20120001 Ver 1_401 Application_20111211

GERALD V GRANT & ASSOCIATES
Engineering *Surveying *Site Planning
2351 Simonton Road
Statesville, North Carolina 28625 8246 2 0 120 0
Telephone [phone]
Fax [phone]
email gerald @gvgrant com
July 13 2011
Ms Karen Higgins Supervisor
401 /Wetlands Unit
Division of Water Quality
Department of Environment and Natural Resources
1650 Mail Service Center
Raleigh NC 27699 1650
Re 401 Permitting PCN Application for
Delbert W Puro and Diane M Puro on
Cook Road, SR 1757
Rowan County
Dear Ms Higgins
Please find enclosed one (1) submittal checklist five (5) copies of the above referenced
application along with two (2) full size sets of the plan profile details and specifications and
three (3) 11 by 17 sets of the plan profile details and specifications for the subject project a
USGS topographic map of the site and our check number 1014 for the $240 00 application fee
If you have any questions or comments please contact me
Sincerely
x4Z11xZ1
Gerald V Grant PE PLS
GVG /gcg
Enclosures
PC Mr Delbert W Puro w /enclosures
USACOE w /enclosures
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1E1 3 ®2011
DENR WATER QUALITY
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Version 14
January 9 2009
401 Oversight/Express Permitting PCN Submittal Checklist
® The application fee (Checks may be made out to N C Division of Water Quality
$240 00 for 401 Water Quality Certification with minor impacts
$570 00 for 401 Water Quality Certification with mayor impacts
Express Review Fee (Amount requested on Acceptance Letter)
® Five (5) complete and collated copies of the PCN Application and supporting
documentation (instead of providing 5 copies of the full size plans you may provide two
copies of full size plans along with three copies of 11 X 17 plans)
❑ Stormwater Management Plan (if applicable — see PCN Form Help File Section E)
1) Please provide three (3) copies of the stormwater management plans along with all
supporting information pertaining to this project including the following
a Entire site development/layout plans delineating all drainage areas
b Design calculation sheets for all proposed BMP(s) sized for both on site and
off site drainage
c BMP supplements for each proposed BMP and Required Items Check List
(hftp //h2o enr state nc us /su /bmp forms htm) along with all required
items
d A Notarized Operation & Maintenance Agreement for each stormwater
management facility
e Detailed construction drawing sheets shall include
(i) Erosion and sediment control plans
(n) Installation and planting schedules for the proposed BMPs
(iii) Appropriately scaled plan views and cross sectional details of all
BMPs and associated components — inlet and outlet structures
forebay respective zones and pertinent elevations
❑ If your project is located within a State implemented Riparian Buffer Rule Area submit the
following along with site plans and PCN form
1) Three (3) copies of the details for on site diffuse flow provisions (refer to
http / /h2o enr state nc us/su/bmp_jorms htm)
❑ DWQ Stream Determination Forms for streams on property and DWQ determination
letter for wetlands or streams (if applicable)
The following is the most critical of all the information that you must provide The quality and
detail of the information will often determine the expeditiousness of the review The following is
a checklist of the types of pertinent information required at a minimum
Maps and Plans
® The most recent version of the 1 24 000 USGS Topographic Map Please cleanly draw or
delineate the site boundaries on the topographic map
❑ The most recent version of the bound and published County NRCS Soil Survey Map
(required for projects within the Neuse River Basin Tar Pamlico River Basin Randleman
Lake Watershed and the Catawba River Basin also recommended for all projects)
Please clearly delineate the site boundaries etc on the map If the delineation obscures
any of the features it is recommended that a clean copy be provided Copies of the

