20191589 Ver 1_PCN Form Submission_20191119

DWR
mrlslon of Water Resources
Pre -Construction Notification (PCN) Form
September 29, 2018 Ver 3
Initial Review
Has this project met the requirements for acceptance in to the review process?*
r Yes
r No
Is this project a public transportation project?*
C Yes r No
Change only if needed.
BIMS # Assigned * Version#*
20191589 1
Is a payment required for this project?*
r No payment required What amout is owed?*
r Fee received IT $240.00
r Fee needed - send electronic notification r $570.00
Reviewing Office *
Winston-Salem Regional Office - (336) 776- Select Project Reviewer*
9800 Sue Homewood:eads\slhomewood
Information for Initial Review
1a. Name of project:
Annex Storm Water Drainage Repairs
1a. Who is the Primary Contact?*
Scott J Martin
1b. Primary Contact Email:*
[e-mail]
Date Submitted
11/19/2019
Nearest Body of Water
Rocky River
Basin
Cape Fear
Water Classification
WS-III
Site Coordinates
Latitude:
35.822804
Longitude:
-79.5559738
1c. Primary Contact Phone:*
[phone]
A. Processing Information 6
County (or Counties) where the project is located:
Randolph
Is this project a public transportation project?*
r Yes r No
1a. Type(s) of approval sought from the Corps:
W Section 404 Permit (wetlands, streams and waters, Clean Water Act)
r Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What type(s) of permit(s) do you wish to seek authorization?
W Nationwide Permit (NWP)
r Regional General Permit (RGP)
r Standard (IP)

1c. Has the NWP or GP number been verified by the Corps?
r Yes r No
Nationwide Permit (NWP) Number:
NWP Numbers (for multiple NWPS):
1d. Type(s) of approval sought from the DWR:
r 401 Water Quality Certification - Regular
r Non-404 Jurisdictional General Permit
W Individual Permit
39 - Commercial/Institutional Developments
le. Is this notification solely for the record because written approval is not required?
For the record only for DWR401 Certification:
For the record only for Corps Permit:
r 401 Water Quality Certification - E)press
r Riparian Buffer Authorization
1f. Is this an after -the -fact permit application?*
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
Acceptance Letter Attachment
1h. Is the project located in any of NC's twenty coastal counties?
r Yes r No
1j. Is the project located in a designated trout watershed?
r Yes r No
B. Applicant Information
1d. Who is applying for the permit?
W Owner r Applicant (other than owner)
le. Is there an Agent/Consultant for this project?*
r Yes r No
2. Owner Information
2a. Name(s) on recorded deed:
SUMMITNORTH LIBERTY HOLDINGS LLC
2b. Deed book and page no.:
002219/00750
2c. Responsible party:
Tim Heiss
2d.Address
Street Address
2000 AMERICHEM WAY
Address Line 2
City
State / Province / I;Lgion
Cuyahoga Falls
OH
Postal / Zip Code
Country
44221
US
r Yes r No
r Yes r No
2e. Telephone Number: 2f. Fax Number:
[phone]
2g. Email Address:*
[e-mail]
C. Project Information and Prior Project History U
1. Project Information

1b. Subdivision name:
(d appropriate)
1c. Nearest municipality/ town:
Liberty
2. Project Identification
2a. Property Identification Number:
8735269370
2c. Project Address
Street Address
7002 GLENN SMITH DR
Address Line 2
City
Liberty
Fbstal / Zip Code
27298
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Rocky River
3b. Water Resources Classification of nearest receiving water:*
WS-III
3c. What river basin(s) is your project located in?*
Cape Fear
3d. Please provide the 12-digit HUC in which the project is located.
030300030501
4. Project Description and History
2b. Property size:
9.68
State / Rovince / Rion
NC
Country
US
4a. Describe the existing conditions on the site and the general land use in the vicinityof the project at the time of this application:*
4 Sections of ditched area and culverts originally set to direct storm water under driveway approach to building. Road is used by heavy trucks servicing annexwarehouse building.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
r Yes r No r Unknown
4d. Attach an 8 1/2 X 11 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for DWR)
Extracted pages from... Liberty Park Avenue USCG Site Map.pdf 2.62MB
4e. 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)
Extracted pages from... Liberty Park Avenue Site Soil Map.pdf 152.15KB
4f. List the total estimated acreage of all existing wetlands on the property:
1.248
4g. List the total estimated linear feet of all existing streams on the property:
1003
4h. Explain the purpose of the proposed project:*
Vegetation has grown up along with silt resulting in backup and ponding causing deterioration of the road bed and asphalt.
Purpose : Restore Storm Water Drainage so Damage Access Road Can be Repaired and Maintained
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
Use excavator to remove vegetation (enough to promote good storm water flow and access for maintenance purposes), silt back down to original grade, and clear culverts. All areas
disturbed by excavation will be covered with "riprap" to prevent base soil erosion.
Vegetation will be disposed of and soil will be relocated to owner property @ 7279 Liberty Park Ave. and used as fill as needed.
4j. Please upload project drawings for the proposed project.
Annex Storm Water Drainage Repairs Plan.pdf 3.84MB
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes r No M Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
r Preliminary r Approved r Not Verified r Unknown r N/A

