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HomeMy WebLinkAbout20140507 Ver 1_401 Application_2014051420140507 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 1b. Specify Nationwide Permit (NWP) number: or General Permit (GP) number: 1c. Has the NWP or GP number been verified by the Corps? m/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 ❑ Riparian Buffer Authorization 1e. Is this notification solely for the record because written approval is not required? For the record only for DWQ 401 Certification: XYes ❑ 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 ❑ 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: E W jr} 2b. County: v Y Q PLV 2c. Nearest municipality / town: V R�_ C) C_ 2d. Subdivision name: 2e. NCDOT only, T.I.P. or state project no: 3. Owner Information 3a. Name(s) on Recorded Deed: C_ E> -%T 3b. Deed Book and Page No. j� f2_Ce L` 5 — (D p t L+19 6_9P19 "Z � 3c. Responsible Party (for LLC if applicable): 3d. Street address: V �S , 3e. City, state, zip: Yj eP" N j11 C_ 3f. Telephone no.: 3g. Fax no.: 3h. Email address: G, v—' Vl L , Iii V Page 1 of 10 PCN Form — Version 1.4 January 2009 o EN MAY 2 1 2014 ' OgNR . I Btinoh 1080►ro2 sitretos 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: 4f. Telephone no.: 4g. Fax no.: 4h. Email address: 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. Project Information and Prior Project History 1. Property Identification 1a. Property identification no. (tax PIN or parcel ID): LaA S 1 N 6 1b. Site coordinates (in decimal degrees): Latitude: -j5 `3 LZ 5 96 Longitude: '-j bye 7 C) 1c. Property size: 2-,B1 acres 2. Surface Waters 2a. Name of nearest body of water to proposed project: S O -J 2b. Water Quality Classification of nearest receiving water: ' H ' M 2c. River basin: _�Jj�✓IV;;cv 3. Project Description \� (Z„\ VC V9 A- CC 3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this application: I 3b. List the total estimated acreage of all existing wetlands on the property: \ o 3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 3d. ^J Explain a� A `i �C S `� �Y'aioS G 0--�� V E�/�i__�th� jp 3eV project: C - s, ,3 P- V c-e- sZ 3e. Describe the overall project in detail, including the type of equipment to be used: J� �� 2.0 -\Z>1 fps , -S o cz—,F /:� C E M - V' � 1.�3 %-fZf� \1�1� ., WVM k� ` �e t_ :� i}�p � 2kf�r� � s P 0-C--ro � -%.� 1-� a"3 © "� 3 D ' It rz ti 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 prior phases) in the past? Yes ❑ No ❑ Unknown Comments: 4b. If the Corps made the jurisdictional determination, what type of determination was made? ❑ Preliminary inal 4c. If yes, who delineated the jurisdictional areas? Name (if known): JA D(Z-MN cS RA-A 1b e Agency /Consultant Company: 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 ❑Unknown 5b. If yes, explain in detail according to "help file" instructions. 6. Future Project Plans 6a. Is this a phased project? ❑ Yes EErNo 6b. If yes, explain. Page 3 of 10 PCN Form — Version 1.4 January 2009 C. Proposed Impacts Inventory 1. Impacts °Summary 1a Which 'sections Were�dompleted below for your- project (check, all,that'apply)• [ Wetlands ❑ Streams —4 ibutanes ❑ Buffers ❑ Open Waters ❑ Porid Construction 2. Wetland.lmpacts If'there -are wetland'impacts proposed on the site, then complete this question for each wetland area impacted Wetland impact Type of impact Type of wetland Forested Type Corps 40jurisdiction or Area impact 2a 2b 2c 2d. 2e T-s P- ( ) r number DWQ (401, other) Permanent or Temporary �T W1 - Choose one .f—" - LL Choose one f itAE 'FLA 1 woe Yes /No - •® o (7, t.�°.