20231626 Ver 1_ePCN Application_20231127

DW R
DHlsloo of Water Resources
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
October 2, 2023 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.
Does this project involve maintenance dredging funded by the Shallow Draft Navigation Channel Dredging and Aquatic Weed Fund or involve the distribution or transmission of energy or
fuel, including natural gas, diesel, petroleum, or electricity?
Yes No
BIMS # Assigned Version# *
20231626 1
Is a payment required for this project?*
No payment required
Fee received
Fee needed - send electronic notification
Reviewing Office*
Raleigh Regional Office - [phone]
Information for Initial Review
la. Name of project:
Raleigh Road Sewer Outfall
la. Who is the Primary Contact? *
Samuel Adam Carter
1b. Primary Contact Email:*
[e-mail]
Date Submitted
11/27/2023
Nearest Body of Water
Bloomery Swamp
Basin
Neuse
Water Classification
WS-IV:NSW
Site Coordinates
Latitude:
35.754132
A. Processing Information
Is this project connected with ARPA funding?
Yes No
County (or Counties) where the project is located:
Wilson
Is this a NCDMS Project
Yes No
Longitude:
-77.982635
What amount is owed?*
$240.00
$323.00
Select Project Reviewer*
Zachary Thomas:zachary.thomas
1c. Primary Contact Phone:*
[phone]
$570.00
$767.00
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
fig. 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 for the permit?
Owner Applicant (other than owner)
le. Is there an Agent/Consultant for this project?
Yes No
2. Owner Information
2a. Name(s) on recorded deed:
SOUTHBURY DEVELOPMENT LLC
2b. Deed book and page no.:
3006 - 197
2c. Contact Person:
David Chapman
2d. Address
Street Address
20 Cochrane Castle Cir
Address Line 2
City State / Province / Region
Pinehurst NC
Postal/Zip Code Country
28374 USA
Yes No
Yes No

2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Samuel Adam Carter
4b. Business Name:
Wetland Solutions, LLC
4c.Address
Street Address
P.O. Box 244
Address Line 2
City
Bunnlevel
Postal / Zip Code
28323
4d. Telephone Number:
[phone]
4f. Email Address:
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(if appropriate)
Bloomery Forest
1c. Nearest municipality / town:
Wilson
2. Project Identification
2f. Fax Number:
State / Province / Region
NC
Country
USA
4e. Fax Number:
2a. Property Identification Number:
3703-11-8405.000; 3703-21-4116.000; 2792-
2b. Property size:
98-7921.000; 3702-09-1421.000
115.38
2c. Project Address
Street Address
4269 &4246 Raleigh Road Parkway
Address Line 2
City
State / Province / Region
Wilson
NC
Postal / Zip Code
Country
28896
USA
3. Surface Waters
3a. Name of the nearest body of water to proposed project:
Bloomery Swamp
3b. Water Resources Classification of nearest receiving water:
WS-IV: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.
030202030402
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: *
Project area consist of Agg fields and mature upland forest with mature headwater wetland. Abbutings parcels are agg fields, upland forest and light residential development.
a

