20240539 Ver 1_ePCN Application_20240409

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# *
20240539 1
Is a payment required for this project?*
No payment required
Fee received
Fee needed - send electronic notification
Select Project Reviewer*
Holley Snider:Holley.Snider
Information for Initial Review
la. Name of project:
COURTESY COPY Blake Farm Pond
1a. Who is the Primary Contact? *
Megan Dean
1b. Primary Contact Email: *
[e-mail]
Date Submitted
4/9/2024
Nearest Body of Water
Futch Creek
Basin
Cape Fear
Water Classification
SA;HQW
Site Coordinates
Latitude: Longitude:
34.20.41 N-77.46.14W
A. Processing Information
Is this project connected with ARPA funding?
Yes No
County (or Counties) where the project is located:
Pender
Is this a NCDMS Project
Yes No
Reviewing Office*
Wilmington Regional Office - [phone]
1c. Primary Contact Phone:*
[phone]
O
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
58 - Utility Line Activities for Water and Other Substances (frequently used)
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:
401 Water Quality Certification - Express
Riparian Buffer Authorization
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
1i. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
Yes No Unknown
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)
1e. Is there an Agent/Consultant for this project?
Yes No
2. Owner Information
2a. Name(s) on recorded deed:
Pender1164
2b. Deed book and page no.:
4606/1545 ; 4369/255
2c. Contact Person:
Blake Farm Pond, LLC
Yes No
Yes No

2d. Address
Street Address
1022 Ashes Drive
Address Line 2
Suite 201
city
Wilmington
Postal / Zip Code
28405
2e. Telephone Number:
[phone]
2g. Email Address:"
[e-mail]
3. Applicant Information (if different from owner)
3a. Name:
Megan Dean
3b. Business Name:
Southern Environmental Group, Inc
3c.Address
Street Address
5315 South College Road
Address Line 2
Suite E
city
Wilmington
Postal / Zip Code
28412
3d. Telephone Number:
[phone]
3f. Email Address:
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Megan Dean
4b. Business Name:
Southern Environmental Group, Inc
4c.Address
Street Address
5315 South College Road
Address Line 2
Suite E
city
Wilmington
Postal / Zip Code
28412
4d. Telephone Number:
[phone]
0. Email Address:'
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality / town:
Scott's Hill
State / Province / Region
NC
Country
USA
2f. Fax Number:
State / Province / Region
NC
Country
USA
3e. Fax Number:
State / Province / Region
NC
Country
USA
4e. Fax Number:
8
2. Project Identification

2a. Property Identification Number:
3271-08-8507-000 & 3262-72-5914-0000
2b. Property size:
4.0
2c. Project Address
Street Address
TBD
Address Line 2
city
Postal / Zip Code
3. Surface Waters
3a. Name of the nearest body of water to proposed project:
Futch Creek
3b. Water Resources Classification of nearest receiving water:
SA;HQW
3c. What river basin(s) is your project located it *
Cape Fear
3d. Please provide the 12-digit HUC in which the project is located.
030300070805
4. Project Description and History
State / Province / Region
Country
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:"
Located above the Pluris Wastewater Treatment Plant off Sidbury Rd., this site presents a forested landscape with the wastewater pond directly below. There is an unnamed stream
running across the southeastern corner of the site.
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:
unknown
4g. List the total estimated linear feet of all existing streams on the property:
top of bank 10ft
4h. Explain the purpose of the proposed project:*
The purpose of this project is to install a water pipe that goes from the easement, under the unnamed stream, and into the pond to provide water. See Appendix D in attachment below.
41. Describe the overall project in detail, including indirect impacts and the type of equipment to be used: *
The engineer for the project has planned to install erosion control prior to beginning any grading and digging operations. Grading of the property will be completed with bulldozers and
backhoes. Use of temporary diversion ditches with check dams to prevent runoff along with the use of permanent ground cover to ensure site stabilization after completion of construction.
Anticipating - 0.02 AC of temporary stream impact. Putting the pipe under the unnamed stream (see appendix D) is necessary as there are no other routes to effectively pull water.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
Yes No 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):
Agency/Consultant Company:
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?
No.
D. Proposed Impacts Inventory O

1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
Wetlands Streams -tributaries Buffers
Open Waters Pond Construction
3. Stream Impacts
F
3a. Reason for impact (?)
3b.lmpact type"
3c. Type of impact*
3d. S. name*
3e. Stream Type*
3f. Type of
3g. S. width
3h. Impact
?)
Jurisdiction*
length*
S1
A water pipe to be installed
Temporary
Dewatering
unnamed
Perennial
Both
10
232
under the stream to pump
Ave age (feet)
near feet)
water into the pond
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
0
3i. Total stream and ditch impacts:
232
3j. Comments:
total 695 sq ff of impact
E. Impact Justification and Mitigation
1. Avoidance and Minimization
3i. Total temporary stream impacts:
232
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
Placement of silt fence and/or tree protection fence at or inside the limits of disturbance to prevent sediment runoff and protect vegetation. Ensuring that
grading activities remain within the denoted limits on the plan to avoid violations of the state erosion control ordinance. Adhering to state law by obtaining
approval for erosion control plans before grading more than one acre of land.
Providing ground cover on exposed slopes within 21 calendar days following the completion of any phase of grading to prevent erosion.
Being prepared for additional erosion control measures as required by representatives of NCDEQ.
Limiting slopes to a maximum grade of 3:1 to minimize erosion potential.
Implementing additional erosion control devices as agreed upon by the field inspector, engineer, and owner to address site -specific needs.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Maintaining erosion control devices throughout all phases of construction until the site is fully stabilized, with additional devices as needed to control
erosion and sedimentation. Regular inspection and repair of erosion control measures every seven days and within 24 hours of rainfall events to ensure
effectiveness. Prompt removal of sediment from behind the silt fence when it reaches about 0.5 feet deep, and repairing or replacing the fence as
necessary to maintain its function.
Fertilizing, reseeding, and mulching areas as needed to maintain vigorous vegetative cover, in accordance with the vegetative plan. Weekly inspection of
temporary diversions and immediate removal of sediment, repair of diversions, and timely outlet maintenance as needed to prevent erosion.
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:
This is a temporary installation of the pipe to fill the pond and will not exist following the completion of this project.
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:
This project does not include nor is adjacent to protected riparian buffers.
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
O
O

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)
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.
Based on the plans for this site, there is no anticipated downstream impact considering they are cutting underneath the stream, are planning to establish
and maintain BMP to protect the waterway in addition to being a temporary pipe, is not at risk for future disturbance.
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 Unknown
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
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?
US Department of the Interior: Fish and Wildlife Service. Project code: 2024-0068079. Refer to Appendix G, H, & I
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?
NOAA Fisheries Essential Fish Habitat. Refer to Appendix K in attachment below.
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?"
NC SHPO HPOWEB2.0 Map. Refer to Appendix L in attachment below.
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?"
FRIS NC Flood Map. Refer to Appendix M in attachment below.
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
Blake Farm Ponds LLC PCN Attachments (1).pdf 6.42MB
File must be PDF or KMZ
Comments
Signature
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:
Megan Dean
Signature
41 -ffim,�%"
Date
4/9/2024