20230631 Ver 1_ePCN Application_20230428

i DWR
Division of Water Resources
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
April 13, 2022 Ver 4.3
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.
Pre -Filing Meeting Date Request was submitted on:
9/21/2020
BIMS # Assigned
20230631
Is a payment required for this project?*
No payment required
Fee received
Fee needed - send electronic notification
Reviewing Office*
Winston-Salem Regional Office - (336) 776-
9800
Information for Initial Review
la. Name of project:
Fieldstone Subdivision Phase 1
la. Who is the Primary Contact?*
Brent Nesom
1b. Primary Contact Email: *
[e-mail]
Date Submitted
4/28/2023
Nearest Body of Water
Fryes Creek
Basin
Yadkin-PeeDee
Water Classification
03040101
Site Coordinates
Latitude:
35.956118
A. Processing Information
Is this project connected with ARPA funding?
Yes No
County (or Counties) where the project is located:
Davidson
Is this a NCDMS Project
Yes No
Longitude:
-80.275046
Version#*
1
What amout is owed?*
$240.00
$570.00
Select Project Reviewer*
Seren Homer:[e-mail]
1c. Primary Contact Phone: *
[phone]
O

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)
Has this PCN previously been submitted?*
Yes
No
Please provide the date of the previous submission.
10/22/2020
1b. 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:
NWP Numbers (for multiple NWPS):
29
1d. Type(s) of approval sought from the DWR:
401 Water Quality Certification - Regular
Non-404 Jurisdictional General Permit
Individual 401 Water Quality Certification
43 - Storm Water Management Facilities
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
1h. 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:
Clayton Properties Group, LLC
2b. Deed book and page no.:
25821053
2c. Contact Person:
Will Derrickson
401 Water Quality Certification - Express
Riparian Buffer Authorization
Yes No
Yes No
O

2d. Address
Street Address
221 Jonestown Road
Address Line 2
City
Winston Salem
Postal / Zip Code
27104
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Brent Nesom
4b. Business Name:
FEI
4c.Address
Street Address
8518 Triad Drive
Address Line 2
city
Colfax
Postal / Zip Code
27235
4d. Telephone Number:
[phone]
4f. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(if appropriate)
Fieldstone
1c. Nearest municipality / town:
Lexington
2. Project Identification
2a. Property Identification Number:
301400000027
2c. Project Address
Street Address
800 South Union Grove Road
Address Line 2
city
Lexington
Postal / Zip Code
27295
3. Surface Waters
3a. Name of the nearest body of water to proposed project:
Fryes Creek
3b. Water Resources Classification of nearest receiving water:
03040101
3c. What river basin(s) is your project located in?
Yadkin-PeeDee
State / Province / Region
NC
Country
USA
2f. Fax Number:
State / Province / Region
NC
Country
USA
4e. Fax Number:
2b. Property size:
33
State / Province / Region
NC
Country
USA

3d. Please provide the 12-digit HUC in which the project is located.
030401011308
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: "
Agricultural areas with some clusters of wooded areas. Very Open for the majority of the site.
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:
2.5
4g. List the total estimated linear feet of all existing streams on the property:
9,470
4h. Explain the purpose of the proposed project:"
Single Family residential subdivision
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:
There are 2 phases of single family residential homes. The overall impacts will be to the wetlands for a pond and the a wetland impact for a culvert crossing.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?
Yes No Q Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
Preliminary Approved Not Verified Unknown N/A
Corps AID Number:
SAW-2020-01640
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): David Brame
Agency/Consultant Company: Pilot
Other:
5d. List the dates of the Corp jurisdiction determination or State determination if a determination was made by the Corps or DWR
10/20/2020
6. Future Project Plans
6a. Is this a phased project?*
Yes No
6b. If yes, explain.
Phase 2 will incorporate 200+ single family residential homes
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
2. Wetland Impacts
W-1
2a1 Reason (?)
Pond
2b. Impact type * (?)
P
2c. Type of W. *
Unknown
2d. W. name
DW1
2e. Forested *
No
2f. Type of Jurisdicition *
?)
Corps
2g• Impact
area *
0.200
(acres)
E�]
Culvert
P
ffUnknownCorpsDW1No
0.090
(acres)

2g. Total Temporary Wetland Impact
0.000
2g. Total Permanent Wetland Impact
0.290
2g. Total Wetland Impact
0.290
2i. Comments:
Installation of Pond will be fill in this impact area (NWP 43) and the Road Crossing will have a Culvert associated (NWP 29)
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:
Refocusing the layout to have only one pond impact and having no streams impacted and only have impacts to Wetlands
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Using low light weight machinery and non -track machinery where applicable.
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:
Area of impact is below individual thresholds for each NWP applied
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
What type of SCM are you providing?
Level Spreader
Vegetated Conveyance (lower SHWT)
Wetland Swale (higher SHWT)
Other SCM that removes minimum 30 % nitrogen
Proposed project will not create concentrated stormwater flow through the buffer
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
2c. Does this project have a stormwater management plan (SMP) reviewed and approved under a state stormwater program or state -approved local government stormwater program?
Yes No
N/A - project disturbs < 1 acre
2d. Which of the following stormwater management program(s) apply:
Local Government State
State Stormwater Programs
Phase II Coastal Counties
HWQ or ORW Other
Comments:
Fast Track Application is to be applied.
G. Supplementary Information
1. Environmental Documentation
1a. 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 impacts outside of the shown are planned.
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
5d. Is another Federal agency involved?*
Yes No Unknown
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
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?
The online USFWS Online search tool https://fws.maps.arcgis.com
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?
Online GIS data system
https://www.habitat.noaa.gov
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?
Using the http://gis.ncdcr.gov/hpoweb/ provided above
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?
Yes No
Be. What source(s) did you use to make the floodplain determination?
Using the firmette maps provided.
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
Wetland Impact Maps.pdf 9.44MB
File must be PDF or KMZ
Comments
See attached PJD for reference
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.
Full Name:
Brent Nesom
Signature
Date
4/28/2023
M