HomeMy WebLinkAbout20230964 Ver 1_signedPCN_HawthornSouthernPines_20230706DocuSign Envelope ID: 5D8666DD-0275-4346-92D8-E82A035FF27C
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Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre -Construction Notification PCN Form
A. Applicant Information
1.
Processing
1 a.
Type(s) of approval sought from the
Corps:
®Section 404 Permit El Section 10 Permit
1 b.
Specify Nationwide Permit (NWP) number: 14 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
❑ No
1 g.
Is the project located in any of NC's twenty coastal counties. If yes, answer 1 In
below.
❑ Yes
® No
1 h.
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
® No
2.
Project Information
2a.
Name of project:
Hawthorn at Southern Pines
2b.
County:
Moore
2c.
Nearest municipality / town:
Southern Pines
2d.
Subdivision name:
2e.
NCDOT only, T.I.P. or state
project no:
3.
Owner Information
3a.
Name(s) on Recorded Deed:
Knollwood Partners, LLC
3b.
Deed Book and Page No.
2952 / 233
3c.
Responsible Party (for LLC if
applicable):
3d.
Street address:
1010 Midland Road
3e.
City, state, zip:
Southern Pines, NC 28387
3f.
Telephone no.:
3g.
Fax no.:
3h.
Email address:
Page 1 of 11
PCN Form — Version 1.3 December 10, 2008 Version
DocuSign Envelope ID: 5D8666DD-0275-4346-92D8-E82A035FF27C
4.
Applicant Information (if different from owner)
4a.
Applicant is:
❑ Agent ® Other, specify: Developer
4b.
Name:
Phil Payonk
4c.
Business name
(if applicable):
Hawthorne Residential Partners
4d.
Street address:
806 Green Valley Road
4e.
City, state, zip:
Greensboro, NC 27408
4f.
Telephone no.:
4g.
Fax no.:
4h.
Email address:
ppayonk@hrpliving.com
5.
Agent/Consultant Information (if applicable)
5a.
Name:
Tamp Bandy
5b.
Business name
(if applicable):
Wetlands & Waters, Inc.
5c.
Street address:
4108 LB Propst Drive
5d.
City, state, zip:
Conover, NC
5e.
Telephone no.:
828-302-3437
5f.
Fax no.:
n/a
5g.
Email address:
jtampbandy@wetlands-waters.com
Page 2 of 11
PCN Form — Version 1.3 December 10, 2008 Version
DocuSign Envelope ID: 5D8666DD-0275-4346-92D8-E82A035FF27C
B. Project Information and Prior Project History
1. Property Identification
la. Property identification no. (tax PIN or parcel ID):
858211667500
Latitude:35.19855°N Longitude: -
1 b. Site coordinates (in decimal degrees):
79.37728°W
(DD.DDDDDD) (-DD.DDDDDD)
1c. Property size:
46.79 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
McDeeds Creek
proposed project:
2b. Water Quality Classification of nearest receiving water:
WS-III; HQW
2c. River basin:
33030004 Cape Fear
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:
Site is currently undeveloped. Adjacent properties include commercial and residential uses.
3b. List the total estimated acreage of all existing wetlands on the property:
+/-20 acres within review area
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
+/-2500 If
3d. Explain the purpose of the proposed project:
Construct road for access to currently proposed development.
3e. Describe the overall project in detail, including the type of equipment to be used:
Project includes development of resdential development that requires road access to US Hwy 1. Road location and
design mandated by NCDOT driveway locations. Current construction includes 2 lane road with sidewalk to serve the
current proposed development.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
El Yes El No ®Unknown
project (including all prior phases) in the past?
Comments:
4b. If the Corps made the jurisdictional determination, what type
El Preliminary El Final
of determination was made?
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
❑ Yes ❑ No ® Unknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
Page 3 of 11
PCN Form — Version 1.3 December 10, 2008 Version
DocuSign Envelope ID: 5D8666DD-0275-4346-92D8-E82A035FF27C
6. Future Project Plans
6a. Is this a phased project? ® Yes ❑ No
6b. If yes, explain.
