20190419 Ver 1_PCN Form Submission_20190401

DWR
MOM— of Water Resources
Pre -Construction Notification (PCN) Form
September 29, 2018 Ver 3
tial Review
Has this project met the requirements for acceptance in to the review process?*
r Yes
r No
Is this project a public transportation project?*
G Yes r No
Change mly if needed.
BIMS # Assigned
20190419
Is a payment required for this project?*
r No payment required
r Fee received
r Fee needed - send electronic notification
Select Project Reviewer*
Andrew Moore:eads\awmoore3
Information for Initial Review
1a. Name of project:
Driveway addition
1a. Who is the Primary Contact?*
Harold Hemrick
1b. Primary Contact Email:*
[e-mail]
Date Submitted
4/1/2019
Nearest Body of Water
Shawneehaw Creek
Basin
Watauga
Water Classification
Trout
Site Coordinates
Version# *
1
Reviewing Office*
Asheville Regional Office - [phone]
1c. Primary Contact Phone:*
[phone]
Latitude:
Longitude:
36.16325791944263
-81.8641519546509
A. Processing Information
County (or Counties) where the project is located:
Avery
Is this project a public transportation project?*
r Yes r No
1a. Type(s) of approval sought from the Corps:
* 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?
F Nationwide Permit (NWP)
F- Regional General Permit (RGP)
W Standard (IP)

1c. Has the NWP or GP number been verified by the Corps?
r Yes r No
1d. Type(s) of approval sought from the DWR:
F_ 401 Water Quality Certification - Regular r 401 Water Quality Certification - Express
r Non -404 Jurisdictional General Permit r Riparian Buffer Authorization
17 Individual Permit
*
1e. Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification: IT Yes r No
For the record only for Corps Permit: r Yes r No
1f. Is this an after -the -fact permit application?*
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
Acceptance Letter Attachment
1h. Is the project located in any of NC's twenty coastal counties?
r Yes r No
1j. Is the project located in a designated trout watershed?
G Yes r No
B. Applicant Information
1d. Who is applying for the permit?
V Owner r Applicant (other than owner)
1e. Is there an Agent/Consultant for this project?
r Yes r No
2. Owner Information
2a. Name(s) on recorded deed:
Harold Hamrick, Sandra Privatte-Robinson
2b. Deed book and page no.:
book 512 page 1295
2c. Responsible party:
2d. Address
Street Address
109 Robert Cook Ln.
Address Line 2
city
Banner Elk
Postal / Zip Aide
28604
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
Fc --Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(d appropriate)
Crooked Creek
1c. Nearest municipality/ town:
Banner Elk
State / Frovince / R�gim
NC
Country
USA
2f. Fax Number:

2. Project Identification
2a. Property Identification Number:
18591840652700000
2c. Project Address
Street Address
109 Robert Cook Ln.
Address Line 2
Cfty
Banner Elk
Postal / Zip Code
28604
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Shawneehaw Creek
3b. Water Resources Classification of nearest receiving water:*
Trout
3c. What river basin(s) is your project located in?*
Watauga
3d. Please provide the 12 -digit HUC in which the project is located.
060101030201
4. Project Description and History
2b. Property size:
.26
State / Ftwince / Region
NC
Country
USA
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:*
Small (1'x1') drainage ditch currently runs next to existing driveway. Ditch is in natural area between exiting drive and street (Crooked creek). Currently the area where the proposed
driveway is brush and Rhododendron.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
r Yes r No r Unknown
4d. Attach an 8 1/2X11 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for DWR)
4e. Attach an 8 1/2X11 excerpt from the most recent version of the published County NRCS Soil Survey map depicting the project site. (for DWR)
4f. List the total estimated acreage of all existing wetlands on the property:
4g. List the total estimated linear feet of all existing streams on the property:
4h. Explain the purpose of the proposed project:*
Addition to existing driveway. Existing drive is very steep and unsafe. The addition provides a nearly flat entrance to the property.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
Install 18 to 24" pipe in existing ditch. Ditch to be dug out to allow pipe to drain along existing path. Pipe will then be covered in gravel and filled in to alow paving of the driveway.
4j. Please upload project drawings for the proposed project.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes r No
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
r Preliminary r Approved r Not Verified r Unknown r WA
Corps AID Number:
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
r Unknown

Other:
5d. List the dates of the Corp jurisdiction determination or State determination if a determination was made by the Corps or DWR
5d1. Jurisdictional determination upload
6. Future Project Plans
6a. Is this a phased project?*
r 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?
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
[ Wetlands r Streams -tributaries
[ Open Waters r Pond Construction
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:
No flow restrictions will result from the project. No additional run off or change of direction will result.
F Buffers
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Pipe will be covered with washed gravel and stone.
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:
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
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
If no, explain why:
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
r 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
Comments:
G. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federallstate/local) funds or the use of public (federal/state) land?*
r Yes r No
2. Violations (DWR Requirement)
u
u

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 (15ANCAC 2B.0200)?*
r Yes r No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project 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.
No flow restrictions or direction will result. Existing run off will not be impacted
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
C Yes r- No r 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?
f Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
f 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
Sh. 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?
Army Corps of Engneers
Consultation Documentation Upload
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?*
https://vwAv.habitat.noaa.gov/application/efhmapper/index.html
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 status?*
r Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
pre existing construction are
7c. Historic or Prehistoric Information Upload
8. Flood Zone Designation (Corps Requirement)
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?*
Deed not listed as floodplain, no flood insurance required

Miscellaneous
Comments
Miscellaneous attachments not previously requested.
Signature u
W 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:
Harold E. Hemrick
Signature
Date
4/1/2019