20171558 Ver 2_Pre-Construction Notification (PCN) Form_20180306

�� �
6fvlslaa of Water Resources
Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
November 25, 2017 Ver 2.1
*
Please note: fields marked with a red asterisk below are required. You will not be able to submit the form until all mandatory questions are ans�red.
Below is a link to the online help file.
http://edocs.deq.nc.gov/WaterResources/0/doc/603610/Page1.aspx
A. Processing Information
County(or Counties) where the project is located:*
Granville
Is this project a public transportation project? *(?)
�' Yes C' No
Is this a NCDOT Project?*
C� Yes C' No
(NCDOT only) T.I.P. or state project number:
EB-5513, G5166A, G5166B
WBS #
50029.1.1, 46232.3.3, 46232.1.2
(for NCDOT use only)
1a. Type(s) of approval sought from the Corps:*
fJ Section 404 Permit (wetlands, streams and waters, Clean Water Act)
r Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What type(s) of permit(s) do you wish to seek authorization?*
� Nationwide Permit (NWP)
� Regional General Permit (RGP)
Nationwide Permit (NWP) Number:
NWP Number Other:
List all MNnurrbers you are applying for not on the drop down list.
14 - Linear transportation
1c. Type(s) of approval sought from the DWR:*
check all that apply
fJ 401 Water Quality Certification - Regular
r Non-404 Jurisdictional General Permit
r 401 Water Quality Certification - Express
�J Riparian Buffer Authorization

1d. Is this notification solelyfor the record because
written approval is not required?
For the record only for DWR 401 Certification
For the record only for Corps Permit:
*
C' Yes C•' No
C' Yes r No
1e. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
If so, attach the acceptance letter from rritigation bank or in-lieu fee program
C' Yes C•' No
i 1f. Is the project located in anyof NCs twentycoastal counties?*
C' Yes �' No
1h. Is the project located in a designated trout watershed?*
C� No
C' Yes
Link to trout information: http://v�uwv.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Agency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact?*
City of Creedmoor - Michael Frangos, Planning Director
1b. PrimaryContact Email:*
mf ra n g os @cityofcree d moo r. o rg
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
I7 Owner r Applicant (other than owner) rJ AgenUConsultant
(Check all that apply)
2. Owner I nformation
2a. Name(s) on recorded deed:
City of Creedmoor
2b. Deed book and page no.:
2c. Responsible party:
(for Corporations)
2d.Address
Street Address
P.O. Box 765
Address Line 2
�Y
Creedmoor
Fbstal / Zip Code
27522
2e. Telephone Number:
(xxx)xxx-xxxx
[phone]
State / Rovince / Region
NC
Country
USA

2f. Fax Number:
[phone]
(xxx)xxx-xxxx
2g. Email Address:*
mfrangos@cityofcreedmoor. org
4. Agent/Consultant (if applicable)
4a. Name:
Gregory W. Price
4b. Business Name:
(if applicable)
Carolina Ecosystems, Inc.
4c. Address
Street Address
3040 M�vy 42 West
Address Line 2
C7ty
Clayton
Fbstal / Zip Code
27520
4d. Telephone Number:
[phone]
(xxx)xxx-xxxx
4e. Fax Number:
(xxx)xxx-x�cx
4f. Email Address:*
[e-mail]
State / R-ovince / I�gion
NC
Country
USA
AgentAuthorization Letter*
Rease provide the Agerrt Authorization Letter if you are subrritting this docurrent.
Creedmoor_Agent_Authorization_Signed.pdf 414.77KB
FlLE 7YFE MJST BE FDF
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
City of Creedmoor Cross City Trails
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Creedmoor
1d. Driving directions*
IF it is a new project and can not easily be found in a C� rrnpping system Rease provide directions.
i Refer to Vicinity Map.
2. Project Identification

