20140415 Ver 1_401 Application_20140414

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Letter of Transmittal
Ecosystem Planning and Restoration
104 Fountain Brook Circle
Suite A
Cary, North Carolina 27511
(919) 388 -0787
To NC DWQ, WBSCP Unit RDU0019 Western NC Streams
512 North Salisbury Street Project.
Raleigh, NC 27604
Date 04/23/2014
Attn Sue Homewood Doc
Number
We are forwarding the following Fv Attached l— Under Separate Cover
NO.
COPIES
TITLE OR DESCRIPTION
COMMENTS
2
Full size plans
22x34
3
Half -size plans
l lxl7
5
PCN applications
8.5x11 Including figures and agency response
letters.
1
Check
$570 permiting fee
AP
THESE ARE TRANSMITTED as checked below:
1— As Requested
lv For Review and Approval
E— For Your Information
r No Exception Taken
r For Comment
Proceed subject to
corrections noted
GENERAL COMMENTS:
Find attached permtittmg information for the project If you
have any questions contact me at 919 - 999 -0262
9 Revisions Requested
1v For Permitting
r-
E�
Ecosystem Planning and Restoration (EPR)
By- Kevin Tweedy
Title- Project Engineer
Page 1 of 1

2 0 1 4 0 4 1 8
o���WATFSOG �® Office Use Only
Corps action ID no
o T 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
1.
Processing
la
Type(s) of approval sought from the
Corps
®Section 404 Permit El Section 10 Permit
1b Specify Nationwide Permit (NWP) number 27 or General Permit (GP) number
1c
Has the NWP or GP number been verified by the Corps?
❑ Yes
® No
1 d
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
If
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
1g
Is the project located in any of NC's twenty coastal counties If yes, answer 1 h
below
❑ Yes
® No
1h
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
® No
2.
Project Information
2a
Name of project
Little Fisher River- Hodges Property
2b
County
Surry
2c
Nearest municipality / town
Mount Airy
2d
Subdivision name
NA
2e
NCDOT only, T I P or state
project no
NA
3.
Owner Information
3a
Name(s) on Recorded Deed
Hodges, Robert B
,
3b
Deed Book and Page No
01428, 0651
3c
Responsible Party (for LLC if
applicable)
3d
Street address
180 Twin Rocks Lane APP
9. R MIA
3e
City, state, zip
Low Gap, NC
3f
Telephone no
336- 352 -4804 15INR - �►A AL 1Y
3g
Fax no
NA
3h
Email address
NA
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
Charles Anderson
4c
Business name
(if applicable)
The Resource Institute, Inc
4d
Street address
2714 Henning Drive
4e
City, state, zip
Winston Salem NC 27106
4f
Telephone no
336 - 750 -0522
4g
Fax no
336- 750 -0177
4h
Email address
canderson @pilotviewrcd org
S.
Agent /Consultant Information (if applicable)
5a
Name
Kevin Tweedy
5b
Business name
(if applicable)
Ecosystem Planning and Restoration
5c
Street address
104 -A Fountain Brook Circle
5d
City, state, zip
Cary, NC 27511
5e
Telephone no
919 - 388 -0787
5f
Fax no
919 - 388 -0789
5g
Email address
ktweedy @eprusa net
Page 2 of 11

