HomeMy WebLinkAbout20171102 Ver 1_PCN Form Submission_20170901Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 9/1/2017 3:24:16 PM (Start Event)
Accept by Carpenter,Kristi 9/1/2017 3:46:31 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: September 6, 2017 5:00 PM
9/1/2017 3:24 PM
�� �
6fvlslaa of Water Resources
Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
June 28, 2017 Ver 1.8
*
Please note: fields marked with a red asterisk below are required. You will not be ab/e to submit the form until all mandatory questions are ans�red.
Below is a link to the DRAFT online help file. http://edocs.deq.nc.gov/WaterResources/0/doc/549884/Page1.aspx
A. Processing Information
County (or Counties) where the project is located:*
Durham
Is this a NCDOT Project?*
C� Yes �' No
(NCDOT only) T.I.P. or state project number:
WBS #
176P.5.R.54
(for f�1CDOT use only)
� 1a. Type(s) of approval sought from the Corps:*
rJ Section 404 Permit (wetlands, streams and waters, Clean Water Act)
r Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What type(s) of permit(s) do you wish to seek authorization?*
fJ Nationwide Permit (NWP)
r Regional General Permit (RGP)
Nationwide Permit (NWP) Number:
NWP Number Other:
List all MN nurrbers you are applying for not on the drop dow n list.
14 - Linear transportation
1c. Type(s) of approval sought from the DWR:*
check all that apply
� 401 Water Quality Certification - Regular
� Non-404 Jurisdictional General Permit
r 401 Water Quality Certification - Express
�7 Riparian Buffer Authorization
1d. Is this notification solelyfor the record because written approval is not required?
For the record only for DWR 401 Certification:
I For the record only for Corps Permit:
1e. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
*
l" Yes C•' No
C' Yes C•' No
If so, attach the acceptance letter from rritigation bank or in-lieu fee program
�' Yes C' No
Acceptance Letter Attachment
Qick the upload button or drag and drop files here to attach docurrent
I 17BP.5.R.54 DMS mitigation acceptance letter .pdf
FlLE IYFE MJST BE FDF
1f. Is the project located in any of NC's twenty coastal counties?*
C' Yes �' No
B. Applicant Information
1a. Who is the Primary Contact?*
Chris Murray
1b. Primary Contact Email:*
cmurray@ncdot.gov
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
(919)220-4633
1d. Who is applying for the permit?
rJ Owner r Applicant (other than owner) r AgenUConsultant
(Check all that apply)
2. Owner I nformation
2a. Name(s) on recorded deed:
NCDOT
2b. Deed book and page no.:
2c. Responsible party:
(for Corporations)
2d.Address
Street Address
2612 N. Duke Street
Address Line 2
��
Durham
Fbstal / Zip Code
27704
2e. Telephone Number:
(xxx)xxx-xxxx
2f. Fax Number:
(xxx)x�c-�ocx
2g. Email Address:*
cmurray@ncdot.gov
72.45KB
State / R-ovince / F�gion
NC
Country
USA
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Replacement of Bridge 310117 over Mud Creek on SR 1308 (Cornwallis
Road)
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
� Durham
1d. Driving directions*
If it is a new project and can not easily be found in a C�5 rrapping system Rease provide directions.
Travel north on US 15-501, take the SR 1308 (Cornwallis Road) e�at, turn left at the top of the off ramp and travel west to the project site.
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)
0801-13-88-3966.SPL;0801-13-88-3966.L01
2b. Propertysize:
(in acres)
2.9 ac
2c. Project Address
Street Address
near 2999 West Cornwallis Road
Address Line 2
��
Durham
Fbstal / Zip Code
27705
State / R-ovince / I�gion
NC
Country
USA
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 howthe 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:*
35.99247
ex:34.208504
3. Surface Waters
Longitude:*
-78.97226
-77.796371
3a. Name of the nearest body of water to proposed project:*
Mud Creek
3b. Water Resources Classification of nearest receiving water:*
WS-V; NSW (16-41-1-10)
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Cape Fear
RiverBasin Lookup
4. Project Description
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:*
� Existing land use in the area is wooded land in Duke Forest.
