20160424 Ver 1_401 Application_20160416

CD,�► FRCEIVEDof WWor KswunAs
April 22, 2016
2 6 20%
Mr. Tim Fox
Water Qua" Re"81 Operations
Asheville Re ionai Ciiice
Division of Water Quality
2090 US 70 Highway
Swannanoa, NC 28778
[phone]
RE: Montreat Road Sidewalk Extension Phase IV
APR 9 �Q
Buncombe County
CDC Project
9
No. 21220
�RMAf Np QUq�I
ER p�M�l
Dear Mr. Fox,
NG
The above referenced project is a proposed sidewalk extension located along Montreat Road just
north of downtown Black Mountain. The project consists of approximately 942 LF of 5' sidewalk
with one stream crossing. Therefore, please find the following information attached for review and
approval:
• PCN Form
• USGS Map
• Soil Survey Plan
• Culvert Extension Plan
• Check in the amount of $240.00
A copy of this submittal package has also been sent to the NC Wildlife Resources Commission.
Please feel free to call if you have any questions or require any additional information during
your review.
Civil Design Concepts, PA
cc: Jamey Matthews
Mailing Address: P.O. Box 5432, Asheville, NC 28813
168 Patton Ave, Asheville, NC 28801 52 Walnut Street, Suite 9, Waynesville, NC 28786
Phone [phone] Fax [phone] Phone: [phone] Fax: [phone]

Adm� '
,[)Ct;,'D
Civil
CCoonoepls, PA
Transmittal
Date: April 22', 2016
Project Name: Montreat Road Sidewalk
CDC Project: 21220
To: Tim Fox
Divison of Water Quality
2090 US 70 Highway
Swannanoa, NC 28778
[phone]
Via: Mail
REMARKS:
Overnight
Date
--------------------
04/22/2016
--------------------
04/22/2016
--------------------
04/22/2016
--------------------
04/22/2016
Hand Delivered _ Pick up @ CDC Office
Description
----------------------------------------- ----- ---------------------------------------------
PCN — Signed
---------------------------------------------------------------------------------------------
$240.00 Check — Application Fee
- -----------------------------------------------------------------------------------------
Supporting Documents Package
---------------------------------------------------------------------------------------------
Sidewalk Bulletin (11 x 17)
---------------------------------------------------------------------------------------------
Cc Jamey Matthews, Town of Black Mountain, 160 Midland Avenue, Black Mountain, North Carolina 28711
S \ACAD\21220\Docs\Planning\COE Submittal Phase IV\2016-04-xx-Transmittal- DWQ docx
Mailing Address: P.O. Box 5432, Asheville, NC 28813
168 Patton Avenue Asheville, NC 28801 52 Walnut Street — Suite 9, Waynesville, NC 28786
Phone [phone] Fax [phone] Phone: [phone] Fax: [phone]

PAI
20160424
APRIL 11, 2016
0
PCN SUBMITTAL PACKAGE
MONTREAT ROAD SIDEWALK PHASE IV
PREPARED FOR: TOWN OF BLACK MOUNTAIN
160 MIDLAND AVE
BLACK MOUNTAIN, NORTH CAROLINA 28711
Mailing Address: P.O. Box 5432, Asheville, NC 28813
168 Patton Avenue Asheville, NC 28801 52 Walnut Street — Suite 9, Waynesville, NC 28786
Phone [phone] Fax [phone] Phone: [phone] Fax: [phone]

Montreat Road Sidewalk
IPaC Trust Resources Report
Generated April 11, 2016 02:35 PM MDT, IPaC v3.0.2
This report is for informational purposes only and should not be used for planning or
analyzing project level impacts. For project reviews that require U.S. Fish & Wildlife
Service review or concurrence, please return to the IPaC website and request an official
species list from the Regulatory Documents page.
IPaC - Information for Planning and Conservation (httpse//ecosJws.gov/ipac1): A project planning tool to help
streamline the U.S. Fish & Wildlife Service environmental review process.

