20140041 Ver 3_401 Application_20211207

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Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
June 1, 2021 Ver 4.1
Initial Review
Has this project met the requirements for acceptance in to the review process?*
Yes
No
Is this project a public transportation project?*
Yes No
Change only if needed.
BIMS # Assigned*
20140041
Is a payment required for this project?
No payment required
Fee received
Fee needed - send electronic notification
Select Project Reviewer*
Erin Davis:eads\ebdavis
Information for Initial Review
1a. Name of project:
Little Pine Creek III Repair
1a. Who is the Primary Contact?*
Lin Xu
1 b. Primary Contact Email:
[e-mail]
Date Submitted
12/7/2021
Nearest Body of Water
Little Pine Creek
Basin
New
Water Classification
C
Site Coordinates
Latitude: Longitude:
36.507430-81.004964
Pre -Filing Meeting Information
Is this a courtesy copy notification?
Yes No
A. Processina Information
County (or Counties) where the project is located:
Allegheny
Is this a NCDMS Project
Yes No
Version# *
3
Reviewing Office*
Central Office - [phone]
1c. Primary Contact Phone:*
[phone]

Is this project a public transportation project?*
Yes No
1a. Type(s) of approval sought from the Corps:
Section 404 Permit (wetlands, streams and waters, Clean Water Act)
Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
Has this PCN previously been submitted?*
Yes
No
1 b. What type(s) of permit(s) do you wish to seek authorization?
Nationwide Permit (NWP)
Regional General Permit (RGP)
Standard (IP)
1c. Has the NWP or GP number been verified by the Corps?
Yes No
If yes, please provide a statement concerning compliance with the Coastal Zone Management Act.
NA
Nationwide Permit (NWP) Number: 03 - Maintenance
NWP Numbers (for multiple NWPS):
1d. Type(s) of approval sought from the DWR:
401 Water Quality Certification - Regular
Non-404 Jurisdictional General Permit
Individual 401 Water Quality Certification
le. Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification:
For the record only for Corps Permit:
1f. Is this an after -the -fact permit application?"
Yes No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
Yes No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
Yes No
1 h. Is the project located in any of NC's twenty coastal counties?
Yes No
1j. Is the project located in a designated trout watershed?
Yes No
B. Applicant Information
1d. Who is applying for the permit?
Owner Applicant (other than owner)
le. Is there an Agent/Consultant for this project?"
Yes No
2. Owner Information
2a. Name(s) on recorded deed:
Jeffery C Anders
2b. Deed book and page no.:
DB:342 PG:1146
2c. Contact Person:
401 Water Quality Certification - Express
Riparian Buffer Authorization
Yes No
Yes No

2d.Address
Street Address
619 Pine Brook Road
Address Line 2
City
Ennice
Postal / Zip Code
28623
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
3a. Name:
Lin Xu
3b. Business Name:
3c. Address
Street Address
217 W Jones St
Address Line 2
City
Raleigh
Postal / Zip Code
27603
3d. Telephone Number:
[phone]
3f. Email Address:
[e-mail]
C. Project Information and Prior Project History
State / Province / Region
NC
Country
Alleghany
2f. Fax Number:
State / Province / Region
NC
Country
Wake
3e. Fax Number
1. Project Information
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality / town:
Sparta
2. Project Identification
2a. Property Identification Number: 2b. Property size:
2c. Project Address
Street Address
Address Line 2
City State / Province / Region
Postal / Zip Code Country
3. Surface Waters
3a. Name of the nearest body of water to proposed project:
Little Pine Creek
3b. Water Resources Classification of nearest receiving water:*
C
3c. What river basin(s) is your project located in?*
New
3d. Please provide the 12-digit HUC in which the project is located.
050500010300
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:*
The Little Pine Creek III watershed is located in the rural countryside approximately 8 miles east of the Town of Sparta. Land use within the Little Pine Creek III watershed is rural and
dominated by agriculture and forest, and is approximately 58 % managed herbaceous cover, 39 % forested, and 3 % cultivated land.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?
Yes No Unknown
If yes, please give the DWR Certification number or the Corps Action ID (exp. SAW-0000-00000).
DWR#14-0041, SAW-2012-01299
4f. List the total estimated acreage of all existing wetlands on the property:
2.3
4g. List the total estimated linear feet of all existing streams on the property:
14736
4h. Explain the purpose of the proposed project:
The repair project will address instability and failing structures related to the stream and wetland restoration project. Total seven repair areas are identified. Please see details on the
construction plan.
41. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:
The Little Pine Creek III repair project involves the stabilization of various areas along Little Pine Creek, UT1, UT2, UT2a, and UT2b along with existing stream crossing upgrades. Stream
repairs will include bank stabilization utilizing toe wood with geolifts, bank grading, repairing existing instream structures, and adding additional instream structures to provide grade control.
All disturbed areas will be stabilized by installing coir fiber matting, temporary and permanent seed and mulch, live stakes, and bare root vegetation.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
Yes No Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
Preliminary Approved Not Verified Unknown N/A
Corps AID Number:
SAW-2012-01299
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?*
Yes 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 project or related activity?
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
Wetlands Streams -tributaries Buffers
Open Waters Pond Construction
3. Stream Impacts
u
3a. Reason for impact (?)
3b.lmpact type*
3c. Type of impact*
3d. S. name*
Stream Type*
3f. Type of
3g. S. width*
3h. Impact
11
��30.
?)
Jurisdiction*
length*
S1
Repair
Tem ora
P rY
Bank Stabilization
Little Pine Creek
Perennial
Both
28
340
�
Average (feet)
(linear feet)
fl
pair air
Permanent
Stabilization
UT1
Intermittent
Both
2
200
Average (feet)
(linear feet)
S3
Repair
Permanent
Stabilization
UT2 Reach 1 Upper
Perennial
Both
70
Average (feet)
(linear feet)
S4
Repair
Permanent
Culvert
UT2 Reach 1 Middle
Perennial
Both
150
Average (feet)
(linear feet)

