20120892 Ver 2_PCN_FillableForm_v4-3_02142023_Forest Ridge Commercial_signed_20230717

E.ME STATE os'YO
•eer�vroEw•
NORTH CAROLINA
Environmental Quality
Water Resources
Office Use Only
Corps Action ID no. Isolated Wetland Permit for Forest Ridge
Commercial, Lot C-5 and Access Road (DWQ Project #12-0892);
Harnett County Date received: [Click to enter.,
DWR project no. [Click enter.] Date received: [Click to enter.]
Site Coordinates:
Latitude (DD.DDDDDD): 35.251724
Longitude (DD.DDDDDD):-79.029559
Form Version 4.3, April 20, 2022
Pre -Construction Notification (PCN) Form
(Ver. 4.2, January 31, 2022))
For Nationwide Permits and Regional General Permits and corresponding Water Quality Certifications
Please note: fields marked with a red asterisk are required. The form is not considered complete until all
mandatory questions are answered.
The PCN help document may be found at this link:
https:Hedocs.deg. nc.gov/WaterResources/DocView.aspx?dbid=0&id=2196924&cr=1
Please ensure you have submitted a pre -filing meeting request at least 30 days prior to submitting this
form, as DWR will not be able to accept your application without documentation of this important first step.
The Division has developed a Pre -filing Meeting Request email address 401 PreFile(a)ncdenr.gov to accept
the federally required pre -filing meeting request and provide confirmation receipt of submittal . This receipt
or similar documentation will satisfy 40 C.F.R. Section 121.4(a) which states "At least 30 days prior to
submitting a certification request, the project proponent shall request a pre -filing meeting with the certifying
agency." In accordance with 40 C.F.R. Section 121.5(b)(7), and (c)(5), all certification requests must
include documentation that a pre -filing meeting request was submitted to the certifying authority at least 30
days prior to submitting the certification request.
Attach documentation of Pre -Filing Meeting Request to this Application.
Date of Pre -filing Meeting Request (MM/DD/YYYY) : 5/19/2023
Pagel of 22 PCN Form Version 4.3- April 20, 2022

A. Processing Information
County (counties) where project is located:
Harnett Additional (if needed).
Is this an ARPA project?
❑ Yes ❑x No
If yes, ARPA project number:
" The project number can be found on the "Letter of Intent to Fund"
(LOIF) or "Offer and Acceptance Letter". If you are unable to locate
Click or tap here to enter text.
your DWI ARPA Funding Project Number, please contact Corey
Basinger at core y.basingeramcdenr.gov for further assistance.
Is this a NCDMS project?
(Click yes only if NCDMS is the applicant or co-
❑ Yes ❑x No
applicant)
Is this a public transportation project?
(Publicly funded municipal, state, or federal road, rail,
❑ Yes ❑x No
or airport project)
Is this a NCDOT project?
❑ Yes ❑x No
If yes, NCDOT TIP or state project number:
Click to enter.
If yes, NCDOT WBS number:
Click to enter.
❑x Section 404 Permit (wetlands, streams, waters,
Clean Water Act)
la. Type(s) of approval sought from the Corps:
❑ Section 10 Permit (navigable waters, tidal
waters, Rivers and Harbors Act)
Has this PCN previously been submitted?
❑ Yes ❑x No
Please provide the date of the previous submission.
Click tn antar a Anti-
❑x Nationwide Permit (NWP)
1 b. What type(s) of permit(s) do you wish to seek
❑ Regional General Permit (RGP)
authorization?
❑ Standard (IP)
This form may be used to initiate the standard/ individual permit
process with the USACE. Please contact your Corps
representative concerning submittals for standard permits. All required items can be included as attachments and
submitted with this form.
1 c. Has the NWP or GP number been verified by the Corps?
❑ Yes ❑x No
NWP number(s) (list all numbers):
NWP 39
RGP number(s) (list all numbers ):
Click to enter
Are you a federal applicant?
❑ Yes ❑x No
If yes, please provide a statement concerning compliance with the Coastal Zone Management Act
Click to enter text
1 d. Type(s) of approval sought from DWR (check all that apply):
❑x 401 Water Quality Certification — Regular
❑ 401 Water Quality Certification— Express
❑ Non-404 Jurisdictional General Permit
❑ Riparian Buffer Authorization
❑ Individual 401 Water Quality Certification
Is this a courtesy copy notification
❑ Yes ❑x No
Page 2 of 22 PCN Form Version 4.3- April 20, 2022

