20110684 Ver 1_401 Application_20110711

Dennison, Laurie
From: Homewood, Sue
Sent: Thursday, July 21, 2011 11:40 AM
To: Dennison, Laurie; Strickland, Bev
Subject: courtesy project
Attachments: D00072111.tif
Hey Laurie,
Can you please enter this PCN in BIMS as a courtesy, I have to send a hold letter on it. Thanks.
Sue Homewood
NC DENR Winston-Salem Regional Office
Division of Water Quality
585 Waughtown Street
Winston-Salem, NC 27107
Voice: [phone]
FAX: [phone]
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be
disclosed to third parties.
VV1J. 1V 6V11 11. L7 717 '1VL V4 61 UZIA--L, AAb Anty
gigot e.uuq
]RECEIVED 201 10684
OF WATFR
o? of Office Use Only:
JUN 2 9,2011 Corps action ID no.
DWQ projeCI no.
RALEIGH REGULATORY FIELD OFFICE Form Version 1.3 Dec 10 2009
Pre-Construction Notification (PCN) Form
A. Applicant Information q?uRTEs""''Y
1. Processing o
1a. Type(s) of approval sought from the
Corps: X Section 404 Permit ? Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number: 39 or General Permit (GP) number:
1 c. Has the NWP or GP number been verified by the Corps? ? Yes X No
f d. Type(s) of approval sought from the DWQ (check all that apply):
401 Water Quality Certification - Regular ? Non-404 JuriSdictlonal General Permit
? 401 Water Quality Certification - Express ? Riparian Buffer Authorizatlon
1 e. Is this notification solely for the record
because wrinen approval is not required? For the record only for DWQ 401
Certification:
? Yes X No For the record only for Corps Permit:

? Yes X No
if. Is payment into a mitigation bank or in-lieu fee program proposod for mitigation
of Impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program. Yes X No
-
l g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below. ? Yes k No
1 h, Is the project located within a NC OCM Area of Environmental Concern (AEC)? ? Yes 1 No
2. Project Information
2a. Name of project: Stevens Project
2b. County: Wilkes
2c. Nearest municipality / town: N. Wilkesboro
11,17
2d. Subdivision name: N/A Iq A) f
2e. NCDOT only, T.I,P. or state

project no: N/A JUL
`
°
3. owner Information ?y NR . d
39. Name(s) on Recorded Deed: Phil Stevens
3b. Deed Book and Page No, 984/316
3c. Responsible Party (for LLC if
applicable):
3d. Street address: PO Box 1565
3e. City, state, zip: North Wilkesboro, NC 28659
3f. Telephone no.: NA
3g. Fax no.: NIA
3h. Email address: NA
Page 1 of 10
PCN Form - Version 1.3 December 10, 2008 Version
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AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION
PIN: 3858-8Z-5213
Tax ID: 1403751
County: Wilkes
Approximate Acres: 1.7
Deed Reference: 984/316
STREET ADDRESS: 119 OLD BRICKYARD RD NORTH WILKESBORO
Property Owner; Phil Stevens
The undersigned, registered property owners of the above noted property, do hereby-authorize
Derek Goddard of BREC PA
(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 all standard and special conditions attached.
Property Owner's Address (if different than' property above):
PO Box 1565
North Wilkesboro, NC 28659
esteven sl2sRecialtycarcomPany,net
We hereby certify the above information submitted in this application is true and accurate to
the best of our knowledge.
r
Authorized Signature
Date: 4Q, Z2 1Zo L ( _
4. Applicant Information (if different from owner)
4a. Applicant is: X Agent ? Other, specify:.
4b, Name:
4c, Business namo
(if applicable):
4d. Street address
4e. City, State, zip:
4f, Telephone no.:
4g, Fax no.:
4h, Email address:
5. Agent/Consultant Information (if applicable)
5a. Name: Derek Goddard
5b. Business name
if applicable): Blue Ridge Environmental Consultants, P.A.
sc. Street address: 467 Calloway Gap Rd.
5d. City, state, zip: West ,Jefferson, NC 28694
Se. Telephone no.: 628-964-9349
5f. Fax no.: N/A
59. Email address: [e-mail]
Page 2 of 10
C. proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
Wetlands X 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
nUmoer- Type of Impact Typo of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWO - non-604, other) (acres)
Temporary
W1 P T ? Yes Corps
No ? DWQ
W2 ? P ? T ? Yes ? Corps
? No ? DWO
W3 ? PC] T ? Yes ? Corps
? No [] DWQ
W4 ? P ? T ? Yes ? Corps
? No ? DWO
W5 ? P ? T ? Yes ? Corps
? No ? DWQ
W6 ? P ? T ? Yes ? Corps
? No ? DWQ
2g, Total wetland Impacts 0
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. 30. Of. 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 M (INT)? other) (feet) feet)

