20120605 Ver 1_401 Application_20120612

2 ®120605
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) Fore
A
Appircanthifiorination
1
Processing
la
Type(s) of approval sought from the Corps
❑ Section 404 Permit 0 Section ID Permit
1b Specify Nationwide Permit (NAP) number or General Permit (GP) number
1 c
Has the NWP or GP number been verified by the Corps?
❑ Yes ❑ No
Id
Type(s) of approval sought from the DWQ (check all that apply)
❑ 401 Water Quality Cerbfication — Regular ❑ Non -404 Jurisdictional General Perm t
❑ 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 Parmit.
❑ Yes ❑ No
If
is payment into a m"ation bank -or in --lieu tee program proposed for
mitigation of impacts? If so attach the acceptance letter from mitigation bank
or in lieu fee program
❑ Yes No
r
19
is the project located m any of NC s twenty coastal counties M yes answer lit
below
❑ Yes CdNo
1 h Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes ❑ No
2
Project Information
2a
Name of project
OW Dint en J n.S ?4 Kl t/
2b
County
2c
Nearest municipality / town
n
2d
Subdivision name
2e
NCDOT only T I P or state project no
3
Owner Information
3a
Name(s) on Recorded Deed
t,V/ IM !2ho
3b
Deed Book and Page No
R % �' Q C/ R
3c
Responsible Party (for LLC if
applicable)
Soa id ®f Dfa, fS
3d
Street address
n
3e
-City state zap
3f
Telephone no
... (ALO- 525C3
3g
Fax no
3h
Email address
I L i
Page 1 of 10
PCN Form - Version 14 January 2009

y�
4
Applicant Information (if different from owner)
4a
Applicant is
❑ Agent
Other specify Member
4b
Name
1 Ourle
C gobrrsorl
4c
Business name
(if applicable)
4d
Street address
1 RQCKww
LY
4e
City state zip
NC 2- 65
4f
Telephone no
4g
Fax no
/V
4h
Email address
Par m E
5
AgentlConsultant Information (if applicable)
5a
Name
f
5b
Business -name
(if applicable)
! \t wvk)
5c
Street address
5d
City state zip
AIOJ VI
5e
Telephone no
Z - 2q&e 45
5f
Fax no
Z -
VR
5g
Email address
biqda
wI erir
J✓
Page 2 of 10

B Project Information and Prior Project History
1 Property Identification
//--1� LL
la Property identification no (tax PIN or parcel ID) � i Z � � iii �� JLpt1��
1b Site coordinates (in decimal degrees) I Latitude Longitude
1c Property size
2cl , acres
2 Surface Waters
2a Name of nearest body of water to proposed project
2b Water Quality Classification of nearest receiving water
2c River basin
3 Project Description
3a Describe the existing conditions on the site and the general land use in the vicinity. o£tne project at the time of this
application �p tp�. 5tiG 1S 0. qjetiti SID(d T I%e r' boI1K Cova l all 9c�raSS % n4at, ar71 a Z
4vas �' is add -}� a shaiC, Blow wlotl����q Se Won OF 40- Cain= Myv- I�Iptpn
t�crC Pm is t ad A aSD,I,L�D sq f+ kaildin houses Oe- (�,-.}�Scht)
ce ?hie pis a lar led werlrq latLuc flee builder
3b List the total estimated acreage of all existing wet ands on the property
3c List the total estimated linear feet of all existing streams (intermittent and perennial) on the property y7en
3d Explain the purpose of the proposed p sect PP a SQ� Gil2'Q ere Q Class f �'�rden
caO access �e r� ler GU i ne , �rsb� M (o1k5, Gavots, a s,
3e Describe the overall pr jec� to. detail including the type of equipment to be used
ak IJt.CJJCAAPW�
4 Judsdictional Determinations
4a Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
ro ect includin all nor in the ast?
( Yes El No El Unknown
Comments
0 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
APVA66 4r% u1tYh Cor t )514,4 � 5Jj5 j2 ►d errh�i�ed �+S�r� rn� r
5 Project History Lij-
5a have pemnts or certifications been requested or obtained fir
this project (including all prior phases) in the past?
❑ Yes j No ❑ Unknown
5b If yes explain in detail according to help file instructions
6 future Project Plans
6a Is this a phased project?
❑ Yes 0 No
6b If yes explain
Page 3 of 10
PCN Form - Version 14 January 2009

C Proposed impacts Inventory
1 Impacts Summary
a %klich sect ons 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
Wetland impact Type of impact Type of wetland Forested
2e 2f
Type of jurisdiction Area of
number
Corps (404 10) or impact
Permanent (P) or
DWQ (401 other% (acres)
Temporary
W4 i
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
YesMo'
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 3b 3c 3d 3e 3f 39
Stream impact Type of impact Strea ame Perennial (PER) or Type of Average Impact
length
number intermittent (INT)? jurisdiction stream
(linear
Permanent (P) or width
(feet) feet)
Temporary (T) !
S1 - Choose one
S2
Choose one
S3
Choose one
S4
Choose one
S5
Choose one
S6 Choosernie
impacts
2�
3h Total stream and trib ry
31 Comments
Page 4 of 10
PCN Form — Version 14 January 2009

