20150862 Ver 2_Permit Mod Request_20160315

Kimley»>Horn
March 9, 2016
Ms. Tasha Alexander
Asheville Regulatory Field Office
US Army Corps of Engineers
151 Patton Avenue, Room 208
Asheville, NC 28801-5006
Ms. Karen Higgins
NC DWR, 401 & Buffer Permitting Unit
512 North Salisbury Street
Raleigh, NC 27604
Re: 404/401 Permit Modification Request
Troutman Charter Academy Project
SAW #2012-00126 & DEQ# 15-0862V2
Troutman, Iredell County, NC
Dear Ms. Alexander/Ms. Higgins:
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DE -WATER RESOURCES
401 & BUFFER PERMITTIN
On behalf of our client, Ryan Companies, Kimley-Horn is requesting a modification to
Nationwide Permit #39 and General 401 Water Quality Certification number 3890 dated
December 10, 2016 and January 4, 2016, respectively. The modification request is a result
of roadway design changes which are necessary to service the proposed school. The
following revised project information is included as part of this modification request:
• Project Summary Sheet
• Pre -Construction Notification Form
• Project Site Figures
o Figure 5 — Proposed Site Layout (2015 ESRI Aerial )
o Figure 6 — Impact Area (2015 ESRI World Imagery Aerial)
• Permit Drawings for Iredell Charter Academy
The revised project impacts will result in permanent impacts to 135 linear feet of an
Unnamed Tributary to Kerr Branch (S1) from the replacement of an existing 41 If, 48" CMP
culvert crossing at Crosstie Road with proposed 118 If of twin 60" RCP culverts. Non-
erosive design criteria will be met from the installation of 2-15 If rip -rap aprons (30 If of
permanent impacts) at the inlet and outlet of the proposed culvert. The rip -rap aprons will
be installed so that the finished elevation of the rip -rap does not exceed that of the original
stream bed. The project requires 60 linear feet of temporary stream impacts to install
impervious dikes, stone rings, and a pumped bypass to allow work in dry conditions.

Kimley>»Horn
Page 2
Please feel free to contact me at [phone] if you have any questions, or if additional
information is necessary.
Sincerely,
KIMLEY-HORN AND ASSOCIATES, INC.
Chris Tinklenberg, PWS
Environmental Scientist
Attachments
Cc: Brian Devlin, Ryan Companies US, Inc.
Chris Bostic, PE, Kimley-Horn and Associates, Inc.

Kimley l) Horn
Project Name: Troutman Charter Academy
Project Summary Sheet
Applicant Name and Address: Brian Devlin
The Ryan Companies US, Inc.
101 East Kennedy Boulevard, Ste. 2450
Tampa, FL 33602
Telephone Number: 813-204-5006
Type of Request: ® Nationwide PCN (NWP # 39) ❑ Individual Permit Application
❑ Jurisdictional Determination ❑ Other:
Included Attachments: ® Project Plans ® USGS Map ® NRCS Soil Survey
® Agent Authorization ® Delineation Sketch ❑ Delineation Survey
❑ Data Forms (Up & Wet) ® NCDWQ Stream Forms ® USACE Stream Forms
❑ NCEEP Confirmation ® Aerial Photo ® Site Photos
® Agency Correspondence ❑ Other: ❑ Other:
Check if applicable: ❑ CAMA County ❑ Trout County ❑ Isolated Waters
❑ Section 7, ESA ❑ Section 106, NHPA ❑ EFH
❑ Mitigation Proposed (❑ NC EEP ❑ On -Site ❑ Off -Site ❑ Other)
County: Iredell
Waterway: Kerr Branch
H.U.C.: HUC 03040102 - South Yadkin
Property Size (acres): 34
Site Coordinates (in decimal degrees): 35.663076 °N
Nearest City/Town: Troutman
River Basin: Yadkin -Pee Dee
USGS Quad Name: Shepherds
Approx. Size of Jurisdiction on Site (acres): 0.12 ac.
-80.848978 °W
Project Location: The proposed project is located southeast of downtown Troutman on the east side of US 21/NC 115
between Lexus Drive and Flower House Loop.
Site Description: The site is currently managed/ undeveloped. The majority of the surrounding area consists of commercial
businesses with some industrial businesses. A low density residential area is located south of the project area.
Impact Summary (if applicable): The project will result in permanent impacts to 135 linear feet of a UT to Kerr Branch (S 1)
from the replacement of an existing 41 If. 48" CMP culvert crossing at Crosstie Road with Droposed 118 if of twin 60" RCP
culverts. 301f of permanent impacts will result from the installation of 2-15 if rip -rap aprons. The project requires 60 linear
feet of temporary stream impacts to install impervious dikes, stone rings, and a pumped diversion to allow work in dry
conditions.
NWP
#
Open Water
(acres)
Wetland
(acres)
Stream Channel
Intermittent and/or
Unimportant Aquatic
Function
Perennial and/or Important Aquatic
Function
Temp. Perm.
Temp. Perm.
Tem . Perm.
Temp. Perm.
If ac If ac
if ac Lf Ac
39
60 0.01 86 0.02
Total
60 0.01 135 0.02
Total Permanent Impact to Waters of the U.S. (acres) 0.02
Kimley-Horn Contact: Chris Tinklenberg, PWS
■
Suite 200
200 South Tryon Street
Charlotte, North Carolina
28202
Direct Number: [phone]
■
TEL [phone]
FAX [phone]

