20200597 Ver 2_401 Application_20220217

Project Submittal Interim Form
NORTH CAROLINA
Envlronm¢ntcl avofiry
Updated September 4, 2020
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.
Project Type: *
For the Record Only (Courtesy Copy)
New Project
Modification/New Project with Existing ID
More Information Response
Other Agency Comments
Pre -Application Submittal
Re-Issuance\Renewal Request
Stream or Buffer Appeal
Project Contact Information
Name: David Cooper
Who is submitting the information?
Email Address:*
[e-mail]
Project Information
Existing ID #: *
20200597
20170001 (no dashes)
Project Name: *
Big Branch Sewer Improvements
Is this a public transportation project?*
Yes
No
Existing Version: *
1
Is the project located within a NC DCM Area of Environmental Concern (AEC)?*
Yes No Unknown
County (ies)*
Wake
Please upload all files that need to be submited.
Click the upload button or drag and drop files here to attach document
BigBranchSewer_PermitModNarrative_20220118.pdf 47.12MB
Only pdf or kmz files are accepted.

Describe the attachments or add comments:
The Big Branch Sewer Improvement project has changed since the original 401/404 certification. Design
changes resulted in revised configuration of sewer easement and slight modification to the limits of disturbance.
Stream and wetland impacts are reduced, and buffer impacts are slightly increased. Please see the attached
narrative, with revised permit drawings, and construction drawings.
By checking the box and signing box below, I certify that:
• I, the project proponent, hereby certifies that all information contained herein is true, accurate, and complete to the
best of my knowledge and belief.
• I, 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 agree that submission of this online 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 online form.
Signature: *
&apet
Submittal Date: Is filled in automatically once submitted.

January 18, 2022
Ms. Stephanie Goss
NC Department of Environmental Quality
Division of Water Resources
Raleigh Regional Office
3800 Barrett Drive
Raleigh, North Carolina 27609
Mr. Lyle Phillips
US Army Corps of Engineers
Raleigh Regulatory Field Office
3331 Heritage Trade Drive
Suite 105
Wake Forest, North Carolina 27587
www.vhb.com
AO
\ihb.
Subject: Modification to Neuse Riparian Buffer Authorization and Section 401 Water Quality Certification for the
Big Branch Sewer Improvement project in Raleigh, Wake County, NC.
References: NCDWR Project #20-0597 Water Quality Certification and Neuse Riparian Buffer Authorization, issued July
23, 2020
USACE Project # SAW-2019-01842 NWP 12 Verification, issued July 29,2020
Ms. Goss and Mr. Phillips:
VHB, on behalf of Highfill Infrastructure Engineering and the City of Raleigh, submitted an application for a Section 404
Nationwide Permit 12, Section 401 Water Quality Certification, and Neuse Riparian Buffer Authorization in May 2020. The
401 Water Quality Certification and Neuse Riparian Buffer Authorization was received on July 23, 2020, and the NWP 12
verification was received on July 29, 2020.
Since the time of the approval, additional coordination and information resulted in changes to the construction drawings,
which affect the riparian buffer and stream impacts. We are submitting this modification based on the revised impacts. The
revisions to the construction drawings resulted in a decrease of stream and wetland impacts from the original submittal.
One crossing of Big Branch was able to be removed from the design, resulting in lower temporary and permanent stream
impact amounts, and easement expansion was able to be eliminated in another area, resulting in less mechanized clearing
impact in a wetland. Buffer impact amounts are slightly greater than those in the original submittal.
Mitigation for impacts to riparian buffers in the amount of 63,699 credits was was provided by RES through two private
mitigation banks. The revisions to the riparian buffer impacts will require the purchase of an additional 2,568 riparian buffer
mitigation credits. A Statement of Availability for the additional credits is attached.
Specific changes to sites, impacts, and mitigation amounts are detailed in the bullet points and tables that follow. A full set
of updated construction drawings and buffer permit drawings, and two revised plan sheets and calculations showing the
smaller wetland impact and the removal of the stream crossing impact from the surface water and wetland permit drawings
are attached for reference.
We are currently requesting a modification to the existing 401 Water Quality Certification and Riparian Buffer Authorization,
and a Nationwide Permit 58 to authorize the above revisions. Thank you for your assistance with this project. If you have
any questions or need additional information, please contact David Cooper at [e-mail] or [phone].
Sincerely,
David G. Cooper
Senior Environmental Scientist
Engineers I Scientists I Planners I Designers
cc: Matthew Cotton, PE, City of Raleigh
Eddie Sasser, PE, Highfill
Venture I
940 Main Campus Drive, Suite 500
Raleigh, North Carolina 27606
P 919.829.0328
F 919.833.0034

