20190059 Ver 1_PCN Form Submission_20190112

DWR
MOM— M W.W, R­­
Pre -Construction Notification (PCN) Form
September 29,2018 Ver 3
21nitial Review
Has this project met the requirements for acceptance in to the review process?*
r Yes
r No
Is this project a public transportation project?*
C Yes r No
Change mly if needed.
BIMS # Assigned Version#*
20190059 1
Is a payment required for this project?
* No payment required What amout is owed?*
* Fee received r $240.00
* Fee needed - send electronic notification r $570.00
Reviewing Office*
Winston-Salem Regional Office - (336) 776- Select Project Reviewer
9800 Sue Homewood:eads\s1hornewood
Information for Initial Review
la. Name of project:
Rollins Property New House Driveway
la. Who is the Primary Contact?*
Chris Rollins
I b. Primary Contact Email:
[e-mail]
Date Submitted
1/12/2019
Nearest Body of Water
Mill Creek
Basin
Cape Fear
Water Classification
WS -11; HQW; NSW
Site Coordinates
Latitude:
36.107219
A. Processing Information
County (or Counties) where the project is located:
Alamance
Is this project a public transportation project?
r Yes r No
Longitude:
-79.267015
la. Type(s) of approval sought from the Corps:
W Section 404 Permit (wetlands, streams and waters, Clean Water Act)
r- Section 10 Permit (navigable Aoters, tidal waters, Rivers and Harbors Act)
1b. What type(s) of permit(s) do you wish to seek authorization?
W Nationwide Permit (NWP)
F Regional General Permit (RGP)
F Standard (P)
1c. Primary Contact Phone:*
[phone]

1c. Has the NWP or GP number been verified by the Corps?
r Yes r No
Nationwide Permit (NWP) Number:
NWP Numbers (for multiple NWPS):
1d. Type(s) of approval sought from the DWR:
,R 401 Water Quality Certification - Regular
F Non -404 Jurisdictional General Permit
F Individual Permit
29 - Residential Developments
1e. Is this notification solelyfor the record because written approval is not required?
For the record only for DWR 401 Certification:
For the record only for Corps Permit:
r 401 Water Quality Certification - Express
r Riparian Buffer Authorization
1f. Is this an after -the -fact permit application?*
r' Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
f Yes r No
Acceptance Letter Attachment
1h. Is the project located in any of NC's twenty coastal counties?
r Yes r No
1j. Is the project located in a designated trout watershed?
O Yes r No
B. Applicant Information
1d. Who is applying for the permit?
W Owner r Applicant (other than owner)
1e. Is there an Agent/Consultant for this project?
r Yes r No
2. Owner Information
2a. Name(s) on recorded deed:
James Christopher Rollins
2b. Deed book and page no.:
3787/0203
2c. Responsible party:
2d. Address
Street Address
2044 Lacy Holt Road
Address Line 2
city
Graham
Postal / Zip Code
27253
2e. Telephone Number:
[phone]
2g. Email Address:*
crollins@triad. rr.00m
2a. Name(s) on recorded deed:
Andrea Elliott Rollins
2b. Deed book and page no.:
3783/0203
State / F rmince / Fbgion
NC
Cbun[ry
us
2f. Fax Number:
r Yes r No
r Yes r No

2c. Responsible party:
2d. Address
Street Address
2044 Lacy Holt Road
Address Line 2
CKY
Graham
Postal / Zip Code
27253
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(if appropriate)
1 c. Nearest municipality / town:
Mebane
2. Project Identification
2a. Property Identification Number:
GPIN 9825171849
2c. Project Address
Street Address
158 E. Stagecoach Road
Address Line 2
CRY
Mebane
Ft%tal / Zip Cade
27302
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Mill Creek
3b. Water Resources Classification of nearest receiving water:*
WS -II; HQW; NSW
3c. What river basin(s) is your project located iri
Cape Fear
3d. Please provide the 12 -digit HUC in which the project is located.
030300020407
4. Project Description and History
State / Rwince / f�Iagion
NC
O�ntry
Alamance
2f. Fax Number:
2b. Property size:
1.01
State / Rwince / Fiagion
NC
Country
US
4a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this application:*
Existing wooded residential lot, adjoin property is single family residential and commercial.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
f Yes r No r Unknown
4d. Attach an 8 1/2X11 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for DWR)
USGS Topo Rollins.pdf 620.18KB
4e. Attach an 8 1/2 X 11 excerpt from the most recent version of the published County NRCS Soil Survey map depicting the project site. (for DWR)
Soils Map Rollins.pdf 1.23MB
4f. List the total estimated acreage of all existing wetlands on the property:
0.049
49. List the total estimated linear feet of all existing streams on the property:
0.0
`^J