Version 14
January 9 2009
current sod survey and /or soil survey map sheets can be obtained from the local NRCS
County Office (http / /www nc nres usda go y /) GIS sod layers are not acceptable
® Vicinity map Please clearly mark the location and approximate boundaries of the property
and project on the map Please indicate north arrow and scale Please include applicable
road names or State Road numbers
® The Site Plan The most critical map to be provided is the site plan You must provide full
sized plans The following is the minimum list of plans that are typically needed
® Pre construction /Pre existing conditions This sheet (or sheets) must include
• All jurisdictional and non jurisdictional wetland stream water features State regulated
buffers (delineated into Zones 1 and 2)
• Topographic contours with elevations
• Any existing structures and impervious areas
• Existing utility lines and easements
• Existing roads culverts and other pertinent features
• North arrow and the scale (1 50 scale is recommended)
® Proposed conditions This sheet (or sheets) must include
• All jurisdictional and non jurisdictional wetland stream water features State regulated
buffers (delineated into Zones 1 and 2)
• Lot layout (if a subdivision or commercial development is proposed) lots must be
developable without further impacts to jurisdictional and non lunsdictional wetlands,
streams, water features, and State regulated buffers Budding envelopes must be
provided when streams wetlands riparian buffers or water features exist on a lot
• All built out structures and impervious cover
• Final grading contours with elevations
• All utilities and easements (including septic fields on all lots within 100 feet of stream
wetland or water features if applicable)
• Impacted areas — these should correspond with the Impact numbers listed on your PCN
form
® Drainage Plans Final drainage plans must include the following
• Locations and pertinent elevations and sizes of the stormwater collection system and
drainage ways
• All inlets and outlets must also be shown with pertinent elevations (Ail outlets to
wetlands must be at a non erosive velocity, generally less than 2 ft/sec during the peak
flow from the 10 yr storm)
• Scaled stormwater BMPs must also be indicated as required by DWQ rules and policies
• In certain cases (see Section E of PCN form) final stormwater management plans must
also be provided (see Stormwater Management Plan Checklist)
❑ Proposed Impacts All impacts to jurisdictional and non-jurisdictional wetland stream
water features and State regulated buffers must be shown and labeled on the site plans at
a scale no smaller than 1 = 50 All excavation fill flooding stabilization and other impacts
that will be conducted in or near jurisdictional and non jurisdictional wetland stream water
features and State regulated buffers must be indicated Please provide cross sectional
details showing the provisions for aquatic life passage (burial of culvert 20% for culverts :5 48
inches and 1 foot for culverts > 48 inches)

Version 14
January 9 2009
Wetland Impacts
❑ Precise grading and final elevation contours must be provided Existing
vegetation and any clearing must be specified
❑ All subsurface utility lines must indicate the location of anti seep collars
Construction detail for anti seep collars must be provided
❑ Roadway or other crossings of riparian wetlands may require floodway culverts to
maintain existing hydrological conditions
❑ Plans should show that the hydrology of remaining wetlands on the site will be
maintained
Stream Impacts
® Stream impacts must be clearly shown on the plans The centerline as well as
the banks of the stream must be surveyed or located by GPS for the portion of
the stream to be impacted
® The inlet and the outlet of all culverts should be aligned with the stream as
much as possible Inlet and outlet elevations and streambed elevations should
be indicated Any inlet or outlet protection must be shown and enumerated on
the impact map(s)
❑ For bottomless culverts or other spans a vertical cross section should be
provided that shows the minimum distance from each span to each stream bank
the stream cross section the height of the span above the stream and the
minimum distance from the edge of each footer to each stream bank
Additionally please provide a signed and sealed geotechnical report of
subsurface sods at the proposed bottomless culvert location The report must
comply with the Division of Highways — Guidelines for Drainage Studies and
Hydraulic Design prepared by A L Hankins Jr State Hydraulics Engineer
1999
❑ Multiple culverts or sectioned box culverts typically require the use of sills off
setting or other means to match the cross section of the existing stream (in order
to maintain stream stability and provide aquatic life passage) A vertical cross
section of the culverts should be shown overlain with the up and downstream
stream cross section including the stream flood prone area
❑ Impacts associated with dam construction must indicate and enumerate all fill
associated with the dam footprint spillway and any bank stream bank
stabilization The length of stream impounded must also be indicated and
enumerated