Current authorization request includes impacts associated with construction of two lane road with pedestrian sidewalk to
serve the residential development and provide access to US-1 by the applicant for development of the Hawthorn at
Southern Pines residential project. Road location dictated by Southern Pines planning and NCDOT allowed drivewayway
access to US Hwy 1. Future road expansion from 2 lane with sidewalk to 4 lane with sidewalks and extention to the north
of McDeeds Creek would be required per Southern Pines infrastructure planning if/when future development occurs or
NCDOT builds and expands the current proposed road.
Page 4 of 11
PCN Form — Version 1.3 December 10, 2008 Version
DocuSign Envelope ID: 5D8666DD-0275-4346-92D8-E82A035FF27C
C. Proposed Impacts Inventory
1. Impacts Summary
1 a. 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.
2b.
2c.
2d.
2e.
2f.
Wetland impact
Type of jurisdiction
number —
Type of impact
Type of wetland
Forested
(Corps - 404, 10
Area of impact
Permanent (P) or
(if known)
DWQ — non-404, other)
(acres)
Temporary T
W1 ®P ❑ T
NWP 14 -road fill
Bottomland
Hardwood
® Yes
❑ No
® Corps
® DWQ
0.17
W2 ® P ❑ T
NWP 14 -road fill
Bottomland
Hardwood
® Yes
❑ No
® Corps
® DWQ
0.10
W3 ®P ❑ T
NWP 14 -road fill
Bottomland
Hardwood
® Yes
❑ No
® Corps
® DWQ
0.22
W4 ❑ P ®T
NWP 14 - Temp
Construction
Bottomland
® Yes
® Corps
0.09
Impacts
Hardwood
❑ No
® DWQ
W5 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W6 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
2g. Total wetland impacts
0.58
2h. Comments: 0.49 permanent fill / 0.09 ac temporary construction impacts
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.
3b.
3c.
3d.
3e.
3f.
3g.
Stream impact
Type of impact
Stream name
Perennial
Type of jurisdiction
Average
Impact
number -
(PER) or
(Corps - 404, 10
stream
length
Permanent (P) or
intermittent
DWQ — non-404,
width
(linear
Temporary (T)
(INT)?
other)
(feet)
feet)
S1 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S2 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S3 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S4 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S5 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S6 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
3h. Total stream and tributary impacts
3i. Comments:
Page 5 of 11
PCN Form — Version 1.3 December 10, 2008 Version
DocuSign Envelope ID: 5D8666DD-0275-4346-92D8-E82A035FF27C
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.
4b.
4c.
4d.
4e.
Open water
Name of waterbody
impact number -
(if applicable)
Type of impact
Waterbody type
Area of impact (acres)
Permanent (P) or
Temporary T
01 ❑P❑T
02 ❑P❑T
03 ❑P❑T
04 ❑P❑T
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.
Wetland Impacts (acres)
Stream Impacts (feet)
Upland
Pond ID
Proposed use or purpose
(acres)
number
of pond
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:
5i. Expected pond surface area (acres):
5j. 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.
6c.
6d.
6e.
6f.
6g.
Buffer impact
number -
Reason
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P) or
for
Stream name
mitigation
(square feet)
(square feet)
Temporary T
impact
re uired?
B1 ❑P❑T
❑Yes
❑ No
B2 ❑ P ❑ T
❑ Yes
❑ No
B3 ❑ P ❑ T
❑ Yes
❑ No
6h. Total buffer impacts
6i. Comments:
Page 6 of 11
PCN Form - Version 1.3 December 10, 2008 Version
DocuSign Envelope ID: 5D8666DD-0275-4346-92D8-E82A035FF27C
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Per Southern Pines and NCDOT requirements and standards, impacts are the minimum necessary to achieve the required
road radius, hwy driveway connection, and constructed sidewalks for pedestrian access.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Extensive design efforts with significant additional construction costs are to be employed to minimize impacts through
utilization of retaining walls and slope design grading.
