20190990 Ver 1_PCN Form Submission_20190723

DR
02*10n of Water R"Ourc"
Pre -Construction Notification (PCN) Form
September 29, 2018 Ver 3
Initial Review
Has this project met the requirements for acceptance into the review process?*
r Yes
r No
Is this project a public transportation project?*
r Yes r No
C1arxJe only if needed.
BIMS # Assigned
20190990
Is a payment required for this project?*
r No payment required
r Fee received
r Fee needed - send electronic notification
Select Project Reviewer*
Alan Johnson:eads\adjohnson1
Information for Initial Review
1a. Name of project:
Cupped Oak Drive
1a. Who is the Primary Contact?*
Dawid Joubert
1 b. Primary Contact Email:*
[e-mail]
Date Submitted
7/23/2019
Nearest Body of Water
North Fork Crooked Creek
Basin
Catawba
Water Classification
Good -Fair
Site Coordinates
Latitude:
35.0941
A. Processing Information
County (or Counties) where the project is located:
Union
Is this project a public transportation project?*
r Yes r No
Longitude:
-80.6680
1a. Type(s) of approval sought from the Corps:
V Section 404 Permit (wetlands, streams and waters, Clean Water Act)
F Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1 b. What type(s) of permit(s) do you wish to seek authorization?
P Nationwide Permit (NWP)
F- Regional General Permit (RGP)
r- Standard (IP)
Version# *
1
Reviewing Office*
Mooresville Regional Office - [phone]
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):
SAW -2018-00292
1d. Type(s) of approval sought from the DWR:
R 401 Water Quality Certification - Regular
F Non -404 Jurisdictional General Permit
F Individual Permit
39 - Commercial/Institutional 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:
F 401 Water Quality Certification - Express
F Riparian Buffer Authorization
1f. Is this an after -the -fact permit application?*
f• Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
19. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
Acceptance Letter Attachment
Cupped Oak Drive DMS Acceptance Letter.pdf
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?
r 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:
NSC Enterprise, Inc.
2b. Deed book and page no.:
6591, 728
2c. Responsible party:
2d. Address
Street Address
PO Box 1499
Address Line 2
City
Indian Trail
Postal / Zip Cade
28079
2e. Telephone Number:
[phone]
29. Email Address:*
dawidj @aol.com
C. Project Information and Prior Project History
1. Project Information
State / Rwime / fbgim
NC
Country
Union
2f. Fax Number:
76.15KB
r Yes r No
rYes rNo
J

1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:
Indian Trail
2. Project Identification 1
2a. Property Identification Number:
07102308
2c. Project Address
Street Address
221 Cupped Oak Drive
Address Line 2
city
Indian Trail
Rstal / Zip Code
28079
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
North Fork Crooked Creek
3b. Water Resources Classification of nearest receiving water:*
Good -Fair
3c. What river basin(s) is your project located in?*
Catawba
3d. Please provide the 12 -digit HUC in which the project is located.
HUC 03040105
4. Project Description and History
2b. Property size:
4.15
State / Ftwince / Fegzm
NC
Cbuntry
Union
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:*
Authorization of permanent impacts to 0.29 acre wetland (impacted), 70 linear feet of intermittent stream (impacted)
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
F Yes r No f Unknown
4c. If yes, please give the DWR Certification number or the Corps Action ID (exp. SAW -0000-00000).
SAW -2018-00292
Project History Upload
PCN1-4-2009interactive-reader-enabled, working file MD-3.pdf
55.96KB
4d. Attach an 8 1/2 X 11 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for DWR)
R -Ph I - Figure 1 Topo.pdf
96.64KB
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)
20180115_17591105750_14_Soil_Map.pdf 592.52KB
4f. List the total estimated acreage of all existing wetlands on the property:
0.29
4g. List the total estimated linear feet of all existing streams on the property:
70
4h. Explain the purpose of the proposed project:*
The site is located at 221 Cupped Oak Drive, Stallings, North Carolina (Mecklenburg County Parcel 07102308). The landowner has graded and filled a 0.29 -acre portion of a previously
identified forested wetland and 70 linear feet of an intermittent stream within the review area without authorization from the Corps. The area of forested wetland is now graded, leveled,
and the site is ready for commercial development. The intermittent stream was filled and relocated to an existing ditch which is piped to a nearby un -named tributary.
41. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*

Stream Relocation
The relocation design will include the removal of the second pipe and the rip -rap, then excavation of a newchannel and stable stream banks. In -channel structures such as root wads
and log vanes will help mimic the previous conditions, create habitat for aquatic life, improve stream structure, and provide reduced flowvelocity during high-flow events.
The stream banks will be stabilized with native riparian seed mix and biodegradable coconut matting, and the buffers will be planted with native riparian shrubs and trees. The restored
stream reach will be constructed to maintain low flows and stable profile. The stream bed will be approximately 3 -feet wide and the bankfull with will be approximately 7 -feet wide. The
banks will be graded to approximately 2:1 slope for improved stability. Proposed typical cross-section for this relocated stream reach is illustrated in Cross -Section 1.
A pump around will be utilized in order to work in the dry. Other erosion and sediment control techniques will be utilized to minimize sediment escape from the sire during construction.
These techniques include employing coir fiber logs within the channel bed immediately downstream of the construction area. These logs are meant to temperately prevent downstream
sediment migration and will be removed once the channel has been stabilized with matting and vegetation.
Stream Buffer Planting Plan
A planting plan will be utilized to revegetate a 10 -foot buffer along the restored stream channel. Natural coconut matting (coir matting) will be installed on both banks of the restored
stream once construction is complete. Live stakes will be installed on the stream banks for stabilization and erosion control. Container plants may be substituted if planting is completed
outside of the dormant season. Vegetation species will be chosen based on the existing plant community and native species will be planted to increase species diversity, particularly in
the riparian zone.
The area to be planted consists of two zones
1. Stream banks
2. Riparian buffer
Native riparian plant species such as silky dogwood (Cornus amomum), black willow (Salix nigra), elderberry (Sambucus canadensis), and soft rush (Juncus effuses) will be planted on
the lower stream banks (Zone 1). The riparian buffer will be planted with species such as red maple (Acer rebrum), river birch (Betula nigra), slippery elm (Ulmus rubra), and spicebush
(Lindera benzoin) (Zone 2). Planting plan and seeding details are summarized in Table 1.
Table 1 — Proposed Planting Plan
Zone 1 — Stream Banks
Common Name Botanical Name Size Spacing
silky dogwood Cornus amomum Plug 1' Toe
black willow Salix nigra Plug 2 O.C.
elderberry Sambucus canadensis Plug 2 O.C.
soft rush Juncus effuses Plug 2 O.C.
Zone 2 — Riparian Buffer
red maple Acer rebrum 3 -gallon 4' O.C.
river birch Betula nigra 3 -gallon 4' O.C.
slippery elm Ulmus rubra 3 -gallon 4' O.C.
spicebush Lindera benzoin 3 -gallon 4'0.C.
Matting must be coir 200 gram at toe of stream bank secured with cinch stakes. The second row of matting must be coconut matting to be secured with cinch stakes on 4 -inch center
spaces. All native seed with appropriate temporary seed should be broadcast.
Table 2 — Proposed Seeding Plan
Al Zoned - Permanent Riparian Seed Mix
Red -top paniograss Panicum rigidulum 20
Little blue stem Schizachyrium scoparium 15
Lanceleaf tickseed Coreopsis lanceolata 10
Patridge pea Chamarcrista fasciculata 10
Black-eyed susan Rudbeckia hirta 10
Beaked panicgrass Panicum anceps 10
River oats Chasmanthium latifolium 5
Deer tongue Dichanthelium clandestinum 5
Virginia wild rye Elymus virginicus 5
Purple top Tridens flavus 5
Tickseed sunflower Bidens aristosa 5
4j. Please upload project drawings for the proposed project.
x Layout-NEW-Layout1.pdf 352.53KB
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes
Comments:
r No
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
r Preliminary r Approved r Not Verified r' Unknown r NxA
Corps AID Number:
SAW -2018-00292
Sc. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Michael Zavislak
Agency/Consultant Company: SUMMIT Engineering, Laboratory & Testing, PC
Other:
4 Unknown

5d. List the dates of the Corp jurisdiction determination or State determination if a determination was made by the Corps or DWR
3/29/19
5d1. Jurisdictional determination upload
SAW -2018-00292 (signed Violation Tearsheet-Memo).pdf 2.22MB
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?
