20110818 Ver 1_Application_20110902

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Office Use Only:
1 0 81 8 Corps action no.
DWQ project no.
.
Forth Version 1.3 Dec 10 2006
Pr e-Construction Notification PC Form
A. Applicant Information
1. Processing
la. Type(s) of approval sought from
Corps: non-reporting nationwide the
permit
®Section 404 Permit ? Secti
on 10, Permit
1 b. Specify Nationwide Permit (NW ) 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):
on - Regular ? Non-004 Jurisdictional General Permit
n - Express ? Riparian Buffer Authorization
le. Is this notification solely for the
because written approval is not ord
equired? For the record only for DWQ 401
Certif lion:
® Yes ? No For the record only for Corps Permit:

® Yes ? No
If. Is payment into a mitigation ban
of impacts? If so, attach the a
fee program. or in-lieu fee program proposed for mitigation
eptance letter from mitigation bank or in-lieu ? Yes ® No
1g. Is the project located in any of
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 pipe replacement of a structure conveying an UT to Moccasin Creek along
SR 1750 (Hagwood Road)
2b. County: Franklin
2c. Nearest municipality / town: Zebulon
2d. Subdivision name:
2e. NCDOT only, T.I.P. or state
project no:
3. Owner Information
3a. Name(s) on Recorded Deed: NCDOT Division 5
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if
applicable): P

E 2011
3d. Street address: 2612 N. Duke Street " Mrimtlb
A
3e. City, state, zip: Durham, NC 27704 -
3f. Telephone no.: [phone]
3g. Fax no.: [phone]
3h. Email address: wbowmanCrDncdot.aov
4. Applicant Information (If dlffe nt from owner) N/A
6. AgentrConsultant Information (ff applicable) N/A
Page I of 8
PCN Form - Version 1.3 December 10, 2008 Version
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B. Project Information and Prior Project History
1. Property Identification
la. Property identification no. (tax P N or parcel ID):
1b. Coordinates (in decimal degree ):
Site: Latitude:35.85057 Longitude: -78.26607
(DD. DDDDDD) (-DD. DDDDDD)
1c. Property size: < 0.01 acres
2. Surface Waters
2a. Name of nearest body of water stream, river, etc.) to Moccasin Creek
proposed project:
2b. Water Quality Classification of n arest receiving water. C NSW
2c. River basin: Neuse
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:
A double line cross pipe has discon cted joints on the outlet end. The associated shoulder and fill section
have collapsed. In order to repair this site, the cross line must be replaced.
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:
60ft (dAht-of-way to right-of-way
3d. Explain the purpose of the posed project: Pipe ends have fallen off. As a result the shoulder section and fill slope
have collapsed. In order to rebui d the shoulder and fill slope the cross line must be replaced.
3e. Describe the overall project in d tail, including the type of equipment to be used:
Plan to replace existing double line of pipe that is 60ft long with a new pipe of the same length. Bridge Maintenance and
Maintenance forces will work togeth r in order to maintain a dry work area. Once this site is dry a backhoe and/or excavator
will be used to replace this cross fin pipe. The pipe ends will be stabilized using rip rap armoring underlined with filter fabric.
Soil material used to rebuild the sho ulder will rest against this rock and will be revegetated using seed, straw, and/or matting
as appropriate. Dewatering measure will be removed.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland ors am determinations by the
Corps or State been requested o 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 inal areas? Agency/Consultant Company: N/A
Name (if known): N/A Other: N/A
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
N/A
Page 2 of 8
PCN Form -Version 1.3 December 10, 2008 Version
S. Project History
5a. Have permits or certifications be en 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
6. Future Project Plans
6a. Is this a phased project? ? Yes ®No
6b. If yes, explain.
WA
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 imps Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWO - non404, other) (acres)
Temporary (T)
W1 ? P ? T N/A N/A ? Yes
? No ? Corps
? DWO N/A
2g. Total Wetland Impacts: NONE
2h. Comments: N/A
3. Stream Impacts
If there are perennial or intermittent s tream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impact .
3a. 3b. 3c. 3d. 3e. 3f. 3g.
Stream impact Type of imps t Stream name Perennial Type of jurisdiction Average Impact
number - (PER) or (Corps - 404, 10 stream length
Permanent (P) or intermittent DWO - non-404, width (linear
Temporary (T) (INT)? other) (feet) feet)
Site 1 ? P ® T i UT to ? PER ® Corps 4ft s 20ft
Stream 1 dewater
n
g Moccasin Creek ® INT ® DWO
Site 1 ® P ? T ri
: UT to ? PER ® Corps 4ft s 20ft
Stream 1 p rap armor g Moccasin Creek ® INT ® DWO concurrent
3h. Total stream and tributary impacts s 20ft
3i. Comments: 20ft RR = up to 10ft inlet and outlet; 20ft of temporary dewatering
4. Open Water Impacts
If there are proposed impacts to lake s, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list all ope water impacts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of
impact number - waterbody Type of impact Waterbody type Area of impact (acres)
Permanent (P) or (if applicable )
Temporary IT)
01 ? P ? T N/A N/A N/A N/A
4f. Total open water Impacts NONE
4g. Comments: N/A
Page 3 of 8
PCN Form - Version 1.3 December 10, 2008 Version

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

Pond ID 5b.

