Pre-Construction Notification (PCN) Form_Friendship Village_updated 7-07-2023.pdf

DW R
mrlsloa of Water Resources
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:
12/1/2022
If this is a courtesy copy,please fill in this with the submission date.
Is this project connected with ARPA funding?*
Yes No
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.
DO NOT CHECK YES,UNLESS YOU ARE DMS 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.
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
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: 29-Residential Developments
Nationwide Permit(NWP)Number: 18-Minor Discharges
NWP Numbers(for multiple NWPS):
NWP 18(SW Bypass pipes)
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 401 Water Quality Certification-Express
Non-404 Jurisdictional General Permit Riparian Buffer Authorization
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: Yes No
For the record only for Corps Permit: 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?"
Deborah Shirley
1c.Primary Contact Phone:*
1 b.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:
Beazer Homes LLC
2b.Deed book and page no.:
DB:018705,DP:01303;DB:018702,DP:00101,02606,01950,02227,02215,02126,00334,00203,
00132,01097,00017;DB:018703,DP:02094;DB:018766,DP:01917;DB:018701,DP:01614,
DP:01397,DP:01233,DP:02105;DB:018714,DP:02129;
2c.Contact Person:
(for Corporations)
Trevor Dalton
2d.Address*
Street Address
801 Corporate Center Dr
Address Line 2
Ste 330
City State/Province/Region
Raleigh NC
Postal/Zip Code Country
27607 USA
2e.Telephone Number:
(xxx)xxx-xxxx
[phone]
2f.Fax Number:
(xxx)xxx-xxxx
2g.Email Address:
[e-mail]
2a.Nari on recorded deed:
Larry Harris(Harris Family Trust)
2b.Deed book and page no.:
DB:019156,DP:00553

2c.Contact Person:
(for Corporations)
2d.Address*
Street Address
2929 Evans Rd
Address Line 2
City State/Province/Region
Apex NC
Postal/Zip Code Country
27502 USA
2e.Telephone Number:
(xxx)xxx-xxxx
[phone]
2f.Fax Number:
(:xx)xxx-xxxx
2g.Email Address:"
[e-mail]
3.Applicant Information(if different from owner)
3a.Name:*
Trevor Dalton
3b.Business Name:
(if applicable)
Beazer Homes-Raleigh
3c.Address
Street Address
801 Corporate Center Drive
Address Line 2
Suite 330
City State/Province/Region
Raleigh NC
Postal/Zip Code Country
27607 USA
3d.Telephone Number:*
[phone] 3e.Fax Number:
(xxx)xxx-xxxx (xxz)xxx-xxxx
3f.Email Address:*
[e-mail]
4.Agent/Consultant(if applicable)
4a.Name:*
Deborah Shirley
4b.Business Name:
(if applicable)
Soil&Environmental Consultants,PA
4c.Address*
Street Address
8412 Falls of Neuse Road
Address Line 2
Suite 104
City State/Province/Region
Raleigh NC
Postal/Zip Code Country
27615 USA
4d.Telephone Number:* 4e.Fax Number:
[phone] [phone]
(xxx)xxx-xxxx (xxx)xxx-xxxx
4f.Email Address:*
[e-mail]
C. Project Information and Prior Project History '

1.Project Information ^
1a.Name of project:"
Friendship Village
1b.Subdivision name:
(if appropriate)
1c.Nearest municipality/town:
Apex
2.Project Identification ^
2a.Property Identification Number:
(tax PIN or parcel ID)
0721-80-1110,0721-80-3174,0721-80-1336,
0721-80-2377,0721-80-1553,0721-80-3505,
0721-80-3619,0721-81-3022,0721-80-4836,
0721-81-4170,0721-81-5061,0721-80-7948,
0721-90-1910,0721-80-9611,0721-80-1975,
2b.Property size:
0721-81-0212,0721-81-2581,0721-81-6313, (in acres)
0721-81-6591,0721-71-9581 34.642
2c.Project Address
Street Address
2912 Walden Road
Address Line 2
City State/Province/Region
Apex NC
Postal/Zip Code Country
27502 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:
35.703113 -78.904622
ex:34.208504 -77.796371
3. Surface Waters
3a.Name of the nearest body of water to proposed project:
Little Beaver Creek
3b.Water Resources Classification of nearest receiving water:
WS-IV;NSW
Surface Water Lookup
3c. What river basin(s)is your project located in?'
Cape Fear
3d.Please provide the 12-digit HUC in which the project is located."`
030300020609
River Basin Lookup
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:
Existing conditions consist of multiple parcels primarily wooded with vacant homes along Walden Road and Evans Road.There are two streams(i.e.SB and SC)and six wetlands(i.e.
W1,W2,W3,W4,W5 and W6)within the project boundaries.These properties are bound by Humie Olive Road to the south,Evans Road&Walden Road to the west,and Terrimini Drive
to the north.General land use in the vicinity consists of rural residential,single family lots,and wooded land.
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:
Approximately 0.503 acres of wetlands
4g.List the total estimated linear feet of all existing streams on the property:
(intermittent and perennial)
Approximately 1,395 LF of streams

