20180849 Ver 1_401 Application_20180615

Action History (UTC -05:00) Eastern Time (US & Canada)
Submit by Anonymous User 6/15/2018 10:46:55 AM (Start Event)
Accept by Montalvo, Sheri A 6/20/2018 10:02:42 AM (Non DOT Initial Review)
The task was assigned to Montalvo, Sheri A. The due date is: June 20, 2018 5:00 PM
6/15/2018 10:48 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%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?*
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?*
IJ Nationwide Permit (NWP)
r Regional General Permit (RGP)
r 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.
Nationwide Permit (NWP) Number: 12 - Utility Lines
Nationwide Permit (NWP) Number: 13 - Bank Stabilization
NWP Number Other:
List all MN nunbers you are applying for not on the drop down list.
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 IJ Riparian Buffer Authorization
F- Individual Permit
*
1d. Is this notification solely for the record because written approval is not required?
For the record onlyfor DWR 401 Certification: r Yes G No

For the record only for Corps Permit:
r Yes r No
1e. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
ff so, attach the acceptance letter from n itigation bank or in -lieu fee program
f Yes r No
1f. Is the project located in anyof NC's twenty coastal counties?*
O Yes r No
1h. Is the project located in a designated trout watershed?*
f Yes r No
Link to trout information: http://wvvw.saw.usace.army.mil/Missions/Regulatory-Permit-ProgranVAgency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact?*
Eric Kulz
1b. Primary Contact Email:*
Eric. [e-mail]
1c. Primary Contact Phone:*
(XXX)XXX-XXXX
[phone]
1d. Who is applying for the permit?
r Owner V Applicant (other than owner) r Agent/Consultant
(Check all that apply)
2. Owner Information
2a. Name(s) on recorded deed:
200 Cornerstone LLC
2b. Deed book and page no.:
17031/2430
2c. Responsible party:
(for Corporations)
Eric Kulz (Town of Cary Easement)
2d. Address
Street Address
2509 Victoria Park Lane
Address Line 2
City State / Province/ Fbgion
Raleigh NC
Fbstal / Zip (ode Country
27614-6858
2e. Telephone Number:
(XXX)XXX-)D=
[phone]
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
2a. Name(s) on recorded deed:
Don Hammett Daycare, LLC c/o Knowledge Learning Corp

2b. Deed book and page no.:
10221/1897
2c. Responsible party:
(for Corporations)
Eric Kulz (Town of Cary Easement)
2d. Address
Street Address
Attn: Tax Dep
Address Line 2
PO Box 6760
City State / Province / Pegion
Portland OR
Postal / Zip Code Country
97228-6760
2e. Telephone Number:
(xxx)xxx-xxxx
[phone]
2f. Fax Number:
(XXX)xxx-xxxx
2g. Email Address:*
[e-mail]
2a. Name(s) on recorded deed:
The Buswell, LP
2b. Deed book and page no.:
14685/1198
2c. Responsible party:
(for Corporations)
Eric Kulz (Town of Cary Easement)
2d. Address
Street Address
1919 Napoli Drive
Address Line 2
City State/ Province/ Fbgion
Apex NC
Fbstal / Zip Code Country
27502-9662
2e. Telephone Number:
(xxx)xxx-xxxx
[phone]
2f. Fax Number:
(XXX)XXX-)O=
2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
3a. Applicant is:
r Agent
F Other Town of Cary - Work in TOC sanitary sewer easement.
IF other please specify.

