HomeMy WebLinkAbout20240470 Ver 1_Attachment C 240311 PCN_FillableForm. Executed_20240322DocuSign Envelope ID: 484D60F4-24CE-4228-B4B6-33E78720397F
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NORTH CAROLINA
Environmental Quality
Water Resources
Office Use Only
Corps Action ID no. SAW 2021-01186 Date received: [Click to enter.]
DWR project no. lick enter.] Date received: [Click to enter.]
Site Coordinates:
Latitude (DD.DDDDDD): 35.59819
Longitude (DD.DDDDDD): 80.79072
Form Version 4.3, February 22, 2024
Pre -Construction Notification (PCN) Form
(Ver. 4.3, February 22, 2024)
For Nationwide Permits and Regional General Permits and corresponding Water Quality Certifications
Please note: fields marked with a red asterisk are required. The form is not considered complete until all
mandatory questions are answered.
The PCN help document may be found at this link:
https://www.deg. nc.gov/water-resources/pcn-help-document-last-updated-1162024
Page 1 of 21 PCN Form Version 4.3- February 22, 2024
DocuSign Envelope ID: 484D60F4-24CE-4228-B4B6-33E78720397F
A. Processing Information
County (counties) where project is located: *
Iredell Additional (if needed).
Is this an ARPA project? *
❑ Yes ❑x No
If yes, ARPA project number:
* The project number can be found on the "Letter of Intent to Fund'
(LOIF) or "Offer and Acceptance Letter". If you are unable to locate
Click or tap here to enter text.
your DWI ARPA Funding Project Number, please contact Corey
Basinger at core y.basinger(cilncdenr.gov for further assistance.
Is this a NCDMS project? *
(Click yes only if NCDMS is the applicant or co-
❑ Yes ❑x No
applicant)
Is this a public transportation project?
(Publicly funded municipal, state, or federal road, rail,
❑ Yes ❑x No
or airport project)
Is this a NCDOT project? *
❑ Yes ❑x No
If yes, NCDOT TIP or state project number:
Click to enter
If yes, NCDOT WBS number: *
Click to enter.
❑x Section 404 Permit (wetlands, streams, waters,
Clean Water Act)
1 a. Type(s) of approval sought from the Corps: *
❑ Section 10 Permit (navigable waters, tidal
waters, Rivers and Harbors Act)
Has this PCN previously been submitted? *
❑x Yes ❑ No
Please provide the date of the previous submission. *
11/11/2022
❑x Nationwide Permit (NWP)
1 b. What type(s) of permit(s) do you wish to seek
❑ Regional General Permit (RGP)
authorization?
❑ Standard (IP)
This form may be used to initiate the standard/ individual permit process with the USACE. Please contact your Corps
representative concerning submittals for standard permits. All required items can be included as attachments and
submitted with this form.
1 c. Has the NWP or GP number been verified by the Corps? *
® Yes ❑ No
NWP number(s) (list all numbers ):
29
RGP number(s) (list all numbers ):
Are you a federal applicant?
❑ Yes ❑x No
If yes, please provide a statement concerning compliance with the Coastal Zone Management Act
1 d. Type(s) of approval sought from DWR (check all that apply):
*
❑x 401 Water Quality Certification — Regular
❑ 401 Water Quality Certification— Express
❑ Non-404 Jurisdictional General Permit
❑ Riparian Buffer Authorization
❑ Individual 401 Water Quality Certification
Is this a courtesy copy notification
❑ Yes ❑x No
Page 2 of 21 PCN Form Version 4.3- February 22, 2024
DocuSign Envelope ID: 484D60F4-24CE-4228-B4B6-33E78720397F
1 e.
Is this notification solely for the record because written approval is not required? *
For the record only for DWR 401 Certification: *
❑ Yes
❑x No
For the record only for Corps Permit: *
❑ Yes
❑x No
1 f.
Is this an after -the -fact permit/certification application? *
❑ Yes
❑x No
1 g.
