20140215 Ver 1_401 Application_20140314

231 40'_ ;
March 3, 2014
Mr. Chuck Cranford
NC DWQ, 401 /Wetlands Unit
1650 Mail Service Center
Raleigh, North Carolina 27699 -1650
Dear Mr. Cranford:
MAR 0 7 2014
A
RE: Pre - Construction Notification Form
Surrett Property — Porters Ridge
Haywood County, North Carolina
Please find enclosed one complete Pre - Construction Notification (PCN) submittal package
for your review for the above referenced project. The complete submittal package includes the
following information:
1. Five copies of the completed PCN form.
2. Five copies of the vicinity map, culvert installation drawing and reference sheets.
3. One attached check in the amount of $240 for the permitting fee.
If upon review you should have any questions or need additional information, please do not
hesitate to contact me.
Sincerely,
Craigory Surrett

O�OF W A rf
y r
DT6 0 V - adLzT +'-i� � aA
2014 Office Use Only:
MAR 0 7 Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Page 1 of 11
PCN Form — Version 1.3 December 10, 2008 Version
Pre - Construction Notification (PCN) Form
A.
Applicant Information
T Jr
1.
Processing
1 a.
Type(s) of approval sought from the
Corps:
®Section 404 Permit El Section 10 Permit
1 b.
Specify Nationwide Permit (NWP) number: or General Permit (GP) number: n/a
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
1 g.
Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below.
❑ 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:
Surrett Property
2b.
County:
Haywood
2c.
Nearest municipality / town:
Canton
2d.
Subdivision name:
Edna Broyles
2e.
NCDOT only, T.I.P. or state
project no:
3.
Owner Information
3a.
Name(s) on Recorded Deed:
Craigory R Surrett & Barbara A Surrett
3b.
Deed Book and Page No.
Bk 860 Pg 1190
3c.
Responsible Party (for LLC if
applicable):
N/A
3d.
Street address:
P.O. Box 816
3e. City, state, zip:
Canton, NC 28716
3f.
Telephone no.:
(828)734 -5435
3g.
Fax no.:
3h.
Email address:
craigsrt82 @yahoo.com
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
4c Business name
(if applicable)
4d Street address
4e City, state, zip
4f Telephone no
4g Fax no
4h Email address
5 Agent /Consultant Information (if applicable)
5a Name
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

B Project Information and Prior Project History
1 Property Identification
1a Property identification no (tax PIN or parcel ID)
8668 -82 -0385
1 b Site coordinates (in decimal degrees) - if you can't get
Latitude 35 5655 Longitude -82 8067
these, dust include a very good vicinity map
1c Property size
2 008 acres
2 Surface Waters
2a Name of nearest body of water (stream, river, etc ) to
Unnamed tributary to North Hominy Creek
proposed project
2b Water Quality Classification of nearest receiving water
C
2c River basin map is available at
French Broad
http Hh2o enr state nc us /adman /maps/
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
This property is undeveloped residential land, partially wooded, with Porters Ridge bordering it on the east side The
surrounding area includes the Edna Broyles subdivision and other residential properties
3b List the total estimated acreage of all existing wetlands on the property
Unknown
3c List the total estimated linear feet of all existing streams (intermittent and perennial) on the property
440 If
3d Explain the purpose of the proposed project
One primary residence is to be built on this property, with a single driveway from Porters Ridge
3e Describe the overall project in detail, including the type of equipment to be used
A 1400 sf residence is to be located on the west side of the property, with a driveway connecting to Porters Ridge on the
east, crossing the unnamed stream with a driveway culvert Equipment to be used includes an excavator and a tractor
4. Jurisdictional Determinations
4a Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
El Yes E] 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
Name (if known)
Other
4d If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation
Page 3 of 11
PCN Form — Version 1 3 December 10, 2008 Version

5
Project History
5a
Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
❑ Yes ❑ No ® Unknown
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
Page 4 of 11

C Proposed Impacts Inventory
1. Impacts Summary
la 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
Culvert
unknown
❑ Yes
® No
® Corps
❑ DWQ
<0 1 ac
W2 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W3 ❑ P ❑ T
❑ Yes
❑ 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
<0 1 ac
2h Comments
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 ❑ T
culvert
unnamed
❑ PER
® INT
® Corps
❑ DWQ
1
25
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
❑ PER
❑ Corps
S6 ❑ P ❑ T
❑ INT
❑ DWQ
3h Total stream and tributary impacts
25
31 Comments
Page 5 of 11

