20220623 Ver 1_More Info Received_20220609

Strickland, Bev
From: Thomas, Kevin <[e-mail]>
Sent: Thursday, June 9, 2022 7:19 AM
To: Perez, Douglas J
Cc: Rauch, Sarah; Turner, Jena; Chewning, Clark
Subject: [External] FW: SAW-2022-00990 : Upper Forney Creek Restoration; Upper Forney
Stream Restoration ID # 20220623 Ver 1
Attachments: 060822 CRM_CEC Response to USACE Comments.docx; PCN_FillableForm_v4-3_
04202022_UpperForney.pdf; ORM_Upload_Sheet_AgResources_Rapanos_
20190428.xlsm; PCN_FillableForm_v4-3_04202022_UpperForney 06.08.22.docx
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
Report Spam.
Good morning Mr. Perez.
Please find the attached CRM with CEC's responses to the USACE Project Manager (Krystynka Stygars') inquires
pertaining to the above referenced Stream Restoration project located in Lincoln County, NC Additionally, we have
updated the project PCN submission (See Signed attached both PDF and Word doc) to reflect The PMs requested
changes (please see the CRM for call outs of the specific changes that have been made). Please reach out if anything else
is needed for you to issues the 401 permit.
Take care and talk soon.
Kevin Thomas, PWS & LSS (NC, SC & FL) / Principal
Civil & Environmental Consultants, Inc.
3701 Arco Corporate Drive Suite 400 Charlotte, NC 28273
Toll -Free: 855-859-9932 • Direct: 980-260-2035 • Fax: [phone]
Mobile: [phone] http://www.cecinc.com
Senior Leadership Integrated Services Personal Business Relationships
CEC CHARLOTTE CELEBRATING JO YEARS
This electronic communication and any attachments are intended solely for the use of the person or entity to which it is addressed, and may contain
information that is confidential, privileged and exempt from disclosure under applicable law, including copyright law. If you are not the intended
recipient of this message, you are prohibited from disclosing, reproducing, distributing, disseminating or otherwise using this transmission. Please
promptly notes the sender by reply electronic communication and immediately delete this message from your system.
The North Carolina Division of Water Resources has received the application called Upper Forney Stream
Restoration that you submitted on 5/2/2022 with corresponding fee received on 5/2/2022. The ID number for
that project is 20220623, Version 1.
Reviewer Contact Information: Doug Perez - [e-mail]
Reviewing Office: Mooresville Regional Office - [phone]
If you have questions, please contact one of the staff members listed below:
Transportation Projects Contact: Kristi Lynn Carpenter at [e-mail]
All other Projects Contact: Sheri Montalvo at [e-mail]
i

Project file link: https://edocs.deq.nc.gov/WaterResources/Browse.aspx?dbid=0&startid=2308638
This email was automatically generated by Laserfiche workflow. Please do not respond to this email address, as
responses aren't monitored.responses aren't monitored.
From: Thomas, Kevin
Sent: Wednesday, June 8, 2022 11:56 AM
To: Stygar, KRYSTYNKA B CIV USARMY CESAW (USA) <[e-mail]>
Cc: Jena Turner ([e-mail]) <[e-mail]>; Sarah Rauch ([e-mail]) <[e-mail]>
Subject: RE: SAW-2022-00990 : Upper Forney Creek Restoration
Good morning Krysta,
Thank you for your timely response and project comments. Please find the attached CRM with CEC's responses to your
inquires as well as the attached aquatic resource table. Additionally, we have updated the project PCN submission (See
Signed attached both PDF and Word doc) to reflect your requested changes (please see the CRM for call outs of the
specific changes that have been made). Please reach out if anything else is needed.
Take care and talk soon.
Kevin Thomas, PWS & LSS (NC, SC & FL) / Principal
Civil & Environmental Consultants, Inc.
3701 Arco Corporate Drive Suite 400 Charlotte, NC 28273
Toll -Free: 855-859-9932 • Direct: 980-260-2035 • Fax: [phone]
Mobile: [phone] http://www.cecinc.com
Senior Leadership Integrated Services Personal Business Relationships
CEC CHARLOTTE
CELEBRATING JO YEARS
r
This electronic communication and any attachments are intended solely for the use of the person or entity to which it is addressed, and may contain
information that is confidential, privileged and exempt from disclosure under applicable law, including copyright law. If you are not the intended
recipient of this message, you are prohibited from disclosing, reproducing, distributing, disseminating or otherwise using this transmission. Please
promptly notes the sender by reply electronic communication and immediately delete this message from your system.
From: Stygar, KRYSTYNKA B CIV USARMY CESAW (USA)<[e-mail]>
Sent: Wednesday, June 8, 2022 7:55 AM
To: Thomas, Kevin <[e-mail]>
Subject: SAW-2022-00990 : Upper Forney Creek Restoration
Kevin,
Good morning, I have evaluated the permit application for this NWP 27 request and need some additional answers/
information.
a) Please sign and date your application
b) Please provide the aquatic resource table (see attached) for the JD
c) Will there be a method to ensure that the stream restoration work is actually providing ecological uplift
meaning does the applicant propose to send updated pictures at the 1, 2, and 5 year after completion to ensure
success?)
2

d) You have CEC listed as the REQUESTOR.... This is not correct, who is going to be responsible for the work, and
ultimately hold the permit? ( The Catawba Lands Conservancy?)
e) Will any of the Bank stabilization be keyed into the channel? (the application proposes all "Temporary impacts",
any "fill" where the Stabilization is within the OHWM counts as permanent impacts.)
Thanks
Krysta
Krystynka B. Stygar
Regulatory Specialist
US Army Corps of Engineers
Wilmington District
Charlotte Field Office
Office : [phone]
Mobile : [phone]
We at the U.S. Army Corps of Engineers Regulatory Branch are committed to improving service to our customers. We
would appreciate your feedback on how we are performing our duties. Our automated Customer Service Survey is
located at: https://regulatory.ops.usace.army.mil/customer-service-survey/
Thank you for taking the time to visit this site and complete the survey.
3

SAW-2022-00990: Upper Forney Creek Restoration
Comment Response Matrix
Catawba Lands Conservancy — Upper Forney Stream Restoration Project
CEC Project 306-602
Comment
Reviewer
CEC Response
a
Please sign and date your application.
KS
Application has been dated and signed.
b
Please provide the aquatic resource table (see attached) for
the JD.
KS
Aquatic resource table has been provided. Please find
attachment.
c
Will there be a method to ensure that the stream
restoration work is actually providing ecological uplift
(meaning does the applicant propose to send updated
pictures at the 1, 2, and 5 year after completion to ensure
success?).
KS
Yes, the Catawba Lands Conservancy (CLC) will ensure that
the stream restoration work is providing ecological uplift.
After restoration work has been completed, CLC will take
photographs annually to ensure success. Photographs will be
sent to the designated USACE representative for the project
for the following seven years post -construction (and/or as
requested by the USACE for the foreseeable future of the
project).
d
You have CEC listed as the REQUESTOR.... This is not
correct, who is going to be responsible for the work, and
ultimately hold the permit? (The Catawba Lands
Conservancy?).
KS
Application has been changed. Sean Bloom from CLC has
been updated as the Requestor.
e
Will any of the Bank stabilization be keyed into the
channel? (the application proposes all "Temporary
impacts", any "fill" where the Stabilization is within the
OHWM counts as permanent impacts.)
KS
CEC has updated the PCN submission. Bank stabilization
impacts have been changed from "temporary" to
"permanent" impacts.
Reviewers:
• KS = Krystynka B. Stygar, Regulatory Specialist, US Army Corps of Engineers, Wilmington District, Charlotte Field Office, Office : [phone], Mobile : (252) 545-
0507

