20191757 Ver 1_PCN Form Submission_20191225

DWR
mrlslon of Water Resources
Pre -Construction Notification (PCN) Form
September 29, 2018 Ver 3
Initial Review
Has this project met the requirements for acceptance in to the review process?*
r Yes
r No
Is this project a public transportation project?*
G Yes r No
Change only if needed.
BIMS # Assigned
20191757
Is a payment required for this project?*
r No payment required
r Fee received
r Fee needed - send electronic notification
Reviewing Office *
Asheville Regional Office - [phone]
Information for Initial Review
1a. Name of project:
shifflett
1a. Who is the Primary Contact?*
Joseph Shifflett
1b. Primary Contact Email:*
[e-mail]
Date Submitted
12/25/2019
Nearest Body of Water
little rock creek
Basin
French Broad
Water Classification
c
Site Coordinates
Latitude:
36.051608
A. Processing Information
County (or Counties) where the project is located:
Mitchell
Is this project a public transportation project?*
r Yes r No
Longitude:
82.187372
1a. Type(s) of approval sought from the Corps:
W Section 404 Permit (wetlands, streams and waters, Clean Water Act)
r Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What type(s) of permit(s) do you wish to seek authorization?
• Nationwide Permit (NWP)
• Regional General Permit (RGP)
W Standard (IP)
Version#*
1
What amout is owed?*
IT $240.00
r $570.00
Select Project Reviewer*
Andrew Moore:eads\awmoore3
1c. Primary Contact Phone:*
[phone]
V

1c. Has the NWP or GP number been verified by the Corps?
r Yes r No
1d. Type(s) of approval sought from the DWR:
W 401 Water Quality Certification - Regular W 401 Water Quality Certification - Express
r Non-404 Jurisdictional General Permit r Riparian Buffer Authorization
r Individual Permit
le. Is this notification solely for the record because written approval is not required?
For the record only for DWR401 Certification: r Yes r No
For the record onlyfor Corps Permit: r Yes r No
1f. Is this an after -the -fact permit application?*
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
1g. 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?
r Yes r No
1j. Is the project located in a designated trout watershed?
r Yes r No
B. Applicant Information
1d. Who is applying for the permit?
W Owner r Applicant (other than owner)
le. Is there an Agent/Consultant for this project?*
r Yes r No
2. Owner Information
2a. Name(s) on recorded deed:
Joseph Shifflett
2b. Deed book and page no.:
399 at page 516
2c. Responsible party:
2d.Address
Street Address
4005 bay oaks circle
Address Line 2
city
englewood
Fbstal / Zip Code
34223
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
State / Rovinoe / Iagion
florida
Country
usa
2f. Fax Number:
C. Project Information and Prior Project History -
I
1. Project Information
1b. Subdivision name:
(d appropriate)
1c. Nearest municipality/ town:
hakersville
1 2. Project Identification

2a. Property Identification Number:
0855-00-82-0890
2c. Project Address
Street Address
96 rockdale
Address tine 2
city
bakersville
Postal / Zip Code
28706
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
little rock creek
3b. Water Resources Classification of nearest receiving water:*
c
3c. What river basin(s) is your project located in?*
French Broad
3d. Please provide the 12-digit HUC in which the project is located.
060101080602
4. Project Description and History
2b. Property size:
2.64
State / Province / Iagion
north carolina
Country
usa
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:*
vacant land, area is a residential area
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
r Yes r No r 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:
4g. List the total estimated linear feet of all existing streams on the property:
800
4h. Explain the purpose of the proposed project:*
to keep bank and tree from collapsing into the stream
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
to place rocks along edge of stream to stop erosion from taking place. I don't believe there will direct or indirect impacts on the stream. Track -hoe would be use to place rocks next to
streams edge
4j. Please upload project drawings for the proposed project
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes r No
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
r Preliminary r Approved r Not Verified r Unknown r N/A
Corps AID Number:
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
6 Unknown
5d1. Jurisdictional determination upload

6. Future Project Plans
6a. Is this a phased project?*
r Yes r No
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
1a. Where are the impacts associated with your project? (check all that apply):
r Wetlands W Streams -tributaries
r Open Waters r Pond Construction
3. Stream Impacts
r Buffers
3a. Reason for impact (?) 3b.lmpact type * 3c. Type of impact* �3�name * 3e. Stream Type * 3f. Type of 3g. S. width * �3h. Impact
(?) Jurisdiction* length*
erosion Permanent Bank Stabilisation lffrock creek Perennial Both h;;1
(line�rfeet)
31. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts: 3i. Total temporary stream impacts:
100 0
3i. Total stream and ditch impacts:
100
3j. Comments:
bank stabilization
E. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
rocks to be placed along the streams edge, set in a manner that looks natural and of natural material
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
felt cloth to be used so nothing can enter the stream
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?
r Yes r No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
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?
r Yes r No
If no, explain why:
all water flow or drainage to be left natural
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
r Yes r No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?
r Yes r No
Comments:
U

G. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
r Yes r 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)?*
r Yes r No
2b Provide an explanation of the violation(s):
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality?*
r Yes r No
3b. If you answered "no," provide a short narrative description.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
(- Yes r 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?*
r Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
r Yes r No
5d. Is another Federal agency involved?*
r Yes r No r Unknown
5e. Is this a DOT project located within Division's 1-8?
(- Yes r No
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?
r Yes r No
5g. Does this project involve bridge maintenance or removal?
r Yes r No
5h. Does this project involve the construction/installation of a wind turbine(s)?*
r Yes r No
51. 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.?
r Yes r No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
everything staying natural
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?*
r Yes r No
Are there submerged aquatic vegetation (SAV) around the project vicinity?*
r Yes r No r Unknown
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
noaa mapper
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?*
r Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
not sure
7c. Historic or Prehistoric Information Upload
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-yearfloodplain?*
r Yes r No
8b. If yes, explain how project meets FEMA requirements:
no habitable structure
8c. What source(s) did you use to make the floodplain determination?*
survey
Miscellaneous
Comments
Miscellaneous attachments not previously requested.
Signature U
*
W By checking the box and signing below, I certify that:
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:
Joseph Shifflett
Signature
C1?A441541~—
Date
12/7/2019