20141278 Ver 1_401 Application_20141214

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Office Use Only
Corps action ID no
DWQ project no
Form Version 14 January 2009
Page 1 of 10
PCN Form — Version 1.4 January 2009
Pre- Construction Notification (PCN) Form
A.
Applicant Information
1.
Processing
la
Type(s) of approval sought from the Corps
❑X Section 404 Permit ❑ Section 10 Permit
1 b Specify Nationwide Permit (NWP) number 18 or General Permit (GP) number
1 c
Has the NWP or GP number been verified by the Corps?
❑X Yes ❑ No
1 d
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 ❑X 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 Z No
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 n No
1 g
Is the project located in any of NC's twenty coastal counties If yes, answer 1 h
below
❑ Yes No
1h
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes No
2.
Project Information
2a
Name of project
Fox Pond Public Fishing Area (PFA) \
2b
County
Vance
2c
Nearest municipality / town
Henderson
2d. Subdivision name
N/A
2e
NCDOT only, T I P or state project no*
N/A
3.
Owner Information p r= n n---'; —'
3a
Name(s) on Recorded Deed
City of Henderson
15 1,
3b
Deed Book and Page No
Deed Book 141, Page 166
- a
3c
Responsible Party (for LLC if
applicable).
N/A
3d
Street address
134 Rose Ave, P O. Box 1434
DENR
3e
City, state, zip
Henderson, NC 27536
3f
Telephone no.
252 - 430 -5700
3g
Fax no.*
252 - 492 -7935
3h
Email address
SOsborne @ci henderson nc us
Page 1 of 10
PCN Form — Version 1.4 January 2009

4.
Applicant Information (if different from owner)
4a
Applicant is.
❑X Agent ❑ Other, specify
4b
Name
Sara Sherman
4c
Business name
(if applicable)
NC Wildlife Resources Commission
4d
Street address
1720 Mail Service Center
4e
City, state, zip
Raleigh, NC 27699
4f
Telephone no
919- 707 -0164
4g
Fax no
919 - 707 -0162
4h
Email address
sara sherman@ncwildlife org
5.
Agent/Consultant Information (if applicable)
5a
Name
see above - Sara Sherman w/ NCWRC
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)
0214 03005
lb
Site coordinates (in decimal degrees)
Latitude 36 319 Longitude 78 371
1c
Property size
27.2 acres
2.
Surface Waters
2a
Name of nearest body of water to proposed project
Fox Pond (Sandy Creek)
2b
Water Quality Classification of nearest receiving water
C
2c
River basin
Tar - Pamlico
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
This protect site is within an existing recreational park There are existing parking lots, playground, tennis courts, and walking trails Other land uses
around the Fox Pond Reservoir are residential and undeveloped
3b
List the total estimated acreage of all existing wetlands on the property 0 09
3c
List the total estimated linear feet of all existing streams (intermittent and perennial) on the property 1,000
3d Explain the purpose of the proposed project
The protect will add a public fishing pier and ADA parking /walkway to the new pier within an existing City Park
3e Describe the overall project in detail, including the type of equipment to be used
see attached
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?
❑X Yes ❑ No ❑ Unknown
Comments
4b
If the Corps made the jurisdictional determination, what type
of determination was made?
Preliminary ❑ Final
4c.
If yes, who delineated the jurisdictional areas?
Name (if known) James Lastinger
Agency /Consultant Company USACE
Other
4d If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation
In email /photo /phone correspondence with Mr Lastinger it was determined that a 5' wetland fringe exists around the Pond
5.
Project History
5a
Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
El Yes ❑ No ❑X 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
la Which sections were completed below for your project (check all that apply)
❑X Wetlands ❑ Streams —tributaries ❑X 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 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 P
Fill
Unknown
No
Corps
002
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
3d
Perennial (PER) or
intermittent (INT)?
3e
Type of
jurisdiction
3f
Average
stream
width
(feet)
39
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 U S then indiv 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)
01
Choose one
Choose
O2
Choose one
Choose
O3 _
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)
5d
Stream Impacts (feet)
5e
Upland
(acres)
Flooded
Filled
Excavated
Flooded
I 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)
5) 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 mitigation, then you MUST fill out Section D of this form
6a. Project is in which protected basin?
❑ Neuse ❑X 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 P
Fishing Pier /access
Fox Pond (Sandy Creek)
No
410
0
B2 _
Yes /No
B3 -
Yes /No
B4 _
Yes /No
B5 _
Yes /No
B6 _
Yes /No
6h Total Buffer Impacts:
410
0
61 Comments.
Page 5 of 10