aE STATE 4�
NORTH CAROLINA
Environmental Quality
Water Resources
Office Use Only
Corps Action ID no. [Click to enter.] Date received: [Click to enter.]
DWR project no. [Click enter.] Date received: [Click to enter.]
Site Coordinates:
Latitude (DD.DDDDDD): 35.519345
Longitude (DD.DDDDDD): 81.014801
Form Version 4.3, April 20, 2022
Pre -Construction Notification (PCN) Form
(Ver. 4.2, January 31, 2022))
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 PCN help document may be found at this link:
https://edocs.deg. nc.gov/WaterResources/DocView.aspx?dbid=0&id=2196924&cr=1
Please ensure you have submitted a pre -filing meeting request at least 30 days prior to submitting this
form, as DWR will not be able to accept your application without documentation of this important first step.
The Division has developed a Pre -filing Meeting Request email address 401 Pre File(a_ncdenr.gov to accept
the federally required pre -filing meeting request and provide confirmation receipt of submittal . This receipt
or similar documentation will 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) *: 2/21/2022
Page 1 of 23 PCN Form Version 4.3- April 20, 2022

A. Processing Information
County (counties) where project is located: *
Lincoln Additional (if needed).
Is this a NCDMS project? *
(Click yes only if NCDMS is the applicant or co-
❑ Yes 0 No
applicant)
Is this a public transportation project?
(Publicly funded municipal, state, or federal road, rail,
❑ Yes 0 No
or airport project)
Is this a NCDOT project? *
❑ Yes 0 No
If yes, NCDOT TIP or state project number:
Click to enter.
If yes, NCDOT WBS number: *
Click to enter.
0 Section 404 Permit (wetlands, streams, waters,
Clean Water Act)
la. Type(s) of approval sought from the Corps:*
❑ Section 10 Permit (navigable waters, tidal
waters, Rivers and Harbors Act)
Has this PCN previously been submitted? *
❑ Yes 0 No
Please provide the date of the previous submission. *
Click to enter a date.
0 Nationwide Permit (NWP)
1 b. What type(s) of permit(s) do you wish to seek
❑ Regional General Permit (RGP)
authorization?
❑ 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.
1c. Has the NWP or GP number been verified by the Corps? *
❑ Yes 0 No
NWP number(s) (list all numbers ):
27
RGP number(s) (list all numbers ):
Click to enter.
Are you a federal applicant?
❑ Yes 0 No
If yes, please provide a statement concerning compliance with the Coastal Zone Management Act
Click to enter text.
1d. Type(s) of approval sought from DWR (check all that apply):
0 401 Water Quality Certification — Regular
❑ 401 Water Quality Certification— Express
❑ Non-404 Jurisdictional General Permit
❑ Riparian Buffer Authorization
❑ Individual 401 Water Quality Certification
Is this a courtesy copy notification
❑ Yes 0 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 0 No
For the record only for Corps Permit: *
❑ Yes 0 No
1f. Is this an after -the -fact permit/certification application? *
❑ Yes 0 No
Page 2 of 23 PCN Form Version 4.3- April 20, 2022

1 g.
Is payment into a mitigation bank or in -lieu fee program proposed for
❑ Yes
❑x No
mitigation of impacts?
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? *
❑ Yes
❑x No
1 i.
Is the project located within an NC DCM Area of Environmental
❑ Yes
❑x No ❑ Unknown
Concern (AEC)?
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.miI/Missions/Regulatory-Permit-
Program/Agency-Coordination/Trout.aspx
Page 3 of 23 PCN Form Version 4.3- April 20, 2022

B. Applicant Information
1a.
Who is the primary contact? *
Sean Bloom
1 b.
Primary Contact Email: *
[e-mail]
1 c.
Primary Contact Phone: * (###)###-####
704-342-3330
1d.
Who is applying for the permit/certification? * (check
all that apply)
® Owner 0 Applicant (other than owner)
1 e.
Is there an agent/consultant for this project?*
® Yes ❑ No
2.
Landowner Information
2a.
Name(s) on Recorded Deed: *
Catawba Lands Conservancy
2b.
Deed Book and Page No.:
Click to enter.
2c.
Contact Person (for corporations):
Sean Bloom
2d.
Address '
Street Address:
4530 Park Road, Suite 420
Address line 2:
Click to enter.
City:
Charlotte
State/ Province/ Region:
NC
Postal/ Zip Code:
28209
Country:
United States
2e.
Telephone Number: (###)###-####
704-342-3330
2f.
Fax Number: (###)###-####
Click to enter.
2g.
Email Address: *
[e-mail]
3.
Applicant Information (if different from owner)
3a.
Name: *
Sean Bloom
3b.
Business Name (if applicable):
Catawba Lands Conservancy
3c.
Address: *
Street Address:
4530 Park Road
Address line 2:
Suite 420
City:
Charlotte
State/ Province/ Region:
NC
Postal/ Zip Code:
28209
Country
United States
3d.
Telephone Number: * (###)###-####
704-342-3330
3e
Fax Number: (###)###-####
Click to ente,
3f.
Email Address: *
[e-mail]
Page 4 of 23 PCN Form Version 4.3- April 20, 2022

4. Agent/ Consultant (if applicable)
4a. Name:
Kevin Thomas
4b. Business Name:
Civil & Environmental Consultants, Inc
4c. Address:
Street Address:
3701 Arco Corporate Drive
Address line 2:
Suite 400
City:
Charlotte
State/ Province/ Region:
NC
Postal/ Zip Code:
28202
Country:
United States
4d. Telephone Number: * (###)###-####
410-259-4757
4e Fax Number: (###)###-####
Click to enter.
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.mii/Missions/Regulatory-Permit-Program/Permits/2017-Nationwide-Permits/Pre-
construction-Notification/
Page 5 of 23 PCN Form Version 4.3- April 20, 2022

C. Project Information and Prior Project History
1. Project Information
1a. Name of project: *
Upper Forney Stream Restoration
1 b. Subdivision name (if appropriate):
Click to enter.
1c. Nearest municipality/town: *
Denver, NC
2.
Project Identification
2a.
Property identification number (tax PIN or parcel ID):
4605004380
2b.
Property size (in acres):
157
2c.
Project Address:
Street Address:
N NC16 Business Highway
Address line 2:
Click to enter.
City:
Denver
State/ Province/ Region:
NC
Postal/ Zip Code:
28037
Country:
United Staets
2d.
Site coordinates in decimal degrees (using 4-6 digits
after the decimal point): *
Latitude (DD.DDDDDD): * 35.519345
Longitude (-DD.DDDDDD): *-81.014801
3. Surface Waters
3a. Name of nearest body of water to proposed project: *
Forney Creek
3b. Water Resources Classification of nearest receiving
C
water: *
The Surface Water Classification map may be found at this link:
https://ncdenr.maps.arcqis.com/apps/webappviewer/index.html?id=6el 25ad7628f494694e259c80dd64265
Catawba
3c. In what river basin(s) is your project located?
Choose additional (if needed)
3d. Please provide the 12-digit HUC in which the project is
030501011303
located:
The Find Your HUC map may be found at this link:
https://ncdenr.maps.arcgis.com/apps/Publiclnformation/index.html?appid=ad3a85aOc6d644aOb97cdO69db238ac3
Page 6 of 23 PCN Form Version 4.3- April 20, 2022