B.
Project Information and Prior Project History
1.
Property Identification
1a
Property identification no (tax PIN or parcel ID)
407100486993
lb
Site coordinates (in decimal degrees)
Latitude 36 5359 Longitude - 80 7870
(DD DDDDDD) ( -DD DDDDDD)
1c
Property size
16 78 acres
2.
Surface Waters
2a
Name of nearest body of water (stream, river, etc) to
Little Fisher River
proposed project
2b
Water Quality Classification of nearest receiving water
Class C — Trout Waters
2c
River basin map is available at
Upper Yadkin - 03040101
http / /h2o 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
Several sections of channel for proposed stream enhancement have been identified as significantly degraded due to loss
of bank vegetation and subsequent lateral erosion
3b
List the total estimated acreage of all existing wetlands on the property
0
3c
List the total estimated linear feet of all existing streams (intermittent and perennial) on the property
Approximately 1,500 ft (652 ft within the proposed work area)
3d
Explain the purpose of the proposed project
The purpose of this project is to provide bank stabilization and habitat improvement through stream enhancement
practices
3e
Describe the overall project in detail, including the type of equipment to be used
This project is being conducted as a NRCS Environmental Quality Incentives Program Project (EQIP) NRCS and state
grant funding are being used to improve stream stability and instream habitat This project is not being used for mitigation
purposes
The proposed work will include bank sloping, benching, replanting, and the used of rock vane structures to promote
stability and improve instream habitat Tracked excavators, dump trucks, and loaders will be the primary pieces of
equipment that are expected to be used for construction
Page 3 of 11
PCN Form — Version 1 3 December 10, 2008 Version

4.
Jurisdictional Determinations
4a
Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
El Yes ®No E] Unknown
project (including all prior phases) in the pasty
Comments no wetland areas have been identified
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
5.
Project History
5a
Have permits or certifications been requested or obtained for
❑ Yes ® No ❑ Unknown
this project (including all prior phases) in the past?
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)
T
—Temporary
W1 ❑ P FIT
❑ Yes
❑ Corps
❑ No
❑ DWQ
W2 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W3 ❑ P ❑ T
❑ Yes
❑ Corps
El No
El DWQ
W4 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W5 ❑ P ❑ T
El Yes
[_1 Corps
❑ No
❑ DWQ
W6 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
2g. Total wetland impacts
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
Stream
Enhancement
Little Fisher River
® PER
❑ INT
® Corps
I ® DWQ
26'
652'
S2 ❑ P ❑ T
❑ PER
[:1 Corps
❑ INT
❑ DWQ
S3 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S4 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S5 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S6 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
3h Total stream and tributary impacts
652
31 Comments impacts are proposed in order to improve overall stream stability and function
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 indivii 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
0. Total open water impacts
4g Comments
5. Pond or Lake Construction
If pond or lake construction proposed, the 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 ❑ Tar - Pamlico ❑ Other
Project is in which protected basin?
❑ 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
B1 ❑P ❑T
-required?
El Yes
❑ No
B2 ❑P ❑T
F-1 Yes
❑ No
B3 ❑P ❑T
El Yes
❑ No
6h Total buffer impacts
61 Comments
Page 6 of 11

D.
Impact Justification and Mitigation
1.
Avoidance and Minimization
1a
Specifically describe measures taken to avoid or minimize the proposed impacts in designing project
This work is being proposed as a stream enhancement project, with the overall intent of improving stream stability and
function Areas of the stream that are currently functioning and stable will not be disturbed
b
Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
Construction equipment access to the stream itself will be limited to the extent practical, and erosion control practices will
be used to minimize any potential impacts from sediment run off during construction For additional information, see the
construction plans and specifications
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?
1 b
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 Impervious
area is less than 24 %, and
no increase in impervious surface is proposed as part of the project
2d
If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan
❑ Certified Local Government
2e
Who will be responsible for the review of the Stormwater Management Plan?
❑ DWQ Stormwater Program
❑ DWQ 401 Unit
3.
Certified Local Government Stormwater Review
3a
In which local government's jurisdiction is this project?
NA
❑ Phase II
3b
Which of the following locally - implemented stormwater management programs
❑ NSW
❑ 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)?
1 c
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)
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
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
NA
Page 10 of 11
PCN Form — Version 1 3 December 10, 2008 Version

S.
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?
E:1 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?
Natural Heritage website and USFWS
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?
It is not near the coast
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?
Site is being reviewed by the NRCS State Archeologist to determine potential effects, per NRCS guidelines and policies
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 Flood maps website
4U �uX
Applicant/Agent's Printed ame
Date
AppllZc Age gZ�i+r�
(Agent's si ture is valid if authorization letter from the applicant
is provided
Page 11 of 11

