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HomeMy WebLinkAboutPre Construction Notification (Army Corps of Engineering)U.S. Army Corps of Engineers (USACE) Fort Worth District Nationwide Permit (NWP) Pre-Construction Notification (PCN) Form This form integrates requirements of the Nationwide Permit Program within the Fort Worth District, including General and Regional Conditions. Please consult instructions included at the end prior to completing this form. n nts • Description of NWP 29 • Part I: NWP Conditions and Requirements Checklist o General Conditions Checklist o NWP 29-Specific Requirements Checklist o Regional Conditions Checklist • Part II: Project Information Form • Part III: Project Impacts and Mitigation Form • Part IV: Attachments Form • Instructions DESCRIPTION OF NWP 29 - RESIDENTIAL DEVELOPMENTS Residential Developments. Discharges of dredged or fill material into non-tidal waters of the United States (U.S.) for the construction or expansion of a single residence, a multiple-unit residential development, or a residential subdivision. This NWP authorizes the construction of building foundations and building pads and attendant features that are necessary for the use of the residence or residential development. Attendant features may include but are not limited to roads, parking lots, garages, yards, utility lines, storm water management facilities, septic fields, and recreation facilities such as playgrounds, playing fields, and golf courses (provided the golf course is an integral part of the residential development). The discharge must not cause the loss of greater than 1/2-acre of non-tidal waters of the U.S., including the loss of no more than 300 linear feet of stream bed, unless for intermittent and ephemeral stream beds this 300 linear foot limit is waived in writing by the district engineer. This NWP does not authorize discharges into non-tidal wetlands adjacent to tidal waters. Subdivisions. For residential subdivisions, the aggregate total loss of waters of U.S. authorized by this NWP cannot exceed 1/2-acre. This includes any loss of waters of the U.S. associated with development of individual subdivision lots. Part I: NWP Conditions and Requirements Checklist To ensure compliance with the General Conditions (GC), in order for an authorization by a NWP to be valid, please answer the following questions: 1. Navigation (Applies to Section 10 waters [i.e. navigable waters of the U.S.], see instruction 4 for link to list): a. Does the project cause more than a minimal adverse effect on navigation? ❑ Yes ❑ No ® N/A b. Does the project require the installation and maintenance of any safety lights and signals prescribed by the U.S. Coast Guard on authorized facilities in navigable waters of the U.S.? ❑ Yes ❑ No ® N/A Page 1 of 18 SWF Recommended Application Form - NWP 29 c. Does the Applicant understand and agree that if future operations by the U.S. require the removal, relocation, or other alteration of the structure or work herein authorized, or if, in the opinion of the Secretary of the Army or his authorized representative, said structure or work shall cause unreasonable obstruction to the free navigation of the navigable waters, the Applicant will be required, upon due notice from the USACE, to remove, relocate, or alter the structural work or obstructions caused thereby, without expense to the U.S.; and no claim shall be made against the U.S. on account of any such removal or alteration? ❑ Yes ❑ No ® N/A If you answered yes to question a. or b. above, or if you answered no to question c. above, please explain how the project would be in compliance with this GC or be aware that the project would require an individual permit application: Not Applicable 2. Aquatic Life Movements: a. Does the project substantially disrupt the necessary life cycle movements of those species of aquatic life indigenous to the waterbody, including those species that normally migrate through the area? ❑ Yes ® No b. Is the project's primary purpose to impound water? ❑ Yes ® No c. Will culverts placed in streams be installed to maintain low flow conditions? ® Yes ❑ No ❑ N/A If you answered yes to question a. or b. above, or if you answered no to question c. above, please explain how the project would be in compliance with this GC or be aware that the project would require an individual permit application: 3. Spawning Areas: a. Does the project avoid spawning areas during the spawning season to the maximum extent practicable? ❑ Yes ❑ No ® N/A b. Does the project result in the physical destruction (e.g., through excavation, fill, or downstream smothering by substantial turbidity) of an important spawning area? ❑ Yes ❑ No ® N/A If you answered no to question a. above, or if you answered yes to question b. above, please explain how the project would be in compliance with this GC or be aware that the project would require an