20181710 Ver 1_401 Application_20181213

Office Use Only:
rEXICL
Corps action ID no.
DWQ project no.
Form Version 1.4 January 2009
C
Pre -Construction Notification (PCN) Form
A. Applicant Information 2 0 1 8 1 7 110
1. Processing
1 a. Type(s) of approval sought from the Corps:
❑X Section 404 Permit
❑ Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: or General Permit (GP) number:
1 c. Has the NWP or GP number been verified by the Corps?
❑ Yes ® No
1 d. Type(s) of approval sought from the DWQ (check all that apply):
❑ 401 Water Quality Certification — Regular ❑ Non -404 Jurisdictional General Permit
❑X 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
le. Is this notification solely for the record
because written approval is not required?
For the record only for DWQ
401 Certification:
❑ Yes X❑ No
For the record only for Corps Permit:
❑X Yes ❑ No
1f. Is payment into a mitigation bank or in -lieu fee program proposed for
j mitigation of impacts? If so, attach the acceptance letter from mitigation bank
or in -lieu fee program.
❑ Yes ❑X No
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below.
❑ Yes ❑X No
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: Red Fox Meadows
2b. County: Avery
2c. Nearest municipality / town: Banner Elk
2d. Subdivision name: Red Fox Meadows
2e. NCDOT only, T.I.P. or state project no:
3. Owner Information
3a. Name(s) on Recorded Deed:
RFM & Gwaltney Farms LLC
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if
applicable):
520/2410 Avery County Registry
William Wakeman III "Bill"
Isla aZ574��
MW
3d. Street address:
306 E Main Street Suite 200
IJEC 1 ,
3e. City, state, zip:
Lakeland, FL 33801
3f. Telephone no.:
863-529-3465
4
3g. Fax no.:
R 1 T
3h. Email address:
[e-mail]
Page 1 of 10
PCN Form — Version 1.4 January 2009

4. Applicant Information (if different from owner)
4a. Applicant is:
❑ Agent ❑ Other, specify:
4b. Name:
4c. Business name
(if applicable):
i 4d. Street address:
4e. City, state, zip:
j 4f. Telephone no.:
4g. Fax no.:
4h. Email address:
5. Agent/Consultant Information (if applicable)
5a. Name:
5b. Business name
(if applicable):
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. Fax no.:
5g. Email address:
Page 2 of 10

