20140562 Ver 1_PermitNoRecd_20140613

Lf WQC/Buffer Application
To: Cherri Smith.. Cory LarsenRaleigh Regional Office
From: 1 & Buffer Permitting nit, Central Office
Date: 6/13/2014 DWR M 14-0562
Elmwood Cemetery Sewer
Project e: County: Vance
Replacement- City of Henderson
60-day Processingi — 8/12/14
pP
® Please review attached a lication/additional information
❑ This is an Individual Permit and will be issued out of the Central office.
This is a "Courtesy Copy" and is located in Laserfiche.
❑ A copy of the application/stormwater has been given to Cory.
Restoration Project NOT for mitigation (issued by ). A copy has been
given to Eric.
❑ Non-EEP mitigation project (issued by O). A copy has been given to Eric.
❑ EEP full delivery project (issued byRO). A copy has been given to Eric.
❑ EEP design-bid build project (issued by RO). A copy has been given to Eric.

Maher, Niki
NI 0.0 MINION
From: Joel Whitford [[e-mail]]
Sent: Friday, June 13., 2014 10:44 AM
To: Higgins, Karen
Cc Maher, Nik9
Subject: Elmwood Cemetery Sewer Replacement-City of Henderson
Attachments: PCN-Form pg 1 -Henderson Elmwood Sewer.pdf; Elmwood%20Cemetery%2OSewer%
20(3).pdf
Dear Ms. Higgins,
Please find attached the revised PCN page 1 with Nationwide permit Number 12 included for the subject project. Please
let me know if you need additional information.
Have a great day.
Thanks,
Joel A. Whitford, PE
Project Manager
iMcGill Assocl'IIC VA,
r
U
ffD JU
m
z
1240 19th Street, Lane NW '{ Hickory, NC 28601
Phone: [phone] I Mobile: [phone] Fax: [phone]
Email:[e-mail] I ebsite: www.mcgillengineers.com
1

4
00 Office Use Only:
l t Corps action ID no.,.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification (PC ) Form
A. Applicant Information
1. Processing
1a. Type(s)of approval sought from the
Corps: ® Section 404 Permit. El Section 10 Permit
1 b. Specify Nationwide Permit(NWP)number:'12 or General Permit(GP)number:
1c. Has the NWP or GP number been verified by the Corps? ❑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
1 e. Is this notification solely for the record For the record only for DWQ 401 For the record only for Corps Permit:
because written approval is not required? Certification:
❑Yes ® No ❑Yes ®No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation ®Yes No
of,impacts? If so,attach the acceptance letter from mitigation bank or in-lieu
fee program.
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h ❑Yes No
below.
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ❑Yes No
2. Project Information
2a. Name of project: Elmwood Cemetery Sewer Replacement
2b. County: Vance
2c. Nearest municipality/town: City of Henderson
2d. Subdivision name: N/A
2e. NCDOT only, T.I.P. or state N/A
project no:
3. Owner Information
3a.- Name(s) on Recorded Deed: 1: Hillcrest Associates (sewer easement); 2:City of Henderson right-of-way
3b. Deed Book and Page No. 1 DB 0659, Pg.0670; 2: NIA-
3c Responsible Party (for LLC if` Franklin Frazier,Assistant City Manager,City of Henderson
applicable):
3d. Street address: 134 Rose Avenue
3e. City, state, zip: Henderson, NC 27536
3f. Telephone no.: 252-430-5703
3g. Fax no.: 252-492-7935 �
3h. Email address: �
Page 1 of 11 JUN 13 1
PCN Form—Version 1.3 De fern r 10, 2008"version