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HomeMy WebLinkAbout20150346 Ver 1_Application_20150408� O��F W ATFROG � � > y O �C Office Use Only: Corps action ID no. DWQ project no. Form Version 1.3 Dec 10 2008 Pre-Construction Notifcation PCN Form A. A licant Information 1. Processing 1 a. Type(s) of approval sought from the Corps: � Section 404 Permit ❑ Section 10 Permit 1 b. Specify Nationwide Permit (NWP) number: NW 3 or General Permit (GP) number: 1 c. Has the NWP or GP number been verified by the Corps? � Yes ❑ No 1 d. 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 1 e. Is this notification solely for the record For the record only for DWQ 401 For the record only for Corps Permit: because written approval is not required? Certification: � Yes ❑ No ❑ Yes � No 1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation � Yes � No of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu fee program. 1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h � Yes ❑ No below. 1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? � Yes ❑ No 2. Project Information 2a. Name of project: Salvo Pipe Replacements on NC 12 2b. County: Dare County 2c. Nearest municipality / town: Salvo 2d. Subdivision name: n/a 2e. NCDOT only, T.I.P. or state 1..1028111 project no: 3. Owner Information 3a. Name(s) on Recorded Deed: NCDOT R-O-W NC 12 - Dare County 3b. Deed Book and Page No. 3c. Responsible Party (for LLC if applicable): 3d. Street address: 3e. City, state, zip: 3f. Telephone no.: 3g. Fax no.: 3h. Email address: Page 1 of 11 PCN Form — Version 1.3 December 10, 2008 Version 4. Applicant Information (if different from owner) 4a. Applicant is: ❑ Agent � Other, specify: Division 1 Environmental Specialist 4b. Name: Paul Williams 4c. Business name (if applicable): 4d. Street address: 113 Airport Drive Suite 100 4e. City, state, zip: Edenton, N.C. 27932 4f. Telephone no.: 1-252-482-1861 cell phone 1-252-333-9812 4g. Fax no.: 1-252-482-8722 4h. Email address: pcwilliams2@ncdot.gov 5. Agent/Consultant Information (if applicable) 5a. Name: 5b. Business name (if applicable): 5c. Street address: 5d. City, state, zip: 5e. Telephone no.: 5f. Fax no.: 5g. Email address: Page 2 of 11 PCN Form — Version 1.3 December 10, 2008 Version B. Project Information and Prior Project History 1. Property Identification 1a. Property identification no. (tax PIN or parcel ID): n/a Latitude: 35.55140° 1 b. Site coordinates (in decimal degrees): Longitude: - 75.46875° (DD.DDDDDD) (-DD.DDDDDD) 1 c. Property size: 0.1 acres 2. Surface Waters 2a. Name of nearest body of water (stream, river, etc.) to Pamlico Sound proposed project: 2b. Water Quality Classification of nearest receiving water: SA;HQW 2c. River basin: Pasquotank 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: Project area consist of NCDOT NC HWY 12 in Dare County. Adjacent properties are 1 residence and an undeveloped subdivision 3b. List the total estimated acreage of all existing wetlands on the property: <0.1 acres 3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 120 feet 3d. Explain the purpose of the proposed project: Replace (2) 18"X88' CMP's under NC HWY 12. The existing pipes are failing. 3e. Describe the overall project in detail, including the type of equipment to be used: The existing culverts will be replaced with (2) 24"X90' CAP's. Once the pipes are in place and back filled, a new roadway surface and grassed shoulder will be established. The banks will be stabilized following NCDOT erosion control BMP's. The work will be accom lished with excavator, backhoe, and dum trucks. 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? � Yes � No ❑ Unknown Comments: 4b. If the Corps made the jurisdictional determination, what type of determination was made? ❑ Preliminary ❑ Final 4c. If yes, who delineated the jurisdictional areas? Name (if known): Paul Williams, Agency/Consultant Company: NCDOT Div. 1 Environmental Specialist 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 � Yes � No ❑ Unknown this project (including all prior phases) in the past? 5b. If yes, explain in detail according to "help file" instructions. Page 3 of 11 PCN Form — Version 1.3 December 10, 2008 Version 6. Future Project Plans 6a. Is this a phased project? ❑ Yes � No 6b. If yes, explain. Page 4 of 11 PCN Form — Version 1.3 December 10, 2008 Version C. Proposed Impacts Inventory 1. Impacts Summary 1 a. Which sections were compieted 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) Tem ora T W1 ❑ P 0 T ❑ Yes ❑ Corps ❑ No ❑ DWQ W2 ❑ P❑ T ❑ Yes ❑ Corps ❑ No ❑ DWQ 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 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 �mpact number - (PER) or (Corps - 404, 10 stream length Permanent (P) or intermittent DWQ — non-404, width (linear Temporary (T) (INT)? other) (feet) feet) fill - culvert � PER � Corps S1 � P❑ T extension unnamed tributary 4 2 ❑ INT ❑ DWQ S2 ❑ P❑ T ❑ PER ❑ Corps ❑ 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 2 3i. Comments: None Page5of11 PCN Form — Version 1.3 December 10, 2008 Version 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. 