20180774 Ver 1_401 Application_20180618

Action History (UTC -05:00) Eastern Time (US & Canada)
Submit by Anonymous User 6/5/2018 6:26:31 AM (Start Event)
Accept by Montalvo, Sheri A 6/6/2018 1:47:02 PM (Non DOT Initial Review)
• The task was assigned to Montalvo, Sheri A. The due date is: June 8, 2018 5:00 PM 6/5/2018 6:27 AM

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://edocs.deq.nc.govMaterResources/0/edocl6247041PCN%20Help%20File%202018-1-30.pdf
A. Processing Information
County (or Counties) where the project is located:*
Caswell
Is this project a public transportation project?*
f Yes f• No
This is any publicly funded by nunicipal,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)
r Standard (IP)
This form may be Corps to initiate the standard/individual permit process. Please contact your Corps representative for submittal of standard permits.
All required items that are not provided in the E -PCN and be added to the miscellaneous upload located at the bottom of this form.
Nationwide Permit (NWP) Number:
NWP Number Other:
List all IWV nurrbers 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 r 401 Water Quality Certification - Express
F Non -404 Jurisdictional General Permit r Riparian Buffer Authorization
r Individual Permit
*
1d. Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification:
r Yes C No
For the record only for Corps Permit: C Yes O No

1e. 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
f Yes C No
1f. Is the project located in anyof NC's twentycoastal counties?*
r Yes C No
1h. Is the project located in a designated trout watershed?*
f Yes f• No
Link to trout information: http://vmw.saw.usace.army.mil/Missions/Regulatory-Permit-ProgranVAgency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact?*
Patricia A. Powell
1b. Primary Contact Email:*
[e-mail]
1c. Primary Contact Phone:*
(XXX)XXX-XXXX
[phone]
1d. Who is applying for the permit?
V Owner r Applicant (other than owner) r Agent/Consultant
(Check all that apply)
2. Owner Information
2a. Name(s) on recorded deed:
Patricia Ann Powell
2b. Deed book and page no.:
Book 389, Page 421
2c. Responsible party:
(for Corporations)
2d. Address
Street Address
193 Cascade Lane
Address Line 2
qty
State/ Province/ Fbgion
Providence
North Carolina
Postal / Zip Code
Country
27315
United States of America
2e. Telephone Number:
(XXX)XXX-)D=
[phone]
2f. Fax Number:
(XXX)XXX-)O=
2g. Email Address:*
[e-mail]
.............
C. Project Information and Prior Project History
1. Project Information

1a. Name of project:*
Powell Access Road
1b. Subdivision name:
(if appropriate)
Caswell Rock
1c. Nearest municipality / town:
*
Providence, North Carolina
1d. Driving directions*
IF it is a new project and can not easily be found in a GPS rrepping system Please provide directions.
Off of Shady Grove Road (700) and 29.
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)
Parcel No.: 0032000001470000
2b. Property size:
(in acres)
4.270
2c. Project Address
Street Address
193 Cascade Lane
Address Line 2
aty
Providence
Postal / Zip Code
27315
State / Province / Fbgion
NC
Country
United States of America
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:*
36.511111 -79.458245
ex: 34.208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Little Mill Creek
3b. Water Resources Classification of nearest receiving water:*
Dan River (Hydrologic Unit Code 03010104)
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Roanoke
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:*
See attached Sketch provided by US Corps of Engineers and USGS Topo Map. The general land use is for
collecting kindle and wood for fireplace, as well as, cleaning falling debris resulting from wind, storms, etc.
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 here to attach docurrent
USGS TOPO MAPpdf.pdf 51.13KB
File type mast 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:
.25 of an acre of wetland
4e. List the total estimated linear feet of all existing streams on the property:
(intermittent and perennial)
450 - 500 Linear Feet
4f. Explain the purpose of the proposed project:*
The purpose of the driveway/passageway to avoid impact to the wetlands gives access to the back (East) of my
the property, 193 Cascade Lane, Providence, NC, 27315.
4g. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:
Overall this is a passageway to acquire kindling, wood, clean debri using a pick-up truck on the upland area, which
is to the right of the wetland.
4h. Please upload project drawings for the proposed project.
Click the upload button or drag and drop files here to attach docurrent
PlanViewandProfileViewProjectpdf.pdf 94.65KB
File type rrust be pdf
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
r Yes f 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
SAW -298-00930
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
David Bailey
U.S. Army Corps of Engineers
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
May 11, 2018
5d1. Jurisdictional determination upload

