20171507 Ver 4_PCN_FillableForm_v4-3_02142023_protected_HASSE AVE EXT MODIFICATION_UPDATED PCN_signed_20240216

SrArE
n
u � o
r
•��quMVMwr
NORTH CAROLINA
Environmental Quality
Water Resources
UPDATED PCN
02/16/2024
Deborah Shirley-S&EC
Office Use Only
Corps Action ID no. USACE: 404 verification issued by James Lastinger
on December 15, 2017 (SAW-2017-02473); 404 verification issued by
Lyle Phillips on 7/26/2022 (SAW-2020-01905; NCDWR: Individual 401
WQ Certification & Jordan Lake Watershed Buffer Authorization (DWR
20171507v3) Date received: Click to enter
DWR project no. lick enter.] Date received: Click to enter.]
Site Coordinates:
Latitude (DD.DDDDDD): 35.729195
Longitude (DD.DDDDDD): 78.916459
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.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) : 8/24/2023
Page 1 of 23 PCN Form Version 4.3- April 20, 2022

A. Processing Information
County (counties) where project is located: *
Wake 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.basinger(cDncdenr.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 ente
If yes, NCDOT WBS number: *
Click to enter.
❑x Section 404 Permit (wetlands, streams, waters,
Clean Water Act)
1 a. 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.
❑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 ❑ No
NWP number(s) (list all numbers ):
14
RGP number(s) (list all numbers ):
Are you a federal applicant?
❑ Yes ❑x No
If yes, please provide a statement concerning compliance with the Coastal Zone Management Act
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
❑x Riparian Buffer Authorization
❑ Individual 401 Water Quality Certification
Is this a courtesy copy notification
❑ Yes ❑x No
Page 2 of 23 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
1 f.
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
❑ 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.miI/Missions/Regulatory-Permit-
Program/Agency-Coordination/Trout.aspx
Page 3 of 23 PCN Form Version 4.3- April 20, 2022

B. Applicant Information
1a.
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 ❑x 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: *
Judy G. Hackney & Edwin Goodwin
2b.
Deed Book and Page No.:
DB13-E, DP:3764; DB:033195, DP: 00151; &
DP:003195, DP:00149
2c.
Contact Person (for corporations):
N/A
2d.
Address *
Street Address:
2505 Olive Chapel Rd
Address line 2:
Click to enter.
City:
Apex
State/ Province/ Region:
NC
Postal/ Zip Code:
27502
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: *
Town of Apex -Russell Dalton
3b.
Business Name (if applicable):
N/A
3c.
Address: *
Street Address:
P.O. Box 250
Address line 2:
Click to enter.
City:
Apex
State/ Province/ Region:
NC
Postal/ Zip Code:
27502
Country
USA
3d.
Telephone Number: * (###)###-####
[phone]
3e
Fax Number: (###)###-#1###
N/A
Page 4 of 23 PCN Form Version 4.3- April 20, 2022

3f. Email Address: * [e-mail]
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-Program/Permits/2017-Nationwide-Permits/Pre-
construction-Notification/
Page 5 of 23 PCN Form Version 4.3- April 20, 2022

