20180919 Ver 1_401 Application_20181029

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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: Q Section 404 Permit ❑ Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number: 27 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps? ❑ Yes ❑X No
1d. Type(s) of approval sought from the DWQ (check all that apply):
0 401 Water Quality Certification — Regular ❑ Non -404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
le. Is this notification solely for the record
For the record only for DWQ
For the record only for Corps Permit:
because written approval is not required?
401 Certification:
Yadkin
2c.
Nearest municipality / town:
❑ Yes ❑X No
❑ Yes
Q No
1f. Is payment into a mitigation bank or in -lieu fee program proposed for
2e.
NCDOT only, T.I.P. or state project no:
mitigation of impacts? If so, attach the acceptance letter from mitigation bank
❑ Yes
❑X No
or in -lieu fee program.
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
❑ Yes
Q No
below.
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:
Meadow Brook Stream Restoration
2b.
County:
Yadkin
2c.
Nearest municipality / town:
Hamptonville
2d.
Subdivision name:
N/A
2e.
NCDOT only, T.I.P. or state project no:
N/A
13. Owner Information
3a. Name(s) on Recorded Deed:
See attached agent authorization letters and map
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if
applicable):
3d. Street address:
3e. City, state, zip:
3f. Telephone no.:
3g. Fax no.:
3h. Email address:
Page 1 of 10
PCN Form — Version 1.4 January 2009

4. Applicant Information (if different from owner)
4a. Applicant is:
❑ Agent X❑ Other, specify: Permittee
4b. Name:
Lin Xu
4c. Business name
(if applicable):
NC Division of Mitigation Services
4d. Street address:
217 W Jones Street
4e. City, state, zip:
Raleigh, NC 27603
4f. Telephone no.:
919-707-8319
4g. Fax no.:
4h. Email address:
[e-mail]
5. Co-Applicant
5a. Name:
Kevin Tweedy, PE
5b. Business name
(if applicable):
Ecosystem Planning and Restoration
5c. Street address:
599 Jones Franklin Road, Suite 150
5d. City, state, zip:
Raleigh, NC 27606
5e. Telephone no.:
919-388-0787
5f. Fax no.:
919-388-0789
5g. Email address:
[e-mail]
Page 2 of 10

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): 14867254364,486700258016,4867254139
1 b. Site coordinates (in decimal degrees): I Latitude: 36.141378 Longitude: -80.819068
1c. Property size:
111.2 acres
2. Surface Waters
2a. Name of nearest body of water to proposed project:
South Deep Creek (12-84-2-(1))
2b. Water Quality Classification of nearest receiving water:
WS -111
2c. River basin:
Yadkin -Pee Dee
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:
The Meadow Brook project is located in pastureland that was previously drained by the installation of ditches and the channelization of the streams.
The project consists of two streams, Meadow Brook and an Unnamed Tributary (UT) to Meadow Brook. Wetlands also exist on the property, although
they are of degraded quality.
3b. List the total estimated acreage of all existing wetlands on the property: 6
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 2,800
3d. Explain the purpose of the proposed project:
See attached
3e. Describe the overall project in detail, including the type of equipment to be used:
See attached
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the ❑X Yes ❑ No ❑ Unknown
Corps or State been requested or obtained for this property /
project (includingall prior phases)in the past? Comments: PJD submitted 1!a/1 s, approved 4/17!18
4b. If the Corps made the jurisdictional determination, what type Preliminary ❑ Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company: EPR
Name (if known): Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Site visit 1/24/18: William Elliott (USACE), Sue Homewood (NCDWR), Cidney Jones (EPR), Thomas Barrett (EPR)
5. Project History
5a. Have permits or certifications been requested or obtained for ❑Yes ❑X No ❑ Unknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project? ❑ Yes ❑X No
6b. If yes, explain.
Page 3 of 10
PCN Form — Version 1.4 January 2009