Detailed revisions to sites, impacts, and mitigation amounts — Big Branch Sewer Improvements
• The width of the existing sewer easement throughout a portion of the project was discovered to be narrower than
initially shown, resulting in a larger easement expansion area and increased buffer impacts between the existing and
proposed easement (Buffer Sites 7, 8, and 9, Sheets SS-1.2 and 1.3).
• Limits of disturbance were able to be lessened in one location, resulting in less buffer impact (Buffer Site 3, Sheet SS-
1.1)
• Additional easement was required in one location for tree removal, resulting in additional buffer impacts (Buffer Site 7,
Sheet SS-1.3).
• A perpendicular stream crossing was able to be omitted, and the buffer impact changed to entirely parallel easement
expansion (Buffer Site 8). Temporary and permanent stream impacts to Big Branch are no longer needed in this location
(Wetland/Surface Water Permit Drawing Site 1, Sheet SS-1.3).
• Re-evaluation of the previous buffer impacts during revision of the permit drawings resulted in adding a small area of
maintained yard to buffer impacts due to the change of use for the easement expansion (Buffer Site 8, Sheet SS-1.3).
• Additional sewer replacement entirely under Cheswick Drive resulted in the need for an additional plan sheet in the
drawings (Sheet SS-1.8). No additional impacts resulted from this addition.
• Easement expansion was eliminated from Station 64+25 to St. Albans Drive, reducing (Buffer Site 12) or eliminating
(Buffer Sites 13 and 14) buffer impacts (Sheets SS-1.5 and SS-1.6). This change also reduced the mechanized clearing
wetland impact (Wetland/Surface Water Permit Drawing Site 5).
Table 1. Big Branch Sewer Improvements: Riparian Buffer Impact Revisions (sq. ft.)
Site
No.„
Zone 1
Allowable
Original
Zone 1
Allowable
Revised
Diff.
Zone 1
Mitigable
Original
Zone 1
Mitigable
Revised
Diff.
Zone 2
Allowable
Original
Zone 2
Allowable
Revised
Diff.
Reason
Buffer
3
0 (No Change)
667 (No Change)
0
2,678
2,429
-249
Reduced limits
of disturbance.
Buffer
7
0 (No Change)
1,859
4,071
+2,212
3,103
5,371
+2,268
Additional
easement
expansion
impacts.
Buffer
8
1,330
0
-1,330
0
1,432
+1,432
151
366
+215
Perpendicular
crossing no
longer needed.
Additional
easement
expansion
impacts.
Buffer
9
0 (No Change)
1,770
2,675
+905
11,007
12,175
+1,168
Additional
easement
expansion
impacts.
Buffer
12
0 (No Change)
7,183
5,072
-2111
5,150
3,495
-1,655
Eliminated
portion of
easement
expansion
impact.
Buffer
13
617
0
-617
0 (No Change)
357
0
-357
Eliminated
easement
expansion
impact.

Site
No.A
Zone 1
Allowable
Original
Zone 1
Allowable
Revised
Diff.
Zone 1
Mitigable
Original
Zone 1
Mitigable
Revised
Diff.
Zone 2
Allowable
Original
Zone 2
Allowable
Revised
Diff.
Reason
Buffer
14
0 (No Change)
1,582
0
-1,582
948
0
-948
Eliminated
easement
expansion
impact.
^Sites not listed had no changes to impacts
Table 2. Big Branch Sewer Improvements: Surface Water Impact Revisions (linear ft. / acres)
Site
No.
Permanent
Stream
Original
Permanent
Stream
Revised
Diff.
Temporary
Stream Original
Temporary
Stream Revised
Diff.
Reason
Stream
1
33 / 0.030
0 / 0.000
33 /
-0.030
34 / 0.032
0 / 0.000
-34 /
-0.032
Stream crossing of Big
Branch no longer needed.
^Sites not listed had no changes to impacts
Table 3. Big Branch Sewer Improvements: Wetland Impact Revisions (acres)
Site No."
Mechanized Wetland Clearing
Original
Mechanized Wetland Clearing
Revised
Diff.
Reason
Wetland 1
(Permit
Drawing Siteexpansion
5)
0.145
0.115
-0.030
Eliminated easement
impact.
^Sites not listed had no changes to impacts
Table 4. Big Branch Sewer Improvements: Revised Total Riparian Buffer Impacts and Mitigation (sq. ft.)
Mitigation
requirements
(sq. ft.)
Allowable
Original
Allowable
Revised
Mitigable
Original
Mitigable
Revised
Mitigation
Original
Mitigation
Revised
Additional
Mitigation
Needed
Zone 1
impact
5,539
3,592
21,233
22,089
63,699
(21,233 x 3)
66,267
(22,089 x 3)
66,267 — 63,699 =
2,568
Zone
ct
32,134
32,576
0
0
0
0

