20200759 Ver 1_Update Pre-Construction Notification Form_20200717

Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
April 11, 2020 Ver 3.1
Please note: fields marked with a red asterisk * below are required. You will not be able to submit the form until all mandatory questions are answered.
Also, if at any point you wish to print a copy of the E-PCN, all you need to do is right-click on the document and you can print a copy of the form.
Below is a link to the online help file.
https://edocs.deq.nc.gov/WaterResources/0/edoc/624704/PCN%20Help%20File%202018-1-30.pdf
County (or Countie s) where the proje ct is locate d:*
Is this a NCDM S Proje ct *
Is this project a public transportation project?*
1a. Type (s) of approv al sought from the Corps:*
1b. What type (s) of pe rmit(s) do you wish to se e k authorization?*
This form may be used to initiate the standard/individual permit process with the Corps. Please contact your Corps representative concerning submittals for standard permits. All required items that
are not provided in the E-PCN can be added to the miscellaneous upload area located at the bottom of this form.
1c. Has the NWP or GP numbe r be e n v e rifie d by the Corps?*
Nationwide Pe rmit (NWP) Numbe r:
NWP Numbe rs (for multiple NWPS):
1d. Type (s) of approv al sought from the DWR:*
1e . Is this notification sole ly for the re cord be cause writte n approv al is not re quire d?
*
For the re cord only for DWR 401 Ce rtification:
For the re cord only for Corps Pe rmit:
1f. Is this an afte r-the -fact pe rmit application?*
1g. Is payme nt into a mitigation bank or in-lie u fe e program propose d for mitigation of impacts?
Acce ptance Le tte r Attachme nt
A. Processing Information
Wake
Yes No
Click Yes, only if NCDMS is the applicant or co-applicant.
Yes No
This is any publicly funded by municipal,state or federal funds road, rail, airport transportation project.
Section 404 Permit (wetlands, streams and waters, Clean Water Act)
Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
Nationwide Permit (NWP)
Regional General Permit (RGP)
Standard (IP)
Yes No
12 - Utility Lines
List all NW numbers you are applying for not on the drop dow n list.
check all that apply
401 Water Quality Certification - Regular 401 Water Quality Certification - Express
Non-404 Jurisdictional General Permit Riparian Buffer Authorization
Individual Permit
Yes No
Yes No
Yes No
If so, attach the acceptance letter from mitigation bank or in-lieu fee program.
Yes No
1h. Is the proje ct locate d in any of NC's twe nty coastal countie s?*
1j. Is the proje ct locate d in a de signate d trout wate rshe d?*
Link to trout information: http://www.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Agency-Coordination/Trout.aspx
1a. Who is the Primary Contact?*
1b. Primary Contact Email:*
1c. Primary Contact Phone :*
1d. Who is applying for the pe rmit?*
1e . Is the re an Age nt/Consultant for this proje ct?*
2. Owner Information
4. Agent/Consultant (if applicable)
Click the upload button or drag and drop files here to attach document
FILE TYPE MUST BE PDF
Yes No
Yes No
B. Applicant Information
Deborah Shirley
[e-mail]
(xxx)xxx-xxxx
[phone]
Owner Applicant (other than owner)
(Check all that apply)
Yes No
2a. Name (s) on re corde d de e d:*
2b. De e d book and page no.:
2c. Re sponsible party:
2d. Addre ss *
2e . Te le phone Numbe r:*
2f. Fax Numbe r:
2g. Email Addre ss:*
Town of Holly Springs
N/A
(for Corporations)
John Schifano
City
Holly Springs
State / Province / Region
NC
Postal / Zip Code
27540
Country
United States
Street Address
PO Box 8
Address Line 2
(xxx)xxx-xxxx
[phone]
(xxx)xxx-xxxx
[e-mail]
4a. Name :*
4b. Business Name :
4c. Addre ss *
Deborah Shirley
(if applicable)
Soil & Environmental Consultants, PA
City
Raleigh
State / Province / Region
NC
Postal / Zip Code
27615
Country
United States
Street Address
8412 Falls of Neuse Road, Suite 104
Address Line 2
1a. Name of proje ct:*
1b. Subdivision name :
1c. Ne are st municipality / town:*
2a. Prope rty Identification Numbe r:
2b. Prope rty size :
2c. Proje ct Addre ss
2d. Site coordinate s in de cimal de gre e s
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 :*
3. Surface Waters
3a. Name of the ne are st body of wate r to propose d proje ct:*
3b. Wate r Re source s Classification of ne are st re ce iv ing wate r:*
Surface Water Lookup
3c. What riv e r basin(s) is your proje ct locate d in?*
3d. Ple ase prov ide the 12-digit HUC in which the proje ct is locate d.*
River Basin Lookup
4. Project Description and History
4a. De scribe the e xisting conditions on the site and the ge ne ral land use in the v icinity of the proje ct at the time of this application:*
4d. Te le phone Numbe r:*
4e . Fax Numbe r:
4f. Email Addre ss:*
Age nt Authorization Le tter *
[phone]
(xxx)xxx-xxxx (xxx)xxx-xxxx
[e-mail]
Please provide the Agent Authorization Letter if you are submitting this document.