i
Table of Contents
IPaC Trust Resources Report ...................................................... 1
Project Description............................................................... 1
Endangered Species.............................................................. 2
MigratoryBirds.................................................................. 5
Refuges & Hatcheries.............................................................. 7
Wetlands. ............ .. g

U.S. Fish & Wildlife Service
IPaC Trust Resources Report
NAME
Montreat Road Sidewalk
LOCATION
Buncombe County, North Carolina
DESCRIPTION
Extension of 942 LF of 5' Sidewalk,
one culvert extension at stream
crossing slated for construction during
summer of 2016.
IPAC LINK
https://ecos.fws.govfiac projectl
5BN5V-N 50 B N-GJTP4BE
L
t
i... J11
U.S. Fish & Wildlife Service Contact Information
Trust resources in this location are managed by:
Asheville Ecological Services Field Office
160 Zillicoa Street
Asheville, NC 28801-1082
[phone]

IPaC Trust Resources Report
Endangered Species
Endangered Species
Proposed, candidate, threatened, and endangered species are managed by the
Endangered Species Program of the U.S. Fish & Wildlife Service.
This USFWS trust resource report is for informational purposes only and should
not be used for planning or analyzing project level impacts.
For project evaluations that require USFWS concurrence/review, please return to the
IPaC website and request an official species list from the Regulatory Documents
section.
Section 7 of the Endangered Species Act requires Federal agencies to "request of the
Secretary information whether any species which is listed or proposed to be listed may
be present in the area of such proposed action" for any project that is conducted,
permitted, funded, or licensed by any Federal agency.
A letter from the local office and a species list which fulfills this requirement can
only be obtained by requesting an official species list either from the Regulatory
Documents section in IPaC or from the local field office directly.
The list of species below are those that may occur or could potentially be affected by
activities in this location:
Arachnids
Spruce -fir Moss Spider Microhexura montivaga
CRITICAL HABITAT
There Is final critical habitat designated for this species.
hap://ecos.fws.goy/tesspubli rofile/speciesProfiile action?spcode=1014
Clams
Appalachian Elktoe Alasmidonta raveneliana
CRITICAL HABITAT
There is final critical habitat designated for this species.
Endangered
Endangered
4/11/2016 2 35 PM IPaC Q 0 2 Page 2

IPaC Trust Resources Report
Endangered Species
Flowering Plants,
Blue Ridge Goldenrod Solidago spithamaea
-Threatened
CRITICAL HABITAT
No critical habitat has been' designated for this species.
htp://ecos.fws.go messubii c rop file/speciesProrile action?socode=Q2J7
Bunched Arrowhead Sagittaria.fasciculata
Endangered
CRITICAL HABITAT
No critical habitat has been designated for this species.
http://ecos.fws.goy/tessubli rofile! neciesProfile action7spcode=Q219
Mountain Sweet Pitcher -plant Sarracenia rubra ssp. jonesii
Endangered
CRITICAL HABITAT -
No critical habitat has been designated for this species.
http://ecos-fws-goy/tes. ubiic/ ro�peciesProfile action?spcode=0210
Spreading Avens Geum radiatum
Endangered
CRITICAL HABITAT
No critical habitat has been designated for this species.
-htto://ecos.fwa.gov/tessubii rop file/speciesProfile action?cnc^de=Q1t":R^
Virginia Spiraea Spirae'a virginiana
Threatened
CRITICAL HABITAT
No critical habitat has been designated for this species. i
gyp://ecos.fws-go v/� tess- public rofiie/ neciesProfile action?spcode=Q2R1
Lichens
Rock Gnome Lichen Gymnoderma lineare
Endangered
CRITICAL HABITAT
No critical habitat has been designated for this species.
http://ecos.fws-gov/tess ublig rop filetspeciesProfile action?spcode=0001
4/11/2016 2.35 PM IPaC v3 0 2 Page 3