2a. Property Identification Number:
(tax RN or parcel ID)
2b. Propertysize:
(in acres)
22 acres
2c. Project Address
Street Address
Address Line 2
��
Fbstal / Zip Code
2d. Site coordinates in decimal degrees
State / Rovince / F�gion
Country
Please collect site coordinates in decimal degrees. Use between 4-6 digits (unless you are using a survey-grade GPS device) after the decimal place as
appropriate, based on howthe location was determined. (For example, most mobile phones with GPS provide locational precision in decimal degrees to
map coordinates to 5 or 6 digits after the decimal place.)
Latitude:* Longitude:*
36.1215 -78.6863
ex:34208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Robertson Creek, Cedar Creek, and Ledge Creek
3b. Water Resources Classification of nearest receiving water:*
WS-IV. NSW
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Neuse
RiverBasin Lookup
4. Project Description
4a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this application:*
The site has been previously disturbed with residential and commercial development. The site is predominantly
maintained roadside areas with patches of hardwood forest at the edge of the study area.
4b. Attach an 8 1/2 X 17 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for
DWR)
C7ick the upload button or drag and drop files here to attach docurrent
Creedmoor JD_Figure2_USGS.pdf 590.12KB
Fle type rrust be pdF
4c. Attach an 8 1/2 X 11 excerpt from the most recent version of the published County NRCS Soil Survey map depicting the project site.
(for DWR)
aick the upload button or drag and drop files here to attach docurrent
Creedmoor_JD_Figure3_NRCS.pdf 335.28KB
Fle type rrust be pdf
4d. List the total estimated acreage of all existing wetlands on the property:

0.79
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
121
4f. Explain the purpose of the proposed project:
To extend pedestrian access to three locations, along NC-56 between Lake Rogers and Main St, along NC-65
between Westbourne Dr. and the Creedmoor Commons shopping center, and along US-15 between NC-56 and
Hillsboro St./Joe Peed Rd.
4g. Describe the overall project in detail, including the type of equipment to be used:
The sidewalk/boardwalk will be constructed through minor grading on the roadside shoulder and placement of
subgrade, followed by paving. Equipment to be used includes backhoes, excavators, dump trucks, and other
standard equipment.
4h. Please upload project drawings for the proposed project.
C7ick the upload button or drag and drop files here to attach docurrent
Fle type rrust be pdF
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
C� Yes �' No �' Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
C' Preliminary C' Approved C' Unknown C•' N/A
Corps AID Number:
Exarrple: SAV�2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other
Phil Mayand Brian Smith
Carolina Ecosystem, Inc.
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Field verification of the delineation was performed by Eric Alsmeyer on May 15, 2014. No PJD was received.
Sd1. Jurisdictional determination upload
aick the upload button or drag and drop files here to attach docurrem
Fle lype rrust be FDF
6. Project History
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past?*
C' Yes �' No �' Unknown
7. Future Project Plans
7a. Is this a phased project?*
C� Yes �' No
7b. If yes, explain.

