20220137 Ver 1_Pre-Construction Notification (PCN) Form_20220208

DWR
mrlsloa of Water Resources
Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
December 6,2021 Ver 4.2
Please note:fields marked with a red asterisk*below are required. You will not be able to submit the form until all mandatory questions are answered.
Also,if at any point you wish to print a copy of the E-PCN,all you need to do is right-click on the document and you can print a copy of the form.
Below is a link to the online help file.
https:Hedoes.deq.nc.gov/WaterResources/0/edoc/624704/PCN%2OHelp/2OFile/202018-1-30.pdf
A. Processing Information
County(or Counties)where the project is located:*
Nash
Is this a NCDMS Project*
Yes No
Click Yes,only if NCDMS is the applicant or co-applicant.
Is this project a public transportation project?*
Yes No
This is any publicly funded by municipal,state or federal funds road,rail,airport transportation project.
Is this a NCDOT Project?*
Yes No
(NCDOT only)T.I.P.or state project number:
U-5947
WBS#*
46884.1.1
(for NCDOT use only)
la.Type(s)of approval sought from the Corps:
Section 404 Permit(wetlands,streams and waters,Clean Water Act)
Section 10 Permit(navigable waters,tidal waters,Rivers and Harbors Act)
Has this PCN previously been submitted?
Yes
No
1 b.What type(s)of permit(s)do you wish to seek authorization?
Nationwide Permit(NWP)
Regional General Permit(RGP)
Standard(IP)
1c.Has the NWP or GP number been verified by the Corps?*
Yes No
Nationwide Permit(NWP)Number: 14-Linear transportation
NWP Numbers(for multiple NWPS):
List all NW numbers you are applying for not on the drop down list.
1d.Type(s)of approval sought from the DWR:
check all that apply
401 Water Quality Certification-Regular 401 Water Quality Certification-Express
Non-404 Jurisdictional General Permit Riparian Buffer Authorization
Individual 401 Water Quality Certification
le.Is this notification solely for the record because written approval is not required?
*
For the record only for DWR 401 Certification: Yes No

For the record only for Corps Permit: Yes No
1f.Is this an after-the-fact permit application?'
Yes No
1g.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
Acceptance Letter Attachment
Click the upload button or dreg and drop files here to attach document
FILE TYPE MUST BE PDF
1 It.Is the project located in any of NC's twenty coastal counties?
Yes No
1j.Is the project located in a designated trout watershed?
Yes No
Link to trout information:http://www.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Agency-Coordination/Trout.aspx
B. Applicant Information U
1a.Who is the Primary Contact?*
Chad Coggins
1c.Primary Contact Phone:"
1b.Primary Contact Email:* (xxx)xxx-xxxx
[e-mail] [phone]
1d.Who is applying for the permit?*
Owner Applicant(other than owner)
(Check all that apply)
1a.Is there an Agent/Consultant for this project?
Yes No
2.Owner Information
2a.Name(s)on recorded deed:
NCDOT
2b.Deed book and page no.:
2c.Contact Person:
(for Corporations)
2d.Address*
Street Address
P.O.Box 3165
Address Line 2
City State/Province/Region
Wilson NC
Postal/Zip Code Country
27895 USA
2e.Telephone Number:*
(xxx)xxx-xxxx
[phone]
2f.Fax Number:
(xxx)xxx-xxxx
2g.Email Address:
[e-mail]
C. Project Information and Prior Project History
1.Project Information
la.Name of project:*
U-5947 Benvenue Roundabout
1 b.Subdivision name:
(if appropriate)
NA

1c.Nearest municipality/town:
Rocky Mount
2.Project Identification U
2a.Property Identification Number: 2b.Property size:
(tax PIN or parcel ID) (In acres)
N/A 3
2c.Project Address
Street Address
Intersection of Benvenue Road,Hunter Hill Road,and US 64
Address Line 2
City State/Province/Region
Rocky Mount NC
Postal/Zip Code Country
27804 Nash
2d. Site coordinates in decimal degrees
Please collect site coordinates in decimal degrees.Use between 4-6 digits(unless you are using a survey-grade GPS device)after the decimal place as appropriate,based on how the location was
determined. (For example,most mobile phones with GPS provide locational precision in decimal degrees to map coordinates to 5 or 6 digits after the decimal place.)
Latitude:" Longitude:
35.96681 77.80318
ex:34.208504 -77.796371
3. Surface Waters
3a.Name of the nearest body of water to proposed project:
Goose Branch
3b.Water Resources Classification of nearest receiving watei
C;NSW
Surface Water Lookup
3c. What river basins)is your project located in?*
Tar-Pamlico
3d.Please provide the 12-digit HUC in which the project is located.
030201010903
River Basin Lookup
4. Project Description and History
4a.Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this application:
This project lies at the confluence of locally and regionally important transportation corridors of US 64(4-lane divided),Hunter Hill Road,Benvenue Rd,and Battle Park Lane.Existing land
use in the area includes a mix of commercial,residential,and Public(Municipal)Parkland.
4b.Have Corps permits or DWR certifications been obtained for this project(including all prior phases)in the past?
Yes No Unknown
4f.List the total estimated acreage of all existing wetlands on the property:
0
4g.List the total estimated linear feet of all existing streams on the property:
(inter nittent and perennial)
25
4h.Explain the purpose of the proposed project:
The purpose of the project is to improve the intersection operations for current and future
traffic at the NC 43(Benvenue Road)and US 64 Bypass Offramp intersection.
4i.Describe the overall project in detail,including indirect impacts and the type of equipment to be used:
This project is centered around the installation of a roundabout at the intersection of Benvenue Road and the US 64 Eastbound Offramp.The project will require moving and upsizing the
existing drainage structure to an enclosed system(See attached Plans/Permit drawings).Standard roadbuilding equipment will be utilized to remove existing asphalt,perform grading,
install drainage and put down new asphalt.The existing drainage network will be upgraded and realigned to conform with the adjusted alignment.Due to the nature of the project there are
no indirect impacts anticipated.
5. Jurisdictional Determinations
5a.Have the wetlands or streams been delineated on the property or proposed impact areas?*
Yes No Unknown

