20180292 Ver 1_401 Application_20180218

E -PCN Submittal
DWR
Division of water Resources
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
January 31, 2018 Ver 2.3
Please note: fields marked with a red asterisk below are required. You will not be able to submit the form until all mandatory questions are ansmred.
Also, if at any point you wish to print a copy of the E -PCN, all you need to do is right -click on the document and you can print a copy of the form.
Below is a link to the online help file.
https:lledoes.deq. nc.govfWaterResources101edoci624704iPCN%20Help%20File%202018-1-30. pdf
A. Processing Information
County (or Counties) where the project is located:
Watauga
Is this project a public transportation project?
r Yes r No
1a. Type(s) of approval sought from the Corps:*
Pr Section 404 Permit (wetlands, streams and waters, Clean Water Act)
r Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What type(s) of permit(s) do you wish to seek authorization?*
17 Nationwide Permit (NWP)
r Regional General Permit (RGP)
Nationwide Permit (NWP) Number: 14 - Linear transportation
NWP Number Other:
List all NN nunbers you are applying for not on the drop down list.
1c. Type(s) of approval sought from the DWR:*
check all that apply
W 401 Water Quality Certification - Regular r 401 Water Quality Certification - Express
r Non -404 Jurisdictional General Permit r Riparian Buffer Authorization
....................................
*
1d. Is this notification solelyfor the record because written approval is not required?
For the record only for DWR 401 Certification:
O Yes G No
For the record only for Corps Permit: O Yes r No

le. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
If so, attach the acceptance letter fromnitigation bank or in -lieu fee program
r Yes r No
1f. Is the project located in anyof NC's twenty coastal counties?*
r Yes r No
1h. Is the project located in a designated trout watershed?*
r Yes r No
Link to trout information: http://wwvv.saw.usace.army.miI/Missions/Regulatory-Permit-Program/Agency-Coordination/Trout.aspx

B. Applicant Information
B. Applicant Information
1a. Who is the Primary Contact?*
Jason Green
1b. Primary Contact Email:*
[e-mail]
1c. Primary Contact Phone:*
[phone]
1d. Who is applying for the permit?
W Owner r- Applicant (other than owner) r- Agent/Consultant
(Check all that apply)
2. Owner Information
2a. Name(s) on recorded deed:
Jason Adam Green
2b. Deed book and page no.:
Book 1732, Page 697 and Book 1846, Page 794
2c. Responsible party:
(for Corporations)
2d. Address
Street Address
244 Wild Blackberry Hill Rd.
Address Line 2
City
Boone
Fbstal / Zip Code
28607
2e. Telephone Number:
(xxx)xxx-Xoax
[phone]
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
State / Rovince / fbgion
NC
Country
USA

C. Project Information and Prior Project History
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Private Driveway
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/ town:
Boone, NC
1d. Driving directions*
It it is a new project and can not easily be found in a GPS napping system Please provide directions.
Site address is 1033 Russ Cornett Rd. (There used to be a mobile home there but it has been removed.) It should come up in Google Maps.
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)
PINs: 2809498820000, 2900403088000
2b. Property size:
(in acres)
14.56
2c. Project Address
Street Address
1033 Russ Cornett Rd
Address Line 2
City
State / Province / Region
Boone
NC
Postal / Zip Code
Country
28607
USA
2d. Site coordinates in decimal degrees
Please collect site coordinates in decimal degrees. Use between 4-6 digits (unless you are using a survey -grade GPS device) after the decimal place as
appropriate, based on howthe location was determined. (For example, most mobile phones with GPS provide locational precision in decimal degrees to
map coordinates to 5 or 6 digits after the decimal place.)
Latitude:* Longitude:*
36.19337 -81.69687
ex: 34.208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Winkler Creek
3b. Water Resources Classification of nearest receiving water:*
WS -II, Tr, HQW
Surface Water Lookup

