20191020 Ver 1_PCN Form Submission_20190728

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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
CharxJe only if needed.
BIMS # Assigned
20191020
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:
Bryan Cart Path
1a. Who is the Primary Contact?*
Michael W Burkhard
1 b. Primary Contact Email:*
[e-mail]
Date Submitted
7/28/2019
Nearest Body of Water
Lake Norman
Basin
Catawba
Water Classification
Ws -IV
Site Coordinates
Latitude:
35.31'35.11" N
A. Processing Information
County (or Counties) where the project is located:
Lincoln
Is this project a public transportation project?*
r Yes r No
Longitude:
80.59'57.43" W
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 venters, tidal waters, Rivers and Harbors Act)
1 b. What type(s) of permit(s) do you wish to seek authorization?
F Nationwide Permit (NWP)
F- Regional General Permit (RGP)
P 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
1d. Type(s) of approval sought from the DWR:
F_ 401 Water Quality Certification - Regular r 401 Water Quality Certification - Express
F Non -404 Jurisdictional General Permit V Riparian Buffer Authorization
F Individual Permit
1e. Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification: r Yes r No
For the record only for Corps Permit: r Yes r No
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?
r Yes r No
Acceptance Letter Attachment
1h. lathe 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?
rJ Owner r" Applicant (other than owner)
1e. Is there an Age nVConsultant for this project?
r Yes (- No
2. Owner Information
2a. Name(s) on recorded deed:
Bart Oscar Bryan ans spouse Michelle Leigh Bryan
2b. Deed book and page no.:
Book 2721 Page 951-952
2c. Responsible party:
2d. Address
Street Address
1739 Dogwood Hill Dr
Address Line 2
aty
Denver
Fbstal / Zip aide
28037
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(d appropriate)
Webbs Chapel Cove
1c. Nearest municipality/town
Denver
State / Province / legion
NC
Country
Lincoln
2f. Fax Number:

2. Project Identification
2a. Property Identification Number:
81992
2c. Project Address
Street Address
7334 Lake Ridge Dr
Address Line 2
cfty
Denver
Postal / Zip Code
28037
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Lake Norman
3b. Water Resources Classification of nearest receiving water:*
WS -IV
3c. What river basin(s) is your project located in?*
Catawba
3d. Please provide the 12 -digit HUC in which the project is located.
030501011202
4. Project Description and History
2b. Property size:
2.239
State / Frmince / Rajm
NC
Country
Lincoln
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:*
This is a single family 2.239 acre lot on Lake Norman. This lot is a heavily wooded with a steep topography. This is typical for all the lots within Webbs Chapel Cove Development.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
r Yes r No r Unknown
4d. Attach an 8 1/2 X11 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for DWR)
USGS Topo Map.pdf
512.93KB
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)
Soil Survey.pdf 559.4KB
4f. List the total estimated acreage of all existing wetlands on the property:
4g. List the total estimated linear feet of all existing streams on the property:
4h. Explain the purpose of the proposed project:*
Due to the steep topography and the length of the lot, accessing their boat dock and pier proves to be a challenging proposition and a safety issue. We a requesting permission to
install a Cart Path within Zone 2 of the Catawba River Buffer.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
The construction of the cart path will be done by hand and skid -steer. The skid -steer will be used to haul materials and will remain in the construction zone of the pathway.
The path way will be 5 feet Wide, 5 to 7 inches deep using a previous fabric. Sand and washed stone will be the components of the path.
No trees greater than 3" caliper will be removed.
4j. Please upload project drawings for the proposed project.
Pathway Plans and Details.pdf
Survey.pdf
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes r No
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 WA
Corps AID Number:
5c. If 5a is yes, who delineated the jurisdictional areas?
560.36KB
510.22KB
r Unknown

