20091183 Ver 2_401 Application_20160216

North Carolina Department of Natural and Cultural Resources
Pat McCrory Susan Kluttz
Governor Secretary
February 3, 2016
Ms. Karen Higgins
NC Division of Water Resources, Winston-Salem Regional Office
1615 Mail Service Center
Raleigh, NC 27699-1617
RE: Water Quality Certification
Horne Creek Crossings
Pilot Mountain State Park
Dear Ms. Higgins:
D C @110WIRE
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DEO-WATER RESOURCES
BUFFER PE MI IN
Enclosed are five copies of a completed application submittal package requesting a Water Quality Certification
for proposed maintenance improvements to three existing vehicular fords along Horne Creek in the River
Section North of Pilot Mountain State Park in Surry County, NC. This application package consists of the
following documentation: a completed PCN form, vicinity and park maps, and a project drawing. Please also
find the enclosed journal transfer documentation indicating that payment of the $240 application fee has been
transferred from Division of Parks and Recreation (DPR) to the Division of Water Quality. This information is
being submitted per previous correspondence with Sue Homewood in the Winston-Salem Regional Office as
well as previous issuance of a Water Quality Certification for similar activities.
The three existing vehicular fords associated with this project are in need of maintenance due to erosion and
sedimentation presumably caused by the cumulative effects of motor vehicle passage and high stormwater
flows. Proposed improvements to each crossing include hardening the approach and exit to each ford with
paver stones and four inches of compacted gravel. The stream bed will be hardened where necessary with
paver stones. A channel will be left between paver stones to allow in -stream sediment transport. Park staff
anticipates using a back hoe and tractor for construction.
DPR is concurrently submitting one copy of this permit application to the US Army Corps of Engineers to
request a General Permit Verification under Nationwide Permit 3 per previous correspondence with Andrew
Williams (USACE, Raleigh Regulatory Field Office). Please contact me if you require any additional
information.
Justin Williamson
Environmental Review Coordinator
North Carolina Division of Parks and Recreation
1615 Mail Service Center, Raleigh, North Carolina 27699-1615
Phone: [phone] / Internet: www.ncparks.gov NORTH CAROLINA STATE PARKS
An Equal Opportunity / Affirmative Action Employer — Made in part by recycled paper Noma* Wondpiil

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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
1a. Type(s) of approval sought from the
Corps:
®Section 404 Permit E] Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number: 3 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps?
® Yes
❑ No
1 d. 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
1h. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
® No
2. Project Information
2a. Name of project:
Horne Creek Stream Crossings
2b. County:
Surry
2c. Nearest municipality / town:
Pinnacle
2d. Subdivision name:
2e. NCDOT only, T.I.P. or state
project no:
3. Owner Information
3a. Name(s) on Recorded Deed:
State of North Carolina (c/o NC Division of Parks & Recreation)
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if
applicable):
3d. Street address:
1615 Mail Service Center (c/o NC State Property Office)
3e. City, state, zip:
Raleigh, NC. 27699
3f. Telephone no.:
[phone]
3g. Fax no.:
[phone]
3h. Email address:
[e-mail] (DPR Land Protection)
Page 1 of 11
PCN Form — Version 1.3 December 10, 2008 Version

4. Applicant Information (if different from owner)
4a. Applicant is:
® Agent ❑ Other, specify:
4b. Name:
NCDNCR, Division of Parks and Recreation (c/o Pilot Mountain State Park)
4c. Business name
(if applicable):
4d. Street address:
MSC 1615
4e. City, state, zip:
Raleigh, NC. 27699-1615
4f. Telephone no.:
[phone]
4g. Fax no.:
[phone]
4h. Email address:
[e-mail]
5. Agent/Consultant Information (if applicable)
5a. Name:
N/A
5b. Business name
(if applicable):
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. Fax no.:
5g. Email address:
Page 2 of 11
PCN Form — Version 1.3 December 10, 2008 Version

B. Project Information and Prior Project History
1. Property Identification
1 a. Property identification no. (tax PIN or parcel ID):
5964-00-46-5352
1 b. Site coordinates (in decimal degrees):
Latitude: 36.2660 Longitude: - 80.4900
(DD.DDDDDD) (-DD.DDDDDD)
1c. Property size:
3,651 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
Home Creek
proposed project:
2b. Water Quality Classification of nearest receiving water:
WS -IV
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 project area consists of three existing fords along Home Creek, which is located in the northeastern portion of the
River Section North of Pilot Mountain State Park. These vehicular crossings are in need of maintenance due to erosion
and sedimentation presumably caused by the cumulative effects of motor vehicles and high stormwater flows. The project
area is along a gravel recreational road that provides access to a group camping and picknicking area, as well as to a
hiking trail just north of the Yadkin River. The northern portion of this area is mostly wooded, while the southern portion is
bordered by a maintained lawn and picnic area. General land use in the vicinity of the project area consists of a mixture
of recreational, residential, agricultural, and undeveloped.
3b. List the total estimated acreage of all existing wetlands on the property:
--78 per NWI wetland mapping.
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
—67,980' per USGS GIS mapping
3d. Explain the purpose of the proposed project:
Improve the condition of 3 stream crossings
3e. Describe the overall project in detail, including the type of equipment to be used:
The project will involve maintenance to three existing stream fords that function as vehicular crossings of Home Creek.
The approach to each entrance and exit of the stream ford will be hardened with paver stones and 4" of compacted
gravel. The stream bed will be hardened where necessary with paver stones. A channel will be left between paver stones
to allow in -stream sediment transport. Park staff anticipates using a back hoe and tractor for construction.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
ElYes [_1No ® Unknown
project (including all prior phases) in the past.'
Comments:
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.
Page 3 of 11
PCN Form — Version 1.3 December 10, 2008 Version

