New Submission

Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
December 4, 2023 Ver 4.3
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.gov/WaterResources/DocView.aspx?dbid=0&id=2196924

A. Processing Information

If this is a courtesy copy, please fill in this with the submission date.
Does this project involve maintenance dredging funded by the Shallow Draft Navigation Channel Dredging and Aquatic Weed Fund, electric generation projects located at an existing or former electric generating facility, or involve the distribution or transmission of energy or fuel, including natural gas, diesel, petroleum, or electricity?*field type radio button
Does this project involve maintenance dredging funded by the Shallow Draft Navigation Channel Dredging and Aquatic Weed Fund, electric generation projects located at an existing or former electric generating facility, or involve the distribution or transmission of energy or fuel, including natural gas, diesel, petroleum, or electricity?YesNo
Is this application for a project associated with emergency response/repairs from Hurricane Helene impacts to your project or property?field type radio button
Is this application for a project associated with emergency response/repairs from Hurricane Helene impacts to your project or property?YesNo
Is this project connected with ARPA funding or S.L. 2023-134 (earmark)?*field type radio button
Is this project connected with ARPA funding or S.L. 2023-134 (earmark)?ARPAS.L. 2023-134 (earmark)No
Please provide the DWI Funding Project Number (ie: SRP-W-ARP-1234 or SRP-W-134-1234).*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
- The DWI Funding Project Number can be located on the “Letter of Intent to Fund” (LOIF) or “Offer and Acceptance Letter”. If you are unable to locate your DWI Funding Project Number, please contact Landon Davidson at Landon.Davidson@deq.nc.gov for further assistance.

	County (or Counties) where the project is located:*field type drop-down
Row 1×	County (or Counties) where the project is located:*field type drop-down	×

Add additional county

Is this a NCDMS Project*field type radio button
Is this a NCDMS ProjectYesNo
Click Yes, only if NCDMS is the applicant or co-applicant.
DO NOT CHECK YES, UNLESS YOU ARE DMS OR CO-APPLICANT.
Is this project a public transportation project?*field type radio button
Is this project a public transportation project?YesNo
This is any publicly funded by municipal,state or federal funds road, rail, airport transportation project.
Is this a NCDOT Project?*field type radio button
Is this a NCDOT Project?YesNo
(NCDOT only) T.I.P. or state project number:field type single line
Input blocked. Maximum character limit of 4000 characters reached.
WBS #*field type single line
(for NCDOT use only)
Input blocked. Maximum character limit of 4000 characters reached.
1a. Type(s) of approval sought from the Corps:*field type checkbox
1a. Type(s) of approval sought from the Corps:Section 404 Permit (wetlands, streams and waters, Clean Water Act)Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
Has this PCN previously been submitted?*field type radio button
Has this PCN previously been submitted?YesNo
Please provide the date of the previous submission.*field type date
1b. What type(s) of permit(s) do you wish to seek authorization?*field type checkbox
1b. What type(s) of permit(s) do you wish to seek authorization?Nationwide Permit (NWP)Regional General Permit (RGP)Standard (IP)
1c. Has the NWP or GP number been verified by the Corps?*field type radio button
1c. Has the NWP or GP number been verified by the Corps?YesNo

	field type drop-down
Nationwide Permit (NWP) Number:×	field type drop-down	×

Add additional NWP

NWP Numbers (for multiple NWPS):field type single line
List all NW numbers you are applying for not on the drop down list.
Input blocked. Maximum character limit of 4000 characters reached.

	field type drop-down
Regional General Permit (RGP) Number:×	field type drop-down	×

