20140623 Ver 1_401 Application_20140614

�oF wnrF9oG 2 0 1 Q 0 6 2 3 Office Use Only:
y T_ Corps action ID no.
° o DWQ project no.
Form Version 1.4 January 2009
Page 1 of 10
PCN Form —Version 1.4 January 2009
� 90
Pre - Construction Notification (PCN) Form
A.
Applicant Information
1.
Processing
1a.
Type(s) of approval sought from the Corps:
❑ Section 404 Permit ❑ Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: or General Permit (GP) number:
1c.
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):
❑X 401 Water Quality Certification — Regular ❑ Non -404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
1e.
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 ❑X No
1g.
Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below.
❑ Yes ❑X No
1h. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
El Yes ❑ No
2.
Project Information
2a. Name of project:
Dillon Harris
2b.
County:
Haywood
2c.
Nearest municipality / town:
Canton
2d.
Subdivision name:
2e.
3.
NCDOT only, T.I.P. or state project no:
Owner Information
3a.
Name(s) on Recorded Deed:
Terry Eugene Harris and Dillon Harris
3b.
Deed Book and Page No.
Book 473 Page 1415
iTL
3c.
Responsible Party (for LLC if
applicable):
3d.
Street address:
2983 Beaverdam Rd
Canton, INC 28716
3e.
City, state, zip:
3f.
Telephone no.:
828- 734 -8586
3g.
Fax no.:
3h.
Email address:
Page 1 of 10
PCN Form —Version 1.4 January 2009
� 90

I
4. Applicant Information (if different from owner)
4a. Applicant is: ❑ Agent ❑ Other, specify:
4b. Name:
4c. Business name
4d. Street address:
4e. City, state, zip:
4f. Telephone no.:
4g. Fax no.:
4h. Email address:
5. Agent/Consultant Information (if applicable)
5a. Name: John Ottinger
5b. Business name Natural Resource Conservation Service
5c. Street address: 589 Raccoon Rd Suite 203
5d. City, state, zip: Waynesville, NC 28786
5e. Telephone no.: 828452- 2741.3
5f. Fax no.:
5g. Email address: john.ottinger @nc.usda.gov
Page 2 of 10

B. Project Information and Prior Project History
1. Property identification
1a. Property identification no. (tax PIN or parcel ID): 8668 -29 -2758
1b. Site coordinates (in decimal degrees): Latitude: 35.585373 Longitude: -82.827606
1c. Property size: 5 acres
2. Surface Waters
2a. Name of nearest body of water to proposed project: Beaverdam Creek
2b. Water Quality Classification of nearest receiving water: Good
2c. River basin: French Broad
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:
Eroding stream bank adjacent to agricultural hay field.
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: 845
3d. Explain the purpose of the proposed project:
Stabilize eroding stream bank and reduce sedimentation reaching the stream.
3e. Describe the overall project in detail, including the type of equipment to be used:
In stream structures such as rock j- hooks, bank sloping, and toe stabilization. Trackhoe will be used for most work.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the ❑ Yes Q No ❑ Unknown
Corps or State been requested or obtained for this property / Comments:
ro'ect (including all prior phases) in the past?
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 ❑X 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 ❑X No
6b. If yes, explain.
Page 3 of 10
PCN Form — Version 1.4 January 2009

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
❑ Wetlands Q 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 impact Type of wetland Forested Type of jurisdiction Area of
number Corps (404,10) or impact
DWQ (401, other) (acres)
Permanent (P) or
W1
Choose one
Choose one
Yes /No
on the site,
3e.
Type of
jurisdiction
Choose one
Yes /No
3a.
Stream impact
number
Permanent (P) or
Temporary (T)
W2 _
Choose one
Choose one
Yes /No
8
W3
Choose one
Choose one
Yes /No
W4 _
Choose one
Choose one
Yes /No
W5
Choose one
Choose one
Yes /No
S3
W6
Choose one
2g. Total
Wetland Impacts:
S4 -
2h. Comments
3. Stream Impacts
If there are perennial
question for all stream
or intermittent stream
sites impacted.
impacts (including temporary
3c.
Stream name
impacts) proposed
3d.
Perennial (PER) or
intermittent (INT)?
on the site,
3e.
Type of
jurisdiction
then complete
3f.
Average
stream
width
(feet)
this
39
Impact
length
len 9
(linear
feet)
3a.
Stream impact
number
Permanent (P) or
Temporary (T)
3b.
of impact
Type . p
Beaverdam Creek
PER
Corps
8
100
S1 T
Stabilization
Choose one
S2
S3
Choose one
Choose one
Choose one
Choose one
S4 -
S5 -
S6
3h. Total stream
and tributary
impacts
100
3i. Comments:
Page 4 of 10
PCN Form — Version 1.4 January 2009

