20231376 Ver 1_ePCN Application_20230920

DW R
Division of Water Resources
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
October 2, 2023 Ver 4.3
Initial Review
Has this project met the requirements for acceptance in to the review process?
Yes No
Is this project a public transportation project?*
Yes No
Change only If needed.
Pre -Filing Meeting Date Request was submitted on:
9/20/2023
Does this project involve maintenance dredging funded by the Shallow Draft Navigation Channel Dredging and Aquatic Weed Fund or involve the distribution or transmission of energy or
fuel, including natural gas, diesel, petroleum, or electricity?
Yes No
BIMS # Assigned
20231376
Is a payment required for this project?*
No payment required
Fee received
Fee needed - send electronic notification
Select Project Reviewer*
Zachary Thomas:zachary.thomas
Information for Initial Review
la. Name of project:
County Farm Park
1a. Who is the Primary Contact?*
Ashley Bentz
1b. Primary Contact Email: *
[e-mail]
Date Submitted
9/20/2023
Nearest Body of Water
UT - North Flat River
Basin
Neuse
Water Classification
WS-11I;NSW
Site Coordinates
Latitude: Longitude:
36.25897-78.91953
A. Processing Information
Is this project connected with ARPA funding?
Yes No
County (or Counties) where the project is located:
Person
Version#*
1
Reviewing Office*
Raleigh Regional Office - (919) 7914200
1c. Primary Contact Phone: *
[phone]
O
Is this a NCDMS Project
Yes No

Is this project a public transportation project?*
Yes No
1a.Type(s)of approval sought from the Corps:
Section 404 Permit (wetlands, streams and waters, Clean Water Act)
Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
Has this PCN previously been submitted?*
Yes
No
1b. What type(s) of permit(s) do you wish to seek authorization?
Nationwide Permit (NWP)
Regional General Permit (RGP)
Standard (IP)
1c. Has the NWP or GP number been verified by the Corps?
Yes No
Nationwide Permit (NWP) Number: 18 - Minor Discharges
NWP Numbers (for multiple NWPS):
1d. Type(s) of approval sought from the DWR:
401 Water Quality Certification - Regular
Non-404 Jurisdictional General Permit
Individual 401 Water Quality Certification
401 Water Quality Certification - Express
Riparian Buffer Authorization
le. Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification: Yes No
For the record only for Corps Permit: Yes No
1f. Is this an after -the -fact permit application? *
Yes No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
Yes No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
Yes No
1h. Is the project located in any of NC's twenty coastal counties?
Yes No
1j. Is the project located in a designated trout watershed?
Yes No
B. Applicant Information
1d. Who is applying for the permit?
Owner Applicant (other than owner)
le. Is there an Agent/Consultant for this project?
Yes No
2. Owner Information
2a. Name(s) on recorded deed:
Person County
2b. Deed book and page no.:
2c. Contact Person:
Katherine Cathey

2d. Address
Street Address
304 S. Morgan Street
Address Line 2
Room 212
city
Roxboro
Postal / Zip Code
27573
2e. Telephone Number:
[phone]
2g. Email Address:'
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Ashley Bentz
4b. Business Name:
S&ME, Inc.
4c.Address
Street Address
3201 Spring Forest Road
Address Line 2
city
Raleigh
Postal / Zip Code
27616
4d. Telephone Number:
[phone]
4f. Email Address:"
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality / town:
Rougemont
2. Project Identification
2a. Property Identification Number:
0921-03-20-8848
2c. Project Address
Street Address
Moores Mill Road
Address Line 2
city
Rougemont
Postal / Zip Code
27572
3. Surface Waters
3a. Name of the nearest body of water to proposed project:"
UT - North Flat River
3b. Water Resources Classification of nearest receiving water:
WS-III;NSW
3c. What river basin(s) is your project located in?"
Neuse
State / Province / Region
NC
Country
us
2f. Fax Number:
State / Province / Region
NC
Country
us
4e. Fax Number:
2b. Property size:
10.5
State / Province / Region
NC
Country
us
a

