20221717 Ver 1_01 Preliminary ORM Data Entry Fields for New ActionsPrint_20221202

Preliminary ORM Data Entry Fields for New Actions
SAW — 201 - BEGIN DATE [Received Date]:
Prepare file folder ❑ Assign Action ID Number in ORM ❑
1. Project Name [PCN Form A2a]: Tuckaseegee Road Carolinas Properties
2. Work Type: Private ❑ Institutional ❑ Government ❑ Commercial ❑✓
3. Project Description / Purpose [PCN Form 133d and 133e]:
The project is approximately 2.43 acres. The Northern region of the review area lies along Tuckaseegee Road and consists of a
residential home with a maintained yard. The Southern region of the review area is forested and includes the observed wetland
feature. The project purpose is for the construction of a residential development and associated infrastructure.
4. Property Owner / Applicant [PCN Form A3 or A41: Owner: Carolinas Properties LLC
Applicant: Carolinas Properties LLC Attn: Mukesh Guntaka
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-2022-01910
7. Project Location - Coordinates, Street Address, and/or Location Description [PCN Form 131b]:
14520 Beatties Ford Road Huntersville, NC 28078
35.4120730/-80.9249830
8. Project Location - Tax Parcel ID [PCN Form 131a]: 061241 10
9. Project Location — County [PCN Form A2b]: Mecklenburg
10. Project Location — Nearest Municipality or Town [PCN Form A2c]: Charlotte
11. Project Information — Nearest Waterbody [PCN Form 132a]: Taggart Creek, Class: C, Index #: 11-137-2
12. Watershed / 8-Digit Hydrologic Unit Code [PCN Form 132c]: Lower Catawba 03050103
Authorization: Section 10 ❑ Section 404
Regulatory Action Type:
Standard Permit
✓ Nationwide Permit # 29 and 58
❑ Regional General Permit #
❑ Jurisdictional Determination Request
❑✓ Section 10 & 404 ❑
❑Pre -Application Request
Unauthorized Activity
0 Compliance
❑ No Permit Required
Revised 20150602