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HomeMy WebLinkAbout20141204 Ver 1_Application_20141118N * i '° � �� : " � ��� � , M ��°� � �; � �1�� �� � » ����.�,. �TATE +C�� .�tJl�'�"� ���RCC�►�,I�A i}:�P.��.T�;:N":�" C�►1� '�'����:�►�.T.�iT�+�31'� F.A'�' 1VI�c�R.�R.'� �' . C) . �c�� � � 2 �► l, R.�tei�Jh, I`�� ��'f l �: �� � C�� "T'��T'� �'A`�".�. +���'EI�NOR 1�:�C�I��.: � 19-'l��-��24� �:��R:��'A�� :: +� _ � . #, ' � � Mr. An�.y �i�lia�c�� �CJ. �. .A.r�:�� �t�rps c��' :�n:�in�er� ��+�i�h �.e���.�tar� :��el� ��i.� � �'� �. :��rii��e �'r�,de i)�.�e� �ui�te 1 �� Wa�� F�re��, N� �2'�� 8"� ���,�e�t: :h�ati���i�,e :P+�r�m.i� � 14 �R..1 � 3 l � ��.+�b� t�rr��� :�.�,d� ��.t�.u,��. t�o�.t�� ��►�t�. ��.r�►��:,� �'�r+���+�t l�urn�►�er. 11�*���.�1(1��:� �'���� :��: ��4�f) I���.r 11�Ir. '�►�"il��a�n�: �1""h+� l�T� I�+�p�ar�:��nt �#� "T��ns�c���.ti�� i� ����u��+d i� ��r�.t�+�� �, ba�� �a►.+� �►�.v+� �r� �:����+� �►�t��a� ��' �I�.. 1 �31 �, �.�►�ay �i����e lZ.t��.d. i�n y't�T�.�u,��, ��►ruu�t�r. �i'hi.� pro,�e+ct r�uu�� �rc�r�. �i�t���. ��flU -� ?��-�� �'�r � t��a� len� +�f 1.4 �es. I��.�a���.o�.s ��.�`"�,c� ar�, �l� i�+�r��s� b� �,�bout �,� acr+��. "�"��� �►�rrc�,j�� ��1� req��re the �re�rla���n�.t a� fi��r�� �+�t p�i�►�s� � s�i�rv��. b�l��v: �►�r��ar� ����t�c��: � T'hese pipes �%�� r�maa�n perche+d. d�:� ta ��.�ss�ive slc�p�. T"�e replacem�.t c�� �ie abc��r� �o�� �wet p�ip�s �a�.I� r�qu�ir� t�:��rc�ra� d��a�e�ir��. A�. �npe��i��u.� �a�a.�.b�.;� dii��e vv�ill �be cc�►�sl�ruct�. �.p�t�r���n c�f �lh� ��sti�:g pi�e� t�► +���a.� a sm�:l �ca��. �`l�a.� �v�t�r �11 %nxp►c�ra��� be pu.��►pe� a�rc�u�+� �he c�on:st��:+��Gic�� �.r�s a��.d �rai.�� b►e c�a�.s��:�ge� ��v��:�tr��m. .��� c�%�t;� �va�ter 1�►+��.t�c� insi�.� ca� the �ca►r�st�uc�c�� �.re�s � �e �u��nped: infi,� �. ��� b�;� � �.�+���sar�. C��.ce �e �.ev� pip�s are i� p1ac�, the imp��rious dai�es v��ll. b+� r��c��r�d. and p�r�+�an�Itr�. ,�c�� �1�r+�aa:�bed eleva.t���s wil� b� r��tored. �'. C�►. ��� 2�t�� �. '�t�"�,,,�.ssc��.ca, �1'� ����'� Pxr�� �336�� �b'i-�11.1 F� �3��� �+��'�4��� 11rIr. A�:t�� Wi11��ac�.s ��t. l 3 � 1 �, ���►� �`rr�e�e �..+c�.d, "�%.�a.��a F��e 2 �c�v��m�r 1 �, 2(} 14 T`�e w�� p��a�� c��arr� �'��`�'�r���� I�T`�''s t�a t�h� �+�ufi�E� :�c��r� :�Tew �:i�.�v+�r �t�I��: � �-). "I�i.� �a��,�e�t w��s ��vi���+� ft�r �� pre�enc� t��' ��ar��,t���+d an� �n�ara:�+�red �p+�ci�s �� .A�t,�uu�� ��', 2� �. �. '��a%� ���j��t ��� h�.�� �:� �:�i'��t a� aara.y� fed.e�a�l1� �i�t+�. �nd�n.���rer�. plant +�r ,�run�a:l ���i�s . �:��tc��� �►m�►1��n.+c+� �vc�rk �i.�,� �b���. �o��l��� �d �.o �urve�� w�r� r�quir+e�.. T�� ��r�aj�ect im�►a�ts �re no� s�;�r��i+�a�rt in. �.�:u�� a;�.+d sh�►uu�� no�t r�:mave c�r ���r�.d� ��i���,� �v���r t��.���;� �.ses. ��+��nv�ater �w�ill be r+�uted #��r�►u,�h g�r�,�s c�� r��:� 1�.�� d��+cl�.��� ���►�r��.iii�,� ��. �h� da.��� li�� �����a Pip� s��e� us�d ��l be �i� ��rnu��. n�cc�ess��r�y tc� +c�r�t� � s�f'e �rc�.d�r�.�. :�� u�il�,�i�,� �a� �r+a�i�►�. c�a�tral :r�.��ssu.�e� au�t�.u�.�+d � th� �.tt;�+�bur��n�� t� ��� �p�li�,�ti�n, d�►�m�stt��� ���e�° ��.