20211636 Ver 1_Pre-Construction Notification Package 11-08-2021_20211108

10/26/21, 8:36 AM Resume Submission
DWR
DSvlslon of Water Resource
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
October 26, 2020 Ver 3.3
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.govANaterResources/0/edoc/624704/PCN%20Help%20File%202018-1-30.pdf (https://edocs.deq.nc.govMlaterResources/0/doc/603610/Pagel.aspx)
A. Processing Information 6
County (or Counties) where the project is located:*
P itt v
Add additional county
Is this a NCDMS Project*
p Yes QQ No
Click Yes, only if NCDMS is the applicant or co -applicant.
Is this project a public transportation project?*
Yes No
This is any publicly funded by municipal,state or federal funds road, rail, airport transportation project.
1 a. Type(s) of approval sought from the Corps:*
19 Section 404 Permit (wetlands, streams and waters, Clean Water Act)
❑ Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
Has this PCN previously been submitted?*
p Yes
an No
1 b. What type(s) of permit(s) do you wish to seek authorization?*
Q Nationwide Permit (NWP)
❑ Regional General Permit (RGP)
❑ Standard (IP)
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 number been verified by the Corps?*
Yes U No
Nationwide Permit (NWP) Number: v
Add additional NWP
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NWP Numbers (for multiple NWPS):
NWP 58 - Utility Line Activities for Water and Other Substances
List all NW numbers you are applying for not on the drop down list.
1d. Type(s) of approval sought from the DWR:
check all that apply
❑ 401 Water Quality Certification - Regular
❑ Non-404 Jurisdictional General Permit
19 Individual Permit
Pre -Filing Meeting Information
401 Water Quality Certification - Express
19 Riparian Buffer Authorization
Before submitting this form please ensure you have submitted the Pre -Filing Meeting Request Form as we will not be able to accept your application without this important first step.
The Pre -Filing Meeting Request Form is used in accordance with 40 C.F.R. Section 121.4(a) "At least 30 days prior to submitting a certification request, the project proponent shall
request a pre -filing meeting with the certifying agency" and in accordance with 40 C.F.R. Section 121.5(b)(7), and (c)(5) all certification requests shall include documentation that a pre -
filing meeting request was submitted to the certifying authority at least 30 days prior to submitting the certification request. Click here (https://www.epa.gov/sites/production/files/2020-
07/documents/clean_water_act_section_401_certification_rule.pdf) to read more information on when this form is needed prior to application submission or here
(https://edocs.deq.nc.gov/Forms/DWR-Pre-Filing-Meeting-Request) to view the form.
ID# Version
Pre -fling Meeting or Request Date*
5/12/2021 FM
Attach documentation of Pre -Filing Meeting Request here:*
Upload
DWR Pre -Filing Meeting Request Form.pdf 49.35KB
le. Is this notification solely for the record because written approval is not required?
*
For the record only for DWR 401 Certification: Q Yes g No
For the record only for Corps Permit: Q Yes g No
1f. Is this an after -the -fact permit application?*
p Yes QQ No
1g. 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
p No
Acceptance Letter Attachment
Click the upload button or drag and drop files here to attach document
Upload
FILE TYPE MUST BE PDF
1 h. Is the project located in any of NC's twenty coastal counties?*
p Yes
QQ No
1j. Is the project located in a designated trout watershed?*
p Yes * No
Link to trout information: http://www.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Agency-Coordination/Trout.aspx (http://www.saw.usace.army.miI/Missions/Regulatory-
Pe rm it-Prog ram/Age ncy-Coord i nation/Trout.aspx)
B. Applicant Information
X
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10/26/21, 8:36 AM Resume Submission
1a. Who is the Primary Contact?*
James Mason, PWS
1c. Primary Contact Phone:*
1b. Primary Contact Email:* (xxx)xxx-XXXX
james.mason@threeoaksenc [phone]
1d. Who is applying for the permit?*
19 Owner Applicant (other than owner)
(Check all that apply)
1e. Is there an Agent/Consultant for this project?*
O Yes No
2. Owner Information
2a. Name(s) on recorded deed:*
Greenville Utilities Commission, ATTN David Springer, PE
2b. Deed book and page no.:
2c. Responsible party:
(for Corporations)
2d. Address*
Street Address
PO Box 1847
Address Line 2
State / Province / Region
Greenville NC
Postal / Zip Code Country
27835 USA
2e. Telephone Number:*
(xxx)xxx-xxxx
[phone]
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
Add another owner
4. Agent/Consultant (if applicable)
4a. Name:*
James Mason, PWS
4b. Business Name:
Three Oaks Engineering
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10/26/21, 8:36 AM Resume Submission
4c. Address*
Street Address
324 Blackwell Street, Suite 1200
Address Line 2
City
State / Province / Region
Durham
NC
Postal / Zip Code
Country
27701
USA
4d. Telephone Number:*
4e. Fax Number:
[phone]
(xxx)xxx-xxxx
(xxx)xxx-xxxx
4f. Email Address:*
[e-mail]
Agent Authorization Letter*
Please provide the Agent Authorization Letter if you are submitting this document.