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
Quantity
3c. Comments: contacted Wildands for Credits (Middle Cape Fear UMB - Daniels Creek) No credits available on 6/20/23
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:
❑ warm ❑ cool ❑cold
4d. Buffer mitigation requested (DWQ only):
square feet
4e. Riparian wetland mitigation requested:
1 acres
4f. Non -riparian wetland mitigation requested:
acres
4g. Coastal (tidal) wetland mitigation requested:
acres
4h. Comments: Requesting 0.49 acre wetland loss at 2:1 mitigation
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 7 of 11
PCN Form — Version 1.3 December 10, 2008 Version
DocuSign Envelope ID: 5D8666DD-0275-4346-92D8-E82A035FF27C
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation?
❑ 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
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
DocuSign Envelope ID: 5D8666DD-0275-4346-92D8-E82A035FF27C
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
❑ 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.
❑ Yes ❑ No
Comments:
2.
Stormwater Management Plan
2a.
What is the overall percent imperviousness of this project?
>24% %
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:
Project to be approved by appropriate authority; Utilizing Wet Ponds to achieve water
quality standards
® Certified Local Government
2e.
Who will be responsible for the review of the Stormwater Management Plan?
❑ DWQ Stormwater Program
❑ DWQ 401 Unit
3.
Certified Local Government Stormwater Review
3a.
In which local government's jurisdiction is this project?
Southern Pines
❑ 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):
❑ 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
DocuSign Envelope ID: 5D8666DD-0275-4346-92D8-E82A035FF27C
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1a. Does the project involve an expenditure of public (federal/state/local) funds or the
❑ Yes ® No
use of public (federal/state) land?
1 b. 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)?
1 c. 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 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
❑ Yes ® 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.
Any Potential future development will be subject to same WS-III; HQW stormwater treatment requirements
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.
Residential development will include installation of new gravity sewer in easement to existing pump station located north
and east of McDeeds Creek.
Page 10 of 11
PCN Form — Version 1.3 December 10, 2008 Version
DocuSign Envelope ID: 5D8666DD-0275-4346-92D8-E82A035FF27C
5.
Endangered Species and Designated Critical Habitat (Corps Requirement)
5a.
Will 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?
❑ Raleigh
5c.
If yes, indicate the USFWS Field Office you have contacted.
❑ Asheville
5d.
What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
NC NHP report
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
❑ Yes ® 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?
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? GIS
Philip M.
Payonk
DocuSigned by:
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Ep
7/6/2023
Applicant/Agent's Printed Name
fiGBE-E-F-gS68r•64�F...
Date
Applicant/Agent's Signature
(Agent's signature is valid only if an authorization letter from the applicant
isprovided.)
Page 11 of 11
PCN Form — Version 1.3 December 10, 2008 Version
DocuSign Envelope ID: 5D8666DD-0275-4346-92D8-E82A035FF27C
M
vuarF�9��
O -c
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre -Construction Notification PCN Form
A. Applicant Information
1.
Processing
1 a.
Type(s) of approval sought from the
Corps:
®Section 404 Permit El Section 10 Permit
1 b.
Specify Nationwide Permit (NWP) number: 58 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
® No
1 g.
Is the project located in any of NC's twenty coastal counties. If yes, answer 1 In
below.
❑ Yes
® No
1 h.
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
® No
2.
Project Information
2a.
Name of project:
Hawthorn at Southern Pines - Gravity Sanitary Sewer
2b.
County:
Moore
2c.
Nearest municipality / town:
Southern Pines
2d.
Subdivision name:
2e.
NCDOT only, T.I.P. or state
project no:
3.
Owner Information
3a.
Name(s) on Recorded Deed:
Knollwood Partners, LLC
3b.