Cick the upload button or drag and drop files here to attach docurrent
Mr. Bailey Letter2018-00930 Unauthorized Activity Letter (2).pdf 731.92KB
File type mist be FDF
6. Project History
6a. Have permits or certifications been requested or obtained forth is 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.
No
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
V Wetlands V Streams -tributaries r Buffers
r- 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 *
Driveway P Headwater Forest
Ivbp label (e.g. lbad Grossing 1 - Calvert, Fern -anent (Pt or
dewatering, etc) Temporary (T)
2g. Total Temporary Wetland Impact
0.000
2g. Total Permanent Wetland Impact
0.004
2g. Total Wetland Impact
0.004
2h. Comments:
2d. Wetland name *2e. 2f. Type of
Forested* Jurisdicition*
Wetland 1 Yes Both
(404, 10) or DhR(401,
other)
2g. Impact
area
0.004
(acres)
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 s fei
type* Type* Jurisdiction* width* length*
S1 Driveway P Culvert UT to Little Mill Perennial Both 2 144 2
Nbp label (e.g. Road Grossing Permanent (Pf or Creek Perennial (FEIP� or Average (linear feet) 8
1) Temporary (T) intermttent (INT) (feet) 8
" All Perennial or Intermittent streams must be verified by DWR or delegated local government.

3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
144
3i. Total temporary stream impacts:
0
3i. Total stream and tributary impacts:
144
3j. Comments:
E. Impact Justification and Mitigation
`WTIVO.._Fit MY!,TirIAfl'117F=-,*
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
The width of the driveway/passageway was limited to what is needed for one pickup truck. The crossing is installed
in the narrowest part of the wetland.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
The crossing will be stabilized by seed and straw to prevent erosion.
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 r No
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:
Not in a Buffered Basin
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?
r Yes f• No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?*
6 Yes
r 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 2B.0200)?*
f• Yes r No
2b. Is this an after -the -fact permit application?*
r Yes r No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
I unknowingly was cleaning the area of debris, and from a recent tornado impact on trees and other falling limbs,
etc. I contacted Environmental Protection and other governing agencies. Thereafter, one of their designees came
out and afterwards US Army Corp, Mr. David Bailey who then advised me of what was done, and what needs to be
done to correct the violation.
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.
This project, driveway will not impact nearby downstream water quality, because it is not near the stream. The
driveway leads directly to the upland area to the right of the wetlands.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
r 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 r 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?
The North Carolina Natural Heritage Program DataBase updated 7/2017.
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 EFH Mapper
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/hpoweb/
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?*
The most recent version (SHPO Arc GIS Mapservice) of the North Carolina State Historic Preservation Office
Database
7c. Historic or Prehistoric Information Upload
Qick the upload button or drag and drop files here to attach document
File must 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?*
f Yes r No
8c. What source(s) did you use to make the floodplain determination?*
FEMA Flood Plan Mapper
Miscellaneous
Miscellaneous attachments not previously requested.
nick the upload button or drag and drop files here to attach docurrent
File mast be FDF or KINE
Signature
rJ 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:*
Patricia Ann Powell
Signature

Date Submitted:
6/5/2018
Initial Review
Is this project a public transportation project?* (?
0 Yes f• No
Change only if needed.
Has this project met the requirements for acceptance in to the review process?*
f• Yes
f No
BIMS # Assigned*
20180774
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
f Fee needed - send electronic notification