20100114 Ver 1_Application_20100210

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:
51b. Business name
(if applicable):
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. Fax no.:
5g. Email address:
Page 2 of 10
PCN Form -Version 1.3 December 10, 2008 Version
Mr. Monte Matthews
SR 1100 Slope Failure, Ashe
Page 2
February 2, 2010
Enclosures
cc: Monte Matthews, US Army Corps of Engineers (1 additional copy)
Ron Linville, Western Piedmont Region Coordinator, NCWRC
Brian Wrenn, Division of Water Quality (21 copies)
Mike Pettyjohn, PE, Division Engineer
Doug Tetzlatf, District Engineer
Doug Eller, County Maintenance Engineer
Heath Slaughter, Division Environmental Officer
Scott Pipes, Roadside Environmental Field Operations Technician
GE IN
Office Use Only
Wa Corps action ID no.
DWQ project no.
Form Version 1 3 Dec 10 2008
Pre-Construction Notification (NCN) Form
A. Applicant Information
1. Processing
1 a. 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:
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
le. Is this notification solely for the record For the record only for DWQ 401 For the record only for Corps Permit.
because written approval is not required? i Certification:
®Yes ? No ? Yes ® No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation I Yes
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu ?
fee program. No
1 g. Is the project located in any of NC's twenty coastal counties If yes, answer 1In ? Yes
below.
I ® No
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ?Yes ®No
2. Project Information
2a Name of project: SR 1100 Slope Failure
2b. County: Ashe
2c. Nearest municipality / town: Todd
i
2d.
Subdivision name:
2e. NCDOT only, T I.P. or state 111C.005035
project no.
3. Owner Information
3a. Name(s) on Recorded Deed. NC Dept, of Transportation
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if

applicable)-
Heath Slaughter
3d. Street address. P. O. Box 250
3e. City, state, zip: North Wilkesboro, NC 28659
3f. Telephone no.. 336-903-9292
3g. Fax no.: [phone]
3h. Email address: hslaughter@ncdot gov
Page ] of 10
PCN Form - Version 1.3 December 10, 2008 Version
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:
Page 2 of 10
PCN Form - Version 1 3 December 10, 2008 Version
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 7 of 10
PCN Form - Version 1.3 December 10, 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? If. no, explain why.
? Yes ? No
Comments:
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project? N/A (linear) %
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, nar rative description of the plan:
State Stormwater Permit
? Certified Local Government
2e. Who will be responsible for the review of the Stormwater Management Plan? ? DWQ Stormwater Program
® DWQ 401 Unit
3. Certified Local Government Stormwater Review

3a. In which local government's jurisdiction is this project? N/A
? Phase II
F1 NSW
3b. Which of the following locally-implemented stormwater management programs ? USMP
apply (check all that apply): ? Water Supply Watershed
? Other:
3c. Has the approved Stormwater Management Plan with proof of approval been ? Yes ? No
attached?
4. DWQ Stormwater Program Review
? Coastal counties
® HOW
4a . Which of the following state-implemented stormwater management programs apply ? ORW
(check all that apply): ? Session Law 2006-246
? Other:
4b . Has the approved Stormwater Management Plan with proof of approval been
? Yes ® No
attached?
5. DWQ 401 Unit Stormwater Review
5a . Does the Stormwater Management Plan meet the appropriate requirements? ? Yes ? No
51b . Have all of the 401 Unit submittal requirements been met? ? Yes ? No
Page 8 of 10
PCN Form -Version 1.3 December 10, 2008 Version
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
la. Does the project involve an expenditure of public (federal/state/local) funds or the ® Yes ? No
use of public (federal/state) land?
1 b. 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)?
1 c. 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
? Yes
? No
letter.)
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): See cover letter
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 9 of 10
PCN Form - Version 1.3 December 10, 2008 Version
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or ® Yes ? No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act ? Yes ® No
impacts?
? Raleigh
5c If yes, indicate the USFWS Field Office you have contacted.
h
ille
? A
ev
s
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
None, if any plants were on the riverbank, they were washed downstream by Mother Nature before our activity started.
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?
WRC will comment
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?
NRHP
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: There was no rise in elevation of the fill
8c. What source(s) did you use to make the floodplain determination? ncfloodmaps.com
J. Heath Slaughter 2/2/10
Applicant/Agent's Printed Name ApplicanUAgent's Sign e Date
(Agent's s nature is valid only if an aulhorizati etter from the applicant
is provided.)
Page 10 of 10
PCN Form -Version 1.3 December 10, 2008 Version
0
y
r
Ls??jrN
V

f
0
8
Z
m
Q,
C IN
O I CO
07\
I?
r?

I?
J
N
t' !ir}•\\\??? \' ? /t??'?,? \ it-? ? I:f ?-U \rr ,.L? ..
r J tel. \ \} \w ??- ! i ?`+? Jean ? _ n ? )l + \ ? /
M 1,
?r if
I, IN
i
t
v r'rf/
1
?Ce
fr 1,
?r'? I ? - ?^ P9 Il V? i ???? AX -
% i'r ar
Jl lr - - 14
N? N,
\
r :? -riot tltn 1'+'._J :>
Bank ,;:.\\^
Failure \
i 1..? . 1

s\l
r •r/

'-
`4 `? ??( ? - ' Orr' ':\i?•

z ? )\\ art. r _- 1 . ,4 E ?? -' V t ro .It_ t ,?:.. r ! "
'.:c+- \\ ? / i./rte 7 - 1 i \ ? ?``.^ i `?` / `\,' /1 ?'/ -/ O ` ? ` _.
\ is - `.. ) :I f r N
-ZI
l
)?Fola ?? ? L? 1+ \\, it S=T,OY1 'FVO' R K
Name: TODD Location: 036.2782573° N 081.5720194° W
Date: 2/2/2010
Scale: 1 inch equals 2000 feet
Copyright (C) 1998, Maptech, Inc
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):
36.27914 Longitude: - 81.57020
Latitude:
(DD.DDDDDD) (-DD.DDDDDD)
1c. Property size: 0.01 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
proposed project: South Fork New River
2b. Water Quality Classification of nearest receiving water: C, HQW
2c. River basin: New
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:
Road failure in a rural setting
31b. 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.
Road parallels the river for miles
3d. Explain the purpose of the proposed project:
reestablish roadway to preexisting condition and protect slope from future damage
3e. Describe the overall project in detail, including the type of equipment to be used:
Armor plated slope with trackhoe
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?
Comments:
? Yes ® No ? Unknown
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
hased project? ? Yes ®No
6a.
E
fyeexplain.
6b. Page 3 of 10
PCN Form - Version 1.3 December 10, 2008 Version
C. Proposed Impacts Inventory
1. Impacts Summary
la. 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 impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWQ - non-404, other) (acres)
Temporary T
W1 ? P ? T ? Yes ? Corps
? No ? DWQ
W2 ? P ? T - ? Yes ? Corps
? No ? DWQ
W3 ? P ? T ? Yes ? Corps
? No ? DWQ
W4 ? P ? T ? Yes ? Corps
? No ? DWQ
W5 ? P ? T ? Yes ? Corps
? No ? DWQ
W6 ? P ? T ? Yes ? Corps
? No ? 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. 3g.
Stream impact Type of impact Stream name Perennial Type of jurisdiction Average Impact
number - (PER) or (Corps - 404, 10 stream length
Permanent (P) or intermittent DWQ - non-404, width (linear
Temporary (T) (INT)? other) (feet) feet)
St ® P ? T Bank Armoring South Fork New
River ® PER
? INT ® Corps
® DWQ > 20 feet 80
S2 ? P ? T ? PER ? Corps
? INT ? DWQ
S3 ? P ? T ? PER ? Corps
? INT ? DWQ
S4 ? P ? T ? PER ? Corps
? INT ? DWQ
S5 ? P ? T ? PER ? Corps
? INT ? DWQ
S6 ? P ? T ? PER ? Corps
? INT ? DWQ
3h. Total stream and tributary impacts 80
3i. Comments:
Page 4 of 10
PCN Form - Version 1.3 December 10, 2008 Version
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. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number- (if applicable) Type of impact Waterbody type Area of impact (acres)
Permanent (P) or
Temporary T
01 ?P?T
02 ?P?T
03 ?P?T
04 ?P?T
41'. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
if and or lake construction proposed, then complete the chart below.
5a. 51b. 5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or purpose (acres)
number of pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
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 an impacts require mitigation, then you MUST fill out Section D of this form.

6a.
? Neuse ?Tor-Pamlico ? Other:
Project is in which protected basin? ? Catawba ? Randleman
61b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number - Reason Buffer Zone 1 impact Zone 2 impact
Permanent (P) or for Stream name mitigation (square feet) (square feet)
Temporary T impact required?
?Yes
B1 ?P?T ? No
?Yes
B2 ?P?T ? No
?Yes
B3 ?P?T ? No
6h. Total buffer impacts
6i. Comments
Page 5 of 10
PCN Form - Version 1.3 December 10, 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.
1 b. 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

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 6 of 10
PCN Form - Version 1.3 December 10, 2008 Version