4a. 4b. 4c. 4d. 4e. Open water Name of waterbody impact number — (if applicable) Type of impact Waterbody type Area of impact (acres) Perm�nent (P) or Tem ora T 01 ❑POT 02 ❑P❑T 03 ❑P❑T 04 ❑P�T 4f. Total open water impacts 4g. Comments: None 5. Pond or Lake Construction If ond or lake construction ro osed, then com lete the chart below. 5a. 5b. 5c. 5d. 5e. Wetland Impacts (acres) Stream Impacts (feet) Upland Pond ID Proposed use or purpose (acres) number of pond Flooded Filled Excavated Flooded Filled Excavated Flooded P1 P2 Sf. Total 5g. Comments: none 5h. Is a dam high hazard permit required? ❑ Yes � No If yes, permit ID no: 5i. Expected pond surFace area (acres): n/a 5j. Size of pond watershed (acres): n/a 5k. Method of construction: n/a 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 an impacts require miti ation, then ou 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 Buffer Zone 1 impact Zone 2 impact Permanent (P) or for Stream name mitigation (square feet) (square feet) Tem ora T im act re uired? B1 ❑P❑T ❑Yes ❑ No B2 ❑ P ❑ T ❑ Yes ❑ No B3 ❑P❑T ❑Yes ❑ No 6h. Total buffer impacts 6i. Comments: none Page 6 of 11 PCN Form — Version 1.3 December 10, 2008 Version D. Impact Justification and Mitigation 1. Avoidance and Minimization 1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project. 1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques. NCDOT's LiMP's. 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 project? ❑ Payment to in-lieu fee program ❑ Permittee Responsible Mitigation 3. Complete if Using a Mitigation Bank 3a. Name of Mitigation Bank: n/a 3b. Credits Purchased (attach receipt and letter) Type Quantity 3c. Comments: n/a 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: n/a 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. n/a Page 7 of 11 PCN Form — Version 1.3 December 10, 2008 Version 6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ 6a. Wiil the project result in an impact within a protected riparian buffer that requires ❑ Yes � No buffer mitigation? 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 requfred. 6c. 6d. 6e. Zone Reason for impact Total impact Multiplier Required mitigation (square feet) (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). n/a 6h. Comments: n/a Page8of11 PCN Form — Version 1.3 December 10, 2008 Version 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: ❑ Yes ❑ No 2. Stormwater Mana ement Plan __ 2a. What is the overali 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: 2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan: NCDOT will follow best management practices for soil and erosion control in compliance with N.C. Sediment and Pollution Control Act and NCDOT NPDES permit. ❑ 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 governmenYs jurisdiction is this project? Dare County ❑ Phase II 3b. Which of the following locally-implemented stormwater management programs ❑ NSW apply (check all that apply): ❑ USMP ❑ Water Supply Watershed � Other: N/A 3c. Has the approved Stormwater Management Plan with proof of approval been ❑ Yes ❑ No attached? 4. DWQ Stormwater Pro ram 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: ncdot 4b. Has the approved Stormwater Management Plan with proof of approval been attached? ❑ Yes � No 5. DWQ 401 Unit Stormwater Review 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 9 of 11 PCN Form — Version 1.3 December 10, 2008 Version F. Supplementary Information 1. Environmental Documentation (DWQ Requirement) 1 a. 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)? 1 c. 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 finai approval letter.) ❑ Yes ❑ No Comments: 2. Violations (DWQ Requirement) 2a. Is the site in violation of DWQ Wetiand 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. . no waste water will be generated from this project Page 10 of 11 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 i m pacts? ❑ 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? NC Natural Heritage Database 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? National Marine Fisheries Database 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? NC State Historic Preservation Data 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: n/a 8c. What source(s) did you use to make the floodplain determinatio . N Flood Maps Paul Williams 4/1/2015 ApplicanbAgenYs Printed Name pplicant/Agent Signature Date (AgenYs signature is valid only if an authorization letter from the applicant is provided.) Page 11 of 11 PCN Form — Version 1.3 December 10, 2008 Version