ID. 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
a. Site #* (?) 2a1 Reason (?) 2b. Impact type * (?) 2c. Type of W. 2d. W. name * 2e. Forested * 2f. Type of 2g. Impact
Jurisdicition*(?) area*
.29 cleared P Bottomland Hardwood Forest Wetland #1 Yes Both 0.290
(acres)
2g. Total Temporary Wetland Impact
0.000
2g. Total Wetland Impact
0.290
2h. Comments:
2g. Total Permanent Wetland Impact
0.290
E. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
after the fact approval.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
after the fact approval.
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
2c. If yes, mitigation is required by (check all that apply):
W DWR W Corps
2d. If yes, which mitigation option(s) will be used for this project?
Mitigation bank W Payment to in -lieu fee r Permittee Responsible
program Mitigation
4. Complete if Making a Payment to In -lieu Fee Program
4a. Approval letter from in -lieu fee program is attached.
r Yes r No
4b. Stream mitigation requested:
(linear Peet)
4d. Buffer mitigation requested (DWR only):
(square feet)
4f. Non -riparian wetland mitigation requested:
(acres)
4c. If using stream mitigation, what is the stream temperature:
4e. Riparian wetland mitigation requested:
(acres)
4g. Coastal (tidal) wetland mitigation requested:
(acres)

4h. Comments
6. Buffer mitigation (State Regulated Riparian Buffer Rules) - required by DWR
6a. Will the project result in an impact within a protected riparian buffer that requires buffer mitigation? If yes, you must fill out this entire form - please contact DWR for more
information.
r Yes r No
[F7Stormwater 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?
[ Level Spreader
C Vegetated Conveyance (lower SHWT)
Q Wetland Swale (higher SHWT)
r Other SCM that removes minimum 30% nitrogen
r- Proposed project will not create concentrated stormwater flowthrough 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 (federallstate/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
2b Provide an explanation of the violation(s):
after the fact
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.
The area of forested wetland is now graded, leveled, and the site is ready for commercial development.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
r Yes r' No r N/A
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
Sa. 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
5d. Is another Federal agency involved?*
r Yes r No r 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)?*
O Yes r No
51. 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.?
r Yes r No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
after the fact approval
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?*
jurisdictional channel not being impacted.
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?*
lot in existing industrial development
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
8c. What source(s) did you use to make the floodplain determination?*
survey
Miscellaneous
Comments
Miscellaneous attachments not previously requested.
Signature
*
P 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:
Michael Zavislak
Signature

Date
7/23/2019

ROY COOPED
Governor
MICHAEL S. REGAN
Secretary
TIM BAUMGARTNER
Dbrcmr
Dawid Joubert
NSC Enterprise, Inc.
PO Box 1499
Indian Trail, NC 28079
Project: Cupped Oak Drive
NOR/ H CAROLINA
Environmental Quality
June 26, 2019
Expiration of Acceptance: 12/25/2019
County: Union
The purpose of this letter is to notify you that the NCDEQ Division of Mitigation Services (DMS) is willing to
accept payment for compensatory mitigation for impacts associated with the above referenced project as
indicated in the table below. Please note that this decision does not assure that participation in the DMS in -
lieu fee mitigation program will be approved by the permit issuing agencies as mitigation for project impacts.
It is the responsibility of the applicant to contact permitting agencies to determine if payment to the DMS will
be approved. You must also comply with all other state, federal or local government permits, regulations or
authorizations associated with the proposed activity including G.S. § 143-214.11.
This acceptance is valid for six months from the date of this letter and is not transferable. If we have not
received a copy of the issued 404 Permit/407 Certification within this time frame, this acceptance will
expire. It is the applicant's responsibility to send copies of the permits to DMS. Once DMS receives a copy
of the permit(s) an invoice will be issued based on the required mitigation in that permit and payment must
be made prior to conducting the authorized work. The amount of the in -lieu fee to be paid by an applicant is
calculated based upon the Fee Schedule and policies listed on the DMS website.
