20170340 Ver 1_401 Application_20170317

Summey Engineering Associates, PLLC
9a Engineering • Land Planning • Consulting
PO Box 968 - Asheboro, NC 27204
[phone] / Fax: [phone] / [e-mail]
TRANSMITTAL
Date: March 21, 2017
To: Karen Higgins
NC DEQ - DWR - 401 & Buffer Permitting
Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
We are sending you attached the following items:
❑ Shop Drawings ❑ Samples
❑ Prints ❑ Specifications
® Plans ❑ Disk
170340
Town of Scotland Neck
Scotland Neck Assisted Living
Water & Sewer Extension
SEA Job No. E-3699
❑ Copy of Letter
❑ Other
# Copies]Drawing
#
Description Disposition
5 ea.
401/404 PCN Application Package For Your Review
1 Ea.
$240 Review Fee
DC(C, pbl#
D
.
14AR 2 2, 2017R1
D
lrtr­ U
Remarks
c: File
Hi Karen — heres a new project for review. Please let me know if anything further is
needed.
Thanks!
H. Mack Summey, Jr.
By: n od�
H. Mack Summey, Jr.

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
1a.
Type(s) of approval sought from the Corps:X❑
Section 404 Permit ❑ Section 10 Permit
1 b.
Specify Nationwide Permit (NWP) number: or General Permit (GP) number: 12
_F
1c.
Has the NWP or GP number been verified by the Corps?
❑ Yes ❑X 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
1e.
Is this notification solely for the record
because written approval is not required?
For the record only for DWQ
401 Certification:
❑X Yes ❑ N
For the record only for Corps Permit:
X❑ 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 ❑X No
1 g.
Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below.
NX Yes ❑ No
1 h.
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes ❑X No
2.
Project Information
2a.
Name of project:
Scotland Neck Assisted Living Facility Water & Sewer Extension
2b.
County:
Halifax
2c.
Nearest municipality / town:
Town of Scotland Neck
2d.
Subdivision name:
N/A
2e.
NCDOT only, T.I.P. or state project no:
3.
3a.
Owner Information
Name(s) on Recorded Deed: Halifax Propco Holdings, LLC
3b.
Deed Book and Page No.
DB2489 Pg. 92 ;y1�
3c.
Responsible Party (for LLC if
applicable):
Ms. Nancy Jackson
p _
PO Box 537 - 1310 Main Street $ FF R P S
Scotland Neck NC 27874
3d.
Street address:
3e.
City, state, zip:
3f.
Telephone no.:
252-826-3152
3g.
Fax no.:
242-826-2107
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.:
4g.
Fax no.:
4h.
Email address:
5.
Agent/Consultant Information (if applicable)
5a.
Name:
H. Mack Summey, Jr.
5b.
Business name
(if applicable):
Summey Engineering Associates, PLLC
5c.
Street address:
PO Box 968
5d.
City, state, zip:
Asheboro NC 27204
5e. Telephone no.:
336-328-0902
5f.
Fax no.:
336-328-0922
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):
4866-12-85-8319
1 b.
Site coordinates (in decimal degrees):
ILatitude: 36.116 Longitude: 77.417951
1 c.
Property size:
21.21 acres
2.
Surface Waters
2a.
Name of nearest body of water to proposed project:
unnamed Tributary to Tar River
2b.
Water Quality Classification of nearest receiving water:
C
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:
Area around proposed site is mostly (75%) farmland, (5%) woodland & (20%) residential areas.
3b.
List the total estimated acreage of all existing wetlands on the property: 0.749
3c.
List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 1,550
3d.
Explain the purpose of the proposed project:
Project includes extension of public Water & Sewer to an Assisted Living Care Facility by the Town of Scotland Neck.
3e. Describe the overall project in detail, including the type of equipment to be used:
Includes 6" PVC SDR -21 Water Line & Sewer line crossing consists of installation of 8" ductile iron pipe. Installation will be by track hoe.
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?
❑ Yes ❑ No ❑X Unknown
Comments: wetlands have been flagged
4b.
If the Corps made the jurisdictional determination, what type
of determination was made?
❑ Preliminary ❑ Final
4c.
If yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company: wetland Solutions, LLC
Other:
4d.
If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5.
Project History
5a.
Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
❑ Yes ❑X No ❑ Unknown
5b.
If yes, explain in detail according to "help file" instructions.
6.
Future Project Plans
6a.
Is this a phased project?
❑ Yes Q 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):
❑X Wetlands ❑X 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.
2.
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
Choose one
Choose one
Yes/No
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:
Impacts include construction of an 8" Ductile Iron Aerial Sewer line. Stream Banks will be disturbed but will be restored with like plantings after sewer
line has been installed.
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
Aerial Sewer Crossing
UT To Tar River
PER
Corps
6
2
S2 T
underground Water Line
UT To Tar River
PER
Corps
6
4
S3 -
Choose one
-
S4 -
Choose one
-
S5 -
Choose one
-
S6 -
Choose one
-
-
3h. Total stream and tributary impacts
6
3i. Comments:
Stream impacts include the installation of an aerial sewer line, stream bottom will not be affected but stream banks will. Stream banks will be restored
