20091078 Ver 1_401 Application_20091009

PARKSCREATION
.09'1078
118 Hamby Road, Suite 336 e Dobson, NC 27017 9 336-401-8235 • Fax: [phone]
October 6, 2009
Mr. Monte Matthews
Raleigh Regulatory Field Office
Department of the Army, Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, NC 27587
Re: Fisher River Park Bank Stabilization Project
401/404 Pre-Construction Notification Application
Dear Mr. Matthews:
Ogk?51_g n? w1?
J
O C T 1 3 2009
WETLANDS aNp WATER OVAUTY
Enclosed for your consideration and approval is the Pre-Construction Notification for the US Army Corps
Nationwide Permit 13 for 100 linear feet of stream bank stabilization for the Fisher River Park Bank
Stabilization Project. This project is located in Surry County. Also enclosed is a photo log for your
reference in reviewing the PCN application.
This is not a stream mitigation project and is funded by Surry County.
If I can be of any further assistance, please contact me at 336-401-8237.
Sincerely,
Le--t-
Adam McComb
Director, Surry County Parks & Recreation Department
Enclosures: PCN, Landowner Authorization Forms, Figures, Photo log
CC: Ron Linville WRC
Laurie Dennison DWQ
AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. PLAN NO. PARCEL ID: 4997-00-63-0796
STREET ADDRESS: Prison Camp Road
Dobson, NC 27017
Please print: Clarence McCormick
Property Owner:
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
Adam McComb
(Contractor / Agent)
of Surry County Park & Rec
(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):
PO Box 498, Dobson, NC
Telephone: (33L) 3M -36lL IWI 11 O % 1
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature
Date: to ' / 'o f
4
Aut orized Signature
Date: 16 q- o r
' 1073
O?oF W AT&'y
1 1 >_ ?
I ?.l l ° Y
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.0 November 2008
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
1 b. Specify Nationwide Permit (NWP) number: 13 or General Permit (GP) number:
1 c. Has the NWP or GP number been verified by the Corps? i
9 Yes

El No
1 d. 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
1 e. Is this notification solely for the record For the record only for DWQ 401 For the record o nly for Corps Permit:
because written approval is not required? Certification:
® Yes ? No ? Yes ® No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation ? Yes ® No
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program.
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h ? Yes ® No
below.
1h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ? Yes ® No
2. Project Information
2a. Name of project: Fisher River Park Bank Stabilization Project
2b. County: Surry
2c. Nearest municipality / town: Dobson p • • .?
2d. Subdivision name: N/A
2e. NCDOT only, T.I.P. or state
t N/A O C T 1 3 2009
projec
no:
WETLANDS AND STORi TE BRANCH
Page 1 of 12
PCN Form - Version 1.0 November 2008 Version
Section A. Applicant Information, continued
3. Owner Information
3a. Name on Recorded Deed: Surry County Clarence McCormick
3b. Deed Book and Page No. 0014 0062 0190 0467
3c. Responsible Party (for LLC if
applicable): Adam McComb
3d. Street address: 118 Hamby Rd, Suite 336 PO Box 498
3e. City, state, zip: Dobson, NC 27017 Dobson, NC 27017
3f. Telephone no.: 336-401-8235
3g. Fax no.: 336-401-8217
3h. Email address: [e-mail]
4. Applicant Information (if different from owner)
4a. Applicant is: ? Agent ® Other, specify: Owner for the park and Agent for the landowner
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: Adam McComb--Same as in #3
5b. Business name
(if applicable):
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. Fax no.:
5g. Email address:
Page 2 of 12
PCN Form - November 2008 Version
Section A. Applicant Information, continued
Page 3 of 12
PCN Form - November 2008 Version
B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): 4997-00-46-5429 (Park parcel) 4997-00-63-0796
1 b. Site coordinates (in decimal degrees): 36°25'6.30'N - 80°43'0.05'W
1c. Property size: 124.72 acres (park parcel) 197.32 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to Fisher River
proposed project:
2b. Water Quality Classification of nearest receiving water: C
2c. River basin: Yadkin Pee-Dee
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:
The streams flow through Fisher River Park and then onto the McCormick parcel for about 75 feet before entering the
Fisher River. The stream historically has been moved and straigtened. The stream has eroded banks due to
straightening and lack of vegetation.
3b. List the total estimated acreage of all existing wetlands on the property:
0
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
2000 linear feet
3d. Explain the purpose of the proposed project:
To stabalize eroding stream banks within the park and to reduce the sediment entering the Fisher River.
3e. Describe the overall project in detail, including the type of equipment to be used:
Project will include bank stabalization along approximately 100 linear feet of a UT to Fisher River near the town of
Dobson. Work will be conducted track hoes, dump trucks and other equipment typically used for stream stabilization
projects.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property / ? Yes ® No ? Unknown
project (including all prior phases) in the past?
4b. If the Corps made the jurisdictional determination, what type
? Preliminary ? Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company:
Name (if known): 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 ? Yes ® No ? Unknown
this project (including all prior phases) in the past?
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.
Page 4 of 12
PCN Form - Version 1.0 November 2008 Version
C. Proposed Impacts Inventory
1. Impacts Summary
1 a. 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. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type of jurisdiction
number- Type of Type of wetland Forested (Corps - 404, Area of impact (acres)
Permanent (P) or impact (if known) DWQ - non-404, other)
Temporary (T)
W1 ? P ? T ? Yes ? No ? Corps
? DWQ
W2 ? PEI T ? Yes ? No ? Corps
? DWQ
W3 ? P ? T ? Yes ? No ? Corps
? DWQ
W4 ? P ? T ? Yes ? No ? Corps
? DWQ
W5 ? PEI T ? Yes ? No ? Corps
? DWQ
W6 ? P ? T ? Yes ? No ? Corps
? DWQ
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. 3b. 3c. 3d. 3e. 3f.
Stream impact Type of Stream name Perennial (PER) or Average stream width (feet) Impact
number - impact intermittent (INT)? length
Permanent (P) or (linear feet)
Temporary (T)

