subject:
Fairhaven
Attachments:
13 372 PCN Revised 042414 pdf
I'm sorry this took me so long John suggested applying for NW 12 instead of NW 3 Sue caught something on p 5 The
only changes are to pp. 1 and 5 and the signature on p 12 is fresh
Please let me know if you need anything else.
Carl von Isenburg, PE
1

wa"r 0
Office tJse Only
Corps action:ID.no
DWQ project -no:
Form Version 1 3, Dec `102008,
Pre - Construction Notification'(PCN) Form
A. Appycant'Information
1. ,Processing�
la T.ype(s),of approval,sought from'the
,Corps,
® Section 404 Permit E] Section 10,P&Mit
1b. Specify Nationwide= Permit (NWP) number 12- Utility Line Activities or�General Permit (GP),number:
le Has,the NWP or GP number, been verified by the Corps?
® Yes
'❑ No
1d Type(s)'of approval `sought from the DWQ (check 611-that apply).
® 401 Water Quality Certification — Regular ['Non -404 Jurisdictional General'Permit
0 401 Water Quality Certification — Express EI Riparian Buffer,Authorization
1e Is this notification solely -for the'record
because,written approval is not - required?
No
For the record only for DWQ 401
Certification
❑TYes ® No
For the record only for Co "rps Permit
[I Yes, ®'No
1 f.- Isspayment into a mitigation bank or,in -lieu fee program proposed for mitigation,
of,impacfs? If'so,,attach the acceptance letter from mitigation bank or in-lieu
fee,program
E] Yes
® No,
1g. Is the project located in,-any of NC's twenty, coastal counties If yes,,dnswerr1
below ,ti
D Yes
_ ®'No
1h. Is`the project located'withm a NC DCM Area of Environmental Concern (AEC)?
❑,Yes
® No
2. Project Information _
°2a. `Name -of project
120 Fairhaven Court, Lewisville, NC stream °bank repair
2b. 'County:
Forsyth
2c: N,eaFrest,municipality toWw
Lewisville
2d. Subdivisiomname.,
NIA
2e. NCDOT only; T.I.P.1or'state
project no.�
N/A -
3. Owner Information
3'a. Name(s) on Recorded Deed. _
Kenneth Black
3b Deed Book and Page, No
DB 2956; PG 662
3c Responsible,Party (for LLC-if'
applicable):
NIA
3d', Street address-
126 Fairhaven Court
3e., Cdy,'state,.zip:
Lewisville
3f. T,elephone nQ.:
336-406 - 3279 ?_
',3g Fax`no.:
NIA
,3h. Email address:
NIA
Page 1 of 12
PCN Form — Version 1.3 December 10,;2068.Version

C. Proposed Impacts Inventory
1. Impacts Summary
la. 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.
2b.
2c.
2d.
2e.
2f.
Wetland impact
Type of jurisdiction
number —
Type of impact
Type of wetland
Forested
(Corps - 404, 10
Area of impact
Permanent (P) or
(if known)
DWQ — non -404, other)
(acres)
Temporary T
W1 ❑ P [--IT
❑ Yes
❑ Corps
❑ No
❑ DWQ
W2 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W3 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W4 El P ❑ T
❑ Yes
Corps
11 Cor
11 No
El DW Q
W5 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W6 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
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
3b.
3c.
3d.
3e
3f.
3g.
Stream impact
Type of impact
Stream name
Perennial
Type of jurisdiction
Average
Impact
number -
(PER) or
(Corps - 404, 10
stream
length
Permanent (P) or
intermittent
DWQ — non -404,
width
(linear
Temporary (T)
(INT)?
other)
(feet)
feet)
S1 ® P [:IT
Stone /np -rap
Reynolds Creek
® PER
❑ INT I
® Corps
® DWQ
10
170
S2 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S3 ❑ P FIT
❑ PER
❑ Corps
❑ INT
❑ DWQ
S4 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S5 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S6 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
3h. Total stream and tributary impacts
170
31. Comments
Page 5 of 12

5. Endangered Species and Designated Critical Habitat.('Corps Requirement)
5a. WdbChis,project occur in o_ r near an area with federally;protected species or
; D Yes No
habitat?
5b. Have ,you°checkedMiih the USFWS'conceming Endangered Specie "s•Act;
[],Yes ® No
Impacts?
E} Raleigh -
5c. If yes; indicate the USFWS_Field Office you'have'contacted.,
Asheville
5d. What.data,sources•did you_ use`to determine whether your site would ImpactEndangered Species or.'Designated Ctiticat
' " _
Habitats
Raleigh'Ecological Field Services office
6. ,Essential'Fish Hatiitat,(Corp -s Requirement)
6a Will this projecf'occur in'or near an'areardesignatetl as;essential,fish` habitat?
❑Yes ®No
6b, What data-sources did you use to determine- whetheryour site would,impact'Essentiai'Fish Habitat?
NCWRC�
T. Historic'-or,prehistoric,Cultural Resources,(Corps Requirement)
7a. Will this,proiect occur,in or near an area that the,state, federal`or tribal;
governments have designated as,tiaving historic or cultural preservation
0 Yes, 0 N
status "(elg., National Historic Trust.designation or "properties significant in
;
North Carolina history and, archaeology)?
7b. Whafdata•sources did.you use to,'determine whetheryour site "would impact historic,or archeologicai,resource's?
'Tlie- National'Registei of Historic.Plac'e"s in Noftli Carolina
B. Flood Zone Designation (Corps Requirement)
8a. Will this project occur,in a FEMA- designated 10t);_year floodplain?
® Yes 0 No
8b. Ifyes, explain how project meets -FEMA requirements: No,change in- channel typical section, only`reinforddment:
8c What sources) did you use to make the:floodplain.deter "urination? NC Flood map Database,
Carl voii I hbn brg,
-
-, p 'ca tlAg nt's'Si ature
ApplicanUAgent's Printed Name
Date
(Agent's signature is valid only if an a tion'letter from.lhe applicant
' is rovided
Page 12 of 12`