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Form Version 1 3 Dec 10 2008
Page 1 of 8
PCN Form — Version 1 3 December 10, 2008 Version
Ei
Pre- Construct'1 6 Notification (PCN) Form
A
Applicant Information
1
Processing
1a
Type(s) of approval sought from the
Corps non - reporting
Section 404 Permit El Section 10 Permit
FN
1b Specify Nationwide Permit (NWP) number NWP 3 and NWP 13 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
1e
Is this notification solely for the record
because written approval is not required?
For the record only for DWQ 401
❑ No
CMNY
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
1g
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)?
j ❑ Yes
® No
2
Project Information
2a
Name of project
NC 55 slope failure
2b
County
Wake
2c
Nearest municipality / town
Fuquay -Vanna
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)
3d
Street address
2612 N Duke Street
3e
City, state zip
Durham NC 27704
3f
Telephone no
(919)220 -4600
3g
Fax no
(919)560 -3371
3h
Email address
wbowman(a.ncdot gov
4
Applicant Information (if different from owner) N/A
5
Agent/Consultant Information (if applicable) N/A
Page 1 of 8
PCN Form — Version 1 3 December 10, 2008 Version
Ei
B Project Information and Prior Project History -
1 Property Identification
1a Property identification no (tax PIN or parcel ID)
1b Coordinates (in decimal degrees)
Site 1
Latitude 35 58519 Longitude -78 75652
(DD DDDDDD) ( DD DDDDDD)
1c Property size
< 0 01 acres
2 Surface Waters
2a Name of nearest body of water (stream, river, etc ) to
Black Creek
proposed project
2b Water Quality Classification of nearest receiving water
B 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 The proximity of an adjacent stream running parallel to NC 55 has resulted in a segment of slope failure Site
is surrounded by wooded and residential lands Repeat scour of this area if left unattended would eventually result in
failure of the roadway
3b List the total estimated acreage of all existing wetlands on the property
NONE — However there are wetlands to the east side of the creek However no impacts to wetlands are proposed as all
construction work is within the fill slope
3c List the total estimated linear feet of all existing streams (intermittent and perennial) on the property
60ft
3d Explain the purpose of the proposed project Repair fill slope and shoulder section to minimize risk of roadway failure
3e Describe the overall project in detail, including the type of equipment to be used
Dewater, drain work site, repair failure by 60ft of hard armoring (sheet piling) and backfdling area to rebuild slope and
shoulder section Equipment ma include a backhoe, excavator, and trucks
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 N/A
4b If the Corps made the jurisdictional determination, what type
El Preliminary El Final
of determination was made
4c If yes, who delineated the jurisdictional 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
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
N/A
Page 2 of 8
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
N/A
C Proposed Impacts Inventory
1 Impacts Summary
1a 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
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 T
W1 ❑ P ❑ T
N/A
N/A
❑ Yes
❑ No
❑ Corps
❑ DWQ
N/A
2g Total Wetland Impacts
NONE
2h Comments Note that wetlands across stream will not be impacted by the proposed activity
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
Impact
number -
(PER) or
(Corps - 404, 10
stream
length
Permanent (P) or
intermittent
DWQ — non -404,
width
(linear
Temporary (T)
(INT)?
other)
(feet)
feet)
Site 1 ❑ P ❑ T
fill
UT to
[-I PER
® Corps
6
N/A
Stream 1
Black Creek
® INT
® DWQ
Site 1 ® P ❑ T
Hard armoring
UT to
❑ PER
® Corps
6
60
Stream 1
using sheet piling
Black Creek
® INT
® DWQ
Site 1 ❑ P ® T
UT to
❑ PER
® Corps
6
60
Stream 1
dewatering
Black Creek
® INT
® DWQ
concurrent
3h Total stream and tributary impacts
60
31 Comments Restoring existing toe of slope by hard armoring, no surface water loss proposed
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
impact number —
waterbody
Type of impact
Waterbody type
Area of impact (acres)
Permanent (P) or
(if applicable)
Temporary T
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
5 Pond or Lake Construction
If pond or lake construction proposed, then complete the chart below
5a
5b
5c
5d
5e
Wetland Impacts (acres)
Stream Impacts (feet)
Upland
Pond ID
Proposed use or purpose of
(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 Total
I NONE
I NONE
NONE
NONE
I NONE
NONE
NONE
5g Comments N/A
5h Is a dam high hazard permit required
❑ Yes El No If yes, permit ID no N/A
51 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 any impacts require mitigation, then you MUST fill out Section D of this form
6a
® Neuse El Tar-Pamlico ®Other Jordan Lake
Project is in which protected basin?
