20180689 Ver 1_401 Application_20180521

Action History (UTC -05:00) Eastern Time (US & Canada)
Submit by Anonymous User 5/21/2018 11:04:44 AM (Start Event)
Accept by Montalvo, Sheri A 5/21/2018 12:46:47 PM (Non DOT Initial Review)
The task was assigned to Montalvo, Sheri A. The due date is: May 24, 2018 5:00 PM
5/21/2018 11:05 AM

DWR
DkIlslon 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 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://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:*
Northampton
Is this project a public transportation project?*
r Yes G No
This is any publicly funded by rrunicipal,state or federal funds road, rail, airport transportation project.
1a. Type(s) of approval sought from the Corps:*
PF 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?*
r% Nationwide Permit (NWP)
Regional General Permit (RGP)
r Standard (IP)
This form may be Corps to initiate the standard/individual permit process. Please contact your Corps representative for submittal of standard permits.
All required items that are not provided in the E -PCN and be added to the miscellaneous upload located at the bottom of this form.
Nationwide Permit (NWP) Number: 36 - Boat Ramps
NWP Number Other:
List all INV nun-bers you are applying for not on the drop dow n list.
Regional General Permit (RGP) Number: 197800056 - Piers, Docks, Boathouses
RGP Number Other:
List all RGP nunbers you are applying for not on the drop dow n list.
1c. Type(s) of approval sought from the DWR:*

check all that apply
Pr 401 Water Quality Certification - Regular r 401 Water Quality Certification - Express
❑ Non -404 Jurisdictional General Permit r Riparian Buffer Authorization
❑ Individual Permit
.............................................
1d. Is this notification sole lyfor the record because written approval is not required?
For the record only for DWR 401 Certification: d Yes G No
For the record only for Corps Permit:
C3 Yes O 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 mitigation bank or in -lieu fee program
r Yes r No
1f. Is the project located in anyof NC's twenty coastal counties?*
r Yes F No
1h. Is the project located in a designated trout watershed?*
r Yes r No
Link to trout information: http://wmAt.saw.usace.army.miI/Missions/Regulatory-Permit-Program/Agency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact?*
Brad Kleinmaier
1b. Primary Contact Email:*
brad. [e-mail]
1c. Primary Contact Phone:*
(xxx)xxx-xxxx
1d. Who is applying for the permit?
W Owner r Applicant (other than owner) r- Agent/Consultant
(Check all that apply)
2. Owner Information
2a. Name(s) on recorded deed:
NC Wildlife Resource Commission
2b. Deed book and page no.:
2c. Responsible party:
(for Corporations)
2d. Address
Street Address
1720 Mail Service Center
Address Line 2
City
Raleigh
Postal / Zip Code
27699
2e. Telephone Number:
State / Province/ Fbgion
NC
Country
USA

(xxx)xxx-xxxx
2f. Fax Number:
[phone]
(xxx)xxx-xxxx
Email Address:*
brad. [e-mail]
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Henrico BAA - Site Renovation
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/ town:
Henrico
1d. Driving directions*
If it is a new project and can not easily be found in a GPS rrapping system Rease provide directions.
From Henrico head west on State Route 1214 (River Road) turn south (left) on Water Front Road
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)
Parcel No. 01-04396; PIN number: 3021-80-9648
2b. Property size:
(in acres)
5.01 acres (approximately 5.5 acres with adjacent easement area)
2c. Project Address
Street Address
142 Water Front Road
Address Line 2
city
State / R-ovince / Fbgion
Henrico
NC
Fbstal / Zip Code
Country
27842
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:* Longitude:*
36.520589 -77.881082
ex: 34.208504 -77.796371
3. Surface Waters

3a. Name of the nearest body of water to proposed project:*
Lake Gaston
3b. Water Resources Classification of nearest receiving water:*
WS -N, B
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Roanoke
River Basin 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:*
Site is currently being used as a public boating access area with a concrete ramp, fixed timber dock, and gravel
access road and parking. Surrounding vicinity use is residential.
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)
Click the upload button or drag and drop files here to attach docurrent
Henrico BAA_USGS Map (8.5 x 11).pdf 776.27KB
File 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)
Click the upload button or drag and drop files here to attach docurrent
Henrico BAA—Soil Survey Map.pdf 452.08KB
File type rrust be pdf
4d. List the total estimated acreage of all existing wetlands on the property:
0
4e. List the total estimated linear feet of all existing streams on the property:
(intermttent and perennial)
0
4f. Explain the purpose of the proposed project:*
Existing site has a deteriorating fixed timber dock and concrete ramp, project is proposed in order to improve
boating access for the public.
4g. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:
Proposed work includes the replacement of the fixed timber dock and concrete ramp with a dual concrete ramp
with floating dock in between lanes, addition of an ADA compliant parking area, and expansion of the gravel
parking area. Construction equipment is likely to include dump trucks, a backhoe for earthwork, a grader, and a
boat for floating dock sections into place.
4h. Please upload project drawings for the proposed project.
Click the upload button or drag and drop files here to attach docurrent
Henrico BAA_USACE Engineering Plans_2018-05-16.pdf 2.83MB
File type rrust be pdf
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes C No r Unknown
Comments:

