20110817 Ver 1_Application_20110902

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- Corps action ID no.
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I r r I 11081.7 DWQ project no.
Form Version 1.3 Dec 10 2008
Pr Construction Notification C Form
A. Applicant Information
1. Processing
1 a . Type(s) of approval sought from
Corps: non-reporting the

Section 404 Permit C] Section 10 Permit
I
1 b . Specify Nationwide Permit (NWF P number: NWP 3 or General Permit (GP) number:
1c, Has the NWP or GP number be en verified by the Corps? ? Yes ® No
Id . Type(s) of approval sought from
® 401 Water Quality Certificati
? 401 Water Quality Certificatio the DWQ (check all that apply):
- Regular ? Non-404 Jurisdictional General Permit
n - Express ? Riparian Butler Authorization
le. Is this notification solely for the
because written approval is not rd
, uired? For the record only for DWQ 401

® Yes ? No For the record only for Corps Permit:

® Yes ? No
1f. Is payment into a mitigation ban
of impacts? If so, attach the acc
fee program. k or in-lie a program sed for mitigation
eptance letter mitigation bank or in-lieu ? Yes ® No
1g. Is the project located in any of N
below. C's twenty coastal counties. If yes, answer 1h ? Yes ® No
1h. Is the project located within a N DCM Area of Environmental Concern (AEC)? ? Yes ® No
2. Project Information
2a. Name of project: Proposed extension of a cross line conveying an unnamed tributary to Michael Creek
on SR 1337 Robert Rowland Road)
2b. County: Vance
2c. Nearest municipality / town: Stovall
2d. Subdivision name: N/A
2e. NCDOT only, T.I.P. or state
project no:
3. Owner Information
3a. Name(s) on Recorded Deed: NCDOT Division 5 p
3b. Deed Book and Page No. N/A
3c. Responsible Party (for LLC if
applicable):
WA SFp
3d. Street address: 2612 N. Duke Street OEN<._.
3e. City, state, zip: Durham, NC 27704
3f. Telephone no.: [phone]
3g. Fax no.: [phone]
3h. Email address: wbowmanoncdot.cov
4. Applicant Information (If diffe nt from owner) N/A
5. Agent/Consultant Information If applicable) N/A
I
i
Page 1 of 8
PCN Form - Version 1.3 December 10, 2008 Version
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B. Project Information and Prio r Project History
1. Property Identification
1a. Property identification no. (tax IN or parcel ID): N/A
1b. Coordinates (in decimal degree s):
Site: Latitude:36.4365 Longitude: -78.5052
(DD. DDDDDD) (-DD.DDDDDD)
1c. Property size: < 0.01 acres
2. Surface Waters
2a. Name of nearest body of water tream, river, etc.) to Michael Creek
proposed project:
2b. Water Quality Classification of n earest receiving water. C
2c. River basin: Roanoke
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:
The existing structure is too sho for the fill section which is a slope stability concern. Site is surrounded by wooded and
agricultural lands.
3b. List the total estimated acreage f all existing wetlands on the property:
NONE
3c. List the total estimated linear fee of all existing streams (intermittent and perennial) on the property:
60 ft
3d. Explain the purpose of the p roposed project: The pipe extension will allow for an adequate and more stable fill slope
at this crossing.
3e. Describe the overall project in d tail, including the type of equipment to be used:
8 feet of pipe will be added to the inlet end of this structure. The area will then be back filled to provide an adequate
slope section. Rip rap will be in tailed underlined with filter fabric for long term stability surrounding the mouth of the pipe
extension. Equipment me inCIL de a backhoe an excavator, and grader.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or str eam determinations by the
Corps or State been requested ci r obtained for this property / ? Yes ®No ? Unknown
project (including all prior phase ) in the past?
Comments: N/A
4b. If the Corps made the jurisdictio al determination, what type
? Preliminary ? Final
of determination was made?
4c. If yes, who delineated the jurisdi Tonal areas? Agency/Consultant Company: WA
Name (if known): N/A I t I Other. N/A
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
N/A
S. Project History
5a. Have permits or certifications bee n requested or obtained for ? Yes ® No ? Unknown
this project (including all prior ph ases) in the past?
5b. If yes, explain in detail according to 'help file' instructions.
N/A
Page 2 of 8
PCN Form - Version 1.3 December 10, 2008 Version
I
Y
6. Future Project Plans
6a. Is this a phased project? ? Yes ®No
6lb If yes, explain.
N/A
C. Proposed Impacts Inventory
1. Impacts Summary
la. Which sections were completed below for your project (check all that apply):
? Wetlands ® Stream - tributaries ? Buffers
? Open Waters ? Pond C onstruction
2. Wetland Impacts
If there are wetland impacts propose d 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 impa ct Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWQ - non404, other) (acres)
Temporary
Wt ? P ? T N/A N/A ? Yes ? Corps WA

? No
? DWQ _
2g. Total Wetland Impacts: NONE
2h. Comments: WA
3. Stream Impacts
If there are perennial or intermittent am impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted .
3a. 3b. 3c. 3d. 3e. 3f. 39.
Stream impact Type of imps 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 M (INT)? other) (feet) feet)
Site 1 ® P ? T fill UT to ? PER ® Corps

