20201855 Ver 1_3 PCN_20210217

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PCN Form – Version 1.4 January 2009
Office Use Only:
Corps action ID no. _____________
DWQ project no. _______________
Form Version 1.4 January 2009
.Pre-Construction Notification (PCN) Form.
A. Applicant Information.
1. Processing
1a. Type(s) of approval sought from the
Corps: Section 404 Permit Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: 3/12 or General Permit (GP) number:
1c. 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
1e. 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

1g. Is the project located in any of NC’s twenty coastal counties. If yes, answer 1h
below. Yes No

1h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? Yes No
2. Project Information
2a. Name of project: 401 South Trunk Sewer Main
2b. County: Wake
2c. Nearest municipality / town: Garner
2d. Subdivision name: not a subdivision
2e. NCDOT only, T.I.P. or state
project no: not a DOT project
3. Owner Information
3a. Name(s) on Recorded Deed: City of Raleigh Public Utilities Raleigh Water
3b. Deed Book and Page No. 13841 / 2332, 010818 / 01656, 17-E / 1575, 17566 / 1622, 7838 / 280, and 3447 / 984
3c. Responsible Party (for LLC if
applicable): Mr. John Sorrell
3d. Street address: P.O. Box 590 / One Exchange Plaza Suite 620
3e. City, state, zip: Raleigh, NC 27601
3f. Telephone no.: [phone]
3g. Fax no.: none
3h. Email address: [e-mail]

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PCN Form – Version 1.4 January 2009

4. Applicant Information (if different from owner)
4a. Applicant is: Agent Other, specify: developer
4b. Name: Barrett Blackburn
4c. Business name
(if applicable): Cambridge-Caddy, LLC
4d. Street address: 831 E. Morehead Street, Suite 245
4e. City, state, zip: Charlotte, NC 28202
4f. Telephone no.: [phone]
4g. Fax no.: none
4h. Email address: [e-mail]
5. Agent/Consultant Information (if applicable)
5a. Name: Jennifer L Robertson
5b. Business name
(if applicable): Atlas Environmental, Inc.
5c. Street address: 338 S. Sharon Amity Road #411
5d. City, state, zip: Charlotte, NC 28211
5e. Telephone no.: 704-512-1206
5f. Fax no.: none
5g. Email address: [e-mail]

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PCN Form – Version 1.4 January 2009

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): 0699892857, 0699582214, 0699583961, 0699492198,
0699279916, and 0699177661
1b. Site coordinates (in decimal degrees): Latitude: 35.666336 Longitude: - 78.691323
1c. Property size: 4,800 linear feet acres
2. Surface Waters
2a. Name of nearest body of water to proposed project: Swift Creek
2b. Water Quality Classification of nearest receiving water: WS-III; NSW
2c. River basin: Neuse River
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: surrounding landuse is a mix of mature forest, residential, railroad track, and golf course
3b. List the total estimated acreage of all existing wetlands on the property: 0.348
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 69
3d. Explain the purpose of the proposed project: The purpose of the project is for the replacement (upsizing) of an existing
sewer line.
3e. Describe the overall project in detail, including the type of equipment to be used: The project will require the use of heavy
equipment for land clearing, grubbing, and earth work.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (including all prior phases) in the past?
Yes No Unknown
Comments:
4b. If the Corps made the jurisdictional determination, what type
of determination was made? Preliminary Final
4c. If yes, who delineated the jurisdictional areas?
Name (if known): Jennifer Robertson
Agency/Consultant Company: Atlas Environmental, Inc.
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
The JD request has been submitted but not yet approved.
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.

6. Future Project Plans
6a. Is this a phased project? Yes No
6b. If yes, explain.

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PCN Form – Version 1.4 January 2009

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.
Wetland impact
number
Permanent (P) or
Temporary (T)
2b.

Type of impact
2c.

Type of wetland
(if known)
2d.

Forested

2e.
Type of jurisdiction
Corps (404, 10) or
DWQ (401, other)
2f.
Area of
impact
(acres)
W1 T Excavation Seep No Corps 0.061
W2 P Excavation Seep Yes Corps 0.022
W3 T Excavation Seep No Corps 0.005
W4 T Excavation Seep No Corps 0.003
W5 T Excavation Seep No Corps 0.030
W6 T Excavation Seep No Corps 0.055
2g. Total wetland impacts: 0.348 ac
2h. Comments: W7 T Excavation Seep No Corps 0.024, W8 T Excavation Seep No Corps 0.009, W9 T Excavation Seep No
Corps 0.002, W10 T Excavation Seep No Corps 0.011, W11 T Excavation Seep No Corps 0.025, W12 T and P Excavation
Seep Partial (8 small trees) Corps 0.056.
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.
Stream impact
number -
Permanent (P) or
Temporary (T)
3b.
Type of impact
3c.
Stream name
3d.
Perennial
(PER) or
intermittent
(INT)?
3e.
Type of jurisdiction
(Corps - 404, 10
DWQ – non-404,
other)
3f.
Average
stream
width
(feet)
3g.
Impact
length
(linear
feet)
S1 T Excavation CH 100 PER Corps 4 23
S2 T Excavation CH 200 PER Corps 6 32
S3 - Choose one - -
S4 - Choose one - -
S5 - Choose one - -
S6 - Choose one - -
3h. Total stream and tributary impacts: 55'
3i. Comments:

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PCN Form – Version 1.4 January 2009

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.
Open water
impact number –
Permanent (P) or
Temporary (T)
4b.
Name of waterbody
(if applicable)
4c.