4. Open Water Impacts
tributaries, sounds, the Atlantic Ocean, or any other open water of
If there are proposed impacts to lakes, ponds, estuaries,
the U.S. then indivii ually list all open water impacts below.
4e.
4a. 4b. 4c. 4d.
Open water Name of waterbody
(if applicable) Type of impact Waterbody Area of impact (acres)
impact number
type
Permanent (P) or
Temporary
Choose one
Choose
01 -
Choose one
Choose
02 -
Choose one
Choose
03
04
Choose one
Choose
4f. 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.
Pond ID number Proposed use or Wetland Impacts (acres) Stream Impacts (feet) Upland
purpose of pond (acres)
Flooded Filled Excavated Flooded Filled Excavated
P1
Choose one
P2 Choose one
5f. Total:
5g. Comments:
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no:
5i. 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. Project is in which protected basin?
❑ Neuse ❑ Tar - Pamlico ❑ Catawba ❑ Randleman ❑ Other:
6b.
Buffer Impact
6c.
Reason for impact
6d.
Stream name
6e.
Buffer
6f.
Zone 1
6g.
Zone 2
number —
mitigation
impact
impact
Permanent (P) or
required?
(square
feet )
(square
feet
Temporary
B1
Yes /No
62
Yes /No
B3
Yes /No
B4
Yes /No
65
Yes /No
B6
Yes /No
6h. Total Buffer Impacts:
6i. Comments:
Page b of i u

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Design specifications follow natural channel stream design principals and meet NRCS standards and specifications.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Machinery will spend limited time in water. Will check machinery regularly for leaks.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for ❑ Yes ❑X No
Waters the U.S. or Waters of the State?
impacts to of
2b. If yes, mitigation is required by (check all that apply): ❑ DWQ ❑ Corps
❑ Mitigation bank
2c. If yes, which mitigation option will be used for this ❑ Payment to in -lieu fee program
project?
❑ Permittee Responsible Mitigation
3. Complete if Usin a Miti ation Bank
3a. Name of Mitigation Bank:
Type: Choose one Quantity:
3b. Credits Purchased (attach receipt and letter) Type: Choose one Quantity:
Type: Choose one Quantity:
3c. Comments:
4. Complete if Making a Payment to In -lieu Fee Pro ram
4a. Approval letter from in -lieu fee program is attached. ❑ Yes
4b. Stream mitigation requested:
linear feet
4c. If using stream mitigation, stream temperature:
Choose one
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:
s. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 6 of 1 U
PCN Form — Version 1.4 January 2009

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
Yes Q No
buffer mitigation?
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.
6c.
Reason for impact
6d.
Total impact
Multiplier
6e.
Required mitigation
Zone
(square feet)
(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 7 of 10

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 ❑X 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
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project? %
X
2b. Does this project re uire a Stormwater Mana ement Plan? ❑ Yes No
2c. if this project DOES NOT require a Stormwater Management Plan, explain why:
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
2e. Who will be responsible for the review of the Stormwater Management Plan?
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project?
3b. Which of the following locally - implemented stormwater management programs
apply (check all that apply):
3c. Has the approved Stormwater Management Plan with proof of approval been
attached?
4. DWQ
Review
4a. Which of the following state - implemented stormwater management programs apply
(check all that apply):
4b. Has the approved Stormwater Management Plan with proof of approval been
5. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements?
5b. Have all of the 401 Unit submittal requirements been met?
❑ Phase 11
❑ NSW
❑ USMP
❑ Water Supply Watershed
❑ Other:
❑ Yes ❑ No
❑Coastal counties
❑HQW
❑ORW
❑Session Law 2006 -246
❑Other:
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Page 8 of 10
PCN Form — Version 1.4 January 2009

F.
Supplementary Information
1.
Environmental Documentation (DWQ Requirement)
1a.
Does the project involve an expenditure of public (federal /state /local) funds or the
Yes ❑ No
use of public (federal /state) land?
1 b.
If you answered "yes" to the above, does the project require preparation of an
document pursuant to the requirements of the National or State
Q Yes ❑ No
environmental
(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 Z 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,
El Yes No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b.
Is this an after - the -fact permit application?
❑Yes Q 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 I ❑Yes Q 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.
Page 9 of 10
PCN Form — Version 1.4 January 2009

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 0 No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act ❑ Yes 0 No
impacts?
5c. If yes, indicate the USFWS Field Office you have contacted.
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
NRCS document CPA -52
6. Essential Fish Habitat (Corps Requirement)
-F 6a. Will this project occur in or near an area designated as essential fish habitat? ❑ Yes ❑X No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
NRCS document CPA -52
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 E] Yes 0 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?
NRCS cultural resources review.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA- designated 100 -year floodplain?
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?
Haywood County GIS records.
1), / /" /�, " �
Applicant/Agent's Printed Name
❑ Yes
—4op2pplicanVAgentV's Signature
(Agent's signature is valid only if an authorization
letter from the applicant is provided.)
Page 10 of 10
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Date

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