20220546 Ver 1_ePCN Application_20220406

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Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
December 6, 2021 Ver 4.2
Initial Review
Has this project met the requirements for acceptance in to the review process?*
Yes
No
Is this project a public transportation project?*
Yes No
Change only if needed.
BIMS # Assigned*
20220546
Is a payment required for this project?
No payment required
Fee received
Fee needed - send electronic notification
Reviewing Office*
Fayetteville Regional Office - [phone]
Information for Initial Review
1a. Name of project:
Southbury Development, LLC
1a. Who is the Primary Contact?*
Samuel Adam Carter
1 b. Primary Contact Email:
[e-mail]
Date Submitted
4/6/2022
Nearest Body of Water
Killets Creek
Basin
Cape Fear
Water Classification
C
Site Coordinates
Latitude:
35.331782
A. Processing Information
County (or Counties) where the project is located:
Moore
Is this a NCDMS Project
Yes No
Longitude:
-79.41655
Is this project a public transportation project?*
Yes No
1a. Type(s) of approval sought from the Corps:
Section 404 Permit (wetlands, streams and waters, Clean Water Act)
Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
Version# *
1
What amout is owed?*
$240.00
$570.00
Select Project Reviewer*
Chad Turlington:eads\ccturlington
1c. Primary Contact Phone:*
[phone]
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Has this PCN previously been submitted?*
Yes
No
1 b. What type(s) of permit(s) do you wish to seek authorization?
Nationwide Permit (NWP)
Regional General Permit (RGP)
Standard (IP)
1c. Has the NWP or GP number been verified by the Corps?
Yes No
Nationwide Permit (NWP) Number: 29 - Residential Developments
Nationwide Permit (NWP) Number: 58 - Utility Line Activities for Water and Other Substances (frequently used)
NWP Numbers (for multiple NWPS):
1d. Type(s) of approval sought from the DWR:
401 Water Quality Certification - Regular
Non-404 Jurisdictional General Permit
Individual 401 Water Quality Certification
le. Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification:
For the record only for Corps Permit:
1f. Is this an after -the -fact permit application?*
Yes No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
Yes No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
Yes No
1 h. Is the project located in any of NC's twenty coastal counties?
Yes No
1j. Is the project located in a designated trout watershed?
Yes No
B. Applicant Information
1d. Who is applying for the permit?
Owner Applicant (other than owner)
le. Is there an Agent/Consultant for this project?
Yes No
2. Owner Information
2a. Name(s) on recorded deed:
Southbury Development, LLC
2b. Deed book and page no.:
5481/539
2c. Contact Person:
David Chapman
2d.Address
Street Address
20 Cochrane Castle Circle
Address Line 2
City
Pinehurst
Postal / Zip Code
28374
2e. Telephone Number:
[phone]
401 Water Quality Certification - Express
Riparian Buffer Authorization
State / Province / Region
NC
Country
USA
2f. Fax Number:
Yes No
Yes No
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2g. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Samuel Adam Carter
4b. Business Name:
Wetland Solutions, LLC
4c.Address
Street Address
P.O. Box 244
Address Line 2
City
Bunnlevel
Postal / Zip Code
28323
4d. Telephone Number:
[phone]
4f. Email Address:
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1 b. Subdivision name:
(if appropriate)
Southbury Development
1c. Nearest municipality / town:
Carthage
2. Project Identification
State / Province / Region
NC
Country
USA
4e. Fax Number:
2a. Property Identification Number:
857700750624, 857700740932,
2b. Property size:
857700746818
32.67
2c. Project Address
Street Address
Cagles Ln
Address Line 2
City
State / Province / Region
Carthage
NC
Postal / Zip Code
Country
28327
USA
3. Surface Waters
3a. Name of the nearest body of water to proposed project:'
Killets Creek
3b. Water Resources Classification of nearest receiving water:
C
3c. What river basin(s) is your project located in?*
Cape Fear
3d. Please provide the 12-digit HUC in which the project is located.