Upload
Forli nes_AGENT_AUTHORIZATI ON_FORM_Flat. pdf
259.96 KB
FILE TYPE MUST BE PDF
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Greenville Utilities Commission Forlines Force Main Project
1b. Subdivision name:
(if appropriate)
1 c. Nearest municipality / town:
W nterville
2. Project Identification
2a. Property Identification Number: 2b. Property size:
(tax PIN or parcel ID) (in acres)
4665960419, 4665977086, 4 11
2c. Project Address
Street Address
Address Line 2
City State / Province / Region
Postal / Zip Code Country
2d. Site coordinates in decimal degrees
x
U
L�1
LJ
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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:*
35.544383-77.42044
ex: 34.208504-77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:
Swift Creek & Gum Swamp
3b. Water Resources Classification of nearest receiving water:*
C; Sw, NSW
Surface Water Lookup (https://ncdenr.maps.arcgis.com/apps/webappviewer/index.html?id=6el25ad7628f494694e259c8Odd64265)
3c. What river basin(s) is your project located in?*
Neuse
Add another river basin
3d. Please provide the 12-digit HUC in which the project is located.*
030202020401
River Basin Lookup (h p:Hncdenr.maps.arcgis.com/apps/Publicinforma on/index.html?appid=ad3a85aOc6d644aOb97cdO69db238ac3)
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 conditions on the site are of an existing sanitary sewer easement, which is a maintained easement. Wooded
floodplain exists outside of the sewer easement The general land use in the vicinity of the project is residential,
commercial, and agricultural, with Pitt Community College adjacent to a portion of the project.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?
Q Yes Q No Q Unknown
4c. If yes, please give the DWR Certification number or the Corps Action ID (exp. SAW-0000-00000).
This project was previously permitted through USACE, which authorized 0.23 acre of wetland impacts
(permanent fill).
Project History Upload
Click the uplo d button or drag and drop files here to attach document
Upload
File type must be PDF
5/16
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4d. Attach an 8 1/2 X 11 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for DWR)
Click the upload button or drag and drop files here to attach document
Upload
G U C_F FM_Pe rm it_To p o 1. pd f
File type must be pdf
2.8MB
4e. Attach an 8 1/2 X 11 excerpt from the most recent version of the published County NRCS Soil Survey map depicting the project site. (for DWR)
Click the upload button or drag and drop files here to attach document
Upload
GUC_FFM_Permit_Soil2.pdf 1.38MB
File type must be pdf
4f. List the total estimated acreage of all existing wetlands on the property:
3.3
4g. List the total estimated linear feet of all existing streams on the property:
(intermittent and perennial)
255
4h. Explain the purpose of the proposed project:*
The Greenville Utilities Commission is proposing sanitary sewer improvements as part of the Forlines Force Main
project in Wnterville, North Carolina. The Commission is proposing improvements to the wastewater system
involving approximately 6,000 linear feet of force main. This project extends along the Swift Creek Canal from Pump
Station No. 2 on SR 1125 (Forlines Road), north to the existing pump station west of Pitt Community College (along
a gravel road off of Sterling Pointe Drive).