Proposed use or purpo

a of 5c.
Wetland Impacts (acres) 5d.
Stream Impacts (feet) 5e.
Upland
(acres)
number pond Flooded Filled Excavated Flooded Filled Excavated Flooded
P1 N/A N/A N/A N/A N/A N/A N/A N/A
P2
5f. T otal NONE NONE NONE NONE NONE NONE NONE
5g. Comments: N/A
5h. Is a dam high hazard permit req ired7
? 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 rips
below. If an impacts require m
an buffer, then complete the chart below. If yes, then individually list all buffer impacts
i ation, then ou MUST fill out Section D of this form.
6a.

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

Reason for
impact 6d.

Stream name 6e.

Buffer
mitigation
required? 6f.

Zone Iimpact
(square feet) 6g.

Zone 2impact
(square feet)
Site ® P ? T
Buffer Impact 1 Rip rep UT to
Moccasin Creek ? Yes
ONO 600 SF 0 SF

6h. Total buffer Impacts 600 SF 0 SF
6i. Comments: No to exceed 40LF o new buffer impacts associated with rip rap and access for dewatering.
D. Impact Justification and Mitiga tion
1. Avoidance and Minimization
1a. Specifically describe measu
This is a replacement site and will re
with rip rap underlined with filter fab
used not to exceed 10ft upstream an
at rock limits and no clearing unless es taken to avoid or minimize the proposed impacts in designing project.
uire minimal disturbance. Site will be dewatered and the pipes replaced will be armored
c for long term stabilization. Only the amount of rip rap necessary for stabilization will be
d 10ft downstream. Additionally impacts within the buffers will be reduced by dewatering
he vegetation conflicts with the pipe work.
1b. Specifically describe measu
Sediment and erosion control Best
construction. es taken to avoid or minimize the proposed impacts through construction techniques.
anagement Practices for protection of surface waters will be enforced during project
Page 4 of 8
PCN Form - Version 1.3 December 10, 2008 Version
2. Compensatory Mitigation for I pacts 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 satory Mitigation for
Waters of the State? ? Yes ®No
2b. If yes, mitigation is required b (check all that apply): ? DWQ ? Corps

2c. If yes, which mitigation option
I 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 t and letter) Type NIA Quantity N/A
3c. Comments: N/A
4. Complete If Making a Payment to In4leu Fee Program
4a. Approval letter from in-lieu fee pr ogram is attached. ? Yes
4b. Stream mitigation requested: N/A linear feet
4c. If using stream mitigation, stream temperature: ? warm ? cool ?cold
4d. Buffer mitigation requested (DWI ) only): N/A square feet
4e. Riparian wetland mitigation reque sted: N/A acres
4f. Non-riparian wetland mitigation quested: N/A acres
4g. Coastal (tidal) wetland mitigation requested: N/A acres
4h. Comments: N/A
5. Complete If Using a Permlttee Responsible Mitigation Plan
5a. If using a permittee respon ble mitigation plan, provide a description of the proposed mitigation plan. N/A
6. Buffer Mitigation (State Regula ted Riparian Buffer Rules) - required by DWQ
6a. Will the project result in an impac
buffer mitigation? t within a protected riparian buffer that requires ? Yes ®No
6b. If yes, then identify the square t
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) NIA
Zone 2 N/A N/A 1.5 NIA
6f. Total buffer mitigation required: NONE
6g. If buffer mitigation is required, di
permittee responsible riparian buffer cuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
restoration, payment into an approved in-lieu fee fund). WA
6h. Comments: NIA
Page 5 of 8
PION Form - Version 1.3 December 10, 2008 Version
E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
Is. 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?
1b. If yes, then is a diffuse flaw plan included? If no, explain why.
? Yes ? No
Comments: N/A
2. Stormwater Management Plan
2a. What is the overall percent impe rviousness of this project? N/A
2b. Does this project require a Sto water Management Plan? ? Yes ® No
2c. If this project DOES NOT requir e a Stormwater Management Plan, explain why: NCDOT state Permit No. NCS000250
2d. If this project DOES require a S rmwater Management Plan, then provide a brief, narrative description of the plan: N/A
? Certified Local Government
2e. Who will be responsible for the view of the Stormwater Management Plan? ? DWQ Stormwater Program
? DWQ 401 Unit
3. Certified Local Government 5 ormwater Review
3a. In which local government's juri diction is this project? Franklin County
? Phase II
3b. Which of the following local ly-im lemented storrnwater management programs ? NSW
? USMP
apply (check all that apply): ? Water Supply Watershed
? Other:
3c. Has the approved Stonnwater Ma nagement Plan with proof of approval been ? Yes ? No
attached? N/A
4. DWQ Stormwater Program Rev low
? Coastal counties
? HOW
4a. Which of the following state-imp emented stormwater management programs apply
ORW
El
(check all that apply): N/A ? Session Law 2006-246
? Other:
4b. Has the approved Stormwater M nagement Plan with proof of approval been
? Yes ? No
attached? N/A
5. DWQ 401 Unit Stormwater Revi ew