D. Impact Justification and Mitigation
1. Avoidance and Minimization
la Specifically describe measures taken to avoid or minimize the proposed impacts in designing project
Avoiding wetlands were not possible due to continuous fringe around the area However, impacts to the Tar - Pamlico buffer were minimized by
choosing a pier location a very short distance to the existing gravel trail resulting in less new development in the buffer
lb Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
Construction equipment can travel to pier construction area on existing gravel walking trail minimizing new, temporary impacts in the Tar - Pamlico
Buffer
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 ❑X 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 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
0-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 project result in an impact within a protected riparian buffer that requires
buffer mitigation?
0 Yes OX No
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 7of10

E.
Stormwater Management and Diffuse Flow Plan (required by DWQ)
1.
Diffuse Flow Plan
1 a
Does the project include or is it adjacent to protected riparian buffers identified
❑X Yes ❑ No
within one of the NC Riparian Buffer Protection Rules?
lb
If yes, then is a diffuse flow plan included? If no, explain why
❑ Yes ❑X No
2.
Stormwater Management Plan
2a
What is the overall percent imperviousness of this project?
138%
2b
Does this project require a Stormwater Management Plan?
❑ Yes ❑X No
2c
If this project DOES NOT require a Stormwater Management Plan, explain why
Adding less than 10,000 sq ft of impervious surface Disturbing less than 1 acre
2d
If this protect 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?
City of Henderon
❑ 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
❑Coastal counties
❑HQW
4a
Which of the following state - implemented stormwater management programs apply
RW
(check all that apply)
Ression 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
0 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
0 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,
❑Yes
❑X No
or Riparian Buffer Rules (15A NCAC 2B 0200)?
2b
Is this an after - the -fact permit application?
El Yes
❑X 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
❑X 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
N/A
- no restrooms or fish cleaning stations are proposed
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
❑ Yes ❑X No
habitat?
5b Have you checked with the USFWS concerning Endangered Species Act
Q Yes ❑ No
impacts?
5c If yes, indicate the USFWS Field Office you have contacted
Raleigh
5d What data sources did you use to determine whether your site would Impact Endangered Species or Designated Critical
Habitat?
Plans and site map were submitted to USFWS for comment 10/21/2014
6. Essential Fish Habitat (Corps Requirement)
6a Will this project occur in or near an area designated as essential fish habitat?
❑ Yes ❑X No
6b What data sources did you use to determine whether your site would Impact Essential Fish Habitat?
NOAA website, not marine 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
❑ Yes ❑X No
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?
Plans and site map submitted to SHPO for comment 10/21/2014
8. Flood Zone Designation (Corps Requirement)
8a Will this project occur In a FEMA - designated 100 -year floodplain?
❑X Yes ❑ No
8b If yes, explain how project meets FEMA requirements
Any local floodplain permit necessary will be obtained
8c What source(s) did you use to make the floodplain determination?
ncfloodmaps com
NCWRC /Sara Sherman
l a Ji D) a 13f "
Applicant/Agent's Printed Name
Appll t/Agent's Signature
Date
(Agent's signature is valid only if an authorization
letter from the applicant is provided
Page 10 of 10

PCN Question 3e
Fox Pond PFA Application
This project proposes to construct a new T- shaped floating fishing pier and ADA concrete sidewalks and
parking spaces. NCWRC biologists and City staff identified the preferred location for the fishing pier
based on more gentle topography in this area of the park as well as the deepest area of water.
The fishing pier will be anchored by a 8'x8'x2' concrete abutment. This abutment and rip rap
stabilization will impact the 5' -wide wetland fringe around the pond. The rip rap on each side of the
abutment will have a maximum width of 6' and the total wetland impacts will be 100 square feet.
The concrete ADA parking spaces will be constructed within an existing gravel parking lot 280' of
sidewalk will be constructed within an existing gravel walking trail. 166' of concrete sidewalk will be
constructed in grass field area of the park.
Equipment used in construction will be excavators, dump trucks, and small tools and equipment owned
by NCWRC Engineering staff. The floating dock will be constructed off -site at a central NCWRC facility
that constructs all docks and delivered to the site for installation.
As requested in USFWS' comments, silt fence during construction is incorporated to the plans on the
downslope side of sidewalk construction. This will prevent sediment from running off into the Pond
during construction.