❑ Catawba ❑ Randleman
6b
6c
6d
6e
6f
6g
Buffer impact
number —
Reason for
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P) or
impact
Stream name
mitigation
(square feet)
(square feet)
Temporary T
required?
Site ❑ P ❑ T
❑ Yes
Buffer Impact 1
N/A
N/A
❑ No
N/A
N/A
6h Total buffer impacts
N/A
N/A
61 Comments No new impacts within the buffers beyond the existing transportation facility (toe of slope) are proposed
D Impact Justification and Mitigation
1 Avoidance and Minimization
1a Specifically describe measures taken to avoid or minimize the proposed impacts in designing project
The impacts to the stream are necessary to repair fill slope and shoulder BMPs will be followed to maintain a dry work area
This slope failure repair cannot be performed without stream impacts
1 b Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
Sediment and erosion control Best Management Practices for protection of surface waters, riparian buffers, and wetlands will
be enforced during project construction
Page 4 of 8
PCN Form — Version 1 3 December 10, 2008 Version
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
El 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 N/A
Quantity N/A
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
N/A linear feet
4c If using stream mitigation, stream temperature
❑ warm ❑ cool ❑cold
4d Buffer mitigation requested (DWQ only)
N/A square feet
4e Riparian wetland mitigation requested
N/A acres
4f Non - riparian wetland mitigation requested
N/A acres
4g Coastal (tidal) wetland mitigation requested
N/A 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
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
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, 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
Page 5 of 8
PCN Form — Version 1 3 December 10, 2008 Version
E
Stormwater Management and Diffuse Flow Plan (required by DWQ)
1
Diffuse Flow Plan
1a
Does the project include or is it adjacent to protected riparian buffers identified
® Yes ❑ No
within one of the NC Riparian Buffer Protection Rules?
lb
If yes, then is a diffuse flow plan included? If no, explain why
❑ Yes ®No
Comments these pipe extensions will not alter storm water runoff at this site
2
Stormwater Management Plan
2a
What is the overall percent imperviousness of this project?
20%
2b
Does this project require a Stormwater Management Plan?
❑ Yes ® No
2c
If this project DOES NOT require a Stormwater Management Plan, explain why Impacts
only to stabilize fill slope
2d
If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan N/A
❑ 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?
❑ Phase II
❑ NSW
3b
Which of the following locally - implemented stormwater management programs
❑ USMP
apply (check all that apply)
❑ Water Su I Watershed
❑ Other
3c Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached? N/A
4
DWQ Stormwater Program Review
❑ Coastal counties
❑ HQW
4a
Which of the following state - implemented stormwater management programs apply
❑ ORW
(check all that apply) N/A
❑ Session Law 2006 -246
❑ Other
4b Has the approved Stormwater Management Plan with proof of approval been
1:1 Yes El No
attached? N/A
5
DWQ 401 Unit Stormwater Review
5a
Does the Stormwater Management 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
0
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)?
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
❑ Yes ❑ No
letter )
Comments N/A
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 yes to one or both of the above questions, provide an explanation of the violation(s) N/A
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
N/A
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 7 of 8
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 LISFWS concerning Endangered Species Act
❑ Yes ® No
impacts?
❑ Raleigh
5c If yes, indicate the LISFWS 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? Biological conclusion provided by NCDOT O N E Biological Surveys Group (see attached email)
http / /www fws Qov /nc- es /es /countyfr html and NC Natural Heritage Program Database, Element Occurrences
6 Essential Fish Habitat (Corps Requirement)
6a Will this project occur in or near an area designated as essential fish
❑ Yes ® No
habitat?
6b What data sources did you use to determine whether your site would impact Essential Fish Habitat?
http / /ocean floridamanne orQ /efh coral /ims /viewer htm
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?
(Note that this site is over 0 2 mile away from northern edge of the Green Level Historic District)
HPO's historic layer using GIS ArcView database and http / /Qis ncdcr Qov /hpoweb/
8 Flood Zone Designation (Corps Requirement)
8a Will this project occur in a FEMA - designated 100 -year fioodplain?
❑ Yes ® No
8b If yes, explain how project meets FEMA requirements N/A
8c What source(s) did you use to make the floodplain determination? http / /www ncfloodmaps com/
fo, J W Bowman, P E
Q A/,
01/11/13
Applicant/Agent's Printed Name
Applicant/Agent's Signatur j
(Agent's signature is valid only if an authorization le inxn the applicant
Date
Is Provide d
Page 8of8
PCN Form — Version 1 3 December 10, 2008 Version
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Name FUQUAY - VARINA Location 035 58519 ° N 078 75&52 'W
Date 1/11/2013 Caption NC 55
Scale 1 Inch equals 2000 feet Wake County Slope Failure Site
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Looking North.
Looking South.
NC 55
Wake County
Maintenance — Slope Failure Site