�lit� ���►+��r�.� �r�l� b� pr+�tecte�d:. +�Jv��r�l.l wat�r q�.�;�.t� ai� th+e �ar+�a �vi11. b�e i�rnp��r�a��d. ��r pav��n,g fi�:� �C� �tr���� ����. .�� appro��.ate :�1��"s vc�i�l b� �.s�d �.ur�r�� �►�:��tr��i��. A��+��.+ed. z� �. 1'r�c�n.�truciio� ��t��.�ii�►n �`+��m�, p��a�: �h�t� wi� pr+apc��e�. +�rc�sic��. �c��trc�� �.���.�r��, �. m���. c�►�ty m�p ar�.d �. :rn�,�rr�ed to�ca�r��h�r :��,�r. By +�c�p� �af fi�is e1��rt��ui� l�t�e�r, �t is r�qu�st� �i�:�.� ��r�. ���r��. +�h������r� wit�h ��.� 1"��a��i �a�r�►�i��'�'�ii�.i�� R�s�+�u���s t���m�ni�sic�n �c�����nnt c�ir+���tl� ��+ �a�u �t��.c��r�ir�� �he 4�4 �T��t����.+�+� ��r�r�i.� �p�����.����. �vv��l� � copy s��� t�► n�.�. By �o�s� c��' ��.s �le+��arc��.i� l�tt��r, it i� r�q��s%t� �h�t �� ;�i.�i�i�►� �►� �a���° :�.+���►�°��� 4� �.�i�'�����d� ��.�� i��u� �.i� �.��►ra�a�.�te pe��t f+ar �r��t��+ctic�n �� t��� �ro,��c�. I� i� r�u�s��. ��� �.y� �cc���rn�:n�s �r���.��1 �+� the 4�D � �rt��.c�.�ti�n be �l��trc��.ica�ly� �`c�r���rd�d c�i�r��ly �� n�� �%�� �, ��py� ���� ��► �� �,T� � ���� �� E�,��.+��rs. 't�% waulc� li�� t�+ �e�gi� ��.��ru�i�c�� a�� s��►r� �s �+��si�►l�. If ��t��� ��'�:���,���►�. �s r�qru�r��, ������ ��i �� :l�n:�►v�. ''�"c►ur ��r1� r��i��v �+� cc��.sit��r�.�t�r� �:i.l� be �p►��+����,�t�d.. ��������� �. � � :��t� �la��.���+�� �����ic��. .��:�r���.��:�.� ���:��r :�n;clt��ur�� c+�: :i�;�r�a t���:�b�r�� l"���t� .��m� �h���.aar�, �►�vi�ian �af` �V`�ct�r :�.�s�u����� II�a�� '�"�nu+�h�, �►i�is��►r� �f ��,�te�r �.�so�:rc�� :L��k� ���G��jc►��.� �':�►, �i�i��a� �,��in�e�r ��u� ��1+��, ���iric� �,�.g�in��r :���v�. �i��.ttir��;tc►n, �c�u.nty �1�aa�.t�n�+�e :��.�.�.e�r I�+��.t� ��au,�h��r, �iv�.�i�►�. Env�ircr�n�n:��.��. t����+�r ��.c� �c�ufi�er, :�.��.�i�e �,n�iro�����,� �"��ld t�pe�t��ns �`���r�+�i�. �� �.���f���������'�� affice Use Only: � ��,r���'��� �- � � � l`� � Corps action I D no. . ':'l.�r�(:%�:i�}:%}Y'::i��!,V�i'.�'.�? : A� � � � � � ,. F � ��............ .� DWQ project na. � f.���'i..i:::;:i.: �i ::Y: .. Form Version 1.3 Dec 10 2C1a8 Pre-�onstruction Noti�ication PC�N �'arm --�-._._�._ A. A licant In�'ormation M�� 1. Processing 1a. Type(s} of approvai sc�ught from the �;����on 404 Perr�nit Section 10 P rmi cor s: � C1 e � p 1 b. Specify Nationwide Permit (NWP) number: 14 ar General �'ermit (C�P) number: 1 c. Has the NWP or GP number been verified by the Corps'? � Yes ��lo 1d. Type(s) of approval sought from the DWQ (check a[I that apply}: (� 4a1 Water Quality Certification - Regular � N�n-4a4 Jurisdictional General Permit ❑ 401 Water Quality Cerkification -- Express ❑ Ripari�n Buffer Authorization 1 e. Is this natification safely for the record For the recQrd only far aWQ 4�1 Fnr the record anly �ar Corps �'ermit: because written approval is not required? Certification: ❑ Yes � No � Yes j�j No 'I f. Is payment into a mitig�tion bank or in-lieu fee prograrn proposed for mitig�tion Yes No �f im acts? If so attach the acce tance letter firom miti atior� bank or �n-lieu � � p a p � fee program. 