20211196 Ver 1_401 Application_20210729

NORTH CAROLINA
Environmental Quality
Water Resources
Office Use Only
Corps Action ID no. SAW-2021-00673
DWR project no. [Click enter.]
Site Coordinates:
Latitude (DD.DDDDDD): 35.735719
Longitude (DD.DDDDDD): 78.735846
Form Version 1.5, September 2020
Date received: [Click to enter.]
Date received: [Click to enter.]
Pre -Construction Notification (PCN) Form
(Ver. 1.5, September 2020)
For Nationwide Permits and Regional General Permits and corresponding Water Quality Certifications
Please note: fields marked with a red asterisk * are required. The form is not considered complete until all mandatory
questions are answered.
The online help file may be found at this link:
https://edocs.deq.nc.gov/WaterResources/0/edoc/624704/PCN%20Help%20File%202018-1-30.pdf
The help document may be found at this link:
http://www.saw. usace.army. m i l/Missions/Regulatory-Perm it-Program/Perm its/2017-Nationwide-Perm its/Pre-
construction-Notification/
Before submitting this form, please ensure you have submitted the Pre -Filing Meeting Request Form as DWR will not be
able to accept your application without this important first step. The Pre -Filing Meeting Request Form is used to satisfy 40
C.F.R. Section 121.4(a) which states "At least 30 days prior to submitting a certification request, the project proponent shall
request a pre -filing meeting with the certifying agency." In accordance with 40 C.F.R. Section 121.5(b)(7), and (c)(5), all
certification requests must include documentation that a pre -filing meeting request was submitted to the certifying authority
at least 30 days prior to submitting the certification request.
Attach documentation of Pre -Filing Meeting Request to this Application.
Date of Pre -filing Meeting Request (MM/DD/YYYY) *: Click or tap to enter a date.
DWR ID # Click to enter. Version Click to enter. (If applicable)
A. Processing Information
County (counties) where project is located: *
Wake Additional (if needed).
Is this a public transportation project? *
(Publicly funded municipal, state, or federal road, rail,
or airport project)
❑ Yes III No
Is this a NCDOT project? *
❑ Yes 0 No
If yes, NCDOT TIP or state project number:
Click to enter.
If yes, NCDOT WBS number: *
Click to enter
la.
Type(s) of approval sought from the Corps: *
0 Section 404 Permit (wetlands, streams, waters,
Clean Water Act)
❑ Section 10 Permit (navigable waters, tidal
waters, Rivers and Harbors Act)
Page 1 of 21
PCN Form - Version 1.5, September 2020

1 b. Permit type(s)? *
❑x Nationwide Permit (NWP)
❑ Regional General Permit (RGP)
❑ Standard (IP)
This form may be used to initiate the standard/ individual permit process with the USACE. Please contact your Corps
representative concerning submittals for standard permits. All required items can be included as separate attachments
and submitted with this form.
1c. Has the NWP or GP number been verified by the Corps? *
E Yes ❑x No
NWP number(s):
29
RGP number(s):
Click to enter.
1d. Type(s) of approval sought from the DWR (check all that apply): *
❑x 401 Water Quality Certification — Regular ❑ 401 Water Quality Certification— Express
E Non-404 Jurisdictional General Permit ❑ Riparian Buffer Authorization
❑ Individual 401 Water Quality Certification
1 e. Is this notification solely for the record because written approval is not required? *
For the record only for DWR 401 Certification: *
►4 Yes ❑ No
For the record only for Corps Permit: *
❑ Yes ❑x No
1f. Is this an after -the -fact permit/certification application? *
E Yes ❑x No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for
mitigation of impacts?
E Yes ❑x No
If yes, attach the acceptance letter from mitigation bank or in -lieu fee program.
1 h. Is the project located in any of NC's twenty coastal counties? *
E Yes ❑x No
1 i. Is the project located within an NC DCM Area of Environmental
Concern (AEC)? *
❑Yes ❑x No ❑Unknown
1j. Is the project located in a designated trout watershed? *
❑ Yes ❑x No
If yes, you must attach a copy of the approval letter from the appropriate Wildlife Resource Commission Office.
Trout information may be found at this link: http://www.saw.usace.army.mil/Missions/Regulatory-Permit-
Program/Agency-Coordination/Trout.aspx
Page 2 of 21 PCN Form - Version 1.5, September 2020

