20180399 Ver 1_401 Application_20180318

DWR
Division of WaaerResources
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
January 31, 2018 Ver 2.3
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 answered.
Also, if at any point you wish to print a copy of the E -PCN, all you need to do is right -click on the document and you can print a copy of the form.
Below is a link to the online help file.
https:lledoes.deq. ne.govlWaterResources101edocl624704/PCN%20Help%20File%202018-1-30. pdf
A. Processing Information
County (or Counties) where the project is located:
Wake
Is this project a public transportation project?*(?)
r Yes r No
1a. Type(s) of approval sought from the Corps:*
r Section 404 Permit (wetlands, streams and waters, Clean Water Act)
PF Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What type(s) of permit(s) do you wish to seek authorization?*
17 Nationwide Permit (NWP)
r Regional General Permit (RGP)
Nationwide Permit (NWP) Number: 12 - Utility Lines
NWP Number Other:
List all MN nunbers you are applying for not on the drop dow n list.
1c. Type(s) of approval sought from the DWR:*
check all that apply
r 401 Water Quality Certification - Regular r 401 Water Quality Certification - Express
r Non -404 Jurisdictional General Permit rJ Riparian Buffer Authorization
...............................................................................................................
*
1d. Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification:
For the record only for Corps Permit:
b Yes r No
O Yes O 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 mitigation bank or in -lieu fee program
0 Yes r No

1f. Is the project located in any of NC's twenty coastal counties?*
f Yes r No
1h. Is the project located in a designated trout watershed?*
r Yes r No
Link to trout information: http://wm.saw.usace.army.miI/Missions/Regulatory-Permit-Program/Agency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact?*
Jonathan Lowry
1b. Primary Contact Email:*
[e-mail]
1c. Primary Contact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
r Owner r Applicant (other than owner) V Agent/Consultant
(Check all that apply)
2. Owner Information
2a. Name(s) on recorded deed:
Heritage Inn of Raleigh, LLC
2b. Deed book and page no.:
Book 016745, Page 01996
2c. Responsible party:
(for Corporations)
Lori Kasowski
2d. Address
Street Address
1202 Westrac Drive, 3rd Floor
Address Line 2
aty
Fargo
Postal / Zip Code
58103
2e. Telephone Number:
(xxx)xxx-xxxx
[phone]
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Jonathan Lowry
State / Rovince / Pegion
ND
Country
USA

4b. Business Name:
(if applicable)
Lowry Engineering
4c. Address
Street Address
1111 Westrac Drive Suite 108
Address Line 2
city
Fargo
Fbstal / Zip Code
58103
4d. Telephone Number:
[phone]
4e. Fax Number:
(xxx)xxx-xxxx
4f. Email Address:*
[e-mail]
State / Province / Region
ND
Country
USA
Agent Authorization Letter*
Rease provide the Agent Authorization Letter if you are subr fitting this docunent.
16009.4_PCN_Agent_Authorization_Signed.pdf 60.29KB
RLETYFE M -ST BE RDF
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Staybridge Suites
1b. Subdivision name:
(if appropriate)
T W Alexander Place
1c. Nearest municipality/ town:*
Raleigh
1d. Driving directions*
If it is a new project and can not easily be found in a GPS napping system Rease provide directions.
Northwest corner of T W Alexander Drive and ACC Boulevard, across T W Alexander from WakeMed Brier Creek Healthplex, 0.4 miles east
of intersection of Glenwood Ave (US Hwy 70) and T W Alexander
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)
0768398793
2b. Property size:
(in acres)
6.99
2c. Project Address

Street Address
8001 ACC Boulevard
Address Line 2
aty
State / Rovince / tbgion
Raleigh
NC
Fbbstal / Zip Code
Country
27610
USA
2d. Site coordinates in decimal degrees
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:*
35.91996 -78.78423
ex: 34.208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Unnamed tributary to Little Brier Creek
3b. Water Resources Classification of nearest receiving water:*
Q NSW
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Neuse
River Basin 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:*
Bottomland Forest/Hardwood Swamps.Wooded with streams on the west and south sides of the site. Current site
land use is vacant. Hospital across the street to the south, residential on the northwest side of the site, commercial
development to the west, and vacant land on all other sides.
4b. Attach an 8 1/2 X 11 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for
DWR)
Click the upload button or drag and drop files here to attach document
16009.4_PCN_USGS Topo Map.pdf 16.01 MB
File type must be pdr
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)
Click the upload button or drag and drop files here to attach document
16009.4_ST_Appendix I_HSG.pdf 480.44KB
File type rust be pdt
4d. List the total estimated acreage of all existing wetlands on the property:
0
4e. List the total estimated linear feet of all existing streams on the property:
(intermittent and perennial)
1,150

