20130896 Ver 1_401 Application_20130813

11 CWS
ii�j I
Carolina Wetland Services, Inc.
550 East Westinghouse Boulevard
Charlotte, NC 28273
704 -527 -1177 - Phone
704 -527 -1133 - Fax
TO: Ms. Karen Higgins
NCDWQ — Wetlands and Storm Water Branch
512 N Salisbury St
9th Floor Archdale Building
Raleigh NC 27603
20130896
Date: 08 -22 -13
CWS Project #: 2013 -3149
ell D)
LETTER OF TRANSMITTAL
WE ARE SENDING YOU: ®Attached ❑Under separate cover via the following items:
❑ Prints ® Plans ® JD Package ❑ Specifications
❑ Copy of letter ❑ Change order ❑ Wetland Survey ® Other
iF FNC'inquRFR ARF NOT AR N(YTRn KiNni.Y N(Yf7FY ii.R AT nKrIP.
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8/22/13
5
Application for Water Quality Certification 3883
2
8/22/13
1
Application Fee Check ($240)
THESE ARE TRANSMITTED as checked below:
®For approval ❑Approved as submitted ❑Resubmit copies for approval
®For your use ❑Approved as noted ❑Submit copies for distribution
❑As requested ❑Returned for corrections ❑Return corrected prints
❑For review and comment ❑For your verification and signature
REMARKS: Karen, Please find attached five copies of the Preconstruction Notification and application for
Water Quality Certification 3883 for the Town of Fairview Pond project in Monroe, NC. A check for the application fee is
also attached.
Copy to: File
Thank you,
omas Blackwell, PWS
Senior Scientist
NORTH CAROLINA - SOUTH CAROLINA

: Corps Submittal Cover Sheet 2 0 1 3 0 8 9 6
Please provide the following info:
1. Project Name Town of Fairview Pond
2. Name of Property Owner /Applicant: Town of Fairview; POC. Mr. Ed Humphries
3. Name of Consultant/Agent: Carolina Wetland Services, Inc. POC Mr. Tom Blackwell
*Agent authorization needs to be attached.
4. Related/Previous Action ID number(s): N/A
5. Site Address:
6. Subdivision Name:
7. City:
.
8. County: Union
9. Lat: N35.1352730 Long: W80.5349460 (Decimal Degrees Please
10. Quadrangle Name: Midland, NC, dated 1996
11. Waterway: UT to Goose Creek
12. Watershed: Yadkin (HU# 03040105)
13. Requested Action:
X Nationwide Permit # 3
General Permit #
20-13 Jurisdictional Determination Request AUG 2 6 ZO
Pre - Application Request vy &gun u _ r�r
The following information will be completed by Corps office:
AID:
Prepare File Folder Assign number in ORM Begin Date
Authorization: Section 10 Section 404
Project Description/ Nature of Activity/ Project Purpose:
Site/Waters Name:
Keywords:
a

J;)CWS1
August 12, 2013
Mr. Steve Kichefski
U.S. Army Corps of Engineers
151 Patton Avenue, Room 208
Asheville, NC 28801
550 E WESTINGHOUSE BLVD.
CHARLOTTE, NC 28273
866 - 527 -1177 (office)
704 -527 -1133 (fax)
Ms. Karen Higgins
NCDWQ — Wetlands and Storm Water Branch
512 N Salisbury St
9th Floor Archdale Building
Raleigh NC 27603
Subject Pre -Con action Notification Pursuant to Nationwide Permit No. 3
Town of Fairview Pond -Project
Union County, North Carolina
Carolina Wetland Services Project No. 2013.3149
The Town of Fairview Pond site is approximately 17 acres in extent. The site is located just southeast of the
intersection of Highway 218 and Concord Highway in the Town of Fairview, North Carolina (Figure 1. USGS Siter
Location Map). The purpose of this project is to repair an existing pond within the project limits that is in disrepair
and is in need of maintenance. The Town of Fairview has sub - contracted Carolina Wetland Services, Inc. (CWS)
to provide Section 404/401 permitting services for this project.
Applicant Name: Town of Fairview POC: Mr. Ed Humphries
Mailing Address: 7400 Concord Highway, Monroe, NC 28110
Phone Number of Owner /Applicant: (704) 564 -3412
Street Address of Project: 7402 Concord Highway, Monroe, NC 28110
Waterway: UT to Goose Creek
Basin: Yadkin (HU# 03040105)
City: Town of Fairview
County: Union
Tax Parcel ID number: portion of 08189031 C
Decimal Degree Coordinate Location of Project Site: N35.1352730, W80.5349460
USGS Quadrangle Name: Midland Quadrangle, North Carolina, dated 1996
Current Land Use
The project site consists of active agricultural field with wooded margins. There is a pond located in the northern
portion of the site. Typical on -site vegetation includes winged elm (Ulmus alata), sweetgum (Liquidambar
styracillua), green ash (Fraxinus pennsylvanica), willow oak (Quercus phellos , common greenbriar (Smilax
rotundifolia), poison ivy (Toxicodendron radicans , Virginia creeper (Parthenocissus quinquefolia) and smallspike
false nettle (Boehmeria cylindrica).
NORTH CAROLINA • SOUTH CAROLINA
WWW.CWS4NC.NET