5s. Does the Stormwater Manageme 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 Documentation (DWQ Requirement)
la. Does the project involve an exp nditure of public (federal/state/local) funds or the ® Yes ? No
use of public (federal/state) land .
1b. If you answered 'yes" to the abo ve, does the project require preparation of an
environmental document pursua nt to the requirements of the National or State ? Yes ® No
(North Carolina) Environmental policy Act (NEPAISEPA)?
1c. If you answered "yes" to the abo ve, 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: N/A
2. Violations (DWQ Requirement
2a. Is the site in violation of DWQ tland Rules (15A NCAC 21-1.0500), Isolated
Wetland Rules (15A NCAC 2H . 300), DWQ Surface Water or Wetland Standards, ? Yes ® No
or Riparian Buffer Rules (15A N CAC 2B.0200)?
2b. Is this an after-the-fact permit a lication? ? Yes ® No
2c. If you answered "yes' to one or oth of the above questions, provide an explanation of the violation(s): WA
3. Cumulative Impacts (DWQ Re uirement)
3a. Will this project (based on past id reasonably anticipated future impacts) result in ? Yes ® No
additional development, which co uld impact nearby downstream water quality?
3b. If you answered "yes' to the abo ve, 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 Requi ment)
4a. Clearly detail the ultimate treatm nt methods and disposition (non-discharge or discharge) of wastewater generated from
the proposed project, or evailabl capacity of the subject facility.
N/A
Page 7 of 8
PCN Form - Version 1.3 December 10. 2008 Version
5. Endangered Species and Desi gnated 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 US F NS concerning Endangered Species Act ? Yes ® No
impacts?
Raleigh
El
5c. If yes, indicate the USFWS Field Office you have contacted. ? Asheville
5d. What data sources did you use determine whether your site would impact Endangered Species or Designated Critical
Habitat? Biologists from NCDO O.N.E. has visited this site and rendered a biological conclusion of 'No Effect'
httg):/twww,tws.gov/nc-estes/cou itvfr.html and NC Natural Heritage Program Database, Element Occurrences

6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near i n area designated as essential fish ? Yes ® No
habitat?
6b. What data sources did you use t determine whether your site would impact Essential Fish Habitat?
hri ://ocean.fioddamarine.o /e corallms/viewer.htm

7. Historic or Prehistoric Cultura Resources (Corps Requirement)
7a. Will this project occur in or near, n area that the state, federal or tribal
governments have designated a having historic or cultural preservation ? Yes ® No
status (e.g., National Historic T st designation or properties significant in
North Carolina history and archa logy)?
7b. What data sources did you use t determine whether your site would impact historic or archeological resources?
HPO's historic layer using GIS View database and htto://ois.ncdcr.aov/hooweb/
E. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA esignated 100-year floodplain? ? Yes ® No
8b. If yes, explain how project meets FEMA requirements: N/A
8c. What source(s) did you use tom ke the floodplain determination? http:/lwww.ncfloodmaos.coml

J. W. Bowman, P.E. 08/31/11
Applicant/Agent's Printed Name Applicant/Agents Signatur
(Agenre signature Is valid ordy if an aurhortatlon I fro m the applicant Date
Is roW
Page 8 of 8
PCN Form - Version 1.3 December 10, 2008 Version
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SR 1750 (Hagwood Road)
Franklin County Maintenance Site

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Name: ZEBULON Location: 035.85057 • N 078.2(0 (r 01 ' W
Date: 8!2/2011 Caption: SR 1750 (Hagwood Rd)
Scale: 1 inch equals 2000 feel Franklin County
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FRANKLIN COUNTY, NORTH CAROLINA
ZEBULON QUADRANGLE
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