20201732 Ver 1_401 Application_20220223

12114/2020 New Submission
r i DWR
1 ... ,
1
Division of Water Resources
Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
October 26,2020 Ver 3.3
Please note.fields marked with a red asterisk*below are required. You will not be able to submit the form until all mandatory questions are answered.
Also,if at any point you wish to print a copy of the E-PCN,all you need to do is right-click on the document and you can print a copy of the form,
Below is a link to the onlne help file
https.Nedocs.deq.nc.govNWaterRResourcesl0ledocI624704lPCN%20Help%20File%202018-1-30.pdf(https.l ledocs.deq.nc.govlWaterResources101docl6036t 01Pagel.aspx)
A. Processing Information
County(or Counties)where the project is located:*
Mitchell
Add additional county
Is this a NCDMS Protect*
O Yes 0 No
Click Yes,only if NCDMS is the applicant or co-applicant.
Is this project a public transportation project?*
O Yes tl No
Thin is airy publicly funded by h unicipal,state or federal funds road.rail.airport transportation project.
la.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?*
C] Yes
la No
lb.What type(s)of permits)do you wish to seek authorization?*
p Nationwide Permit(NWP)
❑ Regional General Permit(RGP)
O Standard;IP)
This form may be used to initiate the standardriedIvidual permit process with the Carps Please contact your Corps representative concerning submittals for standard permits. AA
required items that are not provided In the E-PCN can be added to the miscellaneous upload area located at the bottom of this form.
1c.Has the NWP or GP number been verified by the Corps?*
03 Yes i, No
Nationwide Permit(NWP)Number: 103-Maintenance_ _ _ *•
Add additio ial NWP
https:lledocs,deq.nc.govlFarmslPre-Construction_Notification_Form 112

12/141202D New Submission
NWP Numbers(for multiple NWPS):
List an NW numbers you are applying for not on the drop down list.
Id.Type(s)of approval sought from the DWR:*
check all that apply
0 401 Water Quality Certification-Regular 0 401 Water Quality Certification-Express
❑ Non-404 Jurisdictional General Permit 0 Riparian Buffer Authorization
❑ Individual Permit
Pre-Filing Meeting Information
Before submitting this form please ensure you have submitted the Pre-Filing Meeting Request Form as we will not be able to accept your application without this important first step.
The Pre-Filing Meeting Request Form is used in accordance with 40 C F.R.Section 121.4(a)"At least 30 days prior to submitting a certification request,the project proponent shall
request a pre-filing meeting with the certifying agency"and in accordance with 40 C.F.R.Section 121.5(b)(7),and(c)(5)all certification requests shall include documentation that a pre-
filing meeting request was submitted to the certifying authority at least 30 days prior to submitting the certification request.Click here(https:llwww.epa.govlsiteslproductionlfilesf2020-
071documentslclean water act section 401 certification_rule.pdf)to read more Information on when this form Is needed prior to application submission or here
(https:lledocs.deq.nc.govlFormslDWR-Pre-Filing-Meeting-Request)to view the form
ID# Version
20201732 1 1
Pre-fling Meeting or Request Date*
11/16/2020 w
Attach documentation of Pre-Filing Meeting Request here:*
Upload
DWR Pre-Filing Meeting Request Form.pdf(IFormslhandlersldownloadattachmentashx7req=DownLoad... 56.12KB X
le.Is this notification solely for the record because written approval Is not required?
*
For the record only for DWR 401 Certification: Q Yes Q. No
For the record only for Corps Permit: Q Yes Q. No
If.Is this an after-the-fact permit application?*
C: Yes QQ No
1g.Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
N so,attach the acceptance letter from mitigation bank or In-lieu lee program.
Q Yes QQ No
Acceptance Letter Attachment
Click Ore upload button or drag and drop files here to attach document
Upload
FILE TYPE MUST BE PDF
1 h.Is the project located in any of NC's twenty coastal counties?*
0 Yes i. No
1 j.Is the project located in a designated trout watershed?*
Yes0No
You must submit a copy of the appropriate Wildlife Resource Commission Office.
Link to trout information:http:llwww.saw usace.armymilThMissionsrRegulatory-Permit-Progra•y,Agency-Coord nationlTrout.aspx(http:Awww.saw.usace.army.millMissionslRegulalory-
Permit-Program!Agency-CoordinationfTrout.aspx)
https://edocs.deq.nc.gov/Forms!Pre-Construction_Notificatian_Fortn 2.12