1 e.
Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification:
❑ Yes
❑x No
For the record only for Corps Permit:
❑ Yes
❑x No
1f.
Is this an after -the -fact permit/certification application?
❑ Yes
❑x No
1 g.
Is payment into a mitigation bank or in -lieu fee program proposed for
mitigation of impacts?
® Yes
❑ No
If yes, attach the acceptance letter from mitigation bank or in -lieu fee program.
1 h.
Is the project located in any of NC's twenty coastal counties?
❑ Yes
❑x No
1 i.
Is the project located within an NC DCM Area of Environmental
Concern (AEC)?
❑ Yes
❑x No ❑ Unknown
1j.
Is the project located in a designated trout watershed?
❑ Yes
❑x No
If yes, you must attach a copy of the approval letter from the appropriate Wildlife Resource Commission Office.
Trout information may be found at this link: http://www.saw.usace.army.mil/Missions/Regulatory-Permit-
Program/Agency-Coordination/Trout.aspx
Page 3 of 22 PCN Form Version 4.3- April 20, 2022

B. Applicant Information
1 a.
Who is the primary contact?
Deborah Shirley
1 b.
Primary Contact Email:
[e-mail]
1 c.
Primary Contact Phone: (###)###-####
[phone]
1 d.
Who is applying for the permit/certification? (check
all that apply)
® Owner ❑ Applicant (other than owner)
1 e.
Is there an agent/consultant for this project?
® Yes ❑ No
2.
Landowner Information
2a.
Name(s) on Recorded Deed:
Forest Ridge Subdivision Inc
2b.
Deed Book and Page No.:
DB:967, DP:0576
2c.
Contact Person (for corporations):
Odell Alden Smith Jr.
2d.
Address
Street Address:
400 Odell Road
Address line 2:
Click to enter.
City:
Spring Lake
State/ Province/ Region:
NC
Postal/ Zip Code:
28390
Country:
USA
2e.
Telephone Number: (###)###-####
[phone]
2f.
Fax Number: (###)###-####
N/A
2g.
Email Address:
[e-mail]
3.
Applicant Information (if different from owner)
3a.
Name:
Odell Alden Smith Jr.
3b.
Business Name (if applicable):
Forest Ridge Subdivision Inc
3c.
Address:
Street Address:
400 Odell Road
Address line 2:
Click to PntPr
City:
Spring Lake
State/ Province/ Region:
NC
Postal/ Zip Code:
28390
Country
USA
3d.
Telephone Number: * (###)###-####
[phone]
3e
Fax Number: (###)###-####
N/A
3f.
Email Address:
[e-mail]
Page 4 of 22 PCN Form Version 4.3- April 20, 2022

4. Agent/ Consultant (if applicable)
4a. Name:
Deborah Shirley
4b. Business Name:
Soil & Environmental Consultants, PA
4c. Address:
Street Address:
8412 Falls of Neuse Road
Address line 2:
Suite 104
City:
Raleigh
State/ Province/ Region:
NC
Postal/ Zip Code:
27615
Country:
USA
4d. Telephone Number: (###)###-####
[phone]
4e Fax Number: (###)###-####
[phone]
4f. Email Address:
[e-mail]
Agent Authorization Letter:
Attach a completed/signed agent authorization form or letter. A sample form may be found at this link:
https://www.saw. usace.army. mil/Missions/Regulatory-Permit-Prog ram/Permits/2017-Nationwide-Permits/Pre-
construction-Notification/
Page 5 of 22 PCN Form Version 4.3- April 20, 2022

C. Project Information and Prior Project History
1. Project Information
1 a. Name of project:
Forest Ridge Commercial
1 b. Subdivision name (if appropriate):
Click to enter
1 c. Nearest municipality/town:
Cameron
2.
Project Identification
2a.
Property identification number (tax PIN or parcel ID):
9594-15-8719
2b.
Property size (in acres):
Approximately 28.48 Acres
2c.
Project Address:
Street Address:
Intersection of Highway 24/87 Meloday Lane
Address line 2:
Click to enter
City:
Cameron
State/ Province/ Region:
NC
Postal/ Zip Code:
28326
Country:
USA
2d.
Site coordinates in decimal degrees (using 4-6 digits
after the decimal point): *
Latitude (DD.DDDDDD): 35.251724
Longitude (-DD.DDDDDD):--79.029559
3. Surface Waters
3a. Name of nearest body of water to proposed project:
Muddy Creek (Overhills Lake)
3b. Water Resources Classification of nearest receiving
C
water:
The Surface Water Classification map may be found at this link:
https://ncdenr.maps.arcqis.com/apps/webappviewer/index. html?id=6e125ad7628f494694e259c8Odd64265
Cape Fear
3c. In what river basin(s) is your project located? *
Choose additional (if needed)
3d. Please provide the 12-digit HUC in which the project is
030300040404
located:
The Find Your HUC map may be found at this link:
https://ncdenr.maps.arcgis.com/apps/Publiclnformation/index.html?appid=ad3a85aOc6d644aOb97cdO69db238ac3
Page 6 of 22 PCN Form Version 4.3- April 20, 2022