individual permit application: Not Applicable 4. Migratory Bird Breeding Areas: a. Does the project avoid waters of the U.S. the maximum extent practicable? ❑ Yes that serve as breeding areas for migratory birds to ❑ No ® N/A If you answered no to question a. above, please explain how the project would be in compliance with this GC or be aware that the project would require an individual permit application: Not Applicable S. Shellfish Beds: a. Does the project occur in areas of concentrated shellfish populations? ❑ Yes ® No If you answered yes to question a. above, please explain how the project would be in compliance with this GC or be aware that the project would require an individual permit application: Page 2 of 18 SWF Recommended Application Form - NWP 29 Not Applicable 6. Suitable Material: a. Does the project use unsuitable material (e.g., trash, debris, car bodies, asphalt, etc.)? ❑ Yes ® No b. Is the material used for construction or discharged in a water of the U.S. free from toxic pollutants in toxic amounts (see Section 307 of the Clean Water Act)? ® Yes ❑ No If you answered yes to question a. above, or if you answered no to question b. above, please explain how the project would be in compliance with this GC or be aware that the project would require an individual permit application: 7. Water Supply Intakes: a. Does the project occur in the proximity of a public water supply intake? ❑ Yes ® No If you answered yes to question a. above, please explain how the project would be in compliance with this GC or be aware that the project would require an individual permit application: 8. Adverse Effects From Impoundments: a. Does the project create an impoundment of water? ❑ Yes ® No b. If you answered yes to question a. above, are the adverse effects (to the aquatic system due to accelerating the passage of water, and/or restricting its flow) minimized to the maximum extent practicable? ❑ Yes ❑ No ® N/A If you answered no to question b. above, please explain how the project would be in compliance with this GC or be aware that the project would require an individual permit application: Not Applicable 9. Management of Water Flows: a. Does the project maintain the pre-construction course, condition, capacity, and location of open waters to the maximum extent practicable, for each activity, including stream channelization and storm water management activities? ® Yes ❑ No b. Will the project be constructed to withstand expected high flows? ® Yes ❑ No c. Will the project restrict or impede the passage of normal or high flows? ❑ Yes ® No If you answered no to question a. or b. above, or if you answered yes to question c. above, please explain how the project would be in compliance with this GC or be aware that the project would require an individual permit application: 10. Fills Within 100-Year Floodplains: a. Does the project comply with applicable FEMA-approved state or local floodplain management requirements? ® Yes ❑ No ❑ N/A If you answered no to question a. above, please explain how the project would be in compliance with this GC or be aware that the project would require an individual permit application: Page 3 of 18 SWF Recommended Application Form - NWP 29 11. Equipment: a. Will heavy equipment working in wetlands or mudflats be placed on mats, or other measures be taken to minimize soil disturbance? ❑ Yes ❑ No ® N/A If you answered no to question a. above, please explain how the project would be in compliance with this GC or be aware that the project would require an individual permit application: Not Applicable 12. Soil Erosion and Sediment Controls: a. Will the project use appropriate soil erosion and sediment controls and maintain them in effective operating condition throughout construction? ® Yes ❑ No b. Will all exposed soil and other fills, as well as any work below the ordinary high water mark or high tide line, be permanently stabilized at the earliest practicable date? ® Yes ❑ No c. Be aware that if work will be conducted within waters of the U.S., Applicants are encouraged to perform that work during periods of low-flow or no-flow. If you answered no to question a. or b. above, please explain how the project would be in compliance with this GC or be aware that the project would require an individual permit application: 13. Removal of Temporary Fills: a. Will temporary fills be removed in their entirety and the affected areas returned to pre- construction elevations? ❑ Yes ❑ No ® N/A b. Will the affected areas be revegetated, as appropriate? ❑ Yes ❑ No ® N/A If you answered no to question a. or b. above, please explain how the project would be in compliance with this GC or be aware that the project would require an individual permit application: Not Applicable 14. Proper Maintenance: a. Will any authorized structure or fill be properly maintained, including maintenance to ensure public safety? ® Yes ❑ No If you answered no to question a. above, please explain how the project would be in compliance with this GC or be aware that the project would require an individual permit application: 15. Wild and Scenic River: There are no Wild and Scenic Rivers within the geographic boundaries of the Fort Worth District. Therefore, this GC does not apply. 