20170574 Ver 1_More Info Received_20170718

Homewood, Sue
From: Hugh Creed Associates, Inc, <[e-mail]>
Sent: Tuesday, July 18, 2017 2:46 PM
To: Bailey, David E CIV USARMY CESAW (US); Homewood, Sue
Subject: Re: [Non-DoD Source] Re: Shiloh subdivision PCN, Guilford County; SAW -2017-00979
(UNCLASSIFIED)
Attachments: Shiloh Subdivision PCN 2017-07-18.pdf, Shiloh Subdivision Plans 2017-07-18.pdf
David and Sue,
Attached are the revised PCN and plans with the requested revisions for review and approval.
Thank you,
Norris Z. Clayton
Hugh Creed Associates Inc., P.A.
1306 W. Wendover Ave.
Greensboro, NC 28408
Tele: 336-275-9826
Fax: [phone]
On 7/17/2017 11:26 AM, Homewood, Sue wrote:
Please see attached.
Thanks,
Sue Homewood
Division of Water Resources, Winston Salem Regional Office
Department of Environmental Quality
336 776 9693 office
336 813 1863 mobile
Sue. Homewood(cDncdenr.aov
450 W. Hanes Mill Rd, Suite 300
Winston Salem NC 27105
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
From: Bailey, David E CIV USARMY CESAW (US) [mailto:[e-mail]]
Sent: Monday, July 03, 2017 3:27 PM
To: Hugh Creed Associates, Inc, <hca@triad biz.rr.com>
Cc: Joe Gonzales <[e-mail]>; Homewood, Sue <[e-mail]>
Subject: RE: [Non-DoD Source] Re: Shiloh subdivision PCN, Guilford County; SAW -2017-00979 (UNCLASSIFIED)
CLASSIFICATION: UNCLASSIFIED
Thank you for the revised information, Norris. Based on my review, please address the following:
1) Neither Plan Sheets 1 or 2 show the wetlands or additional streams as delineated by Pilot Environmental.
Please update both plan sheets accordingly;
2) The 54" RCP stream crossing appears to also cross wetland areas, according to Pilot's delineation. Please
calculate wetland impacts for this crossing and update the PCN and plans accordingly;

3) The graphic scale on Plan Sheet 2 appears to be incorrect, as impacts are at least double those reported
on the PCN based on manual scaling. If, on the other hand, the scale is correct, please update the PCN
with the correct impacts.
Please submit the requested information above (via e-mail is fine) within 30 days of receipt of this Notification,
otherwise we may deny verification of the use of the Nationwide Permit or consider your application withdrawn
and close the file.
Please let me know if you have any questions.
-Dave Bailey
David E. Bailey, PWS
Regulatory Project Manager
US Army Corps of Engineers
CE -SAW -RG -R
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
Phone: [phone], Ext. 30.
Fax: [phone]
Email: [e-mail]
We would appreciate your feedback on how we are performing our duties. Our automated Customer Service
Survey is located at: http://corpsmapu.usace.army.mil/cm apex/f?p=136:4:0
Thank you for taking the time to visit this site and complete the survey.
-----Original Message -----
From: Hugh Creed Associates, Inc, [mailto:[e-mail]]
Sent: Monday, June 19, 2017 9:45 AM
To: Bailey, David E CIV USARMY CESAW (US)<[e-mail]>
Cc: Joe Gonzales <[e-mail]>; 'Homewood, Sue' <[e-mail]>
Subject: [Non-DoD Source] Re: Shiloh subdivision PCN, Guilford County; SAW -2017-00979
Mr. Bailey,
Attached are the revisions to the PCN with additional information as requested by you and Ms. Homewood for
review and approval. Please let us know if you need any additional information.
Thank you,
Norris Z. Clayton
Hugh Creed Associates Inc., P.A.
