20110108 Ver 1_401 Application_20110111

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Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification (PCN) Form
A. Applicant Information °®"?----
1. Processing
1 a. Type(s) of approval sought from the

Corps:
® Section 404 Permit ? Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: NWP 12 or General Permit (GP) number:
1 c. Has the NWP or GP number been verified by the Corps? ® Yes ? No
1d. Type(s) of approval sought from the DWQ (check all that apply):
® 401 Water Quality Certification - Regular ? Non-404 Jurisdictional General Permit
? 401 Water Quality Certification - Express ? Riparian Buffer Authorization
1 e. Is this notification solely for the record
because written approval is not required? For the record only for DWQ 401
Certification:
? Yes ® No For the record only for Corps Permit:

? Yes ® No
1f. 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. ? Yes ® No
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below. ® Yes ? No
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ® Yes ? No
2. Project Information
2a. Name of project: Marsh Oaks Sewer Force Main Repair
2b. County: New Hanover
2c. Nearest municipality / town: Wilmington
2d. Subdivision name: Marsh Oaks
2e. NCDOT only, T.I.P. or state
project no:
JAN 3
3. Owner Information
WOW
3a. Name(s) on Recorded Deed: WETt.ANDSANDS
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if
applicable): Matthew W. Jordan, PE, CFPUA
3d. Street address: 235 Government Center Drive
3e. City, state, zip: Wilmington, NC 28403
3f. Telephone no.: 910-332-6542
3g. Fax no.: 910-799-6066
3h. Email address: [e-mail]
Page 1 of 11
PCN Form - Version 1.3 December 10, 2008 Version
4. Applicant Information (if different from owner)
4a. Applicant is: ? Agent ? Other, specify:
4b. Name:
4c. Business name
(if applicable):
4d. Street address:
4e. City, state, zip:
4f. Telephone no.:
4g. Fax no.:
4h. Email address:
5. Agent/Consultant Information (if applicable)
5a. Name:
5b. Business name
(if applicable):
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. Fax no.:
5g. Email address:
Page 2 of 11
PCN Form - Version 1.3 December 10, 2008 Version
B. Project Information and Prior Project History
1. Property Identification
1 a. Property identification no. (tax PIN or parcel ID): R03600-008-191-000
Latitude: 34.172395 N Longitude: -
1 b. Site coordinates (in decimal degrees): 77.471413 W
(DD.DDDDDD) (-DD.DDDDDD)
1 c. Property size: 0.03 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to Pages Creek
proposed project:
2b. Water Quality Classification of nearest receiving water: SA;HQW
2c. River basin: Cape Fear
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:
Land is used for transport of wastewater underground through sewer lines. Easements are maintained per Collection
System Permit WQCS00012, Unmanaged herbaceous cover in a tidal marsh area.
3b. List the total estimated acreage of all existing wetlands on the property:
0.03
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
80
3d. Explain the purpose of the proposed project:
Emergency sewer repair to replace existing PVC, SRD 21 pipe that failed at the creek/wetlands area with ductile iron
super coat pipe.
3e. Describe the overall project in detail, including the type of equipment to be used:
sheet steel, 300 excavator, rubber tire 5CY loader and a rubber tire back hoe were used to complete this
Trench boxes
,
Wooden timber mats were used by the contractor and the mats were installed from the top of the slope of the yard
air
re
.
p
area, across the wet area to the actual point where the excavation would start. Contractor removed soil until the top of the
pipe was visible. As the contractor exposed the pipe, the disturbed soil was removed and placed toward the road to be
used for backfilling the excavation. The contractor installed a new 45 degree bend with new fittings and mega lugs where
the old one had once been. After getting the bend in place, a bed of rock was placed in the ditch to hold and support the
ductile iron pipe that was being cut for installation. After the pipe was fully bedded, the contractor completed his back
filling with the original sandy soil that was excavated from the repair area. Stumps, roots and other large material were
removed from the soil before the soil was placed back over the pipe. After the back fill was completed, the contractor
checked to make sure the silt fence was in place around the entire area where any soil had been removed or placed to
prevent any soil migration into the other stream areas The area surface was relativity level and coastal blend seed was
used to re-establish the grass on the right of way. Straw has been placed over the seeded area.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property / ? Yes ® No ? Unknown
project (including all prior phases) in the past?
Comments:
4b. If the Corps made the jurisdictional determination, what type ? Preliminary ? Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company:
Name (if known): Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Page 3 of 11
PCN Form - Version 1.3 December 10, 2008 Version
5. Project History
5a. Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past? ® Yes ? No ? Unknown
5b. If yes, explain in detail according to "help file" instructions.
The orginal USACE and DWQ permits were attained in 2001 for installation of the sewer line.
6. Future Project Plans
6a. Is this a phased project? ? Yes ® No
6b. If yes, explain.
Page 4 of 11
PCN Form - Version 1.3 December 10, 2008 Version
C. Proposed Impacts Inventory
1. Impacts Summary
1a. Which sections were completed below for your project (check all that apply):
® Wetlands ? Streams - tributaries ? Buffers
? Open Waters ? Pond Construction