3b. Name:
Eric Kulz
3c. Business Name:
(if applicable)
Town of Cary
3d. Address
Street Address
P.O. Box 8005
Address Line 2
City
Cary
Postal / Zip Code
27512-8005
3e. Telephone Number:
[phone]
(xXX)xxx-xxxx
3f. Fax Number:
(xxx)xxx-xxxx
3g. Email Address:*
[e-mail]
State / Province/ Region
NC
Country
USA
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Quarrystone Sanitary Sewer Repair/Stabilization
1b. Subdivision name:
(if appropriate)
Cornerstone
1c. Nearest municipality/ town:*
Cary
1d. Driving directions*
If it is a new project and can not easily be found in a GPS napping system Pease provide directions.
From Downtown Cary travel west on West Chatham St to traffic circle. Continue west on Old Apex Rd to High House Rd. Turn right on High
House Rd and travel west to Davis Dr. Turn left on Davis Dr and take first right onto Cornerstone Dr. Turn left on Quarrystone Cir to cul-de-
sac. Site is on right behind businesses.
2. Project Identification
2a. Property Identification Number:
(tax PN or parcel ID)
0206711, 0270789, and 0378102
2b. Property size:
(in acres)
4.34, 1.86, and 1.04 acres
2c. Project Address

Street Address
200 Cornerstone Dr, 250 Cornerstone Dr, and 151 Quarrystone Cir
Address Line 2
City State/ Province/ Region
Cary NC
Postal / Zip Code Country
27502
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:*
35.786976 -78.848984
ex: 34.208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Turkey Creek
3b. Water Resources Classification of nearest receiving water:*
QNSW
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:*
Project area is within a sanitary sewer easement behind commercial properties within a commercial business park.
Properties to the south consist of single-family residences
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)
(]ick the upload button or drag and drop files here to attach document
Figure 2 - USGS.pdf 162.62KB
File type must 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)
Gick the upload button or drag and drop files here to attach document
Figure 3 - NRCS.pdf 237.96KB
File type must be pdf
4d. List the total estimated acreage of all existing wetlands on the property:
Unknown
4e. List the total estimated linear feet of all existing streams on the property:
(intermittent and perennial)
500 LF
4f. Explain the purpose of the proposed project:*
Emergency repair of ruptured sewer line partially within the bed of a stream, relocation of a portion of the stream
into a relict channel, and stabilization of remaining stream bank within sewer easement..

4g. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:
The project involves removal of approx 260 LF of PVC sewer line, and replacement with ductile iron pipe. The
project also involved diverting flowfrom 85 LF of eAsting relict channel into a relic channel, moving the flowaway
from the sewer line. The old channel was filled, and the remaining eAsting channel banks wer reshaped and
stabilized. Equipment included trackhoes and dump trucks.
4h. Please upload project drawings for the proposed project.
Qick the upload button or drag and drop files here to attach docurrent
Figure 1 - Aerial Photo.pdf
292.85KB
Quarrystone-pre construction. pdf
461.78KB
Qu arrystone- Post Construction. pdf
507.64KB
Quarrystone Impacts Map.pdf
789.91 KB
File type mist be pdf
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes G No r Unknown
Comments:
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:
Exanple: 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.
5dl. Jurisdictional determination upload
Qick the upload button or drag and drop files here to attach docurrent
File type mast be FDF
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 C 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

Ia. Where are the impacts associated with your project? (check all that apply):
F Wetlands V Streams -tributaries fJ Buffers
F- Open Waters r Pond Construction
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 sgfe
type*
Type*
Jurisdiction*
width*
length*
No 2,100
S1 Relocation of
P Fill Turkey Creek
Perennial
Both
10
85
8
flow/channel fill
F2rnanent(P)or
Perennial (F9P)or
Average
(linear feet)
5
Nbp label (e.g. Foad Grossing
Tenporary (T)
internittent (INT)
(feet)
0
1)
S2 Streambank
T Stabilization Turkey Creek
Perennial
Both
10
160
1
stabilization
F2rnanent (F) or
Perennial (FHS or
Average
(linear feet)
Nbp label (e.g. Road Grossing
Tenporary (T)
internittent (INT)
(feet)
6
1)
n
** 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:
85
3i. Total temporary stream impacts:
160
3i. Total stream and tributary impacts:
245
3j. Comments:
A total of 85 linear feet of stream channel was filled for the purpose of relocating the stream flow into a relic
channel and away from the sewer line. The length of the "restored" channel is 120 LF.
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.
V Neuse r Tar -Pamlico
F- Catawba F Randleman
r- Goose Creek r- Jordan Lake
F 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 Turkey Creek
No 2,100
225
Location and Exempt, Allowable, allowable w/ F2rrranent (Fj or
(square feet)
(square feet)
mtigation
Tenporary (T)
6h. Total buffer impacts:
.................
Zone 1 Zone 2
Temporary impacts:
0.00 0.00