Add additional RGP

RGP Numbers (for multiple RGPS):field type single line
List all RGP numbers you are applying for not on the drop down list.
Input blocked. Maximum character limit of 4000 characters reached.
Are you a federal applicant?*field type radio button
Are you a federal applicant?YesNo
If yes, please provide a statement concerning compliance with the Coastal Zone Management Act.*field type multi line
1d. Type(s) of approval sought from the DWR:*field type checkbox
check all that apply
1d. Type(s) of approval sought from the DWR:401 Water Quality Certification - Regular401 Water Quality Certification - ExpressNon-404 Jurisdictional General PermitRiparian Buffer AuthorizationIndividual 401 Water Quality Certification
1e. Is this notification solely for the record because written approval is not required?
*field type radio button
For the record only for DWR 401 Certification: *field type radio button
YesNo
For the record only for Corps Permit: *field type radio button
YesNo
Add
1f. Is this an after-the-fact permit application?*field type radio button
1f. Is this an after-the-fact permit application?YesNo
1g. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?field type radio button
If so, attach the acceptance letter from mitigation bank or in-lieu fee program.
1g. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?YesNo
Acceptance Letter Attachmentfield type file upload
Click the upload button or drag and drop files here to attach document
Drop files here
You have reached the maximum file limit: .
FILE TYPE MUST BE PDF
1h. Is the project located in any of NC's twenty coastal counties?*field type radio button
1h. Is the project located in any of NC's twenty coastal counties?YesNo
1i. Is the project located within a NC DCM Area of Environmental Concern (AEC)?*field type radio button
1i. Is the project located within a NC DCM Area of Environmental Concern (AEC)?YesNoUnknown
1j. Is the project located in a designated trout watershed?*field type radio button
1j. Is the project located in a designated trout watershed?YesNo
You must submit a copy to the appropriate Wildlife Resources Commission Office.
Link to trout information: http://www.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Agency-Coordination/Trout.aspx

	*field type radio button
For the record only for DWR 401 Certification:	*field type radio button YesNo
For the record only for Corps Permit:	*field type radio button YesNo

B. Applicant Information

1a. Who is the Primary Contact?*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
1b. Primary Contact Email:*field type email
1c. Primary Contact Phone:*field type single line
(xxx)xxx-xxxx
Input blocked. Maximum character limit of 4000 characters reached.
1d. Who is applying for the permit?*field type checkbox
1d. Who is applying for the permit?OwnerApplicant (other than owner)
(Check all that apply)
1e. Is there an Agent/Consultant for this project?*field type radio button
1e. Is there an Agent/Consultant for this project?YesNo
2. Owner Information
×
- 2a. Name(s) on recorded deed:*field type single line
  Input blocked. Maximum character limit of 4000 characters reached.
- 2b. Deed book and page no.:field type single line
  Input blocked. Maximum character limit of 4000 characters reached.
- 2c. Contact Person:field type single line
  (for Corporations)
  Input blocked. Maximum character limit of 4000 characters reached.
- 2d. Address*field type address
  Street Address
  Address Line 2
  City
  State / Province / Region
  Postal / Zip Code
  Country
- 2e. Telephone Number:*field type single line
  (xxx)xxx-xxxx
  Input blocked. Maximum character limit of 4000 characters reached.
- 2f. Fax Number:field type single line
  (xxx)xxx-xxxx
  Input blocked. Maximum character limit of 4000 characters reached.
- 2g. Email Address:*field type email
Add another owner
3. Applicant Information (if different from owner)
×
- 3a. Name:*field type single line
  Input blocked. Maximum character limit of 4000 characters reached.
- 3b. Business Name:field type single line
  (if applicable)
  Input blocked. Maximum character limit of 4000 characters reached.
- 3c. Address*field type address
  Street Address
  Address Line 2
  City
  State / Province / Region
  Postal / Zip Code
  Country
- 3d. Telephone Number:*field type single line
  (xxx)xxx-xxxx
  Input blocked. Maximum character limit of 4000 characters reached.
- 3e. Fax Number:field type single line
  (xxx)xxx-xxxx
  Input blocked. Maximum character limit of 4000 characters reached.
- 3f. Email Address:*field type email
Add
4. Agent/Consultant (if applicable)
×
- 4a. Name:*field type single line
  Input blocked. Maximum character limit of 4000 characters reached.
- 4b. Business Name:field type single line
  (if applicable)
  Input blocked. Maximum character limit of 4000 characters reached.
- 4c. Address*field type address
  Street Address
  Address Line 2
  City
  State / Province / Region
  Postal / Zip Code
  Country
- 4d. Telephone Number:*field type single line
  (xxx)xxx-xxxx
  Input blocked. Maximum character limit of 4000 characters reached.
- 4e. Fax Number:field type single line
  (xxx)xxx-xxxx
  Input blocked. Maximum character limit of 4000 characters reached.
- 4f. Email Address:*field type email
Add

C. Project Information and Prior Project History

1. Project Information

1a. Name of project:*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
1b. Subdivision name:field type single line
(if appropriate)
Input blocked. Maximum character limit of 4000 characters reached.
1c. Nearest municipality / town:*field type single line
Input blocked. Maximum character limit of 4000 characters reached.

