20180457 Ver 1_401 Application_20180318

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 answered.
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:lledocs.deq.nc.govMaterResources101edocl6247041PCN%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?*
f Yes f• No
This is any publicly funded by municipal,state or federal funds road, rail, airport transportation project.
1a. Type(s) of approval sought from the Corps:*
V Section 404 Permit (wetlands, streams and waters, Clean Water Act)
F Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What type(s) of permit(s) do you wish to seek authorization?*
IJ Nationwide Permit (NWP)
r Regional General Permit (RGP)
Nationwide Permit (NWP) Number: 13 - Bank Stabilization
NWP Number Other:
List all NW numbers you are applying for not on the drop down list.
1c. Type(s) of approval sought from the DWR:*
check all that apply
IJ 401 Water Quality Certification - Regular ❑ 401 Water Quality Certification - Express
F- Non -404 Jurisdictional General Permit ❑ Riparian Buffer Authorization
*
1d. Is this notification solelyfor the record because written approval is not required?
For the record only for DWR 401 Certification:
For the record only for Corps Permit:
r Yes G No
r Yes f• No
1e. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
V so, attach the acceptance letter from mitigation bank or in -lieu fee program
r Yes r No
1f. Is the project located in anyof NC's twenty coastal counties?*

f Yes
r No
1h. Is the project located in a designated trout watershed?*
C Yes r No
Link to trout information: http://wAw.saw.usace.army.mil/Missions/Regulatory-Permit-ProgranVAgency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact?*
Adam Williams
1b. Primary Contact Email:*
[e-mail]
1c. Primary Contact Phone:*
[phone]
1d. Who is applying for the permit?
❑ Owner r Applicant (other than owner) m Agent/Consultant
(Check all that apply)
2. Owner Information
2a. Name(s) on recorded deed:
Mossy Creek Investments, LLC / Optimus Club of Boone Inc.
2b. Deed book and page no.:
1803/38 (Mossy) , 095/087(Optimus)
2c. Responsible party:
(for Corporations)
2d. Address
Street Address
Address Line 2
204 Furman Rd
aty
Boone
Fbstal / Zip Code
28607
2e. Telephone Number:
[phone]
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Adam Williams
4b. Business Name:
(if applicable)
Brushy Fork Environmental Consulting, Inc
4c. Address
State / Province / Pegion
NC
Country
USA

Street Address
10565 Hwy 421 South
Address Line 2
City
Trade
Pbstal / Zip Code
37691
4d. Telephone Number:
[phone]
(xxx)xxx-xxxx
4e. Fax Number:
(XXX)XXX-XXXX
Email Address:*
[e-mail]
State/ Province/ Region
TN
Country
USA
Agent Authorization Letter*
Reese provide the Agent Authorization Letter if you are subnitting this document.
Signed AA Mossy Creek.pdf 295.18KB
SIGNED Optimus Club AA.pdf 164KB
RLE TYPE MUST BE PDF
C. Project Information and Prior Project History
1. Project Information
..................................................................................................................................................................................................................................
1a. Name of project:*
Winkler Creek Streambank Stabilization - Mossy Creek Investments LLC
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/ town:*
Boone, NC
1d. Driving directions*
V it is a new project and can not easily be found in a GPS napping system Rease provide directions.
Easily found by GPS. Project on Winkler Creek behind apartment building at 204 Furman Rd in Boone.
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)
2910627434000 (Mossy Creek Investments), 2910627769000 (Optimus
Club of Boone, Inc.)
2b. Property size:
(in acres)
0.824 (Mossy Creek Investments), 5.5 (Optimus)
2c. Project Address
Street Address
204 Furman Rd
Address Line 2
City
Boone
Fbstal / Zip Code
28607
State / Province / Region
NC
Country
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 how the 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:*
36.201197 -81.654739
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, CA
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 project is occurring near the downtown Boone area adjacent to an apartment complex This area is made up
of largely impervious surfaces such as buildings, parking lots, and roadways.
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)
nick the upload button or drag and drop files here to attach docunent
Topo-location_ma p_Mossy_Creek. pdf
File type crust be pdf
685.62KB
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)
aick the upload button or drag and drop files here to attach docunent
Soil Map Mossy Creek.pdf 180.18KB
File type rrust be pdf
4d. List the total estimated acreage of all existing wetlands on the property:
0
4e. List the total estimated linear feet of all existing streams on the property:
(internittent and perennial)
180
4f. Explain the purpose of the proposed project:*
The purpose of the project is to stabilize the river right (south) stream bank of Winkler Creek. Approximately 165 ft
of permanent impacts are proposed.
4g. Describe the overall project in detail, including indirect imapacts and the type of equipment to be used:*
The project will stabilize the river right stream bank by installing rock .1 -hooks which will provide grade control and
bank stabilization. Equipment to be used for this proposed construction include track -hoes, skidsteers, and dump
trucks for hauling equipment, and building materials
4h. Please upload project drawings for the proposed project.