1 211 412 0 2 0 New Submission
B. Applicant Information
la.Who is the Primary Contact?*
David W. Poore, PE, CPESC
1c.Primary Contact Phone!*
$xxx)axx.xxxx
lb.Primary Contact Email:*
828-522-4729
[e-mail] :nvatid input
1 d.Who is applying for the permit?*
Owner CJ Appl cant(other than owner)
(Cheek an that apply,
1e.Is there an Agent/Consultant for this project?*
p+ Yes ; No
2. Owner Information
2a.Namels)on recorded deed:*
Susan and David Larson
2b.Deed book and page no.:
145/52
2c.Responsible party:
dor Corporntionv
2d.Address*
Street Address
50 Walnut Straight Road
Address Lirr 2
City State f Province f fleyai
Spruce Pine NC
Postal!Zip Code Country
28777 Mitchell
2e.Telephone Number:*
828 765-2652
2f.Fax Number:
(xxx)xxx-xxxx
29.Email Address:*
[e-mail]
Add another owner
3. Applicant Information (if different from owner)
3a.Name:*
LSusan and David Larson
https:/Iedocs.deq.nc.gov/Forms!Pre-Construction_Notification_Form 3112

12/14/2020 New Submission
3b.Business Name:
(t applicable)
3e.Address*
Street Address
50 Walnut Straight Road
Address Line 2
City State 1 Province/Region
Spruce Pine NC
Postal/Zip Code .^.a.wlry
28777 _ US
3d.Telephone Number:* 3e.Fax Number:
[phone]
(exx)xxx.xxxx :X'Ci�xxx.xxxr
3f.Email Address:*
[e-mail]
4.Agent/Consultant(if applicable)
4a.Name:*
David W. Poore, PE, CPESC
4b.Business Name:
(if applicable)
'West Consultants, PLLC
4c.Address*
Street Address
405 South Sterling Street
Address.•ae a
City State f Province!Region
Morganton NC
Postal/ZipCode Country
28655 US
4d.Telephone Number:*
828-522-4729 4e.Fax Number:
invalid input.
(xxx)xxx•xxxx (ma vix•xxxx
4f.Email Address:*
[e-mail]
Agent Authorization Letter*
Please provide the Agent Authorization Letter it you are submitting this dca-nont
Upload
AUTHORIZATION LETTER.pdf{!Forms!handlersldownloadattachmentashx?req=OownLoad&aid=48058,,. 25 42KB
FILE TYPE MUST SE POF
https:lledocs.deq.nc.govlFormslPre-Construction_Notirication_Form 4,12

12/14/2020 New Submission
C. Project Information and Prior Project History
1. Project Information
la.Name of project:*
Larson Pond Repair
lb.Subdivision name:
(If appropnalel
N/A
1c.Nearest municipality I town:*
Spruce Pine
2. Project Identification
2a.Property Identification Number: 2b.Property size:
(tax PIN or parcel 10J (in acresi
0799-00-76-8970 56.86
2c.Project Address
Street Address
50 Walnut Straight Road
Address Line 2
City state Prov nce i Regtrn
Spruce Pine NC
Poalal Zip Code Country
28777 US
2d. Site coordinates In decimal degrees
Please collect site coordinates!n decimal degrees.Use between 4-6 dig is(unless you are using a survey-grade GPS device)after the decimal place as appropriate,based on how
the location was determined, (For example,most mobile phones with GPS provide locational precaon in decimal degrees to map coordinates to 5 or 6 digits atter the decimal place.)
Latitude:* Longitude:*
35.900186 -82.045813
ex.34 2,3B504 -77 7,6371
3. Surface Waters
3a.Name of the nearest body of water to proposed project:*
UIT to Cathis Creek
3b.Water Resources Classification of nearest receiving water:*
C;TR
Surface Water Lockup(https!7ncdenr.maps arcgis.nomappsiwebappviewerf ndex,ntml?Id=6e125ad7628f494694e259c80dd64265)
1c. What river basins)is your project located In?*
French Broad .. .
Add another river basin
https:/ledocs.deq.nc.gov/Forms/Pre-Construction_Notilication_Form 5,12