1306 W. Wendover Ave.
Greensboro, NC 28408
Tele: 336-275-9826
Fax: [phone]
On 5/23/2017 3:09 PM, Bailey, David E CIV USARMY CESAW (US) wrote:
Messrs. Clayton and Gonzales,
Thank you for your PCN and attached information, dated 5/5/2017 (received 5/8/2017), for the above
referenced project. I have reviewed the information and need clarification before proceeding with verifying the
use of Nationwide Permit 29 (Blockedhttp://saw-reg.usace.army.mil/NWP2017/2017NWP29.pdf). Please submit

00
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`` � SHOA I N� STREAM CROSS I NC LOCATIONS
SHILOH
OAK RIDC7E TOWNIIP ROAD
COUNTY
OAK RIDGE, NORTH ACROLINA
SEAL �— \ v// DATE: DEC. 13, 2016 5GALE:I"=100' o 50 ioo 20 SHEET: OF I
2 10727--
%'P� FNGINEE P�,: � \\\ \ \\ \ \\ ` \ / / // /' HUGH CREED ASSOCIATES, INC., P.A.
o, S Z. C� ° OWNER/DEVELOPER -� � / / / / CONSULTING ENGINEERS & LAND SURVEYORS
,'e,eeme n u►►°°°
STONE MINT, LLC
2Q04 LAWNDALE DRIVE P.O. BOX 9623 PHONE: [phone]
GREENSBORO, NG 27408 1306 W. WENDOVER AVE. OR [phone]
REP: MR. JOE GONZALES GREENSBORO, N.C. 27408 FAX: [phone]
JULY 8, 2017 TELE: 556-362-6584 FIRM LICENSE #C-0551 E—MAIL: HCA®TRIADBIZ.RR.COM
SITE NOTES: - CONTINUED
3.
REFERENCE: OB 7807, PG. 28G
4.
EXISTING ZONE = GU -RPD
JJ)
5.
PROPERTY IS NOT IN A DESIGNATED WATER SUPPLY WATERSHED.
u :C
6.
PARCEL #0164ci37.
Q
7.
PSLAME = PRIVATE SEWER LINE AGCESS AND MAINTENANCE
3 h.
EASEMENT TO SEPTIC, FIELD AREAS.
8.
U = UTILITY EASEMENT
y C1
d
G.
A = LOT # FOR OFF-SITE SEPTIC FIELD EASEMENT
V
OAK RIDC7E TOWNIIP ROAD
COUNTY
OAK RIDGE, NORTH ACROLINA
SEAL �— \ v// DATE: DEC. 13, 2016 5GALE:I"=100' o 50 ioo 20 SHEET: OF I
2 10727--
%'P� FNGINEE P�,: � \\\ \ \\ \ \\ ` \ / / // /' HUGH CREED ASSOCIATES, INC., P.A.
o, S Z. C� ° OWNER/DEVELOPER -� � / / / / CONSULTING ENGINEERS & LAND SURVEYORS
,'e,eeme n u►►°°°
STONE MINT, LLC
2Q04 LAWNDALE DRIVE P.O. BOX 9623 PHONE: [phone]
GREENSBORO, NG 27408 1306 W. WENDOVER AVE. OR [phone]
REP: MR. JOE GONZALES GREENSBORO, N.C. 27408 FAX: [phone]
JULY 8, 2017 TELE: 556-362-6584 FIRM LICENSE #C-0551 E—MAIL: HCA®TRIADBIZ.RR.COM

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SCALE:
I" = 40' HOR
I" = 4' VERT
84 L.F STREAM IM AP G_ // /// � � , DRP.IDlFiELD
/ — SUPPLY L I NE54&)
51 LF 54" RGP
28 LF RIP -RAP
—-5'__c'ON5T�01 ST
16 —
RIP -RAP OUTLET
PIPE Ih
�I2 ''RGP A 4'1 LF B�NV
28'LxGHAN. WIDTH' 24" DEEP 42" RGP
D5�10" 5 IIP -RAP \ 80q.1
I
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ENSURE ALL MATERIALS ARE ON—
cn Q
ch
,q6 L.F STREAM IMPAGT
ULi
DRAINFIELD \
I
SUPPLY LINES (ICj)
55 _CF -54 -BGP /
MINIMUM OF FIVE DAYS AFTER ANY
` — _
36 LF RIP -RAP
/
0
5' CONST. DIST
INSTALLATION BEGINS. TOTAL
WETLANDS IMPAC)
- /
TEMP.