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
The Commission is proposing improvements to the wastewater system involving approximately 6,000 linear feet of
force main. The project also includes improvements at the existing pump station on the southern end of the project.
This project extends along the Swift Creek Canal from Pump Station No. 2 on SR 1125 (Forlines Road), north to the
existing pump station west of Pitt Community College (along a gravel road off of Sterling Pointe Drive). Impacts will
include open trenching of both riparian wetlands (both disturbed and undisturbed) and Swift Creek Canal. Areas
outside of the proposed permanent maintenance corridor will not be impacted. Typical construction equipment, such
as trucks, bulldozers, excavators, and backhoe loaders, will be used during construction.
4j. Please upload project drawings for the proposed project.
Click the upload button or drag and drop files here to attach document
Upload
GUC1901 - Forlines PS & FM - 100% For Permitting_2021-06-22.pdf
17.59MB
Riparian_Buffer_ Impact_ Summary_Form_2021-09-07.pdf
105.78KB
GUC1901 -Color Coded Set for 3 Oaks_2021-10-25.pdf (blob:https://edocs.deq.nc.gov/2ac425b2-f33c-4...
8.04MB
Riparian_Buffer_ Impact_ Summary_Form_2021-09-07_WIB.pdf (blob:https://edocs.deq.nc.gov/cfc4d2d7...
88.13KB
Wetland_Impact_Summary_Form_2021-10-25.pdf (blob:https://edocs.deq.nc.gov/a2888a37-0779-42e2-9...
92.11KB
File type must be pdf
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
Yes
p No
p Unknown
X
X
X
X
X
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Comments
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
Preliminary p Approved QQ Not Verified p Unknown N/A
Corps AID Number:
Example: SAW-2017-99999
SAW-2020-01578
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): James Mason, PWS & Nathan Howell, P\
Agency/Consultant Company: Three Oaks Engineering
Other:
5d1. Jurisdictional determination upload
Click the upload button or drag and drop files here to attach document
Upload
Forlines Force Main_Updated_PJD_Package _08262021Flat. pdf 8.22MB X
File type must be PDF
6. Future Project Plans
Ga. Is this a phased project?*
Yes (g No
Are any other NWP(s), regional general permit(s), or individual permits(s) used, or intended to be used, to authorize any part of the proposed project or related activity?
This includes other separate and distant crossing for linear projects that require Department of the Army authorization but don't require pre -construction notification.
D. Proposed Impacts Inventory
1. Impacts Summary
la. Where are the impacts associated with your project? (check all that apply):
Q 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.
"W." will be used in the table below to represent the word "wetland".
Reason* 2b. Impact type* (') 2c. Type of W. * 2d. W. name* 2e. Forested* 2f. Type of 2g. Impact
J —1 Jurisdicition*(') area*
Clearing/Grubt F
v Floodplain Pool v WA No v Both v ��0.010
(acres)
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Clearing/Grubk
P v
Bottomland Hardwood Fory
WB
No v
Both v
0.060
(acres)
Clearing/Grubk
P v
Bottomland Hardwood Fory
WB
No v
Both v
0.010
(acres)
Clearing/Grubk
P v
Bottomland Hardwood Fory
WB
No v
Both v
0.040
(acres)
Clearing/Grubk
P v
Bottomland Hardwood Fory
WB
No v
Both v
0.020
(acres)
Clearing/Grubk
P v
Bottomland Hardwood Fory
WB
