20201145 Ver 1_401 Application_20200906

DWR
mrlslon of Water Resources
Pre -Construction Notification (PCN) Form
September 1, 2020 Ver 3.2
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 * Version#*
20201145 1
Is a payment required for this project?*
r No payment required What amout is owed?*
r Fee received IT $240.00
r Fee needed - send electronic notification r $570.00
Reviewing Office *
Winston-Salem Regional Office - (336) 776- Select Project Reviewer*
9800 Sue Homewood:eads\slhomewood
Information for Initial Review
1a. Name of project:
Culvert
1a. Who is the Primary Contact?*
Michael Holman
1b. Primary Contact Email:*
[e-mail]
Date Submitted
9/6/2020
Nearest Body of Water
South Beaver Creek
Basin
New
Water Classification
C; Tr.+
Site Coordinates
1c. Primary Contact Phone:*
[phone]
Latitude:
Longitude:
36.358338
-81.506753
A. Processing Information
County (or Counties) where the project is located:
Ashe
Is this a NCDMS Project
r Yes IT No
Is this project a public transportation project?*
r Yes IT No
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?

r Nationwide Permit (NWP)
W Regional General Permit (RGP)
r Standard (IP)
1c. Has the NWP or GP number been verified by the Corps?
r Yes r No
Regional General Permit (RGP) Number:
RGP Numbers (for multiple RGPS):
1d. Type(s) of approval sought from the DWR:
r 401 Water Quality Certification - Regular
r Non-404 Jurisdictional General Permit
r Individual Permit
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:
R 401 Water Quality Certification - E)press
r Riparian Buffer Authorization
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?
R 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:
Michael and Laurie Holman
2b. Deed book and page no.:
Plat Book 6, Page 221, Ashe County Registry
2c. Responsible party:
2d.Address
Street Address
Parcel ID # 13231014028
Address tine 2
Westwood Acres Subdivision
city
West Jefferson
Fistal / Zip Code
28694
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
Slate / Frmnoe / Region
NC
Country
us
2f. Fax Number:
r Yes r No
r Yes r No

C. Project Information and Prior Project History O
1. Project Information
1b. Subdivision name:
(if appropriate)
Westwood Acres Subdivision
1c. Nearest municipality/ town:
West Jefferson
2. Project Identification
2a. Property Identification Number:
2b. Property size:
13231014028
7.228
2c. Project Address
Street Address
TBD- intersects Clarence Lyall Rd and Mulatto Mtn Rd
Address Line 2
Westwood Acres Subdivision
city
State / Province / Region
West Jefferson
NC
Postal / Zip (ode
Country
28694
us
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
South Beaver Creek
3b. Water Resources Classification of nearest receiving water:*
C; Tr:+
3c. What river basin(s) is your project located in?*
New
3d. Please provide the 12-digit HUC in which the project is located.
0505000101
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:*
Residential Subdivision
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:
0
4g. List the total estimated linear feet of all existing streams on the property
500
4h. Explain the purpose of the proposed project:*
Install culvert for driveway to residential property
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
Install two 20 foot culverts: one off Clarence Lyall Rd and the other off Mulatto Mtn Rd for driveway access for residential property. Intend on using backhoe and dump truck with
assistance from DOT.
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 O Unknown
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:
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 Buffers
r- Open Waters r Pond Construction
3. Stream Impacts
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*
Private 1 Driveway Tem orar Culvert South Beaver Creek Perennial Both 4 40 p y Average (feet) (linearfeet)
3i. Total jurisdictional ditch impact in square feet:
0
31. Total permanent stream impacts:
0
3i. Total stream and ditch impacts:
40
3j. Comments:
E. Impact Justification and Mitigation
1. Avoidance and Minimization
3i. Total temporary stream impacts:
40
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
Culverts will be placed when trout are not spawning.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Small equipment used with help of DOT.
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)
u

1. Diffuse Flow Plan
1a. 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:
Not in a buffer zone
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:
Placing culverts in a roadside creek
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?*
r Yes r No
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15ANCAC 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
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.
Private driveway
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
r Yes r Nor N/A
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?
r 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
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.?
r Yes r No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
Ashe County Endangered Species, Threatened Species, and Candidate Species
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 f• No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
NOAA Fisheries Essential Fish Habitat Mapping
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?*
State Historic Preservation Office Historic Properties Map
7c. Historic or Prehistoric Information Upload
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
r Yes r No
8c. What source(s) did you use to make the floodplain determination?*
FEMAFloodplain Maps
Miscellaneous
Comments
Miscellaneous attachments not previously requested.
Signature
*
P 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 AGC);
• 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:
Michael Holman
Signature
eY/ l`C IlCG 41e, 1"
Date
9/6/2020
U