1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h � Y�� � No below. 'Ih. Is the project iacated within a NC DCM Area af Environmental Concern (AEC)? ❑ Yes � No 2. Proj�ct Information 2a. �1ame nf project: SR 1331 B, Raby Greene Rc�ad 2b. County: Watauga 2c. Nearest municipality 1 town. Boone 2d. 5ubdivisian narne: 2e. NCDOT on1y, T.1. P. or stafie .-�...-.---_��......__..�._ project no: 11 C.095101 3. CC�wner lnform�tion 3a. Name(s} c�n Recorded Deed: NCDOT 3b. C�eed Boc�k and Page No. 3c. Responsi bl� Party (for L LC i f -�-�-- -- �---�-�-- _�._.._.�...._�..._______....��...._�.�._ applicabie): 3d. Street address: 801 Statesville Road 3e. City, state, zip: North Wilkesboro, NG 286�9 3f. Telephone no.: 336-9n3-9202 3g. Fax no.: 336-667-4549 3h. Email address: hslaughter�C�ncdot.gov P�ge 1 c�f 1 C� P�N Form -- Versian 1.3 Dec�mber 1�, 2aG8 V�rsic�r� 4. Applicant Informatic�n (if dififerent from owner) 4a. Applicant is: [] Agent ❑ Other, speci�Fy: 4b. Name: 4c. Busines s narne (if �pplicable): 4d. Street address: 4e. City, state, zip: 4f. Telephc�ne no.: 4g. Fax no.: 4h. Emaii address: 5. Agent/Consultant lnformation (if applicable) 5a. f�ame: 5b. Business name (if applicable). 5c. Street address: �d. City, state, Zip: 5e. Telephone na.: 5f. Fax no.: 5g. Ernail address: Page 2 �f � C� P�N Farm -- Version 1.3 December 10, 20�8 Versic�n B. Praject Information and Prior Project History 1. Property Identification 1 a. Property identificatian no. (tax PIN or parcel ID): L�titude: 36.24�09 �.ongitude: - 81.�3�19 1 b. �ite coordinates (in decimal degrees): ��p.pDDDDC2) -DD.DDDDDD � ) 1c. Praperty size: 8.5 acres 2. �urface Waters 2a. Name of nearest body of water (stream, river, etc.) to UTs to SFI�R proposed project: Zb. Water Quality Classificatian of nearest receiving water: C+ 2c. River basin: � �New ��� 3. Praject Description 3a. Describe the existing conditions on the site and the general land use in the vicinity of the praject at the time af fihis applicatian: Unpaved road in a rural area. 3b. List the total estimated acreage of all existing wetlands on the prr�perty: 0 acres 3c. List the tota! estimated linear fieet of all existing streams (intermitt�r�t and perennial) on the properfiy: 200 linear feet 3d. Explain the purpose of the proposed project: Upgrade roadway. 3e. Describe the overall prnject in detail, including the type of equipment to be used: �ee attached cover letfier. 4. Jurisdictional Deterrninations 4a. Nave jurisdictional wetland or stream de�erminatians by the Corps or State been requested or abtained for this property / praject (including all prior phases) in the past? d Yes � No [�] Unknawn Comments: 4b. If the Corps made the jurisdictional determinatian, what type of determinatian was made? � F'relirninary ❑ Fin�l 4c. If yes, who delineated the jurisdictional areas? Agency/Gnnsultant Company: Name (if known): CC�ther: 4d. If yes, list the d�tes of the Corps jurisdictional determinations or �tate determinafiions and att�ch documentation. 