Agent Auth_municipal_TOHS Carolina Springs Offsite FM.docx.pdf 413.15KB
FILE TYPE MUST BE PDF
C. Project I nformation and Prior Project History
1. Project Information
Town of Holly Springs (Carolina Springs) Pump Station & Force Main
(if appropriate)
Holly Springs
2. Project Identification
(tax PIN or parcel ID)
N/A-Linear Utility Project
(in acres)
Approximately 14.16 acres (1.53 onsite; 12.63
offsite)
City
Apex
State / Province / Region
NC
Postal / Zip Code
27539
Country
United States
Street Address
Located from Woods Creek Road to the Utley Creek Water Reclamation Facility
Address Line 2
35.6773
ex: 34.208504
-78.8749
-77.796371
Big Branch; Little Branch
C; C
Cape Fear
030300040102
4b. Hav e Corps pe rmits or DWR ce rtifications be e n obtained for this project (including all prior phase s) in the past?*
4d. Attach an 8 1/2 X 11 e xce rpt from the most re ce nt v e rsion of the USGS topographic map indicating the location of the proje ct site . (for DWR)
4e . Attach an 8 1/2 X 11 e xce rpt from the most re ce nt v e rsion of the publishe d County NRCS Soil Surv e y map de picting the proje ct site . (for DWR)
4f. List the total e stimate d acre age of all e xisting we tlands on the prope rty:
4g. List the total e stimate d line ar fe e t of all e xisting stre ams on the prope rty:
4h. Explain the purpose of the propose d proje ct:*
4i. De scribe the ov e rall proje ct in de tail, including indirect impacts and the type of e quipme nt to be use d:*
4j. Ple ase upload proje ct drawings for the propose d proje ct.
5. Jurisdictional Determinations
5a. Hav e the we tlands or streams be e n de line ate d on the prope rty or propose d impact are as?*
Comme nts:
5b. If the Corps made a jurisdictional de te rmination, what type of de te rmination was made ?*
Corps AID Numbe r:
5c. If 5a is ye s, who de line ate d the jurisdictional are as?
Name (if known):
Age ncy/Consultant Company:
Othe r:
5d1. Jurisdictional de te rmination upload
6. Future Project Plans
6a. Is this a phase d proje ct?*
Are any othe r NWP(s), re gional ge ne ral pe rmit(s), or indiv idual pe rmits(s) use d, or intende d to be use d, to authorize any part of the propose d project or re lated activ ity? This
include s othe r se parate and distant crossing for line ar proje cts that re quire De partme nt of the Army authorization but don’t re quire pre -construction notification.
The existing conditions on the site within the vicinity of the proposed pump stations consists primarily of forestry. The proposed force main path is primarily road side, previously
disturbed areas. There are four (4) perennial stream features (N, F2, G2 & K2), six (6) intermittent stream features (L, M, H2, J2, L2 & M2), and five (5) wetland features (W38 - W42)
located within or adjacent to the proposed pump station and easement locations. Within the proposed pump station and easement locations specifically, streams M & N are located
adjacent to the proposed pump station. Wetlands W38, W42, and streams F2 & G2 are located along Old Holly Springs Apex Road. Streams H2 and J2 are located on in wooded land
between Holly Springs New Mill Road and Thomas Mill Road. Wetlands W39, W40, W41 & stream K2 are all located along Irving Parkway with stream L2 just south of Green Oaks
Parkway. Streams L (adjacent to the proposed pump station) and M2 (north of the treatment plant) have been avoided. The general land use in the vicinity of the project is residential
and commercial development with forested land.
