20230048 Ver 1_01 Preliminary ORM Data Entry Fields for New Actions (Old Beatty Ford Road) Hard Copy_20221229

Preliminary ORM Data Entry Fields for New Actions
SAW _ 2022-01822 BEGIN DATE [Received Date]:
Prepare file folder ❑ Assign Action ID Number in ORM ❑
1. Project Name [PCN Form A2a]: Old Beatty Ford Road
2. Work Type: Private ❑ Institutional ❑ Government ❑ Commercial ❑✓
3. Project Description / Purpose [PCN Form B3d and B3e]:
This project is for the construction of a commercial development which will consist of three industrial
buildings with associated infrastructure.
4. Property Owner / Applicant [PCN Form A3 or A41:
Six owners (see property report)/ Jackson Shaw Attn: Mr. Ryan Beadle
5. Agent / Consultant [PCN Form A5 — or ORM Consultant ID Number]: Atlas Environmental, Jennifer Robertson
6. Related Action ID Number(s) [PCN Form B5b]: SAW-2022-01822
7. Project Location - Coordinates, Street Address, and/or Location Description [PCN Form B1b]:
559 Old Beatty Ford Road China Grove, NC 28023
35.5359730 / 80.593881 0
8. Project Location - Tax Parcel ID [PCN Form B1a]: 140 002, 140 003, 140 167, 140 170, 140 169, 140 168, 133A099,
and 140 004
9. Project Location — County [PCN Form A2b]: Rowan
10. Project Location — Nearest Municipality or Town [PCN Form A2c]: China Grove
11. Project Information — Nearest Waterbody [PCN Form B2a]: Cold Water Creek, Class WS-IV, # 13-17-9-4-(0.5)
12. Watershed / 8-Digit Hydrologic Unit Code [PCN Form B2c]: Rocky 03040105
Authorization: Section 10 ❑ Section 404
Regulatory Action Type:
Standard Permit
✓ Nationwide Permit # 39/18
❑ Regional General Permit #
❑ Jurisdictional Determination Request
❑✓ Section 10 & 404 ❑
R
Pre-Application Request
Unauthorized Activity
0 Compliance
❑ No Permit Required
Revised 20150602