S1 X PDT
Culvert Fill
UT X PER
? INT X Corps
DWQ
1
40
S2 PC] T PER
INT Corps
DWQ
S3 ? P ? T ? PER ? Corps
? INT ? DWQ
S4 ? P n T ? PER ? Corps
? INT ? DWQ
SS ? P ? T ? PER G] Corps
? INT ? DWQ
S6 ? P n T ? PER
? INT ? Corps
? DWQ _
3h, Total stream and tributary impacts 40
3i. Comments:
Page 4 of 10
PCN Form -Version 1.3 December 10. 2008 Version
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8. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): 3858-82-5213
1 b. Site coordinates (in decimal degrees): Latitude: 36.154476 Longitude: • 81.172758
(DO.ODDDOD) (-OD.ODDDDD)
1c. Property size: 1.7 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
proposed project: UT to Yadkin River
2b. Water Quality Classification of noarESt receiving water: C
2c. River basin: Yadkin River Basin
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:
Urban Land
3b. List the total estimated acreage of all existing wetlands on the property:
0 acres
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
80'
3d. Explain the purpose of the proposed project:
Increased Parking Area
3e. Describe the overall project in detail, including the type of equipment to be used:
The proj©ct sooks to install 40' of 60" CMP in a perennial UT to the Yadkin River. A pump Around will be employed to
work In the dry. See attached plans for more details.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (including all prior phases) In the past?
Comments:
O Yes No ? Unknown
4b. If the Corps made the jurisdictional determination, what type
of determination was made? preliminary Final
4c, it yes, who delineated the jurisdictional areas?
Name (if known): Unknown Agency/Consultant Company:
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
S. Project History
5a. Have permits or certifications been requested or obtained for
this project (including all prior phases) In the past? ? Yes X No C] Unknown
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project? [j Yes X No
6b, If yes, explain.
Page 3 of 10
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 eny other open water of
the U.S. then individual) list all open water impacts bolow.
4a. 4b. ac. 4d. 4e.
Open water Name of waterbody
impact number - (if applicable) Type of impact Waterbody typo Area of impact (acres)
Permanent (P) or
Tom ora T
Ot [3PMT
02 ? P [] T
03 (]PQT
04 QP[]T
W, 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.

Pond ID
Proposed use or purpose Wetland Impacts (acres) Stream Impacts (foot) Upland
(acres)
number of pond
Flooded Filled Excavated Flooded Filled Excavated Flooded
P1 Recreation and Agriculture 0 0 0
P2
St. Total
5g. Comments:
Sh. 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 DWO)
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 miti anon, then you MUST fill out Section O of this form.
6a' ? Neuse ? Tar-Pamlico ? Other:
Project is in which protected basin? NA ? 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)
Tem ora im act required?
131 ?PMT ?Yes
No
B2 ?PCT ?Yes
? No
53 [DP[)T 0Yes
? No
6h, Total buffer impacts
61, Comments:
Page 5 of 10
VvL.1v 6vli 1J..vV /J.! .I.. c. ax41 vUf,VL iVlY 11u1 -- `•""1
D, Impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Spocifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Property owner initially considered buying additional property for parking, but was unable to do so. The pipe will be buried
for aquatic passage. No other reasonable alternative exists on the site for parking.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques,
Stringent erosion control standards for sensitive water sheds will be adhered too. Work will be conducted from top of the
bank whenever possible. The installation of the pipe will utilize a pump around procedure to work in the dry.
2. Compensatory Mitigation for impacts to Wators 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 X 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 foe program

