20231614 Ver 1_Addinfo Received_20240205

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Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre -Construction Notification (PCN) Form
A. Applicant Information
1.
Processing
1 a.
Type(s) of approval sought from the
Corps:
®Section 404 Permit El Section 10 Permit
1 b.
Specify Nationwide Permit (NWP) number: NWP 29 or General Permit (GP) number:
1 c.
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):
® 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
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
® No
1g.
Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below.
❑ Yes
® No
1 h.
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
® No
2.
Project Information
2a.
Name of project:
170 Carters Ridge Rd
2b.
County:
Davie
2c.
Nearest municipality / town:
Advance
2d.
Subdivision name:
NA
2e.
NCDOT only, T.I.P. or state
project no:
3.
Owner Information
3a.
Name(s) on Recorded Deed:
Nakeeta Sharpe
3b.
Deed Book and Page No.
00007/0065
3c.
Responsible Party (for LLC if
applicable):
NA
3d.
Street address:
609 Carolina Avenue Northt
3e.
City, state, zip:
Statesville, NC 28677
3f.
Telephone no.:
704-775-2510
3g.
Fax no.:
3h.
Email address:
[e-mail]
Page 1 of 12
PCN Form — Version 1.3 December 10, 2008 Version

4.
Applicant Information (if different from owner)
4a.
Applicant is:
❑ Agent ❑ Other, specify:
4b.
Name:
4c.
Business name
(if applicable):
4d.
Street address:
4e.
City, state, zip:
4f.
Telephone no.:
4g.
Fax no.:
4h.
Email address:
5.
Agent/Consultant Information (if applicable)
5a.
Name:
Bradley Luckey
5b.
Business name
(if applicable):
Pilot Environmental, Inc.
5c.
Street address:
PO Box 128
5d.
City, state, zip:
Kernersville, NC 27285
5e.
Telephone no.:
336.708.4997
5f.
Fax no.:
5g.
Email address:
[e-mail]
Page 2 of 12
PCN Form — Version 1.3 December 10, 2008 Version

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
5776494740
1 b. Site coordinates (in decimal degrees):
Latitude: 35.85666 Longitude: - 80.43621
(DD.DDDDDD) (-DD.DDDDDD)
1 c. Property size:
2.41 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
Humpy Creek
proposed project:
2b. Water Quality Classification of nearest receiving water:
Class C
2c. River basin:
Yadkin
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:
The site contains a gravel driveway, stream crossing, recently cleaered land and wooded land. Structures are not located
on the site. The site is located in a rural and residential area of Advance, Davie County, North Carolina.
3b. List the total estimated acreage of all existing wetlands on the property:
Wetland=0.00 ac
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
Streams=212 LF.
3d. Explain the purpose of the proposed project:
The purpose of the proposed project is to provide access to one single family residence and detached garage.
3e. Describe the overall project in detail, including the type of equipment to be used:
The overall project includes the construction of one single family residence with detached garage. In order to facilitate the
proposed development and access the site, it is necessary to have a stream crossing. Inadvertently, a culvert was
installed in a stream and a second stream was filled for construction of the access road. Graders, haulers, excavators
and other heavy equipment will be used during grading and construction of the single family residence
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
Yes ❑ No Unknown
project (including all prior phases) in the past?
Comments: NCDWR NOV-2023-CV-0015
4b. If the Corps made the jurisdictional determination, what type
El Preliminary El Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas?
Agency/Consultant Company: Pilot Enviromental, Inc.
Name (if known): Bradley Luckey 11.13.23
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.
Page 3 of 12
PCN Form — Version 1.3 December 10, 2008 Version

6. Future Project Plans
6a. Is this a phased project? ❑ Yes ® No
6b. If yes, explain.
Impacts to streams/wetlands, outside of those proposed in this application, are not anticipated as a result of the proposed
project.
Page 4 of 12
PCN Form — Version 1.3 December 10, 2008 Version