5. �roject Histor� 5a. Nave permits or certific�tions been requested or obtained for � Yes j� No ❑ Unknown th�s pra�ect (including all prior phases) �n the past? 5b. 1f yes, explain in detail according to "help fiie" instructions. 6. Future Project Plans 6a. Is this a phased project? ❑ Yes (� No 6b. If yes, explain. P�ge 3 af 10 P�N Fnrm -- Version �1.3 CJecember 1 n, ZOq8 �/"er�ion C. Proposed Impacts Inventory � 1. lmpacts Summary �� 1 a. Which sections were completed below far your project (check aii that apply): ❑ Wetlands j� Streams - tributaries � Buffer� ❑ Open Waters ❑ Pond Construction 2. Wetland Impacts If there are wetland impacts proposed on the site, then complete this questian fc�r each wetland area imp�cted. 2a. 2b. 2c. 2d. 2e. 2f. ____...___.�...� Wetland impact Type of jurisdiction number — Type of impact Type of wetland For�sted (Carps - 404, 10 Area of imp�c� Permanent (P) or {if known) D'U1IQ — non-4�4, �ther) (�cres) Tem orar T d Y�s 0 Corps �.�.._.. W 1 ❑ P❑ T N o D1l1/ � ❑ � ❑ Yes [� Carps _......� W2 ❑ P❑ T N� DWQ ❑ � ❑ Yes � Carps ._....... ..�.....��._ .�.._ W3 ❑ P � T Nr� DWQ � d [�] Y�s d Corps � W4 � P � T N� DWQ ❑ ❑ ❑ Y�s ❑ Garps _ ..._._.� _..�..._........._M.......�..�...._. W5 ❑ P ❑ T �� D� � � � � Y�s ❑ Corps __... W6 ❑ P C] T N� DW � 0 � 2g. Totai wetiand impacts 2h. Comments: 3. Stream impacts If there are perennial or intermittent stream impacts (including tempor�ry impacts) proposed on �he sifie, then c�mplete this question far all stream sites imp�cted. 3a 3b. 3c. 3d. 3e. 3f. ____.�.�... �g .w_� Stream impact Type af impact Stream name Per�nnial Type of jurisdiction Aver�ge ��p��� number - (P�R) or (Corps -�4U4, 1 Q str�arn leng�h Permanent {P) or intermittent p�/(� -. �an-404, width (��n��►�" TemporarY iT) CI�T)? other) (fe�t) �e��) P i pi ng, Ri prap & � P� R � Corps __���.�.�..�_ �...�.._.___.�. ...��...�.._��.��� �� �) P I� T Dewaterin UT#1 to SFNR Ii�T DWQ � �6 g ❑ � P i p i n g, R i p ra p& � P� R j�j C a rp s.�_._...__..� .��...�....� �..� ..��..�.. S 2 � P� T p�waterin U T# 2 t o S F N R Ii�T DWQ 1 �� � � � P i p i n g, R i p ra p& ❑ P� R � C o rp s ..��......._..___�.w �.._.....�.� �_..�.w.�_.__....�..��_ S3 (� P� T pewaterin UT#3 to SFNR 1 �2 g � II�T � �WQ __._V �. . _ �._.� _._.�.�._. .�..._�_.____.. ❑ F'�R [� Corps S4 ❑ P❑ T I i�T DV1/Q � �.i �_ [� P E R �[� C o rps ...��_._. __.___ ._�..._�_.....�.�.. S5 [� P[� T INT DWC� ❑ ❑ [� P � R �.] Corps _ �....._.__�..__..�__,� S6 ❑ P❑ T I1�T C�WQ ❑ � 3h. Total stream and tributary impacts 199 3i. Camments: 49 pipe, 34 riprap, 124 dewater Page 4 af 1 � P�N Farm — Versian 1.3 December 1 a, 2�Q8 Version 4. Open Wafier Impacfis If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, fihe'Atlantic C�cean, or any ather open water o� the U.S. then individualiy list all open water impacts below. 