20120396 Ver 2_401 Application_20240105

DWR
Dlvislon of Water Resources
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
October 2, 2023 Ver 4.3
Initial Review
Has this project met the requirements for acceptance in to the review process?
Yes No
Does this project involve maintenance dredging funded by the Shallow Draft Navigation Channel Dredging and Aquatic Weed Fund or involve the distribution or transmission of energy or
fuel, including natural gas, diesel, petroleum, or electricity?*
Yes No
Is this project a public transportation project?*
Yes No
Change only if needed.
BIMS # Assigned *
Version# *
20120396
2
Is a payment required for this project?*
No payment required
What amount is owed?*
Fee received
$240.00 $570.00
Fee needed - send electronic notification
$323.00 $767.00
Reviewing Office*
Select Project Reviewer*
Central Office - [phone]
Maria Poliui:Maria. Poliui
Information for Initial Review
1a. Name of project:
Moores Fork 2023 Repair
1a. Who is the Primary Contact?*
Lin Xu
1b. Primary Contact Email:* 1c. Primary Contact Phone:*
[e-mail] [phone]
Date Submitted
1 /5/2024
Nearest Body of Water
Moores Creek
Basin
Yadkin-PeeDee
Water Classification
WS-Iv
Site Coordinates
Latitude: Longitude:
35.567147-80.666127
A. Processing Information O
Is this project connected with ARPA funding?
Yes No
County (or Counties) where the project is located:
Surry
Is this a NCDMS Project
Yes No
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.
6/19/2020
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
If yes, please provide a statement concerning compliance with the Coastal Zone Management Act.
Nationwide Permit (NWP) Number: 03 - Maintenance
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
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:
Joshua Lee Horton, Kimberly A Horton
2b. Deed book and page no.:
BK 1765, PG 429-435
2c. Contact Person:
Joshua Lee Horton
401 Water Quality Certification - Express
Riparian Buffer Authorization
Yes No
Yes No

2d. Address
Street Address
351 Horton Road
Address Line 2
city
Mr. Airy
Postal / Zip Code
27030
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
3a. Name:
Lin Xu
3b. Business Name:
NC Division of Mitigation Services
3c.Address
Street Address
217 West Jones Street
Address Line 2
city
Raleigh
Postal / Zip Code
27603
3d. Telephone Number:
[phone]
3f. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Alex French
4b. Business Name:
KC I
4c.Address
Street Address
4504 Falls of Neuse Road, Suite 400
Address Line 2
City
Raleigh
Postal / Zip Code
27609
4d. Telephone Number:
[phone]
0. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality / town:
Mt. Airy
2. Project Identification
State / Province / Region
North Carolina
Country
Surry
2f. Fax Number:
State / Province / Region
NC
Country
Wake
3e. Fax Number:
State / Province / Region
NC
Country
Wake
4e. Fax Number:
O

2a. Property Identification Number: 2b. Property size:
2c. Project Address
Street Address
Address Line 2
City State / Province / Region
Postal / Zip Code Country
3. Surface Waters
3a. Name of the nearest body of water to proposed project:
Moores Creek
3b. Water Resources Classification of nearest receiving water:"
WS-IV
3c. What river basin(s) is your project located in?
Yadkin-PeeDee
3d. Please provide the 12-digit HUC in which the project is located.
03040101110010
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 project site is located in a rural watershed in Surry County. The proposed stream restoration repair areas are within a conservation easement associated with the existing stream
restoration site. Yje project is currently in monitoring year 7 and has dense herbaceous vegetation and plant saplings approximately 7 years old.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?
Yes No Unknown
If yes, please give the DWR Certification number or the Corps Action ID (exp. SAW-0000-00000).
DWQ# 12-0396 issued on January 17, 2013.
SAW-2011-02257 issued on December 12, 2012.
SAW-2011-02257 (2020 Repair) issued on July 22, 2020
4f. List the total estimated acreage of all existing wetlands on the property:
0.83
4g. List the total estimated linear feet of all existing streams on the property:
19370
4h. Explain the purpose of the proposed project:*
The propose of the repair project is to enhance stream channels fulfilling mitigation performance criteria and to stabilize stream channels.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used: *
The Moores Fork 2023 repair entails the construction of a riffle grade control with boulder drops, three live lifts, one riffle enhancement, miscellaneous bank grading, live staking and bare
root planting.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
Yes No 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:
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Andrew Bick
Agency/Consultant Company: Confluence Engineering, PC
Other:
6. Future Project Plans
6a. Is this a phased project?*
Yes O No