RESOLUTION 14 -86
SUPPORTING THE NORTH CAROLINA
WILDLIFE RESOURCES COMMISSION (COMMISSION)
OBTAINING PERMITS FOR A PUBLIC FISHING PIER
CONSTRUCTION PROJECT (PROJECT) AT FOX POND PARK (PARK)
WHEREAS, the Council (Council) for the City of Henderson, North Carolina (City) conducted
its Annual Planning Retreat in January 2014 and identified eight Key Strategic Objectives
(KSO) and Goals; and
WHEREAS, this Resolution addresses two KSOs: KSO 7 - To Expand Leisure and Cultural
Services, Programs, and Facilities; and KSO 8 - Provide Financial Resourcing; and
WHEREAS, the Commission offered to construct a fishing pier at the Park for use of the public,
as well adjacent handicapped parking spaces and a walkway compliant with the
Americans with Disabilities Act; and
WHEREAS, the Henderson -Nance Recreation and Parks Commission supports this plan; and
WHEREAS, complete Project fielding will be provided by the Commission.
NOW, THEREFORE BE IT RESOLVED BY THE COUNCIL THAT IT DOES HEREBY
support the Commission obtaining permits necessary for construction associated with the
Project, which will begin once an agreement between the City and the Commission, that
addresses use, ownership, oversight and maintenance costs, is reviewed by the City
Attorney and approved by the City Manager.
Resolution Book 4
Resolution 14 -86, Page 1 of 2

The foregoing Resolution 14 -86 upon motion of Council Member Rainey and second by Council
Member Coffey, and having been submitted to a roll call vote received the following votes and
was APPROVED on this the 10t' day of November 2014: YES: Coffey, Inscoe, Rainey, Peace -
Jenkins, Daeke, Simmons, Daye and Kearney. NO: None. ABSTAIN: None. ABSENT:
None.
ATTEST:
James D. O'Geary, Mayo
Esther J. AcCrackin, City Clerk
Approved to Legal Foam:
0-(--
D. Rix Edwards, City Attorney
Minute Book 43, p 373, CAF14 -119
Resolution Book 4
Resolution 14 -86, Page 2 of 2

E'2 North Carolina Wildlife Resources Commission
Gordon Myers, Executive Director
December 10, 2014
NC DWR, 401 & Buffer Permitting Unit
512 North Salisbury Street
Raleigh, NC 27604
RE PCN for 401 Certification & Buffer Authorization, NCWRC Fox Pond PFA Project, Vance County
Dear Sir or Madam
The North Carolina Wildlife Resources Commission, in partnership with City of Henderson, is
submitting a PCN for a 401 Certification and Tar - Pamlico Buffer Authorization for construction of a
new public fishing pier Fox Pond Public Fishing Area This project will also require an Army Corps
of Engineers NWP 18
Enclosed are 5 copies site plans, PCN applications, and additional location data maps A
proof of electronic transfer fee of $240 is also enclosed
If you need additional information to complete your review, please contact me at
sara sherman(a ncwildlife org or 919 - 707 -0164
SS
Enclosures
Sincerely,
Sara Sherman, Project Engineer
Division of Engineering Services
DIVISION OF ENGINEERING & LANDS MANAGEMENT
Mailing Address: 1720 Mail Service Center • Raleigh, NC 27699 -1720
Office Location: 1751 Varsity Drive • Raleigh, NC -Telephone: [phone] • Fax: [phone]

Dec 2, 2014 9:10:43 AM
OCP AP DOCUMENT PAYMENT GENERAL INFORMATION
NEXT FUNCTION: ACTION: HISTORY:
BROWSE:
PAY ENTITY 17PT VEND /EMP NBR:
VEND /EMP SHORT NAME: D7-1,,'R DOCUMENT NBR:
DOCUMENT DATE : 11/24/2014 PAYMENT NBR:
IND AMOUNT
SALES TAX /VAT
SALES TAX 2
SALES TAX 3
FREIGHT
ADDITIONAL COST
GROSS INVOICE
PAYMENT AMOUNT
AMO- -T N T P l'�= D
240.00
240.00
24J.0�
PAYMENT TERMS NET PAY IMMEDIATELY
PAYMENT DATE 12/01/2014
PAYMENT ROUTE CD
FACTOR NUMBER
REASON CODE /DESC
DPG
12/02/2014 09:10:33
566000372 40
FCXPOND112414
001 PRTL PYMT NBR: 000
VAT INCLUSIVE N
EXPENSE IND
GL EFFECTIVE DATE: 12/01/2014
EXTRACT DATE
ACCRUAL CANC DATE:
CURRENCY CODE
DISCOUNT
TYPE
NOT TAKEN
DISCOUNT
TAKEN
PAYMENT
STATUS
PAID
PAYMENT
REF NBR
0000073645
PAYMENT
TYPE
ELECTRONIC
HANDLING
CODE
ONE INVC
PER PYMT:
YES
BANK ACCT
PYMT CD:
IGO
MN
D [(
Fac1 1 2014

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