20160464 Ver 1_More Info Received_20160701

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Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.4 January 2009
Page 1 of 10
PCN Form — Version 1.4 January 2009
Pre -Construction Notification (PCN) Form
A.
Applicant Information
1.
Processing
1 a.
Type(s) of approval sought from the Corps:
❑X Section 404 Permit ❑ Section 10 Permit
1b.
Specify Nationwide Permit (NWP) number: 39 or General Permit (GP) number:
1 c.
Has the NWP or GP number been verified by the Corps?
❑X Yes ❑ No
1 d.
Type(s) of approval sought from the DWQ (check all that apply):
X❑ 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 ❑X No
For the record only for Corps Permit:
❑ 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 bankX❑
or in -lieu fee program.
Yes ❑ No
1 g.
Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below.
❑ YesX❑ No
1 h.
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ YesX❑ No
2.
Project Information
2a.
Name of project:
AAA Self Storage
2b.
County:
Guilford
2c.
Nearest municipality / town:
Greensboro
2d.
Subdivision name:
N/A
2e.
NCDOT only, T.I.P. or state project no:
3.
Owner Information
3a.
Name(s) on Recorded Deed:
BMR Land Company, LLC
3b.
Deed Book and Page No.
Bk. 7367 p.2128
3c.
Responsible Party (for LLC if
applicable):
3d.
Street address:
Suite 200 LB&B Building, 109 South Wayne Ave.
3e.
City, state, zip:
Waynesboro, VA 22980
3f.
Telephone no.:
3g.
Fax no.:
3h.
Email address:
Page 1 of 10
PCN Form — Version 1.4 January 2009