20080289 Ver 2_401 Application_20180821

DWR
Dfutslon 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:*
Pitt
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:*
Section 404 Permit (wetlands, streams and waters, Clean Water Act)
rJ 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)
r 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: 03 - Maintenance
NWP Number Other:
List all WV nun-bers you are applying for not on the drop dow n list.
1c. Type(s) of approval sought from the DWR:*
check all that apply
401 Water Quality Certification - Regular r 401 Water Quality Certification - Express
r Non -404 Jurisdictional General Permit rJ Riparian Buffer Authorization
r Individual Permit
*
1d. Is this notification solelyfor the record because written approval is not required?

For the record only for DWR 401 Certification:
For the record only for Corps Permit:
b Yes r No
a Yes r No
1e. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
V 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 r No
1h. Is the project located in a designated trout watershed?*
r Yes r No
Link to trout information: http://wuwv.saw.usace.army.miI/Missions/Regulatory-Permit-Program/Agency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact?*
Sara Sherman
1b. Primary Contact Email:*
[e-mail]
1c. Primary Contact Phone:*
(XXX)XXX-XXXX
1d. Who is applying for the permit?
Pr Owner r- Applicant (other than owner) r Agent/Consultant
(Check all that apply)
2. Owner Information
2a. Name(s) on recorded deed:
State of North Carolina
2b. Deed book and page no.:
33-738
2c. Responsible party:
(for Corporations)
INC Wildlife Resources Commission
2d. Address
Street Address
1720 Mail Service Center
Address Line 2
City
Raleigh
Postal / Zip Code
27699
2e. Telephone Number:
(XXX)XXX-XXXX
2f. Fax Number:
[phone]
(XXX)XXX-XXXX
State / Rovince / Pagion
NC
Country
USA

2g. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Falkland Boating Access Area dock maintenance
1b. Subdivision name:
(if appropriate)
N/A
1c. Nearest municipality / town:
*
Falkland, NC
1d. Driving directions*
r it is a new project and can not easily be found in a GPS rrapping system Rease provide directions.
Beginning at intersection of US264 and NC 43 in Greenville, travel north/west on NC 43. Turn left onto NC 222. Site is on your right.
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)
4741719159
2b. Property size:
(in acres)
8.2
2c. Project Address
Street Address
3013 NC Highway 222
Address Line 2
City
Falkland
Postal / Zip Code
27880
State/ Province/ Region
NC
Country
US
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 how the 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:*
35.695171 -77.490242
ex: 34.208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Tar River
3b. Water Resources Classification of nearest receiving water:*

WS -IV; NSW
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Tar -Pamlico
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:*
This site is an existing public boat ramp with a gravel parking lot, 1 concrete ramp, and 1 floating dock. A private
wildlife club and shooting range is next door. The area is mostly wooded/undeveloped.
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
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
File type rust be pd'
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:
(interrrittent and perennial)
480
4f. Explain the purpose of the proposed project:*
The purpose of this project is dock maintenance. Sediment has accumulated underneath the floating dock and it
does not sit level at all lower water levels.
4g. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:
The floating dock will be removed by removing the pin connecting it to the concrete abutment. Once the dock is
moved out of hte way, the sediment in its footprint will be removed using a mini excavator and/or skid steer. The
removed sediment will be disposed of on high ground outside of the river buffer. Then the dock will be re -installed.
4h. Please upload project drawings for the proposed project.
Click the upload button or drag and drop files here to attach docurrent
Falkland-pcn drawing.pdf 862.4KB
File type mast be pdf
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes r No r Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?
r Preliminary r Approved r Unknown r N/A
Corps AID Number:
Exarrple: SAM2017-99999

5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5dl. Jurisdictional determination upload
Click the upload button or drag and drop files here to attach docurrent
File type crust 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
6b. If yes, please give the DWR Certification number or the Corps Action ID (exp. SAW -0000-00000).
SAW -2008-00856
DWQ Project # 08-0289
Project History Upload
Click the upload button or drag and drop files here to attach docurrent
File type rust be FDF
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.
No
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 rJ Buffers
r- Open Waters r- Pond Construction
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 rJ Tar -Pamlico
r- Catawba r Randleman
r- Goose Creek r Jordan Lake
F Other
6b. Impact Type * 6c. Per or 6d. Stream name * 6e. Buffer mitigation 6f. Zone 1 6g. Zone 2
Temp* required?* impact* impact*

Dock maintenance - allowable T Tar River
Location and Exenpt, Allowable, allowable w/ F2rrmnent (F� or
mitigation Temporary (T)
6h. Total buffer impacts:
Zone 1 Zone 2
Temporary impacts: 160.00 240.00
Zone 1
Zone 2
Permanent impacts: 0.00
0.00
Zone 1
Zone 2
Total buffer impacts: 160.00
240.00
6i. Comments:
Maintenance within a previously permitted buffer impact
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
Click the upload button or drag and drop files here to attach document
File rrust be FDF
E. Impact Justification and Mitigation
1. Avoidance and Minimization
No
160 240
(square feet) (square feet)
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
No new impacts are proposed - new impacts as avoided.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Removed sediment will be disposed of on high ground and not within the river buffer.
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 G No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
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?
r Yes r No
1b. All buffer impacts and high ground impacts require diffuse flow or other form of stormwater treatment. If the project is subject to a
state implemented riparian buffer protection program, include a plan that fully documents how diffuse flow will be maintained.
All Stormwater Control Measures (SCM)s must be designed in accordance with the NC Stormwater Design Manual. Associated
supplement forms and other documentation shall be provided.

What type of SCM are you providing?
r- Level Spreader
r Vegetated Conveyance (lower SHWT)
r` Wetland Swale (higher SHWT)
r Other SCM that removes minimum 30% nitrogen
(check all that apply)
For a list of options to meet the diffuse flow requirements, click here.
Diffus Flow Documentation
Click the upload button or drag and drop files here to attach docurrent
File type rust be PDF
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?
r Yes t: No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?
t: 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:*
Maintenance project - no significant impacts
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 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 quality?*
r Yes t: No
3b. If you answered "no," provide a short narrative description.
No additional improvements are proposed or planned for this site.

4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?
rYesr 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
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
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
No comments were received during 2008 permit application
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
r Yes r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
NCDMF/NOAA websites - not a marine habitat
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)?*
r Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
No comments received during 2008 permit applications
7c. Historic or Prehistoric Information Upload
Click the upload button or drag and drop files here to attach document
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:
No new development or fill is proposed in the floodplain, only maintenance
8c. What source(s) did you use to make the floodplain determination?*
ncfloodmaps.com

Miscellaneous
Miscellaneous attachments not previously requested.
pick the upload button or drag and drop files here to attach docunent
File crust be FDF or KW
Signature
Pr 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:*
Sara Sherman
Signature
Date Submitted:
8/21/2018
Initial Review
Is this project a public transportation project?*(?)
r Yes F No
Change only I needed.
Has this project met the requirements for acceptance in to the review process?*
F Yes
r No
BIMS # Assigned
20080289
Version#*
2
Reviewing Office*
Washington Regional Office - [phone]
Select Project Reviewer*
Robert Tankard:eads\rbtankard
Is a payment required for this project?*
t: No payment required
r Fee received
f Fee needed - send electronic notification

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