16. Tribal Rights: a. Will the project or its operation impair reserved tribal rights, including, but not limited to, reserved water rights and treaty fishing and hunting rights? ❑ Yes ® No ❑ N/A If you answered yes to question a. above, please explain how the project would be in compliance with this GC or be aware that the project would require an individual permit application: Page 4 of 18 SWF Recommended Application Form - NWP 29 17. Endangered Species (see also Box 8 in Part III): a. Is the project likely to jeopardize the continued existence of a threatened or endangered species or a species proposed for such designation, as identified under the Federal Endangered Species Act (ESA), or will the project destroy or adversely modify the critical habitat of such species? ❑ Yes ® No b. Might the project affect any listed species or designated critical habitat? ❑ Yes ® No c. Is any listed species or designated critical habitat in the vicinity of the project? ❑ Yes ® No d. If the project "'may affect" a listed species or critical habitat, has Section 7 consultation addressing the effects of the proposed activity been completed? ❑ Yes ❑ No ® N/A If you answered yes to question a. or b. or c. above, or if you answered no to question d. above, please explain how the project would be in compliance with this GC or be aware that the project would require an individual permit application: 18. Historic Properties (see also Box 9 in Part III): a. Does the project have the potential to cause effects to any historic properties listed, determined to be eligible for listing on, or potentially eligible for listing on the National Register of Historic Places, including previously unidentified properties? ❑ Yes ® No ❑ N/A If you answered yes to question a. above, please explain how the project would be in compliance with this GC or be aware that the project would require an individual permit application: 19. Designated Critical Resource Waters: a. Will the project impact critical resource waters, which include NOAA-designated marine sanctuaries, National Estuarine Research Reserves, state natural heritage sites, and outstanding national resource waters or other waters officially designated by a state as having particular environmental or ecological significance and identified by the district engineer after notice and opportunity for public comment? ❑ Yes ® No If you answered yes to question a. above, be aware that discharges of dredged or fill material into waters of the U.S. are not authorized by NWP 29 for any activity within, or directly affecting, critical resource waters, including wetlands adjacent to such waters. 20. Mitigation (see also Box 10 in Part III): a. Will the project include appropriate and practicable mitigation necessary to ensure that adverse effects on the aquatic environment are minimal? ❑ Yes ® No If you answered no to question a. above, please include an explanation in Box 10 of why no mitigation would be necessary in order to be in compliance with this GC or be aware that the project would require an individual permit application. 21. Water Quality (see also Box 11 in Part III): a. If in Texas, does the project comply with the conditions of the TCEQ water quality certification for NWP 29? ® Yes ❑ No ❑ N/A b. If in "Indian Country," does the project comply with the conditions of the EPA water quality certification for NWPs? ❑ Yes No ® N/A Page 5 of 18 SWF Recommended Application Form - NWP 29 c. If in Louisiana, does the project have an individual water quality certification, waiver, or other approval by the LDEQ? ❑ Yes ❑ No ® N/A If you answered no to question a., b., or c. above, please be aware that the project would require an individual permit application. 22. Coastal Zone Management: The Fort Worth District does not cover any Coastal Zone; therefore, this GC does not apply. 