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Home My WebLink About20140873 Ver 1_401 Application_20140814�pFWATEgO 2 0 1 4 0 8 700$e use Only: ps action ID no DWQ project no. Form Version 1.4 January 2009 Page 1 of 10 PCN Form - Version 1.4 January 2009 C' F-� .A* n Pre - Construction Notification (PCN) Form A. Applicant Information 1. Processing i 17 $00 f, 130 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) numbe :I Q 8'. oO RO (,",j 1c. Has the NWP or GP number been verified by the Corps? 02'Yes ❑ No 1d. Type(s) of approval sought from the DWQ (check all that apply): [2'401 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: El Yes �o For the record only for Corps Permit: , -,/ El Yes l-7 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. ^� L] Yes EKO 1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1h below. ❑ Yes E/No 1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ❑ Yes Blko 2. Project Information 2a. Name of project: C S_ Norr % 5 Pro &,-+v 2b. County: 2c. Nearest municipality / town: W f1i 2d. Subdivision name: 2e. NCDOT only, T.I.P. or state project no: N 3. Owner Information 3a. Name(s) on Recorded Deed: T Chr', 5 �o �c.- Norr -% S 3b. Deed Book and Page No. 3c. Responsible Party (for LLC if applicable): 3d. Street address: toy L C q�ks NccL, (Z l 3e. City, state, zip: WQ In -Iro- NC- 2.7) 17,E 3f. Telephone no.: l pZ 3g. Fax no.: 3h. Email address: '} ono rn S o n V J Cou-1 c.p ri Page 1 of 10 PCN Form - Version 1.4 January 2009 C' F-� .A* n r� 4. Applicant Information (If different.frohi owner) ,A 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) 1.J A 5a Name- - 5b Business name (if applicable) 5c Street,address 5d City, state, zip 5e Telephone no- 5f Fax no 59 Email address Page 2 of,1'0 B Project Information and Prior Project History 1 Property Identification 1a Property identification no (tax PIN or parcel ID) to (u b A_l O 105 lb Site coordinates_ (in decimal degrees) I Latitude Longitude 1c Property size J acres 2 Surface Waters 2a Name of nearest body of water to proposed project TrA ems C r e- t k 2b Water Quality Classi ication of nearest receiving water C _S kt�f �.IS W 2c River basin 3. Project Description 3a Describe the existing conditions on the site and the generai'land use in the vicinity of the project,at the time of this application L o �- �114 �, r 2.c A/\Vk y �ce.� Cle/are � ;.� PrcPr -��: a � fog^ Co '\ s- Vruc�: o.. p� Si:.j(t - �"�•\�� {c�,• 3.cncc �%P�Frc� .� o�'c, }� S !� ..tkhe.9� S�o-�I �� w N�q L R' ( H l t i -ii \�Q F�t1�i• 3b List1he total estimatedvacreage,of,all existing wetlands on the property 3c List the total,estimated linear feet of,all existing streams (intermittent and perennial) on the property 3d Explain the purpose,ofthe , proposedproject o 6,,\kheA�i- r7-F 5�1i+� r� Zi.�� S� me 1: n� (A -0w:1117) Al co s Er ut q boa'c I t + P 3e Describe the overall project imdetail, including, the °type of equipment to,be used r J jk k�ab dJ TJ US._ QXegv +n Q. *r i.,Ikh eaa p. \; 3� �'(T✓n � 4. Jurisdictional Determinations 4a Have jurisdictional wetland,or stream determinations by the Corps or State been requested or obtained for this property / project includin all prior phases) in the past? / 'El Yes [j , Rio ❑ Unknown Comments 4b If the Corps made the jurisdictional determination, what type of determination was made? 53"P reliminary M' Final, 46 If yes, who delineated the jurisdictional areas? Name (if known) Agency /Consultant Company Other 4d If yes, list the dates of the Corps, junsdictional, 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? El Yes YNo 6b If yes, explain Page 3 of 10 PCN Form — Version 1 4 Jarivary 2009 C. Proposed Impacts Inventory 1. Impacts Summary la Which sections Were completed below for your project (check all that,apply) ❑ Wetlands ❑ Streams — tributaries RJ Buffers 5 Open Waters ❑ Pond Construction 2 Wetland Impacts 0 1A If there are wetland "impact's 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),oir ,DWO (401, other) 2f Area of impact (acres) W1 Choose one Ctioose'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 number Permanent (P) or - Temporary (T) 3b Type of impact 3c Stream name 30 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 S6 Choose one Choose one 3h Total stream and tributary impacts 31 Comments Page 4 of 10 PCN Form — Version 1 4 January 2009 z yyi �.;,, s: , . 