4. Project Description and History
4a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of
this application:
Existing conditions consist of one parcel that is subdivided by Melody Lane. The land is primarily cleared with
wetland drainages remaining forested. There is one stream (A) and two wetlands (W1 & W2) within the property
boundaries. General land use in the vicinity of the project area is residential, commercial and wooded land.
4b. Have Corps permits or DWR certifications been obtained for this
® Yes ❑ No ❑ Unknown
project (including all prior phases) in the past?
Isolated Wetland Permit for Forest
Ridge Commercial, Lot C-5 and
If yes, please give the DWR Certification number and/or Corps
Access Road (DWQ Project #12-
Action ID (ex. SAW-0000-00000):
0892); Harnett County
jClick to enter.j
Attach any pertinent project history documentation
02. Is any portion of the work already complete?
® Yes ❑ No
If yes, describe the completed work.
The construction is complete for Forest Ridge Commercial, Lot C-5 Access Road
4c. List of other certifications or approvals/denials received from other federal, state or local agencies for work
described in this application not related to the 404 or 401.
N/A
4d. Attach an 8'h x 11" excerpt from the most recent version of the USGS topographic map indicating the location of
the project site.
4e. Attach an 8'h x 11" excerpt from the most recent version of the published County NRCS Soil Survey map
depicting the project site.
4f. List the total estimated acreage of all existing wetlands on the
Approximately 4.85 acres
property:
4g. List the total estimated linear feet of all existing streams (intermittent
Appoximately 50 linear feet
and perennial) on the property:
4g1. List the total estimated acreage of all existing open waters on the
0 acres
property:
4h. Explain the purpose of the proposed project:
The purpose of the project is to construct commercial lots and the necessary infrastructure.
4i. Describe the overall project in detail, including the type of equipment to be used:
Per the project engineer — The purpose of the project is to create commercial outparcels in two separate phases.
Phase 1 is planned to create up to 7 out parcels with associated access roads. Phase 2 is planned to be
accomplished subsequently and will create 3 to 5 outparcels with associated access roads. The two phases are
separated by a public street (i.e. Melody Lane). The project will be served by public water and sewer and will
include stormwater retention basins and proper storm drainage measures; specifically there are wetland impacts
associated with road crossings and lot fill. Equipment typically used for construction and earthwork such as
backhoes, bulldozers, excavators, graders, pavers, etc will be utilized for this project.
4j. Attach project drawings/site diagrams/depictions of impact areas for the proposed project.
4k. Will this activity involve dredging in wetlands or waters?
❑ Yes ❑x No
If yes, describe the type of dredging, the composition of the dredged material, and the locations of disposal area.
Click to enter text
Page 7 of 22 PCN Form Version 4.3- April 20, 2022

5.
Jurisdictional Determinations
5a.
Have the wetlands or streams been delineated on
the property or in
® Yes
❑ No ❑ Unknown
proposed impact areas?
Comments:
GIICK to enter text.
5b.
If the Corps made a jurisdictional determination,
0 Preliminary ❑ Approved
❑ Emailed concurrence
what type of determination was made?
❑ Not Verified ❑ Unknown
❑ n/a
Corps AID number (ex. SAW-0000-00000):
SAW-2005-01133
Name (if known): Steven Ball
5c.
If 5a is yes, who delineated the jurisdictional
Agency/Consultant Company:
Soil & Environmental
areas?
Consultants, PA
Other: ';lick to enter
5d.
List the dates of the Corps jurisdictional determination or State determination if a determination was made by
either agency.
SAW-2005-01133 PJD issued by Emily Greer on January 4, 2021.
5d1.
Attach jurisdictional determinations.
6. Future Project Plans
6a. Is this a phased project?
® Yes ❑ No
6b. If yes, explain.
Per the project engineer — Yes, this will be a two -phases project. However, the intent is to address the permitting
of all wetland impacts for both phases at this time.
Are any other NWP(s), regional general permit(s), or individual permit(s) used, or intended to be used, to
authorize any part of the proposed project or related activity? This includes other separate and distant crossings
for linear projects that require Department of the Army authorization but don't require pre -construction
notification.
It is my understanding that there are no intended future phases beyond the property boundaries shown.
Therefore, no additional NWP, Regional General Permits, or IP are anticipated.
7. Addresses of adjoining property owners, lessees, etc. whose property adjoins the waterbody (if more than can be
entered here, please attach a supplemental list)
Please reference Harnett County GIS.
8. Scheduling of activity:
Construction timeline will be after permits are issued by agencies, including the local municipality and before
permits expire. The exact date is unknown at this time.
Page 8 of 22 PCN Form Version 4.3- April 20, 2022