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Mr Erin Bennett
- ` y, 111111111 mill 11111111 1111111 111111 ii�pqi
FISH AND WILDLIFE SERVICE
Asheville field Office
160 Zillicoa Street
Asheville North Carolina 28801
April 15, 2013
Ecosystem Planning and Restoration, LLC
104 Fountain Brook Circle, Suite A
Cary, North Carolina 27511
Dear Mr Bennett
Subject Federally Endangered and Threatened Species Assessment, Little Fisher Creek
Restoration and Enhancement Project (Hodges Site), in Surry County, North Carolina
On March 12, 2014, we received a letter from you in which you requested our review and
comments for the proposed project We have reviewed the information presented and we are
providing the following comments in accordance with the provisions of the Fish and Wildlife
Coordination Act, as amended (16 U S C 661- 667e), and section 7 of the Endangered Species
Act of 1973, as amended (16 U S C 1531 -1543) (Act)
Your letter indicates that steam restoration measures are proposed for a 1,500 linear feet segment
of Ring Creek Restoration activities will include bank sloping, benching, replanting of riparian
buffers, realignment of stream channel with the use of rock and log vanes No specific plans for
the project were included The project site consists of agricultural fields and little to no riparian
buffer exists along the length of stream proposed for restoration work
Endangered Species. According to our records and a review of the information presented, no
listed species or their habitats occur on the site Therefore, we believe the requirements under
section 7 of the Act are fulfilled However, obligations under section 7 of the Act must be
reconsidered if (1) new information reveals impacts of this identified action that may affect
listed species or critical habitat in a manner not previously considered, (2) this action is
subsequently modified in a manner that was not considered in this review, or (3) a new species is
listed or critical habitat is determined that may be affected by the identified action
Project Recommendations. We have no objection to the proposed actions and support any
efforts to restore and protect the water quality in the project area Because stream conditions are
least affected where stream banks are stabilized by deep- rooted woody vegetation, stream
restoration efforts should incorporate the use of native vegetation adapted to site conditions
Biodegradable erosion- control materials should be incorporated into bank restoration design in
order to stabilize soils as vegetation becomes established Live, dormant stakes (such as black
willow) may be used to reestablish root structure in riparian areas In areas where banks are

severely undercut, high, and steep, whole tree revetments or rock may be used as a stabilization
treatment (small rock, gravel, sand, and dirt are not recommended due to their erosive nature)
However, it should not extend above the bank -full elevation (the elevation of the channel where
the natural floodplam begins), and deep - rooting woody vegetation should be established along
banks where any channel work is accomplished Tree and shrub plantings should be spaced at
intervals no greater than 10 feet along banks We generally recommend that forested riparian
buffers (a minimum 50 feet wide along intermittent streams and 100 feet wide along perennial
streams [or the full extent of the 100 -year floodplam, whichever is greater]) should be created
and /or maintained along all aquatic areas If these widths are not practicable then we recommend
that the vegetated riparian zone extend at least 25 feet from the stream channel.
Also, the presence of large woody debris is an important aspect of natural stream conditions in
headwater streams Woody debris, detritus and other vegetative materials are the main source of
nutrients and carbon necessary for primary productivity in these stream ecosystems Removal of
this material can affect the production of higher trophic levels, specifically in fish The Service
does not recommend the removal of woody debris within the stream channel or floodplam unless
it is causing a debris blockage (logjam) or will affect the ability to achieve bank stability along a
specific reach of stream
Erosion Control and Wetland /Stream Protection. We recommend that measures to control
sediment and erosion should be installed before any ground disturbing activities occur Grading
and backfllmg should be minimized, and existing vegetation should be retained (if possible) to
maintain shoreline cover for fish and wildlife Disturbed areas should be re- vegetated with
native grass and tree species as soon as the project is completed
We appreciate the opportunity to provide these comments If we can be of assistance or if you
have any questions, please do not hesitate to contact Mr Bryan Tompkins of our staff at
828/258 -3939, Ext 240 In any future correspondence concerning this project, please reference
our Log Number 4 -2 -14 -152
Sincerely,
- origmul.si -lied - -
Janet Mizzi
Field Supervisor
2

