20111115 Ver 1_More Info Received_20120220

of W ATF9
T ti
14, I 0 > 1
lio�0 o <
o�— m5
Office Use Only
Corps action ID no
DWQ project no
Form Version 13 Dec 10 2008
N C Dept of ENR
FEB 16 2012
Winston Salem
Re tonal office
Page 1 of 11
PCN Form — Version 1 3 December 10 2008 Version
Pre - Construction Notification PC Form
A Applicant Information
1
Processing
la
Type(s) of approval sought from the
Corps
0 Section 404 Permit ❑ Section 10 Permit
1 b Specify Nationwide Permit (NWP) number 14 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 ❑ Riparian Buffer Authorization
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
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
1h
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
® No
2
Project Information
2a
Name of project
Champion Hills Jones Keystone
2b
County
Randolph
2c
Nearest municipality / town
Trinity
2d
Subdivision name
Harold Lee Briles
2e
NCDOT only T I P or state
project no
'
'
3
Owner Information F
3a
Name(s) on Recorded Deed
Linda B Hunt
3b
Deed Book and Page No
211111218 JALITY
DSMI)ST
3c
Responsible Party (for LLC if
applicable)
Mr Aaron Keay
3d
Street address
4962 Rex Rd
3e
City state zip
Winston Salem NC 27107
3f
Telephone no
336 785 1286
3g
Fax no
N/A
3h
Email address
N/A
N C Dept of ENR
FEB 16 2012
Winston Salem
Re tonal office
Page 1 of 11
PCN Form — Version 1 3 December 10 2008 Version

4
Applicant Information (if different from owner)
4a
Applicant is
® Agent ❑ Other specify
4b
Name
Mr Peter H Evans
4c
Business name
(if applicable)
Revolution Resources Corp
4d
Street address
1500 -409 Granville Street
4e
City state zip
Vancouver BC Canada V6C 1TB
4f
Telephone no
336 959 8302
4g
Fax no
4h
Email address
pevans123 @triad rr com
5
Agent/Consultant Information (if applicable)
5a
Name
H Mack Summey Jr PE
5b
Business name
(if applicable)
Summey Engineering Associates PLLC
5c
Street address
1342 E Salisbury Street
5d
City state zip
Asheboro NC 27204
5e
Telephone no
336 328 0902
5f
Fax no
336 328 0922
5g
Email address
mack @asheboro com
Page 2 of 11
PCN Form — Version 1 3 December 10 2008 Version

B Project Information and Prior Project History
1 Property Identification
la Property identification no (tax PIN or parcel ID)
6792754441
Latitude 35 723886 Longitude 0043387
lb Site coordinates (in decimal degrees)
(DD DDDDDD) ( DD DDDDDD)
lc Property size
163 88 acres
2 Surface Waters
2a Name of nearest body of water (stream river etc ) to
UT to Uwharne River
proposed project
2b Water Quality Classification of nearest receiving water
WS 111
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
Existing site is wooded with old saw mill roads through the property Area consists of sparsely located single family
residential Disturbance consisted of stream crossing
3b List the total estimated acreage of all existing wetlands on the property
Less than 1/2 acre
3c List the total estimated linear feet of all existing streams (intermittent and perennial) on the property
3d Explain the purpose of the proposed project
Reuse old logging roads and /or construct short narrow drive and install a 50 x60 pad for exploratory drilling operation
3e Describe the overall project in detail including the type of equipment to be used
Drill rig hauled into site on tractor trailer & pulled off trader with DC 9 catepolar Road construction also uses dump truck
bob cat/loader and tractor to install erosion control measures
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) Sue Homewood /John Thomas
Other
4d If yes list the dates of the Corps jurisdictional determinations or State determinations and attach documentation
November 2 2011 no documents received
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
Page 3 of 11
PCN Form — Version 1 3 December 10 2008 Version

6 Future Project Plans
6a is this a phased project? ® Yes ❑ No
6b If yes explain
This could possibly be a phased project in that if gold is found the company may need to do further exploration If this
ocurs further permitting will be requested and appealed for
Page 4 of 11
PCN Form — Version 1 3 December 10 2008 Version