NORTH CAROLINA
Environmental Quality
Water Resources
Office Use Only
Corps Action ID no. SAW-2019-01842 Date received: [Click to enter.]
DWR project no. 20-0597 Date received: [Click to enter.]
Site Coordinates:
Latitude (DD.DDDDDD): 35.835519
Longitude (DD.DDDDDD): -78.626184
Form Version 4, April 4, 2021
Pre -Construction Notification (PCN) Form
(Ver. 4, April 4, 2021))
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.mil/Missions/Regulatory-Permit-Program/Permits/2017-Nationwide-
Permits/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) *: Permit mod. to an existing permit.
DWR ID # 20-0597 Version 2 (If applicable)
Page 1 of 22 PCN Form - Version 1.5, September 2020

A. Processing Information
County (counties) where project is located: *
Wake Additional (if needed).
Is this a NCDMS project? *
(Click yes only if NCDMS is the applicant or co-
applicant)
❑ Yes Z No
Is this a public transportation project? *
(Publicly funded municipal, state, or federal road, rail,
or airport project)
❑ Yes Z No
Is this a NCDOT project? *
E Yes ❑x No
If yes, NCDOT TIP or state project number:
Click to enter.
If yes, NCDOT WBS number: *
Click to enter.
1 a. Type(s) of approval sought from the Corps: *
❑x Section 404 Permit (wetlands, streams, waters,
Clean Water Act)
E Section 10 Permit (navigable waters, tidal
waters, Rivers and Harbors Act)
Has this PCN previously been submitted? *
❑x Yes E No
Please provide the date of the previous submission. *
Click to enter a date.
1 b. What type(s) of permit(s) do you wish to seek
authorization? *
❑x Nationwide Permit (NWP)
E 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 attachments and
submitted with this form.
1 c. Has the NWP or GP number been verified by the Corps? *
Z Yes ❑ No
NWP number(s) (list all numbers ):
58
RGP number(s) (list all numbers ):
Click to enter.
Are you a federal applicant?
❑ Yes Z No
If yes, please provide a statement concerning compliance with the Coastal Zone Management Act *
Click to enter text.
ld. Type(s) of approval sought from DWR (check all that apply): *
❑x 401 Water Quality Certification — Regular ❑ 401 Water Quality Certification— Express
❑ Non-404 Jurisdictional General Permit ❑x Riparian Buffer Authorization
E Individual 401 Water Quality Certification
Page 2 of 22 PCN Form - Version 1.5, September 2020

Pre -Filing Meeting Information
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.
To read more information on when this form is needed prior to application submission:
https://www.epa.gov/sites/production/files/2020-07/documents/clean water act section 401 certification rule.pdf
To view the form: https://edocs.deq.nc.gov/Forms/DWR-Pre-Filing-Meeting-Request
Is this a courtesy copy notification
❑ Yes ❑x No
1 e.
Is this notification solely for the record because written approval is not required? *
For the record only for DWR 401 Certification: *
❑ Yes ❑x No
For the record only for Corps Permit: *
❑ Yes ❑x No
1f.
Is this an after -the -fact permit/certification application? *
❑ Yes © No
1g.
Is payment into a mitigation bank or in -lieu fee program proposed for
mitigation of impacts?
r Yes E 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 3 of 22 PCN Form - Version 1.5, September 2020