Is payment into a mitigation bank or in -lieu fee program proposed for
mitigation of impacts?
® Yes
❑ No
If yes, attach the acceptance letter from mitigation bank or in -lieu fee program.
1 h.
Is the project located in any of NC's twenty coastal counties? *
❑ Yes
❑x No
1 i.
Is the project located within an NC DCM Area of Environmental
Concern (AEC)? *
❑ Yes
❑x No ❑ Unknown
1j.
Is the project located in a designated trout watershed? *
❑ Yes
❑x No
If yes, you must attach a copy of the approval letter from the appropriate Wildlife Resource Commission Office.
Trout information may be found at this link: http://www.saw.usace.army.mil/Missions/Regulatory-Permit-
Program/Agency-Coordination/Trout.aspx
Page 3 of 21 PCN Form Version 4.3- February 22, 2024
DocuSign Envelope ID: 484D60F4-24CE-4228-B4B6-33E78720397F
B. Applicant Information
1 a.
Who is the primary contact? *
David Hughes
1 b.
Primary Contact Email: *
dhughes(z nestcommunities.com
1 c.
Primary Contact Phone: * (###)###-####
;lick to enter
1 d.
Who is applying for the permit/certification? * (check
all that apply)
® Owner ❑ Applicant (other than owner)
1 e.
Is there an agent/consultant for this project?*
® Yes ❑ No
2.
Landowner Information
2a.
Name(s) on Recorded Deed: *
Logan Farms Development Partners, LLC
2b.
Deed Book and Page No.:
2974 / 1062
2c.
Contact Person (for corporations):
David Hughes
2d.
Address *
Street Address:
Click to enter.
Address line 2:
PO Box 3965
City:
Mooresville
State/ Province/ Region:
NC
Postal/ Zip Code:
28117
Country:
us
2e.
Telephone Number: * (###)###-####
Click to enter.
2f.
Fax Number: (###)###-#1###
Click to enter.
2g.
Email Address: *
dhughes@nestcommunities.com
3.
Applicant Information (if different from owner)
3a.
Name: *
Click to enter.
3b.
Business Name (if applicable):
Click to enter.
3c.
Address: *
Street Address:
Click to enter.
Address line 2:
Click to enter.
City:
Click to enter.
State/ Province/ Region:
Click to enter.
Postal/ Zip Code:
Click to enter.
Country
Click to enter.
3d.
Telephone Number: * (###)###-####
Click to enter.
3e
Fax Number: (###)###-####
Click to enter.
3f.
Email Address: *
Click to enter.
Page 4 of 21 PCN Form Version 4.3- February 22, 2024
DocuSign Envelope ID: 484D60F4-24CE-4228-B4B6-33E78720397F
4. Agent/ Consultant (if applicable)
4a. Name:
Chris Huysman
4b. Business Name:
Wetlands and Waters, Inc
4c. Address:
Street Address:
328 East Broad Street
Address line 2:
l ncK to entr
City:
Statesville
State/ Province/ Region:
NC
Postal/ Zip Code:
28677
Country:
us
4d. Telephone Number: (###)###-####
(336)406-0906
4e Fax Number: (###)###-####
GllCK to entc
4f. Email Address:
chrishuysman@wetlands-waters.com
Agent Authorization Letter:
Attach a completed/signed agent authorization form or letter. A sample form may be found at this link:
https://www.saw.usace.army. mil/Missions/Reg ulatory- Perm it-Program/Permits/2017-Nationwide-Permits/Pre-
construction-Notification/
Page 5 of 21 PCN Form Version 4.3- February 22, 2024
DocuSign Envelope ID: 484D60F4-24CE-4228-B4B6-33E78720397F
C. Project Information and Prior Project History
1. Project Information
1 a. Name of project: *
Logan Farms (formerly Doolittle Farms)
1 b. Subdivision name (if appropriate):
Logan Farms
1c. Nearest municipality/town: *
Mooresville
2.
Project Identification
2a.
