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Corps action ID no
DWQ project no
Form Version 14 January 2009
Page 1 of 10
PCN Form — Version 14 January 2009
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Pre - Construction Notification (PCN) Form
A.
Applicant Information
1.
Processing
1a
Type(s) of approval sought from the Corps
® Section 404 Permit ❑ Section 10 Permit
1b Specify Nationwide Permit (NWP) number 29 or General Permit (GP) number
1c
Has the NWP or GP number been verified by the Corps?
® Yes ❑ No
1d
Type(s) of approval sought from the DWQ (check all that apply)
® 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
❑ Yes No
For the record only for Corps Permit
❑ Yes 10 No
If
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 m 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 protect located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes m No
2.
Project Information
2a
Name of project
Mt Pleasant Road Property
2b
County
Johnston
2c
Nearest municipality / town
Gamer
2d
Subdivision name
Mt Pleasant Road Tract
2e
NCDOT only, T I P or state project no
3.
Owner Information
r' in
3a
Name(s) on Recorded Deed
IOM Developers I I n
3b
Deed Book and Page No
Deed 04474 Page 0278
3c
Responsible Party (for LLC if
applicable)
Freddie Stancd
3d
Street address
ENR . wi cia iww 3t!
446 Stancd Road aot r�
3e
City, state, zip
Angier, NC 27501
3f
Telephone no
919- 639 -2073
3g
Fax no
3h
Email address
Page 1 of 10
PCN Form — Version 14 January 2009
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4.
Applicant Information (if different from owner) '
4a
Applicant is
❑ Agent ❑ Other, specify
4b
Name
4c
Business name
(if applicable)
4d
Street address
4e
City, state, zip
0
Telephone no
4g
Fax no
4h
Email address
5.
Agent/Consultant Information (if applicable)
5a
Name
Wyatt Brown
5b
Business name
(if applicable)
Brown's Environmental Group, Inc
5c
Street address
242 Batten Farm Road
5d
City, state, zip
Selma, NC 27576
5e
Telephone no
919 - 524 -5956
5f
Fax no
5g
Email address
brownenvgrp @gmad corn
Page 2 of 10
B.
Project Information and Prior Project History
1.
Property Identification
1a
Property identification no (tax PIN or parcel ID)
161500 -36 -5613
1b
Site coordinates (in decimal degrees)
Latitude 35,351,677 Longitude -78 043588
1 c
Property size
22 acres
2.
Surface Waters
2a
Name of nearest body of water to proposed project
UT to Bullock Branch
2b
Water Quality Classification of nearest receiving water
C,NSWI
2c
River basin
Neuse
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
Yellow Pine Forest
3b
List the total estimated acreage of all existing wetlands on the property 4
3c
List the total estimated linear feet of all existing streams (intermittent and perennial) on the property 550
3d Explain the purpose of the proposed project
Tract is to be developed as single family residence lots
3e Describe the overall project in detail, including the type of equipment to be used
One crossing will be installed for access to property across the wetland, culvert will be installed in the crossing by trackhoe
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?
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)
Agency /Consultant Company
Other
4d If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation
Wetlands - David Schaffer, COE 1 -22 -15 Stream Buffer Determination - Carlos Bagley, Johnston County 12 -31 -14
5
Project History
5a
Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
El Yes 0 No ❑ Unknown
5b
If yes, explain in detail according to "help file" instructions
6.
Future Project Plans
6a
Is this a phased project?
❑ Yes ® No
6b
If yes, explain
Page 3 of 10
PCN Form — Version 14 January 2009
C. Proposed Impacts Inventory
1 Impacts Summary
la Which sections were completed below for your project (check all that apply)
Z Wetlands ❑ Streams — tributaries ❑ 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
install 56 If of 30 in culv
Choose one
Yes
Corps
0082
W2 U3
Choose one
Choose one
Yes /No
-
W3
Choose one
Choose one
Yes /No
-
W4 - .