B. Applicant Information
la.
Who is the primary contact?
David G. Cooper
1b.
Primary Contact Email:
[e-mail]
lc.
Primary Contact Phone: (###)###-####
[phone]
ld.
Who is applying for the permit/certification?
all that apply)
(check
®Owner ❑Applicant (other than owner)
le.
Is there an agent/consultant for this project?
0 Yes ❑ No
2. Landowner Information
2a. Name(s) on Recorded Deed:
City of Raleigh Public Utilities Dept.
2b. Deed Book and Page No.:
Click to ente,
2c. Contact Person (for corporations):
Matthew Cotton, P.E. — Construction Projects
Administrator
2d. Address
Street Address:
1 Exchange Plaza
Address line 2:
#620
City:
Raleigh
State/ Province/ Region:
NC
Postal/ Zip Code:
27601
Country:
USA
*
[phone]
2e. Telephone Number: (lllllt)###-Illlll#
Click to enter.
2f. Fax Number: (11111)llllll-####
2g. Email Address: *
[e-mail]
3.
Applicant Information (if different from owner)
3a.
Name: *
Click to enter.
3b.
Business Name (if applicable):
Click to enter.
3c.
Address: *
Street Address:
Click to enter.
Address line 2:
Click to enter.
City:
Click to enter.
State/ Province/ Region:
Click to enter.
Postal/ Zip Code:
Click to enter.
Country
Click to enter.
3d.
Telephone Number: * (###)###-####
Click to enter.
3e
Fax Number: (###)###-####
Click to enter.
Page 4 of 22
PCN Form - Version 1.5, September 2020

3f. Email Address: *
Click to enter.
4. Agent/ Consultant (if applicable)
4a. Name: *
David G. Cooper
4b. Business Name:
VHB
4c. Address: *
Street Address:
940 Main Campus Drive
Address line 2:
Suite 500
City:
Raleigh
State/ Province/ Region:
NC
Postal/ Zip Code:
27606
Country:
USA
*
(919)74-15784
4d. Telephone Number: (lllllt)###-####
Click to enter.
4e Fax Number: (Illllt)###-####
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 5 of 22 PCN Form - Version 1.5, September 2020

C. Project Information and Prior Project History
1.
Project Information
la.
Name of project: *
Big Branch Sewer
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):
Click to enter.
2b.
Property size (in acres):
Click to enter
2c.
Project Address:
Street Address:
Click to enter.
Address line 2:
Click to enter.
City:
Click to enter.
State/ Province/ Region:
Click to enter.
Postal/ Zip Code:
Click to enter.
Country:
Click to enter.
2d.
Site coordinates in decimal degrees (using 4-6 digits
after the decimal point): *
Latitude (DD.DDDDDD): * 35.835519
Longitude (-DD.DDDDDD): *--78.626184
3.
Surface Waters
3a.
Name of nearest body of water to proposed project: *
Big Branch
3b.
Water Resources Classification of nearest receiving
water: *
C;NSW
The Surface Water Classification map may be found at this link:
https://ncdenr.maps.arcgis.com/apps/webappviewer/index.html?id=6e125ad7628f494694e259c80dd64265
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: *
030202011103
The Find Your HUC map may be found at this link:
https://ncdenr.maps.arcgis.com/apps/Publiclnformation/index.html?appid=ad3a85a0c6d644a0b97cd069db238ac3
Page 6 of 22 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 area consists of an existing sewer line along Big Branch through a primarily residential and
commercial area in north Raleigh.
4b. Have Corps permits or DWR certifications been obtained for this
project (including all prior phases) in the past?
0 Yes ❑ No ❑Unknown
If yes, please give the DWR Certification number and/or Corps
Action ID (ex. SAW-0000-00000):
SAW-2019-01842
#20-059
Attach any pertinent project history documentation
4b2. Is any portion of the work already complete? *
E Yes ® No
If yes, describe the completed work.
Click to enter text.
4c. List of other certifications or approvals/denials received from other federal, state or local agencies for work
described in this application not related to the 404 or 401.
A no -rise certification was coordinated through City of Raleigh stormwater management division.
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:
0.716 acres
4g. List the total estimated linear feet of all existing streams (intermittent
and perennial) on the property:
7,257 linear feet
4g1. List the total estimated acreage of all existing open waters on the
property:
1.685 acres
4h. Explain the purpose of the proposed project:
The project will improve sewer infrastructure by replacing old sewer lines, increasing pipe size as necessary, and
adding sewer lines.
4i. Describe the overall project in detail, including the type of equipment to be used:
The project primarily consists of existing sewer easements which will be widened by mechanized clearing.
Existing sewer pipes in need of repair and upsizing will be excavated via
trenching and replaced. Stream crossings will be open cut, with typical pump -around operations in place to
eliminate sedimentation in streams. Crossings are a angles between 75 and
105 degrees where possible.
4j. Attach project drawings/site diagrams/depictions of impact areas for the proposed project.
4k. Will this activity involve dredging in wetlands or waters? *
E Yes ® No
If yes, describe the type of dredging, the composition of the dredged material, and the locations of disposal area.
Click to enter texi
Page 7 of 22 PCN Form - Version 1.5, September 2020

