20190621 Ver 1_401 Application_20190508

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CDC.
Transmittal
Date: May 3°d, 2019
Project Name: Rolling Hills Estates
CDC Project: 21826
To: NC DWQ, WBSCP Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
$ PAID
0621
ID
Via: ® Mail ❑ Overnight O Hand Delivered ❑ Pick up @ CDC Office ❑ Digital
Remarks:
Description
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CDC Cover Letter
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Agent Authorization Form
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USACE PCN for NWP 12
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Engineering Plans (2-24"x36" & 3-11"x17')
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unn, PE
Bmunn(&cdc og com
Mailing Address: P.O. Box 5432, Asheville, NC 28813
168 Patton Avenue Asheville, NC 28801 52 Walnut Street — Suite 9, Waynesville, NC 28786
Phone [phone] Fax [phone] Phone: [phone] Fax: [phone]

CDC 9rqpt
May 2"d, 2019
WBSCP Unit
NC DWQ
1650 Mail Service Center
Raleigh, NC 27699-1650
RE: Rolling Hills Estate
CDC Project No.: 21826
Dear Reviewer,
On behalf of Rolling Hills Estate, we are providing copies of PCN documents for the subject
project. The proposed project consists of; four single family homes, a water line stream crossing,
and other appurtenances located along Shannondale Court in Clyde, NC.
Please find enclosed the following items for your Records:
USACE PCN Application for NWP12
Engineering Drawings
If you should have any questions or need any additional information during your review, please
do not hesitate to call our office.
Sincerely,
Ben unn, PE
Civil Design Concepts, P.A.
[e-mail]
Mailing Address: P.O. Box 5432, Asheville, NC 28813
168 Patton Avenue Asheville, NC 28801 52 Walnut Street — Suite 9, Waynesville, NC 28786
Phone [phone] Fax [phone] Phone: [phone] Fax: [phone]

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. 10 -13 PLAN NO. PARCEL ID: 8627-634333
STREET ADDRESS: 15 Shannondale Ct, Clyde, NC 26721
Please print:
Property Owner: _PerY J Stamps
Property Owner: Gaddis Properties LLC
The undersigned, registered property owners of the above noted property, do hereby authorize
Benjamin Munn of Civil Design Concepts
(Contractor / Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
PO Box 950, Fort Lauderdale, Florida 33302
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
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Authorized Signature Authorized Signature - -- ------ ---
Date: 3 R 2 /'? Date:

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. 10 -13 PLAN NO. PARCEL ID: 8627-63-4333
STREET ADDRESS: 15 Shannondale Ct, Clyde, NC 28721
Please print:
Property Owner: Perry J Stamos
Property Owner: Gaddis Properties LLC
The undersigned, registered property owners of the above noted property, do hereby authorize
Benjamin Munn , of Civil Design Concepts
(Contractor / Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
PO Box 950, Fort Lauderdale, Florida 33302
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
VP G'#oa' <'AP -T, Z
MONA41WR f6R GnDO/s / a/°bR?iEr
Authorized Signature Authorized Signature
Date: 3 - R z - /? Date:

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. 10 -13 PLAN NO.
PARCEL ID: 8627-63-4333
STREET ADDRESS: 15 Shannondale Ct, Clyde, NC 28721
Please print:
Property Owner: Perry J Stamos
property owner: Gaddis Properties LLC
The undersigned, registered property owners of the above noted property, do hereby authorize
Benjamin Munn of Civil Design Concepts
(Contractor / Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
PO Box 950, Fort Lauderdale, Fkxida 33302
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
VP GAvak CAP�TaL
/�I�NAe1FiR foR G.,DDis /��PER?iE,r
Authorized SignatureAuthorized Signature
Date: 3 ' R z - /'T Date:

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. 10 - 13 PLAN NO. PARCEL ID: 8627-63-4333
STREET ADDRESS: 15 Shannondale Ct, Clyde, NC 28721
Please print:
Property Owner: Perry J Stamps
Property Owner: Gaddis Properties LLC
The undersigned, registered property owners of the above noted property, do hereby authorize
Benjamin Munn of Civil Design Concepts
(Contractor / Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
PO Box 950, Fort Lauderdale, Florida 33302
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
Authorized Signature —
Date:
VP GApai C100"T� Ceif/�iA�TieN
1iANA*ArR f6R 4rr*pol/ /�i �PiERTiEt�
Authorized Signature
Date:

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. 10 -13 PLAN NO. PARCEL ID: 8627-63-4333
STREET ADDRESS: 15 Shannondale Ct, Clyde, NC 28721
Please print:
Property Owner: _Perry J Stamos
Property Owner: Gaddis Properties LLC
The undersigned, registered property owners of the above noted property, do hereby authorize
Benjamin Munn of Civil Design Concepts
(Contractor / Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
PO Box 950, Fort Lauderdale, Florida 33302
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
VP GAoo,� CAo.Tp� Ce�lb��T,:� )
lVAVA,*dCR "-R Cr*00 t 3&A1R7;6x
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Authorized Signature Authorized Signature
Date: 3 2 z - "Y Date:

Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.4 January 2009
Page 1 of 10
PCN 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:
❑ Section 404 Permit x❑ Section 10 Permit
1 b.
Specify Nationwide Permit (NWP) number: NWP 12 or General Permit (GP) number:
1c.
Has the NWP or GP number been verified by the Corps?
❑x 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
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
1 e.
Is this notification solely for the record
because written approval is not required?
For the record only for DWQ
401 Certification:
x❑ Yes ❑ No
For the record only for Corps Permit:
❑ Yes ❑x No
1f.
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.
❑ Yes ❑X No
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1h
below.
❑ Yes x❑ No
1 h.
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ YesX❑ No
2.
Project Information
2a.
Name of project:
Rolling Hills Estate
2b.
County:
Haywood County
2c.
Nearest municipality / town:
Lake Junaluska
2d.
Subdivision name:
Rolling Hills Estate
2e.
NCDOT only, T.I.P. or state project no:
3.
Owner Information
3a.
Name(s) on Recorded Deed:
Gaddis Properties, LLC
3b.
Deed Book and Page No.
870/176
3c.
Responsible Party (for LLC if
applicable):
Perry Stamos
3d.
Street address:
PO Box 950
3e.
City, state, zip:
Fort Lauderdale, Florida 33302
3f.
Telephone no.:
954-565-8900
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:
Q Agent ❑ Other, specify:
4b. Name:
4c. Business name
(if applicable):
4d. Street address:
4e. City, state, zip:
4f. Telephone no.:
4g. Fax no.:
4h. Email address:
5. Agent/Consultant Information (if applicable)
5a. Name:
Benjamin Munn
5b. Business name
(if applicable):
Civil Design Concepts
5c. Street address:
168 Patton Avenue
5d. City, state, zip:
Asheville, NC 28801
5e. Telephone no.:
828-252-5388
5f. Fax no.:
828-252-5365
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):
8627-63-4333
1 b. Site coordinates (in decimal degrees):
I Latitude: -82.9485 Longitude: 35.5358
1c. Property size:
2.22 acres
2. Surface Waters
2a. Name of nearest body of water to proposed project:
Jones Cover Branch
2b. Water Quality Classification of nearest receiving water:
C
2c. River basin:
French Broad
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:
Existing site consists of 4 lots that share a cul-de-sac with bridge access over the Jones Cover Branch.
3b. List the total estimated acreage of all existing wetlands on the property:
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 409
3d. Explain the purpose of the proposed project:
project consists of developing 4 single family houses and the associated Utilities. A 2" water line will need to cross under the Jones Cover Branch.
3e. Describe the overall project in detail, including the type of equipment to be used:
Water pipe to be installed below stream bed via mechanical trenching. Stream to be diverted around trenching.
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 ❑x Unknown
Comments:
4b. If the Corps made the jurisdictional determination, what type
of determination was made?
El Preliminary E] 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 ❑ No ❑x Unknown
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project?
❑x Yes ❑ No
6b. If yes, explain.
This project is part of the overall Rolling Hills Estates development. However, this project scope will be installed in one phase.
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):
❑ Wetlands ❑x 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 T
2b.
Type of impact
2c.
Type of wetland
2d.
Forested
2e.
Type of jurisdiction
Corps (404,10) or
DWQ (401, other)
2f.
Area of
impact
(acres)
W1
W2
W3
W4
W5
W6
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.
Type of impact
3c.
Stream name
3d.
Perennial (PER) or
intermittent (INT)?
3e.
Type of
jurisdiction
3f.
Average
stream
width
(feet)
3g.
Impact
length
(linear
feet)
S1 T
Utility Crossing
Jones Cover Branch
INT
Corps
5
10
S2
S3
S4
S5
S6
3h. Total stream and tributary impacts
10
3i. Comments:
USACE Permitting for a proposed 2" waterline crossing the stream near the existing bridge.
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 indivi uallv list all open water impacts below.
4a.
Open water
impact number
Permanent (P) or
Temporary T
4b.
Name of waterbody
(if applicable)
4c.
Type of impact
4d.
Waterbody
type
4e.
Area of impact (acres)
01
02
03
04
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If pond or lake construction proposed, the complete the chart below.
5a.
Pond ID number
5b.
Proposed use or
purpose of pond
5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
(acres)
Flooded
Filled
Excavated Flooded
Filled Excavated
P1
P2
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 miti ation, then you MUST fill out Section D of this form.
6a. Project is in which protected basin?
❑ Neuse ❑ Tar -Pamlico ❑ Catawba ❑ Randleman ❑ Other:
6b. /
Buffer Impact
number–
Permanent (P) or
—Temporary T
6c.
Reason for impact
6d.
Stream name
6e.
Buffer
mitigation
required?
6f.
Zone 1
impact
(square
feet)
6g.
Zone 2
impact
(square
feet
131
B2
B3
B4
B5
B6
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.
Utilities were routed away from the stream where possible and crossing was limited to one location.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Standard stream crossing methods will be used to divert the stream around the crossing 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?
❑ Yes ❑x 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:
Type:
Type:
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:
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
buffer mitigation?
❑ Yes ❑X 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).
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
❑ Yesx❑ 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.
❑ Yes ❑ No
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project?
16%
2b. Does this project require a Stormwater Management Plan?
❑ Yes Z No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
Impervious area is less than 24% of property.
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 'urisdiction is thisproject?
Lake Junaluska
❑ 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
El Yes ❑x 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?
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)
1 a. Does the project involve an expenditure of public (federal/state/local) funds or the
❑ Yes ❑X No
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
El Yes ❑ No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
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
❑ Yes ❑ No
letter.)
Comments:
2. Violations (DWQ Requirement)
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 ❑x 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 capacity of the subject facility.
The proposed sewer services will be connected to existing sewer mains that flow to the local public WWTP.
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
❑ Yesx❑ No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act
❑ Yes ❑x No
impacts?
5c. If yes, indicate the USFWS Field Office you have contacted.
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
IPAC Online. No Critical Habitat Located at site.
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?
NCDEO Surface Water Classification Online f
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?
North Carolina State Historic Preservation Office
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA -designated 100 -year floodplain?
❑ Yes ❑x No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?
FEMA Online. Flood Map Service Center FRI
v)jalMIVN uvV]
Applicant/Agent's Signature
OS
Applicant/Agent's Printed Name
Date
(Agent's signature is valid only if an authorization
letter from the applicant isprovided.)
Page 10 of 10