20170216 Ver 1_401 Application_20170217

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Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.4 January 2009
Page 1 of 10
PCN Form — Version 1.4 January 2009
Pre -Construction Notification (PCN) Form
A.
Applicant Information
1.
Processing
1 a.
Type(s) of approval sought from the Corps:XQ
Section 404 Permit _ ❑ Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: 29 or General Permit (GP) number:
1 c.
Has the NWP or GP number been verified by the Corps?
❑X Yes ❑ No
1d.
Type(s) of approval sought from the DWQ (check all that apply):
❑X 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 ❑X No
For the record only for Corps Permit:
❑ Yes ❑X 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 ❑X No
1 g.
Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below.
❑ Yes ❑X No
1 h.
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes ❑X No
2.
Project Information
2a. Name of project:
Grassy Knoll Lower Pond Renovation
2b.
County:
Watauga
2c.
Nearest municipality / town:
Blowing Rock
2d.
Subdivision name:
Grassy Knoll
2e.
NCDOT only, T.I.P. or state project no:
3.
Owner Information EB 2 1 2017
3a.
Name(s) on Recorded Deed:
Grassy Knoll Property Owners Assn., Inc.
3b.
Deed Book and Page No.
586,067 1 401 & BUFFER FERMI E
3c.
Responsible Parry (for LLC if
applicable):
c/o Joe Raulerson
3d.
Street address:
143 Grassy Knoll Way
3e.
City, state, zip:
Blowing Rock, NC 28605
3f.
Telephone no.:
828.260.0848
3g. Fax no.:
3h.
Email address:
mer1831 @bellsouth.net
Page 1 of 10
PCN Form — Version 1.4 January 2009

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:
V. Telephone no.:
4g. Fax no.:
4h. Email address:
5. Agent/Consultant Information (if applicable)
5a. Name:
Ronald J. Small, Jr.
5b. Business name
(if applicable):
Reedy Fork Environmental, LLC
5c. Street address:
119 Kensington Rd.
5d. City, state, zip:
Greensboro, NC 27403
5e. Telephone no.:
336.558.5970
5f. Fax no.:
5g. Email address:
rsmallC&reedyfork.net
Page 2 of 10

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
2817372012000
1 b. Site coordinates (in decimal degrees):
Latitude: 36.130937 Longitude: 81.664389
1c. Property size:
0.16 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
proposed project:
UT to Middle Fork South Fork New River
2b. Water Quality Classification of nearest receiving water:
WS -IV
2c. River basin:
New River
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: Site is a manmade, recreational/aesthetic pond in a residential community. Pond is surrounded by
common area, homes, and residential lawn/landscaping.
3b. List the total estimated acreage of all existing wetlands on the property: 0 (open water pond)
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
50' (perennial - pond discharge)
3d. Explain the purpose of the proposed project: We propose to eliminate the existing pond to createtrestore a small
stream channel through it, as well as a small (<0.1 -acre) floodplain/pocket wetland in the old pond basin. We hope to
improve water quality, create aquatic/wildlife habitat, allow fish access, reduce pond slope erosion, and eliminate
private property loss.
3e. Describe the overall project in detail, including the type of equipment to be used: Standard tracked mechanized
equipment and hand labor will be utilized for excavation, grading, pipe removal, and rock/boulder placement. As much
work as possible will be conducted from outside the pond (on the banks), but will be constrained by adjacent homes
and private property. A pump-around/silt bag system will be utilized to manage water during construction.
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?
❑ 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:
I Other.
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
6. 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 3 of 11
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.
Wetland impact
number
Permanent (P) or
Temporar
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 v
Choose one v
Yes/No
VV2 - v
Choose one v
Choose one v
Yes/No
W3 - v
Choose one v
Choose one v
Yes/No v
- v
VV4 - v
Choose one v
Choose one v
Yes/No
W5 - v
Choose one v
Choose one v
Yes/No v
- v
Wg - v
Choose one v
Choose one v
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 - v
Choose one
S2 - v
Choose one v
v
v
S3 - v
Choose one v
v
- v
S4 - v
Choose one
S5 - v
Choose one
56 - v
Choose one v
v
- v
3h. Total stream and tributary
impacts
3i. Comments:
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 individualiv list all open water impacts below.
4a.
Open water
impact number
Permanent (P) or
Temporary
4b.
Name of waterbody
(if applicable)
4c.
Type of impact
4d.
Waterbody
type
4e.
Area of impact (acres)
O1 P v
Grassy Knoll Lower Pond (unofficial)
Drainage v
Pond v
0.1
02 - "
Choose one v
Choose v
03 -
Choose one v
Choose v
04 _
Choose one v
Choose v
4f. Total open water impacts
0•1
4g. Comments' Manmade pond x to be eliminated. on will rain outlet pipes will Be removed, ea en am
will be breached.
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.
Stream Impacts (feet)
5e.
Upland
(acres)
Flooded Filled Excavated
Flooded Filled Excavated
P1
Choose one v
P2
Choose one v
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:
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 mitt ation then vou 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
Temporary
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 v
B2 _
YestNo v
B3 - v
Yes/No v
B4 - "
Yes/No v
B5 _ „
Yes/No v
B6 v
Yes/No v
6h. Total Buffer Impacts:
61. Comments:
Page 5 of 10

