HomeMy WebLinkAbout20160616 Ver 1_401 Application_201606161
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Form Versi 1 4 jannuQ 9nn4
Pre -Construction Notification (PCN) Form
A. Applicant Information
I. Processing
1a Type(s) of approval sought from the Corps I ❑x Section 404 Permit
1 b Specify Nationwide Permit (NWP) number. NWP20
1c. Has the NWP or GP number been verified by the Corps?
or General Permit (GP) number:
1 d. Type(s) of approval sought from the DWQ (check all that apply)
Q 401 Water Quality Certification — Regular
❑ 401 Water Quality Certification — Express
❑ Section 10 Permit
❑x Yes ❑ No
❑ Non -404 Jurisdictional General Permit
❑ Riparian Buffer Authorization
1 e. Is this notification solely for the record For the record only for DWQ
because written approval is not required? 401 Certif►cation•
❑ Yes ❑X 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.
',g. Is the project located in any of NC's twenty coastal counties If yes, answer 1h
below
1 h Is the project located within a NC DCM Area of Environmental Concern (AEC)?
2. Project Information
2a. Name of project- LIT Jones
2b. County Wilson
2c. Nearest municipality / town, Wilson
2d Subdivision name- Brentwood
2e. NCDOT only, T I P. or state project no:
3. Owner Information
3a Name(s) on Recorde=27T2.
T & Llewellyn W Jones
3b. Deed Book and Pag2, page 62
3c Responsible Party (f
applicable)
3d Street addresstwood Drive3e City, state, zip•C 278933f Telephone no595 i
3g Fax no
3h Email address Ilewellynjones@earthl►nk net
For the record only for Corps Permit
❑ Yes ❑X No
❑ Yes ❑X No
❑ YesX❑ No
❑ Yes No
JUN
Page 1 of 10
PCN Form — Version 1 4 January 2009
I
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
4g Fax no,
4h. Email address -
5. Agent/Consultant Information (if applicable)
5a. Name -
5b. Business name
(if applicable):
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
"ll. Property Identification
1a Property identification no (tax PIN or parcel ID)
1 b Site coordinates (in decimal degrees) Latitude 35 75178
Longitude -77 92579
1 C.
Property size. 05
2. Surface Waters acres
2a Name of nearest body of water to proposed project Toisnot Swamp
2b. Water quality Classification of nearest receiving water- WS-III,NSW,CA
2c River basin.
Neuse
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:
Residential lot in a residential neighborhood
3b List the total estimated acreage of all existing wetlands on the property 0
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property 100
3d. Explain the purpose of the proposed project'
Prevent flooding caused by stormwater runoff.
I
• �Describe
used overall project
detail,
lnitype of
to be used: be to place ulverts in the creek, connecting oCity of equipment
42" pipe at he back of the lot
-_ _��•�+��a� ucaermmations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property / 0 Yes ❑ No ❑Unknown
ro'ect (includingall rior hasps in the ast? Comments:
4b If the Corps made the jurisdictional determination, what type
of determination was made? ❑x Preliminary ❑x Final
4c If yes, who delineated the jurisdictional areas
Name (if knowny Eric Alsmeyer, Corps Agency/Consultant Company Corps
4d If yes, list the dates of the Corps jurisdictional determinations or State determinations and
March 16, 2016 attach documentation
5. Project History
5a. Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past? ElYes 21No
5b If yes, explain in detail according to "help file" instructions El Unknown
6. Future Project Plans
6a. Is this a phased project?
6b If yes, explain
❑ Yes ❑X No
Page 3 of 10
PCN Form — Version 1 4 January 2009
C. Proposed Impacts Inventory
�I Impacts Summary
la Which sections were completed below for your project (check all that apply)
❑ Wetlands
❑ Streams — tributaries
❑X Buffers
❑ Open Waters
❑Pond Construction
2. Wetland Impacts
impacts (including
sites impacted
temporary impacts) proposed on the
site, then com plet
e this
3a 3b
Stream impact
number
If there are wetland
impacts proposed on the site, then complete this question
for
3g
Permanent (P) or
2a.
2b.
Average
stream
2c
Temporary (T)
each wetland
area impacted
width
Wetland impact
number
S1 P
Type of impact
PER
Type of wetland
2d
Forested
2e
Type of jurisdictiona
f
Permanent (P) or
4 5
100
S3
Choose one
Corps (404,10) oract
of
F
Tem ora T
Choose one
S5
DWq (401, other)es)
W1
Choose one
Choose one
Choose one
Yes/No
31 Comments
3h Total stream and tributary impacts
Choose one
W3
Choose one
Prevent
Choose one
Yes/No
W4
Choose one
Yes/No
_
Choose one
Yes/No
W5
Choose one
Choose one
Yes/No
W6 -
Choose one
Choose one
Ye /N
s o
2h. Comments. 2g Total Wetland Impacts: 0
` 3. Stream Impacts
k if there are perennial or
intermittent stream
question for all stream
impacts (including
sites impacted
temporary impacts) proposed on the
site, then com plet
e this
3a 3b
Stream impact
number
3c.
