20160504 Ver 1_Application_20160518

Carpenter, Kristi
From:
Sent:
To:
Subject:
Attachments:
Kristi,
This is the NW3 I was referring to.
Thanks,
Brian Wrenn
919-707-8792
Wrenn, Brian L
Wednesday, May 18, 2016 12:09 PM
Carpenter,Kristi
FW: PCN SR -1522 MONTGOMERY COUNTY
SKM BT_36316051807430.pdf
From: King, Art C
Sent: Wednesday, May 18, 2016 10:38 AM
To: '[e-mail]' <[e-mail]>
Cc: Wrenn, Brian L <[e-mail]>
Subject: PCN SR -1522 MONTGOMERY COUNTY
Andy,
Attached is a PCN notification for NWP#3 for a pipe replacement on SR -1522 in Montgomery County. The pipe is in a
HQW zone on Drowning Creek.
A location map, a dewatering plan, a basic design and sediment control design are also included.
Please contact me if you have questions or need additional information.
Thanks,
Art
Art C. King
Division Environmental Office
NCDOT Highway Division 8
910-944-2344 office
910-690-6581 mobile
ackingkncdot.gov
902 N. Sandhills Blvd.
Aberdeen, NC 28315
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.

Email correspondence to and from this sender is subject to the N.C. Public Records Law and may be disclosed to third parties.

o�ot WArF,q
q 9
r
O
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Page 1 of 10
PCN Form — Version 1.3 December 10, 2008 Version
Pre -Construction Notification PC Form
A. Applicant Information
1.
Processing
la.
Type(s) of approval sought from the
Corps:
N Section 404 Permit ❑ Section 10 Permit
1b.
Specify Nationwide Permit (NWP) number: 3 or General Permit (GP) number:
1 c.
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
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.
ElYes
®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)?
❑ Yes
® No
2.
Project Information
2a.
Name of project:
SR -1522 pipe repair
2b.
County:
Montgomery County
2c.
Nearest municipality / town:
Jackson Springs
2d.
Subdivision name:
NA
2e.
NCDOT only, T.I.P. or state
project no:
86.206211
3.
Owner Information
3a.
Name(s) on Recorded Deed:
NCDOT Highway Div. 8
3b.
Deed Book and Page No.
3c.
Responsible Party (for LLC if
applicable):
3d.
Street address:
902 North Sandhills Blvd
3e.
City, state, zip:
Aberdeen, NC 28315
3f.
Telephone no.:
910-944-2344
3g.
Fax no.:
3h.
Email address:
Page 1 of 10
PCN Form — Version 1.3 December 10, 2008 Version

4.
Applicant Information (if different from owner)
4a.
Applicant is:
® Agent ❑ Other, specify:
4b.
Name:
Art C. King
4c.
Business name
(if applicable):
NCDOT Highway hwa Division 8
4d.
Street address:
902 North Sandhills Blvd.
4e.
City, state, zip:
Aberdeen, NC 28315
4f.
Telephone no.:
910-944-2344
4g.
Fax no.:
910-944-5623
4h.
Email address:
[e-mail]
S.
Agent/Consultant Information (if applicable)
5a.
Name:
5b.
Business name
(if applicable):
5c.
Street address:
5d.
City, state, zip:
5e.
Telephone no.:
5f.
Fax no.:
5g.
Email address:
Page 2 of 10
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):
NA
1b. Site coordinates (in decimal degrees):
1c. Property size:
Latitude: 35.2345 Longitude: - 79.6685
(DD.DDDDDD) (-DD.DDDDDD)
<1 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
proposed project:
Drowning Creek
2b. Water Quality Classification of nearest receiving water:
WS-11I;Sw,HQW
2c. River basin:
Lumber
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:
Rural forested
3b. List the total estimated acreage of all existing wetlands on the property:
<0.01
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
100
3d. Explain the purpose of the proposed project:
To replace a failing steel culvert pipe
3e. Describe the overall project in detail, including the type of equipment to be used:
excavate existig pipe,and install a new one using: Track hoe, dump truck, grader, paving equipment.
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?
Comments:
❑ 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.
S. 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?
❑ Yes ® No
6b. If yes, explain.
Page 3 of 10
PCN Form — Version 1.3 December 10, 2008 Version

