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Home My WebLink About20140601 Ver 1_401 Application_20140614S/in r --r/V dv C D / 0 1 U (r✓l} 7 E� ��3"c� i1'R c S" 2L Gl 01✓14L 6210l ct PC CN E-leo< G�� GA 2l� /�✓G /��2r -, 17�.T' %z�2 �c�r✓S7lc' v C �'! o.� OT= ,D I t! �c1YZ r► Y gcl4:3'4.J T"Y,q-epZ- I G4-7-/a,.,r - S Cd �' / S or= ScI��°o 7��✓� mss' dc� cu F,v ? C 77+ /9-^ !c �--c� v PL 4 S6 D U S6- IIISS Sao f ., 20 14060 1 F WATF o� pG Q Office Use Only 0 9 r D Q O® Corps action ID no o < DWQ project no Form Version 1 4 January 2009 Page 1 of 10 PCN Form - Version 1 4 January 2009 1 J ' Pre - Construction Notification (PCN) Form A. Applicant Information 1. Processing la Type(s) of approval sought from the Corps Section 404 Permit ❑ Section 10 Permit lb Specify Nationwide Permit (NWP) number a5!1 or General Permit (GP) number 1c Has the NWP or GP number been verified by the Corps? Yes ❑ No 1d 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 because written approval is not required? For the record only for DWQ 401 Certification ❑ Yes XNo 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 Nlo 1g Is the protect located in any of NC's twenty coastal counties If yes, answer 1 h below ❑ Yeslo 1 h Is the project located within a NC DCM Area of Environmental Concern (AEC)? ❑ Yes o 2. Project Information 2a Name of project CMAtZQES 9AK02 /ZCCfK(- A7 /O,'/AL P60^10 2b County C P 6 ?14 A tv--, 2c Nearest municipality / town -?S de-0 2d Subdivision name �Y' 2e NCDOT only, T I P or state protect no /J 3. Owner Information JUN 3a Name(s) on Recorded Deed <_-HAIZ4,61 V%10 04 IN TY 3b Deed Book and Page No NR dQ -- % K77 G.C- a S 3 stomw r era 3c Responsible Party (for LLC if applicable) ' ^ / MA /L ",O/?JeZs 3d Street address 651 fe eC eJc-, E PO is o x 3e City, state, zip 2 77- S- got0 /V(- 3f Telephone no q 2— 65' 7 2— 2 3g Fax no 3h Email address Page 1 of 10 PCN Form - Version 1 4 January 2009 1 J 4. Applicant Information (if different from owner) fj 6- 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) IV 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 la Property identification no (tax PIN or parcel ID) O 9 0 0 lb Site coordinates (in decimal degrees) Latitude 3 �, 70 3 9 y- Longitude 9 0 g' 3 1c Property size 3 acres 2. Surface Waters 2a Name of nearest body of water to proposed project �. CJ's` 2b Water Quality Classification of nearest receiving water < 2c River basin �� AOC: --Y d.I ✓CYl 3 Project Description 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 Wl•ZjI- %✓04��7 �� J � � �. I Ltr � �•c2� �S �l 7-GY 3b List the total estimated acreage of all existing wetlands on the property /V 3c List the total estimated linear feet of all existing streams (intermittent and perennial) on the property 1 �4 0 G 3d Explain the purpose of the proposed project 0/= Cf A)"'A `zt �.C�r��cr,9 �� o ,� ��/��✓ , Pd r�.e 3e Describe the overall protect in detail, including the type of equipment to be used P d,A 0 v O A-a— COu J'Z�eZld}J c1 i /�G c� cTL� d �?�� Sl�� n 5 Ze"'cs�2 Ltzv9 0 EE'✓e A,r D CQi.A eA -a alb %Z ��- ZL7'L� /s !gyp l �'t'r� 2�s �", La�G a c/��2i�t dz, r P10065— 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 �(J Yes ❑ No ❑ Unknown Comments � s �a /►1A �D past?j 4b If the Corps made the jurisdictional determination, what type of determination was made Preliminary El Final 4c If yes, who delineated the jurisdictional areas? Name (if known) AtJ O W E-, (,�, / L Lf qn.S Agency /Consultant Company Other 6,-s-A C t 4d If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation ,0 C-rew ^n) OV 4 -r>o �✓j 5. Project History 5a Have permits or certifications been requested or obtained for this project (including all prior phases) in the past? El Yes )j�No ❑ Unknown 5b If yes, explain in detail according to "help file" instructions 6. Future Project Plans 6a Is this a phased project? ❑ Yes No 6b If yes, explain Page 3 of 10 PCN Form — Version 1 4 January 2009 •14- C Proposed Impacts Inventory 1. Impacts Summary 1a Which sections were completed below for your protect (check all that apply) 00 co ❑ Wetlands A, Streams - tributaries ❑ Buffers ❑ Open Waters ❑ Pond Construction 2. Wetland Impacts /V If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted 2a Wetland impact number Permanent (P) or Temporary T 2b Type of impact 2c Type of wetland 2d Forested 2e Type of jurisdiction Corps (404,10) or DWQ (401, other) 2f Area of impact (acres) W1 Choose one Choose one Yes /No 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 W6 Choose one Choose one Yes /No 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 Stream impact numb Permanen or Temporary (T) 3b Type of impact 3c Stream name 3d Perennial (PER) or intermittent (INT)? 