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
ta. Where are the impacts associated with your project? (check all that apply):
Wetlands Streams -tributaries Buffers
Open Waters Pond Construction
3. Stream Impacts
3a. Reason for impact (?)
3b.lmpact type "
3c. Type of impact'" �3�name*
��3e.
Stream Type *
3f. Type of
3h. Impact
❑
(?)
]3g.S.width*
Jurisdiction*
length*
gf
Riffle Repair
Permanent
Stabilization
Moores Fork
Intermittent
Both
�
98
Averege (feet)
(linear feet)
S2
Live Lift
Permanent
Stabilization
Moores Fork
Perennial
Both
25
82
Averege (feet)
(linear feet)
S3
Bank Grading and Live Lift
Permanent
Stabilization
Moores Fork
Perennial
Both
25
125
Averege (feet)
(linear feet)
S4
Live Lift
Permanent
Stabilization
Moores Fork
Perennial
Both
25
90
Average (feet)
(linear feet)
SS
Riffle Repair
Permanent
Stabilization
Moores Fork
Perennial
Both
�
61
Averege (feet)
(linear feet)
3i. Total jurisdictional ditch impact in square feet:
0
31. Total permanent stream impacts: 3i. Total temporary stream impacts:
456 0
3i. Total stream and ditch impacts:
456
3j. Comments
E. Impact Justification and Mitigation
1. Avoidance and Minimization
Ia. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
The proposed repair activities are designed to have an overall long-term positive impact. The proposed repair will address structure stability issues on
Moores Fork creek and replant bare areas within the easement.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Equipment traffic will avoid wetlands and properly functioning streams. Construction practices will follow guidelines outlined in the sedimentation and
erosion control permit.
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:
Project authorized under NWP are exempted from compensatory mitigation requirements.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
la. 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 Yadkin river basin is not regulated by NC buffer protection rules.
2. Stormwater Management Plan
Q
V
O

2a. Is this a NC DOT 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
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?
Yes No
1b. 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 (North Carolina)
Environmental Policy Act (NEPA/SEPA)?*
Yes No
Comments:*
A categorical exclusion was prepared by Confluence Engineering and signed off by the Federal Highway Administration on 12/11/2011. The project area
has not changed since construction and all proposed repairs will be within the existing conservation easement and stream footprints.
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.
Development is explicitly prohibited within the conservation easement and the project is not expected to encourage nor facilitate future development.
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.
Asheville
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?
USFWS and NCNHP databased were utilized.

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?
NOAA Essential Fish Habitat Mapper
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?"
Coordination was occurred with NC SHIPO and THPO
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?"
Yes No
8c. What source(s) did you use to make the floodplain determination?"
NC Floodmap
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
MooresRepair2023Repair404_COE.pdf
189.9KB
MooresFork2023Repair401 FeeMemo.pdf
227.7KB
MooresFork2023Repair401 COffice.pdf
234.64KB
Moores Fork 2023 Repair FINAL Construction Plans_2023-12-04.pdf
13.89MB
Moores Fork 2023 Repair FINAL Informal Bid Package 2023-12-18.pdf
1 MB
NWP3_NCDMS Moores Fork_SAW-2011-02257.pdf
219.66KB
Nationwide Permit 03 - Maintenance.pdf
162.24KB
D00011713-001 (401 for Moores).pdf
291.76KB
NWP27_2011-02257_Moores Fork EEP.pdf
4.23MB
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.
Full Name:
Lin Xu
Signature �y
Full Name (DMS Signature)
Lin Xu
DSM Signature �y
Date
1 /5/2024
a