20231228 Ver 1_ePCN Application_20230906

DWR
Division 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
Initial Review
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:
6/6/2023
BIMS # Assigned
20231228
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:
Kennebec and Maude Stewart Waterline Extension
1a. Who is the Primary Contact?*
Kayla Bivens
1b. Primary Contact Email: *
kbivens@ hazena ndsawyer. com
Date Submitted
9/6/2023
Nearest Body of Water
Black Creek
Basin
Neuse
Water Classification
B; NOW
Site Coordinates
Latitude:
35.558125
A. Processing Information
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
Longitude:
-78.739652
Version#*
1
What amout is owed?*
$240.00
$570.00
Select Project Reviewer*
Zachary Thomas:[e-mail]
1c. Primary Contact Phone: *
[phone]
a
Is this project a public transportation project?*
Yes No

1a.Type(s)of approval sought from the Corps:
Section 404 Permit (wetlands, streams and waters, Clean Water Act)
Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
Has this PCN previously been submitted?*
Yes
No
1b. What type(s) of permit(s) do you wish to seek authorization?
Nationwide Permit (NWP)
Regional General Permit (RGP)
Standard (IP)
1c. Has the NWP or GP number been verified by the Corps?
Yes No
Nationwide Permit (NWP) Number:
NWP Numbers (for multiple NWPS):
1d. Type(s) of approval sought from the DWR:
401 Water Quality Certification - Regular
Non-404 Jurisdictional General Permit
Individual 401 Water Quality Certification
58 - Utility Line Activities for Water and Other Substances (frequently used)
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:
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?
Yes No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
Yes No
1h. 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
401 Water Quality Certification - Express
Riparian Buffer Authorization
1d. Who is applying forthe 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 Fuquay-Varina
2b. Deed book and page no.:
per encroachment agreement with NCDOT
2c. Contact Person:
Michael Wagner
2d.Address
Street Address
1415 Holland Road
Address Line 2
city State / Province / Region
Fuquay-Varina NC
Postal / Zip Code Country
27526 United States
Yes No
Yes No

2e. Telephone Number:
[phone]
2g. Email Address:'
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Kayla Bivens
4b. Business Name:
Hazen and Sawyer
4c. Address
Street Address
4011 Westchase Blvd, Suite 500
Address Line 2
City
Raleigh
Postal / Zip Code
27607
4d. Telephone Number:
[phone]
4f. Email Address:"`
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality / town:
Fuquay-Varina
2. Project Identification
2a. Property Identification Number:
Public right-of-way
2c. Project Address
Street Address
Utility corridor along Kennebec and Maude Stewart Road
Address Line 2
City
Fuquay-Varina
Postal / Zip Code
27526
3. Surface Waters
3a. Name of the nearest body of water to proposed project: "
Black Creek
3b. Water Resources Classification of nearest receiving water:
B; 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.
030202011201
4. Project Description and History
2f. Fax Number:
State / Province / Region
NC
Country
United States
4e. Fax Number:
2b. Property size:
5
State / Province / Region
NC
Country
United States
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:
Please refer to the attached Additional Information section.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?
Yes No Unknown
a

4f. List the total estimated acreage of all existing wetlands on the property:
0.02
4g. List the total estimated linear feet of all existing streams on the property:
80
4h. Explain the purpose of the proposed project:"
Please refer to the attached Additional Information section.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:
Please refer to the attached Additional Information section.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?
Yes No Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?
Preliminary Approved Not Verified Unknown N/A
Corps AID Number:
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Kayla Bivens and Keven Arrance
Agency/Consultant Company: Hazen and Sawyer
Other:
6. Future Project Plans
6a. Is this a phased project?*
Yes No
Are any other NWP(s), regional general permit(s), or individual permits(s) used, or intended to be used, to authorize any part of the proposed project or related activity?
No.
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
Wetlands Streams -tributaries n Buffers
Open Waters Pond Construction
2. Wetland Impacts
u
2a1 Reason (?)
2b. Impact type* (?)
2c. Type of W.*
2d. W. name
2e. Forested*
2f. Type of Jurisdicition *
(?)
2g. Impact
area
WA
Pipe crossing 1.
L
ffNCWAM TYPES
W17
L
Both
0.018
acres)
2g. Total Temporary Wetland Impact 2g. Total Permanent Wetland Impact
0.018 0.000
2g. Total Wetland Impact
0.018
2i. Comments:
Please refer to the attached Additional Information section.
3. Stream Impacts
❑
3a. Reason for impact (?)
3b.lmpact type*
3c. Type of impact* :]��name*
�3e. Stream Type*
(?)
3f. Type of
Jurisdiction*
3g. S. width
3h. Impact
length*
S1
Pipe crossing 1.
Temporary
Excavation
SA - UT2 to Black Creek
Intermittent
Both
Average (feet)
15
(linear feet)