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.
A rock -lined plunge pool will be installed at the inlet to dissipate energy and reduce erosive forces, We have eliminated the use of a permanent,
manmade outlet structure (pipe or weir), and will instead utilize natural stone to "step down" any grade change(s) and encourage fish passage up into
the new channel.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
The pond will be slowly dewatered through sils. A pump -around system with silt bags will be used to manage water during construction. and
allow for work to be done "in the dry". We will perform as much excavation as possible from outside the pond. We will avoid any work prior to April
15, in order to avoid trout spawning activities. a will install a rock/gravel check dam for erosion control.
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:
3b. Credits Purchased (attach receipt and letter)
Type: Choose one -
Type: Choose one -
Type: Choose one -
Quantity:
Quantity:
Quantity:
3c. Comments:
4. Complete N Making a Payment to In -lieu Fee Program
4a. Approval letter from in4ieu fee program is attached. ❑ Yes
4b. Stream mitigation requested: linear feet
4c. If using stream mitigation, stream temperature: Choose one IV
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.
Page 6of10
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 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 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
within one of the NC Riparian Buffer Protection Rules?
❑ Yes ® No
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
❑ Yes ❑ No
2. Stormwater Mana ement Plan
2a. What is the overall percent imperviousness of this project?
0%
2b. Does this proaect require a Stormwater Mana ement Plan?
❑ Yes © No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
No development and no creation of impervious surface/built-upon area.
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
2e. Who will be responsible for the review of the Stormwater Management Plan?
3. Certified Local Government Stormwater Review
3a. In which local governments jurisdiction is thisproject?
3b. Which of the following locally -implemented stormwater management programs
apply (check all that apply):
❑ Phase 11
❑ NSW
❑ USMP
❑ Water Supply Watershed
❑ Other.
3c. Has the approved Stormwater Management Plan with proof of approval been
attached?
[]Yes ❑ No
4. DWQ Stormwater Program Review
4a. Which of the following state -implemented stormwater management programs apply
(check all that apply):
❑ Coastal counties
❑ HQW
ORW
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 8 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
Yes © No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act
Yes Q No
impacts?
5c. If yes, indicate the USFWS Field Office you have contacted.
-
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
fws.gov/raleigh/speciestcntylist/watauga.html
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?
PCN Instructions - this project is not located on the coast of NC, where "saltmarshes, oyster reefs, and seagrass beds" exist.
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?
HPOweb
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA -designated 100 -year floodplain?
❑ Yes QX No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?
www.ncttoodmaps.com
Ronald J. Small Jr.
,���k�n�o�
February 12, 2017
Applicant/Agent's Printed Name
Date
Applicant/Agent's Signature
(Agent's signature is valid only if an authorization
letter from the applicant isprovided.)
Page 10 of 10