D. Proposed Impacts Inventory
Impacts Summary
❑x Wetlands
1 a. Where are the impacts associated with your project ❑ Buffers
(check all that apply):
❑ Pond Construction
❑ Streams - tributaries
❑ Open Waters
2. Wetland Impacts
If there are wetland impacts proposed on the site, complete this table for each wetland area impacted.
2a.
2a1.
2b.
2c.
2d.
2e.
2f.
2g.
Site #
Impact
Impact
Wetland Type
Wetland Name
Forested
Jurisdiction
Impact Area
Reason/Type
Duration
?
Type
(ac)
W1
Culvert
Permanent
Headwater
Impact 1 — Road
Yes
Both
0.041
Forest
Crossing — W1
W2
Other
Temporary
Headwater
Impact 1 — Road
Yes
Both
0.012
Forest
Crossing -
Temporary
Construction
Access — W1
W3
Fill (Incl.
Permanent
Headwater
Impact 2 — Lot Fill —
Yes
Both
0.172
Riprap)
Forest
W1
W4
Other
Temporary
Headwater
Impact 2 — Lot Fill —
Yes
Both
0.004
Forest
Temporary
Construction
Access — W1
W5
Fill (Incl.
Permanent
Headwater
Impact 3 — Lot Fill —
Yes
Both
0.144
Riprap)
Forest
W1
Other
Temporary
Headwater
Impact 3 — Lot Fill —
Yes
Both
0.009
W6
Forest
Temporary
Construction
Access — W1
W7
Culvert
Permanent
Headwater
Impact 4 — Road
Yes
Both
0.050
Forest
Crossing — W2
Other
Temporary
Headwater
Impact 4 — Road
Yes
Both
0.018
Forest
Crossing —
W8
Temporary
Construction
Access — W2
W9
Culvert
Permanent
Headwater
Impact 5 — Road
Yes
Both
0.040
Forest
Crossing — W2
Other
Temporary
Headwater
Impact 5 — Road
Yes
Both
0.012
Forest
Crossing —
W10
Temporary
Construction
Access — W2
Page 9 of 22 PCN Form Version 4.3- April 20, 2022

W11
Culvert
Permanent
Headwater
Impact 6- Road
Yes
Both
0.049
Forest
Crossing — W2
Other
Temporary
Headwater
Impact 6- Road
Yes
Both
0.021
Forest
Crossing —
W12
Temporary
Construction
Access — W2
W13
Choose one
Temp/ Pern,
Choose one
Click to cI ILcI
Y/N
Choose one
Click to ente,
W14
Choose one
Temp/ Perm
Choose one
;lick to enter
Y/N
Choose one
Click to enter
W15
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
2g1.
Total temporary wetland impacts
0.076 ac
2g2.
Total permanent wetland impacts
0.496 ac
2g3.
Total wetland impacts
0.572 ac
2h.
Type(s) of material being discharged and the amount of each type in cubic yards:
N/A
2i.
Comments:
Total permanent loss wetlands = 0.496 acres; Total
temporary wetland
impacts = 0.076 ac.
Page 10 of 22 PCN Form Version 4.3- April 20, 2022

3. Stream Impacts
If there are perennial or intermittent stream/ tributary impacts (including temporary impacts) proposed on the site,
complete this table for all stream/ tributary sites impacted.
** All Perennial or Intermittent streams must be verified by DWR or delegated local government
Site #
3a
Impact
Reason
3b.
Impact
Duration
3c.
Impact Type
3d.
Stream Name
3e.
Stream
Type
3f.
Jurisdiction
Type
3g.
Stream Width
(avg ft)
3h.
Impact length
(linear ft) *
S1
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S2
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S3
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S4
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S5
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S6
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S7
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S8
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S9
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S10
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S11
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S12
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S13
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S14
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S15
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S16
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S17
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S18
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S19
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S20
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
3i1. Total jurisdictional ditch
impact:
Click to enter. linear ft
3i2. Total permanent stream
impacts:
Click to enter. linear ft
36. Total temporary stream
impacts:
Click to enter. linear ft
3i4. Total stream and ditch
impacts:
Click to enter. linear ft
3j. Comments:
Click to enter.
Page 11 of 22 PCN Form Version 4.3- April 20, 2022