S2
Pipe crossing 2.
Temporary
Excavation
SB - UT3 to Black Creek
Intermittent
Both
Average (feet)
20
(linear feet)
fl
Pipe crossing 3.
Temporary
Excavation
SC - UT2 to Little Black
Creek
Perennial
Both
37
Aveage (feet)
40
(linear feet)
3i. Total jurisdictional ditch impact in square feet:
0
3L Total permanent stream impacts: 31. Total temporary stream impacts:
0 75
31. Total stream and ditch impacts:
75
3j. Comments
6. Buffer Impacts (for DWR)
6a. Project is in which protect basin(s)?
Check all that apply.
Neuse Tar -Pamlico
Catawba Randleman
Goose Creek Jordan Lake
Other
6b. Impact Type
11
6c. Per or Temp
6d. Stream name
Be.Buffer mitigation required?
6f. Zone 1 impact
6g. Zone 2 impact
131 - Pipe crossing
T
UT1 to Black Creek
No
811
1,664
B2 - Pipe crossing
T
UT3 to Black Creek
No
933
623
133 - Tree clearing
P
UT3 to Black Creek
No
249
185
B4 - Pipe crossing
T
UT1 to Little Black Creek
No
1,191
782
B5 - Pipe crossing
T
UT2 to Little Black Creek
No
1,837
1,364
6h. Total buffer impacts:
Zone 1 Zone 2
Total Temporary impacts: 4,772.00 4,433.00
Zone 1
Zone 2
Total Permanent impacts: 249.00
185.00
Zone 1
Zone 2
Total combined buffer impacts: 5,021.00
4,618.00
6i. Comments:
E. Impact Justification and Mitigation O
1. Avoidance and Minimization
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
Please refer to the attached Additional Information section.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Please refer to the attached Additional Information section.
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:
Proposed impacts are below the threshold at which mitigation is required.
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
Comments:
G. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?
Yes No
1b. If you answered "yes" to the above, does the project require preparation of an environmental document pursuant to the requirements of the National or State (North Carolina)
Environmental Policy Act (NEPA/SEPA)?*
Yes No
Comments:*
The project does not meet the minimum criteria to trigger the preparation of a SEPA document. The project does not involve funds, federal lands, or
federal agency involvement other than USACE authorization under Section 404 of the Clean Water Act.
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.
Please refer to the attached Additional Information section.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?
Yes No N/A
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or habitat?*
Yes No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?
Yes No
5d. Is another Federal agency involved?*
Yes No 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?
Hazen biologist requested an unofficial species list from FWS via the IPaC tool on August 14, 2023. A
copy of the unofficial IPaC resource list is attached for reference. Please refer to the attached Additional Information section for further details on
federally listed species.
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?
Hazen reviewed the Essential Fish Habitat mapper for the Mid -Atlantic region provided through NOAA Fisheries website to determine potential impacts
to Essential Fish Habitat anticipated by the proposed project.
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?"
Please refer to the attached Additional Information section.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?"
Yes No
8b. If yes, explain how project meets FEMA requirements:
The proposed project is within a FEMA-designated 100-year floodplain according to North Carolina's
FEMA GIS data reviewed by Hazen. However, no structures that would alter the 100-year floodplain are
proposed.
8c. What source(s) did you use to make the floodplain determination?"
North Carolina's FEMA GIS data, panel number 3720067600K and 3720067500K, effective date 7/19/2022 and 10/3/2006, respectively.
Miscellaneous
t^
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 dreg and drop files here to attach document
Compiled_PCN Attachments.pdf 37.74MB
File must be PDF or KMZ
Comments
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:
Kayla Bivens
Signature
r/C-tart ffmwd
a
Date
9/6/2023