� 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 - Choos "e one `Choose one `Yes /No Wg - 2g. Total Wetland Impacts: 2h Comments: 3. Stream Impacts N -4 P"t or intermittent stream impacts (including temporary impacts) proposed onAhe site, then complet0his, If there,are perennial question fof all stream sites impacted 3a 3b. 3c. 3d 3e. 3f. 3g Stream impact Type of impact Stream name Perennial,(PER) or Type of Average Impact, length number intermittent (INT)? ,jurisdiction stream width (linear Permanent (P) or (feet) feet) 'Temporary (T) = Choose one - - S1' - _S2 - Choose one _ - - S3 - Choose one - - S4 - Choose one - - S5 - Choose one - - S6 - Choose one - - 3h Total stream and tributary,impacts 3i Comments, Page 4 of 10 PCN Form — Version 1.4 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 indiv' ua'lly 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 Water body 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 kor I_ake•construction ro osed, then 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 vou,MUST fill outlSecfion D of this forma , 6a. Project is in which protected basin? ❑ Neuse ❑ Tar - Pamlico ❑ .Catawba ❑ Randleman ❑ Other. 6b. Buffer Impact' number— Permanent, (P) or Temporary T 6c_ Reason for impact 6d Stream name 6e. Buffer mitigation required? 6f Zone 1 impact (square feet ) 6g Zone 2 impact (square feet B1 - Yes /No B2 - Yes /No B3 - Yes /No B4 - Yes / No ,B5 - Yes /No B6 - Yes /No 6h. Total Buffer'lmpacts: 61 Comments. ,;� Page 5 of 10 'D. Impact Justification, and Mitigation, _ 1. ,Avoidance and Minimization la Specifically describe - measures taken to avoid or minimize the propose r�pa in d ng pro P"' ®� y. ,�; 1_� 1 b.. Specificallydescribe measures taken to avoid or minimize the proposed impacts through construction techniques 2. Comp ensato - Mitigation for - Impacts, to Waters of the, U.S. or Waters of the,State 2a. Does the project require Compensatory Mitigation for ❑ Yes No 1 impacts- to'Watefs +of the U.S or Waters of the State? 2b If yes, mitigation is required 6y °(check all that apply) El _ DWQ Corps ❑ Mitigation bank 2c If yes, which mitigation option will be used for this, ❑ Payment to in -lieu fee program project? ❑ Permittee Responsible,Mitigation 3. Complete if Using a Mitigation Bank , 3a. �Name,of mitigation Bank. Type. Choose one Quantity 3b. Credits Purchased (attach receipt and letter) Type- Choose one Quantity" Type Choose one Quantity. 3c Comments: 4 4. Com Mete if Making�a Payment to In -lieu Fee Pro ram 4a Approval letter from an =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 (DW,Q only). square feet _ 4e. Riparian wetland mitigation requested - acres 4f Non - nparian wetland mitigation requested` acres 4g Coastal (tidal) wetland "mitigation requested: acres - 4h Comments 5. Complete if Using a Permittee Responsible Mitigation Plan 5a If using a permittee responsible mitigation plan,-provide a description of, the proposed, mitigation plan. Page,&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 buffer mitigation? Yes [ No 7� 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. •lf,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 m- lieu- fee,fund) 6h Comments Page 7 of 10 E. Stormwater,Management and Diffuse Flow Plan (required by DWQ) 1. Diffuse Flow Plan, 1 a. Does,the project include or is it adjacent to protected riparian buffers identified ❑ Yes bkNo withimone of the NC Riparian Buffer Protection Rules? - 1 b If yes, then is a diffuse flow plan included? If no, explain why. Yes '❑ No ❑ 2. Stormwater Management Plan 2a What is the overall percent imperviousness of this project, % - 2b Does this rd ect require a,Stormwater Management Plan? No ❑Yes 2c. If,this project DOES NOT requireaa Stormwater Management Plan, explain V '� V-- �L FC-4 � 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 overnment% 'urisdiction isthis project? - - - ❑ Phase II ❑ NSW 3b. Which of the following locally - implemented stormwater management programs ❑ USMP apply (check all that apply): Water Supply Watershed, Other- 8c. 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 El Won Law 2006 -246 (check all that apply)' ❑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 ?' E] Yes ❑ No rh Have all of the 401 Unit submittal requirements been met? ❑ Yes ❑ No Page 8 of °10 PCN Form — Version 1.4 January 2009 F. Supplementary Information 1. Environmental Documentation (DWQ Requirement) la Does the project involve an expenditure of public (federal /state /local) fund's or the El 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 El Yes ❑ "No (North Carolina) Environmental Policy Act (NEPA/SEPA)? 