20230261 Ver 2__20231109_Project_Independence_PCN_Mod_FINAL_20231109

Preliminary ORM Data Entry Fields for New Actions
ACTION ID #: SAW- Begin Date (Date Received):
Prepare file folder Assign Action ID Number in ORM
1. Project Name [PCN Form A2a]:
2. Work Type: Private Institutional Government Commercial
3. Project Description / Purpose [PCN Form B3d and B3e]:
4. Property Owner / Applicant [PCN Form A3 or A4]:
5. Agent / Consultant [PNC Form A5 – or ORM Consultant ID Number]:
6. Related Action ID Number(s) [PCN Form B5b]:
7. Project Location – Coordinates, Street Address, and/or Location Description [PCN Form B1b]:
8. Project Location – Tax Parcel ID [PCN Form B1a]:
9. Project Location – County [PCN Form A2b]:
10. Project Location – Nearest Municipality or Town [PCN Form A2c]:
11. Project Information – Nearest Waterbody [PCN Form B2a]:
12. Watershed / 8-Digit Hydrologic Unit Code [PCN Form B2c]:
Authorization: Section 10 Section 404 Section 10 and 404
Regulatory Action Type:
Pre-Application Request
Unauthorized Activity
Compliance
Standard Permit
Nationwide Permit #39
Regional General Permit #
Jurisdictional Determination Request No Permit Required
Revised 20150602
1600 Ormsby Station Ct, Louisville, KY 40223; 502-500-0117; [e-mail]
(POC: Erin Birch)

kimley-horn.com 200 South Tryon Street, Suite 200, Charlotte, NC 28202 704-333-5131

November 9, 2023

Krysta Stygar
Regulatory Specialist
US Army Corps of Engineers
Wilmington District, Charlotte Field Office
8430 University Executive Park Drive, Suite 611
Charlotte, NC 28262

Paul Wojoski
NC DWR, 401 & Buffer Permitting Unit
512 North Salisbury Street
Raleigh, NC 27604

Re: Pre-Construction Notification (NWP #39 and Individual 401 Water Quality Certification)
Project Independence – Modification (SAW-2021-01846, DWR #20230261)
Concord, Cabarrus County, NC

Dear Ms. Stygar and Mr. Wojoski:

On behalf of our client, Kroger Fulfillment Network, LLC, Kimley-Horn (KH) is submitting the enclosed Section
404/401 Pre-construction Notification modification for the above-referenced project for your review pursuant to
Nationwide Permit #39 and Individual 401 Water Quality Certification (WQC). The proposed project seeks to
construct an on-site roadway connection to service the overall fulfillment center. Authorization is requested under
NWP 39 to install a culvert crossing at Stream 1. The center of the project area is located at
35.368092°, -80.561939°. The following information is included as part of this application submittal:

⚫ Revised Project Summary Sheet
⚫ Revised Pre-Construction Notification Form
⚫ Revised Permit Drawings
⚫ Compensatory Mitigation
This proposed on-site roadway connection (Limits of Disturbance 0.54-acre) is part of the adjacent Project
Independence 54-acre fulfillment center in Concord, Cabarrus County, NC. To maintain separation between
privately owned vehicles (POVs) and commercial vehicles, i.e. sprinter vans and tractor-trailers, the proposed
project seeks an employee-only secondary driveway access into the site.
The fulfillment center is a 200,000 square-foot building that was constructed in 2022, as there were no impacts to
jurisdictional waters. The proposed driveway access will cross an NCDOT mitigation site (Site #12) associated with
TIP No. R-2533B (NC- 49 from West of Irish Buffalo Creek to East of Walker Road). The mitigation site was
established to provide permittee-responsible mitigation for the impacts associated with the R-2533B project.
Design modifications are a result of prohibitive cost and NCDOT preference. The previous design included a wall
to reduce impacts to Stream 1; however, NCDOT prefers not to maintain the wall in perpetuity. The following table
illustrates the changes that are proposed through this modification:
Table 1: Impact Descriptions
PCN Version Type of Impact Impact Size (Stream 1) Required Mitigation
Credits
Original Wall 70 LF/0.01-acre 278
Modification Culvert 272 LF/0.037-acre 1,088
Page 2
kimley-horn.com 200 South Tryon Street, Suite 200, Charlotte, NC 28202 704-333-5131

PROPOSED IMPACTS TO JURISDICTIONAL WATERS

The proposed development seeks authorization under NWP 39 for stream impacts associated with the installation
of a culvert crossing at Stream 1.

Impacts to aquatic resources are proposed to be conducted at one impact site. The following summarizes the
proposed impacts:

Impact Site 1
• Stream 1 – Impact 1A
o One (1) 161 LF 48-inch reinforced concrete pipe (RCP) will be installed at the crossing of Stream
1. The RCP will be buried 1-ft to promote the passage of aquatic organisms. At the inlet, a 79 LF
rip-rap dissipation will be placed in a manner that the boulders will be pushed or “keyed” into the
channel bed so that the finished top elevation of the riprap will not exceed that of the original stream
bed to prevent destabilization of the stream bed or bank upstream of the impact area and to allow
for aquatic life passage. At the outlet, an 8 LF rip-rap dissipation will be placed in the same manner
as the inlet dissipation. The rip-rap dissipations are necessary to reduce discharge velocities and
to meet non-erosive design criteria. The installation of the culvert will result in 272 LF/0.037-acre
of permanent impacts to Stream 1.
• Wetland 1 – Impact 1B
o This impact is associated with grading activities necessary to construct the roadway, as well as the
installation of the inlet rip-rap dissipation for the 48-inch RCP. This impact will result in 0.008-acre
of permanent impacts to Wetland 1.

