20220117 Ver 1_Pre-Construction Notification (PCN) Form_Glenwood_02102022_supplemental_20220210

DWR
IDIOM— of Water Resources
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
December 6, 2021 Ver 4.2
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.govfVVaterResources/0/edoc/624704/PCN / 2OHelp/ 2OFile/ 202018-1-30.pdf
A. Processing Information
County (or Counties) where the project is located:"
Wake
Is this a NCDMS Project"
0Yes ONo
Click Yes, only if NCD MS is the applicant or co -applicant.
Is this project a public transportation project?"
0Yes ONo
This is any publicly funded by municipal,state or federal funds road, rail, airport transportation project.
la. Type(s) of approval sought from the Corps:"
❑O 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?"
O Yes
O 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)
1c. Has the NWP or GP number been verified by the Corps?"
0Yes ONo
Nationwide Permit (NWP) Number:
NWP Numbers (for multiple NWPS):
List all NVV numbers you are applying for not on the drop down list.
1 d. Type(s) of approval sought from the DWR:
check all that apply
❑O 401 Water Quality Certification - Regular
❑ Non-404 Jurisdictional General Permit
❑ Individual 401 Water Quality Certification
58 - Utility Line Activities for Water and Other Substances (frequently used)
le. Is this notification solely for the record because written approval is not required?
❑ 401 Water Quality Certification - Express
Rparlan Buffer Authorization
Should not be
checked.
For the record only for DWR 401 Certification: O Yes O No
For the record only for Corps Permit: O Yes O No
1f. Is this an after -the -fact permit application?"
u Yes O 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.
0 Yes OO No

Acceptance Letter Attachment
Click the upload button or drag and drop files hereto attach document
FILE TYPE MUST BE PDF
1 h. Is the project located in any of NC's twenty coastal counties?"
Yes • No
1j. Is the project located in a designated trout watershed?"
U Yes OO No
Linkto trout information: http://www.saw.usace.army.miI/Missions/Regulatory-Permit-Program/Agency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact?"
Jessica Tisdale
1c. Primary Contact Phone:"
1 b. Primary Contact Email" (xxx)xxx-xxxx
[e-mail] [phone]
1d. Who is applying for the permit?"
[e Owner ❑ Applicant (other than owner)
(Check all that apply)
1e. Is there an AgentlConsultant for this project?"
Yes No
2. Owner Information
2a. Name(s) on recorded deed:"
City of Raleigh
2b. Deed book and page no.:
2c. Contact Person:
(for Corporations)
Whit Wheeler, PE
2d.Address*
Street Address
222 W. Hargett St.
Address Line 2
City State / Province / Region
Raleigh NC
Postal /Zip Code Country
27601
2e. Telephone Number:"
(xxx)xxx-xxxx
[phone]
2f. Fax Number:
[phone]
(xxx)xxx-xxxx
2g. Email Address:"
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:"
Jessica Tisdale
4b. Business Name:
(if applicable)
HDR Engineering, Inc. of the Carolinas
U