Town of Fairview Pond August 12, 2013
Nationwide Permit No. 3 CWS project No. 2013 -3149
According to the Soil Survey of Union County' (Figure 2. NRCS Soil Survey Map, attached), on -site soils
consist of Badin channery silt loam, 2 to 8 percent slopes (BaB), Badin channery silty clay loam, 2 to 8 percent
slopes, eroded (BdB2), Cid channery sift loam,1 to 5 percent slopes (CmB), Goldston very channery sift loam, 4
to 15 percent slopes (GoC), Goldston -Badin complex, 2 to 8 percent slopes (GsB), Goldston -Badin complex, 8 to
15 percent slopes (GsC), and Tatum gravelly silty clay loam, 2 to 8 percent slopes, eroded (TbB2).
Badin channery sift loam and Badin channery silty clay loam are well-drained and exhibit moderate permeability.
Cid channery sift loam is moderately well -drained to poorly drained and exhibits slow permeability. Goldston very
channery sift loam and Goldston -Badin complex are well- drained to excessively drained and exhibit moderately
rapid permeability. Tatum gravelly silty clay loam is well- drained and exhibits moderate permeability. None of the
on -site soil units are listed in the North Carolina Hydric Soils List for Union County2 or the National Hydric Soils
LIst3.
Jurisdictional Delineation
On October 11, 2013, CWS scientists Thomas Blackwell, PWS and Kelly Thames delineated jurisdictional waters
of the U.S. Within the project area. Mr. Steve Kichefski with the U.S. Army Corps of Engineers (USACE) and Mr.
Michael Burkhard with the North Carolina Division of Water Quality (NCDWQ) field- verified jurisdictional areas
during an on -site field meeting on December 11, 2012. Jurisdictional areas were delineated using the (USACE)
Routine On -Sfte Determination Method. This method is defined in the 1987 Corps of Engineers Wetlands
Delineation Manual°, the 2007 USACE Jurisdictional Determination Form Instructional Guidebooks, with further
technical guidance from the Eastern Mountains & Piedmont Regional Supplements, dated April 2012.
The results of the on -site field investigation conducted by CWS indicate that there is one jurisdictional wetland area
(Wetland AA) located within the project area (Figure 3, attached). There is also one jurisdictional open wafter area (Pond
A) with an adjacent jurisdictional Welland area (Wetland BB) located on -site. On -Site waters include unnamed tributaries
to Goose Creek. Goose Creek is part of the Yadkin River basin (HU# 03040105)7 and is rated "Class C Waters" by the
NCDWQ. On -Site jurisdictional waters of the U.S. total approximately 0.856 acres. On -Site jurisdictional waters of the
U.S. are summarized in Table 1 below.
Table 1. Summary of On -Site Waters
Jurisdictional
Feature
USACE/EPA Rapanos Classification
Approx. Acreage (ac.)
Wetland AA
Adjacent to Seasonal RPW
0.003 ac.
Wetland BB
Directly Abutting Pond A
0.327 ac.
Jurisdictional Wetland Total:
0.33 ac.
Jurisdictional
Feature
USACEIEPA Rapanos Classification
Approx. Acreage (ac.)
Pond A
Jurisdictional Pond
0.526 ac.
Jurisdictional Open Waters Total:
0.526 ac.
United States Department of Agriculture (USDA) Natural Resources Conservation Service, 1995. Soil Survey of Union County, North Carolina.
2 United States Department of Agriculture — Natural Resources Conservation Service, 1999. North Carolina Hydria Soils List, USDA -MRCS North Carolina
State Office, Raleigh
3 United States Department of Agriculture — Natural Resources Conservation Service, 2010. 2010 National Hydric Soils List by State
4 Environmental Laboratory. 1987. 'Corps of Engineers Wetlands Delineation Manuar, Technical Report Y -87 -1, US Army Engineer Waterways Experiment
Station, Vicksburg, Mississippi.
5 USACE Jurisdictional Determination Form Instructional Guidebook. 2007. USACE Regulatory National Standard Operating Procedures for conducting an
approved jurisdictional determination (JD) and documenting practices to support an approved JD. USACE Headquarters, Washington, DC.
5 US Army Corps of Engineers, July 2010. Interim Regional Supplement to the Corps of Engineers Wetland Delineation Manual: Eastern Mountains and
Piedmont Region. US Army Engineer Research and Development Center, Vicksburg, Mississippi.
'HU#' is the Hydrologic Unit Code. U.S. Geological Survey, 1974. Hydrologic Unit Map, State of North Carolina.
2