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Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Page l of 11
PCN Form — Version 1.3 December 10, 2008 Version
Pre -Construction Notification (PCN) Form
A. Applicant Information
1.
Processing
1 a.
Type(s) of approval sought from the
Corps:
®Section 404 Permit El Section 10 Permit
1 b.
Specify Nationwide Permit (NWP) number: 39 or General Permit (GP) number:
1c.
Has the NWP or GP number been verified by the Corps?
❑ Yes
N No
1d.
Type(s) of approval sought from the DWQ (check all that apply):
N 401 Water Quality Certification — Regular ❑ Non -404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
1 e.
Is this notification solely for the record
because written approval is not required?
For the record only for DWQ 401
Certification:
❑ Yes N No
For the record only for Corps Permit:
❑ Yes N No
1f.
Is payment into a mitigation bank or in -lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in -lieu
fee program.
❑ Yes
N No
1 g.
Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below.
❑ Yes
N No
1 h.
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
N No
2.
Project Information
2a.
Name of project:
Troutman Charter Academy
2b.
County:
Iredell
2c.
Nearest municipality / town:
Troutman
2d.
Subdivision name:
2e.
NCDOT only, T.I.P. or state
project no:
3.
Owner Information
3a.
Name(s) on Recorded Deed:
MPV Troutman Investors, LLC
3b.
Deed Book and Page No.
DB 2296, PG 1470
3c.
Responsible Party (for LLC if
applicable):
James E. Merrifield
3d.
Street address:
East side of US 21/NC 115 between Lexus Drive and Flower House
Loop
3e.
City, state, zip:
Troutman, NC 28166
3f.
Telephone no.:
704-561-5241
3g.
Fax no.:
3h.
Email address:
[e-mail]
Page l of 11
PCN Form — Version 1.3 December 10, 2008 Version

4.
Applicant Information (if different from owner)
4a.
Applicant is:
❑ Agent ® Other, specify: Ryan Companies US, Inc.
4b.
Name:
Brian Devlin
4c.
Business name
(if applicable):
The Ryan Companies US, Inc.
4d.
Street address:
101 East Kennedy Boulevard, Ste. 2450
4e.
City, state, zip:
Tampa, FL 33602
4f.
Telephone no.:
813-204-5006
4g.
Fax no.:
4h.
Email address:
[e-mail]
5.
Agent/Consultant Information (if applicable)
5a.
Name:
Chris Tinklenberg, PWS
5b.
Business name
(if applicable):
Kimley-Horn and Associates, Inc.
5c.
Street address:
200 South Tryon Street, Suite 200
5d. City, state, zip:
Charlotte, North Carolina 28202
5e. Telephone no.:
704-409-1802
5f.
Fax no.:
5g.
Email address:
[e-mail]
Page 2 of 11
PCN Form — Version 1.3 December 10, 2008 Version

