20141116 Ver 1_401 Application_20141014

JACOB D GRIEB, PE
218 W Holston Ave
Johnson City, TN 37604
502.314.9162
[e-mail]
TO NC DWO. W8SCP Unit
1650 Mail Service Center
Raleigh , NC 27699
WE ARE SENDING YOU
Q Shop drawings
❑ Copy of letter
LETTER OF TRANSMITTAL
DATE
1 10/20/14
JOB NO 14001
ATTENTION.
10/20/14
SUBJECT:
PCN
Tracy Grove Road
Commercial
10/20/14
11 x 17 Exhibit
1
10/20/14
Q Attached ❑ Under separate cover via
❑ Prints ❑ Plans ❑ Samples
❑ Change Order ❑ Agreement & Resolution
the following items
❑ Specifications
COPIES
DATE
NO
DESCRIPTION
1
10/20/14
❑
PCN
1
10/20/14
11 x 17 Exhibit
1
10/20/14
Agent Authorization Form
1
10/20/14
Check Application Fee
THESE ARE TRANSMITTED as checked below
❑
For approval
❑
For your use
Q
As requested
❑
For review and comment
❑
For BIDS DUE
❑ Approved as submitted
❑ Approved as noted
❑ Returned for corrections
20
❑ Resubmit copies for approval
❑ Submit copies for distribution
❑ Return corrected prints
❑ PRINTS RETURNED AFTER LOAN TO US
REMARKS
Please see attached for review If you have any questions please let me know
COPYTO file
SIGNED
Jacdb Grieb, PE

Cs c
2 0 1 4 1 1 1 6
Office Use Only
Corps action ID no
DWQ project no
Form Version 1 4 January 2009
Page 1 of 10
PCN Form — Version 1 4 January 2009
Pre - Construction Notification (PCN) Form AIE
A.
Applicant Information
1.
Processing
la
Type(s) of approval sought from the Corps
❑ Section 404 Permit
❑ Section 10 Permit
lb Specify Nationwide Permit (NWP) number 39 or General Permit (GP) number
1c
Has the NWP or GP number been verified by the Corps?
❑ Yes ❑X 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 X❑ No
For the record only for Corps Permit
❑ Yes ❑X 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 protect located in any of NC's twenty coastal counties If yes, answer 1h
below
❑ Yes NX No
1h
Is the project located within a NC DCM Area of Environmental Concern (AEC)
❑ Yes ❑X No
2.
Project Information
2a
Name of project
Tracy Grove Road Commercial Development
2b
County
Henderson
2c
Nearest municipality / town
Hendersonville
2d
Subdivision name
Dana Road
2e
NCDOT only, T I P or state project no
3.
Owner Information
1,
3a 3a
Name(s) on Recorded Deed
Hooper's Creek Property Management, LLC
2 2 M4 , 4
3b
Deed Book and Page No
DB15882 PG470
3c
Responsible Party (for LLC if
applicable)
Dennis Dorn
401 $ BUFFER P `SL7iJFiCES
ERMrTT�NG
3d
Street address
730 Sugarloaf Rd
3e
City, state, zip
Hendersonville, NC 28792
3f
Telephone no
3g
Fax no
3h
Email address
Page 1 of 10
PCN Form — Version 1 4 January 2009

4.
Applicant Information (if different from owner)
4a
Applicant is
❑X Agent ❑ Other, specify
4b
Name
Jacob D Gneb, PE
4c
Business name
(if applicable)
4d
Street address
218 W Holston Ave
4e
City, state, zip
Johnson City, TN 37604
4f
Telephone no
502 - 314 -9162
4g
Fax no
4h
Email address
Jacob grieb @gmail com
5.
Agent/Consultant Information (if applicable)
5a
Name
Jacob D Gneb, PE
5b
Business name
(if applicable)
5c
Street address
218 W Holston Ave
5d
City, state, zip
Johnson City, TN 37604
5e
Telephone no
502 - 314 -9162
5f
Fax no
5g
Email address
Jacob grieb @gmail com
Page 2 of 10

B.
Project Information and Prior Project History
1.
Property Identification
1a
Property identification no (tax PIN or parcel ID)
9579128256
1b
Site coordinates (in decimal degrees)
Latitude Longitude
1c
Property size
298 acres
2.
Surface Waters
2a
Name of nearest body of water to proposed project
Devils Fork
2b
Water Quality Classification of nearest receiving water
C
2c
River basin
French Broad
3.
Project Description
3a
Existing
Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application
conditions are open space with overgrown vegetation throughout the site General land use with in the area is highway business
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 1260
3d Explain the purpose of the proposed project
Provide development for commercial use space
3e Describe the overall project in detail, including the type of equipment to be used
Overall project will consist of an approximately 11000 sq ft building to house golf and rental equipment including parking, drives, & stormwater BMPs
4.
Jurisdictional Determinations
4a
Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (including all prior phases) in the past?
❑ Yes ❑ No ❑X Unknown
Comments
4b
If the Corps made the jurisdictional determination, what type
of determination was made?
❑ Preliminary ❑ Final
4c
If yes, who delineated the jurisdictional areas?
Name (if known)
Agency /Consultant Company
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
this project (including all prior phases) in the past?
❑ Yes ❑ No X❑ Unknown
5b
If yes, explain in detail according to "help file" instructions
6.
Future Project Plans
6a
Is this a phased project? --T[3
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
la Which sections were completed below for your project (check all that apply)
❑ Wetlands ❑X 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
Wetland impact
number
Permanent (P) or
Temporary T
2b
Type of impact
2c
Type of wetland
2d
Forested
2e
Type of jurisdiction
Corps (404,10) or
DWQ (401, other)
2f
Area of
impact
(acres)
W1
Choose one
Choose one
Yes /No
-
W2
Choose one
Choose one
Yes /No
W3
Choose one
Choose one
Yes /No
W4
Choose one
Choose one
Yes /No
W5
Choose one
Choose one
Yes /No
W6
Choose one
Choose one
Yes /No
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
Stream Impact
number
Permanent (P) or
Temporary (T)
3b
Type of Impact
3c
Stream name
3d
Perennial (PER) or
intermittent (I NT)?
3e
Type of
jurisdiction
3f
Average
stream
width
(feet)
3g
Impact
length
(linear
feet)
S1 P
Culvert
Unnamed Tributary
PER
DWQ
15
150
S2
Choose one
S3
Choose one
S4
Choose one
S5
Choose one
S6
Choose one
3h Total stream and tributary impacts
150
31 Comments
Proposed culvert to provide a efficient and user friendly development
Page 4 of 10
PCN Form — Version 1 4 January 2009

