20091147 Ver 1_Application_20091027

MICHAEL F. EASLEY
GOVERNOR
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
DIVISION OF HIGHWAYS
October 26, 2009
Ms. Sonia Gregory
NCDWQ
401 Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Subject: Nationwide Permit 414
SR-2100 Randolph County
Project # 8C.076123
Ms. Gregory:
OF4 tygl? 100'9 LYNDO
SECRETAR
®91147
The North Carolina Department of Transportation, Highway Division 8 is requesting Nationwide Permit Number
14, and the corresponding DWQ 401 Water Quality Certification for project # 8C.076123 on SR 2100 (Deerfield
Country Rd.) in Randolph County. The proposed project will replace the existing crossing pipes on this road.
Please refer to the detailed site plan drawings and the impact table included in the PCN.
The pipes are being replaced in anticipation of a scheduled paving project. The amount of pipe length increase is
needed to provide a safe shoulder section, and upgrade the road width to currant standards. The paving will be
done along the existing road footprint. The total percentage of impervious surface within the project area will
remain at less than 20%. All erosion control devices used on the project will be appropriate to the location and in
compliance with the current version of the NCDOT Best Management Practices manual. The crossings are located
on unnamed tributaries of Pole Cat Creek, a Class WSIII streams within the Cape Fear River basin. If dewatering
is required at this site, it will be done with moveable devices (precast concrete barriers or sheet metal piles).
Construction will be done under dry conditions whenever possible.
There were no threatened or endangered species observed within the project area during the required minimum
criteria check. If you require any additional information, please contact me.
Sincerely,
(2. Z46
Art C. King
Division Environmental Officer
Highway Division 8
cc: Tim Johnson, PE
Reid Rich
Barry Harrington
P.O. BOX 1067, ABERDEEN NORTH CAROLINA 28315
PHONE [phone] FAX [phone]
® 9 JWX 4 `?0?c?4)
8 'kqy
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.0 November 2008
Pre-Construction Notl cation (PCN) Form
A. Applicant Information
1. Processing
1a. Type(s) of approval sought from the
Corps: ® Section 404 Permit ? Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: 14 or General Permit (GP) number:
tc. 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
tf. 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
ig. 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: Deerfield Country Rd (SR 2100)
2b. County: Randolph
2c. Nearest municipality / town: Randleman
2d. Subdivision name: N/A
2e. NCDOT only, T.I.P. or state
project no: 8C.076123
3. Owner Information
3a. Name on Recorded Deed: NC DOT
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if
applicable):
3d. Street address: PO BOX 1067
3e. City, state, zip: Aberdeen, NC 28315
3f. Telephone no.: 910-944-2344
3g. Fax no.: 910-944-5623
3h. Email address: [e-mail]
Page 1 of 11
PCN Form - Version 1.0 November 2008 Version
Section A. Applicant Information, continued
4. Applicant Information (if different from owner)
4a. Applicant is: ? Agent ® Other, specify: Division Engineer
4b. Name: Timothy Johnson
4c. Business name
(if applicable): North Carolina Department of Transportation