12/14/2020 New Submission
3d.Please provide the 12-digit HUC in which the project Is located.*
060101080104
River Basin Lookup(http://ncdenrmaps.ares s com/apps/Publ.clnformation/ndex.html?appid.ad3a85a0c6d644a0b97cd069db238ac3)
4. Project Description and History
4a.Describe the existing conditions on the site and the general land use En the vicinity of the project at the time of this application:*
The existing pond was built around 1975 through the Soil Conservation Service. It was built with a 6" CMP
discharge pipe. The pipe has rusted and is in need of replacement before it does fail and causes the impoundment
to be compromised. The owner wishes to construct a new discharge line made out of PVC or HDPE. The new pipe
will be installed above the existing sediment level in the pond. Then the existing CMP will be grouted closed.
General land use in the vicinity of the project is residential.
46.Have Corps permits or DWR certifications been obtained for this project(including all prior phases)in the past?*
0 Yes O No Unknown
4d.Attach an 81/2 X 11 excerpt from the most recent version of the USGS topographic map Indicating the location of the project site.(for DWR)
Click the upload button or drag and drop files here to attach document
Upload
File type must be pdf
4e.Attach an 81/2 X 11 excerpt from the most recent version of the published County NRCS Soil Survey map depicting the project site.(for DWR)
Click the upload button or drag and drop files here to attach document
Upload
USGS MAP.pdf(IFcrmsIhandlers/downlaadattachment.ashx?req=DownLoad&a.d=4S0595&authkey=9f2d 246.29KB
File type must be pdf
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:
':intermittent and perennial)
1,700
4h.Explain the purpose of the proposed project:*
The purpose of this project is to replace a rusted discharge pipe for a pond before the pipe fails and compromises
the integrity of the pond.
https:I edocs.deq.nc.gov/Forms!Pre-Construction_Notification_Form 5112

12/14/2020 New Submission
41.Describe the overall project in detail,including indirect impacts and the type of equipment to be used:*
The pond level will be lowered down to the level of the existing sediment in the pond. A new discharge pipe will then
be installed and the pond will be allowed to re-fill. The existing rusted CMP discharge pipe will the be grouted
closed.
41.Please upload project drawings for the proposed project.
Click the upload button or drag end drop rile here to attach d men!
Upload
PIPING COMPONENTS.pdf(IFormslhandlersldownioadattachment.ashx?req=Download&aid=480610&.. 76.09KB X
SOIL MAP.pdf(1Forms!handlers/downloadattachment.ashx?req=Download&aid=480612&authkey=9f2d3.. 473 32KB X
File type must be pol
5. Jurisdictional Determinations
5a.Have the wetlands or streams been delineated on the property or proposed impact areas?*
Yes ' No 0 Unknown
Comments:
No impacts to streams are proposed
5b.H the Corps made a jurisdictional determination,what type of determination was made?
*
C.) Preliminary 0 Approved 17. Not Verified O Unknown 0 N/A
Corps AID Number.
Example.SAW.2017.99999
5c.If 5a is yes,who delineated the jurisdictional areas?
Name(if known):
Agency/Consultant Company:
Other:
5d1.Jurisdictional determination upload
Click the upload button or drag and drop riles here to attach document
Upload
File type m,it ae r'3r
6. Future Project Plans
6a.la this a phased project?*
ics [ No
https://edors.deq.nc.gov/Forms/Pre-Construction Notification_Form T)12

12/14/2020 New Submission
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?
This includes other separate and distant crossing for linear projects that require Department of the Army authorization but don't require pre-construction notification.
I
I
I
D. Proposed Impacts Inventory
1. Impacts Summary
la.Where are the Impacts associated with your project?(check all that apply):
O Wetlands 0 Streams-tributaries . Bjile•s
C1 Open Waters 0 Pond Construction
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!*
Water level in the pond will be drawn down to level of existing sediment in the pond and new
piping will be installed. —
lb.Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Proposed work will be done in the dry.
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?
o Yes No
2b.If this project DOES NOT require Compensatory Mitigation,explain why_
NC Stream Temperature Classificat on Maps can be found under the MitigaLon Concepts tab cn the Wilmington District's RIBITS(https:llribits.usace.army.miiMbits_apexlf7
p=107.27.2734709611497:NO RP:P27,,BUTTON KEY:O) website.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
"'Recent changes to the stormwater rules have required updates to this section'•'
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 Q No
For a list of options to meet the diffuse flow requirements,click here
(httpwifiles.nc.gowncdeg/Waler%20Ouality/Sun`ace%20Water%20Protectionl401iBuffer%24CIanncation%20Memos Options%20for%20Meeting%2OD Huse%20Flow%20Provisions%20c
https:lledocs.deq.nc.gov/Farms/Pre-Construction_Notification_Form B'12