Overall, impacts associated with the proposed roadway connection will result in 272 LF/0.037-acre of
permanent impacts to non-wetland waters of the US (WOTUS) and 0.008-acre of permanent impacts to
wetland WOTUS.
AVOIDANCE AND MINIMIZATION

Avoidance and minimization efforts were implemented during development planning and design to the greatest
extent practicable in order to reduce the overall impacts on the aquatic environment while staying within nationwide
permit thresholds. The final plan demonstrates maximum avoidance and minimization efforts by reducing the
proposed stream and wetland impacts. The rationale to support avoidance and minimization efforts includes the
following:
• Avoidance of the remaining 4,504 LF of streams on-site.
• The culvert length has been reduced since the initial design. Initial plans from July 2022 proposed 265 LF
48-inch RCP, including 4 LF of headwalls and 14.5 LF of rip-rap outlet protection. This plan resulted in 285
LF/0.04-acre of impacts to Stream 1.
• Temporary impacts are not proposed.
• Indirect impacts will be avoided through the implementation of erosion control measures that will be
removed immediately following the activities and any disturbance will be retuned to pre-construction
conditions.

Page 3
kimley-horn.com 200 South Tryon Street, Suite 200, Charlotte, NC 28202 704-333-5131

COMPENSATORY MITIGATION

To maintain separation between privately owned vehicles (POVs) and commercial vehicles, i.e. sprinter vans and
tractor-trailers, the proposed project seeks an employee-only secondary driveway access into the site. The
proposed driveway access will cross an NCDOT mitigation site (Site #12) associated with TIP No. R-2533B (NC-
49 from West of Irish Buffalo Creek to East of Walker Road). The mitigation site was established to provide
permittee-responsible mitigation for the impacts associated with the R-2533B project. The proposed driveway
access requires the installation of a 161 LF, 48-inch RCP as well as 87 LF of riprap inlet and outlet protection.
Installation of the crossing will result in 272 LF of stream bed impacts.

Previous mitigation proposals were determined based on the mitigation calculator spreadsheet. Each iteration
utilizing this approach resulted in roughly a 4:1 mitigation ratio. In lieu of conducting another iteration of mitigation
spreadsheet calculations, the applicant proposes mitigation at 4:1.

Based on a mitigation ratio of 4:1, the applicant proposes the purchase of 1,088 stream mitigation credits
from the NCDMS.

Please feel free to contact me at [phone] if you have any questions or if additional information is necessary.

Sincerely,

KIMLEY-HORN AND ASSOCIATES, INC.

Chris Tinklenberg, PWS
Environmental Scientist

Project Summary Sheet
kimley-horn.com 200 South Tryon Street, Suite 200, Charlotte, NC 28202 704-333-5131

Project Name: Project Independence Modification

Applicant Name and Address: Kroger Fulfillment Network, LLC (POC: Erin Birch)
1600 Ormsby Station Ct
Louisville, KY 40223
Telephone Number: [phone]
Type of Request: Nationwide PCN (NWP #39) Individual Permit Application

Jurisdictional Determination Other:
Included Attachments: Project Plans USGS Map NRCS Soil Survey
Agent Authorization Delineation Sketch Delineation Survey
Data Forms (Up & Wet) NCDWR Stream Forms USACE Stream Forms
NCDMS Confirmation Aerial Photo Site Photos
Agency Correspondence Other: Other:
Check if applicable: CAMA County Trout County Isolated Waters
Section 7, ESA Section 106, NHPA EFH
Mitigation Proposed ( NC EEP On-Site Off-Site Other)
County: Cabarrus Nearest City/Town: Concord
Waterway: Irish Buffalo Branch River Basin: Yadkin Pee Dee
H.U.C.: 03040105 USGS Quad Name: Concord SE
Property Size (acres): 54 acres (0.54-acre LOD) Approx. Size of Jurisdiction on Site (acres): 4.28 ac
Site Coordinates (in decimal degrees): 35.368092 °N -80.561939 °W
Project Location: The subject property is located at 227 Highway 49 in Concord, Cabarrus County, NC.

Site Description: The site is comprised of one parcel and consists of an industrial distribution center.

Impact Summary (if applicable): The proposed modification seeks to construct an on-site roadway connection to service
the overall fulfillment center. Authorization is requested under NWP 39 to install a culvert crossing at Stream 1. The
proposed project will result in 272 LF/0.037-acre of permanent impacts to Stream 1 and 0.008-ac of permanent impacts to
Wetland 1.