23. Regional and Case-By-Case Conditions: See the Regional Conditions checklist below to ensure compliance with this GC. 24. Use of Multiple Nationwide Permits: a. Does the project use more than one NWP for a single and complete project? ❑ Yes ® No b. If you answered yes to question a. above, be aware that unless the project's acreage loss of waters of the U.S. authorized by the NWPs is below the acreage limit of the NWP with the highest specified acreage limit, no NWP can be issued, and the project would require an individual permit application. If you answered yes to question a. above, please explain how the project would be in compliance with this GC and what additional NWP number you intend to use: 25. Transfer of Nationwide Permit Verifications: a. Does the Applicant agree that if he or she sells the property associated with the nationwide permit verification, the Applicant may transfer the nationwide permit verification to the new owner by submitting a letter to the appropriate USACE district office to validate the transfer? ® Yes ❑ No 26. Compliance Certification: a. Does the Applicant agree that if he or she receives the NWP verification from the USACE, they must submit a signed certification regarding the completed work and any required mitigation (the certification form will be sent by the USACE with the NWP verification letter)? ® Yes ❑ No 27. Notification: a. All residential developments and subdivisions as described in NWP 29 must submit a pre- construction notification to the district engineer prior to commencing the activity. b. Does the Applicant agree that he or she will not begin the project until either: 1) He or she is notified in writing by the district engineer that the activity may proceed under the NWP with any special conditions imposed by the district or division engineer; or 2) Forty-five calendar days have passed from the district engineer's receipt of the complete PCN and the Applicant has not received written notice from the district or division engineer? However, if the Applicant was required to notify the USACE pursuant to general condition 17 that listed species or critical habitat might be affected or in the vicinity of the project, or to notify the USACE pursuant to general condition 18 that the activity may have the potential to cause effects to historic properties, the Applicant cannot begin the activity until receiving written notification from the USACE that there is "no effect" on listed species or "no potential to cause effects" on historic properties, or that any consultation required under Section 7 of the Endangered Species Act and/or Section 106 of the National Historic Preservation Act is completed. ❑ Yes ❑ No Page 6 of 18 SWF Recommended Application Form - NWP 29 c. Does the Applicant agree that if the district or division engineer notifies the Applicant in writing that an individual permit is required within 45 calendar days of receipt of a complete PCN, the Applicant cannot begin the activity until an individual permit has been obtained? ❑ Yes ❑ No 28. Single and Complete Project: a. Does the Applicant certify that the project is a "single and complete project" as defined below? ® Yes ❑ No Single and complete project: The term "single and complete project" is defined at 33 CFR 330.2(i) as the total project proposed or accomplished by one owner/developer or partnership or other association of owners/developers. A single and complete project must have independent utility (see definition). Independent utility: Defined as a test to determine what constitutes a single and complete project in the USACE regulatory program. A project is considered to have independent utility if it would be constructed absent the construction of other projects in the project area. Portions of a multi-phase project that depend upon other phases of the project do not have independent utility. Phases of a project that would be constructed even if the other phases were not built can be considered as separate single and complete projects with independent utility. Page 7 of 18 SWF Recommended Application Form - NWP 29 To ensure compliance with the NWP 29-specific requirements please answer the following questions: 1. Does the project involve the construction or expansion of a single residence, a multiple-unit residential development, or a residential subdivision? ® Yes ❑ No If you answered no to question 1. above, be aware that discharges of dredged or fill material into waters of the U.S. are not authorized by NWP 29 and would require an individual permit application. 2. Does the project (for residential subdivisions, including the development of individual subdivision lots) cause the loss of greater than 1/2-acre of non-tidal waters of the U.S ? ❑ Yes ® No If you answered yes to question 2. above, be aware that discharges of dredged or fill material into waters of the U.S. are not authorized by NWP 29 and would require an individual permit application. Note: For residential subdivisions, the aggregate total loss of waters of the U.S. authorized by this NWP cannot exceed 1/2-acre, including any loss of waters of the U.S. associated with development of individual subdivision lots. 3. Does the project cause the loss of more than 300 linear feet of perennial stream bed? ❑ Yes ® No If you answered yes to question 3. above, be aware that discharges of dredged or fill material into waters of the U.S. are not authorized by NWP 29 and would require an individual permit application. 