Stream 1
Michael Creek
® INT
® DWQ 2 8
SRe 1 ®P ? T ri UT to ? PER ® Corps

Stream 1 p rep
Michael Creek
® INT
® DWQ 2 5
Site l ? POT dewatering to ? PER ® Corps 2 28
Stream 1 Michael Creek ® INT ® DWQ
3h. Total stream and tributary Impacts 28
3i. Comments: rip rep will be placed n banks (up to 5ft upstream), not within the flow line
4. Open Water Impacts
If there are proposed impacts to lak , ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list all open ter impacts below.
4a. 4b. 4c. 4d. 4e.
Open water impact Name of water dy
number- (if applicable Type of im
pact
Waterbody type
Area of impact (acres)
Permanent (P) or
Temporary
01 ? P ? T N/A WA N/A N/A
4f. Total open water Impacts NONE
4g. Comments: N/A

Page 3 of 8
PCN Forth - Version 1.3 December 10, 2008 Version

S. Pond or Lake Construction
If and or lake construction roos
, then complete the chart below.
5a.

Pond ID 5b.

Proposed use or purpo

se of 5c.
Wetland Impacts (acres) 5d.
Stream Impacts (feet) 5e.
Upland
(acres)
number pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1 NIA N/A WA N/A N/A N/A NIA N/A
P2
5f. T otal NONE NONE NONE NONE NONE NONE NONE
5g. Comments: NIA
5h. Is a dam high hazard permit req ired?
? Yes No If yes, permit ID no: N/A
5i. Expected pond surface area (ac s): 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 ripa
below. If an impacts require mi
an buffer, then complete the chart below. If yes, then Individually list all buffer impacts
i ation, then you MUST fill out Section D of this form.
6a.

Project is in which protected basin?
® Neuse ?Tar-Pamlico ? Other.
? Catawba ? Randleman
6b.
Buffer impact
number-
Permanent (P) or
Temporary 6c.

Reason for
impact 6d.

Stream name Be.

Buffer
mitigation
required? 6f.

Zone 1 impact
(square feet) 6g.

Zone 2 impact
(square feet)
Site ? P ? T
Buffer Impact 1 N/A N/A ? Yes
? No N/A NIA

6h. Total buffer Impacts N/A N/A
6i. Comments: project site is within Ro anoke River Basin
D. Impact Justification and Mitiga on
1. Avoidance and Minimization
la. Specifically describe measu
The impacts to the stream are minim
pipe end. This extension cannot be s taken to avoid or minimize the proposed impacts in designing project.
I to add 2 pipe joints and maintain a dry work area if necessary and to armor the new
rfcrmed without stream impacts.
1b. Specifically describe measur
Sediment and erosion control Best M
enforced during project construction. s taken to avoid or minimize the proposed impacts through construction techniques.
nagement Practices for protection of surface waters and riparian buffers will be
Page 4 of 8
PCN Form - Version 1.3 December 10, 2008 Version
2. Compensatory Mitigation for I mpacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compe
impacts to Waters of the U.S. o nsatory Mitigation for
' Waters of the State? ? Yes ® No
2b. If yes, mitigation is required b y (check all that apply): ? DWQ ? Corps

2c. If yes, which mitigation option Ha
ll be used for this project? ? Mitigation bank
? 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 receip and letter) Type N/A Quantity N/A
3c. Comments: N/A
4. Complete If Making a Paymen to In-lieu Fee Program
4a. Approval letter from in-lieu fee p ram is attached. ? Yes
4b. Stream mitigation requested: N/A linear feet
4c. If using stream mitigation, strea temperature: ? warm ? cool ?cold
4d. Buffer mitigation requested (DW only): N/A square feet
4e. Riparian wetland mitigation reque sted: WA acres
4f. Non-riparian wetland mitigation n? quested: WA acres
4g. Coastal (tidal) wetland mitigation quested: N/A acres
4h. Comments: N/A
6. Complete If Using a Pemtittee Responsible Mitigation Plan
5a. If using a permittee responsible
N/A iligation plan, provide a description of the proposed mitigation plan.
6. Buffer Mitigation (State Regula ed Riparian Buffer Rules) -required by DWQ
6a. Will the project result in an impa
buffer mitigation? within a protected riparian buffer that requires ? Yes ® No
6b. If yes, then identify the square fe
amount of mitigation required. et of impact to each zone of the riparian buffer that requires mitigation. Calculate the

