20150407 Ver 1_401 Application_20150415

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2 0 1 5 0 4 0 7 Office use Only
Corps action ID no
DWQ protect no
Form Version 1 4 January 2009
V V
Page 1 of 10
PCN Form - Version 1 4 January 2009
Pre - Construction Notification (PCN) Form
A.
Applicant Information
1.
Processing
la
Type(s) of approval sought from the Corps
❑ Section 404 Permit ❑ Section 10 Permit
lb Specify Nationwide Permit (NWP) number 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 ❑ 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 2 No
1 g
Is the protect 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 PNo
2.
Project Information
2a
Name of protect
p��, e 1 /-/,0/7 s ve
2b
County
2c
Nearest municipality 1 town
Mail ksct
2d
Subdivision name
�-
2e
NCDOT only, T I P or state project no
APR 2
3.
Owner Information
3a
Name(s) on Recorded Deed
1 C C r- C 401 a • WATER RESO I
3b
Deed Book and Page No
I f 3 (� 3 L MIT nNG !
3c
Responsible Party (for LLC if
applicable)
3d
Street address
jf
3e
City, state, zip
S L irl) "7
3f
Telephone no
3g
Fax no
3h
Email address
V V
Page 1 of 10
PCN Form - Version 1 4 January 2009

4
Applicant Information (if different from owner)
4a
Applicant is
❑ Agent
®.Other, specify
�U e
4b
Name
4c
Business name
(if applicable)
/
�r /Vsi 1 J� r� d t
/ / /r /
CGa/L. 1 A i- /0 fie-
4d
Street address
-(qua,- e,
4e
City, state, zip
/-?j V
/Q Al L
4f
Telephone no
'4g
Fax no
7dq —
% 91- % 3
4h
Email address
I S wel-3
JA i_ t�
n 1 '
5.
Agent/Consultant Information (if applicable)
5a
Name
5b
Business name
(if applicable)
5c
Street address
5d
City, state, zip
5e
Telephone no
5f
Fax no
5g
Email address
Page 2 of 10

B.
Project Information and Prior Project History
1.;
',Property Identification
1a
- _
Property identification no (tax PIN or parcel ID)
000 eO
y�aSS qo�q - 1 U? • 3r0�
1b
Site coordinates (in decimal degrees)
Latitude N 35 3 j L1, /a fy /Longitude W �r ,S-,r- y j 0 (p
1c
Property size �p1s �� N re
acres k///9
2. ;Surface Waters
2a
Name of nearest body of water to proposed protect
21b
Water Quality Classification of nearest receiving water
C 7/2 W S _ L37
2c
River basin
L'
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
'to 1 &0-f 00u rs e- // �J` ,-,-etL an r� S u rr punlh l 9 a r -u- d "OPI 64ke
'f o M p TrePS , TA sA a e -f rdo, p1t; e1 /VD //ONJ" ® r4l, -i 7-v9 /6,W-
3b
List the total estimated acreage of all existing wetlands on the property
3c
List the total estimated linear feet of all existing streams (intermittent and perennial) on the property 41119
3d
Explain the purpose of the proposed project ?V -p��ve f rt�1 �� a ��� iv St/n �•5 �l f
TVr grQPn (jn� �(([rrOrrn!/� /n9 alPly
3e
Describe the overall project in detail, including the type of equipment to be used rpm d✓ erp,�s a ,�
raplu� w, - /A- Smalle,- Ara-is. W11/ use cha, ` -111N/1 1'P111d ✓2 A/0
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 [j, =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
5.
Project History
5a
Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
❑ Yes B` O ❑ unknown
5b
If yes, explain in detail according to 'help file" instructions
6.
Future Project Plans
6a
Is this a phased project?
❑ Yes o
6b
If yes, explain
Page 3 of 10
PCN Form - Version 1 4 January 2009
M

