20180702 Ver 1_401 Application_20180522

Action History (UTC -05:00) Eastern Time (US & Canada)
Submit by Anonymous User 5/22/2018 10:14:43 AM (Start Event)
Accept by Montalvo, Sheri A 5/23/2018 12:19:39 PM (Non DOT Initial Review)
The task was assigned to Montalvo, Sheri A. The due date is: May 25, 2018 5:00 PM
5/22/2018 10:15 AM

DWR
Division of water Resources
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://edocs.deq.nc.govMaterResources/0/edocl6247041PCN%2OHelp%2OFile%202018-1-30.pdf
A. Processing Information
County (or Counties) where the project is located:*
Alamance
Is this project a public transportation project?*
f Yes f• No
This is any publicly funded by nunicipal,state or federal funds road, rail, airport transportation project.
1a. Type (s) of approval sought from the Corps:*
V Section 404 Permit (wetlands, streams and waters, Clean Water Act)
F Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What type(s) of permit(s) do you wish to seek authorization?*
r Nationwide Permit (NWP)
r Regional General Permit (RGP)
W Standard (IP)
This form may be Corps to initiate the standard/individual permit process. Please contact your Corps representative for submittal of standard permits.
All required items that are not provided in the E -PCN and be added to the miscellaneous upload located at the bottom of this form.
1c. Type(s) of approval sought from the DWR:*
check all that apply
V 401 Water Quality Certification - Regular r 401 Water Quality Certification - Express
r Non -404 Jurisdictional General Permit V Riparian Buffer Authorization
r Individual Permit
*
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:
r Yes r No
r 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 mitigation bank or n- lieu fee program
r Yes r No
1f. Is the project located in anyof 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://wAw.saw.usace.army.mil/Missions/Regulatory-Permit-Prograni/Agency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact?*
Kristin Foust
1b. Primary Contact Email:*
[e-mail]
1c. Primary Contact Phone:*
(XXX)XXX-XXXX
[phone]
1d. Who is applying for the permit?
V Owner r- Applicant (other than owner) r] Agent/Consultant
(Check all that apply)
2. Owner Information
2a. Name(s) on recorded deed:
Laurelton Village Inc
2b. Deed book and page no.:
3586/0245
2c. Responsible party:
(for Corporations)
Kristin Foust
2d. Address
Street Address
1851 S Main Street
Address Line 2
City
Graham
Rbstal / Zip Code
27253
2e. Telephone Number:
(XXX)XXX-XXXX
2f. Fax Number:
(XXX)XXX-)D=
2g. Email Address:*
[e-mail]
State/ Province/ F2gion
NC
Country
USA
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Knightdale Drive
1b. Subdivision name:

(if appropriate)
Lacy Ridge
1c. Nearest municipality/ town:
Graham
1d. Driving directions*
f it is a new project and can not easily be found in a CPS rrapping system Please provide directions.
From Interstate 40/85 Exit 147, South NC87, Right on Rogers Road, Right on Lacy Holt Road, Left on Knightdale Drive.
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)
130050 and 174520
2b. Property size:
(in acres)
5.56 ac and 3.31 ac
2c. Project Address
Street Address
2323 Knightdale Drive and 2319 Knightdale Drive
Address Line 2
City
State / Province / Fbgion
Graham
NC
Postal / Zip Code
Country
27253
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 how the 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:*
36.027952N -79.422814W
ex: 34.208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Unnamed Tributary to Big Alamance Creek
3b. Water Resources Classification of nearest receiving water:*
Unnamed Tributary to Big Alamance Creek
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Cape Fear
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:*
Vacant Wooded Land intended for residential construction