2. Project Identification

2a. Property Identification Number:field type single line
(tax PIN or parcel ID)
Input blocked. Maximum character limit of 4000 characters reached.
2b. Property size:field type single line
(in acres)
Input blocked. Maximum character limit of 4000 characters reached.
2c. Project Addressfield type address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
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:*field type single line	Longitude:*field type single line
row 1	Latitude:*field type single line ex: 34.208504 Input blocked. Maximum character limit of 4000 characters reached.	Longitude:*field type single line -77.796371 Input blocked. Maximum character limit of 4000 characters reached.

3. Surface Waters
3a. Name of the nearest body of water to proposed project:*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
3b. Water Resources Classification of nearest receiving water:*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Surface Water Lookup

	3c. What river basin(s) is your project located in?*field type drop-down
Row 1×	3c. What river basin(s) is your project located in?*field type drop-down	×

Add another river basin

3d. Please provide the 12-digit HUC in which the project is located.*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
River Basin Lookup
4. Project Description and History
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:*field type multi line
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*field type radio button
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?YesNoUnknown
If yes, please give the DWR Certification number or the Corps Action ID (exp. SAW-0000-00000).field type multi line
4b(2). Is Any Portion of the Work Already Complete?*field type radio button
4b(2). Is Any Portion of the Work Already Complete?YesNo
If yes, describe the completed work.field type multi line
4c. List of Other Certificates or Approvals/Denials received from other Federal, State, or Local Agencies for work described in this application, not related to the 404 or 401.field type multi line
4f. List the total estimated acreage of all existing wetlands on the property:field type single line
Input blocked. Maximum character limit of 4000 characters reached.
4g. List the total estimated linear feet of all existing streams on the property:field type single line
(intermittent and perennial)
Input blocked. Maximum character limit of 4000 characters reached.
4h. Explain the purpose of the proposed project:*field type multi line
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*field type multi line
4k. Will this activity involve dredging in wetlands or waters?*field type radio button
4k. Will this activity involve dredging in wetlands or waters?YesNo
If yes, Describe the type of dredging, the composition of the dredged material and the location of disposal area.field type multi line
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*field type radio button
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?YesNoUnknown
Comments:field type single line
Input blocked. Maximum character limit of 4000 characters reached.
5b. If the Corps made a jurisdictional determination, what type of determination was made?*field type radio button
5b. If the Corps made a jurisdictional determination, what type of determination was made?PreliminaryApprovedNot VerifiedUnknownN/A
Corps AID Number:field type single line
Example: SAW-2017-99999
Input blocked. Maximum character limit of 4000 characters reached.

5c. If 5a is yes, who delineated the jurisdictional areas?

	field type single line
Name (if known):	field type single line Input blocked. Maximum character limit of 4000 characters reached.
Agency/Consultant Company:	field type single line Input blocked. Maximum character limit of 4000 characters reached.
Other:	field type single line Input blocked. Maximum character limit of 4000 characters reached.

5d. List the dates of the Corp jurisdiction determination or State determination if a determination was made by the Corps or DWR.field type multi line
6. Future Project Plans
6a. Is this a phased project?*field type radio button
6a. Is this a phased project?YesNo
6b. If yes, explain.field type multi line
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.field type multi line
7. Addresses of Adjoining Property Owners, Lessees, Etc., Whose Property Adjoins the Waterbody (if more than can be entered here, please attach a supplemental list)field type multi line
8. Scheduling of Activity:field type multi line

D. Proposed Impacts Inventory

1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):field type checkbox
1a. Where are the impacts associated with your project? (check all that apply):WetlandsStreams-tributariesBuffersOpen WatersPond Construction
2. Wetland Impacts

If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
"W." will be used in the table below to represent the word "wetland".