Corps AID Number:
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
5d1. Jurisdictional determination upload
6. Future Project Plans
6a. Is this a phased project?*
r Yes r No
Are any other NWP(s), regional general permit(s), or individual permits(s) used, or intended to be used, to authorize any part of the proposed project or related activity?
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
W Wetlands r Streams -tributaries r Buffers
F Open Waters r Pond Construction
2. Wetland Impacts
a. Site #* (?) 2a1 Reason (?) 2b. Impact type * (?) 2c. Type of W.* 2d. W. name * 2e. Forested * 2f. Type of 2g. Impact
Jurisdicition*(?) area*
t
:::Ytter Clearing P Unknown EE Corps 0.180
(acres)
2g. Total Temporary Wetland Impact
0.000
2g. Total Wetland Impact
0.180
2h. Comments:
Map on Pg. 2 of Project Plan Upload
E. Impact Justification and Mitigation
1. Avoidance and Minimization
2g. Total Permanent Wetland Impact
0.180
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
Remove only vegitation needed to restore flow, and provide maintenance access to area
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Errosion control with riprap
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:
Intent of project is to only perform necessary work to restore stormwater flow.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
r Yes r No
If no, explain why:
u

Project will not disturb largest part of the wetland on parcel nor the 1003 linear ft of intermittent stream.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
r Yes r No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?
r Yes r No
Comments:
G. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
r Yes r No
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
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality?*
r Yes r No
3b. If you answered "no," provide a short narrative description.
No additional development, clear existing storm water route
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
r Yes r Nor N/A
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or habitat?*
r Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
r Yes r No
5d. Is another Federal agency involved?*
r Yes r No r Unknown
5e. Is this a DOT project located within Division's 1-8?
r Yes r No
5f. Will you cut anytrees in order to conduct the work in waters of the U.S.?
r Yes r No
5g. Does this project involve bridge maintenance or removal?
r Yes r No
5h. Does this project involve the construction/installation of a wind turbine(s)?'
r 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.?
r Yes r No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
None Listed on 2011 Wetland Survey On File
Consultation Documentation Upload
Extracted pages from... Liberty Park Avenue Site JD Report (002).pdf 12.77KB
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?*
N/A Due to intermittent storm water flow only (e.g. no long term pooling to supportfish habitat)
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal governments have designated as having historic or cultural preservation status?*
r Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
None available, maps indicate this was farm land.
7c. Historic or Prehistoric Information Upload
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-yearfloodplain?*
r Yes r No
8c. What source(s) did you use to make the floodplain determination?*
GIS
Miscellaneous
Comments
Miscellaneous attachments not previously requested.
Signature u
*
fJ 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:
Scott J Martin
Signature
Date
11/19/2019

Liberty Park Avenue Site
Randolph County, North Carolina
CWS Project No. 2010-2774 WWW.CWS-INC.NET
USGS Site Location MapFIGURE NO.
1
SCALE:
CWS PROJECT NO:
APPLICANT NO:
DATE:
DRAWN BY:
CHECKED BY:
2010-2774 TJB
GCA
1-21-111" : 2,000'
I
2,000 0 2,0001,000 Feet
REFERENCE: USGS 7.5 MINUTE TOPOGRAPHIC MAP SERIES, LIBERTY QUADRANGLE, NORTH CAROLINA, DATED 1980.
Old US-421
US-421
Hwy 49
Ol
d US-421J
o
h
n Ma
rs
h
R
o
a
d
G l e n n S m it h D ri ve
VaB
HeB
VaC
ApB
CmA
ApC
GeB2
GeC2
W
GeB2
GaB
VaC
GeC2
GaC
ApC
VaB
W
ApC
W
VaC
W
VaC
GaC
Liberty Park Avenue Site
Randolph County, North Carolina
CWS Project No. 2010-2774 WWW.CWS-INC.NET
USDA-NRCS Soil Survey
of Randolph County
FIGURE NO.
2
SCALE:
CWS PROJECT NO:
APPLICANT NO:
DATE:
DRAWN BY:
CHECKED BY:
2010-2774 TJB
GCA
1-21-111" : 2,000'
I
6000600300 Feet
REFERENCE: USDA-NRCS SOIL SURVEY OF RANDOLPH COUNTY, DATED 2007.
Legend
Project Limits
Roads
Railroad