4. Does the project cause the loss of more than 300 linear feet of intermittent or ephemeral stream bed? ❑ Yes ® No If you answered yes to question 4. above, be aware that the 300 linear foot limit must be waived in writing by the district engineer in order for the project to be authorized by NWP 29 and otherwise would require an individual permit application. 5. Does the project cause a discharge into non-tidal wetlands adjacent to tidal waters? ❑ Yes ® No If you answered yes to question S. above, be aware that discharges of dredged or fill material into waters of the U.S. are not authorized by NWP 29 and would require an individual permit application. Page 8 of 18 SWF Recommended Application Form - NWP 29 REGIONAL CONDITIONS CHECKLIST To ensure compliance with the Regional Conditions within the Fort Worth District, in the State of Texas, in order for an authorization by a NWP to be valid, please answer the following questions (for projects in Texas only): 1. Will the project include required compensatory mitigation at a minimum one-for-one ratio for all special aquatic sites that exceed 1/10 acre and require pre-construction notification, and for all losses to streams that exceed 300 linear feet and require pre-construction notification (unless the appropriate District Engineer determines in writing that some other form of mitigation would be more environmentally appropriate and provides a project-specific waiver of this requirement)? ❑ Yes ❑ No ® N/A If you answered no to question 1. above, be aware that the project would not be authorized by a NWP 29 and would require an individual permit application. 2. Does the project involve a discharge into habitat types that are wetlands (typically referred to as pitcher plant bogs) that are characterized by an organic surface soil layer and include vegetation such as pitcher plants (Sarracenia sp.), sundews (Drosera sp.), and sphagnum moss (Sphagnum sp.) or wetlands (typically referred to as bald cypress-tupelo swamps) comprised predominantly of bald cypress trees (Taxodium distichum), and water tupelo (Nyssa aquatica), that are occasionally or regularly flooded by fresh water with common associates including red maple (Acer rubrum), swamp privet (Forestiera acuminata), green ash (Fraxinus pennsylvanica), water elm (Planera aquatica), lizard's tail (Saururus cernuus), water mermaid weed (Proserpinaca spp.), buttonbush (Cephalanthus occidentalis), and smartweed (Polygonum spp.)? ❑ Yes ® No If you answered yes to question 2. above, notification of the District Engineer is required in accordance with NWP GC 27, and the USACE will coordinate with other resource agencies as specified in NWP GC 27(d). 3. Is the project in the area of Caddo Lake within Texas that is designated as a "Wetland of International Importance" under the Ramsar Convention? ❑ Yes ® No If you answered yes to question 3. above, notification of the District Engineer is required in accordance with NWP GC 27, and the USACE will coordinate with other resource agencies as specified in NWP GC 27(d) 4. a. Is the project in an area of Dallas, Denton, or Tarrant counties that is within the study area of the "Final Regional Environmental Impact Statement (EIS), Trinity River and Tributaries" (May 1986)? ❑ Yes ® No b. If Yes, does the project meet the criteria and follow the guidelines specified in Section III of the Record of Decision for the Regional EIS, including the hydraulic impact requirements? ❑ Yes ❑ No ® N/A If you answered no to question 4b. above, be aware that the project would not be authorized by a NWP 29 and would require an individual permit application. Page 9 of 18 SWF Recommended Application Form - NWP 29 To ensure compliance with the Regional Conditions within the Fort Worth District, in the State of Louisiana, in order for an authorization by a NWP to be valid, please answer the following questions (for projects in Louisiana only): 1. Does the activity cause the permanent loss of greater than 1/2 acre of seasonally inundated cypress swamp and/or cypress-tupelo swamp? ❑ Yes ® No If you answered yes to question 1. above, be aware that the project would not be authorized by a NWP 29 and would require an individual permit application. 2. Does the activity cause the permanent loss of greater than 1/2 acre of pine savanna, pine flatwoods, and/or pitcher plant bogs? ❑ Yes ® No If you answered yes to question 2. above, be aware that the project would not be authorized by a NWP 29 and would require an individual permit application. 3. Has the activity been determined to have an adverse impact upon a federal or state designated rookery and/or bird sanctuary? ❑ Yes ® No If you answered yes to question 3. above, be aware that the project would not be authorized by a NWP 29 and would require an individual permit application. 