2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact
number -
Type of impact
Type of wetland
Forested Type of jurisdiction
(Corps - 404, 10
Area of impact
Permanent (P) or (if known) DWQ - non-404, other) (acres)
Temporary T
Line Maintenance
Acitvity /
Salt/Brackish
® Yes
® Corps
0
03
W1 ? P ®T Easement Marsh ? No ® DWQ .
Clearing
? Yes ? Corps
W2 ? P ? T ? No ? DWQ
? Yes ? Corps
W3 ? P ? T ? No ? DWQ
? Yes ? Corps
W4 ? P ? T ? No ? DWQ
? Yes ? Corps
W5 ? P ? T ? No ? DWQ
? Yes ? Corps
W6 ? P ? T ? No ? DWQ
2g. Total wetland impacts 0.03
2h. Comments:
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.
3a. 3b. 3c. 3d. 3e. 3f. 3g•
Stream impact Type of impact Stream name Perennial Type of jurisdiction Average Impact
number - (PER) or (Corps - 404, 10 stream length
Permanent (P) or intermittent DWQ - non-404, width (linear
feet)
Temporary (T) (INT)? other) (feet)
S1 ? P ? T ? PER
? INT ? Corps
? DWQ
? PER ? Corps
S2 ? P ? T ? INT ? DWQ
? PER ? Corps
S3 ? P ? T ? INT ? DWQ
? PER ? Corps
S4 ? P ? T ? INT ? DWQ
? PER ? Corps
S5 ? P ? T ? INT ? DWQ
? PER ? Corps
S6 ? P ? T ? INT ? DWQ
3h. Total stream and tributary impacts
3i. Comments:
Page 5 of 11
PCN Form - Version 1.3 December 10, 2008 Version
4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list all open water impacts below.
4a. 4b. 4c. 4d. 4e.
Open water
impact number - Name of waterbody
(if applicable)
Type of impact
Waterbody type
Area of impact (acres)
Permanent (P) or
Temporary T

01 ?P?T
02 ?P?T
03 ?P?T

04 ?P?T

4f. Total open water impacts

4g. Comments:

5. Pond or Lake Construction
If and or lake construction proposed, then complete the chart below.
5a. 5b. 5c.
Wetland Impacts (acres) 5d.
Stream Impacts (feet) 5e.
Upland
Pond ID Proposed use or purpose (acres)
number of pond Flooded Filled Excavated Flooded Filled Excavated Flooded
P1
P2
5f. Total
5g. Comments:
5h. Is a dam high hazard permit required?
? Yes No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWO)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If an impacts require mitigation, then you MUST fill out Section D of this form.

6a. ? Neuse ? Tar-Pamlico ? Other:
Project is in which protected basin? ? Catawba ? Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number -
Reason
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P) or for Stream name mitigation (square feet) (square feet)
Temporary T impact required?
?Yes
B1 ?P?T ? No
? Yes
B2 ? P ? T ? No
?Yes
B3 ?P?T ? No
6h. Total buffer impacts
6i. Comments:
Page 6 of 11
PCN Form - Version 1.3 December 10, 2008 Version
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Replace existing SRD 21 PVC pipe that failed at the creek /wetlands area with ductile iron super coat pipe. Contractor was
instructed to use mats to work from in wetlands area and silt fencing was used to line the nearby creek to prevent turbidity.
Contractor was instructed to pump any and all ground water into the sanitary sewer system. Contractor was constructed to
have sheet steel on site to address water issue if tide becomes an issue.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Timber mats were placed within easement and all work was performed off of matts. Sandy soil was removed from excavation
and reused for fill. Silt fence was used to protect near by stream. Area was returned back to slope except for area where
stumps were removed. There was no environmental impact from repair work to the stream. All work was performed within
easement.
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? ? Yes ® No
2b. If yes, mitigation is required by (check all that apply): ? DWQ ? Corps

