20140374 Ver 1_401 Application_20140414

Dewberry
April 7, 2014
Ms. Karen Higgins
Wetlands, Buffer, and Stormwater —
Compliance & Permitting Unit
NC Division of Water Quality
1650 Mail Service Center
Raleigh, North Carolina 27699 -1650
Reference: City of Raleigh
Knightsbridge Way Bank Stabilization
Buffer Permit Application
Dewberry Project No. 50022492
Dear Ms Higgins:
201403T4
Dewberry Engineers Inc
2301 Rexwoods Drive, Suite 200
Raleigh, NC 27607.3366
919881 9939
919 881 9923 fax
www dewberry com
Enclosed are five copes of a Pre - Construction Notification (PCN) Permit Application Package for the City
of Raleigh Knightsbridge Way Bank Stabilization project. For your review we have enclosed five copes of
the PCN Application Form, Attachment A — Additional Information, USGS Quadrangle Map, site photos,
bank stabilization detail, and the $240.00 application fee.
The project titled "Knightsbridge Way Bank Stabilization" consists of replacing in -place an existing
sanitary sewer line that has become eroded and stabilizing the stream bank that is in the proximity. This
activity will occur in a sanitary sewer easement that has not been maintained in the last 10 years
The construction described in this permit application will result in approximately 5,155 square feet of
Zone 1 and 1,603 square feet of Zone 2 buffer impacts within an unmaintained utility easement and 53
linear feet of stream disturbance
Please contact me with any questions regarding this permit application.
Sincerely,
Dewberry Engineers Inc
Matthew W. Watt, PE
Project Engineer
Enclosures
CC Sammy Locklear, Public Utilities
P:\50022492\Adm\Permits\Knightsbridge
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APR 1 0 2014

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20 1 4 0 3 T 4
Office Use Only
Corps action ID no
DWQ project no
Form Version 14 January 2009
Page 1 of 10
PCN Form — Version 1.4 January 2009
Pre - Construction Notification (PCN) Form
A.
Applicant Information
1.
Processing
1a
Type(s) of approval sought from the Corps
® Section 404 Permit ❑ Section 10 Permit
1b Specify Nationwide Permit (NWP) number 13 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 ❑X 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
p Yes ❑ No
For the record only for Corps Permit
59 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 ❑X No
1 g
Is the project located in any of NC's twenty coastal counties If yes, answer 1 h
below
❑ Yes Q No
1h Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes Q No
2.
Project Information
2a
Name of project
Knightsbridge Way Bank Stabilization
2b
County
Wake
2c
Nearest municipality / town
City of Raleigh
2d
Subdivision name
Southhall
2e
NCDOT only, T I P or state project no
3.
Owner Information
3a
Name(s) on Recorded Deed
3b
Deed Book and Page No
3c
Responsible Party (for LLC if
applicable)
City of Raleigh (Public Utilities Department)
3d
Street address
3324 Lake Woodard Drive
3e
City, state, zip
Raleigh, NC 27604
3f
Telephone no •
919 - 996 -4540
3g
Fax no.
919 - 857 -4545
3h
Email address
Page 1 of 10
PCN Form — Version 1.4 January 2009

4.
Applicant Information (if different from owner)
4a
Applicant is
[X] 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
Matthew W Watt, PE
5b
Business name
(if applicable)
Dewberry Engineers Inc (Dewberry)
5c
Street address
2301 Rexwoods Dnve Suite 200
5d
City, state, zip
Raleigh, NC 27607
5e
Telephone no
919- 424 -3749
5f
Fax no
919 -881 -9923
5g
Email address
mwatt @dewberry cam
Page 2 of 10

B. Project Information and Prior Project History
1. Property Identification
1a Property Identification no (tax PIN or parcel ID)
11725827927 000
1b Site coordinates (in decimal degrees)
I Latitude 35 8181 Longitude -78 5658
1c Property size
017 acres
2. Surface Waters
2a Name of nearest body of water to proposed project
Bridges Creek
2b Water Quality Classification of nearest receiving water
C,NSW
2c River basin
Neuse
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
See Attachment A - Additional Information
3b List the total estimated acreage of all existing wetlands on the property 0
3c List the total estimated linear feet of all existing streams (intermittent and perennial) on the property 0
3d Explain the purpose of the proposed project
See Attachment A - Additional Information
3e. Describe the overall project in detail, including the type of equipment to be used
See Attachment A - Additional Information
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?
[] Yes ❑ No ❑X Unknown
Comments
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
5. Project History
5a Have permits or certifications been requested or obtained for
this project (Including all prior phases) in the past?
❑Yes ❑ No ❑X Unknown
5b If yes, explain in detail according to "help file" instructions
6. Future Project Plans
6a Is this a phased project
❑ Yes ❑X No
6b If yes, explain
Page 3 of 10
PCN Form — Version 1.4 January 2009