3c. What river basin(s) is your project located in?*
New
River Basin Lookup
4. Project Description
4a. 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 property is currently a mix of vacant pasture and forest. General land use in the vicinity is comprised of
residential homes.
4b. Attach an 8 1/2 X 11 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for
DWR)
Click the upload button or drag and drop files hereto attach docurrent
File type rrust be pdf
4c. Attach an 8 1/2 X 11 excerpt from the most recent version of the published County NRCS Soil Survey map depicting the project site.
(for DWR)
Click the upload button or drag and drop files here to attach docurrent
File type rrust be pdf
4d. List the total estimated acreage of all existing wetlands on the property:
1.5 acres
4e. List the total estimated linear feet of all existing streams on the property:
(interndtent and perennial)
1000 linear feet
4f. Explain the purpose of the proposed project:*
To access a proposed residential building site on higher ground.
4g. Describe the overall project in detail, including indirect imapacts and the type of equipment to be used:
The project will be the building of approximately 600 linear feet of private driveway to access a proposed
residential dwelling on higher ground. The resulting driveway will have a 12' wide compacted gravel travel surface
and grass shoulders. The project will be built with two track hoes and one dump truck. Fill will be excavated from a
borrow area on site.
4h. Please upload project drawings for the proposed project.
Click the upload button or drag and drop files here to attach docurrent
Project Map.pdf 949.59KB
File type rrust be pdf
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes r No r Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?
r Preliminary r Approved r Unknown r N/A
Corps AID Number:
Exarrple: SAW -2017-99999

5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5d1. Jurisdictional determination upload
Cick the upload button or drag and drop files hereto attach docurrent
File type rrust be FDF
6. Project History
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past?*
r Yes r No r Unknown
7. Future Project Plans
7a. Is this a phased project?*
r Yes C No
Are any other NWP(s), regional general permit(s), or individual permits(s) used, or intended to be used, to authorize any part of the
proposed project or related activity? This includes other separate and distant crossing for linear projects that require Department of the
Army authorization but don't require pre -construction notification.
No

D. Proposed Impacts Inventory
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
rJ Wetlands rJ Streams -tributaries F Buffers
F- Open Waters r- Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. Site # - Reason for impact*
2b. Impact type *
2c. Type of wetland *
2d. Wetland name
*2e.
2f. Type of
2g. Impact
Forested*
Jurisdicition*
area*
W1
P
Isolated Wetlands
W1
No
Both
0.005
K/hp label (e.g. Fbad Crossing 1 - Culvert,
Permanent (P) or
(404, 10) or D \R(401,
(acres)
dewatering, etc)
Temporary (T)
other)
W2
P
Isolated Wetlands
W2
No
Both
0.060
Ivbp label (e.g. Foad Crossing 1 - Culvert,
Permanent (P) or
(404, 10) or C7\R(401,
(acres)
dewatering, etc)
Temporary (T)
other)
W3
P
Unknown
W3
Yes
Both
0.005
lvep label (e.g. Poad Crossing 1 - Calvert,
Permanent (P) or
(404, 10) or DAR (401,
(acres)
dewatering, etc)
Terrporary (T)
other)
2g. Total Temporary Wetland Impact
0.000
2g. Total Permanent Wetland Impact
0.070
2g. Total Wetland Impact
0.070
2h. Comments:
Impact areas estimated by USACE representative Amanda Jones Fuemmeler.
W1 will be a 40' by 3' diameter culvert.
W2 will be an elevation of the road bed using clean fill soil collected from on-site borrrow area.
W3 will be a 20' by 2' diameter culvert.
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. Site # - Reason for 3b.lmpact 3c. Type of impact* 3d. Stream name* 3e. Stream 3f. Type of 3g. Stream 3h. Impact
impact* type * Type * Jurisdiction * width * length*
S1 P Culvert Unnamed Tributaryto Perennial Both 5 40
lvep label (e.g. Poad Crossing 1) Permanent (P) or Winkler Creek Perennial (PEP) or Average (feet) (linear feet)
T-wrary (T) internittent (INT)
— All Perennial or Intermittent streams must be verified by DWR or delegated local government.
31. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:

40
31. Total temporary stream impacts:
3i. Total stream and tributary impacts:
40
3j. Comments:
Stream impact will be comprised of:
(1) 40' long by 4' diameter culvert pipe for everyday flow, and
(1) 40' long by 3' diameter culvert pipe for high water events.