4b. Attach an 8 1/2 X 11 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for
DWR)
C7ick the upload button or drag and drop files here to attach docurrent
17BP.5.R.54 usgs map.pdf 2.71 MB
Fle type rrust be pdF
4c. Attach an 8 1/2 X 11 excerpt from the most recent version of the published County NRCS Soil Survey map depicting the project site.
(for DWR)
Qick the upload button or drag and drop files here to attach docurrent
17BP.5.R.54 soil survey map.pdf 684.29KB
Fle type rrust be pdf
4d. List the total estimated acreage of all existing wetlands on the property:
0.18 ac in project limits
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
270 linear feet perenntial in project limits
4f. Explain the purpose of the proposed project:
Replacement of Bridge 310117 is structurally deficient and requires replacement. Location of the bridge in relation
to the adjacent Cornwallis Road and Erwin Road intersection requires improvements to Cornwallis Road.
4g. Describe the overall project in detail, including the type of equipment to be used:
Replacement of Bridge 310117 and improvements to SR 1308 (Cornwallis Road). Equipment includes crane,
backhoe, grader, bulldozer, etc.
4h. Please upload project drawins for the proposed project.
C7ick the upload button or drag and drop files here to attach docurrent
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5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
C� Yes �' No !' Unknown
Comments:
Yes. Originally in March 2014 and updated in January 2017.
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
C' Preliminary �' Approved C' Unknown
Corps AID Number:
Exarrple: SAV�2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other
Jason Dilday
NCDOT
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Delineation conducted by Jason Dilday (NCDOT) in January 2017 with site visit by USACE and NCDENR-DWR on 2/3/17.
5d1. Jurisdictional determination upload
aick the upload button or drag and drop files here to attach docurreM
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6. Project History
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past?*
C' Yes C•' No C' Unknown
7. Future Project Plans
7a. Is this a phased project?*
C' Yes C•' 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.
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
r% Wetlands I7 Streams-tributaries r7 Buffers
r Open Waters r Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. Site # - Reason for
impact
Site 1
N�p label (e.g. f�ad Qossing 1)
Site 1
N�p label (e.g. F�ad Qassing 1)
Site 1
fv�p label (e.g. Id�ad Qossing 1)
Site 2
N�p label (e.g. I�ad Qossing 1)
2b. Impact type * 2c. Type of wetland
P Headwater Forest
F�rrranent (P� or Terrporary
��
P Headwater Forest
F2rrranent (Pj or Terrporary
��
P Headwater Forest
F2rrranent (P� or Terrporary
��
P Headwater Forest
F�rrranent (Pj or Terrporary
��
2d. Wetland name 2e. Forested 2f. 2g. Impact
Jurisdiction area
type
Fill Yes Both 0.050
(404, 10) or C7�NR (acres)
(401, other)
Excavation Yes Both 0.010
(404, 10) or d�NR (acres)
(401, other)
Mech Clearing Yes Both 0.110
(404, 10) or CNVR (acres)
(401, other)
Mech Clearing Yes Both 0.010
(404, 10) or C7�NR (acres)
(401, other)
2g. Temporary Wetland Impact
0.000
2g. Permanent Wetland Impact
0.180
2g. Total Wetland Impact
0.180
2h. Comments:
Impacts include permanent fill, permanent excavation and permanent mechanized clearing.
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. Site #- 3b.lmpact 3c. Type of 3d. Stream 3e. Stream 3f. 3g. Stream 3h. Impact
Reason for type impact name Type Jurisdiction width length
impact type
Row 1 Site 1 P Fill Mud Creek Perennial Both Average 103
N�p label (e.g. F2rrranent (P� or F�rennial (Fff� or 2 (linear feet)
RDad (7ossing 1) Terrporary (� interrrittent (IfV�
Row2 Site 1 T Dewatering Mud Creek Perennial Both
N�p label (e.g. F�rrranent (P� or F�rennial (� or
13�ad CYossing 1) Terrporary (� interrrittent (IfVn
"" All Perennial or Intermittent streams must be verified by DWR or delegated local government.
