20211307 Ver 1_ePCN Application_20210831

DWR
Dlrlslon of Water Resources
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
June 1, 2021 Ver4.1
Initial Review
Has this project met the requirements for acceptance in to the review process?*
r Yes
r No
Is this project a public transportation project?*
r Yes r No
Change only if needed.
BIMS # Assigned
20211307
Is a payment required for this project?*
r No payment required
r Fee received
r Fee needed - send electronic notification
Select Project Reviewer*
Sue Homeowod:eadsWhomewood
'Information for Initial Review
la. Name of project:
COURTESY COPY McCloskey/240 Natalie Drive Project
1a. Who is the Primary Contact?*
Steven A. (Steve) McCloskey
1b. Primary Contact Email:*
[e-mail]
Date Submitted
8/31/2021
Nearest Body of Water
Silas Creek
Basin
Yadkin -Pee Dee
Water Classification
Silas Creek
Site Coordinates
Latitude: Longitude:
36.089880-80.350560
A. Processing Information
County (or Counties) where the project is located:
Forsyth
Is this a NCDMS Project
r Yes r No
Is this project a public transportation project?*
r Yes r No
Pre -Filing Meeting Information
Version#*
1
Reviewing Office*
Winston-Salem Regional Office - (336) 776-
9800
1c. Primary Contact Phone:*
[phone]
Is this a courtesy copy notification?*
r Yes r No

ID#
Version
Pre -fling Meeting or Request Date
7/27/2021
Attach documentation of Pre -Filing Meeting Request here:
nick the upload button or drag and drop files here to attach document
DWR Pre -Filing Meeting Request Form (003).pdf
File type mast be FCF
1a. Type(s) of approval sought from the Corps:
V Section 404 Permit (wetlands, streams and waters, Clean Water Act)
r Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
Has this PCN previously been submitted?*
r Yes
r No
1b. What type(s) of permit(s) do you wish to seek authorization?
r Nationwide Permit (NWP)
r Regional General Permit (RGP)
W Standard (IP)
1c. Has the NWP or GP number been verified by the Corps?
r Yes r No
Are you a federal applicant?*
r Yes r No
If yes, please provide a statement concerning compliance with the Coastal Zone Management Act.*
Not applicable.
Nationwide Permit (NWP) Number:
NWP Numbers (for multiple NWPS):
52.85KB
1d. Type(s) of approval sought from the DWR:
W 401 Water Quality Certification - Regular r 401 Water Quality Certification - Express
r Non-404 Jurisdictional General Permit r Riparian Buffer Authorization
r Individual 401 Water Quality Certification
le. Is this notification solelyfor the record because written approval is not required?
For the record onlyfor DWR 401 Certification: r Yes r No
For the record onlyfor Corps Permit: r Yes r No
1f. Is this an after -the -fact permit application?*
r Yes IT No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
1h. Is the project located in any of NC's twenty coastal counties?
r Yes r No
1j. Is the project located in a designated trout watershed?
r Yes r No
B. Applicant Information
1d. Who is applying for the permit?
W Owner r Applicant (other than owner)
le. Is there an Agent/Consultant for this project?*
r Yes r No
2. Owner Information
2a. Name(s) on recorded deed:
Steven A. McCloskey

2b. Deed book and page no.:
Forsyth County, Book: 2248 Page: 3313
2c. Contact Person:
WA
2d.Address
Street Address
240 Natalie Drive
Address tine 2
City
Winston-Salem
Postal / Zip Code
27104-2457
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Justin Takac
4b. Business Name:
Fidelis Contractors LLC
4c.Address
Street Address
6440 Derby Way
Address tine 2
city
Trinity
Postal / Zip Code
27370
4d. Telephone Number:
[phone]
4f. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(if appropriate)
Greenbriar Estates
1c. Nearest municipality/ town:
Winston-Salem
2• Project Identification
State / Province / legion
North Carolina
Country
USA
2f. Fax Number:
[phone]
State / Province / Region
North Carolina
Country
USA
4e. Fax Number:
2a. Property Identification Number:
2b. Property size:
ID:6805-04-9366.000
.8498
2c. Project Address
Street Address
240 Natalie Drive
Address tine 2
city
State / Province / legion
Winston-Salem
North Carolina
Fatal / Zip Code
Country
27104-2457
USA
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Silas Creek
3b. Water Resources Classification of nearest receiving water:*