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
Tax Parcel #4750-11-1496
1 b. Site coordinates (in decimal degrees):
Latitude: 35.663076 Longitude: -80.848978
(DD.DDDDDD) (-DD.DDDDDD)
1 c. Property size:
34 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
Kerr Branch
proposed project:
2b. Water Quality Classification of nearest receiving water:
Class C Water
2c. River basin:
Yadkin — Pee Dee
3. Project Description
3a. 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 proposed project site is located southeast of downtown Troutman, Iredell County, NC. The project is located on US 21
and the majority of the surrounding area consists of commercial businesses with some industrial businesses. A low density
residential area is located south of the project area.
3b. List the total estimated acreage of all existing wetlands on the property:
0 acres
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
—1,260 If
3d. Explain the purpose of the proposed project:
The project seeks to construct a charter school on a 34 -acre property that would accommodate over 1,000 elementary
and middle school students at full enrollment. Offsite roadway improvements are necessary in order to service the new
school including the construction of a round -a -bout along US21/NC 115. New location roadway is proposed to serve as
the main entrance in to the school.
3e. Describe the overall project in detail, including the type of equipment to be used:
The project will result in permanent impacts to 135 linear feet of an Unnamed Tributary to Kerr Branch (S1) from the
replacement of an existing 41 If, 48" CMP culvert crossing at Crosstie Road with proposed 118 If of twin 60" RCP culverts.
Non-erosive design criteria will be met from the installation of 2-15 If rip -rap aprons (30 If of permanent impacts) at the
inlet and outlet of the proposed culvert. The rip -rap aprons will be installed so that the finished elevation of the rip -rap
does not exceed that of the original stream bed. The project requires 60 linear feet of temporary stream impacts to install
impervious dikes, stone rings, and a pumped bypass to allow work in dry conditions. The project will require typical site
development equipment including but not limited to excavators, wheeled backhoes, track hoes, and dump trucks.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
®Yes El No El Unknown
project (including all prior phases) in the past?
Comments: SAW#2012-00126
4b. If the Corps made the jurisdictional determination, what type
El Preliminary ®Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas?
Agency/Consultant Company:
Name (if known): Not known
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Page 3 of 11
PCN Form — Version 1.3 December 10, 2008 Version

5. Project History
5a. Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
❑ Yes ® No ❑ Unknown
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project?
❑ Yes ® No
6b. If yes, explain.
C. Proposed Impacts Inventory
1. Impacts Summary
1a. Which sections were completed below for your project (check all that apply):
❑ Wetlands ® Streams - tributaries ❑ Buffers
❑ Open Waters ❑ Pond Construction
Page 4 of 11
PCN Form — Version 1.3 December 10, 2008 Version

2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a.
2b.
2c.
2d.
2e.
2f.
Wetland impact
Type of jurisdiction
number—
Type of impact
Type of wetland
Forested
(Corps - 404, 10
Area of impact
Permanent (P) or
(if known)
DWQ — non -404, other)
(acres)
Temporary (T)
W 1 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W2 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W3 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W4 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W5 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W6 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
2g. Total wetland impacts
2h. Comments:
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a.
3b.
3c.
3d.
3e.
3f.
3g.
Stream impact
Type of impact
Stream name
Perennial
Type of jurisdiction
Average
Impact
number -
(PER) or
(Corps - 404, 10
stream
length
Permanent (P) or
intermittent
DWQ — non -404,
width
(linear
Temporary (T)
(INT)?
other)
(feet)
feet)
Installation of
S1 — Impact 1
Impervious Dike
UT to Kerr Branch
❑ PER
® Corps
8
40
E]P ® T
and Pumped
E] INT
E] DWQ
Diversion
S1 — Impact 2
Installation of
UT to Kerr Branch
® PER
® Corps
8
15
® P ❑ T
Riprap apron
❑ INT
❑ DWQ
S1 — Impact 3
Replace existing
® PER
® Corps
® P ❑ T
48" CMP w/ Twin
UT to Kerr Branch
❑ INT
❑ DWQ
8
105
60" RCPs
S1 — Impact 4
Installation of
UT to Kerr Branch
® PER
® Corps
8
15
® P ❑ T
Riprap apron
❑ INT
❑ DWQ
S1 — Impact 5
Installation of
UT to Kerr Branch
® PER
® Corps
8
20
E]P ® T
Impervious Dike
E] INT
E] DWQ
S6 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
3h. Total stream and tributary impacts
195
3i. Comments: An existing 41 If CMP culvert will be replaced with 118 If of twin RCPs. The net loss of waters of the US from
the culvert replacement is 105 If. The total project net loss of waters of the US is 135 If.
Page 5 of 11
PCN Form — Version 1.3 December 10, 2008 Version