nick the upload button or drag and drop files here to attach docur ant
COMBINED Mossy Ck USACE Submittal 3-26-18.pdf 2.62MB
Rle type rust 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:
Area was delineated for wetlands and none epst on the property. Wetland
Datasheets and map are attached in Miscellaneous attachments.
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
r Preliminary r Approved r Unknown f• N/A
Corps AID Number:
Exarple:SAW--2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
Josselyn Lucas, WPIT
Brushy Fork Environmental Consulting, Inc.
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5dl. Jurisdictional determination upload
dick the upload button or drag and drop files here to attach docurent
Mossy Creek PJD.pdf 132.98KB
Rle 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?
f Yes C No r Unknown
7. Future Project Plans
7a. Is this a phased project?*
f Yes r 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.
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
r- Wetlands P Streams -tributaries r Buffers
r- Open Waters F Pond Construction
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. Reason for impact*3b.lmpact 3c. Type of impact*3d. Stream name* 3e. Stream 3f. Type of 3g. Stream 3h. Impact
type* Type* Jurisdiction* width* length*
S1 1 P Bank Winkler Creek Perennial Both
Nbp label (e.g. Poad Crossing 1) Permanent (Pt or Stabilization Perennial (PER) or
Temporary (1) internittent (INT)
" All Perennial or Intermittent streams must be verified by DWR or delegated local government.
3i. Total jurisdictional ditch impact in square feet:
0
31. Total permanent stream impacts:
165
3i. Total temporary stream impacts:
0
3i. Total stream and tributary impacts:
165
3j. Comments:
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:*
The proposed work and associated impacts are intended to stabilize approbmately 165 linear feet of stream bank
along the stream reach while minimizing impacts to aquatic resources. Design measures which minimize impacts
include installation of J -hooks. All disturbed buffer areas will be immediately seeded upon completion (temporary -
rye grain and browntop millet), matted (coconut/coir matting) and stabilized at the close of each construction day.
25 165 4
Average (feet) (linear feet)
1
2
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
All streambank disturbances will be stabilized same day and covered with coir (coconut matting) and livestaked to
reduce sedimentation during construction. Only equipment in good condition will be used on this project, no leaks
will be tolerated. Equipment will work from the streamanks to perform the majority of the work. In -stream access of
equipment will be absolutely minimized.
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?
f Yes
C No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
This is a streambank restoration project which will not have impacts requiring mitigation on Waters of the U.S. or Waters of the State.
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?
f Yes
C No
For a list of options to meet the diffuse flow requirements, click here.

If no, explain why:
Project is not within an NC Riparian Buffer Protection area.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?
f Yes r No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?*
r Yes
f No
To look up low density requirement click here 15A NCAC 02H.1003(2)
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?
f 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 213.0200)?
f 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?*
f Yes r No
3b. If you answered "no," provide a short narrative description.
The project is a streambank stabilization only which will not lead to additional development.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
r Yes f 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
5c. If yes, indicate the USFWS Field Office you have contacted.
Asheville
5d. Is another Federal agency involved?*
f Yes r No r Unknown
5e. Is this a DOT project located within Division's 1-8?*

f Yes r No
5f. Will you cut any trees 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?*
f Yes r No
Link to the NLEB SLOPES document: http://saw-reg.usace.army.mil/NLEB/1-30-17-signed_NLEB-SLOPES&apps.pctf
5h. Does this project involve the construction/installation of a wind turbine(s)?**
f 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.?*
f Yes r No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
USFW Asheville office was contacted in regards to impacts to endangered species or critical habitat areas. Please
see miscellaneous attachments for USFW response letter.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
f Yes r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
NOAA - Office of Habitat Protection Division
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/hpoveb/
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)?*
f Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
HPOWeb: NCHPO GIS Service.
7c. Historic or Prehistoric Information Upload
aick the upload button or drag and drop files here to attach document
Mossy SHPO Map.pdf 3.11 MB
File rust 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
8b. If yes, explain how project meets FEMA requirements:
The proposed project is not anticipated to cause an increase in flood elevation. A No -Rise Certification will be
submitted by Brushy Fork Engineering Division, LLC. to the Town of Boone floodplain administrator.
8c. What source(s) did you use to make the floodplain determination?*
Town of Boone Web Mapper:
hftps://gisviemr.tovvnofboone.net/maps/default.htm
Miscellaneous

Miscellaneous attachments not previously requested.
gickthe upload button or drag and drop files here to attach docunent
Mossy_Crk_Combined_for_submittal.pdf 2.9MB
18-186—Mossy Creek Investments Winkler Creek Stream Restoration Project—Watauga
182.45KB
Co.pdf
Mossy Creek USACE Submittal Coversheet.pdf 79.87KB
File crust be FDF or KIVZ
Signature
P 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:*
Adam Williams
Signature
Sign
Initial Review
Is this project a public transportation project?*(?
r Yes r No
Change only If needed.
Has this project met the requirements for acceptance in to the review process?*
r Yes
f No
BIMS # Assigned*
20180457
Version#*
1
Reviewing Office*
Winston-Salem Regional Office - [phone]
Select Project Reviewer*
Sue Homewood:eads\slhomewood
Is a payment required for this project?*
f No payment required
f Fee received
r Fee needed - send electronic notification
What amout is owed?*
r $240.00
0 $570.00