20120778 Ver 1_401 Application_20120912

NCDENR-
North Carolina Department of Environment and Natural Resources
Division of Parks and Recreation
Beverly Eaves Perdue, Governor Lewis R. Ledford, Director Dee Freeman, Secretary
August 31, 2012
Mr. Ian McMillan
North Carolina Division of Water Quality
1650 Mail Service Center
Raleigh, NC 27699 -1650 0 � � RR 9 n
RE: Water Quality Certification Request S E P- 4 2012
UT To Grassy Creek Sewer Stabilization
Pilot Mountain State Park (Surry County)
Dear Mr. McMillan:
Enclosed are five copies of a completed application submittal package requesting a Water Quality Certification
(No. 38803) which corresponds to US Army Corps of Engineers ( USACE) Nationwide Permit 3. This application
package consists of the following documentation: a completed PCN form, two maps, and two project drawings.
Please also find the enclosed journal transfer documentation indicating that payment of the $240 application fee has
been transferred from the account of the Division of Parks and Recreation (DPR) to the Division of Water Quality.
We respectfully request an expedited review due to the emergency nature of these repairs and the potential for the
structural integrity of the sewer pipe and water quality to be compromised if this area is not stabilized as soon as
possible.
The project will involve stabilization of approximately 30 feet of eroded streambank and exposed sewer pipe in the
southeastern portion of the Mountain Section of Pilot Mountain State Park in Surry County, North Carolina. The
eroded area will be backflled with 12- inch compacted lifts and covered with geotextile fabric. Riprap with an
average diameter of 21 inches will be placed over the compacted fill, with larger riprap placed at the toe of the
streambank. Park staff anticipates using a small walk behind skid- steer to place the heavy material; smaller
material will be placed by hand around the pipe.
DPR is concurrently submitting one copy of this permit application to Mr. Monte Matthews of the USACE Raleigh
Field Office to request a General Permit Verification under Nationwide Permit 3. DPR is also submitting one copy
of this application to Mr. David McHenry of the NC Wildlife Resources Commission since this project is located
within one of North Carolina's 25 designated `trout counties'. Please contact me if you require additional
information.
Sincerely,
Amin K. Davis
Environmental Review Coordinator
Division of Parks and Recreation, Natural Resources Program
North Carolina Department of Environment and Natural Resources
(919) 707 -9329 / amin.davis @ncdenr.gov
1615 Mail Service Center, Raleigh, North Carolina 27699 -1615
Phone: 919 - 707 -9300 • Internet: www.ncoarks.gov
An Equal Opportunity • Affirmative Action Employer - 50 % Recycled • 10 % Post Consumer Paper

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Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre - Construction Notification PCN Form
A. Applicant Information
1. Processing
1 a. Type(s) of approval sought from the
Corps:
®Section 404 Permit El Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: 3 or General Permit (GP) number:
1 c. Has the NWP or GP number been verified by the Corps?
® Yes
❑ No
1d. 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
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 Permit:
❑ 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
® No
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
. below.
[I Yes
® No
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
® No
2. Project Information
2a. Name of project:
UT To Grassy Creek Sewer Stabilization
2b, County:
Surry
2c. Nearest municipality / town:
Pinnacle
`
2d. Subdivision name:
2e. NCDOT only, T.I.P. or state
project no:
4 20 2
3. Owner Information L by NR . GyR
3a. Name(s) on Recorded Deed: State of North Carolina (c /o NC Division of Parks & Recreation ® gra
3b. Deed Book and Page No.
296/495
3c. Responsible Party (for LLC if
applicable):
3d. Street address:
1615 Mail Service Center (c /o NC State Property Office)
3e. City, state, zip:
Raleigh, NC. 27699
3f. Telephone no.:
(919) 707 -9363
3g. Fax no.:
(919) 715 -5161
3h. Email address:
sue.regier @ncdenr.gov (DPR Head of Land Protection)
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:
NCDENR, Division of Parks and Recreation (c /o Pilot Mountain State Park)
4c. Business name
(if applicable):
4d. Street address:
MSC 1615
4e. City, state, zip:
Raleigh, NC. 27699 -1615
4f. Telephone no.:
(919) 707 -9329
4g. Fax no.:
(919) 715 -5161
4h. Email address:
amin.davis @ncdenr.gov
5. Agent/Consultant Information (if applicable)
5a. Name:
N/A
5b. Business name
(if applicable):
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. Fax no.:
5g. Email address:
Page 2 of 11
PCN Form — Version 1.3 December 10, 2008 Version