The project involves construction of sidewalk in three areas. This will be done in 3 phases of construction. Phase 2
is located along NC-65 between Westbourne Dr. and the Creedmoor Commons shopping center. Phase 3 is
located along NC-56 between Lake Rogers and Main St. Phase 4 is located along US-15 between NC-56 and
Hillsboro St./Joe Peed Rd.
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? This includes other separate and distant crossing for linear projects that require Department of the
Army authorization but don't require pre-construction notification.
No.
D. Proposed I m pacts I nventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
rJ Wetlands r Streams-tributaries rJ Buffers
� Open Waters r Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. Site #- Reason for 2b. Impact type * 2c. Type of wetland * 2d. Wetland name * 2e•
impact� Forested *
Site 1 - Fill for
Boardwalk Pilings
N�plabel(e.g.F�ad Qassing 1)
Site 2 - Fill for
Boardwalk Pilings
Rhap label (e.g. I�ad Qassing 1)
Site 3 - Fill for
Retaining Wall
N�p label (e.g. f�ad Qossing 1)
Site 1 - Boardwalk
P�ccess
N�p label (e.g. Fd�ad CYossing 1)
Site 2 - Boardwalk
Access
fv�p label (e.g. Id�ad Q�ossing 1)
P Bottomland Hardwood Site 1
�rrrener� (�j or Terrporary Forest
��
P Bottomland Hardwood Site 2
F�rrranent (P) or Terrporary Forest
��
P Bottomland Hardwood Site 3
F2rrrenent (F) or Tenporary Fo1'est
��
T Bottomland Hardwood Site 1
F2rrrsnent (P� or Terrporary Fol'est
��
T Bottomland Hardwood Site 2
F�rrranent (Pj or Terrporary FoPest
��
Yes
Yes
Yes
Yes
Yes
2g. Total Temporary Wetland Impact
0.051
2g. Total Permanent Wetland Impact
0.011
2g. Total Wetland Impact
0.062
2h. Comments:
Site 1 permanent impacts for boardwalk piles = 8.03 sq. ft.; Site 2 permanent impacts for boardwalk piles = 1.40
sq. ft.
2f. 2g. Impact
Jurisdiction area*
type *
Both 0.000
(404, 10) or CANR (acres)
(401, other)
Both 0.000
(404, 10) or C7JVR (acres)
(401, other)
Both 0.011
(404, 10) or C7JVR (acres)
(401, other)
Both 0.041
(404, 10) or CMR (acres)
(401, other)
Both 0.010
(404, 10) or UNR (acres)
(401, other)
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.
"" All Perennial or Intermittent streams must be verified by DWR or delegated local government.

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.
5. Pond or Lake Construction
If pond or lake construction is proposed, then complete the chart below.
6. Buffer Impacts (for DWR)
If project will impact a protected riparian buffer, then complete the chart below. Individually list all buffer impacts below.
6a. Project is in which protect basin(s)?*
Check all that apply.
rJ Neuse r Tar-Pamlico
r Catawba r Randleman
� Goose Creek r Jordan Lake
r Other
6b. Impact Type * 6c. Per or 6d. Stream name *
Te mp *
Site 1- Allowable P Robertson Creek
Location and 6cerrpt, Allowable, allowable w/ rritigation F�rrranent (F) or
Terrporary (�
Site 2- Allowable P UT to Cedar Creek
Location and C errpt, Allowable, allowable w/ rritigation F2rrranent (F) or
Terrporary (�
Site 3- Allowable P UT to Ledge Creek
Location and 6cerrpt, Allowable, allowable w/ rritigation F2rrranent (F) or
Terrporary (�
Site 4- Allowable P UT to Ledge Creek
Location and 6cerrpt, Allowable, allowable w/ rritigation F�rrrenent (P� or
Terrporary (�
Site 5- Allowable P UT to Ledge Creek
Location and C errpt, Allowable, allowable w/ rritigation F2rrranent (Fj or
Terrporary (�
6h. Total buffer impacts:
Temporary impacts:
Permanent impacts:
Total buffer impacts:
6i. Comments:
Zone 1
0.00
Zone 1
3,610.00
Zone 1
3,610.00
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
Zone 2
0.00
Zone 2
2,509.00
Zone 2
2,509.00
6e. Buffer 6f. Zone 1 6g. Zone 2
mitigation impact* impact'�
required?*
No 1,249 830
(squarefeet) (squarefeet)
No 264 207
(squarefeet) (squarefeet)
No 0 181
(squarefeet) (squarefeet)
No 659 865
(squarefeet) (squarefeet)
No 1,438 426
(squarefeet) (squarefeet)