B. Applicant Information
la.
Who is the primary contact? *
Troy Beasley - WithersRavenel
1 b.
Primary Contact Email: *
[e-mail]
lc.
*
[phone]
Primary Contact Phone: (###)#ll#-####
id.
Who is applying for the permit/certification? * (check
all that apply)
►z Owner ❑ Applicant (other than owner)
le.
Is there an agent/consultant for this project?*
r Yes ❑ No
2. Landowner Information
2a. Name(s) on Recorded Deed: *
RCU, LLC
2b. Deed Book and Page No.:
018255; 01962
2c. Responsible Party (for corporations):
Rudy C Upton
2d. Address *
Street Address:
112 B Pheasant Wood Ct
Address line 2:
Click to enter.
City:
Morrisville
State/ Province/ Region:
NC
Postal/ Zip Code:
27560
Country:
USA
*
[phone]
2e. Telephone Number: (###)### 111111lt
Click to enter.
2f. Fax Number: (lllllt)###-####
2g. Email Address: *
[e-mail]
3.
Applicant Information (if different from owner)
3a.
Name: *
Rudy C. Upton
3b.
Business Name (if applicable):
RCU, LLC
3c.
Address: *
Street Address:
112 B Pheasant Wood Ct
Address line 2:
Click to enter.
City:
Morrisville
State/ Province/ Region:
NC
Postal/ Zip Code:
27560
Country
USA
3d.
*
[phone]
Telephone Number: (###)###-lllllllt
3e
Click to enter.
Fax Number: (###)Illllt-####
Page 3 of 21
PCN Form - Version 1.5, September 2020

3f. Email Address: *
[e-mail]
4. Agent/ Consultant (if applicable)
4a. Name: *
Troy Beasley
4b. Business Name:
WithersRavenel
4c. Address: *
Street Address:
219 Station Road
Address line 2:
Suite 101
City:
Wilmington
State/ Province/ Region:
NC
Postal/ Zip Code:
28405
Country:
USA
4d. Telephone Number: * (Illt#)###-####
[phone]
4e Fax Number: (#/1/F)Illl#-##/1#
Click to enter.
4f. Email Address: *
[e-mail]
Agent Authorization Letter:*
Attach a completed/signed agent authorization form or letter. A sample form may be found at this link:
https://www.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Permits/2017-Nationwide-Permits/Pre-
construction-Notification/
Page 4 of 21 PCN Form - Version 1.5, September 2020

C. Project Information and Prior Project History
1.
Project Information
la.
Name of project: *
Campbell Road Subdivision
1 b.
Subdivision name (if appropriate):
Click to enter.
lc.
Nearest municipality/town: *
Raleigh
2.
Project Identification
2a.
Property identification number (tax PIN or parcel ID):
PIN: 0772826775
2b.
Property size (in acres):
8.46 acres
2c.
Project Address:
Street Address:
3101 Campbell Road
Address line 2:
Click to enter.
City:
Raleigh
State/ Province/ Region:
NC
Postal/ Zip Code:
27606
Country:
USA
2d.
Site coordinates in decimal degrees (using 4-6 digits
after the decimal point): *
Latitude (DD.DDDDDD): * 35.735719
Longitude (-DD.DDDDDD): *-78.735846
3.
Surface Waters
3a.
Name of nearest body of water to proposed project: *
Woodys Lake (Stream Index: 27-43-4)
3b.
Water Resources Classification of nearest receiving
water: *
WS-III;NSW
The Surface Water Classification map may be found at this link:
https://ncdenr. maps.arcgis.com/apps/webappviewer/index. html?id=6e 125ad7628f494694e259c80dd64265
3c.
In what river basin(s) is your project located? *
Neuse
Choose additional (if needed)
3d.
Please provide the 12-digit HUC in which the project is
located: *
030202011001
The Find Your HUC map may be found at this link:
https://ncdenr.maps.arcgis.com/apps/Publiclnformation/index.html?appid=ad3a85a0c6d644a0b97cd069db238ac3
Page 5 of 21 PCN Form - Version 1.5, September 2020