SS
Repair
Permanent
Culvert
UT2Reach1Lower
Perennial
Both
Average (feet)
(linear feet)
S6
Repair
Permanent
Stabilization
UT2 Reach 2
Perennial
Both
6
30
Average (feet)
(linear feet)
S7
Repair
Temporary
Stabilization
UT2A
Perennial
Both
50
Average (feet)
(linear feet)
S8
Repair
Permanent
Stabilization
UT213
Intermittent
Both
�20
Average (feet)
(linear feet)
31. Total jurisdictional ditch impact in square feet:
0
31. Total permanent stream impacts: 3i. Total temporary stream impacts:
670 390
31. Total stream and ditch impacts:
1060
3j. Comments:
E. Impact Justification and Mitigation
1. Avoidance and Minimization
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
Limit grading activities within the limit of disturbance area
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Follow the proposed sedimentation and erosion control measures, seeding, mulch and plant
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 this project DOES NOT require Compensatory Mitigation, explain why:
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
la. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
Yes No
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250? *
Yes No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?
Yes No
2c. Does this project have a stormwater management plan (SMP) reviewed and approved under a state stormwater program or state -approved local government stormwater program?
Yes No
N/A - project disturbs < 1 acre
2d. Which of the following stormwater management program(s) apply:
Local Government State
State Stormwater Programs
Phase II Coastal Counties
HWQ or ORW Other Sedimentation and erosion control permit
Comments
G. Supplementary Information
1. Environmental Documentation
v

1a. Does the project involve an expenditure of public (federallstatellocal) funds or the use of public (federal/state) land?*
Yes No
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 (North Carolina)
Environmental Policy Act (NEPA/SEPA)?*
Yes No
Comments: *
CE documents were completed and approved.
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)? *
Yes No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality?
Yes No
3b. If you answered "no," provide a short narrative description.
This is a repair project for an existing stream restoration project.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
Yes No 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?*
Yes No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
Yes No
5d. Is another Federal agency involved?*
Yes No Unknown
Se. Is this a DOT project located within Division's 1-8?
Yes No
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?
Yes No
5g. Does this project involve bridge maintenance or removal?
Yes No
5h. Does this project involve the construction/installation of a wind turbine(s)?*
Yes 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.?
Yes No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
CE documents
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?
Yes No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?
US Fishing and Wildlife
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?*
Yes No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
SHPO
8. Flood Zone Designation (Corps Requirement)

8a. Will this project occur in a FEMA-designated 100-year floodplain?*
Yes No
8c. What source(s) did you use to make the floodplain determination?*
Flood map
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.
Click the upload button or dreg and drop files here to attach document
LPIIIRepair_2022_lmpact Summary Estimate.pdf 92.57KB
LPC_Sealed_Signed.pdf 86.37MB
LittlePinel I IRepair401 FeeMemo.pdf 220.79KB
File must be PDF or KMZ
Comments
Signature
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:
Lin Xu
Signature
Full Name (DMS Signature)
Lin Xu
DSM Signature
l!G
Date
12/7/2021

Little Pine Creek Repairs -
2022
Reach
Impact length
(LF)
Channel width
(approx. LF)
Perinnial or
Intermittent
Little Pine Creek
340
28
P
UT1
200
2
1
UT2 Reach 1 Upper
70
2
P
UT2 Reach 1 Middle
150
3
P
UT2 Reach 1 Lower
200
5
P
UT2 Reach 2
30
6
P
UT2A
50
3
P
UT213
1 20
1 3
1 1
sum 1060

Main type(s) of work
Sloping/matting; structural repairs;
toe wood w/ geolift
Rock step pools / grade control
Rock cross vanes
Culvert upgrade and cross vanes
Culvert removal and cross vanes;
toe wood w/ geolift
Sloping/matting and cross vane; toe
wood w/ geolift
Sloping/matting; toe wood w/
geolift
Head cut repair

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
NORTH CAROLINA
Environmental Quality
MEMORANDUM:
TO: Debby Davis
FROM: Lin Xu u<
SUBJRCT: Payment of Permit Fee for 401 Certificate Application
DATE: December 7, 2021
The Division of Mitigation Services (DMS) is implementing a repair project for Little Pine Creek III Site in
Allegheny County (DMS IMS 9 94903). The activities associated with this restoration proj ect involve
stream restoration related temporary stream impact. To conduct these activities, the DMS must submit a Pre -
construction Notification (PCN) Form to the Division of Water Resources (DWR) for review and
approval. The DWR assesses a fee of $570.00 for this review.
Please transfer $570.00 from DMS Fund 9 2984, Account 9 535120 to DWR as payment forthis review.
If you have any questions concerning this matter, I can be reached at 919-707-8319. Thanks for your
assistance.
cc: Erin Davis, DWR

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