Based on the information supplied by you in your request to use the DMS, the impacts for which you are
requesting compensatory mitigation credit are summarized in the following table. The amount of mitigation
required and assigned to DMS for this impact is determined by permitting agencies and may exceed the
impact amounts shown below.
River Basin Impact Location Impact Type Impact Quantity
(8 -digit HUC
Yadkin 03040105 Riparian Wetland 0.290
Upon receipt of payment, DMS will take responsibility for providing the compensatory mitigation. The
mitigation will be performed in accordance with the In -Lieu Fee Program instrument dated July 28, 2010 as
applicable. Thank you for your interest in the DMS in -lieu fee mitigation program. If you have any questions
or need additional information, please contact Kelly Williams at [phone].
cc: Michael Zavislak, agent
Sincerely,
Jam s. Stanfill
Asset anagement Supervisor
Nath Carolina Department of Emm onrnental Coality I Division of Mitigation Services
29 W.Jones Street 11652 Mail Service Center I Raleigh, North Carolina 27699-1652
919.707.8976

4
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COVER SHEET
WETLAND AREA OUTSIDE OF SS ESMT = ±10,887 SF
D:\!Michael!\!SUMMIT!\4678 - Ultimate USA Real Estate, Inc\4678.501 Cupped Oak Drive\Wetlands\7-17-18\R-Ph I - Figure 1 Topo.doc SUMMIT ELT, PC Project: 4678.501 7/24/2018 Figure 1 USGS Topographic Map Cupped Oak Drive Stallings, NC Subject Site
Soil Map—Union County, North Carolina
Natural Resources
Conservation Service
Web Soil Survey
National Cooperative Soil Survey
1/15/2018
Page 1 of 338834803883510388354038835703883600388363038836603883480388351038835403883570388360038836303883660530140530170530200530230530260530290530320530350530380530410530440
530140 530170 530200 530230 530260 530290 530320 530350 530380 530410 530440
35° 5' 43'' N 80° 40' 9'' W35° 5' 43'' N80° 39' 57'' W35° 5' 36'' N
80° 40' 9'' W35° 5' 36'' N
80° 39' 57'' WN
Map projection: Web Mercator Corner coordinates: WGS84 Edge tics: UTM Zone 17N WGS84
0 50 100 200 300
Feet
0 20 40 80 120
Meters
Map Scale: 1:1,430 if printed on A landscape (11" x 8.5") sheet.
Soil Map may not be valid at this scale.
MAP LEGEND MAP INFORMATION
Area of Interest (AOI)
Area of Interest (AOI)
Soils
Soil Map Unit Polygons
Soil Map Unit Lines
Soil Map Unit Points
Special Point Features
Blowout
Borrow Pit
Clay Spot
Closed Depression
Gravel Pit
Gravelly Spot
Landfill
Lava Flow
Marsh or swamp
Mine or Quarry
Miscellaneous Water
Perennial Water
Rock Outcrop
Saline Spot
Sandy Spot
Severely Eroded Spot
Sinkhole
Slide or Slip
Sodic Spot
Spoil Area
Stony Spot
Very Stony Spot
Wet Spot
Other
Special Line Features
Water Features
Streams and Canals
Transportation
Rails
Interstate Highways
US Routes
Major Roads
Local Roads
Background
Aerial Photography
The soil surveys that comprise your AOI were mapped at
1:24,000.
Warning: Soil Map may not be valid at this scale.
Enlargement of maps beyond the scale of mapping can cause
misunderstanding of the detail of mapping and accuracy of soil
line placement. The maps do not show the small areas of
contrasting soils that could have been shown at a more detailed
scale.
Please rely on the bar scale on each map sheet for map
measurements.
Source of Map: Natural Resources Conservation Service
Web Soil Survey URL:
Coordinate System: Web Mercator (EPSG:3857)
Maps from the Web Soil Survey are based on the Web Mercator
projection, which preserves direction and shape but distorts
distance and area. A projection that preserves area, such as the
Albers equal-area conic projection, should be used if more
accurate calculations of distance or area are required.