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. then individually list all open water impacts below.
4a.
4b.
4c.
4d.
4e.
Open water
Name of waterbody
impact number -
(if applicable)
Type of impact
Waterbody type
Area of impact (acres)
Permanent (P) or
Temporary T
01 ❑P❑T
02 ❑P❑T
03 ❑P❑T
04 ❑P❑T
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If pond or lake construction proposed, then complete the chart below.
5a.
5b.
5c.
5d.
5e.
Wetland Impacts (acres)
Stream Impacts (feet)
Upland
Pond ID
Proposed use or purpose
(acres)
number
of pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
5f. Total
5g. Comments:
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If any impacts require mitigation, then you MUST fill out Section D of this form.
6a.
❑ Neuse El Tar -Pamlico El Other:
Project is in which protected basin?
❑ Catawba ❑ Randleman
6b.
6c.
6d.
6e.
6f.
6g.
Buffer impact
number-
Reason
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P) or
for
Stream name
mitigation
(square feet)
(square feet)
Temporary T
impact
re uired?
B1 ❑P❑T
El Yes
❑ No
B2 ❑P❑T
El Yes
❑ No
B3 ❑P❑T
El Yes
❑ No
6h. Total buffer impacts
6i. Comments:
Page 6 of 11
PCN Form - Version 1.3 December 10, 2008 Version

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
An earlier proposed roundabout along US Hwy 21 was removed, avoiding the need to extend an existing culvert which would
have resulted in additional permanent impacts. The sidewalk along the entrance into the school was designed to the minimum
width required to minimize impacts to the stream channel during and post -construction.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
The project is utilizing new impervious area but accompanied with proper sedimentation basins and ponds for water quality
considerations within project footprint. The side -slopes are at a maximum of 2:1 where appropriate to minimize stream
impacts. Temporary construction impacts will be limited by the installation of stone rings an impervious dike for temporary
stream diversion as well as restoring/stabilizing when construction is complete.
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 yes, mitigation is required by (check all that apply):
❑ DWQ ❑ Corps
2c. If yes, which mitigation option will be used for this
project?
❑ Mitigation bank
ElPayment to in -lieu fee program
❑ Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter)
Type
Quantity
3c. Comments:
4. Complete if Making a Payment to In -lieu Fee Program
4a. Approval letter from in -lieu fee program is attached.
❑ Yes
4b. Stream mitigation requested:
linear feet
4c. If using stream mitigation, stream temperature:
❑ warm ❑ cool ❑cold
4d. Buffer mitigation requested (DWQ only):
square feet
4e. Riparian wetland mitigation requested:
acres
4f. Non -riparian wetland mitigation requested:
acres
4g. Coastal (tidal) wetland mitigation requested:
acres
4h. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 7 of 11
PCN Form — Version 1.3 December 10, 2008 Version

6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation?
❑ Yes ® No
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.
Zone
6c.
Reason for impact
6d.
Total impact
(square feet)
Multiplier
6e.
Required mitigation
(square feet)
Zone 1
3 (2 for Catawba)
Zone 2
1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in -lieu fee fund).
6h. Comments:
Page 8 of 11
PCN Form — Version 1.3 December 10, 2008 Version