4. Project Description and History
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 project site contains an existing residence and associated structures in the western portion of the site
adjacent to Campbell Road. The majority of the site consists of undeveloped woodlands. The general land use
in the vicinity consists of residential land use.
4b. Have Corps permits or DWR certifications been obtained for this
project (including all prior phases) in the past? *
❑Yes El No ❑Unknown
4c. If yes, please give the DWR Certification number and/or Corps
Action ID (ex. SAW-0000-00000):
SAW-2021-00673
fClick to enter.]
Attach any pertinent project history documentation
4d. Attach an 8'/2 x 11" excerpt from the most recent version of the USGS topographic map indicating the location of
the project site.
4e. Attach an 8'/2 x 11" excerpt from the most recent version of the published County NRCS Soil Survey map
depicting the project site.
4f. List the total estimated acreage of all existing wetlands on the
property:
0.24 acres
4g. List the total estimated linear feet of all existing streams (intermittent
and perennial) on the property:
0 linear feet
4g1. List the total estimated acreage of all existing open waters on the
property:
0 acres
4h. Explain the purpose of the proposed project: *
The purpose of the proposed project is to construct a residential subdivision to meet the demand for housing in
Wake County.
4i. Describe the overall project in detail, including the type of equipment to be used: *
Click to enter text.
4j. Attach project drawings/site diagrams/depictions of impact areas for the proposed project.
5.
Jurisdictional Determinations
5a.
Have the wetlands or streams been delineated on the property or in
proposed impact areas? *
@ Yes ❑ No El Unknown
Comments:
A formal delineation of the entire property was completed by WithersRavenel.
5b.
If 5a is yes, who delineated the jurisdictional
areas?
Name (if known): Alyssa Ricci
Agency/Consultant Company: WithersRavenel
Other: Click to enter.
5c.
If the Corps made a jurisdictional determination,
what type of determination was made? *
❑ Preliminary ❑ Approved ❑x Emailed Concurrence
❑ Not Verified ❑ Unknown
Corps AID number (ex. SAW-0000-00000):
SAW-2021-00673
Page 6 of 21 PCN Form - Version 1.5, September 2020

5d. List the dates of the Corps jurisdictional determination or State determination if a determination was made by
either agency.
Lyle Phillips with the USACE issued an email, dated 5/7/2021, specifying that he concurred with the delineation
per the submitted USACE JD Request. A copy of the email has been provided as an attachment.
NCDWR issued a Riparian Buffer Determination Letter on 4/26/2021 for the project site. A copy of the Buffer
Determination Letter has been attached to this application.
5d1. Attach jurisdictional determinations.
Page 7 of 21 PCN Form - Version 1.5, September 2020

6. Future Project Plans
6a. Is this a phased project?
❑ Yes ❑x No
6b. If yes, explain.
Click to enter.
Are any other NWP(s), regional general permit(s), or individual permit(s) used, or intended to be used, to authorize
any part of the proposed project or related activity? This includes other separate and distant crossings for linear
projects that require Department of the Army authorization but don't require pre -construction notification.
No
Page 8 of 21 PCN Form - Version 1.5, September 2020