Type of impact Stream me
na
3d
Perennial (PER) or 3e
Type of
3f
3g
Permanent (P) or
yP
intermittent (INT)? jurisdiction
Average
stream
Impact
length
Temporary (T)
width
(linear
S1 P
Culvert(feet)
UT Jones
PER
feet)
S2
Choose one
Corps
4 5
100
S3
Choose one
S4
Choose one
S5
Choose one
S6
Choose one
31 Comments
3h Total stream and tributary impacts
100
Page 4 of 10
PCN Form — Version 1 4 January 2009
�4. Open Water Impacts
r If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
,the U S then indiv ually list all open water impacts below
4a 4b 4c 4d
Open water Name of waterbody 4e
impact number (if applicable) Type of impact Waterbody Area of impact (acres)
Permanent (P) or
Tem ora T type
01 Choose one Choose
02 Choose one Choose
03 Choose one Choose
04 Choose one Choose
4g. Comments: 4f Total open water impacts
S. Pond or Lake Construction
If pond or lake construction Proposed, the complete the chart below
5a. 5b. 5c 5d
Pond ID number Proposed use or Wetland Im acts acres 5e
P ( ) Stream Impacts (feet) Upland
purpose of pond
Flooded Filled Excavated Flooded Filled Excavated (acres)
P1 Choose one
P2 Choose one
5f. Total:
6g. Comments:
5h Is a dam high hazard permit required?
Yes E] No If yes, permit ID no:
5i Expected pond surface area (acres):
5j Size of pond watershed (acres)
Sk Method of construction
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below If yes, then
below If any impacts require mitigation, then
individually list all buffer
impacts
you MUST fill out Section D of this form
6a. Project is in which protected basin?
QX Neuse E] Tar -Pamlico [] Catawba
[:] Randleman
❑ Other
6bET
6c
6d
Buffer
Reason for impact
P
Stream name
6e
6f
6g
num
Buffer
Zone 1
Zone 2
Permane
mitigation
impact
impact
Tem o
required?
(square
(square
B1 p
pipe
UT to Toisnot Swamp
No
feet
feet
B2
3,821
1,540
E33
Yes/No
64 -
Yes/No
B5 -
Yes/No
B6
Yes/No
61 Comments
Page 5 of 10
Yes/No
6h Total Buffer Impacts: 3,821 1,540
k Li. impact: austitication and Mitigation
1. Avoidance and Minimization
la Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Continued flooding issues and stream evaluation no viable alternatives
1 b Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
Use of erosion control measures and work to be done during low flow periods
2. Com ensato Mitl ation for Im acts 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 States ❑Yes X❑ No
2b. If yes, mitigation is required by (check all that apply);
❑ DWQ El Corps
2c. If yes, which mitigation option will be used for this ❑ Mitigation bank
protect? LfO
Payment to In -lieu fee program
Permittee Responsible Mitigation
3. Complete if Using a Mitl ation Bank
3a Name of Mitigation Bank:
Type- Choose one
3b Credits Purchased (attach
Quantity:
receipt and letter) Type Choose one
Quantity
JQuantity
Type Choose one
3c. Comments -
4. Complete if Making a Pa ment to In-Ileu Fee Pro ram
4a. Approval letter from in -lieu fee program is attached
❑ Yes
4b Stream mitigation requested.
4c If using stream mitigation, stream temperature Choose one linear feet
4d Buffer mitigation requested (DWQ only):
4e Riparian wetland mitigation requested,
square feet
4f. Non -riparian wetland mitigation requested
acres
4g Coastal (tidal) wetland mitigation requested
acres
4h Comments
acres
S. 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
`j. 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 ❑x 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.
6c. 6d. 6e.
Zone Reason for impact Total impact Multiplier Required mitigation
(square feet) (square feet)
Zone 1
3 (2 for Catawba)
Zone 2 1 5
—L—
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
i=
E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
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
1 b If yes, then is a diffuse flow plan included? If no, explain why
❑ Yes
2. Stormwater Management Plan
2a What Is the overall percent imperviousness of this project?
2b Does this project require a Stormwater Management Plan? ❑ Yes
2c. If this project DOES NOT require a Stormwater Management Plan, explain why
N/A
❑X No
❑ No
0 No
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 local government's junsdictlon is this oroiect?
3b Which of the following locally -implemented stormwater management programs
apply (check all that apply) -
3c. Has the approved Stormwater Management Plan with proof of approval been
attached?
4. DWQ Stormwater Pro gram Review
4a. Which of the following state -implemented stormwater management programs apply
(check all that apply):
4b Has the approved Stormwater Management Plan with proof of approval been
attached?