4f. Explain the purpose of the proposed project:*
Construction of a new Staybridge Suites Hotel with parking lot and two driveways onto ACC Boulevard.
4g. Describe the overall project in detail, including indirect imapacts and the type of equipment to be used:
Construction of a new hotel in the northeast corner of the site, asphalt parking lot, 2 driveways, new water and
sewer service, engineered filter strip for stormwater discharge. Will not disturb the existing tree conservation area.
Backhoes, bulldozers, excavators, skid steers, aggregate trucks, and other standard site construction equipment
is anticipated for use on the site.
4h. Please upload project drawings for the proposed project.
nick the upload button or drag and drop files here to attach docurrent
16009.4_ASR Approved_18-01-31.pdf 16.08MB
File type rrust be pdf
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas? *
f Yes f No r Unknown
Comments:
The Riparian Buffer has been defined on the plat. BM 2013 Pg 1286 of the
Wake County Registry
5b. If the Corps made a jurisdictional determination, what type of determination was made?
r Preliminary r Approved r Unknown r N/A
Corps AID Number:
Exarrple: SAW -2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5d1. Jurisdictional determination upload
Click the upload button or drag and drop files here to attach docurrent
File type crust be RDF
6. Project History
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past?*
r Yes r No r Unknown
7. Future Project Plans
7a. Is this a phased project?*
f Yes r No
Are any other NWP(s), regional general permit(s), or individual permits(s) used, or intended to be used, to authorize any part of the
proposed project or related activity? 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 Impacts Inventory
.......................................................................................................................................................................................................................................
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
F Wetlands r Streams-tributaries V Buffers
r- Open Waters r- Pond Construction
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
F Catawba r Randleman
r Goose Creek r Jordan Lake
r Other
6b. Impact Type*
6c. Per or 6d. Stream name * 6e. Buffer mitigation
6f. Zone 1
6g. Zone 2
Temp* required?*
impact*
impact*
Allowable
P UT to Little Brier Creek No
691
451
Location and Exempt, Allowable, allowable w/
F brrranent (F) or
(square feet)
(square feet)
mitigation
Terrporary (l)
6h. Total buffer impacts:
Zone 1 Zone 2
Temporary impacts: 0.00 0.00
Zone 1 Zone 2
Permanent impacts: 691.00 451.00
Zone 1 Zone 2
Total buffer impacts: 691.00 451.00
6i. Comments:
Non -electric Utility Line - Aerial sanitary sewer crossing per City of Raleigh Detail S-51.
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
dick the upload button or drag and drop files hereto attach docurrent
16009.4_Stream Crossing.pdf 1.93MB
File rrust be FEF
E. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*

The sanitary sewer tie in location is in the southwest corner of the site. The riparian buffer onsite is adjacent to the
south property line and spans 90% of the total length. Originally we had tried to route the sewer service parallel to
the south property line and then north along the east property line in order to avoid crossing the riparian buffer,
however the City of Raleigh Reviewer for our site indicated the 30' break in the tree conservation area was
intended to be used for utility crossings and requested we route the sewer as currently shown.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Construction will be completed when the creek is dry. Proper erosion control measures will be in place prior to any
disturbance in this area. All preparation that can be performed outside of the buffer will be done so. The work will
be completed as quickly and efficiently as possible to minimize disturbance.
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?
r Yes C No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
*** Recent changes to the stormwater rules have required updates to this section .***
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?
r Yes r No
1b. 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 flow will be maintained.
All Stormwater Control Measures (SCM)s must be designed in accordance with the NC Stormwater Design Manual. Associated
supplement forms and other documentation shall be provided.
What type of SCM are you providing?
V Level Spreader
r Vegetated Conveyance (lower SHWT)
r— Wetland Swale (higher SHWT)
r— Other SCM that removes minimum 30% nitrogen
(check all that apply)
For a list of options to meet the diffuse flow requirements, click here
Diff us Flow Documentation
Qick the upload button or drag and drop files here to attach docurrent
File type mast be PDF
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
r Yes G No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?*
f Yes
r No
To lookup low density requirement click here 15A NCAC 02H .1003(2).
2c. Does this project have a stormwater management plan (SMP) reviewed and approved under a state stormwater program or state -
approved local government stormwater program?*

