20150676 Ver 2_More Info Received_20160615

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Corps action ID no.
DWQ project no.
MCEV MODEWWWR Form Version 1.4 January 2009
Page 1 of 10
PCN Form —Version 1.4 January 2009
Pre-ConstructiodUMO16ft Mon (PCN) Form
A.
Applicant Information y," . ty Rggln'nit
r,
1.
Processing N+:z,:,,;:y or Fagio ci O,a;c3
la.
Type(s) of approval sought from the Corps:
jg Section 404 Permit ❑ Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number: 14 or General Permit (GP) number:
1 c.
Has the NWP or GP number been verified by the Corps?
[] Yes ❑ No
1d.
Type(s) of approval sought from the DWQ (check all that apply):
® 401 Water Quality Certification — Regular ❑ Non -404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express 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 M No
For the record only for Corps Permit:
❑ Yes 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 No
1g.
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 No
2.
Project Information
2a.
Name of project:
Stephen Tubaugh Farm
2b.
County:
Beaufort
2c.
Nearest municipality / town:
Washington
2d.
Subdivision name:
N/A
2e.
NCDOT only, T.I.P. or state project no:
3.
3a.
Owner Information
Name(s) on Recorded Deed: Stephen R. Tubaugh
3b.
Deed Book and Page No.
1424/476 MN
3c. Responsible Party (for LLC if
applicable):
3d. Street address:
I
1545 Wares Chapel Lane a Duality sl
3e.
City, state, zip:
tonalRegi
Washington, NC 27889 hington Regional Office
3f.
Telephone no.:
[phone]
3g.
Fax no.:
[phone]
3h.
Email address:
I [e-mail]
Page 1 of 10
PCN Form —Version 1.4 January 2009

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B.
Project Information and Prior Project History
1.
Property Identification
1a.
Property identification no. (tax PIN or parcel ID):
1b.
Site coordinates (in decimal degrees):
I 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
O
4.
Jurisdictional Determinations
4a.
Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
roiect (includingall prior phases)in the past?
Q Yes ❑ No ❑ Unknown
Comments:
4b.
If the Corps made the jurisdictional determination, what type
of determination was made?
0 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?
ED Yes El 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 ❑l No
6b.
If yes, explain.
Page 3 of 10
PCN Form - Version 1.4 January 2009

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4. Open Water Impacts
If there are proposed impacts to takes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list all open water impacts below.
4s.
4b.
4c.
4d.
4e.
Open water
impact number
Name of waterbody
(if applicable)
Type of impact
Waterbody
Area of impact (acres)
Permanent(P)or
type
Tem ora
01 -
Choose one
Choose
02 -
Choose one
Choose
03 -
Choose one
Choose
04 -
Choose one
Choose
4f. Total openwater impacts
49. Comments:
S. Pond or Lake Construction
If pond or lake construction proposed. the complete the chart below.
5a.
5b.
5c.
5d.
5e:
Pond ID number
Proposed use or
Wetland Impacts (acres)
Stream Impacts (feet)
Upland
purpose of pond
(acres)
Flooded
Filled
Excavated
Flooded I Filled
Excavated
P1
Choose one
P2
Choose one
5f. Total:
59. Comments:
Sh. 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:
G. 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.
6c.
6d:
6e.
6f,
6g.
Buffer Impact
Reason for impact
Stream name
Buffer
Zone 1
Zone 2
number—
mitigation
impact
impact
Permanent (P) or
required?
(square
(square
`
Temporary
feet) -A
feet
B1 P
Access Road
Ut to Cherry Run
No
q Q 0S
u
62
Ye"o
B3
Yes/No
B4 -
Yes/No
B5 -
Yes/No
B6 -
Yes/No
6h. Total Buffer Impacts::
6i. Comments:
Page 5 of 10

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6a. Will the project result in an impact within a protected riparian buffer that requires
Yes © No
buffer mitigation?
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
Multiplier
6e.
Required mitigation
(square feet)
(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

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F. Supplementary information
1.
Environmental Documentation (DWQ Requirement)
1a.
Does the project involve an expenditure of public (federal/statellocal) funds or the
❑ Yes
Q No
use of public (federal/state) land?
1b.
If you answered "yes" to the above, does the project require preparation of an
❑Yes
❑ No
environmental document pursuant to the requirements of the National or State
(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
❑Yes
No
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards,
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
M 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.
NSA
Page 9 of 10
PCN Form — Version 1.4 January 2009

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