20100966 Ver 1_401 Application_20101110

o?aF WATF,9pG O O O 9 6 6
O 'c
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.0 November 2008
Pre-Construction Notification (PCN) Form
A. Applicant Information COURTESY
1. Processing
1 a. Type(s) of approval sought from the
Corps:
®Section 404 Permit El Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: 39 or General Permit (GP) number:
1c. Has the NW P 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
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below. ? Yes ® No
1 h. Is the project located within a NO DCM Area of Environmental Concern (AEC)? ? Yes ® No
2. Project Information
2a. Name of project: Henson Project Site
2b. County: Watauga
2c. Nearest" municipality / town: Boone

2d. Subdivision name: AT V
N/A
2e. NCDOT only, T.I.P. or state
project no: N/A pEyR lQ `?' .
i7c
3. Owner Information t?i'r-1TR
A I
OR 4
3a. Name on Recorded Deed: -
Lisa Silber 4 `'? ?j. '` "., '.•
3b. Deed Book and Page No. 1523/843 ??'?, ?' i''_;,`':• `;;
3c. Responsible Party (for LLC if
applicable):
Lisa Silber
3d. Street address: 5018 E. Karen Drive ,!-
3e. City, state, zip: Scottsdale, AZ 85254
3f. Telephone no.: 818.879.3151
3g. Fax no..
3h. Email address:
Page 1 of 12
PCN Form - Version 1.0 November 2008 Version
B. Project Information and Prior Project History
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
6a. Is this a phased project? ? Yes ® No
6b. If yes, explain.
PCN Form - November 2008 Version
C. Proposed Impacts Inventory
1. Impacts Summary
1 a. 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 Type of wetland Forested (Corps - 404, Area of impact (acres)
Permanent (P) or impact (if known) DWQ - non-404, other)
Temporary T
-
W1 ®P ? T QualityLow /Urban ? Yes ID No a DWQ 0.099
W2 ? P ? T ? Yes ? No ? Corps
? DWQ
W3 ? P ? T ? Yes ? No ? Corps
? DW Q
W4 ? P ? T ? Yes ? No ? Corps
? DWQ
W5 ? P ? T ? Yes ? No ? Corps
? DW Q
W6 ? P ? T ? Yes ? No ? Corps
? DWQ
2g. Total wetland impacts 0.099 ac
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.
Stream impact Type of Stream name Perennial (PER) or Average stream width (feet) Impact
length
number - impact intermittent (INT)? (linear feet)
Permanent (P) or
Temporary (T)
S1 ? P ? T ? PER ? INT
S2 ? P ? T ? PER ? INT
S3 ?P?T ?PER ?INT
S4 ? P ? T ? PER ? INT
S5 ?P?T ?PER ?INT
S6 ? P ? T ? PER ? INT
3g. Total stream and tributary Impacts 0
3h. Comments: The -133 linear feet of Hodges Creek will be avoided during all ground-disturbing activities.
Page 5 of 12
PCN Form - Version 1.0 November 2008 Version
C. Proposed Impacts Inventory, continued
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 individual) list all o en water impacts below.
4a. 4b. 4c. 4d. 4e.
Open water
impact number Name of
waterbody
Type of impact
Waterbody type
Area of impact (acres)
- Permanent (if
(P) or applicable)
Temporary

01 ?P?T
02 ?P?T
03 ?P?T
04 ?P?T
4f. Total open water impacts 0 impacts
4g. Comments:
2
PCN Form - November 2008 Version
Proposed Impacts Inventory, continued
5. Pond or Lake Construction
If and or lake construction pro osed, then complete the chart below.
5a. 5b. 5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or (acres)
number purpose of pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
5f. Total 0 impacts
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 ou 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. 6f. 6g.
Buffer impact
number - Reason Buffer Zone 1 impact (square Zone 2 impact
Permanent (P) for impact Stream name mitigation feet) (square feet)
or Temporary required?
T
131 ?P?T ?Yes ?No
B2 ? PEI T ? Yes ? No
B3 ?P?T ?Yes ?No
6h. Tota l buffer impacts
6i. Comments:
Page 7 of 12
PCN Form - November 2008 Version
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.
The proposed work and associated impacts are intended create a commercial site, while minimizing impacts to aquatic
resources. All disturbed areas will be immediately seeded upon completion (temporary & permanent seed + straw) and
stabilized.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
All heavy equipment will be kept out of the stream during project construction. No hydraulic leaks will be tolerated on
equipment working in or around the project area. .
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
? 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 8 of 12
PCN Form - Version 1.0 November 2008 Version
D. Impact Justification and Mitigation, continued
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 Reason for Impact Total impact
(square feet) Multiplier Required mitigation
(square feet)
Zone 1 3 (2 for Catawba)
Zone 2 1.5
Total buffer mitigation required:
6c. 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).
6d. Comments:
PCN Form - November 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
within one of the NC Riparian Buffer Protection Rules? ? Yes ® No
1 b. If yes, then is a diffuse flow plan included? ? Yes ? No
2. Determination if the Project Requires a Stormwater Management Plan
2a. Does the project require a Non-404 Jurisdictional General Permit? ? Yes ® No
2b. Is the project subject to General Certification 3704 or 3705? ? Yes ® No
3. Determination of Stormwater Review Jurisdiction