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
File 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)
Click the upload button or drag and drop files here to attach document
File type must be pdf
4d. List the total estimated acreage of all existing wetlands on the property:
75 ft
4e. List the total estimated linear feet of all existing streams on the property:
(intermittent and perennial)
450 ft
4f. Explain the purpose of the proposed project:*
Driveway Crossings for 2 residential lots.
4g. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
Mini Excavator used to install driveway crossings
4h. Please upload project drawings for the proposed project.
Click the upload button or drag and drop files here to attach docurrent
Knightdale Dr Crossing Map.pdf 559.06KB
File type mist be pdf
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
r Yes r No r Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
O Preliminary C Approved r Unknown f N/A
Corps AID Number:
Example: SAWt-2017-99999
SAW 2018-00928
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
David Bailey
US Army Corps of Engineers
Sue Homewood / NCDWQ
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
May 10, 2018 and November 1, 2017 (NC)
5d1. Jurisdictional determination upload
Click the upload button or drag and drop files here to attach docurrent
2018-00928 Wetlands and Streams Sketch Map.pdf 402.44KB
File type mist be FDF
6. Project History
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past?*
f 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.
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
rJ Wetlands rJ Streams -tributaries r Buffers
r" 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 impact* 2b. Impact type * 2c. Type of wetland* 2d. Wetland name *2e. 2f. Type of 2g. Impact
Forested* Jurisdicition* area*
Driveway Crossing P Unknown WAII-WA11 Yes Both 0.020
Nbp label (e.g. Road Grossing 1 - Qalvert, Perrrenent (P) or (404, 10) or DJbR(401, (acres)
dewatering, etc) Temporary (T) other)
2g. Total Temporary Wetland Impact
0.000
2g. Total Permanent Wetland Impact
0.020
2g. Total Wetland Impact
0.020
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. Reason for impact*3b.lmpact
3c. Type of impact*3d. Stream name*
3e. Stream 3f. Type of
3g. Stream 3h. Impact s
Ifei
type*
Type* Jurisdiction*
width* length*
S1 Driveway Crossing P
Culvert Unnamed Trinutary
Perennial Both
3 450 1
rvbp label (e.g. Road Grossing F2rnanent(P)or
to Big Alamance
Perennial (FER)or
Average (linear feet)
1) Tenporary (T)
Creek
intermittent (INT)
(feet) 3
0
** All Perennial or Intermittent streams must be verified by DWR or delegated local government.
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
450
3i. Total temporary stream impacts:

0
3i. Total stream and tributary impacts:
450
3j. Comments:
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:*
Install Concrete Pipe with rip rap at ends with compacted fill and crush and run on top of fill.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Use mini excavator to place pipe and make minimal disturbance in the area.
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?
f Yes r 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?
f Yes r No
For a list of options to meet the diffuse flow requirements, click here.
If no, explain why:
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?
f Yes r No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?*
r Yes
f No
To look up low density requirement click here 15A NCAC 021-1.1003(2)
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 21-1.1300), or
DWR Surface Water or Wetland Standards or Riparian Buffer Rules (15A NCAC 2B.0200)?*
f Yes r No
2b. Is this an after -the -fact permit application?*
f Yes r 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?*
f Yes r No
3b. If you answered "no," provide a short narrative description.
1 Driveway crossing per lot for residential house.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
f Yes f• Nor N/A
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?*
f Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
f Yes r No
5d. Is another Federal agency involved?*
f Yes r No r Unknown
5e. Is this a DOT project located within Division's 1-8?*
t' Yes f• No
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?
r Yes r No
5g. Does this project involve bridge maintenance or removal?
r Yes f• 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 r 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.?
f Yes r No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
NA
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
f Yes r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*

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)?*
f Yes IT No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
NA
7c. Historic or Prehistoric Information Upload
Click the upload button or drag and drop files here to attach docunent
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?*
f Yes C No
8c. What source(s) did you use to make the floodplain determination?*
NA
Miscellaneous
Miscellaneous attachments not previously requested.
Click the upload button or drag and drop files here to attach docunent
Knightdale Drive Crossings.pdf 33.29KB
File mist be FDF or KNE
Signature
V 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:*
Kristin M Foust
Signature a,
��f
Date Submitted:
5/22/2018
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
f No
BIMS # Assigned*
20180702
Version#*
Reviewing Office*
Winston-Salem Regional Office - [phone]
Select Project Reviewer*
Sue Homewood:eads\slhomewood
Is a payment required for this project?*
f No payment required
f Fee received
r Fee needed - send electronic notification
What amout is owed?*
f $240.00
r $570.00