Name (if known):
Agency/Consultant Company:
Other:
5d1. Jurisdictional determination upload
6. Future Project Plans
6a. Is this a phased project?*
r Yes f• 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?
FD. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
r Wetlands r Streams -tributaries V Buffers
F- Open Waters r Pond Construction
6. Buffer Impacts (for DWR)
6a. Project is in which protect basin(s)?
Check all that apply.
F- Neuse r Tar -Pamlico
V Catawba r Randleman
F Goose Creek r Jordan Lake
F Other
6b. Impact Type
6c. Per or Temp
6d. Stream name
6e. Buffer mitigation required? 6f. Zone 1 impact
6g. Zone 2 impact
P
P
Little Creek
No
0
575
6h. Total buffer impacts:
Zone 1 Zone 2
Total Temporary impacts: 0.00 0.00
Zone 1 Zone 2
Total Permanent impacts: 0.00 575.00
Zone 1 Zone 2
Total combined buffer impacts: 0.00 575.00
6i. Comments:
This pathway has been designed to be as previous as possible. See detail on site plan
Supporting Documentation
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:
The path way has been laid out to ensure no trees greater than 3" caliper will be removed.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
During construction, the skid -steer will remain within the pathway to avoid any other buffer disturbance.
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 F No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:

No impacts to Lake Norman
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?
r" Level Spreader
Q Vegetated Conveyance (lower SHWT)
[ Wetland Swale (higher SHWT)
Other SCM that removes minimum 30% nitrogen
V Proposed project will not create concentrated stormvoter 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)?
f Yes r No
2c. Does this project have a stormwater management plan (SMP) reviewed and approved under a state stormwater program or state -approved local government stormwater
program?
r Yes r No
3. Stormwater Requirements
3a. Select whether a completed stormwater management plan (SMP) is included for review and approval or if calculations are provided to document the project will not cause
degradation of downstream surface waters.*
r Stormwater Management r Antidegradation
Plan Calculations
3b. Stormwater Management Plan
3c. Antidegradation Calculations:
Comments:
This is a single family lot, Storm Water management is not required only diffused flow
FG_ 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.
This will be a stable pathway
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
C' Yes r No r WA
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
5d. Is another Federal agency involved?*
r Yes r No
Se. 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
59. Does this project involve bridge maintenance or removal?
r Yes r No
5h. Does this project involve the construction/installation of a wind turbine(s)?*
r Yes r No
r Unknown
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.?
r Yes r No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
USFWS Web site
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?*
Reviewed Duke Lake Managements shore line classification.
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?*
Searched the web
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?*
FEMA Flood Maps
Miscellaneous
Comments
Miscellaneous attachments not previously requested.
Michelle Doctor Ltr04052019.pdf 445.02KB
Recorded Plat Webbs Chapel Cove.pdf 234.99KB
Recorded Deed.pdf 76.02KB
Signature
*
[7 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 W Burkhard
Signature
Aol)a 1 i4 gUatK`h.Yd
Date
7/28/2019

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. PLAN NO. PARCEL ID:
STREET ADDRESS:
Please print:
Property Owner: V
Property Owner:
Om
The undersigned, registered property owners of the above noted property, do hereby authorize
P r i M (✓UAA-d {) B iN C &rA of � V'At1/1Gtir(
(Contractor / Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
IT" D06WOOC� All In -belovcr 6 U10"
Telephone:
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature �� Authoriz Signature
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Bart Bryan
7334 Lake Ridge Dr
Denver, NC 28037
PATHWAY CONSTRUCTION SEQUENCE:
1. 760 -contour line has been delineated and marked
2. 50 -foot Catawba River Buffer both Zone 1 and Zone 2 has been delineated and marked
3. Field layout the "Pathway"
4. No trees larger than 3 -inch caliper will be removed during the construction of the pathway
5. At the end of each day the work done will be stabilized
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OrthoCarolina Huntersville
10030 Gilead Road
Huntersville, NC 28078
704-323-2800
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Date: 41,P51161
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Statement of Medical Necessity:
Signature
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Scott Smith, MD
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Mark Suprock, MD
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Brian Delay, MD
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Alexander Chasnis, MD
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Jack Vesano, MD
o Sarah Knoedler, PA -C
o -Mike Skropeta, PA -C
&�" Steve Russo, PA -C
o William Thomas, PA -C
Not intended for medication