20230197 Ver 1_ePCN Application_20230203

DWR
Division of Water Resources
Initial Review
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
April 13, 2022 Ver 4.3
Has this project met the requirements for acceptance in to the review process?*
Yes
No
Is this project a public transportation project?*
Yes No
Change only if needed.
Pre -Filing Meeting Date Request was submitted on:
9/13/2019
BIMS # Assigned* Version#*
20230197 1
Is a payment required for this project?*
No payment required
Fee received
Fee needed - send electronic notification
Reviewing Office*
Raleigh Regional Office - [phone]
Information for Initial Review
la. Name of project:
Old Apex Road Water Line Replacement
la. Who is the Primary Contact?*
Eric Kulz
What amout is owed?*
$240.00
$570.00
Select Project Reviewer*
Zachary Thomas:eads\ztthomas
1 b. Primary Contact Email:* lc. Primary Contact Phone:*
[e-mail] [phone]
Date Submitted
2/3/2023
Nearest Body of Water
UT to Crabtree Creek
Basin
Neuse
Water Classification
C; NSW
Site Coordinates
Latitude: Longitude:
35.768433 -78.807697
A. Processing Information
County (or Counties) where the project is located:
Wake
Is this a NCDMS Project
Yes No
Is this project a public transportation project? *
Yes No

la. 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
Please provide the date of the previous submission.*
9/13/2019
1 b. What type(s) of permit(s) do you wish to seek authorization?
Nationwide Permit (NWP)
Regional General Permit (RGP)
Standard (IP)
lc. Has the NWP or GP number been verified by the Corps?
Yes No
Nationwide Permit (NWP) Number: 58 - Utility Line Activities for Water and Other Substances (frequently used)
NWP Numbers (for multiple NWPS):
ld. Type(s) of approval sought from the DWR:
401 Water Quality Certification - Regular
Non-404 Jurisdictional General Permit
Individual 401 Water Quality Certification
le. 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:
If. Is this an after -the -fact permit application?*
Yes No
lg. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
Yes No
lg. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
Yes No
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
B. Applicant Information
Id. Who is applying for the permit?
Owner Applicant (other than owner)
le. Is there an Agent/Consultant for this project?*
Yes No
2. Owner Information
2a. Name(s) on recorded deed:
Town of Cary Utility Easement
2b. Deed book and page no.:
2c. Contact Person:
Eric Kulz
401 Water Quality Certification - Express
Riparian Buffer Authorization
Yes No
Yes No

2d. Address
Street Address
Town of Cary
Address Line 2
P.O. Box 8005
City
Cary
Postal / Zip Code
27512-8005
State / Province / Region
NC
Country
Wake
2e. Telephone Number: 2f. Fax Number:
[phone]
2g. Email Address: *
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(if appropriate)
lc. Nearest municipality / town:
Cary
2. Project Identification
2a. Property Identification Number:
0753741749
2c. Project Address
Street Address
1405 Old Apex Road
Address Line 2
City
Cary
Postal / Zip Code
27513-5254
3. Surface Waters
3a. Name of the nearest body of water to proposed project: *
UT to Crabtree Creek
3b. Water Resources Classification of nearest receiving water: *
C; NSW
3c. What river basin(s) is your project located in?*
Neuse
3d. Please provide the 12-digit HUC in which the project is located.
030202010801
4. Project Description and History
2b. Property size:
3.27
State / Province / Region
NC
Country
Wake
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:*
Project area is a Town of Cary Utility Easement, located within an approximate 4.48 acre parcel at 1412 Old Apex Road
in Cary, NC. The project area is currently undeveloped woodlands in the area of the utility easement. A commercial
landscaping nursery is located to the southwest, and a Town of Cary fire station is located to the northeast. Undeveloped properties and a pond are located to the northwest across Old
Apex Road. Single-Fanily residential properties are located to the southeast, across a railroad right-of-way.
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:
0.003 acres within project area
4g. List the total estimated linear feet of all existing streams on the property:
20 linear feet within project area
4h. Explain the purpose of the proposed project: *
The proposed project consists of the replacement (reinforcement) of existing 12-inch diameter waterline with a 16-inch
diameter waterline, located along Old Apex Road in Cary, NC. The project extends approximately 8,300 linear feet of
from an existing 20" waterline at SW Cary Parkway and will connect to an existing 12" waterline on Maynard Road. This project will include crossing a UT to Crabtree Creek in the
proposed project area.

4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used: *
The existing utility corridor for the project is primarily within the Old Apex Road right-of-way. In the area of the proposed impacts, the waterline must be moved out of the right-of-way due to
the presence of an existing RCP culvert underneath Old Apex Road. A utility easement was obtained for the portion of the line outside the road ROW. Moving the waterline off the existing
roadway and into a wooded area adjacent to the road requires the establishment of a new 20'-wide utility maintenance corridor, which will be regularly mowed and maintained by the Town
of Cary.
The establishment of the new maintenance corridor will require temporary wetland and stream impacts, which will be restored to pre -construction contours and seeded with a wetland seed
mix. The corridor will be regularly mowed and maintained, resulting in the conversion of a headwater forested wetland to an herbaceous wetland, and permanent removal of forested
riparian buffer along the stream channel.
Construction techniques and equipment used will be typical of utility installations.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
Yes
Comments:
No Unknown
Wetlands and streams were delineated by WithersRavenel on 03/29/2019. See Stream/Wetland
DElineation Map in 2019 PCN submittal (attached).
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
Preliminary Approved Not Verified Unknown N/A
Corps AID Number:
SAW-2019-02117 (NW Permit Verification)
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?*
WithersRavenel
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?
No
D. Proposed Impacts Inventory
1. Impacts Summary
la. Where are the impacts associated with your project? (check all that apply):
Wetlands
Open Waters
2. Wetland Impacts
Streams -tributaries
Pond Construction
Buffers
u
2a. Site #* (?)
2a1 Reason (?)
2b. Impact type* (?)
2c. Type of W.*
2d. W. name
2e. Forested*
2f. Type of Jurisdicition*
(?)
2g. Impact
area*
Impact 1
Waterline Crossing
T
Headwater Forest
Wetland
Yes
Both
0.003
(acres)
2g. Total Temporary Wetland Impact
0.003
2g. Total Wetland Impact
0.003
2i. Comments:
2g. Total Permanent Wetland Impact
0.000
The 0.003 acres of temporary wetland impacts will result in the permanent conversion of headwater
forested wetlands to herbaceous wetlands.
3. Stream Impacts
3a. Reason for impact (?)
3b.Impact type*
3c. Type of impact*
3d. S. name*
3e. Stream Type*
(?)
3f. Type of
Jurisdiction*
3g. S. width
3h. Impact
length*
S1
Waterline Crossing
Temporary
Other
UT to Crabtree Creek
Intermittent
Both
3
Average (feet)
20
(linear feet)