4h.Explain the purpose of the proposed project:*
The proposed project is a residential development including the necessary infrastructure.
41.Describe the overall project in detail,including indirect impacts and the type of equipment to be used:
The overall project consists of a single-family residential and townhome development and the construction of roadway infrastructure,utilities,single-family lots,mailbox kiosk and
Stormwater Control Measures(SCM).Specifically,there are stream,riparian buffer,and wetland impacts associated with road crossings,utilities and stormwater discharges.Equipment
typically used for construction and earthwork such as backhoes,bulldozers,excavators,graders,pavers etc.will be utilized for this project.
5. Jurisdictional Determinations
5a.Have the wetlands or streams been delineated on the property or proposed impact areas?
Yes No C)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
SAW-2022-00446
5c.If 5a is yes,who delineated the jurisdictional areas?
Name(if known): Steven Ball
Agency/Consultant Company: Soil&Environmental Consultants,PA
Other:
5d.List the dates of the Corp jurisdiction determination or State determination if a determination was made by the Corps or DWR.
SAW-2022-00446-Email verified by Lyle Phillips on March 1st,2023.
Apex 21-008-Site visit on March 18,2022.Town of Apex Buffer letter issued on March 23,2022.
6.Future Project Plans
6a.Is this a phased project?*
Yes No
6b.If yes,explain.
The development is proposing 4 phases for construction purposes only.
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.
It is my understanding that there are no intended future phases beyond the property boundaries shown.Therefore,no additional NWP,Regional General Permits,or IF are anticipated.
D. Proposed Impacts Inventory
1. Impacts Summary
la.Where are the impacts associated with your project?(check all that apply):
Wetlands Streams-tributaries Buffers
Open Waters Pond Construction
2.Wetland Impacts
If there are wetland impacts proposed on the site,then complete this question for each wetland area impacted.
"W."will be used in the table below to represent the word"wetland".
2a1 Reason*(?) 2b.Impact type*(?) 2c.Type of W. 2d.W.name* 2e.Forested* 2f.Type of Jurisdicition* 2g_Impact
area
Impact 1 Road Crossing-Fill P Headwater Forest WS Yes Both 0.007
(acres)
Impact 2B Lot Fill P Headwater Forest W1 Yes Both 0.029
(acres)
Impact 7A SW Bypass P Headwater Forest W3 Yes Both 0.030
(acres)
IMpact 7B SW Bypass P Headwater Forest W3 Yes Both 0.015
(acres)
Impact 2A &Road Crossing-Culvert P Headwater Forest W1 Yes Both 0.066)

2g.Total Temporary Wetland Impact
0.000
2g.Total Permanent Wetland Impact
0.147
2g.Total Wetland Impact
0.147
21.Comments:
3. Stream Impacts
If there are perennial or intermittent stream impacts(including temporary impacts)proposed on the site,then complete this question for all stream sites impacted.
"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 3g.S.width* 3h.Impact
(?) Jurisdiction* length*
S1 Impact 1:Road Crossing- Permanent Culvert Stream B Perennial Both 4 122
Culvert Average(feet) (linear feeQ
S2 Impact 1:Road Crossing- Permanent Other Stream B Perennial Both 5 25
Dissipator(Permanent-No Average(feet) pinearfeet)
Permanent Loss)
S3 Impact 1:Road Crossing- Temporary Other Stream B Perennial Both
Construction Access Average(feet) pinearfeet)
S4 Impact 2:Road Crossing- Permanent Culvert Stream C Intermittent Both 63
Culvert Average(feet) (linear feet)
S5 Impact 2:Road Crossing- Permanent Other Stream C Intermittent Both 5 33
Dissipator(Permanent-NO Average(feet) (linear feet)
Permanent Loss)
S6 Impact 2:Road Crossing- Temporary Other Stream C Intermittent Both 5 4
Construction Access Average(feet) linear feat)
S7 Impact 8:Sanitary Sewer Temporary Other Stream B Perennial Both 34
Crossing Average(feet) (linear feet)
**All Perennial or Intermittent streams must be verified by DWR or delegated local government.
3i.Total jurisdictional ditch impact in square feet:
0
3i.Total permanent stream impacts:
243
3i.Total temporary stream impacts:
43
3i.Total stream and ditch impacts:
286
3j.Comments:
Total permanent loss stream=185 LF(0.018 acres);Total permanent-no permanent loss stream=58 LF(0.006 acres) Total temporary stream=43 LF
(0.005 acres);Temporary stream impacts will be brought back to pre-construction stream bed elevations and the stream banks will be stabilized.
E. Impact Justification and Mitigation u
1.Avoidance and Minimization