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 proposed action area is comprised of a mix of coniferous and deciduous forest. At the time of this
application, the general land use in the vicinity of the proposed action area includes undeveloped woodland to
the south, east, and west; and commercial and some small residential areas to the north. A railroad runs parallel
to the eastern boundary of the proposed action area.
4b. Have Corps permits or DWR certifications been obtained for this
❑ Yes ❑ No ❑ Unknown
project (including all prior phases) in the past? *
If yes, please give the DWR Certification number and/or Corps
[Click to enter.]
Action ID (ex. SAW-0000-00000):
jClick to enter.]
Attach any pertinent project history documentation
4b2. Is any portion of the work already complete? *
❑ Yes ❑x 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.
Click to enter text.
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
0 acres
property:
4g. List the total estimated linear feet of all existing streams (intermittent
8388 linear feet
and perennial) on the property:
4g1. List the total estimated acreage of all existing open waters on the
0 acres
property:
4h. Explain the purpose of the proposed project:
Forney Creek is an EPA 303d listed stream and sits in a watershed experiencing excessive vertical and lateral
erosion. The purpose of the proposed project includes: 1) permit and design a stream restoration project in order
to physically and biologically restore and enhance Forney Creek -- with the primary goal of maximizing
environmental benefit and ecological uplift, 2) reduce sediment loading to 303d listed waters, 3) establish
vegetated riparian buffers along the stream corridors which will be protected in perpetuity through the existing
conservation easement.
Page 7 of 23 PCN Form Version 4.3- April 20, 2022

4i. Describe the overall project in detail, including the type of equipment to be used: *
Under the proposed action, upper Forney Creek would be restored through restoration and stream realignment of
the mainstem channel. The goal of the proposed design plan is to address the cause of the stream's
degradation. Under the proposed action, approximately 8,406 linear feet of degraded stream channels would be
reconstructed to improve bedform diversity, lateral stability, and floodplain connectivity. Additionally, hydrologic
modifications (floodplain drainage ditches, berms, levees, and other fill areas) would be removed to promote
wetland formation. The proposed action aims to improve overland and subsurface water exchange and sediment
transport continuity, increase channel sinuosity to reduce flow velocities, promote the formation of natural pools
and riffles, and improve lateral and vertical stability of the proposed project area. Riparian/slope wetlands would
be established by plugging drainage ditches, reconnecting stream channels to wetland areas, planting native
wetland plant species, and permanently protecting restored streams and riparian wetland areas. Restoration
practices include construction of new, off-line channel segments, installation of woody debris in the form of wood
toe, and installation of natural grade control structures such as stone and log riffles, and boulder toe to reconnect
streams to their floodplain and promote bedform diversity.
Priority 1 restoration techniques would be applied to approximately 4,969 linear feet of stream, while Priority 2
restoration techniques would be applied to approximately 3,437 linear feet of stream. Priority 1 restoration within
Forney Creek will include replacing the incised channel with a new, stable stream at an elevation that promotes
ecological uplift and reduced flow velocity. To ensure there would be no net loss of habitat, the proposed stream
restoration would restore the approximate 7,036 linear feet of existing stream to be impacted, as well as create
an additional 1,370 linear feet of Priority 1 stream within the project area. Priority 2 restoration will create a new
floodplain and stream banks with the stream alignment remaining at the present location.
Equipment to be used includes general construction equipment such as excavators, backhoes, bulldozers,
graders, and dump and haul trucks.
4j. Attach project drawings/site diagrams/depictions of impact areas for the proposed project.
4k. Will this activity involve dredging in wetlands or waters? *
❑ Yes ❑x No
If yes, describe the type of dredging, the composition of the dredged material, and the locations of disposal area.
Click to enter text.
Page 8 of 23 PCN Form Version 4.3- April 20, 2022

5.
Jurisdictional Determinations
5a.
Have the wetlands or streams been delineated on the property or in
® Yes ❑ No ❑ Unknown
proposed impact areas?
Comments:
Please see the attached Pre -JD Features Map (Figure 6)
5b.
If the Corps made a jurisdictional determination,
❑ Preliminary ❑ Approved ❑ Emailed concurrence
what type of determination was made? *
❑x Not Verified ❑ Unknown ❑ n/a
Corps AID number (ex. SAW-0000-00000):
Click to enter.
Name (if known): Kevin Thomas, PWS
5c.
If 5a is yes, who delineated the jurisdictional
Agency/Consultant Company: CEC
areas?
Other: Click to enter.
5d.
List the dates of the Corps jurisdictional determination or State determination if a determination was made by
either agency.
Click to enter.
5d1. Attach jurisdictional determinations.
6. Future Project Plans
6a. Is this a phased project?
❑ Yes ❑x No
6b. If yes, explain.
Click to enter.
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.
At this time, no future projects are planned requiring permits for impacts to Waters of The U.S., this is considered
a single and complete project.
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:
Click to enter.
Page 9 of 23 PCN Form Version 4.3- April 20, 2022

D. Proposed Impacts Inventory
Impacts Summary
❑ Wetlands 0 Streams - tributaries
1a. Where are the impacts associated with your project ❑ Buffers ❑ Open Waters
(check all that apply):
❑ Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, complete this table for each wetland area impacted.
2a.
Site #*
2a1.
Impact
Reason/Type*
2b.
Impact
Duration*
2c.
Wetland Type*
2d.
Wetland Name*
2e.
Forested
?*
2f.
Jurisdiction
Type*
2g.
Impact Area
(ac)*
W1
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
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
Click to enter. ac
2g2. Total permanent wetland impacts
Click to enter. ac
2g3. Total wetland impacts
Click to enter. ac
2h. Type(s) of material being discharged and the amount of each type in cubic yards:
Click to enter text.
2i. Comments:
Click to enter text.
Page 10 of 23 PCN Form Version 4.3- April 20, 2022