Type of impact
4d.

Waterbody
type
4e.

Area of impact (acres)
O1 - Choose one Choose
O2 - Choose one Choose
O3 - Choose one Choose
O4 - Choose one Choose
4f. Total open water impacts:
4g. Comments: there is no open water on site
5. Pond or Lake Construction
If pond or lake construction proposed, then complete the chart below.
5a.

Pond ID
number
5b.

Proposed use or purpose
of pond

5c.
Wetland Impacts (acres)
5d.
Stream Impacts (feet)
5e.
Upland
(acres)
Flooded Filled Excavated Flooded Filled Excavated
P1 Choose one
P2 Choose one
5f. Total:
5g. Comments: no pond construction is proposed
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 DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If any impacts require mitigation, then you MUST fill out Section D of this form.
6a.Project is in which protected basin? Neuse Tar-Pamlico Catawba Randleman Other:
6b.
Buffer impact
number –
Permanent (P) or
Temporary (T)
6c.

Reason for impact
6d.

Stream name
6e.

Buffer
mitigation
required?
6f.

Zone 1
impact
(square
feet)
6g.

Zone 2
impact
(square
feet)
B1 - Yes/No
B2 - Yes/No
B3 - Yes/No
B4 - Yes/No
B5 - Yes/No
B6 - Yes/No
6h. Total buffer impacts:
6i. Comments: The two buffer areas are already disturbed from when the sewer line was oringinally installed and from
mainteance of the existing easement.

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PCN Form – Version 1.4 January 2009

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Additional impacts have been avoided by utilizing the existing sewer line easement. The temporary disturbances within the
wetlands will be restored by re-establishing the pre-existing grades and planting a wetland seed mixture once contruction is
complete. The two stream crossings will be restored by re-establishing the pre-existing stream bed grades once construction
is complete.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Construction of the sewer line replacement will occur within the existing 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: Choose one
Type: Choose one
Type: Choose one
Quantity
Quantity
Quantity
3c. Comments: not applicable
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: Choose one
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.
not applicable

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PCN Form – Version 1.4 January 2009

6. Buffer Mitigation (State Regulated Riparian Buffer Rules) – required by DWQ
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
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: no new impacts will occur within the two stream buffers, the project involves replacement of an existing sewer
line

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PCN Form – Version 1.4 January 2009

E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
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? Yes No
1b. If yes, then is a diffuse flow plan included? If no, explain why.

Yes No
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project? >24 % %
2b. Does this project require a Stormwater Management Plan? Yes No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: replacement of an existing sewer line
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:

2e. Who will be responsible for the review of the Stormwater Management Plan? not applicable
3. Certified Local Government Stormwater Review
3a. In which local government’s jurisdiction is this project? Wake County
3b. Which of the following locally-implemented stormwater management programs
apply (check all that apply):
Phase II
NSW
USMP
Water Supply Watershed
Other:
3c. Has the approved Stormwater Management Plan with proof of approval been
attached?
Yes No
4. DWQ Stormwater Program Review
4a. Which of the following state-implemented stormwater management programs apply
(check all that apply):
Coastal counties
HQW
ORW
Session Law 2006-246
Other: WS-III; NSW
4b. Has the approved Stormwater Management Plan with proof of approval been
attached? Yes No
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

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PCN Form – Version 1.4 January 2009

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1a. Does the project involve an expenditure of public (federal/state/local) funds or the
use of public (federal/state) land? Yes 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)?
Yes No
1c. 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
letter.)
Comments:
Yes No
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 (15A NCAC 2B .0200)?
Yes No
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):
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? Yes No
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 (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.
sanitary sewer

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PCN Form – Version 1.4 January 2009

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? Yes No
5b. Have you checked with the USFWS concerning Endangered Species Act
impacts? Yes No
5c. If yes, indicate the USFWS Field Office you have contacted. Raleigh
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
NCDENR Natural Heritage Program Map Viewer and GIS Layer, FWS iPac; see enclosed desktop review and self
certification for Federal T&E completed by Atlas
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?
NOAA web page
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 (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
Yes No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
See enclosed NC HPO review report completed by Atlas
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? FEMA floodmaps GIS layer

Jennifer L Robertson

Applicant/Agent's Printed Name

Applicant/Agent's Signature
(Agent's signature is valid only if an authorization letter from the applicant
is provided.)

January 20,
2021

Date