�No v
Both v
0.010
(acres)
Clearing/Grubk
P v
Bottomland Hardwood Fory
WC
Yes v
Both v
0.020
(acres)
Clearing/Grubk
P v
Bottomland Hardwood Fory
WC
Yes v
Both v
0.002
(acres)
Clearing/Grubk
P v
Bottomland Hardwood Fory
WC
Yes v
Both v
0.020
(acres)
Clearing/Grubk
P v
Bottomland Hardwood Fory
WC
Yes v
Both v
0.060
(acres)
10
Clearing/Grubk
P v
Bottomland Hardwood Fory
WC
Yes v
Both v
0.110
(acres)
10
Clearing/Grubk
P v
Bottomland Hardwood Fory TWC
Yes v
Both v
Q,25Q
(acres)
11
Clearing/Grubk
P v
Bottomland Hardwood Fory
WC
Yes v
Both v
Q,QQ4
(acres)
12
Clearing/Grubk
P v
Bottomland Hardwood Fory
WC
Yes v
Both v
0.010
(acres)
12
Clearing/Grubk
P v
Bottomland Hardwood Fory
WC
Yes v
Both v
0.020
(acres)
13
Clearing/Grubk
P v
Floodplain Pool v
WD
No v
Both v
0.001
(acres)
13
Clearing/Grubk
P v
Floodplain Pool v
WD
No v
Both v
0.004
(acres)
15
Clearing/Grubk
P v
Bottomland Hardwood Fory
WE
Yes v
Both v
0.010
(acres)
15
Fle�ring/Grubk
P v
Bottomland Hardwood Fory
WE
Yes v
Both v
0.010
(acres)
16
Clearing/Grubk
P v
Bottomland Hardwood Fory
WE
Yes v
Both v
Q,24Q
(acres)
16
Clearing/Grubk
P v
Bottomland Hardwood Fory
WE
Yes v
Both v
0.190
(acres)
19
Clearing/Grubk
P v
Bottomland Hardwood Fory
WF
Yes v
Both v
Q,2$Q
(acres)
f::]Clearing/Grubt
IE
v
Bottomland Hardwood Fory
WF �E]FBoth
v
0.170
acres)
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2g. Total Temporary Wetland Impact
0.000
2g. Total Permanent Wetland Impact
1.551
2g. Total Wetland Impact
1.551
2h. Comments:
result in no loss of function (since the soil, hydrology, and vegetation would be the
same/similar to pre -construction) and no permanent loss of water. Under this designation,
this impact would NOT require mitigation. -
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".
Reason for impact* (')
3b.lmpact
3c. Type of impact*
3d. S. name*
3e. Stream
3f. Type of
3g. S. width*
3h. Impact
F13a.
type*
Type* (')
Jurisdiction*
length*
fl
Dewatering/Open
Temporary v
Dewatering
Swift Creek Canal
Perennial
Both v
15
20
Average (feet)
Qinear feet)
Eiwatering/OpeWn
Temporary v
Dewatering v
SA
Perennial v
Both v
4
11
Average (feet)
Qinear feet)
S3
Dewatering/Open
Temporary v
Dewatering v
SD
Intermittent v
DWR v
10
12
Average (feet)
Qinear feet)
�]�ewatering/O�peWnAverage
Temporary v
Dewatering v
SB
Perennial v
Both v
6
12
(feet)
Qinear feet)
fl
Dewatering/pen
O
Temporary !
Dewatering �
SF
Intermittent �
DWR �
3
14
Average (feet)
Qinear feet)
Add another impact
** All Perennial or Intermittent streams must be verified by DWR or delegated local government.
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
0
3i. Total temporary stream impacts:
69
3i. Total stream and ditch impacts:
69
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3j. Comments
Temporary impacts to Swift Creek Canal include dewatering to open trench the stream bed.
This will occur in order to place the new sewer line. The impact totals 0.009 ac. of temporary
impact.
6. Buffer Impacts (for DWR)
If project will impact a protected riparian buffer, then complete the chart below. Individually list all buffer impacts below.
6a. Project is in which protect basin(s)?*
Check all that apply.
Q Neuse
❑ Catawba
❑ Goose Creek
❑ Other
❑ Tar -Pamlico
❑ Randleman
❑ Jordan Lake
6b. Impact Type*
6c. Per or Temp*
6d. Stream name*
6e. Buffer mitigation required?*
6f. Zone 1 impact*
6g. Zone 2
?)