C. Project Information and Prior Project History
1. Project Information
1a. Name of project: *
Hasse Avenue Extension MODIFICATION
1 b. Subdivision name (if appropriate):
1c. Nearest municipality/town: *
Apex
2.
Project Identification
2a.
Property identification number (tax PIN or parcel ID):
0721491564, 0721492956, 0722411102 &
0722406699
2b.
Property size (in acres):
+/- 5 acres
2c.
Project Address:
Street Address:
2500 Olive Chapel Road
Address line 2:
City:
Apex
State/ Province/ Region:
NC
Postal/ Zip Code:
27502
Country:
USA
2d.
Site coordinates in decimal degrees (using 4-6 digits
after the decimal point): *
Latitude (DD.DDDDDD): * 35.729195
Longitude (-DD.DDDDDD): *-78.916459
3. Surface Waters
3a. Name of nearest body of water to proposed project: *
Reedy Branch
3b. Water Resources Classification of nearest receiving
WS-IV;NSW
water: *
The Surface Water Classification map may be found at this link:
https://ncdenr.maps.arcqis.com/apps/webappviewer/index.html?id=6e125ad7628f494694e259c80dd64265
Cape Fear'}ional
3c. In what river basin(s) is your project located? *
(if needed)
3d. Please provide the 12-digit HUC in which the project is
030300020609
located: *
The Find Your HUC map may be found at this link:
htti)s://ncdenr.mai)s.arcgis.com/apps/Publiclnformation/index.html?appid=ad3a85aOc6d644aOb97cdO69db238ac3
Page 6 of 23 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 of the property that this road extension runs through consists primarily of forested land and
field areas as well as some rural single-family homes. Specifically, there are eight (8) wetland features (W1-W8),
two (2) ponds (Pond 1 & 2), two (2) intermittent streams (SB & SC), and one (1) perennial stream (SA) located
on property. General land use in the vicinity of the project consists of forested land with residential
neighborhoods. Olive Chapel Road bounds the property to the south.
4b. Have Corps permits or DWR certifications been obtained for this
® Yes ❑ No ❑ Unknown
project (including all prior phases) in the past?
USACE: 404 verification issued by
James Lastinger on December 15,
2017 (SAW-2017-02473); 404
verification issued by Lyle Phillips on
If yes, please give the DWR Certification number and/or Corps
7/26/2022 (SAW-2020-01905;
Action ID (ex. SAW-0000-00000):
NCDWR: Individual 401 WQ
Certification & Jordan Lake
Watershed Buffer Authorization
(DWR 20171507v3)
jClick to enter.]
Attach any pertinent project history documentation
4b2. Is any portion of the work already complete? *
❑ Yes ❑x No
If yes, describe the completed work.
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 0.29 acres
property:
4g. List the total estimated linear feet of all existing streams (intermittent
Approximately 300 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 extend the existing Hasse Ave Road from the Sweetwater subdivision south to
Olive Chapel Road.
4i. Describe the overall project in detail, including the type of equipment to be used:
The overall project consists of the construction of roadway extension of Hasse Ave to Olive Chapel Road.
Specifically, there are two (2) road crossings that impact wetlands, streams, and buffers. Equipment typically
used for construction and earthwork such as backhoes, bulldozers, excavators, graders, pavers etc. will be
utlizied for this project.
4j. Attach project drawings/site diagrams/depictions of impact areas for the proposed project.
Page 7 of 23 PCN Form Version 4.3- April 20, 2022

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 8 of 23 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:
5b.
If the Corps made a jurisdictional determination,
❑x Preliminary ❑ Approved ❑ Emailed concurrence
what type of determination was made? *
❑ Not Verified ❑ Unknown ❑ n/a
Corps AID number (ex. SAW-0000-00000):
SAW-2020-01905
Name (if known): Steven Ball
5c.
If 5a is yes, who delineated the jurisdictional
Agency/Consultant Company: Soil & Environmental
areas?
Consultants, PA
Other: Click to enter.
5d.
List the dates of the Corps jurisdictional determination or State determination if a determination was made by
either agency.
USACE: Site visit and jurisdictional determination issued by Samantha Dailey on December 14, 2020.
Town of Apex: Site visit and determination issued on November 9, 2020 by Jessica Bolin (Apex 20-004)
5d1.
Attach jurisdictional determinations.
6. Future Project Plans
6a. Is this a phased project?
❑ Yes ❑x 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.
It is my understanding that there are no intended future phases beyond the property boundaries shown.
Therefore, no additional NWP, Reginal 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 Wake 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 9 of 23 PCN Form Version 4.3- April 20, 2022