NWP
#
Open Water
(acres)
Wetland
(acres)
Stream Channel
Intermittent and/or Unimportant
Aquatic Function
Perennial and/or Important
Aquatic Function
Temp. Perm. Temp. Perm. Temp. Perm. Temp. Perm.
lf ac lf ac lf ac lf Ac
39 0.008 272 0.037
Total 0.008 272 0.037
Total Permanent (Loss) Impact to Wetland Waters of the U.S. 0.008
Total Permanent (Loss) Impact to Non-Wetland Waters of the U.S. 272 / 0.037

Kimley-Horn Contact: Chris Tinklenberg, PWS Direct Number: [phone]
Email: [e-mail]

Page 1 of 24 PCN Form Version 4.3- April 20, 2022
Office Use Only
Corps Action ID no. SAW-2021-01846 Date received: [Click to enter.]
DWR project no. 20230261 Date received: [Click to enter.]
Site Coordinates:
Latitude (DD.DDDDDD): 35.368092
Longitude (DD.DDDDDD): 80.561939

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://edocs.deq.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 [e-mail] 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) *: 12/16/2022

Page 2 of 24 PCN Form Version 4.3- April 20, 2022

A. Processing Information
County (counties) where project is located: * Cabarrus Additional (if needed).
Is this an ARPA project? * ☐ Yes ☒ 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
your DWI ARPA Funding Project Number, please contact Corey
Basinger at [e-mail] for further assistance.
Click or tap here to enter text.
Is this a NCDMS project? *
(Click yes only if NCDMS is the applicant or co-
applicant)
☐ Yes ☒ No
Is this a public transportation project? *
(Publicly funded municipal, state, or federal road, rail,
or airport project)
☐ Yes ☒ No
Is this a NCDOT project? * ☐ Yes ☒ No
If yes, NCDOT TIP or state project number: Click to enter.
If yes, NCDOT WBS number: * Click to enter.
1a. Type(s) of approval sought from the Corps: *
☒ Section 404 Permit (wetlands, streams, 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. * 2/10/2023
1b. What type(s) of permit(s) do you wish to seek
authorization? *
☒ Nationwide Permit (NWP)
☐ Regional General Permit (RGP)
☐ 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.
1c. Has the NWP or GP number been verified by the Corps? * ☒ Yes ☐ No
NWP number(s) (list all numbers ): 39
RGP number(s) (list all numbers ): Click to enter.
Are you a federal applicant? ☐ Yes ☒ No
If yes, please provide a statement concerning compliance with the Coastal Zone Management Act *
Click to enter text.
1d. Type(s) of approval sought from DW R (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
Is this a courtesy copy notification ☐ Yes ☒ No

Page 3 of 24 PCN Form Version 4.3- April 20, 2022
1e. 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/certification application? * ☐ Yes ☒ No
1g. 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.
1h. Is the project located in any of NC’s twenty coastal counties? * ☐ Yes ☒ No
1i. Is the project located within an NC DCM Area of Environmental
Concern (AEC)? * ☐ Yes ☒ No ☐ Unknown
1j. Is the project located in a designated trout watershed? * ☐ Yes ☒ 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 4 of 24 PCN Form Version 4.3- April 20, 2022

B. Applicant Information
1a. Who is the primary contact? * Chris Tinklenberg
1b. Primary Contact Email: * [e-mail]
1c. Primary Contact Phone: * (###)###-#### 803-881-3919
1d. Who is applying for the permit/certification? * (check
all that apply) ☒ Owner ☐ Applicant (other than owner)
1e. Is there an agent/consultant for this project?* ☒ Yes ☐ No

2. Landowner Information
2a. Name(s) on Recorded Deed: * Kroger Fullfilment Network, LLC
2b. Deed Book and Page No.: Click to enter.
2c. Contact Person (for corporations): Erin Birch
2d. Address *
Street Address: 1600 Ormsby Station Ct
Address line 2: Click to enter.
City: Louisville
State/ Province/ Region: KY
Postal/ Zip Code: 40223
Country: United States
2e. Telephone Number: * (###)###-#### 502-500-0117
2f. Fax Number: (###)###-#### Click to enter.
2g. Email Address: * [e-mail]

3. Applicant Information (if different from owner)
3a. Name: * Click to enter.
3b. Business Name (if applicable): Click to enter.
3c. Address: *
Street Address: Click to enter.
Address line 2: Click to enter.
City: Click to enter.
State/ Province/ Region: Click to enter.
Postal/ Zip Code: Click to enter.
Country Click to enter.
3d. Telephone Number: * (###)###-#### Click to enter.
3e Fax Number: (###)###-#### Click to enter.
3f. Email Address: * Click to enter.

