20100844 Ver 1_Application_20101013

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Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification C Form
A. Applicant Information
C Processing
1a. Type(s) of approval sought from the

Corps:

Section 404 Permit E] Section 10 Permit
®
16. Specify Nationwide Permit (NWP) number: 3 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
le. 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
1.h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ? Yes ® No
2. Project Information
2a. Name of project: NI-2090 Existing Box Culvert Replaced By Proposed Pipe
2b. County: Beaufort
2c. Nearest municipality / town: Washington
2d. Subdivision name: N/A
2e. NCDOT only, T.I.P. or state
project no: 28.200711
_
3. Owner Information
3a. Name(s) on Recorded Deed: North Carolina Department of Transportation
3b. Deed Book and Page No. N/A
3c.
I Responsible Party (for LLC if
applicable): N/A
3d. Street address: 105 Pactolus Highway NC 33 P.O. Box 1587
3e. City, state, zip: Greenville, NC 27835
3f. Telephone no.: 252-830-3490
3 g. Fax no.: 252-830-3341
3 h. Email address: [e-mail]
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Page 1 of 11 Ww??,??_pg lu
PCN Form -Version 1.3 Decemti sk4iD gs on
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4,. Applicant Information (if different from owner)
4-a. Applicant is: ? Agent ® Other, specify: Division 2 Environmental Officer
4b. Name: Jay B. Johnson
4c. Business s name
{if applicable):
North Carolina Depratment of Transportation
Ad. Street address: P.O. Box 1587
4e. City, state, zip. Greenville, NC 27835
4f. Telephone no.: 252-830-3490
4g. Fax no.: 252-830-3341
4h. Email address: [e-mail]
5. Agent(Consultant Information (if applicable)
5a. Name: NIA
5b. Business name
(if applicable):
5c. Street address:
5d. City, state, zip:
Se. Telephone no.:
5F. Fax no.:
5g. Email address:

a

IB. Project Information and Prior Project History
1. Property Identification
la. Property identification no. (tax PIN or parcel ID): N/A
Latitude: N 35.553064 Longitude: - W
lb. Site coordinates (in decimal degrees): 77.016152
(DD.DDDDDD) (-DD.DDDDDD)
1c. Property size: N/A acres
:2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to Runyon Creek
proposed project:
2b. Water Quality Classification of nearest receiving water. C;NSW
)c. River basin: Tar-Pamlico
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:
Residential
3b. List the total estimated acreage of all existing wetlands on the property:
N/A
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
60' This site is part of a longer adjacent stream system
3d. Explain the purpose of the proposed project:
Box Culvert To Pipe Replacement ; the existing box culvert has deteoriated and needs replacing.
:3e. Describe the overall project in detail, including the type of equipment to be used:
The Existing 30' Long Box culvert will be replaced with a Proposed 84" x 50' CAAPA. Excavators,Dump Trucks,and
Crane Trucks will be used for the Bridge To Pipe Replacement.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property / ®Yes ? No ? Unknown
project (including all prior phases) in the past?
Comments:
4b. If the Corps made the jurisdictional determination, what type ? Preliminary ? Final
of determination was made?
Pfc. If yes, who delineated the jurisdictional areas? Agency/Consultant Company: NCDCM And NCDOT
Name (if known): Mr. Stephen Lane,NCDCM Mr. Jay B. Other:
Johnson,NCDOT
3d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
August 23, 2010
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
S. Future Project Plans
6a. Is this a phased project? ? Yes ®No
iib. If yes, explain.
Page 4 of 11
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
?. 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
W1 ? P ? T ? Yes ? Corps
? No ? DWQ
? P ? T
VV2 ? 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 ? PEI T ? Yes ? Corps
? No ? DWQ
2g. Total wetland impacts 0
2h. Comments: No 404 Wetland Impacts
3. Stream Impacts
It 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)
S1 [DP ? T ® PER
? INT ? Corps
? DWQ 10' 30'
S2 E] P E] T ? PER ? Corps
? INT ? DWQ
S3 ? P ? T ? PER ? Corps
? INT ? DWQ
S4 ? PEI T ? PER ? Corps
? INT ? DWQ
S5 ? P ? T ? PER ? Corps
? INT ? DWQ
S9 [] P ? T El PER E] Corps
I ? INT ? DWQ
31i. Total stream and tributary impacts 30'
3i'. Comments: 30 Linear Feet of Stream Impacts
Page 5 of 11
PCN Form - Version 1.3 December 10, 2008 Version
4. Open Water Impacts
If hare 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)
Permanent (P) or
Temporary
01 ?P?T
02 ?P?T
03 ?P?T
04 ?P?T
4L Total open water impacts None
4g. Comments: None
6. Pond or Lake Construction
If Pond or lake construction promWed, then complete 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
SL Total None
5g. Comments: None
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:
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 mitigation, then you MUST fill out Section D of this form.
6a.
® Neuse ?Tar-Pamlico ? Other. None
Project is in which protected basin? ? Catawba ? Randleman
6b. 6c. 6d. 6e. of. 6g.
Buffer impact
number- Reason Buffer Zone 1 impact Zone 2 impact
i Permanent (P) or for Stream name mitigation (square feet) (square feet)
Temporary im ct required?
B1 ®P ? T Pipe Runyon Creek ® No 485 Sq. Ft. 0 Sq. Ft.
s
62 ® PEI T Pipe Runyon Creek ® No 490 Sq. Ft. 0 Sq. Ft.
B3 ® P ? T Pipe Runyon Creek ® No 530 Sq. Ft. 0 Sq. Ft.
6h. Total buffer impacts
6i. Comments: See Page 6-A for Totals
Page 6 of 11
PCN Form -Version 1.3 December 10, 2008 Version
i
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)
Permanent (P) or
Temporary
01 ?P?T
02 ?P?T
03 ?P?T
.04 ?P?T
4f. Total open water impacts None
4g. Comments:
5. Pond or Lake Construction
If, pond or lake construction proposed, then complete the chart below.
53. 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
51: Total None
56. Comments: None
5h. Is a dam high hazard permit required?
? Yes ? No If yes, permit ID no:
5i ? Expected pond surface area (acres):
fij: Size of pond watershed (acres):
5k. Method of construction:
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 mitigation, then you MUST fill out Section D of this form.
6a.
? Neuse ®Tar-Pamlico ? Other. None
Project is in which protected basin? ? Catawba ? Randleman
6b' 6c. 6d. 6e. 6f. 6g.
Duffer impact
number- Reason Buffer Zone 1 impact Zone 2 impact
Permanent (P) or for Stream name mitigation (square feet) (square feet)
Temporary impact required?
81 SPOT Pipe B 4 Runyon Creek ®Nos 535 Sq. Ft. 0 Sq. Ft.
812 ?P?T s
?No
B3 ?P?T s
?No
6h. Total buffer impacts 2040 Sq. Ft. 0 Sq. Ft.
6i. Comments:
Paged 10
PCN Form -Version 1.3 December 10, 2008 Version
D. impact Justification and Mitigation
1. Avoidance and Minimization
'I a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Wetland Impacts have been minimized to the extent feasible, with impacts occurring only where necessary to accommodate
the Proposed Bridge, Telephone Line and Cable TV Lines.
'I b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Use of existing roadway to operate construction equipment; no equipment will enter wetlands.
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? ? Yes ® No
2b. If yes, mitigation is required by (check all that apply): ? DWQ ? Corps