D. Proposed Impacts Inventory
Impacts Summary
la. Where are the impacts associated with your project
(check all that apply):
❑x Wetlands
❑x Buffers
❑ Pond Construction
❑x 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.
Site #*
2a1.
Impact
Reason/Type*
2b.
Impact
Duration*
2c.
Wetland Type*
2d.
Wetland Name*
2e.
Forested
?*
2f.
Jurisdiction
Type*
2g.
Impact Area
(ac)*
W1
Road/
Driveway
Crossing
Permanent
Headwater
Forest
Impact Area 2 — W8
(W1)
Yes
Both
0.255
W2
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
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
Click to enter
W5
Choose one
"emp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
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
emp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W11
Choose one
emp/ 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
Click to enter. ac
2g2. Total permanent wetland impacts
0.255 ac
2g3. Total wetland impacts
0.255 ac
2h. Type(s) of material being discharged and the amount of each type in cubic yards:
Click to E ter text.
2i. Comments:
Click to enter text.
Page 10 of 23 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
3a
3b.
3c.
3d.
3e.
3f.
3g.
3h.
Site #*
Impact Reason*
Impact
Impact
Stream Name*
Stream
Jurisdiction
Stream
Impact
Duration*
Type*
Type*
Type*
Width (avg
length
ft) *
(linear ft)
S1
Impact Area 1 —
Permanent
Crossing/
Stream B1
Intermittent
Both
5
105
Road Crossing —
Culvert
Culvert
S2
Impact Areal —
Permanent
Other
Stream B1
Intermittent
Both
5
47
Road Crossing —
Rip Rap
(Permanent — No
Permanent Loss)
S3
Impact Areal —
Temporary
Other
Stream B1
Intermittent
Both
5
11
Road Crossing —
Temporary
Construction
Access/Dewatering
Measures
S4
Click to enter
Temp/
Choose
Click to enter
Per/Int
Choose
Click to enter
Click to enter
Perm
one
one
S5
Click to enter
Temp/
Choose
Click to enter
Per/Int
Choose
Click to enter
Click to enter
Perm
one
one
S6
Click to enter
Temp/
Choose
Click to enter
Per/Int
Choose
Click to enter
Click to enter
Perm
one
one
S7
Click to enter
Temp/
Choose
Click to enter
Per/Int
Choose
Click to enter
Click to enter
Perm
one
one
S8
Click to enter
Temp/
Choose
Click to enter
Per/Int
Choose
Click to enter
Click to enter
Perm
one
one
S9
Click to enter
Temp/
Choose
Click to enter
Per/Int
Choose
Click to enter
Click to enter
Perm
one
one
S10
Click to enter
Temp/
Choose
Click to enter
Per/Int
Choose
Click to enter
Click to enter
Perm
one
one
S11
Click to enter
Temp/
Choose
Click to enter
Per/Int
Choose
Click to enter
Click to enter
Perm
one
one
S12
Click to enter
Temp/
Choose
Click to enter
Per/Int
Choose
Click to enter
Click to enter
Perm
one
one
S13
Click to enter
Temp/
Choose
Click to enter
Per/Int
Choose
Click to enter
Click to enter
Perm
one
one
S14
Click to enter
Temp/
Choose
Click to enter
Per/Int
Choose
Click to enter
Click to enter
Perm
one
one
S15
Click to enter
Temp/
Choose
Click to enter
Per/Int
Choose
Click to enter
Click to enter
Perm
one
one
S16
Click to enter
Temp/
Choose
Click to enter
Per/Int
Choose
Click to enter
Click to enter
Perm
one
one
Page 11 of 23 PCN Form Version 4.3- April 20, 2022

S17
Click to enter
Temp/
Choose
Click to enter
Per/Int
Choose
Click to enter
Click to enter
Perm
one
one
S18
Click to enter
Temp/
Choose
Click to enter
Per/Int
Choose
Click to enter
Click to enter
Perm
one
one
S19
Click to enter
Temp/
Choose
Click to enter
Per/Int
Choose
Click to enter
Click to enter
Perm
one
one
S20
Click to enter
Temp/
Choose
Click to enter
Per/Int
Choose
Click to enter
Click to enter
Perm
one
one
3i1.
Total jurisdictional ditch
Click to enter. linear ft
impact:
3i2.
Total permanent stream
152 linear ft
impacts:
M.
Total temporary stream
11 linear ft
impacts:
3i4.
Total stream and ditch
163 linear ft
impacts:
3j.
Comments:
Total permanent stream impacts =105 LF (0.012 acres), total permanent -no permanent impacts = 47LF (0.004
acres), total temporary stream = 11 LF (0.001 acres)
Page 12 of 23 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
Click 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
Click 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 to
Click to
lick to
Click to
Click tc,
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:
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 13 of 23 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
❑x Jordan ❑ Goose Creek ❑ Randleman
❑ Other: ;lick 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
Crossing/ Culvert/
Bridge
Permanent
Impact Area 1 -
Stream B1
No
8,936
14,734
B2
Choose one
Temp/ Perm
Click to enter.
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: 18,936 sq ft
Zone 2: 4,734 sq ft
6h. Total combined buffer impacts:
Zone 1: 18,936 sq ft
Zone 2: 4,734 sq ft
6i. Comments:
Click to enter.
Please attach supporting documentation (impact maps, plan sheets, etc.) for the proposed project.
Page 14 of 23 PCN Form Version 4.3- April 20, 2022