C. Proposed Impacts Inventory
1. Impacts Summary
1a Which sections were completed below for your protect (check all that apply)
❑ Wetlands ® Streams — tributaries X❑ 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
2a
Wetland impact
number
Permanent (P) or
Temporary
2b
Type of impact
2c
Type of wetland
2d
Forested
2e
Type of jurisdiction
Corps (404,10) or
DWQ (401, other)
2f
Area of
impact
(acres)
)
W1
Choose one
Choose one
Yes /No
-
W2
Choose one
Choose one
Yes /No
W3
Choose one
Choose one
Yes /No
W4
Choose one
Choose one
Yes /No
-
W5 -
Choose one
Choose one
Yes /No
W6
Choose one
Choose one
Yes /No
2g Total
Wetland Impacts:
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
Stream impact
number
Permanent (P) or
Temporary (T)
3b
Type of impact
3c
Stream name
3d
Perennial (PER) or
intermittent (INT)?
3e
Type of
jurisdiction
3f
Average
stream
width
(feet)
3g
Impact
length
(linear
feet)
S1 P
Stabilization
Bridges Creek
I INT
DWQ
5
53
S2
Choose one
S3
Choose one
S4
Choose one
_
S5
Choose one
S6
Choose one
3h Total stream and tributary impacts
53
31 Comments
Page 4 of 10
PCN Form — Version 1 4 January 2009

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 then indiv ually list all open water impacts below
4a
Open water
impact number
Permanent (P) or
Temporary
4b
Name of waterbody
(if applicable)
4c
Type of impact
4d
Waterbody
type
4e
Area of impact (acres)
01
Choose one
Choose
02
Choose one
Choose
03
Choose one
Choose
04
Choose one
Choose
4f Total open water impacts
4g Comments.
5. Pond or Lake Construction
If pond or lake construction proposed, then complete the chart below
5a
Pond ID number
5b
Proposed use or
purpose of pond
5c
Wetland Impacts (acres)
5d
Stream Impacts (feet)
5e
Upland
(acres)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
P1
Choose one
P2
Choose one
5f Total:
5g Comments
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no
51 Expected pond surface area (acres)
5j Size of pond watershed (acres)
5k Method of construction
6. Buffer Impacts (for DWQ)
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. Project is in which protected basin?
❑X Neuse ❑ Tar - Pamlico ❑ Catawba ❑ Randleman ❑ Other
6b
Buffer Impact
number —
Permanent (P) or
Temporary
6c
Reason for impact
6d
Stream name
6e
Buffer
mitigation
required? q
6f
Zone 1
impact
(square
feet
6g
Zone 2
impact
(square
feet
81 P
Bank Stabilization
Bridges Creek
No
5,155
1,603
B2
Yes /No
B3
Yes /No
B4
Yes /No
B5
Yes /No
B6
Yes /No
6h Total Buffer Impacts:
5,155
1,603
61 Comments Sanitary sewer easement has not been maintained within the last 10 years
Page 5 of 10

D. Impact Justification and Mitigation I
1. Avoidance and Minimization
1a Specifically describe measures taken to avoid or minimize the proposed impacts In designing project
See Attachment A- Additional Information
lb Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
Impacts to area will be minimized by confining work area to minimal extents possible and using erosion control devices A pump- around or coffer dams
will be used for the duration of the whole protect to ensure all work occurs in the dry
2. Coin ensato Mitigation for Impacts to Waters of the U S or W t f th
2a Does the project require Compensatory Mitigation for
Impacts to Waters of the U S or Waters of the State?
a ers o e State
[] Yes ❑X No
2b If yes, mitigation is required by (check all that apply)
❑ DWQ ❑ Corps
g
2c If yes, which mitigation option will be used for this
project?
,
❑ Mitigation bank
❑ 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 Choose one
Type Choose one
Type Choose one
Quantity
Quantity
Quantity
3c Comments.
4. Complete if Making a Payment to In -lieu Fee Pro ram
4a Approval letter from in -lieu fee program is attached
❑ Yes
4b Stream mitigation requested
linear feet
4c If using stream mitigation, stream temperature
Choose one
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
5. Complete if Using a Permittee Responsible Mitigation Plan
5a If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan
Page 6 of 10
PCN Form — Version 1 4 January 2009