2c. If yes, which mitigation option will be used for this

pro
project? ? Mitigation bank

? Payment to in-lieu fee program

? Pennittee Responsible Mitigation
a. Complete if Using a Mitigation Bank
2;a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter) Type Quantity
3c. Comments:
4, Complete if Making a Payment to Indieu 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:
5. Complete If Using a Perrnittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 7 of 11
PCN Form -Version 1.3 December 10, 2008 Version
6: Buffer Mitigation (State Regulated Riparian Buffer Rules) -required by DWQ
i
6#. Will the project result in an impact within a protected riparian buffer that requires ? Yes ® No
buffer mitigation?
66. 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.
6c. 6d. 6e.
Zone Reason for impact Total impact Multiplier Required mitigation
(square feet) (square feet)
Zime 1 3 (2 for Catawba)
Z(ine 2 1.5
6f. Total buffer mitigation required: None
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).
WA
6h. Comments:
i
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?
1b . If yes, then is a diffuse flow plan included? If no, explain why.
Comments: Sheet Flow through the Vegetated Shoulders and Silt Fence will be ® Yes ? No
used to treat Stormwater Run-Off From the Road.
2. Stormwater Management Plan
2a . What is the overall percent imperviousness of this project? N/A Roadway/Bridge Project %
2b . Does this project require a Stonmwater 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:
Diffuse Flow Through Vegetation and Special Silt Fences will be used to contain sed iment on the project as shown on
the plan sheet.
? 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? N/A
? Phase II
3b. Which of the following locally-implemented stonmwater management programs ? NSW
? USMP
apply (check all that apply): ? Water Supply Watershed
? Other: WA
3c. Has the approved Stormwater Management Plan with proof of approval been ? Yes ®No
attached?
4. DWQ Stomwater Program Review
® Coastal counties
? HQW
443. Which of the following state-implemented stormwater management programs apply ? ORW
(check all that apply): ? Session Law 2006-246
® Other. NPDES Permit
4t>. Has the approved Stormwater Management Plan with proof of approval been
attached? ? Yes ® No
5.1 DWQ 401 Unit Stormwater Review
5a.
i 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
attached?
5. DWQ 401 Unit Stormwater Review
i
5a
. Does the Stormwater Management Plan meet the appropriate requirements?
? Yes ? No
i
5b
. Have all of the 401 Unit submittal requirements been met?
? Yes ? No
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
la. Does the project involve an expenditure of public (federal/statellocal) funds or the ® Yes ? No
use of public (federal/state) land?
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 ? 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 21-1.1300), 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):
1 Cumulative Impacts (DWQ Requirement)
3ia. Will this project (based on past and reasonably anticipated future impacts) result in ? Yes ® No
additional development, which could impact nearby downstream water quality?
31). 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 10 of 11
PCN Form - Version 1.3 December 10, 2008 Version
1
6. Endangered Species and Designated Critical Habitat (Corps Requirement)
1
a. Will this project occur in or near an area with federally protected species or
? Yes
® No
habitat?
I
5b. Have you checked with the USFWS concerning Endangered Species Act