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
3a
3b.
3c.
3d.
3e.
3f.
3g.
3h.
Site #*
Impact
Impact
Impact Type*
Stream Name*
Stream
Jurisdiction
Stream Width
Impact length
Reason*
Duration'
Type*
Type*
(avg ft) *
(linear ft)
S1
Stream
Temporary
Relocation
Forney Creek
Perennial
Both
20
4918
restoration
SA1
S2
Stream
Permanent
Bank
Tributary SA2
Intermittent
Both
4
195
restoration
Stabilization
Reach 1
S3
Stream
Temporary
Relocation
Tributary SA2
Intermittent
Both
4
46
restoration
Reach 2
S4
Stream
Permanent
Bank
Tributary SA5
Perennial
Both
6
450
restoration
Stabilization
S5
Stream
Permanent
Bank
Tributary SA6
Intermittent
Both
7
338
Restoration
Stabilization
S6
Stream
Temporary
Relocation
Tributary SA7
Intermittent
Both
4
144
Restoration
Reach 1
S7
Stream
Temporary
Relocation
Tributary SA7
Perennial
Both
10
99
restoration
Reach 2
S8
Stream
Temporary
Relocation
Tributary SA8
Intermittent
Both
3
66
restoration
S9
Stream
Temporary
Relocation
Tributary SA9
Intermittent
Both
3
20
Restoration
Reach 1
S10
Stream
Permanent
Bank
Tributary SA9
Perennial
Both
6
760
Restoration
Stabilization
Reach 2
S11
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S12
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S13
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S14
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S15
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S16
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
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
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
0 linear ft
impact:
3i2. Total permanent stream
1743 linear ft
impacts:
M. Total temporary stream
5293 linear ft
impacts:
Page 11 of 23 PCN Form Version 4.3- April 20, 2022

34. Total stream and ditch 0 linear ft
impacts:
3j. Comments:
To ensure there would be no net loss of habitat, Priority 1 and Priority 2 restoration techniques would be applied
to the impacted length (7,036 ft) of the stream as well as the creation of an additional 1,370 linear feet of stream.
The severely incised mainstem will be relocated where necessary and restored, tributaries will be reconnected to
the mainstem, wetland establishment and growth will be promoted, and the new natural stream channel design
will provide an ecological uplift. Please see attached Stream Impact table.
Page 12 of 23 PCN Form Version 4.3- April 20, 2022

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*
4d.
Activity Type*
4e.
Waterbody
Type*
4f.
Impact area
(ac)*
01
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
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
I Choose one
Click to enter.
4g.
Total temporary open water impacts
Click to enter. ac
4g.
Total permanent open water impacts
Click to enter. ac
4g.
Total open water impacts
Click to enter. ac
4h.
Comments:
Click to enter.
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.
5b.
5c.
5d.
5e.
Pond ID
Proposed use or
Wetland Impacts
(ac)
Stream
Impacts (ft)
Upland
#
purpose of pond
Impacts (ac)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
P1
Choose one
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
P2
Choose one
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
P3
Choose one
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
5f.
Total
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
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 23 PCN Form Version 4.3- April 20, 2022

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.)
❑ 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)
131
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B2
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B3
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B4
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B5
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B6
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B7
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B8
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B9
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B10
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B11
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B12
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B13
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B14
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B15
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B16
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B17
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B18
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B19
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B20
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
6h. Total temporary impacts:
Zone 1: Click to enter. sq ft
Zone 2: Click to enter. sq ft
6h. Total permanent impacts:
Zone 1: Click to enter. sq ft
Zone 2: Click to enter. sq ft
6h. Total combined buffer impacts:
Zone 1: Click to enter. sq ft
Zone 2: Click to enter. sq ft
6i. Comments:
Click to enter.
Please attach supporting documentation (impact maps, plan sheets, etc.) for the proposed project.
Page 14 of 23 PCN Form Version 4.3- April 20, 2022

E. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts through project design:
The proposed stream restoration project has been designed as a primarily Priority 1 restoration project. Small
sections of Priority 2 restoration are required along the mainstem and tributaries in areas where it could not be
avoided due to channel, valley, and floodplain constraints. Updates from the 30% design phase to the 60%
design phase included reducing the amount of channel crossings between the proposed and existing channels
from approximately 22 crossings to approximately 10 crossings. Current 60% design plan has approximately
3,835 linear feet of Priority 1 restoration and 1,087 linear feet of Priority 2 restoration on the mainstem channel
as well as approximately 1,134 linear feet of Priority 1 and 2,350 linear feet of Priority 2 restorations on the
tributary channels. This results in approximately 4,969 linear feet of Priority 1 and 3,437 linear feet of Priority 2
restoration throughout the entire project. Combining Priority 1 and 2 results in a total of 8,406 linear feet of
restoration throughout the entire project. The proposed restoration matches the existing impacts (7,036 LF) 1:1
with an additional 1,370 linear feet of aquatic bed establishment, ensuring no net loss of habitat. Please see
attached Stream Impact Table.
1 b. Specifically describe measures taken to avoid or minimize proposed impacts through construction techniques:
The newly realigned (Priority 1) channel will be constructed away from the existing channel and appropriate
pump -around techniques will be used in areas where the proposed and existing channels must cross or where
Priority 2 restoration must take place.
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? * ❑ DWR ❑ Corps
(check all that apply)
2b. If yes, which mitigation option(s) will be used for this ❑ Mitigation Bank
project? * (check all that apply) ❑ In Lieu Fee Program
❑ Permittee Responsible Mitigation
3. Complete if using a Mitigation Bank
(Must satisfy NC General Statute143-214.11 (d1).)
3a. Name of mitigation bank:
Click to enter.
3b. Credits purchased/requested:
Type: Choose one
Quantity Click to enter.
Type: Choose one
Quantity Click to enter.
Type: Choose one
Quantity Click to enter.
Attach receipt and/or approval letter.
3c. Comments:
Click to enter.
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
Page 15 of 23 PCN Form Version 4.3- April 20, 2022

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
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
❑ Yes
❑ No
that requires buffer mitigation?
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.
6c.
6d.
6e.
Zone
Reason for impact
Total impact
Multiplier
Required mitigation
(square feet)
(square feet)
Zone
1
Click to enter.
Click to enter.
Choose one
Click to enter.
Zone
2
Click to enter.
Click to enter.
Choose one
Click to enter.
6f. Total buffer mitigation required
Click to enter.
6g.
If buffer mitigation is required, is payment to a mitigation bank or
❑ Yes ❑ No
NC Division of Mitigation Services proposed?
6h.
If yes, attach the acceptance letter from the mitigation bank or NC Division of Mitigation
Services.
6i.
Comments:
Click to enter.
Page 16 of 23 PCN Form Version 4.3- April 20, 2022

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
❑ Yes 0 No
identified within one of the NC Riparian Buffer Protection Rules?
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://deg.nc.gov/about/divisions/energV-mineral-land-resources/energV-mineral-land-permit-
guidance/stormwater-bmp-manual).
Associated supplement forms and other documentation must be provided.
❑ Level Spreader
What Type of SCM are you
❑ Vegetated Conveyance (lower seasonal high water table- SHWT)
providing?
❑ Wetland Swale (higher SHWT)
(Check all that apply)
❑ Other SCM that removes minimum 30% nitrogen
❑ 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? *
El Yes 0 No
2b.
Does this project meet the requirements for low density projects as
defined in 15A NCAC 02H .1003(2)? *
0 Yes El No
To look up low density requirements, click here:
http://reports.oah.state. nc. us/ncac/title%2015a%20-%20environmental%20Quality/chapter%2002%20-
%20environmental%20management/subchapter%20h/15a%20ncac%2002h%20.1003.pdf
2c.
Does this project have a stormwater management plan (SMP)
❑ Yes ❑ No
reviewed and approved under a state stormwater program or state -
approved local government stormwater program? *
0 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?
❑ Local Government
(Check all that apply.)*
❑ State
If you have local government approval, please include the SMP on their overall impact map.
Local Government Stormwater Programs *
❑ Phase II ❑ USMP
❑ NSW ❑ Water Supply
Page 17 of 23 PCN Form Version 4.3- April 20, 2022

