20150676 Ver 2_401 Application_20160516

Montalvo, Sheri A
From: Scarbraugh, Anthony
Sent: Friday, May 06, 2016 9:00 AM
To: Montalvo, Sheri A
Subject: RE: Stephen Tubaugh Farm
Ver. 2
Anthony Scarbraugh
Environmental Senior Specialist
Division of Water Resources — Water Quality Regional Operations
Department of Environmental Quality
252 948 3924 office
anthony scarbraugh@ncdenr gov
943 Washington Square Mall
Washington, NC 27889
fC'. -'--^Nothing Compares .-
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties
From: Montalvo, Sheri A
Sent: Wednesday, May 04, 2016 11:30 AM
To: Scarbraugh, Anthony <[e-mail]>
Subject: Stephen Tubaugh Farm
Anthony,
I have a PCN for the above. Should I version it to 20091282?
Thanks
Sheri, MDvutatvo
401 & Buffer Permitting Unit - Administrative Assistant
Division of Water Resources
Department of Environmental Quality
919-807-6303 (office)
sheri.montalvo a,ncdenr.gov
Physical: 512 N. Salisbury St., Ste 942-D, Raleigh, NC 27604
Mailing. 1617 Mail Service Center, Raleigh, NC 27699-1617
1

Office Use Only:
Corps action ID no.
o PAID
DWQ project no.
Form Version 1.4 January 2009
Pre -Construction Notification (PCN) Form s?
A. Applicant Information DOM
1. Processing
1a. Type(s) of approval sought from the Corps:
Section 404 Permit ❑ Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number: 14 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps?
0 Yes ❑ No
1 d. Type(s) of approval sought from the DWQ (check all that apply):
El 401 Water Quality Certification — Regular ❑ Non -404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express El Riparian Buffer Authorization
le. Is this notification solely for the record
because written approval is not required?
For the record only for DWQ
401 Certification:
❑ Yes 0 No
For the record only for Corps Permit:
❑ Yes 0 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 [D No
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below.
0 Yes ❑ No
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes 0 No
2. Project Information
2a. Name of project:
Stephen Tubaugh Farm
2b. County.
Beaufort
2c. Nearest municipality / town:
Washington Inn -
2d. Subdivision name:
N/A
2e. NCDOT only, T.I.P. or state project no.
,
3. Owner Information
3a. Name(s) on Recorded Deed:
Stephen R Tubaugh D Q. TE RES URCES
A01 g,
3b. Deed Book and Page No.
1424/476
3c. Responsible Party (for LLC if
applicable):
3d. Street address:
1545 Wares Chapel Lane
3e. City, state, zip:
Washington, NC 27889
3f. Telephone no.:
[phone]
3g. Fax no -
[phone]
3h. Email address:
[e-mail]
Page 1 of 10
PCN Form — Version 1.4 January 2009

4. Applicant Information (if different from owner)
4a. Applicant is:
❑ Agent ❑ Other, specify:
4b. Name:
4c Business name
(if applicable):
4d. Street address:
4e. City, state, zip:
4f. Telephone no.:
j
4g. Fax no.:
4h. Email address:
S. Agent/Consultant Information (if applicable)
5a. Name:
a
I
5b. Business name
(if applicable):
i
5c Street address:
5d City, state, zip:
5e. Telephone no.:
5f. Fax no
5g. Email address:
Page 2 of 10

B.
Project Information and Prior Project History
1.
Property Identification
1a.
Property identification no. (tax PIN or parcel ID):
1 b.
Site coordinates (in decimal degrees).
Latitude. 35.603046 Longitude. 77 035551
1c.
Property size:
72.45 acres
2.
Surface Waters
2a.
Name of nearest body of water to proposed project:
Unnamed tributary to Cherry Run
2b. Water Quality Classification of nearest receiving water:
NSW;C; Sw
2c.
River basin:
Tar -Pamlico
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 majority of the property is in active agriculture with approximately 15 acres of managed forested land.
3b.
List the total estimated acreage of all existing wetlands on the property: 5
3c.
List the total estimated linear feet of all existing streams (intermittent -and perennial) on the property: 2,356
3d. Explain the purpose of the proposed project:
The purpose of this wetland, stream and buffer impact permit and authorization is for minor wetland fill associated with the fill of
3e. Describe the overall project in detail, including the type of equipment to be used:
Proposed building construction and associated grading will require minor wetland, stream and buffer impacts. Equipment will include backhoe and trud
4.
Jurisdictional Determinations
4a.
Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (includingall prior phases)in the past?
0 Yes ❑ No ❑ Unknown
Comments:
4b.
If the Corps made the jurisdictional determination, what type
of determination was made?
❑l Preliminary ❑ Final
4c.
If yes, who delineated the jurisdictional areas?
Name (if known): Gary Beecher - USACOE
Agency/Consultant Company. AnthonY Scarbraugh- DWR
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Mr Beecher with US ACOE issued an NW14 on July 1, 2015.
Mr Scarbraugh issued an stream determination on August 10, 2015
5.
Project History
5a.
Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
0 Yes ❑ No ❑ Unknown
5b. If yes, explain in detail according to "help file" instructions.
A NW 18 was issued by the proposed stream, wetland and buffer crossing on July 1, 2015.
6.
Future Project Plans
6a.
Is this a phased project?
❑ Yes ❑9 No
6b.
If yes, explain.
Page 3 of 10
PCN Form — Version 1.4 January 2009

