20220375 Ver 1_ePCN Application_20220309

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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*
20220375
Is a payment required for this project?
No payment required
Fee received
Fee needed - send electronic notification
Reviewing Office*
Fayetteville Regional Office - [phone]
Information for Initial Review
1a. Name of project:
Simpson Property
1a. Who is the Primary Contact?*
Jon Swaim
1 b. Primary Contact Email: *
[e-mail]
Date Submitted
3/9/2022
Nearest Body of Water
Watsons Lake
Basin
Lumber
Water Classification
B
Site Coordinates
Latitude:
35.166448
A. Processing Information
County (or Counties) where the project is located:
Moore
Is this a NCDMS Project
Yes No
Longitude:
-79.433227
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*
Chad Turlington:eads\ccturlington
1c. Primary Contact Phone:*
[phone]
u

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: 18 - Minor Discharges
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:
James Frederick Webb Simpson & Taylor Dowd Simpson
2b. Deed book and page no.:
5104/453
2c. Contact Person:
William Huntley
2d.Address
Street Address
8 Clark Court
Address Line 2
City
Pinehurst
Postal / Zip Code
28374
2e. Telephone Number:
[phone]
2g. Email Address:
[e-mail]
401 Water Quality Certification - Express
Riparian Buffer Authorization
State / Province / Region
North Carolina
Country
United States
2f. Fax Number:
Yes No
Yes No
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4. Agent/Consultant (if applicable)
4a. Name:
Jon Swaim
4b. Business Name:
McGill Associates, PA
4c.Address
Street Address
1240 19th Street Lane NW
Address Line 2
City
State / Province / Region
Hickory
North Carolina
Postal / Zip Code
Country
28601
United States
4d. Telephone Number:
4e. Fax Number:
[phone]
4f. Email Address:"
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1 b. Subdivision name:
(if appropriate)
Country Club of NC
1c. Nearest municipality / town:
Pinehurst
2. Project Identification
2a. Property Identification Number:
2b. Property size:
00018855
1.3410
2c. Project Address
Street Address
430 Lake Dornoch Drive
Address Line 2
City
State / Province / Region
Pinehurst
North Carolina
Postal / Zip Code
Country
28374
United States
3. Surface Waters
3a. Name of the nearest body of water to proposed project:
Watsons Lake
3b. Water Resources Classification of nearest receiving water:*
B
3c. What river basin(s) is your project located in?*
Lumber
3d. Please provide the 12-digit HUC in which the project is located.
030402030202
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 proposed project is located at 430 Lake Dornoch Drive in Pinehurst, North Carolina. The subject property contains a residential structure with an attached boathouse within Watsons
Lake. Land use surrounding the subject property is undeveloped, residential, and the Country Club of North Carolina.
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:
0
4h. Explain the purpose of the proposed project: *
The proposed project will convert a boathouse into a playroom on the subject property. See Appendix 2 - PhotoSheet 1 in the Miscellaneous Section.
41. Describe the overall project in detail, including indirect impacts and the type of equipment to be used: *
The channel from Watsons Lake leading to the existing boathouse will be impounded approximately 15 linear feet from the existing house foundation Oust beyond the existing concrete
block wall and wooden boardwalk, see Photosheet) with clean fill material. The earth impoundment will be lined with erosion control fabric to stabilize and prevent sedimentation. The work
area will be dewatered by pumping to a silt bag located in an upland area on the property. The silt bag will be positioned to allow for clean water to return to Watsons lake. The lake bottom
within the boathouse will be allowed to dry and unsuitable material removed using small excavator and hand tools. The boathouse bottom and approximately 5 linear feet of the lake
channel will be filled with compacted soil resulting in Permanent Impact OW-2 (0.0064 - Acres). A concrete floor will be poured within the boathouse footprint and the opening framed in
permanently. Impact OW-1 (0.0025 - Acres) consists of temporary impacts due to work pad/causeway and impoundment. See Appendix 1 - Impacts Map. Special care will be taken to
ensure that the shoreline and natural lake bed will not be heavily impacted. Once construction is complete and the site is stable, all impoundment fill material will be carefully removed to
ensure the natural bed of the lake is not excavated. Any disturbed shoreline will be stabilized with native NC wetland seed mix and fully biodegradable matting.
No indirect impacts are anticipated at this time.
Typical equipment to be used includes skid steers, small excavators, and dewatering device.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
Yes No
Comments:
No wetlands or streams on the property.
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): Alex Lowdermilk
Agency/Consultant Company: McGill Associates, P.A.
Other: 12/16/2021
6. Future Project Plans
6a. Is this a phased project?*
Yes No
Unknown
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
4. Open Water Impacts
4a. Site #
4a1. Impact Reason
4b. Impact type
4c. Name of waterbody
4d. Activity type
4e. Waterbody type
4f. Impact area
OW-2
Fill
P
Watsons Lake
Fill
Lake
0.01
OW-1
Work pad/Causeway
T
Watsons Lake
Causeway
Lake
0.01
4g. Total temporary open water Impacts:
0.01
4g. Total open water impacts:
0.02
4g. Total permanent open water impacts:
0.01
4h. Comments:
See Appendix 1 - Impacts map for approximate impacts.
OW-1 - 0.0025 Acres of Temporary Impacts
OW-2 - 0.0064 Acres of Permanent Impacts
Impact area in table above wouldn't allow for lower acreage on impacts so please refer to impacts map for correct acreage for each impact.
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 project has been designed to limit permanent impacts to open water. A temporary impoundment will be used to ensure that work occurs in the dry
and sedimentation of Watsons Lake is limited.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
All work in the open water shall be performed during dry conditions. The contractor shall provide adequate pump - around or diversion to keep the work
area dry. Return water from the silt bag will be monitored to ensure that clean water is being returned to Watsons Lake. All impoundment fill material will
be carefully removed so no impacts will occur to the natural bed of the lake.
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 project work does not exceed any of the thresholds required for compensatory mitigation.
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:
The project is located in the Lumber River Basin which is not subject to Riparian Buffer Protection Rules.
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.
No additional development anticipated as a result of the proposed work.
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
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
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
5i. 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?
https://ipac.ecosphere.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?
https://www.habitat.noaa.gov/apps/efhmapper/
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?*
hftp://gis.ncdcr.gov/hpoweb/
8. Flood Zone Designation (Corps Requirement)
Sa. Will this project occur in a FEMA-designated 100-year floodplain?*
Yes No
8b. If yes, explain how project meets FEMA requirements:
All appropriate floodplain permits will be acquired prior to construction.
8c. What source(s) did you use to make the floodplain determination?*
https://fris. nc.govKris/Home.aspx?ST=NC
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
Final Appendices.pdf 4.83MB
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.
,v

Full Name:
Jon Swaim
Signature
a& ¢».
Date
3/9/2022