20120663 Ver 1_401 Application_20120712

I Mil
k �C�
201 2066 3
Office Use Only
Corps action ID no
DWQ project no
Form Version 13 Dec 10 2008
Page 1 of 10
PCN Form — Version 1 3 December 10 2008 Version
Pre - Construction Notification (PCN) Form
A
Applicant Information
1
Processing
la
Type(s) of approval sought from the
Corps
j� Section 404 Permit ❑ Section 10 Permit
lb Specify Nationwide Permit (NWP) number 27 or General Permit (GP) number
1c
Has the NWP or GP number been verified by the Corpse
❑ Yes
X No
id
Type(s) of approval sought from the DWQ (check all that apply)
X 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
❑ 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 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
1h
Is the project located within a NC DCM Area of Environmental Concern (AEC)
❑ Yes
X No
2
Project Information
2a
Name of project
Obids Creek Stream Restoration
2b
County
Ashe
2c
Nearest municipality / town
West Jefferson
2d
Subdivision name
NA
2e
NCDOT only T I P or state
project no
N/A
3
Owner Information
3a
Name(s) on Recorded Deed
Gary and Judy Bare
3b
Deed Book and Page No
417/2443
3c
Responsible Party (for LLC if
applicable)
N/A
Z012 Py/
3d
Street address
176 Kingswood Drive
3e
City state zip
West Jefferson NC 28694
atg�1Y
3f
Telephone no
N/A
3g
Fax no
N/A
3h
Email address
N/A
Page 1 of 10
PCN Form — Version 1 3 December 10 2008 Version

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
Derek Goddard
5b
Business name
(if applicable)
Blue Ridge Environmental Consultants P A
5c
Street address
1305 South Collegiate Drive
5d
City state zip
Wilkesboro NC 28697
5e
Telephone no
828 964 9349
5f
Fax no
336 838 4318
5g
Email address
derek @brec biz
Page 2 of 10

B Project Information and Prior Project History
1 Property Identification
1 a Property identification no (tax PIN or parcel ID)
12346 051 & 12346 052
1 b Site coordinates (in decimal degrees)
Latitude 36 315849 Longitude 81 388423
(DD DDDDDD) ( DD DDDDDD)
1 c Property size
96 acres
2 Surface Waters
2a Name of nearest body of water (stream river etc ) to
proposed project
Obids Creek
2b Water Quality Classification of nearest receiving water
C Tr
2c River basin
New
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
Agricultural site Cattle Pasture No Riparian Buffers
3b List the total estimated acreage of all existing wetlands on the property
10 acres
3c List the total estimated linear feet of all existing streams (intermittent and perennial) on the property
3500 Perennial
3d Explain the purpose of the proposed project
To Prevent and decrease erosion and improve water quality
3e Describe the overall project in detail including the type of equipment to be used
The project will utilize a track loader To install in stream structures that prevents and reduces erosion The project will aid
floodplain connectivity and wildlife habitat A riparian buffer will be established with livestock exclusion fencing
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 pasty
Comments
El Yes X No El Unknown
4b If the Corps made the jurisdictional determination what type
of determination was made9
❑ Preliminary Final
imina rY
4c If yes who delineated the jurisdictional areas2
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
5 Project History
5a Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past
❑ Yes X No ❑Unknown
5b If yes explain in detail according to help file instructions
6 Future Project Plans
6a Is this a phased projects
❑ Yes X No
6b If yes explain
Page 3 of 10
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 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
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
W1 P T
❑ Yes
Corps
No
❑ DWQ
W2 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W3 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W4 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W5 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W6 ❑ P ❑ T
❑ Yes
❑ Corps
❑ 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 X
Restoration
Obids Creek
X PER
E:1 INT
X Corps
X DWQ
6
2500
S2 P X
Restoration
UT Obids Creek
X PER
❑ INT
X Corps
X DWQ
3
100
S3 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S4 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S5 ❑ P ❑ T
❑ PER
❑ Corps
❑ IN
❑ DWQ
S6 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
3h Total stream and tributary impacts
3500
31 Comments
Page 4 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 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
01 ❑P ❑T
02 ❑P ❑T
03 ❑P ❑T
04 ❑P ❑T
4f Total open water impacts
4g Comments
5 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)
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
❑ Neuse ❑ Tar Pamlico ❑ Other
Project is in which protected basing 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)
Temporary
impact
re uired�
B1 ❑P ❑T
❑Yes
❑ No
B2 ❑ P ❑ T
❑ Yes
❑ No
B3 ❑P ❑T
❑Yes
❑ No
6h Total buffer impacts
61 Comments
Page 5 of 10