? Permittee Responsible Mitigation
3. Comploto 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. Q Yes
4b. Stream mitigation requested: linear feet
4c. If using stream mitigation, stream temperature: ? warm 0 cool ?cold
4d. Buffer mitigation requested (DWQ only): square feet
4e, riparian wetland mitigation requested: acres
4f. Non-riparian wetland mitigation requested: acres
49, Coastal (tidal) wetland mitigation requested: acres
4h. Comments:
5. Complete if Using a Permittee Responsiblo Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 6 of 10
PCN Form -Version 1.3 December 10. 2008 Version

6. Buffer Mitigation (Stato Regulated Riparian Buffer Rules) - required by DWQ
6a. Will the project result in an Impact within a protected riparian buffer that requires
buffer mitigation? ? Yea X No
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requiros mitigation. Calculate the
amount of mitigation required.

Zone 6c.
Reason for impact 6d.
Total impact
(square feet)
Multiplier 60.
Required mitigation
(square feet)
Zone t 3 (2 for Catawba)
Zone 2 1,5
6f. Total buffer mitigation required:
69. If buffer mitigation is required, discuss what type of mitigation Is proposed (e.g., payment to private mitigation bank,
permitter responsible riparian buffer restoration, payment into an approved in-lieu foe fund).
6h. Comments.,
Page 7 of 10
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E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
t a, Does the project include or is it adjacent to protected riparian buffers identified [] Yes X No
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diff use flow plan included? If no, explain why. ? Yes C1 No
Comments:
2. Stormwater Management Plan

2a. What is the overall porcent imperviousness of this project? 0 %
2b, Does this project require a Stormwater Management Plan? ? Yes X No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: Project is in forested, rural setting, All
stormwater is diffuse flow over vegetated surfaces.
2d. If this project DOES require a Stormwater Management flan, then provido a brief, narrative description of the plan:
? Certified Local Govemment
2e. Who will be responsible for the review of the Stormwater Management Plan? Q DWQ Stormwater Program
Q DWQ 401 Unit
3. Certified Local Government Stormwater Review

3a. In which local government's jurisdiction Is this project?
Phase II
? NSW
3b. Which of the following focally-implemented stormwater management programs Q USMP
apply (check all that apply): ? Water Supply Watershed
? Other:
3c. Has the approved Stormwater Management Plan with proof of approval teen ? Yes Q No
attached?
4, OWQ Stormwater Program Review
Coastal counties
? HOW
4a. Which of the following state-implemented stormwater management programs apply ? ORW
(check all that apply): ? Session Law 2006-246
Q Other:
4b. Has the approved Stormwater Management Flan with proof of approval been
Q Yes ? No
attached?
5. DWO 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements? Q Yes ? No
5b. Have all of the 401 Unit submittal requirements been met? ? Yes ? No
Page 8 of 10
PCN Form - Version 1.3 December 10, 2008 Version

F. Supplementary Information
1. Environmental Documentation (DWO Requirement)
I a. Does the project involve an expenditure of public (fed©rOstate/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 tho requirements of the National or Stab ? 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 approved
Q Yes ® No
letter,)
Comments:
2. Violations (DWO Requirement)
2a. Is the site in violation of DWO Wetland Rules (15A NCAC 2H .0500), isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Wator 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 (DWO 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?
$b. 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,
4. Sewage Disposal (DWO 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
Page 9 of 10
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?

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?
http:ftwww.ncnhp.org • http://www.saw.usaco,army,mll/WETLAND/ese - http://www.fws.gov/nc-es/es/os,html
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? D Yes ® No
6b, What data sources did you use to determine whether your site would impact Essential Fish Habitat?
httpa/ocean.floridamarine.org/efh_coralAm siviewer, htm
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 Cl 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?
http://www.hpo.ncdcr.gov
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year ftoodplain? Yes ? No
80. If yes, explain how project meets FEMA requirements: Owner will procure all needed documentation.
8c. What source(s) did you use to make the floodpialn determinatlon? http://www,ncfloodmaps,com
Derek Goddard 6124/2011
Applicant/Agent's Printed Name Applicant/Agent's l Cate
(AQent's slgnature Is valkl only If an authorizatlon letter from the applicant
is provided.)
Page 10 of 10.
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