IPaC Trust Resources Report
Endangered Species '
Mammals
Carolina Northern Flying Squirrel Glaucomys sabrinus coloratus Endangered
CRITICAL HABITAT
No critical habitat has been designated for this species. j
fstn://ecos.fws.gov/tess publi rofil / oeciesProfile action?spcode=AO9M' i
Gray Bat Myotis grisescens Endangered
CRITICAL HABITAT
No critical habitat has been designated for this species. v
hyo://ecas.fws.go /v tess publi / rofil /speciesProfile action?spcode=AO4J
Northern Long-eared Bat Myotis septentrionalis Threatened
CRITICAL HABITAT
No critical habitat has been designated for this species.
htto://ecos.fws.gov/tes.ubli t rod file/soeciesProfile action?spcode=AOJE
I
i
Critical Habitats
There are no critical habitats in this location
I I
4/11/2016 2.35 PM IPaC v3.0 2
Page 4

IPaC Trust Resources Report
Migratory Birds
Migratory Birds
Birds are protected by the Migratory Bird Treaty Act and the Bald and Golden Eagle
Protection
Any activity that results in the take of migratory birds or eagles is prohibited unless
authorized by the U.S. Fish & Wildlife Service.111 There are no provisions for allowing
the take of migratory birds that are unintentionally killed or injured.
Any person or organization who plans or conducts activities that may result in the take
of migratory birds is responsible for complying with the appropriate regulations and
implementing appropriate conservation measures.
1.50 C.F.R. Sec. 10.12 and 16 U.S.C. Sec. 668(a)
Additional information can be found using the following links:
• Birds of Conservation Concern
• • • •1 -, •1 •1 '11.11!
Conservation measuresfor birds
It•Hvnw1.. •• • 11.1.•-11- • - - 1-1 •• • • •.1
•1 -, • 11-. - •1•
Year-round bird occurrence data
1 ! 1wi •• • d. 11.1.•- 1-1 ! • - 11"l •• .1• • •.T-
.k•g.11 •• •1!
The following species of migratory birds could potentially be affected by activities in this
location:
Bald Eagle Haliaeetus leucocephalus
Year-round
http://ecos.fws.go /V tes. ubli r rofil /speciesProfile action?spcode=BO08
Black -billed Cuckoo Coccyzus erythropthalmus
Season: Breeding
hip://ecos.tws.goyttesspubli roo file/speciesProfile action?spoode=BOHI
Blue -winged Warbler Vermivora pinus
Season: Breeding
Brown -headed Nuthatch Sitta pusilla
Year-round
Canada Warbler Wilsonia canadensis
Season: Breeding
Bird of conservation concern
Bird of conservation concern
Bird of conservation concern
Bird of conservation concern
Bird of conservation concern
4/11/2016 2:35 PM IPaC v3 0 2 Page 5

IPaC Trust Resources Report
Migratory Birds
Fox Sparrow Passerella iliaca Bird of conservation concern
Season: Wintering
Golden -winged Warbler Vermivora chrysoptera Bird of conservation concern
Season: Breeding
hffo://ecos.fws.goy/te% ubli ./ roofil /speciesProfile action'?spcode=BOG4
Kentucky Warbler Oporornis formosus
Bird of conservation concern
Season: Breeding
Loggerhead Shrike Lanius ludovicianus
Bird of conservation concern
Year-round
hhn://ecos.fws.gov/tesspubli roofil //speciesProfile action?spcode=BOFY
Louisiana Waterthrush Parkesia motacilla
Bird of conservation concern
Season: Breeding
Peregrine Falcon Falco peregrinus
Bird of conservation concern
Season: Breeding
htte://ecos.fws.gov/tess p ubli rop file/speciesProfile action?socode=BOFU
Prairie Warbler Dendroica discolor
Bird of conservation concern
Season: Breeding
Red Crossbill Loxia curvirostra
Bird of conservation concern
Year-round
hffo://ecos.fws.gov/tess publi 1profile/speciesProfile action?spcode=BOFS
Red-headed Woodpecker Melanerpes erythrocephalus Bird of conservation concern
Season: Breeding
Rusty Blackbird Euphagus carolinus Bird of conservation concern
Season: Wintering
Short -eared Owl Asio flammeus Bird of conservation concern
Season: Wintering
hffo://ecos.fws.goy/tes.publi rofil /speciecprofile action?spcode=BOHD
Swainson's Warbler Limnothlypis swainsonii Bird of conservation concern
Season: Breeding
Wood Thrush Hylociehla mustelina Bird of conservation concern
Season: Breeding
Worm Eating Warbler Helmitheros vermivorum Bird of conservation concern
Season: Breeding
Yellow -bellied Sapsucker sphyrapicus varius Bird of conservation concern
Season: Breeding
hftpl/lecos.fws.go /v tes.publi / rofile/ peciesPmfile action?spcode=BOFR
4/11/2016 2.35 PM IPaC v3 0 2 Page 6