Choose one
W
Choose one
Yes/No
-
W5 -
Choose one
Choose one
Yes /No
-
W6
-
Choose one
�
Choose one
Yes /No a
- S
2g Total Wetland Impacts:
0082
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)
3g
Impact
length
(linear
feet)
S1
S2
S3
S4
S5
Choose one
- r
-
S6 I
Choose one
B
- Ell
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
4b
4c
4d
4e
Open water
Name of waterbody
impact number
(if applicable)
Type of impact
Waterbody
Area of impact (acres)
Permanent (P) or
type
Temporary T
01
Choose one
BChoose
02
Choose one
Choose
03 -
Choose one
Choose
L di
04 -
Choose one
EIIChoose
B
4f Total open water impacts
4g Comments
5 Pond or Lake Construction
If pond or lake construction proposed, the complete the chart below
5a
5b
5c
5d
5e
Pond ID number
Proposed use or
Wetland Impacts (acres)
Stream Impacts (feet)
Upland
purpose of pond
(acres)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
P1
Choose one
El
P2
Choose one
El
I
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. 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 Protect is in which protected basin?
0 Neuse ❑ Tar - Pamlico ❑ Catawba ❑ 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
131 -
Yes /No
B2 -
Yes /No
B3 - Ell
Yes /No
B4 - E]
Yes/No
B5 -
Yes/No El
B6 -
Yes /No 3
6h. Total Buffer Impacts:
61 Comments Determined not subject by Carlos Bagley, Johnston County Government
Page 5 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
We are crossing the wetland at the most narrow section to minimize impact
lb Specifically describe measures taken to avoid or minimize the proposed Impacts through construction techniques
Care will be taken to install culvert during dry weather conditions as possible, care taken to avoid trees
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a Does the protect require Compensatory Mitigation for
Impacts to Waters of the U S or Waters of the State?
❑ Yes [0 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
protects
❑ 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
❑ 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 14 January 2009
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a Will the protect result in an impact within a protected riparian buffer that requires
buffer mitigation?
C] Yes 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
15
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 protect include or is it adjacent to protected riparian buffers identified
within one of the NC Riparian Buffer Protection Rules?
❑ Yes No
lb
If yes, then is a diffuse flow plan included? If no, explain why
❑ Yes [] No
2.
Stormwater Management Plan
2a
What is the overall percent imperviousness of this project?
%
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 protect DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan
Stormwater Management Plan is under Johnston County jurisdiction
2e
Who will be responsible for the review of the Stormwater Management Plan?
Certified local government
3
Certified Local Government Stormwater Review
3a
In which local government's jurisdiction is this project?
Johnston County
3b
Which of the following locally - implemented stormwater management programs
apply (check all that apply)
❑ Phase II
❑ NSW
❑ USMP
[] Water Supply Watershed
❑ Other
3c
Has the approved Stormwater Management Plan with proof of approval been
attached?
❑Yes No
4.
DWQ Stormwater Program Review
4a
Which of the following state - implemented stormwater management programs apply
(check all that apply)
❑Coastal counties
❑HQW
❑ORW
❑Session Law 2006 -246
❑Other
4b
Has the approved Stormwater Management Plan with proof of approval been
attached?
❑ Yes ❑ No
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 14 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
❑ 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 ❑ 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 ❑ 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 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 in
E] Yes 0 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
Page 9 of 10
PCN Form — Version 14 January 2009
S. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a WIII this project occur in or near an area with federally protected species or
❑ Yes No
habitat
5b Have you checked with the USFWS concerning Endangered Species Act
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')
Emily Jernigan, Natural Heritage Data Explorer
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
http /www habitat noaa gov /protection /efh /habitatmapper html
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 S 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?
Dept Cultural Resources
8 Flood Zone Designation (Corps Requirement)
8a WIII this project occur in a FEMA - designated 100 -year floodplain?
❑ Yes ® No
8b If yes, explain how project meets FEMA requirements
8c What source(s) did you use to make the floodplain determination?
NC FEMA Maps
Signature
Date
Appflcant/Agent's Printed Name
ppllcant/Agent's
(Agent's signature is valid only if an authorization
letter from the applicant is provided
Page 10 of 10
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