E. Impact Justification and Mitigation
E. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
All stream crossing will be perpendicular to the stream channels. Culverts will be embedded in the streams. No
work will be done either upstream or downstream of the culvert pipes. Intend to work in the dry where possible.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Erosion control silt fencing will be used to prevent any silt from entering the streams and buffer areas. A native
grass seed mix will be used to vegetate and stabilize all exposed soil. Mats, coconut or other, will be used where
necessary to help stabilize soil on slopes near streams.
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?
r Yes r No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
USACE representative indicated it does not after site evaluation.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
— Recent changes to the stormwater rules have required updates to this section .-
1. Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection
Rules?
r Yes r No
For a list of options to meet the diffuse flow requirements, click here.
If no, explain why:
USACE representative indicated it does not after site evaluation.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
r Yes r No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H.1003(2)?
r Yes
r No
To lookup low density requirement click here 15A NCAC 02H .1003(2)

G. Supplementary Information
G. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
r Yes r No
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15A NCAC 2H .0500), Isolated Wetland Rules (15A NCAC 2H .1300), or
DWR Surface Water or Wetland Standards or Riparian Buffer Rules (15A NCAC 2B .0200)?
r Yes r No
2b. Is this an after -the -fact permit application?*
r Yes r No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in additional development, which could impact
nearby downstream water quality?*
r Yes r No
3b. If you answered "no," provide a short narrative description.
My intent in build a single family dwelling on property, not to develop the property.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?
f Yes r Nor N/A
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or habitat?*
r Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
r Yes r No
5d. Is another Federal agency involved?*
r Yes r No f Unknown
5e. Is this a DOT project located within Division's 1-8?*
r Yes r No
5f. Will you cut anytrees in order to conduct the work in waters of the U.S.?*
r Yes r No
5g. Does this project involve bridge maintenance or removal?*
r Yes r No
Link to the NLEB SLOPES document: http://saw-reg.usace.army.mil/NLEB/1-30-17-signed_NLEB-SLOPES&apps.pdf
5h. Does this project involve the construction/installation of a wind turbine(s)?"*

r Yes r No
5i. Does this project involve (1) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhammers,
mechanized pile drivers, etc.?*
r Yes r No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
USACE representative Amanda Jones Fuemmeler
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
r Yes r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
USACE representative Amanda Jones Fuemmeler
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data: http://gis.ncdcr.gov/hpovveb/
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 status (e.g., National Historic Trust designation or properties significant in North Carolina history and archaeology)?*
r Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
USACE representative Amanda Jones Fuemmeler
7c. Historic or Prehistoric Information Upload
Cick the upload button or drag and drop files here to attach docurrent
File rrust be FDF
8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https://msc.fema.gov/portal/search
8a. Will this project occur in a FEMA -designated 100 -year floodplain?*
r Yes r No
8c. What source(s) did you use to make the floodplain determination?*
FEMA map, Watauga County GIS map
Miscellaneous
Miscellaneous attachments not previously requested.
nick the upload button or drag and drop files hereto attach docurrent
File rust be FDF

Signature Page
Signature
m By checking the box and signing below, I certify that:
■ I have given true, accurate, and complete information on this form;
■ I agree that submission of this PCN form is a "transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic
Transactions Act');
■ I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic
Transactions Act');
■ I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature; AND
■ I intend to electronically sign and submit the PCN form.
Full Name:*
Jason Adam Green
Signature
,Aasoo Ac,?4q gi-ee�4

Initial Review
Is this project a public transportation project?*(?)
r Yes r No
Change only ff needed.
Has this project met the requirements for acceptance in to the review process?*
t: Yes
r No
BIMS # Assigned *
20180292
Version#*
Reviewing Office*
Winston-Salem Regional Office - [phone]
Select Project Reviewer*
Sue Homewood:eads\slhomewood
Is a payment required for this project?*
r No payment required
f Fee received
G Fee needed - send electronic notification
What amout is owed?
* $240.00
r $570.00