Property identification number (tax PIN or parcel ID):
4667770903.000
2b.
Property size (in acres):
49.127
2c.
Project Address:
Street Address:
601 West Park Ave
Address line 2:
CIICK to enter.
City:
Mooresville
State/ Province/ Region:
NC
Postal/ Zip Code:
28115
Country:
2d.
Site coordinates in decimal degrees (using 4-6 digits
after the decimal point): *
Latitude (DD.DDDDDD): * 35.59819
Longitude (-DD.DDDDDD): *-80.79072
3. Surface Waters
3a. Name of nearest body of water to proposed project: *
Back Creek
3b. Water Resources Classification of nearest receiving
WS-II
water: *
The Surface Water Classification map may be found at this link:
https://experience.arcgis.com/experience/7073e9l 22ab74588b8c48ded34c3df55/
Yadkin-PeeDee
3c. In what river basin(s) is your project located? *
3d. Please provide the 12-digit HUC in which the project is
030401020501
located:
The Find Your HUC map may be found at this link:
https://ncdenr.maps.arcqis.com/apps/Publiclnformation/index.html?appid=ad3a85aOc6d644aOb97cdO69db238ac3
Page 6 of 21 PCN Form Version 4.3- February 22, 2024
DocuSign Envelope ID: 484D60F4-24CE-4228-B4B6-33E78720397F
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 existing conditions on the site at the time of the application in 2022 were mainly pasture land. The site is currently being developed as a
residential development. The surrounding area is mixed residential communities on adjacent properties.
4b. Have Corps permits or DWR certifications been obtained for this
® Yes ❑ No ❑ Unknown
project (including all prior phases) in the past? *
If yes, please give the DWR Certification number and/or Corps
SAW 2021-01186
Action ID (ex. SAW-0000-00000):
Attach any pertinent project history documentation
4b2. Is any portion of the work already complete? *
® Yes ❑ No
If yes, describe the completed work.
A small isolated wetland was filled for the development and an existing driveway crossing to access the creek
has been removed. The proposed road crossing is located where the existing driveway was located.
4c. List of other certifications or approvals/denials received from other federal, state or local agencies for work
described in this application not related to the 404 or 401.
Zoning, water, sewer, local engineering.
4d. Attach an 8'h x 11" excerpt from the most recent version of the USGS topographic map indicating the location of
the project site.
4e. Attach an 8'h x 11" excerpt from the most recent version of the published County NRCS Soil Survey map
depicting the project site.
4f. List the total estimated acreage of all existing wetlands on the
0.04 acres
property:
4g. List the total estimated linear feet of all existing streams (intermittent
2250 linear feet
and perennial) on the property:
4g1. List the total estimated acreage of all existing open waters on the
0 acres
property:
4h. Explain the purpose of the proposed project:
The purpose of this project is to develop a residential subdivision to serve the growing need for housing within
this area.
4i. Describe the overall project in detail, including the type of equipment to be used:
The project will use typical earth moving equipment to grade the property and then begin construction of the
subdivision. Energy dissipation is not needed as determined by the engineer due to sizing of the crossing and
because the culvert will be buried one foot.
4j. Attach project drawings/site diagrams/depictions of impact areas for the proposed project.
4k. Will this activity involve dredging in wetlands or waters? *
❑ Yes ❑x No
If yes, describe the type of dredging, the composition of the dredged material, and the locations of disposal area.
Page 7 of 21 PCN Form Version 4.3- February 22, 2024
DocuSign Envelope ID: 484D60F4-24CE-4228-B4B6-33E78720397F
5.
Jurisdictional Determinations
5a.
Have the wetlands or streams been delineated on
the property or in
® Yes ❑ No ❑ Unknown
proposed impact areas?
Comments:
Click to enter text.
5b.
If the Corps made a jurisdictional determination,
❑x Preliminary ❑ Approved ❑ Emailed concurrence
what type of determination was made? *
❑ Not Verified ❑ Unknown ❑ n/a
Corps AID number (ex. SAW-0000-00000):
SAW 2021-01186
Name (if known): Chris Huysman
5c.