4. Does the activity fell any existing den or candidate den trees within areas known to be occupied by the threatened Louisiana black bear? (Candidate den trees are defined as bald cypress and/or tupelo gum with visible cavities, having a minimum diameter-at-breast-height of 36 inches, and associated with rivers, lakes, streams, bayous, sloughs, or other waterbodies.) ❑ Yes ® No If you answered yes to question 4. above, be aware that the project would not be authorized by a NWP 29 and would require an individual permit application. 5. Does the project involve instream activities in the following waterways: Bayou Boeuf Tributaries in Rapides Parish: (Brown Creek, Mack Branch, Clear Creek, Little Brushy Creek, Loving Creek, Little Loving Creek, Long Branch, Bayou Clear, Castor Creek, Valentine Creek, and Little Bayou Clear), Amite River (LA Highway 37 at Grangeville to Port Vincent), Bogue Falaya River and Tributaries, Abita River and Tributaries, Bayou Chinchuba (between U.S. 190 and Louisiana Highway 59), West Pearl River, Bogue Chitto River and Tributaries, and Red River tributaries in Grant Parish (Black Creek, Swafford Creek, Cypress Creek, Beaver Creek, Cress Creek, Jordon Creek, Hudson Creek, Gray Creek, Moccosin Branch and James Branch)? ❑ Yes ® No If you answered yes to question 5. above, notification of the District Engineer is required in accordance with NWP GC 27 due to the occurrence of threatened or endangered species. 6. To the best of the applicant's knowledge, is any excavated and/or fill material to be placed within wetlands free of contaminants? ❑ Yes ❑ No ® N/A If you answered no to question 6. above, be aware that the project would not be authorized by a NWP 29 and would require an individual permit application. 7. Regional Condition 7 applies to work within the Louisiana Coastal Zone and/or the Outer Continental Shelf off Louisiana, and therefore does not apply in the USACE Fort Worth District. Work in these areas may require coordination with the USACE Galveston or New Orleans districts. Page 10 of 18 SWF Recommended Application Form - NWP 29 S. Does the activity adversely affect greater than 1/10 acre of wetlands, and/or adversely impact a designated Natural and Scenic River, a state or federal wildlife management area, and/or refuge? ❑ Yes ® No If you answered yes to question 8. above, notification of the District Engineer is required in accordance with NWP GC 27. 9. Be aware that NWP 29, via disavowal of water quality certification by the LDEQ, is considered denied without prejudice. Individual requests for approval under NWP 29 will be considered on a case-by-case basis only after receipt by the appropriate USACE district of an individual water quality certification, waiver, or other approval by the LDEQ. Additional Discussion: Page 11 of 18 SWF Recommended Application Form - NWP 29 Part II: Project Information Box 1 Project Name: Applicant Name Randall's University Park Re plat of Lot 3R Ali ]afFer Applicant Title Applicant Company, Agency, etc. Owner Mailing Address Applicant's internal tracking number (if any) 5727 Richmond Ave, APT. 202 Dallas TX 75206 Work Phone with area code Home Phone with area c«ie Fax # E-mail Address 979 202-1933 aiiinksa@yahoo.com Relationship of applicant to property: ® Owner ❑ Purchaser ❑ Lessee ❑ Other: Application is hereby made for verification that subject regulated activities associated with subject project qualify for authorization under a USACE nationwide permit or permits as described herein. I certify that I am familiar with the information contained in this application, and that to the best of my knowledge and belief, such information is true, complete, and accurate. I further certify that I possess the authority to undertake the proposed activities. I hereby grant to the agency to which this application is made the right to enter the above-described location to inspect the proposed, in-progress, or completed work. I agree to start work only after all necessary permits have been received. Signature of applicant Date (mm/dd/yyyy) Box 2 Authorized Agent/Operator Name and Signature: (If an agent is acting for the applicant during the permit process) Rabon Metcalf P.E. Agent/Operator Title Agent/Operator Company, Agency, etc. Owner RME Consulting Engineers Mailing Address P.O. Box 9253 - College Station TX 77842 E-mail Address rabon@rmengineer.com Work Phone with area code Home Phone with area code 1 Fax # Cell Phone # 979 764-0704 (979) 764-0704 I hereby authorize the above-named agent to act in my behalf as my agent in the processing of this application and to furnish, upon request, supplemental information in support of this permit application. I understand that I am bound by the actions of m agent, and I understand that if a federal or state permit is issued I or m agent, must sign the permit. Signature of apple' Da a (mm/dd/yyyy) I ceitil'i that I am familiar with the information contained in this application, and that to the best of my knowledge and belief, such information is true complete, and accurate. Signature of authorized agent Date (mm/dd/yyyy) Box 3 Name of property owner, if other than