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. 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. 26. 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
Wl ❑ P ❑ T
NA
❑ Yes
❑ Corps
❑ No
❑ DWQ
W2 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W3 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W4 ❑P❑T
1-1 Yes
El Corps
El No
❑DWQ
W5 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W6 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑DWQ
2g. Total wetland impacts
2h. Comments:
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for ail stream sites impacted.
3a.
3b.
3e.
3f.
3g.
Stream impact
Type of impact
Stream name
Perennial
Type of jurisdiction
Average
Impact
number -
Permanent(P)or
(PER) or
intermittent
(Corps - 404, 10
stream
length
Temporary (T)
(INT)?
DWQ—non-404,
other)
width
(feet)
(linear
feet)
S1 ®P ❑ T
pipe
UT of Drowning
® PER
®Corps
Creek
❑ INT
® DWQ
5-11ft
loft
S2 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S3 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S4 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S5 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S6 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑DWQ
3h. Total stream and tributary impacts
10ft
3i. Comments: Pipe lengthen by 10 feet to meet current safety standards for road shoulder width.
Page 4 of 10
PCN Form — Version 1.3 December 10, 2008 Version

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.
Open water
4b.
Name of waterbody
4c.
4d.
4e.
impact number-
Permanent (P) or
(if applicable)
Type of impact
Waterbody type
Area of impact (acres)
Temporary T
01 ❑P❑T
NA
02 ❑P❑T
03 ❑P❑T
04 ❑P❑T
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If pond or lake construction proposed, then complete the chart below.
5a.
5b.
5c.
5d.
5e.
Pond IDWetland
Proposed use purpose
Impacts (acres)
Stream Impacts (feet)
Upland
number
ofpond
(acres)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
NA
P2
5f. Total
5g. Comments:
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 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-
Permanent (P) or
Reason
for
Stream name
Buffer
mitigation
Zone 1 impact
(square feet)
Zone 2 impact
Temporary
impact
required?
(square feet)
B1 ❑P❑T
NA
El Yes
❑ No
B2 ❑P❑T
El Yes
❑ No
B3 ❑P❑T
El Yes
❑ No
6h. Total buffer impacts
6i. Comments:
Page 5 of 10
PCN Form - Version 1.3 December 10, 2008 Version

D. Impact Justification and Mitigation
1. Avoidance and Minimization
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Pipe replaced in it's original location. Addition pipe length installed to meet current safety standards.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Dewatering and excavation in the dry will be conducted using current NCDOT BMP's.
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 6 of 10
PCN Form — Version 1.3 December 10, 2008 Version

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
3 (2 for Catawba)
Zone 2
1.5
6f. Total buffer mitigation required:
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).
6h. Comments:
Page 7 of 10
PCN Form — Version 1.3 December 10, 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? If no, explain why.
Comments:
❑ Yes ❑ No
2.
Stormwater Management Plan
2a.
What is the overall percent imperviousness of this project?
<33 %
2b.
Does this project require a Stormwater Management Plan?
® Yes ❑ No
2c.
If this project DOES NOT require a Stormwater Management Plan, explain why: In an HQW zone
2d.
If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
Will utilize BMP's and erosion controls designed for projects in HQW areas.
❑ 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
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?
4.
DWQ Stormwater Program Review
❑ Coastal counties
4a.
Which of the following state -implemented stormwater management programs apply
® HQW
❑ ORW
(check all that apply):
❑ Session Law 2006-246
❑ Other:
4b.
Has the approved Stormwater Management Plan with proof of approval been
attached?
® Yes ❑ No
5.
DWQ 401 Unit Stormwater Review
5a.
Does the Stormwater Management Plan meet the appropriate requirements?
❑ Yes ❑ No
5b.
Have all of the 401 Unit submittal requirements been met?
❑ Yes ❑ No
Page 8 of 10
PCN Form — Version 1.3 December 10, 2008 Version

F.
Supplementary Information
1.
Environmental Documentation (DWQ Requirement)
la.
Does the project involve an expenditure of public (federal/state/local) funds or the
®Yes
❑ No
use of public (federal/state) land?
1b.
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
letter.)
❑ Yes
❑ No
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 "yes" 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
El 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 9 of 10
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
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
❑ Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
USF&W maps, NCDOT staff site survey.
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?
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
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
El Yes El No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
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?
Applicant/Agent's Printed Name
Date
Applicant/Agerit's Sign lure
(Agent's signature is valid only if an authorization letter from the applicant
is rovided.
Page 10 of 10
PCN Form — Version 1.3 December 10, 2008 Version