If 5a is yes, who delineated the jurisdictional
Agency/Consultant Company: Wetlands and Waters, Inc
areas?
Other: (;link to enter
5d.
List the dates of the Corps jurisdictional determination or State determination if a determination was made by
either agency.
Site visit conducted on September 28, 2021
5d1.
Attach jurisdictional determinations.
6. Future Project Plans
6a. Is this a phased project?
❑ Yes ❑x No
6b. If yes, explain.
Are any other NWP(s), regional general permit(s), or individual permit(s) used, or intended to be used, to
authorize any part of the proposed project or related activity? This includes other separate and distant crossings
for linear projects that require Department of the Army authorization but don't require pre -construction
notification.
7. Addresses of adjoining property owners, lessees, etc. whose property adjoins the waterbody (if more than can be
entered here, please attach a supplemental list)
TSCHUDI TIFFANY R ETAL
76S STILLWELL BRANCH RD
CHEROKEE, NC 28719
8. Scheduling of activity:
Page 8 of 21 PCN Form Version 4.3- February 22, 2024
DocuSign Envelope ID: 484D60F4-24CE-4228-B4B6-33E78720397F
D. Proposed Impacts Inventory
Impacts Summary
❑ Wetlands ❑x Streams - tributaries
1a. Where are the impacts associated with your project ❑ Buffers ❑ Open Waters
(check all that apply):
❑ Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, complete this table for each wetland area impacted.
2a.
Site #*
2a1.
Impact
Reason/Type*
2b.
Impact
Duration*
2c.
Wetland Type*
2d.
Wetland Name*
2e.
Forested
?*
2f.
Jurisdiction
Type*
2g.
Impact Area
(ac)*
W1
Fill (Incl.
Riprap)
Permanent
Isolated
Wetland
W1
No
DWR
0.02
W2
Fill (Incl.
Riprap)
Permanent
Isolated
Wetland
W2
No
DWR
0.02
W3
Choose one
.'emp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W4
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W5
Choose one
-emp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W6
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W7
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W8
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W9
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W10
Choose one
-emp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W11
Choose one
-emp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W12
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W13
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W14
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W15
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
2g1. Total temporary wetland impacts
Click to enter. ac
2g2. Total permanent wetland impacts
0.04 ac
2g3. Total wetland impacts
0.04 ac
2h. Type(s) of material being discharged and the amount of each type in cubic yards:
Click to enter text.
2i. Comments:
Isolated Wetlands — not regulated: Half of the isolated wetland will be filled in order to install a road and the other half will be filled to add a lot
to the development. The isolated wetland serves very little function for biology and mainlyjust collects minimal storm runoff. It appears to be
constructed for a livestock water source.
Page 9 of 21 PCN Form Version 4.3- February 22, 2024
DocuSign Envelope ID: 484D60F4-24CE-4228-B4B6-33E78720397F
Page 10 of 21 PCN Form Version 4.3- February 22, 2024
DocuSign Envelope ID: 484D60F4-24CE-4228-B4B6-33E78720397F
3. Stream Impacts
If there are perennial or intermittent stream/ tributary impacts (including temporary impacts) proposed on the site,
complete this table for all stream/ tributary sites impacted.
** All Perennial or Intermittent streams must be verified by DWR or delegated local government
Site #*
3a
Impact
Reason*
3b.
Impact
Duration*
3c.
Impact Type*
3d.
Stream Name*
3e.
Stream
Type*
3f.
Jurisdiction
Type*
3g.
Stream Width
(avg ft) *
3h.