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 indiv ually 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 ❑T
03 ❑P ❑T
04 ❑P ❑T
4f 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
5f. Total
5g Comments
5h Is a dam high hazard permit required
❑ Yes ❑ No If yes, permit ID no
51 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 El Tar-Pamlico ❑Other
Project is in which protected basin? N/A
❑ 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?
El Yes
61 ❑P ❑T
❑ No
❑ Yes
B2 ❑ P ❑ T
❑ No
El Yes
B3 ❑P ❑T
❑ No
6h Total buffer impacts
61 Comments
Page 6 of 11

D
Impact Justification and Mitigation
1.
Avoidance and Minimization
la
Specifically describe measures taken to avoid or minimize the proposed impacts in designing project
A single driveway crossing will be perpendicular to stream to minimize impact with the building footprint located away
from stream
b
Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
Silt fence and stabilized construction entrance will be used, slopes will be gradual, and limited machinery will be used on
the property to minimize 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 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
Page 7 of 11
PCN Form — Version 1 3 December 10, 2008 Version

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
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? If yes, you will have to fill out this entire form — please
contact the State for more information
❑ 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
Page 8 of 11

E
Stormwater Management and Diffuse Flow Plan (required by DWQ)
1
Diffuse Flow Plan
1 a
Does the project include or is it adjacent to protected riparian buffers identified
❑ Yes ® No
within one of the NC Riparian Buffer Protection Rules?
lb
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?
5%
2b
Does this project require a Stormwater Management Plan?
❑ Yes ® No
2c
If this project DOES NOT require a Stormwater Management Plan, explain why
The overall percent imperviousness is less than 24%
2d
If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan
N/A
2e
Who will be responsible for the review of the Stormwater Management Plan?
❑ Certified Local Government
❑ DWQ Stormwater Program
N/A
❑ DWQ 401 Unit
3
Certified Local Government Stormwater Review
3a
In which local government's jurisdiction is this project?
N/A
❑ Phase II
❑ NSW
3b
Which of the following locally - implemented stormwater management programs
❑ 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
❑ Yes No
❑
attached?
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)
la Does the project involve an expenditure of public (federal /state /local) funds or the
❑ Yes ® No
use of public (federal /state) land?
lb 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)
Wetland Standard Violation (Fill and Hydrologic conditions 15A NCAC 02B 0231, Removal of Best Usage 15A NCAC 02B 0211,
Failure to Secure a 401 Water Quality Certification (WQC)
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
Only one single residence with a driveway connecting to Porters Ridge is proposed for this property
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
An onsite septic permit for a 3 bedroom house was approved on Feb 24, 2009 and is good through Dec 31, 2016
A copy of the permit is attached
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?
❑ 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?
Bryan Tompkins at USFWS Asheville office confirmed there are no protected species or habitats on 02/07/2014.
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?
NOAA Habitat Mapper Online and confirmed by Bryan Tompkins at USFWS Asheville on 02/07/2014.
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?
NC State Historic Preservation Office online
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? NC Floodplain Mapping Program online
Craigory Surrett
1 1
03/03/2014
i� 4
Applicant/Agent's Printed Name
App cant/Age is Signature
Date
(Agent's signature is valid only if an authorization letter from the applicant
is provided.)
Page 11 of 11

2000 0 1000 2000 401
GRAPHIC RCAI F. 1 INCH = 2000 FFFT

40
TOWN 0
CANTON
A
PROJECT
LOCATION
NEWFOUND RD
I
ROLLING HILLS RD
C
II
VICINITY MAP
NOT TO SCALE
N
(PORTERS RIDGE
l �
N HOMINY RD

60 0 30 60 120
Tsiiiiiiiia CULVERT INSTALLATION
GRAPHIC SCALE 1 INCH = 60 FEET

EFH Data Notice: Essential Fish Habitat (EFH) is defined by textual descriptions contained in the
fishery management plans developed by the regional Fishery Management Councils. In most cases
mapping data can not fully represent the complexity of the habitats that make up EFH. This report
should be used for general interest queries only and should not be interpreted as a definitive
evaluation of EFH at this location. A location- specific evaluation of EFH for any official purposes
must be performed by a regional expert. Please refer to the following links for the appropriate
regional resources.
NOAA, iPC, Sources: Esri, GEBCO, NOAA, National
Geographic, DeLorme, NAVTEO, Geonemes.ag, and
dher contributors
Query Results
Degrees, Minutes, Seconds: Latitude = , Longitude =
Decimal Degrees: Latitude = , Longitude =
The query location intersects with spatial data representing EFH and /or HAPCs for the following
species /management units.
HAPCs
No Habitat Areas of Particular Concern (HAPC) were identified at the report
location.
EFH Areas Protected from Fishing
No EFH Areas Protected from Fishing (EFHA) were identified at the report location.