Zone 6c.
Reason for impact 6d.
Total impact
(square feet)
Multiplier 6e.
Required mitigation
(square feet)
Zone 1 N/A N/A 3 (2 for Catawba) N/A
Zone 2 N/A N/A 1.5 N/A
6f. Total buffer mitigation required: NONE
6g. If buffer mitigation is required, di
permittee responsible riparian buffer r? uss what type of mitigation is proposed (e.g., payment to private mitigation bank,
;storation, payment into an approved in-lieu fee fund). N/A
6h. Comments: N/A
Page 5 of 8
PCN Form - Version 1.3 December 10, 2008 Version
E. Stormwater Management and iffuse 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 B ffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
? Yes ® No
Comments: this pipe extension % ill not alter storm water runoff at this site
2. Stormwater Management Play
2a. What is the overall percent imp( rviousness of this project? 20%
2b. Does this project require a Story water Management Plan? ? Yes ® No
2c. If this project DOES NOT requi a Stormwater Management Plan, explain why: NCDOT state Permit No. NCS000250
2d. If this project DOES require a S II
Mmtwater Management Plan, then provide a brief, narrative description of the plan: WA
? Certified Local Government
2e. Who will be responsible for the view of the Stormwater Management Plan? ? DWQ Stormwater Program
? DWO 401 Unit
3. Certified Local Government S ormwater Review
3a. In which local government's juris iction is this project? Vance County
? Phase II
3b. Which of the following locally-im lemented stomnvater management programs ? NSW
? USMP
apply (check all that apply): ? Water Supply Watershed
? Other.
3c. Has the approved Stormwater M nagement Plan Wth proof of approval been ? Yes ? No
attached? N/A
4. DWQ Stormwater Program Rev ew
? Coastal counties
[I HOW
4a. Which of the following state-impl mented stormwater management programs apply ? ORW
(check all that apply): NIA ? Session Law 2006-246
? Other:
4b. Has the approved Stormwater M nagement Plan with proof of approval been
attached? N/A ? Yes ? No
5. DWQ 401 Unit Stormwater Revi w
Sa
Does the Stormwater ManagemI nt Plan meet the appropriate requirements? N/A
. ? Yes ? No
5b. Have all of the 401 Unit submittal requirements been met? N/A ? Yes ? No
Page 6 of 8
PCN Form - Version 1.3 December 10, 2008 Version
F. Supplementary Information
1. Environmental Documentatio (DWQ Requirement)
la. Does the project involve an exp nditure of public (federal/slate/local) funds or the ® Yes ? No
use of public (federal/state) Ian ?
1b. If you answered "yes" to the a ve, does the project require preparation of an
environmental document pursu m to the requirements of the National or State ? Yes ® No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1c- If you answered "yes" to the ab e, has the document review been finalized by the
State Clearing House? (If so, a ach a copy of the NEPA or SEPA final approval
letter.) ? Yes ? No
Comments: NIA
2. Violations (DWQ Requirement
2a. Is the site in violation of DWQ
Wetla
d R
l
15A NCAC 2H tland Rules (15A NCAC 2H.0500), Isolated
300
DW
n
u
es (
. ),
Q Surface Water or Wetland Standards, ? Yes ® No
or Riparian Buffer Rules (15A N AC 2B.0200)?
2b. Is this an after-the-fact permit ap lication? ? Yes ® No
2c. If you answered "yes" to one or th of the above questions, provide an explanation of the violation(s): N/A
3. Cumulative Impacts (DWQ R ulroment)
3a. Will this project (based on past
additional development, which co reasonably anticipated future impacts) result in
uld impact nearby downstream water quality? ? Yes ®No
3b. If you answered "yes" to the abo e, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you a nswered "no," provide a short narrative description.
N/A
4. Sewage Disposal (DWQ Requl ment)
4a. Clearly detail the ultimate treatm nt methods and disposition (non-discharge or discharge) of wastewater generated from
the proposed project, or availabi capacity of the subject facility.
N/A
Page 7 of 8
PCN Form - Version 1
S. Endangered Species and Des ignated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or
habitat? ? Yes ® No
5b. Have you checked with the US
im
t
? S concerning Endangered Species Act
? Yes ® N
pac
s o
5c. If yes, indicate the USFWS Field I
Office you have contacted. ? Raleigh
? Asheville
data sources did you use t determine whether your site would impact Endangered Species or Designated Critical
t?
www.fws.aov/nc-es/es/cou
r tvfr html and NC Natural Heritage Program Database, Element Occurrences
6.Essential
Fish Habitat (Corps equirement)
6a. Will this project occur in or near a area designated as essential fish
habitat? ? Yes ® No
6b. What data sources did you use t determine whether your site would impact Essential Fish Habitat?
hftr)://ocean.floridamarine.org/efh -ggLaL/lmsNiewer.htm

7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near area that the state, federal or tribal
governments have designated as having historic or cultural preservation

status (e.g., National Historic Trus
t designation or properties significant in ? Yes
®No
North Carolina history and archa ology)?
7b. What data sources did you use t determine whether your site would impact historic or archeological resources?
HPO's historic layer using GIS A View database and http:/Lqis.nodcr.gov/hpoweb
/
8. Flood Zone Designation (Corps equirernent)
8a. Will this project occur in a FEMA 0-year floodpi in?
a ? Yes No
Bb. If yes, explain how project meets requirements,
WA
8c. What source(s) did you use to ma a the floodplain determination? http://www ncfloodmaDS corn/

J. W. Bowman, P.E. vV 09/01111
ApplicanUAgent's Printed Name ApplicanVAgent s Signatu Date
(Agenra sivoture Is veild only If an authorization I from the applicant
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Name: STOVALL
Date: 8288011
Scale: 1 etch equals 1000 feet
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Caption: SR 1337
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