IPaC, Trust Resources Report
Refuges & Hatcheries
Wildlife refu9es -a,n'd•fish.T;hatcheriesJ ,,
Refuge and fish hatchery data is unavailable-at'thistime. "
' •4/11/2016 2.35 PM i IPaC.v3.0 2 Pege 7

IPaC Trust Resources Report
Wetlands
Wetlands in the National Wetlands Inventory
Impacts to NWI wetlands and other aquatic habitats may be subject to regulation under
Section 404 of the Clean Water Act, or other State/Federal statutes.
For more information please contact the Regulatory Program of the local US. Army
Corps of Engineers District.
DATA LIMITATIONS
The Service's objective of mapping wetlands and deepwater habitats is to produce reconnaissance level information
on the location, type and size of these resources. The maps are prepared from the analysis of high altitude imagery.
Wetlands are identified based on vegetation, visible hydrology and geography. A margin of error is inherent in the use
of imagery; thus, detailed on4he-ground inspection of any particular site may result in revision of the wetland
boundaries or classification established through Image analysis.
The accuracy of image interpretation depends on the quality of the imagery, the experience of the image analysts,
the amount and quality of the collateral data and the amount of ground truth verification work conducted. Metadata
should be consulted to determine the date of the source imagery used and any mapping problems.
Wetlands or other mapped features may have changed since the date of the Imagery or field work. There may be
occasional differences in polygon boundaries or classifications between the information depicted on the map and the
actual conditions on site.
DATA EXCLUSIONS
Certain wetland habitats are excluded from the National mapping program because of the limitations of aerial
imagery as the primary data source used to detect wetlands. These habitats include seagrasses or submerged
aquatic vegetation that are found in the intertidal and subtidal zones of estuaries and nearshore coastal waters.
Some deepwater reef communities (coral or tuberficid worm reefs) have also been excluded from the inventory.
These habitats, because of their depth, go undetected by aerial imagery.
DATA PRECAUTIONS
Federal, state, and local regulatory agencies with jurisdiction over wetlands may define and describe wetlands in a
different manner than that used in this inventory. There is no attempt, in either the design or products of this
inventory, to define the limits of proprietary jurisdiction of any Federal, state, or local government or to establish the
geographical scope of the regulatory programs of government agencies. Persons intending to engage in activities
involving modifications within or adjacent to wetland areas should seek the advice of appropriate federal, state, or
local agencies concerning specified agency regulatory programs and proprietary jurisdictions that may affect such
activities.
There are no wetlands in this location
4/11/2016 2.35 PM IPaC v3.0 2 Page 8