3i. Total jurisdictional ditch impact in square feet:
0
31. Total permanent stream impacts: 3i. Total temporary stream impacts:
0
3i. Total stream and ditch impacts:
20
3j. Comments:
The 20 If of stream impacts are temporary, and will be restored to pre -construction contours.
6. Buffer Impacts (for DWR)
6a. Project is in which protect basin(s)?
Check all that apply.
Neuse
Catawba
Goose Creek
Other
20
Tar -Pamlico
Randleman
Jordan Lake
6b. Impact Type
6c. Per or Temp
6d. Stream name 16e.
Buffer mitigation required?
6f. Zone 1 impact
6g. Zone 2 impact
Clearing
P
UT to Crabtree Creek
No
1,358
831
6h. Total buffer impacts:
Total Temporary impacts:
Total Permanent impacts:
Total combined buffer impacts:
6i. Comments:
Zone 1
0.00
Zone 1
1,358.00
Zone 2
0.00
Zone 2
831.00
Zone 1 Zone 2
1,358.00
E. Impact Justification and Mitigation
1. Avoidance and Minimization
831.00
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
Stream and wetland impacts will be temporary, with the impact areas restored to pre -construction contours. Impact areas will be reseeded with a wetland
seed mix following completion of the installation.
The proposed utility installation has been designed to align with the existing waterline as much as possible along Old Apex Road. The relocation in the
project area is necessary due to the presence of an existing 30-inch RCP culvert underneath Old Apex Road. Due to the presence of the culvert,
installation of the water line within the Old Apex Road right-of-way would require relocation and reconstruction of the existing culvert and roadway.
The corridor will cross the unnamed tributary at a perpendicular angle as it enters a culvert under Old Apex Road, minimizing impacts to the riparian
buffer.
lb. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Construction activities will be conducted under an Erosion and Sediment Control Plan, which will be submitted to NCDEMLR for approval. Construction
access to the proposed corridor will be from high ground, and equipment usage in the jurisdictional areas will be minimized as much as possible,
reducing disturbance to pre -construction contours. Silt fence will be used as appropriate.
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:
Project impacts are below agency mitigation thresholds.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan

1a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
Yes No
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
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
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
N/A - project disturbs < 1 acre
Comments:
Project will not result in new impervious surface, new stormwater flow, or concentrated flow. Pre -project contours will be restored.
G. Supplementary Information
1. Environmental Documentation
la. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
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: *
Local funds only. Also, 15A NCAC 01C .0407 states that standard maintenance/repair activities do not require filing of environmental documents. (3)
specifies existing utilities.
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 result in additional development, which could impact nearby downstream water quality?*
Yes No
3b. If you answered "no," provide a short narrative description.
Project involves replacing existing infrastructure.
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
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. Is another Federal agency involved?*
Yes
No Unknown
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
5h. Does this project involve the construction/installation of a wind turbine(s)?*
Yes No
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?
USFWS iPaC website accessed 02/02/2023.
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? *
Site is not located iwhtin a coastal county.
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal governments have designated as having historic or cultural preservation status?*
Yes No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
HPOWeb 2.0 accessed 02/02/2023.
8. Flood Zone Designation (Corps Requirement)
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?*
Map No. 3720075300K eff. date 7/19/22
Miscellaneous
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
Old Apex Rd Water Line Transmittal Letter and Attachments.pdf 10.09MB
File must be PDF or KMZ
Comments
Applications for 404/401 approvals and Neuse buffer authroization were submitted for this project in 2019 (SAW-2019-02117 and DWR# 20191230). The project was delayed and the
approvals expired. No chances have been made to the project design or impacts. We are re -applying for the permits/approvals. This is a request to reissue a previously approved project
with no changes.
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:
Eric Kulz
Signature
Date
2/3/2023

STORMWATER DIVISION
February 3, 2023
NC Division of Water Resources
401 and Buffer Permitting Unit
1617 MSC
Raleigh, NC 27699-1617
ATT: 401 and Buffer Permitting Branch Supervisor
RE: Application for 401 WQC and Neuse Buffer Authorization
Old Apex Road Waterline Replacement
DWR# 20191230
Cary, NC
Enclosed are attachments to the Town's application for the above -referenced project. The project site
is a water line stream crossing under a UT to Crabtree Creek (Neuse Basin). Applications for
404/401 approvals and Neuse buffer authorization were submitted for this project in 2019 (SAW-
2019-02117 and DWR# 20191230). The project was delayed and the approvals expired. No
chances have been made to the project design or impacts. We are re -applying for the
perm its/approvals.
The Town proposes the following:
1. Clearing/grubbing of a 20-foot corridor at the location of the stream crossing for the purposes of
installing the water line;
2. Open -cut installation of the water line beneath the intermittent UT to Crabtree Creek;
3. Restore the pre -project contours of the stream bed and banks; and
4. Re -vegetate the corridor with a wetland seed mix in the wetland, and grass for the remainder of
the corridor. A 20-foot utility easement will be maintained.
Proposed impacts are 0.003 acres of forested headwater wetland (temporary; converted to herbaceous
wetland), 20 LF of temporary stream impact, and 1,358 SF of Z1 buffer impacts/831 SF of Zone 2
impacts.
We are proposing the work be covered under a NW 58 from USACE and corresponding GC 4276, and
a Neuse Lake buffer authorization for impacts associated with clearing the 20-foot easement and re -
vegetating with herbaceous vegetation.
Please feel free to contact me at [phone] if you have any questions regarding this application or
project.
Sincerely,
!�� IJA
Eric W.'T<ulz
Environmental Specialist
cc: File Copy
TOWN Of CARY
316 North Academy Street • Cary, NC 27513 • PO Box 8005 • Cary, NC 27512-8005
te1919-469-4030 • fax [phone] • www.townofcary.org

TABLE OF CONTENTS
401 Pre -Application Meeting Request Email
USGS Topographic Map (2019)
USDA Soils Map (1970)
Impact Maps
Aerial Photograph (2017)
Utility Easement Documents
Previous 404/401 Approvals