4., Open Waterlmpacts If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of the U S then individua�fly list all open water impacts !below 4a 4b 4c 4d 4e Open water Name of waterbody impact number (iflapplicable) Type of impact Waterbody Area of impact (acres) Permanent (P) or �kH type Temporary T 01 Q },- �� -zr5 Gf�ek t hooseone Choose 0 (o 02 �A� er S C ^e < V ;�aose one Choose p 00 S 03 Choose=e Choose 04 Choose one Choose 4f Total open water impacts 4g Comments 5 Pond or Lake Construction N„ ki; If and or lake construction proposed, complete the,chart below _ 5a 5b 15c 5d 5e. Pond ID, number Proposed use or Wetland.lmpacts (acres) Stream Impacts (feet) Upland purpose of pond (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) 51 Size of pond watershed (acres) 5k Method,of construction 6. Bufferlmpacts (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 you MUST fill out Section D ofthis form _ 6a Protect is in which protected basin? E] Neuse E] Tar-Pamlico ❑ Catawba E] Randleman ❑Other" 6b 6c 6d 6e 6f 6g Buffer Impact Reason for impact Stream name Buffer, Zone 1 Zone 2 number — mitigation impact impact Permanent (P) or' required? (square (square Temporary T _ feet ) feet Yes /No Z$JJ B2 Yes /No B3 Yes /No B4 Yes/No -- B5 Yes/No B6 Yes/No 6h Total Buffer Impacts: ZS�tJ 61 Comments Page,6 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 protect 5A-A6 Zt S�.ort� nom. 1 b Specifically describe measures taken to,avoid or minimize,the, proposed impacts through construction techniques` S \A- -T2rt e- 6 t J��2 �'u �''c- ✓x-. �- S�-3.. ��c -i�1, -'�/'o.... to }cam �n �, - �rAn�Ftrs Cr�el� y %„\k�• -OZ �v,t'1 Est ns+•rlle �l,o� io ba�'Lc�, 11 +o ,2 Compensatory Mitigation for Impacts to Waters.of the U.S or Waters of the State . 2a Does the protect require Compensatory ,Mitigabon for impacts to Waters of the U.S or Waters of the State? ❑ Yes LErNo 2b If yes, mitigation,is required by (check all,that- apply) ❑ DWQ O'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 Pa ment,to In -lieu Fee Program 4a Approval, ettenfrom 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- ripanawwetland 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 -e 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 E] Yes EO/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 6e 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 la Does the project include or is,it adjacent to protected,ripanan, buffers identified j(Yes, ❑ No within one of the NCI Riparian Buffer Protection Rules? lb If,yes, then is a diffuse flow plan included If, no, explain why u. 5b�rc1 ,nc .6q �'?tT ;o� e� cc ❑ Yes No '2. Stormwater Management Plan 2a What is the overall percent Imperviousness °of this project? 0 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 3a In which local overnment!s jurisdiction is this project? ❑ Phase 11, ❑ 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•,proofof approval been ❑ Yes ❑ No attached? 4 DWQ Stormwater Program Review ❑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 El Yes use of public (federal /state) land No 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" to4he`above; has the document review been finalized by the State Clearing House? (If so, attadh a +copy of,the NEPA or SEPA,fnal approval letter ) ❑ Yes ❑ No Comments 2 Violations (DWQ Requirement) 2a Is the site in violation of DWQ Wetland Rules (15A NCAC 2H 0500), Isolated f Wetland Rules (15A NCAC 2H 1300), DWQ Surface Water or Wetland Standards, F] Yes [ (No or,Riparian,Buffer Rules (15A NCAC 2B 0200)? 2b Is this an after - the -fact permit application? ❑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 an ❑ 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," prcMe 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 14 January 2009 5. Endangered Species and Designated Cribcal Habitat,(Corps Requirement) 5a WiiIl,this• protect occur in or near an area with federally,protected,species'or ,habitat? O'Yes �o '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. Histoncior Prehistoric Cultural, Resources (Corps Requirement) 7a WIII this protect occur in or near an area that the state, federal or tribal governments have designated as having historic or cultural preservation status (e g , National Historic Trust designation or properties significant in North Carolina history and archaeol'ogy)? []'Yes MIN o 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? Eeyes Q No 8b If yes, explain how protect meets FEMA requirements 8c What source(s) did you use to make the floodplain determmation7 Arc> Applicant /Agent's Printed Name Date Appticant/Agent's Signature (Agent's signature is valid only if an,authonzation letter from the applicant is provided Page 10 of 10 �� 4N y� 6 ti t c op, r k 0 V � 0 'f x � � � . '/'''`` i -� � ' ^ � i \ | � '~ ! ! i .-- | ` . ` . � ` � | `. ' ~