20240213 Ver 1_ePCN Application_20240131

i DWR
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.
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
Version# *
20240213
1
Is a payment required for this project?*
No payment required
Fee received
Reviewing Office*
Fee needed - send electronic notification
Fayetteville Regional Office - [phone]
Select Project Reviewer*
Chad Turlington:chad.turlington
Information for Initial Review
la. Name of project:
COURTESY COPY 1185 Longleaf Drive
1a. Who is the Primary Contact?*
Samuel Adam Carter
1b. Primary Contact Email: * 1c. Primary Contact Phone:*
[e-mail] [phone]
Date Submitted
1/31/2024
Nearest Body of Water
Joes Fork
Basin
Cape Fear
Water Classification
WS-III
Site Coordinates
Latitude: Longitude:
35.220298-79.458796
A. Processing Information O
Is this project connected with ARPA funding?
Yes No
County (or Counties) where the project is located:
Moore
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:
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
29 - Residential Developments
le. Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification:
For the record only for Corps Permit:
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
fig. 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
401 Water Quality Certification - Express
Riparian Buffer Authorization
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:
FAC HOLDINGS, LLC
2b. Deed book and page no.:
6021 / 394
2c. Contact Person:
Ron Jackson
2d. Address
Street Address
335 FIELDS DRIVE
Address Line 2
City
State / Province / Region
ABERDEEN
NC
Postal/Zip Code
Country
28315
USA
Yes No
Yes No

2e. Telephone Number:
[phone]
2g. Email Address:'
[e-mail]
3. Applicant Information (if different from owner)
3a. Name:
Samuel Adam Carter
3b. Business Name:
Wetland Solutions, LLC
3c.Address
Street Address
P.O. Box 244
Address Line 2
City
Bunnlevel
Postal / Zip Code
28323
3d. Telephone Number:
[phone]
3f. Email Address:"`
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Adam Carter
4b. Business Name:
Wetland Solutions, LLC
4c.Address
Street Address
P.O. Box 244
Address Line 2
City
Bunnlevel
Postal / Zip Code
28323
4d. Telephone Number:
[phone]
4f. Email Address:
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(if appropriate)
Village Acres
1c. Nearest municipality I town:
Pinehurst
2. Project Identification
2f. Fax Number:
State / Province / Region
NC
Country
USA
3e. Fax Number:
State / Province / Region
NC
Country
USA
4e. Fax Number:
2a. Property Identification Number: 2b. Property size:
856310259455 0.3310

2c. Project Address
Street Address
1185 Longleaf Drive
Address Line 2
City
Pinehurst
Postal / Zip Code
28374
3. Surface Waters
3a. Name of the nearest body of water to proposed project:
Joes Fork
3b. Water Resources Classification of nearest receiving water:
WS-III
3c. What river basin(s) is your project located in?*
Cape Fear
3d. Please provide the 12-digit HUC in which the project is located.
030300040301
4. Project Description and History
State / Province / Region
NC
Country
USA
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 project area is a forested lot. All abutting and ajoining lots are either forested or have a single home surround the project lot.
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:
.133ac
4g. List the total estimated linear feet of all existing streams on the property:
44ft
4h. Explain the purpose of the proposed project: *
The purpose of this project is to construct a road crossing for access home site in backside of lot.
41. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:
The road crossing will consist of grubing, fill material and a 18inch culvert. A tracthoe and backhoe will be utiltized to construction road.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?
Yes No G 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): Adam Carter
Agency/Consultant Company: Wetland Solutions, LLC
Other:
6. Future Project Plans
Ga. 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 Buffers
Open Waters Pond Construction
2. Wetland Impacts
2a1 Reason (?)
2b. Impact type* (?)]2c.
Type of W.
2d. W. name
2e. Forested* ��2f.
Type of Jurisdicition'�
(?)
2g. Impact
area
W1 7Toad
CrossingJP
Headwater Forest
W1
Yes
Both
0.016
acres)
2g. Total Temporary Wetland Impact
0.000
2g. Total Wetland Impact
0.016
2i. Comments:
E. Impact Justification and Mitigation
1. Avoidance and Minimization
2g. Total Permanent Wetland Impact
0.016
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
Wetland delineation to find the smallest area to cross the wetland and minimize the impact.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
We will use BMPs along with silt fence, 57rock chicken wire backing to avoid sedimentation transport and avoid future impact from sedimentation. We
will be inspecting after rain events.
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:
Falls below a .10ac of impact in the Cape Fear
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
Yes No
If no, explain why:
Mid Cape Fear no 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:
G. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?
Yes No
2. Violations (DWR Requirement)
a

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.
No where to develope surrounding this lot. Either weltand a road or a utiltilty easment.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?
Yes No N/A
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
5d. Is another Federal agency involved?
Yes No
5e. Is this a DOT project located within Division's 1-8?
Yes No
Unknown
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
USFWS IPAC search. See attached
6. Essential Fish Habitat (Corps Requirement)
Ga. 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?
NOAA's Essential Fish Habitat Mapper
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?
HPOWEB2.0
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?
NC Flood Risk Information System
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
1185 Longleaf Drive JD Packet.pdf 5.64MB
File must be PDF or KMZ
Comments
Signature

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:
Samuel Adam Carter
Signature
15;sM4W6i/e~ C-'Werf
Date
1/31/2024