From:
Crystal L. Penton
To:
Eric Kulz
Subject:
FW: [External] Extension Request DWR #19-1230 Old Apex Waterline Reinforcement
Date:
Thursday, February 2, 2023 11:12:56 AM
Attachments:
—WRD0000.ipo
imaae001.ma
Eric —
Below is the email I received DEQ that references the pre -filing date. I think I've shared everything
you might need to make the application, but if there is something I have missed let me know. Thank
you for helping out with this!
Crystal Penton, P.E.
Utility Engineer
CARY, NC
UTILITIES DEPARTMENT
PO Box 8005 1 Cary, NC 27512-8005
316 N. Academy Street I Cary, NC 27513
phone: [phone]
❑
In keeping with the NC Public Records Law, emails, including attachments, may be released to others upon request for inspection and
copying.
From: Homewood, Sue <[e-mail]>
Sent: Tuesday, January 31, 2023 10:30 AM
To: Crystal L. Penton <Crystal. Penton @townofca ry.org>
Cc: Goss, Stephanie <[e-mail]>; Gibby, Jean B SAW
<[e-mail]>; Thomas, Zachary T <[e-mail]>
Subject: FW: [External] Extension Request DWR #19-1230 Old Apex Waterline Reinforcement
IYou don't often get email from [e-mail]. Learn why this is important
Hello Crystal,
Unfortunately the previous authorization was issued under a General Certification (and Nationwide
Permits with the USACE) that no longer exists, therefore we have no ability to issue an extension.
You will need to submit a new application for a new authorization. I believe that the USACE is likely
to request the same, I have copied Ms. Gibby so she is aware of your situation.
In submittal of a new application, you can use the original application submittal date as the "pre -
filing request date" on the PCN form and please indicate that this is a request to reissue a previously

approved project with no changes. That will help us process it efficiently as we won't need to re -
review the project in detail.
Please let me know if you have any follow up questions
Thanks,
Sue Homewood (she/her/hers)
401 & Buffer Permitting Branch
Division of Water Resources
Sue.Homewood(@ncdenr.gov
336 813 1863
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
From: Rowland, Kelsey S <[e-mail]>
Sent: Tuesday, January 31, 2023 10:21 AM
To: Homewood, Sue <[e-mail]>
Subject: FW: [External] Extension Request DWR #19-1230 Old Apex Waterline Reinforcement
Kelsey Rowland, MEM
Environmental Specialist, Division of Water Resources
North Carolina Department of Environmental Quality
[phone]
kelsey.rowland(@ncdenr.gov
1617 Mail Service Center, Raleigh, INC 27699-1617
From: Crystal L. Penton<Crysta1.Penton (@townofcary.org>
Sent: Thursday, January 19, 2023 1:48 PM
To: Rowland, Kelsey S <Kelse)1.Rowlanc1Pncdenr.gov>
Cc: Robert Hirt <Robert.Hirt(@townofcary.org>
Subject: [External] Extension Request DWR #19-1230 Old Apex Waterline Reinforcement
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an
attachment to Report Spam.
Good afternoon Kelsey —
The Town of Cary (TOC) had previously received a 401 permit approval for the Old Apex Waterline
Reinforcement which includes the installation of a new 24-inch waterline along a portion of Old Apex
Rd. I have attached the permit number DWR# 19-1230 from November 2019 for your reference.
This project was put on hold in 2021, however TOC is ready to begin moving this project forward

again. TOC would like to request an extension of this permit. Please let me know what steps need
to be taken to extend the permit approval for this project. The project was fully designed when it
was placed on hold and no changes have been made to the design in the interim.
Thank you for your assistance in this matter,
Crystal Penton, P.E.
Utility Engineer
CARY, NC
UTILITIES DEPARTMENT
PO Box 8005 1 Cary, NC 27512-8005
316 N. Academy Street I Cary, NC 27513
phone: [phone]
In keeping with the NC Public Records Law, emails, including attachments, may be released to others upon request for inspection and
copying.
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BDt)C'lfreQQq§ IAF5CABC-4AAB-4196-8D32-43AB7OB7C30D
EXCISE TAX: $65.00
INSTRUMENT PREPARED BY: TOWN ATTORNEY'S OFFICE, WITHOUT TITLE EXAMINATION
CHECKED BY: FLORIDA HUGHES
MAIL AFTER RECORDING TO
TOWN OF CARY
REAL ESTATE SECTION
P.O. BOX 8005
CARY, Nc 27512-8005
BRIEF DESCRIPTION FOR INDEX: PIN 0753741749
WAKE COUNTY. NC
CHARLES P. GILLIAM
REGISTER OF DEEDS
PRESENTED & RECORDED ON
12-04-2020 AT 08:48:34
STATE OF NC REAL ESTATE
EXCISE TAX: $65.00
BOOK: 018221 PAGE: 00518 - 00523
STATE OF NORTH CAROLINA PERMANENT UTILITY AND PIPELINE
EASEMENT
WAKE COUNTY
THIS DEED OF PERMANENT EASEMENT FOR UTJ�,JJTY01) PIPELINE PURPOSES
("Utility and Pipeline Easement" or "UPE"), made this day of , by K & D
Ramsey LLC with a mailing address of 1412 Old Apex Road, Cary, NC 27513 Grantors, to and for the
benefit of the TOWN OF CARY, a municipal corporation of the State of North Carolina, with a mailing
address of P.O. Box 8005, Cary, NC 27512-8005, Grantee. The designation Grantors and Grantee as
used herein shall include said parties, their heirs, successors and assigns, and shall include the singular,
plural, masculine, feminine or neuter as required by context.
WITNESSETH:
WHEREAS, the Grantors are the owners of a certain lot or parcel of land with a site address of
1405 Old Apex Road, located in Wake County, North Carolina and more particularly described in Deed
Book 15875 at Page 196, Wake County Registry ("Grantor Property"), and have agreed to convey to the
Grantee, according to the terms set forth below, the permanent utility and pipeline easement interest
hereafter described; and
WHEREAS, Grantee desires the permanent utility and pipeline easement.
NOW THEREFORE, for good and valuable consideration, the receipt of which is hereby
acknowledged, the Grantors hereby give, grant, bargain, sell, and convey unto the Grantee, its successors
and assigns, the right, privilege and permanent Utility and Pipeline Easement in, on, over, under, along,
Submitted electronically by Town of Cary in compliance with North Carolina statutes eovernin¢ recordable documents and the
terms of the submitter aareement with the Wake Countv Reeister of Deeds.