D. Proposed Impacts Inventory
1. Impacts Summary
la. Where are the impacts associated with your project
(check all that apply):
❑x Wetlands
❑ Buffers
❑ Pond Construction
❑ Streams - tributaries
❑ Open Waters
2. Wetland Impacts
If there are wetland impacts proposed on the site, complete this table for each wetland area impacted.
2a.
Site #*
2a1.
Impact
Reason/Type*
2b.
Impact
Duration*
2c.
Wetland Name*
2d.
Wetland Type*
2e.
Forested
?*
2f.
Jurisdiction
Type*
2g.
Impact Area
(ac)*
W1
Road/
Driveway
Crossing
Permanent
Wetland A
Headwater
Forest
Yes
Both
0.07 ac
W2
Choose one
Temp/
Perm
Click to enter
Choose one
Y/N
Choose one
Click to
enter
W3
Choose one
Temp/
Perm
Click to enter
Choose one
Y/N
Choose one
Click to
enter
W4
Choose one
Temp/
Perm
Click to enter
Choose one
Y/N
Choose one
Click to
enter
W5
Choose one
Temp/
Perm
Click to enter
Choose one
Y/N
Choose one
Click to
enter
W6
Choose one
Temp/
Perm
Click to enter
Choose one
Y/N
Choose one
Click to
enter
2g1. Total temporary wetland impacts
Click to enter. ac
2g2. Total permanent wetland impacts
0.07 ac
2g3. Total wetland impacts
0.07 ac
2h. Comments:
See PCN Cover Letter for more information on proposed impacts.
Page 9 of 21 PCN Form - Version 1.5, September 2020

3. Stream Impacts
If there are perennial or intermittent stream/ tributary impacts (including temporary impacts) proposed on the site,
complete this table for all stream/ tributary sites impacted.
** All Perennial or Intermittent streams must be verified by DWR or delegated local government
Site #*
3a.
Impact Reason/
Type*
3b.
Impact
Duration*
3d.
Stream Name*
3e.
Stream
Type*
3f.
Jurisdiction
Type*
3g.
Stream Width
(avg ft) *
3h.
Impact length
(linear ft) *
S1
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S2
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S3
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S4
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S5
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S6
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S7
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S8
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S9
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S10
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S11
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S12
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S13
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S14
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S15
Choose one
Temp/ Perm
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
3i1. Total jurisdictional ditch impact:
Click to enter. linear ft
3i2. Total permanent stream impacts:
Click to enter. linear ft
3i3. Total temporary stream impacts:
Click to enter. linear ft
3i4. Total stream and ditch impacts:
Click to enter. linear ft
3j. Comments:
Click to enter text.
Page 10 of 21 PCN Form - Version 1.5, September 2020

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., individually list all open water impacts in the table below.
4a.
Site #*
4b.
Impact Reason/
Type*
4c.
Impact
Duration*
4d.
Waterbody Name*
4e.
Waterbody
Type*
4e1.
Jurisdiction
Type*
4f.
Impact area (ac)*
01
Choose one
Temp/
Perm
Click to enter.
Choose one
Choose one
Click to enter.
02
Choose one
Temp/
Perm
Click to enter.
Choose one
Choose one
Click to enter.
03
Choose one
Temp/
Perm
Click to enter.
Choose one
Choose one
Click to enter.
04
Choose one
Temp/
Perm
Click to enter.
Choose one
Choose one
Click to enter.
4g. Total temporary open water impacts
Click to enter. ac
4g. Total permanent open water impacts
Click to enter. ac
4g. Total open water impacts
Click to enter. ac
4h. Comments:
Click to enter.
5. Pond or Lake Construction
If pond or lake construction is proposed, complete the table below. (*This does NOT include offline stormwater
management ponds.)
5a.
Pond ID
#
5b.
Proposed use or
purpose of pond
5c.
Wetland Impacts (ac)
5d.
Stream Impacts (ft)
5e.
Upland
Impacts (ac)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
P1
Choose one
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
P2
Choose one
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
5f. Total
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
5g. Comments:
Click to enter.
5h. Is a dam high hazard permit required?
❑ Yes ❑ No
If yes, permit ID no.:
Click to enter.
5i. Expected pond surface area (acres):
Click to enter.
5j. Size of pond watershed (acres):
Click to enter.
5k. Method of construction:
Click to enter.
Page 11 of 21 PCN Form - Version 1.5, September 2020