3d. Please provide the 12-digit HUC in which the project is located.
030202010104
4. Project Description and History
4a. 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 site is currently undeveloped and forested. There is a very rudimentary farm/logging road present along the route of the proposed access road. General land use in the vicinity of the
project is primarily undeveloped or agricultural with pockets of rural residential areas. The site is bounded to the west by the North Flat River.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?
Yes No Unknown
4f. List the total estimated acreage of all existing wetlands on the property:
0.04
4g. List the total estimated linear feet of all existing streams on the property:
301
4h. Explain the purpose of the proposed project:*
The purpose of the project is to provide access and amenities for a proposed park in Person County. This park will provide hiking, biking, and walking trails as well as a picnic area,
restrooms, parking, stormwater, and related utilities.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:
The overall project will involve construction of an access road, stormwater, parking, restroom facilities, and related utilities for a proposed recreational park in Person County. Construction
will be performed by standard commercial construction equipment. No specialized equipment not regularly seen on commercial projects is anticipated.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
Yes No O Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?
Preliminary Approved Not Verified Unknown N/A
Corps AID Number:
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Walter Cole
Agency/Consultant Company: S&ME, Inc.
Other:
6. Future Project Plans
6a. Is this a phased project?*
Yes No
Are any other NWP(s), regional general permit(s), or individual permits(s) used, or intended to be used, to authorize any part of the proposed project or related activity?
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
Wetlands Streams -tributaries p Buffers
Open Waters Pond Construction
2. Wetland Impacts
U
2a1 Reason (?)
2b. Impact type*(?)
2c. Type of W.
2d. W. name
2e. Forested*
2f. Type of Jurisdicition *
?)
2g. Impact
area
culvert
P
Headwater Forest
W1
Yes
Corps
0.037
(acres)
2g. Total Temporary Wetland Impact
0.000
2g. Total Permanent Wetland Impact
0.037
2g. Total Wetland Impact
0.037

2i. Comments:
Wetland impacts will be the result of the construction of the access road crossing and will total 1,630 sq ft (0.037ac). A 41' reinforced concrete pipe will
be installed to maintain hydrologic connectivity on both sides of the wetland.
3. Stream Impacts
F I
S1
3a. Reason for impact (?)
Road crossing
3b.lmpact type"
Permanent
3c. Type of impact*
Culvert
3d. S. name*
S1
3e. Stream Type*
?)
Intermittent
3f. Type of
Jurisdiction*
Corps
3g. S. width
Average (feet)
3h. Impact
length*
45
(linear feet)
g2
Road crossing
Permanent
Rip Rap Fill
S1
Intermittent
Corps
Average (feet)
24
(linear feet)
31. Total jurisdictional ditch impact in square feet:
0
3L Total permanent stream impacts: 31. Total temporary stream impacts:
69 0
3i. Total stream and ditch impacts:
69
3j. Comments:
Impacts are the result of the installation of a culverted stream crossing of an intermittent stream. Permanent impacts to the stream as a result of the
culvert installation will total 45 LF (522 sq ft) and those from rip rap fill will result in 24 LF (493 sq ft). Impacts as a result of the rip rap fill will not result in
a permanent loss of waters.
6. Buffer Impacts (for DWR)
6a. Project is in which protect basin(s)?
Check all that apply.
Neuse Tar -Pamlico
Catawba Randleman
Goose Creek Jordan Lake
Other
6b. Impact Type
6c. Per or Temp
6d. Stream name
6e. Buffer mitigation required?
6f. Zone 1 impact
6g. Zone 2 impact
Deemed allowable
P
S1
No
2,012
1,310
Deemed allowable
T
S1
No
638
342
6h. Total buffer impacts:
Zone 1 Zone 2
Total Temporary impacts: 638.00 342.00
Zone 1 Zone 2
Total Permanent impacts: 2,012.00 1,310.00
Zone 1 Zone 2
Total combined buffer impacts: 2,650.00 1,652.00
61. Comments:
Riparian buffer impacts are the result of a perpendicular road crossing. Permanent impacts are the result of the road, while temporary impact areas are
located within the temporary construction limits and will be allowed to regrow woody vegetation post construction. Temporary and permanent impacts will
total 4,302 sq ft (0.098 ac). As a perpendicular crossing with less than 0.01 ac of buffer impacts, buffer impacts for this project are considered deemed
allowable.
E. Impact Justification and Mitigation
1. Avoidance and Minimization
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
Originally, plans called for the stormwater control measure to be located within the stream and riparian buffer zone of Area C to minimize grading and
clearing necessary for the park. The stormwater control measure was shifted further into the uplands and has avoided all impacts to that stream and
riparian buffer zone. Appropriate sediment and erosion control practices equaling those outlined in the most recent version of the "North Carolina
Sediment and Erosion Control Planning and Design Manual" will be used to minimize impacts to the jurisdictional features.
a