4 Open Water Impacts N
es nes tributaries sounds the Atlantic Ocean or any other open water of
If there are proposed impacts to lakes ponds ua
the U S then indiv ually list all open water imoacts below _ p
4a 4b 4c 4d 14e
Open water Name of waterbody
rrpact nurnbe lef applicable) Tvpe of impact Waterbody Area of impact (acres)
Permanent (P) or type
Temporary
01
Choose one
Choose
O2
Choose one
Choose
03
Chao a one
Choose
04
Choose one
Choose
4f Total open xater impacts
4g Comments
Lake Construction 69
5 Pond or
If Dond or lake construction proDosed the complete the chart below
5a 5b 5c 5d 5e
Pond ID number Proposed use or Wetland Impacts (acres) Stream Impacts (feet) Upland
purpose of pond (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
S Buffer Imparts 4for 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
6c
Reason for impact
6d
Stream name
6e
Buffer
6f
Zone 1
6g
Zone 2
mdWftn
impact
impact
number—
Permanent (P) or
required?
(square
feet )
(square
feet
Temporary
B1
Y o
B2
Yes/No
B3
Ze r
Yes/No
B4
Yes/No
B5
Yes/No
66
Yes/No
6h Total Buffer Impacts
s
L / r
61 Comments X p / i1�� �l%11��Qo /PiT /'►Q Ii/A,l CG Gl!.i�'j yYvvcU
rage o or i u
�r

D impact Justification and Mrtrgatron '/ uA anJ f 1 InA blAi PIO
11 Avoidance and Minimization
la SpecifigAy describe measures taken to avoid or minimize the proposed impacts in designin project ��,�
C04V Ich u3 ii be %�2� RS Yi�tF, ai as p%plWe, S s � � 1 � w A�
ley. �Yiern p�e�rv�S -b Of
lb Specifically describe measures taken to avoid or minimize the proposed impacts through con truction techniques '�'he
Holz d� IS to 11 be used Mini i ma) if , sedlmem- UM I e���e n v e
btA+, VAi� I be Vi reed up at � -h me ate � 2 6442 ay? wn&u
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 ff 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
© Perfmftee Responstble Mitigation
3 Complete if Using a Mitigation Bank
3a Name of Mitigation Bank
3b Credits Purchased lattach reoetpt and ietter)
Type Choose one
Type Choose one
Type Choose one
Quantity
Quantity
Quantity
3c Comments
4 Complete IfIftking 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 wetland7rnhgation 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 S of 1,0
PCN Form - Version 14 January 2009
M+S
1.

6 Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a ilinil the project iesuit in an impact within a protected riparian buffe, that requires � 0 Yes ("No
buffer mitigation?
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
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)
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 os 4 adjacent to protected riparian buffers identified
vPS ❑ No
within one of the NC Riparian Buffer Protection Rules?
1b if yes then is a diffuse now plan included? If no explain wny �o��n7
firm l5 s m � tut i 1 %►'!01?1 fU D P S
[]Yes ( No
LOM
="e Yuri off
2
Stormwater Management Plan
2a
What is the overall percent imperviousness of this project?
3O
2b
Does this ro ec+ re L re a Stormwater Management Plan?
❑ Yes D-No
2c if this project DOES NOT require a Stormwater Management Plan explain why
(,vita is very srna& And pr�lec* boll be "hAple -d for P S
S7lormuxtk' rmMfF
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 lunsdwtiori +s this project? /A%
❑ 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 ❑ No
attached?
4
DWQ Stormwater Program Review A
❑Coastal counties
❑HQW
4a
Which of the following state - implemented stormwater management programs apply
OORW
(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 8 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
0 Yes ffNo
habitat
Yes [KNo
5b Have you checked with the USFWS concerning Endangered Species Act
- npaacts"
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'7
6 Essential Fish habitat (Corps Requiremen)
6a Will this protect occur in or near an area designated as essential fish habitat?
❑ Yes allo
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
0 Yes 2mo
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'7
8 Flood Zone Designation (Corps Requirement)
8a Will this project occur in a FEMA designated 100 year floodplain?
2 Yes ❑ No
8b If yes explain how project meets FEMA requirements
8c What source(s) did you use to make the floodpiain determination?
(Dune C Ab/rson
c
4440piplicant/Agent
Applicant/Agent s Printed Name
s Signature
(Agents signature is valid only if an authorization
Date
letter from the applicant is provided
Page 10 of 10

River Access Project Description
A series of 4 steps will be constructed Ubing G W limber The, grill be 12 -17 feet wide
The steps will be back filled with gravel, dirt and sand The steps will lead to a flat area
at the edge of ire river At the ,hate* s edge 2 steps approxnnately 28 feet wide will be
constructed to serve as secure footing and access to the water for boaters and students
Tlus width is deemed necessary for tits project to be useful and safe for elementary
students to safely access the water's edge for school projects and activities The project
will be constructed with hand tools, and saws The clearing will be done with chain
saws The bank adjacent to the steps has a natural, gentle slope which will de cleared of
brush and smoothed out to allow for canoes to slide down the bank into the water 3 trees
will be removed in this area. Die entire area affected by this projected is gencroasly
estimated at 28 feet by 28 feet The area surrounding the steps and canoe launch will be
monitored for erosion and problems with drainage by a Board member and school staff
The project was designed and will be constructed as an Eagle Scout project The funding
for this is part of a grant provided by Lowe s Toolbox for Education for a trail, outdoor
classroom and river access for the students at New Dimensions School