20120096 Ver 1_401 Application_20120212

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20120096
Office Use Only
Corps action ID no
DWQ project no
Form Version 1 4 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
❑ Section 404 Permit ❑ Section 10 Permit
lb Specify Nationwide Permit (NWP) number or General Permit (GP) number
1c
Has the NWP 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 ❑X Ripanan Buffer Authonzation�
le
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
if
GIs payment into a mitigation bank or in lieu fee program proposed for __
mitigation of impacts? If so_ attach_the acceptance letter from mitigation bank
nor in lieu fee program
_
❑Yes X❑ No
_
�1 g
Is the protect located in any of NC s twenty coastal counties If yes answer 1 h�
,below, � J
❑ Yes) ❑X No
1 h
Is the protect located within a NC DCM Area of Environmental Concern (AEC)? )
Yes X❑ No)
2
Project Information
�2a
Name of project
Eric Brock Streambank Protection
2b
County r
Wilson
�2c
Nearest municipality / town)
Sims p
,2d
Subdivision name
N/A
2e
NCDOT only T I P or state project no
FER
3 j -Owner Information)
,3a
Name(s) on Recorded Deed l
Vickie Thompson Brock WE VDaAND S7 AI M
'3b
Deed Book and Page No
2007E/121
3c
Responsible Party (for LL_C if
applicable)
'3d
Street address
6324 Old Davis Road
3e
City state zip
Sims NC 27880
3f
Telephone no '
252 373 0472
3g
Fax no 1
N/A
3h
Email address
N/A
Page 1 of 10
PCN Form — Version 14 January 2009

�4 f (Applicant Information (if different from_owner)
4a Applicant is-
Elf-Agent ❑,Other specify,'
4b Name)
Ac Business name;
(if applicable)
Ad Street address;
4e City state zip 1
4f Telepho_ne no
4g Fax no
4h Email address
5 LAgent/consultant information (if apphcable)i
5a iName,
�5b Business name,
'(if applicable) i
67c Street address j
5d City state zips
5e Tei_ephone no
r5f Fax no ;
'5g Email address
Page 2 of 10

B Project Information and Prior Project Hlstory
(1I �ProperEy Identification
1a Property identification no (tax PIN or parcel ID)
Pin # 2793 37 1403 000
1b Site coordinates (in decimal degrees
I Latitude] 35 7672 (Longitudel78 0121
1 c Property size
44 7 acres
12) Surface Waters
l2a Name of nearest body of water to proposed protect i
Bloomery Swamp
2b Water Quality Classification of nearest receiving water r
C NSW
2c River basin;
Neuse
4 Project Description
,3a�_Describe the existing conditions on the site and the general land use in the vicinity of the protect at the time of this,
�apphcation , _ _ _ _ _ _ _
500 ft of stream being wooded on the east side and cropland on the west side
3b List the total estimated acreage of all existing wetlands on the property 40
3c List the total estimated linear feet of all existing streams (intermittent and perennial) on the property 500
3d Explain the purpose of the proposed protect I
Re slope stream bank to help eliminate erosion taking on stream bank After re sloping the area will be seeded and will become established with grass
+3e Describe the overall protect in detail including the type of equipment to be used)
Banks will be sloped bank iAth the use of a bulldozer and excavator
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 ast ?i
❑ Yes, f4No` ❑ Unk_nown
Comments
- --
4b If the Corps made the jurisdictional determination what type
of determination was made?
Preliminary El 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
i
5 Project History+
5a Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past ?i
❑Yes ❑X No, El 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 1O_L_i _
PCN Form — Version 1 4 January 2009

C Proposed Impacts Inventory
1 Impacts Summary
1a Which sections were completed below for your project (check all that apply)
❑ Wetlands ❑ Streams —tributaries ❑X Buffersl ❑ 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
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
Choose one
S2
Choose one
S3
Choose one
S4
Choose one
S5
Choose one
S6
Choose one
3h Total stream and tributary impacts
31 Comments
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
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 required?
❑ 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 vou MUST fill out Section D of this form
6a Project Is In which protected basin?
❑X Neuse ❑ Tar Pamlico ❑ Catawba ❑ Randleman ❑ Other
6b
Buffer Impact
number —
Permanent (P) or
Temporary
6c _
Reason for impact
6d
,Stream name;
6e
Buffer
mitigation'
required?
6f
Zone 1
impacts
((square
feet )
6g _
Zone 2'
Impact
(square
feet
B1 P
Sloping eroding banks
Tributary of Bloomery Swamp
No
15 000
B2
Yes /No
B3
Yes /No
B4
Yes /No
B5
Yes /No
B6
Yes /No
6h Total Buffer Impacts
15 000
61 Comments Plan to slope banks to help reduce erosion on banks
Page 5 of 10