Silas Creek
3c. What river basin(s) is your project located in?*
Yadkin-PeeDee
3d. Please provide the 12-digit HUC in which the project is located.
030401011303
4. Project Description and History
4a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this application:*
General land use is residential subdivision. The ebsting streambank is eroding and requires streambank stabilization to protect home.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
r Yes r No r Unknown
4b(2). Is Any Portion of the Work Already Complete?*
r Yes r No
If yes, describe the completed work.
4c. List of Other Certificates or Approvals/Denials received from other Federal, State, or Local Agencies for Work Described in This Application. not related to the 404 or 401.
None
4f. List the total estimated acreage of all existing wetlands on the property:
0
4g. List the total estimated linear feet of all existing streams on the property:
125 feet, perennial
4h. Explain the purpose of the proposed project:*
The existing streambank is eroding and requires streambank stabilization to protect home.
41. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
Dirt to stabilize the streambank: 16 quad -axle trucks at 18-19T each.
Erosion Control Matting (6 Rolls of Coir Matting)
Rip Rap: Large and medium size stone to armor bank, and new channel (if needed and approved)
Equipment:
CAT 259D3 skid steer
CAT 308CR (19,OOOIb Mini -excavator)
4k. Will this activity involve dredging in wetlands or waters?*
r Yes r No
If yes, Describe the type of dredging, the composition of the dredged material and the location of disposal area.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
r Yes r No f Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
r Preliminary r Approved r Not Verified r Unknown r N/A
Corps AID Number:
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
6. Future Project Plans
6a. Is this a phased project?*
r Yes r No
Are any other NWP(s), regional general permit(s), or individual permits(s) used, or intended to be used, to authorize any part of the proposed projector related activity?
No
7. Addresses of Adjoining Property Owners, Lessees, Etc., Whose Property Adjoins the Waterbody (if more than can be entered here, please attach a supplemental list)

Rev. and Mrs. Don Schmidt - 5149 Little Brook Lane, Winston-Salem, NC 27104
- 260 Natalie Drive, Winston-Salem, NC 27104
8. Scheduling of Activity:
Hope to start shortly after approval (hoping for end of September or early October). Project should take about a week to complete.
D. Proposed Impacts Inventory'
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
r Wetlands W Streams -tributaries ❑ Buffers
r Open Waters r Pond Construction
2h.Type(s) of Material Being Discharged and the Amount of Each Type in Cubic Yards:
No material will be discharged into stream.
3. Stream Impacts
3a. Reason for impact (?) 3b.lmpact type * 3c. Type of impact* 3d. S. name * 3e. Stream Type * 3f. Type ofwidth * 3h. Impact
(?) :1 Jurisdiction* length*
1
Bank stabilization Tem orar Bank Stabilization creek Perennial DWR ]�;;]
P Y (linearfeet)
31. Total jurisdictional ditch impact in square feet:
0
31. Total permanent stream impacts:
0
31. Total stream and ditch impacts:
75
31. Total cubic yard stream impacts:*
0
3j. Comments
4g. Total cubic yard open water impacts:*
0
E. Impact Justification and Mitigation
1. Avoidance and Minimization
3i. Total temporary stream impacts:
75
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
See plan to be submitted by Consultant Mr. Takac.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
See measures to be submitted by Consultant Mr. Takac.
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?
r Yes r No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
Project is very small in scope.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
r Yes r No
If no, explain why:
Not within NC Riparian Buffer Protection Rules.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
r Yes r No
U