4.
Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other
open water of the U.S., individually list all open water impacts in the table below.
4a.
Site #
4a1.
Impact Reason
4b.
Impact
Duration
4c.
Waterbody Name
4d.
Activity Type*
4e.
Waterbody
Type
4f.
Impact area
(ac)
01
;lick to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
02
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
03
dick to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
04
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
05
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
4g.
Total temporary open water impacts
Click to enter. ac
4g.
Total permanent open water impacts
Click to enter. ac
4g.
Total open water impacts
Click to enter. ac
4h.
Comments:
Click to enter.
5.
Pond or Lake Construction
If pond or lake construction is proposed, complete
the table below. (*This
does NOT include
ofFline stormwater
management ponds.)
5a.
5b.
5c.
5d.
5e.
Pond ID
Proposed use or
Wetland Impacts
(ac)
Stream
Impacts (ft)
Upland
#
purpose of pond
Impacts (ac)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
P1
Choose one
Click tc,
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
P2
Choose one
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
P3
Choose one
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
5f.
Total
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
5g.
Comments:
Click to enter.
5h.
Is a dam high hazard permit required?
❑ Yes ❑ No
If yes, permit ID no.:
Click to enter.
5i.
Expected pond surface area (acres):
Click to enter.
5j.
Size of pond watershed (acres):
Click to enter.
5k.
Method of construction:
Click to enter
Page12 of 22 PCN Form Version 4.3- April 20, 2022

6. Buffer Impacts (DWR requirement)
If project will impact a protected riparian buffer, then complete the chart below. Individually list all buffer impacts.
6a. Project is in which protected basin(s)?
(Check all that apply.)
❑ Neuse ❑ Tar -Pamlico ❑ Catawba
❑ Jordan ❑ Goose Creek ❑ Randleman
❑ Other: Click to enter.
Site #*
6b.
Impact Type*
6c.
Impact Duration*
6d.
Stream Name*
6e.
Buffer
Mitigation
Required?*
6f.
Zone 1 Impact*
(sq ft)
6g.
Zone 2 Impact*
(sq ft)
131
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
132
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
133
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
134
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
135
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
136
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
137
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
138
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
139
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B10
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
1311
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B12
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B13
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B14
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B15
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B16
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B17
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B18
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B19
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B20
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
6h. Total temporary impacts:
Zone 1: Click to enter sq ft
Zone 2: Click to enter. sq ft
6h. Total permanent impacts:
Zone 1: Click to enter sq ft
Zone 2: Click to enter. sq ft
6h. Total combined buffer impacts:
Zone 1: Click to enter sq ft
Zone 2: Click to enter. sq ft
6i. Comments:
Click to enter.
Please attach supporting documentation (impact maps, plan sheets, etc.) for the proposed project.
Page 13 of 22 PCN Form Version 4.3- April 20, 2022

E. Impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts through project design:
S&EC completed a stream and wetland delineation for the entire property in order to identify natural resources
so that impacts could be avoided and minimized to the maximum extent practicable. Proposed impacts include
four (4) road crossings and two (2) lot fill areas. Impact area 1 is a proposed wetland impacts for a road crossing
and associated utility services (i.e. sanitary sewer and waterline). Proposed impacts include permanent wetland
loss, and temporary (i.e. construction access) wetland impacts. This road crossing is necessary to provide
access to the proposed lots C6-C9 on the southern portion of the property. Per the project engineer, NCDOT will
only be willing to grant access to the proposed lots via the existing street stub off Melody Lane and the additional
access to the Highway NC24/87 at the far southern end to meet the 600' minimum distance between
intersections. See additional information provided on sheet WLM-2 "LOTS C7 & C8 SITE DESIGN CRITERIA &
WETLAND BACKFILL SPECIFIC NOTES". Retaining walls will be utilized on both sides of the crossing to
minimize wetland impacts. Wetland mitigation is proposed at a 2:1 ratio to compensate for the permanent
wetland loss. Impact areas 2 and 3 are proposed wetland impacts for lot fill. Proposed impacts include
permanent wetland impacts and temporary (i.e. construction access) wetland impacts. This lot fill is necessary to
provide commercial lots designed per Harnett County minimum design criteria for lot sizes (Harnett Co LIDO
Section 14.4 & 14.5-pg 82) and lateral/cross access. Lateral access and interconnectivity of parking lots is also
required by the Harnett County fire marshal (Harnett Co LIDO Section 2.9-pg 163). See additional information
provided on sheet WLM-2 "LOTS C7 & C8 SITE DESIGN CRITERIA & WETLAND BACKFILL SPECIFIC
NOTES". Retaining walls will be utilized to minimize permanent loss impacts. Wetland mitigation is proposed at
a 2:1 ratio to compensate for the permanent wetland loss. Impact areas 4, 5, and 6 are proposed wetland
impacts for road crossings and associated utility services (i.e. sanitary sewer and waterline). These road
crossings are necessary to provide access to the proposed lots on the northern portion of the property. Proposed
impacts include permanent wetland loss, and temporary (i.e. construction access) wetland impacts. Per the
project engineer, NCDOT will only be willing to grant access to the proposed lots via the existing street stub off
Melody Lane and the additional access to the Highway NC24/87 at the far southern end to meet the 600'
minimum distance between intersections. See additional information provided on sheet WLM-2.1 "SITE DESIGN
CRITERIA & WETLAND BACKFILL SPECIFIC NOTES". 3:1 slopes are proposed to minimize permanent loss
wetland impacts. Wetland mitigation is proposed at a 2:1 ratio to compensate for the permanent wetland loss.
Temporary wetland impacts will be brought back to pre -construction contours and allowed to revegetate with
adjacent wetland seed source.
1 b. Specifically describe measures taken to avoid or minimize proposed impacts through construction techniques:
Per the project engineer — The measures to be taken to avoid/minimize proposed impacts will include multiple
dewatering techniques such as cofferdams, pump around, and measures that will be identified in the eroision
and sediment control (E&S) plan; such as silt fencing and retention basins.
2. Compensatory Mitigation for Impacts to Waters of the U.S., Waters of the State, or Riparian Buffers
2a. If compensatory mitigation is required, by whom is it required? ❑x DWR ❑x Corps
(check all that apply)
2b. If yes, which mitigation option(s) will be used for this ❑ Mitigation Bank
project? * (check all that apply) ❑x In Lieu Fee Program
❑ Permittee Responsible Mitigation
3. Complete if using a Mitigation Bank
(Must satisfy NC General Statute143-214.11 (d1).)
3a. Name of mitigation bank:
Click to enter.
3b. Credits purchased/requested:
Type: Choose one
Quantity Click to enter.
Page 14 of 22 PCN Form Version 4.3- April 20, 2022