5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or in
proposed impact areas?
0 Yes ❑ No ❑ Unknown
Comments:
PJD/AJD (for 1 ephemeral feature) is attached, which was provided concurrent with the original permit
verification for this project.
5b. If the Corps made a jurisdictional determination,
what type of determination was made? *
❑x Preliminary ❑x Approved E Emailed concurrence
❑ Not Verified ❑ Unknown ❑ n/a
Corps AID number (ex. SAW-0000-00000):
SAW-2019-01842
5c. If 5a is yes, who delineated the jurisdictional
areas?
Name (if known): David Cooper
Agency/Consultant Company: VHB
Other: Click to enter.
5d. List the dates of the Corps jurisdictional determination or State determination if a determination was made by
either agency.
USACE: PJD/AJD dated 7/29/2020. NCDWR: Please refer to the attached stream origin/buffer applicability
determination dated 2019-10-07.
5d1. Attach jurisdictional determinations.
6.
Future Project Plans
6a.
Is this a phased project?
❑ Yes ❑x No
6b.
If yes, explain.
This is a sewer upgrade project, and is not phased.
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.
Click to enter.
7.
Addresses of adjoining property owners, lessees, etc. whose property adjoins the waterbody (if more than can be
entered here, please attach a supplemental list)
Click to enter.
8.
Scheduling of activity:
Project expected to go to bid as soon as possible, March 2022.
Page 8 of 22 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
❑x Buffers
❑ Pond Construction
❑x 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 #*
2a 1.
Impact
Reason/Type*
2b.
Impact
Duration*
2c.
Wetland Type*
2d.
Wetland Name*
2e.
Forested
?*
2f.
Jurisdiction
Type*
2g.
Impact Area
(ac)*
W1
Mechanized
Clearing
Temporary
Bottomland
Hardwood
Forest
WA
No
Both
0.115
W2
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W3
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W4
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W5
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W6
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W7
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W8
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W9
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W10
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W11
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W12
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W13
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W14
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W15
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
2g1. Total temporary wetland impacts
0.115 ac
2g2. Total permanent wetland impacts
0 ac
2g3. Total wetland impacts
0.115 ac
2h. Type(s) of material being discharged and the amount of each type in cubic yards:
N/A
2i. Comments:
Mechanized clearing impacts have been reduced from the prior approval due to avoiding easement expansion in
this area. Sewer will be replaced only within the existing easement in this vicinity.
Page 9 of 22
PCN Form - Version 1.5, September 2020

Page 10 of 22 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*
3b.
Impact
Duration*
3c.
Impact Type*
3d.
Stream Name*
3e.
Stream
Type*
3f.
Jurisdiction
Type*
3g.
Stream Width
(avg ft) *
3h.
Impact length
(linear ft) *
S1
Sewer
replacement,
stream
stabilization
Permanent
Fill (Incl.
Riprap)
Site 1, Big
Branch
Perennial
Both
20
0
S2
Erosion
Control
Temporary
Dewatering
Site 1, Big
Branch
Perennial
Both
20
0
S3
Erosion
Control
Temporary
Dewatering
Site 2, SA
Intermittent
Both
5
21
S4
Replace
existing sewer
Permanent
Fill (Incl.
Riprap)
Site 3, Big
Branch
Perennial
Both
20
40
S5
Erosion
Control
Temporary
Dewatering
Site 3, Big
Branch
Perennial
Both
20
30S
S6
Sewer
abandonment
Temporary
Dewatering
Site 4, Big
Branch
Perennial
Both
20
83
S7
Replace
existing sewer
Permanent
Fill (Incl.
Riprap)
Site 5, SE
Perennial
Both
5
17
S8
Erosion
Control
Temporary
Dewatering
Site 5, SE
Perennial
Both
5
30
S9
Replace
existing sewer
Permanent
Fill (Incl.
Riprap)
Site 6, Big
Branch
Perennial
Both
20
22
S10
Erosion
Control
Temporary
Dewatering
Site 6, Big
Branch
Perennial
Both
20
30
S11
Replace
existing sewer
Permanent
Fill (Incl.
Riprap)
Site 7, Big
Branch
Perennial
Both
20
42
S12
Erosion
Control
Temporary
Dewatering
Site 7, Big
Branch
Perennial
Both
20
30
S13
Manhole
protection
Permanent
Bank
Stabilization
Site 8, Big
Branch
Perennial
Both
20
45
S14
Manhole
protection
erosion control
Temporary
Dewatering
Site 8, Big
Branch
Perennial
Both
20
0
S15
Replace
existing sewer
Permanent
Fill (Incl.
Riprap)
Site 9, Big
Branch
Perennial
Both
20
31
S16
Erosion
Control
Temporary
Dewatering
Site 9, Big
Branch
Perennial
Both
20
30
S17
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose
one
Click to enter
Click to enter
S18
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose
one
Click to enter
Click to enter
S19
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose
one
Click to enter
Click to enter
Page 11 of 22
PCN Form - Version 1.5, September 2020