5. DWQ 401 Unit Stormwater Review
5a Does the Stormwater Management Plan meet the appropriate requirements?
5b Have all of the 401 Unit submittal requirements been met?
f
City of Wilson
❑ Phase II
❑ NSW
❑ USMP
❑ Water Supply Watershed
X❑ Other nia
❑ Yes ❑X No
❑Coastal counties
❑HQW
❑ORW
❑Session Law 2006-246
[]Other
❑ Yes ❑ No
[—]Yes No
❑ Yes ❑ No
Page 8 of 10
PCN Form — Version 1 4 January 2009
I�
N
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
la Does the project involve an expenditure of public (federal/state/local) funds or the
use of public (federal/state) land? ❑ Yes No
1b 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
letter )
❑Yes ❑ No
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, E] Yes OX 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
additional development, which could impact nearby downstream water quality? F[E]]Yes XQ No
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
n/a the proposed project, or available capacity of the subject facility
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
habitat' ❑ Yes ❑X No
5b Have you checked with the USFWS concerning Endangered Species Act
impacts
❑Yes ❑x No
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?
Field survey and testing
6. Essential Fish Habitat (Corps Requirement)
6a Will this project occur in or near an area designated as essential fish habitat
❑ Yes ❑X No
6b What data sources did you use to determine whether your site would Impact Essential Fish Habitat?
Field survey and testing
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 (e g , National Historic Trust designation or properties significant in ❑ Yes ❑X No
North Carolina history and archaeology)
l 7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
NC Cultural Resources Website
8. Flood Zone Designation (Corps Requirement)
8a Will this project occur in a FEMA -designated 100 -year floodplain?
8b If yes, explain how project meets FEMA requirements•
8c What source(s) did you use to make the floodplain determination?
City. County and state flood maps
Llewellyn W Jones
Applicant/Agent's Printed Name
wt�M� n,
Applicant/ gent's Signat
(Agent's signature is valid only if an aS
letter from the applicant is orov c
Page 10 of 10
❑ Yes ❑X No
ation
6/8/2016
Date
Water Resources
FNVIRONMFNTAI. QUALITY
March 16, 2016
Llewellyn Jones
403 Brentwood Drive
Wilson, NC 27897
PAT IvICCRORY
6oi error
DONALD R. VAN DER VAART
,SecretNy
S. JAY ZIMMERMAN
Director
Subject: Buffer Determination Letter
NBRRO #16-056
Wilson County
Determination Type:
Buffer
Intermittent/Perennial
® Neuse (15A NCAC 2B.0233)
Start@
❑ Tar -Pamlico (15A NCAC 2B 0259)
❑ Intermittent/Perennial Determination (where local buffer
USGS
To o
ordinances apply)
ElJordan (15A NCAC 2B .0267)
(governmental and/or interjurisdictional
Entire Properties
projects)
Project Name: 403 Brentwood Drive, Wilson NC 27897
Address/Location: 403/405 Brentwood Drive Wilson NC 27897
Stream(s): A — (Unnamed Tributary to Toisnot Swamp)
Determination Date: March 9, 2016 Staff: Jason Robinson, Cherri Smith
Stream
E/UP*
Not Subject
Subject
Start@
Stop@
Soil
Survey
USGS
To o
A
P
X
Entire Properties
X
ciur = rpnemerauintermittentIPerenniat
Explanation: The stream(s) listed above has been located on the most recent published NRCS Soil Survey of
Wilson County, North Carolina and/or the most recent copy of the USGS Topographic map at a 1:24,000 scale.
Each stream that is checked "Not Subject" has been determined to not be at least intermittent or is not present.
Streams that are checked "Subject' have been located on the property and possess characteristics that qualify it to be
at least an intermittent stream. There may be other streams located on the property that do not show up on the maps
referenced above but may be considered junsdictional according to the US Army Corps of Engineers
This on-site determination shall expire five (5) years from the date of this letter. Landowners or affected
parties that dispute a determination made by the DWR may request a determination by the Director. An
appeal request must be made within sixty (60) days of date of this letter. A request for a determination by the
Director shall be referred to the Director in writing. If sending via US Posta/ Service: c/o Karen Higgins;
D IVR — 401 Bc Buffer Permitting Unit; 1617 Mail Service Center; Raleigh, NC 27699-1617. If sending via
[)IN bion of IV,10.•r Rcsourre,, Rolelgh Re um.il Office, \Vater OW11rV 01)0,lilono SCLtlon http , portal iicdcnr or! %kch
162S \l,ul Senlc.cCenter, Ralcigll, I\C 27699-1628 Phone (ill')) 791-420
1 oc.ttlon 351)11 R mctt Drive. Raleigh. NC 2709 Fix (l)lt)) 7,0-7159
ACME Mapper 2.1 - 3.4 km N of Wilson NC Page 1 of 1
http://mapper.acme.com/ 3/1/2016
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