BDtkilfreQQq§ R F5CABC-4AAB-4196-8D32-43AB7OB7C30D
across and through a portion of Grantor Property as generally shown for illustrative purposes on Exhibit
A and more particularly described as follows:
All that tract or parcel of land situated in Cary, Wake County North Carolina, more particularly described
as follows:
Beginning at an existing iron pipe the southeastern right-of-way of Old Apex Rd, said point also being the
southwest corner of the subject property and having ground coordinates of N: 734,269.01, E:
2,056,792.89 (see attached exhibit for datum description); thence from the point of beginning so located,
along said right-of-way the following courses and distances: North 41 °37'59" East 109.29 feet to a point
to an existing iron pipe, thence North 35°30'32" East 98.87 feet to a point to an existing iron pipe, thence
North 29'37'11" East 100.20 feet to a point, thence North 23°52'47" East 98.28 feet to a point, thence
North 17°57'05" East 100.24 feet to a point to an existing iron pipe, thence North 11 °57'44" East 15.08
feet to a point, thence leaving said right of way along an existing Utility and Pipeline Easement (DB
6986, PG 320) the following courses and distances: South 76°21'02" East 1.33 feet to a point, thence
North 14°24'01" East 133.06 feet to a point, thence North 02°11'06" East 252.54 feet to a point, thence
along the northern property line of the subject property North 89°44'41" East 4.33 feet to a point, thence
along the new easement line the following courses and distances: South 01°41'39" West 160.69 feet to a
point, thence South 00°04'57" East 45.26 feet to a point, thence along a curve to the right having a radius
of 360.00 feet, an are length of 95.79 feet, and a chord bearing and distance of South 07°32'26" West,
95.51 feet to a point, thence South 14°53'36" West 101.87 feet to a point, thence South 17°50'27" West
35.06 feet to a point, thence South 17°35'25" West 19.17 feet to a point, thence South 20°56'40" West
14.16 feet to a point, thence South 24°03'20" East 20.61 feet to a point, thence South 20°56'40" West
31.64 feet to a point, thence South 65°56'40" West 20.61 feet to a point, thence South 20°56'40" West
9.10 feet to a point, thence South 24°25'00" West 50.09 feet to a point, thence South 27°24'14" West
49.10 feet to a point, thence South 30°53'13" West 49.34 feet to a point, thence South 33°38'53" West
50.75 feet to a point, thence South 35°57'41" West 48.66 feet to a point, thence South 38°51'47" West
46.51 feet to a point, thence South 41 °47'25" West 47.79 feet to a point, thence South 42032101" West
28.66 feet to a point in the southern property line of the subject property, thence along said property line
North 49°33'32" West 7.86 feet to the point and place of beginning containing 0.171 acres (7,429 square
feet) more or less, according to a map entitled "Exhibit "A" Permanent Utility and Pipeline Easement,
property of K and D Ramsey LLC", prepared by WithersRavenel, dated November 1, 2018.
This Utility and Pipeline Easement is for utility purposes including to improve, upgrade, remove, inspect,
replace, repair, maintain, use and operate such pipelines, laterals, interceptors, mains, manholes, conduits,
facilities and related appurtenances within the UPE are as may be necessary or convenient for the receipt,
conveyance, transmission and distribution of water, reclaimed water, and/or wastewater and for access
thereto.
Further Specific Terms and Conditions Applicable to the UPE:
Grantors shall not obstruct, encroach upon, or utilize the UPE in any way that interferes with its
use by Grantee as provided hereunder. The placing or planting of trees and shrubs and the
placing or installation of structures and improvements are deemed to interfere with Grantee's use,
unless permitted in accordance with paragraph 3 below.
Grantee may remove, clear and keep removed from the UPE any structures, fill, embankments,
trees, plants and other vegetation, materials, improvements and obstructions of any nature.
Following completion of initial installation, Grantee shall restore all disturbed areas in
accordance with generally accepted engineering and landscaping practices located in the UPE as
of the date hereof as a result of the exercise of the Grantee's rights hereunder. Grantor may elect
to plant ground cover or grasses. Certain encroachments within the UPE may thereafter be

BKO18221 PGO0520
DocuSign Envelope ID: DCF5CABC-4AAB-4196-8D32-43AB70B7C30D
permitted by Grantee in accordance with Grantee policies and procedures and in accordance with
a valid executed Town of Cary Encroachment Agreement, provided Grantors bear all risk of
damage to any such encroachment caused by Grantee exercising its rights hereunder.
Grantors shall retain fee simple ownership of the UPE, provided however, no use may be made of
the UPE by Grantor which interferes with Grantee's rights hereunder.
TO HAVE AND TO HOLD the aforesaid permanent and perpetual Utility and Pipeline Easement
and all privileges and appurtenances thereunto belonging to the said Grantee forever and the aforesaid
Temporary Construction Easement and all privileges and appurtenances thereunto belonging to the said
Grantee for the time period stated above. Grantors do warrant and covenant that they are seized of the
UPE and TCE areas in fee and have the right to grant and convey this UPE and TCE and that they will
warrant and defend the said grant of easement against claims of all persons whomsoever.
IN WITNESS WHEREOF, the Grantors have hereunto set their hands and seals, or if corporate, have
caused this instrument to be signed in its corporate name by its duly authorized officers, on the day and
year first above written.
K & D Ramsey, LLC,
a North Carolina limited liability company
By:��i_�
F ature2
wT,. -.k ram ey
r
(typed or printed name)
Title: Manager
STATE OF
COUNTY OFF ,j
I, t" $!i L(Cc 11�+ 'j h P S a Notary Public of the County and State aforesaid,
certify that Xed personally came before me this day and acknowledged that he/she is
Manager of K & D Ramsey, ILLC, a North Carolina limited liability company, and that he/she, as
Manager, being authorized to do so, voluntarily executed the foregoing on behalf of said limited liability
company for the purposes stated therein.
Witness my hand and official seal, this the day of bc, ('Nrnh� 1 20 oRO.
,,pNuamggq,
°p Not Public
may' NOTARY V: ?
puB%-\G :U ; Printed name of Notary Public
....... �-r -0D /p o�-3
MY Commission expires:_ri`14�1-
., o

BKQLIWIfref�gq§IF5CABC-4AAB-4196-8D32-43AB70B7C30D
EXHIBIT A
[Illustrative map of UPE and TCE]