Town of Fairview Pond August 12, 2013
Nationwide Permit No. 3 CWS project No. 2013 -3149
- Agency Correspondence
Cultural Resources
A letter was forwarded to the State Historic Preservation Office (SHPO) on July 29, 2013, to determine the
presence of any areas of architectural, historic, or archaeological significance that would be affected by the
project. As of the date of this submittal, a response from SHPO has not yet been received.
Protected Species
A letter was forwarded to the North Carolina Natural Heritage Program ( NCNHP) on July 29, 2013 to determine
the presence of any federally- listed, candidate endangered, threatened species or critical habitat located within the
project area. In a response dated August 1, 2013 NCNHP stated that "....there may be impacts to an unnamed
tributary of Goose Creek with drains to designated Critical Habitat for the federally endangered Carolina
heelsplitter, (Lasmigona decorata)" (Agency Correspondence, attached). CWS has field- reviewed the site and
there was no habitat identified to support the Carolina heelsplitter; in addition there is a break in surface water
connection to any waters draining to Goose Creek.
Purpose and Need for the Project
The Town of Fairview has purchased this property for use as a community park. As part of this project, the Town
of Fairview proposes to restore the existing on -site pond for use as a stocked fishing pond. In addition, the town
proposes to restore the historic spring head located close to the northwestern property boundary.
The maintenance work on the pond is necessary as the pond dam is badly overgrown and the pond has become
badly silted. Water levels in the pond have receded significantly and it is suspected that tree growth on the dam is
causing the dam to seep. In addition, the banks of the pond have become overgrown with vegetation which limits
access to the water. The town proposes to clear the bankside vegetation and to dredge the pond to increase its
depth. A fountain will be installed to improve the oxygenation of the water. The pond will be temporarily drained
to perform the maintenance work. Once dredging has been completed the pond will be returned to its normal pool
elevation.
There is a historic spring head located on the property. The historic alignment of Concord Highway passed
through the project site and this spring head was an important water source alongside the highway. The spring
has become silted in over time but the historic stonework protecting the spring is still evident. The Town of
Fairview proposes to dredge the spring to restore the flow of water and make a feature of the spring highlighting
the historic importance of the site.
Avoidance and Minimization
Impacts to on -site jurisdictional waters of the U.S. have been reduced to the maximum extent practicable. The Town
of Fairview Park Pond Project has been designed to avoid impacts to jurisdictional waters wherever possible and
minimize the extent of necessary impacts to jurisdictional waters. Proper sediment and erosion control measures will
be used to minimize disturbances to downstream waters. All work will be done in accordance with Water Quality
Certification No. 3883.
In areas where impacts to Jurisdictional Waters of the State are unavoidable, steps have been taken to minimize
both the extent and severity of the impacts.