5b. If the Corps made a jurisdictional determination, what type of determination was made?
r Preliminary r Approved r Unknown
Corps AID Number:
Example: SAM2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
r N/A
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5d1. Jurisdictional determination upload
Click the upload button or drag and drop files here to attach docurrent
File 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?*
r Yes r No r Unknown
7. Future Project Plans
7a. Is this a phased project?*
r Yes r 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 r Streams -tributaries r Buffers
rJ Open Waters r Pond Construction
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. Site # - Reason for 4b. Impact type * 4c. Name of waterbody*
impact*
Boat Ramp P Lake Gaston
IVbp label (e.g. Fdnad Crossing 1) Permanent (P) or (if applicable)
Terrporary (T)
4g. Total temporary open water Impacts:
0.00
4d. Activity type* 4e. Wate rbody type * 4f. Impact
area
Fill Lake 0.07
(acres)

4g. Total permanent open water impacts:
0.07
4g. Total open water impacts:
0.07
4h. Comments:
Proposed boat ramps will require placement of fill to meet standards for slope of boat ramps.
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:*
Proposed ramp and dock located in same location as existing ramp to limit disturbance of lakebed and bank.
Additionally vertical curve at the top of the ramp was shortened and maximum ramp grade was increased above
standard in order to minimize amount of fill to be placed within Lake Gaston.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Concrete boat ramp will be poured and allowed to cure away from the lake and will be pushed into place rather
than pouring near the water. Erosion control practices will be followed including installation of a turbidity curtain to
limit lake disturbance to the area immediately adjacent to the existing and proposed ramps. Silt fence will be used
to prevent silt from leaving the site during construction.
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?
r Yes r No
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?
f Yes r No
For a list of options to meet the diffuse flow requirements, click here.
If no, explain why:
Project is not within a riparian buffer area.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
r Yes r No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?
r Yes
r No
To look up low density requirement click here 15A NCAC 02H .1003(2)
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?*
r Yes r 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 Policy Act (NEPA/SEPA)?*
r Yes r No
Comments: *
Project does not meet minimum requirements for completion of NEPA/SEPA.
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)?
r Yes r No
2b. Is this an after -the -fact permit application?*
r Yes r 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?*
r Yes r No
3b. If you answered "no," provide a short narrative description.
Project is to provide a renovation of existing facilities, use of the site will remain the same as it has in the past
therefore no change in development is anticipated.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?
f Yes r Nor NiA
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?*
r Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
r Yes r No
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. Is another Federal agency involved?*
r Yes r No r Unknown
5e. Is this a DOT project located within Division's 1-8?*
r Yes r No
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?
r Yes r No
5g. Does this project involve bridge maintenance or removal?
r Yes r No

Link to the NLEB SLOPES document: http://saw-reg.usace.army.mil/NLEB/1-30-17-signed_NLEB-SLOPES&apps.pdf
5h. Does this project involve the construction/installation of a wind turbine(s)?*
f Yes r No
5i. Does this project involve (1) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhammers,
mechanized pile drivers, etc.?
r Yes r No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
Consulted with NCWRC Habitat Conservation office and USFWS Raleigh Field Office.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
r Yes t: No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
Consulted with NCWRC Habitat Conservation office and USFWS Raleigh Field Office.
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/hpovveb/
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)?*
r Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
Consultation with State Historic Preservation Office.
7c. Historic or Prehistoric Information Upload
Click the upload button or drag and drop files here to attach docurrent
ER 18-0717.pdf 95.96KB
File 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?*
r Yes r No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?*
FEMAfloodplain map
Miscellaneous
Miscellaneous attachments not previously requested.
Click the upload button or drag and drop files here to attach docurrent
Henrico BAA_DEQ-DWR 401 Funds Transfer.pdf 119.43KB
HenricoBAA_USFWS Endangered -Threatened Species List.pdf 200.64KB
File rrust be FDF or VWQ

Signature
m 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 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:*
Brad Kleinmaier
Signature
Date Submitted:
5/21/2018
Initial Review
..............................................................................................................................................................................................................................................................................................
Is this project a public transportation project?*(?)
f Yes r No
Change only if needed.
Has this project met the requirements for acceptance in to the review process?*
r Yes
r No
BIMS # Assigned *
20180689
Version#*
1
Reviewing Office
Raleigh Regional Office - [phone]
Select Project Reviewer*
Stephanie Goss:eads\szgoss
Is a payment required for this project?*
r No payment required
r Fee received
r Fee needed - send electronic notification
What amout is owed?
r $240.00
* $570.00