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1a. Does the project involve an expenditure of public (federal/state/local) funds or the
❑ Yes
© No
use of public (federal/state) land?
1b. If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State
❑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
❑ 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
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.
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.
This project does not generate any sewertwastewater.
Page 9 of 10
PCN Form — Version 1.4 January 2009

SAMPLE AGENT AUTHORIZATION FORM
PROPER 7 r LEGAL DESG IP T ION:
LOT NO. PLAN NO. PARCEL ID: c:cc'
STREET ADDRESS:
Please print:
Property Owner:
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
Of
(Contractor / Agent) (Name of cbnsuking firm)
to act on my behalf and take all a tions necessary for the processir!g, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Propert i Ovm2r '.'s Address (if different than properhy above):
•J
Telephone: (: - {: •=,a- '*
We hereby certify the above information submitter; in This appiication is true and accurate to the
best of our knowledge.
Authorized Signature Authorized Signature
Date: 2 -- ! - -�-o 17 -,__e:

Grassy Knoll Lower Pond Renovation
Grassy Knoll Way, Blowing Rock, NC 28605
February 12, 2017
Site Map
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source — www.google.com/maps
Pond location
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4 reedyfork
Environ mentallandscapes
Ron Small
Reedy Fork Environmental, LLC
PO Box 10406
Greensboro, NC 27404

Grassy Knoll Lower Pond Renovation
Grassy Knoll Way, Blowing Rock, NC 28605
July 19, 2016
Ron Small
Reedy Fork Environmental, LLC
PO Box 10406
Greensboro, NC 27404
Upstream pond and culvert oust on other side of street)
Overview of pond (looking upstream from dam)
Overview of pond edge (looking downstream)
Overview of pond edge (looking downstream)
Earthen dam Earthen dam (eroded downstream slope)

Grassy Knoll Lower Pond Renovation
Grassy Knoll Way, Blowing Rock, NC 28605
July 19, 2016
Sloughing pond banks
Ron Small
Reedy Fork Environmental, LLC
PO Box 10406
Greensboro, NC 27404
Pond outlet (looking downstream)
Stable channel (downstream from pond outlet) Stable channel (-1.5'w X 3"-6" d)

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Grassy Knoll Lower Pond Renovation
Grassy Knoll Way, Blowing Rock, NC 28605
February 16, 2017
Proposed Plant List
Ron Small
Reedy Fork Environmental, LLC
PO Box 10406
Greensboro, NC 27404
Scientific Name
Common Name
Amelanchier arborea
seNceberry
Athyrium spp.
lady fem
Callicarpa americana
beautyberry
Dryopteris spp.
wood fern
Eupatoriadelphus fistulosus
joe pye weed
Kalmia latifolia
mountain laurel
Osmunda spp.
cinnamon fern
Polystichum spp.
christmas fem
Rhododendron catawbiense
rhododendron
ndron maximum
a
rhododendron
Scientific Name
Common Name
Asclepias incamata
swamp milkweed
Chasmanthium latifolia
ri\er oats
Iris virginica
blue flag iris
Juncus effusus
soft rush
Lobelia cardinalis
cardinal flower
Peltandra virginica
arrow amam
Saururus cemuus
lizard tail
Schoenoplectus pungens
common three -square
Schoenoplectus tabemaemontani
softstem bulrush
Scientific Name
Common Name
Cephalanthus occidentalis
buttonbush
Comus alba
red twig dogwood
Hex glabra
inkberry
Ilex verticillata
winterberry
Itea virginica
virginia sweetspire
Lindera benzoin
spicebush
Prunus virginiana
chokeberry
Sambucus canadensis
elderberry