20220265 Ver 1_ePCN Application_20220214

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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*
20220265
Is a payment required for this project?
No payment required
Fee received
Fee needed - send electronic notification
Reviewing Office*
Winston-Salem Regional Office - (336) 776-
9800
Information for Initial Review
1a. Name of project:
Cielo Falls
1a. Who is the Primary Contact?*
Ken Fearn
1 b. Primary Contact Email:*
[e-mail]
Date Submitted
2/14/2022
Nearest Body of Water
North Prong Lewis Fork
Basin
Yadkin-PeeDee
Water Classification
C, Tr
Site Coordinates
Latitude:
36.240387
A. Processing Information
County (or Counties) where the project is located:
Wilkes
Is this a NCDMS Project
Yes No
Longitude:
-81.391729
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*
Sue Homewood:eads\slhomewood
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:
Wilkes Mountain Properties LLC
2b. Deed book and page no.:
1319/68
2c. Contact Person:
Ken Fearn
2d.Address
Street Address
704 Dover Road
Address Line 2
City
Greensboro
Postal / Zip Code
27408
2e. Telephone Number:
[phone]
2g. Email Address:
[e-mail]
401 Water Quality Certification - Express
Riparian Buffer Authorization
State / Province / Region
NC
Country
USA
2f. Fax Number:
Yes No
Yes No
U

3. Applicant Information (if different from owner)
3a. Name:
Ken Fearn
3b. Business Name:
Wilkes Mountain Properties LLC
3c.Address
Street Address
704 Dover Road
Address Line 2
City
Greensboro
Postal / Zip Code
27408
3d. Telephone Number:
[phone]
3f. Email Address:"
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Derek Goddard
4b. Business Name:
BREC, PA
4c.Address
Street Address
1520 Meadowview Drive
Address Line 2
City
Wilkesboro
Postal / Zip Code
28697
4d. Telephone Number:
(336)8444088
4f. Email Address:
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(if appropriate)
Cielo Falls
1c. Nearest municipality I town:
Purlear
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:
0802050
8.32
2c. Project Address
Street Address
Cielo Falls Common Area
Address Line 2
City
State / Province / Region
Purlear
NC
Postal / Zip Code
Country
28665
3. Surface Waters
3a. Name of the nearest body of water to proposed project:'r
North Prong Lewis Fork

3b. Water Resources Classification of nearest receiving water:*
C; Tr
3c. What river basin(s) is your project located in?*
Yadkin-PeeDee
3d. Please provide the 12-digit HUC in which the project is located.
030401010205
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: *
Site is a residential development in Rugged mountain land that is heavily wooded and prone to wildfires and slow response times for fire services.
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
4g. List the total estimated linear feet of all existing streams on the property:
1250
4h. Explain the purpose of the proposed project: *
The pond is being constructed as a fire prevention pond with a dry hydrant to aid in the response time for fires in the community. Currently response times are poor and the risk of loss of
property and life is high because of the proximity to a water source to the community. Additionally the mountain road steepness also slow down retrieval times to ferry water from the
source to the site.
Alternate solutions where evaluated, such as extending public water. This is not feasible since it is several miles away. We also evaluated an offiine pond, but the steepness of the valley
made this impossible to construction.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:
The project will install a .14 ac inline pond to be constructed in the dry with a planned cold water discharge pipe. The project will utilize a pump around. Traditional construction equipment
will be utilized. The erosion control specifications will utilize plastic free matting and adhere to standards for sensitive watersheds. All slopes will be stabilized at the end of each work day
to prevent any off site sedimentation.
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:
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Derek Goddard
Agency/Consultant Company: BREC
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
5. Pond or Lake Construction

5a. Pond ID number 5b. Proposed use or purpose of 5c. Wetland
pond impacts
(acres)
Flooded Filled
P1 Other
P2
5f. Total:
5g. Comments:
49 feet is reflective of the approximate length of the pipe through the dam
5h. Is a dam high hazard permit required?
Yes No
If yes, permit ID no:
5i. Expected pond surface area (acres):
.14
5k. Method of construction:
Dam
E. Impact Justification and Mitigation
1. Avoidance and Minimization
5d. Stream
impacts (feet)
Excavated Flooded Filled
100 49
100 49
5j. Size of pond watershed (acres):
45.73
Excavated
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
Alternate solutions where evaluated, such as extending public water. This is not feasible since it is several miles away. We also evaluated an offline
pond, but the steepness of the valley made this impossible to construction.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
All work will be conducted in the dry
A cold water discharge will be utilized
Erosion control for sensitive watershed will be used and all work will be stabilized at the end of each day. Matting will be plastic free
The pond fill up will be conducted slowly as to not dewater the downstream channel
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
1a. 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:
No Impervious created
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:
No Impervious created
G. Supplementary Information
1. Environmental Documentation
Se. Upland
(acres)
0

1a. Does the project involve an expenditure of public (federallstatellocal) 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.
No Impervious created, Pond will have a cold water discharge and will be significantly shaded.
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
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
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?
USFWS.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?
USFWS.org
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?*
http://gis.ncdcr.gov/hpoweb/
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?*
NCFRIS.com

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
PCN_SUBMISSION_02142022.pdf 92.93MB
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:
Derek Goddard
Signature
Date
2/14/2022

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Soil Map —Wilkes County, North Carolina
Map Unit Legend
Map Unit Symbol
Map Unit Name
Acres in AOI
Percent of AOI
CeF
Chestnut-Ashe complex, 25 to
7.0
22.7%
90 percent slopes, very
sto ny
ChE
Chestnut-Edneyville complex,
17.8
57.5%
25 to 60 percent slopes,
sto ny
EsD
Evard-Cowee complex, 8 to 25
2.1
6.9%
percent slopes, stony
EsE
Evard-Cowee complex, 25 to
4.0
12.8%
60 percent slopes, stony
Totals for Area of Interest
31.0
100.0%
USDA Natural Resources Web Soil Survey 1 /11 /2022
Conservation Service National Cooperative Soil Survey Page 3 of 3

Contact Name*
Contact Email Address*
Project Owner*
Project Name*
Project County*
Owner Address:
Is this a transportation project?*
Derek Goddard
[e-mail]
Ken Fearn
Cielo Falls Fire Suppression Pond
19VAI'F
Street Address
704 Dover Road
Address Line 2
City
Greensboro
Postal / Zip Code
27408
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
NC
Country
USA
Do you know the name of the staff member you would like to request a meeting with?
Please give a brief project description below and include location information.
Approximately .5 to 1 Acre Fire Suppression Pond for the Cielo Falls
Community located in Wilkes County NC
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