20160323 Ver 1_Application_20160331

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2 0 1 6 0 3 2 3 For e 0 2008
Pre -Construction Notification (PCN) Form
A. Applicant Information
1. Processiing
1 a. Type(s) of approval sought from the
Corps:
®Section 404 Permit El Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number: 29 or General Permit (GP) number: n/a
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-Corps7 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
1 g. 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:
18050 Joe Brown Highway After -the -Fact Permit
2b. County:
Cherokee
2c. Nearest municipality / town:
Unaka Community i=p
2d. Subdivision name:
I "-
2e. NCDOT only,-T:l.'P. or state
project no:
T_ 1-IfIll g'L I2016
3. Owner Information STORMWATER P i1r,1r.
3a. Name(s) on Recorded Deed*
Floyd E. and Lisa R. Jillson
3b. Deed Book and Page No.
00968-0517
3c. Responsible Party (for LLC if
applicable):
3d. Street address:
1285 Near Ocean Drive Site Location: 18050 Joe Brown Highway
3e. City, state, zip:
Vero Beach, FL 32963 Murphy, NC (Unaka Community)
3f. -Telephone-no.:
772-643-6554
3g. Fax no.:
3h. Email address:
[e-mail]
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
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:
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

B. Project Information and Prior Project History
1. Property Identification
1 a. Property identification no. (tax PIN or parcel ID):
Parcel ID 4556 0016 5224 000
1b. Site coordinates (in decimal degrees)- - if you can't get
Latitude: 35.1919 Longitude: -84.1853
these, just include a very good vicinity map
(DD.DDDDDD) (-DD DDDDDD)
1c. Property size:
100.83 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
UT Moccasin Creek
proposed project,
2b. Water Quality Classification of nearest receiving water:
C; Tr
2c. River basin: map is available at
Hiwassee (06020002)
hftp://h2o.enr.state.nc.us/admin/maps/
3_ Project Description-
escription3a.
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 is an undeveloped rural land. The general land use in the vicinity of the property is rural developed
residential, agricultural, and undeveloped forested.
3b. List the total estimated acreage of all existing wetlands on the property:
Unknown
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
Approximately 3,000 If
3d. Explain the purpose of the proposed project:
An off-line pond.
3e. Describe the overall project in detail, including the type of equipment to be used:
An existing metal culvert located under the driveway into the property was replaced with a plastic culvert.
Typical equipment (excavator, backhoe, bulldozer and dump truck) was used to dig the off-line pond. Water
intake from Moccasin creek was used to fill the off-line pond.
Page 3 of 11
PCN Form — Version 1.3 December 10, 2008 Version

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?
Comments.
❑ Yes ® No ❑ Unknown
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 ❑ Unknown
5b.
If yes, explain in detail according to "help file" instructions.
6.
Future Project Plans
6a.
Is this a phased project?
❑ Yes ® No
6b.
If yes, explain.
Page 4 of 11

C. Proposed Impacts Inventory
1. Impacts Summary -
la. 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
Waterintakefor-
Headwater
® Yes-
® Corps-
0.03
off-line pond
❑ 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 -
El No
❑ DWQ
2g. Total wetland impacts
0.03
2h. Comments: Fill & grading in wetland abutting south stream bank of UT of Moccasin Creek complete during
construction of water intake
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
-(PER)
or
(Corps - 404, 10
stream
length
Permanent P
() or
intermittent
DWQ— non404;
width
(linear
Temporary -(T)_
(INT)?
other)
(feet)
feet)
S1 ® P"❑T
Stream crossing
(new culvert
DT Moccasin-
® PER
®Corps
4
10
length)
Creek
❑ INT
❑ DWQ
S2 ®P ❑ T
Water intake for
UT Moccasin
® PER
® Corps
4
134
off-line pond
Creek
❑ INT
❑ DWQ
S3 ❑ P ❑ T
❑ PER
❑- Corps
❑ INT
❑ DWQ
S4 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S5 ❑ P ❑ T
ID
❑ PER-
❑ Corps
INT
Q DWQ
3h. Total stream and tributary impacts
143
3i. Comments: 50 If of existing culvert was replaced with 60 If of new culvert in SE portion of property on access road.
Impacts for water intake structure include low rip -rap dam, rip -rap bank stabilization & small shallow impoundment of
the UT.
Page 5 of 11