BDUC i2EhfreQQYD?�?F5CABC-4AAB-4196-8D32-43AB7OB7C30D
EXHIBIT A
NITY MAP
1-_ GENERAL NOTES
IT
1) THIS IS NOT A BOUNDARY SURVEY. THE PURPOSE OF THIS PLAT IS TO DEFINE A NEW
EASEMENT ON AN EXISTING PARCEL.
SITE 2.) AREAS COMPUTED BY COORDINATE METHOD.
3.) BASIS OF BEARING NAD 83(2011)
4.) ALL DISTANCES ARE HORIZONTAL GROUND DISTANCES.
5.) ALL CORNERS NOT LABELED ARE COMPUTED POINTS
6.) THIS PLAT WAS PREPARED WITHOUT THE BENEFIT OF A TITLE
REPORT AND MAY BE SUBJECT 70 ANY MATTERS A COMPLETE SEARCH MAY DISCLOSE.
THIS MAP IS NOT A CERTIFIED SURVEY AND HAS NOT BEEN REVIEWED BY A LOCAL
GOVERNMENT AGENCY FOR COMPLIANCE WITH ANY APPLICABLE LAND
NO SCALE DEVELOPMENT REGULATIONS.
- - - - - - - - - - - - - - - .
35' CP&L EASEMENT
N BM 1985 PG 1039 NORTH
L i L2 N 89'43'46" E 299.01 '(TOTAL) NAD 8312011
CP
- TO NE CORNER -
I
I
I
I
I
i
I
I
1
I
/
1
I
1
I
/
SEE SHEET 2 FOR
CONTINUATION
ry
v�
EXISTING UTILITY &
PIPELINE EASEMENT
DB 6986 PG 320
J
1
CP
m I
J
UTILITY & PIPELINE
EASEMENT AREAS
Z I..
TOTAL AREA: 10,492 SO FT
Q. I_.
OVERLAP AREA: 3,063 SO FT
NET AREA: 7,429 SO FT
00
C J.,
K&D RWSEY LLC
O C
DB 15875 PG 196
PIN 0753-74-1749
IaF
1405 OLD APEX RD
L:
CARY" NC 27513
L
N::,
PROPOSED PERMANENT
U
UTILITY & PIPELINE
EASEMENT
7,429 SO FT
EXISTING UTILITY &
(cP
PIPELINE EASEMENT
DB 6986 PG 320
WnEM'S COMF7047F
LINE TABLE
LINEI
BEARING
DISTANCE
L 1
N 89'43 11 E
16.76
L2
N 89'44 41 E
4.33
L3
S 01'41'39" W
160.69'
L4
S 00'0457" E
45.26'
L5
S 14'53 36 W
101.87
L6
S 175027 W
35. 66
L7
S 17'35 25" W
19. 17'
L8
S 24'0320 E
20.61
L9
S 20'56'40" W
31.64'
L 10
S 6556'40" W
20.61 '
L J J
S 20'S6 40 W
9.10
L 12
S 24.25 00 W
50. 99
L 13
S 27.24 14 W
49.10
L14
S 30'53'13" W
49.34'
L 15
S 3338 53 W
50.75
L 16
S 35`57'41 " W
48.66'
L 17
S 38'51 '47" W
46.51 '
L 18
S 41 '4 225 W
47.79
L 19
S 42'32'01 " W
28.66'
L20
N 49733 32 W
7.86
L21
N 41'37 59 E
109.29
L22
N 35'30 32 E
98.87
L23
N 29'37'11 " E
100.20'
L24
N 23'5247" E
98.28'
L25
N 17'57 05 E
100.24
L26
N 11'5744" E
99.66'
L27
N 07-15 49 E
98.95
L28
N 01'07 37 E
99.92
L29
N 02'43' l7" W
100. 15'
L30
N 11'57*44" E
15.08'
L31
S 76'21 02 E
1.33
L32
N 14'24 01 E
133.06
L33
N 02-11'06" E
1 252.54'
CURVE TABLE
CURVE RADIUS ARC LENGTH CHORD LENGTH CHORD BEARING
C 7 360.00 95. 79
95.51 S 07'32 26 W
LEGEND
IPF - IRON PIPE FOUND
AIF - ANGLE IRON FOUND
CP - COMPUTED POINT
ADJOINER -
BOUNDARY
RIGHT OF WAY - -
NEW EASEMENT - - - - - -
®P,\A CARO
pEESSl 29
QQ '9C
SEAL
G ` L-6146
®`A SURD
'q
L RUDOLF A. VANDERVELDE ✓R, PLS, CERTIFY THAT THIS PLAT WAS DRAWN UNDER MY SUPERVISION FROM AN ACTUAL SURVEY PERFORMED UNDER MY
SUPERVISION (DEED DESCRIPTION RECORDED 1N BOOK (SEE), PAGE (MAP); THAT THE BOUNDARIES NOT SURVEYED ARE CLEARLY INDICATED AS DRAWN
FROM INFORMATION FOUND IN BOOK (SEE), PAGE (MAP); THAT THE RATIO OF PRECISION AS CALCULATED IS 1: 15,000, AND THAT THIS MAP MEETS THE
REQUIREMENTS OF THE STANDARDS OF PRACTICE FOR LAND SURVEYING IN NORTH CAROLINA (21 NCAC 56. 1600).
DATUM, NAD 83-2011, PROJECT (WT1172) CONTROL ESTABLISHED BY THE TOWN OF CARY IN 2009. ALL GROUND COORDINATES SHOWN HEREON WERE
DERIVED FROM A BASE FILE FOR THIS PROJECT (WTI 172) PROVIDED BY THE TOWN OF CARY. ALL CURRENT(2018) FIELDWORK/CHECKS COMPLETED BY
WITHERSRAVENEL WERE ALIGNED WITH SAID BASE FILE.
TEAS IST DAY OF NOVEMBER 2018. A - 1 1 n • GRAPHIC SCALE
/ 60 0 30 60
Q
RUDOLF A. VAND£RVELDE ✓R., PLS U L-5t46 1 inch - 60 ft.
DATE: 11-1-2018 EXHIBIT "A"
SCALE: I"=60' PERMANENT UTILITY AND PIPELINE EASEMENT �/
SURVEYED BY: RAV PROPERTY OF W i t h e rs Ra ve n e l
DRAWN BY: RAV 1<AND D RAMSEY LLC ®/ Engineers I Planners I Surveyors
CAD FILE: 1405 OLD APEX RD EXIT. TOWNSHIP: CARY COUNTY: WAKE STATE: NC 115 MacRen- Dd,e I Cary, INC 27511
t: 919.469.3340 I license #: C-0832
PROJECT NO: 02170716.00 1 PIN: 0753-74-1749 SHEET 1 OF 2 1 www.withemmvenel.com