3e Type of jurisdiction 3f Average stream width (feet) 3g Impact length (linear feet) S1 Choose one t"fl VTI �- ZM S2 - Choose one � -�d�,Q C '�qJ�� J - Q .- ,� .. �- 1 S3 Choose one S4 Choose one S5 Choose one S6 Choose one 3h Total stream and tributary impacts 31 Comments Page 4 of 10 PCN Form - Version 1 4 January 2009 4. Open Water Impacts P{ If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of the U S then indivii ually 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 Waterbody type 4e Area of impact (acres) O1 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 or lake construction proposed, the complete the chart below 5a Pond ID number 5b Proposed use or purpose of pond 5c Wetland Impacts (acres) IV A 5d Stream Impacts (feet) 5e Upland (acres) Flooded Filled Excavated Flooded Filled Excavated P1 P(91JD Choose one D 3 76,' P2 Choose one 5f Total. t/,� 35' R , 5g Comments 5h Is a dam high hazard permit required? ❑ Yes No If yes, permit ID no 51 Expected pond surface area (acres) 5t Size of pond watershed (acres) 5k Method of construction EXAK7k(f,� dl� W Jr pl1E/Z- VLL)trt & ,gtfo 6. Buffer Impacts (for DWQ) dJ (A ��`� �'�'�� G� S P1 1_-Z AY 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 you MUST fill out Section D of this form 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 Impacts: 61 Comments Page 5 of 10 19 D Impact Justification and Mitigation 1. Avoidance and Minimization 1a Specifically describe measures taken to avoid or minimize the proposed impacts in designing protect S�<zc.T�.. / /►.. �,� -C�� /,✓i G f, � �'�% f zc�� 3�d � �"f' z7.� -vg-�J /�—o � a �� Lip- �,�''g -2 Szl'.�6'1� -� -1 i°Q.J� z'a �3 � C�rz� vczC�io �Sl�✓G!P ,�g.��.�i 1 b Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques L'Zzep Cy oe�e �dr✓i~ �� Sz do v f z .00 r,�,.r �s' � o✓Cc� /z ,�L �o wr n� R4-r- G»� -z-d LM' T--0 �'r2�xiT- 2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State Gz'S 2a Does the protect require Compensatory Mitigation for impacts to Waters of the U S or Waters of the State? ❑ Yes No 'k, 2b If yes, mitigation is required by (check all that apply) ❑ DWQ ❑ Corps 2c If yes, which mitigation option will be used for this protect ❑ Mitigation bank ❑ Payment to in -lieu fee program ❑ Permittee Responsible Mitigation 3. Complete if Using a Mitigation Bank 3a Name of Mitigation Bank 3b Credits Purchased (attach receipt and letter) Type Choose one Type Choose one Type Choose one Quantity Quantity Quantity 3c Comments 4. Complete if Making a Payment to In -lieu Fee Program 4a Approval letter from in -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 (DWQ only) square feet 4e Riparian wetland mitigation requested acres 4f Non - riparian 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 6 of 10 PCN Form — Version 1 4 January 2009 6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ 6a Will the protect result in an impact within a protected riparian buffer that requires buffer mitigation? Yes >�rNo 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 Zone 6c Reason for impact 6d Total impact (square feet) Multiplier 6e Required mitigation (square feet) Zone 1 3 (2 for Catawba) Zone 2 1 5 6f Total buffer mitigation required: 6g If 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 in -lieu fee fund) 6h Comments Page 7 of 10 E. Stormwater Management and Diffuse Flow Plan (required by DWQ) N,N 1. Diffuse Flow Plan la Does the project include or is it adjacent to protected riparian buffers identified ❑ Yes ❑ No within one 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 project require a Stormwater Management Plan? ❑ Yes ❑ No 2c If this project DOES NOT require a Stormwater Management Plan, explain why 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 fu �a 3a In which local government's jurisdiction is this project? ❑ Phase II ❑ NSW 3b Which of the following locally - implemented stormwater management programs ❑ USMP apply (check all that apply) ❑ Water Supply Watershed ❑ Other 3c Has the approved Stormwater Management Plan with proof of approval been ❑ Yes ❑ No attached? 