la.Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
S&EC completed a wetland delineation and Jordan Lake Watershed Buffer evaluation for the entire property in order to identify natural resources so that
impacts could be avoided&minimized to the maximum extent practicable.Proposed impacts include two(2)road crossings,one(1)utility crossing,and
two(2)wetland impacts associated with stormwater bypass pipes.Jordan Lake Watershed buffer impacts will be submitted to the Town of Apex for a No
Practical Alternatives review.Impact 1 is proposed road crossing on a perennial stream and wetland.Proposed impacts include permanent(i.e.culvert&
headwalls),permanent-no permanent loss(i.e.riprap dissipator,buried)and temporary(i.e.construction access)stream impacts,and permanent
wetland loss.This road crossing is necessary to provide access to the western portions of the property,and also to provide a connection from the
existing Vetrina Way to Evans Road per the Town of Apex's Unified Development Ordinance(UDO).Stream and wetland impacts have been minimized
by utilizing head walls and retaining walls at the crossing,and by designing the crossing at a near perpendicular angle.Wetland mitigation is being
proposed at a 2:1 ratio to compensate for these proposed impacts.Impact 2&2A is proposed road crossing on an intermittent stream and wetland.
Proposed impacts include permanent(i.e.culvert&headwalls),permanent-no permanent loss(i.e.riprap dissipator,buried)and temporary(i.e.
construction access)stream impacts,and permanent wetland loss.Similar to Impact 1,this road crossing is necessary to provide access to the western
portion of the property,and also to provide a connection from the existing Vetrina Way to Evans Road per the Town of Apex's Unified Development
Ordinance(UDO).Stream and wetland impacts have been minimized by utilizing head walls and retaining walls at the crossing,and by designing the
crossing at a near perpendicular angle.Wetland mitigation is being proposed at a 2:1 ratio to compensate for these proposed impacts.Impact 2B is
proposed wetland fill for a residential lot.Proposed impacts include permanent wetland loss.This impact is necessary because of the elevation of the
existing Vetrina Way stub and the need to connect per the Town of Apex's Unified Development Ordinance(UDO)standards.The Vetrina Way extension
is abutting proposed lot 60 and it is necessary to bring the elevation of the lot up to meet the road elevation.Wetland mitigation is being proposed at a
2:1 ratio to compensate for these proposed impacts.Impacts 7A&7B are proposed stormwater bypass pipes impacting a wetland.Proposed impacts
include permanent wetland loss.This impact is necessary to bring the offsite stormwater to the stream as it naturally flowed.Wetland mitigation is being
proposed at a 2:1 ratio to compensate for these proposed impacts.Impact 8 is a proposed sanitary sewer crossing of a perennial stream.Proposed
impacts include temporary stream impacts for open-cut construction.This impact is necessary to bring sanitary sewer to the proposed development.
Stream impacts have been minimized by crossing the stream at a perpendicular angle.Temporary stream impacts will be brought back to pre-
construction elevations and the stream banks will be stabilized.
1 b.Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Town of Apex erosion control plan approval required which includes skimmer basins,diversion ditches,silt fence,silt fence outlets,ground cover
stabilization,and other stabilization techniques to minimize length of exposure of disturbed areas.
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
2c.If yes,mitigation is required by(check all that apply):
DWR Corps
2d.If yes,which mitigation option(s)will be used for this project?
Mitigation bank Payment to in-lieu fee program Permittee Responsible Mitigation
4. Complete if Making a Payment to In-lieu Fee Program
4a.Approval letter from in-lieu fee program is attached.
Yes No
4b.Stream mitigation requested: 4c.If using stream mitigation,what is the stream temperature:
(Linear feet)
NC Stream Temperature Classification Maps can be found under the Mitigation Concepts tab on the Wilmington District's RIBITS website.
4e.Riparian wetland mitigation requested:
4d.Buffer mitigation requested(DWR only): (acres)
(square feet) 0.295
4f.Non-riparian wetland mitigation requested: 4g.Coastal(tidal)wetland mitigation requested:
(acres) (acres)
4h.Comments
S&EC reviewed the NCDWR Approved Mitigation Banks in NC list,there were four(4)banks listed within the 03030002 HUC that had riparian wetland
credits available.All four(4)banks were contacted and no riparian wetland credits are available,therefore the NCDMS was utilized.
6. Buffer mitigation (State Regulated Riparian Buffer Rules) -required by DWR
6a.Will the project result in an impact within a protected riparian buffer that requires buffer mitigation?If yes,you must fill out this entire form-please contact DWR for more information.
Yes No
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
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).
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
Hint:projects that have vested rights,exemptions,or grandfathering kom 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 programs)apply(check all that apply):"
Local Government State
If you have a local government approval please include the SMP on their overall impact map.
Local Government Stormwater Programs*
Phase II NSW
USMP Water Supply
Please identify which local government Stormwater program you are using.
Town of Apex
Comments:
Three stormwater wetlands are proposed within the boundary of the project.
The Town of Apex has reviewed the SCM designs and currently has no additional comments.Plan will be approved once the 401/404 permits and NCDOT encroachment/driveway permits
are issued.
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
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.
We have reviewed the"Draft Internal Policy,Cumulative impacts and the 401 Water Quality Certification and Isolated Wetlands Programs"document
prepared by the NC Division of Water Quality on April 10,2004,version 2.1.The draft states that many private developments are unlikely to cause
cumulative impacts,including projects such as urban in-fill,most residential subdivisions and small commercial developments as well as agricultural and
silvicultural operations.The Friendship Village project is a residential development.Additionally,the project is located within the Town of Apex
jurisdiction,therefore the adjacent properties that have potential for development will have the following regulations to protect downstream waters:1)the
Water Supply,Watershed Protection Program which limits development densities as well as requires protective riparian buffers;2)the Phase II NPDES
Stormwater Permit Program,this program includes permitting requirements for Municipal Separate Storm Sewer Systems(MS4s)in addition to post-
construction stormwater management requirements,and 3)the Jordan Watershed Riparian Buffer Protection regulations,these regulations require
limited development within the riparian buffer area in addition to"diffuse flow"requirements and may require Best Management Practices that control
nitrogen if diffuse flow cannot be achieved.We anticipate that the DWR will advise us if any additional information is needed.
4. Sewage Disposal (DWR Requirement)