6. Buffer Impacts (DWR requirement)
If project will impact a protected riparian buffer, then complete the chart below. Individually list all buffer impacts.
6a. Project is in which protected basin(s)?
* (Check all that apply.)
❑x Neuse ❑ Tar -Pamlico ❑ Catawba
❑ Jordan ❑ Goose Creek ❑ Randleman
E Other: Click to enter.
Site #*
6b.
Impact Type*
6c.
Impact Duration*
6d.
Stream Name*
6e.
Buffer
Mitigation
Required?*
6f.
Zone 1 Impact*
(sq ft)
6g.
Zone 2 Impact*
(sq ft)
B1
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B2
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B3
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B4
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B5
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B6
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B7
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B8
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B9
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B10
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
6h. Total temporary impacts:
Zone 1: Click to enter. sq ft
Zone 2: Click to enter. sq ft
6h. Total permanent impacts:
Zone 1: Click to enter. sq ft
Zone 2: Click to enter. sq ft
6h. Total combined buffer impacts:
Zone 1: Click to enter. sq ft
Zone 2: Click to enter. sq ft
6i. Comments:
There are no proposed impacts to Neuse River Riparian Buffers.
Please attach supporting documentation (impact maps, plan sheets, etc.) for the proposed project.
Page 12 of 21 PCN Form - Version 1.5, September 2020

E. Impact Justification and Mitigation
1.
Avoidance and Minimization
la.
Specifically describe measures taken to avoid or minimize the proposed impacts through project design: *
Prior to site plan design, the applicant requested that a detailed wetland delineation be conducted so that
impacts to wetlands and "waters" could be minimized.
There are no proposed impacts for construction of lots or stormwater management. Proposed impacts have
been minimized to those necessary for the cul-de-sac at the eastern terminus of Franklin Oaks Drive. The
alignment of Franklin Oaks Drive was dictated by the need for onsite septic systems to treat wastewater for each
lot. As shown in the attached Site Plan, the suitable soils for septic are located along the southern portion of the
property. Therefore, the road needed to be located within the soils that were unsuitable for septic along the
northern portion of the property to allow sufficient area within septic suitable soils to accommodate the house,
septic tank, drain field and repair field. If Franklin Oaks Way was aligned along the southern property boundary,
there would not be enough area within septic suitable soils to accommodate the septic systems, making the
project unfeasible.
1 b.
Specifically describe measures taken to avoid or minimize proposed impacts through construction techniques: *
Access during construction will occur from uplands. Silt fencing will be installed around all disturbed areas to
prevent loss of sediment into adjacent waters.
2. Compensatory Mitigation for Impacts to Waters of the U.S., Waters of the State, or Riparian Buffers
2a. If compensatory mitigation is required, by whom is it required? *
(check all that apply)
❑ DWR ❑ Corps
2b. If yes, which mitigation option(s) will be used for this
project? * (check all that apply)
❑ Mitigation Bank
❑ In Lieu Fee Program
❑ Permittee Responsible Mitigation
3. Complete if using a Mitigation Bank (Must satisfy NC General Statute143-214.11 (d1).)
3a. Name of mitigation bank:
Click to enter.
3b. Credits purchased/requested:
Type: Choose one
Quantity Click to enter.
Type: Choose one
Quantity Click to enter.
Type: Choose one
Quantity Click to enter.
Attach receipt and/or approval letter.
3c. Comments:
Click to enter.
4. Complete if Using an In Lieu Fee Program
4a. Attach approval letter from in lieu fee program.
4b. Stream mitigation requested:
Click to enter. linear feet
4c. If using stream mitigation, what is the stream temperature:
Choose one
Page 13 of 21
PCN Form - Version 1.5, September 2020

