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Form Version 1.3 Dec 10 2008
Pre - Construction Notification (PCN) Form
A. Applicant Information
1. Processing COURTESY
1 a. Type(s) of approval sought from the
Corps:
®Section 404 Permit [I Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: 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
le. 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 1 h
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:
Cotton Road Water Main
2b. County:
Lee
2c. Nearest municipality / town:
Sanford
2d. Subdivision name:
N/A
2e. NCDOT only, T.1.P. or state N/A
project no:
3. Owner Information
RAI
ND
3a. Name(s) on Recorded Deed:
Town of Sanford
3b. Deed Book and Page No.
A
3c. Responsible Party (for LLC if
applicable):
Paul M. Weeks, P.E. City Engineer
3d. Street address:
225 E. Weatherspoon Drive
3e. City, state, zip:
Sanford, NC 27330
3f. Telephone no.:
919 -777 -1119
3g. Fax no.:
919 - 774 -8179
3h. Email address:
[e-mail]
Page 1 of 12
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:
John R. Davis, Jr.
5b. Business name
(if applicable):
Soil Horizons, Inc.
5c. Street address:
285 Dreamcatcher Trail
5d. City, state, zip:
Youngsville, NC 27596
5e. Telephone no.:
919 -818 -5087
5f. Fax no.:
919 - 5542363
5g. Email address:
[e-mail]
Page 2 of 12

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
NC DOT Right of Way
1 b. Site coordinates (in decimal degrees):
Latitude: 35.541698 Longitude: 79.229116
(DD.DDDDDD) (- DD.DDDDDD)
1c. Property size:
NA acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
Big Buffaloe Creek
proposed project:
2b. Water Quality Classification of nearest receiving water:
C Index 1740
2c. River basin: map is available at
Cape Fear
http:// h2o.enr.state.nc.us/admin/maps/
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:
County road crossing of forested creek ecosystem. Sewer easement nearby.
Proposed 10" water main crossing will be in mowed right of way from Cotton Road.
3b. List the total estimated acreage of all existing wetlands on the property:
None
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
Approximate 30 feet of perennial stream will be impacted by water main crossing.
3d. Explain the purpose of the proposed project:
Established public water supply to residents and businesses of Lee County, NC.
3e. Describe the overall project in detail, including the type of equipment to be used:
Project will include stream bed excavation with excavation and other earth moving equipment so a water pipe can be
buried.
A temporary stream pump around device will be setup while work is being conducted. Temporary devices will be
removed after completion and stream bed will be returned to its normal condition silt fencing and sediment basins will be
installed to keep upland soil disturbance out of waters. 10" HDPE water main will be buried approx. 10 feet below stream
bed.
Page 3 of 12
PCN Form — Version 1.3 December 10, 2008 Version

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?
Comments:
❑ Yes ® No ❑ Unknown
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):
Agency /Consultant Company:
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
S. 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.
Page 4 of 12

C. Proposed Impacts Inventory
1. Impacts Summary
la. Which sections were completed below for your project (check all that apply):
❑ Wetlands ® Streams - tributaries ❑ Buffers
❑ Open Waters ❑ Pond Construction
2. Wetland Impacts N/A
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
Type of jurisdiction
number —
Type of impact
Type of wetland
Forested
(Corps - 404,10
Area of impact
Permanent (P) or
(if known)
DWQ — non -404, other)
(acres)
Temporary
W1 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W2 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W3 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W4 ❑ P [IT
❑ Yes
❑ Corps
❑ No
❑ DWQ
W5 ❑ P [IT
❑ Yes
❑ Corps
❑ No
❑ DWQ
W6 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
2g. Total wetland Impacts
None
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
Temporary (T)
(INT)?
other)
(feet)
feet)
S1 ❑ P ❑ T
Stream bed
excavation
Big Buffaloe Creek
® PER
[I INT
®Corps
® DWQ
18
30
S2 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S3 ❑ P [IT
❑ PER
❑ Corps
❑ INT
❑ DWQ
S4 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S5 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S6 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
3h. Total stream and tributary impacts
30"
3i. Comments: Stream bed conditions will be reestablished after water main is buried.
Page 5 of 12

4. Open Water Impacts N/A
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
Name of waterbody
impact number —
(if applicable)
Type of impact
Waterbody type
Area of impact (acres)
Permanent (P) or
Tem ora
01 ❑ PC] T
02 ❑P ❑T
03 ❑P ❑T
04 ❑P ❑T
4f. Total open water impacts
None
4g. Comments: None
5. Pond or Lake Construction N/A
If pond or lake construction proposed, th en complete the chart below.
5a.
5b.
5c.
5d.
5e.
Wetland Impacts (acres)
Stream Impacts (feet)
Upland
Pond ID
Proposed use or purpose
(acres)
number
of pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
5f. Total
5g. Comments: None
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) N/A
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.
❑ Neuse El Tar-Pamlico El 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
impact
re uired?
61 ❑P [IT
El Yes
❑ No
B2 ❑P ❑T
El Yes
❑ No
B3 ❑P ❑T
El Yes
❑ No
6h. Total buffer Impacts
6i. Comments: None
Page 6 of 12