S20
Click to enter
Temp/ Perm
Choose one
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:
197 linear ft
3i3. Total temporary stream
impacts:
254 linear ft
3i4. Total stream and ditch
impacts:
451 linear ft
3j. Comments:
Stream Impacts at Site 1 have been eliminated as compared to the previous approval.
Site 8 bank stabilization has same linear footage of stream impact for permanent riprap bank stabilization and
temporary dewatering/erosion control. The permanent stream impacts primarily result from riprap stream bed
stabilization where open cut sewer replacement will take place. Riprap to be installed per the attached plan set
at stream bed elevation.
Page 12 of 22 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 #*
4a1.
Impact Reason
4b.
Impact
Duration*
4c.
Waterbody Name*
4b.
Activity Type*
4e.
Waterbody
Type*
4f.
Impact area
(ac)*
01
Replace foot bridge,
stabilization
Permanent
PA
Bank
Stabilization/ Fill
(Incl. Riprap)
Pond
0.004
02
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
03
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
04
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
05
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
4g. Total temporary open water impacts
0 ac
4g. Total permanent open water impacts
0.004 ac
4g. Total open water impacts
0.004 ac
4h. Comments:
Pond impact 0.004 acre for riprap stabilization below replacement of existing foot bridge.
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.
P3
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 13 of 22
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
❑ 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
Utility Lines
Permanent
Site 1, Big Branch
Yes
1406
0
B2
Utility Lines
Permanent
Site 1, Big Branch
No
0
1290
B3
Utility Lines
Permanent
Site 2, Big Branch
Yes
733
0
B4
Utility Lines
Permanent
Site 2, Big Branch
No
0
712
B5
Utility Lines
Permanent
Site 3, Big Branch
Yes
667
0
B6
Utility Lines
Permanent
Site 3, Big Branch
No
0
2429
B7
Utility Lines
Permanent
Site 4, Big Branch
Yes
107
0
B8
Utility Lines
Permanent
Site 4, Big Branch
No
0
190
B9
Utility Lines
Permanent
Site 5, Big Branch
Yes
330
0
B10
Utility Lines
Permanent
Site 5, Big Branch
No
0
1430
B11
Utility Lines
Permanent
Site 6, Big Branch
Yes
15
0
B12
Utility Lines
Permanent
Site 6, Big Branch
No
0
294
B13
Utility Lines
Permanent
Site 7, Big Branch
Yes
4071
0
B14
Utility Lines
Permanent
Site 7, Big Branch
No
0
5371
B15
Utility Lines
Permanent
Site 8, Big Branch
Yes
1432
0
B16
Utility Lines
Permanent
Site 8, Big Branch
No
0
366
B17
Utility Lines
Permanent
Site 9, Big Branch
Yes
2675
0
B18
Utility Lines
Permanent
Site 9, Big Branch
No
0
12175
B19
Utility Lines
Permanent
Site 10, Big Branch
Yes
2306
0
B20
Utility Lines
Permanent
Site 10, Big Branch
No
0
1566
6h. Total temporary impacts:
Zone 1: 0 sq ft
Zone 2: 0 sq ft
6h. Total permanent impacts:
Zone 1: 25681 sq ft
Zone 2: 32567 sq ft
6h. Total combined buffer impacts:
Zone 1: 25681 sq ft
Zone 2: 32567 sq ft
6i. Comments:
Please refer to the additional impacts documented on the attached continuation of this table for B21 through B31
buffer impacts.
Please attach supporting documentation (impact maps, plan sheets, etc.) for the proposed project.
Page 14 of 22 PCN Form - Version 1.5, September 2020