4h. Explain the purpose of the proposed project:*
Construct a single family residential driveway for a new house on the property.
41. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
Fill portion of wetlands for single family driveway. Driveway Will have culvert and equipment used will be backhoe and dump truck.
4j. Please upload project drawings for the proposed project.
Site Plan Rollins.pdf 1016.07KB
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes r No 4 Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
r Preliminary r Approved r Not Verified r Unknown r N/A
Corps AID Number:
SAW -2016-00858
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): USACE
Agency/Consultant Company:
Other:
5d1. Jurisdictional determination upload
6. Future Project Plans
6a. Is this a phased project?*
r Yes r No
Are any other NWP(s), regional general permit(s), or individual permits(s) used, or intended to be used, to authorize any part of the proposed project or related activity?
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
W Wetlands r Streams -tributaries r Buffers
F Open Waters r Pond Construction
2. Wetland Impacts
2a1 Reason (?) 2b. Impact type * (?) 2c. Type of W. * 2d. W. name * 2e. Forested* �J.rlsdlcltlon
f. Type of 2g. Impact
*(?) area*
2016-00858 Fill for driveway. P Unknown Unknown Yes Both 0.049
(acres)
2g. Total Temporary Wetland Impact
0.000
2g. Total Wetland Impact
0.049
2h. Comments:
E. Impact Justification and Mitigation
1. Avoidance and Minimization
2g. Total Permanent Wetland Impact
0.049
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
The wetlands are only filled for driveway. This is the only place to cross on the property to get to the roadway.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Only filling area needed for driveway.

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?
r Yes r No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
Small amount of fill.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
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?
r Yes r No
What type of SCM are you providing?
F- Level Spreader
r" Vegetated Conveyance (lower SHWT)
r" Wetland Swale (higher SHWT)
r- Other SCM that removes minimum 30% nitrogen
rJ Proposed project will not create concentrated stormwater flow through the buffer
Diffuse Flow Documentation
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
r Yes r No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?
r Yes r No
Comments
G. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
r Yes r No
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15A NCAC 2H .0500), Isolated Wetland Rules (15A NCAC 2H .1300), or DWR Surface Water or Wetland Standards or
Riparian Buffer Rules (15A NCAC 2B.0200)?*
r Yes r No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality? *
r Yes r No
3b. If you answered "no," provide a short narrative description.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
r Yes r Nor N/A
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or habitat?
r Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
r Yes r No
5c. If yes, indicate the USFWS Field Office you have contacted.

Raleigh
5d. Is another Federal agency involved?*
r- Yes r No C Unknown
5e. Is this a DOT project located within Division's 1-8?
r Yes r No
5f. Will you cut anytrees in order to conduct the work in waters of the U.S.?
r Yes r- No
5g. Does this project involve bridge maintenance or removal?
r Yes r No
Sh. Does this project involve the construction/installation of a wind turbine(s)?*
r Yes r No
5i. Does this project involve (1) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhammers, mechanized pile drivers, etc.?
C Yes r No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
Checked online maps from FWS
Consultation Documentation Upload
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
r Yes r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
Checked online maps from FWS and USACE.
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 status?*
r Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
Alamance County GIS
7c. Historic or Prehistoric Information Upload
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA designated 100 -year floodplain?*
r Yes r- No
8b. If yes, explain how project meets FEMA requirements:
Fill will be in the 100 year floodplain outside of Floodway. I will obtain a City of Mebane Floodplain Development Permit before starting construciton.
8c. What source(s) did you use to make the floodplain determination?*
Alamance County GIS and NC Firm maps.
Miscellaneous u
Comments
Miscellaneous attachments not previously requested.
Signature
*
W By checking the box and signing below, I certify that:
• I have given true, accurate, and complete information on this form;
• I agree that submission of this PCN form is a "transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act');
• I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature; AND
• I intend to electronically sign and submit the PCN form.
Full Name:
James Christopher Rollins
Signature

Sign
Date
1/12/2019