S1 ® P ? T Bank
stabilizati UT to Fisher
River
® PER ? INT
6
100
on
S2 ? P ? T ? PER ? INT
S3 ? P ? T ? PER ? INT
S4 ? P ? T ? PER ? INT
S5 ? P ? T ? PER ? INT
S6 ? P ? T ? PER ? INT
3g. Total stream and tributary impacts 600
3h. Comments:
Page 5 of 12
PCN Form - Version 1.0 November 2008 Version
C. Proposed Impacts Inventory, continued
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 individual) list all open water impacts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of
impact number waterbody Type of impact Waterbody type Area of impact (acres)
- Permanent (if
(P) or applicable)
Temporary (T)
01 ?P?T
02 ?P?T
03 ?P?T
04 ?P?T
4f. Total open water impacts
4g. Comments:
Page 6 of 12
PCN Form - November 2008 Version
C. Proposed Impacts Inventory, continued
5. Pond or Lake Construction
If pond or lake construction proposed, then complete the chart below.
5a. 5b. 5c. 5d. 5e.

P
d ID Wetland Impacts (acres) Stream Impacts (feet) Upland
on Proposed use or (acres)
number purpose of pond
Flooded Filled Excavated Flooded Filled Excavated Flooded
P1
P2
5f. Tota I
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.
? Neuse ? Tar-Pamlico ? Other:
Project is in which protected basin? ? Catawba ? Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number - Reason Buffer Zone 1 impact (square Zone 2 impact
Permanent (P) for impact Stream name mitigation feet) (square feet)
or Temporary required?
T
B1 ?P?T ?Yes ?No
B2 ?P?T ?Yes ?No
B3 ?P?T ?Yes ?No
6h. Total buffer impacts
6i. Comments:
Page 7 of 12
PCN Form - November 2008 Version
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Proposed impacts are required to stabilize stream banks. Project will result in bank sloping of 100 linear feet (LF) of
stream along the UT at the confluence with Fisher River.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Contractor will work from the top of bank to avoid disturbing the streambed.
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

El 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 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: warm, cool, cold
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.
Page 8 of 12
PCN Form - Version 1.0 November 2008 Version
D. Impact Justification and Mitigation, continued
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 Reason for impact Total impact
(square feet) Multiplier Required mitigation
(square feet)
Zone 1 3 (2 for Catawba)
Zone 2 1.5
Total buffer mitigation required:
6c. 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).
6d. Comments:
Page 9 of 12
PCN Form - November 2008 Version
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 ? Yes ® No
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? ? Yes ® No
2. Determination if the Project Requires a Stormwater Management Plan
2a. Does the project require a Non-404 Jurisdictional General Permit? ? Yes ® No
2b. Is the project subject to General Certification 3704 or 3705? ? Yes ® No
3. Determination of Stormwater Review Jurisdiction
3a. Is this project subject to any of the following state-implemented stormwater ? Coastal counties
management programs (check all that apply)? ? HQW
El ORW
If so, attach one copy of the approval letter from the DWQ and one copy of the ? Session Law 2006-246
approved stormwater management plan. ? Other:
3b. In which local government's jurisdiction is this project? Town of Dobson
3c. Is this local government certified to implement a state stormwater program? ? Yes ? No
If so, attach one copy of the approval letter from the local government and one copy
of the approved stormwater management plan (or one copy of the approved
Stormwater management plan stamped as approved).
4. Information Required for DWQ 401 Unit Stormwater Review
4a. What is the overall percent imperviousness according to the most current site plan? >5
4b. Does this project contain any areas that meet the criteria for "high density" per ? Yes ® No
General Certifications 3704 and 3705?
4c. If the site is over 24% impervious and/or contains high density areas, then provide a brief narrative description of the
stormwater management plan.
4d. Has a completed BMP Supplement Form with all required items been submitted ? Yes ? No
for each stormwater BMP?
Page 10 of 12
PCN Form - Version 1.0 November 2008 Version
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1a. Does the project involve an expenditure of public (federal/state/local) funds or the ® Yes ? No
use of public (federal/state) land?
1b. If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State ? Yes ® No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1c. If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
letter.) ? Yes ® No
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards, ? Yes ® No
or Riparian Buffer Rules (15A NCAC 2B.0200)?
2b. Is this an after-the-fact permit application? ? Yes ® No
2c. If you answered "yes" to 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 ? Yes ® No
additional development, which could impact nearby downstream water quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
Page 11 of 12
PCN Form - Version 1.0 November 2008 Version
F. Supplementary Information, continued
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or Y
? es No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act ® Yes ? No
impacts?

5c. If yes, indicate the USFWS Field Office you have contacted. ?
Raleigh
? Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
NCWRC Natural Heritage website, Natural Heritage workroom, USFWS
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?
USFWS
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 ? Yes ® No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
North Carolina Office of Archives and History website was searched.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? -0 yes ? No
8b. If yes, explain how project meets FEMA requirements: Bank sloping will not have an adverse impact on the flood levels.
8c. What source(s) did you use to make the floodplain determination? North Carolina Floodplain Mapping Information System,
Sury County GIS

-??
'
Applicant/Agent's Printed Name Applicant/Agent
s Signature
(Agent's signature is valid only if an authorization letter from the applicant Date
is provide .)
Page 12 of 12
PCN Form - November 2008 Version