20151247 Ver 1_Application_20151202 (2)

Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification (PCN) Form
A. Applicant Information
1. Processing
1 a. Type(s) of approval sought from the
Corps: non-reporting � Section 404 Permit ❑ Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number: non-reporting 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
1 e. Is this notification solely for the record For the record only for DWQ 401 For the record only for Corps Permit:
because written approval is not required? Certification:
❑ Yes � No � Yes ❑ No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation � Yes � No
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program.
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1h ❑ Yes � No
below.
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ❑ Yes � No
2. Project Information
2a. Name of project: Proposed pipe replacement SR 2132 (Dean Avenue)
2b. County: Wake
2c. Nearest municipality / town: Raleigh
2d. Subdivision name: N/A
2e. NCDOT only, T.I.P. or state WgS No. 5.209211A
project no:
3. Owner Information
3a. Name(s) on Recorded Deed: NCDOT Division 5
3b. Deed Book and Page No. N/A
3c. Responsible Party (for LLC if N/A
applicable):
3d. Street address: 2612 N. Duke Street
3e. City, state, zip: Durham, NC 27704
3f. Telephone no.: [phone]
3g. Fax no.: [phone]
3h. Email address: Ihopkins(c�ncdot.qov
4. Applicant Information (if different from owner) N/A
5. Agent/Consultant Information (if applicable) N/A
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PCN Form — Version 1.3 December 10, 2008 Version

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): N/A
1 b. Coordinates (in decimal degrees):
Site: Latitude:35.86146 Longitude: -78.56230
(DD.DDDDDD) (-DD.DDDDDD)
1 c. Property size:
0.065 ac
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to UTs to Perry Creek
proposed project:
2b. Water Quality Classification of nearest 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:
The 36" RCP that is 40ft long with dislocated or missing joints. The structure is undersized and has separated causing the
roadwa shoulders to fail. Site is surrounded b wooded land residential roperties.
3b. List the total estimated acreage of all existing wetlands on the property:
NONE
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
90 ft
3d. Explain the purpose of the proposed project: The pipe replacement will keep the roadway from failing.
3e. Describe the overall project in detail, including the type of equipment to be used:
A new 48" CMP that is 50ft long will be installed to replace the old pipe. If removed the existing structure would collapse a
retaining wall and parking pad of an adjacent private property. Therefore a new pipe will be placed 20ft north and the old pipe
and old channel will be filled. Channel changes will be necessary upstream and downstream of the proposed pipe. The banks
of the newly cut channel sections will be armored with rip rap underlined with geotextile for long term stability up to and
surrounding the pipe ends. The NCDOT will also dewater the work zone as needed during construction. Equipment may
include an excavator, a backhoe, and rader.
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
Comments: N/A
4b. If the Corps made the jurisdictional determination, what
type of determination was made? ❑ Preliminary ❑ Final
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 � Yes � No ❑ Unknown
for this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
N/A
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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)
Tempora T
W 1 ❑ P❑ T N/A N/A ❑ Yes ❑ Corps N/A
❑ No ❑ DWQ
2g. Total Wetland Impacts: NONE
2h. Comments: No wetlands existing within the project footprint.
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 UT to � PER � Corps
pipe fill Perry Creek � INT � DWQ 3 75
Site 1� P❑ T channel change UT to � PER � Corps
3 70
with rip rap Perry Creek � INT � DWQ
Site 1❑ P� T dewatering UT to � PER � Corps 3 90
Perry Creek � INT � DWQ
3h. Total stream and tributary impacts 90
3i. Comments:
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)
Tem orar T
01 ❑ P❑ T N/A N/A N/A N/A
4f. Total open water impacts NONE
4g. Comments: N/A
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PCN Form - Version 1.3 December 10, 2008 Version

5. Pond or Lake Construction
If ond or lake construction ro osed, then com lete the chart below.
5a. 5b. 5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or purpose (acres)
number of 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. NONE NONE NONE NONE NONE NONE NONE
Total
5g. Comments: N/A
5h. Is a dam high hazard permit required?
❑ Yes � No If yes, permit ID no: N/A
5i. 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 ❑ Tar-Pamlico ❑ Other:
Project is in which protected basin? ❑ Catawba ❑ Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number— Reason for impact Buffer Zone 1 impact Zone 2 impact
Permanent (P) or Stream name mitigation (square feet) (square feet)
Tem orar T re uired?
Site � P❑ T Pipe replacement UT to Perry Creek � Yes 2,g50 1,900
Buffer Impact 1 � No
6h. Total buffer impacts 2,850 1,900
6i. Comments: Necessary shift of the pipe will involve unavoidable impacts to buffers. Access through buffer for installation of
dewatering materials. Note clearing at the outlet will be limited to only those specific trees necessary for construction.
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Clearing and use of rip rap will be limited only to the amount necessary to ensure long term stability.
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 will be enforced during project
construction.
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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 ❑ Yes � No
impacts to Waters of the U.S. or Waters of the State?
2b. If yes, mitigation is required by (check all that apply): ❑ DWQ ❑ Corps
❑ Mitigation bank
2c. If yes, which mitigation option will be used for this project? ❑ 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 ❑ Yes � No
buffer mitigation?
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.
6c. 6d. 6e.
Zone Reason for impact Total impact Multiplier Required mitigation
(square feet) (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
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PCN Form — Version 1.3 December 10, 2008 Version

E. Stormwater Management and Diffuse 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 Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
Comments: this pipe replacement will not alter storm water runoff at this site, no new ❑ Yes � No
ditches will be cut through the buffers
2. Stormwater Mana ement 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: no new ditches will be cut through buffers
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? N/A
❑ Phase II
3b. Which of the following locally-implemented stormwater management programs ❑ NSW
apply (check all that apply): ❑ USMP
❑ Water Supply 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
attached? N/A ❑ Yes ❑ No
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
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PCN Form — Version 1.3 December 10, 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?
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 ❑ Yes � No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1 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
letter.) ❑ Yes ❑ No
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
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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 USFWS concerning Endangered Species Act � Yes � No
i m pacts?
❑ 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?
no habitat for Dwarf wedgemussel, Michaux's sumac, nor Red-cockaded woodpecker exists at this crossing, neither has any occurrences
been recorded at this location. Clearing acreage will be reported to the USFWS per the programmatic agreement concerning the listing of the
Northern Long Ear Bat. No protective species surveys are required.
http://www.fws.qov/nc-es/es/countvfr.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.floridamarine.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?
HPO's historic layer using GIS ArcView database, SHPO's webpage http://qis.ncdcr.qov/hpoweb/
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: N/A
8c. What source(s)did you use to make the floodplain determination? http://fema.maps.arcgis.com/home/webmap/viewer.html
>or J. R. Hopkins, P.E. Q ��pk, 12/02/15
ApplicanUAgent's Signatur Date
ApplicanUAgent's Printed Name (AgenYs signature is valid onfy if an authorization let er from the applicant
Is pro�ided.} ,
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PCN Form — Version 1.3 December 10, 2008 Version