Please identify which local government stormwater program you are using.
Click to enter.
State Stormwater Programs * ❑ Phase II ❑ HQW or ORW
❑ Coastal Counties ❑ Other
Comments:
Click to enter.
Page 18 of 23 PCN Form Version 4.3- April 20, 2022

G. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local)
❑ Yes ❑x No
funds or the 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 (North Carolina) Environmental
El Yes El No
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
❑ Yes ❑ No
NEPA or SEPA final approval letter.)
Comments:
Click to enter.
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
❑ Yes ❑x No
(15A NCAC 2H. 1400) DWR Surface Water or Wetland Standards or
Riparian Buffer Rules (15A NCAC 2B .0200)? *
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
❑ Yes ❑x No
downstream water quality? *
3b. If you answered "no", provide a short narrative description:
This project is not anticipated to result in additional development as it is a protected and buffered stream corridor
in a forested area. The stream will remain protected in the riparian buffer which will prevent additional
development nearby.
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
Page 19 of 23 PCN Form Version 4.3- April 20, 2022

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.
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected
❑ Yes 0 No
species or habitat? (IPAC weblink: https://www.fws.gov/ipac/ ffws.govl)
5b. Have you checked with the USFWS concerning Endangered Species
® Yes ❑ No
Act impacts? *
5c. If yes, indicate the USFWS Field Office you have contacted.
Asheville
5d. Is another federal agency involved? *
❑ Yes N No ❑ Unknown
If yes, which federal agency?
Click to enter.
5e. Is this a DOT project located within Divisions 1-8? *
❑ Yes 0 No
5f. Will you cut any trees in order to conduct the work in waters of the
U.S.? *
®Yes El No
5g. Does this project involve bridge maintenance or removal? *
❑ Yes 0 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
❑ Yes ❑ No
can be found in the NLEB SLOPES, Appendix F, pages 3-7.
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.armV.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 N 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,
❑ Yes N No
mechanized pile drivers, etc.? *
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? *
USFWS IPaC database and NC Natural Heritage Program database. Additionally, biologists from CEC and CLC
performed site visits to assess potential suitable habitats for special status species.
Attach consultation documentation.
6. Essential Fish Habitat (Corps Requirement)
Page 20 of 23 PCN Form Version 4.3- April 20, 2022

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? *
El Yes No El Unknown
Will this project affect submerged aquatic vegetation? *
❑ Yes ❑x No ❑ Unknown
Explain: Click to enter.
6b. What data source(s) did you use to determine whether your site would impact Essential Fish Habitat?
National Oceanic and Atmospheric Administration (NOAA) Essential Fish Habitat Mapper
https://www.habitat.noaa.gov
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
❑ Yes ❑x No
properties significant in North Carolina history and archaeology)?
7b. What data source(s) did you use to determine whether your site would impact historic or archeological
resources? *
NC Historic Preservation Office's HPOWEB Application https://nc.marps.arcgis.com. Please see attached NC
SHPO Map.
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? *
❑ Yes ❑x No
8b. If yes, explain how the project meets FEMA requirements.
Click to enter.
8c. What source(s) did you use to make the floodplain determination?
FEMA Flood Map Service Center: https://msc.fema.gov/portal/search
Flood Map # 3710460400J. Please see the attached Pre -JD Features Map (Figure 6).
Page 21 of 23 PCN Form Version 4.3- April 20, 2022

H. Miscellaneous
Comments:
Hello, please find the attachments for the Application Request Package for scheduling and review. Upon review
of the attachments, please provide any comments via the Comment Response Matrix (CRM) for the
administrative record. Thank you!
(The comprehensive list of all project attachments is as follows:)
- DWR Pre -Filing Meeting Request Form
- Figures 1-6: Vicinity Map, USGS Topographic Map, Aerial Map, NRCS Current Soils Map, NRCS Published
Soils Map, NWI/NHD Map, & Pre -JD Features Map.
- NC SHPO Map
-Stream Impact Table
- Upper Forney Stream Restoration 60% Design Plan Set
- Upper Forney Stream Restoration 60% Design Erosion Prevention and Sediment Control Plans and Details
- USFWS Official Species List Report
- USFWS Biological Assessment Report
- Old Stumpy Preserve Baseline Documentation Report
- Saint James Preserve Baseline Documentation Report
- Aquatic Resource Table
Attach pertinent documentation or attachments not previously requested
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: * Kevin Thomas
Signature:�—
Date: * 5/2/2022
Page 22 of 23 PCN Form Version 4.3- April 20, 2022

Page 23 of 23 PCN Form Version 4.3- April 20, 2022

Waters_Name I State I Cowardin_Code I HGM_Code I Meas_Type I Amount I Units I Waters Type I Latitude I Longitude I Local Waterway
SA-1 NORTH CAROLINA R3 RIVERINE Linear 4918 FOOT DELINEATE 35.51769900-81.01276700 Forney Creek
SA-2 (Reach 1) NORTH CAROLINA R4 RIVERINE Linear 529 FOOT DELINEATE 35.51448085-81.01465178 Forney Creek
SA-2 (Reach 2) NORTH CAROLINA R4 RIVERINE Linear 46 FOOT DELINEATE 35.51361789-81.01204062 Forney Creek

NORTH CAROLINA
Environmental Quality
Water Resources
Office Use Only
Corps Action ID no. [Click to enter.]
DWR project no. lick enter.]
Site Coordinates:
Latitude (DD.DDDDDD): 35.519345
Longitude (DD.DDDDDD): 81.014801
Form Version 4.3, April 20, 2022
Date received: [Click to enter.]
Date received: [Click to enter.]
Pre -Construction Notification (PCN) Form
(Ver. 4.2, January 31, 2022))
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 PCN help document may be found at this link:
https://edocs.deq.nc.gov/WaterResources/DocView.aspx?dbid=0&id=2196924&cr=1
Please ensure you have submitted a pre -filing meeting request at least 30 days prior to submitting this
form, as DWR will not be able to accept your application without documentation of this important first step.
The Division has developed a Pre -filing Meeting Request email address 401 PreFile©ncdenr.gov to accept
the federally required pre -filing meeting request and provide confirmation receipt of submittal . This receipt
or similar documentation will 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) : 2/21/2022
Page 1 of 23 PCN Form Version 4.3- April 20, 2022

A. Processing Information
County (counties) where project is located: *
Lincoln Additional (if needed).
Is this a NCDMS project? *
(Click yes only if NCDMS is the applicant or co-
applicant)
❑ Yes ❑x No
Is this a public transportation project?
(Publicly funded municipal, state, or federal road, rail,
or airport project)
❑ Yes
❑x No
Is this a NCDOT project? *
❑x No
• Yes
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)
❑ Section 10 Permit (navigable waters, tidal
waters, Rivers and Harbors Act)
Has this PCN previously been submitted? *
❑ Yes ❑x 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)
❑ Regional General Permit (RGP)
❑ Standard (IP)
This form may be used to initiate the standard/ individual permit process with
representative concerning submittals for standard permits. All required items
submitted with this form.
the USACE. Please contact your Corps
can be included as attachments and
1 c. Has the NWP or GP number been verified by the Corps? *
• Yes ❑x No
NWP number(s) (list all numbers ):
27
RGP number(s) (list all numbers ):
Click to enter.
Are you a federal applicant?
• Yes ❑x No
If yes, please provide a statement concerning compliance with the Coastal Zone Management Act *
Click to enter text
1 d. 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 ❑ Riparian Buffer Authorization
❑ Individual 401 Water Quality Certification
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
1 f. Is this an after -the -fact permit/certification application?
❑ Yes ❑x No
Page 2 of 23
PCN Form Version 4.3- April 20, 2022