BDUC i2ElheQQq§ CF5CABC-4AAB-4196-8D32-43AB70B7C30D
_
I
SEE SHEET ONE FOR
yyglp9V�°r JT
I I
CONTINUATION
SITE
PROPOSED PERMANENT
V UTILITY & PIPELINE
EASEMENT
7,429 SO FT
EXISTING UALITY &
°P
PIPELINE EASEMENT
ICINITY MAP NO SCALE
j.:.:. v
DB 6986 PG 320
REFERENCES
v.
1) DEED BOOK 12159 PAGE 1068
N
2 DEED BOOK 13251 PACE 0118
NAD8312011 ice" h
3) DEED BOOK 15875 PAGE 0195
4) DEED BOOK 07887 PAGE 0295
EXHIBIT A
5) DEED BOOK 02914 PAGE 1758
6) DEED BOOK 06986 PAGE 0320 1" /
7) BOOK OF MAPS 1978 PG 0450
8) BOOK OF MAPS 1996 PG 1755 / v C3j
9) MAP ENTITLED "PROPERTY OF FRED PERRON, 411211973" 1 IPF /
BY SMITH & SMITH. '
10) MAP ENTITLED PROPERTY OF WILMARTH INVESTMENTS, LLC'
912112007 BY JOHN Y. PHELPS SR. PLS.
11) MAP ENTITLED UTILITY EASEMENT MAP PROPERTY OF II /
SOORAS LTD — OLD APEX RD. WATERLINE CONNECTION h /
DATED 918195 (IN TOWN OF CARY FILES)
I /
LEGEND / rip /
IPF — IRON PIPE FOUND \
AIF — ANGLE IRON FOUND
CP — COMPUTED POINT
/ v /
ADJOINER /
BOUNDARY / �10
RIGHT OF WAY
NEW EASEMENT — — — — — —
THIS MAP IS NOT A CERTIFIED
SURVEY AND HAS NOT BEEN �Oj/ CP
REVIEWED BY A LOCAL (} /
GOVERNMENT AGENCY FOR / N
COMPLIANCE WITH ANY '
APPLICABLE LAND DEVELOPMENT
REGULATIONS. /
/ PROPOSED PERMANENT
/ EASEMENT P/PEUN£
7,429 SO FT
6
PF C n\G
h G o
/
'
'
/ �O IPF
J ' N
�1 \
GROUND' COORDS
N-734,269.01
E=2,056,79289 1
9j RQ-
NOW OR FORMERLY �J
K AND D RAMSEY LLC
DB 07887 PG 0295
SM 1996 PG 1755
PIN 0753-15-63-4923
7�
o G /
CAR(),
QQ�ESSIp�� �9
SEAL
L-5146
GRAPHIC SCALE
/ 60 0 30 61)
SEE SHEET ONE FOR /
LINE/CURVE TABLES / 1 inch = 60ft.
DATE: 11-1-2018 EXHIBIT "A"
SCALE: I°=60' PERMANENT UTILITY AND PIPELINE EASEMENT
SURVEYED BY: RAV PROPERTYOF
DRAWN BY: RAV I<AND D RAMSEY LLC
CAD FILE: 1405 OLD APEX RD EXH. TOWNSHIP: CARY I COUNTY: WAKE STATE: NC
PROJECT NO:02170716.00 1 PIN:
SHEET 2 OF 2
1�
WithersRavenel
®/
Engineers I Planners I Surveyors
115 MacKenan Drive I Cary, NC 27511
t: 919.469.3340 I license #: C-0832
www.withemmvenel.com

ROY COOPER.
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Director
November 1, 2019
Town of Cary Utility Easement
Attn: Shuyan Tian
318 N. Academy Street
Cary, NC 27512
STATE'
NORTH CAROLINA
Envirorunental Quality
DWR #19-1230
Wake County
Subject: APPROVAL OF 401 WATER QUALITY CERTIFICATION WITH ADDITIONAL CONDITIONS
AUTHORIZATION CERTIFICATE PER THE NEUSE RIVER BASIN RIPARIAN BUFFER
PROTECTION RULES (15A NCAC 02B .0233) WITH ADDITIONAL CONDITIONS
Old Apex Road Waterline Reinforcement
To Whom It May Concern:
You have our approval for the impacts listed below for the purpose described in your
application received by the Division of Water Resources (Division) on September 16, 2019 with
payment received on September 18, 2019. These impacts are covered by the attached Water
Quality General Certification Number 4133 and the conditions listed below. This certification is
associated with the use of Nationwide Permit Number 12 once it is issued to you by the U.S.
Army Corps of Engineers. Please note that you should get any other federal, state or local
permits before proceeding with your project, including those required by (but not limited to)
Sediment and Erosion Control, Non -Discharge, and Water Supply Watershed regulations.
This approval requires you to follow the conditions listed in the enclosed certification and the
following additional conditions:
The following impacts are hereby approved provided that all of the other specific and
general conditions of the Certification and Buffer Rules are met. No other impacts are
approved, including incidental impacts. [15A NCAC 02B .0506(b)(c)] and15A NCAC
02B .0233(8)]
North Carolina Department of Environmental Quality z Division of \vaterResources
�✓ Raleigl i Regional office ' 3600 Barry tt Drive I Raleigh, North Carolina 1.7609
uea=wrm.uf,P'7� "\ /""/ 919.791.4200

Old Apex Road Waterline Easement
DWR #19-1230
401 AND BUFFER APPROVAL
Page 2 of 4
Type of Impact
Amount Approved
(units)
Permanent
Amount Approved
(units)
Temporary
Wetland
W1: Waterline Crossing
0 (acres)
0.003 (acres)
Stream
S1: Waterline Crossing
0 (linear feet)
20 (linear feet)
Buffers - Zone 1
131: waterline Installation & Easement
1,358 (square feet)
0 (square feet)
Buffers - Zone 2
61: Waterline Installation & Easement
831 (square feet)
0 (square feet)
2. Stormwater Management Plan (SMP) Approval from Local Community Required
The stormwater management plan (SMP) must be approved by the Town of Wake Cary and
meet the requirements of this Certification. The SMP may not be modified without prior
written authorization from the Town of Cary. [15A NCAC 02H .0506(b)(3)]
3. The permittee shall report to the Raleigh Regional Office any noncompliance with this
certification, any violation of stream or wetland standards [15A NCAC 02B .0200] including
but not limited to sediment impacts, and any violation of state regulated riparian buffer
rules [15A NCAC 02B .0200]. Information shall be provided orally within 24 hours (or the
next business day if a weekend or holiday) from the time the applicant became aware of the
circumstances. A written submission shall also be provided within 5 business days of the
time the applicant becomes aware of the circumstances. The written submission shall
contain a description of the noncompliance, and its causes; the period of noncompliance,
including exact dates and times, if the noncompliance has not been corrected, the
anticipated time compliance is expected to continue; and steps taken or planned to reduce,
eliminate, and prevent reoccurrence of the noncompliance. The Division may waive the
written submission requirement on a case -by -case basis.
4. Protective Fencing
The outside buffer, wetland or water boundary and along the construction corridor within
these boundaries approved under this authorization shall be clearly marked with orange
warning fencing (or similar high visibility material) for the areas that have been approved to
infringe within the buffer, wetland or water prior to any land disturbing activities to ensure
compliance with 15 NCAC 02H .0500. [15A NCAC 02H .0506 (b)(2) and (c)(2) and 15A NCAC
02H .0507 (c)]

