20180434 Ver 1_PCN Form Submission_20180326

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 3/26/2018 9:55:44 AM (Start Event)
Accept by Carpenter,Kristi 3/26/2018 5:19:38 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: March 29, 2018 5:00 PM
3/26/2018 9:56 AM

�� �
6fvlslaa of Water Resources
Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
January 31, 2018 Ver 2.3
*
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 ans�red.
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://edocs. deq. nc.gov/WaterResources/0/edoc/624704/PCN%20Help%20File%202018-1-30. pdf
A. Processing Information
County(or Counties) where the project is located:*
Tyrrell
� Is this project a public transportation project? *(')
G Yes C' No
Is this a NCDOT Project?*
r Yes C' No
(NCDOT only) T.I.P. or state project number:
WBS #
1.208911
(for NCDOT use only)
1a. Type(s) of approval sought from the Corps:*
�J 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 MNnurrbers you are applying for not on the drop down list.
13 - Bank Stabilization
I 1c. Type(s) of approval sought from the DWR:*
check all that apply
�J 401 Water Quality Certification - Regular
r Non-404 Jurisdictional General Permit
r 401 Water Quality Certification - Express
r Riparian Buffer Authorization

*
1d. Is this notification solelyfor the record because written approval is not required?
I For the record only for DWR 401 Certification: C' Yes �' No
i For the record only for Corps Permit: !' Yes C� No
1e. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
If so, attach the acceptance letter from rritigation bank or in-lieu fee program
C' Yes C•' No
1f. Is the project located in anyof NC's twentycoastal counties?*
�' Yes �' No
1g. Is the project located within a NC DCM Area of Environmental Concern (AEC)?*
C' Yes C•' No C' Unknown
i 1h. Is the project located in a designated trout watershed?*
C' Yes G No
Link to trout information: http://ww�.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Agency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact?*
I Paul Williams
1b. Primary Contact Email:*
[e-mail]
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
r Owner r% Applicant (other than owner) r AgenUConsultant
(Check all that apply)
2. Owner I nformation
2a. Name(s) on recorded deed:
NCDOT Right-of-Way SR 1229 Old US 64 - Tyrrell County
2b. Deed book and page no.:
2c. Responsible party:
(for Corporations)
2d.Address
Street Address
Address Line 2
Qty
Fbstal / Zip Code
2e. Telephone Number:
(xxx)xxx-xxxx
2f. Fax Number:
(xxx)xxx-x�cx
2g. Email Address:*
State / Rovince / F�gion
Country

[e-mail]
3. Applicant Information (if different from owner)
3a. Applicant is:
C' Agent
C� Other ,�LUOT Division 1 tnvironmental Specialist
If other please specify.
3b. Name:
Paul Williams
3c. Business Name:
(if applicable)
NC Department of Transportation
3d. Address
Street Address
113 Airport Dr.
Address Line 2
��
Edenton
Fbstal / Zip Code
27932
3e. Telephone Number:
[phone]
(xxx)x�c-�ocx
3f. Fax Number:
[phone]
(xxx)xxx-xxxx
3g. Email Address:*
[e-mail]
State / Rovince / F�gion
NC
Country
USA
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Bank Stabilization - Tyrrell SR 1229 Old US 64
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Columbia
1d. Driving directions*
If it is a new project and can not easily be found in a C�5 rrapping system Rease provide directions.
On SR 1229, 250 feet East of SR 1221.
2. Project Identification
2a. Propertyldentification Number:
(tax RN or parcel ID)

2b. Propertysize:
(in acres)
2
2c. Project Address
Street Address
Address Line 2
Qty
Columbia
Fbstal / Zip Code
27925
2d. Site coordinates in decimal degrees
State / FYovince / F�gion
NC
Country
USA
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:*
35.9459405
ex:34.208504
3. Surface Waters
Longitude:*
-76.1277615
-77.796371
3a. Name of the nearest body of water to proposed project:*
Unnamed canal to Little Alligator River
3b. Water Resources Classification of nearest receiving water:*
SC; Sw
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Pasquotank
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:*
� Project area consist of NCDOT SR 1229 and roadside canal to the Little Alligator River. The adjacent
property consists of forested wetlands and the NCDOT barge facility.
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
Topo.pdf 1.02MB
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
Soil_Map.pdf 694.12KB
Fle type rrust be pdf
4d. List the total estimated acreage of all existing wetlands on the property:
1