C Proposed Impacts Inventory
1 Impacts Summary
la 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
❑ Yes
❑Corps
W1 ❑ P ❑ T
❑ No
❑ DWQ
❑ Yes
❑ Corps
W2 ❑ P ❑ T
❑ No
❑ DWQ
❑ Yes
❑ Corps
W3 ❑ P ❑ T
❑ No
❑ DWQ
❑ Yes
❑ Corps
W4 ❑ P ❑ T
❑ No
❑ DWQ
❑ Yes
❑ Corps
W5 ❑ P ❑ T
❑ No I
❑ DWQ
❑ Yes
❑ Corps
W6 ❑ P ❑ T
❑ No
❑ DWQ
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
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
Permanent
UT to Uwharne
® PER
® Corps
15
30
Crossing
River
❑ INT
® DWQ
S2 ❑ P ®T
Temporary
UT to Uwharne
❑ PER
® Corps
15
20
Crossing
River
❑ INT
® DWQ
❑ PER
❑ Corps
S3 ❑ P ❑ T
❑ INT
❑ DWQ
❑ PER
❑ Corps
S4 ❑ P ❑ T
❑ INT
❑ DWQ
❑ PER
❑ Corps
S5 ❑ P ❑ T
❑ INT
❑ DWQ
❑ PER
❑ Corps
S6 ❑ P ❑ T
❑ INT
❑ DWQ
3h Total stream and tributary impacts
31 Comments Crossing #1 to be made permanent stone to be leveled out to prevent water ponding This crossing was an
old logging road that was just reused Stone was put on stream bed Crossing #2 will be removed and restored immediately
Page 5 of 11
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 ❑ PEI T
4f Total open water impacts
4g Comments
6 Pond or Lake Construction
If pond 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
51 Expected pond surface area (acres)
5l 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
❑ 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
Zone 2 impact
Permanent (P) or
for
Stream name
mitigation
(square feet)
(square feet)
Temporary T
im act
re uiredl
131 ❑P ❑T
❑Yes
❑ No
B2 ❑P ❑T
❑Yes
❑ No
B3 ❑P ❑T
❑Yes
❑ No
6h Total buffer impacts
61 Comments
Page 6 of 11
PCN Form — Version 1 3 December 10 2008 Version

D Impact Justification and Mitigation
1 Avoidance and Minimization
1a Specifically describe measures taken to avoid or minimize the proposed impacts in designing project
Project used existing road beds for stream crossing no new crossings were made
1 b Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
No digging in the stream was done rip rap placed carefully on existing stone in stream bottom
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 7 of 11
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 8 of 11
PCN Form —Version 1 3 December 10 2008 Version

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 ® 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?
1313%
2b
Does this project require a Stormwater Management Plan?
❑ Yes ® No
2c
If this project DOES NOT require a Stormwater Management Plan explain why Project
is not creating permanent
impervious 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?
Randolph County
❑ Phase II
3b
Which of the following locally implemented stormwater management programs
❑ NSW
❑ USMP
apply (check all that apply)
® Water Supply Watershed
❑ Other
3c Has the approved Stormwater Management Plan with proof of approval been
® Yes ❑ 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 ❑ 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 9 of 11
PCN Form — Version 1 3 December 10 2008 Version

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?
lb 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
❑ Yes No
❑
letter)
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)9
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) Permittee did not
know that a permit of this type was needed since it was only a temporary disturbance at the time Decision has been made to
request crossing to be permanent
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
Project disturbance is temporary only crossing will remain however no new permanent Impervious surface will be
created
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
None Generated
Page 10 of 11
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?
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?
The USFWS website search engine
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 Habitat Conservation Website
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?
NC Listings in the National Register of Historic Places as of 1/24/12
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
8c What source(s) did you use to make the floodplain determination? Randolph County GIS
Peter H Evans
1/24/12
Applicant/Agents Printed Name
Date
Applican Ag is Signature
(Agents signature is valid only if an authorization letter from the applicant
is provided
Page 11 of 11
PCN Form — Version 1 3 December 10 2008 Version