1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Specific attention will be paid to ensure grading is only performed to the extent needed for the proposed project and all grading not required will be
avoided. Additional impacts to the jurisdictional features will be avoided through the use of appropriate sediment and erosion control devices.
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 this project DOES NOT require Compensatory Mitigation, explain why:
Impact amounts are below those generally requiring mitigation.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
la. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
Yes No
What type of SCM are you providing?
Level Spreader
Vegetated Conveyance (lower SHWT)
Wetland Swale (higher SHWT)
Other SCM that removes minimum 30 % nitrogen
Proposed project will not create concentrated stormwater flow through the buffer
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?
Yes No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?
Yes No
Comments:
The stormwater plan for the project has been approved by Person County and is in compliance with the Falls Lake Watershed ordinance.
G. Supplementary Information
1. Environmental Documentation
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 (North Carolina)
Environmental Policy Act (NEPA/SEPA)?*
Yes No
Comments: *
Site does not meet criteria for needing completion of SEPA/NEPA.
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15A NCAC 2H .0500), Isolated Wetland Rules (15A NCAC 2H .1300), or DWR Surface Water or Wetland Standards or
Riparian Buffer Rules (15A NCAC 2B .0200)? *
Yes No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality? *
Yes No
3b. If you answered "no," provide a short narrative description.
This project is being provided as an amenity for county residents and is not anticipated to results in additional development.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?
Yes No N/A
4b. Describe, in detail, the treatment methods and dispositions (non -discharge or discharge) of wastewater generated from the proposed project. If the wastewater will be treated at a
treatment plant, list the capacity available at that plant.
Septic or composting toilets will be utilized for this project.
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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 habitat?*
Yes No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?"
Yes No
5d. Is another Federal agency involved?"
Yes No
5e. Is this a DOT project located within Division's 1-8?
Yes No
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?
Yes No
5g. Does this project involve bridge maintenance or removal?
Yes No
5h. Does this project involve the construction/installation of a wind turbine(s)?*
Yes No
Unknown
5i. Does this project involve (1) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhammers, mechanized pile drivers, etc.?
Yes No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
The NC Natural Heritage Program online data explorer (https://www.ncnhp.org/data) and US Fish and Wildlife Service Information for Planning and
Consultation (IPaC) report. No critical habitat was identified within the site and no element occurrences of protected species have been observed within
the site. NCNHP identified populations of several federally -protected species in the North Flat River bordering the western side of the site for the park.
The project will perform work within an intermittent tributary of the North Flat River. This intermittent stream does not have sufficient flow to support these
aquatic species. Work will be performed in the dry and appropriate sediment and erosion control measures will be implemented to reduce the potential
for the site to impact protected species.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
Yes No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?
The USFWS IPaC report and the National Marine Fisheries Service Essential Fish Habitat Mapper
(https://www.habitat.noaa.gov/protection/efh/efhmapper/)
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? *
Yes No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?"
The North Carolina State Historic Preservation Office web mapping tool HPOWEB (https://www.ncder.gov/about/history/division-historical-resources/gis-
maps-and-data)
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?"
Yes No
8c. What source(s) did you use to make the floodplain determination?"
The project engineer and the FEMA Firm map 3720092100K effective 12/6/2019.
Miscellaneous
Please use the space below to attach all required documentation or any additional information you feel is helpful for application review. Documents should be combined into one file when
possible, with a Cover Letter, Table of Contents, and a Cover Sheet for each Section preferred.
Click the upload button or drag and drop files here to attach document
Impact Maps.pdf
1.21 MB
Grading Plans.pdf
4.25MB
IPaC Report.pdf
578.55KB
NCNHP Report.pdf
1.54MB
FEMA Firmette.pdf
745.04KB
23-274 Person County Farm Park Buffer Determination 08072023.pdf
1.37MB
Agent Authorization.pdf
25.67KB
Person County Farm Parck PJD Request.pdf
4.37MB
File must be PDF or KMZ
Comments

Signature
0
p By checking the box and signing below, I certify that:
• The project proponent hereby certifies that all information contained herein is true, accurate, and complete to the best of my knowledge and belief'; and
• The project proponent hereby requests that the certifying authority review and take action on this CWA 401 certification request within the applicable reasonable period of time.
• I have given true, accurate, and complete information on this form;
• I agree that submission of this PCN form is a "transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature; AND
• I intend to electronically sign and submit the PCN form.
Full Name:
Ashley Bentz
Signature
(�✓.fl�r, rt�.rtz
Date
9/20/2023