t
2/12/2016 Buncombe Cmnly Endangered Species, Threatened Spedes,Federal Species of Concern, and Candidate Species
Endangered Species, Threatened Species,Federal Species of
Concern, and Candidate Species,
Buncombe County, North Carolina
Updated: 7-24-2015
Common Name Scientific name Federal Record Status
Status
Vertebrate:
Allegheny woodrat
Neotoma magister
FSC
Current
Appalachian Bewick's wren
Thryomanes bewickii altus
FSC
Historic
Bachman's sparrow
Aimophila aestivalis
FSC
Historic
Blotchside logperch
Percina burtoni
FSC
Historic
Bog turtle
Glyptemys muhlenbergii
T (S/A)
Current
Carolina northern flying squirrel
Glaucomys sabrinus coloratus
E
Current
Cerulean warbler
Dendroica cerulea
FSC
Current
Eastern small -footed bat
Myotis leibii
FSC
Current
Gray bat
Myotis grisescens
E
Current
Hellbender
Cryptobranchus alleganiensis
FSC
Current
Longhead darter
Percina macrocephala
FSC
Historic
Mountain blotched chub
Erimystax insignis eristigma
FSC
Obscure
Northern long-eared bat
Myotis septentrionalis
T
Current
Northern saw -whet owl
Aegolius acadicus pop. 1
FSC
Current
(Southern Appalachian
population)
Paddlefish
Polyodon spathula
FSC
Historic
Pygmy salamander
Desmognathus wrighti
FSC
Current
Rafinesque's big -eared bat
Corynorhinus rafinesquii
FSC
Historic
Red crossbill (Southern
Loxia curvirostra
FSC
Current
Appalachian)
Southern Appalachian black-
Poecile atricapillus practicus
FSC
Historic
httpJ/www.fws.gov/raleigWspecies/CntylisVbuncombe.html 1/3

211212016
BLncombe Candy Endangered Species, Threatened Species,Federal Species of Concern, and Candidate Species
capped chickadee
Southern Appalachian eastern
woodrat
Southern water shrew
Snotffn chub (=turquise shiner)
Yellow -bellied sapsucker
(Southern Appalachian
population)
Invertebrate:
Appalachian elktoe
Diana fritillary (butterfly)
French Broad crayfish
Southern Tawny Crescent
butterfly
Spruce -fir moss spider
Tan riffleshell
Vascular Plant:
Neotoma floridana haematoreia FSC
Sorex palustris punctulatus
Erimonax monachus
Sphyrapicus varius
appalachiensis
Alasmidonta raveneliana
Speyeria diana
Cambarus reburrus
Phyciodes batesd maconensis
Microhexura montivaga
Epioblasma florentina walkeri
(=E. walkeri)
Blue Ridge Ragwort
Packera millefolium
Butternut
Juglans cinerea
Cain's reedgrass
Calamagrostis cainii
Darlington's spurge
Euphorbia purpurea
Fraser fir
Abies fraseri
Fraser's loosestrife
Lysimachia fraseri
French Broad heartleaf
Hexastylis rhombiformis
Gray's lily
Lilium grayi
Gray's saxifrage
Saxifraga caroliniana
Large -leaved Grass -of -Parnassus Parnassia grandifolia
Mountain catchfly
Silene ovata
Mountain heartleaf
Hexastylis contracta
Piratebush
Buckleya distichophylla
Spreading avens
Geum radiatum
Sweet pinesap
Monotropsis odorata
Virginia spiraea
Spiraea virginiana
Nonvascular Plant:
Lichen:
Rock gnome lichen
Gymnoderma lineare
FSC
T
FSC
Current
Current
Historic
Current
E
Historic
FSC
Current
FSC
Current
FSC
Historic
E
Current
E
Historic and Obscure
FSC
FSC
FSC
FSC
FSC
FSC
FSC
FSC
FSC
FSC
FSC
FSC
FSC
E
FSC
T
E
Current
Historic
Current
Current
Current
Historic
Current
Current
Current
Historic
Current
Current
Current
Current
Current
Historic
Current
Definitions of Federal Status Codes:
E = endangered. A taxon "in danger of extinction throughout all or a significant portion of its range."
T = threatened. A taxon "likely to become endangered within the foreseeable future throughout all or a
significant portion of its range."
C = candidate. A taxon under consideration for official listing for which there is sufficient information to
support listing. (Formerly "Cl" candidate species.)
httpJAwm.fws.gov/raIE4gtVspecies/critylisVbuncombe.htmi 2/3