with like plantings. Aerial Crossing of sewer will provide minimal impacts to stream, critters can still go under aerial sewer line. Also includes
installation of 6" PVC SDR -21 Water line. Will be underground. Sandbags and by-pass pump will be used for dry install of utilities. Stream restored.
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 indiv* ually list all open water impacts below.
4a.
Open water
impact number
Permanent (P) or
Temporary T
4b.
Name of waterbody
(if applicable)
4c.
Type of impact
4d.
Waterbody
type
4e.
Area of impact (acres)
01
Choose one
Choose
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, 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 you 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 T
6c.
Reason for impact
6d.
Stream name
6e.
Buffer
mitigation
required?
6f.
Zone 1
impact
(square
feet)
6g.
Zone 2
impact
(square
feet
B1 -
Yes/No
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
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Aerial sewer crossing utilized due to depth of sanitary sewer which eliminated major impact to stream bed. Took most direct route to existing
sewer. No other options available.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
An aerial pipe will be installed although during construction a bypass (pumped) will be constructed to help prevent erosion to the stream banks
that will be disturbed during the installation.
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 ❑X 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
El 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:
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 Q 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
1a.
Does the project include or is it adjacent to protected riparian buffers identified
❑X Yes ❑ No
within one of the NC Riparian Buffer Protection Rules?
1 b.
If yes, then is a diffuse flow plan included? If no, explain why.
Flows will be dispersed long before they reach the stream by a rip rap outlet pad.
Q Yes ❑ No
2.
Stormwater Management Plan
2a.
What is the overall percent imperviousness of this project?
11.9%
2b.
Does this project require a Stormwater Management Plan?
❑ Yes ❑X No
2c.
If this project DOES NOT require a Stormwater Management Plan, explain why:
Project impervious area is less than 12%.
2d.
If this project DOES require a Stormwater Management Plan, then provide a brief, narrative
description of the plan:
N/A
2e.
Who will be responsible for the review of the Stormwater Management Plan?
Town of Scotland Neck
3.
Certified Local Government Stormwater Review
3a.
In which localgovernment's jurisdiction is thisproject?
Town of Scotland Neck
❑X Phase II
❑ NSW
3b.
Which of the following locally -implemented stormwater management programs
❑ USMP
apply (check all that apply):
❑ Water Supply Watershed
❑ Other:
3c.
Has the approved Stormwater Management Plan with proof of approval been
El Yes ❑X 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):
❑Session Law 2006-246
❑Other:
4b.
Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑X No
attached?
5.
DWQ 401 Unit Stormwater Review
5a.
Does the Stormwater Management Plan meet the appropriate requirements?
❑X Yes ❑ No
5b.
Have all of the 401 Unit submittal requirements been met?
❑X 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 ❑X 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 ❑X 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
❑ Yes ❑X 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 ❑X No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b.
Is this an after -the -fact permit application?
El Yes Q 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 Q 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.
All wastewater will be directed to a utility for disposal.
public
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.
-
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
The USFWS webside search engine
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?
NOAA Habitat Conservation Webside
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?
NC Listings in the National Register of Historic Places as of 3/7/17
8. Flood Zone Designation (Corps Requirement)
-T-
8a. Will this project occur in a FEMA -designated 100 -year floodplain?
❑ Yes m No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?
NC Flood Maps
//eLVIal AAwO
Applicant/Agent's Signature
Applicant/Agent's Printed Name
Date
(Agent's signature is valid only if an authorization
letter from the applicant isprovided.)
Page 10 of 10

W-
py
Project Name: Scotland Neck
Location: Halifax County, NC
P.O. Box 244 Property ID: 4866-12-85-8319
RiinnIP.vP.I NC. Map Title- Wetland Delineation
'
28
25
..
2.1 22
4n ,AT
'&F_' — ^--
Legend
� �
��» Scotian d_Neok_PameiVVost
o Scotland Neck Flags
Wetland Lines
�~~--- A8 Line
r
----' CLine
O Line
r
-----ELine
G Line
------ J Line
KLine
U�
E ��.
�
U�r��^ | ����V|
1inch=O
S 0.03 miles
O 100 200 3OOFeet |
| 75July 2016
1 1 1 1 .

s
t h',
•
w
*,
116
M Gya�� � M; • ti` ,,
Yi
x �- � ,�'1� �': � .•' • • �. � 1 fav .['� " 1�
v X� �( • it
' _. .aF - y ..l � fir• • • .'.�. -
1
`' 7„i't !'tiY 'a. t . • ti. � ,t,• a '• r a` 1
•
r• .,• ,
s ,
`-tr yti
.��0�9q�)�y��I�,��fU,r(�JAalrr�s',n

Legend
a
��
��8� Scotland _Nook_PorooLVVoo
SoilMapUnits
BaA 'Be1hera loam, O to 1 percent o|opoo
EmB ' Emporia fine loamy sand, 2 t 0 percent slopes
[--�
GoA' Goldsboro fine sandy loam, 0 to 2 percent slopes
�_-
| � Gy132 ' Gritneysandy clay loam, 2 t 8 percent slopes, moderately eroded
�~
LyA - Lynchburg fine sandy loam, 0 to 2 percent slopes, Southern Coastal Plain
!-----
t4' ! NoA' Nob000 fine sandy loam, 0 to 2 percent slopes
`
Project Name: Scotland Neck NX, s Figure:
2
^� LOC@t\OO���@lif@X(�OUnh/,��(�
Property 4866-12-85-8319 s 1 inch =0.05 miles
P.O.Box 244 � Map Title: NRCS Soil MGD 0 100 200 300 Feet | 25July 2016
" o�nq���g�

-Hirg Sch
41
14
fland Nee
'10/
.9
4 •
V, 4'a
k ZZ
J
ad to Tower e
BOLUT10N8 LLC
P.O. Box 244
RiinnIP.vP.I N('
IR
Ce11
Copyright:© 2013 National - eographic Society;
Project Name: Scotland Neck 0 500 1,000 1,500 2,000 Feet Figure: 3
Location: Halifax County, NC I I I I I
N
Property ID: 4866-12-85-83191 inch= 0.19 miles
*
Map Title: USGS 7.5 -Minute Topo; Hobgood Quadrangle WE
25 July 2016
—I
cl�l
v
xtbukee Ch
Legend
Scotland—Neck—Parcel—West

SOLUTIONS LLC
P.O. Box 244
Riinnlaval Nr:2R1?.1
Legend
Scotland-Neck-Parcel—West
Contour at 100 feet
Interval
Op — 100
500
- Contour at 20 feet
a Contour at 4 feet
Contour at 2 feet
Project Name: Scotland Neck
Location: Halifax County, NC
Property ID: 4866-12-85-8319
Map Title: NRCS Soil Map
f�
0 100 200 300 Feet
I I I I
S
Figure: 4
1 inch = 0.05 miles
25 July 2016

Cf)
OHE-
< oHE
UE y 0
Z
3� < t mo
OHE
3- HAWLEY PITTMAN, JW
ANNIE PITTMAN �
a& ism Pa Zle
ppmm 0 omm
0 1-
0
ow MARY JENE DAY
MADISON DAY
nft 090
o
Ei
Lo^ &AV I@ -I.-
ONKES Cl
GLORIA G. N 00-
D.B.21mmw Z-
3: psmeowim 8ta
Z
NKES
GLORIA G. NO
DX MA P& 471 0
psm000mm
0
Mwz&v� m
2 0 0
fl
WF
0
— GLORIA P. BATTS
T pAr4apoW40
4
WF
JAMES C. WIGGINS o'
LENDO M. WIGGINS
MM006MM
0/y�
I
F"
9
WWW WMW MFIA
mm
w
JAMES C. WIGGINS
LENDO M. WIGGINS
DJL 21K PM 8
PARMOOMM
01
0,
c (4

1. OBTAIN PLAN APPROVAL FROM NCDENR- LQ AND .�,_L
OTHER APPLICABLE PERMITS PRIOR TO STARTING F-?OJECT.
2. INSTALL TEMPORARY ROCK CHECK DAM IN STREAM 3ELOW PROPOSED RIP -RAP DAM LOCATION,
3. INSTALL TWO(2) CLASS 1 RIP -RAP DAMS WITH PCNL "ETHYLENE FABRIC ON THE FAclE TO HOLD WATER.
(ONE ON EACH SIDE OF PROPOSED CONSTRUCTION AREA ) SEE DETAIL
4. BEGIN A BYPASS PUMPING OPERATION FROM THE L:ISTREAM SIDE TO THE DOOM STREAM SIDE.
5. INSTALL WATER AND SANITARY SEWER MAINS
6. WHEN INSTALLATION IS COMPLETED STABILIZE ALL ESTURBED AREAS AND REMOVE BYPASS PUMP
AND RIP -RAP DAMS.
96/ STORAGE � � `\
I
SECTION
DETAIL FOR BYPASS PUMP AROUND
NO SCALE
I
rGRATE
GRATE
INV 9 -r -
TRANSFORMER
z :3
0 0
rz
dz k^
z
s
8 U
toll
uJ
Z Z
0
:z
„®
.........
Sheet No,
of