1g. Is payment into a mitigation bank or in -lieu fee program proposed for
mitigation of impacts?
• Yes 0 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? *
• Yes 0 No
1 i.
Is the project located within an NC DCM Area of Environmental
Concern (AEC)? *
❑ Yes 0 No ❑ Unknown
1j.
Is the project located in a designated trout watershed?*
• Yes 0 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-
P rog ra m/Ag e n cy-Coo rd i n at i o n/T ro u t. as px
Page 3 of 23 PCN Form Version 4.3- April 20, 2022

B. Applicant Information
la. Who is the primary contact? *
Sean Bloom
lb. Primary Contact Email: *
sean©catawbalands.org
*
704-342-3330
lc. Primary Contact Phone: (#!##)#/## ####
ld. Who is applying for the permit/certification? * (check
all that apply)
® Owner ❑x Applicant (other than owner)
1 e. Is there an agent/consultant for this project?*
® Yes ❑ No
2. Landowner Information
2a. Name(s) on Recorded Deed: *
Catawba Lands Conservancy
2b. Deed Book and Page No.:
Click to enter.
2c. Contact Person (for corporations):
Sean Bloom
2d. Address *
Street Address:
4530 Park Road, Suite 420
Address line 2:
Click to enter.
City:
Charlotte
State/ Province/ Region:
NC
Postal/ Zip Code:
28209
Country:
United States
*
704-342-3330
2e. Telephone Number: (###)### ####
Click to enter.
2f. Fax Number: (###)### ####
2g. Email Address: *
sean©catawbalands.org
3.
Applicant Information (if different from owner)
3a.
Name: *
Sean Bloom
3b.
Business Name (if applicable):
Catawba Lands Conservancy
3c.
Address: *
Street Address:
4530 Park Road
Address line 2:
Suite 420
City:
Charlotte
State/ Province/ Region:
NC
Postal/ Zip Code:
28209
Country
United States
3d.
Telephone Number: * (###)###-####
704-342-3330
3e
Click to enter.
Fax Number: (###)### ####
3f.
Email Address: *
sean©catawbalands.org
Page 4 of 23
PCN Form Version 4.3- April 20, 2022

4. Agent/ Consultant (if applicable)
4a. Name: *
Kevin Thomas
4b. Business Name:
Civil & Environmental Consultants, Inc
4c. Address: *
Street Address:
3701 Arco Corporate Drive
Address line 2:
Suite 400
City:
Charlotte
State/ Province/ Region:
NC
Postal/ Zip Code:
28202
Country:
United States
*
410-259-4757
4d. Telephone Number: (###)### ####
4e Fax Number: (###)###-####
Click to ente
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. mi I/Missions/Regulatory-Permit-Program/Permits/2017-Nationwide-Permits/Pre-
construction-Notification/
Page 5 of 23 PCN Form Version 4.3- April 20, 2022

C. Project Information and Prior Project History
1.
Project Information
la.
Name of project: *
Upper Forney Stream Restoration
1 b.
Subdivision name (if appropriate):
Click to enter
lc.
Nearest municipality/town: *
Denver, NC
2. Project Identification
2a. Property identification number (tax PIN or parcel ID):
4605004380
2b. Property size (in acres):
157
2c. Project Address:
Street Address:
N NC16 Business Highway
Address line 2:
Click to enter.
City:
Denver
State/ Province/ Region:
NC
Postal/ Zip Code:
28037
Country:
United Staets
2d. Site coordinates in decimal degrees (using 4-6 digits
after the decimal point):
Latitude (DD.DDDDDD): * 35.519345
Longitude (-DD.DDDDDD): *-81.014801
3. Surface Waters
3a. Name of nearest body of water to proposed project: *
Forney Creek
3b. Water Resources Classification of nearest receiving
water: *
C
The Surface Water Classification map may be found at this
https://ncdenr. maps.arcgis.com/apps/webappviewer/index.
link:
html?id=6e125ad7628f494694e259c80dd64265
3c. In what river basin(s) is your project located?*
Catawba
Choose additional (if needed)
3d. Please provide the 12-digit HUC in which the project is
located:
030501011303
The Find Your HUC map may be found at this link:
https://ncdenr. maps.arcgis.com/apps/Public) nformation/i ndex. html?appid=ad3a85a0c6d644a0b97cd069db238ac3
Page 6 of 23 PCN Form Version 4.3- April 20, 2022

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 proposed action area is comprised of a mix of coniferous and deciduous forest. At the time of this
application, the general land use in the vicinity of the proposed action area includes undeveloped woodland to
the south, east, and west; and commercial and some small residential areas to the north. A railroad runs parallel
to the eastern boundary of the proposed action area.
4b. Have Corps permits or DWR certifications been obtained for this
project (including all prior phases) in the past? *
❑ Yes ❑ No ❑ Unknown
If yes, please give the DWR Certification number and/or Corps
Action ID (ex. SAW-0000-00000):
[Click to enter.]
[Click to enter.]
Attach any pertinent project history documentation
4b2. Is any portion of the work already complete? *
❑ Yes ❑x 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 or401.
.;lick to enter te,
4d. Attach an 8'% x 11" excerpt from the most recent version of the USGS topographic map indicating the location of
the project site.
4e. Attach an 8Y2 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 acres
4g. List the total estimated linear feet of all existing streams (intermittent
and perennial) on the property:
8388 linear feet
4g1. List the total estimated acreage of all existing open waters on the
property:
0 acres
4h. Explain the purpose of the proposed project:
Forney Creek is an EPA 303d listed stream and sits in a watershed experiencing excessive vertical and lateral
erosion. The purpose of the proposed project includes: 1) permit and design a stream restoration project in order
to physically and biologically restore and enhance Forney Creek -- with the primary goal of maximizing
environmental benefit and ecological uplift, 2) reduce sediment loading to 303d listed waters, 3) establish
vegetated riparian buffers along the stream corridors which will be protected in perpetuity through the existing
conservation easement.
Page 7 of 23 PCN Form Version 4.3- April 20, 2022