12/14/2020 New Submission
if no,explain why:
2. Stormwater Management Plan
2a.Is this a NCDOT project subject to compliance with NCDOrs Individual NPDES permit NCS000250?*
0 Yes ®Q No
2b.Does this project meet the requirements for low density projects as defined in 15A NCAC 02H.1003(2)7*
C Yes 0 No
To look up low density requirement cl ck here 15A NCAC 02H 1003(2)(http.//reports.oah.slate.nc.us+ncaclt lie%2015a%20%20environmental°%20quaiity/chapter%2002%20-
%20environmental%20managementlsubchapter%20h115a%20ncac%2002h%20 1003.pdf)
Comments:
G. Supplementary Information
9. Environmental Documentation
la.Does the project Involve an expenditure of public(federaUstatellocal)funds or the use of public(federal/state)land?*
C.1 Yes (!i. Na
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)7*
-, Yes r , Nu
3. Cumulative Impacts (DWR Requirement)
3a.Will this project(based on past and reasonably anticipated future Impacts)result in additional development,which could impact nearby downstream water quality?*
0 Yes 60 No
3b.If you answered"no,"provide a short narrative description.
This project is a maintenance project and will not promote development.
4. Sewage Disposal (DWR Requirement)
4a.Is sewage disposal required by DWR for this project?*
Yes Q No QQ N/A
httpslledocs.deq.nc.gov/FonnslPre-Construction_Notification_Form 9.1.2

12/14/2020 New Submission
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?*
O Yes ) No
Sb.Have you checked with the USFWS concerning Endangered Species Act impacts?*
O Yes :it No
Ed.Is another Federal agency involved?*
O Yes C1 No © Unknown
5e.Is this a DOT project located within Division's 1.8?*
Q Yes No
5f.Will you cut any trees in order to conduct the work in waters of the U.S.?*
O Yes p+ No
5g.Does this project involve bridge maintenance or removal?*
O Yes t0 No
Link to the NLEB SLOPES dac.me-.I: http::/saw-reg,usace army mil/NLEBl1-30.17-signed NLEBSLOPES&apps.pdf(httpllsaw-reg.usace army.mil1NLEB/1-30-17-signed NLEB-
SLOPES&apps.pdf)
Sh.Does this project involve the constructionlinstallation of a wind turbine(s)?"*
O Yes d No
Si.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.?*
O Yes )No
$j.What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
websites
Consultation Documentation Upload
Click the upload button or drag and drop rhea here to attach document
Upload
File type must be PDF
6. Essential Fish Habitat (Corps Requirement)
6a.Will this project occur in or near an area designated as an Essential Fish Habitat?*
Yes No
fib.What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
website
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State H stcric Preservat on Office Historic Properties Map(does not Include archaeological data jltjpJ(gis.ncdcr ggyllmeiggLaMmagis.ncticr,ggyaumfggp
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(e.g.,National
Historic Trust designation or properties significant in North Carolina history and archaeology)?*
i_i Yes i i Nc
https://edocs.deq.nc.gov/Forms/Pro-Construction Notification_Form 2