Town of Fairview Pond August 12, 2013
Nationwide Permit No. 3 CWS proiect No. 2013 -3149
Proposed Impacts to Jurisdictional Waters
Unavoidable impacts associated with the construction of the Town of Fairview Pond Project include the removal of
sediments from 0.001 acre of Wetland AA and the flooding of 0.327 acre of Wetland BB.
Wetland Impacts
Unavoidable impacts to jurisdictional wetlands total approximately 0.328 acre. Impacts to Wetland BB total 0.327
acre and are the result of clearing of forested wetland vegetation around Pond A and the flooding of these areas
when the pond is returned to its normal pool condition (Figure 4, attached). Wetland BB has formed on the
periphery of the pond as a result of receding water levels due to the failing dam. Once the dam is repaired the
water levels will be returned to their normal level. Impacts to Wetland AA total 0.001 acre and are the result of the
removal of sediment from the historic spring head at the upstream end of Wetland AA. Wetland impacts are
summarized in Table 2.
Table 2. Proposed Impacts to Jurisdictional Waters
Jurisdictional
Feature
Jurisdiction
Impact Type
NWP
No.
Temporary Impact
Area (acres)
Permanent
Impacts
Area (acres)
USACEIEPA Rapanos
Classification
Wetland AA
Adjacent to Seasonal RPW
Dredging
3
0
0.001
Wetland BB
Directly Abutting Pond A
Flooding
3
0
0.327
Total Wetland Impacts
0 acre
0.328 acre
On behalf of the Town of Fairview, CWS is submitting a Pre- Construction Notification Application with attachments
in accordance with Nationwide Permit General Condition No. 31 and pursuant to Nationwide Permit (NWP) No. 3,
(enclosed).
Compensatory Mitigation
The majority of wetland impacts (0.387 acre) are limited to the flooding of wetlands that formed on the margins of
the on -site pond as a result of lowered water levels caused by the leaking dam. Therefore, no mitigation is
proposed for these impacts.
4

Town of Fairview Pond August 12, 2013
Nationwide Permit No. 3 CWS project No. 2013 -3149
Please do not hesitate to contact Tom Blackwell at 704 - 527 -1177 or tom @cws- inc.net should you have any
questions or comments regarding this permit submittal.
Sincerely,
/:I
c'" &U
Thomas J. Blackwell, PWS
Senior Scientist
Kell hames
Staff Scientist II
Enclosures: Figure 1. USGS 7.5- Minute Midland, North Carolina Topographic Quadrangle
Figure 2. USDA -NRCS Union County Soil Survey
Figure 3. Approximate Jurisdictional Boundary Field Map
Figure 4. Proposed Impacts
Agent Authorization Form
Pre - Construction Notification Pursuant to Nationwide Permit No. 3
Agency Correspondence
cc: Mr. Ed Humphries, Town of Fairview

i
Legend
Project Limits
i
Fairvie
Fairview Road i
Sch__
BaB - Badin channery silt loam, 2 to 8 percent slopes
BdB2 - Badin channery silty clay loam, 2 to 8 percent slopes, eroded
CmB - Cid channery silt loam, 1 to 5 percent slopes
GoC - Goldston very channery silt loam, 4 to 15 percent slopes
GsB - Goldston -Badin complex, 2 to 8 percent slopes
GsC - Goldston -Badin complex, 8 to 15 percent slopes
TbB2 - Tatum gravelly silty clay loam, 2 to 8 percent slopes, eroded
W - Open Water
FIGURE NO. USGS Site Location Map
2 Town of Fairview Pond Project
Fairview, North Carolina
CWS Project No. 2013 -3149
[L)) MS
WWW.CWS -/NC.N
'.1/ 'r
BdB2
11
500 250 0
E 1" : 500'
PROJECT NO.
2013 -3149
ICANT NO
500 Feet
7 -29 -13
BY TJ B
_o BY GCA

AGENT CERTIFICATION OF AUTHORIZATION
I, Mr. Ed Humphries, representing The Town of Fairview, hereby certify that I have
authorized Thomas Blackwell of Carolina Wetland Services, Inc. to act on my behalf and
take all actions necessary to the processing, issuance, and acceptance of this request for
wetlands determination / permitting and any and all standard and special conditions
attached.
We hereby certify that the above information submitted in this application is true and
accurate to the best of our knowledge.
Ar&ftX
Date
Agent's signature
8/12/13
Date
Completion of this form will allow the agent to sign all future application correspondence.