NC Stream Temperature Classification Maps can be found under the Mitigation Concepts tab on the Wilmington
District's RIBITS website: (Please use the filter and select Wilmington district)
https://ribits.usace.army.mil/ribits apex/f?p=107:27:2734709611497::NO:RP:P27 BUTTON KEY:O
4d.
Buffer mitigation requested (DWR only):
Click to enter. square feet
4e.
Riparian wetland mitigation requested:
Click to enter. acres
4f.
Non -riparian wetland mitigation requested:
Click to enter. acres
4g.
Coastal (tidal) wetland mitigation requested:
Click to enter. acres
4h.
Comments:
Click to enter.
5. Complete if Providing a Permittee Responsible Mitigation Plan
5a. If proposing a permittee responsible mitigation plan, provide a description of the proposed mitigation plan,
including the amount of mitigation proposed.
Click to enter.
5b. Attach mitigation plan/documentation.
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — DWR requirement
6a. Will the project result in an impact within a protected riparian buffer
that requires buffer mitigation?
❑ Yes El No
If yes, please complete this entire section — please contact DWR for more information.
6b. If yes, identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required in the table below.
Zone
6c.
Reason for impact
6d.
Total impact (square
feet)
Multiplier
6e.
Required mitigation
(square feet)
Zone 1
Click to enter.
Click to enter.
Choose one
Click to enter.
Zone 2
Click to enter.
Click to enter.
Choose one
Click to enter.
6f. Total buffer mitigation required
Click to enter.
6g. If buffer mitigation is required, is payment to a mitigation bank or
NC Division of Mitigation Services proposed?
❑ Yes ❑ No
6h. If yes, attach the acceptance letter from the mitigation bank or NC Division of Mitigation Services.
6i. Comments:
Click to enter.
Page 14 of 21 PCN Form - Version 1.5, September 2020

F. Stormwater Management and Diffuse Flow Plan (DWR requirement)
1.
Diffuse Flow Plan
la.
Does the project include or is it adjacent to protected riparian buffers
identified within one of the NC Riparian Buffer Protection Rules?
r Yes ❑ No
1 b.
All buffer impacts and high ground impacts require diffuse flow or other forms of stormwater treatment. If the
project is subject to a state implemented riparian buffer protection program, include a plan that fully documents
how diffuse flow will be maintained.
All Stormwater Control Measures (SCM) must be designed in accordance with the NC Stormwater Design
Manual (https://deq.nc.gov/about/divisions/energy-mineral-land-resources/energy-mineral-land-permit-
guidance/stormwater-bmp-manual).
Associated supplement forms and other documentation must be provided.
What Type of SCM are you
providing?
(Check all that apply)
❑ Level Spreader
❑ Vegetated Conveyance (lower seasonal high water table- SHWT)
E Wetland Swale (higher SHWT)
❑ Other SCM that removes minimum 30% nitrogen
0 Proposed project will not create concentrated stormwater flow through the
buffer
For a list of options to meet the diffuse flow requirements, click here:
Attach diffuse flow documentation.
2.
Stormwater Management Plan
2a.
Is this an NCDOT project subject to compliance with NCDOT's
Individual NPDES permit NCS000250?
❑Yes No
2b.
Does this project meet the requirements for low density projects as
defined in 15A NCAC 02H .1003(2)? *
0 Yes ❑ No
To look up low density requirements, click here:
http://reports.oah.state.nc.us/ncac/title%2015a%20-%20environmental%20quality/chapter%2002%20-
%20environmental%20management/subchapter%20h/15a%20ncac%2002h%20.1003.pdf
2c.
IS the project over an acre?
0 Yes ❑ No
2d.
Does this project have a stormwater management plan (SMP)
reviewed and approved under a state stormwater program or state-
approved local government stormwater program? *
0 Yes ❑ No
Note: Projects that have vested rights, exemptions, or grandfathering from state or locally implemented
stormwater programs or projects that satisfy state or locally -implemented stormwater programs through use of
community in -lieu programs should answer "no" to this question.
2e.
Which of the following stormwater management program(s) apply?
(Check all that apply) *
0 Local Government
❑ State
If you have local government approval, please include the SMP on their overall impact map.
Page 15 of 21
PCN Form - Version 1.5, September 2020