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
103
3i. Total temporarystream impacts:
17
3i. Total stream and tributary impacts:
120
(feet)
Average 17
2 (linear feet)
(feet)
3j. Comments:
Impacts include permanent fill (with subsequent placement in Class I rip rap lined lateral base ditch) and temporary
fill for dewatering.
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.
5. Pond or Lake Construction
If pond or lake construction is proposed, then complete the chart below.
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.
r Neuse
r Catawba
r Goose Creek
r Other
6b. Impact Type
r Tar-Pamlico
r Randleman
�J Jordan Lake
6c. Per or 6d. Stream name
Te mp
6e. Buffer
mitigation
required?
6f. Zone 1 6g. Zone 2
impact impact
Site 1 Allowable with mitigation P Mud Creek Yes 11,130 1,563
Location and Exerrpt, Allowable, allowable w/ rritigation F�rrranent (P� or (square feet) (square feet)
Terrporary (�
6b. Impact Type
6c. Per or 6d. Stream name
Te mp
Site 2 Allowable bridge impact P Mud Creek
Location and 6cerrpt, Allowable, allowable w/ rritigation F�rrranent (F) or
Terrporary (�
Site 2 Allowable road crossing P Mud Creek
impBCt F�rrranent (P� or
Location and 5cerrpt, Allowable, allowable w/ rritigation Terrporary (�
6h. Total buffer impacts:
Temporary impacts:
Permanent impacts:
Total buffer impacts
6i. Comments:
Zone 1
0.00
Zone 1
13,761.00
Zone 1
7 3,761.00
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
C7ick the upload button or drag and drop files here to attach docurrent
176P.5.R.54 permit drawing set.pdf
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Zone 2
0.00
Zone 2
4,576.00
Zone 2
4,576.00
E. Impact Justification and Mitigation
1. Avoidance and Minimization
6e. Buffer 6f. Zone 1 6g. Zone 2
mitigation impact impact
required?
No 2,500 400
(squarefeet) (squarefeet)
i.n
3.69MB
131 2,613
(squarefeet) (squarefeet)
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
Specific information was sent via email on 6/13/17 to the USACE and NCDENR-DWR regarding avoidance and
minimization efforts. This email is attached to the pcn application.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Specific information was sent via email on 6/13/17 to the USACE and NCDENR-DWR regarding avoidance and
minimization efforts. This email is attached to the pcn application.
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?
C•' Yes �' No
2c. If yes, mitigation is required by (check all that apply):
rJ DWR �J Corps
2d. If yes, which mitigation option(s) will be used for this project?
� Mitigation bank rJ Payment to in-lieu fee program r Permittee Responsible Mitigation
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)
103 linear feet
4c. If using stream mitigation, stream temperature:
warm
4d. Buffer mitigation requested (DWR only):
(squarefeet)
11,130 sf in BZ 1 impact and 1,563 sf in BZ 2 impact
4e. Riparian wetland mitigation requested:
(acres)
0.18 acre
4f. Non-riparian wetland mitigation requested:
(acres)
4g. Coastal (tidal) wetland mitigation requested:
(acres)
4h. Comments
6. Buffer mitigation (State Regulated Riparian Buffer Rules) - required by DWR
6a. Will the project result in an impact within a protected riparian buffer that requires buffer mitigation? If yes, you must fill out this entire
form - please contact DWR for more information.
C� Yes C' 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 in the table below.
6c. Reason for impact 6d. Total impact Multiplier 6e. Required
(square feet) mitigation (square
feet)
Zone 1 Roadway fill and stream relocation 11,130 11,130
Zone 2 Roadway fill and stream relocation 1,563 1,563
6f. Total buffer mitigation required
12693
6g. If buffer mitigation is required, is payment to a mitigation bank or NC Division of Mitigation Services proposed?
C' Yes C' No
6h. Attach the acceptance letter from the mitigation bank or NC Division of Mitigation Services.
17BP.5.R.54 DMS mitigation acceptance letter .pdf 72.45KB
(FDF only)
6i. If no, then discuss what type of mitigation is proposed.