0.08 AGRE5 _ —
STONE 2
RIP—RAP DAM
INSTALL SANDBAGS TO DEWATER
OUTLET
CONSTRUCTION AREA.
3.
INSTALL PUMP AND DEWATERING
L.F
\
WETLANDS
41 RG
i
i INV. �
EXISTING STREAMBED LEVEL.
IN
X02. 1
AND FILTER FABRIC.
5.
BEGIN PUMPING AND CONTINUE
PUMPING DURING STORM DRAIN
INSTALLATION.
6.
i
ii
RIP -RAP OUTLET _
i i i
i' i 7 \y
PIPE 17 --�
54" ROP
-_
i' 3�,
36'xGHAN. WI0THx24" DEEP
050--tCPr_GLA55 I RI P
—
DIVERT FLOW THROUGH STORM
DRAIN PIPE. SPREAD OUT STONE
DAM KEEPING RIP—RAP OUTLET
LEVEL WITH EXISTING
SCALE:
I" = 40' HOR
I" = 4' VERT
84 L.F STREAM IM AP G_ // /// � � , DRP.IDlFiELD
/ — SUPPLY L I NE54&)
51 LF 54" RGP
28 LF RIP -RAP
—-5'__c'ON5T�01 ST
16 —
RIP -RAP OUTLET
PIPE Ih
�I2 ''RGP A 4'1 LF B�NV
28'LxGHAN. WIDTH' 24" DEEP 42" RGP
D5�10" 5 IIP -RAP \ 80q.1
m
' BELow
2„
N
STREAM
FLOW
INSTALL SANDBAGS
TO STOP FLOW
GONTRAGTOR 15 TO
NOTIFY EROSION
CONTROL INSPEGTOR
BEFORE ANY STREAM
DISTURBANGE OGGURS.
SANDBAGS
INLET PIPE
DEWATERING
PIPE
PUMP
- FLOW DEWA,TERIN PIPE
.►M SWO ::
J
Li
I
1.
J
Q
w
cn
CD
ENSURE ALL MATERIALS ARE ON—
cn Q
ch
Li
ULi
U C�
C)
MINIMUM OF FIVE DAYS AFTER ANY
FLOW
RAIN EVENT AND NO FORECAST OF
0
INSTALLATION BEGINS. TOTAL
INSTALLATION TIME SHOULD BE LESS
TEMP.
THAN EIGHT HOURS.
STONE 2
RIP—RAP DAM
INSTALL SANDBAGS TO DEWATER
OUTLET
CONSTRUCTION AREA.
3.
INSTALL PUMP AND DEWATERING
LINES.
4.
CUT OUT STREAMBED AND INSTALL
RIP—RAP OUTLET WITH TOP AT
EXISTING STREAMBED LEVEL.
INSTALL TEMPORARY STONE DAM
AND FILTER FABRIC.
5.
BEGIN PUMPING AND CONTINUE
PUMPING DURING STORM DRAIN
INSTALLATION.
6.
CUT DITCH FOR STORM DRAIN PIPE
WITH BACKHOE. LAY STORM DRAIN
PIPE ONE FOOT BELOW STREAMBED
AND INSTALL ENDWALL.
7.
IMMEDIATELY REMOVE SANDBAGS TO
DIVERT FLOW THROUGH STORM
DRAIN PIPE. SPREAD OUT STONE
DAM KEEPING RIP—RAP OUTLET
LEVEL WITH EXISTING
STREAMBEAD.