6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a Will the protect result in an impact within a protected riparian buffer that requires
buffer mitigation?
❑ Yes ❑X 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
6c
6d
6e
Zone
Reason for impact
Total impact
Multiplier
Required mitigation
(square feet)
(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
Page 7 of 10

E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1a Does the project include or is it adjacent to protected riparian buffers Identified Yes ❑ No
within one of the NC Riparian Buffer Protection Rules?
lb If yes, then is a diffuse flow plan Included? If no, explain why
Project will not alter diffuse flow patterns
❑ Yes ❑X No
2. Stormwater Management Plan
2a What Is the overall percent Imperviousness of this project?
0%
2b Does this project require a Stormwater Management Plan?
❑ Yes No
2c If this project DOES NOT require a Stormwater Management Plan, explain why
Disturbed area will be less than 1 acre
2d If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan
2e Who will be responsible for the review of the Stormwater Management Plan?
3. Certified Local Government Stormwater Review
3a In which local government's jurisdiction is this project?
City of Raleigh
❑ Phase II
3b Which of the following locally- implemented stormwater management programs
❑ NSW
apply (check all that apply)
❑ USMP
❑ Water Supply Watershed
n Other None
3c Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
4. DWQ Stormwater Program Review
❑Coastal counties
4a. Which of the following state - implemented stormwater management programs apply
❑HQW
ORW
(check all that apply).
HSession Law 2006 -246
ZOther None
4b Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
5. 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 8 of 10
PCN Form — Version 1.4 January 2009

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
la Does the project Involve an expenditure of public (federal /state /local) funds or the
Yes
El No
use of public (federal /state) land?
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
QX No
(North Carolina) Environmental Policy Act (NEPA /SEPA)?
1 c 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
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,
C] Yes
QX No
or Riparian Buffer Rules (15A NCAC 28 0200)?
2b. Is this an after - the -fact permit application?
❑ Yes
OX 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
development,
❑Yes
MX No
additional 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 alter the capacity of the sanitary sewer collection system
F4. Sewage Disposal (DWG! 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
No wastewater will be generated during this project
Page 9 of 10
PCN Form — Version 1.4 January 2009

S. 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?
5c If yes, indicate the USFWS Field Office you have contacted
-
5d. What data sources did you use to determine whether your site would Impact Endangered Species or Designated Critical
Habitat?
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?
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?
8. Flood tone Designation (Corps Requirement)
8a Will this project occur in a FEMA- designated 100 -year floodplain?
❑ Yes ❑X No
8b If yes, explain how project meets FEMA requirements
8c. What source(s) did you use to make the floodplain determination?
FEMA FIRM Map # 372017250111, Effective May 2, 2006
Ruffin L. Hall
City Manager
City of Raleigh
Post Office Box 590
Raleigh, North Carolina 27602
Applicant/Agent's Printed Name A cant/Agent's S g ature Date
(Agent's nature is valid only if an authonzation
letter from the applicant is provided
Page 10 of 10

O�O� W A TEAOG
y
0 <
Office Use Only
Corps action ID no
DWQ project no
Form Version 1 4 January 2009
Page 1 of 10
PCN Form — Version 1 4 January 2009
Pre - Construction Notification (PCN) Form
A.
Applicant Information
1.
Processing
1a
Type (s) of approval sought from the Corps
❑X Section 404 Permit ❑ Section 10 Permit
1b Specify Nationwide Permit (NWP) number 13 or General Permit (GP) number
1 c
Has the NWP or GP number been verified by the Corps?
❑ Yes ❑ No
1 d
Type(s) of approval sought from the DWQ (check all that apply)
❑ 401 Water Quality Certification — Regular ❑ Non -404 Jurisdictional General Permit
[:1401 Water Quality Certification — Express ❑X 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
❑X Yes ❑ No
For the record only for Corps Permit
❑X 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 ❑X No
1 g
Is the project located in any of NC's twenty coastal counties If yes, answer 1 h
below
❑Yes ❑X No
1h
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes ❑X No
2.
Project Information
2a
Name of project
Knightsbridge Way Bank Stabilization
2b
County
Wake
2c
Nearest municipality / town
City of Raleigh
2d
Subdivision name
Southhall
2e
NCDOT only, T I P or state project no
3.
Owner Information
3a
Name(s) on Recorded Deed
3b
Deed Book and Page No
3c
Responsible Party (for LLC if
applicable)
City of Raleigh (Public Utilities Department)
3d
Street address
3324 Lake Woodard Drive
3e
City, state, zip
Raleigh, NC 27604
3f
Telephone no
919 - 9964540
3g
Fax no
919 - 857 -4545
3h
Email address
Page 1 of 10
PCN Form — Version 1 4 January 2009