4i. Describe the overall project in detail, including the type of equipment to be used:
Under the proposed action, upper Forney Creek would be restored through restoration and stream realignment of
the mainstem channel. The goal of the proposed design plan is to address the cause of the stream's
degradation. Under the proposed action, approximately 8,406 linear feet of degraded stream channels would be
reconstructed to improve bedform diversity, lateral stability, and floodplain connectivity. Additionally, hydrologic
modifications (floodplain drainage ditches, berms, levees, and other fill areas) would be removed to promote
wetland formation. The proposed action aims to improve overland and subsurface water exchange and sediment
transport continuity, increase channel sinuosity to reduce flow velocities, promote the formation of natural pools
and riffles, and improve lateral and vertical stability of the proposed project area. Riparian/slope wetlands would
be established by plugging drainage ditches, reconnecting stream channels to wetland areas, planting native
wetland plant species, and permanently protecting restored streams and riparian wetland areas. Restoration
practices include construction of new, off-line channel segments, installation of woody debris in the form of wood
toe, and installation of natural grade control structures such as stone and log riffles, and boulder toe to reconnect
streams to their floodplain and promote bedform diversity.
Priority 1 restoration techniques would be applied to approximately 4,969 linear feet of stream, while Priority 2
restoration techniques would be applied to approximately 3,437 linear feet of stream. Priority 1 restoration within
Forney Creek will include replacing the incised channel with a new, stable stream at an elevation that promotes
ecological uplift and reduced flow velocity. To ensure there would be no net loss of habitat, the proposed stream
restoration would restore the approximate 7,036 linear feet of existing stream to be impacted, as well as create
an additional 1,370 linear feet of Priority 1 stream within the project area. Priority 2 restoration will create a new
floodplain and stream banks with the stream alignment remaining at the present location.
Equipment to be used includes general construction equipment such as excavators, backhoes, bulldozers,
graders, and dump and haul trucks.
4j. Attach project drawings/site diagrams/depictions of impact areas for the proposed project.
4k. Will this activity involve dredging in wetlands or waters? *
❑ Yes ❑x No
If yes, describe the type of dredging, the composition of the dredged material, and the locations of disposal area.
Click to enter tex,
Page 8 of 23 PCN Form Version 4.3- April 20, 2022

5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or in
proposed impact areas?
IX Yes ❑ No ❑ Unknown
Comments:
Please see the attached Pre -JD Features Map (Figure
6)
5b. If the Corps made a jurisdictional determination,
what type of determination was made? *
❑Approved ❑ Emailed concurrence
❑ Unknown ❑ n/a
• Preliminary
❑x Not Verified
Corps AID number (ex. SAW-0000-00000):
Click to enter.
5c. If 5a is yes, who delineated the jurisdictional
areas?
Name (if known): Kevin Thomas, PWS
Agency/Consultant Company: CEC
Other: Click to enter.
5d. List the dates of the Corps jurisdictional determination or State determination if a determination was made by
either agency.
.:lick to enter.
5d1. Attach jurisdictional determinations.
6.
Future Project Plans
6a.
Is this a phased project?
❑ Yes ❑x No
6b.
If yes, explain.
Click to enter.
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.
At this time, no future projects are planned requiring permits for impacts to Waters of The U.S., this is considered
a single and complete project.
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:
Click to enter.
Page 9 of 23 PCN Form Version 4.3- April 20, 2022

D. Proposed Impacts Inventory
1. Impacts Summary
1 a. Where are the impacts associated with your project
(check all that apply):
❑ Wetlands
❑ Buffers
❑ Pond Construction
® 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 #
2a1.
Impact
Reason/Type*
2b.
Impact
Duration*
2c.
Wetland Type
2d.
Wetland Name*
2e.
Forested
?
2f.
Jurisdiction
Type*
2g.
Impact Area
(ac)*
W1
Choose one
Temp/ Perm
Choose one
Click to enter
`ON
Choose one
Click to enter
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
Click to enter. ac
2g2. Total permanent wetland impacts
Click to enter. ac
2g3. Total wetland impacts
Click to enter. ac
2h. Type(s) of material being discharged and the amount of each type in cubic yards:
Click to enter text.
2i. Comments:
Click to enter text.
Page 10 of 23 PCN Form Version 4.3- April 20, 2022

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
Stream
restoration
Temporary
Relocation
Forney Creek
SA1
Perennial
Both
20
4918
S2
Stream
restoration
Permanent
Bank
Stabilization
Tributary SA2
Reach 1
Intermittent
Both
4
195
S3
Stream
restoration
Temporary
Relocation
Tributary SA2
Reach 2
Intermittent
Both
4
46
S4
Stream
restoration
Permanent
Bank
Stabilization
Tributary SA5
Perennial
Both
6
450
S5
Stream
Restoration
Permanent
Bank
Stabilization
Tributary SA6
Intermittent
Both
7
338
S6
Stream
Restoration
Temporary
Relocation
Tributary SA7
Reach 1
Intermittent
Both
4
144
S7
Stream
restoration
Temporary
Relocation
Tributary SA7
Reach 2
Perennial
Both
10
99
S8
Stream
restoration
Temporary
Relocation
Tributary SA8
Intermittent
Both
3
66
S9
Stream
Restoration
Temporary
Relocation
Tributary SA9
Reach 1
Intermittent
Both
3
20
S10
Stream
Restoration
Permanent
Bank
Stabilization
Tributary SA9
Reach 2
Perennial
Both
6
760
Si 1
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S12
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S13
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S14
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S15
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S16
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
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
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:
0 linear ft
3i2. Total permanent stream
impacts:
1743 linear ft
3i3. Total temporary stream
impacts:
5293 linear ft
Page 11 of 23
PCN Form Version 4.3- April 20, 2022

3i4. Total stream and ditch
impacts:
0 linear ft
3j. Comments:
To ensure there would be no net loss of habitat, Priority 1 and Priority 2 restoration techniques would be applied
to the impacted length (7,036 ft) of the stream as well as the creation of an additional 1,370 linear feet of stream.
The severely incised mainstem will be relocated where necessary and restored, tributaries will be reconnected to
the mainstem, wetland establishment and growth will be promoted, and the new natural stream channel design
will provide an ecological uplift. Please see attached Stream Impact table.
Page 12 of 23 PCN Form Version 4.3- April 20, 2022

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
4d.
Activity Type*
4e.
Waterbody
Type*
4f.
Impact area
(ac)*
01
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
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
Click to enter. ac
4g. Total permanent open water impacts
Click to enter. ac
4g. Total open water impacts
Click to enter. ac
4h. Comments:
Click to enter
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.
,lick 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 23
PCN Form Version 4.3- April 20, 2022

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.)
❑ Neuse ❑ Tar -Pamlico ❑ Catawba
❑ Jordan ❑ Goose Creek ❑ Randleman
❑ Other: Click to entci .
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
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B2
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B3
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B4
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B5
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B6
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B7
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B8
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B9
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B10
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B11
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B12
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B13
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B14
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B15
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B16
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B17
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B18
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B19
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B20
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
6h. Total temporary impacts:
Zone 1: Click to enter. sq ft
Zone 2: Click to enter. sq ft
6h. Total permanent impacts:
Zone 1: Click to enter. sq ft
Zone 2: Click to enter. sq ft
6h. Total combined buffer impacts:
Zone 1: Click to enter. sq ft
Zone 2: Click to enter. sq ft
6i. Comments:
Click to enter.
Please attach supporting documentation (impact maps, plan sheets, etc.) for the proposed project.
Page 14 of 23 PCN Form Version 4.3- April 20, 2022