This product is generated from the USDA-NRCS certified data as
of the version date(s) listed below.
Soil Survey Area: Union County, North Carolina
Survey Area Data: Version 17, Oct 3, 2017
Soil map units are labeled (as space allows) for map scales
1:50,000 or larger.
Date(s) aerial images were photographed: Jun 14, 2015—Feb 8,
2017
The orthophoto or other base map on which the soil lines were
compiled and digitized probably differs from the background
imagery displayed on these maps. As a result, some minor
shifting of map unit boundaries may be evident.
Soil Map—Union County, North Carolina
Natural Resources
Conservation Service
Web Soil Survey
National Cooperative Soil Survey
1/15/2018
Page 2 of 3
Map Unit Legend
Map Unit Symbol Map Unit Name Acres in AOI Percent of AOI
ScA Secrest-Cid complex, 0 to 3
percent slopes
3.1 70.5%
TbB2 Tarrus gravelly silty clay loam,
2 to 8 percent slopes,
moderately eroded
1.3 29.5%
Totals for Area of Interest 4.4 100.0%
Soil Map—Union County, North Carolina
Natural Resources
Conservation Service
Web Soil Survey
National Cooperative Soil Survey
1/15/2018
Page 3 of 3

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RODEN REYNOLDS.BRYAN.KENNETH.1263385574
Digitally signed by RODEN REYNOLDS.BRYAN.KENNETH.1263385574
DN: c=US, o=U.S. Government, ou=DoD, ou=PKI, ou=USA, cn=RODEN
REYNOLDS.BRYAN.KENNETH.1263385574
Date: 2019.03.29 08:07:59 -04'00'


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Legend
-- Unauthorized Stream Discharge
Stream
Parcels
Unathorized Wetland Discharge
II Wetland
Project area
r'
.
SAW -2018-001292 Cupped Oak Drive
Unauthorized Discharge
Description; The wetland and stream boundaries shown on this map were
georeferenced using the WV01 satellite image, parcel data, and a 2007
delineation of the properly. The fill boundaries were estimated based on
"unauthorized
Map created by David id Shaeffer on 3128!2099 at
L. S
the WV01 satellite image. The filled stream labeled as
$: EDT
Stream Discharge'" was not included in the 2007 dellneation but was
identified by NCDOT in 2014 as part of the Monroe Bypass project and
again in 2018 as part of ajurisdicitonal determination request reviewed
Image Source: WV01 Panchromatic
under SAW -2018-00292. The property owner tilled the stream without a
Acquisition Date: 2099-03-06 07:04 PM UTC
permit after the Corps delineation field review in 2018. The Corps found
the 2014 and 2007 delineations showing the wetland area after the Corps
site inspection of the 2018 delineation.

!.
Service Layer Credits: Esri, HERE, Garmin, © OpenStreetMapService Layer Credits: Esri, HERE, Garmin, © OpenStreetMap
Description:
Page 1 of 6
μ
!.
Overview Map
Photographed by Bryan Roden-Reynolds
on 3/26/2019 at 10:12:00 AM EDT
Camera: Trimble TDC100_4G
Location Source: Camera's internal GPS
Heading Source: Camera's internal compass
Map generated on 3/26/2019 using the
Photo Log Toolbar, written by Jason C. Deters
Mapped Photo Log
for Cupped Oak Drive
SAW-2018-00292
0 80 16040
Feet
Coordinate System: GCS WGS 1984Coordinate System: GCS WGS 1984
Photo Coordinates: -80.668335 35.093965Photo Coordinates: -80.668335 35.093965
Upper Left Corner: -80.669553 35.094818Upper Left Corner: -80.669553 35.094818
Lower Right Corner: -80.667116 35.093112Lower Right Corner: -80.667116 35.093112
Legend
!.Photo Location
Field of View
!.
Service Layer Credits: Esri, HERE, Garmin, © OpenStreetMapService Layer Credits: Esri, HERE, Garmin, © OpenStreetMap
Description:
Page 2 of 6
μ
!.
