20120071 Ver 1_Application_20120125

Office Use Only
1 Corps action ID no
DWQ project no
Form Version 1 3 Dec 10 2008
Page 1 of 10
PCN Form — Version 1 3 December 10 2008 Version
Pre - Construction Notification (PCN) Form
A Applicant Information
I
Drocessing
1 a
Type(s) of approval sought rrom the
Corps
®Section 404 Permit El Section 10 Permit
1b Specify Nationwide Permit (NWP) number NW 14 or General Permit (GP) number
is
Has the NWP or GP number been verified by the Corps?
❑ Yes
® 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
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 1 h
below
❑ Yes
® No
1h
Is the project located witnin a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
® No
2
Project Information
2a
Name of project
SR 1146 Baker Road
2b
County
Cherokee
2c
Nearest municipality / town
Murphy
2d
Subdivision name
N/A
2e
NCDOT only T I P or state
project no
14 020031
3
Owner Information
3a
Name(s) on Recorded Deed
North Carolina Department or Transportation
3b
Deed Book and Page No
N/A
3c
Responsible Party (for LLC if
applicable)
N/A
3d
Street address
N/A
3e
City state zip
I N/A
3f
Telepnone no
N/A
3g
Fax no
N/A
3h
Email address
N/A
Page 1 of 10
PCN Form — Version 1 3 December 10 2008 Version

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 existing gravel road is surrounded primarily by pasture with some closed canopy oak pine forest along
one side of a short section of road The road serves four single family houses
3b
List the total estimated acreage of all existing wetlands on the property
N/A
3c
List the total estimated linear feet of all existing streams (intermittent and perennial) on the property
N/A
3d
Explain the purpose of the proposed project
To widen and pave the existing gravel road to current North Carolina Department of Transportation secondary road
standards
Se
Describe the overall project in detail including the type of equipment to be used
The water in the streams will be diverted and the existing culverts replaced and /or extended The road footprint will be
widened by removing vegetation and cutting and filling to the required width The road bed will be prepared and then
paved Back hoes dump truck paving equipment water pumps diversion pipe and various hand tools will be used to
accomplish the work
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?
Comments NIA
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 N/A
Name (if known) N/A
Other N/A
4d
If yes list the dates of the Corps jurisdictional determinations or State determinations and attach documentation
N/A
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
N/A
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)
Tem orarV T
W 1 ❑ P ❑ T
N/A
N/A
❑ Yes
❑ No
❑ Corps
❑ DWQ
N/A
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
�I /A
2h Comments N/A
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)
S1 ®P ❑ T
roadside Channel
Q to Rock "%Ford
❑ PER
® Corps
<1
90
Rejocatfonreek
®INT
®pV�/Q
S1A [I P ®T
I flow ©►versi�in
u tQ Rocky F6R,
El PER
[Xj Corps
<1
115
Creek
® INT
® DWQ
S2 ®P ❑ T
Cujvelxtensrn
UT to RQO-- d
® PER
® Corps
`0
Greek
❑INT
® DWQ
S2A ❑ P ®T
IowL��etvn
UTJtoRocky Ford
®PER
® Corps
2
Creek
❑ INT
® DWQ
S3 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
SM ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S4 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S4A ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
Page 4 of 10
PCN Form — Version 1 3 December 10 2008 Version

3h Total stream and tributarN impacts
20
31 Comments Total Temp�t�r Impact for swtdbag cofferdam artd Flaw diversion Ljs,1 k5 linear feet
Total Impact for roadside seep relocation is 90 linear feet
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
Temoorary (T
4b
Name of waterbody
(if applicable)
4c
Type of impact
4d
Waterbody type
4e
Area of impact (acres)
01 ❑ ° ❑ T
N/A
N/A
N/A
N/A
02 ❑P ❑T
03 ❑ PEI T
04 ❑ PEI T
4f Total open water impacts
N/A
4g Comments N/A
5 Pond or Lake Construction
If pond or lake construction proposed then complete the chart below
5a
Pond ID
number
5b
Proposed use or purpose
of pond
5c
Wetland Impacts (acres)
5d
Stream Impacts (feet)
5e
Upland
(acres)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
P2
5f Total
N/A
N/A
N/A
N/A
N/A
N/P
N/A
5g Comments N/A
5h Is a darn high hazard permit required?
❑ Yes ❑ No If yes permit ID no
51 Expected pond surface area (acres)
N/A
51 Size of pond watershed (acres)
N/A
5k Method of construction
N/A
Page of 10
PCN Form — Version 1 3 December 10 2008 Version