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply)
❑D Wetlands ❑l Streams — tributaries ED Buffers ❑ Open Waters ❑ Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a.
Wetland impact
number
Permanent (P) or
Temporary
2b.
Type of impact
2c
Type of wetland
2d.
Forested
2e.
Type of jurisdiction
Corps (404,10) or
DWQ (401, other)
2f.
Area of
impact
(acres)
W1 P
Fill
Rivenne Swamp Forest
Yes
Corps
-075
W2 -
Choose one
Choose one
Yes/No
-
W3 -
Choose one
Choose one
Yes/No
-
W4 -
Choose one
Choose one
Yes/No
-
W5
Choose one
Choose one
Yes/No
-
W6 -
Choose one
Choose one
Yes/No
-
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.
Stream impact
number
Permanent (P) or
Temporary (T)
3b.
Type of impact
3c.
Stream name
3d.
Perennial (PER) or
intermittent (INT)?
3e.
Type of
jurisdiction
3f.
Average
stream
width
(feet)
3g.
Impact
length
(linear
feet) -
S1 P
Culvert
Ut to Cherry Run
INT
DWQ
S2 -
Choose one
-
-
S3 -
Choose one
-
-
S4 -
Choose one
-
-
S5 -
Choose one
-
-
S6 -
Choose one
-
-
3h. Total stream and tributary impacts
3i. Comments: j
Page 4 of 10
PCN Form — Version 1 4 January 2009

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.
Open water
impact number
Permanent (P) or
Temporary
4b.
Name of waterbody
(if applicable)
4c.
Type of impact
4d.
Waterbody
type
4e.
Area of impact (acres)
01 -
Choose one
Choose
O2 -
Choose one
Choose
03 -
Choose one
Choose
04 -
Choose one
Choose
4f. Total open water impacts
4g. Comments:
S. Pond or Lake Construction
If pond or lake construction proposed, the complete the chart below.
5a.
Pond ID number
5b.
Proposed use or
purpose of pond
5c.
Wetland Impacts (acres)
5d.
Stream Impacts (feet)
5e.
Upland
(acres)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
P1
Choose one
P2
Choose one
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 vou MUST fill out Section D of this form.
6a. Project is in which protected basin?
❑ Neuse ❑ Tar -Pamlico ❑ Catawba ❑ Randleman ❑ Other
6b.
Buffer Impact
number —
Permanent (P) or
Temporary
6c.
Reason for impact
6d.
Stream name
6e.
Buffer
mitigation
required?
6f.
Zone 1
impact
(square
feet)
6g.
Zone 2
impact
(square
feet)4\
B1 P
Access Road
Ut to Cherry Run
No
133�
B2 -
Yes/No
B3 -
Yes/No
B4 -
Yes/No
B5 -
Yes/No
B6 -
Yes/No
6h. Total Buffer Impacts:
6i. Comments:
Page 5 of 10

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
The crossing is the minimum needed to access the adjacent property.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Silt fencing to be maintained until disturbed area is stabilized with grass. Fill will be sloped and stabilized.
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
❑payment 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: Choose one
Type: Choose one
Type: Choose one
Quantity:
Quantity:
Quantity:
3c. Comments: I j
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:
Choose one
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 6 of 10
PCN Form — Version 1.4 January 2009

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 7 of 10

E.
Stormwater Management and Diffuse Flow Plan (required by DWQ)
1.
Diffuse Flow Plan
la
Does the project include or is it adjacent to protected riparian buffers identified
Yes ❑ No
within one of the NC Riparian Buffer Protection Rules?
1b.
If yes, then is a diffuse flow plan included? If no, explain why.
Stormwater will be runoff through the existing buffer.
❑ Yes 0 No
2.
Stormwater Management Plan
2a.
What is the overall percent imperviousness of this project?
0
2b.
Does this project require a Stormwater Management Plan?
❑ Yes ❑l 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:
2e.
Who will be responsible for the review of the Stormwater Management Plan?
3.
Certified Local Government Stormwater Review
3a.
In which localgovernment's jurisdiction is thisproject?
❑ Phase II
❑ NSW
3b.
Which of the following locally -implemented stormwater management programs
❑ USMP
apply (check all that apply).
❑ Water Supply Watershed
0 Other: 401
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
❑ORW
(check all that apply):
F] Session Law 2006-246
DOther: 401
4b.
Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑] No
attached?
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 8 of 10
PCN Form — Version 1.4 January 2009

F.
Supplementary Information
1.
Environmental Documentation (DWQ Requirement)
1 a.
Does the project involve an expenditure of public (federal/state/local) funds or the
❑ Yes ❑D 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)?
1c.
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
El Yes 0 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.
N/A
Page 9 of 10
PCN Form —Version 1.4 January 2009

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
Yes ❑ No
impacts?
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
Websde
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?
N/A
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?
Website
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?
Website
S+tPkei;\ R,TV.ba(At >\Jt4a�,N%
16
Applicant/Agent's Printed Name
Date
A plicant/Agent's Signa re
(Agent's signature is valid only if an authorization
letter from the applicant is provided
Page 10 of 10

-
°�-e-I
I�
d
k
I--
LA-
(
O!
I
l
♦
'
I
JI
l