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Home My WebLink About20180167 Ver 1_401 Application_20180218�oF wAr�q �c I 1 > �Bs U 5 2018 Office Us0 1 & BUFFER PI Corps acti DWQ project no. 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: y� Section 404 Permit ❑ Section 10 Permit 1 b. Specify Nationwide Permit (NWP) number: Z or General Permit (GP) number: 1c. Has the NWP or GP number been verified by the Corps? Yes ❑ No 1d. Type(s) of approval sought from the OWQ (check all that apply): 401 Water Quality Certification - Regular ❑ Non -404 Jurisdictional General Permit ❑ 401 Water Quality Certification - Express ❑ Riparian Buffer Authorization le. Is this notification solely for the record because written approval is not required? For the record only for DWQ 401 Certification: ❑ Yes 0 No For the record only for Corps Permit: ❑ Yes gZ 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 Z No 1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1h below, ❑YesNo 1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ❑ Yes No 2. Project Information 2a. Name of project: 2b. County: r 2c. Nearest municipality / town: -id-6ubdivistoffame: C9A+-onlp, TtP-orstete-pFejeet f *.- 3. Owner Information 3a. Name(s) on Recorded Deed: L72 3b. Deed Book and Page No. 3c. Responsible Party (for LLC if applicable): 3d. Street address:' 3e. City, state, zip: o y 6 - 3f. Telephone no.:.� 3g. Fax no.: 3h. Email address: iota," mom., ' h r� ►r�1 ca' :,�,i / cow PM @ 12 0 16 M U 5 2018 DVQ--WATER R S U S 401 & BUFFER PERMITTING u \J t NC Department of Environmental Quality Page 1 of 10 Received PCN Form -Version 1.4 January 2009 FEB 0 Z 2018 _. Winston-Salem Regional Office 4. Applicant information IN different from owner) 4a. Applicant Is: ❑ Agent ❑ Other, specify: 4b. Name: 4c. Business name applicable): 4d. Street address: 4e. City, state, zip: 4f. Telephone no.: 4g. Fax no.: 4h. Email address: 5. AgenlMonsultent Information (N oppii s) I6a. Name: 15 b. Business name Of 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 1. 'Prt�etrty�ltlirratkn , 1 a. Property identification no. (tax PIN or parcel ID): 0 Q Q 1 b. Site coordinates (in dedmal Latitude: , of Longitude: - j Q Edegrees): 1c. Property size: acres 2. Surface waters 2a. Name of nearest body of water to proposed project: (y 2b. Water Quality Classification of nearest receiving water: 2c. River basin: n 3. Project Description 3a. bescribe the existing conditions on the site and the general land use in the vicinity of the project at the time of this application: . List the total estimated acreage of all existing wetlands on the property:. List the total estimated linear feet of all existing streams (intermittent and perennlaQ on the property: �,,L h1LY16�);1. r Explain the purpose of the proposed project: 3e. Describe the overall project in detail, including the type of equipment to be used: 4. Jurisdictional Determinations 4a. Have jurisdictional wetland or stream determinations by the Corps or State been requested or obtained for this property / ro ect (Including an nrinrchases) in thepast? tgYes ❑ 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): ck t -o i-kLx-v")ff.L._Y_'7;--)c4 Agency/Consultant Company: oth -DL,�DR 4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation. S. Project History 5a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past? Ye 9No ❑Unknown 5b. If yes, explain in detail according to "help file instructions. 6. Future Project Plans 6a. Is this a phased project? ❑ Yes O No 6b. If yes, explain. Page 3 of 10 PCN Form — Version 1.4 January 2009 C. Proposed Impacts inventory I. Impacts Summary 1a. Which sections were completed below for your project (check all that apply): ❑ Wetlands ❑ Streams —tributaries ❑ Buffers ❑ Open Waters [Pond Construction 2. Wetland Impacts If there are wetland impacts proplo on the site, then complete this question for each wetland area impacted. 