D
Impact Justification and Mitigation
1
Avoidance and Minimization
is
Specifically describe measures taken to avoid or minimize the proposed impacts in designing project
This impact is the only practical alternative to have adequately prevent failing banks and improve long term water quality
by reducing erosion Erosion control will be adhered to for sensitive watersheds
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 The stream have to much flow for a
pump around
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
❑ 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 6 of 10
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 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
❑
Comments
2
Stormwater Management Plan
2a
What is the overall percent imperviousness of this project?
1 %
2b
Does this project require a Stormwater Management Plan9
❑ 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 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 Plans
❑ DWQ Stormwater Program
❑ DWQ 401 Unit
3
Certified Local Government Stormwater Review
3a
In which local government s jurisdiction is this project?
❑ 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'2
4
DWQ Stormwater Program Review
❑ Coastal counties
4a
Which of the following state implemented stormwater management programs apply
❑ HQW
❑ ORW
(check all that apply)
❑ 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 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
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
❑ 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 (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
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
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 WIII 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 ?
5c If yes indicate the USFWS Field Office you have contacted
❑ Raleigh
® Asheville
5d What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
http / /www, ncnhp org http / /www saw usace army mil/WETLAND /esa http / /www fws gov /nc es /es /es html
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?
http //ocean flondamanne org /efh_coralfims /viewer 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
❑ 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 floodplain?
® Yes ❑ No
8b If yes explain how project meets FEMA requirements No rise to the flood way will occur
8c What source(s) did you use to make the floodplain determination? http / /www ncfloodmaps com
Derek Goddard
JLL )-
6/21/12
Applicant/Agent s Printed Name
-0ZJ
Applicant /Agent s Signature
Date
(Agent s signature is valid only if an authorization letter from the applicant
is provided
Page 10 of 10

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Sod Map —Ashe County North Carolina
Map Unit Legend
Ashe County North Carolina (NC009)
Map Unit Symbol
Map Unit Name
Acres In AOI
Percent of AOI
CaF
Chandler loam 25 to 65 percent slopes
182
159/
CfD
Clifton loam 8 to 15 percent slopes
36
32/
CfE
Clifton loam 15 to 25 percent slopes
219
192/
Co
Colvard fine sandy loam
127
11 1 /
To
Toxaway loam
204
178/
TsD
Tusquitee loam 8 to 15 percent slopes
38
33/6
WaD
Watauga loam 8 to 15 percent slopes
60
53/6
WaE
Watauga loam 15 to 25 percent slopes
49
430/
WaF
Watauga loam 25 to 45 percent slopes
227
199/
Totals for Area of Interest
1142
1000/
USDA Natural Resources Web Sod Survey 6/1/2012
Conservation Service National Cooperative Sod Survey Page 3 of 3

AGENT AUTHORIZATION FORM
Property Legal Description
Book /Page 417/2443
PIN 12346 051 & 12346 052
Street Address off of Bare Road —West Jefferson, NC 28694
Property Owner Gary and Judy Bare
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)
176 Kingswood Drive — West Jefferson NC 28694
We hereby certify the above information submitted in this application is true and accurate to
the best of our knowledge
Authorized S ture
Date _ 6?' S/ xil'7

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