Overview Map
Photographed by Bryan Roden-Reynolds
on 3/26/2019 at 10:12:27 AM EDT
Camera: Trimble TDC100_4G
Location Source: Camera's internal GPS
Heading Source: Camera's internal compass
Map generated on 3/26/2019 using the
Photo Log Toolbar, written by Jason C. Deters
Mapped Photo Log
for Cupped Oak Drive
SAW-2018-00292
0 80 16040
Feet
Coordinate System: GCS WGS 1984Coordinate System: GCS WGS 1984
Photo Coordinates: -80.668281 35.093978Photo Coordinates: -80.668281 35.093978
Upper Left Corner: -80.669499 35.094831Upper Left Corner: -80.669499 35.094831
Lower Right Corner: -80.667063 35.093125Lower Right Corner: -80.667063 35.093125
Legend
!.Photo Location
Field of View
!.
Service Layer Credits: Esri, HERE, Garmin, © OpenStreetMapService Layer Credits: Esri, HERE, Garmin, © OpenStreetMap
Description:
Page 3 of 6
μ
!.
Overview Map
Photographed by Bryan Roden-Reynolds
on 3/26/2019 at 10:12:37 AM EDT
Camera: Trimble TDC100_4G
Location Source: Camera's internal GPS
Heading Source: Camera's internal compass
Map generated on 3/26/2019 using the
Photo Log Toolbar, written by Jason C. Deters
Mapped Photo Log
for Cupped Oak Drive
SAW-2018-00292
0 80 16040
Feet
Coordinate System: GCS WGS 1984Coordinate System: GCS WGS 1984
Photo Coordinates: -80.66832 35.09399Photo Coordinates: -80.66832 35.09399
Upper Left Corner: -80.669538 35.094843Upper Left Corner: -80.669538 35.094843
Lower Right Corner: -80.667102 35.093138Lower Right Corner: -80.667102 35.093138
Legend
!.Photo Location
Field of View
!.
Service Layer Credits: Esri, HERE, Garmin, © OpenStreetMapService Layer Credits: Esri, HERE, Garmin, © OpenStreetMap
Description:
Page 4 of 6
μ
!.
Overview Map
Photographed by Bryan Roden-Reynolds
on 3/26/2019 at 10:13:46 AM EDT
Camera: Trimble TDC100_4G
Location Source: Camera's internal GPS
Heading Source: Camera's internal compass
Map generated on 3/26/2019 using the
Photo Log Toolbar, written by Jason C. Deters
Mapped Photo Log
for Cupped Oak Drive
SAW-2018-00292
0 80 16040
Feet
Coordinate System: GCS WGS 1984Coordinate System: GCS WGS 1984
Photo Coordinates: -80.668232 35.094037Photo Coordinates: -80.668232 35.094037
Upper Left Corner: -80.669450 35.094890Upper Left Corner: -80.669450 35.094890
Lower Right Corner: -80.667013 35.093185Lower Right Corner: -80.667013 35.093185
Legend
!.Photo Location
Field of View
!.
Service Layer Credits: Esri, HERE, Garmin, © OpenStreetMapService Layer Credits: Esri, HERE, Garmin, © OpenStreetMap
Description:
Page 5 of 6
μ
!.
Overview Map
Photographed by Bryan Roden-Reynolds
on 3/26/2019 at 10:14:01 AM EDT
Camera: Trimble TDC100_4G
Location Source: Camera's internal GPS
Heading Source: Camera's internal compass
Map generated on 3/26/2019 using the
Photo Log Toolbar, written by Jason C. Deters
Mapped Photo Log
for Cupped Oak Drive
SAW-2018-00292
0 80 16040
Feet
Coordinate System: GCS WGS 1984Coordinate System: GCS WGS 1984
Photo Coordinates: -80.668241 35.094044Photo Coordinates: -80.668241 35.094044
Upper Left Corner: -80.669459 35.094897Upper Left Corner: -80.669459 35.094897
Lower Right Corner: -80.667023 35.093192Lower Right Corner: -80.667023 35.093192
Legend
!.Photo Location
Field of View
!.
Service Layer Credits: Esri, HERE, Garmin, © OpenStreetMapService Layer Credits: Esri, HERE, Garmin, © OpenStreetMap
Description:
Page 6 of 6
μ
!.