	2a. Site #*(?)field type single line	2a1 Reason*(?)field type single line	2b. Impact type*(?)field type drop-down	2c. Type of W.*field type drop-down	2d. W. name*field type single line	2e. Forested*field type drop-down	2f. Type of Jurisdicition*(?)field type drop-down	2g. Impact area*field type number
W1×	2a. Site #*(?)field type single line Input blocked. Maximum character limit of 4000 characters reached.	2a1 Reason*(?)field type single line Input blocked. Maximum character limit of 4000 characters reached.	2b. Impact type*(?)field type drop-down	2c. Type of W.*field type drop-down	2d. W. name*field type single line Input blocked. Maximum character limit of 4000 characters reached.	2e. Forested*field type drop-down	2f. Type of Jurisdicition*(?)field type drop-down	2g. Impact area*field type number (acres)	×

Add

2g. Total Temporary Wetland Impactfield type number
2g. Total Permanent Wetland Impactfield type number
2g. Total Wetland Impactfield type number
2h.Type(s) of Material Being Discharged and the Amount of Each Type in Cubic Yards:field type single line
Input blocked. Maximum character limit of 4000 characters reached.
2i. Comments:field type multi line
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.
"S." will be used in the table below to represent the word "stream".

	3a. Reason for impact*(?)field type single line	3b.Impact type*field type drop-down	3c. Type of impact*field type drop-down	3d. S. name*field type single line	3e. Stream Type*(?)field type drop-down	3f. Type of Jurisdiction*field type drop-down	3g. S. width*field type number	3h. Impact length*field type number	field type number
S1×	3a. Reason for impact*(?)field type single line Input blocked. Maximum character limit of 4000 characters reached.	3b.Impact type*field type drop-down	3c. Type of impact*field type drop-down	3d. S. name*field type single line Input blocked. Maximum character limit of 4000 characters reached.	3e. Stream Type*(?)field type drop-down	3f. Type of Jurisdiction*field type drop-down	3g. S. width*field type number Average (feet)	3h. Impact length*field type number (linear feet)	field type number	×

Add another impact

** All Perennial or Intermittent streams must be verified by DWR or delegated local government.
3i. Total jurisdictional ditch impact in square feet:field type number
3i. Total permanent stream impacts:field type number
3i. Total temporary stream impacts:field type number
3i. Total stream and ditch impacts:field type single line
Input blocked. Maximum character limit of 4000 characters reached.
3i. Total cubic yard stream impacts:*field type number
3j. Comments:field type multi line
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. Site #*(?)field type single line	4a1. Impact Reasonfield type single line	4b. Impact type*(?)field type drop-down	4c. Name of waterbody(?)field type single line	4d. Activity type*field type drop-down	4e. Waterbody type*field type drop-down	4f. Impact area*field type number
O1×	4a. Site #*(?)field type single line Input blocked. Maximum character limit of 4000 characters reached.	4a1. Impact Reasonfield type single line Input blocked. Maximum character limit of 4000 characters reached.	4b. Impact type*(?)field type drop-down	4c. Name of waterbody(?)field type single line Input blocked. Maximum character limit of 4000 characters reached.	4d. Activity type*field type drop-down	4e. Waterbody type*field type drop-down	4f. Impact area*field type number (acres)	×

Add another impact

4g. Total temporary open water Impacts:field type number
4g. Total permanent open water impacts:field type number
4g. Total open water impacts:field type number
4g. Total cubic yard open water impacts:*field type number
4h. Comments:field type multi line
5. Pond or Lake Construction

If pond or lake construction is proposed, then complete the chart below.

	5b. Proposed use or purpose of pondfield type drop-down	5c. Wetland impacts (acres)field type single line	field type single line	field type single line	5d. Stream impacts (feet)field type single line	field type single line	field type single line	5e. Upland (acres)field type single line
	5b. Proposed use or purpose of pondfield type drop-down	5c. Wetland impacts (acres)field type single line Input blocked. Maximum character limit of 4000 characters reached.	field type single line Input blocked. Maximum character limit of 4000 characters reached.	field type single line Input blocked. Maximum character limit of 4000 characters reached.	5d. Stream impacts (feet)field type single line Input blocked. Maximum character limit of 4000 characters reached.	field type single line Input blocked. Maximum character limit of 4000 characters reached.	field type single line Input blocked. Maximum character limit of 4000 characters reached.	5e. Upland (acres)field type single line Input blocked. Maximum character limit of 4000 characters reached.
P1	5b. Proposed use or purpose of pondfield type drop-down	5c. Wetland impacts (acres)field type single line Input blocked. Maximum character limit of 4000 characters reached.	field type single line Input blocked. Maximum character limit of 4000 characters reached.	field type single line Input blocked. Maximum character limit of 4000 characters reached.	5d. Stream impacts (feet)field type single line Input blocked. Maximum character limit of 4000 characters reached.	field type single line Input blocked. Maximum character limit of 4000 characters reached.	field type single line Input blocked. Maximum character limit of 4000 characters reached.	5e. Upland (acres)field type single line Input blocked. Maximum character limit of 4000 characters reached.
P2	5b. Proposed use or purpose of pondfield type drop-down	5c. Wetland impacts (acres)field type single line Input blocked. Maximum character limit of 4000 characters reached.	field type single line Input blocked. Maximum character limit of 4000 characters reached.	field type single line Input blocked. Maximum character limit of 4000 characters reached.	5d. Stream impacts (feet)field type single line Input blocked. Maximum character limit of 4000 characters reached.	field type single line Input blocked. Maximum character limit of 4000 characters reached.	field type single line Input blocked. Maximum character limit of 4000 characters reached.	5e. Upland (acres)field type single line Input blocked. Maximum character limit of 4000 characters reached.

	field type single line	field type single line	field type single line	field type single line	field type single line	field type single line	field type single line
5f. Total:	field type single line Input blocked. Maximum character limit of 4000 characters reached.	field type single line Input blocked. Maximum character limit of 4000 characters reached.	field type single line Input blocked. Maximum character limit of 4000 characters reached.	field type single line Input blocked. Maximum character limit of 4000 characters reached.	field type single line Input blocked. Maximum character limit of 4000 characters reached.	field type single line Input blocked. Maximum character limit of 4000 characters reached.	field type single line Input blocked. Maximum character limit of 4000 characters reached.

5g. Comments:field type multi line
5h. Is a dam high hazard permit required?field type radio button
5h. Is a dam high hazard permit required?YesNo
If yes, permit ID no:field type single line
Input blocked. Maximum character limit of 4000 characters reached.
5i. Expected pond surface area (acres):field type single line
Input blocked. Maximum character limit of 4000 characters reached.
5j. Size of pond watershed (acres):field type single line
Input blocked. Maximum character limit of 4000 characters reached.
5k. Method of construction:field type single line
Input blocked. Maximum character limit of 4000 characters reached.
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)?*field type checkbox
Check all that apply.
6a. Project is in which protect basin(s)?NeuseTar-PamlicoCatawbaRandlemanGoose CreekJordan LakeOther

	6b. Impact Type*(?)field type single line	6c. Per or Temp*(?)field type drop-down	6d. Stream name*field type single line	6e. Buffer mitigation required?*field type drop-down	6f. Zone 1 impact*field type number	6g. Zone 2 impact*field type number
B1×	6b. Impact Type*(?)field type single line Input blocked. Maximum character limit of 4000 characters reached.	6c. Per or Temp*(?)field type drop-down	6d. Stream name*field type single line Input blocked. Maximum character limit of 4000 characters reached.	6e. Buffer mitigation required?*field type drop-down	6f. Zone 1 impact*field type number (square feet)	6g. Zone 2 impact*field type number (square feet)	×

Add another impact

6h. Total buffer impacts:
Total Temporary impacts:
Add
Total Permanent impacts:
Add
Total combined buffer impacts:
Add
6i. Comments:field type multi line

	Zone 1field type number	Zone 2field type number
Total Temporary impacts:	Zone 1field type number	Zone 2field type number

	Zone 1field type number	Zone 2field type number
Total Permanent impacts:	Zone 1field type number	Zone 2field type number

	Zone 1field type number	Zone 2field type number
Total combined buffer impacts:	Zone 1field type number	Zone 2field type number

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:*field type multi line
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*field type multi line
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?field type radio button
2a. Does the project require Compensatory Mitigation for impacts to Waters of the U.S. or Waters of the State?YesNo
2b. If this project DOES NOT require Compensatory Mitigation, explain why:field type multi line
2c. If yes, mitigation is required by (check all that apply):field type checkbox
2c. If yes, mitigation is required by (check all that apply):DWRCorps
2d. If yes, which mitigation option(s) will be used for this project?field type checkbox
2d. If yes, which mitigation option(s) will be used for this project?Mitigation bankPayment to in-lieu fee programPermittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:field type single line
Input blocked. Maximum character limit of 4000 characters reached.

3b. Credits Purchased/Requested (attach receipt and letter)

	Type:field type drop-down	Quantity:field type single line
Row 1×	Type:field type drop-down	Quantity:field type single line Input blocked. Maximum character limit of 4000 characters reached.	×

Add additional credits

3c. Commentsfield type multi line
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached.field type radio button
4a. Approval letter from in-lieu fee program is attached.YesNo
4b. Stream mitigation requested:field type single line
(linear feet)
Input blocked. Maximum character limit of 4000 characters reached.
4c. If using stream mitigation, what is the stream temperature:field type drop-down
NC Stream Temperature Classification Maps can be found under the Mitigation Concepts tab on the Wilmington District's RIBITS website.
4d. Buffer mitigation requested (DWR only):field type single line
(square feet)
Input blocked. Maximum character limit of 4000 characters reached.
4e. Riparian wetland mitigation requested:field type single line
(acres)
Input blocked. Maximum character limit of 4000 characters reached.
4f. Non-riparian wetland mitigation requested:field type single line
(acres)
Input blocked. Maximum character limit of 4000 characters reached.
4g. Coastal (tidal) wetland mitigation requested:field type single line
(acres)
Input blocked. Maximum character limit of 4000 characters reached.
4h. Commentsfield type multi line
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 including mitigation credits generated.field type multi line
6. Buffer mitigation (State Regulated Riparian Buffer Rules) - required by DWR
6a. Will the project result in an impact within a protected riparian buffer that requires buffer mitigation? If yes, you must fill out this entire form - please contact DWR for more information.field type radio button
6a. Will the project result in an impact within a protected riparian buffer that requires buffer mitigation? If yes, you must fill out this entire form - please contact DWR for more information.YesNo

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 in the table below.

	6c. Reason for impactfield type single line	6d. Total impact (square feet)field type number	Multiplierfield type drop-down	6e. Required mitigation (square feet)field type number
Zone 1	6c. Reason for impactfield type single line Input blocked. Maximum character limit of 4000 characters reached.	6d. Total impact (square feet)field type number	Multiplierfield type drop-down	6e. Required mitigation (square feet)field type number

	field type single line	field type number	field type drop-down	field type number
Zone 2	field type single line Input blocked. Maximum character limit of 4000 characters reached.	field type number	field type drop-down	field type number

6f. Total buffer mitigation requiredfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
6g. If buffer mitigation is required, is payment to a mitigation bank or NC Division of Mitigation Services proposed?field type radio button
6g. If buffer mitigation is required, is payment to a mitigation bank or NC Division of Mitigation Services proposed?YesNo
6i. If no, then discuss what type of mitigation is proposed.field type multi line
6j. Comments:field type multi line

Miscellaneous

Commentsfield type multi line
Please use the space below to attach all required documentation or any additional information you feel is helpful for application review. Documents should be combined into one file when possible, with a Cover Letter, Table of Contents, and a Cover Sheet for each Section preferred.field type file upload
Click the upload button or drag and drop files here to attach document
Drop files here
You have reached the maximum file limit: .
File must be PDF or KMZ

Signature

*field type checkbox
By checking the box and signing below, I certify that:
·   The project proponent hereby certifies that all information contained herein is true, accurate, and complete to the best of my knowledge and belief’; and
·   The project proponent hereby requests that the certifying authority review and take action on this CWA 401 certification request within the applicable reasonable period of time.
· 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.
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A. Processing Information

1e. Is this notification solely for the record because written approval is not required?

B. Applicant Information

2. Owner Information

3. Applicant Information (if different from owner)

4. Agent/Consultant (if applicable)

C. Project Information and Prior Project History

1. Project Information

2. Project Identification

5c. If 5a is yes, who delineated the jurisdictional areas?

D. Proposed Impacts Inventory

6h. Total buffer impacts:

E. Impact Justification and Mitigation

3b. Credits Purchased/Requested (attach receipt and letter)

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 in the table below.

F. Stormwater Management and Diffuse Flow Plan (required by DWR)

G. Supplementary Information

Miscellaneous

Signature