2a. Wetland impact number Permanent (P) or Temporary 2b. Type of impact 2c. 2d. Type of wetland Forested 2e. Type of jurisdiction Corps (404,10) or DWQ (401, otter) 2f. Area of impact (acres) W1 Choose one Choose one YestNo W2 - Choose one Choose one Yes/No W3 Choose one Choose one YesNo W4 Choose one Choose one Yes No W5 Choose one Choose one Yeaft We Choose one Choose one Yes/No - 29. Total Weaand Impacts: 2h. Comments: 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. Stream impact number Permanent (P) or Temporary (T) 3b. 3a 3d. 3e. 3f. Type of imp Stream name Perennial (PER) or Type of Average intermittent ONT)7 jurisdiction stream width feet) 3g.. Impact length (linear feet) S1 Choose one 82 Chose one S3 Choose one S4 Choose are S5 Choose one Se - Choose one 3h. Total stream and tributary impacts 3i. Comments: 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 Intdi ually list all open water In ads below. 4a. Open water impact number Permanent (P) or Temporary 4b. Name of wat r ody (if applicable 4c. 4d, 4e. Type of impact Waterbody Area of impact (acres) we 01 Choose one Choose 02 Choose o Choose 03 - Choose one Choose 04 Choose one Choose 0. Total open water Impacts 4g. Comments: 5. Pond or Lake Construction If Pond or lake on Droposed, the com fete the dart below. 58. 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 Filed Excavated P1 L _ ✓ Choose one re.c (0 I P2 � ON r.(' choose one a C -325' 5f. Total: 59. 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 DWO) If project will Impact a protected riparian buffer, then complete the chart below. if yes, then individually list all buffer imparts below. It any IMPacts r uire mita ation then u MUST fill out Section D of this form. 6a. Project Is In protected basin? ❑ Neuse ❑ Tar-Pamlco ❑ Catawba ❑ Randleman ❑ Other. Bb. Buffer Impact number — Permanent (P) or Tem ora 6c. Resson 6d. Stream name 6e. Buffer mitigation required? 6f. Zone 1 6Zone 2 impact impact (square (square feet)feet B1 Yes/No B2 Yes/No 63 Yea1No B4 Yes/No B5 Yes/No B6 - Y" No 6h. Total Buffer Impacts: 61. Comments: Page 5 of 10 D. Impact Justification and Mitigation 1. Avoidance and Minimization 18. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project. I b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques. �� 2. COMIMMallory Mitigation for Impacts to Waters of the U.S. or Waters of the State 2a. Does the project require Compensatory Mitigation for ❑ 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): ❑ DWQ ❑ Corps 2c. If yes, which mitigation option will be used for this project? ❑ Mitigation bank ❑ Payment to in-lieu fee program ❑ Permittee Responsible Mitigation 3. Complete If Using a Mitigation Bank 3a. Name of Mitigation Bank: 3b. Credits Purchased (att receipt and fetter) Type: Choose one Type: Choose one Type: Choose one Quantity: Quantity: Quantity: 3c. Comments: 4. Complete If Making a Payment to In-lieu Program 4a. Approval letter from In-lieu fee program is attachZIW, ❑ 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: Cres 4h. Comments: S. Complete if Using a Permittee Responsible Mitigation Pian 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.1Ndl the project result i" impact within a protected riparian buffer that requires buffer mitigation? ❑ Yes ❑ No 6b. If yes, then Identify the squarefe f impact to each zone of the riparian buffer that requires mitigation. Calculate the amount of mitigation required. Zone Bc. Reason for impact 6d. To pact Multiplier (square et) 6e. Required mitigation (square feet) Zone 1 3 (2 for Catawba) Zone 2 1.5 6f. Total buffer mitigatlo quired: 6g. If buffer mitigation is required, discuss what type of mitigation is proposed g., payment to private mitigation bank, permittee responsible riparian buffer restoration, payment into an approved i 'eu 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 within one of the NC Riparian Buffer Protection Rules? Yes No 1b. If yes, then is a diffuse flow plan included? if no, explain why. ❑ Yes i No 2. Stormwater Management Plan 2a. What is the overall percent imperviousness of this project? 2b. Does this project require a Stormwater Management Plan? ❑Yes No 2c. If this project DOES NOT require a Stormwater Management Plan, explain why: 2d. If this project DOES req ire a Stormwater Management Plan, then provide a brief, narrative description of the plan: 2e. Who will be responsible for the revs of the Stormwater Management Plan? 3. Certified Local Government StoT a r Review 3a. In which local governmenrs jurisdiction is lhj Drolect? 