E. Impact Justification and Mitigation
Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts through project design:
S&EC completed a wetland delineation and stream buffer evaluation for the entire property so that
natural resources could be identified, and impacts minimized to the maximum extent practicable. Note
that this modification request only includes changes to Impact Area 1, there are no changes to Impact
Area 2. Impact Area 1 is proposed road crossing. Proposed impacts include permanent loss (i.e.
culvert & headwalls), permanent -no permanent loss (i.e. riprap dissipator pads) and temporary (i.e.
construction access) stream impacts, and associated riparian buffer impacts. This road crossing is
necessary to provide a connection to Olive Chapel Road. Stream and buffer impacts have been
minimized by utilizing headwalls and retaining walls. Stream mitigation is proposed at a 2:1 ratio to
compensate for these additional permanent loss impacts. To support the proposed changes to Impact
Area 1, please see below per the project engineer and the Town of Apex:
The Town of Apex updated their standards and specifications for retaining walls when they hired their
new Director of Transportation & Infrastructure. Section 219 of their standards now indicate that they
will now follow NCDOT standards for retaining wall structures. NCDOT and thus Apex will not permit
walls over 10' tall using MSE wall systems. Due to the ability to provide long term maintenance, the
new director of their Transportation and Infrastructure department will not permit walls that use MSE
design over 10'. Their preferred method is to use a standard NCDOT style headwall around any
culvert and be able to tie slopes and grades to that style of headwall. The town has provided the
following guidance:
• All retaining wall calculations should consider the standard AASHTO 250 psf traffic load surcharge
when retaining a public roadway.
• 4' is the max height that a standard segmental gravity wall can be, and does not require engineering
seal.
• The max height for a cast in place gravity wall is 12'.
• Anything above 12' would have to be an MSE wall design — which as stated above will not be
approved by the director.
• Anything above 4' requires a structural engineer to sign and seal the plans.
• Proposed MSE Wall Systems w/ SRW (Segmental Retaining Wall) Units and SRW Units for
Standard Segmental Gravity Walls must be listed as approved on NCDOT's Geotechnical Qualified
Products list, found at the following link.
*https://connect.ncdot.gov/resources/Geological/Pages/Products.aspx
*This is allowable for design of walls up to 10 feet in height. Cast in place gravity walls are also still
allowable as previously noted.
*Additionally NCDOT does allow larger block precast gravity walls. Please see attached email from
NCDOT geotechnical unit. Town of Apex has approved these systems in the past and we are ok with
them for future projects.
• Apex will require maintenance area behind the wall graded at 6H:1 V.
• Apex will require a safety rail at the top of the wall where it's adjacent to the sidewalk
• Apex will require a 2:1 theoretical slope from the top of the right of way elevation down to the invert
of the culvert.
Impact Area 2 is proposed road crossing. Proposed impacts include permanent wetland impacts. This
road crossing is necessary to provide a connection to Olive Chapel Road. Wetland mitigation has
already been paid for this crossing.
Page 15 of 23 PCN Form Version 4.3- April 20, 2022