Comments:
See attached Permit Drawings
5b.If the Corps made a jurisdictional determination,what type of determination was made?
Preliminary Approved Not Verified Unknown N/A
Corps AID Number:
Example:SAW-2017-99999
5c.If 5a is yes,who delineated the jurisdictional areas?
Name(if known): Chad Coggins
Agency/Consultant Company: NCDOT
Other:
6.Future Project Plans
6a.Is this a phased project?*
Yes No
Are any other NWP(s),regional general permit(s),or individual permits(s)used,or intended to be used,to authorize any part of the proposed project or related activity?This includes other
separate and distant crossing for linear projects that require Department of the Army authorization but don't require pre-construction notification.
No
D. Proposed Impacts Inventory
1. Impacts Summary
1a.Where are the impacts associated with your project?(check all that apply):
Wetlands Streams-tributaries Buffers
Open Waters Pond Construction
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.
"S."will be used in the table below to represent the word"stream".
11
3a.Reason for impact*(?) 3b.lmpact type* 3c.Type of impact* 3d.S.name* �re,.Stream Type* 3f.Type of 3g.S.width* 3h.Impact
Jurisdiction* length*
S1 Site 1 Permanent Bank Stabilization �Fs, ranch Perennial Both 10 23
Average(feet) (linear feet)
S2 Site 1 Temporary Dewatering Goose Branch Perennial Both 10 25
Average(feet) (linear feet)
"All Perennial or Intermittent streams must be verified by DWR or delegated local government.
31.Total jurisdictional ditch impact in square feet:
0
31.Total permanent stream impacts:
23
31.Total temporary stream impacts:
25
31.Total stream and ditch impacts:
48
3j.Comments:
There will be approximately 30'of open ditch lined with riprap to dissipate stormwater flow prior to discharge into Goose Branch.
6. Buffer Impacts (for DWR)
If project will impact a protected riparian buffer,then complete the chart below.Individually list all buffer impacts below.
6a.Project is in which protect basin(s)?
Check all that apply.
Neuse Tar-Pamlico
Catawba Randleman
Goose Creek Jordan Lake
Other

6b.Impact Type*(?) 6c.Per or Temp*(?) 6d.Stream name* 6e.Buffer mitigation required?" 6f.Zone 1 impact* 6g.Zone 2 impact*
F777
P Goose Branch No 561 E(-1u-r-:1--
et) t)
::::
6h. Total buffer impacts:
Zone 1 Zone 2
Total Temporary impacts: 0.00 0.00
Zone 1 Zone 2
Total Permanent impacts: 561.00 0.00
Zone 1 Zone 2
Total combined buffer impacts: 561.00 0.00
61.Comments:
E. Impact Justification and Mitigation u
1.Avoidance and Minimization
la.Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
This project was designed in a manner that completely avoids any wetland impacts and only minor impacts to the riparian buffer and stream bank.The
storm water discharge that requires the only jurisdictional impacts on this property has been designed to impact an area of riparian buffer that is currently
managed turf and provides no thermal cover(tree canopy).Due to the lack of canopy or extensive root mat,the stormwater outlet will not require
extensive clearing or grubbing activities to install.
1 b.Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
BMPs and Permit Conditions will be strictly observed throughout construction and all erosion control devices will be monitored and inspected per
NPDES Guidelines.
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 this project DOES NOT require Compensatory Mitigation,explain why:
Impacts associated with this project do not meet the thresholds for requiring mitigation.
NC Stream Temperature Classification Maps can be found under the Mitigation Concepts tab on the Wilmington District's RIBITS website.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
Recent changes to the stormwater rules have required updates to this section.***
1. Diffuse Flow Plan
la.Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
• Yes No
1 b.All buffer impacts and high ground impacts require diffuse flow or other form of stormwater treatment. If the project is subject to a state implemented riparian buffer protection program,
include a plan that fully documents how diffuse flow will be maintained.
All Stormwater Control Measures(SCM)s must be designed in accordance with the NC Stormwater Design Manual. Associated supplement forms and other documentation shall be
provided.
What type of SCM are you providing?
Level Spreader
Vegetated Conveyance(lower SHWT)
Wetland Swale(higher SHWT)
Other SCM that removes minimum 30%nitrogen
Proposed project will not create concentrated stormwater flow through the buffer
(check all that apply)
For a list of options to meet the diffuse flow requirements,click here.
2.Stormwater Management Plan