4c. Address"
Street Address
555 Fayetteville Street
Address Line 2
Suite 900
City
Raleigh
Postal /Zip Code
27601
4d. Telephone Number:"
[phone]
4f. Email Address:"
[e-mail]
C. Proiect Information and Prior Proiect History
1. Project Information
1a. Name of project:"
5151 Glenwood Ave
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:"
State / Province / Region
North Carolina
Country
U.S.
4e. Fax Number:
(xxx)xxx-xxxx
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2. Project Identification lJ
2a. Property Identification Number: 2b. Property size:
(tax PIN or parcel ID) (in acres)
2c. Project Address
Street Address
5151 Glenwood Avenue
Address Line 2
City
Raleigh
Postal /Zip Code
27612
State / Province / Region
North Carolina
Country
U.S.
2d. Site coordinates in decimal degrees
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:"
35.844785-78.688098
ex: 34.208504-77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:"
Hare Snipe Creek
3b. Water Resources Classification of nearest receiving water:"
QNSW
Surface Water Lookup
3c. What river basin(s) is your project located in?"
Neuse
3d. Please provide the 12-digit HUC in which the project is located."
030202010803
River Basin Lookup
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 site is located within a City of Raleigh sewer easement which has a sewer line crossing Hare Snipe Creek. The eastern stream bank has eroded behind the existing sanitary sewer
manhole and has compromised the structural integrity of the manhole. The property this easement is located on currently has no use and the property to the west has commercial
buildings.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?"
O Yes O No O Unknown
4f. List the total estimated acreage of all existing wetlands on the property:
none (study area in easement)
4g. List the total estimated linear feet of all existing streams on the property:
(intermittent and perennial)
40 feet (study area in easement)
4h. Explain the purpose of the proposed project:"
The purpose of the project is to stabilize a failing downstream left streambank to protect the stability of a sanitary sewer manhole.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:"
The project will temporarily impact approximately 40 linear feet of Hare Snipe Creek near 5151 Glenwood Ave at 35.8448,-78.6881 decimal degrees. Work will entail creating a dry work
area, establishing a stable toe, constructing a stable bank using rock/geotextile, coir matting or a combination of the two and establishing a stable segment of stream bed at the base of the
bank. It is not anticipated that any tree removals will occur in the buffer zone. The site will be accessed from the existing sanitary sewer easement to the northeast of the site. Erosion
control measures will be installed prior to work. A "pump around" will be established in order to create a dry work area.
Disturbed areas will be reseeded and mulched when work is complete. It is expected that a tire or track -
mounted excavator and a dump truck will be used to place the boulders, reconstruct the streambank,
and stabilize the streambank. Please see the five attached details, "pump around", temporary silt fence, temporary construction entrance, bank stabilization, and seeding details.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?"
Yes No O Unknown
Comments:
Study area in easement
5b. If the Corps made a jurisdictional determination, what type of determination was made?"
O Preliminary O Approved O Not Verified O Unknown O N/A
Corps AID Number:
Example: SAW-2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): N/A
Agency/Consultant Company:
Other:
6. Future Project Plans
6a. Is this a phased project?"
Yes 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 projector 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.
N/A
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
❑ Wetlands OO Streams -tributaries Buffers
C Open Waters O Pond Construction
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".
u
3a. Reason for im pact" (?)
3b.lmpact type"
3c. Type of impact"
3d. S. name"
3e. Stream Type"
M
3f. Type of
Jurisdiction"
3g. S. width"
3h. Impact
length"
S1
Stream bank stabilization
=
Stabilization :]Fepe
Creek
Perennial
Both
15
Average (feet)
40
Qinear feet)
** 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:
40
3i. Total stream and ditch impacts:
40
3j. Comments:
E. Impact Justification and Mitigation
1. Avoidance and Minimization
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:"
See project description in Section CAA.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:"
See attached details referenced in Section CAA.
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?
v Yes No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
This is for notification only.
NC Stream Temperature Classification Maps can be found under the Mitigation Concepts tab on the Wilmington District's RIBITS website.
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
1a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
OO Yes No
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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. 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 SHWi)
Other SCM that removes minimum 30% nitrogen
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
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?"
0Yes ONo
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?"
OYes 0No
To look up low density requirement click here 15A NCAC 02H .1003(2).
Comments:
G. Supplementary Information
u
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
O 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)?"
V Yes
O No
Comments:"
This project is only to provide bank stabilization to protect the existing sanitary sewer manhole.
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?"
O Yes
O No
3b. If you answered "no," provide a short narrative description.
It is a sanitary sewer mantainence project and will not spur development.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?"
v Yes V No O 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?" N H P and PAC
V Yes • No 4�
reports
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?"
attached.
Yes No
5d. Is another Federal agency involved?"
Yes v No
Unknown
5e. Is this a DOT project located within Division's 1-8?"
0Yes ONo
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?"
0Yes ONo
5g. Does this project involve bridge maintenance or removal?"
O Yes 0• No
Link to the NLEB SLOPES document: http://saw-reg.usace.army.mil/NLEB/1-30-17-signed_NLEB-SLOPES&apps.pdf An N H P and I PAC report
5h. Does this project involve the construction/installation of a wind turbine(s)?*" were ran for the project
O Yes o No area. We anticipate a "No
pp pp��..}}n n1- a ��,.}}
5i. Does this project involve (1) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhamnQ ,Ynbt�han tea p9 r 94, .?"
O Yes o No species due to the small
5j. What data sources did you use t:!4etermine whether your site would impact Endangered Species or Designated Critical Habitat?,scale, short duration of
N/A- not required for notification. the project, no species
listed within 1-mile and
Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?"
Yes
No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?"
NOAA Fish Map
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
Linkto the State Historic Preservation Office Historic Properties Map (does not include archaeological data: http://gis.ncdcr.gov/hpoweb/
the erosion control
measures taken to
protect Hare Snipe Creek.

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)?"
n Yes O No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?"
N/A
8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: F
8a. Will this project occur in a FEMA-designated 100-year floodplain?"
O• Yes O No
8b. Ifyes, explain how project meets FEMA requirements:
No added structures in the floodplain.
8c. What source(s) did you use to make the floodplain determination?"
FEMA Floodplain GIS Map
Miscellaneous
Comments
Supporting information is provided in Attachment A.
Agent Authorization is attached.
v
Please use the space below to attach all required documentation or any additional information you feel is helpful for application review. Documents should be combined into one file when
possible, with a Cover Letter, Table of Contents, and a Cover Sheet for each Section preferred.
Click the upload button or drag and drop files here to attach document
COR_AgentAuthorization . pdf 207.43KB
5151 Glenwood Ave —Attachment A.pdf 5.89MB
File must be PDF or KMZ
Signature
❑O By checking the box and signing below, I certify that:
• 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.
• have given true, accurate, and complete information on this form;
• 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.
Full Name:"
Jessica Tisdale
Signature"
�����?�tll
Date
1/20/2022
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