20180408 Ver 1_401 Application_20180318

DWR
Division of WaaerResources
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
January 31, 2018 Ver 2.3
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:lledoes.deq. ne.govlWaterResources101edocl624704/PCN%20Help%20File%202018-1-30. pdf
A. Processing Information
County (or Counties) where the project is located:
New Hanover
Is this project a public transportation project?*(?)
r Yes r No
1a. Type(s) of approval sought from the Corps:*
r Section 404 Permit (wetlands, streams and waters, Clean Water Act)
PF Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What type(s) of permit(s) do you wish to seek authorization?*
17 Nationwide Permit (NWP)
r Regional General Permit (RGP)
Nationwide Permit (NWP) Number: 12 - Utility Lines
NWP Number Other:
List all MN nunbers you are applying for not on the drop dow n list.
1c. Type(s) of approval sought from the DWR:*
check all that apply
r 401 Water Quality Certification - Regular r 401 Water Quality Certification - Express
W Non -404 Jurisdictional General Permit r Riparian Buffer Authorization
...............................................................................................................
*
1d. Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification:
For the record only for Corps Permit:
b Yes r No
O Yes r No
1e. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
If so, attach the acceptance letter from mitigation bank or in -lieu fee program
0 Yes r No

1f. Is the project located in any of NC's twenty coastal counties?*
r Yes
r No
1g. Is the project located within a NC DCM Area of Environmental Concern (AEC)?*
C•' Yes r No r Unknown
1h. Is the project located in a designated trout watershed?*
r Yes t: No
Link to trout information: http://wAm.saw.usace.army.miI/Missions/Regulatory-Permit-Program/Agency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact?*
Chris Ford
1b. Primary Contact Email:*
[e-mail]
1c. Primary Contact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
r Owner r Applicant (other than owner) fJ Agent/Consultant
(Check all that apply)
2. Owner Information
2a. Name(s) on recorded deed:
Town of Wrightsville Beach
2b. Deed book and page no.:
2c. Responsible party:
(for Corporations)
2d. Address
Street Address
321 Causeway Drive
Address Line 2
Municipal Complex, Town Hall
aty
Wrightsville Beach
Postal / Zip Code
28480
2e. Telephone Number:
(xxx)xxx-xxxx
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
State / Province / Fbgion
NC
Country
Us

4a. Name:
Highfill Infrastructure Engineering, PC
4b. Business Name:
(if applicable)
4c. Address
Street Address
2703 Jones Franklin Road, Suite 201
Address Line 2
aty
Cary
Pbstal / Zip Code
27518
4d. Telephone Number:
[phone]
(xxx)xxx-xxxx
4e. Fax Number:
(XXX)XXX-XXXX
4f. Email Address:*
[e-mail]
State / Province / Region
NC
Country
US
Agent Authorization Letter*
Rease provide the Agent Author¢ation Letter if you are submtting this docurrent.
Signed—Authorization Letter.pdf 36.61 KB
RLE TYPE U ST BE RDF
.... ...... ...... ..... ...... ...... ..... ...... ...... ...... ...... ..... ...... ..... ..... .......
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
NEI1 2018 Force Main Replacement
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/ town:
Town of Wrightsville Beach
1d. Driving directions*
If it is a new project and can not easily be found in a GPS napping system Rease provide directions.
From Wake Forest take 1-40 E to N College Rd, turn left on US 74/Eastwood Rd, continue straight. The site is at the NC Wildlife Resources
Commission Boat Ramp on the intracoastal waterway.
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)
N/A
2b. Property size:
(in acres)
2c. Project Address

Street Address
Address Line 2
City State / Province / Region
Wstal / 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:' Longitude:
34.2178 -77.8111
ex: 34.208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Intracoastal Waterway
3b. Water Resources Classification of nearest receiving water:*
SB
Surface Water Lookup
3c. What river basin(s) is your project located in?*
White Oak
River Basin Lookup
4. Project Description
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:*
The owner operates a wastewater collection system that discharges to the Cape Fear Public Utility Authority
(CFPUA) system via a single 14 -inch diameter force main that was constructed in 1982. The force main is primarily
constructed of ductile iron (DI) pipe, with the exception of the waterway crossings which are high density
polyethylene (HDPE) pipe.
The vicinity of the project is undeveloped woodland.
4b. Attach an 8 1/2 X 11 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for
DWR)
Click the upload button or drag and drop files here to attach docurrent
File type crust be pdf
4c. Attach an 8 1/2 X 11 excerpt from the most recent version of the published County NRCS Soil Survey map depicting the project site.
(for DWR)
Oick the upload button or drag and drop files here to attach docurrent
File type rust be pdt
4d. List the total estimated acreage of all existing wetlands on the property:
Only 0.23 acre disturbed temporarily
4e. List the total estimated linear feet of all existing streams on the property:
(intermittent and perennial)
Tidal influence
4f. Explain the purpose of the proposed project:*