Buffer Impact Table (continued)
Site #*
6b. Impact
Type*Impact*(sqft)Impact*(sqft)
6c. Impact
Duration*
6d. Stream Name*
6e. Buffer
Mitigation
Required?*
6f. Zone 1
p
6g. Zone 2
p
B21
Utility Lines '
Permanent
Site 11, SC
No
3059
1067
B22
Utility Lines
Permanent
Site 12, Big Branch
Yes
5072
0
B23
Utility Lines
Permanent
Site 12, Big Branch
No
0
3495
B24
Utility Lines
Permanent
Site 13, SE Impact
Eliminated
No
0
0
B25
Utility Lines
Permanent
Site 14, Big Branch
Impact Eliminated
No
0
0
B26
Utility Lines
Permanent
Site 15, Big Branch
Yes
1737
0
B27
Utility Lines
Permanent
Site 15, Big Branch
No
0
654
B28
Utility Lines
Permanent
Site 16, Big Branch
Yes
1538
0
B29
Utility Lines
Permanent
Site 16, Big Branch
No
0
1250
B30
Utility Lines
Permanent
Site 17, Big Branch
No
231
204
B31
Utility Lines
Permanent
Site 18, Big Branch
No
302
83

E. Impact Justification and Mitigation
1.
Avoidance and Minimization
la.
Specifically describe measures taken to avoid or minimize the proposed impacts through project design: *
The sewer improvement project follows, for the most part, the existing sewer lines and is within existing sewer
easement. New easement was needed in some areas. Easements have been kept away from aquatic resources
where practicable. This permit modification removes one crossing of Big Branch and eliminates easement
expansion impacts within a wetland.
1b.
Specifically describe measures taken to avoid or minimize proposed impacts through construction techniques: *
Sedimentation will be controlled by pump -around operations where open cut will be used to replace the existing
sewer lines. Riprap stream stabilization will reduce the likelihood of future instability in the reaches that will be
open cut.
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)
❑x 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
15
3.
Complete if using a Mitigation Bank (Must satisfy NC General Statute143-214.11 (d1).)
3a.
Name of mitigation bank:
EBX-Neuse I, LLC or EBX Upper Neuse
3b.
Credits purchased/requested:
Type: Riparian Buffer
Quantity 2568
Type: Choose one
Quantity Click to enter.
Type: Choose one
Quantity Click to enter.
Attach receipt and/or approval letter.
3c.
Comments:
Prior mitigation payments were made for the amount of 63699 buffer credits were previously made as described
in the cover letter. The Buffer SOA for the additional 2568 buffer credits required for this permit modification is
attached.
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
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
Page 15 of 22
PCN Form - Version 1.5, September 2020

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 mitigation credits generated.
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?
❑ No
@ Yes
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
Changes to Utility /
Easement Expansion
856 (greater than
previous approval for
which mit. is already
paid)
3
2568
Zone 2
0
0
1.5
0
6f. Total buffer mitigation required
2568
6g. If buffer mitigation is required, is payment to a mitigation bank or
NC Division of Mitigation Services proposed?
❑ No
►_ Yes
6h. If yes, attach the acceptance letter from the mitigation bank or NC Division of Mitigation Services.
6i. Comments:
As noted in cover letter and above, mitigation for 21,233 sf of buffer impact in the amount of 63,699 buffer credits
has been paid. This permit mod. documents the changes to buffer impacts which resulted in an additional 856 sf
of Zone 1 mitigable impact at 3:1, requiring the purchase an additional 2568 buffer credits.
Page 16 of 22 PCN Form - Version 1.5, September 2020

F. Stormwater Management and Diffuse Flow Plan (DWR requirement)
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?
0 Yes ❑ 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/dispersed 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
E Vegetated Conveyance (lower seasonal high water table- SHWT)
❑ Wetland Swale (higher SHWT)
❑ Other SCM that removes minimum 30% nitrogen
❑x 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 ❑x No
2b.
Does this project meet the requirements for low density projects as
defined in 15A NCAC 02H .1003(2)? *
❑x Yes ❑ No
To look up low density requirements, click here:
http://reports.oah.state. nc. us/ncac/title%2015a%20-%20environ mental%20q ua lity/chapter%2002%20-
%20environmental%20management/su bchapter%20h/ 15a%20ncac%2002h%20.1003. pdf
2c.
Does this project have a stormwater management plan (SMP)
reviewed and approved under a state stormwater program or state -
approved local government stormwater program? *
E Yes ❑x No
❑ n/a — project disturbs < 1 acre
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.
2d.
Which of the following stormwater management program(s) apply?
(Check all that apply.)*
❑ Local Government
E State
If you have local government approval, please include the SMP on their overall impact map.
Local Government Stormwater Programs *
El Phase II ❑ USMP
❑ NSW E Water Supply
Page 17 of 22
PCN Form - Version 1.5, September 2020

