20160173 Ver 1_401 Application_20160223

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PCN Form – Version 1.3 December 10, 2008 Version
Office Use Only:
Corps action ID no. _____________
DWQ project no. _______________
Form Version 1.3 Dec 10 2008
Pre-Construction Notification (PCN) Form
A. Applicant Information
1. Processing
1a. Type(s) of approval sought from the
Corps: Section 404 Permit Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: 18 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps? Yes No
1d. Type(s) of approval sought from the DWQ (check all that apply):
401 Water Quality Certification – Regular Non-404 Jurisdictional General Permit
401 Water Quality Certification – Express Riparian Buffer Authorization
1e. Is this notification solely for the record
because written approval is not required?

For the record only for DWQ 401
Certification:
Yes No
For the record only for Corps Permit:

Yes No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program.
Yes No

1g. Is the project located in any of NC’s twenty coastal counties. If yes, answer 1h
below.
Yes No

1h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? Yes No
2. Project Information
2a. Name of project: Apex Summit Church
2b. County: Wake
2c. Nearest municipality / town: Apex
2d. Subdivision name:
2e. NCDOT only, T.I.P. or state
project no:
3. Owner Information
3a. Name(s) on Recorded Deed: BCP Lufkin LLC
3b. Deed Book and Page No. 014251/02628,016256/00689,016244/00532,016244/00532
3c. Responsible Party (for LLC if
applicable): Benjiman Whited
3d. Street address: 4000 West North St
3e. City, state, zip: Raleigh, NC 27603
3f. Telephone no.: [phone]
3g. Fax no.:
3h. Email address: [e-mail]

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PCN Form – Version 1.3 December 10, 2008 Version

4. Applicant Information (if different from owner)
4a. Applicant is: Agent Other, specify:
4b. Name:
4c. Business name
(if applicable):
4d. Street address:
4e. City, state, zip:
4f. Telephone no.:
4g. Fax no.:
4h. Email address:
5. Agent/Consultant Information (if applicable)
5a. Name: Jay Keller
5b. Business name
(if applicable): Keller Environmental
5c. Street address: 7921 Haymarket Lane
5d. City, state, zip: Raleigh, NC 27615
5e. Telephone no.: [phone]
5f. Fax no.: [phone]
5g. Email address: [e-mail]

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PCN Form – Version 1.3 December 10, 2008 Version

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): 0751272686,0751270856,0751179766,0751179458
1b. Site coordinates (in decimal degrees): Latitude: 35.721803 Longitude: - 78.82380
(DD.DDDDDD) (-DD.DDDDDD)
1c. Property size: 8.30 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
proposed project: Middle Creek
2b. Water Quality Classification of nearest receiving water: C; NSW
2c. River basin: Neuse
3. Project Description
3a. 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 property is forested primarily with mixed pine/hardwood. The general land use in the vicinity of the project consists of
residential, businesses, and forested areas. Please refer to the attached USGS, Wake County Soil Survey, and Apex
Summit Church 2013 TopoAerial Maps for more information on the project setting.
3b. List the total estimated acreage of all existing wetlands on the property:
0.02 Acre
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
180 Linear Feet
3d. Explain the purpose of the proposed project:
The purpose of the project is to develop the property with parking lot, water and stormater infrastructure necessary to
provide building area for a church center.
3e. Describe the overall project in detail, including the type of equipment to be used:
The project consists of an approximately 45,000 sq. ft. building including parking lot, water and stormwater infrastucture
to be constructed. Standard earth-moving equipment (i.e., graders, excavators) will be utilized.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (including all prior phases) in the past?
Comments: DWR stream determination conducted 1-26-16.
Yes No Unknown
4b. If the Corps made the jurisdictional determination, what type
of determination was made? Preliminary Final
4c. If yes, who delineated the jurisdictional areas?
Name (if known): Jay Keller
Agency/Consultant Company: Keller Environmental
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
January 28, 2016 DWR stream determination letter.
5. Project History
5a. Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past? Yes No Unknown
5b. If yes, explain in detail according to “help file” instructions.

6. Future Project Plans
6a. Is this a phased project? Yes No
6b. If yes, explain.

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PCN Form – Version 1.3 December 10, 2008 Version

C. Proposed Impacts Inventory
1. Impacts Summary
1a. Which sections were completed below for 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, then complete this question for each wetland area impacted.
2a.
Wetland impact
number –
Permanent (P) or
Temporary (T)
2b.

Type of impact
2c.

Type of wetland
(if known)
2d.

Forested

2e.
Type of jurisdiction
(Corps - 404, 10
DWQ – non-404, other)
2f.

Area of impact
(acres)
W1 P T Fill Headwater Yes
No
Corps
DWQ .02
W2 P T Yes
No
Corps
DWQ
W3 P T Yes
No
Corps
DWQ
W4 P T Yes
No
Corps
DWQ
W5 P T Yes
No
Corps
DWQ
W6 P T Yes
No
Corps
DWQ
2g. Total wetland impacts 904 SF
(0.02 Ac.)
2h. Comments:
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a.
Stream impact
number -
Permanent (P) or
Temporary (T)
3b.
Type of impact
3c.
Stream name
3d.
Perennial
(PER) or
intermittent
(INT)?
3e.
Type of jurisdiction
(Corps - 404, 10
DWQ – non-404,
other)
3f.
Average
stream
width
(feet)
3g.
Impact
length
(linear
feet)
S1 P T PER
INT
Corps
DWQ
S2 P T PER
INT
Corps
DWQ
S3 P T PER
INT
Corps
DWQ
S4 P T PER
INT
Corps
DWQ
S5 P T PER
INT
Corps
DWQ
S6 P T PER
INT
Corps
DWQ
3h. Total stream and tributary impacts 0
3i. Comments:

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PCN Form – Version 1.3 December 10, 2008 Version

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. then individually list all open water impacts below.
4a.
Open water
impact number
– Permanent (P)
or Temporary
(T)
4b.
Name of waterbody
(if applicable)
4c.