2/128016 Buncombe County EndarWed Species, Threatened Speoies,Federal Species of Concern, and Carddate Species
BGPA =Bald and Golden Eagle Protection Act. See below.
FSC=Federal Species of Concern. FSC is an informal term. It is not defined in the federal Endangered
Species Act. In North Carolina, the Asheville and Raleigh Field Offices of the US Fish and Wildlife
Service (Service) define Federal Species of Concern as those species that appear to be in decline or
otherwise in need of conservation and are under consideration for listing or for which there is insufficient
information to support listing at this time.Subsumed under the term "FSC" are all species petitioned by
outside parties and other selected focal species identified in Service strategic plans, State Wildlife Action
Plans, or Natural Heritage Program Lists.
T(S/A) = threatened due to similarity of appearance. A taxon that is threatened due to similarity of
appearance with another listed species and is listed for its protection. Taxa listed as T(S/A) are not
biologically endangered or threatened and are not subject to Section 7 consultation. See below.
EXP = experimental population. A taxon listed as experimental (either essential or nonessential).
Experimental, nonessential populations of endangered species (e.g., red wolf) are treated as threatened
species on public land, for consultation purposes, and as species proposed for listing on private land.
P = proposed. Taxa proposed for official listing as endangered or threatened will be noted as "PE" or
"PT", respectively.
Bald and Golden Eagle Protection Act (BGPA .
In the July 9, 2007 Federal Register( 72:37346-37372), the bald eagle was declared recovered, and
removed (de -listed) from the Federal List of Threatened and Endangered wildlife. This delisting took
effect August 8,2007. After delisting, the Bald and Golden Eagle Protection Act (Eagle Act) (16 U.S.C.
668-668d) becomes the primary law protecting bald eagles. The Eagle Act prohibits take of bald and
golden eagles and provides a statutory definition of "take" that includes "disturb". The USFWS has
developed National Bald Eagle Management Guidelines to provide guidance to land managers,
landowners, and others as to how to avoid disturbing bald eagles. For mor information, visit
http://www.fws.gov/mi rg atorybirds/baldea lg e.htm
Threatened due to similarity of appearance T(SW):
In the November 4, 1997 Federal Register (55822-55825), the northern population of the bog turtle (from
New York south to Maryland) was listed as T (threatened), and the southern population (from Virginia
south to Georgia) was listed as T(S/A) (threatened due to similarity of appearance). The T(S/A)
designation bans the collection and interstate and international commercial trade of bog turtles from the
southern population. The T(S/A) designation has no effect on land management activities by private
landowners in North Carolina, part of the southern population of the species. In addition to its official
status as T(S/A), the U.S. Fish and Wildlife Service considers the southern population of the bog turtle as
a Federal species of concern due to habitat loss.
Definitions of Record Status:
Current - the species has been observed in the county within the last 50 years.
Historic - the species was last observed in the county more than 50 years ago.
Obscure - the date and/or location of observation is uncertain.
Incidental/migrant - the species was observed outside of its normal range or habitat.
Probable/potential - the species is considered likely to occur in this county based on the proximity of
known records (in adjacent counties), the presence of potentially suitable habitat, or both.
ht4)l/www.fws.gov/raleigtVspecies/cntylisttwr-ombe.htmi 313

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Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.4 January 2009
Pre -Construction Notification (PCN) Form
A. Applicant Information
1. Processing
1a. Type(s) of approval sought from the Corps:
® Section 404 Permit ❑ Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number: 29 or General Permit (GP) number.
1c. 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
le. 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 1h
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: Montreat Road Sidewalk Extension
2b. County: Buncombe
2c. Nearest municipality / town: Black Mountain
2d. Subdivision name: NA
2e. NCDOT only, T.I.P. or state project no:
3. Owner Information
3a. Name(s) on Recorded Deed:
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if
applicable):
3d. Street address:
3e. City, state, zip:
3f. Telephone no.:
3g. Fax no.:
3h. Email address:
Page 1 of 10
PCN Form — Version 1.4 January 2009