1 b. Specifically describe measures taken to avoid or minimize proposed impacts through construction techniques:
Dewatering, pump -around and /or diversion channel will be used at the stream crossing. Retaining Wall added
on west side to minimize wetland impacts. Erosion Control Plan will be developed for approval by Town of Apex.
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? * ❑ 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) ❑ 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:
RES-EBX sponsored RES Cape Fear 02 Umb Mit Bank,
specifically from the Dairyland Site
3b.
Credits purchased/requested:
Type: Stream
Quantity
66 LF
Type: Riparian Wetland
Quantity 0 acres
Type: Choose one
Quantity lick to enter.
Attach receipt and/or approval letter.
3c.
Comments:
Stream and mitigation from the previously authorized impacts have been paid (i.e. 144 LF stream and 0.51 acres
wetland), see attached MRT's. The updated impacts resulted in an additional 66 LF of stream mitigation. Please
see attached SOA from RES. NOTE in this updated PCN, I didn't request an updated SOA since the new stream
mitigation needed is less than the previous (i.e. 72 LF vs. 66 LF)
4.
Complete if Using an In Lieu Fee Program
4a.
Attach approval letter from in lieu fee program.
4b.
Stream mitigation requested:
Click to enter 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)
https://ribits.usace.army.mil/ribits apex/f?p=107:27:2734709611497::NO:RP:P27 BUTTON KEY:O
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:
Click to enter.
5. Complete if Providing a Permittee Responsible Mitigation Plan
Page 16 of 23 PCN Form Version 4.3- April 20, 2022

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
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 17 of 23 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 ❑ 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..qov/about/divisions/energy-mineral-land-resources/energy-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)
❑x 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-%20environmental%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 *
❑x NSW ❑x Water Supply
Page 18 of 23 PCN Form Version 4.3- April 20, 2022

Please identify which local government stormwater program you are using.
Town of Apex
State Stormwater Programs * ❑ Phase II ❑ HQW or ORW
❑ Coastal Counties ❑ Other
Comments:
Stormwater for the roadway will be routed offsite to BMP's (Wet Ponds and/or Stormwater Wetlands
Page 19 of 23 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
❑ Yes ❑ 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:
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):
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? *
Page 20 of 23 PCN Form Version 4.3- April 20, 2022

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 INC 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 Hasse Ave
Extension Modification project is a road extension. Additionally, the project is located within the Town
of Apex ETJ, therefore the adjacent properties that have potential for development will have the
following regulations to protect downstream waters: 1) the Jordan Watershed Riparian Buffer
Protection regulations, these regulations require limited development within the riparian buffer area in
addition to "diffuse flow" requirements and could require Best Management Practices that control
nitrogen if diffuse flow cannot be achieved; 2) the Phase II NPDES Stormwater Permit Program, this
program includes permitting requirements for Municipal Separate Storm Sewer Systems (MS4s) in
addition to post -construction stormwater management requirements; 3) the Water Supply, Watershed
Protection Program which limits development densities as well as requires protective riparian buffers.
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 .pdf)
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project? I ❑ Yes ❑x 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.
UIIGrn lV CI III -,I
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/ fy 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?
U., i 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.
Page 21 of 23 PCN Form Version 4.3- April 20, 2022

Representative photos of signs of bat use can be found in the NLEB SLOPES, Appendix F, pages 3-7. Link to
NLEB SLOPES document: htti)://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 .pdf)
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 .pdf)
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 March 08, 2022.
Determinations made by S&EC include proposed actions are 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 and concurrence email from the USFWS dated 8/4/2022.
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:
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 EssentialFish Habitat was identified near the project.
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data):
http://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 ❑ Yes ❑x No
preservation status (e.g., National Historic Trust designation or
properties significant in North Carolina history and archaeology)?
Page 22 of 23 PCN Form Version 4.3- April 20, 2022

7b. What data source(s) did you use to determine whether your site would impact historic or archeological
resources? *
Froehling & Robertson completed a field visit and State Historic Preservation Office environmental review
request that was submitted to NC SHPO on September 1, 2020. They received response from SHPO on October
8, 2020 determining that no historic resources would be affected by the project. Please see attached response.
7c. Attach historic or prehistoric documentation.
8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: htti)s://msc.fema.ciov/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.
Per the project engineer, the stream crossing will be designed to minimize backwater effects.
8c. What source(s) did you use to make the floodplain determination?
NC Flood Risk Information System Floodplain Mapping Program and confirmation from the project engineer.
H. Miscellaneous
Comments:
Click to enter.
I Attach pertinent documentation or attachments not previously requested I
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
Digitally signed by Deborah E.
Signature: * Deborah E. Shirley Shirley
Date: 2024.02.16 10:57:50-0500'
Date: * 12/5/2023
Page 23 of 23 PCN Form Version 4.3- April 20, 2022