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
Q Wetlands Q 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.
2b.
2c.
2d.
2e.
2f.
Wetland impact
Type of impact
Type of wetland
Forested
Type of jurisdiction
Area of
number
Corps (404,10) or
impact
Permanent (P) or
DWQ (401, other)
(acres)
Temporary T
W1 -
Choose one
Choose one
Yes/No
-
W2 -
Choose one
Choose one
Yes/No
-
W3 -
Choose one
Choose one
Yes/No
-
W4 -
Choose one
Choose one
Yes/No
-
W5 -
Choose one
Choose one
Yes/No
-
W6 - Choose one Choose one Yes/No -
2g. Total Wetland Impacts:
2h. Comments:
See attached
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.
3b.
3c.
3d.
3e,
3f.
3g.
Stream impact
Type of impact
Stream name
Perennial (PER) or
Type of
Average
Impact
number
intermittent (INT)?
jurisdiction
stream
length
Permanent (P) or
width
(linear
Temporary (T)
(feet)
feet)
S1 T
Relocation
Meadow Brook R1
PER
Corps
12.5
1,304
S2 T
Relocation
Meadow Brook R2
PER
Corps
14.5
327
S3 T
Relocation
Meadow Brook R3
PER
Corps
21
289
S4 T
Relocation
UT1 to Meadow Brook
PER
Corps
8
361
S5 T
Stabilization
Meadow Brook R4
PER
Corps
21
283
S6 P
Culvert
UT1 to Meadow Brock
PER
Corps
8
35
3h. Total stream and tributary impacts 2,599
3i. Comments:
The proposed project is being performed for stream restoration credits and the proposed channels will provide more aquatic function than the existing
channels. Meadow Brook and UT to Meadow Brook will be lengthened as a part of this project. All impacts except the culvert on the UT will be
temporary. The culvert is proposed in order to keep the cattle, farm equipment, and associated pollutants out of the stream.
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 individually list all open water imracts below.
4a.
4b.
4c.
4d.
4e.
Open water
Name of waterbody
impact number
(if applicable)
Type of impact
Waterbody
Area of impact (acres)
Permanent (P) or
type
Temporary
Choose one
Choose
01 -
O2 -
Choose one
Choose
03 -
Choose one
Choose
04 - Choose one Choose
4f. Total open water impacts +
4g. Comments: o open wa er exis s on si e
6. Pond or Lake Construction
If pond or lake construction p o osed, then com tete the chart below.
5a. 5b. 5c. 5d. 5e.
Pond ID number Proposed use or Wetland Impacts (acres) Stream Impacts (feet) Upland
purpose of pond (acres)
Flooded Filled Excavated Flooded Filled Excavated
P7
Choose one
P2
Choose one
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 mitigation, then you MUST fill out Section D of this form.
6a. Project is in which protected basin?
❑ Neuse ❑ Tar -Pamlico ❑ Catawba ❑ Randleman ❑ Other-
ther6b.
6b.
6c.
6d.
6e. 6f.
6g.
Buffer Impact
Reason for impact
Stream name
Buffer Zone 1
Zone 2
number-
mitigation impact
impact
Permanent (P) or
required? (square
(square
Temporary T)
feet)
feet
131 -
Yes/No
B2 -
Yes/No
B3 -
Yes/No
B4 -
Yes/No
B5 -
Yes/No
B6 -
Yes/No
6h. Total Buffer Impacts:
6i. 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.
See attached
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
See attached
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 if Making a Payment to In -lieu Fee Program
4a. Approval letter from in -lieu fee program is attached.
❑ Yes
4b. Stream mitigation requested:
linear feet
4c. If using stream mitigation, stream temperature:
Choose one
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 6 of 10
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
Yes ❑X No
buffer mitigation?
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.
6c. 6d. 6e.
Zone Reason for impact Total impact Multiplier Required mitigation
(square feet) (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
1a. Does the project include or is it adjacent to protected riparian buffers identified
❑ Yes X❑ No
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
The project is not located in a protected buffer area.
❑ Yes ❑ No
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project?
0%
2b. Does this project require a Stormwater Management Plan?
❑ Yes ❑X No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
The percent imperviousness of the project will not be altered as no impervious surfaces will be added to the area. Forested wetland
areas adjacent to the stream will promote increased plant uptake and retention of surface runoff before it reaches the stream channels, minimizing
overland flow velocities.
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 localgovernment's jurisdiction is thisproject?
❑ Phase II
❑ NSW
3b. Which of the following locally -implemented stormwater management programs
❑ USMP
apply (check all that apply):
❑ Water Supply Watershed
❑ Other:
3c. Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
4. DWQ Stormwater Program Review
❑Coastal counties
❑HQW
4a. Which of the following state -implemented stormwater management programs apply
❑ORW
(check all that apply):
E] Session Law 2006-246
[]Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
S. 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

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1a. Does the project involve an expenditure of public (federal/state/local) funds or the
use of public (federal/state) land?
1 b. 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
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
❑R Yes ❑ No
❑ Yes ❑X No
1 c. 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
letter.) ❑ Yes ❑ No
Comments:
2. Violations (DWQ Requirement)
I
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 Q No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after -the -fact permit application? El Yes ❑X 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 ❑X 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 cappacity of the subject facility.
No wastewater will be generated from the project.
Page 9 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
0 Yes ❑ No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act
0 Yes ❑ No
impacts?
5c. If yes, indicate the USFWS Field Office you have contacted.
Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
USFWSwas contacted 6/21/17 but no response was received.
https:/ www.fws.gov/midwest/endangered/mammals/nieb/pdf/NLEBFactSheetOlApril2Ol5.pdf.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat?
❑ Yes Q No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
USFWS County List, NC Natural Heritage Data, NC Wildlife Resources Commission
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 X❑ 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?
State Historic Preservation Office contacted June 21, 2017. Response received July 19, 2017.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA -designated 100 -year floodplain?
❑X Yes ❑ No
8b. If yes, explain how project meets FEMA requirements:
CLOMR application has been submitted to FEMA. A LOMR package will be produced post -construction.
8c. What source(s) did you use to make the floodplain determination?
FEMA DFIRM panel 3710486600J, effective May 18, 2009.
Lin Xu
Applicant/Agent's Printed Name Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization
letter from the applicant isprovided.)
Kevin Tweedy
10/25/18
Co -Applicant's Printed Name
Date
Co -Applicant's Signature
Page 10 of 10