Please identify which local government stormwater program you are using. *
Click to enter.
State Stormwater Programs *
❑ Phase II
❑ Coastal Counties
❑ HOW or ORW
❑ Other
Comments:
Click to enter.
Page 18 of 22 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? *
E No
A Yes
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)? *
El Yes
®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:
Project is funded by the City of Raleigh.
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),
Federally Non -Jurisdictional Wetlands /Classified Surface Waters
(15A NCAC 2H. 1400) DWR Surface Water or Wetland Standards or
Riparian Buffer Rules (15A NCAC 2B .0200)? *
E Yes
® 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 project is a result of existing degraded and undersized infrastructure, and is not expected to increase
development in the surrounding area, which is already developed.
3c.
If yes, provide a qualitative or quantitative cumulative impact analysis in accordance with the most recent DWR
policy. (Attach .pdf)
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project? *
❑ Yes ❑x 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.
Click to enter.
Page 19 of 22
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.gov]) *
® Yes ❑ No
5b. Have you checked with the USFWS concerning Endangered Species
Act impacts? *
® Yes ❑ No
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. Is another federal agency involved? *
Yes ❑ No ❑ Unknown
If yes, which federal agency?
FEMA
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.?
0Yes El No
5g. Does this project involve bridge maintenance or removal? *
❑ Yes ❑x No
5g1. If yes, have you inspected the bridge for signs of bat use such as
staining, guano, bats, etc.? Representative photos of signs of bat use
can be found in the NLEB SLOPES, Appendix F, pages 3-7.
❑ Yes ❑ No
Representative photos of signs of bat use can be found in the NLEB SLOPES, Appendix F, pages 3-7. Link to
NLEB SLOPES document: http://saw-reg.usace.army.mil/NLEB/1-30-17-signed NLEB-SLOPES&apps.pdf
If you answered yes to 5g1, did you discover any signs of bat use? *
❑ Yes ❑ No ❑ Unknown
If yes, please show the location of the bridge on the permit drawings/ project plans
5h. Does this project involve the construction/ installation of a wind
turbine(s)? *
El Yes ❑x 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 ❑x 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? *
VHB reviewed the current list of USFWS protected species for Wake County, NC and submitted biological
conclusions based on on -site habitat evaluation and species surveys to the Raleigh field office. The self -certify
letter was submitted on Sept. 16, 2019 and no comment was received within 30 days, indicating concurrence
with our conclusions. All conclusions were No Effect or May Affect, Not Likely to Adversely Affect, with
the exception of the Northern Long-eared bat, for which the project relies on the findings of the 1/5/2016 PBO.
The NLEB is also not currently listed in Wake County.
Attach consultation documentation.
6. Essential Fish Habitat (Corps Requirement)
Page 20 of 22
PCN Form - Version 1.5, September 2020

6a.
Will this project occur in or near an area designated as
an Essential Fish Habitat?
El Yes ❑x No
Is there submerged aquatic vegetation (SAV) around
the project vicinity? *
❑ Yes ❑x No ❑ Unknown
Will this project affect submerged aquatic vegetation? *
❑ Yes ❑x No ❑ Unknown
Explain: No SAV is present.
6b.
What data source(s) did you use to determine whether your site would impact Essential Fish Habitat? *
NOAA EFH mapper shows no EFH in the project vicinity.
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 ©No
7b.
What data source(s) did you use to determine whether your site would impact historic or archeological
resources? *
The SHPO HPOweb mapping indicates no historic structures within the project corridor. The project is within an
area that is highly developed and does not contain any potentially historic structures. The majority of the project
will replace existing sewer line.
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? *
0 Yes ❑ No
8b.
If yes, explain how the project meets FEMA requirements.
The project was coordinated as a No -Rise Certification through the City of Raleigh stormwater management
division.
8c.
What source(s) did you use to make the floodplain determination?
FEMA FIRM panel shows the project is within the 100-year floodplain.
H. Miscellaneous
Comments:
Click to enter.
Attach pertinent documentation or attachments not previously requested
Page 21 of 22 PCN Form - Version 1.5, September 2020

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: * David G. Cooper
Signature: * Click to enter. �G2
Date: * 2/17/2022
Page 22 of 22 PCN Form - Version 1.5, September 2020