20191188 Ver 1_PCN-Form-v1_3 Dec 2008_20190903

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Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Page 1 of 13
PCN Form — Version 1.3 December 10, 2008 Version
Pre -Construction Notification (PCN) Form
A.
Applicant Information
1.
Processing
1 a.
Type(s) of approval sought from the
Corps:
®Section 404 Permit El Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: 18 or General Permit (GP) number:
1c.
Has the NWP or GP number been verified by the Corps?
® Yes
❑ No
1d.
Type(s) of approval sought from the DWQ (check all that apply):
® 401 Water Quality Certification — Regular ❑ Non -404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ® Riparian Buffer Authorization
1e.
Is this notification solely for the record
because written approval is not required?
For the record only for DWQ 401
Certification:
❑ Yes ® No
For the record only for Corps Permit:
❑ Yes ® 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
® No
1h.
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
® No
2.
Project Information
2a.
Name of project:
Finch Mill
2b.
County:
Wilson
2c.
Nearest municipality / town:
Wilson
2d.
Subdivision name:
N/A
2e.
NCDOT only, T.I.P. or state
project no:
3.
Owner Information
3a.
Name(s) on Recorded Deed:
William McKinley Finch and Shirley Jean Finch
3b.
Deed Book and Page No.
1121/46
3c.
Responsible Party (for LLC if
applicable):
3d.
Street address:
5264 Mamie Rd
3e.
City, state, zip:
Wilson, NC 27893
3f.
Telephone no.:
3g.
Fax no.:
3h.
Email address:
Page 1 of 13
PCN Form — Version 1.3 December 10, 2008 Version

4.
Applicant Information (if different from owner)
4a.
Applicant is:
❑ Agent ® Other, specify: Tower Owner/Project Proponent
4b.
Name:
American Tower Corporation
4c.
Business name
(if applicable):
See above
4d.
Street address:
10 Presidential Way
4e.
City, state, zip:
Woburn, MA 01801
4f.
Telephone no.:
4g.
Fax no.:
4h.
Email address:
5.
Agent/Consultant Information (if applicable)
5a.
Name:
Tower Engineering Professionals, Inc.
5b.
Business name
(if applicable):
TEP OpCo, LLC.
5c.
Street address:
326 Tryon Rd
5d.
City, state, zip:
Raleigh, NC 27603
5e.
Telephone no.:
919-661-6351
5f.
Fax no.:
919-661-6350
5g.
Email address:
[e-mail]
Page 2 of 13

B.
Project Information and Prior Project History
1.
Property Identification
1a.
Property identification no. (tax PIN or parcel ID):
2782 98 7069 000
1 b.
Site coordinates (in decimal degrees):
Latitude: 35.74786111 Longitude: - 78.0201
(DD.DDDDDD) (-DD.DDDDDD)
1 c.
Property size:
59.27 acres
2.
Surface Waters
2a.
Name of nearest body of water (stream, river, etc.) to
Shepard Branch
proposed project:
2b.
Water Quality Classification of nearest receiving water:
WS -IV; NSW
2c.
River basin: map is available at
Neuse River Basin
http://h2o.enr.state.nc.us/admin/maps/
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:
Cleared land, forested land, and an existing guyed communications tower and associated access road.
3b.
List the total estimated acreage of all existing wetlands on the property:
The assessed area includes the existing 50 -ft x 50 -ft fenced communications tower compound, —12 -ft x 1,100 -ft
access drive, three —20 -ft x —200 -ft guy anchor alleys, a 30 -ft buffer surrounding the aforementioned areas, and an
assessment 50 -ft up and down -stream of an existing stream crossing. Within this assessed area, three (3) potential
forested wetland areas were delineated in the immediate vicinity of the stream (described in 3c), and three (3)
potential herbaceous wetland areas were delineated in the vicinity of the southwestern and southeastern guy
anchor alleys. Within the assessed area, these delineated wetland features total approximately 0.55 acres.
3c.
List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
Within the assessed area, a potential perennial stream was delineated from 0 to 50 -ft up and down -stream of an
existing stream crossing approximately 750 -ft south-southwest of the existing tower.
3d.
Explain the purpose of the proposed project:
The purpose of the proposed project is the replacement of two (2) culverts within a stream crossing and the replacement
of two (2) culverts with a pipe arch along an existing access road associated with an existing guyed communications
tower in order to minimize impacts to stream flow and minimize erosion of improvement features into adjacent water
courses.
3e.
Describe the overall project in detail, including the type of equipment to be used:
Phase 1: Beginning of road work and bulk grading. The contractor will blade the existing road to match cross slope.
Capture and reuse of existing stone will occur where feasible. A stretch of access road is to be repaired, two (2) existing
12 -inch CMP culverts are to be replaced with 20LF of 18 -inch HDPE, and two (2) existing 24 -inch RCP culverts are to be
removed and replaced with a 49 -in x 33 -in x 20 -in pipe arch. Banks around the proposed culvert removal will be stabilized
with rip rap and a temporary pump line and sandbags will be employed to allow for continuity of stream flow.
Phase 2: Construction of the access road. Install surface course to match depth and cross slopes. Apply shortcrete on
slopes of new road. Compaction shall be with sheepsfoot roller or rubber -tired rollers weighing at least eight tons for base
course and smooth drum vibrator rollers for surface coarse/finish grade.
Phase 3: Permanent seeding and stabilizing of all disturbed areas.
Page 3 of 13
PCN Form — Version 1.3 December 10, 2008 Version

