HomeMy WebLinkAbout20140614 Ver 1_401 Application_20140614AID 2 0 1 4 0 6 1 4
Of W A rE�
Office Use Only:
r I Corps action ID no.
1 I DWQ project no.
Form Version 1.4 January 2009
1`I.U.UCut. UI r-04M
JUN 16 2014
Winston- S..:Iern
Page 1 of 10 Reaional Office
PCN 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:
❑X Section 404 Permit ❑ Section 10 Permit
1b.
Specify Nationwide Permit (NWP) number: 18 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):
❑X 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 ❑X No
For the record only for Corps Permit:
❑ Yes ❑X 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 ❑X No
1 g.
Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below.
❑ Yes ❑X No
1h.
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes ❑ No
2.
Project Information
2a.
Name of project:
Oakley Dam Improvements
2b.
County:
Alamance AIM
2c.
Nearest municipality / town:
Elon IVLS��Ligu\y 14:15 nh I
2d.
Subdivision name:
2e.
NCDOT only, T.I.P. or state project no:
1 % 2014
3.
Owner Information
AIR
3a.
Name(s) on Recorded Deed:
Gary M. Sr. and Pam B. (�a,�,j�� W
3b.
Deed Book and Page No.
Book 2832, Page 0522
3c.
Responsible Party (for LLC if
applicable):
3d.
Street address:
3016 Amick Road
3e.
City, state, zip:
Elon, NC 27244
3f.
Telephone no.:
336- 516 -0758
3g.
Fax no.:
3h.
Email address:
gmoakley1 @hotmail.com
F RECEIVED
1`I.U.UCut. UI r-04M
JUN 16 2014
Winston- S..:Iern
Page 1 of 10 Reaional Office
PCN Form — Version 1.4 January 2009
4. Applicant Information (if different from owner)
4a Applicant is
❑ Agent ❑ Other, specify
4b Name
4c 'B'usiness, 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)
170380
lb
Site coordinates (in decimal degrees)
Latitude 36 130291
Longitude -79 527123
1 c
Property size
acres
2.
Surface Waters
2a
Name of nearest body of water to proposed project
Travis Creek
2b
Water Quality Classification of nearest receiving water
WS -V, NSW
2c
River basin
Cape Fear
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
3b,
List the total estimated, acreage of all existing wetlands on ,the
property
3c
List the total estimated linear feet of all existing streams (intermittent and perennial) on th&property
3d
Explain the purpose of the proposed project
3e
Describe the overall project in detail, including the type of equipment to be used
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 X❑ No ❑ Unknown
Comments
4b
If the Corps made4he jurisdictional determination, what type
of determination was made?
❑ Preliminary ❑ Final
4c
If yes, who delineated the jurisdictional areas?
Name (if known)
Agency /Consultant Company
I 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 ❑X No ❑ Unknown
5b
If, yes', explain in detail according to "help file" instructions
6'.
Future Project Plans
6a
Is this a phased project?
❑ Yes ❑X No
6b
If yes, explain
Page 3' of °10
PCN Form — Version 1 4 January 2009
C. Proposed Impacts Inventory
1' Impacts Summary
1 a 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
Wetland impact
number
Permanent (P) or
Temporary
2b
Type of impact
2c
Type of wetland
2d
Forested
2e
Type of junsdiction
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 (here, are perennial or intermittent,stream impacts (including temporary impacts) proposed on the site, then complete this
questionj& all stream sites impacted
3a
Stream impact
number
Permanent (P) 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
S2
Choose one
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
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the US then indiv ually list all open water impacts below
46
Open water
impact number
Permanent (P), or
Temporary
4b
Name of waterbody
(if applicable)
4c
Type of impact
4d
Waterbody
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 or lake construction proposed, the n,complete therchart 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 mite ation, 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
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
D.
Impact Justification and Mitigation
1
Avoidance and Minimization
1a
Specifically describe measures, taken to avoid or minimize the proposed "impacts'in designing project
lb
Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
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
2b
If yes, mitigation ,is required by (check all that apply)-
❑ DWQ ❑ Corps
2c
If yes, which mitigation option will be used for this
project?
❑ Mitigation bank
❑ Payment to in -lieu fee program
❑ Permittee Responsible Mitigation
3
Complete if Using a,Miti ation 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) = requi'red by DWQ
6a VUII the project result in an impact within a protected riparian buffer that requires
❑ Yes ❑ No
buffer mitigation?
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
Be
Zone
Reason for impact
Total impact
Multiplier
Required mitigation
(square feet)
(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)
1.
Diffuse Flow Plan
1,a IDoes the project include or is it adjacent to protected riparian buffers identified
within one of the NC Ri arian'Buffer Protection Rules?
❑ Yes ❑ No
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 re wre ,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
3a
In which local government's jurisdiction is this project?
3b
Which,,of,the following locally - implemented stormwater management programs
apply (check all that apply)
❑ Phase II
❑ NSW
El USMP
❑ Water Supply Watershed
❑ Other
3c
Has the approved Stormwater Management Plan With proof of approval been
attached?
❑ Yes ❑ No
4.
DWQ Stormwater Program Review
4a
Which of the following state = implemented stormwater management programs apply
(check all that apply)
E]Coastal counties
❑HQW
❑ORW
❑Session Law 2006 -246
❑Other
4b
Has the approved Stormwater Management Plan with proof of approval been
attached?
❑ Yes ❑ No
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
❑ No
use of public (federal /state) land?
lb
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
E] 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,
❑X Yes�
❑ No
or Riparian Buffer Rules (15A NCAC 2B 0200)
2b
Is this an after - the -fact permit application?
❑X Yes
❑ No
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 project (based on past and reasonably anticipated future impacts) result in
El Yes
❑ No
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
Page 9 of 10
PCN Form — Version 1 4 January 2009
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
-
5d What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
6 Essential Fish Habitat (Corps Requirement)
6a Will this project 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?
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
statuss(e g , National, Histonc Trust designation,or properties significant in
North Carolina history and archaeology)9
❑ Yes ❑ No
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 in 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?
Applicant/Agent's Printed Name
Date
Applicant/Agent's Signature
(Agent's signature is valid only if an authorization
letter from the applicant is provided
Page 10 of 10
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