Local Government Stormwater Programs *
❑x Phase II ❑ USMP
❑ NSW ❑ Water Supply
Please identify which local government stormwater program you are using.*
Wake County
State Stormwater Programs *
❑Phase II ❑ HQW or ORW
❑ Coastal Counties ❑ Other
Comments:
The project meets conditions for low density, and therefore stormwater management for the residential lots is not
required. The stormwater management plan consists of collection of run off from Franklin Oaks Way within and
underground detention system. The underground detention has a slow drawdown releasing runoff from the first
flush (1" storm) in 2-5 days. This design meets Wake County's Target CN design tool requirements. The outflow
from the detention system is discharged through a riprap dissipator designed for the 10-year storm. Prior to
entering the riparian buffer, stormwater from the detention system will flow through an additional 50' Wake
County Water Supply Watershed Buffer and into a topographically flat area outside of the riparian buffer which
will provide sheet flow prior to entering the riparian buffer and therefore diffuse flow is not required.
Page 16 of 21 PCN Form - Version 1.5, September 2020

G. Supplementary Information
1.
Environmental Documentation
la.
Does the project involve an expenditure of public (federal/state/local)
funds or the use of public (federal/state) land? *
❑ Yes
❑x No
1 b.
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
El No
lc.
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.) *
❑ Yes
• No
Comments:
Click to enter.
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),
DWR Surface Water or Wetland Standards or Riparian Buffer Rules
(15A NCAC 2B .0200)? *
❑ Yes ❑x No
2b. If you answered "yes" to the above question, provide an explanation of the violation(s):
Click to enter.
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? *
❑ Yes ❑x No
3b.
If you answered "no", provide a short narrative description:
The proposed project consists of a small six lot subdivision which has no future phases and will not be a catalyst
for future development that could impact nearby downstream water quality.
3c.
If yes, attach a qualitative or quantitative cumulative impact analysis (.pdf) in accordance with the most recent
DWR policy.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project? *
Yes ❑ No ❑ N/A
4b. If yes, describe in detail the treatment methods and dispositions (non -discharge or discharge) of wastewater
generated from the proposed project. If the wastewater will be treated at a treatment plant, list the capacity
available at that plant.
The proposed project will treat wastewater within individual underground septic systems on each lot.
Page 17 of 21
PCN Form - Version 1.5, September 2020