I T Y
lz.
NOTE : MAP INCLUDES ONLY STATE MAINTAINED ROADS
OR IMPORTANT NON -SYSTEM ROADS.
ROADS SHOWN AS OF OCTOBER 18. 2004. I
MONTGOMERY COL
N
W
E
S
■ "R" RAILROAD COMPANY STRUCTURE
cmuMR
NATIONAL FOREST BOUNDARY
F
■"S"OVERHFAD SIGN
STATE FOREST BOUNDARY
T 160`0
FEDEftAt GAMELAND SOUNDARY
14A '6
1601 \1
�"i"TUNNEL
STATE GAMEIAND BOUNDARY
.,
20
■ "Ll" PEDESTRIAN, CATTLE UNDERPASS
— _ —
MILITARY RESERVATION BOUNDAI
NTYLINE
/
am
Gig "
■ "y" VEHICLE UNDERPASS LESS THAN 2V
— - - —
STATE UNE
(aI
1
e ,
-
■ "V1r NCDOT AND PRIVATE PEDESTRIAN BRIDGES
r --
4 =T
INCORPORATEDCm ORVIl1AGC
(GENERALIZED)
1k�oe ,1
G4Y.
■"Y" SINGLE POLE SIGN STRUCTURE
FREEORTOLLF£RRY
CANAL
61
NARROW STREAM
WDESITLEAM
1,
Pq.^n'gMa.
DAMWRHLOCR
�\\ i
RESENVOIR,POND,OR LAID:
IiAyINR1'
I�
-
O
COAWUNm ANOTOWNCENTER
®
COUNTYSEAT
' 1514
3
i
SCHOOL
COLIEGEORUNNERSIW
.
-JD
INT�/6 1
v =o
s
f 98
CHURCH
CHURCH WTH CEMETERY
CEMETERY
1606
i.
*
PATROL STATION
®
CORREGDONAL OR PENAL WSTN
0
®
HIGHWAY GARAGE OR SAINT. YA
1625 1003
®
HIGHWAY pV.OROIST.OFFICE
9`1590
Q
✓
WBGHTSTATON
163] J e 521
av G
Q
MONUMENT�SMAl1HIBTONCAL;
Z
Y
LiGHT110USE
F'^MY
22 a 571
2
MWNiAiN t+ENC
/IU
100
f 1.2
A
TRIANGULATION STATION
/
COASTGUARDSTADON
I /
b•B
u 529 162
.4
yj
MILITARY MIUMED
1521
{>}
COMMIRCIALORMUNIVI'M-FIEL
`.'
V
e
HMIGARONFIEID
I
ie
20
a
't
IANDING STRIP
1524 +�
1832 \ .%a.
rte^ �
QJ
MARIffD AU%ILVIRY FIELD
I T Y
lz.
NOTE : MAP INCLUDES ONLY STATE MAINTAINED ROADS
OR IMPORTANT NON -SYSTEM ROADS.
ROADS SHOWN AS OF OCTOBER 18. 2004. I
MONTGOMERY COL
NORTH CAROLINA
BRIDGE LOCATION
PREPARmeYTHE
NORTH CAROLINA DEPARTMENT OF TRANSPOF
DMGION OF HIGHWAYS - GIS UNIT
U.S.DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION
SCALE
1 0 1 2 3 4 MILES
0 0.5 1 MILE
SCALE FOR EK ARGEMEIM
,lea,gxAllMe.4TNISW I'
�i�♦ I f1,x41 iiW u
\RA\IT/�!3\RC[TV nr
N
W
E
S
NORTH CAROLINA
BRIDGE LOCATION
PREPARmeYTHE
NORTH CAROLINA DEPARTMENT OF TRANSPOF
DMGION OF HIGHWAYS - GIS UNIT
U.S.DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION
SCALE
1 0 1 2 3 4 MILES
0 0.5 1 MILE
SCALE FOR EK ARGEMEIM
,lea,gxAllMe.4TNISW I'
�i�♦ I f1,x41 iiW u
\RA\IT/�!3\RC[TV nr

P:Qe b�c:ecl -RP RAP
L�=wu av,
STREAM EED
E= EVATi0N
I
-d
w
u�
3
I

T",PCro,ry -5 )- 'Fences
insta11eaaS necessm,,.
&IV- 70 5'r*/�
=t ►saa _ _� 3
°a
oa o
-- o°d
o°-
ozi
0000. 1!00000C
;R:a RAP
IY.M.
0 0i
°o°oii ''p0cC" races
��-cessafy• �
I
= I
--_-
i
-UT �n�o �rown:,� Gree I
9

PRECAS i Cortr-RE
$ARF+IEP� iLA11_
OR
s'1Etiy sxsL-A lNb
11
X/v7 - 0; �
2rtC "ST conc.RETF; i
BAaP,tER R1\it_ C�
S'CGFL 5NEE i iNr `-•
' I_