20080350 Ver 3_401 Application_20170217 (2)

1-.0 Corps
WN A Q Office Use Only:
Corps action ID no.
v DWQ project no.
M
Form Version 1.4 January 2009
Pre -Construction Notification (PCN) Form
A. Applicant Information
1. Processing
1a. Type(s) of approval sought from the Corps
1 b. Specify Nationwide Permit (NWP) number: #29
1c. Has the NWP or GP number been verified by the Corps?
❑X Section 404 Permit
❑ Section 10 Permit
or General Permit (GP) number:
Q Yes
❑ No
1 d. Type(s) of approval sought from the DWQ (check all that apply):
91401 Water Quality Certification - Regular ❑ Non -404 Jurisdictional General Permit
❑ 401 Water Quality Certification - Express ❑ Riparian Buffer Authorization
1e. Is this notification solely for the record For the record only for DWQ
For the record only for Corps Permit:
because written approval is not required? 401 Certification:
❑ Yes 0 No
❑ Yes [R] 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
Q Yes ❑ No
or in -lieu fee program.
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1h
❑ Yes [X] No
below.
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes No
2. Project Information
2a. Name of project: Windsor Run
2b. County:
Mecklenburg
2c. Nearest municipality / town:
Matthews, North Carolina
2d. Subdivision name:
NA
2e. NCDOT only, T.I.P. or state project no:
3. Owner Information
3a. Name(s) on Recorded Deed:
ELP Matthews, LLC
3b. Deed Book and Page No.
Book 29150, Page 416-426
3c. Responsible Party (for LLC if
James Wilhour
applicable):
3d. Street address:
701 Maiden Choice Lane
3e. City, state, zip:
Catonsville, MD 21228
410-402-2425
3f. Telephone no.:
13g. Fax no.:
3h. Email address:
[e-mail]
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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:
MT
4f. Telephone no.:
4g. Fax no.:
4h. Email address:
5. Agent/Consultant Information (if applicable)
5a. Name:
Eric Nagy �-
5b. Business name
(if applicable):
EMH&T, Inc
5c. Street address:
5500 New Albany Road
5d. City, state, zip:
Columbus, OH 43054
5e. Telephone no.:
[phone]
5f. Fax no.:
[phone]
5g. Email address:
[e-mail]
Page 2 of 10