Deed Book and Page No.
2952 / 233
3c.
Responsible Party (for LLC if
applicable):
3d.
Street address:
1010 Midland Road
3e.
City, state, zip:
Southern Pines, NC 28387
3f.
Telephone no.:
3g.
Fax no.:
3h.
Email address:
Page 1 of 12
PCN Form — Version 1.3 December 10, 2008 Version
DocuSign Envelope ID: 5D8666DD-0275-4346-92D8-E82A035FF27C
4.
Applicant Information (if different from owner)
4a.
Applicant is:
❑ Agent ® Other, specify: Developer
4b.
Name:
Phil Payonk
4c.
Business name
(if applicable):
Hawthorne Residential Partners
4d.
Street address:
806 Green Valley Road
4e.
City, state, zip:
Greensboro, NC 27408
4f.
Telephone no.:
4g.
Fax no.:
4h.
Email address:
ppayonk@hrpliving.com
5.
Agent/Consultant Information (if applicable)
5a.
Name:
Tamp Bandy
5b.
Business name
(if applicable):
Wetlands & Waters, Inc.
5c.
Street address:
4108 LB Propst Drive
5d.
City, state, zip:
Conover, NC
5e.
Telephone no.:
828-302-3437
5f.
Fax no.:
n/a
5g.
Email address:
jtampbandy@wetlands-waters.com
Page 2 of 12
PCN Form — Version 1.3 December 10, 2008 Version
DocuSign Envelope ID: 5D8666DD-0275-4346-92D8-E82A035FF27C
B. Project Information and Prior Project History
1. Property Identification
la. Property identification no. (tax PIN or parcel ID):
858211667500
Latitude:35.2038629°N Longitude: -
1 b. Site coordinates (in decimal degrees):
79.3753831 °W
(DD.DDDDDD) (-DD.DDDDDD)
1c. Property size:
46.79 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
McDeeds Creek
proposed project:
2b. Water Quality Classification of nearest receiving water:
WS-III; HQW
2c. River basin:
33030004 Cape Fear
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:
Site is currently undeveloped. Adjacent properties include commercial and residential uses.
3b. List the total estimated acreage of all existing wetlands on the property:
+/-20 acres within review area
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
+/-2500 If
3d. Explain the purpose of the proposed project:
Construct gravity sewer line to serve currently proposed residential development. Utility will be sized to accommodate
potential additional capacity as mandated by Southern Pines
3e. Describe the overall project in detail, including the type of equipment to be used:
Install gravity sewer from the proposed development with 20' permanent maintained easement and 20' additional
temporary construction easement. Easement will cross McDeeds Creek with aerial construction on pilings.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
El Yes El No ®Unknown
project (including all prior phases) in the past?
Comments:
4b. If the Corps made the jurisdictional determination, what type
El Preliminary El Final
of determination was made?
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
❑ Yes ❑ No ® Unknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
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6. Future Project Plans
6a. Is this a phased project? ❑ Yes ® No
6b. If yes, explain.
Current authorization request includes impacts associated with construction of a gravity sewer line to serve the proposed
development. This portion of the project to be completed by the current developer. Southern Pines has required the
sewer be sized with additional capacity and constructed in a manor that will allow for a connection to handle additional
potential future development.
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C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
® Wetlands ❑ Streams - tributaries ❑ Buffers
❑ Open Waters ❑ Pond Construction
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2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a.
2b.
2c.
2d.
2e.
2f.
Wetland impact
Type of jurisdiction
number —
Type of impact
Type of wetland
Forested
(Corps - 404, 10
Area of impact
Permanent (P) or
(if known)
DWQ — non-404, other)
(acres)
Temporary T
NWP 58 -gravity
sewer installation
W1 ❑ P ® T
with 20'
Bottomland
® Yes
® Corps
0.49
permanent
Hardwood
❑ No
® DWQ
maintained
easement
NWP 58 -20'
W2 ❑ P ®T
temporary
Bottomland
® Yes
® Corps
0.49
construction
Hardwood
❑ No
® DWQ
easement
W3 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W4 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W5 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W6 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
2g. Total wetland impacts
2h. Comments: 0.49 permanent maintenance easement / 0.49 acre temporary construction easement
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.