4a.Is sewage disposal required by DWR for this project?*
Yes No N/A
4b.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.
Yes,there is public sewer/wastewater for the project.A non-discharge permit will be issued for the project from the Town of Apex for service by the
Western Wake Regional Water Reclamation Facility(WWRWR)in New Hill,NC.
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
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 construction/installation of a wind turbine(s)?**
Yes No
51.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?
S&EC completed a Threatened&Endangered Species Report,to include a Self-Certification letter through the US Fish&Wildlife Service(USFWS),a
query through the INC Natural Heritage Program database,and an official Species List through the iPac.A formal request was sent to the USFWS on
December 16,2022.The USFWS has 30 days to respond from the date of the sent request.S&EC received no response from USFWS within the 30
days which in their interpretation means that they concur with the determinations made by S&EC.The S&EC determinations were that the proposed
project is not likely to adversely affect any federally-listed endangered or threatened species,their formally designated critical habitat,or species
currently proposed for listing under the Endangered Species Act(ESA).Please see attached S&EC Threatened&Endangered Species report.
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?
The NOAA Habitat Conservation/Habitat Protection:National Marine Fish Service;Essential Fish Habitat Mapper website was referenced.No Essential
Fish Habitat was identified near the project.
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.nedcr.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?
The NC State Historic Preservation Office HPOWEB GIS Service interactive map was referenced on November 28,2022,no historic listings or study list
entries or determined eligible listings were identified within the property boundaries.SHPO provided a response letter on April 6,2023,which provided
minor comments concerning the Stewarts Cemetery(WA1066)and the 10'buffer around the existing cemetery.SHPO also determined that the project
as proposed will not have an effect on any historic structures.See attached letter from SHPO ER-0781.
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 No

8c.What source(s)did you use to make the floodplain determination?*
NC Flood Risk Information System Floodplain Mapping Program and confirmation from the project engineer.
Miscellaneous
Comments
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
13909 Friendship Village Submittal Attachments.pdf 29.24MB
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:*
Deborah E.Shirley
Signature*
'Pill"iF r
Date
5/12/2023