C. Proposed Impacts Inventory
1. Impacts Summary
la Which sections were completed below for your project (check all that apply)
❑ 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
Choose one
Choose one
Yes /No
W2
Choose one
Choose one
Yes /No
W3
Choose one
Choose one
Yes /No
W4
Choose one
Choose one
Yes /No
W5
Choose one
Choose one
Yes /No
W6
Choose one
Choose one
Yes /No
2g Total Wetland Impacts:
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
Choose one
S2
Choose one
S3
Choose one
S4
Choose one
S5
Choose one
S6
Choose one
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 indivii ually list all open water impacts below
4a
Open water
impact number
Permanent (P) or
Temporary T
4b
Name of waterbody
(if applicable)
4c
Type of impact
4d
Waterbody
type
4e
Area of impact (acres)
01
Choose one
Choose
02
Choose one
Choose
03
Choose one
Choose
04
Choose one
Choose
4f Total open water impacts
4g Comments
5. Pond or Lake Construction
If pond or lake construction proposed, the complete the chart below
5a
Pond ID number
5b
Proposed use or
purpose of pond
5c
Wetland Impacts (acres)
5d
Stream Impacts (feet)
5e
Upland
(acres)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
P1
Choose one
P2
Choose one
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)
5t Size of pond watershed (acres)
5k Method of construction
6. Buffer Impacts (for DWQ)
If protect 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?
❑ Neuse ❑ Tar - Pamlico EErtatawba ❑ Randleman ❑ Other
6b
Buffer Impact
number —
Permanent (P) or
Temporary T
6c
Reason for impact
6d
Stream name
6e
Buffer
mitigation
required?
6f
Zone 1
impact
(square
feet )
6g
Zone 2
impact;
(square,
feet
B1
% P e 1- BPS
b
6DNo
1 u v o
B2
Yes /No
B3
Yes /No
B4
Yes /No
B5
Yes /No
B6
Yes /No
6h Total Buffer Impacts:
61 Comments ''1 replan I- smd1filr - 5A1"kb1 1`a P/KPQ 0-/ f /"S
Page 5 of 10

D.
Impact Justification and Mitigation
1.
Avoidance and Minimization
1a
Specifically describe measures take //n to avoid or minimize the ptropo�s�ed impacts in designing project
W el J � d n �y C n it s e w -S .► �D it44V /_ 2 d/I e
�,
1 b
Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
1vv ��Jti� /a rj, e eqaJ�� � f �v 6u 7�J�v� zale
2.
Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a
Does the project 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'?
❑ 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 1 4 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
+. 'es E] 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
m
rBC � Z �P'0
S
J� v v v
3 (2 for Catawba)
Zone 2
1 5
6f Total buffer mitigation required:
a, J U
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)
W rep %Pe WP �/L a119'A ia vreL Na
6h Comments rerloee iv j` Ik var it a4 �r d,'✓&- rla, /I W.' 11 pla-, �
//•
re i Q rrn S. / t w @d,-,v �%�rt t° 1 hl reA& A
w: r'�u�c a C'dr+l•'.1�irt•�d., o e- p /a.4, /J
Page 7 of 10
V ✓J411 .

E.
Stormwater Management and Diffuse Flow Plan (required by DWQ)
1.
Diffuse Flow Plan
1 a
Does the project include or is it adjacent to protected riparian buffers identified
[B'Yes ❑ No
within one of the NC Riparian Buffer Protection Rules?
1 b
If yes, then is a diffuse flow plan included? If no, explain why
f PYnOV t'�j i� ?Q� replue,`�� w %�� oilu- plans
❑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 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?
3.
Certified Local Government Stormwater Review
3a
In which local government's jurisdiction is this project?
❑ Phase II
❑ NSW
3b
Which of the following locally - implemented stormwater management programs
❑ USMP
apply (check all that apply)
❑ Water Supply Watershed
❑ Other
3c
Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
4.
DWQ Stormwater Program Review
❑Coastal counties
❑HQW
4a
Which of the following state - implemented stormwater management programs apply
❑ORW
(check all that apply)
E] Session Law 2006 -246
❑ Other
4b
Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
5.
DWQ 401 Unit Stormwater Review
5a
Does the Stormwater Management Plan meet the appropriate requirements?
❑ Yes ❑ No
51b
Have all of the 401 Unit submittal requirements been met?
❑ Yes ❑ No
Page 8 of 10
PCN Form — Version 1 4 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,
E] Yes
©'No
or Riparian Buffer Rules (15A NCAC 2B 0200)?
2b
Is this an after - the -fact permit application?
❑ Yes
i
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 protect (based on past and reasonably anticipated future impacts) result in
El Yes
Leo
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
Tk,s W" /1 0', IV kle- 1p wiA Wa> %f 9aet �, Will, or&-j s
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b(A ;Ifr 4- Pli rl',a� oil 6'4LI
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 1 4 January 2009

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
-
5d What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
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?
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
North Carolina history and archaeology)?
❑ Yes ❑ No
7b What data sources did you use to determine whether your site would impact historic or archeological resources?
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?
�CCmPl -S �W2/'s
Applicant/Agent's Printed Name
y��l11"
Date
Applicant/Agjent's Signature
`(Agent's signature is valid only if an authorization
letter from the applicant is provided
Page 10 of 10

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13 greens complex showing trees and severe
damagy ausing shade issues.
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Eastern tip to southwestern corner of hole
14 greens complex.

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Approximate location of trees at 14 complex needed
for summer /winter shade relief.
C?oo(je earth
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Approximate location of trees at 14 complex needed
for summer /winter shade relief.
C?oo(je earth

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Removal of the marked trees would afford us
the most shade relief in both summer and
winter.

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Trees on east side of•hole 14 greens complex
causing similar issues.
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