3b.
3c.
3d.
3e.
3f.
3g.
Stream impact
Type of impact
Stream name
Perennial
Type of jurisdiction
Average
Impact
number -
(PER) or
(Corps - 404, 10
stream
length
Permanent (P) or
intermittent
DWQ — non-404,
width
(linear
Temporary (T)
(INT)?
other)
(feet)
feet)
S1 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S2 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S3 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S4 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S5 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S6 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
3h. Total stream and tributary impacts
3i. Comments:
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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.
4b.
4c.
4d.
4e.
Open water
Name of waterbody
impact number -
(if applicable)
Type of impact
Waterbody type
Area of impact (acres)
Permanent (P) or
Temporary T
01 ❑P❑T
02 ❑P❑T
03 ❑P❑T
04 ❑P❑T
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.
Wetland Impacts (acres)
Stream Impacts (feet)
Upland
Pond ID
Proposed use or purpose
(acres)
number
of pond
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:
5i. Expected pond surface area (acres):
5j. 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.
6c.
6d.
6e.
6f.
6g.
Buffer impact
number -
Reason
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P) or
for
Stream name
mitigation
(square feet)
(square feet)
Temporary T
impact
re uired?
B1 ❑P❑T
❑Yes
❑ No
B2 ❑ P ❑ T
❑ Yes
❑ No
B3 ❑ P ❑ T
❑ Yes
❑ No
6h. Total buffer impacts
6i. Comments:
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D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Sanitary sewer easement has been located to minimize impacts to jurisdictional wetlands.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Construction will utilize the minimum necessary temporary construction easement, and provide the minimum required
permanent easement allowed by Southern Pines. Pre-existing contours will be re-established. Construction techniques will be
designed and installed in accordance and compliance with NWP 58 and its WQC conditions.
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
El 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 mitigation requested:
linear feet
4c. If using stream mitigation, stream temperature:
❑ warm ❑ cool ❑cold
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.
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6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation?
❑ 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
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:
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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
❑ 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.
❑ Yes ❑ No
Comments:
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: Project to be approved by appropriate
authority
2d.
If this project DOES require a Stormwater Management Plan, then provide a brief, narrative
description of the plan:
Project to be approved by appropriate authority; Utilizing Wet Ponds to achieve water
quality standards
® Certified Local Government
2e.
Who will be responsible for the review of the Stormwater Management Plan?
❑ DWQ Stormwater Program
❑ DWQ 401 Unit
3.
Certified Local Government Stormwater Review
3a.
In which local government's jurisdiction is this project?
Southern Pines
❑ 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):
❑ 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
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F.
Supplementary Information
1.
Environmental Documentation (DWQ Requirement)
1a.
Does the project involve an expenditure of public (federal/state/local) funds or the
❑ Yes
® No
use of public (federal/state) land?
1 b.
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)?
1 c.
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 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
❑ Yes
® 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.
Any Potential future development will be subject to same WS-III; HQW stormwater treatment requirements
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.
replace existing force main sewer utility on site with gravity
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5.
Endangered Species and Designated Critical Habitat (Corps Requirement)
5a.
Will 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?
❑ Raleigh
5c.
If yes, indicate the USFWS Field Office you have contacted.
❑ Asheville
5d.
What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
NC NHP report
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
❑ Yes ® 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?
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? GIS
Philip M.
Payonk
Signed by:
LP��P0�610e
7/6/2023
Printed Name
Date
ApspIart/A ent's Signature
cApplicant/Agent's
(Agent's signature is valid only if an authorization letter from the applicant
isprovided.)
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