E.
Stormwater Management and Diffuse Flow Plan (required by DWQ)
1.
Diffuse Flow Plan
1a.
Does the project include or is it adjacent to protected riparian buffers identified
❑ Yes ® No
within one of the NC Riparian Buffer Protection Rules?
1 b.
If yes, then is a diffuse flow plan included? If no, explain why.
❑ Yes ❑ No
Comments:
2.
Stormwater Management Plan
2a.
What is the overall percent imperviousness of this project?
28%
2b.
Does this project require a Stormwater Management Plan?
® Yes ❑ No
2c.
If this project DOES NOT require a Stormwater Management Plan, explain why:
2d.
If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
Per Town of Troutman Regulations, a BMP designed for a 10 -year storm will be required. Stormwater system shall be
designed to remove 85 percent of Total Suspended Solids (TSS) for the 1 -inch storm.
Post -development peak flow rates
shall not exceed the 2- and 10 -year pre -development peak flow rates. Stormwater approval
will be provided once
approval is received.
❑ Certified Local Government
2e.
Who will be responsible for the review of the Stormwater Management Plan?
❑ DWQ Stormwater Program
❑ DWQ 401 Unit
3.
Certified Local Government Stormwater Review
3a.
In which local government's jurisdiction is this project?
Town of Troutman
❑ Phase II
❑ NSW
3b.
Which of the following locally -implemented stormwater management programs
❑ USMP
apply (check all that apply):
❑ Water Supply Watershed
® Other: NCDOT
3c.
Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ® No
attached?
4.
DWQ Stormwater Program Review
❑ Coastal counties
❑ HQW
4a.
Which of the following state -implemented stormwater management programs apply
❑ 0 R
(check all that apply):
❑ Session Law 2006-246
® Other:
4b.
Has the approved Stormwater Management Plan with proof of approval been
attached?
❑ Yes ® No
5.
DWQ 401 Unit Stormwater Review
5a.
Does the Stormwater Management Plan meet the appropriate requirements?
❑ Yes ❑ No
5b.
Have all of the 401 Unit submittal requirements been met?
❑ Yes ❑ No
Page 9 of 11
PCN Form — Version 1.3 December 10, 2008 Version

F.
Supplementary Information
1.
Environmental Documentation (DWQ Requirement)
1a.
Does the project involve an expenditure of public (federal/state/local) funds or the
❑ Yes ® No
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
❑ Yes ❑ No
(North Carolina) Environmental 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 NEPA or SEPA final approval
❑ Yes ❑ No
letter.)
Comments:
2.
Violations (DWQ Requirement)
2a.
Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards,
❑ Yes ® No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b.
Is this an after -the -fact permit application?
❑ Yes ® No
2c.
If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3.
Cumulative Impacts (DWQ Requirement)
3a.
Will this project (based on past and reasonably anticipated future impacts) result in
❑ Yes ® No
additional development, which could impact nearby downstream water quality?
3b.
If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
4.
Sewage Disposal (DWQ Requirement)
4a.
Clearly detail the ultimate treatment methods and disposition (non -discharge or discharge)
of wastewater generated from
the proposed project, or available capacity of the subject facility.
Page 10 of 11
PCN Form — Version 1.3 December 10, 2008 Version

5. 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
impacts? Formal Section 7 Consultation has been submitted and is pending
® Yes ❑ No
as of the submittal date of this PCN.
E] Raleigh
5c. If yes, indicate the USFWS Field Office you have contacted.
® Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
Letter correspondence dated August 18, 2015, the North Carolina Department of Environment and Natural Resources Natural
Heritage Program stated that there were no resources of concern located within a one mile radius of the site.
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?
The project is located in Iredell County, and is therefore not anticipated to impact EFH.
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 ® 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?
A search of the N.C. State Historic Preservation Office HPOWEB GIS service confirmed the project will not impact historic
or archeological resources.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA -designated 100 -year floodplain?
❑ Yes ® No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?
Chris Tinklenberg, PWS,
3/9/2016
Applicant/Agent's Printed Name
Date
Applicant/Agent's Signature
(Agent's signature is valid only if an authorization letter from the applicant
isprovided.)
Page 11 of 11
PCN Form — Version 1.3 December 10, 2008 Version

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8 REVISED PER NCDOT COMMENT 02/29/16 MRC ■ KHA PROJECT LICENSED PROFESSIONAL
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A REVISED PER TOWN/MSTA COMMENTS 12/28/15 JCB 333 FAYETTEVILLE STREET, SUITE 600, RALEIGH, NC 27601 DESIGNED BY JCB
TJ A REVISED PER TOWN COMMENTS 12/03/15 JCB PHONE: [phone] FAX: [phone] DRAWN BY JCB
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8 REVISED PER NCDOT COMMENT 02/29/16 MRC ■ KHA PROJECT LICENSED PROFESSIONAL
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TJ A REVISED PER TOWN COMMENTS 12/03/15 JCB PHONE: [phone] FAX: [phone] DRAWN BY JCB
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