4.
Applicant Information (if different from owner)
4a
Applicant is
❑X 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
Matthew W Watt, PE
5b
Business name
(if applicable)
Dewberry Engineers Inc (Dewberry)
5c
Street address
2301 Rexwoods Drive Suite 200
5d
City, state, zip
Raleigh, NC 27607
5e
Telephone no
919 - 424 -3749
5f
Fax no
919- 881 -9923
5g
Email address
mwatt @dewberry com
Page 2 of 10

B.
Project Information and Prior Project History
1.
Property Identification
1a
Property identification no (tax PIN or parcel ID)
1725827927 000
1b
Site coordinates (in decimal degrees)
Latitude 35 8181 Longitude -78 5658
1c
Property size
017 acres
2.
Surface Waters
2a
Name of nearest body of water to proposed project
Bridges Creek
2b
Water Quality Classification of nearest receiving water
C,NSW
2c
River basin
Neuse
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
See Attachment A - Additional Information
3b
List the total estimated acreage of all existing wetlands on the property 0
3c
List the total estimated linear feet of all existing streams (Intermittent and perennial) on the property 0
3d Explain the purpose of the proposed project
See Attachment A - Additional Information
3e Describe the overall project in detail, including the type of equipment to be used
See Attachment A - Additional Information
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?
❑ Yes ❑ No ❑X Unknown
Comments
4b
If the Corps made the jurisdictional determination, what type
of determination was made?
E] 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
5.
Project History
5a
Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
❑Yes ❑ No ❑X Unknown
5b
If yes, explain in detail according to "help file" instructions
6.
Future Project Plans
6a
Is this a phased project?
❑ Yes ❑X No
6b
If yes, explain
Page 3 of 10
PCN Form — Version 1 4 January 2009

C. Proposed Impacts Inventory
1. Impacts Summary
la Which sections were completed below for your project (check all that apply)
❑ Wetlands ❑X Streams — tributaries ❑X 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
2a
Wetland impact
number
Permanent (P) or
Temporary T
2b
Type of impact
2c
Type of wetland
2d
Forested
2e
Type of Jurisdiction
Corps (404,10) or
DWQ (401, other)
2f
Area of
impact
(acres)
W1
Choose one
Choose one
Yes /No
-
W2
Choose one
Choose one
Yes /No
W3
Choose one
Choose one
Yes /No
W4
Choose one
Choose one
Yes /No
W5
Choose one
Choose one
Yes /No
W6
Choose one
Choose one
Yes /No
2g Total Wetland Impacts:
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
Stream impact
number
Permanent (P) or
Temporary (T)
3b
Type of impact
3c
Stream name
3d
Perennial (PER) or
intermittent (INT)?
3e
Type of
Jurisdiction
3f
Average
stream
width
(feet)
3g
Impact
length
(linear
feet)
S1 P
Stabilization
Bridges Creek
INT
DWQ
5
53
S2
Choose one
S3
Choose one
S4
Choose one
S5
Choose one
S6
Choose one
3h Total stream and tributary impacts
53
31 Comments
Page 4 of 10
PCN Form — Version 1 4 January 2009