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.
USACE please reference Action ID: 200902181 for Surry County. For DWR please reference DWQ # 09-1183 for Surry
County.
6. Future Project Plans
6a. Is this a phased project?
® Yes ❑ No
6b. If yes, explain.
Future plans for these stream crossings include bridging these existing crossings or abandoning these streams as a
vehicle access once an alternate vehicle route to the Yadkin River is designated. Bridging is contingent on available
funding. Abandoning the streams as a vehicle access is the preferred option but is land dependent.
Page 4 of 11
PCN Form — Version 1.3 December 10, 2008 Version

C. Proposed Impacts Inventory
1. Impacts Summary
1a. 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:
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
Home Creek
® PER
❑ INT
® Corps
® DWQ
10
15
S2 ®P ❑ T
Home Creek
® PER
❑ INT
® Corps
® DWQ
10
15
S3 ® P ❑ T
Horne Creek
® PER
❑ INT
® Corps
® DWQ
10
15
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
45
3i. Comments:
Page 5 of 11
PCN Form —Version 1.3 December 10, 2008 Version

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
5k. Method of construction:
02 ❑P❑T
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
03 ❑P❑T
you MUST fill out Section D
of this form.
6a.
04 ❑P❑T
❑Tar -Pamlico ❑Other:
Project is in which protected basin?
❑ Catawba
4f. Total open water impacts
6b.
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
Flooded
P1
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P) or
for
Stream name
P2
(square feet)
(square feet)
Temporary T
impact
required?
5f. Total
131 ❑P❑T
El Yes
5g. Comments:
5h. Is a dam high hazard permit required?
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.
❑'Neuse
❑Tar -Pamlico ❑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
El Yes
❑ No
B2 ❑P❑T
El Yes
❑ No
B3 ❑P❑T
El Yes
❑ No
6h. Total buffer impacts
6i. Comments:
Page 6 of 11
PCN Form - Version 1.3 December 10, 2008 Version

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
A channel will be created by paver stones to allow for improved in -stream sediment transport to alleviate excess
sedimentation that occurs adjacent to the existing fords after high flows in Home Creek. The maintenance measures should
also reduce impact from vehicular crossings over the existing fords.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
N/A
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 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
ElPayment 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
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:
❑ 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.
N/A
Page 7 of 11
PCN Form — Version 1.3 December 10, 2008 Version

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 11
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?
<1 %
2b. Does this project require a Stormwater Management Plan?
❑ Yes ® No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: Below required threshold
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?
N/A
❑ 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: N/A
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 11
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:
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):
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.
Small scope of this project and future protection of these crossings is not anticipated to result in additional development
and adverse cumulative impacts.
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.
N/A
Page 10 of 11
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?
❑ 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?
GIS File of rare species occurences provided by NC Natural Heritage Program
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?
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
® 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?
Consultations with the State Historic Preservation Office on 8-27-09
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: Project complies with Sury County development regulations per
personal communication between Amin Davis of DPR and Kim Bates of Surry County on 10-27-09.
8c. What source(s) did you use to make the floodplain determination? ncfloodmaps -
Justin Williamson/ NC DPR
1-8-16
Applicant/Agent's Printed Name
Date
Applicant/Agent's Signature
(Agent's signature is valid only if an authorization letter from the applicant
is provided.
Page 11 of 11
PCN Form — Version 1.3 December 10, 2008 Version

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LEGEND _ t
Stream Crossings
Q Park Boundaries —
Drainage Areas (-1,360acres)
— Roads
Streams ► 1 *�� �� �j,Si !'
_,..— Unnamed Tributaries �) S X15 trcI c lFra�4t,
5' Elevation Contours (LIDAR)`" ` 7
0 0.1250.25 0.5
Miles
0 1,250 2,500 5,000
Feet I
Scale: 1" = 2,500'
Sources: NCDOT, USGS, NCCGIA (20 10 Aerial Photography) Prepared / Date: AKD/4-25-13
Horne Creek Stream Crossings
North Carolina Division of Topography
Pilot Mountain State Park Parks and Recreation
Surry County, North Carolina
Figure 3

i
Gravel Road
® Stream Channel
Stream Centerline
2' Elevation Contours
Paver Stones & Gravel
® Approach
In -Stream
1
1i
NOTES: 1
1.) Features Depicted Are Not to Scale I
2.) Drawing Is ATypical Section Of All Three Crossings
Sources: NCDOT, NCFMP Prepared / Date: AKD/11-5-09
Horne Creek Crossings
Pilot Mountain State Park
Surry County, North Carolina
North Carolina Division of Proposed Maintenance
Parks and Recreation
Figure 3

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