Type: Choose one I Quantity Click to enter.
Type: Choose one I Quantity Click to enter.
Attach receipt and/or approval letter.
3c. Comments:
Click to enter.
4.
Complete if Using an In Lieu Fee Program
4a.
Attach approval letter from in lieu fee program.
4b.
Stream mitigation requested:
0 linear feet
4c.
If using stream mitigation, what is the stream temperature:
Choose one
NC Stream Temperature Classification Maps can be found under the Mitigation Concepts tab on the Wilmington
District's RIBITS website: (Please use the filter and select Wilmington district)
htti)s://ribits.usace.army.mil/ribits apex/f?p=107:27:2734709611497::NO: RP:P27 BUTTON KEY:O
4d.
Buffer mitigation requested (DWR only):
0 square feet
4e.
Riparian wetland mitigation requested:
0.994 acres
4f.
Non -riparian wetland mitigation requested:
0 acres
4g.
Coastal (tidal) wetland mitigation requested:
0 acres
4h.
Comments:
S&EC reviewed the NCDWR Approved Mitigation Banks in NC list, there were two banks listed within the
03030004 HUC that had riparian wetland credits available. Both banks were contacted and neither bank had
riparian wetland credits available, therefore NCDMS was utilized.
5. Complete if Providing a Permittee Responsible Mitigation Plan
5a. If proposing a permittee responsible mitigation plan, provide a description of the proposed mitigation plan,
including mitigation credits generated.
Click to enter.
5b. Attach mitigation plan/documentation.
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — DWR requirement
6a. Will the project result in an impact within a protected riparian buffer
that requires buffer mitigation?
❑ Yes ❑x No
If yes, please complete this entire section — please contact DWR for more information.
6b. If yes, identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required in the table below.
Zone
6c.
Reason for impact
6d.
Total impact
(square feet)
Multiplier
6e.
Required mitigation
(square feet)
Zone 1
Click to enter.
Click to enter.
Choose one
Click to enter.
Zone 2
:,lick to enter.
Click to enter.
Choose one
Click to enter.
6f. Total buffer mitigation required
Click to enter.
Page 15 of 22 PCN Form Version 4.3- April 20, 2022

6g. If buffer mitigation is required, is payment to a mitigation bank or ❑ Yes ❑ No
NC Division of Mitigation Services proposed?
6h. If yes, attach the acceptance letter from the mitigation bank or NC Division of Mitigation Services.
6i. Comments:
Click to tenter.
Page 16 of 22 PCN Form Version 4.3- April 20, 2022

