Pre-Construction Notification (PCN) Form_amend_20221214.pdf

DWR
Dirlslna of Water Resourcra
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
April 13, 2022 Ver 4.3
Please note: fields marked with a red asterisk * below are required. You will not be able to submit the form until all mandatory questions are answered.
Also, if at any point you wish to print a copy of the E-PCN, all you need to do is right -click on the document and you can print a copy of the form.
Below is a link to the online help file.
https://edocs.deq.nc.gov/WaterResources/0/edoc/624704/PCN % 20Help % 20File % 202018-1-30.pdf
A. Processing Information
Pre -Filing Meeting Date Request was submitted on:
7/5/2022
If this is a courtesy copy, please fill in this with the submission date.
County (or Counties) where the project is located:
Wake
Is this a NCDMS Project*
Yes No
Click Yes, only if NCDMS is the applicant or co -applicant.
Is this project a public transportation project?*
Yes No
This is any publicly funded by municipal,state or federal funds road, rail, airport transportation project.
1a. Type(s) of approval sought from the Corps: *
Section 404 Permit (wetlands, streams and waters, Clean Water Act)
Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
Has this PCN previously been submitted? *
Yes
No
1 b. What type(s) of permit(s) do you wish to seek authorization?
Nationwide Permit (NWP)
Regional General Permit (RGP)
Standard (IP)
1c. Has the NWP or GP number been verified by the Corps?*
Yes No
Nationwide Permit (NWP) Number:
NWP Numbers (for multiple NWPS):
List all NW numbers you are applying for not on the drop down list.
1d. Type(s) of approval sought from the DWR:
check all that apply
401 Water Quality Certification - Regular
Non-404 Jurisdictional General Permit
Individual 401 Water Quality Certification
58 - Utility Line Activities for Water and Other Substances (frequently used)
1e. Is this notification solely for the record because written approval is not required?
*
For the record only for DWR 401 Certification:
For the record only for Corps Permit:
401 Water Quality Certification - Express
Riparian Buffer Authorization
Yes No
Yes No
1f. Is this an after -the -fact permit application? *
Yes No

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

4c. Address
Street Address
555 Fayetteville Street, Suite 400
Address Line 2
City
Raleigh
Postal / Zip Code
27601
4d. Telephone Number:*
[phone]
4f. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
State / Province / Region
NC
Country
USA
4e. Fax Number:
1a. Name of project:*
3550 Horton Street
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality / town:
Raleigh
2. Project Identification
2a. Property Identification Number:
2b. Property size:
(tax PIN or parcel ID)
(in acres)
2c. Project Address
Street Address
3550 Horton Street
Address Line 2
City
State / Province / Region
Raleigh
NC
Postal / Zip Code
Country
27607
USA
2d. Site coordinates in decimal degrees
Please collect site coordinates in decimal degrees. Use between 4-6 digits (unless you are using a survey -grade GPS device) after the decimal place as appropriate, based on how the location was
determined. (For example, most mobile phones with GPS provide locational precision in decimal degrees to map coordinates to 5 or 6 digits after the decimal place.)
Latitude: * Longitude:
35.814213-78.690962
ex: 34.208504-77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:
House Creek
3b. Water Resources Classification of nearest receiving water:
QNSW
Surface Water Lookup
3c. What river basin(s) is your project located in?
Neuse
3d. Please provide the 12-digit HUC in which the project is located.
030202010803
River Basin Lookup
4. Project Description and History
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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:*
Both of the repair sites under this project name are located within a City of Raleigh easement which has a sewer line crossing House Creek. The stream banks have eroded and exposed
existing manholes.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?
Yes No Unknown
4f. List the total estimated acreage of all existing wetlands on the property:
none (study area in easement)
4g. List the total estimated linear feet of all existing streams on the property:
(intermittent and perennial)
4h. Explain the purpose of the proposed project: *
The purpose of this project is to stabilize and repair a streambank in two locations. The first location (Photographs 1 &2) is a manhole which has been exposed due to an eroded
streambank. The second location (Photographs 3 & 4) is a streambank which has failed and risks exposing a nearby manhole and buried gravity sewer pipe. The project will temporarily
impact a total of approximately 600 square feet of streambank on House Creek near 3550 Horton Street at 35.814213,-78.690962 decimal degrees.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used: *
Work will entail creating a dry work area, establishing a stable toe, removing two fallen trees from stream, constructing a stable bank using rock/geotextile, coir matting and establishing a
stable segment of stream bed at the base of the bank. The site will be accessed by the existing sewer easement from east of the site. 40 LF of the permanent disturbance will occur inside
the maintained easement at the first location (either side of the stream) and 20 LF of the permanent disturbance will occur at the second location within the maintained easement. Erosion
control measures will be installed prior to work.
Stone will be placed to establish to create a stable work area. Disturbed areas will be reseeded and mulched when work is complete. It is expected that a rubber tire loader or skid steer
loader and a dump truck will be used to place the boulders, reconstruct the streambank, and stabilize the streambank. Please see the four attached details; temporary silt fence, temporary
construction entrance, bank stabilization, and seeding details.
5. Jurisdictional Determinations
Sa. Have the wetlands or streams been delineated on the property or proposed impact areas?
Yes No Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?
Preliminary Approved Not Verified Unknown N/A
Corps AID Number:
Example: SAW-2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
6. Future Project Plans
6a. Is this a phased project?*
Yes No
Are any other NWP(s), regional general permit(s), or individual permits(s) used, or intended to be used, to authorize any part of the proposed project or related activity? This includes other
separate and distant crossing for linear projects that require Department of the Army authorization but don't require pre -construction notification.
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
Wetlands Streams -tributaries Buffers
Open Waters Pond Construction
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this question for all stream sites impacted.
"S." will be used in the table below to represent the word "stream".
❑
3a. Reason for impact* (?)
3b.lmpact type*
3c. Type of impact*
3d. S. name*
3e. Stream Type*
(?)
3f. Type of
Jurisdiction*
3g. S. width*
3h. Impact
length*
S1
Stream bank stabilization
Permanent
Stabilization
House Creek
Perennial
DWR
10
Average (feet)
40
Qinear feet)