Page 5 of 24 PCN Form Version 4.3- April 20, 2022

4. Agent/ Consultant (if applicable)
4a. Name: * Chris Tinklenberg
4b. Business Name: Kimley-Horn and Associates
4c. Address: *
Street Address: 580 Kingsley Park Drive
Address line 2: Suite 125
City: Fort Mill
State/ Province/ Region: SC
Postal/ Zip Code: 29715
Country: United States
4d. Telephone Number: * (###)###-#### 803-881-3919
4e Fax Number: (###)###-#### Click to enter.
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-Program/Permits/2017-Nationwide-Permits/Pre-
construction-Notification/

Page 6 of 24 PCN Form Version 4.3- April 20, 2022
C. Project Information and Prior Project History
1. Project Information
1a. Name of project: * Project Independence
1b. Subdivision name (if appropriate): Click to enter.
1c. Nearest municipality/town: * Concord

2. Project Identification
2a. Property identification number (tax PIN or parcel ID): 5539 42 3541 0000
2b. Property size (in acres): (LOD)
2c. Project Address:
Street Address: 227 Highway 49
Address line 2: Click to enter.
City: Concord
State/ Province/ Region: NC
Postal/ Zip Code: 28025
Country: United States
2d. Site coordinates in decimal degrees (using 4-6 digits
after the decimal point): *
Latitude (DD.DDDDDD): * 35.368092
Longitude (-DD.DDDDDD): * -80.561939

3. Surface Waters
3a. Name of nearest body of water to proposed project: * Irish Buffalo Branch
3b. Water Resources Classification of nearest receiving
water: *
C
The Surface Water Classification map may be found at this link:
https://ncdenr.maps.arcgis.com/apps/webappviewer/index.html?id=6e125ad7628f494694e259c80dd64265
3c. In what river basin(s) is your project located? * Yadkin-PeeDee
Choose additional (if needed)
3d. Please provide the 12-digit HUC in which the project is
located: *
030401050203
The Find Your HUC map may be found at this link:
https://ncdenr.maps.arcgis.com/apps/PublicInformation/index.html?appid=ad3a85a0c6d644a0b97cd069db238ac3

Page 7 of 24 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: *
The site is located at 227 Highway 49 in Concord, Cabarrus County, NC. The site is comprised of one parcel and
consists of a an industrial distribution center.
4b. Have Corps permits or DWR certifications been obtained for this
project (including all prior phases) in the past? * ☒ Yes ☐ No ☐ Unknown
If yes, please give the DWR Certification number and/or Corps
Action ID (ex. SAW-0000-00000):
SAW-2021-01846
2023-0261
Attach any pertinent project history documentation
4b2. Is any portion of the work already complete? * ☒ Yes ☐ No
If yes, describe the completed work.
The distribution center, associated parking lot, and one entrance have been completed.
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.
Click to enter text.
4d. Attach an 8½ x 11” excerpt from the most recent version of the USGS topographic map indicating the location of
the project site.
4e. Attach an 8½ 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
property: 0.017 acres
4g. List the total estimated linear feet of all existing streams (intermittent
and perennial) on the property: 4,776 linear feet
4g1. List the total estimated acreage of all existing open waters on the
property: 0 acres
4h. Explain the purpose of the proposed project: *
This proposed on-site roadway connection (Limits of Disturbance 0.54-acre) is part of the adjacent Project
Independence 54-acre fulfillment center in Concord, Cabarrus County, NC. To maintain separation between
privately owned vehicles (POVs) and commercial vehicles, i.e. sprinter vans and tractor-trailers, the proposed
project seeks an employee-only secondary driveway access into the site.
4i. Describe the overall project in detail, including the type of equipment to be used: *
The fulfillment center is a 200,000 square-foot building that was constructed in 2022, as there were no impacts to
jurisdictional waters. The proposed driveway access will cross an NCDOT mitigation site (Site #12) associated with TIP
No. R-2533B (NC-49 from West of Irish Buffalo Creek to East of Walker Road). The mitigation site was established to
provide permittee-responsible mitigation for the impacts associated with the R-2533B project. The proposed
development seeks authorization under NWP 39 for stream and wetland impacts associated with the installation of a
culvert crossing at Stream 1. The proposed project will result in 272 LF/0.037-acre of permanent impacts to Stream 1
and 0.008-ac of permanent impacts to Wetland 1. Design modifications are a result of prohibitive cost and NCDOT
preference. The previous design included a wall to reduce impacts to Stream 1; however, NCDOT prefers not to
maintain the wall in perpetuity.
General construction equipment including, but not limited to, bulldozers, excavators, front-end loaders, etc. will be used
for construction purposes.
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 ☒ No

Page 8 of 24 PCN Form Version 4.3- April 20, 2022
If yes, describe the type of dredging, the composition of the dredged material, and the locations of disposal area.
Click to enter text.

Page 9 of 24 PCN Form Version 4.3- April 20, 2022

5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or in
proposed impact areas? * ☒ Yes ☐ No ☐ Unknown
Comments:
Click to enter text.
5b. If the Corps made a jurisdictional determination,
what type of determination was made? *
☒ Preliminary ☐ Approved ☐ Emailed concurrence
☐ Not Verified ☐ Unknown ☐ n/a
Corps AID number (ex. SAW-0000-00000): SAW-2021-01846
5c. If 5a is yes, who delineated the jurisdictional
areas?
Name (if known): Chris Tinklenberg, PWS
Agency/Consultant Company: Kimley-Horn
Other: Click to enter.
5d. List the dates of the Corps jurisdictional determination or State determination if a determination was made by
either agency.
September 2, 2021
5d1. Attach jurisdictional determinations.

6. Future Project Plans
6a. Is this a phased project? ☐ Yes ☒ No
6b. If yes, explain.
Click to enter.
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.
Click to enter.

