20210969 Ver 1_ePCN Application_20210521

Division of Water Resources
Pre -Construction Notification (PCN) Form
April 4, 2021 Ver 4
Initial Review
Has this project met the requirements for acceptance in to the review process?*
0 Yes
O No
Is this project a public transportation project? *
0Yes ONo
Orange only if needed.
BIMS # Assigned *
20210969
Is a payment required for this project?*
d No payment required
0 Fee received
O Fee needed - send electronic notification
Select Project Reviewer*
Sue Homewood:eads\slhomewood
Version#*
1
Reviewing Office*
Winston-Salem Regional Office - (336) 776-
9800
Information for Initial Review
la. Name of project:
COURTESY COPY - Larry Brown brook crossing
la. Who is the Primary Contact?*
Laurence Brown
1b. Primary Contact Email:*
[e-mail]
Date Submitted
5/21/2021
Nearest Body of Water
Lake Townsend
Basin
Cape Fear
Water Classification
WS-III NSW
Site Coordinates
Latitude:
36.217696
Longitude:
-79.726955
lc. Primary Contact Phone:*
[phone]
A. Processing Information
County (or Counties) where the project is located:
Guilford
Is this a NCDMS Project
0 Yes 0 No
Is this project a public transportation project?*
0Yes 0No
la. Type(s) of approval sought from the Corps:
Section 404 Permit (wetlands, streams and waters, Clean Water Act)
❑ Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
Has this PCN previously been submitted?*

r Yes
f No
1b. What type(s) of permit(s) do you wish to seek authorization?
❑ Nationwide Permit (NWP)
FI Regional General Permit (RGP)
❑ Standard (IP)
lc. Has the NWP or GP number been verified by the Corps?
0 Yes No
Regional General Permit (RGP) Number:
RGP Numbers (for multiple RGPS):
Id. Type(s) of approval sought from the DWR:
❑ 401 Water Quality Certification - Regular
pi Non-404 Jurisdictional General Permit
❑ Individual 401 Water Quality Certification
le. Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification:
For the record only for Corps Permit:
If. Is this an after -the -fact permit application?*
CI Yes G, No
❑ 401 Water Quality Certification - Express
❑ Riparian Buffer Authorization
lg. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
rYes GNo
lg. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
Acceptance Letter Attachment
1h. Is the project located in any of NC's twenty coastal counties?
rYes fiNo
1j. Is the project located in a designated trout watershed?
OYes 4No
f Yes r No
✓ Yes r No
B. Applicant Information
a
Id. Who is applying for the permit?
pi Owner ❑ Applicant (other than owner)
le. Is there an Agent/Consultant for this project?*
OYes ONo
2. Owner Information
2a. Name(s) on recorded deed:
Laurence D Brown ; Shannon L Brown
2b. Deed book and page no.:
008390-00572
2c. Contact Person:
Larry Brown
2d. Address
Street Address
5302 Yanceyville Road
Address Line 2
aly
Browns Summit
Fbstal / Tip Code
27214
2e. Telephone Number:
[phone]
2g. Email Address:*
State / Rovince / IZ?gion
NC
Canty
Guilford
2f. Fax Number:

[e-mail]
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(if epprwriete)
NYA
lc. Nearest municipality/town:
Browns Summit
2. Project Identification
2a. Property Identification Number:
128230
2c. Project Address
Street Address
7733 Doggett Road
Address Line 2
atY
Browns Summit
Fbstal / Zp Code
27214
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Lake Townsend
3b. Water Resources Classification of nearest receiving water:*
WS-III NSW
3c. What river basin(s) is your project located in?*
Cape Fear
2b. Property size:
10.1
State / Ftovirce / Region
NC
Ca+*y
United States
3d. Please provide the 12-digit HUC in which the project is located.
030300020107
4. Project Description and History
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:*
10.1 acres of un developed residential land.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
6 Yes CS No 0 Unknown
4d. Attach an 8 1/2 X 11 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for DWR)
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)
4f. List the total estimated acreage of all existing wetlands on the property:
0
4g. List the total estimated linear feet of all existing streams on the property:
1180 ft
4h. Explain the purpose of the proposed project:*
Cross the brook on the south side of the property that we may enter the center of the property for a future home build.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
We will improve the Duke Power right of way ( have discussed with Duke Power ) to enter the property from the main road. We will turn right at the second pole and go straight to the
property , cross the brook and head straight away from the creek on the other side, as to minimize any portion of driveway from being parallel to the brook. Silt fence will be used where
driveway is being developed near zone 1 and 2 riparian buffer zones.
4j. Please upload project drawings for the proposed project.
7733 doggett pdf.pdf 612.99KB
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
0 Yes 0 No
f Unknown

Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
0 Preliminary 0 Approved 0 Not Verified 4 Unknown 0 N/A
Corps AID Number:
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
5d1. Jurisdictional determination upload
6. Future Project Plans
6a. Is this a phased project?*
(i Yes
O No
6b. If yes, explain.
I am currently installing a driveway to access the property. Perk testing / home placement will be determined at a later date.
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?
D. Proposed Impacts Inventory
1. Impacts Summary
la. Where are the impacts associated with your project? (check all that apply):
❑ Wetlands ® Streams -tributaries
❑ Open Waters ❑ Pond Construction
3. Stream Impacts
m Buffers
S1
3a. Reason for impact (?)
drive way
3b.lmpact type*
Permanent
3c. Type of impact*
Culvert
3d. S. name*
unknown
3e. Stream Type*
(?)
Intermittent
3f. Type of
Jurisdiction*
Corps
3g. S. width*
3
Average (feet)
3h. Impact
length*
20
(linear feet)
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
20
3i. Total stream and ditch impacts:
20
3j. Comments:
15-20 feet of pipe will be used for a 10 foot wide driveway.
6. Buffer Impacts (for DWR)
6a. Project is in which protect basin(s)?
Check all that apply.
❑ Neuse
❑ Catawba
❑ Goose Creek
❑ Other
3i. Total temporary stream impacts:
0
❑ Tar -Pamlico
❑ Randleman
® Jordan Lake
6b. Impact Type
6c. Per or Temp
6d. Stream name
6e. Buffer mitigation required?
6f. Zone 1 impact
6g. Zone 2 impact
driveway and culvert
P
n/a
No
720
480
6h. Total buffer impacts:
Zone 1
Zone 2

Total Temporary impacts:
Total Permanent impacts:
Total combined buffer impacts:
0.00
Zone 1
720.00
Zone 1
720.00
0.00
Zone 2
480.00
Zone 2
480.00
6i. Comments:
I have discussed with Teresa Andrews that 2500 sqft can be disturbed without mitigation. I intend to stay well below that limit and avoid any parallel
driveway next to the brook disturbing zones 1 and 2.
Supporting Documentation
E. Impact Justification and Mitigation
1. Avoidance and Minimization
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
Silt fence will be used during construction to minimize disturbance to riparian zones 1 and 2.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
The location of crossing is designed for ease of crossing with minimal tree / shrub removal on both sides of the brook crossing. The driveway will be
designed to minimize any impact on riparian zones 1 and 2 by avoiding running parallel in the riparian zones. We will come straight to the brook and
leave straightway from the brook. Little more than 600 sqft should be disturbed on either side of the brook.
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?
C Yes
f No
2b. If this project DOES NOT require Compensatory Mitigation, explain why
I have discussed with Theresa Andrews that as long as less than 2500 sgft of riparian buffer are disturbed mitigation will not be needed. I intend to be well below this threshold.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
L)
1. Diffuse Flow Plan
la. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
C Yes
If no, explain why:
single driveway for single residential home
('No
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
C Yes (r Yes (7 No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?
( Yes rNo
Comments:
G. Supplementary Information
1. Environmental Documentation
la. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
C Yes t7 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)?*
C Yes G No

3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality?*
C Yes 0 No
3b. If you answered "no," provide a short narrative description.
single residential home
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
C Yes C No 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?*
CYes No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
C Yes 0 No
5d. Is another Federal agency involved?*
C Yes
5e. Is this a DOT project located within Division's 1-8?
CYes allo
C No C Unknown
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?
CYes 0No
5g. Does this project involve bridge maintenance or removal?
CYes C No
5h. Does this project involve the construction/installation of a wind turbine(s)?*
0 Yes 0 No
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.?
CYes 0No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
https://www.fws.gov/endangered/
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?*
C Yes C No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
https://www.fws.gov/endangered/
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? *
C Yes C No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
https://nc.maps.arcgis.com/apps/webappviewer/index html?id=79ea671 ebdcc45639f0860257d5f5ed7
7c. Historic or Prehistoric Information Upload
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
CS Yes CNo
8c. What source(s) did you use to make the floodplain determination?*
https://msc.fema.gov/portal/search?AddressQuery=7733 %20doggett%20road %20browns %20summit%20NC%2027214#searchresultsanchor
Miscellaneous U
Comments

Miscellaneous attachments not previously requested.
Signature
By checking the box and signing below, I certify that:
• The project proponent hereby certifies that all information contained herein is true, accurate, and complete to the best of my knowledge and belief; and
• The project proponent hereby requests that the certifying authority review and take action on this CWA 401 certification request within the applicable reasonable period of time.
• 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:
Laurence Brown
Signature
I&ow- 4J'ta wL
Date
5/21/2021

5/21/2021
GFS Data Viewer
Guilford County, NC
Disclaimer: While every effort is made to keep information provided over the internet accurate and
up-to-date, Guilford County does not certify the authenticity or accuracy of such information. No
Map Scale
1 inch = 42 feet