20220107 Ver 1_ePCN Application_20220120

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Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
December 6, 2021 Ver 4.2
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*
20220107
Is a payment required for this project?
No payment required
Fee received
Fee needed - send electronic notification
Reviewing Office*
Asheville Regional Office - [phone]
Information for Initial Review
1a. Name of project:
Jones - Residence
1a. Who is the Primary Contact?*
Ronnie Dilbeck
1 b. Primary Contact Email:
[e-mail]
Date Submitted
1 /20/2022
Nearest Body of Water
Mill Creek
Basin
Little Tennessee
Water Classification
WS-11I;Tr
Site Coordinates
Latitude: Longitude:
35.05494-83.19119
A. Processing Information
County (or Counties) where the project is located:
Macon
Is this a NCDMS Project
Yes No
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)
Version# *
1
What amout is owed?*
$240.00
$570.00
Select Project Reviewer*
Kaylie Yankura:eads\kyankura
1c. Primary Contact Phone:*
[phone]

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
Nationwide Permit (NWP) Number:
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
29 - Residential Developments
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:
David Jones
2b. Deed book and page no.:
2c. Contact Person:
2d.Address
Street Address
298 River Knoll Way
Address Line 2
City
Dahlonega
Postal / Zip Code
30533
2e. Telephone Number:
[phone]
2g. Email Address:
[e-mail]
401 Water Quality Certification - Express
Riparian Buffer Authorization
State / Province / Region
GA
Country
USA
2f. Fax Number:
Yes No
Yes No
U

3. Applicant Information (if different from owner)
3a. Name:
Ronnie Dilbeck, PG
3b. Business Name:
CreekStone, PLLC
3c.Address
Street Address
132 Blueberry Lane
Address Line 2
City
Franklin
Postal / Zip Code
28734
3d. Telephone Number:
[phone]
3f. Email Address:"
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Ronnie Dilbeck, PG
4b. Business Name:
CreekStone, PLLC
4c.Address
Street Address
132 Blueberry Lane
Address Line 2
City
Franklin
Postal / Zip Code
28734
4d. Telephone Number:
(828)2004585
4f. Email Address:
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(if appropriate)
Mill Creek Village
1c. Nearest municipality I town:
Highlands
2. Project Identification
State / Province / Region
NC
Country
USA
3e. Fax Number
State / Province / Region
NC
Country
USA
4e. Fax Number
2a. Property Identification Number:
2b. Property size:
7540611338
0.35
2c. Project Address
Street Address
0 Meadow House Lane
Address Line 2
City
State / Province / Region
Highlands
NC
Postal / Zip Code
Country
28734
USA
3. Surface Waters
3a. Name of the nearest body of water to proposed project:'r
Mill Creek

3b. Water Resources Classification of nearest receiving water:*
WS-III;Tr
3c. What river basin(s) is your project located in?*
Little Tennessee
3d. Please provide the 12-digit HUC in which the project is located.
06010204
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 in the vicinity of the project location in residential.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?
Yes No Unknown
4f. List the total estimated acreage of all existing wetlands on the property:
0.09
4g. List the total estimated linear feet of all existing streams on the property:
0
4h. Explain the purpose of the proposed project:
To construct a residential building.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:
The proposed residential pad is to be constructed utilizing mid -sized heavy machinery. An 18,000 lb track hoe, mid -sized skid steer and sheep's foot shall be utilized.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
Yes No Unknown
Comments:
please refer to attached Aquatic Resource Map
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
Preliminary Approved Not Verified Unknown N/A
Corps AID Number:
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Ronnie Dilbeck, PG
Agency/Consultant Company: CreekStone, PLLC
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
2. Wetland Impacts
U
2a1 Reason (?)
2b. Impact type*(?)
2c. Type of W.*
2d. W. name*
2e. Forested*
r.)Type of Jurisdicition*
2g. Impact
area
Residential JL
Isolated Wetlands
Jones
No
DWR
0.055
(acres)

2g. Total Temporary Wetland Impact
0.000
2g. Total Permanent Wetland Impact
0.055
2g. Total Wetland Impact
0.055
2i. Comments:
E. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
The building footprint was minimized to reduce potential impacts. The driveway was positioned in upland area to reduce further impacts.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Limits of disturbance and silt fences will be meticulously positioned and maintained to reduce chances of further impact.
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:
The proposed impact is below mitigation threshold.
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
If no, explain why:
There is no buffer on -site
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
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?"
Yes 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)? *
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.
There is no intention of additional development to this site.
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
5e. 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
Unknown
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?
www.fws.gov
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?
www.fisheries.noaa.gov and www.fws.gov
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?*
North Carolina State Historical Preservation National Register
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?*
www.fema.gov
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 drag and drop files here to attach document
agentAUTHORIZATION.pdf 1.1 MB
DWR Pre -Filing Meeting Request Form (6).pdf 111.95KB
jonesARM1.0.pdf 127.48KB
jonesWETLANDimpactMAP1.0.pdf 127.83KB
File must be PDF or KMZ
Comments
Please find attached Aquatic Resource Map and Wetland Impact Map.
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:
Ronald Thomas Dilbeck
Signature
Date
1 /20/2022

SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. t off, PLAN NO. PARCEL ID: �154oCo 12500
1A\`\
STREET ADDRESS: cay� Ic
Please print: (
Property Owner: C�yV1N �
Property Owner: fir- k4 ` �` ` 1 C31, nt\
The undersigned, registered property owners of the above noted property, do hereby authorize
PC) v,In "I P _ D, \1c c� P of
(Contractor / Agent) (Name of consulting firm
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
Telephone: -770 54 C7 - �opo
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Si ature
Date: Cv ;2C)
Authorized nature
Date: U ?2�

Contact Name*
Ronald T. Dilbeck, PG
Contact Email Address*
[e-mail]
Project Owner*
David Jones
Project Name*
Jones - Residence
Project County*
Macon
Owner Address: *
Street Address
298 River Knoll Way
Address Line 2
City
Dahlonega
Postal / Zip Code
30533
Is this a transportation project?*
Yes No
Type(s) of approval sought from the DWR:
401 Water Quality Certification - 401 Water Quality Certification -
Regular Express
Individual Permit Modification
Shoreline Stabilization
Does this project have an existing project ID#?*
Yes No
State / Province / Region
GA
Country
United States
Do you know the name of the staff member you would like to request a meeting with?
Amy Annino
Please give a brief project description below and include location information.
The project is located in Highlands, NC, 0 Meadow House Lane or Lot
#103 of Mill Creek Village. The purpose of the project it to construct a
residential building pad. The site consists of wetlands and the
approximate impact is less than .09 acre.
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.
1 understand by signing this form that I cannot submit my application until 30 calendar days after this pre -filing
meeting request.
1 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*
Submittal Date 12/14/2021

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