impact*
Utility - Sewer Lines—Replac(
P
Swift Creek Canal
No
62
36
(square feet)
(square feet)
Utility - Sewer Lines—Replac(
P
Swift Creek Canal
No
0
124
(square feet)
(square feet)
Utility - Sewer Lines—Replac(
P
Swift Creek Canal
No
0
7,084
(square feet)
(square feet)
Utility - Sewer Lines—Replac(
P
SA
No
531
204
(square feet)
(square feet)
Utility - Sewer Lines—ReplacE
P
Swift Creek Canal
No
0
2,599
(square feet)
(square feet)
Utility - Sewer Lines—ReplacE
P
Swift Creek Canal
No
0
3,439
(square feet)
(square feet)
Utility - Sewer Lines —ReplacE
P
Swift Creek Canal
No
0
1,432
(square feet)
(square feet)
Utility - Sewer Lines—ReplacE
P
SB
to
318
0
(square feet)
(square feet)
Utility - Sewer Lines—ReplacE
P
Swift Creek Canal
No
F(square
6,522
feet)
(square feet)
Add another impact
6h. Total buffer impacts:
Zone 1
Zone 2
Total Temporary impacts: 0.00
0.00
.............................................................................................................................................................................................................................................................................................................................
Zone 1
Zone 2
Total Permanent impacts: 911.00
21,440.00
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Zone 1 Zone 2
Total combined buffer impacts: 911.00 21 ,440.00
6i. Comments
(Site 2 - 17 sq. ft; Site 3 - 4,663 sq. ft.; Site 5 - 3,439 sq. ft.; Site 6 - 564 sq. ft.; Site 7 - 6,310
sq. ft.).
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
Click the upload button or drag and drop files here to attach document
Upload
Riparian_Buffer_ Impact_ Summary_Form_2021-09-07.pdf 105.78KB
GUC1901 -Color Coded Set for 3 Oaks_2021-10-25.pdf (blob:https://edocs.deq.nc.gov/deb2b901-309d-... 8.04MB
Riparian_Buffer_ Impact_ Summary_Form_2021-09-07_WIB.pdf (blob:https://edocs.deq.nc.gov/25fea4b1... 88.13KB
File must be PDF
E. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
The proposed new force main will be installed as close to the existing maintenance corridor
as possible, thereby minimizing jurisdictional and riparian buffer impacts, specifically impacts
to wooded wetland areas. The existing force main is surrounded by wetlands, however,
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Best Management Practices for the Protection of Surface Waters will be employed. Silt
fencing will be installed along the entire project. Rock check dams will also be used where
appropriate to minimize flow velocity and stormwater runoff into Swift Creek. Additional
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?
p Yes
p No
2c. If yes, mitigation is required by (check all that apply):
❑ DWR 12 Corps
2d. If yes, which mitigation options) will be used for this project?
❑ Mitigation bank Q Payment to in -lieu fee program ❑ Permittee Responsible Mitigation
4. Complete if Making a Payment to In -lieu Fee Program
4a. Approval letter from in -lieu fee program is attached.
p Yes (- No
4b. Stream mitigation requested:
(linear feet)
0
4c. If using stream mitigation, what is the stream temperature:
v
NC Stream Temperature Classification Maps can be found under the Mitigation Concepts tab on the Wilmington District's RIBITS (https://ribits.usace.army.miI/ribits_apex/f?
p=107:27:2734709611497::NO:RP:P27_BUTTON_KEY:O) website.
X
X
X
l^J
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4d. Buffer mitigation requested (DWR only):
(square feet)
0
4f. Non -riparian wetland mitigation requested:
(acres)
0
4h. Comments
Acquisition of mitigation is in progress, will send mitigation letter once it is received.
4e. Riparian wetland mitigation requested:
(acres)
1.56
4g. Coastal (tidal) wetland mitigation requested:
(acres)
0
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
*** Recent changes to the stormwater rules have required updates to this section .***
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?
p Yes
p No
1 b. All buffer impacts and high ground impacts require diffuse flow or other form 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)s 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 shall be provided.
What type of SCM are you providing?