2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?
r Yes r- No
Comments:
G. Supplementary Information
1. Environmental Documentation
la. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
r- Yes r No
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15A NCAC 2H .0500), Isolated Wetland Rules (15A NCAC 2H .1300), or DWR Surface Water or Wetland Standards or
Riparian Buffer Rules (15A NCAC 2B .0200)? *
r- Yes r No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality?*
r- Yes r No
3b. If you answered "no," provide a short narrative description.
Residential neighborhood is already built out and no new construction is likely to occur.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
r Yes r- Nor N/A
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?*
r- Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
r- Yes r No
5d. Is another Federal agency involved?*
r- Yes r No r Unknown
5e. Is this a DOT project located within Division's 1-8?
r- Yes r No
5f. Will you cut anytrees in order to conduct the work in waters of the U.S.?
r- Yes r No
5g. Does this project involve bridge maintenance or removal?
r- Yes r No
5h. Does this project involve the construction/installation of a wind turbine(s)?'
r- Yes r No
51. Does this project involve (1) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhammers, mechanized pile drivers, etc.?
r- Yes r No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
ESA Implementation & Regulation Revisions website.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
r- Yes r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
Essential Fish Habitat / NOAA
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?*
r Yes r No

7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
NC Department of Natural & Cultural Resources GIS
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
r Yes r No
8c. What source(s) did you use to make the floodplain determination?*
FEMA Flood Map ServiceCenter, Map # 3710680500J.
Miscellaneous
Please use the space below to attach all required documentation or any additional information you feel is helpful for application review. Documents should be combined into one
file when possible, with a Cover Letter, Table of Contents, and a Cover Sheet for each Section preferred.
dick the upload button or drag and drop files here to attach document
Overhead Tax Parcel View, 240 Natalie Drive.pdf 500.91 KB
File rrust be FDF a K,&
Comments
Thank you for your time and consideration.
Signature
*
W By checking the box and signing below, I certify that:
• The project proponent hereby certifies that all information contained herein is true, accurate, and complete to the best of my knowledge and belief; and
The project proponent hereby requests that the certifying authority review and take action on this CWA 401 certification request within the applicable reasonable period of time.
• I have given true, accurate, and complete information on this form;
• I agree that submission of this PCN form is a "transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act');
• I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature; AND
I intend to electronically sign and submit the PCN form.
Full Name:
Steven A. McCloskey
Signature
1 T7TWnf 4 41CC+ #1-1
Date
8/31 /2021

Contact Name*
Contact Email Address*
Project Owner*
Project Name*
Project County*
Owner Address:*
Is this a transportation project?*
Steven A. McCloskey
[e-mail]
Steven A. McCloskey
McCloskey/240 Natalie Drive Project
Forsyth
Street Address
240 Natalie Dr.
Address Line 2
aty
Winston-Salem
Postal / Zip axle
27104
C Yes c: No
Type(s) of approval sought from the DWR:
W 401 Water Quality Certification - F- 401 Water Quality Certification -
Regular Express
F- Individual Permit F- Modification
F- Shoreline Stabilization
Does this project have an existing project ID#?*
C Yes c: No
State / Province / Pegion
NC
Country
United States
Do you know the name of the staff member you would like to request a meeting with?
Ms. Sue Homewood
Please give a brief project description below and include location information.*
Streambank Stabilization Project to protect home.
By digitally signing below, I certify that I have read and understood that per the Federal Clean Water Act Section
401 Certification Rule the following statements:
• This form completes the requirement of the Pre -Filing Meeting Request in the Clean Water Act Section 401 Certification
Rule.
• I understand by signing this form that I cannot submit my application until 30 calendar days after this pre -filing
meeting request.
• I also understand that DWR is not required to respond or grant the meeting request.
Your project's thirty -day clock started upon receipt of this application. You will receive notification regarding meeting location
and time if a meeting is necessary. You will receive notification when the thirty -day clock has expired, and you can submit an
application.

Signature *
15;7wvw ,4 wca a.5l-xr
Submittal Date 7/28/2021