20221593 Ver 1_1 Preliminary ORM Data Entry Fields for New Actions_print_20221107

Preliminary ORM Data Entry Fields for New Actions
SAW — 20 22-01527
BEGIN DATE [Received Date]:
Prepare file folder ❑ Assign Action ID Number in ORM ❑
1. Project Name [PCN Form A2a]: Queen Street
2. Work Type: Private ❑ Institutional ❑ Government ❑ Commercial ❑✓
3. Project Description / Purpose [PCN Form 133d and 133e]:
The project is approximately 14.2 acres. The site generally consists of undeveloped land, previous structures were
recently demolished. The project purpose is for the construction of 26 residential town homes and associated
infrastructure.
4. Property Owner / Applicant [PCN Form A3 or A41: Owner: Moorse, Rick; Gaither, Mitch
Applicant: Moore & Son Site Contractors Attn: Mr. Brian Kirk
5. Agent / Consultant [PCN Form AS — or ORM Consultant ID Number]: Atlas Environmental, Jennifer Robertson
6. Related Action ID Number(s) [PCN Form BSb]: SAW-2022-01527
7. Project Location - Coordinates, Street Address, and/or Location Description [PCN Form 131b]:
153 Queen Street Hendersonville, NC 28792
Lat: 35.336787, Long:-82.463309
8. Project Location - Tax Parcel ID [PCN Form 131a]: 9569750342
9. Project Location — County [PCN Form A2b]: Henderson
10. Project Location — Nearest Municipality or Town [PCN Form A2c]: Hendersonville
11. Project Information — Nearest Waterbody [PCN Form 132a]: Mud Creek, Class C, Index #: 6-55
12. Watershed / 8-Digit Hydrologic Unit Code [PCN Form 132c]: Upper French Broad, 06010105
Authorization: Section 10 ❑ Section 404
Regulatory Action Type:
❑Standard Permit
✓ Nationwide Permit # 18
❑ Regional General Permit #
❑ Jurisdictional Determination Request
❑✓ Section 10 & 404 ❑
❑Pre -Application Request
Unauthorized Activity
0 Compliance
❑ No Permit Required
Revised 20150602