2a.Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
Yes No
Comments:
See Stormwater Management Plan included with Permit Drawings
G. Supplementary Information
1. Environmental Documentation
la.Does the project involve an expenditure of public(federal/state/local)funds or the use of public(federal/state)land?
Yes No
1 b.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(North Carolina)
Environmental Policy Act(NEPA/SEPA)?*
Yes No
Comments:*
MCDC Available upon request
2.Violations (DWR Requirement)
2a.Is the site in violation of DWR Water Quality Certification Rules(15A NCAC 2H.0500),Isolated Wetland Rules(15A NCAC 2H.1300),or DWR Surface Water or Wetland Standards or
Riparian Buffer Rules(15A NCAC 2B.0200)?*
Yes No
3. Cumulative Impacts (DWR Requirement)
3a.Will this project(based on past and reasonably anticipated future impacts)result in additional development,which could impact nearby downstream water quality?*
Yes No
3b.If you answered"no,"provide a short narrative description.
This is a single and complete project intended to address specific traffic safety issues at an adjacent intersection.
4. Sewage Disposal (DWR Requirement)
4a.Is sewage disposal required by DWR for this project?*
Yes No N/A
5. Endangered Species and Designated 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 USFWS concerning Endangered Species Act impacts?*
• Yes No
5c.If yes,indicate the USFWS Field Office you have contacted.
Raleigh
5d.Is another Federal agency involved?*
Yes No Unknown
5e.Is this a DOT project located within Division's 1-8?*
Yes No
5j.What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
IPAC,onsite evaluations,and direct correspondence with Mr.Gary Jordan(USFWS).
6. Essential Fish Habitat(Corps Requirement)
6a.Will this project occur in or near an area designated as an Essential Fish Habitat?
Yes No
6b.What data sources did you use to determine whether your site would impact an Essential Fish Habitat?
EFH Mapper
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map(does not include archaeological data: http_//gis.ncdcr.gov/hpoweb/

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 status(e.g.,National Historic Trust
designation or properties significant in North Carolina history and archaeology)?
Yes No
7b.What data sources did you use to determine whether your site would impact historic or archeological resources?*
HEU Letters attached for Archaeology and Architecture
8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https://msc.fema.gov/portal/search
8a.Will this project occur in a FEMA-designated 100-year floodplain?*
Yes No
8b.If yes,explain how project meets FEMA requirements:
Goose Creek is a FEMA regulated stream.Based on the effective model,Benvenue Road does not overtop during the 100-Year flood event,so the
majority of excavation will be in an ineffective area from the culvert.Additionally,the excavation if modeled in a cross-section would be given an
ineffective area since it is perpendicular to the flow.Since we are not proposing fill in the floodplain,all the proposed excavation would be within
ineffective areas.
8c.What source(s)did you use to make the floodplain determination?*
NCFRIS
Miscellaneous
Comments
Please use the space below to attach all required documentation or any additional information you feel is helpful for application review.Documents should be combined into one file when
possible,with a Cover Letter,Table of Contents,and a Cover Sheet for each Section preferred.
Click the upload button or dreg and drop files here to attach document
HA NoSurveyRevised.pdf 548.16KB
U-5947 No Archaeological Survey.pdf 6.67MB
U-5947_Permit_Drawings_20220114.pdf 1.56MB
U-5947_Buffer_Drawings_20220114.pdf 939.75KB
USFWS_NCDOT_U-5947 Official Concurrence.pdf 168.62KB
U-5947 Vicinity.pdf 149.83KB
File must be PDF or KMZ
Signature
*
By checking the box and signing below,I certify that:
• The project proponent hereby certifies that all information contained herein is true,accurate,and complete to the best of my knowledge and belief';and
• The project proponent hereby requests that the certifying authority review and take action on this CWA 401 certification request within the applicable reasonable period of time.
• I have given true,accurate,and complete information on this form;
• I agree that submission of this PCN form is a"transaction"subject to Chapter 66,Article 40 of the NC General Statutes(the"Uniform Electronic Transactions Act");
• I agree to conduct this transaction by electronic means pursuant to Chapter 66,Article 40 of the NC General Statutes(the"Uniform Electronic Transactions Act");
• I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature;AND
• I intend to electronically sign and submit the PCN form.
Full Name:*
Chad Coggins
Signature*
Date
1/27/2022