20110435 Ver 1_401 Application_20110511

201 10435
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Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification PCN Form
A. Applicant Information T7% A 19 r.n\
1. Processing a
1 a. Type(s) of approval sought from the
Corps:
® Section 404 Permit ? Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number: NWP 3 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps? ® Yes ? No
1d. 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 N 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 NC DCM Area of Environmental Concern (AEC)? ? Yes N No
2. Project Information
2a. Name of project: Fournier Dam Emergency Spillway Repairs Dam ID NC 03718
2b. County: Polk
2c. Nearest municipality / town: Saluda
2d. Subdivision name: NA
2e. NCDOT only, T.I.P. or state
project no: NA
3. Owner Information
L5 1?p Ls-
3a. Name(s) on Recorded Deed: William Fournier
3b. Deed Book and Page No. P4-34
t
3c. Responsible Party (for LLC if
applicable): William FournierNR - nVACUU-
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3d. Street address: 1282 S. Barksdale Rd.
3e. City, state, zip: Mt. Pleasant, SC 29464
3f. Telephone no.: 843-860-5064
3g. Fax no.: NA
3h. Email address: [e-mail]
Page 1 of 12
PCN Form - Version 1.3 December 10, 2008 Version
4. Applicant Information (if different from owner)
4a. Applicant is: ® Agent ? Other, specify:
4b. Name: Don Sipher
4c. Business name
(if applicable): Froehling&Robertson, inc.
4d. Street address: 1734 Seibel Dr., NE
4e. City, state, zip: Roanoke, VA 24012
4f. Telephone no.: 540-344-7939
4g. Fax no.: 540-344-3657
4h. Email address: [e-mail]
5. Agent/Consultant Information (if applicable)
5a. Name:
5b. Business name
(if applicable):
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. Fax no.:
5g. Email address:
Page 2 of 12
PCN Form - Version 1.3 December 10, 2008 Version
B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): P4-34
1 b. Site coordinates (in decimal degrees): Latitude: 35.25N Longitude: - 82.343W
(DD.DDDDDD) (-DD.DDDDDD)
1 c. Property size: 8.0 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
proposed project: Camp Creek
2b. Water Quality Classification of nearest receiving water: Class C - trout
2c. River basin: Green River
Page 3 of 12
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 pond is drained due to a principle spillway pipe failure. The surrounding area has some residential development with
potential for more.
3b. List the total estimated acreage of all existing wetlands on the property:
The pond is 1.7 acres at normal pool. Starting at the toe of the dam a second smaller pond (est. 0.5 acre) owned by
separate party is also drained due to a problem with its structure. This tributary channel inside steep side slopes is all
that could be considered wetland
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
850 I.f.from two branches that make up the pond
3d. Explain the purpose of the proposed project:
The project is for repair of the dam and improving the Auxiliary Spillway for a 100 yr storm capacity.
3e. Describe the overall project in detail, including the type of equipment to be used:
ANTICIPATED EQUIPMENT NEEDED INCLUDES BACKHOE, DUMPTRUCKS, CONCRETE TRUCKS,
ROLLERS/TAMPERS, PICKUP TRUCK, HYDROSEEDER, GROUT PUMP
RECOMMENDED CONSTRUCTION SEQUENCE
1. LOCATE AND FLAG BENCHMARKS SUCH THAT THEY ARE VISIBLE AND WILL NOT BE DESTROYED.
2. FLAG ANY TREES THAT ARE CLOSE TO THE WORK AREA AND ARE NOT TO BE REMOVED.
3. PLACE CONSTRUCTION ENTRANCE AS NOTED ON THE PLAN SHEET.
4. PLACE SILT FENCE AS NOTED ON THE PLAN SHEET.
5. CUT AND REMOVE ALL TREES IN THE WORK AREA. DIG OUT ROOT BALLS PER DETAIL ON PLANS. REMOVE
ALL DEBRIS FROM THE DOWNSTREAM SLOPE AND HAUL OFF-SITE TO WASTE PIT.