D Impact Justification and Mitigation
1 Avoidance and Minimization
1a 1Specifically describe mea_sure_s taken to avoid or minimize the proposed Impacts In designing project)
Design for this will not impact the stream _
1 b' Specifically describe measures taken to avoid or minimize the proposed Impacts through construction techniques)
Stream bank well be sloped away from channel bottom and the sediment vnll be pulled away from the channel Area will be seeded and site will
become established with grass shrubs and trees
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
projects
❑ Mitigation bank
❑ Payment to in lieu fee program
f ram
y p g
❑ Permittee 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 Permittee 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 14 January 2009

6 , Buffer Mitigation (State Regulated Riparian Buffer Rules) —required by DWQI
`6a Will the project result in an impact within _a protected riparian buffer that requires)
'buffer mitigations
bu
Yes X No
6b * yes then identify the square feet of impact to each zone of the riparian buffer that regwres mitigation Calculate the)
amount of mitigation required
'Zone_)
- -�
16c _
LReason for impact
�6d _
Jotal impact
,(square feet))
Multiplier
6e) _
~Required mitigation
!(square feet))
Zone 1
3 (2 for Catawba)
Zone 2
15
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) v
6h Comments i
Page 7 of 10

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
❑X Yes; El' Noi
v
1 b
If yes then is a diffuse flow plan included? If no explain why
❑ Yes ❑X No
2
Stormwater Management Plan
2a
What is the overall percent imperviousness of this project?
ova
2b
Does this project require a Stormwater Management Plan?
❑ Yes ❑ No
2c
If this project DOES NOT require a Stormwater Management Plan explain why
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 governments jurisdiction is this project?
3b
Which of the following locally implemented stormwater management programs
apply (check all that apply)
❑ Phase II
❑ NSW
❑ USMP
❑ Water Supply Watershed
❑ Other
3c
Has the approved Stormwater Management Plan with proof of approval been
attached?
El Yes ❑ No
4
DWQ Stormwater Program Review
4a
Which of the following state implemented stormwater management programs apply
(check all that apply)
❑Coastal counties
❑HQW
❑ORW
❑Session Law 2006 246
❑Other
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 8 of 10
PCN Form — Version 14 January 2009

F Supplementary Information
1 Environmental Documentation (DWQ Requirement)
la Does the project involve an expenditure of public (federal /state /local) funds or the
❑ Yes
❑ No
use of public (federal /state) land?
1b 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
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 i
— µ
El Yes
Q No
4
or Riparian Buffer Rules (15A NCAC 2B 0200) ?)
2b Js this an after the fact permit apphaU
con��
❑Yes
❑X 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 ins
❑Yes
Q 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 ' T
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
G
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
habitat?
❑ Yes ❑ No
5b Have you checked with the USFWS concerning Endangered Species Act
impacts?
❑ Yes ❑ No
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 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?
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 (e g National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
❑ Yes ❑ No
7b What data sources did you use to determine whether your site would impact historic or archeological resources?
8 Flood Zone Designation (Corps Requirement)
8a Will this project occur in a FEMA designated 100 year floodplain? 7-13
Yes ❑ No
8b If yes explain how project meets FEMA requirements
8c What source(s) did you use to make the floodplain determination?
Vickie Thompson Brock
'Applicant/Agent s Printed Name;
7
f
)1.210-
'Date)
Applicant/Agent s Signature
(Agents signature is valid only if an authonzatiori�
letter from the applicant is provided
Page 10 of 10

Customer(s): ERIC F BROCK,
VICKIE L BROCK
PCN Map Date: 1/31/2012
Field Office: WILSON SERVICE CENTER
Agency: Wilson Soil and Water
Assisted By: Ricky Hayes
State and County: NC, WILSON
Legend
brockconplan
— Streams
Roads
0 Soils
v
225 0 225 450 675 900
Feet

'--7F-
PCN Map Date: 1/31/2012
Customer(s): ERIC F BROCK,
Field Office: WILSON SERVICE CENTER
VICKIE L BROCK Agency: Wilson Soil and Water
Assisted By: Ricky Hayes
State and County: NC, WILSON
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02 'r
—' bd ,r a j Vickie Brock
Fa`mv� + j Tract 3205
- Streambank Protection (500ft)
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Legend
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Roads
drg_s_ncl95.sid
RGB
N
O Red: Band -1
230 0 230 460 690 920
kaj Green: Band 2
Feet
Blue: Band-3