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. 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)
Temporary T
W1 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W2 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W3 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W4 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W5 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W6 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
2g. Total wetland impacts
2h. Comments: Wetland impacts are not proposed.
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
Road Fill/Keyed In
Unnamed
® PER
® Corps
4
34/30
Rip -Rap
❑ INT
❑ DWQ
S2 ®P ❑ T
Road and
Sideslope Fill
Unnamed
® PER
❑ INT
® Corps
❑ DWQ
2.5
139
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
169/30
3i. Comments: Stream Impact 1 will permanently impact 34 linear feet (136 square feet) of stream channel with access road fill
(culvert, sideslopes) and permanently impact 30 linear feet (120 square feet) of rip -rap inlet/outlet protection.
Stream Impact 2 will permanently impact 139 linear feet (348 square feet) of stream channel with access road fill.
Page 5 of 12
PCN Form — Version 1.3 December 10, 2008 Version

Temporary impacts are not proposed. Mitigation is not proposed.
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 individually 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 ❑P❑T
02 ❑P❑T
03 ❑PFIT
04 ❑P❑T
4f. Total open water impacts
4g. Comments: Open water impacts are not proposed.
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
Flooded
P1
P2
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:
Page 6 of 12
PCN Form — Version 1.3 December 10, 2008 Version

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 El Tar -Pamlico El 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
required?
131 ❑P❑T
❑Yes
❑ No
B2 ❑P❑T
❑Yes
❑ No
B3 ❑P❑T
❑Yes
❑ No
6h. Total buffer impacts
6i. Comments: Buffer impacts are not proposed.
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
The applicant has selected the crossing location in a relative straight portions of the streams. There are no other options to
access the property without stream crossings. The applicant selected the crossing location in an area that does not contain
wetlands. The remaining 208 linear feet of stream channel are being avoided.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Sediment and erosion control devices, including silt fence and silt fence outlets will be used to prevent down -gradient
sedimentation. If water is present during rip -rap installation, then a temporary coffer dam will be installed upgradient of the
culvert crossing. During rip -rap installation, water will be pumped around the construction footprint. Upon completion of the
culvert installation, the temporary sand bag coffer dam will be removed and flow will be diverted through the culvert.
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 ® No
impacts to Waters of the U.S. or Waters of the State?
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 Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter)
Type
Quantity
Page 7 of 12
PCN Form — Version 1.3 December 10, 2008 Version

3c. Comments: The applicant does not propose mitigation for impacts to streams.
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:
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?
❑ 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 12
PCN Form — Version 1.3 December 10, 2008 Version

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?
low density %
2b.
Does this project require a Stormwater Management Plan?
❑ Yes ® No
2c.
If this project DOES NOT require a Stormwater Management Plan, explain why: The project is low density. This estimate
accounts for anticipated impervious from lot development. Vegetative swales have been constructed adjacent to the
existing driveway crossing and area of woody vegtation have been allowed to establish along remaining portions of
stream on the site.
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?
Davie County
❑ 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
attached?
❑ Yes ❑ No
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 12
PCN Form — Version 1.3 December 10, 2008 Version

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. 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
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: A NEPA or SEPA is not required as part of this project.
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): The applicant is a
private individual who purchased the property with the intention to construct a primary residence sometime prior to Feburary
2023. The applicants were not aware of environmental protection regulations for streams or wetlands until informed by
NCDEMLR compliance concerns and NCDWR NOV 2023-CV-0015. Prior to NCDWR NOV, the applicants contractor
installed approximately 30 linear feet of 36" corrugated plastic pipe culvert into an estimated 34 linear feet of stream channel
for a driveway crossing. Additionally, the contractor filled an estimated 126 linear feet of stream channel for construction of
the access drive. Upon discovery of potential compliance concerns, the applicant immediately engaged another contractor to
stablize uplands areas and install silt fencing and other BMPs to prevent down -gradient sediment lost to waters and engaged
Pilot Environmental, Inc. (Pilot) to complete a forensic delineation of the site and to assist returning the site to compliance.
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.
We are not aware of additional development that will result which will impact nearby downstream water quality.
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.
Impacts from wastewater generation are not proposed.
Page 10 of 12
PCN Form — Version 1.3 December 10, 2008 Version