Gick the upload button or drag and drop files here to attach docurrent
Wetland Impacts Complete Set.pdf
Buffer Impacts Complete Set.pdf
Fle rrust be F�F
E. Impact Justification and Mitigation
1. Avoidance and Minimization
1.16M6
1.46M6
� 1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
The sidewalks are designed to parallel existing roads as much as practicable to minimize wetland disturbance. A
boardwalk will be proposed in Phase 2 to avoid impacts to Robertson Creek and minimize impacts to associated
wetlands. A retaining wall is proposed in Phase 2 to minimize wetland impacts. No stream impacts are proposed
throughout all phases.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Sediment and erosion control measures will be implemented according to NC requirements, and approved by
NCDEQ prior to implementation. Jurisdictional areas not permitted to be impacted that are adjacent to construction
areas will be clearly marked with protection fencing or other similar method to avoid inadvertent encroachment.
Wetlands will be returned to e�asting grade. Copies of the issued permits and impact areas will be provided to the
prime contractor and all subcontractors wrorking in or near jurisdictional areas.
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?
C' Yes C•' No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
Only very minimal permanent impacts to wetlands (0.011 acre) and buffers (allowable) and no impacts to streams.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1a. Does this project require a Stormwater Management Plan?
C' Yes C•' No
1e. If this project DOES NOT require a Stormwater Management Plan, explain why:
There will be limited increase in impervious surface as a result of this project adding a section of sidewalk. The
e�asting stormwater drainage patterns have been retained, with enhancements to the ditches via riprap
stabilization of banks to ensure non-erosive velocities.
2. Diffuse Flow Plan
2a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection
Rules?
r Yes c' No
2b. All buffer impacts and high ground impacts require diffuse flow or other form of stormwater treatment. Include a plan that fully
documents how diffuse flow will be maintained.
If, due to site constraints, a BMP other than a level spreader is proposed, please provide a plan for stormwater treatment as outlined
I in Chapter 8 of the NC Stormwater BMP Manual and attach a BMP Supplement Form
What documentation are you providing?
r Level Spreader
r Other BMP
(check all that apply)
Diffused Flow Documentation
C7ick the upload button or drag and drop files here to attach docurrent
Fle type rrust be FDF

G. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
C� Yes l" 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 PolicyAct (NEPA/SEPA)?*
r Yes l" 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
NEPAor SEPAfinal approval letter.)*
C' Yes C•' No
Comme nts: *
A CE was prepared for the project.
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)? *
C' Yes C•' No
2b. Is this an after-the-fact permit application?*
C' Yes C•' No
2c. If you answered "yes" to one or both of the above questions, 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 downstream water quality?*
C' Yes �' No
3b. If you answered "no," provide a short narrative description.
The project is located in the City of Creedmoor and is mostly developed. This project will not promote growth in the
area due to the built out nature of the area.
4. Sewage Disposal (DWR Requirement)
4a. 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.
No wastewater will be generated from this project.
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 l" No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
C� Yes �' No
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. Is another Federal agency involved?*

r Yes r No r Unknown
5e. Is this a DOT project located within Division's 1-8?*
C� Yes C' No
Sj. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
Site survey for smooth coneflower due to a small marginal area of roadside habitat. No individuals of this species
were found.
i USFWS Website http://w�nn�v.fws.gov/no-es/es/countyfr.html, for Granville County
North Carolina Natural Heritage Program GIS data updated July 2017
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
C' Yes C•' No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
NOAA EFH mapper
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data: http://gis.ncdcr.gov/hpoweb/
7a. Will this project occur in or near an area that the state, federal or tribal governments have designated as having historic or cultural
preservation status (e.g., National Historic Trust designation or properties significant in North Carolina historyand archaeology)?*
C' Yes �' No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
HPOWEB Map Service http://gis.ncdcr.gov/hpoweb/
� National Register of Historic Places http://www.nps.gov/nr/research/
7c. Historic or Prehistoric Information Upload
Gick the upload button or drag and drop files here to attach docurrent
Fle rrust be FDF
8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https://msc.fema.gov/portal/search
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
C•' Yes C' No
8b. If yes, explain how project meets FEMA requirements:
Coordination with the local flood plain administrator will be performed and approvals acquired prior to construction,
if necessary.
8c. What source(s) did you use to make the floodplain determination?*
North Carolina Floodplain Mapping Program http://w�nN.ncfloodmaps.com/
Miscellaneous attachments not previously requested.
C7ick the upload button or drag and drop files here to attach docurrent
Fle rrust be FDF
Signature
*
r% By checking the box and signing below, I certify that:

■ 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 AcY');
■ I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic
Transactions AcY');
■ 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:*
Gregory Ward Price
Signature
�t�c i f ��� ���tf�
� Date:
current_date