Old Apex Road Waterline Easement
DWR #19-1230
401 AND BUFFER APPROVAL
Page 3 of 4
5. This approval is for the purpose and design described in your application. The plans and
specifications for this project are incorporated by reference as part of the Certification and
Buffer Authorization. If you change your project, you must notify the Division and you may
be required to submit a new application package with the appropriate fee. If the property is
sold, the new owner must be given a copy of this approval letter and General Certification
and is responsible for complying with all conditions. [15A NCAC 02B .0507(d)(2)]
This approval and its conditions are final and binding unless contested. [G.S. 143-215.5]
This Certification and Buffer Authorization can be contested as provided in General Statute
150E by filing a written petition for an administrative hearing to the Office of Administrative
Hearings (hereby known as OAH) within sixty (60) calendar days.
A petition form maybe obtained from the OAH at http://www.ncoah.com/ or by calling the OAH
Clerk's Office at [phone] for information. A petition is considered filed when the original
and one (1) copy along with any applicable OAH filing fee is received in the OAH during normal
office hours (Monday through Friday between 8:00am and 5:00pm, excluding official state
holidays).
The petition may be faxed to the OAH at [phone], provided the original and one copy of
the petition along with any applicable OAH filing fee is received by the OAH within five (5)
business days following the faxed transmission.
Mailing address for the OAH:
If sending by First Class Mail
via the US Postal Service:
Office of Administrative Hearings
6714 Mail Service Center
Raleigh, NC 27699-6714
If sending via delivery service
(e.g. UPS, FedEx):
Office of Administrative Hearings
1711 New Hope Church Road
Raleigh, NC 27609-6285
One (1) copy of the petition must also be served to Department of Environmental Quality:
William F. Lane, General Counsel
Department of Environmental Quality
1601 Mail Service Center
Raleigh, NC 27699-1601

Please send one (1) copy of the petition to DWR:
If sending by First Class Mail
via the US Postal Service:
Karen Higgins
NC DWR — 401 & Buffer Permitting
Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
Old Apex Road Waterline Easement
DWR #19-1230
401 AND BUFFER APPROVAL
Page 4 of 4
If sending via delivery service
(e.g. UPS, FedEx):
Karen Higgins
NC DWR-401 & Buffer Permitting
Branch
512 N. Salisbury Street
Raleigh, NC 27604
This letter completes the review of the Division under section 401 of the Clean Water Act and
the Neuse Riparian Buffer Rules as described in 15A NCAC 02B .0233. Please contact Stephanie
Goss at 919-791-4256 or step [e-mail]_ if you have any questions or concerns.
Sincerely,
�il)2 S. Jay Zimmerman, P.G., Chief
Water Quality Regional Operations Section
Enclosure: GC 4133
cc: U.S. Army Corps of Engineers; Raleigh Regulatory Field Office; 3331 Heritage Trade
Drive, Ste. 105; Wake Forest, NC 27597
DWR RRO 401 file
DWR 401 & Buffer Permitting Unit via Laserfiche
Martin Richmond via e-mail at [e-mail]

U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id. SAW-2019-02117 County: Wake U.S.G.S. Quad: NC -Cary
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Permittee:
Town of Cary
Shuyan Tian
Address:
318 N. Academy Street
Cary, NC 27512
Telephone Number:
919-469-4381
E-mail:
Shuyan.tian(atownofcary.org
Size (acres) N/A Nearest Town Cary
Nearest Waterway Hoffman Lake River Basin Neuse
USGS HUC 03020201 Coordinates Latitude: 35.7684
Longitude:-78.8076
Location description: The proiect site is located on the east site of Old Apex Road, south of its intersection with West Chatham
Street, near the town of Cary, Wake County, North Carolina.
Description of projects area and activity: This permit verificiation allows for 148 square feet of temporary wetland impacts and
20 linear feet of temporary stream channel impacts from open cutting for the replacement of an existing water line crossing.
No mitigation is required for this proposal.
Applicable Law(s): ® Section 404 (Clean Water Act, 33 USC 1344)
❑ Section 10 (Rivers and Harbors Act, 33 USC 403)
Authorization: NWP 12. Utility Line Activities
SEE ATTACHED NWP GENERAL, REGIONAL, AND/OR SPECIAL CONDITIONS
Your work is authorized by the above referenced permit provided it is accomplished in strict accordance with the enclosed
Conditions, your application signed and dated 9/16/2019, and the enclosed plans entitled "Old Apex Road waterline
reinforcement" dated 10/5/2018. Any violation of the attached conditions or deviation from your submitted plans may subject
the permittee to a stop work order, a restoration order, a Class I administrative penalty, and/or appropriate legal action.
This verification will remain valid until the expiration date identified below unless the nationwide authorization is modified, suspended
or revoked. If, prior to the expiration date identified below, the nationwide permit authorization is reissued and/or modified, this
verification will remain valid until the expiration date identified below, provided it complies with all requirements of the modified
nationwide permit. If the nationwide permit authorization expires or is suspended, revoked, or is modified, such that the activity would
no longer comply with the terms and conditions of the nationwide permit, activities which have commenced (i.e., are under construction)
or are under contract to commence in reliance upon the nationwide permit, will remain authorized provided the activity is completed
within twelve months of the date of the nationwide permit's expiration, modification or revocation, unless discretionary authority has
been exercised on a case -by -case basis to modify, suspend or revoke the authorization.
Activities subject to Section 404 (as indicated above) may also require an individual Section 401 Water Quality Certification. You
should contact the NC Division of Water Resources (telephone [phone]) to determine Section 401 requirements.
For activities occurring within the twenty coastal counties subject to regulation under the Coastal Area Management Act (LAMA), prior
to beginning work you must contact the N.C. Division of Coastal Management Morehead City, NC, at [phone].
This Department of the Army verification does not relieve the permittee of the responsibility to obtain any other required Federal, State
or local approvals/permits.
If there are any questions regarding this verification, any of the conditions of the Permit, or the Corps of Engineers regulatory program,
please contact James Lastinger at 919-554-4884 ext 32or James.C.Lastinger(&usace.army.mil.
Corps Regulatory Official: Date: 10/30/2019
Expiration Date of Verification: 03/18/2022

The Wilmington District is committed to providing the highest level of support to the public. To help us ensure we
continue to do so, please complete the Customer Satisfaction Survey located at
http://corpsmapu.usace.anny.mil/cm_apex/Vp=136:4:0
Copy furnished:
Agent: WithersRavenel
Martin Richmond
Address: 115 Makenan Dr.
Cary, NC 27517
Telephone Number: 919-535-5206
E-mail: mrichmond(&witherravenel.com