6. REMOVE DOWNSTREAM SECTION OF THE OLD CMP AND CONSTRUCT BULKHEADS AT BOTH ENDS. MIX
THE CEMENT AND NON-SHRINK ADMIXTURES AND GROUT OLD PIPE FULL OF GROUT (SEE GROUT
INSTALLATION NOTES).
7. CONSTRUCT THE SAND FILTER AT THE END OF THE 10" CMP.
8. REMOVE EXISTING RIP RAP FROM CURRENT AUXILIARY SPILLWAY AND STORE NEAR THE TOE OF THE
EMBANKMENT.
9. STRIP TOPSOIL FROM DAM TOP AND DAM EMBANKMENT AND STORE ON THE DESIGNATED TEMPORARY
STOCKPILE.
10. BEGIN EXCAVATING TRENCH FOR THE NEW CONCRETE CHUTE SPILLWAY AND TEST SOIL BEARING IN
THE BOTTOM OF THE TRENCH.
11. BACKFILL THE EXISTING AUXILIARY SPILLWAY WITH THE EXCAVATED MATERIAL AND STOCKPILE THE
REMAINING SOIL..
12. PLACE UNDER DRAINS ALONG THE BOTTOM OF THE TRENCH FOR THE NEW CONCRETE CHUTE
SPILLWAY.
13. PLACE CONCRETE FOR THE CONCRETE CHUTE.
14. ALLOW THE CONCRETE TO SET UP FOR AT LEAST THREE DAYS BEGIN FORMING AND POURING
DRAGON'S TEETH AND CONCRETE SIDEWALLS.
15. ALLOW SIDEWALL TO SET FOR AT LEAST THREE DAYS AND THEN BEGIN FORMING AND POURING
CONCRETE BRIDGE DECK SLAB.
16. PLACE AND COMPACT EXCESS SOIL ALONG THE TOP OF DAM TO RESTORE ORIGINAL GRADE.
17. EXCAVATE TRENCH FOR SIPHON PIPE, TEST SOIL BEARING IN BOTTOM OF TRENCH.
18. CONSTRUCT THE SIPHON PIPE SYSTEM AS SHOWN ON THE PLANS, USING MECHANICAL CONNECTIONS
AND INSTALL THE TRASH GUARD ON THE UPSTREAM END OF THE PIPE. PLACE SIPHON, ALONG WITH ALL OF
THE VALVES, THRUST BLOCKS, AND RODENT GUARD.
19. BACKFILL TRENCH AND COMPACT ACCORDING TO THE SPECIFICATIONS.
20. PLACE STORED RIP-RAP AT THE BASE OF THE CONCRETE CHUTE SPILLWAY AND SIPHON OUTLET PIPE
ACCORDING TO THE APRON DETAIL.
21. SEED AND MULCH ANY DISTURBED AREAS.
Page 4 of 12
PCN Form - Version 1.3 December 10, 2008 Version
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:
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:
Name (if known): Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
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.
NC DENR approval of dam repair design has been obtained.
6. Future Project Plans
6a. Is this a phased project? ? Yes ®No
6b. If yes, explain.
Page 5 of 12
PCN Form - Version 1.3 December 10, 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 impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWQ - non-404, other) (acres)
Temporary T
W1 ? P ®T Construction Pond ? Yes
® No ® Corps
? DWQ 0.007
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 0.007
2h. Comments: Repair of existing dam
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 ? PER ? Corps
? INT ? DWQ
S2 ? P ? T ? PER ? Corps
? INT ? DWQ
S3 ? P ? T ? PER ? Corps
? INT ? DWQ
S4 ? P ? T ? PER ? Corps
? INT ? DWQ
S5 ? P ? T ? PER ? Corps
? INT ? DWQ
S6 ? P ? T ? PER ? Corps
? INT ? DWQ
3h. Total stream and tributary impacts
3i. Comments:
Page 6 of 12
PCN Form - Version 1.3 December 10, 2008 Version
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. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number - (if applicable) Type of impact Waterbody type Area of impact (acres)
Permanent (P) or
Temporary T
01 ?P?T
02 ?P?T
03 ?P?T
04 ?P?T
411 Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If and or lake construction proposed, then complete the chart below.
