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HomeMy WebLinkAbout20150208 Ver 1_401 Application_20150215C1earWater Environmental Consultants, Inc. www.cwenv.com February 18, 2015 Mr David Brown US Army Corps of Engineers Asheville Regulatory Field Office 151 Patton Avenue, Room 208 Asheville, North Carolina 28801 -2638 Ms Karen Higgins NC DWR, 401 & Buffer Permitting Unit 512 N Salisbury Street, 9s' Floor Raleigh, NC 27604 RE: Camp Watia ( +/ -252 Acres) Swain County, North Carolina Dear Mr. Brown and Ms. Higgins, 2 0 1 5 0 2 0 8 RM The attached Pre- Construction Notification (PCN) is being submitted on behalf of Water Creek Farms, LLC represented by Mr David Nolletti The project site is located off Watia Road near Almond, Swam County, North Carolina Water Creek Farms, LLC is seeking a Nationwide Permit 39 for the development of a recreational youth camp with associated infrastructure Also attached is our request for a Jurisdictional Determination A copy of this package has been sent to Ms Andrea Leslie of the NC Wildlife Resources Commission and Mr Bryan Tompkins of the US Fish and Wildlife Service for review. A courtesy copy of this application has also been submitted to Mr Tun Fox of the NC Division of Water Resources, Asheville Regional Office Please do not hesitate to contact me at 828 - 698 -9800 if you have any questions or comments Respectfully, -�Ls- Kevin Mitchell Biologist Copy Furnished NC Division of Water Resources, Asheville — Tim Fox NC Wildlife Resources Commission — Adrea Leslie US Fish and Wildlife Service — Bryan Tomplans 224 South Grove Street, Suite F Hendersonville, NC 28792 828 - 698 -9800 Tel 828 - 698 -9003 Fax R C ement CAdle, Principal Corps Submittal Cover Sheet Please provide the following info 1. Project Name: Camp Watia 2. Name of Property Owner /Applicant: Water Creek Farms, LLC 3. Name of Consultant/Agent- ClearWater Environmental Consultants, Inc. *Agent authorization needs to be attached. 4. Related/previous Action ID numbers(s)• none 5. Site Address. 5030 Watia Road 6. Subdivision Name- N/A 7 City: Almond 8. County- Swain 9. Lat• 35.345286N Long. - 83.600630W (Decimal Degrees Please 10 Quadrangle Name: Wesser 11. Waterway. Townhouse Branch 12. Watershed. Little Tennessee 06010202 13. Requested Action: X Nationwide Permit # 39 _ General Permit # X Jurisdictional Determination Request Pre - Application Request The following information will be completed by the Corps office. AID: Prepare File Folder Assign number in ORM Begin Date Authorization- Section 10 Section 404 Project Description/Nature of Activity/Project Purpose Site/Waters Name: Keywords: 1 711 M I �' � 11�M 11 Department of the Army NCDENR Wilmington District, Corps of Engineers NC MR, Webscape Unit Attn: Scott McLendon, Chief Regulatory Division Attn: Karen Higgins PO Box 1890 512 North Salisbury Street Wilmington, NC 28402 -1890 Raleigh, North Carolina 27604 I, the current landowner /managing partner of the property identified below, hereby authorize C1earWater Environmental Consultants, Inc. (CEQ to act on my behalf as my agent during the processing of jurisdictional determination requests and permits to impact Wetlands and Water of the US subject to Federal ,jurisdiction under Section 404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of 1899. CEC is authorized to provide supplemental information as needed at the request of the USAGE or DWR. Additionally, I authorize representatives of the Wilmington District, US Army Corps of Engineers to enter upon the property herein described for the purposes of conducting on- site investigations and issuing a determination associated with Wetlands and Waters of the US subject to Federal jurisdiction under Section 404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of 1899. Property Owner of Record: UATIn &VM. V'tRW L — Property Owner of Address: Q rad �'-,� LkVJ L4 Ootev- Kr' e South Grove Street, Suite F endersonville, NC 28792 'Phone 828 -698 -9800 www.cwenv.com Proof of Ownership Detailed Property Card Parcel Information Parcel Number. 662100753434 Subdivision, Lot Number Legal Description: 869.891 Approximate Acres. 869 891 Owner Information Name. WATIA CREEK FARMS LLC Mailing Address 2 TOWN SQUARE BLVD STE 310 ASHEVILLE, NC 28803 -0000 Srtus/Pbysieal Address 5030 WATIA RD Value Information Land Value $3,025,250.00 Building Value $199,740.00 Out Budding Value: $32,780.00 Total Assessed Value: $3,257,770.00 Deed Information 09/09/1999, $0.00, DEWITT DENNIS 3 1/2 INT., 228 1 02/12/2004, $3,500,000.00, WATIA CREEK LIMITED PARTNERSHIP, 286 943 Friday, January 30, 2015 Deed Reference 02/01/2004, $3,500,000.00, 00286 0943 02/01/2004, $3,500,000.00, 00286 0943 09/01/1999, $0.00, 00228 0001 09/01/1999, $0.00, 00228 0001 This website is updated every 90 days and offers the most up to date information at the time of publication Please contact the Swain County GIS department or Tax Office for the most current parcel ownership data Detailed Property Card Parcel Information Parcel Number 662100753434 Subdivision: Lot Number Legal Description 869.891 Approximate Acres 869.891 Owner lnformation Name- WATIA CREEK FARMS LLC Mailing Address- 2 TOWN SQUARE BLVD STE 310 ASHEVILLE, NC 28803 -0000 Sdus/Pbysical Address 5030 WATIA RD Value information Land Value $3,025,250 00 Building Value: $199,740.00 Out Budding Value. $32,780.00 Total Assessed Value: $3,257,770.00 Deed Information 09/09/1999, $0.00, DEWITT DENNIS 1 1/2 INT., 228 1 02/12/2004, $3,500,000 00, WATIA CREEK LIMITED PARTNERSHIP, 286 943 Friday, January 30, 2015 Deed Reference 02/01/2004,$3,500,000.00,00286 0943 02/01/2004, $3,500,000.00, 00286 0943 09/0111999, $0.00, 00228 0001 09/01/1999,$0.00,00228 0001 This website is updated every 90 days and offers the most up to date information at the time of publication Please contact the Swain County GIS department or Tax Office for the most current parcel ownership data. O�0 W A r�c9QG h r Office Use Only Corps action ID no DWQ project no Form Version 1 3 Dec 10 2008 Page 1 of 11 PCN Form — Version 1 3 December 10, 2008 Version Pre - Construction Notification (PC Form A. Applicant Information 1. Processing is Type(s) of approval sought from the Corps ® Section 404 Permit ❑ Section 10 Permit lb Specify Nationwide Permit (NWP) number 39 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- 0 Yes ® 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 ® No 1g 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 Camp Watia 2b County. Swain 2c Nearest municipality / town Almond 2d Subdivision name. N/A 2e NCDOT only, T.I P or state project no N/A 3. 3a Owner Information Name(s) on Recorded Deed Water Creek Farms, LLC 3b Deed Book and Page No 00286/0943 3c Responsible Party (for LLC if applicable): Attn. David A. Nolletti , FEB 2 0 9 3d Street address- Two Town Square, Suite 310 j 3e City, state, zip Asheville, NC 28803 o+; 3f Telephone no 3g Fax no: 3h Email address Page 1 of 11 PCN Form — Version 1 3 December 10, 2008 Version 4. Applicant Information (if different from owner) 4a Applicant is ❑ Agent ❑ Other, specify. 4b Name 4c Business name 4d. Street address 4e City, state, zip 4f Telephone no 4g Fax no. 4h Email address 5. Agent/Consultant Information (if applicable) 5a Name R Clement Riddle 5b. Business name ClearWater Environmental Consultants, Inc (if applicable) 5c Street address 224 South Grove Street, Suite F 5d City, state, zip Hendersonville, North Carolina 28792 5e. Telephone no 828 -698 -9800 5f Fax no n/a 59 Email address clement @cwenv com Page 2 of 11 PCN Form — Version 1 3 December 10, 2008 Version B. Project Information and Prior Project History I. Property Identification 1a Property identification no (tax PIN or parcel ID) 662100753434 lb Site coordinates (in decimal degrees) Latitude 35 345286 Longitude. - 83.600630 (DD DDDDDD) ( -DD DDDDDD) 1c Property size Parcel is approximately 870 acres Project area is 252 acres 2. Surface Waters 2a Name of nearest body of water (stream, river, etc ) to Townhouse Branch & Unnamed Tributaries to proposed project: Townhouse Branch 2b. Water Quality Classification of nearest receiving water C 2c River basin- Little Tennessee 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 - The project site contains several out buildings and a residential home Existing conditions on site include maintained agriculture fields, a pond located at the eastern edge the of property, and forested areas Land use in the vicinity includes agricultural, residential, and forests 3b List the total estimated acreage of all existing wetlands on the property Approximately 2 43 acres within the delineated boundary 3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property Approximately 13,570 linear feet within the delineated boundary. 44 C-1- .. u.- -e . - --,- u 1 NulPuSa ul uie prvposea project The purpose of the proposed project is to develop an affordable residential youth camp for the YMCA 3e. Describe the overall project in detail, Including the type of equipment to be used The project will consist of low density residential cabins, administration and parking areas, and associated infrastructure The youth camp would be constructed using typical construction and earth moving equipment The proposed project will include the construction of a wastewater treatment facility and the installation of a new sewer and water line The installation of the sewer and water lines will be a temporary impact The lines will be trenched In and stream contours will be returned to preexisting conditions The project will also include the construction of a 1,800 square foot dock. 4. Jurisdictional Determinations 4a Have jurisdictional wetland or stream determinations by the Corps or State been requested or obtained for this property / project`(mcludmg 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? Agency /Consultant Company Name (if known) Other 4d If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation 5. Project History 5a Have permits or certifications been requested or obtained for this project (including all prior phases) in the past? Yes ® No ❑ Unknown 5b If yes, explain in detail according to "help file" instructions Page 3 of 11 PCN Form — Version 1 3 December 10, 2008 Version 6. Future Project Plans 6a. Is this a phased project? ❑ Yes ® No 6b If yes, explain — C Proposed Impacts Inventory 1 Impacts Summary 1a Which sections were completed below for your project (check all that apply) ® Wetlands ® Streams - tributaries ❑ Buffers ® Open Waters ❑ Pond Construction Page 4 of 11 PCN Form – Version 1 3 December 10, 2008 Version Page 5 of 11 PCN Form — Version 1 3 December 10, 20 08 Version 2 Wetland Impacts If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted 2a Wetland impact 2b 2c 2d 2e 2f number — Permanent (P) or Type of impact Type of wetland Forested Type of jurisdiction (Corps - 404, 10 Area of impact Tern ora T (if known) DWQ — non -404, other) (acres) W1 ®P ❑ T Impact Site #1 ❑ Yes ® Corps Fill ❑ No ® DWQ 0 004 ® Corps W2 ®P ❑ T Impact Site #2 ❑ Yes Fill ❑ No ® DWQ 002 W3 ❑ P ❑ T ❑ Yes ❑ Corps ❑ No ❑ DWQ ❑ Corps W4 ❑ P ❑ T ❑ Yes ❑ No ❑ DWQ ❑ Corps W5 ❑ P ❑ T ❑ Yes ❑ No ❑ DWQ ❑ Corps W6 ❑ P ❑ T ❑ Yes ❑ No ❑DWQ 2g. Total wetland impacts 0 024 2h Comments 3. Stream Impacts If there are perennial or intermittent stream question for all stream sites impacted impacts (including temporary 3c Stream name impacts) 3d. Perennial proposed on the site, then complete 3e. Type of jurisdiction this g mpact 3a Stream impact number - 3b. Type of impact Permanent (P) or (PER) or 7Average (Corps - 404, 10 ngth Temporary (T) intermittent (INT)? DWQ — non -404, near S1 ®P ❑ T Impact Site #1 UT Townhouse ® PER other) (eet) ® Corps eet) Fill Branch UT Townhouse ❑ INT ® PER ® DWQ ® Corps 65 S3 ®P ❑ T Impact Site #3 Culvert Branch INT ®DWQ UT Townhouse ® PER ® Corps 20 S4 ®P ❑ T Impact Site #4 Culvert Branch ❑ INT ® DWQ UT Townhouse ® PER ® Corps 32 S5 ®P [:IT Impact Site #5 Culvert Branch ❑ INT ® DWQ Townhouse ® PER ® Corps 26 S6 ®P ❑ T Impact Site #6 Culvert Branch ❑ INT ® DWQ UT Townhouse ® PER ® Corps 1 Impact Site #7 Utility Crossing Branch ❑ INT ® DWQ UT Townhouse ® PER ® Corps 20 Impact Site #8 Utility Crossing Branch ❑ INT ® DWQ Townhouse ® PER ® Corps 70 Impact Site #9 ffComments Utility Crossing Branch ❑ INT ® DWQ 20 Impact Site #10 After Fact Culvert Townhouse ®PER ®Corps Replacement Branch ❑ INT ®pWQ 0 nd tributary impacts 254 Page 5 of 11 PCN Form — Version 1 3 December 10, 20 08 Version Page 6 of 11 PCN Form — Version 1 3 December 10, 2008 Version 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 individually list all open water impacts below 4a Open water 4b Name of waterbody 4c 4d. 4e impact number — Permanent (P) or (if applicable) Type of impact Waterbody type Area of impact (acres) Temporary T 01 ®P ❑ T Footers For Dock Pier Lake 0.001 02 ❑P ❑T 03 ❑P [IT 04 ❑P [IT 4f. Total open water impacts 0 001 4g Comments 5. Pond or Lake Construction If pond or lake construction proposed, then complete the chart below 5a 5b. 5c 5d 5e Pond ID Proposed use or purpose Wetland Impacts (acres) Stream Impacts (feet) Upland number of pond (acres) Flooded Filled Excavated Flooded Filled Excavated Flooded P1 P2 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. ❑ Neuse ❑ Tar - Pamlico ❑ Other Project is in which protected basin? ❑ Catawba ❑ Randleman 6b Buffer impact 6c 6d 6e. 6f 6g, number — Permanent (P) or Reason for Stream name Buffer mitigation Zone 1 impact (square feet) Zone 2 impact (square feet) Temporary T im act required? 131 ❑P ❑T El Yes ❑ No B2 ❑P ❑T El Yes ----F ❑ No B3 ❑P ❑T El Yes ❑ No 6h Total buffer impacts 61 Comments• Page 6 of 11 PCN Form — Version 1 3 December 10, 2008 Version D. Impact Justification and Mitigation 1. Avoidance and Minimization 1a Specifically describe measures taken to avoid or minimize the proposed impacts in designing project Stream and wetland impacts were avoided to the maximum extent practicable Stream crossings were designed to utilize existing culverts and to be installed perpendicular to the stream flow Rock will be placed in the channel for stabilization at the utility line crossings, however, the finished top elevation of the nprap will not exceed that of the original stream bed Stream impacts are limited to the amount necessary to install the lines 1 b Specifically describe measures taken to avoid or minimize the proposed impacts through construcbon techniques Construction equipment will be operated from high ground during construction. Silt fencing will be installed along the entire length of the streams and wetlands The installation of the proposed utility line crossings should take less than one day to install 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 ® 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? El 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 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 mibgabon requested linear feet 4c If using stream mitigation, stream temperature ❑ warm ❑ cool ❑cold 4d Buffer mibgabon 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 descnpbon of the proposed mitigation plan Page 7 of 11 PCN Form — Version 1 3 December 10, 2008 Version 6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWO 6a. Will the project result in an impact within a protected riparian buffer that requires ❑ Yes ❑ No buffer mitigation? 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 6c 6d 6e. Zone Reason for impact Total impact Multiplier Required mitigation (square feet) (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 8 of 11 PCN Form — Version 1 3 December 10, 2008 Version Page 9 of 11 PCN Form — Version 1 3 December 10, 2008 Version E. Stormwater Management and Diffuse Flow Plan (required by DWQ) 1. Diffuse Flow Plan 1a Does the project include or is it adjacent to protected riparian buffers itq[] within one of the NC Riparian Buffer Protection Rules? Yes ® No 1b If yes, then is a diffuse flow plan included? If no, explain why Comments Yes ® No 2. Stormwater Management Plan 2a What is the overall percent imperviousness of this project'? <1 % 2b Does this project require a Stormwater Management Plan? ❑ Yes ® No 2c If this project DOES NOT require a Stormwater Management Plan, explain why Less than 1 % impervious surface area will be added as a result of this project 2d If this project 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? 