Impact length
(linear ft)
S1
Road Crossing
Permanent
Crossing/
Culvert
UT Back Creek
Perennial
Both
12
144
S2
Pump Around
Temporary
Dewatering
UT Back Creek
Perennial
Both
12
20
S3
:Iick to enter
Temp/ Perm
Choose one
Click to ente,
Per/Int
Choose one
Click to enter
Click to enter
S4
:Iick to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S5
:Iick to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S6
:Iick to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S7
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S8
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S9
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S10
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S11
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S12
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S13
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S14
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S15
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S16
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S17
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S18
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S19
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S20
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
3i1. Total jurisdictional ditch
impact:
Click to enter. linear ft
3i2. Total permanent stream
impacts:
144 linear ft
M. Total temporary stream
impacts:
20 linear ft
3i4. Total stream and ditch
impacts:
Click to enter. linear ft
3j. Comments:
Click to enter.
Page 11 of 21 PCN Form Version 4.3- February 22, 2024
DocuSign Envelope ID: 484D60F4-24CE-4228-B4B6-33E78720397F
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., individually list all open water impacts in the table below.
4a.
Site #*
4a1.
Impact Reason
4b.
Impact
Duration*
4c.
Waterbody Name*
4d.
Activity Type*
4e.
Waterbody
Type*
4f.
Impact area
(ac)*
01
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
02
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
03
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
04
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
05
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
4g.
Total temporary open water impacts
Click to enter. ac
4g.
Total permanent open water impacts
Click to enter. ac
4g.
Total open water impacts
Click to enter. ac
4h.
Comments:
Click to enter.
5.
Pond or Lake Construction
If pond or lake construction is proposed, complete
the table below. (*This
does NOT include offline stormwater
management ponds.)
5a.
5b.
5c.
5d.
5e.
Pond ID
Proposed use or
Wetland Impacts
(ac)
Stream
Impacts (ft)
Upland
#
purpose of pond
Impacts (ac)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
P1
Choose one
Click to
Click to
lick to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
P2
Choose one
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
P3
Choose one
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
5f.
Total
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
5g.
Comments:
Click to enter.
5h.
Is a dam high hazard permit required?
❑ Yes ❑ No
If yes, permit ID no.:
Click to enter.
5i.
Expected pond surface area (acres):
Click to enter.
5j.
Size of pond watershed (acres):
Click to enter.
5k.
Method of construction:
Click to enter.
Page 12 of 21 PCN Form Version 4.3- February 22, 2024
DocuSign Envelope ID: 484D60F4-24CE-4228-B4B6-33E78720397F
6. Buffer Impacts (DWR requirement)
If project will impact a protected riparian buffer, then complete the chart below. Individually list all buffer impacts.
6a. Project is in which protected basin(s)?
* (Check all that apply.)
❑ Neuse ❑ Tar -Pamlico ❑ Catawba
❑ Jordan ❑ Goose Creek ❑ Randleman
❑ Other: ;lick to enter
Site #*
6b.
Impact Type*
6c.
Impact Duration*
6d.
Stream Name*
6e.
Buffer
Mitigation
Required?*
6f.
Zone 1 Impact*
(sq ft)
6g.
Zone 2 Impact*
(sq ft)
131
Choose one
Temp/ Perm
Click to enter.
iN
Click to enter.
CliCK to enter.
132
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
133
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
134
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
135
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
136
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
137
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
138
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
139
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B10
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
1311
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter
Click to enter.
B12
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter
Click to enter.
B13
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B14
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B15
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B16
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B17
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B18
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B19
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B20
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
6h. Total temporary impacts:
Zone 1: Click to enter. sq ft
Zone 2: Click to enter. sq ft
6h. Total permanent impacts:
Zone 1: Click to enter. sq ft
Zone 2: Click to enter. sq ft
6h. Total combined buffer impacts:
Zone 1: Click to enter. sq ft
Zone 2: Click to enter. sq ft
6i. Comments:
Click to enter.
Please attach supporting documentation (impact maps, plan sheets, etc.) for the proposed project.
Page 13 of 21 PCN Form Version 4.3- February 22, 2024
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E. Impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts through project design:
Site plans have been developed in order to reduce impacts to the most practicable extent possible. The culvert has been designed to
improve the current stream crossing on site in order to not impact additional areas. The culvert is necessary to adhere to local ordinances
involving emergency vehicle access.