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 then indiv ually list all open water impacts below
4a
Open water
impact number
Permanent (P) or
Temporary T
4b
Name of waterbody
(if applicable)
4c
Type of impact
4d
Waterbody
type
4e
Area of impact (acres)
01
Choose one
Choose
02
Choose one
Choose
03
Choose one
Choose
04
Choose one
Choose
4f Total open water impacts
4g Comments
5. Pond or Lake Construction
If pond or lake construction proposed, the complete the chart below
5a
Pond ID number
5b
Proposed use or
purpose of pond
5c
Wetland Impacts (acres)
5d
Stream Impacts (feet)
5e
Upland
(acres)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
P1
Choose one
P2
Choose one
5f Total:
5g Comments
5h Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no
51 Expected pond surface area (acres)
5l Size of pond watershed (acres)
5k Method of construction
6. Buffer Impacts (for DWQ)
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. Project is in which protected basin?
❑X Neuse ❑ Tar - Pamlico ❑ Catawba ❑ Randleman ❑ Other
6b
Buffer Impact
number —
Permanent (P) or
Temporary T
6c
Reason for impact
6d
Stream name
6e
Buffer
mitigation
required
6f
Zone 1
impact
(square
feet)
6g
Zone 2
impact
(square
feet
B1 P
Bank Stabilization
Bridges Creek
No
5,155
1,603
B2
Yes /No
B3
Yes /No
B4
Yes /No
B5
Yes /No
B6
Yes /No
6h Total Buffer Impacts:
5,155
1,603
61 Comments, Sanitary sewer easement has not been maintained within the last 10 years
Page 5 of 10

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a Specifically describe measures taken to avoid or minimize the proposed impacts In designing project
See Attachment A- Additional Information
lb Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
Impacts to area will be minimized by confining work area to minimal extents possible and using erosion control devices A pump- around or coffer dams
will be used for the duration of the whole protect to ensure all work occurs in the dry
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
a
2c If yes, which mitigation option will be used for this
project?
❑Mitigation bank
❑ 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 Choose one
Type Choose one
Type Choose one
Quantity
Quantity
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
Choose one
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
5. Complete if Using a Permittee Responsible Mitigation Plan
5a If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan
Page 6 of 10
PCN Form — Version 1 4 January 2009

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?
❑ Yes ❑X 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
6c
6d
6e
Zone
Reason for impact
Total impact
Multiplier
Required mitigation
(square feet)
(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
Page 7 of 10

E.
Stormwater Management and Diffuse Flow Plan (required by DWQ)
1.
Diffuse Flow Plan
1a
Does the project include or is it adjacent to protected riparian buffers identified
❑X 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
Protect will not alter diffuse flow patterns
❑ Yes ❑X No
2.
Stormwater Management Plan
2a
What is the overall percent Imperviousness of this project?
0%
2b
Does this project require a Stormwater Management Plan?
❑ Yes ❑X No
2c
If this project DOES NOT require a Stormwater Management Plan, explain why
Disturbed area will be less than 1 acre
2d
If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan
2e
Who will be responsible for the review of the Stormwater Management Plan?
3.
Certified Local Government Stormwater Review
3a
In which local government's jurisdiction Is this project?
City of Raleigh
❑ Phase II
3b
Which of the following locally - Implemented stormwater management programs
❑ NSW
apply (check all that apply)
❑ USMP
❑ Water Supply Watershed
❑X Other None
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
❑X Other None
4b
Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
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 8 of 10
PCN Form — Version 1 4 January 2009

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
lb 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
❑X 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
letter )
❑ Yes
❑ No
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,
E] Yes
❑X No
or Riparian Buffer Rules (15A NCAC 2B 0200)?
2b Is this an after - the -fact permit application
El Yes
❑X 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 WIII this project (based on past and reasonably anticipated future Impacts) result in
El Yes
❑X 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
Protect will not alter the capacity of the sanitary sewer collection system
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
No wastewater will be generated during this protect
Page 9of10
PCN Form —Version 14 January 2009

S. 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?
5c If yes, indicate the USFWS Field Office you have contacted
-
5d What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
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?
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?
8. Flood Zone Designation (Corps Requirement)
8a Will this project occur in a FEMA- designated 100 -year floodplain?
❑ Yes ❑X No
8b If yes, explain how project meets FEMA requirements
8c What source(s) did you use to make the floodplain determination?
FEMA FIRM Map # 3720172500J, Effective May 2, 2006
Ruffin L Hall
City Manager
City of Raleigh
Post Office Box 590 —�4w
l
Raleigh, North Carolina 27602 I-dvLl-
Applicant/Agent's Printed Name A cant/Agent's S g ature Date
(Agent's nature is valid only if an authorization
letter from the applicant is provided
Page 10 of 10

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