9 Certified ❑ Certified Local Government Stormwater Program ® DWQ 401 Unit 3. Certified Local Government Stormwater Review 3a In which local government's jurisdiction is this project? ❑ Phase II 3b Which of the following locally - implemented stormwater management programs ❑ NSW apply (check all that apply), ❑ USMP ❑ Water Supply Watershed ❑ Other 3c Has the approved Stormwater Management Plan with proof of approval been ❑ Yes ❑ No attached? mwater Program Review FWhich ❑ Coastal counties the following state - i mplemented stormwater management programs apply ❑ HQW El ORW (check all that apply)* ❑ 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 9 of 11 PCN Form — Version 1 3 December 10, 2008 Version F. Supplementary Information 1. Environmental Documentation (DWQ Requirement) la Does the project involve an expenditure of public (federal /state/local) funds or the use of public (federal/state) land? ❑ Yes ® No 1b 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 letter ) ❑ Yes ❑ No Comments 2. Violations (DWQ Requirement) 2a Is the site in violation of DWQ Wetland Rules (15A NCAC 2H 0500), Isolated Wetland Rules (15A NCAC 21-1.1300), DWQ Surface Water or Wetland Standards, ❑ Yes ® No or Riparian Buffer Rules (15A NCAC 213 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 violabon(s) 3. Cumulative Impacts (DWQ Requirement) 3a Will this project (based on past and reasonably anticipated future impacts) result in additional development, which could impact nearby downstream water quality? ❑Yes ® No 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 descnpbon 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 A wastewater treatment plant is being proposed to treat all wastewater generated from the site Page 10 of 11 PCN Form — Version 1 3 December 10, 2008 Version 5. Endangered Species and Designated Critical Habitat (Corps Requirement) 5a. Will this project occur in or near an area with federally protected species or habitat? ❑ Yes ® No 5b. Have you checked with the USFWS concerning Endangered Species Act impacts'? ❑ Yes ® No 5c If yes, indicate the USFWS Field Office you have contacted ❑ Raleigh ❑ Asheville 5d What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat? FWS county data and Natural Heritage Program GIS data 6. Essential Fish Habitat (Corps Requirement) 6a Will this project occur in or near an area designated as essential fish habitats ❑Yes ® No 6b What data sources did you use to determine whether your site would impact Essential Fish Habitat? South Atlantic Habitat and Ecosystem IMS Impact will not occur in a marine system. 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 status (e g , National Historic Trust designation or properties significant in El Yes No North Carolina history and archaeology)? 7b What data sources did you use to determine whether your site would impact historic or archeological resources? National Register of Historic Places records maintained by the NC State Historic Preservation Office (SHPO) and available on SHPO's HPOWEB GIS service There is a boxed house and log barn (HPO Site ID SW0037) 2 0 miles south of the proposed camp It is the opinion of CEC, that the proposed activity is not likely to threaten the integrity of this site 8. Flood Zone Designation (Corps Requirement) 8a Will 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? FEMA Map Service Center, 3700662100J, Effective Date February 18, 2009 - i.. C\ e Mc�t ou to �' 2 -17-6- Applicant/Agent s Printed Name pplicant/A ant's Signature Date (Agent's signature is valid only if an authorization letter from the applicant Is rovided Page I 1 of 11 PCN Form — Version 1 3 December 10, 2008 Version