4a. 4b. 4c. 4d. � 4e. apen water Name of waterbody impact number — (if applicable) Type of imp�ct Waterbody tYpe Ar�a of impact (acres) Permanent {P} or Tem orar T CJ1 ❑P�]T Q2❑P❑T 03 ❑P❑T CJ4 ❑P❑T 4f. Total open water impacts 4g. Cc�mments: 5. Pand or Lake Cc�nstruction If ond or lake consfiructian ra osed, then com lefie the chart below. �a. 5b. 5c. 5d. 5e. Wetland lmpacts (acres) Sfiream lmpac�s (feet} Upl�nd Pond ID Proposed use or purpose (�cres) number of pond _ _ _ ..�____M_..� _�.�..�..�� Flooded Filled Excavated Flaod�d Fill�d Excava�ed Flooded P1 P2 5f. Total 5g. Comments: N/A 5h. Is a dam high h�zard permit required? ❑ Yes (� No If yes, permit f� nca: 5i. Expected pand surFace area (acres): 5j. Size ofi pond watershed (acres�: �k. Method of construction: 6. �uffer Impacts (for DWQ) lf project will impact � protected riparian buffer, then complete th� ch�rt below. If yes, then individually Iist �11 bu#fer imp�cts belaw. If an impacts require mitiqafiion, then you �l1ST fill out Section D of this form. 6a. [� N�use (� Tar-Pamlico ❑ CJth�r: Project is in which protected basin? (� C�t�wba [�] Randlem�r� 6 b. 6�. 6d . 6�. � 6f. �� �---.-�-.-�—�_.__...�._. _..�. Buffer impact number-- Reason �uff�r Zone 1 impact Zone � irnpact Permanent (P} or for Stream name mitig�tion (square feet} {square fee�) Tem orar T im act re uired� __. ❑ Y�s _ _�_.�._._�....._._..._.�....� B1 ❑P❑T N� � ❑ Y�s _ �_..._ ..�.... B2 ❑P�T �� ❑ Q� Yes . _ B3 ❑ P ❑ T N� ❑ 6h. Total buffer impacts 6i. Comments: Page5�f1� P�N Form — Version 1.3 December 10, 2�08 �fersion D. Irr�pact Justificatican and Mitigation ��� � 1. Avaidance and Minimization 1 a. Specifically describe measures taken to avoid or minimize th� prapased impacts in designing project. The pipe lengths are the mir�imum needed to improve roadway. 1 b. Specifically describe measures taken fio avoid or minimize th� proposed' impacts through construcfiion techniques. All appropriate BMPs will be used during construction 2. Campensatory Mitigation for Impacts to Waters of the Uo�. or Waters of the �tate 2a. Does the project require Campensatory Mitigation for � Y�s [�J No impacts to Waters af the U.S. or Vllaters of the State? 2b. If yes, mi�igatior� is required by (check �.11 that apply): � C�WQ ❑ Cor'p� ❑ I�/litigation bank 2c. If yes, which rnitig�t ion option will be used for this ro'�ect'? � Payment t� in-Iieu fee pro�ram � 1 0 Permittee Responsible Mitigation 3. Complete if Using a Mitigation Bank 3a. Name of Mitigation Bank: 3b. Credits Purchased (attach receipt and letter) iype Quantity 3c. Comments: 4. Complete if Making a Paymen# to In-lieu Fee Program 4a. Approval letter from in-lieu fee program is attached. � Y�s � 4b. Stream mitigation requested: 98 linear feet 4c. If using stream mitigation, stream temper�ture: ❑ w�rm ❑ cot�l �cold �� 4d. Buffer mitiga�ion requested (DWQ onLy): sguare feet 4e. Riparian wetland mitigation requested: acres 4f. Non-riparian wetland mitigation requested: acres 4g. Coastal (tidal) wetland mitigation requested: acres 4h. Comments: 5. Corn�plete if Using a Permit#ee �.esponsible Mitigation Plan 5a. Ifi using a permittee responsible mitigation plan, provide a description of the proposed miiigation pl�n. Page 6 c�f 1 C� P�N Form -- Version 1.3 C�ecember 10, 20�8 Version 6. Buffer Mitigation (State Regulated Riparian Buffer Ruies) — required by DWQ 6a. Will the project result in an impact within a pr�tected riparian buffer that require� ❑ Yes � Rlo buffer mitigation? 