16 'If you answered "yes' to the above, has the document review been.fnalized by the State Clearing House? (If so, attach a.copy of the NEPA or SEPA final approval Yes Q 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 No or Riparian Buffer Rules (15A -NCAC 2_B .0200)? - _ 215. Is this an after - the -fact permit application? ❑Yes 4 No 2c. If you answered "yes" to one or,both of the above questions, provide amexplanation of'the- violation(s): 3. Cumulative,lmpacts,(MCI Requirement) 3a Will this project (based on past and reasonably anticipated future impacts) result in El Yes No additional development, whicNcould impact,nearby downstream water quality? ,3b. Ifyou answered —yes" to th&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`mefhods and disposition (non'-discharge or dischargb);of wastewater generated from the proposed project, or,avadable capacity of the subject facility. p Page 9 of 10 PCN Form — Version 1.4 January 2009 ,5. Endangered Species <and Designated Critical Habitat (Corps Requirement) 5a. Will this protect ,occur in or near an area with federally protected species or Yes No habitat? 5b Have you',checked with the USFWS concerning Endangered Species;Act No' impacts? ,Yes 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' Habitat,(Corps Requirement) 6a. Will this project occur in or near an,area designated,as essential fish habitat? Yes No F- o 6b What data sources did you use to,determin&whether your site would impact Essential FishAabitat? 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 haveAesignatedsas having historic or cultural preservation National.Histodc Yes No status (e g , Trust designation or properties significant in 7j North Carolina history- and archaeology)? - 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 6 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? o rNf\— G1S ✓l*` 6 Appllcant/Agent's Printed Name Applicant/Agent's SI 9 nature Date (Agent's signature is valid only if an authorization letter from the,applicant is providefl Page 10 of 10 0) BertelkamID Automation, inc. INDUSTRIAL AUTOMATION SPECIALISTS i Qa N D c Cn sro � 'I i r P G -r� N _ Corporate Office: Knoxville, Tennessee 423 - 588 -7691 • Toll Free: 800- 251 -9134 • Telefax: 423 -588 -9845 Birmingham, AL - 800- 251 -9134 Chattanooga, TN - 800- 251 -9134 Huntsville, AL - 205 -880 -7773 Raleigh, NC - 919 - 781 -3226 Charlotte, NC - 800- 782 -6228 Columbia, SC - 800- 251 -9134 Johnson City, TN - 800- 251 -9134 Winston - Salem, NC - 800- 251 -9134 Greenville, SC - 800 -442 -7955 Nashville, TN - 800- 782 -3769 MAY 2014 ow = vwwo 0'6j lrY sro � 'I i r P G -r� N _ Corporate Office: Knoxville, Tennessee 423 - 588 -7691 • Toll Free: 800- 251 -9134 • Telefax: 423 -588 -9845 Birmingham, AL - 800- 251 -9134 Chattanooga, TN - 800- 251 -9134 Huntsville, AL - 205 -880 -7773 Raleigh, NC - 919 - 781 -3226 Charlotte, NC - 800- 782 -6228 Columbia, SC - 800- 251 -9134 Johnson City, TN - 800- 251 -9134 Winston - Salem, NC - 800- 251 -9134 Greenville, SC - 800 -442 -7955 Nashville, TN - 800- 782 -3769 is + -XI '�5!'\ Z-2 7 71 sy y�v.�'�4.�'#��'� ^��4 +�� ��L,i����� 1'��wr Fr Ff•,. ,�S 1 BeflelkamID Automc - HM on, inc. INDUSTR /:4L AUTOMATION SPECIAL /STS Z Qe NJ 1 V - (A Cn G ro i I it ,l Y' N, Corporate Office: Knoxville, Tennessee 423 -588 -7691 • Toll Free 800 - 251 -9134 • Telefax 423 -588 -9845 Birmingham, AL - 800,- 251 -9134 Chattanooga, TN - 800 -25,1 -9134 Huntsville, AL -205- 880 -7773 Raleigh, NC - 919- 781 -3226, Charlotte, NG - 800 - 782 -6228 Columbia,, SC - 800 - 251' -9134 Johnson City, TN - 800 - 251 -9134 Winston - Salem, NC - 800 - 251 -9134 Greenville, SC - 800 -442 -7955 Nashville, TN - 800 - 782 -3769