3b. Which of the following locally -implemented storm ter management programs apply (chi all that apply): ❑ Phase II ❑ NSW USMP Water Supply Watershed Other: 3c. Has the approved Stormwater Management Pian with proof "*p I been attached? EJ Yes ❑ No 4. DWQ Stonnwater Program Review 4a. Which of the following state -implemented stormwater management progre s apply (check all that apply): OCoastal counties ❑HOW 80RW Se"Ion Law 2006-248 ❑Other. 4b. Has the approved Stormwater Management Plan with proof of approval been attached? ❑ Yes ❑ No 5. DWQ 401 Unit Stormwater Review 5a. Does the Stormwater Management Plan meet the appropriate requirements? as ❑ 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) la. Does the project involve an expenditure of public (federal/state/local) funds or the ❑ Yes O(No use of public (federal/state) land? 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 0 Yes ❑ No (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.) . ❑ 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, VYes ❑ 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,ohe•or 156th.of the above.questions, provida anyeifantitfon cifkthe v>ditiort(s):` 3. Cumulative Impacts (DWQ Requirement) 3a. Will this project (based on past and reasonably anticipated future impacts) result in xNo additional development.❑Yes 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. 0A - Page 9 of 10 PCN Form — Version 1.4 January 2009 S. Endangered::8pectes<andM"ignated,:Crltical'Habftat�(C ores=Requiratentj 5a. Will lthisat? project occur in or near an area with federally protected species orhabi Yes Eau 5b. Have you checked with the USFWS concerning Endangered Species Act impacts? gYes ❑ No 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? 1*1%CA C 6. EssendaWllsh Habitat°(qo�?s R9 lulrefnand 6a. Will this project occur in or near an area designated as essential fish habitat? ❑ Yes Wo 6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat? C. i 7. Historic or PnahlatorrultUirail'Ftsisoiut cis (Corps RegWi mento 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 ;KNO North Carolina history and archaeology)? 7b. What data sources did you use to determine whether your site would Impact historic or archeological resources? 8. Flood Zone Dealg�atiori`(Corps'Requirement) 8a. Will this project occur in a FEMA -designated 100 -year floodplain? ❑ Yes tdNo 8b. If yes. explain how project meets FEMA requirements: 8c. What source(s) did you use to make the floodplain determination? Appiicant/Agerift Printed Name Ap nVAgeei Signetuth3'`' Date _ (AgerWs ature is vald only If an authoizetlon tett r from thea licant a ovided. Page 10 of 10 2/1/2018 Benjamin Ray aerial Mar2008.JPG OK a e� � e r!' A a -.. � � � � • � �' � diie *T-�^� * ♦ fid? ,''+� https://mail.google.com/mail/u/0/?tab=wm#search/sue/l 6l 33Oe2441 af3d4?projector=1 &messagePartld=0.3 1/2 2/1/2018 31.408864 ?698! W -L v - Search Line Path . Pro Measure the distance between two points on the ground Map Length Ground Length Heading J Mouse Navigation X Places ightseeina Tour iarold Bowlin meeting place 'ossible `Jerification.kmz iporary Places ♦ a nary Database 'he new Google Earth :orders and Labels 'laces 416.10 1 Feet_ 416.44 135.08 degrees Benjamin Ray aerial stream length measurement.JPG t 3 A �� . � � �, • _� • '�► # ��, f, .' ` � +tom ... 6 a. r Save Clear 4 r. https://mail.google.com/mail/u/0/?tab=wm#search/sue/161330e2441 af3d4?projector-1 &messagePartld=0.4 1/2 2/l/2018 f CSA .3 Doo BSERVA7, RY moa-, X60 O Benjamin Ray topo.JPG syRD.,� 2200-. f G',` 00 2200 2661 Anr https://mai1.google.com/mail/u/0/?tab=wm#search/sue/161330e2441af3d4?projector-1 &messagePartId=0.6 1/2 2/1/2018 Benjamin Ray soils survey.JPG Nit. LID nE https://mail.google.com/mail/u/0/?tab=wm#search/sue/l61330e2441 af3d4?projector=1 &messagePartld=0.5 1/2 E � -. '�� Yds` (r,Yl ✓� -� �t' � __ p p {•. � , r 17, t,1 •u 4 � 1 AOZwn r ` : 2/1/2018 lower pond.JPG .. k https://mail.google.com/mail/u/0/?tab=wm#search/sue/l 61330e2441 af3d4?projector-1 &messagePartld=0.8 1/2 2/11/2018 stream channel below pond outlet.JPG https://mail.google.com/mail/u/0/?tab=wm#search/sue/16133Oe2441 af3d4?projector=1 &messagePartid=0.9 iif,