12/14(2020 New Submission
7b.What data sources did you use to determine whether your site would impact historic or archeological resources?*
'website
7c.Historic or Prehistoric Information Upload
Click the upload button or drag and drop files here to attach document
Upload
File must be POP
8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https.pmsc.fema.gov:portal/search(https 'msc fame goy/portal/search)
U.Will this project occur in a FEMA-designated 100-year floodplain?*
0 Yes 0. No
8c.What source(s)did you use to make the ftoodplain determination?*
FIRM maps, County G1S maps
Miscellaneous
Comments
•
Miscellaneous attachments not previously requested.
Click the upload button or drag and drop flee here to attach document
Upload
File mull be PDF or KMZ
Signature
*
is By checking the box and s gning below,I certify that:
• The project proponent hereby certifies that all Information contained herein,s 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 th s PCN form is a"Iransacton'subject to Chapter 66,Article 40 of the NC General Statutes(the"Uniform Electronic Transactions Act');
• I agree to conduct this transact on by electronic means pursuant to Chapter 66,Article 40 of the NC General Statutes(the'Uniform Electronic Transactions Act'):
• I understand that an electron c 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:*
David W. Poore, PE, CPESC
https;//edocs.deq.nc.gov/Forms/Pre-Construction_Notifcation_Form 11 i 12

12/14/2020 New Submission
Signature*
x
eDeNtrr J' �iti^t/
Date
Date captured on form submission
Submit Save as Draft
https:l/edocs.deq.nc.gov/Fomts/Pre-Construction_Notification_Form 12112

Pond Dam Piping, Ltd. •
*HOME DHOW TO BUILD A POND POND PIPING SYSTEMS
DUCK PONDS VALVES
ACCESSORIES t.CONTACT IFACEBOOK
Conventional Pond Piping System
Top of Dam
Trail;Rack Emergency Spillway Elevation
PVC R4ct Pipe
o Fe
•
3:1 Slope —
UD Slide PVC Pipe
Gate g
sommin
46,
• Arm-Seep Collar
PVC Pipe PVC Riser Tee
Pond Dam Piping offers skimmers for sediment basins, a variety of pond liners,
aerators&fountains,end wall sections from Hartman, outlet control structure
devices for detention and retention ponds, flash board, flash board risers,valves,
and everything for your pond, lake,water garden, koi pond,fish farm,dam,levee,
dike, spillway and more.
Copyright O 2020 Pond Dam Piping,Ltd..All Rights Reserved.i site developed by
eqg media

6
ig
ettto
CD
CD
V)
ran.
ta
og

toto
ear
0

111 1041
� `. 4 �

' "
R
�*� r
■
u
6

Soil Map—Mitchell County,North Carolina
a (LARSON POND REPAIR) EN
N N
N N
W
405520 405560 405600 405640 405680 405720 405760
35°54'6"N 1 35°54'6"N
A
0
—
R
w
R3 4 • M
. . Ng _ .
M ,
lr
cc
,ir., R.., -_ . * FeD2
G
• SFeD2 ..
it
M
X010 i kg)MET NCQA b@ dalod aitGT110 a0Go
35°53'55"N 35°53'55"N
405520 405560 405600 405640 405680 405720 405760
3 3
k c
Map Scale:1:1,610 if printed on A portrait(8.5"x 11")sheet N
P. N Meters 6
0 20 40 80 120
Feet
0 50 100 m200 co 300
Map projection:Web Mercator Coer ordinates:WG5843 Edge tics:URA Zone 17N WGS84
usoa Natural Resources Web Soil Survey 11/3/2020
Conservation Service National Cooperative Soil Survey Page 1 of 3