4. Applicant Information (if different from owner)
4a. Applicant is:
❑ Agent Q Other, specify:
4b. Name:
Jamey Matthews
4c. Business name j
(if applicable):
Town of Black Mountain
4d. Street address:
160 Midland Avenue
4e. City, state, zip:
Black Mountain, North Carolina, 28711
4f. Telephone no.:
828-419-9300
4g. Fax no.:
828-669-2030
4h. Email address:
5. Agent/Consultant Information (If applicable)
5a. Name:
Jesse Gardner, P.E.
5b. Business name
(if applicable):
Civil Design Concepts, PA
5c. Street address:
168 Patton Avenue
5d. City, state, zip:
Asheville, NC 28801
5e. Telephone no.:
[phone]
5f. Fax no.:
[phone]
5g. Email address:
[e-mail]
Page 2 of 10

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
1b. Site coordinates (in decimal degrees):
Latitude: 35.634431 Longitude: -82.316217
1c. Property size:
0 acres
2. Surface Waters
2a. Name of nearest body of water to proposed project:
UT to Flat Creek
2b. Water Quality Classification of nearest receiving water:
C
2c. River basin:
lFrench Broad
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 is in a residential area along a state maintained roadway.
3b. List the total estimated acreage of all existing wetlands on the property: NA
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: NA
3d. Explain the purpose of the proposed project:
Extension of public sidewalk along Montreat Road.
3e. Describe the overall project in detail, including the type of equipment to be used:
Construction equipment for sidewalk installation to consist of backhoe, tamper, siltfence, concrete and dump trucks.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (includingall prior phases)in the past?
❑ Yes © No ❑ Unknown
Comments:
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): NSA
Agency/Consultant Company:
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
N/A
5. Project History
5a. Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
❑X Yes ❑ No ❑Unknown
5b. If yes, explain in detail according to "help file' instructions.
Previous Permit #SAW -2008-0052 - Resubmitting due to permit expiring
6. Future Project Plans
6a. Is this a phased project?
❑ Yes © No
6b. If yes, explain.
Page 3 of 10
PCN Form — Version 1.4 January 2009

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
❑ Wetlands ❑X 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.
Wetland impact
number
Permanent (P) or
Temporary T
2b.
Type of impact
2c.
Type of wetland
2d.
Forested
2e.
Type of jurisdiction
Corps (404,10) or
DWQ (401, other)
2f.
Area of
impact
(acres)
W1 -
Choose one
Choose one
Yes/No
-
W2 -
Choose one
Choose one
Yes/No
-
W3 -
Choose one
Choose one
Yes/No
-
VV4 -
Choose one
Choose one
Yes/No
-
W5 -
Choose one
Choose one
Yes/No
-
W6 -
Choose one
Choose one
Yes/No
-
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.
Stream impact
number
Permanent (P) or
Temporary (T)
3b.
Type of impact
3c.
Stream name
3d.
Perennial (PER) or
intermittent (INT)?
3e.
Type of
jurisdiction
3f.
Average
stream
width
(feet)
3g.
Impact
length
(linear
feet)
S1 P
Culvert
UT to Flat Creek
PER
Corps
3
22
S2 -
Choose one
-
-
S3 -
Choose one
_
S4 -
Choose one
S5 -
Choose one
S6 -
Choose one
3h. Total stream and tributary impacts
25
3i. Comments:
N/A
Page 4 of 10
PCN Form — Version 1.4 January 2009

