20091183 Ver 2_More Info Received_20160208 (2)

S. 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?
Sc. If yes, indicate the USFWS Field Office you have contacted.
❑ Raleigh
❑ Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
GIS File of rare species occurences provided by NC Natural Heritage Program
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?
NOAA 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
®Yes El 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?
Consultations with the State Historic Preservation Office on 8-27-09
8. Flood Zone Designation (Corps Requirement)
Be. Will this project occur in a FEMA -designated 100 -year floodplain?
® Yes ❑ No
8b. If yes, explain how project meets FEMA requirements: Project complies with Surry County development regulations per
personal communication between Amin Davis of DPR and Kim Bates of Surry County on 10-27-09.
8c. What source(s) did you use to make the floodplain determination? ncfloodmaps
Justin Williamson/ NC DPR
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1-8-16
Applicant/Agent's Printed Name
Date
Applicant/Agent's Signature
(Agent's signature is valid only if an authorization letter from the applicant
isprovided.)
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PCN Form — Version 1.3 December 10, 2008 Version