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)
Click to enter.

8. Scheduling of activity:
Click to enter.

Page 10 of 24 PCN Form Version 4.3- April 20, 2022

D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project
(check all that apply):
☒ Wetlands ☒ Streams - tributaries
☐ Buffers ☐ Open Waters
☐ Pond Construction

2. Wetland Impacts
If there are wetland impacts proposed on the site, complete this table for each wetland area impacted.
2a.
Site #*
2a1.
Impact
Reason/Type*
2b.
Impact
Duration*
2c.
Wetland Type*
2d.
Wetland Name*
2e.
Forested
?*
2f.
Jurisdiction
Type*
2g.
Impact Area
(ac)*
W1 Grading Permanent Headwater
Forest
W1 Yes Both 0.008
W2 Choose one Temp/ Perm Choose one Click to enter Y/N Choose one
W3 Choose one Temp/ Perm Choose one Click to enter Y/N Choose one Click to enter
W4 Choose one Temp/ Perm Choose one Click to enter Y/N Choose one
W5 Choose one Temp/ Perm Choose one Click to enter Y/N Choose one
W6 Choose one Temp/ Perm Choose one Click to enter Y/N Choose one Click to enter
W7 Choose one Temp/ Perm Choose one Click to enter Y/N Choose one Click to enter
W8 Choose one Temp/ Perm Choose one Click to enter Y/N Choose one Click to enter
W9 Choose one Temp/ Perm Choose one Click to enter Y/N Choose one Click to enter
W10 Choose one Temp/ Perm Choose one Click to enter Y/N Choose one Click to enter
W11 Choose one Temp/ Perm Choose one Click to enter Y/N Choose one Click to enter
W12 Choose one Temp/ Perm Choose one Click to enter Y/N Choose one Click to enter
W13 Choose one Temp/ Perm Choose one Click to enter Y/N Choose one Click to enter
W14 Choose one Temp/ Perm Choose one Click 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 0.00 ac
2g2. Total permanent wetland impacts 0.008 ac
2g3. Total wetland impacts 0.008 ac
2h. Type(s) of material being discharged and the amount of each type in cubic yards:
Click to enter text.

Page 11 of 24 PCN Form Version 4.3- April 20, 2022
2i. Comments:
The proposed development seeks authorization under NWP 39 for stream impacts associated with the installation
of a culvert crossing at Stream 1.

Impacts to aquatic resources are proposed to be conducted at one impact site. The following summarizes the
proposed impacts:

Impact Site 1
• Wetland 1 – Impact 1B
o This impact is associated with grading activities necessary to construct the roadway, as well as
the installation of the inlet rip-rap dissipation for the 48-inch RCP. This impact will result in 0.008-acre of
permanent impacts to Wetland 1.

Page 12 of 24 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 Culvert Permanent Crossing/
Culvert
S1 Intermittent Both 6 272
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: 272 linear ft
3i3. Total temporary stream
impacts: 0 linear ft
3i4. Total stream and ditch
impacts: 272 linear ft

Page 13 of 24 PCN Form Version 4.3- April 20, 2022
3j. Comments:
The proposed development seeks authorization under NWP 39 for stream impacts associated with the installation of a
culvert crossing at Stream 1.

Impacts to aquatic resources are proposed to be conducted at one impact site. The following summarizes the
proposed impacts:

Impact Site 1
• Stream 1 – Impact 1A
o One (1) 161 LF 48-inch reinforced concrete pipe (RCP) will be installed at the crossing of Stream 1.
The RCP will be buried 1-ft to promote the passage of aquatic organisms. At the inlet, a 79 LF rip-rap dissipation will
be placed in a manner that the boulders will be pushed or “keyed” into the channel bed so that the finished top
elevation of the riprap will not exceed that of the original stream bed to prevent destabilization of the stream bed or
bank upstream of the impact area and to allow for aquatic life passage. At the outlet, an 8 LF rip-rap dissipation will be
placed in the same manner as the inlet dissipation. The rip-rap dissipations are necessary to reduce discharge
velocities and to meet non-erosive design criteria. The installation of the culvert will result in 272 LF/0.037-acre of
permanent impacts to Stream 1.

Page 14 of 24 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)*
O1 Click to enter. Temp/ Perm Click to enter. Choose one Choose one Click to enter.
O2 Click to enter. Temp/ Perm Click to enter. Choose one Choose one Click to enter.
O3 Click to enter. Temp/ Perm Click to enter. Choose one Choose one Click to enter.
O4 Click to enter. Temp/ Perm Click to enter. Choose one Choose one Click to enter.
O5 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.
Pond ID
#
5b.
Proposed use or
purpose of pond
5c.
Wetland Impacts (ac)
5d.
Stream Impacts (ft)
5e.
Upland
Impacts (ac) Flooded Filled Excavated Flooded Filled Excavated
P1 Choose one Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
P2 Choose one Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
P3 Choose one Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
5f. Total Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
enter.
Click to
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.