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 indi ually list all open water impacts below.
4a.
4b.
4c.
4d.
4e.
Open water
Name of waterbody
impact number —
(if applicable)
Type of impact
Waterbody type
Area of impact (acres)
Permanent (P) or
Temporary
01 1--]P❑T
02 ❑P❑T
03 ❑P❑T
04 ❑P❑T
4f. Total-open water-Impacts-
4g. Comments:
6. Pond or Cake Construction
If pond or lake construction proposed, then complete the chart below.
5a.
5b.
5c.
5d.
5e.
Wetland Impacts (acres)
Stream Impacts (feet)
Upland
Pond ID
Proposed use or purpose
(acres)
number
of pond
Flooded
Filled
Excavated
-Flooded
Filled
Excavated
Flooded
P1
P2
6f: 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:
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
impact
required?
B1 ❑P❑T
❑Yes
❑ No
B2 ❑P❑T
❑Yes
❑ No
B3 ❑ P ❑ T
El- Yes
❑ No
6h. Total buffer impacts
6i. Comments:
Page 6 of 11

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
The location of the pond was chosen, because that area was previously disturbed and used for agriculture and
did not qualify as a wetland. This location also allowed for the current drive/road way through the property to
remain the same and not disturb any additional property. Rip -rap was used for bank stabilization.
b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
The rusted metal culvert was replaced with a plastic 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
impacts to Waters of the U.S. or Waters of the State?
❑.Y_es ® 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
❑ Rayment to in -lieu fee program
❑Y= Permittee- Responsible MAigation
3. Complete if Using a Mitigation Bank
3a Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letteo
Type
Quantity
3c. Comments:
4. Complete if Making a Payment to In4ieu 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:
Page 7 of 11
PCN Form — Version 1.3 December 10, 2008 Version

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.
S. Buffer Mitigation (State Regulated Riparian Buffer Rutes} — required by DWQ-
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation? -If yes, you will have to fill out this entire form — please
contact the State for more information.
[:] Yes ❑ No
6b_ -if yes, then identify the square feet of impactio each2one of the riparian buffer that requires mibgation. 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,Catawbay
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

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 N.C. Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
El Yes El No
Comments:
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project?
%
2b. Does this project require a Stormwater Management Plan?
❑ Yes Q 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:
❑ 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?
❑ 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
4a. Which of the following state -implemented stormwater management programs apply
El HQW
El 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
6. 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 ®N°
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
letter.)
❑ Yes ❑ No
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 ❑ Na
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
Corps issued notification of unauthorized activity (Action ID SAW -2016-0013) dated January 27, 2016 for impacts to
UTs of Moccasin Creek.
This permit request is being submitted to satisfy the remedial actions requested by the agencies in their issued
violation documents and agreed to be submit during the site meeting of February 23, 2016 with representatives of
the agencies.
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.
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.
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?
5c. If yes, indicate the USFWS Field Office you have ,contacted.
F-1 Raleigh
❑ Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat? Latest Corps updated Heritage database & USFWS map for northern long-eared bat (NLEB) consultation
areas. Property is within consultation areas for NLEB.
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?
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?
Latest Corps updated Heritage database.
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? Latest North Carolina on-line FEMA Map, Panel
4556, Map No. 3700455600J, effective date November 19, 2008
Floyd E. Jillson
4ts�vand
3/26/2016
Applicant/Agent's Printed Name
nt's u e
Date
(Agent's signf an aut nation letter from the applicant
is rov' d
Page 11 of 11

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