applicant: Multiple Current Owners fWmu/tfpleprmentprvp&-Wowneras, dk ir/weandindudealistasan Owner Title Owner Company, Agency, etc. Page 12 of 18 SWF Recommended Application Form - NWP 29 Mailing Address Work Phone with area code Home Phone with area code Box 4 Project location, including street address, city, county, state, and zip code where proposed activity will occur: Chimney Hill Drive, College Station, Brazos County, TX - 77840 Nature of Activity (Description of project; include all features; see instructions): Residential development of five (5) lots which will included the installation of 60 LF of 60" diameter culvert. Project Purpose (Description of the reason or purpose of the project; see instructions): Has a delineation of waters of the U.S., including wetlands, been completed? (see instructions) ❑ Yes, Attached ® No If a delineation has been completed, has it been verified in writing by the USACE? ❑ Yes, Date of approved or preliminary jurisdictional determination (mm/dd/yyyy): USACE project: ❑ No Are color photographs of the existing conditions available? ❑ Yes, Attached ® No Are aerial photographs available? ® Yes, Attached ❑ No ❑ Multiple Waters of the U.S. (if mumple waters of t*e us, check here and compleis fhe table in Attachment D Waterbody(ies) (if known; otherwise enter "an unnamed tributary to'J: Unnamed Tributary Tributa ies to what known, downstream waterbod ies : Burton Creek Latitude & longitude (Decimal Degrees): N 30.63514 W 96.33216 USGS Quad map name(s): Watershed(s) and other location descriptions, if known: Burton Creek which discharges into Carters Creek Directions to the project location: From SH 6 go west on FM 60 (University Drive), take a right onto Spring Loop, take a left on Chimney Hill Drive. The project is on the right (north side) at the cul-de-sac of Chimney Hill Drive. Part III: Project Impacts and Mitigation Box 5 Reason(s) for Discharge into waters of the U.S.: Construction of 60 LF of 60" diamater culvert Type(s) of material being discharged and the amount of each type in cubic yards: Common Fill -300 CY Total surface area (in acres) of wetlands or other waters of the U.S. to be filled: 0 acres Page 13 of 18 SWF Recommended Application Form - NWP 29 Indicate the proposed impacts to waters of the U.S. in ACRES (for wetlands and impoundments) and LINEAR FEET (for rivers and streams), and identify the impact(s) as permanent and/or temporary for each waterbody type listed below. The table below is intended as a tool to summarize impacts by resource type for planning compensatory mitigation and does not replace the table of waters of the U.S. in Attachment D for those projects with impacts to multiple waters of the U.S. Perm anent Tern rary Waterbod Type Acres Linear feet Acres Linear feet Non-forested wetland Forested wetland Perennial stream Intermittent stream Ephemeral stream Impoundment Other: Total: Potential indirect and/or cumulative impacts of proposed discharge (if any): Required drawings (see instructions): Vicinity map: ® Attached To-scale plan view drawing(s): ® Attached To-scale elevation and/or cross section drawing(s): ® Attached Is any portion of the work already complete? ❑ Yes ® No If yes, describe the work: Box 6 Authority: (see instructions) Is Section 10 of the Rivers and Harbors Act for projects affecting navigable waters applicable? ❑ Yes ® No (see Fort worm Dis&ictNavigable waters list) Is Section 404 of the Clean Water Act applicable? ❑ Yes ❑ No Box 7 Larger Plan of Development: Is the discharge of fill or dredged material for which Section 10/404 authorization is sought intended for a residential development project which is part of a larger plan of development? ❑ Yes ® No (If yes, please provide lfie information in the remainder of Box 7) Does the residential development project have independent utility in addition to the larger plan of development? ❑ Yes ❑ No If yes, explain: If discharge of fill or dredged material is part of development, name and proposed schedule for that larger development (start-up, duration, and completion dates): Page 14 of 18 SWF Recommended Application Form - NWP 29 Location of larger development (If discharge of fill or dredged material is part of a plan of development, a map of suitable quality and detail for the entire project site should be included): Total area in acres of entire project area (including larger plan of development, where applicable): Box 8 Federally Threatened or Endangered Species (see instructions) Please list any federally-listed (or proposed) threatened or endangered species or critical habitat potentially affected by the project (use scientific names (i.e., genus species), if known): Not Applicable Have surveys, using U.S. Fish and Wildlife Service (USFWS) protocols, been conducted? ❑ Yes, Report attached ❑ No (explain): If a federally-listed species would potentially be affected, please provide a