4d.
Street address: PO BOX 1067
4e. City, state, zip: Aberdeen, NC, 28315
4f. Telephone no.: 910-944-2344
4g. Fax no.: 910-944-5623
4h. Email address: [e-mail]
5. Agent/Consultant Information (if applicable)
5a. Name: Reid Rich
5b. Business name
(if applicable): North Carolina Department of Transportation
5c. Street address: 126 Dot Drive
5d. City, state, zip: Asheboro, NC, 27205
5e. Telephone no.: 336-625-2078
5f. Fax no.: 336-625-0146
5g. Email address: [e-mail]
Page 2 of 11
PCN Form -November 2008 Version
B. Project Information and Prior Project History
1. Property Identification
1 a. Property identification no. (tax PIN or parcel ID):
lb- Site coordinates (in decimal degrees): 35.79901'N - -79.71268'W
1 c. Property size: acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
proposed project: polecat Creek
2b. Water Quality Classification of nearest receiving water: WS III
2c. River basin: Cape Fear
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:
unpaved secondary road crossing
3b. List the total estimated acreage of all existing wetlands on the property:
0
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
60
3d. Explain the purpose of the proposed project:
replace existing culvert to meet currect standards in conjunction with Secondary Road Construction Project
3e. Describe the overall project in detail, including the type of equipment to be used:
Grade, Drain, Base, Pave and Erosion Control. utilizing backhoe, pan, dozer, motor grader and excavator
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
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): 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? E Yes ? No
6b. If yes, explain.
temporary erosion control measures installed prior to clearing and grubbing phase. Ditchline measures placed as final
grade established. Seeding as work progresses
Page 3 of 11
PCN Form - Version 1.0 November 2008 Version
C. Proposed Impacts Inventory
1. Impacts Summary
la. 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
number -
Type of
Type of wetland
Forested Type of jurisdiction
(Corps - 404,
Area of impact (acres)
Permanent (P) or impact (if known) DWQ - non-404, other)
Temporary
W1 ? P ? T E] Yes El No ? Corps
? DWQ
W2 El P ? T ? Yes [I No ? Corps
? DWQ
W3 El PEI T El Yes El No ? Corps
? DWQ
W4 ? P [-I T E] Yes ? No ? Corps
? DWQ
W5 El P ? T ? Yes El No E] Corps
? DWQ
W6 ? PEI T ? Yes ? No ? Corps
? DWQ
2g. Total wetland impacts
2h. Comments: NA
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.
Stream impact 3b.
Type of' 3c.
Stream name 3d.
Perennial (PER) or 3e.
Average stream width (feet) 3f.
Impact
length
number- impact intermittent(INT)? (linear feet)
Permanent (P) or
Temporary (T)
S1 ®P ? T pipe unnamed ? PER ® INT 5 24ft
S2 ? P ® T dewater ? PER ® INT 20ft
S3 ? P ? T ? PER ? INT
S4 ? P ? T ? PER ? INT
S5 ? P ? T ? PER ? INT
S6 ? P ? T ? PER ? INT
3g. Total stream and tributary impacts 44ft
3h. Comments: replacing 36ft of 36" RCP pipe with 60ft of 66" CMP arch. 20" of temp impact for dewatering (if needed).
Page 4 of 11
PCN Form - Version 1.0 November 2008 Version
C. Proposed Impacts Inventory, continued
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 individual) list all o en water impacts below.
4a. 4b. 4c. 4d. 4e.
Open water
impact number Name of
waterbody
Type of impact
Waterbody type
Area of impact (acres)
- Permanent (if
(P) or applicable)
Temporary T
Ot ?P?T
02 ?P?T
03 ?P?T
04 ?P?T
4f. Total open water impacts 0
4g. Comments: NA
Page 5 of 11
PCN Form - November 2008 Version
C. Proposed Impacts Inventory, continued
5. Pond or Lake Construction
If pond or lake construction proposed, then complete the chart below.
5a. 5b. 5c. bd. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or (acres)
number purpose of pond
Flooded Filled Excavated Flooded Filled Excavated Flooded
P1
P2
5f. Total
5g. Comments: NA
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 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 (square
Zone 2 impact
Permanent (P) for impact Stream name mitigation feet) (square feet)
or Temporary required?
61 ?p?T ?Yes ?No
B2 ? P ? T ? Yes ? No
B3 ?P?T ?Yes ?No
6h. Total buffer impacts
6i. Comments: The project is outside of the Randleman buffer limits.
Page 6 of 11
PCN Form -November 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.
to install correct size pipe to minimize scour at inlet and outlet of pipe due to restricted flow of substandard culvert.
lb. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
install erosion control devices
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
project? ? Mitigation bank
? Payment to in-lieu fee program

? 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:
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.
Page 7 of 11
PCN Form - Version 1.0 November 2008 Version
D. Impact Justification and Mitigation, continued
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? ? 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
Reason for impact Total impact
(square feet) Multiplier Required mitigation
(square feet)
Zone 1 3 (2 for Catawba)
Zone 2 1.5
Total buffer mitigation required:
6c. 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).
6d. Comments: NA
Page 8 of 11
PCN Form -November 2008 Version
E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan

la. 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? ? Yes ? No
2. Determination if the Project Requires a Stormwater Management Plan
2a. Does the project require a Non-404 Jurisdictional General Permit? ? Yes ® No
2b. Is the project subject to General Certification 3704 or 3705? ? Yes N No
3. Determination of Stormwater Review Jurisdiction
3a. Is this project subject to any of the following state-implemented stormwater ? Coastal counties
? HQW
management programs (check all that apply)? ? ORW
attach one copy of the approval letter from the DWQ and one copy of the
If so ? Session Law 2006-246
,
approved stormwater management plan. ? Other:
3b. In which local government's jurisdiction is this project?
3c. Is this local government certified to implement a state stormwater program? ? Yes ? No
If so, attach one copy of the approval letter from the local government and one copy
of the approved stormwater management plan (or one copy of the approved
Stormwater management plan stamped as approved).
4. Information Required for DWQ 401 Unit Stormwater Review

4a. What is the overall percent imperviousness according to the most curent site plan? less than 24%

4b. Does this project contain any areas that meet the criteria for "high density" per ? Yes N No
General Certifications 3704 and 3705?
4c. If the site is over 24% impervious and/or contains high density areas, then provide a brief narrative description of the
stormwater management plan.
4d . Has a completed BMP Supplement Form with all required items been submitted ? Yes ? No
for each stormwater BMP?
Page 9 of 11
PCN Form - Version 1.0 November 2008 Version
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?
lb. 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)?
I 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 final approval
? Yes
? No
letter.)
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 'es' 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.
Page 10 of 11
PCN Form - Version 1.0 November 2008 Version
F. Supplementary Information, continued
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?
USFWW arcmap layer for known endangered species sites. Onsite survey by NCDOT staff.
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?
Arcmap
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 SHPO
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?
_ lb/ZG?
Applicant/Agent's Printed Name ApplicanUAg nt's Signature
(Agent's signature is valid only if an authorization letter from the applicant
Date
is rovided.
Page 11 of 11
PCN Form -November 2008 Version
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