1 b. Specifically describe measures taken to avoid or minimize proposed impacts through construction techniques:
An Erosion Control Plan as advised by local NCDEQ authorities will be followed such as installing silt fences along the tributary and creating
check dams where it is found to be appropriate. Permit includes pump around so that construction can occur in the dry.
2. Compensatory Mitigation for Impacts to Waters of the U.S., Waters of the State, or Riparian Buffers
2a. If compensatory mitigation is required, by whom is it required? * ❑ DWR ❑x Corps
(check all that apply)
2b. If yes, which mitigation option(s) will be used for this ❑ Mitigation Bank
project? * (check all that apply) ❑ In Lieu Fee Program
❑ Permittee Responsible Mitigation
3. Complete if using a Mitigation Bank
(Must satisfy NC General Statute143-214.11 (d1).)
3a. Name of mitigation bank:
Click to enter.
3b. Credits purchased/requested:
Type: Choose one
Quantity lick to enter.
Type: Choose one
Quantity lick to enter.
Type: Choose one
Quantity ;lick to enter.
Attach receipt and/or approval letter.
3c. Comments:
Click to enter.
4.
Complete if Using an In Lieu Fee Program
4a.
Attach approval letter from in lieu fee program.
4b.
Stream mitigation requested:
Click to enter linear feet
4c.
If using stream mitigation, what is the stream temperature:
Choose one
NC Stream Temperature Classification Maps can be found under the Mitigation Concepts tab on the Wilmington
District's RIBITS website: (Please use the filter and select Wilmington district)
https://ribits.ops. usace.armV. mil/ords/f?p=107:2::::::
4d.
Buffer mitigation requested (DWR only):
Click to enter square feet
4e.
Riparian wetland mitigation requested:
Click to enter acres
4f.
Non -riparian wetland mitigation requested:
Click to enter acres
4g.
Coastal (tidal) wetland mitigation requested:
Click to enter acres
4h.
Comments:
Click to
Page 14 of 21 PCN Form Version 4.3- February 22, 2024
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5. Complete if Providing a Permittee Responsible Mitigation Plan
5a. If proposing a permittee responsible mitigation plan, provide a description of the proposed mitigation plan,
including mitigation credits generated.
Click to enter.
5b. Attach mitigation plan/documentation.
6.
Buffer Mitigation (State Regulated Riparian Buffer Rules) — DWR requirement
6a.
Will the project result in an impact within a protected riparian buffer
❑ Yes ❑x No
that requires buffer mitigation?
If yes, please complete this entire section — please contact DWR for more information.
6b.
If yes, identify the square feet of impact to each zone of the riparian buffer that requires
mitigation. Calculate the
amount of mitigation required in the table below.
6c.
6d.
6e.
Zone
Reason for impact
Total impact
Multiplier
Required mitigation
(square feet)
(square feet)
Zone 1
Click to enter.
Click to enter.
Choose one
Click to enter.
Zone 2
Click to enter.
Click to enter.
Choose one
Click to enter.
6f. Total buffer mitigation required
Click to enter.
6g.
If buffer mitigation is required, is payment to a mitigation bank or
❑ Yes ❑ No
NC Division of Mitigation Services proposed?
6h.
If yes, attach the acceptance letter from the mitigation bank or NC Division of Mitigation Services.
6i.
Comments:
Click to enter.
Page 15 of 21 PCN Form Version 4.3- February 22, 2024
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F. Stormwater Management and Diffuse Flow Plan (DWR requirement)
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers
❑ Yes ❑x No
identified within one of the NC Riparian Buffer Protection Rules?
1 b. All buffer impacts and high ground impacts require diffuse flow or other form of stormwater treatment. If the
project is subject to a state implemented riparian buffer protection program, include a plan that fully documents
how diffuse/dispersed flow will be maintained.