8.
SEED CONSTRUCTION SITE AS NEEDED.
HIIIIIIIIIIIIIIIIIIIN
mmmmm
mmommmmmmmmiFmmm
Immom
`lamomm
mmommmmmmmmm
mmmlemm]ummlqklmummm
mmmmm
m
' BELow
2„
N
STREAM
FLOW
INSTALL SANDBAGS
TO STOP FLOW
GONTRAGTOR 15 TO
NOTIFY EROSION
CONTROL INSPEGTOR
BEFORE ANY STREAM
DISTURBANGE OGGURS.
SANDBAGS
INLET PIPE
DEWATERING
PIPE
PUMP
- FLOW DEWA,TERIN PIPE
.►M SWO ::
J
Li
I
1.
J
Q
w
cn
CD
ENSURE ALL MATERIALS ARE ON—
cn Q
ch
Li
ULi
U C�
C)
MINIMUM OF FIVE DAYS AFTER ANY
FLOW
RAIN EVENT AND NO FORECAST OF
0
w
PLAN VIEW
MP
TEMP.-
STONE
EMP.-
STONE
DEWATERING PIPE DAM
STORM DRAIN
SIDE VIEW
TEMPORAR`r STREAM
GROSSINO FOR
STORM DRAIN INSTALLATION
NO SCALE
I I I CAR `C
I+00 0+00 1500 50
��=o��oFEssioti9 ��'
" R 5 E CR0551I+ +00 EAL
10727
" R SE R S I Cl N � �',� FNL� ��
4 ,
Z.
OWNER/DEVELOPER
STONE MINT, LLG
2gO4 LAWNDALE DRIVE
GREENSBORO, NG 2-7408
REP: MR. JOE GONZALES
I I I I I I I I TELE: 336-362-6584 JULY 18, 2017
STREAM GROSS I NC S
PROFILES ANi7 r:)ETA I LS
SH I LOH
"151"1 HAPPY HILL ROAD
OAK RIDGE TOWN5HIP, GUILFORD COUNTY
OAK RIDGE, NORTH ACROLINA
DATE: MAY 2, 2017 SCALE: NOTED ° SHEET: 2 OF 2
HUGH CREED ASSOCIATES, INC., P.A.
CONSULTING ENGINEERS & LAND SURVEYORS
P.O. BOX 9623
1306 W. WENDOVER AVE.
GREENSBORO, N.C. 27408
FIRM LICENSE #C-0551
PHONE: [phone]
OR [phone]
FAX: [phone]
E-MAIL: HCA®TRIADBIZ.RR.COM
NOTES:
1.
PRIOR TO INSTALLATION OF
SANDBAGS, CONTRACTOR TO
ENSURE ALL MATERIALS ARE ON—
SITE AND READY FOR INSTALLATION.
WEATHER CONDITIONS SHOULD BE A
STREAM
MINIMUM OF FIVE DAYS AFTER ANY
FLOW
RAIN EVENT AND NO FORECAST OF
RAIN FOR 48—HOURS AFTER
INSTALLATION BEGINS. TOTAL
INSTALLATION TIME SHOULD BE LESS
TEMP.
THAN EIGHT HOURS.
STONE 2
RIP—RAP DAM
INSTALL SANDBAGS TO DEWATER
OUTLET
CONSTRUCTION AREA.
3.
INSTALL PUMP AND DEWATERING
LINES.
4.
CUT OUT STREAMBED AND INSTALL
RIP—RAP OUTLET WITH TOP AT
EXISTING STREAMBED LEVEL.
INSTALL TEMPORARY STONE DAM
AND FILTER FABRIC.
5.
BEGIN PUMPING AND CONTINUE
PUMPING DURING STORM DRAIN
INSTALLATION.
6.
CUT DITCH FOR STORM DRAIN PIPE
WITH BACKHOE. LAY STORM DRAIN
PIPE ONE FOOT BELOW STREAMBED
AND INSTALL ENDWALL.