4.
Jurisdictional Determinations
4a.
Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (including all prior phases) in the past?
Comments:
El Yes E] No ®Unknown
4b.
If the Corps made the jurisdictional determination, what type of
determination was made?
El Preliminary ❑ Final N/A
4c.
If yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
4d.
If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5.
Project History
5a.
Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
❑ Yes ❑ No ® Unknown
5b.
If yes, explain in detail according to "help file" instructions.
6.
Future Project Plans
6a.
Is this a phased project?
❑ Yes ® No
6b.
If yes, explain.
Page 4 of 13

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
® Wetlands ® Streams - tributaries ® Buffers
❑ Open Waters ❑ Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a.
2b.
2c.
2d.
2e.
2f.
Wetland impact
Type of jurisdiction
number —
Type of impact
Type of wetland
Forested
(Corps - 404, 10
Area of impact
Permanent (P) or
(if known)
DWQ — non -404, other)
(acres)
Temporary T
W1 ®P ❑ T
Permanent fill
® Yes
❑ No
® Corps
® DWQ
0.001
W2 ❑ P ®T
Disturbance
® Yes
❑ No
® Corps
® DWQ
0.001
W3 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W4 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W5 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W6 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
2g. Total wetland impacts
0.002
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.
3b.
3c.
3d.
3e.
3f.
3g.
Stream impact
Type of impact
Stream name
Perennial
Type of jurisdiction
Average
Impact
number -
(PER) or
(Corps - 404, 10
stream
length
Permanent (P) or
intermittent
DWQ — non -404,
width
(linear
Temporary (T)
(INT)?
other)
(feet)
feet)
142-ft2/02-y3 soil
Unnamed
® PER
® Corps
S1 ®P ❑ T
removed below
tributary of
❑INT
®DWQ
8
30.0
OHWM
Shepard Branch
S2 ❑ P ®T
3.0-y3 temporary
Unnamed
tributary of
PER
®Corps
g
30.0
stream fill
Shepard Branch
❑INT
®DWQ
S3 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S4 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S5 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S6 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
3h. Total stream and tributary impacts
30 -ft
3i. Comments: Impacts are confined to 30 total linear feet of stream
Page 5 of 13

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 im acts 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 ❑P❑T
02 ❑P❑T
03 ❑P❑T
04 ❑P❑T
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If pond or lake construction proposed, then 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
Flooded
P1
P2
5f. Total
5g. Comments:
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:
Page 6 of 13

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.
® Neuse ❑ Tar -Pamlico ❑ Other:
Project is in which protected basin?
❑ Catawba ❑ Randleman
6b.
6c.
6d.
6e.
6f.
6g.
Buffer impact
number —
Reason for
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P)
impact
Stream name
mitigation
(square feet)
(square feet)
or Temporary
required?
T
131 ®P ❑ T
Access rd
Unnamed tributary of
❑ Yes
1705.0
395.0
improvement
Shepard Branch
® No
B2 ❑ P ❑ T
❑ Yes
❑ No
B3 ❑P❑T
El Yes
❑ No
6h. Total buffer impacts
1705.0
395.0
6i. Comments: The majority of these impacts are within previously disturbed/non-vegetative areas.
Page 7 of 13