Zone 1 Zone 2
Permanent impacts: 2,100.00 225.00
Zone 1 Zone 2
Total buffer impacts: 2,100.00 225.00
6i. Comments:
Impacts associated with streambank stabilization to protect sewer line. Impacts shown on previously uploaded
figure.
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
Qick the upload button or drag and drop files here to attach docurnxA
File mist be FDF
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 project involves repair of an existing sewer line, realignment of a portion of the stream into a relict channel to
move away from the sewer line, and stabilization of the remaining stream within the easement. Impacts from
realignment are temporary and due to differences in length of existing and relict channel. Riprap was limited to
areas where the stream could erode and affect the sewer line in the future.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Use of silt fence and tree protection fence. Pump -around was used during repair and realignment.
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?
r Yes F No
For a list of options to meet the diffuse flow requirements, click here.
If no, explain why:
Surface contours will be restored to pre -project elevations.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250? *
f Yes C 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 look up 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, exemptions, or grandfathering from state or locally implemented stormwater programs or projects that satisfy state or locally-irrplerrented stormwater programs
through use of comrunity 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 f Antidegradation
Plan Calculations
3b. Stormwater Management Plan: If submitting a SMP for review and approval, it shall complywith the high-density development
requirements set forth in 15ANCAC 02H .1003. Include all appropriate stormwater control measure supplemental forms and associated
items.
Click the upload button or drag and drop files here to attach docurrent
Stormwater.pdf 6.73KB
FILE TYPE MUST 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).
Click the upload button or drag and drop files here to attach document
RLE TYPE NUSTBEPDF
G. Supplementary Information
1. Environmental Documentation
la. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land? *
r Yes r 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)?*
r Yes r No
Comments:*
15A NCAC 01 C .0407 states that standard maintenance/repair activities do not require filing of environmental
documents. (3) specifies ebsting utilities.
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 r No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
Emergency repair to replace a ruptured sewer line.
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.
Replacing and ebsting sewer line with a new line of the same diameter/capacity.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
f Yes r 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?*
C 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?
f 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)?'
f 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.?
r Yes r No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
NCNHP website (5/4/18) and USFWS iPac website (5/4/18).
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?*
Project area is not located within the 20 coastal counties
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 r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*

NC Historic Protection Office HPOWEB Service (accessed 5/4/18). No elements on or near the project site.
7c. Historic or Prehistoric Information Upload
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File mist 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 6 No
8c. What source(s) did you use to make the floodplain determination?*
Map No. 3720076400K Firm Panel: 0764. date: 5/2/06.
Miscellaneous
Miscellaneous attachments not previously requested.
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Quarrystone Permit Photos.pdf 1.22MB
File rrust be FDF or IQv7
Signature
PF 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:*
Eric W. Kulz
Signatures -g
651-11 %rte • C�-
Date Submitted:
6/15/2018
Initial Review
Is this project a public transportation project?* (?
f Yes C No
Change only ff needed.
Has this project met the requirements for acceptance in to the review process?*
r Yes
f No
BIMS # Assigned *
20180849
Version#*

Reviewing Office*
Raleigh Regional Office - [phone]
Select Project Reviewer*
Stephanie Goss:eads\szgoss
Is a payment required for this project?*
r No payment required
r Fee received
r Fee needed - send electronic notification
What amout is owed?*
f $240.00
r $570.00