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? (IPAC weblink: https://www.fws.gov/ipac/ [fws.gov1)*
❑ Yes ❑x No
5b.
Have you checked with the USFWS concerning Endangered Species
Act impacts? *
• Yes ❑x No
5c.
If yes, indicate the USFWS Field Office you have contacted.
Choose one
5d.
Is another federal agency involved? *
❑ Yes ❑x No ❑ Unknown
If yes, which federal agency?
Click to enter.
5e.
Is this a DOT project located within Divisions 1-8? *
❑ Yes ❑x No
5f.
Will you cut any trees in order to conduct the work in waters of the*
U.S.?
y Yes ❑ No
5g.
Does this project involve bridge maintenance or removal? *
E Yes 0 No
Link to NLEB SLOPES document: http://saw-req.usace.army.mil/NLEB/1-30-17-signed NLEB-
SLOPES&apps. pdf
5h.
Does this project involve the construction/ installation of a wind
turbine(s)? *
E Yes 0 No
If yes, please show the location of the wind turbine(s) on the permit drawings/ project plans (attach .pdf)
5i.
Does this project involve blasting and /or other percussive activities
that will be conducted by machines, such as jackhammers,
mechanized pile drivers, etc.? *
E Yes 0 No
If yes, please provide details to include type of percussive activity, purpose, duration, and specific location of this
activity on the property (attach .pdf)
5j.
What data sources did you use to determine whether your site would impact Endangered Species or Designated
Critical Habitat? *
WR reviewed the USFWS iPaC data, located at: https://ecos.fws.gov/ipac/ to identify the federally listed species
known to occur in Wake County. WR also reviewed the NC Natural Heritage Program (NCNHP) database,
located at https://ncnhde.natureserve.org/, as well as NCNHP GIS data to identify if there were any known
occurrences of endangered species on or near the proposed project. The review of the NCNHP data did not
identify any recent occurrences of federally listed threatened or endangered species or critical habitat on the
subject property or within 1.0 miles of the project, see attached NCNHP project review letter. Furthermore, site
reviews did not identify any potential habitat for any federally protected species known to occur in Wake County.
Therefore, the proposed project will not adversely affect federally protected species.
Attach consultation documentation.
6.
Essential Fish Habitat (Corps Requirement)
6a.
Will this project occur in or near an area designated as
an Essential Fish Habitat? *
El Yes
❑x No
Are there submerged aquatic vegetation (SAV) around
the project vicinity? *
El Yes
❑x No
E Unknown
Page 18 of 21
PCN Form - Version 1.5, September 2020

Will this project affect submerged aquatic vegetation?
❑ Yes I No
Explain: Click to enter.
❑ Unknown
6b. What data source(s) did you use to determine whether your site would impact Essential Fish Habitat? *
WR reviewed the NOAA Essential Fish Habitat online mapper, located at:
http://www.habitat.noaa.gov/protection/efh/efhmapper/index.html. There are no waters classified as EFH in
Wake County.
Page 19 of 21 PCN Form - Version 1.5, September 2020

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)? *
❑Yes ❑x No
7b.
What data source(s) did you use to determine whether your site would impact historic or archeological
resources? *
WR reviewed the NC State Historic Preservation Office's online database, located at:
http://gis.ncdcr.gov/hpoweb/, to determine if there were any known historic or cultural resources within or in the
vicinity of the proposed project. The database review did not identify any known resources within or in the
vicinity of the proposed project.
7c.
Attach historic or prehistoric documentation.
8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https://msc.fema.gov/portal/search
8a. Will this project occur in a FEMA-designated 100-year floodplain? *
❑ Yes
❑x No
8b. If yes, explain how the project meets FEMA requirements.
Click to enter.
8c. What source(s) did you use to make the floodplain determination?
www.ncfloodmaps.com
Page 20 of 21 PCN Form - Version 1.5, September 2020

H. Miscellaneous
Comments:
Click to enter.
Attach pertinent documentation or attachments not previously requested
I. Signature*
❑x By checking the box and signing below, I, as the project proponent, certify to the following:
• The project proponent hereby certifies that all information contained herein is true, accurate, and complete, to
the best of my knowledge and belief;
• The project proponent hereby requests that the certifying authority review and take action on this CWA 401
certification request within the applicable reasonable period of time;
• The project proponent hereby agrees 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");
• The project proponent hereby agrees to conduct this transaction by electronic means pursuant to Chapter 66,
Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• The project proponent hereby understands that an electronic signature has the same legal effect and can be
enforced in the same way as a written signature; AND
• As the project proponent, I intend to electronically sign and submit the PCN/online form.
Full Name: * Troy Beasley - WithersRavenel - Authorized Agent
Signature: *
-
��-e3
Date: * 7/6/2021
Page 21 of 21 PCN Form - Version 1.5, September 2020