D.
Impact Justification and Mitigation
1.
Avoidance and Minimization
1a.
Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
The proposed action was designed to include sufficient improvements to the existing access road and stream crossing
while minimizing impacts to surface water features as much as possible. BMPs have been included in the design
processes and are described in detail in section D1 b.
b.
Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
During culvert removal, a sandbag and pump system will be employed to minimize impacts to stream flow. For access
road repair, geosynthetic fabric will be used during access road improvement to minimize runoff. For culvert installation in
flat areas, cut and fill slopes shall be stabilized immediately upon completion of roadway grading. These areas shall be
blanketed wherever they are located within 50 -ft of a surface water feature or where a suitable vegetative area does not
exist. Roadside ditches shall be provided with adequate protective lining or rip -rap wherever runoff cannot sheet flow
away from the roadway. Adequately sized culverts or other suitable cross drains shall be provided at seeps, springs, and
drainage courses. For rip rap outlet protection, geosynthetic fabric will be placed after topsoil removal and prior to placing
stone. Riprap will be extended on the backside of culvert aprons to at least'/ depth of pipe on both sides to prevent
scour around the pipe.
2.
Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a.
Does the project require Compensatory Mitigation for
❑ Yes ® No
impacts to Waters of the U.S. or Waters of the State?
2b.
If yes, mitigation is required by (check all that apply):
❑ DWQ ❑ Corps
❑ Mitigation bank
2c.
If yes, which mitigation option will be used for this
El Payment to in -lieu fee program
project?
❑ Permittee Responsible Mitigation
3.
Complete if Using a Mitigation Bank
3a.
Name of Mitigation Bank:
3b.
Credits Purchased (attach receipt and letter)
Type
Quantity
3c. 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:
❑ warm ❑ cool ❑cold
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:
Page 8 of 13
PCN Form — Version 1.3 December 10, 2008 Version

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.
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
buffer mitigation? If yes, you will have to fill out this entire form — please
contact the State for more information.
❑ Yes ® No
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.
Zone
6c.
Reason for impact
6d.
Total impact
(square feet)
Multiplier
6e.
Required mitigation
(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).
6h. Comments:
Page 9 of 13

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
® 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.
Comments: The proposed action consists of repairs to an existing culverted
crossing. The majority of buffer zone impacts are located within previously
disturbed/non-vegetated areas including the existing gravel access road and
existing culverted crossing as well as within the stream bed itself. In vegetated
❑ Yes ® No
areas, cut and fill slopes shall be stabilized immediately upon completion of
roadway grading. These areas shall be blanketed wherever they are located within
50 -ft of a surface water feature or where a suitable vegetative area does not exist.
When construction activities are completed, all disturbed areas will be permanently
seeded and stabilized. Impacts to the vegetative buffer area will be minimal.
2.
Stormwater Management Plan
2a.
What is the overall percent imperviousness of this project?
N/A %
2b.
Does this project require a Stormwater Management Plan?
❑ Yes ® No
2c.
If this project DOES NOT require a Stormwater Management Plan, explain why: Does not exceed disturbance threshold
and consists of improvements to existing impervious surfaces.
2d.
If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
❑ Certified Local Government
2e.
Who will be responsible for the review of the Stormwater Management Plan?
❑ DWQ Stormwater Program
❑ DWQ 401 Unit
3.
Certified Local Government Stormwater Review
3a.
In which local government's jurisdiction is this project?
Wilson County
❑ 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
attached?
❑ Yes ❑ No
5.
DWQ 401 Unit Stormwater Review
Page 10 of 13
PCN Form — Version 1.3 December 10, 2008 Version

C. Stormwater Management and Diffuse Flow Plan (required by DWQ), continued
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 11 of 13

F.
Supplementary Information
1.
Environmental Documentation (DWQ Requirement)
1a.
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
❑ Yes ❑ No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
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 NEPA or SEPA final approval
letter.)
❑ Yes ❑ No
Comments:
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,
❑ Yes ® No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b.
Is this an after -the -fact permit application?
❑ Yes ® No
2c.
If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3.
Cumulative Impacts (DWQ Requirement)
3a.
Will this project (based on past and reasonably anticipated future impacts) result in
❑ Yes ® 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.
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.
N/A
Page 12 of 13
PCN Form — Version 1.3 December 10, 2008 Version

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
® Yes ❑ No
impacts?
® Raleigh
5c. If yes, indicate the USFWS Field Office you have contacted.
❑ Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
USFWS Information, Planning, and Conservation System (IPaC) preliminary species list for Wilson County, NC and an
informal biological assessment completed by TEP.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat?
❑ Yes ® No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
USFWS Information, Planning, and Conservation System (IPaC) preliminary species list for Wilson County, NC and an
informal biological assessment completed by TEP.
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?
This project occurs in a previously disturbed area.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA -designated 100 -year floodplain?
❑ Yes ® No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination? FEMA Firm panel 3720279200K dated April 16, 2013
Ryan Malek
�. 't'
8/30/2019
Applicant/Agent's Printed Name
Date
Applicant/Agent's Signature
(Agent's signature is valid only if an authorization letter from the applicant
isprovided.)
Page 13 of 13