Soil Map—Mitchell County, North Carolina
(LARSON POND REPAIR)
MAP LEGEND MAP INFORMATION
Area of Interest(AOI) g Spoil Area The soil surveys that comprise your AOI were mapped at
Area of Interest(AOI) Stony Spot 1:12,000.
Soils a Very Stony Spot Warning:Soil Map may not be valid at this scale.
0 Soil Map Unit Polygons
Wet Spot Enlargement of maps beyond the scale of mapping can cause
ow. Soil Map Unit Lines misunderstanding of the detail of mapping and accuracy of soil
6. Other line placement.The maps do not show the small areas of
CISoil Map Unit Points contrasting soils that could have been shown at a more detailed
Special Line Features
Special Point Features scale.
Blowout Water Features
Streams and Canals Please rely on the bar scale on each map sheet for map
Borrow Pit measurements.
Transportation
Clay Spot Rails Source of Map: Natural Resources Conservation Service
Closed Depression Web Soil Survey URL:
✓wr Interstate Highways Coordinate System: Web Mercator(EPSG:3857)
• Gravel Pit US Routes
O.10 Maps from the Web Soil Survey are based on the Web Mercator
: Gravelly Spot Major Roads projection,which preserves direction and shape but distorts
distance and area.A projection that preserves area,such as the
▪ Landfill Local Roads Albers equal-area conic projection,should be used if more
it Lava Flow accurate calculations of distance or area are required.
Background
Marsh or swamp . Aerial Photography This product is generated from the USDA-NRCS certified data as
of the version date(s)listed below.
an4 Mine or Quarry
Soil Survey Area: Mitchell County,North Carolina
co Miscellaneous Water Survey Area Data: Version 14,Jun 4,2020
Perennial Water Soil map units are labeled(as space allows)for map scales
Rock Outcrop 1:50,000 or larger.
▪ Saline Spot Date(s)aerial images were photographed: May 3,2020—May 7,
2020
4 • Sandy Spot
The orthophoto or other base map on which the soil lines were
Severely Eroded Spot compiled and digitized probably differs from the background
imagery displayed on these maps.As a result,some minor
Sinkhole shifting of map unit boundaries may be evident.
Slide or Slip
oa Sodic Spot
USDA Natural Resources Web Soil Survey 11/3/2020
rora Conservation Service National Cooperative Soil Survey Page 2 of 3

Soil Map—Mitchell County,North Carolina LARSON POND REPAIR
Map Unit Legend
Map Unit Symbol Map Unit Name Acres in AOI Percent of AOI
FeC2 Fannin sandy clay loam,8 to 1.9 17.2%
15 percent slopes,eroded
FeD2 Fannin sandy clay loam, 15 to 1.0 8.9%
30 percent slopes,eroded
ScC Saunook silt loam,8 to 15 7.2 64.6%
percent slopes,stony
W Water 1.0 9.3%
Totals for Area of Interest 11.1 100.0%
USDA Natural Resources Web Soil Survey 11/3/2020
Conservation Service National Cooperative Soil Survey Page 3 of 3

PIN: .' - ,.. '•_'. • " v ' 4. r . . -, r.. _s a 4' >
.: ' •' :.:.. .
OWNER: -.•►; - _ � _ � ,•s , �.;• _ ��a
r
•
•
ACCOUNT NUM: .2. { s
DEED REF: {;{ :
DEED DATE: 373
#
GRANTOR: 4
LEGAL AC: ` - •',,
•
LOCATION: _ _ h ;`-_ - .
. 4.
r -
LAND VALUE: k'.I ti
BLDG VALUE: ;= _
TOTAL VALUE: µ,, rr,� S
•
;ft 210k. ,.e 1'1-4 . ;' . -4)..
•
1 inch = 400 feet : ~ - 'it , : ;i ; r
4;42: :p.if,
teas; 4 . ,,,;r ,
S ' . ,r ..-,- 4,
'k ++fifi
A
% kIP
''K IC F'7L#' F
41 GA as ;+ $ + • -, •
DISCLAIMER: --` ,lop
r
]F - -
itivii..,_ . .
srx v ' �r