Yes No Unknown
Click the upload button or drag and drop files here to attach document
USGS Offsite.pdf 2.61MB
File type must be pdf
Click the upload button or drag and drop files here to attach document
Soil Survey Offsite.pdf 1.38MB
File type must be pdf
Approximately 0.03 acres within easement
(intermittent and perennial)
Approximately 407 linear feet within the eastment and pump station area
The purpose of this project is to construct and to provide wastewater service to a large portion of the Town of Holly Springs extra territorial jurisdiction. The service area will eventually
include residential and commercial development as well as two (2) Wake County Public School System schools. The force main is approximately 19,000 feet in length and will discharge
to the Town of Holly Springs Utley Creek Water Reclamation Facility.
The overall project consists of the construction of a pump station and a force main. Specifically, there are nine (9) open cut construction access areas that impact streams and or
wetlands. Heavy equipment typically used for the sanitary sewer installation will be used (e.g. excavators, bulldozers, etc.).
Click the upload button or drag and drop files here to attach document
02190372.10 Impact Maps.pdf 8.61MB
Sheets-Details-EC Details.pdf 9.39MB
File type must be pdf
Yes No Unknown
Preliminary Approved Not Verified Unknown N/A
Example: SAW-2017-99999
AID for Pump Station & Force Main not issued to date, PJD package sent via email on June 2, 2020
Steven Ball
Soil & Environmental Consultants, PA
Click the upload button or drag and drop files here to attach document
File type must be PDF
Yes No
It is my understanding that there are no intended future phases beyond the easements shown. Therefore, no additional NWP, Regional General Permits, or IP are anticipated.
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Whe re are the impacts associate d with your proje ct? (che ck all that apply):
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
"W." will be use d in the table be low to re pre se nt the word "wetland".
2a. Site #*(?)2a1 Reason *(?)2b. Impact type *(?)2c. Type of W.*2d. W. name *2e . Fore ste d *2f. Type of
Jurisdicition *(?)
2g. Impact
are a *
2g. Total Te mporary We tland Impact
2g. Total Pe rmane nt We tland Impact
2g. Total We tland Impact
2h. Comme nts:
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this question for all stream sites impacted.
"S." will be used in the table below to represent the word "stream".
3a. Reason for impact *(?)3b.Impact type *3c. Type of impact *3d. S. name *3e . Stre am Type *
(?)
3f. Type of
Jurisdiction *
3g. S. width *3h. Impact
le ngth *
S1
S2
S3
S4
S5
S6
S7
** All Perennial or Intermittent streams must be verified by DWR or delegated local government.
3i. Total jurisdictional ditch impact in square fe e t:
Wetlands Streams-tributaries Buffers
Open Waters Pond Construction
Impact 2 Construction Access
(Permanent-no
permanent loss)
P Headwater Forest W38 Yes Both 0.010
(acres)
Impact 2 Temporary Construction
Access
T Headwater Forest W38 Yes Both 0.017
(acres)
Impact 7 Temporary Construction
Access
T Headwater Forest W41 Yes Both 0.003
(acres)
0.020
0.010
0.030
Impact 1B-Temporary
Construction Access
(Permanent-No permanent
loss)
Permanent Other Stream N Perennial Both 27
Average (feet)
39
(linear feet)
Impact 1A-Temporary
Construction Access
(Permanent-no permanent
loss)
Permanent Other Stream M Intermittent Both 8
Average (feet)
65
(linear feet)
Impact 3-Temporary
Construction Access
(Permanent-no permanent
loss)
Permanent Other Stream F2/G2 Perennial Both 11
Average (feet)
109
(linear feet)
Impact 4-Construction
Access (Permanent-no
permanent loss)
Permanent Other Stream H2 Intermittent Both 2
Average (feet)
77
(linear feet)
Impact 5-Construction
Access (Permanent-No
Permanent Loss)
Permanent Other Stream J2 Intermittent Both 2
Average (feet)
30
(linear feet)
Impact 6-Temporary
Construction Access
(Permanent-No Permanent
Loss)
Permanent Other Stream K2 Perennial Both 10
Average (feet)
55
(linear feet)
Impact 8-Temporary
Construction Access
(Permanent-No Permanent
Loss)
Permanent Other Stream L2 Intermittent Both 7
Average (feet)
37
(linear feet)
3i. Total pe rmane nt stre am impacts:
3i. Total te mporary stre am impacts:
3i. Total stre am and ditch impacts:
3j. Comme nts:
1. Avoidance and Minimization
1a. Spe cifically de scribe me asure s take n to av oid or minimize the propose d impacts in de signing the proje ct:*
1b. Spe cifically de scribe me asure s take n to av oid or minimize the propose d impacts through construction te chnique s:*
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Doe s the proje ct re quire Compe nsatory M itigation for impacts to Wate rs of the U.S. or Wate rs of the State ?