All Stormwater Control Measures (SCM) must be designed in accordance with the NC Stormwater Design
Manual (https://deg.nc..qov/about/divisions/energy-mineral-land-resources/energy-mineral-land-permit-
guidance/stormwater-bmp-manual).
Associated supplement forms and other documentation must be provided.
❑ Level Spreader
What Type of SCM are you
❑ Vegetated Conveyance (lower seasonal high water table- SHWT)
providing?
❑ Wetland Swale (higher SHWT)
(Check all that apply)
❑ Other SCM that removes minimum 30% nitrogen
❑ Proposed project will not create concentrated stormwater flow through the
buffer
For a list of options to meet the diffuse flow requirements, click here.
Attach diffuse flow documentation.
2.
Stormwater Management Plan
2a.
Is this an NCDOT project subject to compliance with NCDOT's
Individual NPDES permit NCS000250? *
❑ Yes 0 No
2b.
Does this project meet the requirements for low density projects as
defined in 15A NCAC 02H .1003(2)? *
❑ Yes 0 No
To look up low density requirements, click here:
http://reports.oah. state. nc.us/ncac/title%2015a%20-%20environmental%20guality/chapter%2002%20-
%20environmental%20management/subchapter%20h/15a%20ncac%2002h%20.1003.pdf
2c.
Does this project have a stormwater management plan (SMP)
❑x Yes ❑ No
reviewed and approved under a state stormwater program or state -
approved local government stormwater program? *
❑ n/a — project disturbs < 1 acre
Note: Projects that have vested rights, exemptions, or grandfathering from state or locally implemented
stormwater programs or projects that satisfy state or locally -implemented stormwater programs through use of
community in -lieu programs should answer "no" to this question.
2d.
Which of the following stormwater management program(s) apply?
❑x Local Government
(Check all that apply.)*
❑ State
If you have local government approval, please include the SMP on their overall impact map.
❑ Phase II ❑ USMP
Local Government Stormwater Programs *
❑ NSW ❑x Water Supply
Page 16 of 21 PCN Form Version 4.3- February 22, 2024
DocuSign Envelope ID: 484D60F4-24CE-4228-B4B6-33E78720397F
Please identify which local government stormwater program you are using.
Mooresville
State Stormwater Programs * 0 Phase II ❑ HQW or ORW
❑ Coastal Counties ❑ Other
Comments:
Click to enter.
Page 17 of 21 PCN Form Version 4.3- February 22, 2024
DocuSign Envelope ID: 484D60F4-24CE-4228-B4B6-33E78720397F
G. Supplementary Information
1. Environmental Documentation
1 a. Does the project involve an expenditure of public (federal/state/local)
❑ Yes ❑x No
funds or the 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 (North Carolina) Environmental
El Yes El No
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
❑ Yes ❑ No
NEPA or SEPA final approval letter.)
Comments:
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),
Federally Non -Jurisdictional Wetlands /Classified Surface Waters
❑ Yes ❑x No
(15A NCAC 2H. 1400) DWR Surface Water or Wetland Standards or
Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. If you answered "yes" to the above question, provide an explanation of the violation(s):
3. Cumulative Impacts (DWR Requirement)
3a. Will this project (based on past and reasonably anticipated future
impacts) result in additional development, which could impact nearby
❑ Yes ❑x No
downstream water quality? *
3b. If you answered "no", provide a short narrative description:
The project is a stand alone development project.
3c. If yes, provide a qualitative or quantitative cumulative impact analysis in accordance with the most recent DWR
policy. (Attach .pdf)
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project? * I ❑ Yes ❑ No ❑ N/A
4b. If yes, 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.
Click to enter.
Page 18 of 21 PCN Form Version 4.3- February 22, 2024
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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
❑ Yes ❑x No
species or habitat? (IPAC weblink: https://www.fws.gov/ipac/ ffws.govl)
5b. Have you checked with the USFWS concerning Endangered Species
❑ Yes ❑x No
Act impacts? *
5c. If yes, indicate the USFWS Field Office you have contacted.