U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id.SAW 2021-00803 County: Mitchell U.S.G.S.Quad: NC-Spruce Pine
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Permittee: Susan& David Larson
Address: 50 Walnut Straight Road
Spruce Pine,NC 28777
Telephone Number: [phone]
E-mail: Isilarsonnornail.com
Size(acres) 56.861 Nearest Town Spruce Pine
Nearest Waterway North Toe River River Basin French Broad-Holston
USGS HUC 06010108 Coordinates Latitude:35.900186
Longitude:-82.045813
Location description: at the Larson Residence 50 Walnut Straight road in Spruce Pine.NC PIN 10799-00-76-8970
Description of projects area and activity: This verification authorizes the replacement of the 6" CMP discharge nine with a new
discharge line made out of PVC or HDPE.The pipe has rusted and is in need of replacement.
Applicable Law(s): ®Section 404(Clean Water Act,33 USC 1344)
Authorization: NWP 3. Maintenance
SEE ATTACHED NWP GENERAL, REGIONAL, AND/OR SPECIAL CONDITIONS& NCWRC
Comments
Your work is authorized by the above referenced permit provided it is accomplished in strict accordance with the enclosed
plans I of 1 dated 4/1/2021.Any violation of the attached conditions or deviation from your submitted plans may subject the
permittee to a stop work order,a restoration order,a Class 1 administrative penalty,and/or appropriate legal action.
This verification will remain valid until the expiration date identified below unless the nationwide authorization is modified,suspended
or revoked. If, prior to the expiration date identified below, the nationwide permit authorization is reissued andor modified, this
verification will remain valid until the expiration date identified below, provided it complies with all requirements of the modified
nationwide permit. If the nationwide permit authorization expires or is suspended,revoked,or is modified,such that the activity would
no longer comply with the terms and conditions of the nationwide permit,activities which have commenced(i.e.,are under construction)
or are under contract to commence in reliance upon the nationwide permit, will remain authorized provided the activity is completed
within twelve months of the date of the nationwide permit's expiration, modification or revocation, unless discretionary authority has
been exercised on a case-by-case basis to modify,suspend or revoke the authorization.
Activities subject to Section 404 (as indicated above) may also require an individual Section 401 Water Quality Certification. You
should contact the NC Division of Water Resources(telephone [phone])to determine Section 401 requirements.
This Department of the Army verification does not relieve the permittee of the responsibility to obtain any other required Federal, State
or local approvals/permits.
If there are any questions regarding this verification,any of the conditions of the Permit,or the Corps of Engineers regulatory program,
please contact Brandee.C.Boggs at 8282717980x4224or brandee.c.boggs(a7usace.armv.mil.
Corps Regulatory Official: S t9yr Date:05/12/2021
Expiration Date of Verification: 03/18/2022
CF: [e-mail];Andrea Leslie;Amy Annino

Action ID Number: SAW 2021-00803 County: Mitchell
Permittee:Susan & David Larson
Project Name: Larson Pond
Date Verification Issued: 05/12/2021
Project Manager: Brandee.C.Boggs
Upon completion of the activity authorized by this permit and any mitigation required by the permit,
sign this certification and return it to the following address:
US ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Attn: Brandee.C.Boggs
Asheville Regulatory Office
U.S Army Corps of Engineers
151 Patton Avenue, Room 208
Asheville,North Carolina 28801
or
brandee.c.boggsa usace.army.mil
Please note that your permitted activity is subject to a compliance inspection by a U. S. Army Corps of
Engineers representative. Failure to comply with any terms or conditions of this authorization may
result in the Corps suspending, modifying or revoking the authorization and/or issuing a Class I
administrative penalty, or initiating other appropriate legal action.
I hereby certify that the work authorized by the above referenced permit has been completed in
accordance with the terms and condition of the said permit, and required mitigation was completed in
accordance with the permit conditions.
Signature of Permittee Date

'il DELOE ML Topo North Americas"'9
fi
M..!.-51'. --t:.\-. -'•A__Ic
14f
,..k..--",...ci:.41\
._, ,
--„,--- ,,
'+6
. r L_ 11
•~ *�FL. I � r r F � ILf •~ x ?
?lif .
.-.. *4 - Ic:
�L -
- J
• f,./1 .0k
•
7.12--..
Th)1
Ci,. . spyir, + —_
• •74., t• --- Fail I / • .--.--- -.,2,\, ,_\„ . .
z c
- = i
by V f 1 ti L — i)s "f .I
,\V:i.,, / . F
' \ ''..• - f r ""
I, it . +
af4......, I f _..„, ,
. T 5 ,_::.--'-,
f Y — 1 4`
rs
I' 4 t MalSITEr ham`
77,
' 1 -r--
. .,......\\)."---\, , N-.1.i ..
„--.-Ic....T,T,,,,,=„_,. :31, I: ilt
i . Z (1. I 0. - -t. . r 1. r,,... '.
_:,./ . - 1 ' ', 1.4.!'/..rfi__\? ,.\\V. . \
/1 c\I.
( � cr 0♦'• i l �� ,� r i t. I
• 3,-7.-r
, .fin e tj
F
! 11. ri0
k.� � 5 J
•
•
.% ,../- . -1.411.,11:. .%._
.e.
r., •
, „F.-- ,. _ u ---.
•
f\ii......_____„, ir
Data use subject to license •
©DeLorme Topo NorthAmencar'9
■ ■ ■ ft
0 600 1200 1600 2400 3000 3600
wwwdelorme com !AN(7.3°W) Data Zoom 13-1