20181054 Ver 1_401 Application_20180731

Action History (UTC -05:00) Eastern Time (US & Canada)
Submit by Anonymous User 7/31/2018 3:35:24 PM (Start Event)
Accept by Montalvo, Sheri A 8/2/2018 1:56:02 PM (Non DOT Initial Review)
• The task was assigned to Montalvo, Sheri A. The due date is: August 3, 2018 5:00 PM
7/31/2018 3:36 PM

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:*
Guilford
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: 29 - Residential Developments
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:
O Yes O No
For the record only for Corps Permit: O 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?*
Bradley Luckey
1b. Primary Contact Email:*
[e-mail]
1c. Primary Contact Phone:*
(XXX)XXX-XXXX
[phone]
1d. Who is applying for the permit?
❑ owner V Applicant (other than owner) r Agent/Consultant
(Check all that apply)
2. Owner Information
2a. Name(s) on recorded deed:
James and Melissa Babcock
2b. Deed book and page no.:
8027/2693
2c. Responsible party:
(for Corporations)
2d. Address
Street Address
1144 Constantine Court
Address Line 2
qty State/ Province/ Fbgion
Greensboro NC
Fbstal / Zip Code Country
27407
2e. Telephone Number:
(XXX)XXX-XXXX
[phone]
2f. Fax Number:
(XXX)XXX-)O=
2g. Email Address:*
[e-mail]
.................................
3. Applicant Information (if different from owner)
3a. Applicant is:

O Agent
f• Other Builder
If other please specify.
3b. Name:
Alex Mumford
3c. Business Name:
(if applicable)
Wolfe Homes
3d. Address
Street Address
200-J Pomona Drive
Address Line 2
City
Greensboro
Postal / Zip Code
27407
3e. Telephone Number:
[phone]
(xxx)xxx-xxxx
Fax Number:
(xxx)xxx-xxxx
3g. Email Address:*
Alex. [e-mail]
State / Province / Pegion
NC
Country
us
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
3309 Gaston Road
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/ town:
Greensboro
1d. Driving directions*
If it is a new project and can riot easily be found in a CPS napping system Pease provide directions.
3309 Gaston Road, Greensboro, NC 27407
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)
7832730955
2b. Property size:
(in acres)
2.04
2c. Project Address

Street Address
3309 Gaston Road
Address Line 2
City
State/ Province/ Region
Greensboro
NC
Postal / Zip Code
Country
27407
us
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:*
36.010607 -79.88926
ex: 34.208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Reddicks Creek
3b. Water Resources Classification of nearest receiving water:*
WS -Iv
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Cape Fear
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 site is being developed with a single family residence. Surrounding properties include a golf course, wooded
land and single family residences.
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)
(]ick the upload button or drag and drop files here to attach docurrent
topo.pdf 227.93KB
File type rrust be pdf
4c. Attach an 8 112 X 11 excerpt from the most recent version of the published County NRCS Soil Survey map depicting the project site.
(for DWR)
(]ick the upload button or drag and drop files here to attach document
soils.pdf 457.07KB
File type mist 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:
(intermittent and perennial)
150
4f. Explain the purpose of the proposed project:*
The purpose of the proposed project is to develop the site with a single family residence.
4g. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*

The overall project consists of development of the site with a single family residence and associated driveway. To
facilitate development of the site and construction of the proposed road and sewer line stream crossings, clearing
and grading the site is necessary. Graders and other heavy equipment will be used during site construction. A
water supply well will be drilled on the site to provide water to the residence.
4h. Please upload project drawings for the proposed project.
Click the upload button or drag and drop files here to attach docurrent
stream cross REV 7-31-18.pdf 664.87KB
File type mast be pdt
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:
The stream is high -banked. Wetlands are not present. The stream was dry
at the time of our site visit. The stream is intermittent based on our
observations.
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:
Bcarrple: SAWW-2017-99999
The USACE has not verified the site to the best of my knowledge.
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
Bradley Luckey
Pilot Environmental, Inc.
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
The site has not been verified by the USACE or the NCDWR.
5d1. Jurisdictional determination upload
Click the upload button or drag and drop files here to attach docurrent
File type mist 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 r 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.
The applicant is not aware of other permits that are associated with the
development of the site.
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):