I Payment to in-lieu fee program.
6j. Comments:
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1a. Does this project require a Stormwater Management Plan?
C•' Yes C' No
1b. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
See cover sheet in permit drawings.
1c. What is the overall percent imperviousness of this project?
22
%
1d. Who will be responsible for the review of the Stormwater Management Plan?*
r Certified Local Government
� DWR 401 & Buffer Permitting Branch
2. Diffuse Flow Plan
r DEMLR Stormwater Review
r DWR Transportation Permitting Branch
2a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection
Rules?
C' Yes C' No
2b. All buffer impacts and high ground impacts require diffuse flow or other form of stormwater treatment. Include a plan that fully
documents howdiffuse flowwill be maintained.
If, due to site constraints, a BMP other than a level spreader is proposed, please provide a plan for stormwater treatment as outlined
in Chapter 8 of the NC Stormwater BMP Manual and attach a BMP Supplement Form
What documentation are you providing?
r Level Spreader
� Other BMP
(check all that apply)
Diffused Flow Documentation
C7ick the upload button or drag and drop files here to attach docurrent
176P.5.R.54 Stormwater management plan.pdf
Fle type rrust be FDF
5. DWR 401 Stormwater Review
23.48K6
5a. Is the Stormwater Management Plan (including BMP Supplemental Forms and Operation and Maintenance Agreements) attached?
C' Yes C' No
Stormwater Management Plan Upload
aick the upload button or drag and drop files here to attach docurrent
176P.5.R.54 Stormwater management plan.pdf
file type rrust be pdf
G. Supplementary Information
1. Environmental Documentation
23.48K6
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
C� Yes l" No
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 (North Carolina) Environmental PolicyAct (NEPA/SEPA)?*
r Yes l" No
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
NEPAor SEPAfinal approval letter.)*
C' Yes �' No
Comments:*
The Department wil complete a MCDC or Categorical Exclusion.
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)? *
C' Yes �' No
2b. Is this an after-the-fact permit application?*
C' Yes C•' No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
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?*
C' Yes �' No
3b. If you answered "no," provide a short narrative description.
The project will not result in additional development.
4. Sewage Disposal (DWR Requirement)
4a. Describe, in detail, the treatment methods and dispositions (non-discharge or discharge) of wastewater generated from the
proposed project. If the wastewater will be treated at a treatment plant, list the capacity available at that plant.
The project wil not generate wastewater.
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?*
C� Yes �' No
Sb. Have you checked with the USFWS concerning Endangered Species Act impacts?*
C� Yes C' No
Sc. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. Is this a DOT project located within Division's 1-8?*
�' Yes
C' No
5i. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
Survey information provided by NCDOT staff and private engineering firm staff.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
C' Yes �' No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
Mapped information.
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)?*
C' Yes C•' No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
Coordination with State HPO office.
7c. Historic or Prehistoric Information Upload
C7ick the upload button or drag and drop files here to attach docurrent
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8. Flood Zone Designation (Corps Requirement)
Link to the FEMAFIoodplain Maps: https://msc.fema.gov/portal/search
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
C•' Yes C' No
8b. If yes, explain how project meets FEMA requirements:
Project will be permitted under NCDOT MOA with NCFMP.
8c. What source(s) did you use to make the floodplain determination?*
FEMA map
Miscellaneous attachments not previously requested.
Gick the upload button or drag and drop files here to attach docurrent
17BP.5.R.54 avoidance and minimization letter.pdf 2.67M6
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Signature
*
fJ By checking the box and signing below, I certify that:
■ 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 AcY');
■ I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic
Transactions AcY');
. 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:*
Christopher A. Murray
Signature
�.'�7��" �L1 r`r'c�c�
d
Date
9/1 /2017
Initial Review
Is this project a public transportation project?
C� Yes C' No
Only change this if the project has been reassigned.
Has this project met the requirements for acceptance in to the review process?*
C� Yes
C' No
� BIMS#Assigned*
20171102
Version#*
Reviewing Office *
Central Office - (919) 707-9000
Select Project Reviewer*
i Rob Ridings:eads\rgridings