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
5964 -00-46 -5352
1b. Site coordinates (in decimal degrees):
Latitude: 36.3660 Longitude: - 80.457
(DD DDDDDD) (- DD.DDDDDD)
1c. Property size:
3,651 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
Grassy Creek
proposed project:
2b. Water Quality Classification of nearest receiving water:
WS -IV
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:
The project area consists of an approximately 30 -foot eroded area along the left streambank of an unnamed tributary to
Grassy Creek in the southeastern portion of Pilot Mountain State Park. An eight -inch sewer pipe that runs along the left
bank has been exposed in this eroded area. The project area is primarily wooded and bordered by US Highway 52 to the
east. General land use in the vicinity of the project area consists of a mixture of recreational, rural residential, and
agricultural lands.
3b. List the total estimated acreage of all existing wetlands on the property:
78 acres (per NWI wetland mapping).
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
— 67,980' per USGS GIS mapping.
3d. Explain the purpose of the proposed project:
Stabilize the eroded streambank and exposed eight -inch sewerline.
3e. Describe the overall project in detail, including the type of equipment to be used:
The project will involve stabilization of approximately 30 feet of eroded streambank by backfilling the eroded area in
compacted lifts of 12 inches and covering with geotextile fabric. Riprap with an average diameter of 21 inches would then
be placed over the compacted fill with larger riprap placed at the toe of the streambank. Park staff anticipates using a
small walk behind skid steer to place the heavy material; smaller material will be placed by hand around the pipe.
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
[I Preliminary El Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas?
Agency /Consultant Company:
Name (if known):
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
❑ 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.
Page 4 of 11
PCN Form — Version 1.3 December 10, 2008 Version

C. Proposed Impacts Inventory
1. Impacts Summary
1a. 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
W1 ❑ P [IT
❑ Yes
❑ Corps
❑ No
❑ DWQ
W2 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W3 ❑P ❑T
❑Yes
[I 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: N/A
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
Permanent P or
()
intermittent
DWQ —non -404,
(linear
Temporary (T)
(INT)?
other)
(feet)
feet)
S1 ®P ❑ T
® PER
® Corps
4
30
❑ INT
® DWQ
S2 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S3 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S4 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S5 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S6 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
3h. Total stream and tributary impacts
30
3i. Comments: Necessary to stabilize eroded streambank and protect exposed sewer line.
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
Tem ora T
01 ❑P ❑T
02 ❑P ❑T
03 ❑P ❑T
04 ❑P ❑T
4E Total open water impacts
4g. Comments: N/A
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: N/A
5h. Is a dam high hazard permit required?
❑ Yes ®No If yes, permit ID no:
5i. Expected pond surface area (acres):
N/A
5j. Size of pond watershed (acres):
N/A
5k. Method of construction:
N/A
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: N/A
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
impact
required?'
61 ❑P ❑T
El Yes
❑ No
B2 ❑P ❑T
❑Yes
❑ No
B3 ❑P ❑T
❑Yes
❑ No
6h. Total buffer impacts
6i. 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.
The streambank stabilization is anticipated to improve the structural integrity of this eroded area. The design incorporates
geotextile fabric and adequately -sized riprap to maximize stability.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
N /A.
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
Ea. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
N/A
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
❑ 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.
6c.
6d.
6e.
Zone
Reason for impact
Total impact
Multiplier
Required mitigation
(square feet)
(square feet)
Zone 1
3 (2 for Catawba)
Zone 2
1.5
6f. Total buffer mitigation required:
69. 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).
N/A
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
1a. 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?
<1 %
2b. Does this project require a Stormwater Management Plan?
❑ Yes ® No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: Well below required threshold.
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?
N/A
❑ Phase II
3b. Which of the following locally- implemented stormwater management programs
❑ NSW
❑ USMP
apply (check all that apply):
❑ Water Supply Watershed
® Other: N/A
3c. Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
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: N/A
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 9 of 11
PCN Form — Version 1.3 December 10, 2008 Version

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the project involve an expenditure of public (federal /state /local) funds or the
® Yes ❑ No
use of public (federal /state) land?
1 b. 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,
❑ Yes ® No
or Riparian Buffer Rules (15A NCAC 213 .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 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?
5c. If yes, indicate the USFWS Field Office you have contacted.
El Raleigh
❑ Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
GIS file of rare species occurrences and significant natural heritage areas provided by the NC Natural Heritage Program.
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?
Previous personal communications with NOAA National Marine Fisheries Service staff.
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?
Consultations with the Office of State Archeology staff on 8/13/12.
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? GIS data provided by http: / /www.ncfloodmaps.com
Amin Davis/ NC DPR
I
L
8/16/12
Applicant/Agent's Printed Name
WC
Date
—bM
Applicant/Agent's Signature
(Agent's 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

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Sewer Pipe Stabilization North Carolina Division of Vicinity Map
Pilot Mountain State Park Parks and Recreation
Surry County, North Carolina
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