Erin Bennett
From: Besler, Doug A <doug besler@ncwiIdlife org>
Sent: Tuesday, March 2S, 2014 1045 AM
To: ebennett @eprusa net
Cc- Hodges, Kinnon B
Subject: Stream Stabilization project in Surry County
Good morning Ms Bennett,
Thank you for requesting a review of the Little Fisher and Ring Creek stream stabilization projects in Surry County, North
Carolina I forward the request to Kin Hodges, our District 7 Fisheries Biologist, who completed the review We see no
issues with either project and support the work We will have no objections to the projects and would not request the trout
spawning moratorium for any permits The Little Fisher site, as you pointed out, is Hatchery Supported and is stocked by
our agency from March through June annually Anglers will often make us aware of any perceived water quality issues,
so making sure the contractors pay particular attention to sediment and erosion control plans will be very helpful in
minimizing this
Good luck with your project and we will comment on the actual permits as quickly as we can so you can move forward
with your project Please let Kin or myself know if you have any questions
Thanks,
Doug
Doug Besler
Mountain Region Fisheries Supervisor
North Carolina Wildlife Resources Commission
645 Fish Hatchery Rd
Marion, NC 28752
828- 659 -8684 Ext 221 (Office)
919 -818 -7886 (Mobile)
doug besler(&ncwildlife oig
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NC REQUEST FOR CULTURAL RESOURCE REVIEW (Ver, 0107)
(This document Is Freedom of Information Exempt)
I to. Jim Errante, CRS, NRCS, 1635 Assembly St., Room 950, Columbia SC 29201
Ph (803) 253 -3937, FAX [phone], Jim errenteCsc usda gov
Dat Z County '75-R rT _ Program Type- Lre? J r°
NRC S Cooperator /Reference Name(s).
Tra #(s) if more that more than one form submitted for this same cooperator: 7-- � 7!>.:P!2
List Jndertakhgs by Name r'�%5'�'�tnt /j1etf� • lntQrdts. e 7°rm),,
Size of APE (Area of Potential Effect) on iv (estimate total area to be disturbed in acres),
Percentage of Ground Surface (soil) Visible < 20'%
Type of Ground Cover (if present) S��"H�, (.✓0- t.6$
Comments or:Noteworthy Characteristics ((i.e, soil dralnage /terrain /disturbances).
Name of USGS Quad(s) Containing APE �� b� 6t*•. Y��ivG
Staple a photocopy of the practice area (8 6 x 11) taken from a USGS topo quad map series (or a map of very
similar likeness) and clearly note the APE! Use a scale as close to 1:24,000 as possible. Please keep in mind
that the reviewer must be able to easily relocate your APE on a regular USGS topo quad map.
If any cultural resources (prehistoric or historic) are known to exist In the immediate vicinity of the practice
area briefly describe.
Landowner/ Local recollections of CR in APE
Print name of Contact person to respond to regarding this request A a JE� "
-- - -- -- -
----------------- • ----- - - - - -- --------------------------------------- - - - - -- -
(BELOW TO BE COMPLETED BY SHPO AND(OR CRS)
archaeological sites have been prevlousl ec ed within the APE of this practice.
Comments - ,--- - - - -.. C.e_C..k- _��4:�!'. __ _.�
y----- -------------- - - - - -- -------- --
............ - ------------------ ...............................................----------....--
roceed with Conservation Planning activities. CR Survey should be documented on the Invent
of Planning Area form and NC- CPA -52 or optional CR Survey Documentation form (see eFOTG, sec
If at anyurna, evidence of cuitual resources Is found In the APE then all MRCS assibted activitles shoWd be baited
Additional follow up is needed for the Cultural Resources Review Contact Jim Errante prior to
proceeding with design or installation 2
Signature Date
wv" c., /.S Co,, izk"/ A