r Yes
r No
Fant: projects that have vested rights, exerrptions, or grandfathering from state or locally implerrented storrrwater programs or projects that satisfy state or locally -implemented stormwater programs
through use of cormunity in -lieu programs should answer no to this question.
3. Stormwater Requirements
3a. Select whether a completed stormwater management plan (SMP) is included for review and approval or if calculations are provided
to document the project will not cause degradation of downstream surface waters. *
r Stormwater Management Plan r Antidegradation Calculations
3b. Stormwater Management Plan: If submitting a SMP for review and approval, it shall comply with the high-density development
requirements set forth in 15A NCAC 02H .1003. Include all appropriate stormwater control measure supplemental forms and associated
items.
gick the upload button or drag and drop files here to attach docurrent
16009.4_ST_Report_ASR Approved_18-01-31.pdf 10.1 MB
FILE IYFE MBT BE FDF
3c. Antidegradation Calculations: If submitting calculations to document the project will not cause degradation of downstream surface
waters, the documentation shall include a detailed analysis of the hydrological impacts from stormwater runoff when considering the
volume and velocity of stormwater runoff from the project built upon area and the size and existing condition of the receiving
waterbody(ies).
gick the upload button or drag and drop files here to attach docurrent
FILE TYPE NMT 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?*
r Yes r No
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15A NCAC 2H .0500), Isolated Wetland Rules (15A NCAC 2H .1300), or
DWR Surface Water or Wetland Standards or Riparian Buffer Rules (15A NCAC 2B .0200)? *
r Yes r No
2b. Is this an after -the -fact permit application?*
r Yes F No
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?*
r Yes R No
3b. If you answered "no," provide a short narrative description.
Construction of a hotel on this site is consistent with the future land use plan. The site will have less than 25%
impervious cover, leaving 75% of the site as open/green space and existing trees.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?
r Yes r Nor NiA
4b. 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.

The sewage will be discharged through a service pipe and into the City collection system where it will be routed to
a treatment plant. The City has accepted service of the area utilizing existing treatment facilities.
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?*
r Yes F No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
r Yes C No
5d. Is another Federal agency involved?*
r Yes r No r Unknown
5e. Is this a DOT project located within Division's 1-8?*
r Yes r No
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?
F Yes r No
5g. Does this project involve bridge maintenance or removal?*
r Yes r No
Link to the NLEB SLOPES document: http://saw-reg.usace.army.mil/NLEB/1-30-17-signed_NLEB-SLOPES&apps.pdf
5h. Does this project involve the construction/installation of a wind turbine(s)?**
r Yes G No
5i. Does this project involve (1) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhammers,
mechanized pile drivers, etc.?*
r Yes G No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
https://fws. maps.arcg is.com/home/webmap/viewer. html?webmap=9d8de5e265ad4fe09893cf75b8d bfb77
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
r Yes r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
https://www.habitat.noaa.gov/protection/efh/efhmapper/
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 history and archaeology)?*
r Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
http://gis.ncdcr.gov/hpoweb/
7c. Historic or Prehistoric Information Upload
Cick the upload button or drag and drop files hereto attach docurrent
File rust 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?*
r Yes r No
8c. What source(s) did you use to make the floodplain determination?*
FEMA FIRM Map Number 3720076800J Revised 05/02/06
Miscellaneous
Miscellaneous attachments not previously requested.
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16009.4_PCN Cover Letter.pdf 97.08KB
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Signature
m 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 Act');
■ I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic
Transactions Act');
■ I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature; AND
■ I intend to electronically sign and submit the PCN form.
Full Name:*
Jonathan Lowry
Signature
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Initial Review
Is this project a public transportation project?* (?)
r Yes r No
Change only if needed.
Has this project met the requirements for acceptance in to the review process?*
r Yes
r No
BIMS # Assigned *
20180399
Version#*
1
Reviewing Office*
Raleigh Regional Office - [phone]
Select Project Reviewer*
Stephanie Goss:eads\szgoss
Is a payment required for this project?*

F No payment required
r Fee received
r Fee needed - send electronic notification