030300030303
4. Project Description and History
4a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this application:
Tract is forested and subdivisions surround the proposed project area
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?
Yes No Unknown
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4f. List the total estimated acreage of all existing wetlands on the property:
3.68
4g. List the total estimated linear feet of all existing streams on the property:
1891
4h. Explain the purpose of the proposed project: *
The purpose of this project is to construct a road crossing and provide utilities for the approved subdivision
41. Describe the overall project in detail, including indirect impacts and the type of equipment to be used: *
The project consist of constructing two road crossing and installing culverts for both. Both culverts will be recessed 20 % within stream bed. BMPs will be in effect through the construction
process.
We will be removing the old road crossing. Returning wetland back to grade and planting the riparian zone with hydrophytic local native varieties of wood stem veg. Tract -hoe and bac-hoe
will be utilized during construction. Silt fence, 57rock,celcer matting, annual warm weather seed mix and temporary waddles will be utilized. Effects will increase treatment function of
proposed increase of surface water to headwater wetland.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
Yes No
Comments:
Early secession veg growth. Sedimentation intrusion from timbering
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
Preliminary Approved Not Verified Unknown N/A
Corps AID Number:
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Samuel Adam Carter
Agency/Consultant Company: Wetland Solutions, LLC
Other:
6. Future Project Plans
Unknown
6a. Is this a phased project?*
Yes No
Are any other NWP(s), regional general permit(s), or individual permits(s) used, or intended to be used, to authorize any part of the proposed project or related activity?
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
Wetlands Streams -tributaries Buffers
Open Waters Pond Construction
2. Wetland Impacts
2a1 Reason (?)
2b. Impact type*(?)
2c. Type of W.
2d. W. name*
2e. Forested*
2f. Type of Jurisdicition*
M
2g. Impact
area*
W1
Rd interconnectivity
P
Headwater Forest
Wetland
No
Both
0.123
(acres)
W2
Rd Interconnectivity
P
Headwater Forest
Wetland
No
Both
0.022
W3
Sewer
T
Headwater Forest
Wetland
Yes
Corps
(acres)
0.013
(acres)
W4
Sewer
L
Headwater Forest
Wetland
Yes
Corps
0.019
(acres)
2g. Total Temporary Wetland Impact
0.032
2g. Total Wetland Impact
0.177
21. Comments:
Utility impacts are forested and the road impacts are void of trees mostly grass and sedge
2g. Total Permanent Wetland Impact
0.145

3. Stream Impacts
11
S1
3a. Reason for impact (?)
Rd infurstructure
3b.lmpact type*
Permanent
3c. Type of impact*
Culvert
3d. S. name* ��3e.
UT
Stream Type*
(?)
Perennial
3f. Type of
Jurisdiction*
Both
3g. S. width"
Average (feet)
31h. Impact
length*
81
(linear feet)
S2
Rd infustmscture
Permanent
Culvert
UT 7Perennial
Both
Average (feet)
80
Qinear feet)
31. Total jurisdictional ditch impact in square feet:
0
31. Total permanent stream impacts:
161
31. Total stream and ditch impacts:
161
3j. Comments:
Steam is degraded from sediment transport from forestry activity
E. Impact Justification and Mitigation
1. Avoidance and Minimization
3i. Total temporary stream impacts:
0
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
We have delineated out the property and have designed the impacts to the least amount feasible for infrastructure. We are using exsisting crossing to
lower impact.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
We will be using BMPs along with a maintenance regiment after rain falls.
Materials to be used to help contain and reduce sedimentation transport.
silt fence, 57 rock, warm weather grass seed, celcer matting, and waddles will be used
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
2c. If yes, mitigation is required by (check all that apply):
DWR Corps
2d. If yes, which mitigation option(s) will be used for this project?