6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Cal�ulate the amount of mitigation required. 6c. 6d. � �e. � Zone ��ason for impact Tatal impact Muifiiplier Required mitigation (square feet) �square feet) Zane 1 3(2 for Catawba) Zone 2 1.5 6f. Total buffer mi�tigatic�n req�aired: 6g. If buffer mitigation is required, discuss what type c�f mitigation is propc�sed {e.g., payment �a private mitigation barik, permittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund). 6h. Cc�mments: Page '7 �f 10 P�N Form -- Versian 1.3 December 10, 200� Ver�ion E. Stormwater Management and Diffuse Flow Plan (required by i�WQ) 1. C�iffuse F'Iow Plan � a. Does the prc�ject include or is it adjacent to protected riparian buffers identified within one of the NC Ri arian Buffer Protection Rules? � Yes j� N° p 1 b. If yes, then is a diffuse flow plan included? 1f no, explain why. [.� Yes ❑ Na Comments: 2. Stormwater Mana ement Plan 2a. What is the overall percent imperviousness of this project? °Ia 2b. Does this project require a Stormwater lVlanagement Plan? � Yes ��I� 2c. If this praject DOES NOT require a Stormwater Management Plan, explain why: 2d. If this project DOES require a Stormwater Managemenfi Plan, then provide a brief, narrative description �f the plan: Falls under DOT NPDES Permifi 0 Certified Lc�cal Governmenfi 2e. Who will be responsible for the review of the Stormwater Mar�agement Plan? 0 DWQ Stormwater Program ❑ DWQ 401 Unit 3. Certified �ocal Government Stormwater Review 3a. In which local government's jurisdiction is this project? � [,� Phase II 3b. Which of the followin locall -im lemented starrnwater mana ement ro rams ���� g Y � 9 p g ❑ U;� �/I P apply (check a!I that apply): [� Water Supply W�tershed [� �Jther: 3c. Has the approved Stormwater Management Plan with proof of appraval been ❑ Yes � Na attached? 4. D'1�VVQ Stormwater Program �eview ❑ Cc�astal countie� ❑ HQW 4a. Which of the following state-implemented storrnwater manag�ment programs apply ���W (check all th�t applY): �] Sessior� Law 2�06-24� ❑ C�th��: . 4b. Has the �pproved Stormwater Management Plan with proof of approval beer� att�ched? ❑ ��� ❑ �� 5. DWQ 401 Unit Stormwater Review 5a. Does the Stormwater Management Plan meet the appropriat� requirements? ❑ Yes ❑ No 5b. Have all of the 441 Unit submittal requirements been met? � Y�� ��� Page8af10 P�N Form -- Versic�n 1.3 December 10, 20�8 Version F. Supplementary Information 1. Environmental Documentation {DWQ Requirement) 1 a. Does the project involve an expenditure of public (federal/statellaca(} funds ar the �,�s use of public (federal/state) land'? � � �° 1 b. If you answered "yes" to the abc�ve, does the project require prep�ration of an environmental document pursuant to the requirements af the National or �tate ❑ Yes � No (North Carolina) Environmental Palicy Act (NEPA/SEPA)? 