Page 15 of 24 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)
B1 Choose one Temp/ Perm Click to enter. Y/N Click to enter. Click to enter.
B2 Choose one Temp/ Perm Click to enter. Y/N Click to enter. Click to enter.
B3 Choose one Temp/ Perm Click to enter. Y/N Click to enter. Click to enter.
B4 Choose one Temp/ Perm Click to enter. Y/N Click to enter. Click to enter.
B5 Choose one Temp/ Perm Click to enter. Y/N Click to enter. Click to enter.
B6 Choose one Temp/ Perm Click to enter. Y/N Click to enter. Click to enter.
B7 Choose one Temp/ Perm Click to enter. Y/N Click to enter. Click to enter.
B8 Choose one Temp/ Perm Click to enter. Y/N Click to enter. Click to enter.
B9 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.
B11 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 16 of 24 PCN Form Version 4.3- April 20, 2022
E. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts through project design: *
Avoidance and minimization efforts were implemented during development planning and design to the greatest
extent practicable in order to reduce the overall impacts on the aquatic environment while staying within
nationwide permit thresholds. The final plan demonstrates maximum avoidance and minimization efforts by
reducing the proposed stream and wetland impacts. The rationale to support avoidance and minimization efforts
includes the following:
• Avoidance of the remaining 4,504 LF of streams on-site.
• The culvert length has been reduced since the initial design. Initial plans from July 2022 proposed 265 LF
48-inch RCP, including 4 LF of headwalls and 14.5 LF of rip-rap outlet protection. This plan resulted in 285
LF/0.04-acre of impacts to Stream 1.
• Temporary impacts are not proposed.
1b. Specifically describe measures taken to avoid or minimize proposed impacts through construction techniques: *
Indirect impacts will be avoided through the implementation of erosion control measures that will be removed immediately
following the activities and any disturbance will be retuned to pre-construction conditions.

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? *
(check all that apply)
☒ DWR ☒ Corps
2b. If yes, which mitigation option(s) will be used for this
project? * (check all that apply)
☐ Mitigation Bank
☒ 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.
Type: Choose one Quantity Click to enter.
Type: Choose one 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: 272 linear feet
4c. If using stream mitigation, what is the stream temperature: warm
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)
https://ribits.usace.army.mil/ribits_apex/f?p=107:27:2734709611497::NO:RP:P27_BUTTON_KEY:0

Page 17 of 24 PCN Form Version 4.3- April 20, 2022
4d. Buffer mitigation requested (DWR only): Click to enter. square feet
4e. Riparian wetland mitigation requested: Click to enter. acres
4f. Non-riparian wetland mitigation requested: Click to enter. acres
4g. Coastal (tidal) wetland mitigation requested: Click to enter. acres
4h. Comments:
To maintain separation between privately owned vehicles (POVs) and commercial vehicles, i.e. sprinter vans
and tractor-trailers, the proposed project seeks an employee-only secondary driveway access into the site. The
proposed driveway access will cross an NCDOT mitigation site (Site #12) associated with TIP No. R-2533B (NC-
49 from West of Irish Buffalo Creek to East of Walker Road). The mitigation site was established to provide
permittee-responsible mitigation for the impacts associated with the R-2533B project. The proposed driveway
access requires the installation of a 161 LF, 48-inch RCP as well as 87 LF of riprap inlet and outlet protection.
Installation of the crossing will result in 272 LF of stream bed impacts.

Previous mitigation proposals were determined based on the mitigation calculator spreadsheet. Each iteration
utilizing this approach resulted in roughly a 4:1 mitigation ratio. In lieu of conducting another iteration of
mitigation spreadsheet calculations, the applicant proposes mitigation at 4:1.

Based on a mitigation ratio of 4:1, the applicant proposes the purchase of 1,088 stream mitigation credits from
the NCDMS.

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 ☐ 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 Click to enter. Click to enter. Choose one Click to enter.
6f. Total buffer mitigation required Click to enter.
6g. If buffer mitigation is required, is payment to a mitigation bank or
NC Division of Mitigation Services proposed? ☐ Yes ☐ No
6h. If yes, attach the acceptance letter from the mitigation bank or NC Division of Mitigation Services.
6i. Comments:
Click to enter.

Page 18 of 24 PCN Form Version 4.3- April 20, 2022

Page 19 of 24 PCN Form Version 4.3- April 20, 2022
F. Stormwater Management and Diffuse Flow Plan (DWR requirement)
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
1b. 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://deq.nc.gov/about/divisions/energy-mineral-land-resources/energy-mineral-land-permit-
guidance/stormwater-bmp-manual).
Associated supplement forms and other documentation must be provided.
What Type of SCM are you
providing?
(Check all that apply)
☐ Level Spreader
☐ Vegetated Conveyance (lower seasonal high water table- SHWT)
☐ Wetland Swale (higher SHWT)
☐ 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? * ☐ 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 requirements, click here:
http://reports.oah.state.nc.us/ncac/title%2015a%20-%20environmental%20quality/chapter%2002%20-
%20environmental%20management/subchapter%20h/15a%20ncac%2002h%20.1003.pdf
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
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?
(Check all that apply.)*
☐ Local Government
☐ State
If you have local government approval, please include the SMP on their overall impact map.
Local Government Stormwater Programs * ☐ Phase II ☐ USMP
☐ NSW ☐ Water Supply

Page 20 of 24 PCN Form Version 4.3- April 20, 2022
Please identify which local government stormwater program you are using. *
Click to enter.
State Stormwater Programs * ☐ Phase II ☐ HQW or ORW
☐ Coastal Counties ☐ Other
Comments:
This project is within NCDOT right of way. NCDOT does not require storm water detention within its ROW. The storm
water systems within NCDOT right of way has been analyzed, sized appropriately, reviewed, and approved by
NCDOT’s storm water division.