ot WATF9
O `C
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 ❑Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: 3 or General Permit (GP) number:
1c. 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
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
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.
❑ 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:
Town of Fairview Pond
2b. County:
Union
2c. Nearest municipality / town:
Town of Fairview
2d. Subdivision name:
N/A
2e. NCDOT only, T.I.P. or state
project no:
N/A
3. Owner Information
3a. Name(s) on Recorded Deed:
Harry and Sandry Haigler
3b. Deed Book and Page No.
5724 -265
3c. Responsible Party (for LLC if
applicable):
Mr. Ed Humphries, Town of Fairview
3d. Street address:
7400 Concord Highway
3e. City, state, zip:
Monroe, NC 28110
3f. Telephone no.:
704 - 564 -3412
3g. Fax no.:
3h. Email address:
Page 1 of 13
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):
Town of Fariview
4d. Street address:
7400 Concord Highway
4e. City, state, zip:
Monroe, NC 28110
M. Telephone no.:
704 - 564 -3412
4g. Fax no.:
4h. Email address:
5. Agent/Consultant Information (if applicable)
5a. Name:
Tom Blackwell, PWS
5b. Business name
(if applicable):
Carolina Wetland Services, Inc.
5c. Street address:
550 E. Westinghouse Blvd.
5d. City, state, zip:
Charlotte, NC 28273
5e. Telephone no.:
704 - 527 -1177
5f. Fax no.:
704 - 527 -1133
5g. Email address:
tom @cws - inc.net
Page 2 of 13
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):
portion of 08189031C
1 b. Site coordinates (in decimal degrees):
Latitude: 35.1352730 Longitude: -
80.534946°
(DD.DDDDDD) (- DD.DDDDDD)
1c. Property size:
17 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
proposed project:
Goose Creek
2b. Water Quality Classification of nearest receiving water:
Class C
2c. River basin:
Yadkin (HU# 03040105)
Page 3 of 13
PCN Form — Version 1.3 December 10, 2008 Version

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 site consists of active agricultural field with wooded margins. There is a pond located in the northern portion
of the site. Typical on -site vegetation includes winged elm (Ulmus alata), sweetgum (Liquidambar styraciflus), green ash
(Fraxinus pennsylvanica), willow oak (Quercus phellos), common greenbriar (Smilax rotundifolia), poison ivy
(Toxicodendron radicans), Virginia creeper (Parthenocissus quinquefolia) and smallspike false nettle (Boehmeria
cylindrica).
3b. List the total estimated acreage of all existing wetlands on the property:
0.33 acres
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
0
3d. Explain the purpose of the proposed project:
The Town of Fairview has purchased this property for use as a community park. As part of this project the Town of Fairview
proposes to restore the existing on -site pond for use as a stocked fishing pond. In addition, the town proposes to restore
the historic spring head located close to the northwestern property boundary.
The maintenance work on the pond is necessary because the pond dam is badly overgrown and the pond has become badly
silted. Water levels in the pond have receded significantly and it is suspected that tree growth on the dam is causing the
dam to seep. In addition the banks of the pond have become overgrown with vegetation which limits access to the water.
The town proposes to clear the bankside vegetation and to dredge the pond to increase its depth. A fountain will be
installed to improve the oxygenation of the water. The pond will be temporarily drained to perform the maintenance work.
Once dredging has been completed the pond will be returned to its normal pool elevation.
There is an historic spring head located on the property. The historic alignment of Concord Highway passed through the
project site and this spring head was an important water source along site the highway. The spring has become silted in
over time but the historic stonework protecting the spring is still evident. The Town of Fairview proposes to dredge the
spring to restore the flow of water and make a feature of the spring highlighting the historic importance of the site.
3e. Describe the overall project in detail, including the type of equipment to be used:
. Water levels in the pond have receded significantly and it is suspected that tree growth on the dam is causing the dam
to seep. In addition the banks of the pond have become overgrown with vegetation which limits access to the water. The
town proposes to clear the bankside vegetation and to dredge the pond to increase its depth. A fountain will be installed
to improve the oxygenation of the water. The pond will be temporarily drained to perform the maintenance work. Once
dredging has been completed the pond will be returned to its normal pool elevation.
There is an historic spring head located on the property. The historic alignment of Concord Highway passed through the
project site and this spring head was an important water source along site the highway. The spring has become silted in
over time but the historic stonework protecting the spring is still evident. The Town of Fairview proposes to dredge the
spring to restore the flow of water and make a feature of the spring highlighting the historic importance of the
site. Unavoidable impacts to jurisdictional wetlands total approximately 0.328 acre. Impacts to Wetland BB total 0.327
acre and are the result of clearing of forested wetland vegetation around Pond A and the flooding of these areas when
the pond is returned to its normal pool condition (Figure 4, attached). Wetland BB has formed on the periphery of the
pond as a result of receding water levels due to the failing dam. Once the dam is repaired the water levels will be
returned to their normal level. Impacts to Wetland AA total 0.001 acre and are the result of the removal of sediment from
the historic spring head at the upstream end of Wetland AA. .
A track hoe and other typical construction equipment will be used to construct this project
Page 4 of 13
PCN Form — Version 1.3 December 10, 2008 Version