1 c. If you answered "yes" to the abave, has the document review been finalized by the �tate Clearing Hause? (ff so, attach a copy c�t the NEPA or �EPA final approval letter.) [� Yes � i�a Cornments: 2. �'iolations (DWQ Requirement) 2a. Is the site in violation of DWQ Wetland Ru1es (15A NCAC 2H .0500}, Isnlated Wetland Rules (15A NCAC 2H .� 300), DWQ Surface Water �r W�tiand Standards, [�j Yes j� Na or Riparian 8uffer 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 af the abt�ve questions, provide an explanation of the violation(s). 3. Cumulative Impacts (�WQ Requirement) 3a. Wiil this project (based on past and reasonably anticipated fu�ure impacts} result in � Y�s ��� additional development, which could impact nearby downstre�m �nrater qu�lity? 3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance wifih the mc�st recent DWQ paiicy. lf you answered "no," provide a shor� narr�tive description. 4. Sewage Disposal (DWQ Requirement) 4a. Clearly detail the ultimate treatment methods and disposition {nc�n-discharg� or discharge) of wastevvater ger�erated fror� the proposed praject, or available capacity of the subject fa�iiity. N/A Page 9 �f 1 a P�N Form -- Version 1.3 December 10, Zt��8 Version 5. Endangered Species and Designated Critical Mabitat (Corps Requirement� 5a. Wiil this project occur in or near an area with federally protected species or ��es No habEtat? � 5b. Nave you checked with the USFWS concerning Endangered Spe�ies Act �,�5 � impacts? ❑ � ° 0 Raleigh 5c. Ifi y�s, ind icafie the U�FWS Field Ofifice you have contacted, [�] Asheville 5d. What data sources did you use to determine whether your site w�uld impact Endangered Sp�cies c�r Designated Crifiical Habitat'? G15 and visu�l observation 6. Essential Fish Nabitat �Corps Requirement) 6a. Will this project occur in or near an area designated as essen�i�l fish habitat? ❑ Yes i� No 6b. What data sources did you use to determine whether your site wauld impact Essenti�l Fish f�abitat? WRC will comment 7. Nistoric or Prehistoric Cultural Resc�urces (Corps Requir�ment) 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 �.�e� ��� status (e.g., Nation�l Histor�c Trust designation or properties significant in North Carolina histary and archaeoiogy)? 7b. What d�ta sources did you use to determine whether your sit� wauld impact historic or �rcheological resources? Praject submitted to HEU 8. Flood Zone Designation {Corps Requirement) 8a. Will this project occur in a FEMA-designated 1Q0-year floodpl�in? � Yes � Nc� 8b. If yes, explain how project meets FEMA requirements: Road will be undercut to maintain current elevation. 8c. What source(s) did you use to make the floodplain det�rmin�tion? FRiS �� J. �eath Slaughter -�. 11 /18/14 � d Applicant/Ag�ent's Printed Name Applicant/Agent's Sign re C�ate (Agent's si ature is valid oniy if an authori�at� letter from fih� applicant _ �� is provided.) __ Page 1(� �f 1� P�N Farm -- Version 1.3 december 1Q, 2008 Version