? Yes ®No
impacts?
5c. If yes, indicate the USFWS Field Office you have contacted. E] Raleigh
? Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
Mr. Stephen Lane,NCDCM and Mr. Garcy Ward,NCDWQ
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? ® Yes ? No
61b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
On-Site Investigation
T. Historic or Prehistoric Cultural Resources (Corps Requirement)
7ia. 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)?
71). What data sources did you use to determine whether your site would impact historic or archeological resources?
NCSHPO
8! Flood Zone Designation (Corps Requirement)
8.•). Will this project occur in a FEMA-designated 100-year floodplain? ® Yes ? No
8ti. If yes, explain how project meets FEMA requirements: Pipe designed to no-rise standards
8c. What source(s) did you use to make the floodplain determination? FEMA FIRM Maps
Jay B. Johnson October 6,
2010
ApplicanUAgenYs Printed Name Ap cag
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Michael W
Lane, Stephen
Monday, August 23, 2010 3:36 PM
Sutton, Michael W
Johnson, Jay B; Casey, Timothy J
RE: Beaufort County Pipes on SR1501
Hil Mike,
Ilhave visited Sites 1 and 2 on SR1501 as described in Randy Boyd's July 1, 2010 Memo and
determined that they are both outside of any CAMA AEC's and therefore will not require a
permit from DCM. Please let me know if I may be of any further assistance with these
projects.
Sincerely,
Stephen Lane
Coastal Management Representative
--?---Original Message-----
From: Sutton, Michael W
Sent: Tuesday, August 03, 2010 10:27 AM
To: Lane, Stephen
Cc: Johnson, Jay B; Casey, Timothy J
Subject: Beaufort County Pipes
Good Morning Mr. Stephen.... Hope all is well in your world today.... Division 2 has 2 pipe
replacements in Beaufort County,NC and we would like to get a CAMA Jurisdictional call on
tl?iem...attached are maps for your use.... if you have any questions,call me at
252-830-3490..... Many Thanks ...mike
i
Einail correspondence to and from this sender is subject to the N.C. Public Records Law and
may be disclosed to third parties.
NON-NBIS 2090
REPLACE 3'x 2.5'x 30' RCBC WITH 84 "x50' CAAPA
SR 1501, HIGHLAND DRIVE/OLD BATH HIGHWAY
OVER RU.NYON CREEK
WASHINGTON USGS QUAD M4P
SHEET NUMBER 6 OF THE SOIL SURVEY OFBEAUFORT COUNTY
TAR-PAMLICO RIVER BASIN C;NSW
FIRM PANEL 5696 PAMLICO 03020104
MAP NUMBER 3720569600J OCTOBER 6, 2010
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PIPE NUMBER 2090
Y= 662112.1723
X= 2590033.2138
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W 77.016152 DEGREES
1 inch = 2,000 feet
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Feet

. NON-NBIS 2090-
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OVER RUNYON CREEK
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SHEET NUMBER 6 OF THE SOIL SURVEY OF BEAUFORT COUNTY
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FIRM PANEL 5696 PAMLICO 03020104
MAP NUMBER 3720569600J OCTOBER 6, 2010
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NON-NBIS 2090
REPLACE 3'x 2.5'x 30' RCBC WITH 84 "x50' CAAPA
SR 1501, HIGHLAND DRIVE/OLD BATH HIGHWAY
OVER RUNYON CREEK
WASHINGTON USGS QUAD MAP
SHEET NUMBER 6 OF THE SOIL SURVEY OF BEA UFORT COUNTY
TAR-PAMLICO RIVER BASIN CASW
FIRM PANEL 5696 PAMLICO 03020104
MAP NUMBER 3720569600J OCTOBER 6, 2010
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