2b. If this proje ct DOES NOT re quire Compe nsatory M itigation, e xplain why:
NC Stream Temperature Classification Maps can be found under the Mitigation Concepts tab on the Wilmington District's RIBITS website.
*** Recent changes to the stormwater rules have required updates to this section .***
1. Diffuse Flow Plan
1a. Doe s the proje ct include or is it adjace nt to prote cte d riparian buffers ide ntifie d within one of the NC Riparian Buffe r Prote ction Rule s?
For a list of options to meet the diffuse flow requirements, click here.
0
412
0
412
Total permanent-no permanent loss stream = 412 LF. Identified as "permanent-no permanent loss", riprap will be "keyed" into the stream bed for
stabilization, will not obstruct stream flows. Additionally, at Impacts 4 & 5 (i.e. intermittent streams), the stream banks will be sloped for future
maintenance access.
E. Impact Justification and Mitigation
S&EC completed a wetland and stream delineation for approximately 24,000 linear foot of proposed easement at 50’ wide to identify natural resources
so that impacts could be avoided & minimized to the maximum extent practicable. This easement delineation included three (3) different routes south
of Thomas Mill Road. The proposed project entails constructing a force main from a pump station located on the proposed Carolina Springs property
to the Utley Creek Water Reclamation Facility for the treatment of wastewater for proposed and future developments. Directional drill or bore & jack
construction methods are not being proposed for this project. This is because the cost of bore and jack as well as HDD can be cost prohibitive,
particularly in areas where rock is encountered. Additionally, the Town of Holly Springs will have to maintain the 30’ wide permanent maintenance
corridor that would affect the wetlands and/or streams, therefore the open cut construction method has been proposed. Impact areas 1A and 1B are
proposed temporary construction access with “permanent-no permanent loss” stream impacts. These impacts are identified as “permanent-no
permanent loss” impacts because riprap will be “keyed” into the stream bed and banks for stability. These impacts are necessary for the construction
of the force main and to avoid any impact to the Woods Creek Road public right of way. Impact area 2 is proposed temporary and “permanent-no
permanent loss” wetland impacts for a temporary construction access as well as a permanent maintained corridor access within the wetland. Wetland
impacts were minimized by placing the force main on the east side of Old Holly Springs Apex Road vs. the west which would have resulted in greater
wetland impacts. Impact area 3 is proposed “permanent-no permanent loss” stream impact for a temporary construction access. This impact is
identified as a “permanent-no permanent loss” impact because riprap will be “keyed” into the stream bed and banks for stability. The NCDOT has
plans to realign this road and replace the bridge at this location. The proposed impact was designed on the east side of Old Holly Springs Apex Road
vs. the west side to avoid the force main being approximately 80 ft. from the outside travel lane which would make the utility and easement more
difficult to access for future maintenance activities. Impact areas 4 & 5 are both proposed “permanent-no permanent loss” stream impacts for
permanent construction access. These impacts are identified as “permanent-no permanent loss” impacts because riprap will be “keyed” into the
stream bed and banks for stability, in addition the stream banks at these locations will be sloped for future maintenance access. These impact
locations were designed in these locations because of property owners and their concerns regarding force main locations on their properties. Impact
area 6 is proposed “permanent-no permanent loss” stream impact for a temporary construction access. This impact is identified as a “permanent-no
permanent loss” impact because riprap will be “keyed” into the stream bed and banks for stability. This crossing location was chosen because this
area has been previously disturbed from another sanitary sewer easement, and because this easement route #3 impacted less wetlands and streams
than routes 1 & 2. Impact area 7 is proposed temporary wetland impact for a temporary construction access. The force main has been designed on
the east of Irving Parkway because there are many obstacles on the west side of the road such as storm drainage, a potable water line, sewage force
main. These existing easements and utility lines would make installation on the west side of Irving Parkway impractical. Impact area 8 is proposed
“permanent-no permanent loss” stream impact for a temporary construction access. This impact is identified as a “permanent-no permanent loss”
impact because riprap will be “keyed” into the stream bed and banks for stability. This location was chosen because of an existing easement to access
the Utley Creek Water Reclamation Facility. Note that stream impacts to feature “L” (onsite) was avoided by relocating the pump station, and “M2” by
connecting to an existing force main on the west side of the Utley Creek Water Reclamation Facility. Temporary wetland impacts will be brought back
to pre-construction contours and allowed to revegetate with existing wetland seed source.