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: Carolina Wetland Services
Name (if known): Thomas Blackwell, PWS and Kelly Thames
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Mr. Steve Kichefski with the U.S. Army Corps of Engineers (USACE) and Mr. Michael Burkhard with the North Carolina
Division of Water Quality (NCDWQ) verbally verified jurisdictional areas during an on -site field meeting on December 11,
2012.
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.
6. Future Project Plans
6a. Is this a phased project?
® Yes ❑ No
6b. If yes, explain.
There will likely be future phases of this park. However, there will be no impacts to jurisdictional waters associated with
these phases.
Page 5 of 13
PCN Form — Version 1.3 December 10, 2008 Version

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. 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 ❑ T
flooding
Wetland BB-
Forested
® Yes
E] No
® Corps
C] DWQ
0.327
W2 ®P ❑ T
Dredging
Wetland AA
® Yes
❑ No
® Corps
❑ DWQ
0.001
W3 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W4 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W5 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
I ❑ DWQ
W6 ❑ P ❑ T
❑ Yes
El Corps
❑ No
❑ DWQ
2g. Total wetland impacts
0.327
2h. Comments: Permanent Wetland Impacts total 0.328 acres
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 [IT
❑ PER
❑ Corps
❑ INT
❑ DWQ
S2 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S3 ❑ P [IT
❑ 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
3i. Comments:
Page 6 of 13
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
03 ❑P
04 ❑P
4E 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
5E Total
5g. Comments:
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no:
5i. 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 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?
B1 ❑P
❑Yes
❑ No
B2 ❑P
El Yes
❑ No
B3 ❑ P ❑ T
❑ Yes
❑ No
6h. Total buffer impacts
6i. Comments:
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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.
Impacts to on -site jurisdictional waters of the U.S. have been reduced to the maximum extent practicable. The Town of
Fairview Park Pond Project has been designed to avoid impacts to jurisdictional waters wherever possible and minimize the
extent of necessary impacts to jurisdictional waters. Proper sediment and erosion control measures will be used to minimize
disturbances to downstream waters. All work will be done in accordance with Water Quality Certification No. 3883.
In areas where impacts to Jurisdictional Waters of the State are unavoidable, steps have been taken to minimize both the
extent and severity of the impacts.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Impacts to on -site jurisdictional waters of the U.S. have been reduced to the maximum extent practicable. Proper sediment
and erosion control measures will be used to minimize disturbances to downstream waters. All work will be constructed in the
dry in accordance with Water Quality Certification No. 3883
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
El 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 In4leu 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.
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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:
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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?
0%
2b. Does this project require a Stormwater Management Plan?
❑ Yes ® No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: There is no change in impervious surface
associated with this project.
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
I
❑ 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?
Union 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
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
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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?
1b. 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
❑ 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)?
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.
This is a maintenance project and will not result in additional future development.
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.
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PCN Form — Version 1.3 December 10, 2008 Version