❑ Level Spreader
❑ Vegetated Conveyance (lower SHWT)
❑ Wetland Swale (higher SHWT)
❑ Other SCM that removes minimum 30% nitrogen
Q Proposed project will not create concentrated stormwater flow through the buffer
(check all that apply)
For a list of options to meet the diffuse flow requirements, click here
(https://files. nc.gov/ncdeq/Wate r%20Qu ality/Surface%20 Wate r%20 Protection/401 /Buffer%20CIarif icatio n %2OM emos/Options%20for%2OM eeti ng %2OD iffuse%20FIow%2OP rovisions%20c
Diffuse Flow Documentation
Click the upload button or drag and drop files here to attach document
Upload
File type must be PDF
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS00025O?*
p Yes pQ No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?*
Q Yes p No
To look up low density requirement click here 15A NCAC 02H .1003(2) (http://reports.oah.state.nc.us/ncac/title%2015a%20-%20environmental%20quality/chapter%2002%20-
%20environmental%2Omanagement/subchapter%20h/15a%20ncac%2002 h%20.1003.pdf).
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10/26/21, 8:36 AM
Resume Submission
Comments
G. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
Yes U 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 QQ No
Comments:*
Local funding only (Greenville Utilities Commission)
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15A NCAC 2H .0500), Isolated Wetland Rules (15A NCAC 2H .1300), or DWR Surface Water or Wetland
Standards or Riparian Buffer Rules (15A NCAC 2B .0200)?*
Yes No
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?*
p Yes QQ No
3b. If you answered "no," provide a short narrative description.
The proposed project is the improvement of an existing sewer line, so no additional
development is anticipated as a result of the project.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
Yes No ) N/A
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or habitat?*
Yes No
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10/26/21, 8:36 AM Resume Submission
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
Yes No
5d. Is another Federal agency involved?*
Yes No O Unknown
5e. Is this a DOT project located within Division's 1-8?*
Yes No
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?*
Yes No
5g. Does this project involve bridge maintenance or removal?*
O Yes OQ No
Link to the NLEB SLOPES document: http://saw-reg.usace.army.mil/NLEB/1-30-17-signed_NLEB-SLOPES&apps.pdf (http://saw-reg.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)?**
O Yes ( No
5i. Does this project involve (1) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhammers, mechanized pile drivers, etc.?*
Yes No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
NCNHP database; USFWS IPaC; in -field surveys. As of July 22, 2021, the USFWS IPaC
lists West Indian manatee, American Alligator, and Neuse River waterdog as having ranges
that potentially overlap the project area. NLEB, Atlantic sturgeon, and bald eagle were also
Consultation Documentation Upload
Click the upload button or drag and drop files here to attach document
Upload
Forlines Force Main—USFWS Self Certification Package_08262021.pdf 3.16MB
USFWS Self Certification Response Email.pdf 121.37KB
File type must be PDF
6. Essential Fish Habitat (Corps Requirement)
Ga. Will this project occur in or near an area designated as an Essential Fish Habitat?*
^ Yes U No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
NOAA EFH Mapper
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/ (http://gis.ncdcr.gov/h/hpoweb
X
X
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 OQ No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
HPOWEB 2.0
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10/26/21, 8:36 AM Resume Submission
7c. Historic or Prehistoric Information Upload
Click the upload button or drag and drop files here to attach document
Upload
File must be PDF
8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https://msc.fema.gov/portal/search (https://msc.fema.gov/portal/search)
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
Q Yes No
8b. If yes, explain how project meets FEMA requirements:
No Rise Certification from will be obtained for installation of generator at Forlines Rd pump
station.
8c. What source(s) did you use to make the floodplain determination?*
FEMA Floodplain Maps
Miscellaneous
Comments
Miscellaneous attachments not previously requested.
Click the upload button or drag and drop files here to attach document
Upload
Greenville Utilities Commission_Forlines Force Main_Scoping Meeting Request.pdf 15.61MB
File must be PDF or KMZ
Signature
*
❑ By checking the box and signing below, I certify that:
X
u
The project proponent hereby certifies that all information contained herein is true, accurate, and complete to the best of my knowledge and belief'; and
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.
• 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.
https://edocs.deq.nc.gov/Forms/form/resume/675/109155 15/16

10/26/21, 8:36 AM
Resume Submission
Full Name:*
Signature*
Sign
Date
Date will be captured on form submission
Save as Draft
https://edocs.deq.nc.gov/Forms/form/resume/675/109155 16/16