3a. Is this project subject to any of the following state-implemented stormwater
management programs (check all that apply)? ? Coastal counties
? HQW
? ORW
If so, attach one copy of the approval letter from the DWQ and one copy of the ? Session Law 2006-246
approved stormwater management plan. ? Other:
3b. In which local government's jurisdiction is this project? Boone, NC
3c. Is this local government certified to implement a state stormwater program? ? Yes ® No
If so, attach one copy of the approval letter from the local government and one copy
of the approved stormwater management plan (or one copy of the approved
Stormwater management plan stamped as approved).
4. Information Required for DWQ 401 Unit Stormwater Review

4a. What is the overall percent imperviousness according to the most current site plan? -0%- Car lot will be ravelled.

4b. Does this project contain any areas that meet the criteria for "high density" per
General Certifications 3704 and 3705? ? Yes ® No

4c. If the site is over 24% impervious and/or contains high density areas, then provide a brief narrative description of the
stormwater management plan.
N/A
4d. Has a completed BMP Supplement Form with all required items been submitted
for each stormwater BMP? ? Yes ® No
Page 10 of 12
PCN Form - Version 1.0 November 2008 Version
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the project involve an expenditure of public (federal/state/local) funds or the El 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)?
1c. 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: N/A
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): N/A
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.
No future impacts are proposed to on-site jurisdictional areas.
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.
N/A
PCN Form - Version 1.0 November 2008 Version
F. Supplementary Information, continued
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?
El 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?
BFEC contacted Bryan Tompkins with US Fish and Wildlife Service who has indicated that no Federal species of concern
will be impacted as a result of the project.
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?
NOAA -- Office of Habitat Protection Division
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?
North Carolina Historic Preservation Office - Renee Gledhill Early has received the site information and has responded
with no reservations concerning cultural resources (see attached letter).
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: This project proposes no impacts to the FEMA floodplain.
Be. What source(s) did you use to make the floodplain determination? Property Survey

Glen Henson 9/30/2010
Applicant/Agent's Printed Name Applicant/ gent's Signature
(Agent's signature is valid only if an authorization letter from the applicant
Date
is provided.)
Page 12 of 12
PCN Form - November 2008 Version
rlro,
ik--;41 �
IN ij

17 00° 161 86° 163 33° 1675 00°
'f ? / ',',`'--'#!-'?i ?-/• sG 1 Cam:-•- .,. ?r_? . _:,?- , ,` ?,., ? ,,,,\??` 1•,?,?,.,
Alk"
. - _?, .y .•1..:x.1: ` ••. •.:..• f . t• ? .)
66) 1
,? (( W t4? \ ?. ? f. \? 1 ` •? egrlJ , ? ?1 ??• ' r?al10/
Z-
? I •220 . Y•• -J . ?? w ,y -?? -Z
u

beach s.d -` ??. • ' -
C-1
t
? ? ? olJ/J? rl >> ? .S.?t? ???? ?ileld ?
: •, ? 1? ?I
'
?
-

Z- ?
(//t r Ci\ ,
11 1
\1
II4 like U: ?? ,• •? ••t `•./` ?'
11' 1? -

co tiu1 Ill 1 Ilo?.,./?? 1 • 1 C-? ,+ ?.\ ` k? ,,1• 1 j?

C
co)

l

co) -j c
i

^ ?
,? 1'`
?`.'? . gyp' `` 1•? ?? ?'_ - BM I-46
•
-3 1
Z- N -Z

(CL co

51,

? 'r+
em !fir\ri
, -
J
(
'
i
S Q
I f
; Q
ll'
/
?
? ji?
-''?,.J1'1 ?) _:$' ? `•?...?I ?,.J 1, ? (?`i? 1, ? ? f- _ >>;?\.?_-_-'?'j ? .(. /•. ?' -`°
--

W71301 17
r
0&4 1.6 1
6 1.6 3 3 3 1.6 6
0 0
Name: BOONE Location: 036.2072885° N 081.6862936° VV
Date: 10/14/2010 Caption: Henson Site Location Map
-Scale:-l-inch-equals-1333-fee - - -- -
Copyright (C) 1998, Maptech, Inc.