Page 21 of 24 PCN Form Version 4.3- April 20, 2022

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
1c. 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
NEPA or SEPA final approval letter.) *
☐ Yes ☒ No
Comments:
The project has yet to receive a WBS number from NCDOT, therefore, the SEPA document has not been
finalized by the State Clearing House.

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
(15A NCAC 2H. 1400) DW R Surface Water or Wetland Standards or
Riparian Buffer Rules (15A NCAC 2B .0200)? *
☐ Yes ☒ No
2b. If you answered “yes” to the above question, provide an explanation of the violation(s):
Click 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
downstream water quality? *
☐ Yes ☒ No
3b. If you answered “no”, provide a short narrative description:
No additional future development is anticipated as a result of this project.
3c. If yes, provide a qualitative or quantitative cumulative impact analysis in accordance with the most recent DWR
policy. (Attach .pdf)

4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project? * ☐ 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.
Click to enter.

Page 22 of 24 PCN Form Version 4.3- April 20, 2022

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? (IPAC weblink: https://www.fws.gov/ipac/ [fws.gov]) * ☒ 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. Asheville
5d. Is another federal agency involved? * ☐ Yes ☒ No ☐ Unknown
If yes, which federal agency? Click to enter.
5e. Is this a DOT project located within Divisions 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
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
can be found in the NLEB SLOPES, Appendix F, pages 3-7.
☐ Yes ☐ No
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 ☒ No
If yes, please show the location of the wind turbine(s) on the permit drawings/ project plans (attach .pdf)
5i. Does this project involve blasting and /or other percussive activities
that will be conducted by machines, such as jackhammers,
mechanized pile drivers, etc.? *
☐ Yes ☒ No
If yes, please provide details to include type of percussive activity, purpose, duration, and specific location of this
activity on the property (attach .pdf)
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated
Critical Habitat? *
A review of the North Carolina Natural Heritage Program (NCNHP) database on September 15, 2021, did not
indicate known occurrences of threatened or endangered species within the project boundary. Potentially
suitable habitat for threatened and endangered species on-site was surveyed. A concurrence request letter was
submitted to the USFWS on September 15, 2021. Since the project seeks impacts to suitable habitat of listed
plant species, but no occurrences were detected during the appropriate survey window, a biological conclusion of
“may affect, not likely to adversely affect” (MANLAA) was recommended to USFWS. A concurrence response
letter from USFWS was received on October 4, 2022, indicating that the USFWS was in agreeance with a
MANLAA biological conclusion. A copy of USFWS’s response is attached.
Attach consultation documentation.

6. Essential Fish Habitat (Corps Requirement)

Page 23 of 24 PCN Form Version 4.3- April 20, 2022
6a. Will this project occur in or near an area designated as
an Essential Fish Habitat? * ☐ Yes ☒ No
Is there submerged aquatic vegetation (SAV) around
the project vicinity? * ☐ Yes ☒ No ☐ Unknown
Will this project affect submerged aquatic vegetation? * ☐ Yes ☒ No ☐ Unknown
Explain: Click to enter.
6b. What data source(s) did you use to determine whether your site would impact Essential Fish Habitat? *
NCNHP element occurrence database did not indicate the presence of EFH within the project boundary.

7. Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data):
http://gis.ncdcr.gov/hpoweb/
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural
preservation status (e.g., National Historic Trust designation or
properties significant in North Carolina history and archaeology)? *
☐ Yes ☒ No
7b. What data source(s) did you use to determine whether your site would impact historic or archeological
resources? *
Kimley-Horn consulted the North Carolina State Historic Preservation Office (SHPO) HPOWEB GIS service on
August 2, 2022. No historical, archeological, or cultural resources were identified within the site boundary. A
request letter was submitted to SHPO to determine the presence of archeological, cultural, or historic resources
on August 2, 2022. A response of “no comment” was received from SHPO on August 25, 2022, and is attached.
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 ☒ No
8b. If yes, explain how the project meets FEMA requirements.
Click to enter.
8c. What source(s) did you use to make the floodplain determination?
FIRM Panel 3710553900K

H. Miscellaneous
Comments:
Click to enter.
Attach pertinent documentation or attachments not previously requested

Page 24 of 24 PCN Form Version 4.3- April 20, 2022
I. Signature *
☒ 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: * Chris Tinklenberg
Signature: *
Date: * 11/8/2023