4. DWQ Stormwater Program Review Ai f\ ❑Coastal counties ❑HQW 4a Which of the following state - implemented stormwater management programs apply ❑ORW (check all that apply) ❑Session Law 2006 -246 ❑ 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? ❑ Yes ❑ No 5b 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) funds or the ❑ Yes 'WNo 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 ❑ Yes ❑ No (North Carolina) Environmental Policy Act (NEPA /SEPA)? 1c If you answered "yes" to the above, has the document review been finalized by the State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval ❑ Yes ❑ 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 2B 0200)? 2b Is this an after - the -fact permit applications El Yes ,KNo 2c If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s) 3. Cumulative Impacts (DWQ Requirement) 3a Will this protect (based on past and reasonably anticipated future impacts) result in ❑Yes �rNo additional development, which could impact nearby downstream water quality? 3b If you answered "yes" to the 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 methods and disposition (non - discharge or discharge) of wastewater generated from the proposed project, or available capacity of the subject facility C3 ,*J (-- l3 C;V2Cb'n -• CAR rte' A"11 7&--10 9 L 2OOA, S ✓4� S c/( r4C�' Pilopd-e-0 Pdri o S� z 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 o habitat 5b Have you checked with the USFWS concerning Endangered Species Act ❑Yes(lo impacts 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? W012,5-1 7e — LrS" 1- (.f F4 vt N/C.j94 -/F!F S-E'2VJ CE-.- S'ug:rerZ— Ei`' .Spe -C(tS SPe tf /- t')0e'4A-L.- Ql= 6. Essential Fish Habitat (Corps Requirement) 6a Will this protect occur in or near an area designated as essential fish habitat? ❑ Yes �<No 6b What data sources did you use to determine whether your site would impact Essential Fish Habitat? ACH /P1472JJ -5z /t0w,, X 0'eL1,11xA E �f�n.� G� av✓ P �t'YL° 1 /�-/Z �a-z t✓t Gt `�' S 41! 2 /nt 6- A- N0 7 S Q `CS 7. Historic or Prehistoric Cultural Resources (Corps Requirement) 7a Will this protect occur in or near an area that the state, federal or tribal governments have designated as having historic or cultural preservation ❑ Yes *5rN0 status (e g , National Historic Trust designation or properties significant in North Carolina history and archaeology)? 7b What data sources did you use to determine whether your site would impact historic or archeological resources? NA7l a,�q T�L�JS7 �o�C f! rsrd2 c c P2C3(= U471drJ G✓�� S 2 A.) L.lf� ?i�✓r�.r o t t- /l( 2- c z 8. Flood Zone Designation (Corps Requirement) 8a Will this protect occur in a FEMA - designated 100 -year floodplain? ❑YesNo JNR- 8b If yes, explain how protect meets FEMA requirements 8c What source(s) did you use to make the floodplain determination? �A D I`�/`t /" ►'L� iP�2z'7 13 Y ibJ "�J Avg co jo ey 7, /� a/ � �/Qv✓t� OT= �'�`/ G�aor� /S' 3,o e Yom, r ,°L� Sri Applicant /Agent's Printed Name Applicant/Agent's Signature Date (Agent's signature is valid only if an authorization letter from the applicant is provided Page 10 of 10 7la1Cz �' b YO M 11 _j IAL M'f 1% \-1401-rf VRP, Y4 6— —'� fo 'A x , 'T 7 I A ' K,:7 E:mm L-4 �61 Aj):N63 _Zz Lri, VC "N w < � _ff-' ='.` -O 'z I v a 1, 0 1� v.1 I V3_ _--j t ^., v TV ;Y -.I • Z— eo 'tn' -A lu f— �/•�J` :`4tI�L3 R.��a'a�`v\r' \,�� - ^:\ �f ```'ice -. tr ,• r'J ''��1 � � �! fJ.. �\` .y��, _ v,: -.� i• w:..,�,�.<�` `'�> VNI i;t it IM-,T) — 1, 1, 7- .41 IL f; f V`K N VY I t_1 _3Z \ • C %�/ 1 ...^ ``•'\.'_ ��-, - ,'`•,•i � t -� ` -y`•, r`.,_}11,J �'I ryry ..." _�, _`l l.��_ �•( -,r: \ rl ice-,^ % � _ � \ 7A Vy "'�ti .: ii ``i,• \'� AL -Z/ -oas 4z Y. \Q I 17 e MX z I _N V V14 D ibl f u . 1, lr� I ! 1, 1 1 - , CV1 j for ,n mx% LX% 11 IN r ?,;e j Z-4 AV M4 A) �QQ t �� ai i ,��J r ` >. /`•�% ��r-, L' , • �' r I \�, t r-~ r� ` ,ry 'jam: .--� HIJ'((; L �• ' 1 _ Y \._` 1, ~ F'�'S 11 �c f x ,—, V�v IL' M X\, %V11 1 " ( v ti _.. :.. ..fir• '' - " � - ` I CD r Z3 ... . v • i t r Lu 1 � Il,, kni }�'r�� . - r f SINN—, 09 ;.1 ffr4.1 TDL IS Its YIk it < .I WON "FL vz. wgi 0 � a X1 A' I r Jr % f f '7i WH N Nx m 0 57 1 / 1 -11, 1 0 '1 j. - .- ii , , _. . . . . ..'. r.} 41.t " NN k. 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