B. Project Information and Prior Project History
1. Property Identification
la. Property identification no. (tax PIN or parcel ID): PIN 158914347825
1b. Site coordinates (in decimal degrees): latitude: 36.17 Longitude: 81.860
1c. Property size: 48.20 acres
2. Surface Waters
2a. Name of nearest body of water to proposed project: Whitehead Creek
2b. Water Quality Classification of nearest receiving water:
2c. River basin: Elk River
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:
tree covered
3b. List the total estimated acreage of all existing wetlands on the property: less than 1 acre
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
3d. Explain the purpose of the proposed project:
Development of 11 residential lots
3e. Describe the overall project in detail, including the type of equipment to be used:
11 houses are to be built with approximately 2.940 feet of paved road for access to individual driveways at each lot. Bull dozers, trackhoes, motor grad
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (including all priorphases) in thepast?
❑ Yes ❑ No ® Unknown
Comments:
4b. If the Corps made the jurisdictional determination, what type
of determination was made?
❑ Preliminary ❑ Final
4c. If yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5. Project History
5a. Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
❑ Yes ❑X No ❑ Unknown
5b. If yes, explain in detail according to 'help file" instructions.
6. Future Project Plans
6a. Is this a phased project? ® Yes ❑ No
6b. If yes, explain. Red Fox Meadow is an 11 lot community and will not be a phased project.
However, the parcel and road will be shared by a future development.
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 appy):
❑ Wetlands ❑ 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.
Wetland impact
number
Permanent (P) or
Temporary CT)
2b.2c. 2d. 2e.
Type of impact Type of wetland Forested Type of jurisdiction
Corps (404,10) or
DWQ (401, other) _
2f. i
Area of
impact
(acres)
W1 P
Culvert Headwater Wetland Yes DWQ
500 sgft
W2 P
Culvert Headwater Wetland Yes DWQ
500 sqft
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:
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.
Stream impact
number
Permanent (P) or
Temporary (T)
3b. 3c. 3d. 3e. 3f. 3g.
Type of impact Stream name Perennial (PER) or Type of Average impact
intermittent (INT)? jurisdiction stream length
width (linear
(feet) feet)
S1 -
Choose one -
S2 -
Choose one -
S3 -
Choose one -
S4 -
Choose one -
S5 -
Choose one
S6 -
Choose one
3h. Total stream and tributary impacts
3i. Comments:
I
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 impacts below.
4a. 4b.
Open water Name of waterbody
impact number (rf applicable)
Permanent (P) or
Temporary
4c. 4d.
Type of impact Waterbody
type
4e.
Area of impact (acres)
01
Choose one Choose
02
Choose one Choose
03 -
Choose one Choose
04
Choose one Choose
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If pond or lake construction proposed, the complete 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
P1 Choose one
P2 Choose one
5f. Total:
59. 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 constriction:
6. Buffer Impacts (for DWO)
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.
6b. sc.
Buffer Impact Reason for impact
number—
Permanent (P) or
Temporary
6d.
6e. 6f. 6g.
Stream name Buffer Zone 1 Zone 2
mitigation impact impact
required? (square (square
feet) feet
B1 -
Yes/No
B2
Yes/No
B3
Yes/No
B4 -
Yes/No
B5 -
YestNo
B6 -
YeslNo
6h. Total Buffer Impacts:
6i. Comments:
Page 5 of 10

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
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 ® No
2b. If yes, mitigation is required by (check all that apply):
❑ DWQ ❑ Corps
i
2c. If yes, which mitigation option will be used for this
projects
❑ Mitigation bank
❑Payment to in -lieu fee program
❑ Permittee Responsible Mitigation
i
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: 70 linear feet
4c. If using stream mitigation, stream temperature: cool
4d. Buffer mitigation requested (DWQ only): 500 sgft 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
buffer mitigation?
E] Yes XQ No
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.
Zone
6c.
Reason for impact
6d.
Total impact
(square feet)
Multiplier
6e.
Required mitigation
(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).
I
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?
1b. If yes, then is a diffuse flow plan included? If no, explain why.
❑ Yes ❑ No
I
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project?
%
2b. Does this project require a Stormwater Management Plan?
❑ Yes ❑Q No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
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 local governments jurisdiction is thisproject?
Avery County
❑ Phase II
3b. Which of the following locally -implemented stormwater management programs
❑ NSW
USMP
apply (check all that apply):
8 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):
❑Session Law 2006-246
[]Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
5. 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)
la. Does the project involve an expenditure of public (federal/statellocal) funds or the
use of public (federallstate) land?
❑ Yes
Q No
1b. 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
❑ Yes
❑ No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1c. 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)
j
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,
❑X Yes
❑ No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after-the-fact permit application?
®Yes
❑ No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
two storm water pipes were installed in an unnamed tribtuary in what has been declared to be headwater wetlands
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in
©Yes
❑ 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.
there will be 11 house sites in the future with each site requiring individual erosion control plans
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 capacity of the subject facility.
septic tank
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
❑ Yes ❑X No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act
©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?
USFWS Endangered Spieces for Avery County NC
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat?
❑ Yes © No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
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 ® 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?
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA -designated 100 -year floodplain?
❑ Yes © No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?
100 year flood plane maps of NC
William Wakeman IIIA
la
�'tT
a2
Applicant/Agent's Printed Name
Applican Agen s Signature
Date
(Agent's signature is valid only if an authorization
letter from the applicant isprovided.)
Page 10 of 10