Conservation Plan Map Date 6/19/2012
c ud L.awtb� bufj ✓,4/,v6-
Customer(s) ROBERT B HODGES Field Office DOBSON SERVICE CENTER
Agency NRCS
District SURRY SOIL & WATER CONSERVATION DISTRICT Assisted By JOSEPH BAILEY
Approximate Acres 23 8 State and County NC, SURRY
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4' Feet

AGENT AUTHORIZATION FORM
FOR WNCSI STREAM PROJECTS
PROPERTY LEGAL DESCRIPTION:
LOT NO N/A PLAN NO. N/A PARCEL ID: 407100486993
STREET ADDRESS: 180 Twin Rocks Lane Low Gap, NC 27024
Please print:
Property Owner: Hodges, Robert B
Property Owner:
The property owners above have entered into a Memorandum of Understanding with Resource
Institute, Inc. that authorizes the activities proposed on the subject property (see attached for
reference). As an authorized representative of Resource Institute, I do hereby authorize
Kevin Tweedy , of Ecosystem Planning and Restoration
(Contractor / Agent) (Name of consulting firm)
to act on behalf of Resource Institute 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.
Resource Institute's Address:
2714 Henning Drive, Winston - Salem, NC 27106
Telephone: (336)- 750 -0522
We hereby certify the above information submitted in this application Is true and accurate to the
best of our knowledge.
V
Authorized Signature Authorized Signature
Date: (` 1 ` 11-1 Date:

Mutual Agreement
for
Stream Restoration Project
Resource Institute (RI) is a non -profit organization that assists organizations and individuals in
carrying out projects to protect natural and human resources while promoting economic development.
RI can assist with projects in a variety of ways, including, but not limited to, fund- raising,
administering project funds, and contracting for services needed to complete a project. RI has recently
adopted a project referred to as the Western North Carolina Stream Initiative to help farmers and
landowners address eroding stream banks that are negatively affecting them through loss of property,
hazards for livestock, sediment transport into a stream and degraded aquatic habitat. The
farmer /landowner has either initiated an application for assistance through USDA/NRCS's EQIP
program or has already signed an agreement/contract for assistance with USDA/NRCS's EQ1P
program. RI's role is to help attain the funding, for the design, construction oversight and unmet
construction needs of the work for sites with current EQIP program agreements /contracts through
USDA/NRCS.
RI will assist the farmer/landowner by helping to address issues related to managing and
contracting for the required design, planning, permitting and construction work for stream enhancement
practices on the site, as well as necessary structure work, and bank stabilization. RI's objective is to
help address current water quality degradation issues; however, work cannot be guaianteed for acts of
nature related to flood events. RI is working with NRCS, Conservation Districts and the
farmer /landowner to help reduce those impacts as much as possible.
In providing services to the fanner/landowner on this tract of land for stream
restoration/stabilization activities to be performed we thereby mutually agree to the following items:
1. The farmer /landowner will allow ingress and egress for all activities related to the stream
restoration/stabilization such as. surveys, engineering, construction, monitoring, etc. for RI and
its agents.
2. Farmer /landowner will follow the contractual guidance in the EQIP program with USDA,
NRCS
3. Farmer /landowner will provide RI with a copy of the NRCS EQIP contract, for the purpose of
allowing RI to share with RI's other fenders in an effort to help obtain matching dollars
4. RI will serve as the financial manager for all funds related to the stream restoration/stabilization
activities received for the project.
5. RI will provide project management services such as, obtaining the technical resources, bidding
and contracting of project elements, and project construction oversight.
6. RI will work with farmers /landowners to resolve differences between construction costs and
payment schedule rates

Signature Sheet:
Stream Restoration Project Agreement Letter
-Z-- >�
County
WAr
MIM
Date
Resource Institute Incorporated
Resource In$ itute RC &D, Inc.
Date