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
Open water
impact number
Permanent (P) or
Temporary T
4b
Name of waterbody
(if applicable)
4c
Type of impact
4d
Waterbody
type
4e
Area of impact (acres)
01
Choose one
Choose
O2
Choose one
Choose
03
Choose one
Choose
04
Choose one
Choose
4f Total open water impacts
4g Comments
5. Pond or Lake Construction
If pond or lake construction proposed, then complete the chart below
5a
Pond ID number
5b
Proposed use or
purpose of pond
5c
Wetland Impacts (acres)
5d
Stream Impacts (feet)
5e
Upland
(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
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 Project is in which protected basin?
❑ Neuse ❑ Tar - Pamlico ❑ Catawba ❑ Randleman ❑ Other
6b
Buffer Impact
number —
Permanent (P) or
Temporary T
6c
Reason for impact
6d
Stream name
6e
Buffer
mitigation
required?
6f
Zone 1
impact
(square
feet
6g
Zone 2
impact
(square
feet
131
Yes /No
B2
Yes /No
B3
Yes /No
B4
Yes /No
B5
Yes /No
B6
Yes /No
6h Total Buffer Impacts
61 Comments
Page 5 of 10

D.
Impact Justification and Mitigation
1.
Avoidance and Minimization
1a Specifically describe measures taken to avoid or minimize the proposed impacts In designing project
Developed altrenative site plans to minimize stream impacts Use of LID and BMP to design stormwater quality devices
1 b Specifically describe measures taken to avoid or minimize the proposed Impacts through construction techniques
Use of ConSPAN to limit strem impacts for entrance to site
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 ❑X 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
El 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 Choose one
Type Choose one
Type Choose one
Quantity
Quantity
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
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
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
Page 6 of 10
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 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
6d
6e
Zone
Reason for impact
Total impact
Multiplier
Required mitigation
(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
la
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?
1b
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'?
25%
2b
Does this project require a Stormwater Management Plan?
0 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
Construction of potentiial permeable pavement, rain barrels, filter strip, and wet detention Other BMP's may be used as well
2e
Who will be responsible for the review of the Stormwater Management Plan?
City of Hendersonville
3.
Certified Local Government Stormwater Review
3a
In which local government's jurisdiction is this project?
City of Hendersonville
0 Phase II
❑ NSW
3b
Which of the following locally - implemented stormwater management programs
❑ USMP
apply (check all that apply)
❑ Water Supply Watershed
❑ Other
3c
Has the approved Stormwater Management Plan with proof of approval been
❑Yes ❑X 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?
❑X Yes ❑ No
5b
Have all of the 401 Unit submittal requirements been met?
❑ Yes ❑X No
Page 8 of 10
PCN Form — Version 1 4 January 2009

F. Supplementary Information
1
Environmental Documentation (DWQ Requirement)
la
Does the project involve an expenditure of public (federal /state /local) funds or the
❑ Yes X❑ No
use of public (federal /state) land?
1 b
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)?
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 ❑ 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,
E] Yes ❑X No
or Riparian Buffer Rules (15A NCAC 2B 0200)?
2b
Is this an after - the -fact permit application?
El Yes ❑X 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 ❑X 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 faculty
Site
will be served by City of Hendersonville sewer department
Page 9 of 10
PCN Form — Version 1 4 January 2009

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?
❑X Yes ❑ No
5b Have you checked with the USFWS concerning Endangered Species Act
impacts?
Fx� Yes ❑X No
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?
Website, existing data from previous project within area
6. Essential Fish Habitat (Corps Requirement)
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?
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 (e g , National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
❑ Yes ❑X No
7b What data sources did you use to determine whether your site would impact historic or archeological resources?
8. Flood Zone Designation (Corps Requirement)
8a Will this project occur in a FEMA - designated 100 -year floodplain?
❑X Yes ❑ No
8b If yes, explain how project meets FEMA requirements
Stream does not have a determined floodway Culvert will be desinged to not increse the floodplain more than a foot per FEMA regulations
8c What source(s) did you use to make the floodplain determination?
FEMA and City of Hendersonville
Applicant/Agent's Printed Name
(O 1101 12-01y-
Date
p licant/Agent's Signature
(Agent' ignature is valid only if an authorization
letter from the applicant is provided
Page 10 of 10

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION
PIN# 9579128256
STREET ADDRESS 9999 Tracy Grove Road Hendersonville, NC 28792
Please print
Property Owner Hooper's Creek Property Management, LLC
The undersigned, registered property owners of the above noted property, do hereby authorize
Jacob D Gneb, PE
to act on my behalf 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
Property Owner's Address (if different than property above)
730 Sugarloaf Rd Hendersonville, NC 28792
Telephone
We hereby certify the above information submitted in this application is true and accurate to the
best of our kno ledge
Auth ized Sig ture
Date 10'

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