a2 Stream bank stabilization Permanent Stabilization House Creek Perennial DWR 10 20
Average (feet) (linear feet)
** All Perennial or Intermittent streams must be verified by DWR or delegated local government.
31. Total jurisdictional ditch impact in square feet:
0
31. Total permanent stream impacts:
60
3i. Total temporary stream impacts:
0
3i. Total stream and ditch impacts:
60
3j. Comments:
E. Impact Justification and Mitigation
1. Avoidance and Minimization
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
See project description in Section C.4.i.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:'
See attached details referenced in Section CA.i.
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 this project DOES NOT require Compensatory Mitigation, explain why:
Impacts are below mitigation threshold
NC Stream Temperature Classification Maps can be found under the Mitigation Concepts tab on the Wilmington District's RIBITS website.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
*** Recent changes to the stormwater rules have required updates to this section .***
1. Diffuse Flow Plan
la. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
Yes No
u
1 b. All buffer impacts and high ground impacts require diffuse flow or other form of stormwater treatment. If the project is subject to a state implemented riparian buffer protection program,
include a plan that fully documents how diffuse flow will be maintained.
All Stormwater Control Measures (SCM)s must be designed in accordance with the NC Stormwater Design Manual. Associated supplement forms and other documentation shall be
provided.
What type of SCM are you providing?
Level Spreader
Vegetated Conveyance (lower SHWT)
Wetland Swale (higher SHWT)
Other SCM that removes minimum 30 % nitrogen
Proposed project will not create concentrated stormwater flow through the buffer
(check all that apply)
For a list of options to meet the diffuse flow requirements, click here
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?
Yes No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?'
Yes No
To look up low density requirement click here 15A NCAC 02H .1003(2).
Comments:

G. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
Yes 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
Comments:*
The impacts to House Creek are minimal from the two permanent stream stabilization locations.
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15A NCAC 2H .0500), Isolated Wetland Rules (15A NCAC 2H .1300), or DWR Surface Water or Wetland Standards or
Riparian Buffer Rules (15A NCAC 2B .0200)? *
Yes No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in additional development, which could impact nearby downstream water quality?*
Yes No
3b. If you answered "no," provide a short narrative description.
This project is solely to repair an existing sewer system and no additional development is planned.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
Yes No N/A
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or habitat?
Yes No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
Yes No
5d. Is another Federal agency involved?*
Yes No
5e. Is this a DOT project located within Division's 1-8?*
Yes 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 No
Link to the NLEB SLOPES document: http://saw-reg.usace.army.mil/NLEB/1-30-17-signed_NLEB-SLOPES&apps.pdf
5h. Does this project involve the constructionlinstallation of a wind turbine(s)?* *
Yes No
Unknown
5i. Does this project involve (1) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhammers, mechanized pile drivers, etc.?
Yes No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
The ECOS IPAC database and the NCNHP data explorer results are attached for the project location.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat? *
Yes No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?
NOAA Fish Map
7. Historic or Prehistoric Cultural Resources (Corps Requirement)

Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data: http_//gis.ncdcr.gov/hpoweb/
7a. Will this project occur in or near an area that the state, federal or tribal governments have designated as having historic or cultural preservation status (e.g., National Historic Trust
designation or properties significant in North Carolina history and archaeology)?"
Yes No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
http://gis.ncdcr.gov/hpoweb/. Stream stabilization is for a small area and archaeological resources were not reviewed.
8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https:Hmsc.fema.gov/portal/search
8a. Will this project occur in a FEMA-designated 100-year floodplain?'�
Yes No
8c. What source(s) did you use to make the floodplain determination?"`
FEMA Floodplain GIS Map
Miscellaneous
Comments
Supporting information is provided in Attachment A.
Agent authorization is within Attachment A.
- NHP is within Attachment A.
- IPAC report is within Attachment A.
- Pre -filing meeting request is within Attachment A.
u
Please use the space below to attach all required documentation or any additional information you feel is helpful for application review. Documents should be combined into one file when
possible, with a Cover Letter, Table of Contents, and a Cover Sheet for each Section preferred.
Click the upload button or drag and drop files here to attach document
3550 Horton Street Attachment A.pdf 3.41 MB
File must be PDF or KMZ
Signature
By checking the box and signing below, I certify that:
• The project proponent hereby certifies that all information contained herein is true, accurate, and complete to the best of my knowledge and belief'; and
• The project proponent hereby requests that the certifying authority review and take action on this CWA 401 certification request within the applicable reasonable period of time.
• I have given true, accurate, and complete information on this form;
• I agree that submission of this PCN form is a "transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature; AND
• I intend to electronically sign and submit the PCN form.
Full Name:"
Jessica Tisdale
Signature *
jfaI X Tui,�G
Date
12/14/2022