Mitigation bank Payment to in -lieu fee program Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
Daniels mitigation and NCDMS
3b. Credits Purchased/Requested (attach receipt and letter)
Type: Quantity:
Riparian wetland .18
Stream 161
3c. Comments
6. Buffer mitigation (State Regulated Riparian Buffer Rules) - required by DWR
6a. Will the project result in an impact within a protected riparian buffer that requires buffer mitigation? If yes, you must fill out this entire form - please contact DWR for more information.
Yes No
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
la. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
Yes No

If no, explain why:
Not in Neuse or Tar River Basin
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?
Yes No
Comments:
G. Supplementary Information
1. Environmental Documentation
la. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?
Yes No
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (1 SA NCAC 2H .0500), Isolated Wetland Rules (15A NCAC 2H .1300), or DWR Surface Water or Wetland Standards or
Riparian Buffer Rules (15A NCAC 2B .0200)? *
Yes No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality?
Yes No
3b. If you answered "no," provide a short narrative description.
No space for future development slotted a this time.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
Yes No N/A
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or habitat?*
Yes No
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.
Raleigh
5d. Is another Federal agency involved?*
Yes No
5e. Is this a DOT project located within Division's 1-8?
Yes No
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?
Yes No
5g. Does this project involve bridge maintenance or removal?
Yes No
5h. Does this project involve the construction/installation of a wind turbine(s)?*
Yes No
Unknown
51. Does this project involve (1) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhammers, mechanized pile drivers, etc.?
Yes No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
USFWS IPAC site
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
Yes No

6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
https://www.fisheries. noaa. gov/resource/map/essential-fish-habitate-mapper
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?*
Yes No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
hftp;//www.hpo.ncder.gov/
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplairl
Yes No
8c. What source(s) did you use to make the floodplain determination?*
NC Flood Risk Information System f(http://fris.nc.gov/fris/Home.aspa?ST=NC
Miscellaneous u
Please use the space below to attach all required documentation or any additional information you feel is helpful for application review. Documents should be combined into one file when
possible, with a Cover Letter, Table of Contents, and a Cover Sheet for each Section preferred.
Click the upload button or drag and drop files here to attach document
Authorization Ietter.PDF
36.14KB
Southbury PJD_20220121.pdf
154.55KB
Southbury_Form_JD Request Signed.pdf
293.59KB
Southbury_Parcel 1 details.pdf
235.94KB
Southbury_Parcel 2 details.pdf
237.64KB
Southbury_Parcel 3 details.pdf
243.81 KB
Southbury_Upland_Datasheets_Atlantic _and _ Gulf_ Coastal_Plain_Fillable.pdf
458.72KB
Southbury_Wetland_Datasheets_Atlantic _and _ Gulf_ Coastal_Plain_Fillable.pdf
472.14KB
20119B - Southbury PH2 WETLAND IMPACTS.pdf
3.22MB
RES Cape Fear 03 SOA - Feed & Seed - Southbury.pdf
173.83KB
Southbury Development Ph2 DMS Acceptance.pdf
235.02KB
Southbury Fig 2 - Wetlands_20220124.pdf
1.35MB
Southbury Fig 2b - Wetland Impacts_20220124.pdf
1.37MB
Southbury Fig 3 - Topo_20220121.pdf
1.23MB
Southbury Fig 4 - Soils_20220121.pdf
1.15MB
Southbury Fig 5 - NWI_20220121.pdf
1.27MB
Southbury Fig 6 - Flood_20220121.pdf
694.43KB
Southbury _IPAC report.pdf
485.35KB
Southbury_SHPO map.pdf
File must be PDF or KMZ
235.18KB
Comments
Signature
By checking the box and signing below, I certify that:
• The project proponent hereby certifies that all information contained herein is true, accurate, and complete to the best of my knowledge and belief'; and
• The project proponent hereby requests that the certifying authority review and take action on this CWA 401 certification request within the applicable reasonable period of time.
• I have given true, accurate, and complete information on this form;
• I agree that submission of this PCN form is a "transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature; AND
I intend to electronically sign and submit the PCN form.
Full Name:
Samuel Adam Carter
Signature
156ffe& 11?14T WIC71t
Date
4/6/2022