5. 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] 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?
The IPaC report for the site identifies the following federally protected species: Tri-colored bat (PT), Schweinitz's
sunflower (E) and Michaux's Sumac (E) as protected species that could be proximate to the project area.
The project area has previously been impacted and cleared, however, adjacent areas contains a mature hardwood forest
estimated to older than 30 years in age. Mid and understory vegetation is densely vegetated. Suitable habitat for
Schweinitz's sunflower or Micaux's sumac would not be expected to have been located within the project area.
Therefore, we have made a determination of no effect for these species.
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?
Based on our knowledge of the site, the site is not located in or near an area designated as essential fish habitat. Best
management practices and the construction of stormwater ponds will prevent sediment from entering down -gradient
waterbodies which may contain fish.
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?
We reviewed the SHPO Map (http://gis.ncdcr.gov/hpoweb/) to identify cultural resources of the site. The map does not
identify listed or eligible for listing properties on or proximate to the project area. A copy of the map is included as an
attachment.
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? FEMA NHFL (Drawing 4, attached)
Digitally signed by Bradley Luckey
DIM: cn=Bradley Luckey, o=Pilot
Bradley
Bradley S. Luckey, PWS
Enviromental, Inc., ou,
Luckey email=[e-mail],
c=US
2.5.24
Date: 2024.02.05 13:27:21-05'00'
Date
Applicant/Agent's Signature
Applicant/Agent's Printed Name
(Agent's signature is valid only if an authorization letter from the applicant
Page 11 of 12
PCN Form — Version 1.3 December 10, 2008 Version

OOR' �����e. ��� � j �

W. i
M.
Drawing 2A
USDA Soil Survey
of Davie County, NC
Published 1995
Scale: 1" = 300'
Wei
00
—00
:* 1';1
PIIJ-3T/ A
P I L O T E N V I R O N M E N T A L, I N C
PCC2
LEGEND
Site Boundary
Published Soil Map
Carters Ridge Road
Approximate 2.41-Acre Tract
Advance, Davie County, NC
Pilot Project 10344

h
Drawing 3
USFWS NWI
Wetlands Mapper
Scale: 1" = 200'
J .
y:
r
PILL
P I L O T E N V I R 0 N M E N T A L. I N C
P
LEGEND
Site Boundary
Freshwater Emergent
Freshwater Forested/Shrub
Estuarine and Marine Deepwater
Estuarine and Marine
Freshwater Pond
Lake
® Riverine
Other
NWI Map
Carters Ridge Road
Approximate 2.41-Acre Tract
Advance, Davie County, NC
Pilot Project 10344

C
OL
�" '44.
' * + . „ ,•
i Jrr IP
� sh
� f
' PAN E� ,
1371057660 K
* y
if . 31161 0
h
r ;� �-P� " V
N ti.L
LEGEND
Site Boundary
n 1 `¢Annual Chance Flood Hazard
MR egulatoiy Floodvay
Sped al Floodw@y
L Area of Undetermined Flood Hazard
h _ 0.2%Annual Chance Flood Hazard
Future Conditions 1 V.Annual Chance Flood Hazard
A M Area with R educed Risk Due to Levee
FEA
Drawing 4 CarterMR d ie Road
National Flood Hazard Layer ` - v Approximate 2.41-Acre Tract
From FEMA Web Map Service O�. �f.Y) P
Advance, Davie County, NC
Scale: 1" - VOO, P I L 0 E N V I R 0 N M E N T A L, I N C
Pilot Project 10344

Legend
Culvert
—••—•• Proposed Rip Rap Dissipator
Existing Stream
Existing Relocated Stream
• • • • • Area of Permanent Impact from Culvert
—• Area of Permanent Impact From Fill
Site Boundary
Drawing 5 �:,r, Wetland Map Overview
Satellite Imagery from ESRI Carters Ridge Road
and Pilot GPS Data Approximate 2.41-Acre Tract
Scale: 1" = 100' p11.13 Advance, Davie County, NC
Date:2.5.24 Pi LOT BNVIR0NMENTAL.INC Pilot Project10344

62
15 LF 60 SF MW
34 LF/136 SF
4
- t
40 LF/160 SF }**
x#
S 15 LF/60 SF
■ 1p .
Drawing 5
DEM from NCOne Map
and Pilot GPS Data
Scale: 1" = 25'
Date: 2.5.24
139 LF/348 SF
SF
PILOT
P I L O T E N V I R 0 N M E N T A L. I N C
33 LF/83 SF
i0
Legend
Culvert
-••-•• Proposed Rip Rap Dissipator
Existing Stream
Existing Relocated Stream
• • - - - Area of Permanent Impact from Culvert
— - — • Area of Permanent Impact From Fill
Site Boundary
Wetland Map
Carters Ridge Road
Approximate 2.41-Acre Tract
Advance, Davie County, NC
Pilot Project 10344