A stream bypass with cofferdam and a pump around will be used as well as silt fence, silt fence outlets and check dams (see detail sheet #25).
Yes No
There are no proposed permanent loss stream impacts for the project, all "permanent-no permanent loss" impacts will have riprap "keyed" in to the stream bed and will not obstruct
stream flows, "permanent-no permanent loss" wetland impacts are less than 0.10 acre. Impacts have been avoided to the maximum extent practicable. Therefore compensatory
mitigation in the form of mitigation payment has not been proposed.
F. Stormwater M anagement and Diffuse Flow Plan (required by DWR)
Yes No
If no, e xplain why:
2. Stormw ater Management Plan
2a. Is this a NCDOT proje ct subje ct to compliance with NCDOT’s Indiv idual NPDES pe rmit NCS000250?*
2b. Doe s this proje ct me e t the re quire me nts for low de nsity proje cts as de fine d in 15A NCAC 02H .1003(2)?*
To look up low density requirement click here 15A NCAC 02H .1003(2).
Comme nts:
1. Environmental Documentation
1a. Doe s the proje ct inv olv e an e xpe nditure of public (fe de ral/state /local) funds or the use of public (fe de ral/state ) land?*
1b. If you answe re d “ye s” to the abov e , doe s the proje ct re quire pre paration of an e nv ironme ntal docume nt pursuant to the re quireme nts of the National or State (North Carolina)
Env ironme ntal Policy Act (NEPA/SEPA)?*
Comme nts:*
2. Violations (DWR Requirement)
2a. Is the site in v iolation of DWR Wate r Quality Ce rtification Rule s (15A NCAC 2H .0500), Isolate d We tland Rule s (15A NCAC 2H .1300), or DWR Surface Wate r or We tland Standards or
Riparian Buffe r Rule s (15A NCAC 2B .0200)?*
3. Cumulative Impacts (DWR Requirement)
3a. Will this proje ct (base d on past and re asonably anticipate d future impacts) re sult in additional de v e lopme nt, which could impact ne arby downstre am wate r quality?*
3b. If you answe re d “no,” prov ide a short narrativ e de scription.
4. Sewage Disposal (DWR Requirement)
4a. Is se wage disposal re quire d by DWR for this proje ct?*
4b. De scribe , in de tail, the tre atme nt me thods and dispositions (non-discharge or discharge ) of waste wate r ge ne rate d from the propose d proje ct. If the waste wate r will be treate d
at a tre atment plant, list the capacity av ailable at that plant.
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this proje ct occur in or ne ar an are a with fe de rally prote cte d spe cie s or habitat?*
5b. Hav e you che cke d with the USFWS conce rning Endange re d Spe cie s Act impacts?*
5d. Is anothe r Fe de ral age ncy inv olv e d?*
5e . Is this a DOT proje ct locate d within Div ision's 1-8?*
5f. Will you cut any tre e s in orde r to conduct the work in wate rs of the U.S.?*
No diffuse flow required, no proposed imperviousness or concentrated flows.
Yes No
Yes No
Per Question 3a, this project does not require Stormwater Management Plan or Antidegradation Calculations. There is no proposed new impervious area for the Force Main.
G. Supplementary Information
Yes No
Yes No
The project will be built and paid for by a developer and will receive a reimbursement. SEPA/NEPA not required per the project engineer.
Yes No
Yes No
We have reviewed the “Draft Internal Policy, Cumulative impacts and the 401 Water Quality Certification and Isolated Wetlands Programs” document
prepared by the NC Division of Water Quality on April 10, 2004, version 2.1. The draft states that other publically funded projects may or may not
result in cumulative impacts. The Town of Holly Springs (Carolina Springs) Pump Station & Force Main project is a privately funded (with partial public
reimbursement) within a partially developed watershed. Please note that this project is located within the Town of Holly Springs, therefore the adjacent
properties that have potential for development will have the following regulations to protect downstream waters: 1) The Cape Fear River Basin
Riparian Area Protection Rules, these regulations require limited development within the riparian buffer area, in addition diffuse flow of runoff is
required and/or Best Management Practices may be needed if diffuse flow cannot be achieved; 2) the Phase II NPDES Stormwater Permit Program,
this program includes permitting requirements for Municipal Separate Storm Sewer Systems (MS4s) in addition to post-construction stormwater
management requirements. We anticipate that the DWR will advise us if any additional information is needed.
