20140957 Ver 1_01_PCN_Form_North Carolina_20170227

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Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.4 January 2009
Page 1 of 10
PCN Form — Version 1.4 January 2009
Pre -Construction Notification (PCN) Form
A.
Applicant Information
1.
Processing
1 a.
Type(s) of approval sought from the Corps:
❑X Section 404 Permit Section 10 0 rmit
1 b.
Specify Nationwide Permit (NWP) number: 12 or General Permit (GP) number:
1c.
Has the NWP or GP number been verified by the Corps?
❑X Yes ❑ No
1 d.
Type(s) of approval sought from the DWQ (check all that apply):
❑X 401 Water Quality Certification — Regular ❑ Non -404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑X Riparian Buffer Authorization
1 e.
Is this notification solely for the record
because written approval is not required?
For the record only for DWQ
401 Certification:
❑ Yes ❑X No
For the record only for Corps Permit:
❑ Yes ❑X 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
1 g.
Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below.
❑ Yes ❑X No
1 h.
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes ❑X No
2.
Project Information
2a.
Name of project:
Atlantic Coast Pipeline
2b.
County:
Northampton, Halifax, Nash, Wilson, Johnston, Sampson, Cumberland, Robeson
2c.
Nearest municipality / town:
Not Applicable - linear project, See Appendix A - Figures 1 and 2
2d.
Subdivision name:
Not Applicable
2e.
NCDOT only, T.I.P. or state project no:
Not Applicable
3.
Owner Information
3a.
Name(s) on Recorded Deed:
Atlantic Coast Pipeline, LLC
3b.
Deed Book and Page No.
N/A
3c.
Responsible Party (for LLC if
applicable):
Leslie Hartz
3d.
Street address:
707 E Main Street, 19th Floor
3e.
City, state, zip:
Richmond, VA 23219
3f.
Telephone no.:
[phone]
3g.
Fax no.:
3h.
Email address:
[e-mail]
Page 1 of 10
PCN Form — Version 1.4 January 2009

4.
Applicant Information (if different from owner)
4a.
Applicant is:
❑ Agent Q Other, specify: Atlantic Coast Pipeline, LLC
4b.
Name:
Leslie Hartz
4c.
Business name
(if applicable):
4d.
Street address:
707 E Main Street, 19th Floor
4e.
City, state, zip:
Richmond, VA 23219
4f.
Telephone no.:
[phone]
4g.
Fax no.:
4h.
Email address:
[e-mail]
5.
Agent/Consultant Information (if applicable)
5a.
Name:
Richard Gangle
5b.
Business name
(if applicable):
Dominion Resources Services, Inc.
5c.
Street address:
5000 Dominion Blvd
5d.
City, state, zip:
Glen Allen, Virginia 23060
5e.
Telephone no.:
[phone]
5f.
Fax no.:
5g.
Email address:
[e-mail]
Page 2 of 10

B.
Project Information and Prior Project History
1.
Property Identification
1a.
Property identification no. (tax PIN or parcel ID):
Not Applicable
1 b.
Site coordinates (in decimal degrees):
Latitude:
Longitude:
1c.
Property size:
3,023 acres
2.
Surface Waters
2a.
Name of nearest body of water to proposed project:
See Appendix C
2b.
Water Quality Classification of nearest receiving water:
See Appendix C
2c.
River basin:
See Appendix C
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:
See Section B3a of the attached supplemental information
3b.
List the total estimated acreage of all existing wetlands on the property: 558
3c.
List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 31,700
3d.
See
Explain the purpose of the proposed project:
Section 133d of the attached supplemental information
3e.
See
Describe the overall project in detail, including the type of equipment to be used:
Section B3e of the attached supplemental information
4.
Jurisdictional Determinations
4a.
Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (includingall prior phases in the past?
❑ Yes ❑X No ❑ Unknown
Comments: See Section 64a of supplemental information
pp
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): See Section 134c of supplemental information
Agency/Consultant Company:
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
See Section B4 of supplemental information
5.
Project History
5a.
Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
❑X Yes ❑ No ❑ Unknown
5b. If yes, explain in detail according to "help file" instructions.
See Section B5 of supplemental information
6.
Future Project Plans
6a.
Is this a phased project?
❑ Yes ❑X No
6b.
If yes, explain.
Page 3 of 10
PCN Form — Version 1.4 January 2009

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
❑X Wetlands Strea X — tributaries Buffers Open \❑X ters P❑d 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
2d.
Forested
2e.
Type of jurisdiction
Corps (404,10) or
DWQ (401, other)
2f.
Area of
impact
(acres)
W1 -
Choose one
Choose one
Yes/No
-
W2 -
Choose one
Choose one
Yes/No
W3 -
Choose one
Choose one
Yes/No
W4 -
Choose one
Choose one
Yes/No
W5 -
Choose one
Choose one
Yes/No
W6 -
Choose one
Choose one
Yes/No
2g. Total Wetland Impacts:
2h. Comments:
See Appendix C and Appendix A - Figure A-4 of the Supplemental Information for wetland impacts summaries for the pipeline facilities.
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
3f.
Average
stream
width
(feet)
3g.
Impact
length
(linear
feet)
S1 -
Choose one
S2 -
Choose one
S3 -
Choose one
-
S4 -
Choose one
-
-
S5 -
Choose one
-
S6 -
Choose one
-
3h. Total stream and tributary impacts
3i. Comments:
See Section C, Appendix C and Appendix A - Figure A-4 of the Supplemental Information for waterbody impacts summaries for the pipeline facilities.
Page 4 of 10
PCN Form — Version 1.4 January 2009