5d. Is another federal agency involved? *
❑ Yes ❑x No ❑ Unknown
If yes, which federal agency?
5e. Is this a DOT project located within Divisions 1-8? *
❑ Yes ❑x No
5f. Will you cut any trees in order to conduct the work in waters of the
U.S.? *
❑ Yes ❑x No
5g. Does this project involve bridge maintenance or removal? *
❑ Yes ❑x No
5g1. If yes, have you inspected the bridge for signs of bat use such as
staining, guano, bats, etc.? Representative photos of signs of bat use
❑ Yes ❑x No
can be found in the NLEB SLOPES, Appendix F, pages 3-7.
Representative photos of signs of bat use can be found in the NLEB SLOPES, Appendix F, pages 3-7. Link to
NLEB SLOPES document: http://saw-reg.usace.army.mil/NLEB/1-30-17-signed NLEB-SLOPES&apps.pdf
If you answered yes to 5g1, did you discover any signs of bat use? *
❑ Yes ❑ No ❑ Unknown
If yes, please show the location of the bridge on the permit drawings/ project plans
5h. Does this project involve the construction/ installation of a wind
turbine(s)? *
❑ Yes ❑x No
If yes, please show the location of the wind turbine(s) on the permit drawings/ project plans (attach .pdf)
5i. Does this project involve blasting and /or other percussive activities
that will be conducted by machines, such as jackhammers,
❑ Yes ❑x No
mechanized pile drivers, etc.? *
If yes, please provide details to include type of percussive activity, purpose, duration, and specific location of this
activity on the property (attach .pdf)
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated
Critical Habitat? *
See Appendix A for ipac.
Attach consultation documentation.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as
an Essential Fish Habitat? *
❑ Yes ❑x No
Is there submerged aquatic vegetation (SAV) around
the project vicinity? *
El Yes ❑x No El Unknown
Will this project affect submerged aquatic vegetation? *
❑ Yes ❑x No ❑ Unknown
Page 19 of 21 PCN Form Version 4.3- February 22, 2024
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Explain: Click to enter
6b. What data source(s) did you use to determine whether your site would impact Essential Fish Habitat?
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data):
http://gis. ncdcr.,qov/hpoweb/
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural
❑ Yes ❑x No
preservation status (e.g., National Historic Trust designation or
properties significant in North Carolina history and archaeology)?
7b. What data source(s) did you use to determine whether your site would impact historic or archeological
resources? *
See Appendix B
7c. Attach historic or prehistoric documentation.
8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https://msc.fema.,qov/portal/search
8a. Will this project occur in a FEMA-designated 100-year floodplain? *
❑ Yes ❑x No
8b. If yes, explain how the project meets FEMA requirements.
8c. What source(s) did you use to make the floodplain determination?
FIRM Panel for site included in the mapping attached hereto.
H. Miscellaneous
Comments:
See attached cover letter for further discussion.
Attach pertinent documentation or attachments not previously requested
Page 20 of 21 PCN Form Version 4.3- February 22, 2024
DocuSign Envelope ID: 484D60F4-24CE-4228-B4B6-33E78720397F
I. Signature *
❑x By checking the box and signing below, I, as the project proponent, certify to the following:
• The project proponent hereby certifies that all information contained herein is true, accurate, and complete, to
the best of my knowledge and belief;
• 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;
• The project proponent hereby agrees 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");
• The project proponent hereby agrees to conduct this transaction by electronic means pursuant to Chapter 66,
Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• The project proponent hereby understands that an electronic signature has the same legal effect and can be
enforced in the same way as a written signature; AND
• As the project proponent, I intend to electronically sign and submit the PCN/online form.
Full Name: * David Hughes
DocuSigned by:
Signature: * VM-� """ ,s
Bey, e�sarem�r�
Date: * 3/19/2024
Page 21 of 21 PCN Form Version 4.3- February 22, 2024