Action ID Number: SAW-2019-02117 County: Wake
Permittee: Town of Cary, Shuyan Tian
Project Name: Old Apex Road waterline reinforcement
Date Verification Issued: 10/30/2019
Project Manager: James Lastinger
Upon completion of the activity authorized by this permit and any mitigation required by the permit,
sign this certification and return it to the following address:
US ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Attn: James Lastinger
Raleigh Regulatory Office
U.S Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
or
[e-mail]
Please note that your permitted activity is subject to a compliance inspection by a U. S. Army Corps of
Engineers representative. Failure to comply with any terms or conditions of this authorization may
result in the Corps suspending, modifying or revoking the authorization and/or issuing a Class I
administrative penalty, or initiating other appropriate legal action.
I hereby certify that the work authorized by the above referenced permit has been completed in
accordance with the terms and condition of the said permit, and required mitigation was completed in
accordance with the permit conditions.
Signature of Permittee
Date

NOTIFICATION OF ADMINISTRATIVE APPEAL OPTIONS AND PROCESS AND
REQUEST FOR APPEAL
Applicant: Town of Cary, Shuyan Tian File Number: SAW-2019-02117
Date: 10/30/2019
Attached
is:
See Section below
PROFFERED PERMIT (Standard Permit or Letter of permission)
A
RED PERMIT (Standard Permit or Letter of permission)
B
DENIAL
LAPPROVED
C
JURISDICTIONAL DETERMINATION
D
INARY JURISDICTIONAL DETERMINATION
E
SECTION I - The Prollowing identifies your righ and options regarding an administrative appeal of the above decision.
Additional information may be found at or http://www.usace.anny.mil/Missions/CivilWorks/Res ulatoiyPros4ramandPennits.aspx
or the Corps regulations at 33 CFR Part 331.
A: INITIAL PROFFERED PERMIT: You may accept or object to the permit.
• ACCEPT: If you received a Standard Permit, you may sign the permit document and return it to the district engineer for final
authorization. If you received a Letter of Permission (LOP), you may accept the LOP and your work is authorized. Your
signature on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety, and waive all
rights to appeal the permit, including its terms and conditions, and approved jurisdictional determinations associated with the
permit.
• OBJECT: If you object to the permit (Standard or LOP) because of certain terms and conditions therein, you may request
that the permit be modified accordingly. You must complete Section II of this form and return the form to the district
engineer. Your objections must be received by the district engineer within 60 days of the date of this notice, or you will
forfeit your right to appeal the permit in the future. Upon receipt of your letter, the district engineer will evaluate your
objections and may: (a) modify the permit to address all of your concerns, (b) modify the permit to address some of your
objections, or (c) not modify the permit having determined that the permit should be issued as previously written. After
evaluating your objections, the district engineer will send you a proffered permit for your reconsideration, as indicated in
Section B below.
B: PROFFERED PERMIT: You may accept or appeal the permit
• ACCEPT: If you received a Standard Permit, you may sign the permit document and return it to the district engineer for final
authorization. If you received a Letter of Permission (LOP), you may accept the LOP and your work is authorized. Your
signature on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety, and waive all
rights to appeal the permit, including its terms and conditions, and approved jurisdictional determinations associated with the
permit.
• APPEAL: If you choose to decline the proffered permit (Standard or LOP) because of certain terms and conditions therein,
you may appeal the declined permit under the Corps of Engineers Administrative Appeal Process by completing Section II of
this form and sending the form to the division engineer. This form must be received by the division engineer within 60 days
of the date of this notice.
C: PERMIT DENIAL: You may appeal the denial of a permit under the Corps of Engineers Administrative Appeal Process by
completing Section 11 of this form and sending the form to the division engineer. This form must be received by the division
engineer within 60 days of the date of this notice.
D: APPROVED JURISDICTIONAL DETERMINATION: You may accept or appeal the approved JD or provide new
information.
• ACCEPT: You do not need to notify the Corps to accept an approved JD. Failure to notify the Corps within 60 days of the
date of this notice, means that you accept the approved JD in its entirety, and waive all rights to appeal the approved JD.
• APPEAL: If you disagree with the approved JD, you may appeal the approved JD under the Corps of Engineers
Administrative Appeal Process by completing Section 11 of this form and sending the form to the district engineer. This form
must be received by the division engineer within 60 days of the date of this notice.
E: PRELIMINARY JURISDICTIONAL DETERMINATION: You do not need to respond to the Corps regarding the
preliminary JD. The Preliminary JD is not appealable. If you wish, you may request an approved JD (which may be appealed),
by contacting the Corps district for further instruction. Also you may provide new information for further consideration by the
Corps to reevaluate the JD.

SECTION II - REQUEST FOR APPEAL o BJECTIONS TO AN INITIAL PROFFERED PERMIT
REASONS FOR APPEAL OR OBJECTIONS: (Describe your reasons for appealing the decision or your objections to an initial
proffered permit in clear concise statements. You may attach additional information to this form to clarify where your reasons or
objections are addressed in the administrative record.)
ADDITIONAL INFORMATION: The appeal is limited to a review of the administrative record, the Corps memorandum for the
record of the appeal conference or meeting, and any supplemental information that the review officer has determined is needed to
clarify the administrative record. Neither the appellant nor the Corps may add new information or analyses to the record.
However, you may provide additional information to clarify the location of information that is already in the administrative
record.
POINT F CONTACT F QUESTIONS RR INFORMATION:
If you have questions regarding this decision and/or the
If you only have questions regarding the appeal process you may
appeal process you may contact:
also contact:
District Engineer, Wilmington Regulatory Division
Mr. Phillip Shannin, Administrative Appeal Review Officer
Attn: James Lastinger
CESAD-PDO
Raleigh Regulatory Office
U.S. Army Corps of Engineers, South Atlantic Division
U.S Army Corps of Engineers
60 Forsyth Street, Room 10M15
3331 Heritage Trade Drive, Suite 105
Atlanta, Georgia 30303-8801
Wake Forest, North Carolina 27587
Phone: [phone]
RIGHT OF ENTRY: Your signature below grants the right of entry to Corps of Engineers personnel, and any government
consultants, to conduct investigations of the project site during the course of the appeal process. You will be provided a 15 day
notice of any site investigation, and will have the opportunity to participate in all site investigations.
Date:
Telephone number:
Signature of appellant or agent.
For appeals on Initial Proffered Permits send this form to:
District Engineer, Wilmington Regulatory Division, Attn: James Lastinger , 69 Darlington Avenue, Wilmington, North
Carolina 28403
For Permit denials, Proffered Permits and Approved Jurisdictional Determinations send this form to:
Division Engineer, Commander, U.S. Army Engineer Division, South Atlantic, Attn: Mr. Phillip Shannin, Administrative
Appeal Officer, CESAD-PDO, 60 Forsyth Street, Room 1OM15, Atlanta, Georgia 30303-8801
Phone: [phone]

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REINFORCEMENT 1 115 MacKenan Drive I Cary, INC 27511
t: 919.469.33401 license #: C-0832 I www.withersravenel.com