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
The water main will be crossing the stream in the existing road right of way at the a right angle.
No forest overstory will be impacted.
b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Silt fencing, sediment basins etc. will be installed to keep sediment out of waters. Customary stream pump around
technique will be used to control stream flows during construction to limit sediment in waters.
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
El 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:
Page 7 of 12
PCN Form — Version 1.3 December 10, 2008 Version

6. Complete If Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
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? If yes, you will have to fill out this entire form — please
contact the State for more information.
El 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: WA
Page 8 of 12

E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1 a. 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 El No
Comments:
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project?
%
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 impervious surface will be created by
project.
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 Goverment Stormwater Review
3a. In which local government's jurisdiction is this project?
❑ Phase Il
3b. Which of the following locally- implemented stormwater management programs
❑ NSW
❑ 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
attached?
❑ Yes ❑ No
S. 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 12
PCN Form — Version 1.3 December 10, 2008 Version

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1a. Does the project involve an expenditure of public (federal /state/local) funds or the
® Yes ❑ No
use of public (federal /state) land? Local funds only.
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
❑ Yes ® No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
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
❑ Yes ® No
letter.)
Comments:
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,
❑ Yes ®No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after- the -fad 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
❑ 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.
Project will not spawn nearby development that could degrade waters in the immediate watershed area.
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.
N/A
Page 10 of 12
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?
® 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?
US Fish and Wildlife Ecological Services website and NC Natural Heritage Program websites.
btlp://www.fws.ov /raleigh/species /cnlylist/lee.html
http://www.ncnhp.org/web/nhp /nhp-mgp-viewe
The only federally endangered species found in this general area is the Cape Fear Shiner.
State protected species include freshwater bivalves: Triangle floater, threatened and Brook floater
endangered.
Since the nature of this project involves temporary impacts to the stream bed it is not expected that these
impacts will affect aquatic species. Even though suitable habitat exists in the subject stream for these
species, no detailed assessment of actual individual protected species occurrence was conducted.
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?
Site is located far enough inland that it will not impact 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?
NC State Historic Preservation Office website. http: / /www.hpo.ncdcr.gov/
Closest site is approximately 1,700 feet to the southeast, the Mike Atkins Farm.
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: No above grade fills will be involved in the installation of the water
main.
8c. What source(s) did you use to make the floodplain determination? The NC Floodplain mapping program. See attachdd.
Page 11 of 12

John R. Davis, Jr.
a
Applicant/Agent's Printed Name pplicantlAgenfs Si ature
(Agents signat6fe is valid only if an authorization letter from the applicant
Page 12 of 12
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Youngsville, NC 27596
Date:
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250 -- — -- - - - - -- - -- - - ., -- —
a
240 — — -- - - -- -- - -- ; - - - - -- - - - -- — - -`
230 �—
220 - -- ----------- - -' - -- 200- - - - -- -- - - - -; -- -- - - - -- -
190- - - - - - ----- - - -- -- 41+00 - --
- - - --
O
i
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- - - - -- - -- - - - - - -- - - - -- - -- 250
-- -- - - - - -- - - - - -- - 240
i
- — - -- - - - - -- - -230
-- �- -- - --- -- - - - -- - - -- -- - - -220
- - -'�- - ----------------- - - -� -- -210
- - -, - -- - -- - - - - -- - - - - - -- -200
00- ------- - - - - -- -- -44 +00 -190
PU

1
--q, Cotten Road
}�nrvYru, \Inri¢rnceni
* wpor Cities
+ Bandvnras
y °.s DF1RM Grid
- Rheas and Streams
Tmnsects (CmW)
0 Coraty Boundw ea
® ConsW Bmw Reemnee Systems
Roads
— He Highway
US Highway
MaaES,lnendale Highway
Pastitat Aran
® Exealerribrid Jurisdictions
_ coastal Sounds
1OOyr Flooding - Floodsray (AE) 0 3000 Fee[
1 )
- IODW Flooding - Has OFF, (AE)
® WX FioodIng - Ho WIFS (A)
® 10OW Flooding' WOW Zone
- WOyr Flooding (Shaded X)
North Carolina
-- ease Flaw SMOM (synod) Floodplain Mapping Program
- Crow Sections