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201 2000 1
Office Use Only
Corps action ID no
DWQ project no
Form Version 14 January 2009
Page 1 of 10
PCN Form — Version 14 January 2009
Pre - Construction Notification (PCN) Form
A
Applicant Information
1
Processing
la
Type(s) of approval sought from the Corps 7-
❑X Section 404 Permit ❑ Section 10 Permit
1 b Specify Nationwide Permit (NWP) number 39 or General Permit (GP) number
1c
Has the NWP or GP number been verified by the Corps?
❑ Yes ❑X No
1d
Type(s) of approval sought from the DWQ (check all that apply)
Q 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
X❑ Yes ❑ No
For the record only for Corps Permit
❑X 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 ❑X No
1g
Is the project located in any of NC s twenty coastal counties If yes answer 1 h
below
❑ Yes ❑X No
1 h
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes ❑X No
2
Project Information
2a
Name of project
DELBERT W PURO
2b
County
ROWAN
2c
Nearest municipality / town
CLEVELAND
2d
Subdivision name
NA
2e
NCDOT only T I P or state project no
3
Owner Information
3a
Name(s) on Recorded Deed
DELBERT W PURO AND WIFE DIANE M PURO
3b
Deed Book and Page No
606 40 W
3c
Responsible Party (for LLC if
applicable)
NA STAPIry
3d
Street address
625 COOK ROAD
3e
City state zip
CLEVELAND NC 27013
3f
Telephone no
907 350 9391
3g
Fax no
3h
Email address
d puro @hotmail com
Page 1 of 10
PCN Form — Version 14 January 2009

4
Applicant Information (if different from owner)
4a
Applicant is
❑ Agent ❑ Other specify
4b
Name
4c
Business name
(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
Gerald V Grant P E
5b
Business name
(if applicable)
Gerald V Grant & Associates
5c
Street address
2351 Simonton Road
5d
City state zip
Statesville NC 28625 8246
5e
Telephone no
704 872 3136
5f
Fax no
704 872 3057
5g
Email address I
gerald@gvgrant com
Page 2 of 10

IS
Project Information and Prior Project History
1
Property Identification
1a
Property identification no (tax PIN or parcel ID)
555 001
1 b
Site coordinates (in decimal degrees)
Latitude 35 695 Longitude 80 762
1c
Property size
533422 acres
2
Surface Waters
2a
Name of nearest body of water to proposed project
BEAVER DAM CREEK
2b
Water Quality Classification of nearest receiving water
C
2c
River basin
YADKIN
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
Agriculture timber land and crop land
3b
List the total estimated acreage of all existing wetlands on the property 1
3c
List the total estimated linear feet of all existing streams (intermittent and perennial) on the property 2 000
3d Explain the purpose of the proposed project
Construct a commercial driveway to furnish access from an existing state maintained road to an existing commercial building
3e Describe the overall project in detail including the type of equipment to be used
Grading and excavation equipment will be used to clear the site install a reinforced concrete culvert 50 feet long with concrete head walls cut and fill o
O
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?
❑ Yes ❑X No ❑ Unknown
Comments
4b
If the Corps made the jurisdictional determination what type
of determination was made?
❑ Preliminary ❑ Final
4c
If yes who delineated the jurisdictional areas?
Name (if known)
Agency /Consultant Company
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
this project (including all prior phases) in the past
El Yes ❑X No ❑ Unknown
5b
If yes explain in detail according to help file instructions
6
Future Project Plans
6a
Is this a phased project?
❑ Yes ❑X No
6b
If yes explain
Page 3 of 10
PCN Form — Version 1 4 January 2009