7.
IMMEDIATELY REMOVE SANDBAGS TO
DIVERT FLOW THROUGH STORM
DRAIN PIPE. SPREAD OUT STONE
DAM KEEPING RIP—RAP OUTLET
LEVEL WITH EXISTING
STREAMBEAD.
8.
SEED CONSTRUCTION SITE AS NEEDED.
STORM DRAIN
SIDE VIEW
TEMPORAR`r STREAM
GROSSINO FOR
STORM DRAIN INSTALLATION
NO SCALE
I I I CAR `C
I+00 0+00 1500 50
��=o��oFEssioti9 ��'
" R 5 E CR0551I+ +00 EAL
10727
" R SE R S I Cl N � �',� FNL� ��
4 ,
Z.
OWNER/DEVELOPER
STONE MINT, LLG
2gO4 LAWNDALE DRIVE
GREENSBORO, NG 2-7408
REP: MR. JOE GONZALES
I I I I I I I I TELE: 336-362-6584 JULY 18, 2017
STREAM GROSS I NC S
PROFILES ANi7 r:)ETA I LS
SH I LOH
"151"1 HAPPY HILL ROAD
OAK RIDGE TOWN5HIP, GUILFORD COUNTY
OAK RIDGE, NORTH ACROLINA
DATE: MAY 2, 2017 SCALE: NOTED ° SHEET: 2 OF 2
HUGH CREED ASSOCIATES, INC., P.A.
CONSULTING ENGINEERS & LAND SURVEYORS
P.O. BOX 9623
1306 W. WENDOVER AVE.
GREENSBORO, N.C. 27408
FIRM LICENSE #C-0551
PHONE: [phone]
OR [phone]
FAX: [phone]
E-MAIL: HCA®TRIADBIZ.RR.COM

E3 0� VJA �<G
o -r
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 ❑ rmit
1 b.
Specify Nationwide Permit (NWP) number: 29 or General Permit (GP) number:
1c.
Has the NWP or GP number been verified by the Corps?
❑ 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 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.
❑ Yes ❑X 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:
Shiloh Subdivision
2b.
County:
Guilford
2c.
Nearest municipality / town:
Oak Ridge
2d.
Subdivision name:
Shiloh
2e.
NCDOT only, T.I.P. or state project no:
3.
Owner Information
3a.
Name(s) on Recorded Deed:
Stone Mint, LLC
3b.
Deed Book and Page No.
DB 7807, pg. 289
3c.
Responsible Party (for LLC if
applicable):
Joe Gonzales
3d.
Street address:
2904A Lawndale Ave.
3e.
City, state, zip:
Greensboro, NC 27408
3f.
Telephone no.:
336-362-6584
3g.
Fax no.:
336-288-6181
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:
Norris Z. Clayton
5b.
Business name
(if applicable):
Hugh Creed Associates, Inc., PA
5c.
Street address:
1306 W. Wendover Ave.
5d.
City, state, zip:
Greensboro, NC 27408
5e.
Telephone no.:
336-275-9826
5f.
Fax no.:
336-275-3379
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):
PIN #6899579267
1 b.
Site coordinates (in decimal degrees):
Latitude: 36.2103 Longitude: 80.0304
1 c.
Property size:
83.65 acres
2.
Surface Waters
2a.
Name of nearest body of water to proposed project:
UT to East Belews Creek
2b.
Water Quality Classification of nearest receiving water:
B
2c.
River basin:
Dan- Roanoke
3.
Project Description
3a.
Property
Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
is vacant land, timbered 5-10+/- years ago, adjacent land is farmland and rural subdivisions
3b.
List the total estimated acreage of all existing wetlands on the property: 1.22
3c.
List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 2,585
3d.