description and a biological evaluation. ❑ Yes, Report attached ❑ Not attached Has Section 7 consultation been initiated by another federal agency? ❑ Yes, Initiation letter attached ❑ No Has Section 10 consultation been initiated for the proposed project? ❑ Yes, Initiation letter attached ❑ No Has the USFWS issued a Biological Opinion? ❑ Yes, Report attached ❑ No If es, list date Opinion was issued mm/dd/ Box 9 Historic properties and cultural resources Please list any historic properties listed (or eligible to be listed) on the National Register of Historic Places which the project has the potential to affect: Not Applicable Has an archaeological records search been conducted? ❑ Yes, Report attached ❑ No (explain): Are any cultural resources of any type known to exist on-site? ❑ Yes ❑ No Has an archaeological pedestrian survey been conducted for the site? ❑ Yes, Report attached ❑ No (explain): Has Section 106 or SHPO consultation been initiated by another federal or state agency? ❑ Yes, Initiation letter attached ❑ No Has a Section 106 MOA been signed by another federal agency and the SHPO? ❑ Yes, Attached ❑ No If es, list date MOA was signed mm/dd/ Box 10 Proposed Conceptual Mitigation Plan Summa (see instructions) Measures taken to avoid and minimize impacts to waters of the U.S. (if any): Impacts are below the limits established b NWP 29. Applicant proposes combination of one or more of the following mitigation types: ❑ Mitigation Bank ❑ On-site ❑ Off-site Number of sites: ❑ None Page 15 of 18 SWF Recommended Application Form - NWP 29 Applicant proposes to purchase mitigation bank credits: ❑ Yes ❑ No Mitigation Bank Name: Number of Credits: Indicate in ACRES (for wetlands and impoundments) and LINEAR FEET (for rivers and streams) the total quantity of waters of the U.S. proposed to be created, restored, enhanced, and/or preserved for purposes of providing compensatory mitigation. Indicate mitigation site type (on- or off-site) and number. Indicate waterbody type (non-forested wetland, forested wetland, perennial stream, intermittent stream, ephemeral stream, impoundment, other) or non-jurisdictional (uplands'). Mitigation Site Type and Number Waterbody Type Created Restored Enhanced Preserved e.g., On site 1 Non-forested wetland 0.5 acre eg., Off-site 1 Intermittent stream 500 LF 1000 LF Totals: For uplands, lease indicate if designed as an upland buffer. Summary of Mitigation Work Plan (Describe the mitigation activities listed in the table above): If no mitigation is proposed, provide a detailed explanation of why no mitigation would be necessary to ensure that adverse effects on the aquatic environment are minimal: Impacts are below the limits established by NWP 29. Has a conceptual mitigation plan been prepared in accordance with the USACE regulations and LJ Yes, Attached LJ No (explain): Mitigation site(s) latitude & longitude (Decimal USGS Quad map name(s): Degrees): Other location descriptions, if known: Directions to the mitigation location(s): Box 11 Water Quality Certification (see instructions): For Texas: Does the project meet the conditions of the Texas Commission on Environmental Quality (TCEQ) Clean Water Act Section 401 certification for NWP 29? ® Yes ❑ No Does the project include soil erosion control and sediment control Best Management Practices (BMPs)? ® Yes ❑ No Does the project include BMPs for post-construction total suspended solids control? ® Yes ❑ No Page 16 of 18 SWF Recommended Application Form - NWP 29 For Louisiana: Individual water quality certification issued by LDEQ? ❑ Yes, Attached ❑ No Water quality certification waiver or other approval by LDEQ? ❑ Yes, Attached ❑ No Explain: For Tribal Lands ("Indian Country': Does the project meet the conditions of the EPA water quality certification for NWPs? ® Yes ❑ No Box 12 List of other certifications or approvals/denials received from other federal, state, or local agencies for work described in this application: Would include but is not restricted to zoning, building, and flood lain Z permits Agency Approval T 2 Identification No. Date Applied Date Approved Date Denied City of College Station Development Permit Randall's University Park 12/1/10 2/16/11 TCE SWP3 3/8/11 3/8/11 Page 17 of 18 SWF Recommended Application Form - NWP 29 Part IV: Attachments Included A. List of Property Owners ❑ B. Delineation of Waters of the U.S., Including Wetlands ❑ C. Color Photographs ❑ D. Table of Waters of the U.S. Impacted by the Proposed Project ❑ E. Required Drawings/Figures F. Threatened or Endangered Species Reports and/or Letters ❑ G. Historic Properties and Cultural Resources Reports and/or Letters ❑ H. Conceptual Mitigation Plan ❑ I. Other: ❑ End of Form Page 18 of 18 SWF Recommended Application Form - NWP 29 RANDALL'S UNIVERSITY PARK: LOTS 3R-2A thru 3R-2E CHIMNEY HILL DR.. COLLEGE STAT t , / ION N \ N.T.S. 30 z al E ~Nj co ;;0*16 2154 kSTER OD AIP VICINITY MAP