C Proposed Impacts Inventory
1 Impacts Summary
la 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
Wetland Impact
number
Permanent (P) or
Temporary T
2b
Type of Impact
2c
Type of wetland
2d
Forested
2e
Type of jurisdiction
Corps (404 10) or
DWQ (401 other)
2f
Area of
Impact
(acres)
W1
Choose one
Choose one
Yes /No
W2
Choose one
Choose one
Yes /No
W3
Choose one
Choose one
Yes /No
W4
Choose one
Choose one
Yes /No
W5
Choose one
Choose one
Yes /No
W6
Choose one
Choose one
Yes /No
2g Total Wetland Impacts
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
Stream Impact
number
Permanent (P) or
Temporary (T)
3b
Type of Impact
3c
Stream name
3d
Perennial (PER) or
Intermittent (INT)?
3e
Type of
jurisdiction
3f
Average
stream
width
(feet)
3g
Impact
length
(linear
feet)
S1 P
Culvert
UNNAMED TRIBUTARY
PER
DWQ
20
85
S2
Choose one
S3
Choose one
S4
Choose one
S5
Choose one
S6
Choose one
3h Total stream and tributary impacts
85
31 Comments
60 RCP 50 LF 2 CONCRETE HEADWALLS 8 LF ENERGY DISSIPATOR 27 = 85 LF
Page 4 of 10
PCN Form — Version 14 January 2009

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 indivi ually list all open water impacts below
4a
Open water
impact number
Permanent (P) or
Temporary T
4b
Name of waterbody
(if applicable)
4c
Type of impact
4d
Waterbody
type
4e
Area of impact (acres)
01
Choose one
Choose
02
Choose one
Choose
03
Choose one
Choose
04
Choose one
Choose
4f Total open water impacts
4g Comments
5 Pond or Lake Construction
If pond or lake construction proposed the complete the chart below
5a
Pond ID number
5b
Proposed use or
purpose of pond
5c
Wetland Impacts (acres)
5d
Stream Impacts (feet)
5e
Upland
(acres)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
P1
Choose one
P2
Choose one
5f Total
5g Comments
5h Is a dam high hazard permit required2
Yes ❑ No If yes permit ID no
51 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 any impacts require mitigation then you MUST fill out Section D of this form
6a Project is in which protected basin?
❑ Neuse ❑ Tar Pamlico ❑ Catawba ❑ Randleman [-]Other
6b
Buffer Impact
number —
Permanent (P) or
Temporary T
6c
Reason for impact
6d
Stream name
6e
Buffer
mitigation
required
6f
Zone 1
impact
(square
feet )
6g
Zone 2
impact
(square
feet
B1
Yes /No
B2
Yes /No
B3
Yes /No
B4
Yes /No
B5
Yes /No
B6
Yes /No
6h Total Buffer Impacts
61 Comments
Page 5 of 10

D Impact Justification and Mitigation
1 Avoidance and Minimization
1a Specifically describe measures taken to avoid or minimize the proposed impacts in designing project
CONCRETE HEADWALLS USED TO REDUCE CULVERT LENGTH BY 30 FEET
lb Specifically describe measures taken to avoid or minimize the proposed Impacts through construction techniques
MINIMUM AREA WILL BE CLEARED
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 ❑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
El to In lieu fee program
ram
❑ Permlttee Responsible Mitigation
3 Complete if Using a Mitigation Bank
3a Name of Mitigation Bank
3b Credits Purchased (attach receipt and letter)
Type Choose one
Type Choose one
Type Choose one
Quantity
Quantity
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
Choose one
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 Permlttee Responsible 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 4 January 2009

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 ❑X 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 7 of 10

E
Stormwater Management and Diffuse Flow Plan (required by DWQ)
1
Diffuse Flow Plan
la
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 diffuse flow plan included? If no explain why
❑ Yes ❑ No
2
Stormwater Management Plan
2a
What is the overall percent Imperviousness of this project?
1 25 %
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
SECTION
18 24(c)(5)(b)(2) OF THE ROWAN COUNTY SOIL EROSION SEDMENTATION CONTROL ORDINANCE DOES NOT REQUIRE
STORMWATER CONTROLS FOR PROJECTS WITH LESS THAN 10 A IMPERVIOUS
2d
If this project DOES require a Stormwater Management Plan then provide a brief narrative description of the plan
2e
Who will be responsible for the review of the Stormwater Management Plan?
3
Certified Local Government Stormwater Review
3a
In which local government s jurisdiction is this project'?
ROWAN
❑ Phase II
❑ NSW
3b
Which of the following locally Implemented stormwater management programs
❑ USMP
apply (check all that apply)
❑ Water Supply Watershed
❑ Other
3c
Has the approved Stormwater Management Plan with proof of approval been
❑Yes ❑X No
attached?
4
DWQ Stormwater Program Review
❑Coastal counties
❑HQW
4a
Which of the following state implemented stormwater management programs apply
❑ORW
(check all that apply)
❑Session Law 2006 246
❑Other
4b
Has the approved Stormwater Management Plan with proof of approval been
❑ Yes Q No
attached?
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 8 of 10
PCN Form — Version 14 January 2009