2c. If yes, which mitigation option will be used for this
project? ? Mitigation bank
? Payment to in-lieu fee program

? Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter) Type Quantity
3c. Comments:
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached. ? Yes
4b. Stream mitigation requested: linear feet
4c. If using stream mitigation, stream temperature: ? warm ? cool ?cold
4d. Buffer mitigation requested (DWQ only): square feet
4e. Riparian wetland mitigation requested: acres
4f. Non-riparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requested: acres
4h. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 7 of 11
PCN Form - Version 1.3 December 10, 2008 Version
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) - required by DWO
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation? ? Yes ® No
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.

Zone 6c.
Reason for impact 6d.
Total impact
(square feet)
Multiplier 6e.
Required mitigation
(square feet)
Zone 1 3 (2 for Catawba)
Zone 2 1.5
1 6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund).
6h. Comments:
Page 8 of 11
PCN Form - Version 1.3 December 10, 2008 Version
E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan

la. Does the project include or is it adjacent to protected riparian buffers identified ? Yes ® No
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
? Yes No
Comments:
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project? 0%
2b. Does this project require a Stormwater Management Plan? ? Yes ® No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: No imperious acreage
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
? Certified Local Government
2e. Who will be responsible for the review of the Stormwater Management Plan? ? DWQ Stormwater Program
? DWQ 401 Unit
3. Certified Local Government Stormwater Review

3a. In which local government's jurisdiction is this project?
? Phase II
? NSW
3b. Which of the following locally-implemented stormwater management programs ? USMP
apply (check all that apply): ? Water Supply Watershed
? Other:
3c. Has the approved Stormwater Management Plan with proof of approval been ? Yes ? No
attached?
4. DWQ Stormwater Program Review
? Coastal counties
? HQW
4a. Which of the following state-implemented stormwater management programs apply ? ORW
(check all that apply): ? Session Law 2006-246
? Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
? Yes ? No
attached?
5. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements? ? Yes ? No
5b. Have all of the 401 Unit submittal requirements been met? ? Yes ? No
Page 9 of 11
PCN Form - Version 1.3 December 10, 2008 Version
F. Supplementary Information
1. Environmental Documentation (DWO Requirement)
1 a. Does the project involve an expenditure of public (federal/state/local) funds or the ® Yes ? No
use of public (federal/state) land?
1 b. If you answered "yes" to the above, does the project require preparation of an
S
? Yes ® No
tate
environmental document pursuant to the requirements of the National or
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1 c. If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval F1 Yes El No
letter.)
Comments:
2. Violations (DWO Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
d
d
d S
? Yes ® No
ar
s,
tan
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetlan
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after-the-fact permit application? ® Yes ? No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s): No violation
incurred during this event. This is an after-the-fact permit based on an emergency repair to a ruptured sewer line.
3. Cumulative Impacts (DWO Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in ? Yes ® No
additional development, which could impact nearby downstream water quality?
3b. If you answered "yes" to the above, 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.
4. Sewage Disposal (DWO 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.
The existing line ties in to the Northside WWTP.
Page 10 of 11
PCN Form - Version 1.3 December 10, 2008 Version
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or ? Yes ® No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act ? Yes ® No
impacts?
El Raleigh
5c. If yes, indicate the USFWS Field Office you have contacted.
? Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
The NC Natural Heritage Program GIS layer was used to determine the presence of federally listed species. No federally
protected species in or near the site were noted.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? ? Yes ® No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
The NOAA Fisheries Essential Fish Habitat Mapper GIS program was used to determine the presence of essential fish
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 ? Yes ® No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
The Natural Trust for Historic Preservation website mapping resource was used to determine the presence of cultural
resources. No cultural resources were found.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? ® Yes ? No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination? The NC Floodplain Mapping Information Sysytem
website was used to determine the boundaries of the 100-year floodplain.

Matthew W. Jordan 1/25/2011

Applicant/Agent's Printed Name 4CC
Applica a 's Signature
Date
(Agent's signature is valid my if an authorization letter from the applicant
is provided.)
Page 11 of 11
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WILMINGTON, NC 28406 Project No:
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