Two recent failures of the DI force main pipe in the salt marsh on the east side of the ICW have raised concerns
over the condition of this portion of the force main. The area is adjacent to the western end of the Wrightsville
Beach Boating Access owned by the North Carolina Wildlife Resources Commission (NCWRC). Both failures have
been between the concrete anchor block and the isolation valve. The owner desires to replace the DI portion of
the pipeline from the point that the HDPE ends at the ICW crossing, to Pelican Drive.
4g. Describe the overall project in detail, including indirect imapacts and the type of equipment to be used:
Replacement of 540 LF of 14" FM by pipe bursting. Replacement of 41 LF of 14" FM by open -cut. Only 0.23 of 1
acre will be impacted. Equipment will include excavators, backhoes, trench boxes and bursting equipment.
4h. Please upload project drawings for the proposed project.
(lick the upload button or drag and drop files hereto attach docurrent
TWB1801-NEI FM Rehab-BASE.pdf 4.6MB
File type rrust be pdf
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
f Yes r No f Unknown
Comments:
Tidal influenced marsh
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
r Preliminary r Approved r Unknown r N/A
Corps AID Number:
Exarrple: SAW2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5d1. Jurisdictional determination upload
Click the upload button or drag and drop files hereto attach docurrent
File type rrust be FDF
6. Project History
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past?*
r Yes r No r Unknown
6b. If yes, please give the DWR Certification number or the Corps Action ID (exp. SAW -0000-00000).
N/A (the number or ID was unknown since it was issued 30 years ago)
Project History Upload
Click the upload button or drag and drop files hereto attach docurrent
File type rmst be FDF
7. Future Project Plans
7a. Is this a phased project?*
r Yes r No

Are any other NWP(s), regional general permit(s), or individual permits(s) used, or intended to be used, to authorize any part of the
proposed project or related activity? This includes other separate and distant crossing for linear projects that require Department of the
Army authorization but don't require pre -construction notification.
CAMA permit
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
V Wetlands
r— Open Waters
r— Streams -tributaries
r— Pond Construction
r— Buffers
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. Site # - Reason for impact* 2b. Impact type * 2c. Type of wetland *
Force main replacement T
Ivbp label (e.g. Fbad Crossing 1 - Qalvert, F2rnanent (P) or
dewatering, etc) Terrporary (l)
2g. Total Temporary Wetland Impact
0.230
2g. Total Permanent Wetland Impact
0.000
2g. Total Wetland Impact
0.230
2h. Comments:
Tidal Freshwater
Marsh
E. Impact Justification and Mitigation
1. Avoidance and Minimization
2d. Wetland name *2e. 2f. Type of 2g. Impact
Forested* Jurisdicition* area*
Intracoastal No Corps 0.230
Waterway (404, 10) orDV\R(401, (acres)
other)
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
Using trenchless technologies so the only impacts are on each end of the force main.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Using trenchless technologies so the only impacts are on each end of the force main.
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?
r Yes
r No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
. ..... ..... ...... ..... ...... ......
*** Recent changes to the stormwater rules have required updates to this section .***

1. Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection
Rules?
f Yes r No
For a list of options to meet the diffuse flow requirements, click here.
If no, explain why:
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
r Yes r No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?
r Yes
r No
To look up low density requirement click here 15A NCAC 02H .1003(2).
2c. Does this project have a stormwater management plan (SMP) reviewed and approved under a state stormwater program or state -
approved local government stormwater program?*
r Yes
r No
Fant: projects that have vested rights, exerrptions, or grandfathering from state or locally irrplerrented storrrwater prograrrs or projects that satisfy state or locally-irrplerrented storrrwater prograrrs
through use of community in -lieu prograrrs should answer no to this question.
3. Stormwater Requirements
3a. Select whether a completed stormwater management plan (SMP) is included for review and approval or if calculations are provided
to document the project will not cause degradation of downstream surface waters.*
r Stormwater Management Plan r Antidegradation Calculations
3b. Stormwater Management Plan: If submitting a SMP for review and approval, it shall complywith the high-density development
requirements set forth in 15A NCAC 02H .1003. Include all appropriate stormwater control measure supplemental forms and associated
items.
Click the upload button or drag and drop files here to attach docurrent
FlLE TYPE MBT BE FDF
3c. Antidegradation Calculations: If submitting calculations to document the project will not cause degradation of downstream surface
waters, the documentation shall include a detailed analysis of the hydrological impacts from stormwater runoff when considering the
volume and velocity of stormwater runoff from the project built upon area and the size and existing condition of the receiving
waterbody(ies).
Click the upload button or drag and drop files hereto attach docurrent
FlLE TYPE MBT BE PDF
G. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
r Yes r No
1b. If you answered "yes" to the above, does the project require preparation of an environmental document pursuant to the
requirements of the National or State (North Carolina) Environmental Policy Act (NEPA/SEPA)?*
r Yes r No
Comments:*

Not applicable to this project
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15A NCAC 2H.0500), Isolated Wetland Rules (15A NCAC 2H.1300), or
DWR Surface Water or Wetland Standards or Riparian Buffer Rules (15A NCAC 2B.0200)? *
r Yes r No
2b. Is this an after -the -fact permit application?*
r Yes f• No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in additional development, which could impact
nearby downstream water quality?*
r Yes r No
3b. If you answered "no," provide a short narrative description.
Work of the Project includes the replacement of approximately 600 linear feet of 14 -inch ductile iron force main
with 16 -inch high density polyethylene force main via pipe bursting primarily. No expansion of the system. The
inside diameter of the 16" HDPE is 13" which is smaller than the existing pipe.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
f Yes r No f NSA
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or habitat?*
r Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
r Yes r No
5c. If yes, indicate the USFWS Field Office you have contacted.
5d. Is another Federal agency involved?*
r Yes r No r Unknown
5e. Is this a DOT project located within Division's 1-8?*
r Yes r No
5f. Will you cut anytrees in order to conduct the work in waters of the U.S.?*
r Yes r No
5g. Does this project involve bridge maintenance or removal?*
r Yes r No
Link to the NLEB SLOPES document: http://saw-reg.usace.army.mil/NLEB/1-30-17-signed_NLEBSLOPES&apps.pdf
5h. Does this project involve the construction/installation of a wind turbine(s)?**
f Yes r No
51. Does this project involve (1) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhammers,
mechanized pile drivers, etc.?*
f Yes 47 No

5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
Work is in an existing right -of -way. Will return to preconstruction conditions.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
r Yes r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
Only partially flooded. Located in right of way easement.
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data: http://gis.ncdcr.gov/hpoweb/
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)?*
r Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
http://gis.ncdcr.gov/hpoweb/
7c. Historic or Prehistoric Information Upload
gick the upload button or drag and drop files here to attach docurrent
File crust be FDF
8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https:Hmsc.fema.gov/portal/search
8a. Will this project occur in a FEMA -designated 100 -year floodplain?*
t: Yes r No
8b. If yes, explain how project meets FEMA requirements:
Buried pipe. No changes in elevation.
8c. What source(s) did you use to make the floodplain determination?*
https://msc.fema.gov/portal/search#searchresultsanchor
Miscellaneous
Miscellaneous attachments not previously requested.
gick the upload button or drag and drop files here to attach docurrent
File rrust be FDF or ME
Signature
W By checking the box and signing below, I certify that:
■ I have given true, accurate, and complete information on this form;
■ I agree that submission of this PCN form is a "transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic
Transactions Act');
■ I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic
Transactions Act');
■ I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature; AND
■ I intend to electronically sign and submit the PCN form.

Full Name:*
Chris Ford
Signature
Initial Review
Is this project a public transportation project?* (?
r Yes r No
Change only K needed.
Has this project met the requirements for acceptance in to the review process?*
r Yes
C No
BIMS # Assigned *
20180408
Version#*
Reviewing Office *
Wilmington Regional Office - [phone]
Select Project Reviewer*
Chad Coburn:eads\cccoburn
Is a payment required for this project?*
r No payment required
f Fee received
r Fee needed - send electronic notification
What amout is owed?
r $240.00
r $570.00