Type of impact
4d.

Waterbody type
4e.

Area of impact (acres)
O1 P T
O2 P T
O3 P T
O4 P T
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If pond or lake construction proposed, then complete the chart below.
5a.

Pond ID
number
5b.

Proposed use or purpose of
pond

5c.
Wetland Impacts (acres)
5d.
Stream Impacts (feet)
5e.
Upland
(acres)
Flooded Filled Excavated Flooded Filled Excavated Flooded
P1
P2
5f. Total
5g. Comments:
5h. Is a dam high hazard permit required?
Yes No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:

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PCN Form – Version 1.3 December 10, 2008 Version

6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If any impacts require mitigation, then you MUST fill out Section D of this form.
6a.
Project is in which protected basin?
Neuse Tar-Pamlico Other:
Catawba Randleman
6b.
Buffer impact
number –
Permanent (P)
or Temporary
(T)
6c.

Reason for
impact
6d.

Stream name
6e.

Buffer
mitigation
required?
6f.

Zone 1 impact
(square feet)
6g.

Zone 2 impact
(square feet)
B1 P T Stormwater
Outlet UT to Middle Creek Yes
No 1,500 1,000
B2 P T Yes
No
B3 P T Yes
No
6h. Total buffer impacts 1,500 1,000
6i. Comments:
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Eastern sewer line was placed upstream of intermittent stream origin. Retaining walls and BMPs were placed in locations to
minimize stream, wetland & riparian wetland areas impacts.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Erosion control devices & tree protection fences will be heavily utilized in these Herndon (easily-disturbed) soils to protect
environmental areas of concern.
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 yes, mitigation is required by (check all that apply): DWQ Corps
2c. If yes, which mitigation option will be used for this project?
Mitigation bank
Payment to in-lieu fee program
Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter) Type Quantity

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PCN Form – Version 1.3 December 10, 2008 Version

3c. Comments:
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached. Yes
4b. Stream mitigation requested: linear feet
4c. If using stream mitigation, stream temperature: warm cool cold
4d. Buffer mitigation requested (DWQ only): square feet
4e. Riparian wetland mitigation requested: acres
4f. Non-riparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requested: acres
4h. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.

6. Buffer Mitigation (State Regulated Riparian Buffer Rules) – required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation?
Yes No

6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.
Zone
6c.
Reason for impact
6d.
Total impact
(square feet)

Multiplier
6e.
Required mitigation
(square feet)
Zone 1 3 (2 for Catawba)
Zone 2 1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund).

6h. Comments:

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PCN Form – Version 1.3 December 10, 2008 Version

E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
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. If yes, then is a diffuse flow plan included? If no, explain why.
Comments:
Yes No
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project? 67 %
2b. Does this project require a Stormwater Management Plan? Yes No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
The stormwater management plan has been preliminarily approved and is being finalized currently by the Town of Apex
staff. Sand filters will be utilized to treat the on-site stormwater then discharged through the riparian buffers to the
intermittent stream on the east-side of the site.
2e. Who will be responsible for the review of the Stormwater Management Plan?
Certified Local Government
DWQ Stormwater Program
DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local government’s jurisdiction is this project? Town of Apex
3b. Which of the following locally-implemented stormwater management programs
apply (check all that apply):
Phase II
NSW
USMP
Water Supply Watershed
Other:
3c. Has the approved Stormwater Management Plan with proof of approval been
attached?
Yes No
4. DWQ Stormwater Program Review
4a. Which of the following state-implemented stormwater management programs apply
(check all that apply):
Coastal counties
HQW
ORW
Session Law 2006-246
Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
attached? Yes No
5. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements? Yes No
5b. Have all of the 401 Unit submittal requirements been met? Yes No

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PCN Form – Version 1.3 December 10, 2008 Version

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
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.)
Comments:
Yes No
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards,
or Riparian Buffer Rules (15A NCAC 2B .0200)?
Yes No
2b. Is this an after-the-fact permit application? Yes No
2c. If you answered “yes” to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ 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 “yes” to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered “no,” provide a short narrative description.
Future impacts are not anticipated since this a single/complete project.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
On-site wastewater will go to Town of Apex wastewater collection system. An existing sewer line is on-site.

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PCN Form – Version 1.3 December 10, 2008 Version

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
Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
US Fish & Wildlife; NC Natural Heritage Databases.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? Yes No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
http://ocean.floridamarine.org/sa_efh/. Essential fish habitat is not located near the proposed project.
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
Yes No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
NC SHPO Database
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:
8c. What source(s) did you use to make the floodplain determination? NC Floodmaps

Jay Keller

Applicant/Agent's Printed Name

_______________________________
Applicant/Agent's Signature
(Agent's signature is valid only if an authorization letter from the applicant
is provided.)

February 22,
2016

Date