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 indivi ually 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)
01
Choose one
Choose
02 -
Choose one
Choose
03 -
Choose one
Choose
O4 -
Choose one
Choose
4f. Total open water impacts
4g. Comments: See bection U, Appendix U and Appendix A - Hgure A-4 ot the 6upplemental Information tor wetland mpac s summaries or e
pipeline facilities.
5. Pond or Lake Construction
If pond or lake construction proposed, the 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
P1
Choose one
P2
Choose one
5f. Total:
5g. Comments: Not applicable
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:
Not applicable
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?
X❑ Neuse ❑X Tar -Pamlico Dawba C]ndleman Other
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 -
Yes/No
B2 -
Yes/No
B3 -
Yes/No
B4 -
Yes/No
B5 -
Yes/No
B6 -
Yes/No
6h. Total Buffer Impacts:
6i. Comments: See Section C6 of the attached supplemental information, Table 5.
Page 5 of 10

D.
Impact Justification and Mitigation
1.
Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
See Section Mal and D1a2 of the attached supplemental information
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
See Section D1 b1 and D1 b2 of the attached supplemental information
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
El 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: Choose one
Type: Choose one
Type: Choose one
Quantity:
Quantity:
Quantity:
3c.
Evaluation of bank credits available is currently underway and a plan will be submitted with the final application.
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:
Choose one
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.
Atlantic is evaluating the need for permittee responsible mitigation based on available credits from banks in appropriate service areas/watersheds. A
plan for mitigating impacts will be provided with the final application.
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PCN Form — Version 1.4 January 2009

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
❑X Yes ❑ No
buffer mitigation?
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.
6c.
6d.
6e.
Zone
Reason for impact
Total impact
Multiplier
Required mitigation
(square feet)
(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).
See Section D6 of the attached supplemental information
See Section D6 of the attached supplemental information
6h. Comments:
Page 7 of 10

E.
Stormwater Management and Diffuse Flow Plan (required by DWQ)
1.
Diffuse Flow Plan
1 a.
Does the project include or is it adjacent to protected riparian buffers identified
❑X Yes ❑ No
within one of the NC Riparian Buffer Protection Rules?
1 b.
If yes, then is a diffuse flow plan included? If no, explain why.
An Erosion and Sediment Control Plan is being developed and will be submitted once completed, an
for diffuse is the development E&S
❑ Yes ❑X No
evaluation
of need a plan part of of plans.
2.
Stormwater Management Plan
2a.
What is the overall percent imperviousness of this project?
2b.
Does this project require a Stormwater Management Plan?
❑ Yes 0 No
2c.
If this project DOES NOT require a Stormwater Management Plan, explain why:
This
is a linear project and impervious surfaces are expected to be significantly less than 24%.
2d.
If this project DOES require a Stormwater Management Plan, then provide a brief, narrative
description of the plan:
2e.
Who will be responsible for the review of the Stormwater Management Plan?
3.
Certified Local Government Stormwater Review
3a.
In which localgovernment's jurisdiction is thisproject?
TBD
❑ Phase II
❑ NSW
3b.
Which of the following locally -implemented stormwater management programs
❑ USMP
apply (check all that apply):
❑ Water Supply Watershed
❑ Other:
3c.
Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
4.
DWQ Stormwater Program Review
❑Coastal counties
❑ HQW
4a.
Which of the following state -implemented stormwater management programs apply
❑ORW
(check all that apply):
❑Session Law 2006-246
❑ Other:
4b.
Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
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
Page 8 of 10
PCN Form — Version 1.4 January 2009

F.
Supplementary Information
1.
Environmental Documentation (DWQ Requirement)
1 a.
Does the project involve an expenditure of public (federal/state/local) funds or the
Yes ❑ No
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
❑X Yes ❑ No
(North Carolina) Environmental 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 NEPA or SEPA final approval
❑ Yes ❑X No
letter.) Atlantic Coast Pipeline, LLC is submitting an application to FERC, FERC will be
Comments: writing an EIS. See Supplemental Information Section F.1.
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,
E] Yes ❑X No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b.
Is this an after -the -fact permit application?
El Yes ❑X No
2c.
If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
Not Applicable
3.
Cumulative Impacts (DWQ Requirement)
3a.
Will this project (based on past and reasonably anticipated future impacts) result in
El Yes ❑X No
additional development, which could impact nearby downstream water quality?
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.
See Section F3 of the attached supplemental information
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.
Not
applicable
Page 9 of 10
PCN Form — Version 1.4 January 2009

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or
Yes ❑ No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act
❑X Yes ❑ No
impacts?
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
See Section F5 of the attached supplemental information
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat?
❑ Yes ❑X No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
See Section F6a of the attached supplemental information
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
❑ Yes ❑ No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
See Section F7 of the attached supplemental information
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA -designated 100 -year floodplain?
❑X Yes ❑ No
8b. If yes, explain how project meets FEMA requirements:
See Section F9 of the attached supplemental information and Figure 5 of Appendix A
8c. What source(s) did you use to make the floodplain determination?
FEMA Flood Map Service Center
Applicant/Agent's Printed Name
Date
Applicant/Agent's Signature
(Agent's signature is valid only if an authorization
letter from the applicant is provided.
Page 10 of 10