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 im acts 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 -
Choose one,
Choose
02 -
'
Choose one
Choose
03 -
Choose one
Choose
04 -
Choose one
Choose
4f. Total open water Impacts
4g. Comments: N/A
5. Pond or Lake Construction
If pond or lake construction proposed, the complete the chart below.
5a.
Pond ID number
5b.
Proposed use or
purpose of pond
5c.
Wetland Impacts (acres) -
5d. 5e.
Stream Impacts (feet) Upland
(acres)
Flooded Filled Excavated
Flooded Filled
Excavated
P1
Choose one
P2
Choose one
r
5f. Total:
5g. Comments: N/A
5h. Is a dam high hazard permit required?
❑ Yes ® No If yes, permit ID no:
51. Expected pond surface area (acres):
5j. Size of pond watershed (acres): ,
5k. Method of construction:
N/A
6. Buffer Impacts (for DWO)
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. Project is in which protected basin?
❑ Neuse ❑ Tar -Pamlico ❑ Catawba ❑ Randleman ❑ Other:
6b.
Buffer Impact
number —
Permanent(P)or
TemporaryT
6C.
Reason for impact
6d.
Stream name
6e.
Buffer
mitigation
required?
6f.
Zone 1
impact
(square
feet)
6g.
Zone 2
impact
(square
feet
B1 -
Yes/No
B2 -
t
Yes/No
B3 -
Yes/No
B4 -
Yes/No
B5 -
Yes/No
B6 -
Yes/No
6h. Total Buffer Impacts:
61. Comments: N/A
Page 5 of 10

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 location of the crossing Is oriented so to be as perpendicular as possible and to avoid existing trees to minimize overall disturbance within the
stream buffer.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Proper erosion control BMPs will be Installed to minimae any loss of sediment into the stream during construction.
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 Q 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
❑ Payment to in -lieu fee program
❑ Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank: N/A
3b. Credits Purchased (attach receipt and letter)
Type: Choose one
Type: Choose one
Type: Choose one
Quantity:
Quantity:
Quantity:
WA
3c. Comments:
4. Complete If Making a Payment to In -lieu Fee Pro ram
4a. Approval letter from in -lieu fee program is attached. ❑ Yes
4b. Stream mitigation requested: linear feet
4c. If using stream mitigation, stream temperature: Choose one
4d. Buffer mitigation requested (DWQ only): square feet
4e. Riparian wetiand mitigation requested: acres
4f. Non -riparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requested: acres
4h. Comments: N/A
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 6 of 10
PCN Form — Version 1.4 January 2009

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 requiresYes
No
buffer mitigation?
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.
6c.
6d.
6e.
Zone
Reason for impact
Total impact
Multiplier
Required mitigation
(square feet)
(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).
N/A
6h. Comments: N/A
Page 7 of 10

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?
1b. If yes, then is a diffuse flow plan included? If no, explain why.
N/A
❑ Yes ❑ No
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project?
%
2b. Does this project require a Stormwater Management Plan?
❑ Yes © No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
Exempt per Town of Black Mountain Ordinances.
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
N/A
2e. Who will be responsible for the review of the Stormwater Management Plan?
N/A
3. Certified Local Government Stormwater Review
3a. In which localgovernment's jurisdiction Is thisproject?
❑ Phase II
3b. Which of the following locally -implemented stormwater management programs
❑ NSW
apply (check all that apply):USMP
HWater
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
❑HOW
4a. Which of the following state -implemented stormwater management programs applyHSession
ORW
(check all that apply):
Law 2006-246
[-]Other
4b. Has the approved Stormwater Management Plan with proof of approval been
❑ Yes © No
attached?
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 8 of 10
PCN Form — Version 1.4 January 2009

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
la. Does the project involve an expenditure of public (federal/state/local) funds or the
❑X 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
Q 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: N/A
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
Q No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after -the -fact permit application?
❑Yes
❑X No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
N/A
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in
❑Yes
Q 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.
N/A
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 9 of 10
PCN Form — Version 1.4 January 2009

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or
[:1 Yes Q 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.
Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
USFWS Endangered Species Program Website
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat?
❑ Yes Q No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
South Atlantic Fishery Management Council
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?
Site previously development - historiclarcheological Impact not applicable.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA -designated 100 -year floodplain?
❑ Yes Q No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?
2010 FEMA Firm 3710071000J
Applicant/Agent's Printed NameA
licant/Agent's Signature
Date
(Agent's signature Is valid only If an authorization
letter from the applicant isprovided.)
Page 10 of 10