F. Stormwater Management and Diffuse Flow Plan (DWR requirement)
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers
❑ Yes ❑x No
identified within one of the NC Riparian Buffer Protection Rules?
1 b. All buffer impacts and high ground impacts require diffuse flow or other form of stormwater treatment. If the
project is subject to a state implemented riparian buffer protection program, include a plan that fully documents
how diffuse/dispersed flow will be maintained.
All Stormwater Control Measures (SCM) must be designed in accordance with the NC Stormwater Design
Manual (https://deg.nc.gov/about/divisions/energv-mineral-land-resources/energv-mineral-land-permit-
guidance/stormwater-bmp-manual).
Associated supplement forms and other documentation must be provided.
❑ Level Spreader
What Type of SCM are you
❑ Vegetated Conveyance (lower seasonal high water table- SHWT)
providing?
❑ Wetland Swale (higher SHWT)
(Check all that apply)
❑ Other SCM that removes minimum 30% nitrogen
❑ Proposed project will not create concentrated stormwater flow through the
buffer
For a list of options to meet the diffuse flow requirements, click here.
Attach diffuse flow documentation.
2.
Stormwater Management Plan
2a.
Is this an NCDOT project subject to compliance with NCDOT's
Individual NPDES permit NCS000250?
El Yes ❑x No
2b.
Does this project meet the requirements for low density projects as
defined in 15A NCAC 02H .1003(2)?
❑ Yes ❑x No
To look up low density requirements, click here:
http://reports.oah.state.nc.us/ncac/title%2015a%20-%20environ mental%20guality/chapter%2002%20-
%20environmental%20management/subchapter%20h/15a%20ncac%2002h%20.1003.pdf
2c.
Does this project have a stormwater management plan (SMP)
❑x Yes ElNo
reviewed and approved under a state stormwater program or state -
approved local government stormwater program?
❑ n/a — project disturbs < 1 acre
Note: Projects that have vested rights, exemptions, or grandfathering from state or locally implemented
stormwater programs or projects that satisfy state or locally -implemented stormwater programs through use of
community in -lieu programs should answer "no" to this question.
2d.
Which of the following stormwater management program(s) apply?
❑x Local Government
(Check all that apply.)
❑ State
If you have local government approval, please include the SMP on their overall impact map.
❑x Phase II ❑ USMP
Local Government Stormwater Programs
❑ NSW ❑ Water Supply
Page 17 of 22 PCN Form Version 4.3- April 20, 2022

Please identify which local government stormwater program you are using.
Harnett County
State Stormwater Programs ❑ Phase II ❑ HQW or ORW
❑ Coastal Counties ❑ Other
Comments:
The SCM's that will be utilized for this project will include wet detention basins designed to NCDEQ's Stormwater
Minimum Design Criteria Manual.
Page 18 of 22 PCN Form Version 4.3- April 20, 2022

G. Supplementary Information
1. Environmental Documentation
1 a. Does the project involve an expenditure of public (federal/state/local)
❑ Yes ❑x No
funds or the use of public (federal/state) land?
1 b. If you answered "yes" to the above, does the project require
preparation of an environmental document pursuant to the
requirements of the National or State (North Carolina) Environmental
El Yes El No
Policy Act (NEPA/SEPA)?
1 c. If you answered "yes" to the above, has the document review been
finalized by the State Clearing House? (If so, attach a copy of the
❑ Yes ❑ No
NEPA or SEPA final approval letter.)
Comments:
Click to enter.
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15A
NCAC 2H .0500), Isolated Wetland Rules (15A NCAC 2H .1300),
Federally Non -Jurisdictional Wetlands /Classified Surface Waters
❑ Yes ❑x No
(15A NCAC 2H. 1400) DWR Surface Water or Wetland Standards or
Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. If you answered "yes" to the above question, provide an explanation of the violation(s):
DICK to enter.
3. Cumulative Impacts (DWR Requirement)
3a. Will this project (based on past and reasonably anticipated future
impacts) result in additional development, which could impact nearby
❑ Yes ❑x No
downstream water quality?
3b. If you answered "no", provide a short narrative description:
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 Forest Ridge Commercial project is a commercial development.
Additionally, the project is located within the Harnett County jurisdiction, therefore the adjacent properties that
have potential for development will have the following regulations to protect downstream waters: 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. We
anticipate that the DWR will advise us if any additional information is needed.
3c. If yes, provide a qualitative or quantitative cumulative impact analysis in accordance with the most recent DWR
policy. (Attach .pdo
Page 19 of 22 PCN Form Version 4.3- April 20, 2022