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
22760112
1 b. Site coordinates (in decimal degrees):
ILatitude: 35.084396 Longitude: -80.718526
1c. Property size:
83.2000000 acres
2. Surface Waters
Fourmile Creek
2a. Name of nearest body of water to proposed project:
2b. Water Quality Classification of nearest receiving water:
Fourmile Creek is classified as "C".
2c. River basin:
Catawba River Watershed
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 site is primarily composed of active construction, abandoned pasture land, and hay fields. The northwestern corner of the site is forested. One
(1) excavated pond, four (4) wetlands, and one (1) stream were located on the site. A series of electric transmission lines cross the eastern portion
of the site In a north/south orientation. The land use to the north, south, east, and west of the site is entirely residential.
3b. List the total estimated acreage of all existing wetlands on the property: 1.27000000
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 374.00000000
3d. Explain the purpose of the proposed project:
Purpose of project is to develop a senior living retirement community on the site. For more detail please see the permit application report.
3e. Describe the overall project in detail, including the type of equipment to be used:
Please see the permit application report.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the x❑ Yes ❑ No ❑ Unknown
Corps or State been requested or obtained for this property /
Comments:
oro'ect (includingall riot phases)in the past?
4b. If the Corps made the jurisdictional determination, what type ® Preliminary ❑ Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company: EMH&T, 2014
Name (if known): EMH&T (2014) & John McAdams Cc (2006) Other: John McAdams Co., 2006.
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Please see the permit application report.
5. Project History
5a. Have permits or certifications been requested or obtainedfor ❑x Yes ❑ No ElUnknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
EMH&T -Nationwide Permit #29 & Section 401 WQC In 2008. EMH&T - Nationwide Permit & Section 401 WQC In 2014. Please see application repos
6. Future Project Plans
6a. Is this a phased project? Yes ❑ No
6b. If yes, explain.
Phase I of the project is currently under construction. A Nationwide Permit and Section 401 WQC were issued in 2015 for impacts to 0.37 acre of
wetland and 35 linear feet of stream. The plans for Phase II have been modified and an additional 0.125 acre of wetland Impacts is requested.
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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):
X❑ Wetlands ® Streams — tributaries ❑ 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. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type of impact Type of wetland Forested Type of jurisdiction Area of
number Corps (404,10) or impact
Permanent (P) or DWQ (401, other) (acres)
Temporary (T)
W1 P Fill Non -Tidal Freshwater Marsh No Corps 0.27400000
W2 P
Fill
Non -Tidal Freshwater Marsh
Non -Tidal Freshwater Marsh
No
No
Corps
0.14700000
W3 P
Fill
Choose one
Corps
0.07400000
W4 J
Choose one
Yes/No
W5
Choose one
Choose one
Yes/No
W6 Choose one Choose one Yes/No
2g. Total Wetland Impacts: :1.4950000(
2h. Comments:
The applicant is requesting impacts to 0.495 acres of Wetlands A, B, and E, which includes 0.37 acre of wetland impacts that were previously
approved under a 2015 Nationwide Permit #29 & Section 401 Water Quality Certification (WQC). Based the addition of Phase II, the applicant has
requested the USACE to suspend the 2015 Nationwide Permit and reissue all Impacts under a current Nationwide Permit #29. A current Section 40
C f _�f r n 1 is rs3n1F ic_�!ct ratx,3ae}cr��Rr �. l lifinn�! �e4alY nln�rp cq_lhaJtormdf nnr.IFn�+fin X nn 4
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 (PER) or Type of Average Impact
number intermittent (INT)? jurisdiction stream length
Permanent (P) or width (linear
Temporary (T) (feet) feet)
S1 T
Sanitary Sewer Crossing
Stream 1
_
INT
Corps
4.00000000
35.00000000
S2
Choose one
S3
Choose one
S4
Choose one
S5 Choose one
S6 Choose one
3h. Total stream and tributary impacts
3i. Comments:
The applicant Is requesting a temporary Impact to 35 linear feet of Intermittent Stream 1. This Impact was previously approved under a 2015
Nationwide Permit and Section 401 WQC. The applicant has requested that the USACE suspend the 2015 Nationwide Permit and reissue all impacts
under a Nationwide Permit #29. A Section 401 WQC that encompasses all impacts is also requested. For additional detail please see the permit
nnn1ji-Minn rnnnrf
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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 im acts below.
4a.
4b. 4c.
4d.
4e.
Open water
Name of waterbody
impact number
(if applicable) Type of impact
Waterbody
Area of impact (acres)
Permanent (P) or
type
TemporaryT)
Choose one
Choose
01 -
02 -
Choose one
Choose
03
Choose one
Choose
04
Choose one
Choose
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.
Pond ID number Proposed use or Wetland Impacts (acres) Stream Impacts (feet) Upland
purpose of pond (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 you 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 T feet feet
B1 -
Yes/No
B2 -
Yes/No
B3 -
Yes/No
B4 -
Yes/No
B5
— 4- -
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.
Please see the permit application report.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Please see the permit application report.
2. Mitigation for Impacts to Waters of the U.S. or Waters of the State
_Compensatory
2a. Does the project require Compensatory Mitigation for
❑Q Yes ❑ No
impacts to Waters of the U.S. or Waters of the State?
2b. If yes, mitigation is required by (check all that apply): ❑ DWQX❑ Corps
❑ Mitigation bank
2c. If yes, which mitigation option will be used for this 0 Payment to in -lieu fee program
project?
❑ Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
Type: Choose one Quantity:
3b. Credits Purchased (attach receipt and letter) Type: Choose one Quantity:
Type: Choose one Quantity:
3c. Comments:
4. Complete if Making a Payment to In -lieu Fee Program
4a. Approval letter from in -lieu fee program is attached.
Q Yes
4b. Stream mitigation requested:
0.00000000 linear feet
4c. If using stream mitigation, stream temperature:
Choose one
4d. Buffer mitigation requested (DWQ only):
0.00000000 square feet
4e. Riparian wetland mitigation requested:
0.12500000 acres
'
4f. Non -riparian wetland mitigation requested:
0.00000000 acres
0.00000000 acres
4g. Coastal (tidal) wetland mitigation requested:
4h. Comments: Impacts to 0.37 acre of wetlands that were approved under the 2015 permitting action were mitigated using in -lieu fee.
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.
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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 Yes ❑x 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.
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
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
1a. Does the project include or is it adjacent to protected riparian buffers identified
within one of the NC Riparian Buffer Protection Rules? _—__
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
2. Stormwater Manapiement Plan
2a. What is the overall percent imperviousness of this project?
2b. Does this project require a Stormwater Management Plan?
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
❑ Yes
❑X No
❑ Yes ❑ No
40000000 %
0 Yes ❑ No
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan
The Stormwater Management Plan was approved by Mecklenburg County on November 22, 2015. This approved plan routed natural drainage
passing through the existing pond through the site's stormwater system and discharged it into Stream 1. A copy of that approved Stormwater Plan
has been included under separate cover.
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 jurisdiction is this project?
3b. Which of the following locally -implemented stormwater management programs
apply (check all that apply):
Mecklenburg County
Mecklenburg County
El Phase II
❑ NSW
HUSMP
Water Supply Watershed
E] Other:
3c. Has the approved Stormwater Management Plan with proof of approval been OYes ❑ No
attached?
4. DWQ Stormwater Program 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?
❑Coastal counties
❑HQW
❑ ORW
❑Session Law 2006-246
❑Other:
0 Yes ❑ No
0 Yes ❑ No
Q Yes ❑ No
Page 8 of 10
PCN Form — Version 1.4 January 2009
i

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1a. Does the project involve an expenditure of public (federal/state/local) funds or the
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
(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
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,
or Riparian Buffer Rules (15A NCAC 2B .0200)?
❑ Yes M No
El Yes ❑ No
❑ Yes ❑ No
❑ Yes[K] No
2b. Is this an after -the -fact permit application? ❑Yes
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)
0 No
3a. Will this project (based on past and reasonably anticipated future impacts) result in El Yes ❑X 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.
This current site development plan shows the site at full bulldout. No further expansion of the project is anticipated.
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.
Wastewater generated from the site will be directed to the sanitary sewer line proposed to be constructed as a part of this development.
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 ❑X 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. Asheville -Field Office
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
U.S. Fish & Wildlife Service's website showing federally listed specles for Mecklenburg County, NC. Please see the permit application report. FM
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat?
❑ YesX❑ No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
NOAA Essential Fish Habitat Mapper
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 ❑X 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 review of North Carolina Slate Historic Preservation Office's (NC SHPO) GIS mapping application is included in the attached application report.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA -designated 100 -year floodplain? ❑ Yes[R] No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?
FEMA Floopplain Map Panel #3710448900K
James Wilhour / ; 0 t-017
Applicant/Agent's Printed Name Applicant/Agent's Signature Date
(A ant's signature Is valid only if an authorization
letter from the applicant Isprovided.)
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