Liberty Park Avenue Site January 21, 2011
Jurisdictional Delineation Report and Request for Verification CWS Project No. 2010-2774
4

Intermittent Streams
Stream C flows south across the central portion of the site for approximately 1,003 linear feet (Figure 3, enclosed).
Stream C was evaluated to be intermittent and exhibited strong bed and bank, weak flow, moderate sinuosity, substrate
consisting of fine sand and silt, depositional bars, and an average ordinary high water width of 2 feet. Biological
sampling revealed a weak presence of benthic macroinvertebrates limited to amphipods and isopods. Due to evidence
of flow for at least three consecutive months in an average year, Stream C was classified as a Relatively Permanent
Water with Seasonal Flow (Seasonal RPW) according to USACE/EPA guidance. Intermittent Seasonal RPW Stream
C scored 30 out of a possible 100 points on the USACE Stream Quality Assessment Worksheet and 25 out of a
possible 63.5 points on the NCDWQ Stream Classification Form, indicating unimportant intermittent status (SCP 3,
enclosed). Photographs E and F are representative of Unimportant Intermittent Seasonal RPW Stream C.

Wetlands
Wetland AA is a palustrine forested wetland (PFO1B), approximately 1.227 acres in extent, located directly
abutting Perennial RPW Stream A at the southern end of the project area (Figure 3, enclosed). Wetland AA
exhibits low chroma soils (2.5Y 5/2) with common, prominent redox concentrations (5YR 5/8), surface water,
wetland drainage patterns, waterstained leaves, and oxidized rhizospheres. Dominant vegetation in this wetland
includes soft rush (Juncus effusus), red maple, sweetgum, willow oak, black willow (Salix nigra), buttonbush
(Cephalanthus occidentalis), and sedge (Carex sp.). A Wetland Determination Data Form representative of
Wetland AA is enclosed as DP1. Photograph G is representative of Wetland AA.

Wetland BB is a palustrine forested wetland (PFO1B), approximately 0.976 acre in extent, located directly
abutting Perennial RPW Stream A at the southern end of the project area (Figure 3, enclosed). Wetland BB
exhibits low chroma soils (2.5Y 4/1) with common, prominent redox concentrations (5YR 4/6), surface water,
wetland drainage patterns, waterstained leaves, and oxidized rhizospheres. Dominant vegetation in this wetland
includes soft rush, cattail (Typha latifolia), red maple, sweetgum, tag alder (Alnus serrulata), black willow, silky
dogwood (Cornus amomum), and sedge (Carex sp.). A Wetland Determination Data Form representative of
Wetland BB is enclosed as DP2. Photograph H is representative of Wetland BB.

Wetlands CC and DD are palustrine forested wetlands (PFO1B), approximately 0.665 acre and 0.403 acre in
extent respectively. Wetland CC is located directly abutting Seasonal RPW Stream C at the northern end of the
project area (Figure 3, enclosed). Wetland DD is connected to Wetland CC via a pipe which runs beneath a
large berm. Wetland CC and DD exhibit low chroma soils (10YR 5/1) with common, prominent redox
concentrations (10YR 3/6); surface water, wetland drainage patterns, waterstained leaves, and oxidized
rhizospheres. Dominant vegetation in this wetland includes willow oak, green ash, red maple, sweetgum , black
gum (Nyssa sylvatica), elderberry (Sambucus nigra), black willow, greenbriar (Smilax rotundifolia), soft rush,
and sedge (Carex sp.). A Wetland Determination Data Form representative of Wetlands CC and DD is
enclosed as DP3. Photographs I and J are representative of Wetlands CC and DD respectively.

Wetland EE is a linear wetland, approximately 0.180 acre in extent, located directly abutting Seasonal RPW
Stream C at the northern end of the project area (Figure 3, enclosed). Wetland EE has been extensively
manipulated in the past and is now divided into several sections connected by concrete pipes. Wetland EE
exhibits low chroma soils (2.5Y 4/1) with common, prominent redox concentrations (5YR 4/6), surface water,
wetland drainage patterns, waterstained leaves, and oxidized rhizospheres. Dominant vegetation in this wetland
includes soft rush, cattail, woolgrass (Scirpus cyperinus), silky willow (Salix sericea), black willow, silky
dogwood, eastern baccharis (Baccharis halimifolia), and sedges (Carex spp.). A Wetland Determination Data
Form representative of Wetland EE is enclosed as DP4. Photograph K is representative of Wetland EE.