PERMIT DRAWINGS
NC-49
ST:0409-CB
ST:0410.1-ENDWALL
ST:0409.1-HEADWALL
ST:0408-CB
ST:0407-CB
ST:0402-DI
ST:0403-DI
ST:0404-DI
ST:0406-CB
ST:0405-DI
ST:0505.1-DI
ST:0410-CB
59
0
59
5
60
0
60
5
58
7
58
8
58
9
59
1
59
2
59
3
59
4
59
6
59
7
59
8
59
9
60
1
60
2
60
3
60
4
60
6
60
7
60
8
60
9
585
580
585
590
595
585
590
595
600
595
590
Hor. Scale:1"=20'
0+00
57
5
.
8
57
6
.
2
57
7
.
8
9
0+50
57
7
.
0
58
9
.
3
8
57
8
.
0
59
2
.
8
4
1+00
57
8
.
3
59
3
.
3
8
58
0
.
8
59
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.
1
0
1+50
58
2
.
4
58
8
.
5
3
58
4
.
0
58
4
.
7
2
2+00
58
3
.
3
58
0
.
6
3
58
1
.
9
58
0
.
7
8
2+50
58
1
.
0
58
0
.
9
3
58
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.
0
3+00
58
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6
58
5
.
6
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58
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4
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.
8
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0
4
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:

5
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7
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4
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O
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:

5
7
7
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4
74 LF OF
48" RCP @ 2.98%
EW

4
1
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:

5
8
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V

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:

5
7
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:

5
7
5
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2
87 LF OF
48" RCP @ 2.67%
EXIST 2
0
2

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F

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36" RCP

@

5
.
6
4
%
CULVERT (411 TO 412)
THIS DOCUMENT, TOGETHER WITH THE CONCEPTS AND DESIGNS PRESENTED HEREIN, AS AN INSTRUMENT OF SERVICE, IS INTENDED ONLY FOR THE SPECIFIC PURPOSE AND CLIENT FOR WHICH IT WAS PREPARED. REUSE OF AND IMPROPER RELIANCE ON THIS DOCUMENT WITHOUT WRITTEN AUTHORIZATION AND ADAPTATION BY KIMLEY-HORN AND ASSOCIATES, INC. SHALL BE WITHOUT LIABILITY TO KIMLEY-HORN AND ASSOCIATES, INC.
NC LICENSE #F-0102
200 SOUTH TRYON STREET, SUITE 200
CHARLOTTE, NORTH CAROLINA 28202
PHONE [phone]
C 2023FC-11 CULVERT - PLAN AND PROFILE
DATE: 11/01/2023
NORT
H
THIS PLAN IS CONCEPTUAL IN NATURE AND HAS BEEN PRODUCED WITHOUT THE BENEFIT OF A SURVEY, CODE RESEARCH, OR CONTACT WITH THE CITY, COUNTY, ETC.
NCDOT STANDARDS TO BE USED
FOR DRAINAGE STRUCTURES:
CB NCDOT STD. 840.01
DI NCDOT STD 840.15
MH NCDOT STD 840.31
TBJB NCDOT STD 840.34
PPES NCDOT STD 310.04
ENDWALL NCDOT STD 838.01
Hor. Scale:1"=20'
Vert. Scale:1"=4'
Impact Site 1
Stream 1 -Impact 1A
272 LF -Permanent
Culvert Impact Site 1
Wetland 1 -Impact 1B
0.008-acre -Permanent
Grading/Fill

COMPENSATORY
MITIGATION

November 8, 2023

Erin Birch
Kroger Fulfillment Network, LLC
1014 Vine Street
Cincinnati, OH 45202 Expiration of Acceptance: 5/8/2024

Project: Project Independence County: Cabarrus

The purpose of this letter is to notify you that the NCDEQ Division of Mitigation Services (DMS) is willing to
accept payment for compensatory mitigation for impacts associated with the above referenced project as
indicated in the table below. Please note that this decision does not assure that participation in the DMS in-
lieu fee mitigation program will be approved by the permit issuing agencies as mitigation for project impacts.
It is the responsibility of the applicant to contact permitting agencies to determine if payment to the DMS will
be approved. You must also comply with all other state, federal or local government permits, regulations or
authorizations associated with the proposed activity including G.S. § 143-214.11.
This acceptance is valid for six months from the date of this letter and is not transferable. If we have not
received a copy of the issued 404 Permit/401 Certification within this time frame, this acceptance will
expire. It is the applicant’s responsibility to send copies of the permits to DMS. Once DMS receives a copy
of the permit(s) an invoice will be issued based on the required mitigation in that permit and payment must
be made prior to conducting the authorized work. The amount of the in-lieu fee to be paid by an applicant is
calculated based upon the Fee Schedule and policies listed on the DMS website.
Based on the information supplied by you in your request to use the DMS, the impacts for which you are
requesting compensatory mitigation credit are summarized in the following table. The amount of mitigation
required and assigned to DMS for this impact is determined by permitting agencies and may exceed the
impact amounts shown below.
River Basin Impact Location
(8-digit HUC) Impact Type Impact Quantity
Yadkin 03040105 Warm Stream 272

Upon receipt of payment, DMS will take responsibility for providing the compensatory mitigation. The
mitigation will be performed in accordance with the In-Lieu Fee Program instrument dated July 28, 2010.
Thank you for your interest in the DMS in-lieu fee mitigation program. If you have any questions or need
additional information, please contact [e-mail].
Sincerely,

FOR James. B Stanfill
Deputy Director

cc: Chris Tinklenberg, agent