E. Impact Justification and Mitigation
1.
Avoidance and Minimization
1a.
Specifically describe measures taken to avoid or minimize the proposed impacts through project design:
The proposed stream restoration project has been designed as a primarily Priority 1 restoration project. Small
sections of Priority 2 restoration are required along the mainstem and tributaries in areas where it could not be
avoided due to channel, valley, and floodplain constraints. Updates from the 30% design phase to the 60%
design phase included reducing the amount of channel crossings between the proposed and existing channels
from approximately 22 crossings to approximately 10 crossings. Current 60% design plan has approximately
3,835 linear feet of Priority 1 restoration and 1,087 linear feet of Priority 2 restoration on the mainstem channel
as well as approximately 1,134 linear feet of Priority 1 and 2,350 linear feet of Priority 2 restorations on the
tributary channels. This results in approximately 4,969 linear feet of Priority 1 and 3,437 linear feet of Priority 2
restoration throughout the entire project. Combining Priority 1 and 2 results in a total of 8,406 linear feet of
restoration throughout the entire project. The proposed restoration matches the existing impacts (7,036 LF) 1:1
with an additional 1,370 linear feet of aquatic bed establishment, ensuring no net loss of habitat. Please see
attached Stream Impact Table.
1 b.
Specifically describe measures taken to avoid or minimize proposed impacts through construction techniques: *
The newly realigned (Priority 1) channel will be constructed away from the existing channel and appropriate
pump -around techniques will be used in areas where the proposed and existing channels must cross or where
Priority 2 restoration must take place.
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)
❑ 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
3. Complete if using a Mitigation Bank (Must satisfy NC General Statute143-214.11 (d1).)
3a. Name of mitigation bank:
Click to ente,
3b. Credits purchased/requested:
Type: Choose one
Quantity Click to enter.
Type: Choose one
Quantity Click to enter.
Type: Choose one
Quantity Click to enter.
Attach receipt and/or approval letter.
3c. Comments:
lick to enter.
4. Complete if Using an In Lieu Fee Program
4a. Attach approval letter from in lieu fee program.
4b. Stream mitigation requested:
Click to entei . linear feet
4c. If using stream mitigation, what is the stream temperature:
Choose one
Page 15 of 23
PCN Form Version 4.3- April 20, 2022

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
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?
❑ Yes ❑ No
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
Zone 1
CIICK to enter.
Click to enter.
Choose one
Click to enter.
Zone 2
Click to enter.
Click to enter.
Choose one
Click to enter.
6f. Total buffer mitigation required
Click to enter.
6g. If buffer mitigation is required, is payment to a mitigation bank or
NC Division of Mitigation Services proposed?
❑ Yes ❑ No
6h. If yes, attach the acceptance letter from the mitigation bank or NC Division of Mitigation Services.
6i. Comments:
lick to enter.
Page 16 of 23 PCN Form Version 4.3- April 20, 2022

F. Stormwater Management and Diffuse Flow Plan (DWR requirement)
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers
identified within one of the NC Riparian Buffer Protection Rules?
❑ Yes ❑x 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
❑ Vegetated Conveyance (lower seasonal high water table-SHWT)
❑ Wetland Swale (higher SHWT)
❑ Other SCM that removes minimum 30% nitrogen
❑ 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-%20environmental%20quality/chapter%2002%20-
%20environmental%20management/subchapter%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?
❑ Yes ❑ No
❑x 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.)
0 Local Government
0 State
If you have local government approval, please include the SMP on their overall impact map.
Local Government Stormwater Programs *
0 Phase II ❑ USMP
❑ NSW ❑ Water Supply
Page 17 of 23
PCN Form Version 4.3- April 20, 2022

Please identify which local government stormwater program you are using.
Click to enter.
State Stormwater Programs
❑ Phase II ❑ HQW or ORW
❑ Coastal Counties ❑ Other
Comments:
Click to enter.
Page 18 of 23 PCN Form Version 4.3- April 20, 2022

G. Supplementary Information
1. Environmental Documentation
1 a. Does the project involve an expenditure of public (federal/state/local)
funds or the use of public (federal/state) land? *
❑ Yes
❑x No
1 b. If you answered "yes" to the above, does the project require
preparation of an environmental document pursuant to the
requirements of the National or State (North Carolina) Environmental
Policy Act (NEPA/SEPA)?
❑Yes
❑ 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:
Click to enter.
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)?
❑ Yes
❑x No
2b. If you answered "yes" to the above question, provide an explanation of the violation(s):
ACK 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:
This project is not anticipated to result in additional development as it is a protected and buffered stream corridor
in a forested area. The stream will remain protected in the riparian buffer which will prevent additional
development nearby.
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
Page 19 of 23 PCN Form Version 4.3- April 20, 2022

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.
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.govl) *
❑ Yes ❑x 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.
Asheville
5d. Is another federal agency involved? *
❑ Yes ❑x No ❑ Unknown
If yes, which federal agency?
Click to enter.
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.?*
®Yes ❑ 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-req.usace.army.mil/NLEB/1-30-17-siqned 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)? *
❑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 otherpercussive activities
that will be conducted by machines, such as jackhammers,
mechanized pile drivers, etc.?
❑ 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? *
USFWS IPaC database and NC Natural Heritage Program database. Additionally, biologists from CEC and CLC
performed site visits to assess potential suitable habitats for special status species.
Attach consultation documentation.
6. Essential Fish Habitat (Corps Requirement)
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PCN Form Version 4.3- April 20, 2022

6a. Will this project occur in or near an area designated as
an Essential Fish Habitat?
❑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: Click to ente
6b.
What data source(s) did you use to determine whether your site would impact Essential Fish Habitat? *
National Oceanic and Atmospheric Administration (NOAA) Essential Fish Habitat Mapper
https://www.habitat.noaa.gov
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 ❑x No
7b. What data source(s) did you use to determine whether your site would impact historic or archeological
resources? *
NC Historic Preservation Office's HPOWEB Application https://nc.marps.arcgis.com. Please see attached NC
SHPO Map.
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? *
❑ Yes
❑x No
8b. If yes, explain how the project meets FEMA requirements.
Olick to ci i«,
8c. What source(s) did you use to make the floodplain determination?
FEMA Flood Map Service Center: https://msc.fema.gov/portal/search
Flood Map # 3710460400J. Please see the attached Pre -JD Features Map (Figure 6).
Page 21 of 23 PCN Form Version 4.3- April 20, 2022

H. Miscellaneous
Comments:
Hello, please find the attachments for the Application Request Package for scheduling and review. Upon review
of the attachments, please provide any comments via the Comment Response Matrix (CRM) for the
administrative record. Thank you!
(The comprehensive list of all project attachments is as follows:)
- DWR Pre -Filing Meeting Request Form
- Figures 1-6: VicinityMap, USGS Topographic Map, Aerial Map, NRCS Current Soils Map, NRCS Published
Soils Map, NWI/NHD Map, & Pre -JD Features Map.
- NC SHPO Map
- Stream Impact Table
- Upper Forney Stream Restoration 60% Design Plan Set
- Upper Forney Stream Restoration 60% Design Erosion Prevention and Sediment Control Plans and Details
- USFWS Official Species List Report
- USFWS Biological Assessment Report
- Old Stumpy Preserve Baseline Documentation Report
- Saint James Preserve Baseline Documentation Report
- Aquatic Resource Table
Attach pertinent documentation or attachments not previously requested
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 oftime;
• 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: Kevin Thomas
Signature: (% C/
Date: * 5/2/2022
Page 22 of 23
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Page 23 of 23 PCN Form Version 4.3- April 20, 2022