Overview Map
Photographed by Bryan Roden-Reynolds
on 3/26/2019 at 10:14:17 AM EDT
Camera: Trimble TDC100_4G
Location Source: Camera's internal GPS
Heading Source: Camera's internal compass
Map generated on 3/26/2019 using the
Photo Log Toolbar, written by Jason C. Deters
Mapped Photo Log
for Cupped Oak Drive
SAW-2018-00292
0 80 16040
Feet
Coordinate System: GCS WGS 1984Coordinate System: GCS WGS 1984
Photo Coordinates: -80.668221 35.094079Photo Coordinates: -80.668221 35.094079
Upper Left Corner: -80.669439 35.094931Upper Left Corner: -80.669439 35.094931
Lower Right Corner: -80.667003 35.093226Lower Right Corner: -80.667003 35.093226
Legend
!.Photo Location
Field of View
Page 1 of 10
PCN Form – Version 1.4 January 2009
Office Use Only:
Corps action ID no. _____________
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: Section 404 Permit Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: 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 DWQ (check all that apply):
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:
Yes No
For the record only for Corps Permit:
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 No
1g. Is the project located in any of NC’s twenty coastal counties. If yes, answer 1h
below. Yes No
1h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? Yes No
2. Project Information
2a. Name of project:
2b. County:
2c. Nearest municipality / town:
2d. Subdivision name:
2e. NCDOT only, T.I.P. or state project no:
3. Owner Information
3a. Name(s) on Recorded Deed:
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if
applicable):
3d. Street address:
3e. City, state, zip:
3f. Telephone no.:
3g. Fax no.:
3h. Email address:
Cupped Oak Drive
Union
Stallings
NSC Enterprises, Inc.
NSC Enterprises, Inc.
PO Box 1499
Indian Trail, NC 28079
704-622-0827
[e-mail]
39
Page 2 of 10
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:
5b. Business name
(if applicable):
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. Fax no.:
5g. Email address:
Mr. Michael D. Zavislak
Summit Engineering, Laboratory & Testing, PC
101 Rice Bent Way, Unit 9
Columbia, SC 29229
803-708-7945
803-708-7946
[e-mail]
Page 3 of 10
PCN Form – Version 1.4 January 2009
B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
1b. Site coordinates (in decimal degrees): Latitude: Longitude:
1c. Property size: acres
2. Surface Waters
2a. Name of nearest body of water to proposed project:
2b. Water Quality Classification of nearest receiving water:
2c. River basin:
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:
3b. List the total estimated acreage of all existing wetlands on the property:
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
3d. 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 /
project (including all prior phases) in the past?
Yes 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 No Unknown
5b. If yes, explain in detail according to “help file” instructions.
6. Future Project Plans
6a. Is this a phased project? Yes No
6b. If yes, explain.
PIN 07102308
-80.668
4.15
North Fork Crooked Creek
Class C
Upper Pee Dee (HUC 03040105)
The landowner has graded and filled a 0.29 acre portion of a previously identified forested wetland and 70 linear feet of an intermittent stream within
the review area without authorization from the Corps. The area of forested wetland is now graded, leveled, and the site is ready for commercial
development. The intermittent stream was filled and relocated to an existing ditch which is piped to a nearby unnamed tributary.
0.29
To submit a Pre-Construction Notification for an after-the-fact Nationwide Permit 39, with additional future impacts. Restoration of 70 linear feetofstrea
Authorization of permanent impacts to 0.29 acre wetland (impacted), 70 linear feet of intermittent stream (impacted).
Summit Engineering, Laboratory
35.0941
620
Michael D. Zavislak
Page 4 of 10
PCN Form – Version 1.4 January 2009
C. Proposed Impacts Inventory
1. 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 proposed on the site, then complete this question for each wetland area impacted.
2a.
Wetland impact
number
Permanent (P) or
Temporary (T)
2b.
Type of impact
2c.
Type of wetland
2d.
Forested
2e.
Type of jurisdiction
Corps (404,10) or
DWQ (401, other)
2f.
Area of
impact
(acres)
W1
W2
W3
W4
W5
W6
2g.Total Wetland 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.
Type of impact
3c.
Stream name
3d.
Perennial (PER) or
intermittent (INT)?