4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
800
4f. Explain the purpose of the proposed project:*
I Repair an existing roadway shoulder and stabilize the canal bank with Class B stone to maintain a stable roadway
and shoulder along SR 1229 for the safety of the traveling public.
4g. Describe the overall project in detail, including indirect imapacts and the type of equipment to be used:*
Appro�mately 525 linear feet of shoulder/canal bank will be repaired with backfill and stabilized with Class B stone.
Additionally, appro�amately 25 linear feet of canal bank will be stabilized with Class B stone at an existing dual
culvert for a total of 550 linear feet of canal bank impact. This work will be accomplished using tracked excavator,
backhoe, and dump trucks.
4h. Please upload project drawings for the proposed project.
C7ick the upload button or drag and drop files here to attach docurrent
Old US 64 Bank Stabilization 2.pdf 169.02KB
Old US 64 Bank Stabilization 1.pdf 167.73KB
Fle type rrust be pdf
� 5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
�' Yes C' No C' Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
G Preliminary C' Approved C' Unknown �' fWA
Corps AID Number:
Exarrple: SAV�2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:
Paul Williams
NCDOT
Sd. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5d1. Jurisdictional determination upload
C7ick the upload button or drag and drop files here to attach docurrent
Fle type rrust be FDF
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 !' Unknown
7. Future Project Plans
7a. Is this a phased project?*
C' 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.
D. Proposed I m pacts I nventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
� Wetlands
fJ Open Waters
4. Open Water Impacts
r Streams-tributaries
r Pond Construction
r Buffers
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. Site # - Reason for
impact *
Canal Bank Repair and
stabilization
N�p label (e.g. F�ad Qossing 1)
4b. Impact type * 4c. Name of waterbody*
P Unnamed canal to Little
F2rrrenent(P�or Alligator River
Terrporary (� �� applicable)
4g. Total temporary open water Impacts:
0.00
4g. Total permanent open water impacts:
0.09
4g. Total open water impacts:
0.09
4h. Comments:
4d. Activitytype * 4e. Waterbodytype *4f. Impact
area*
Stabilization Ditch 0.09
(acres)
Appro�mately 3,824 sq. ft. of surface water will be permanently impacted. Approbmately 0.33 yards of backfill and
Class B stone will be placed every linear foot below NWL.
E. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
Eroded areas will be repaired and stabilized a distance waterward to maintain a consistent canal bank. The project
will not extend the riprap and backfill waterward more than necessary to maintain a consistent canal bank and a
clear recovery area for the roadway shoulder.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
NCDOT BMP's will be followed during the project and erosion control devices will be installed to prevent sediment
loss from the project site.
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
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
Impacts are belowthe threshold requiring mitigation.

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
1a. 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
For a list of options to meet the diffuse flow requirements, click here.
If no, explain why:
In Pasquotank River Basin.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
C•' Yes C' No
G. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
�' Yes �' 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)?*
C' Yes G No
Comments:*
Activity and impacts covered by Minimum Criteria Checklist.
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
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 qualit�i?*
C' Yes C•' No
3b. If you answered "no," provide a short narrative description.
i Project repairs an e�sting roadway shoulder.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project? *

C' Yes C' No r f�UA
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 �' No
5d. Is another Federal agency involved?*
C' Yes C•' No
5e. Is this a DOT project located within Division's 1-8?*
�' Yes C' No
C' Unknown
Sj. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
NC Natural Heritage Data Explorer Website
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
C' Yes C•' No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
I National Marine Fisheries Database
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
I 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)?*
f Yes C•' No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources? *
State Historic Preservation Office Historic Properties Map Website
7c. Historic or Prehistoric Information Upload
qick the upload button or drag and drop files here to attach docurrent
Fle rrust be FDF
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?*
C� Yes C' No
8b. If yes, explain how project meets FEMA requirements:
n/a
8c. What source(s) did you use to make the floodplain determination?*
i NCFloodmaps.com, Zone AE
i Miscellaneous

Miscellaneous attachments not previously requested.
C7ick the upload button or drag and drop files here to attach docurrent
CAMA Non-JD.pdf 170.2K6
NCWRC - NCDMF comments.pdf 131.83KB
Fle rrust be F�F or I�WQ
Signature
N7 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:*
Paul Collins Williams, Jr.
Signature
Ci�)rif/���/:r' %{�Y/:am.:. T'%t.
Initial Review
Is this project a public transportation project? *(?)
G Yes C' No
Change only if needed.
� Has this project met the requirements for acceptance in to the review process?*
C' Yes
C' No
BIMS # Assigned*
I 20180434
Version#*
1
Reviewing Office*
Washington Regional Office - [phone]
Select Project Reviewer*
i Garcy Ward:eads\gpward
Is a payment required for this project?*
C' No payment required
r Fee received
C' Fee needed - send electronic notification