F Suppleme itnry Information
11 Environmci tal Documentation (DWQ Requirement) I
1a Does the pio, -ct involve an expenditure of public (federal /state /local) funds or the ❑ Yes ❑X No
use of publi (federal /state) land
1 b If you ans
-d yes to the above does the project require preparation of an
environm
I CIoC,Ument pursuant to the requirements of the National or State
(North Caro
i) Environmental Policy Act (NEPA/SEPA)?
1c If you ansa
i d yes to the above has the document review been finalized by the
State Clen
j I louse? (If so attach a copy of the NEPA or SEPA final approval
letter )
Commcnt
2 Violation ,L� NQ Requirement)
❑ Yes ❑ No
❑ Yes ❑ No
2a Is the site i iolation of DWQ Wetland Rules (15A NCAC 2H 0500) Isolated
Wetland R � (15A NCAC 2H 1300) DWQ Surface Water or Wetland Standards El Yes ❑X No
or Ripanai ffer Rules (15A NCAC 26 0200)?
2b Is this ii i the fact permit application? El Yes ❑X No
2c If you ans J yes to one or both of the above questions provide an explanation of the violation(s)
3 Cumul ti mpacts (DWQ Requirement)
3a Will this pi,
additional c
(based on past and reasonably anticipated future impacts) result in ❑X Yes ❑ No
lopment which could impact nearby downstream water quality
3b If you ns d yes to the above submit a qualitative or quantitative cumulative impact analysis in accordance with the
most rice i 1vQ policy If you answered no provide a short narrative description
THE REMAIN tic, A 11AY BE FURTHER DEVELOPED FOR COMMERCIAL USE IN THE DISTANT FUTURE GREATER THAN 10 YEARS
AWAY
4 Sewan- D
4a Clearl det
the Drol os
ON SITL U 11
.sal (DWQ Requirement)
IIc ultimate treatment methods and disposition (non discharge or discharge) of wastewater generated from
o available capacity DISPOSAL IS AVAILABLE THE ONLY I I Y SEWAGE DISPOSAL IN THE FORESEEABLE FUTURE
Page 9 of 10
PCN Form — Version 14 January 2009

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 ❑X No
habitat
5b Have you checked with the USFWS concerning Endangered Species Act
❑ Yes Q No
Impacts
5c If yes Indicate the USFWS Field Office you have contacted
5d What data sources did you use to determine whether your site would Impact Endangered Species or Designated Critical
Habitat?
6 Essential Fish Habitat (Corps Requirement)
6a WIII this project occur In or near an area designated as essential fish habitat?
❑ Yes ❑X No
6b What data sources did you use to determine whether your site would Impact Essential Fish Habitat?
USFWS & NCWRC
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 X❑ 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?
NATIONAL TRUST FOR HISTORIC PRESERVATION
8 Flood Zone Designation (Corps Requirement)
8a WIII this project occur in a FEMA designated 100 year floodplain?
❑X Yes ❑ No
8b If yes explain how project meets FEMA requirements
Complies with FEMA Design Guidelines for Flood Damage Reduction
8c What source(s) did you use to make the floodplain determination?
FIRM 3710476000K 06 16 2009
ava.,,.e 1127
Applicant/Agent s Printed Name
Applicant/Agent s Signature
Date
(Agents signature is valid only if an authorization
letter from the applicant is provided
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