flood zone data
Maw Ckas
+ Bercrharks
a DFIRM Grid
Rivers and Streams
County Boundaries
® Coastd Bamer Resource Systems
Roads
- NC Highway
SUS Highway
asssmm Interstate Highway
Political Areas
0 Extratemtorml Jurisdictions
- Coastal Sounds
_ looyr Flooring - Floodoray (AE) 0 900 Feet
- IDOw Flooring - Has BFE's (AE)
%J 1DDyr Flooring - No BFE's (A)
M togyr Flooding - Velocity Zone
- WCyr Flooding (Shaded X)
North Carolina
- Base Flood Elevation (Syrrto) Floodplain Mapping Program
- Cross Sections

IMPROVEMENT PERMIT
SOIUSITE.EVALUATION REPORT
Haywood County Environmental Health Dept; 111feynewille, NO k 828- 452•LGV
`Ir FITST X SITE EVALUATION HMO AUGERED
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FACTORS
AREA 1
AREA 2
AREA 3
AREA 4
o slope (° /9)
Sag Texture
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Sac-
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U
U
Ur 1
Soil StmetuTe
S
S
S '.
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„U 9
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Soil Depth (in)
Saprolite Depth (in)
From Surface,
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Sapralite Texture ,
�.e
Ifepth to Rook
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cv Sod /Site Drainage
jql
Other (Specify)
N
00
SPIN' `IU AP#: 8668 BLOCK: 82 LOT# 2164
Property Owner, Kevin Ensley Date:_ �
Property Address: North Hominy Road, Canton
S�bdivislon: Edna Broyles Section. B -10 Lot: C
Property Location: Canton, 1-40 East to exit 33, L on Newfound Road,
L on North Hominy, L on Roljing Hill Drive, to end, straight onto Porters Ridge,
Into subdivision to 1st Lot on L
Request By: Kevin Ensley
Owner: X Agent; Phone #: [phone]
Address: PO Box 1401
Waynesville, NO 28786
Type of Water Supply. Individual Well
Evaluation fnr 1 # Single Family Residence(s) 3 # Bedrooms each
# Mobile Home(s) # Bedrooms each
Multiple Family Residence: # Units # Bedrooms each
Buslness Type; Size of Facility:
Describe any grading or filling existing an site: Road and Drive -k
Available Space: Yes X No 11. Repair Space 100 % I Z LTAf d dd r- � An area is present an this property, as shown in the diagram, which can be
+ classified as Provesronally Suitable for a ground absorption sewage
REMARKS (DIAGRAM ON BACK),' d1spo4W system to serve 1 Bedroom Residence , at accordance
CL.
Do not grade or change this lot In any way unless specifically approved by an I with the NO Laws and Rules for SepArage To eatfrrent, and Disposal ystems 15A
= Environmental Health Specialist from this office. NCAC 111A ,1900
House site and/or drive must not interfere with area approved for system and must be
L, staked before an Autharizatlon For Wastewater System Construction will be
II issued.
0
° tvtlnimum setbacks from approved area: ,50 feet to surface waters (stream), 100 feet
from +nvells, 5 feet from foundations, 10 feet frorp property line and water lines, (Other
x pertinent setback may apply.)
Surface and/or subsurface intercepter cidctr may be required up slope of system area
0
Drainlield type approved for this lot:
i° =Conventional (Gravel) f-�M2:5 % Reduction (3' chamber or EPSAi
0
Q2' Chamber =PPBPS (T &.J Panel)
M
Q iV' Diameter Fabric Wrapped Pipe
=Other
co
0
F-1 This site is unsuitable far a ground absorption sewage disposal system for the
` Wloviing reasons:
This report is based an a site evalualion compteted an M h
Any alteration of the site (natural or man inlllcL -4 or changes Made iinn the size, design, location, or
type of proposed structure made after this darts, uptessspecifcally approved in writing by the
Haywood County Haaith DeparimentFw9l, render this report inaccurate and unreliable, and may
render this site unsuitable for the installation of a grboird absorption sewage disposal system, if
you have anyquestions, please contact the Heallh Department
THIS IMPROVEMENT PERMIT EXPIRES ON
I understand the requireme is of Wepartund the information 1 have provided is accurate to the
best of rhy knowledge.
er Agent
Sanitarian

06- 11 -'13 10 36 FROM- Haywood Go Inspect. 828 -452 -6791 T -679 P000 3f0003 F -147
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