4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project? I ® Yes ❑ No ❑ N/A
4b. If yes, describe in detail the treatment methods and dispositions (non -discharge or discharge) of wastewater
generated from the proposed project. If the wastewater will be treated at a treatment plant, list the capacity
available at that plant.
Wastewater will be addressed through the extension of existing adjacent sewer mains and the installation will be
permitted by Harnett Regional Water & NCDEQ Water Resources.
5.
Endangered Species and Designated Critical Habitat (Corps Requirement)
5a.
Will this project occur in or near an area with federally protected
® Yes ❑ No
species or habitat? (IPAC weblink: https://www.fws.gov/ipac/ Ifws.govl)
5b.
Have you checked with the USFWS concerning Endangered Species
® Yes ❑ No
Act impacts?
5c.
If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d.
Is another federal agency involved?
❑ Yes ❑ No ❑x Unknown
If yes, which federal agency?
,lick to enter.
5e.
Is this a DOT project located within Divisions 1-8?
❑ Yes ❑x No
5f.
Will you cut any trees in order to conduct the work in waters of the
U.S.?
®Yes El No
5g.
Does this project involve bridge maintenance or removal?
❑ Yes ❑x No
5g1.
If yes, have you inspected the bridge for signs of bat use such as
staining, guano, bats, etc.? Representative photos of signs of bat use
❑ Yes ❑ No
can be found in the NLEB SLOPES, Appendix F, pages 3-7.
Representative photos of signs of bat use can be found in the NLEB SLOPES, Appendix F, pages 3-7. Link to
NLEB SLOPES document: http://saw-reg.usace. army. mil/NLEB/1-30-17-signed
NLEB-SLOPES&apps.pdf
If you answered yes to 5g1, did you discover any signs of bat use?
❑ Yes ❑ No ❑ Unknown
If yes, please show the location of the bridge on the permit drawings/ project plans
5h.
Does this project involve the construction/ installation of a wind
turbine(s)?
❑ Yes ❑x No
If yes, please show the location of the wind turbine(s) on the permit drawings/ project plans (attach .pdo
5i.
Does this project involve blasting and /or other percussive activities
that will be conducted by machines, such as jackhammers,
❑ Yes ❑x No
mechanized pile drivers, etc.?
If yes, please provide details to include type of percussive activity, purpose,
duration, and specific location of this
activity on the property (attach .pdo
Page 20 of 22 PCN Form Version 4.3- April 20, 2022

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 NC Natural Heritage Program database, and an official
Species List through the iPac. A formal request was sent to the USFWS on June 5, 2023. The USFWS has 30
days to respond from the date of the sent request.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.
Attach consultation documentation.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as
an Essential Fish Habitat?
❑ Yes ❑x No
Is there submerged aquatic vegetation (SAV) around
the project vicinity?
El Yes ❑x No El Unknown
Will this project affect submerged aquatic vegetation?
❑ Yes ❑x No ❑ Unknown
Explain: Click to enter.
6b. What data source(s) did you use to determine whether your site would impact Essential Fish Habitat?
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):
hftp://qis.ncdcr.gov/hpoweb/
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural
preservation status (e.g., National Historic Trust designation or
❑ Yes ❑x No
properties significant in North Carolina history and archaeology)?
7b. What data source(s) did you use to determine whether your site would impact historic or archeological
resources?
The NC State Historic Preservation Office HPOWEB GIS Service interactive map was referenced on June 20,
2023, no historic listings or study list entries or determined eligible listings were identified within the property
boundaries. Additionally, no structures exist within the project boundaries.
7c. Attach historic or prehistoric documentation.
8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https://msc.fema.gov/portal/search
8a. Will this project occur in a FEMA-designated 100-year floodplain? *
❑ Yes ❑x No
8b. If yes, explain how the project meets FEMA requirements.
Click to enter.
Page 21 of 22 PCN Form Version 4.3- April 20, 2022

8c. What source(s) did you use to make the floodplain determination?
NC Flood Rish Information System Floodplain Mapping Program and confirmation from the project engineer.
H. Miscellaneous
Comments:
( lirrlr 4n anfar
Attach pertinent documentation or attachments not previously requested
I. Signature *
❑x By checking the box and signing below, I, as the project proponent, certify to the following:
• The project proponent hereby certifies that all information contained herein is true, accurate, and complete, to
the best of my knowledge and belief;
• The project proponent hereby requests that the certifying authority review and take action on this CWA 401
certification request within the applicable reasonable period of time;
• The project proponent hereby agrees that submission of this PCN form is a "transaction" subject to Chapter
66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• The project proponent hereby agrees to conduct this transaction by electronic means pursuant to Chapter 66,
Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• The project proponent hereby understands that an electronic signature has the same legal effect and can be
enforced in the same way as a written signature; AND
• As the project proponent, I intend to electronically sign and submit the PCN/online form.
Full Name: Deborah Shirley
Signature: * -,iiur, Deborah E. Shirley Digitally signed by Deborah E. Shirley
Date: 2023.07.17 17:28:48-04'00'
Date: 7/17/2023
Page 22 of 22 PCN Form Version 4.3- April 20, 2022