r Wetlands rJ Streams -tributaries m Buffers
r" Open Waters r" 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
Temp*
type*
Type*
Jurisdiction*
S1 Road Crossing
P Culvert Unnamed
Intermittent
Both
Nbp label (e.g. Road Grossing
Permanent (P) or
Perennial (Pff� or
mitigation
1)
Tenporary (T)
intermittent (INT)
Zone 1
S2 Sewer Crossing
T Other Unnamed
Intermittent
Both
tvbp label (e.g. Road Grossing
Fernanent (P) or
Perennial (FffP) or
1)
Tenporary (T)
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
3i. Total permanent stream impacts:
32
31. Total temporary stream impacts:
7
31. Total stream and tributary impacts:
39
3j. Comments:
The proposed stream crossing will permanently impact 32 linear feet of intermittent stream channel with culvert fill.
The stream is a weak intermittent stream that has been dry. Therefore, temporary stream impacts are not
proposed for the road crossing. A sewer line crossing will be installed by open cut/back-fill and will result in 7 linear
feet of temporary stream impact. The stream will be restored to similar pre -construction conditions following
installation of the sewer line. Permanent stream impacts are not proposed for the sewer line crossing.
6. Buffer Impacts (for DWR)
If project will impact a protected riparian buffer, then complete the chart below. Individually list all buffer impacts below.
6a. Project is in which protect basin(s)?*
Check all that apply.
F' Neuse
F Catawba
r- Goose Creek
r Other
6b. Impact Type *
6c. Per or
2
Temp*
Road
P
Location and Bcenpt, Allowable, allowable w/
Perasnent (F) or
ration
Tenporary (T)
Underground Utility
T
Location and Bcerrpt, Allowable, allowable w/
Permanent () or
mitigation
Temporary (T)
6h. Total buffer impacts:
Zone 1
F' Tar -Pamlico
F Randleman
rJ Jordan Lake
6d. Stream name * 6e. Buffer mitigation
required?*
Unnamed No
Unamed No
Zone 2
3g. Stream 3h. Impact s
width*
length*
2
32 6
Average
(linear feet) 4
(feet)
2
7 1
Average
(linear feet) 4
(feet)
6f. Zone 1 6g. Zone 2
impact* impact*
788 540
(square feet) (square feet)
419 159
(square feet) (square feet)

Temporary impacts: 419.00 159.00
Zone 1 Zone 2
Permanent impacts: 788.00 540.00
Zone 1 Zone 2
Total buffer impacts: 1,207.00 699.00
6i. Comments:
The applicant is not requesting buffer authorization for the proposed exempt buffer impacts.
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
click the upload button or drag and drop files here to attach docurrent
File mist be FDF
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 road and utility crossing have been designed to cross the stream in areas that are relatively straight and with
few meanders. Additionally, the crossings have been designed as near to perpendicular as possible. The road
and utility crossings have been designed to avoid removal of large trees within the stream buffer.
The residence and its amenities have been designed to avoid impact to remaining WoUS located on the site.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
The crossings are proposed to be installed in the dry. The crossing limits will be measured in the field prior to
installation.
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
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
Based on the amount of impacts, mitigation is not proposed.
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
1b. All buffer impacts and high ground impacts require diffuse flow or other form of stormwater treatment. If the project is subject to a
state implemented riparian buffer protection program, include a plan that fully documents how diffuse flow will be maintained.
All Stormwater Control Measures (SCM)s must be designed in accordance with the NC Stormwater Design Manual. Associated
supplement forms and other documentation shall be provided.
What type of SCM are you providing?

r Level Spreader
rJ Vegetated Conveyance (lower SHWT)
r Wetland Swale (higher SHWT)
r Other SCM that removes minimum 30% nitrogen
(check all that apply)
For a list of options to meet the diffuse flow requirements, click here.
Diff us Flow Documentation
Click the upload button or drag and drop files here to attach docurrent
File type crust be FDF
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
r No
To look up low density requirement click here 15A NCAC 02H.1 003(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?*
f 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.
One single family residence is being constructed on the lot. Other impacts to WoUS are not anticipated as a result
of the proposed project.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
r Yes r Nor N/A
4b. Describe, in detail, the treatment methods and dispositions (non -discharge or discharge) of wastewater generated from the
proposed project. If the wastewater will be treated at a treatment plant, list the capacity available at that plant.
The project will discharge wastewater to the municipal treatment system. Impacts to WoUS, outside of those
proposed in this application, are not anticipated as a result of the proposed project's sewer treatment.
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?*
f Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
C Yes r No
5d. Is another Federal agency involved?*
C Yes r No
5e. Is this a DOT project located within Division's 1-8?*
f Yes r No
5f. Will you cut anytrees in order to conduct the work in waters of the U.S.?
f Yes r No
5g. Does this project involve bridge maintenance or removal?
f Yes G No
f Unknown
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)?*
C5 Yes G No
51. 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 G No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
Pilot consulted the USFWS List of Protected Species for Guilford County. The USFWS identifies the following
protected species in Guilford County: small whorled pogonia (T). Based on our observations, suitable habitat for
small whorled pogonia is not located on the site.
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?*
The stream is intermittent and was dry at the time of our site visit. The stream does not provide suitable habitat for
fish species.
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/hpo\Aeb/
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?*
The site is located within the Pilot Life - Sedgefield Historic District. The land use in this district is for residential
purposes. The land use is not changing. This will fit the general land use of the district.
7c. Historic or Prehistoric Information Upload
nick the upload button or drag and drop files here to attach document
SHPO.pdf 381.16KB
File must be FDF
8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https:Hmsc.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 FIRM 3710783200J
Miscellaneous
Miscellaneous attachments not previously requested.
Click the upload button or drag and drop files here to attach docurrent
Parcel Info.pdf
41.55KB
Agent Authorization for JD_NC - Babcock.pdf
497.49KB
Agent Authorization for JD_NC - Wolfe.pdf
70.41 KB
Photo Page Template.pdf
552.23KB
DWR Stream Form v4.11.pdf
331.02KB
Pilot 3847Gaston Road DP 1.pdf
90.99KB
FEMA.pdf
192.04KB
File mist be FDF or IME
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:*
Bradley S. Luckey
Signature
.��a5' �
Date Submitted:
7/31/2018
Initial Review
Is this project a public transportation project?* (?
r Yes C No
Change only if needed.
Has this project met the requirements for acceptance in to the review process?*
F Yes
f No
BIMS # Assigned *
20181054
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
f $570.00