4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?
Yes No Unknown
4f. List the total estimated acreage of all existing wetlands on the property:
44.93
4g. List the total estimated linear feet of all existing streams on the property:
1,910ft
4h. Explain the purpose of the proposed project:*
The purpose of this project is to construct a sewerline outfall for the proposed residential development and for current and future residents.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used: *
The over all project will consist of constructing a sewer line corridor and sewer line install. A 12ft of the proposed 30ft easment will remain forested across the wetland sections of the
easment. Silt fence will be constructed after corridor is cleared. The 12in sewer line will be installed on pillars going across all wetlands. Open cut trench constructed in uplands restore
open cut trench back to grade. Seed, mat and maintenance regiment. Excavator and backhoe will be used for install.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?
Yes No Unknown
Comments:
Site visit with The over all project will consist of constructing a sewer line corridor and sewer line
install. Silt fence will be constructed after corridor is cleared. The 12in sewer line will be installed on
pillars going across all wetlands. Open cut trench constructed in uplands restore open cut trench back
to grade. Seed, mat and maintenance regiment. Excavator and backhoe will be used for install. with
the Army Corps of Engineers had site visit and approved the wetland delineation
5b. If the Corps made a jurisdictional determination, what type of determination was made?
Preliminary Approved Not Verified Unknown N/A
Corps AID Number:
SAW-2023-01059
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Samuel Adam Carter
Agency/Consultant Company: Wetland Solutions, LLC
Other:
5d. List the dates of the Corp jurisdiction determination or State determination if a determination was made by the Corps or DWR
Billy Standridge 7/6/2023
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?
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
O
2a1 Reason (?)
2b. Impact type* (?)
2c. Type of W.
2d. W. name
2e. Forested*
2f. Type of Jurisdicition *
2g• Impact
?)
area *
W1
Clear utility easment
T
Headwater Forest
W1
Yes
Both
0.115
(acres)
W2
Clear utilty easment
T
Headwater Forest
W2
Yes
Both
0.075
(acres)
W1
Fillers
P
Head water Forest
W1
Yes
Both
0.000
(acres)
llers
PiE�]
P
Headwater Forest
W2
Yes
Both
0.013
(acres)

2g. Total Temporary Wetland Impact
0.190
2g. Total Wetland Impact
0.203
2i. Comments:
3. Stream Impacts
2g. Total Permanent Wetland Impact
0.013
❑
3a. Reason for impact (?)
3b.lmpact type "
3c. Type of impact*
3d. S. name *
3e. Stream Type*
(?)
3f. Type of
Jurisdiction*
3g. S. width
3h. Impact
length*
St
Not impacting
Temporary
Other
Bloomery
Perennial
Corps
10
Average (feet)
16
(linear feet)
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
3i. Total temporary stream impacts:
0
16
3i. Total stream and ditch impacts:
16
3j. Comments:
Will not be impacting directly.
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
6c. Per or Temp
6d. Stream name
6e. Buffer mitigation required?
6f. Zone 1 impact
6g. Zone 2 impact
Temparary
T
Bloomery Swamp
No
1,006
685
6h. Total buffer impacts:
Zone 1 Zone 2
Total Temporary impacts: 1,006.00 685.00
Zone 1
Zone 2
Total Permanent impacts: 0.00
0.00
Zone 1
Zone 2
Total combined buffer impacts: 1,006.00
685.00
6i. Comments:
E. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
The tract of land and the project area has been delineated in order to avoid and design the project down to the least amount of impact. We used the
narrowest wetland areas as our impact areas for crossing the wetlands.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
We are not open cutting the wetlands, but will be using pillars for and aerial crossing to avoid excessive impacts to stream and wetland areas. We will be
keep a 15 to 16ft maintained easment that will be maintained twice a year. Herbaceous strata will be inplimented and maintained.
I
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:
Falls below deemed mitigable thresholds stated in NW58A
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
la. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
Yes No
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
la. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?
Yes No
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15A NCAC 2H .0500), Isolated Wetland Rules (15A NCAC 2H .1300), or DWR Surface Water or Wetland Standards or
Riparian Buffer Rules (15A NCAC 2B .0200)? *
Yes No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality?
Yes No
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?
Yes No N/A
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or habitat?*
Yes No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?
Yes No
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. Is another Federal agency involved?*
Yes No Unknown
5e. Is this a DOT project located within Division's 1-8?
Yes No

5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
USFWSIPAC
See attached
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?
NOAA fisheries web search
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?
SHPO online web search
See attached
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:
Installing line above the designated Fema flood elevation on pillars
8c. What source(s) did you use to make the floodplain determination?"
NC Flood Risk Information System
Miscellaneous
Please use the space below to attach all required documentation or any additional information you feel is helpful for application review. Documents should be combined into one file when
possible, with a Cover Letter, Table of Contents, and a Cover Sheet for each Section preferred.
Click the upload button or drag and drop files here to attach document
Raleigh Road West _NW_JD PACKETpdf 18.81 MB
File must be PDF or KMZ
Comments
Attached JD_NW packet has been condensed down.
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:
Samuel Adam Carter
Signature
a5wwnr✓e3/`lrw 64tee t
Date
11 /27/2023
L