5a. 5b. 5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or purpose (acres)
number of pond
Flooded Filled Excavated Flooded Filled Excavated Flooded
P1
P2
5f. Total
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, the n complete the chart below. If yes, then individually list all buffer impacts
below. If an impacts require mitigation, then you MUST fill out Section D of this form.
6a.
? Neuse
? Tar-Pamlico ? Other: NA
Project is in which protected basin? ? Catawba ? Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number - Reason Buffer Zone 1 impact Zone 2 impact
Permanent (P) or for Stream name mitigation (square feet) (square feet)
Temporary T impact required?
61 ?P?T ?Yes
? No
B2 ?P?T ?Yes
? No
B3 ?P?T ?Yes
? No
6h. Total buffer impacts
6i. Comments:
Page 7 of 12
PCN Form - Version 1.3 December 10, 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.
Repair measures kept to existing footprint to greatest extent possible
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Features to be worked on are clustered in the same area to minimize disturbed 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

El 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: NA
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.
NA
Page 8 of 12
PCN Form - Version 1.3 December 10, 2008 Version
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 3 (2 for Catawba)
Zone 2 1.5
6f. Total buffer mitigation required:
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).
6h. Comments:
Page 9of12
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?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
? Yes ? No
Comments:
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project? 7.9%
2b. Does this project require a Stormwater Management Plan? ? Yes ® No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: Less than 1 acre total disturbed area
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
? Certified Local Government
2e. Who will be responsible for the review of the Stormwater Management Plan? ? DWQ Stormwater Program
? DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project? Polk County, NC
? Phase II
3b. Which of the following locally-implemented stormwater management programs ? NSW
? USMP
apply (check all that apply): ? Water Supply Watershed
® Other: NA
3c. Has the approved Stormwater Management Plan with proof of approval been ? Yes ? No
attached?
4. DWQ Stormwater Program Review
? Coastal counties

4a.
Which of the following state-implemented stormwater management programs apply ? HQW
? ORW
(check all that apply): ? Session Law 2006-246
® Other: NA
4b. Has the approved Stormwater Management Plan with proof of approval been
attached? ? Yes ? No
5. DWQ 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 10 of 12
PCN Form - Version 1.3 December 10, 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 ? 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)?
1 c. 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
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 ? 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.
Adjacent parcels are already zoned for residential development which may occur regardless of this project.
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.
NA
Page 11 of 12
PCN Form - 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 ? Yes ® No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act ® Yes ? No
impacts?

5c. If yes, indicate the USFWS Field Office you have contacted. ?
Raleigh
? Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
USFWS website indicates only Endangered species in Polk County, NC is the White Irisette which is an upland plant.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? T[:] Yes ® No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
USFWS website and NC Wildlife Resources 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?
NCNHP Heritage online GIS
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? : E[A
? No
:7
_
_
8b. If yes, explain how project meets FEMA requirements: Repair of existing dam
8c. What source(s) did you use to make the floodplain determination? FMIS flood maps online
Donald J. Sipher
, 2, 2 ? 4/20/2011
Applicant/Agent's Printed Name Applicant/ gen ' Vgnature Date
(Agent's signature is valid only an authorization letter from the applicant
is rovided.
Page 12 of 12
PCN Form - Version 1.3 December 10, 2008 Version
1 Apr 20 11 03:13p Fournier
AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. PLAN NO.
843-884-2211 p.2
PARCEL ID: POLK County, NC P4 34
STREET ADDRESS: 8431 Howard Gap Rd,
Saluda, NC 28773
Please print:
Property Owner: William Foumier
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
Don Sinher , of Froehling and Robertson, Inc.
(Contractor / Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
1282 S. Barksdale Rd.
Mt. Pleasant, SC 29464
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
r
Authorized Sig •ture Authorized Signature
Date: ? 7-)- o 7N Date: