20170897 Ver 1_Other_20170822 (21)

OF WATCR
I I Pre -Construction Notification (PCN) Form Instructions o� 0�
D
C
The PCN form is required for applicants seeking the following approvals: Corps 404 or Section 10
Permit, or DWQ 401 Certification, Buffer Authorization, Isolated/non-404 Wetlands Permit.
PURPOSE FOR THE PCN:
The PCN — Pre -Construction Notification form helps regulators from the state and federal agencies in
North Carolina better understand and evaluate the impacts of activities that you propose to do in or
around streams, wetlands, or other waters that may affect water quality, the health of the aquatic
ecosystem, or water access or flow, in the immediate or nearby drainage area.
The PCN is a combined effort by the US Army Corps of Engineers (USACE- known as the "Corps") and
the NC Division of Water Quality (DWQ) to coordinate regulatory requirements for work in (or affecting)
wetlands, streams, riparian buffers, and waters within North Carolina. By accurately completing the PCN
form, we can determine if you meet requirements to proceed with your project as proposed. We can
evaluate the measures you propose to take to avoid or mitigate for any damage to the environment. Our
review of your completed form will provide us with necessary information about your project to determine
if we can allow you to begin your project without the time, expense or uncertainty involved in going
through a major permit process.
Many Corps Nationwide permits and some general permits require the applicant to complete and submit
a PCN form before starting any work in an area that may impact streams, wetlands or other waters.
Activities that require a NC General Water Quality Certification, a stormwater permit, or a buffer permit
within protected watersheds, use the PCN form. The responsible state or federal agencies will review
your application for completeness within 30 days of receipt. We will notify you if we need additional
information to process your request. You may not begin work until your application is complete. Once
your application is complete, the Corps will process it within 45 days for a Nationwide or General Permit,
and the NC DWQ will process your 401 Certification within 60 days.
How do I know if I need to complete a PCN?
Many nationwide permits require completion of a PCN prior to starting work. Some routinely require
PCNs and all may require PCNs if special regional conditions are met. Please read the nationwide permit
and all conditions to determine specific requirements. The following chart provides a list of nationwide
permits with PCN requirements:
Note: Do not use the PCN form if you are requesting a Corps Individual Permit or NC DWQ Individual
Water Quality Certification. The Corps Individual Permit application form is available online at
http://www.saw.usace.army. mil/Missions/ReguIatoryPerm itProgram/Permits.aspx.
Which nationwide permits require a PCN?
(Asterisk *and bold is a more commonly used NWP in the Wilmington District; gray is a NWP presently
not used in District)
NWP 1 — Aids to navigation: rarely (see regional conditions)
NWP 3 — Maintenance: usually
NWP 4 — Fish & wildlife devices: rarely (see regional conditions)
Revised for 2012-2017 Nationwide Permits, March 26, 2013

Pre -Construction Notification (PCN) Form Instructions
NWP 5 — Scientific devices: rarely (see regional conditions)
NWP 6 — Surveys: rarely (see regional conditions)
NWP 7 — Outfall Structures: always
NWP 8 — Offshore Oil & Gas structures: always
NWP 12 — Utility line structures: usually
NWP 13 — Bank stabilization: usually
NWP 14 — Linear transportation projects: usually
NWP 16 — Return water from disposal: usually (see regional conditions)
NWP 17 — Hydropower projects: alway-
NWP 18 — Minor discharges: usually
NWP 19 — Minor dredging: usually (see regional conditions)
NWP 21 — Surface coal mining: alwayr=
NWP 22 — Removal of vessels: usually (see regional conditions)
NWP 23 — Approved categorical exclusions: sometimes (see RGL)
NWP 27 — Aquatic restoration: usually
NWP 29 — Residential developments/ individual residences: always
NWP 31 — Flood control maintenance: always
NWP 33 — Temporary construction: always
NWP 34 — Cranberry production: always
NWP 35 — Maintenance dredging: sometimes (see regional conditions)
NWP 36 — Boat ramps: sometimes (see regional conditions)
NWP 37 — Emergency protection: always
NWP 38 — Hazmat clean up: always
NWP 39 — Commercial, institutional developments: always
NWP 40 — Agricultural activities: always
NWP 41 — Reshaping ditches: usually
NWP 42 — Recreational facilities: always
NWP 43 — Stormwater Management: always (see regional conditions)
NWP 44 — Mining: always
NWP 45 — Repair of uplands: always
NWP 46 — Discharges in ditches: always
NWP 48 — Commercial aquaculture: usually
NWP 49 — Coal re -mining: always
NWP 50 — Underground coal mining: always
NWP 51 — Land -Based Renewable Energy Generation Facilities - always
NWP 52 — Water -Based Renewable Energy Generation Pilot Projects - always
ii. INFORMATION WE NEED TO KNOW
.®�oF wA r�RQc
A
e3Nii� _-("
We need to know details about how to contact you, where you propose to work, what you will be doing,
and how you will compensate for impacts to streams, wetlands or other waters as a result of your work.
All information is required unless otherwise stated as optional. Incomplete applications cannot be
accepted for review and will be returned to the applicant. You can obtain help in completing each
question on the form through the instructions in this document.
iii. FEES:
Revised for 2012-2017 Nationwide Permits, March 26, 2013 2

OF WATCR
I I Pre -Construction Notification (PCN) Form Instructions o� 0�
D
C
DWQ Water Quality Certifications - North Carolina requires fees for processing water quality certifications
and buffer permits.
Checks should be made out to the "NC Division of Water Quality", with the specific name of the project or
applicant identified on the check. Please staple your check to the front of the application package.
The required fees are as follows:
Major water quality applications: Greater than or equal
Physical Address
to one acre of wetlands/waters AND/OR Greater than or
(if sending by delivery service, UPS, FedEx, etc.)
equal to 150 feet of streams (whether intermittent or
$570.00
perennial)
512 North Salisbury Street
Minor water quality applications: Less than one acre of
Raleigh, NC 27604
wetlands/waters AND Less than 150 feet of streams
$240.00
(whether intermittent or perennial)
For more information on the required NC DWQ fees, see the DWQ Application Fees document at
http://Porta1.ncdenr.org/web/wq/swp/ws/401 /certsandPermits/apply/fees
Note: If the project is sponsored by a federal agency, the DWQ requires the name of project printed on
the US Treasury check and the project application fee mailed to: NC DWQ, 401/Wetlands Unit, 1650 Mail
Service Center, Raleigh, NC, 27699-1650
DWQ Buffer Permits - If written approval is sought solely for Buffer Rules, the application fee does not
apply, and the applicant should clearly state (in a cover letter) that only Buffer Rule approval is sought in
writing.
Corps Permits - There is no fee for Nationwide or General Permits processed by the Corps of Engineers.
iv. WHERE TO SEND YOUR COMPLETED PCN FORM:
Copies of your completed PCN with all required attachments must be sent to the Corps of to DWQ, or
both agencies, depending on the approval sought. Additionally, review the specific reporting
requirements for your project as some conditions of approval require you to send a copy of your PCN to
coordinating agencies.
DWQ Certifications: All PCN Forms processed by NC DWQ must be sent to:
Mailing Address
Physical Address
(if sending by first class mail via the US Postal Service)
(if sending by delivery service, UPS, FedEx, etc.)
NC DWQ, WBSCP Unit
NC DWQ, WBSCP Unit
1650 Mail Service Center
512 North Salisbury Street
Raleigh, NC 27699-1650
Raleigh, NC 27604
Revised for 2012-2017 Nationwide Permits, March 26, 2013 3

o� war�9
Pre -Construction Notification (PCN) Form Instructions o��'�.
r
Pliii� -c
Number of Copies Required for DWQ: Provide five (5) complete and collated copies of the PCN
Application and supporting documentation (instead of providing 5 copies of the _full size_ plans you may
provide two copies of _full size_ plans along with three copies of 11 X 17 inch size plans)
Corps Permits — PCN Forms are processed at each Corps Field Office for the counties in which the
Legend
Regulatory Field offices
IFOI by county
-
Asheville
Wilmington
0 Raleigh
V,�ashington
activity is proposed. The map and list shows the counties that are served by each Corps field office.
Corps Field Office
Asheville Regulatory Field Office
US Army Corps of Engineers
151 Patton Avenue - Room 208
Asheville, NC 28801-5006
Telephone: [phone]
Fax: [phone]
US Army Corps of Engineers
Alamance
Franklin
Wilmington District
Surry
US Army Corps of Engineers
Regulatory Program Contacts
Forsyth
Northampton
Counties Served
3331 Heritage Trade Drive - Suite 105
Chatham
Alexander Caldwell Haywood
McDowell
Wake
Alleghany Catawba Henderson
Mecklenburg
Guilford
Ashe Cherokee Iredell
Mitchell
Swain
Avery Clay Jackson
Polk
Transylvania
Buncombe Cleveland Lincoln
Rowan
Union
Burke Gaston Macon
Rutherford
Watauga
Cabarrus Graham Madison
Stanley
Yancey
Raleigh Regulatory Field Office
Alamance
Franklin
Nash
Surry
US Army Corps of Engineers
Caswell
Forsyth
Northampton
Vance
3331 Heritage Trade Drive - Suite 105
Chatham
Granville
Orange
Wake
Wake Forest, NC 27587
Davidson
Guilford
Person
Warren
Davie
Halifax
Randolph
Wilkes
Telephone: [phone]
Durham
Johnston
Rockingham
Wilson
Fax: [phone]
Edgecombe
Lee
Stokes
Yadkin
Washington Regulatory Field Office
Currituck
Hyde
Pasquotank Washington
US Army Corps of Engineers
Beaufort
Dare
Jones
Perquimans Wayne
2407 West 5" Street
Bertie
Gates
Lenoir
Pitt
Washington, NC 27889
Camden
Green
Martin
Tyrrell
Chowan
Hertford
Pamlico
Telephone: [phone]
Craven
Carteret*
*Croatan National
Forest Only
Fax: [phone]
Revised for 2012-2017 Nationwide Permits, March 26, 2013 4

Pre -Construction Notification (PCN) Form Instructions
Wilmington Regulatory Field Office
Anson
Duplin
Onslow
US Army Corps of Engineers
Bladen
Harnett
Pender
69 Darlington Avenue
Brunswick
Hoke
Richmond
Wilmington, NC 28403
Carteret
Montgomery
Robeson
Columbus
Moore
Sampson
Telephone: [phone]
Cumberland
New Hanover
Scotland
Fax: [phone]
.®�oF wA r�RQc
A
C3Nii� _-("
Number of Copies Required for Corps: Provide one complete PCN Application and supporting
documentation. Copies of all plans and attachments for the administrative record must be no larger than
11 x 17 inches. Please contact the Corps project manager for the county in which the work is proposed
to see if materials can be sent electronically or if "working copies" of oversized maps are requested to
assist the project manager to help process the application.
Specific Reporting Requirements: There are specific reporting requirements for projects located in
counties that have trout waters, coastal counties, and western NC counties, as well as specific drainage
basins covered by state riparian buffer rules.
Counties with "Trout Waters" Require Additional Coordination: The NC Wildlife Resources Commission
can help determine if your project may impact trout waters. If your project is within a trout county listed
below, you must send a copy of your PCN to WRC to assess potential impacts to trout waters.
If your project is in a trout county: Alleghany, Ashe, Avery, Buncombe, Burke, Caldwell, Cherokee, Clay,
Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Stokes,
Surry, Swain, Transylvania, Watauga, Wilkes County, or Yancey County, send a copy of your PCN to:
Mr. David McHenry Mountain Region Coordinator
20830 Great Smoky Mtn. Expressway
Waynesville, NC 28786
Telephone: [phone]
Fax: [phone]
Coastal Counties with "Areas of Environmental Concern" Require Additional Coordination: If your
proposed project is in a coastal county, you need to check to see if the work is in an "Area of
Environmental Concern" and requires a CAMA permit. If the project occurs in any of North Carolina's
twenty coastal counties: Beaufort, Bertie, Brunswick, Camden, Carteret, Chowan, Currituck, Craven,
Dare, Gates, Hertford, Hyde, New Hanover, Onslow, Pamlico, Pasquotank, Pender, Perquimans, Tyrrell
or Washington counties, you need to determine if a CAMA permit is required for your project.
Contact the North Carolina Division of Coastal Management (DCM) for help. DCM will determine if the
project is within a designated Area of Environmental Concern, in which case you must apply directly to
DCM for a CAMA permit. DCM and the Corps share a joint permit application for CAMA permits. Many
CAMA permits do not require completing a PCN.
NC Division of Coastal Management Telephone: [phone]
400 Commerce Avenue Fax: [phone]
Morehead City, NC 28557-3421
Revised for 2012-2017 Nationwide Permits, March 26, 2013 5

OF WATCR
I I Pre -Construction Notification (PCN) Form Instructions o� 0�
D
C
Projects within river basins with NC Riparian Buffer protection: If your project is located within the Neuse,
Tar -Pamlico, Catawba, or Randleman River Basins you must ensure you are meeting the requirements
for diffuse flow provisions set out in the North Carolina Administrative Code. Specific requirements for
each river basin are located at the following website (see "River Basin Reports":
http://portal.ncdenr.org/web/wq/ps/csu/rules
Western counties with US FWS designated critical aquatic watersheds:
All Corps permits require you to check to ensure that no state or federally protected plant, animal or
ecological community is adversely impacted by your proposed project.
If your project is in the following counties: Avery, Cherokee, Forsyth, Graham, Haywood, Henderson,
Jackson, Macon Mecklenburg, Mitchell, Stokes, Surry, Swain, Transylvania, Union and Yancey, you must
send an advance copy of your PCN to the Asheville Field Office of the US Fish and Wildlife Center for
review to ensure there will be no adverse impacts to critical aquatic habitats as a result of your project.
Send your PCN package to:
The US Fish and Wildlife Service
160 Zillicoa Street
Asheville, North Carolina 28801
Telephone: [phone]
Section A. Applicant Information Instructions
1. Processing — By completing these fields accurately, we can determine how your application will be
reviewed.
1 a. Type(s) of approval sought from the Corps:
How do I know if my parcel has wetlands or waters on it that are regulated by the Corps?
Not all waters or wetlands are regulated by the Corps. To find out how this process is done, and to learn
about how to survey your property for waters and wetlands, visit the Corps web site section on
Jurisdictional Determinations.
Section 404 Permit - the discharge of dredged or fill material into all waters of the United States, including
wetlands, as regulated under the Clean Water Act. Typical activities requiring Section 404 permits are:
Depositing of fill or dredged material in waters of the US or adjacent wetlands, site development fill for
residential, commercial, or recreational developments, construction of revetments, culvert placement,
groins, breakwaters, levees, dams, dikes, and weirs, or placement of riprap and road fills.
Section 10 Permit - the construction of any structure in or over any navigable water of the United States,
as regulated under the Rivers and Harbors Act. Activities such as dredging, construction of docks and
bulkheads and placing navigation aids require review under Section 10 to ensure that they will not cause
an obstruction to navigation. Typical activities requiring Section 10 permits are: construction of piers,
wharves, bulkheads, dolphins, marinas, ramps, floats intake structures, and cable or pipeline crossings or
dredging and excavation.
1 b. Specify Corps Nationwide Permit (NWP) number or General Permit (GP) number:
Revised for 2012-2017 Nationwide Permits, March 26, 2013 6

OF WATCR
I I Pre -Construction Notification (PCN) Form Instructions o� 0�
DD C
To review the requirements for the use of Nationwide, Regional or General permits, and to determine
which permit applies to your project, go to the Corps website.
Need more information on nationwide permits?
http://www.saw. usace.army. mil/Missions/Regu latoryPermitProgram/Permits/NationwidePermits.aspx
Need more information on general permits?
http://www.saw. usace.army. mil/Missions/RegulatoryPermitProgram/Permits/RegionalGeneralPermits.aspx
You may also use the Corps website to obtain the name, email and phone number for a Corps project
manager for each county in North Carolina and provides additional information regarding the identification
and regulation of wetlands, streams and other waters.
http://www.saw. usace.army. mil/Missions/Regu latorVPermitProgram/Contact/Cou ntyLocator.aspx
The DWQ issues a corresponding Certification (General or Individual) based on the permit type issued by
the Corps. Until a Corps permit type can be determined, DWQ will not be able to tell you what type of
Water Quality Certification will be required. The DWQ's 401/Wetlands Unit website details the current
requirements for the 401 Water Quality Certification Program and also whether or not Riparian Buffer
Rules are applicable. You should read the full text of the General Certification (GC) matching the specific
404 Permit requested. In some cases, you will not have to get written approval for General Certifications,
provided that you meet all of the conditions of the GC. Website link:
http://Portal.ncdenr.org/web/wq/swp/ws/401
1c. Has the NWP or GP number been verified by the Corps?
The Corps determines which Nationwide, Regional, or General Permit is required. If you have verified
with the Corps which permit will be used for your project then check the appropriate box. If you have not
confirmed with the Corps, contact the local field office representative to ensure you are applying for the
appropriate permit. For DWQ submittals, provide a copy of your 404 written approval from the Corps if it
has been issued.
1d. Type(s) of approval sought from the DWQ (check all that apply):
If your project requires a Section 404 permit from the Corps, then it generally requires a 401 Water
Quality Certification from the DWQ. Those applicants checking the Express 401 Water Quality
Certification box are verifying that they have been accepted into Express Review (for Express review
requirements and procedures refer to the following website:
http://portal.ncdenr.org/web/wq/swp/ws/401 /express
Non -404 Jurisdictional General Permits are for jurisdictional Waters of the State (including wetlands and
streams) that are not regulated under Section 404. Riparian Buffer Authorizations may be required for
impacts to riparian buffers in the Catawba, Neuse, Tar -Pamlico, and any other River Basin approved for
buffer protection in the NC Administrative Code (15A NCAC 02B).
1 e. Is this notification solely for the record because written approval is not required?
If the "Yes" box has been checked (either for DWQ or the Corps), ensure that your project impacts are
indeed under the threshold for the permit that is being applied for. If the applicant is unsure of which box
to check after reviewing the NW or GC, call the DWQ Central Office at 919-733-1786 (for DWQ
thresholds) or your local Corps field office
(http://www.saw.usace.army.mil/Missions/RegulatoryPermitProgram/Contact.aspx ) to avoid unnecessary
Revised for 2012-2017 Nationwide Permits, March 26, 2013 7

OF WATCR
I I Pre -Construction Notification (PCN) Form Instructions o� 0�
D
C
project delays. If the 401 Water Quality Certification box is checked in item A.1 d, then it is assumed by
DWQ that you are seeking written concurrence and are not simply submitting a notification for the record.
1f. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
If so, attach the acceptance letter from the mitigation bank or in -lieu fee program.
The Corps determines mitigation amounts and ratios (if applicable) for Section 404 jurisdictional features
in all projects requiring a Section 404 permit.
The DWQ may determine mitigation amounts and ratios for features not regulated under Section 404 (in
accordance with 15A NCAC 2H .0506 (h), compensatory mitigation may be required for losses of 150
linear feet or more of streams and/or one (1) acre or more of wetlands). For linear, public transportation
projects, impacts equal to or exceeding 150 linear feet per stream shall require mitigation. Compensatory
stream mitigation shall be required at a 1:1 ratio for all perennial and intermittent stream impacts in
watersheds classified as ORW, HQW, Trout, WS -1 and WS -11.
Buffer Mitigation may be required for any project with State Regulated Riparian Buffer Rules in effect at
the time of application for buffer impacts resulting from activities classified as "Allowable with Mitigation"
within the Table of Uses" section of the Buffer Rules or require a variance under the Buffer Rules. See
DWQ's May 2007 "Red Book":
http://portal.ncdenr.org/c/document library/get file?p I id=38446&folderld=285750&name=DLFE-8513.pdf
The DWQ and Corps will accept permittee responsible mitigation, payments into an in -lieu fee program
(for North Carolina, this program is the NCEEP program) or credit purchase from a mitigation bank.
Mitigation design and monitoring protocols shall follow the most current Corps Wilmington District Stream
Mitigation Guidelines. Compensatory mitigation plans shall be submitted for written DWQ and Corps
approval as required in those protocols. See:
http://www.saw. usace.army. mil/Missions/Regu latoryPermitProgram/Mitigation.aspx
If mitigation is proposed through an in -lieu fee program (NCEEP) or a private mitigation bank, the
acceptance letter from NCEEP or the mitigation bank must be included in the application package
specifying that they have the appropriate number of credits that your project requires.
More information about NCEEP in -lieu fee program can be found at: http://portal.ncdenr.org/web/eep
1g. Is the project located in any of NC's twenty coastal counties?
A list of the 20 Coastal Counties can be found at: http://Portal.ncdenr.org/web/cm/cama-counties
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
To learn more about AECs and CAMA permits, visit the NC Division of Coastal Management's web site:
http://dcm2.enr.state.nc.us/Permits/aecs,htm
2. Project Information - These fields will help us identify your project and direct it to the correct Corps or
agency project manager for review and cataloguing.
2a. Name of project:
If your project has a formal name please use this. If your project does not have a formal name, please
identify your project by the owner name and proposed activity (Jones Property Access Road, Smith Guest
House, etc.) List in parenthesis any other names that have been used to identify the project in the past.
2b. County: List the county in which the project is located.
Revised for 2012-2017 Nationwide Permits, March 26, 2013 8

OF WATCR
I I Pre -Construction Notification (PCN) Form Instructions o� 0�
DD C
2c. Nearest municipality / town: Name of nearest city or town.
2d. Subdivision name: Identify if the applicable project is in a named subdivision.
2e. NCDOT only. T.I.P. or State project number: Only NCDOT projects must fill in this item.
3. Owner Information — Although the agencies will communicate with the individual(s) listed as applicant
on the PCN, the owner receive the original of all communications. The permit/certification must be issued
to the legal owner of the property.
3a. Name on Recorded Deed: A responsible individual must be identified for the proposed project, even
if it is a corporate effort.
3b. Deed Book and Page Number: This field cannot be left blank unless this project is a municipal or
NCDOT project.
3c. Responsible Party: You must identify an individual as the contact and responsible party for the
proposed project, even if the land is owned by a corporation. A corporate officer with signing authority for
the corporation must provide written authorization for the designated individual to represent the corporate
interests. The authorization letter must be included with the PCN for the application to be considered
complete by DWQ.
3d -3h. Address information (Self explanatory)
4. Applicant Information - You may choose to hire a consultant or agent to assist you with securing the
necessary permits for your project; however, the agencies may not communicate with anyone other than
the owner about your property or project unless the owner has provided written authorization for us to
work with the applicant or agent/consultant. The Corps Agent Authorization Form will satisfy this
requirement for both agencies. (sample form on web:
http://www.saw.usace.army.mil/Portals/59/docs/regulatory/regdocs/Permits/SAMPLE AGENT AUTHORIZATION FORM.pdf )
4a. Applicant is: Specify if the applicant is an agent or another party.
4b. Name of applicant: The owner of the property of the proposed project is a required field if the "owner"
is different from the "applicant'.
A4c-4h. Address information (Self explanatory)
5. Agent/Consultant Information - If you list an agent or consultant as the applicant, you must include
an agent authorization letter with your PCN application for it to be considered complete. A signed and
dated copy of an Agent Authorization letter must be attached if the Agent has signatory authority for the
owner/applicant.)
5a -5g. Address information (Self explanatory)
Revised for 2012-2017 Nationwide Permits, March 26, 2013 9

OF WATCR
I I Pre -Construction Notification (PCN) Form Instructions o� 0�
C3 C
Section B. Project Information and Prior Project History Instructions
1. Property Identification
1a. Property identification no. (Tax PIN or parcel ID): List the identifying tax ID, parcel ID or PIN
(whichever is the primary identifying information for real estate tax purposes in the county in which your
property is located). This information can frequently be found online through your county tax records or
on a real estate tax invoice for the property, or from the local County tax assessor's office or register of
deeds. Some counties have interactive GIS maps that show the property identification numbers as well.
Web link to find tax parcel ID for your county: http://www.ncspo.com/gis/county.htm
Or from NCSU: http://www.lib.ncsu.edu/gis/counties.html
1 b. Site coordinates (in decimal degrees): The site coordinates are necessary so the agencies can
accurately locate and analyze impacts from your proposed project. For linear projects, such as roads or
utility lines, attach a sheet that separately lists the coordinates for each crossing of a waterbody. For a
single coordinate, clearly label the location in which this coordinate was taken on attached site maps.
Site coordinates can be obtained from maps, surveys, or from GPS devices. Coordinates should be
written as Latitude and longitude and expressed in decimal degrees.
About decimal degrees: Decimal degrees (DD) express latitude and longitude geographic coordinates as
decimal fractions. The convention is to express decimal degrees of latitude first, and then decimal
degrees of longitude.
For example, the decimal degree representation of the location of the United States Capitol is "38.889722
latitude and -77.008889 longitude". The latitude coordinates for NC fall between 36.617520 on the north
and 33.723370 on the southernmost border. All longitudinal coordinates in North Carolina are negative.
The longitude coordinates for NC fall between -75.416567 on the east and -84.421925 on the western
border.
Decimals must be carried out to enough places to correctly reflect the reported accuracy. In order to
reflect accuracy within about 100 feet, latitude and longitude coordinates should be carried out to at least
4 places for decimal degrees. A coordinate stored with 6 decimal places reflects an accuracy of
approximately 1 inch or better, and can only be obtained with a GPS or precise surveying tool.
There are many conversion programs available to convert from traditional "degrees/minutes/seconds" to
decimal degrees. Here is one online site: http://www.fcc.gov/mb/audio/bickel/DDDMMSS-decimal.html
About `geocoding" : If you know the address of the proposed activity, you can "geocode" (which is
converting street addresses or other locations to latitude and longitude) the address to coordinates. This
link is to one of many online geocoding resources: http://www.gpsvisualizer.com/geocoding.html
1 c. Property size: This information can be found on a property survey, plat, or from tax parcel records.
List in acres (or fraction of an acre). If the project is a phased project, then list the acres by phase. For
example if the permit is requested for Phase I of a two phase project, then the entry might read, "Phase 1
= 34.5 acres out of total project area of 74.5 acres".
2. Surface Waters
2a. Name of nearest body of water to proposed project: The nearest named body of water can be found
by looking on the 1:24,000 USGS Topographic map for the project. USGS maps may be found at:
Revised for 2012-2017 Nationwide Permits, March 26, 2013 10

OF WATCR
I I Pre -Construction Notification (PCN) Form Instructions o
C3 C
http://www.digital-topo-maps.com/. You may also consult other resources such as NC One Map
httl)://data.nconemap.com/geoportal/dataexplorer/index.'sp.
If a creek or other waterbody does not have a known name, please identify it as an "Unnamed tributary to
" and list the nearest named stream to which it drains.
2b. Water Quality Classification of nearest receiving water: Surface Water Classifications are
designations applied to surface water bodies, such as streams, rivers and lakes, which define the best
uses to be protected within these waters (for example swimming, fishing, drinking water supply) and carry
with them an associated set of water quality standards to protect those uses. Surface water classifications
are one tool that state and federal agencies use to manage and protect all streams, rivers, lakes, and
other surface waters in North Carolina. Visit this web page to learn more about water classifications in
North Carolina and look -up tools for waters in each major river basin.
http://portal. ncdenr.org/web/wq/ps/csu/classifications
2c. River basin: This must be one of NC's 17 designated major river basins, see:
http://Portal.ncdenr.org/c/document library/get file?uuid=c6e928f7-5849-4f65-be27-c7d325de604a&groupld=38364.
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: Use the land cover and use classifications adopted by North Carolina for
mapping (A Standard Classification System for the Mapping of Land Use and Land Cover, State of North
Carolina Governor's Office of State Planning, Center for Geographic Information and Analysis, January
1994). Select the most appropriate category (or multiple categories) that describes the property in its
current state. This classification is available online: htti)://www.negice.com/Portals/3/documents/nclulc.html#P2
Add any descriptions to the standard classification that will help the agencies understand more about the
condition of the property.
3b.List the total estimated acreage of all existing wetlands on the Property: (404 jurisdictional and non -
404 jurisdictional) In order to estimate the wetland acreage on the site, a wetland delineation of the
property should be conducted and submitted to the Corps. A jurisdictional determination (either
preliminary or finalized) should list 404 and non -404 wetlands on property.
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
If Corps determinations differ from DWQ determinations of the streams on the site, list the lengths for both
agencies (e.g., DWQ: 1,050 linear feet intermittent, 200 linear feet perennial - Corps: 750 linear feet
intermittent, 200 linear feet perennial).
3d. Describe the purpose of the proposed project: This can be a simple explanation, but it is critically
important because the purpose dictates how alternatives to your proposed work are considered. Provide
a clear, concise description of the primary goals of the proposed project (usually no more than one or two
sentences); for example: build a driveway to access a new single family residence.
3e. Describe the overall project in detail, including the type of equipment to be used: Fully describe the
project and what is planned to occur. Explain any site specific constraints that may exist on the property
Revised for 2012-2017 Nationwide Permits, March 26, 2013 11

OF WATCR
I I Pre -Construction Notification (PCN) Form Instructions o� 0�
D
C
that will affect how your project is built. Also list any special or unique equipment here that may be used
on the project.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the Corps or State been requested or
obtained for this project (including all prior phases) in the past? Learn more about jurisdictional
determinations by visiting the Corps web site at:
http://www.saw. usace.army. mil/Missions/Regu latorVPermitProgram/Jurisdiction.aspx
4b. If the Corps made the jurisdictional determination, what type of determination was made? In June
2008, Corps issued guidance on the use of preliminary jurisdictional determinations (JD), when a permit
applicant may opt to receive a preliminary JD instead of an approved JD, and what must be done in each
case. See RGL-08-02 Jurisdictional Determinations:
http://www. usace.army. mil/Portals/2/docs/civilworks/RGLS/rgl08-02. pdf
4c.lf yes, who delineated the jurisdictional areas? Provide the name and organization of the person or
persons who delineated the jurisdictional areas.
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach
documentation. Provide the dates and attach copies of the JD or DWQ letter.
5. Project History
5a.Have permits or certifications been requested or obtained for this prosect (including all prior phases) in
the past? This includes 404 permits, 401 Certifications, Riparian Buffer Authorizations, Isolated Wetland
(non -404 General) Permits, and State and local stormwater management plans.
5b. If yes, explain. Include the Corps Action ID Number, DWQ Project Number, application date, and
dates permits and certifications were issued or withdrawn. Provide copies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and buffer
impacts, along with associated mitigation (where applicable). If this is an NCDOT project, list and
describe permits issued for prior segments of the same T.I.P. project, along with construction schedules.
6. Future Project Plans
6a. Is this a phased project? Some construction and development projects are divided into smaller,
manageable parts for logistical or economic reasons. If this application is for a phased project, the owner
must get Corps approval in the context of how the project will be phased.
6b. If yes, explain. Clearly describe each phased project and provide a proposed timeframe for
completion of each phase. Provide a site plan that clearly depicts the boundaries of each proposed
phase. Include information if the project has undergone review through a master planning process for a
municipality.
Section C. Proposed Impacts Inventory Instructions
Revised for 2012-2017 Nationwide Permits, March 26, 2013 12

Of W ATZR
Pre -Construction Notification (PCN) Form Instructions o� 0�
D C
1. Impacts Summary
1a. Which sections were completed below for your project (check all that apply): Identify if the proposed
project will have an effect and you have completed the sections in part C on the PCN form on wetlands,
open waters, streams, protected riparian (river) buffers, or if you propose to construct a pond.
2. Wetland Impacts - Are there wetland impacts proposed on the site? Complete this section if there
are proposed impacts to wetlands complete the wetland impact table. (If no, continue to next question.)
For each wetland impacted, complete a separate row on the table. If there are more than six wetlands
impacted, attach a separate sheet containing all of the information requested.
2a. Wetland impact number / Permanent (P) or Temporary (T): Each wetland impacted must be
identified on a location map (W1, W2, W3, etc.) and included in this table. If you have more than 6
wetlands impacted, submit an additional sheet with a table listing the additional impacts.
Permanent (P) or Temporary (T): Check the corresponding box (P) permanent or (T) temporary for each
wetland impact.
• Temporary impacts — a change in the aquatic environment (generally during the construction of a
project) that is of sufficiently short duration to have no (or only minimal) impacts to the ecology of the
area, and within a reasonably short duration will restore to its original, pre -construction function.
• Permanent impacts - if the fill or alteration of the wetland will result in a post construction loss or
change in ecosystem type. (For example, if a forested wetland is cleared for construction and is kept clear
post -construction, it will still be a permanent impact because of the change in ecosystem type, even
though the land cover may still be wetland.)
2b. Type of impact: The most common types of impacts are due to: fill, flooding, excavation, land
clearing, drain, or culverts. If your project proposes another type of impact, please list.
2c. Type of wetland: (if known) Identify which type of wetland will be impacted for each wetland listed on
your map. NC WAM recognizes 16 general wetland types for North Carolina (Bottomland Hardwood
Forest, Riverine Swamp Forest, Headwater Wetland, Floodplain Pool, Pocosin, Hardwood Flat, Pine Flat,
Pine Savanna, Small -Basin Wetland, Non-Riverine Swamp Forest, Mountain Bog, Seep, Non -Tidal
Freshwater Marsh, Tidal Freshwater Marsh, Salt/Brackish Marsh, and Estuarine Woody Wetland)
More information can be found at: http://portal.ncdenr.org/web/wq/swp/ws/pdu/ncwam
This page contains links to documents and a key that can be used to classify wetland types.
2d. Forested: Please identify (Yes or No) - Identify (yes) if the wetland is currently forested.
2e. Type of jurisdiction: If it is a 404 wetland, check "Corps". If it is a non -404 wetland, check "DWQ ".
2f. Area of impact (acres): Calculate to the nearest 0.01 (hundredth) acre.
2g. Total wetland impacts: Add all of the proposed impacts to calculate the total. Note: If impacts are
separated into DWQ and Corps impacts, then specify the total impacts for each (e.g. Corps: 0.35 / DWQ:
0.41)
2h. Comments: Explain any items that may need clarification or that do not fit perfectly into the table.
Revised for 2012-2017 Nationwide Permits, March 26, 2013 13

OF WATCR
I I Pre -Construction Notification (PCN) Form Instructions o� 0�
D
C
3. Stream Impacts — Are there stream impacts proposed on the site? Complete this section if there are
proposed impacts to perennial or intermittent streams (including temporary impacts). (If no, continue to
question 4.) For each stream section impacted, complete a separate row on the table. If there are more
than six distinct stream impacts, attach a separate sheet containing all of the information requested.
3a. List by Stream impact number: / Permanent (P) or Temporary (T): Each stream impacted must be
identified on a location map (S1, S2, S3, etc.) and included in this table. If you have more than 6 stream
impacts, submit an additional sheet with a table listing the additional impacts. For linear projects, such as
roads or utility lines, attach a sheet that separately lists the coordinates for each crossing of a stream.
• Temporary impacts — a change in the aquatic environment (generally during the construction of a
project) that is of sufficiently short duration to have no (or only minimal) impacts to the ecology of the
area, and within a reasonably short duration will restore to its original, pre -construction morphology and
function.
Permanent impacts - if the fill or alteration of the stream will result in a post construction loss or
change in stream morphology and function.
3b. Type of impact: The most common types of impacts to streams include, but are not limited to:
Placement of fill, Culverts (& associated dissipation devices), Dam construction, Flooding, Excavation,
Stabilization (specify type: cement walls, rip -rap, crib walls, gabions, etc.); Relocation (specify type:
restoration, ditching, straightening, other) Note: If stream relocation is proposed, then attach plans and
profiles showing the linear footprint for both the original and relocated streams.
3c. Stream Name: Identify if the stream impacted is a named stream. If the stream impacted is an
unnamed tributary (UT) please identify this as UT1, UT2, etc. (e.g., UT1 to Swift Creek) to number the
tributaries to the closest downstream named stream.
3d. Perennial or Intermittent: Identify if the proposed impact is in a perennial or intermittent stream. Note
the difference between Corps and DWQ definitions. If the stream only meets one agency definition and
not both, note this in the comments.
DWQ Definitions:
A perennial stream means a well-defined channel that contains water year round during a year of normal
rainfall with the aquatic bed located below the water table for most of the year. Groundwater is the primary
source of water for a perennial stream, but it also carries stormwater runoff. A perennial stream exhibits the
typical biological, hydrological, and physical characteristics commonly associated with the continuous
conveyance of water. 15A NCAC 02B .0233(2)(i)
An intermittent stream means a well-defined channel that contains water for only part of the year, typically
during winter and spring when the aquatic bed is below the water table. The flow may be heavily
supplemented by stormwater runoff. An intermittent stream often lacks the biological and hydrological
characteristics commonly associated with the conveyance of water. 15A NCAC 02B .0233(2)(g)
Corps Definitions:
A perennial stream has a well-defined channel that contains flowing water year-round during a typical year
of normal rainfall. The aquatic bed is located below the water table for most of the year. Groundwater is the
primary source of water for a perennial stream, but it also carries precipitation run off. Perennial streams
support a diverse aquatic community of organisms year round and are typically the streams that support
major fisheries. (65 FR 12898).
Revised for 2012-2017 Nationwide Permits, March 26, 2013 14

OF WATCR
I I Pre -Construction Notification (PCN) Form Instructions o� 0�
DP C
An intermittent stream has flowing water during certain times of the year, when ground water provides water
for stream flow. During dry periods, intermittent streams may not have flowing water. Runoff from
precipitation is a supplemental source of water for stream flow. (65 FR 12898). The biological community of
intermittent streams is composed of species that are aquatic during a part of their life history or move to
perennial water sources
3e. Type of jurisdiction (Corps -404, DWQ — non -404, other): If it is a 404 jurisdictional stream, check the
Corps box. If it is a non -404 jurisdictional stream (deemed not jurisdictional by the Corps, but considered
a stream by DWQ — such as an isolated stream), check the DWQ box.
3f. Average stream width (feet): Average stream width should be measured across the channel at the
ordinary high water mark or bank full bench. This should be field measured at the impact location.
3g. Impact length (linear feet): The stream impact length should be measured along the centerline of the
stream. When proposing a culvert, the impact length is generally greater than the length of the culvert
and associated dissipater since the existing stream usually has some sinuosity (curvature).
3h. Total stream and tributary impacts: Add all of the proposed impacts to calculate the total. (Note: if
Corps and DWQ totals are different, note different totals in comments.)
3i. Comments: Explain any items that may need clarification or differences between DWQ and Corps
requirements that were input into the table.
4. Open Water Impacts - Are there open water impacts proposed on the site? Examples of "open
waters" are lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean. Complete this section if there
are proposed impacts to open waters, complete the open water impact table. (If no, continue to question
5.)
4a. Open Water Impact Number: Permanent (P) or Temporary (T) - Each open water impacted must be
identified on a location map (01, 02, 03, etc.) and included in this table. If you have more than 4 open
waters impacted, submit an additional sheet with a table listing the additional impacts.
Permanent (P) or Temporary (T): Check the corresponding box (P) permanent or (T) temporary for each
open water impact. Temporary impacts are a change in the open water (generally during the construction
of a project) that is of sufficiently short duration to have minimal impacts to the ecology of the area, and
within a reasonably short duration will restore to its original, pre -construction function. Permanent
impacts occur if the fill or alteration of the open water will result in a post construction loss or change in
ecosystem type.
4b. Name of waterbody: Enter the name of the waterbody as it is labeled on the USGS topographic map.
If the open water impacted is unnamed, please use the label corresponding to the map or site plan.
4c. Type of impact: Examples of impact types are: fill, excavation, dredging, flooding, drainage,
bulkheads, bridge, causeway, other (specify).
4d. Waterbody type: Waterbody types include: lake, pond, estuary, sound, bay, ocean, etc.
4e. Area of impact: The total area should be calculated to the nearest 0.01 (hundredth) acre.
Revised for 2012-2017 Nationwide Permits, March 26, 2013 15

OF WATCR
I I Pre -Construction Notification (PCN) Form Instructions o� 0�
D
C
4f. Total open water impacts: Add all of the proposed impacts to calculate the total.
4g. Comments: Explain any items that may need clarification or that do not fit perfectly into the table.
5. Pond or Lake Construction - Complete this section if the project involves proposed construction of a
pond or impoundment. Note: If a pond is being constructed solely to meet State stormwater
requirements, then this section does not need to be filled out and the "No" box should be checked.
However, if a local government is requiring the pond for a local stormwater requirement, then this section
does need to be completed. If construction of a pond or lake is proposed, all associated wetland and
stream impacts must be included above in the wetland and stream impact sections. Also, the proposed
pond should be described here and illustrated on any maps included with this application. The impact
numbers should correspond with those on your impact maps.
5a. Pond Identification Number: The impact numbers should correspond with those on your impact
maps. If you have more than two (2) constructed ponds or lakes, submit an additional sheet with a table
listing the additional impacts. Note that the Corps has very stringent guidelines for any pond construction
that will result in impacts to wetlands, streams or waters. Consult the 2009, Corps of Engineers
Wilmington District irrigation pond guidance for the construction of ponds or impoundments on their web
site.
5b. Proposed use or purpose of proposed work: Some example purposes of the proposed work include
(e.g., livestock watering, irrigation, aesthetics, trout pond, local stormwater requirement, etc.).
5c. Wetland Impacts (acres) - Provide the total acreage to the nearest one-hundredth of an acre (eg. 0.26
impacts (acres) for flooded wetlands, filled wetlands and excavated wetlands requested to construct the
lake or pond.) Provide the total acreage to the nearest one-hundredth of an acre (eg. 0.26 acres) when
reporting flooded, filled or excavated wetlands. [Note that "Section C. 2. Wetlands Impacts" of the PCN
form must also be completed if any wetlands are impacted.]
5d. Stream Impacts (feet): Provide the total length (to the nearest foot) of stream impact for flooded
stream, filled streams, andor excavated streams requested to construct the lake or pond. [Note that
"Section C. 3. Stream Impacts" of the PCN Form must also be completed if any streams are impacted.
5e. Upland Impacts (acres): Provide the total acreage to the nearest one-hundredth of an acre (eg. 0.26
acres) that will be flooded to construct the lake or pond. [Note: This information is for DWQ as the Corps
does not regulate pond construction in uplands.]
5f. Total: Add all of the proposed impacts to calculate the total.
5g. Comments: Explain any items that may need clarification or that do not fit perfectly into the table.
5h. Is a dam high hazard permit required? - Check yes or no. If no, continue to next question.
If the dam height will exceed 15 feet and impounded water volume (at the dam crest) will exceed 10 acre-
feet, or if the dam is deemed to be a high hazard structure that would cause significant property damage
or loss of life upon failure, you are required to obtain two additional permits (one for construction and one
for impoundment of water) from the North Carolina Department of Environment and Natural Resources
Revised for 2012-2017 Nationwide Permits, March 26, 2013 16

OF WATCR
I I Pre -Construction Notification (PCN) Form Instructions o� 0�
D
C
(DENR) Dam Safety Program. To ensure that your pond will conform to all state laws, contact the DENR
Dam Safety Program (919-707-9220) or the nearest regional DENR office before beginning construction.
Also check to see if local county or municipal ordinances require additional permits.
5i. Expected pond surface area (acres): This should be the combined total of the flooded wetland acres
and flooded upland acres in the table (C.5.f) and identified to match project maps and plans.
50. Size of pond watershed (acres): Provide the size of the pond watershed is the area (in acres) that will
be draining into the proposed pond or lake, measured from the outlet or dam of the lake.
5k. Method of construction: Include dam, embankment, excavation, installation of draw -down valve or
spillway, etc. in description.
6. Buffer Impacts - If the project will impact a State of North Carolina protected riparian buffer, then
complete the chart below. If no, then continue to "Section D. Impact Justification and Mitigation" of the
PCN Form. Some local municipalities have their own buffer protections on watersheds that are not
protected by the State (the Corps does not administer riparian buffer rules). Local municipality buffer
protections should not be listed.
6a. Project is in which protected State protected river basin? List the name of the corresponding river
basin: Neuse, Tar -Pamlico, Catawba, Randleman, or Other: [there are no other basins at this time.]
6b. Buffer Impacts - Permanent or Temporary: The impact numbers should be labeled and correspond
with those on your impact maps. Check the corresponding box (P) permanent or (T) temporary for each
buffer impact.
Temporary. The only use categories that allow temporary impacts are for temporary roads and
temporary sediment and erosion control devices. These impacts must correspond with those
categories listed in the respective river basin table of uses in the Red Book rule.
6c. Reason for impact: The reason for the impact should correspond with the categories in the river basin
table of uses (if applicable) in the Red Rule Book.
Reference links to "Red Book":
http://portal.ncdenr.org/c/document library/get file?p I id=38446&folderld=285750&name=DLFE-8513.pdf
6d. Stream name: Enter the name of the stream adjacent to the buffer (i.e., the stream labeled on the
USGS topographic map). If the stream has no name, then call it an unnamed tributary (UT) to the
nearest named stream. If there are multiple unnamed tributaries to the same named stream on the site,
then list them numerically (such as UT -1 to Swift Creek, UT -2 to Swift Creek, UT -1 to Davis Creek, etc.).
6e. Buffer mitigation required? Please refer to the table of uses to determine if riparian buffer mitigation is
required. If you are unsure if mitigation is required or if the impacts are "allowable", please call the NC
DWQ Buffer Coordinator [phone].
6f. Zone 1 impact (square feet): Zone 1 shall begin at the most landward limit of the top of bank or the
rooted herbaceous vegetation and extend landward a distance of 30 feet on all sides of the surface water,
measured horizontally on a line perpendicular to the surface water.
Revised for 2012-2017 Nationwide Permits, March 26, 2013 17

CSF W ATZ9
I I Pre -Construction Notification (PCN) Form Instructions o� 0�
DD C
6g. Zone 2 impact (square feet): Zone 2 shall begin at the outer edge of Zone 1 and extend landward 20
feet as measured horizontally on a line perpendicular to the surface water. The combined width of Zones
1 and 2 shall be 50 feet on all sides of the surface water. Ensure that the buffer impact is broken down by
zones and is also enumerated by zone on your impact maps.
6h. Total buffer impacts: Add all of the proposed impacts to calculate the total.
6i. Comments: Explain any items that may need clarification or that do not fit perfectly into the table.
Section D. Impact Justification and Mitigation Instructions
By law, you must exhaust all reasonable measures to avoid impacts before you propose any impacts to
protected aquatic environments, such as streams, wetlands, and open waters. In this section, you must
provide a justification that explains how you minimized all proposed impacts. The justification must detail
the design and proposed construction measures you took to avoid or minimize impacts. If the impacts
are required by a local government or other agency, the claim must be supported with appropriate written
documentation from the local government or other agency. Include relevant site constraints factors that
shaped your design or construction choice, as such as topography, building ordinances, and accessibility.
1. Avoidance and Minimization
1a.Specifically describe measures taken to avoid or minimize the proposed impacts in designing the
rp oiect: Minimizing and avoiding impacts should be a critical part of the design process. The following is
a checklist of avoidance and minimization questions that DWQ Staff often look for in applications. If the
answer is "yes" to any of the below questions then you should provide a specific justification addressing
these issues as to why the impacts are necessary.
• Are there any stream crossings at angles less than 75 degrees or greater than 105 degrees?
• Are there any stream crossings that cross two streams above or at the confluence of those
streams?
• Is any single stream crossed more than once?
• Can property access routes be moved or reduced to avoid stream, wetland, water, and buffer
impacts?
• Can a building, parking lot, etc. be realigned to avoid impacts?
• Can the site layout be reconfigured to avoid impacts?
• Can headwalls or steeper side slopes be used safely to avoid/minimize impacts?
• Can a retaining wall be used safely to avoid/minimize impacts?
• Can cul de sacs be used in place of a crossing?
• Can lots be reshaped or have shared driveways to avoid impacts?
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction
techniques: List all techniques and practices that you plan to use to avoid and minimize impacts from the
construction of the project (e.g., scheduling issues to avoid certain time -specific impacts aquatic impacts,
erosion control measures, hand clearing versus use of heavy equipment, site access from high ground,
pre -fabrication of materials in high ground to minimize time in sensitive environments, building elevated
structures over wetlands or streams to transport equipment, etc.)
Revised for 2012-2017 Nationwide Permits, March 26, 2013 18

OF WATCR
I I Pre -Construction Notification (PCN) Form Instructions o� 0�
D
C
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
Both the Corps and DWQ can require compensatory mitigation for impacts to waters in North Carolina.
The Corps determines the compensatory mitigation requirements for Waters of the US and DWQ has the
authority to require additional mitigation requirements. The DWQ may also require compensatory
mitigation on Waters of the State (that are not considered Waters of the US, such as isolated and other
non -404 wetlands, isolated open waters, and isolated streams).
• Corps: Mitigation will be required when necessary to ensure that adverse effects to the
environment are minimal. In addition, in the Wilmington District, as outlined in the NWP Regional
Conditions, specific mitigation is required in special designation waters such as trout waters (section 2.7),
and for streambed loss (see section D 3.1 & D 3.2). To learn more about Corps mitigation requirements,
visit the Mitigation web site at: http://www.saw.usace.army.mil/Missions/RegulatoryPermitProgram/Mitioation.aspx
• DWQ: Generally, mitigation may be required for projects involving equal to or greater than one
acre of wetlands or equal to or greater than 150 linear feet of stream.
2a.Does the project require Compensatory Mitigation for impacts to Waters of the U.S. or Waters of the
State? Contact your regional Corps and DWQ offices if you are unsure whether or not compensatory
mitigation is required. An on-site meeting may be required to make this determination. For Corps permit
applications, review the web links for nationwide permits and regional conditions (listed under section 2
instructions above) to determine if you need to propose mitigation measure for your project. Review the
DWQ general certification you are applying for to determine if any project specific mitigation thresholds
are stated: http://portal.ncdenr.org/web/wq/swp/ws/401/certsandpermits
2b. If yes, mitigation is required by whom? Mitigation may be required by DWQ, the Corps, or by both
agencies.
2c. If yes, which mitigation option will be used for this project? Applicants must propose the type of
mitigation that will be done to offset impacts. Mitigation options in NC include mitigation banks, in -lieu fee
(payment to NC Ecosystem Enhancement Program — EEP), or permittee -responsible mitigation. The
Corps and DWQ will accept mitigation that is most appropriate for the proposed project and to best offset
adverse impacts.
[Important Note regarding 2008 changes to NC Mitigation laws: According to North Carolina Session Law
2008-152, Senate Bill 1885 (link listed below), applicants other than NCDOT may satisfy compensatory
wetlands mitigation requirements by the following actions, if those actions meet or exceed the requirements
of the United States Army Corps of Engineers:
(1) Participation in a private wetlands mitigation bank. — This option is only available in a hydrologic area
where there is at least one private wetlands mitigation bank that has been (i) approved by the United States
Army Corps of Engineers and that has available mitigation credit or (ii) approved by the North Carolina
Division of Water Quality for resources regulated under the Neuse and Tar Pamlico rules and that has
available mitigation credit. For purposes of this subdivision, "hydrologic area" means the eight digit
Hydrologic Unit Code where the mitigation bank is located.
(2) Payment of a fee established by the Department into the Ecosystem Restoration Fund established in
G.S. 143 214.12. — This option is only available to an applicant if the option under subdivision (1) of this
subsection is not available as an option.
(3) Donation of land to the Ecosystem Enhancement Program or to other public or private nonprofit
conservation organizations as approved by the Department.
Revised for 2012-2017 Nationwide Permits, March 26, 2013 19

OF WATCR
I I Pre -Construction Notification (PCN) Form Instructions o� 0�
DD C
(4) Preparing and implementing a wetlands restoration plan.
http://www.ncleg.net/Sessions/2007/Bills/Senate/HTML/Sl 885v4.html
Note: Applicants must include the following documentation to support the answer checked on the PCN for
proposed compensatory mitigation:
• Payment into an approved mitigation bank must include a receipt of payment and details of credits
purchased. See section D.3 for detailed instructions and requirements regarding mitigation banks.
• In -lieu fee program (NC EEP, Riparian Buffer Restoration Fund, etc.) mitigation must include a
written receipt and a confirmation document. See section DA for detailed instructions and requirements
regarding in -lieu fee mitigation.
• Permittee -responsible mitigation must include a mitigation plan that accompanies this application.
See section D.5 for detailed instructions and requirements regarding permittee -responsible mitigation.]
3. Mitigation Bank
If you are going to pay into a mitigation bank to meet your mitigation obligation, a copy of the banking
receipt and credit description for your project must be attached to this PCN. Any application lacking a
required mitigation documentation or payment shall be placed on hold as incomplete.
3a. Name of Mitigation Bank: The Corps mitigation web site, RIBITS, includes a Mitigation Bank locator
for all Corps -approved banks.
3b. Credits Purchased: Attach receipt and letter from the Mitigation Bank, specifying the type and
quantity of credits purchased.
3c. Comments: Explain any items that may need clarification or that do not fit perfectly into this Mitigation
Bank section (extenuating circumstances, multiple types of credits and quantities, etc.).
4. In -lieu fee program (NC EEP)
Mitigation may be made by payment to the NC Ecosystem Enhancement Program. Please note that it is
the applicant's responsibility to contact the NC EEP at [phone] to obtain written approval
indicating that the NC EEP is willing to accept payment for the mitigation associated with this project.
That approval must be attached to this form.
If you select mitigation via an in -lieu fee program, a copy of the approval for your project and a receipt for
payment must be attached to this PCN. Any application lacking a required confirmation documentation or
NC EEP concurrence shall be placed on hold as incomplete.
[Note: If you elect to use the EEP or a private mitigation bank, DWQ recommends that you request the
maximum possible mitigation amount that DWQ may require so that you will not have to get further approval
from them on short notice.]
4a. Approval letter from in -lieu fee program (NC EEP) is attached. If you are proposing to use an in -lieu
fee program to meet your mitigation obligation, you must check yes and include the approval letter,
otherwise your application package is considered incomplete.
4b. Stream mitigation requested: Enter the linear feet of stream mitigation that is requested from NC
EEP. This should be the length of stream after the multiplier ratio has been calculated. For example, 100
linear feet of stream is being impacted that needs to be mitigated at a 2:1 ratio — therefore, 200 linear feet
of stream is the amount of stream mitigation that will be requested.
Revised for 2012-2017 Nationwide Permits, March 26, 2013 20

OF WATCR
I I Pre -Construction Notification (PCN) Form Instructions o� 0�
DD C
4c. If using stream mitigation, stream temperature: The required temperature should correspond with the
impacted stream type (choose warm, cool, or cold). See the Corps web page on stream mitigation as it
includes the NC Wildlife Commission River Basin Habitat Classifications Maps that are used to determine
warm, cool, or cold status.
4d. Buffer mitigation requested (DWQ only): Enter the square footage of riparian buffer mitigation that is
requested. This amount should be the result of using the multiplier ratio that corresponds with both Zone
1 and Zone 2 impacts
4e. Riparian wetland mitigation requested: This amount should be the result of using the multiplier ratio
that corresponds with the acreage of riparian wetland impact.
4f. Non -Riparian wetland mitigation requested: This amount should be the result of using the multiplier
ratio that corresponds with the acreage of non -riparian wetland impact.
4g. Coastal (tidal) wetland mitigation requested: This amount should be the result of using the multiplier
ratio that corresponds with the acreage of coastal wetland impact.
4h. Comments: Explain any items that may need clarification or that do not fit perfectly into this in -lieu fee
program section (extenuating circumstances, multiple types of mitigation methods, etc.).
5. Complete if Using a Permittee -Responsible Mitigation Plan
If you select permittee -responsible mitigation, a copy of the mitigation plan for your project must be
attached to this PCN. Any application lacking a required mitigation plan shall be placed on hold as
incomplete.
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan:
In addition to a brief description here, attach a formal mitigation plan including maps, planting plan, and
monitoring plan.
Provide a brief description of the proposed mitigation plan. The description should provide as much
information as possible, including, but not limited to:
• Site location (attach direction and map, if offsite)
• Affected stream and river basin,
• Type of mitigation proposed (restoration, enhancement, creation or preservation),
• Amount of mitigation (acreage/linear feet),
• A plan view,
• Preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and
• A description of the current site conditions and proposed method of construction.
Final mitigation plans must contain detailed plans, specifications, calculations and other supporting data
that show that the appropriate mitigation will be achieved at the ratios required. Any means of permanent
protection, such as a permanent conservation easement, must be finalized and supporting documentation
attached.
6. Buffer Mitigation (State Regulated Riparian Buffer Rules)
Revised for 2012-2017 Nationwide Permits, March 26, 2013 21

OF WATCR
I I Pre -Construction Notification (PCN) Form Instructions o� 0�
It.tl 7_ r
D
C
If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., riparian buffer restoration,
payment into the riparian buffer restoration fund).
Attach all appropriate information as identified within 15A NCAC 2B .0242, .0244, or .0260.
If you elect to use the NC EEP or a private mitigation bank, DWQ recommends that you request the
maximum possible mitigation amount that DWQ may require so that you will not have to get further
approval from them on short notice.
[Note: If the buffer is also a wetland (and you are mitigating for wetland losses on the site), then there is no
need to "double -count" the buffer/wetland area affected. Compute the buffer mitigation needed first, and
then subtract the buffer/wetland area from the wetland mitigation needed.]
6a. Will the project result in an impact within a protected riparian buffer that requires buffer mitigation?
Check "yes" or "no". To determine whether or not your project requires mitigation, check the appropriate
section in the "DWQ Red Rule Book" for the subject river basin. Items in the respective "Table of Uses"
where the "Allowable with Mitigation" box is checked require mitigation. Additionally, requests for minor
variances or after -the -fact impacts always require mitigation.
6b. Zones of the Buffer - Zone 1 is measured from the stream top of bank to 30 feet landward on all sides
of the surface water (measured horizontally on a line perpendicular to the surface water). Zone 2 extends
horizontally 20 feet landward of Zone 1.
6c. Reason for impact — The reason should correspond with the use in the Table of Uses in the DWQ Red
Rule book.
6d. Total impact (square feet) — This number should correspond with the square footage on your impact
map that requires mitigation.
6e. Required mitigation (square feet) — Multiply the total impact for each Zone (listed in 6c) with the
Multiplier number in the Multiplier column and enter the result here.
6f. Total buffer mitigation required: Add the required mitigation for Zones 1 and 2 in column 6d to
determine the total mitigation required.
6g.lf buffer mitigation is required, discuss what type of mitigation is proposed (e.g. payment to private
mitigation bank, payment into the NC EEP riparian buffer restoration fund, or on-site riparian buffer
restoration). If on-site riparian buffer restoration is proposed, a detailed restoration plan must be included
in the application package following the most recent DWQ guidelines:
http://portal.ncdenr.org/web/wq/swp/ws/401 /ri pa rian buffers
6h.Comments: Explain any items that may need clarification or that do not fit perfectly into this Buffer
Mitigation section.
Section E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
Revised for 2012-2017 Nationwide Permits, March 26, 2013 22

OF WATCR
I I Pre -Construction Notification (PCN) Form Instructions o� 0�
D
C
1a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC
Riparian Buffer Protection Rules? As part of the on-site jurisdictional determination, DWQ staff field staff
will determine if and where the NC Riparian Buffer Protection Rules apply on your project.
1 b. If yes, then is a diffuse flow plan included? If yes to the above, then you must include a diffuse flow
plan that shows that all stormwater from the project is either:
• Converted to diffuse flow outside of the protected riparian buffer through the correct design and
implementation of a level spreader, OR
• Treated by an appropriately designed BMP that removes a minimum of 30% of total nitrogen and
total phosphorus. A BMP must be provided if the slopes are too steep for a level spreader of if the flows
are too large for a level spreader.
Please see Chapter 8 of the DWQ BMP Manual, for detailed information on how to meet diffuse flow
requirements. If level spreaders are being used, then one completed Level Spreader Supplement Form with
all required items been submitted for each proposed level spreader. If another BMP is being used, make
sure to include the appropriate BMP Supplement Form with all required items.
If you answered "yes" to one of the above questions, then complete the rest of Section E.
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project? Does the project require a Non -404
Jurisdictional General Permit? Non -404 Jurisdictional General Permits require submittal of a stormwater
management plan if the development is greater than 24% impervious or contains drainage areas that are
greater than 24% impervious.
2b. Does this project require a Stormwater Management Plan? Is this project subject to a General
Certification 3704 or 3705? These two General Certifications require submittal of a stormwater
management plan if the development is greater than 24% impervious or contains drainage areas that are
greater than 24% impervious.
Note for both 2a and 2b: For the NCDOT, the stormwater management plan must comply with NCDOT's
Individual NPDES permit NCS000250. For applicants other than the NCDOT, the plan must comply with the
current version of Stormwater Management Plan Requirements for Applicants other than the NC
Department of Transportation.
3. Certified Local Government Stormwater Review (DWQ Requirement)
3a. In which local government's jurisdiction is this project? In other words, which local government is
responsible for reviewing and approving your development plans? This information can be obtained from
the stormwater program map given in the link above but should be verified with the local jurisdiction's
staff.
3b. Which of the following locally -implemented stormwater management programs apply (check all that
apply):? Is this project subject to any of the following state -implemented stormwater management
programs? If your project is subject to one of these programs, then you can submit the DWQ's approval
letter and approved stormwater management plan and that will meet the stormwater management plan
requirements associated with the 401 Certification Program.
3c. Has the approved Stormwater Management Plan with proof of approval been attached?
Revised for 2012-2017 Nationwide Permits, March 26, 2013 23

CSF W ATZ9
I I Pre -Construction Notification (PCN) Form Instructions o� 0�
D
C
Is this local government certified to implement a state stormwater program?
A list of local governments that are certified to implement state stormwater programs is available at:
http://h2o.enr.state.nc.us/ncwetlands/documents/JurisdictionsthatareCertified-2.pdf. Please note that for
some jurisdictions, the certification only applies to certain areas, such as the Water Supply Watershed
designated areas. If your project is subject to one of these programs, then you can submit the local
government's approval letter and approved stormwater management plan and that will meet the
stormwater management plan requirements associated with the 401 Certification Program.
If the project is not under the jurisdiction of either a certified local government or a state -implemented
stormwater management program, then the DWQ 401 Unit will review the Stormwater Management Plan.
4. DWQ Stormwater Program Review
4a. What is the overall percent imperviousness according to the most current site plan?
Divide the total area of impervious surfaces (including building footprints, roads, driveways, sidewalks,
gravel -surfaces areas, and amenity areas, etc.) by the total site area that is being developed at the time
of permitting. If you are developing the site in phases, then do not include areas reserved for future
development in the total site area.
4b. Does the site contain any areas that meet the criteria for "high density" per General Certifications
3704 and 3705?
General Certifications 3704 and 3705 require a stormwater management plan for any drainage area that
is anticipated to contain impervious surface cover of equal to or greater than 24 percent. Per NCAC 2B
15A: 02H.1000, a "drainage area" is defined as "the entire area contributing surface runoff to a single
point."
Provide an inventory of each drainage area on the site that includes all proposed building footprints,
roads, driveways, sidewalks, gravel -surfaced areas, amenity areas, etc. The inventory should reflect the
final built -out conditions, including the possibility of impervious surfaces that may be added in the future.
If proposed percent impervious on any drainage area is more than 20 but less than 24 percent, then
attach an accounting of impervious surfaces for that drainage area. A Stormwater Management Plan
(SMP) must be provided for any drainage areas that exceed 24 percent imperviousness.
4c. Provide a brief narrative description of the stormwater management plan.
Describe the types, sizes and locations of the BMPs that will be used to treat the stormwater from the site.
Refer to the Stormwater Policy for Applicants Other than the NCDOT to determine the BMP treatment
requirements based on surface water classification.
4d. Has a completed BMP Supplement Form with all required items been submitted for each
stormwater BMP?
BMP Supplement Forms are available on the DWQ web site: The stormwater management plan will NOT
be reviewed until ALL of the required items have been submitted. Please note that on many of the BMP
supplement forms, the required items checklist can be found at the bottom of the form in the second tab.
Section F. Supplementary Information
1. Environmental Documentation (DWQ requirement)
Revised for 2012-2017 Nationwide Permits, March 26, 2013 24

OF WATCR
I I Pre -Construction Notification (PCN) Form Instructions o� 0�
D
C
1 a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public
(federal/state) land? If the "yes" box is checked, an environmental document (SEPA) may be required.
1 b. Does the project require preparation of an environmental document pursuant to the requirements of
the State (North Carolina) Environmental Policy Act (NEPA/SEPA)? The environmental documents that
may be required are an Environmental Assessment (EA) or an Environmental Impact Statement (EIS).
This website also provides links to applicability, agency contacts, guidance documents and other useful
information.
1 c. Has the document review been finalized by the State Clearing House? (If so, attach a copy of the
NEPA or SEPA final approval letter.) If this document is required, your PCN application will not be
considered complete without the final approval letter from the State Clearing House (SCH).
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, or Riparian Buffer Rules 0 5A NCAC 2B
.0200)? A Notice of Violation does not have to be issued for a site to be in violation of the
aforementioned rules and/or standards. If your site has unauthorized fill in wetlands, streams, or riparian
buffers then this box should be checked. If a Notice of Violation is issued for your site, then a copy of the
Notice of Violation must be included in your application package or your application package will be
considered incomplete.
2b. Is this an after -the -fact permit application? (This is also a Corps item of interest) Check "yes" if the
impacts you are applying for have already been implemented.
2c. Provide an explanation of the violation(s): Describe the nature of the violation and any resolutions
that have been discussed to get the site back into compliance.
3. Cumulative Impacts (DWQ requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in additional
development, which could impact nearby downstream water quality? Please refer to the web site for more
information on DWQ's Cumulative Impacts Policy.
3b. 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. Please refer to DWQ's
Cumulative Impact Policy referred to in 3a to determine whether the project requires a qualitative or a
quantitative cumulative impact analysis.
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.
Any disposal method that suggests that further impacts may be required other than those shown must be
clearly addressed on the site plans. If onsite septic is proposed, provide a copy of the septic permit and
Revised for 2012-2017 Nationwide Permits, March 26, 2013 25

OF WATCR
I I Pre -Construction Notification (PCN) Form Instructions o� 0�
D
C
show the septic layout as well as the proposed house and driveway footprint(s) on thea site plans (include
repair areas if they are required).
5. Endangered Species and Designated Critical Habitat (Corps requirement)
The Corps, as authorized under General Condition 18 and 31 of the Nationwide Permits, requires that
activities which may affect a listed species or critical habitat will not be authorized by any nationwide
permit without completion of Section 7 Endangered Species Act consultation.
For activities that may affect (either adversely or beneficial) federally -listed endangered or threatened
species or designated critical habitat, the pre -construction notification (PCN) must include the name(s) of
the endangered or threatened species that may be impacted by the proposed work or that utilize the
designated critical habitat that may be impacted by the proposed work.
The District Commander determines whether the proposed activity "may affect" or will have "no affect" to
listed species and designated critical habitat and notifies the applicant of the Corps' determination within
45 days of receipt of a complete PCN. Applicants shall not begin work until the Corps provides notification
that the proposed activities will have "no affect" on listed species or critical habitat, or until section 7
consultation has been completed.
5a. Will this project occur in or near an area with federally protected species or habitat? The Corps has a
web page explaining how to check your project vicinity for possible presence of federally protected
species.
[NOTE: If your project is anywhere within a designated FWS watershed of interest (maps are on web page),
and your project is served by the FWS Asheville Field Office (see counties listed in 5b), you must provide a
copy of your PCN to the Asheville FWS Field Office. The address is listed in instruction under section F.5b.]
5b. Have you checked with the USFWS concerning Endangered Species Act impacts? The US Fish and
Wildlife Service field offices in NC are listed below.
Asheville FWS Field Office - All NC counties west of and including Anson, Stanly, Davidson, Forsyth and
Stokes Counties:
US Fish and Wildlife Service
Asheville Field Office
160 Zillicoa Street
Asheville, NC 28801
Telephone: [phone]
Raleigh FWS Field Office: all counties east of and including Richmond, Montgomery, Randolph, Guilford,
and Rockingham Counties:
The Raleigh Field Office
US Fish and Wildlife Service
Raleigh Field Office
Post Office Box 33726
Raleigh, NC 27636-3726
Telephone: [phone]
5c. If yes, indicate the USFWS Field Office you contacted - Check the appropriate box.
Revised for 2012-2017 Nationwide Permits, March 26, 2013 26

OF WATCR
I I Pre -Construction Notification (PCN) Form Instructions o� 0�
r� c
5d. What data sources did you use to determine whether your site would impact Endangered Species or
Designated Critical Habitat? The Corps provides a web page with links to state and federal online tools to
check for endangered species. Additionally, please indicate if a biological survey or other resources were
used to make this check.
6. Essential Fish Habitat (Corps requirement)
The Corps, as stated in general condition 22 and 31 of the nationwide permits requires completion of a
PCN form for identification of projects that require coordination involving "Essential Fish Habitat" (EFH).
EFH are defined as "those waters and substrate necessary to fish for spawning, breeding, feeding, or
growth to maturity." Available information should be interpreted with a risk -averse approach to ensure that
adequate areas are protected as EFH for the managed species. In North Carolina, salt marshes, oyster
reefs, and seagrass beds are designated EFH for red drum and penaeid shrimp, species managed
cooperatively by state and federal authorities.
For questions about EFH in NC, contact:
Mr. Fritz Rohde
National Marine Fisheries Service
101 Pivers Island Road
Beaufort, North Carolina 28516
6a. Will this project occur in or near an area designated as essential fish habitat?
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
List websites utilized, professionals contacted, publications resourced, etc.
7. Historic or Prehistoric Cultural Resources (Corps requirement)
The Corps, as stated in general condition 20 and 31 of the nationwide permits, requires completion of a
PCN form for identification of projects that require coordination involving historic or pre -historic cultural
resources. For an activity that may affect a historic property listed on, determined to be eligible for listing
on, or potentially eligible for listing on, the National Register of Historic Places, for non -Federal applicants
the PCN must state which historic property may be affected by the proposed work or include a vicinity
map indicating the location of the historic property. Federal applicants must provide documentation
demonstrating compliance with Section 106 of the National Historic Preservation Act.
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 (e.g., National Historic Trust designation or
properties significant in North Carolina history and archaeology)? The NC State Historic Preservation
Office has a web site with links to resources about historic and pre -historic cultural resources within the
state: http://www.hpo.dcr.state.nc.us Listed National Register sites can be downloaded, as well as
information on archeological resources in the state.
7b. What data sources did you use to determine whether your site would impact historic or archeological
resources? List websites utilized, professionals contacted, publications resourced, etc.
8. Flood Zone Designation (Corps Requirement)
Revised for 2012-2017 Nationwide Permits, March 26, 2013 27

CSF W ATZ9
I I Pre -Construction Notification (PCN) Form Instructions o� 0�
D
C
The Presidents Executive Order No. 11988 states that federal agencies shall provide leadership and shall
take action to reduce the risk of flood loss, to minimize the impact of floods. Additionally, Executive Order
11990, Protection of Wetlands, requires federal agencies to consider the need to mitigate flood and storm
hazards in consideration of all actions. The Corps, as stated in general condition 10 and 31 of the
nationwide permits, requires completion of a PCN form for identification of projects that require
coordination involving work in FEMA designated 100 -Year Floodplains. The proposed activity must
comply with applicable FEMA approved state or local floodplain management requirements.
8a. Will this project occur in a FEMA -designated 100 -year floodplain? The state of NC, in cooperation
with FEMA, provides maps that show floodplain determination. These flood maps can be viewed or
downloaded over the web at http://www.ncfloodmaps.com . To provide a national standard without
regional discrimination, the 1 % annual chance (100 -year) flood has been adopted by FEMA as the base
flood for floodplain management and flood insurance purposes. A 1 % annual chance flood (or base flood)
has a 1 % annual chance of being equaled or exceeded in any given year. The 1 % annual chance
floodplain identifies areas that are expected to be inundated by the 1 % annual chance flood. The 1 %
annual chance floodplain, shown on a Flood Insurance Rate Map, is also called a Special Flood Hazard
Area, where the National Flood Insurance Program's floodplain management regulations must be
enforced by the community as a condition of participation in the Program.
The floodway is the channel of a stream, plus any adjacent floodplain areas, that must be kept free from
encroachment so that the 1 % annual chance flood can be carried without substantial increases in flood
heights. Minimum Federal standards limit such increases to 1.0 foot; however, communities can develop
more stringent standards. Regulatory floodways are depicted on a Flood Insurance Rate Map and are
presented to communities as a minimum standard that must be adopted.
8b. If yes, explain. Provide written explanation of specific situation, and any documentation provided to
municipality regarding development in floodplains.
8c. What source(s) did you use to make the floodplain determination? FEMA flood insurance risk maps
(FIRMs) are the definitive source for floodplain determination. These can be obtained online, through
your property survey, municipality or mortgage bank.
Applicant/Agent's Signature and Date — The applicant should print their name in the first block, then
sign and date. NC 15 NCAC 2H .502(f) reads as follows: "Who Must Sign Applications. The application
shall be considered a "valid application" only if the application bears the signature of a responsible officer
of the company, municipal official, partner or owner. This signature certifies that the applicant has title to
the property, has been authorized by the owner to apply for certification or is a public entity and has the
power of eminent domain. Said official in signing the application shall also certify that all information
contained therein or in support thereof is true and correct to the best of his/her knowledge."
Note: The signature cannot be an electronic signature. If an agent is signing for the owner, an agent
authorization letter must be attached. A sample authorization letter is available on the Corps web site.
Revised for 2012-2017 Nationwide Permits, March 26, 2013 28