3e.
Type of
jurisdiction
3f.
Average
stream
width
(feet)
3g.
Impact
length
(linear
feet)
S1
S2
S3
S4
S5
S6
3h. Total stream and tributary impacts
3i. Comments:
Fill Bottomland Hardwood Forest Yes Corps 0.29
Yes/No -
Yes/No -
Yes/No -
Yes/No -
Yes/No -
0.29
The landowner has graded and filled a 0.29 acre portion of a previously identified forested wetland.
Relocation unnamed INT Corps 2 70
The intermittent stream was filled and relocated to an existing stormwater ditch which is piped to a nearby unnamed tributary. The stream channel will
be restored.
P
-
-
-
-
-
Choose one
Choose one
Choose one
Choose one
Choose one
Choose one
Choose one
Choose one
Choose one
Choose one
P
-
-
-
-
-
Choose one
Choose one
Choose one
Choose one
Choose one
-
-
-
-
-
-
-
-
-
-
Page 5 of 10
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 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)
O1
O2
O3
O4
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If pond or lake construction proposed, then complete the chart below.
5c.
Wetland Impacts (acres)
5d.
Stream Impacts (feet)
5e.
Upland
(acres)
5a.
Pond ID number
5b.
Proposed use or
purpose of pond
Flooded Filled Excavated Flooded Filled Excavated
P1
P2
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
B2
B3
B4
B5
B6
6h.Total Buffer Impacts:
6i. Comments:
wetland/stream Fill Other 0.001
employing coir fiber logs within the channel bed immediately downstream of the construction area
Choose one
Yes/No
T
-
-
-
Choose one
Choose one
Choose one
Choose
Choose
Choose
Choose one
-
-
-
-
-
-
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
)
Page 6 of 10
PCN Form – Version 1.4 January 2009
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
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 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
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:
Type:
Type:
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:
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.
Not applicable.
Stream channel will be restored.
Choose one
Choose one
Choose one
Choose one
Page 7 of 10
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 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 8 of 10
PCN Form – Version 1.4 January 2009
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? Yes No
1b. If yes, then is a diffuse flow plan included? If no, explain why.
Yes 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 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?
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):
Phase II
NSW
USMP
Water Supply Watershed
Other:
3c. Has the approved Stormwater Management Plan with proof of approval been
attached? Yes No
4. DWQ Stormwater Program Review
4a. Which of the following state-implemented stormwater management programs apply
(check all that apply):
Coastal counties
HQW
ORW
Session Law 2006-246
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? Yes No
5b. Have all of the 401 Unit submittal requirements been met? Yes No
The site is not adjacent to protected NC Riparian Buffers.
The project will not result in a change to the impervious surface.
Page 9 of 10
PCN Form – Version 1.4 January 2009
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? Yes No
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
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
Yes No
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:
Yes No
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 No
2b. Is this an after-the-fact permit application? Yes 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
additional development, which could impact nearby downstream water quality? Yes No
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.
The landowner has graded and filled a 0.29 acre portion of a previously identified forested wetland and 70 linear feet of an intermittent stream within
the review area without authorization from the Corps. The area of the forested wetland is now graded, leveled, and the site is ready for commercial
development. The intermittent stream was filled and relocated to an existing stormwater ditch which is piped to a nearby unnamed tributary.
Authorization of permanent impacts to 0.29 acre wetland (impacted), 70 linear feet of intermittent stream (impacted) and 0.0904 acre wetland.
The stream relocation will not result in additional sewage.
Page 10 of 10
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? Yes No
5b. Have you checked with the USFWS concerning Endangered Species Act
impacts? Yes 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?
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?
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 (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
Yes No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? Yes No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?
Applicant/Agent's Printed Name
_______________________________
Applicant/Agent's Signature
(Agent's signature is valid only if an authorization
letter from the applicant is provided.)

Date
-
USFWS Endangered and Threatened Species ofConcern by County for North Carolina online database for Union County.
North Carolina Natural Heritage Program (NCNHP) Data Explorer
NOAA Fisheries: https://www.habitat.noaa.gov/application/efhmapper/index.html
SHPO online GISService
FEMA FIRM No. 3710540900J