S. 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?
❑ 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?
A letter was forwarded to the North Carolina Natural Heritage Program ( NCNHP) on July 29, 2013 to determine the
presence of any federally- listed, candidate endangered, threatened species or critical habitat located within the project
area. In a response dated August 1, 2013 NCNHP stated that "....there may be impacts to an unnamed tributary of
Goose Creek with drains to designated Critical Habitat for the federally endangered Carolina heelsplitter, (Lasmigona
decorata)" (Agency Correspondence, attached). CWS has field- reviewed the site and there was no habitat identified to
support the Carolina heelsplitter; in addition there is a break in surface water connection to any waters draining to Goose
Creek.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat?
F[] Yes ® No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
NOAA Fisheries: http: / /sharpfin. nmfs .noaa.govtwebsite /EFH_Mapper /map.aspx
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?
A letter was forwarded to the State Historic Preservation Office (SHPO) on July 29, 2013, to determine the presence of
any areas of architectural, historic, or archaeological significance that would be affected by the project. As of the date of
this submittal, a response from SHPO has not yet been received.
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?
Mr. Tom Blackwell, PWS
8 -12 -13
Applicant/Agent's Printed Name
Applicant/Agent's Signature
Date
(Agent's signature is valid only if an authorization letter from the applicant
is provided.)
Page 12 of 13
PCN Form — Version 1.3 December 10, 2008 Version

Page 13 of 13
PCN Form — Version 1.3 December 10, 2008 Version

�T
NCDMR
North Carolina Department of Environment and Natural Resources
Office of Conservation, Planning, and Community Affairs
Pat McCrory Linda Pearsall John E. Skvada, III
Governor Director Secretary
August 1, 2013
Carolina Wetland Services
Atten: Kelly Thames and Thomas Blackwell
550 E. Westinghouse Blvd.
Charlotte, NC 28273
Subject: CWS Project No. 2013 -3149
Proposed Town of Fairview Park Project, Fairview, NC, Union County.
To whom it may concern:
The Natural Heritage Program has no record of rare species, Critical Habitat, Significant Natural Heritage
Areas, or high quality natural communities within the proposed project area. From maps provided and
comments provided in your letter of request, there may be impacts to an unnamed tributary of Goose
Creek which drains to designated Critical Habitat for the Federal Endangered Carolina Heelsplitter,
Lasmigona decorata. Goose Creek Aquatic Habitat is recognized by the Natural Heritage Program as a
Significant Natural Heritage Area. Within a two -mile radius of the project boundary, we have records of
both federal and state listed species and high quality natural communities; a table of these features is
provided in Table 1, attached.
The use of Natural Heritage Program data should not be substituted for actual field surveys,
particularly if the project area contains suitable habitat for rare species, important natural
communities, or priority natural areas.
Please do not hesitate to contact me if you have questions or need further information: 919 - 707 -8687 or
judith.ratcliffena,ncdenr. ov
Judith Ratcliffe
Freshwater Ecologist, Eastern Region
NC Natural Heritage Program

Table 1. Rare Species and High Quality Natural Communities Documented Within 2 Mile Radius of the Proposed Town of Fairview Park, Union
County, NC.
Scientific Name
Common Name
State Status
Federal Status
TAXO GROUP
Carolina
Freshwater
Lasmi ona decorata
Heels litter
Endangered
En dan eyed
Bivalve
Freshwater
Stro hitus undulatus
Creeper
Threatened
Bivalve
Federal
Species of
Freshwater
Villosa vau haniana
Carolina Creekshell
Endangered
Concern
Bivalve
Special
Freshwater
Villosa constricta
Notched Rainbow
Concern
Bivalve
Significantly
Freshwater
Villosa delumbis
Eastern Creekshell
Rare
Bivalve
Federal
Special
Species of
Etheostoma collis
Carolina Darter
Concern
Concern
Freshwater Fish
Significantly
Mastico his a ellum
Coachwhip
Rare
Reptile
Federal
Significantly
Species of
Eurybia mirabilis
Piedmont Aster
Rare
Concern
Vascular Plant
Gillenia sti ulata
Indian Physic
Threatened
Vascular Plant
Federal
Significantly
Species of
Isoetes vir inica
Virginia Quillwort
Rare
Concern
Vascular Plant
Natural
Piedmont Alluvial Forest
Community
Natural
Mesic Mixed Hardwood Forest Piedmont Subtype)
Community
Natural
Piedmont Bottomland Forest (Typic Low Subtype)
Community