6 Buffer Impacts (for DWQ)
If project will impact a protected noanan buffer then complete the chart below It 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
6t
6g
Buffer impact
number —
Reason
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P) or
for
Stream name
mitigation
(square feet)
(square feet)
Temoorary T)
impact
required?
B1 ❑ P ❑ T
N/A
N/A
Nos
N/A
N/A
B2 ❑ P ❑T
El Yes
❑ No
B3 ❑ P ❑ T
❑ Yes
❑ No
6h Total buffer impact-,
N/A
N/A
61 Comments N/A
D Impact Justification and Mitigation
1 Avoidance and Minimization
1 a Specifically describe measures taken to avoid or minimize the proposed impacts in designing project
� .y^� ^^g -.wc f [i"�"�' v"'e -,xe. w; r `4C R+,na, „^ryw ''�"",�'°'D�""i�
u Vert is bean eeiid_ed the minamu_m Ingti�necessary'to widen the roa_dItoseco_nd_ary roadtandards
lb Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
Erasion arld S�d►mentatfon Contrjil ir�egsi les will lie implemented bxtater wilt pq divertgd arou c�curverf ides acid /or be
arcclude�ifrbm ut±iprkjareas du ring installation
2 Compensatory Mitigation for impacts to Waters of the U S or Waters of the State
2a Does the project require Compensatory Mitigation for
❑ Yes ❑ No
impacts to Waters of the U S or Waters of the State?
2b If yes mitigation is required by (check all that apply)
❑ DWQ ❑ Corps
❑ Mitigation banK
2c If yes which mitigation option will be used for this
® Payment to in lieu fee program
project?
❑ Permittee Responsible Mitigation
3 Complete if Using a Mitigation Bank
3a Name of Mitigation Bank N/A
3b Credits Purchased (attach receipt and letter)
Type N/A
Quantity N/A
3c Comments N/A
Page 6 of 10
PCN Form — Version 1 3 December 10 2008 Version

4
Complete if Making a Payment to In lieu Fee Program
4a Approval letter from in lieu fee program is attachea
❑ Yes
41b
Stream mitigation requested
linear teet
4c
If using stream mitigation stream temperature
❑ warm ❑ cool ®cold
4d
Buffer mitigation requested (DWQ only)
N/A square feet
4e
Riparian wetland mitigation requested
N/A acres
4f
Non noanan wetland mitigation requested
N/A acres
4g
Coastal (tidal) wetland mitigation requested
N/A 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
N/A 1
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
N/A
N/A
3 (2 for Catawba)
N/A
Zone 2
1 5
6f Total buffer mitigation required
N/A
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)
N/A
6h
Comments N/A
Paae 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
1 a
Does the project include or is it adjacent to protected riparian buffers identified
Yes No
❑ ®
within one of the NC Riparian Buffer Protection Rules?
lb
It yes then is a diffuse flow plan included? If no explain why
❑ Yes No
❑
Comments N/A
2
Stormwater Management Plan
2a
What is the overall percent imperviousness of this project?
N/A %
2b
Does this project require a Stormwater Management Plan?
® Yes ❑ No
2c
If this project DOES NOT require a Stormwater Management Plan explain why N/A
2d
If this project DOES require a Stormwater Management Plan then provide a brief narrative description of the plan
Project is covered by individual NPDES Permit NCS000250
❑ Certified Local Government
2e
Who will be responsible for the review of the Stormwater Management Plan?
❑ DWO Stormwater Program
❑ DWO 401 Unit
3
Certified Local Government Stormwater Review
3a In which local government s jurisdiction is this project?
N/A
❑ Phase II
3b
Which of the following locally implemented stormwater management programs
❑ NSW
❑ USMP
apply (check all that apply)
❑ Water Supply Watershed
❑ Other
3c
Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
arached'
4
DWO Stormwater Proaram 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
attached?
❑ Yes ❑ No
5
DWO 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
Page 8 of 10
PCN Form — Version 1 3 December 10 2008 Version

F Supplementary Information
1 Environmental Documentation (DWO Requirement)
la Does the project involve an expenditure of public (federal /s ate /local) funds or the
Yes ❑ No
use of public (federal /state) land?
lb IT 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 rinalized 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
El 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
This is a short (approximately 0 3 miles) rural secondary dead end road The road is being upgraded to minimum
secondary road standards and is not expected to affect development patterns significantly
4 Sewage Disposal (DWO Requirement)
4a Clearly detail the ultimate treatment methods and aisposition (non discharge or discharge) of wastewater generated from
the proposed project or available capacity of the subject facility
N/A
Page 9 of 10
PCN �::orm — 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
i Yes © No
habita�?
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
❑ Asheville
5d
What data sources did you use to determine whether your site would Impact Endangered Species or Designated Critical
Habitat?
North Carolina Natu al Heri,age Database
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?
N/A There are no marine or estuarine communities within the Blue Ridge Province
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
Nortn Carolina history ano arcnaeology)?
7b
What data sources did you use to determine whether your site would impact historic or archeological resources?
7eprcafect r5 along ap exsbngroadway #hattaas bee�h, ghly� disturbec# therefioe we beve the p ©thaeologica
end hston esoress mnmalxa tis ri early 2fl ect #uarrrt Bose on a paxd�Tri+~ssubrnit(edtotheVCQOT
umanEntrironrrient Unit for cultural resourcesevies
8
Flood Zone Designation (Corps Requirement)
8a Will this project occur in a FEMA designated 100 year floodplain? ❑ Yes Z No
8b
If yes explain how project meets FEMA requirements
8c What source(s) did you use to make the fioodplain determination? NC Floodplain Mapping Program
Wesley Gnndstaff
0 7 11 8/2 01 2
Applicant /Agent s Printed Name
Date
/�1 Applicant /Age'n� 6ignature
(Agent s�isignature is valid only if a a� ization letter from the applicant
is a�fid )
Page 10 of 10
PCN Form - Version 1 3 Decembe 10 2008 Version