Yes No N/A
Non-discharge wastewater will be treated at the Utley Creek Water Reclamation Facility with a capacity of 6.0 Million Gallons Per Day.
Yes No
Yes No
Yes No Unknown
Yes No
5g. Doe s this proje ct inv olv e bridge mainte nance or re mov al?*
Link to the NLEB SLOPES document: http://saw-reg.usace.army.mil/NLEB/1-30-17-signed_NLEB-SLOPES&apps.pdf
5h. Doe s this proje ct inv olv e the construction/installation of a wind turbine (s)?**
5i. Doe s this proje ct inv olv e (1) blasting, and/or (2) othe r pe rcussiv e activitie s that will be conducte d by machine s, such as jackhamme rs, me chanize d pile driv e rs, e tc.?*
If ye s, ple ase prov ide de tails to include type of pe rcussiv e activ ity, purpose , duration, and spe cific location of this activ ity on the prope rty.
5j. What data source s did you use to de te rmine whe the r your site would impact Endange re d Spe cie s or De signate d Critical Habitat?*
Consultation Docume ntation Upload
6. Essential Fish Habitat (Corps Requirement)
6a. Will this proje ct occur in or ne ar an are a de signate d as an Esse ntial Fish Habitat?*
6b. What data source s did you use to de te rmine whe the r your site would impact an Esse ntial Fish Habitat?*
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 proje ct occur in or ne ar an are a that the state , fe de ral or tribal gov e rnme nts hav e de signate d as hav ing historic or cultural pre se rv ation status (e .g., National Historic
Trust de signation or prope rtie s significant in North Carolina history and archae ology)?*
7b. What data source s did you use to de te rmine whe the r your site would impact historic or arche ological re source s?*
7c. Historic or Pre historic Information Upload
8. Flood Zone Designation (Corps Requirement)
Link to the FEM A Floodplain M aps: https://msc.fema.gov/portal/search
8a. Will this proje ct occur in a FEM A-designate d 100-ye ar floodplain?*
8b. If ye s, e xplain how proje ct me e ts FEM A require me nts:
8c. What source (s) did you use to make the floodplain de te rmination?*
Comme nts
M isce llane ous attachme nts not pre v iously re que ste d.
Yes No
Yes No
Yes No
Yes No
Click the upload button or drag and drop files here to attach document
File must be PDF
The NC Natural Heritage Programs Data Explorer Map was used to search for elemental occurrences of federally protected species listed within and
within 1-mile of the project boundaries. It was determined based on the search that there are no elemental occurrences that are listed as federally
Threatened/Endangered within or within 1-mile of the project boundaries. References: NC Natural Heritage Program. 2020. Geographic Information
System (GIS) data. NCDNCR, Raleigh, NC. Available at http://www.ncnhp.org/. (Accessed: May 14, 2020).
Click the upload button or drag and drop files here to attach document
File type must be PDF
Yes No
The NOAA Habitat Conservation/Habitat Protection: National Marine Fish Service; Essential Fish Habitat Mapper website was referenced. No Essential
Fish Habitat was identified near the project.
Yes No
The NC State Historic Preservation Office HPOWEB GIS Service interactive map was referenced on May 13, 2020, one "surveyed only" listing was
identified adjacent to the proposed Force Main route. This listing is the Holland Cemetery (WA7475), a 1880-1998 cemetery feature listed as
"surveyed only". It is located on the east side of Old Holly Springs Apex Road and north of Cypress Hill Lane. The proposed Force Main easement was
shifted to the west side of Old Holly Springs Apex Road at the intersection of Old Holly Springs Apex Road and Ivy Arbor Way, to the north of this
cemetery.
Click the upload button or drag and drop files here to attach document
File must be PDF
Yes No
There will be no above ground structures installed within the 100-year floodplains.
NC Flood Risk Information System Floodplain Mapping Program and confirmation from the project engineer.
M iscellaneous
Click the upload button or drag and drop files here to attach document
SKETCH MAP_Carolina Springs Forcemain - PJD Request 2020 (PRINTED).pdf 2.25MB
File must be PDF or KMZ
*
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 :*
Signature *
Date
Signature
By checking the box and signing below, I certify that:
Deborah E. Shirley
6/9/2020