Construction
Explain the purpose of the proposed project:
of a 63 lot rural subdivision with a community well and water system and individual septic fields
3e. Describe the overall project in detail, including the type of equipment to be used:
Clear & grade roads, install well house, water and septic lines, pump lines to septic fields, crossing creek twice. Equip. clover, track hoe & excavator
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 ❑X No ❑ Unknown
Comments:
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:
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 ❑X 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 Strea X — tributaries Buffers Open \❑ters P❑d 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
Culvert
Choose one
Yes
Corps
0.08
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:
0.08
2h. Comments:
Wetland Delineation prepared by Pilot Environmental, Inc.
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 P
Culvert
Unnamed
PER
Corps
5
55
S2 T
Rip -Rap Dissapator
Unnamed
PER
Corps
5
36
S3 T
Const. Disturbance
Unnamed
PER
Corps
5
5
S4 P
Culvert
Unnamed
PER
Corps
5
51
S5 T
Rip -Rap Dissipator
Unnamed
PER
Corps
5
28
S6 T
Const. Disturbance
Unnamed
PER
Corps
5
5
3h. Total stream and tributary impacts
172
3i. Comments:
Two stream crossings to have culverts. S1 is 51 LF 54" RCP with rip -rap outlet, and S4 is 47 LF 42" RCP with rip -rap outlet for access road crossings.
98 LF of culverts, stream lengths 106 LF, permanent impact / 64 LF rip -rap outlets, temporary impact / and 10 LF construction disturbance, temporary
Impact = Total of 180 LF stream impact
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 indivi 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
O4 -
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 Dawba C]ndleman 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
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Off-site septic areas are located across the stream from the lots. The access road and supply lines have to cross the stream. We grouped the supply
lines to the septic areas into two groups and crossed the stream with the access roads in the same crossing. We designed the crossings to be
perpendicular to the stream to minimize the impact.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Access road crossings are nearly perpendicular to the stream. Both pipes are to be buried one foot below the stream bed with the top of the rip -rap
placed at original stream bed elevation. During construction the stream will be sandbagged and pumped for dry installation to minimize steam impacts
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
❑ 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
1 a.
Does the project include or is it adjacent to protected riparian buffers identified
❑ Yes X❑ 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.
Local requirements for low density development do not require diffused flow plan
❑ Yes ❑ No
2.
Stormwater Management Plan
2a.
What is the overall percent imperviousness of this project?
7.85%
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:
Preliminary Plan was approved by the Town of Oak Ridge and Guilford County as a low density development
and a Stormwater Management Plan is
not
required.
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?
N/A
3.
Certified Local Government Stormwater Review
3a.
In which localgovernment's jurisdiction is thisproject?
Town of Oak Ridge, NC
❑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
❑ 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 ❑ No
attached?
5.
DWQ 401 Unit Stormwater Review
5a.
Does the Stormwater Management Plan meet the appropriate requirements?
❑ Yes ❑ No
5b.
Have all of the 401 Unit submittal requirements been met?
❑ 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 ❑ 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 ❑ 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,
F] Yes ❑X No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b.
Is this an after -the -fact permit application?
F1 Yes ❑X 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 ❑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.
4.
Sewage Disposal (DWQ Requirement)
4a.
Clearly detail the ultimate treatment methods and disposition (non -discharge or discharge) of wastewater generated from
the proposed prol'ect, or available capacity of the subject facility.
63
Lots with individual sub -surface systems
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 ❑x 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?
https://www.f,vs.gov/raleigh/species/cntylist/guilford.html
Please see attached
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?
http://www.habitat.noaa.gov/protection/efh/efhmapper/index.html
Please see attached
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?
NC State Historic Preservation Office website - http://hpo.ncdcr.gov/
Please see attached
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA -designated 100 -year floodplain?
❑ Yes ❑X No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?
'
UL -1 1a1a�i7
Joe Gonzales
Applicant/Agent's Printed Name
App is gent's Signature
Date
(Agent's nat r valid only if an authorization
le-$er fr the applicant isprovided.)
Page 10 of 10