20200290 Ver 1_PCN Form Submission_20200224

DWR
Dlrlslon of Water Resources
Pre -Construction Notification (PCN) Form
September 29, 2018 Ver 3
Initial Review
Has this project met the requirements for acceptance in to the review process?*
r Yes
r No
Is this project a public transportation project?*
G Yes r No
Change only if needed.
BIMS # Assigned
20200290
Is a payment required for this project?*
r No payment required
r Fee received
r Fee needed - send electronic notification
Select Project Reviewer*
Garcy Ward:eads\gpward
Information for Initial Review
1a. Name of project:
US 17 on ramp Chocowinity
1a. Who is the Primary Contact?*
Jay Johnson
1b. Primary Contact Email:*
[e-mail]
Date Submitted
2/24/2020
Nearest Body of Water
Maple Branch
Basin
Tar -Pamlico
Water Classification
Tar river
Site Coordinates
Latitude:
35.50618
A. Processing Information
County (or Counties) where the project is located:
Beaufort
Is this project a public transportation project?*
IT Yes r No
Is this a NCDOT Project?*
IT Yes r No
(NCDOT only) T.I.P. or state project number:
N/A
WBS # (1)
2.200711
1a. Type (a) of approval sought from the Corps:
Longitude:
77.09327
Version#*
1
Reviewing Office*
Washington Regional Office - [phone]
1c. Primary Contact Phone:*
[phone]
U

W 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?
W Nationwide Permit (NWP)
r Regional General Permit (RGP)
r Standard (IP)
1c. Has the NWP or GP number been verified by the Corps?
r Yes r No
Nationwide Permit (NWP) Number: 03 - Maintenance
NWP Numbers (for multiple NWPS):
3
1d. Type(s) of approval sought from the DWR:
W 401 Water Quality Certification - Regular
r Non-404 Jurisdictional General Permit
r Individual Permit
le. Is this notification solely for the record because written approval is not required?
For the record only for DWR401 Certification:
For the record only for Corps Permit:
r 401 Water Quality Certification - Express
FJ Riparian Buffer Authorization
1f. Is this an after -the -fact permit application?*
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
Acceptance Letter Attachment
1h. Is the project located in any of NC's twenty coastal counties?
r Yes r No
11. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
r Yes r No r Unknown
1j. Is the project located in a designated trout watershed?
d Yes r No
B. Applicant Information
1d. Who is applying for the permit?
r Owner W Applicant (other than owner)
le. Is there an Agent/Consultant for this project?*
r Yes r No
2. Owner Information
2a. Name(s) on recorded deed:
NCDOT
2b. Deed book and page no.:
2c. Responsible party:
2d.Address
Street Address
1037 W. H. Smith Blvd
Address Lim 2
city
Greenville
Postal / Zip Cate
27834
State / Province / legion
North Carolina
Country
USA
r Yes r No
r Yes r No
V

2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
3a. Name:
N/A
3b. Business Name:
3c.Address
Street Address
WA
Address tine 2
City
WA
Postal / Zip Code
WA
3d. Telephone Number:
[phone]
3f. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
ff appropriate)
1c. Nearest municipality/ town:
Chocowinity
F-
2. Project Identification
2a. Property Identification Number:
2c. Project Address
Street Address
Address Line 2
City
Postal / Zip Code
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Maple Branch
3b. Water Resources Classification of nearest receiving water:*
Tar river
3c. What river basin(s) is your project located in?*
Tar -Pamlico
3d. Please provide the 12-digit HUC in which the project is located.
030201040102
4. Project Description and History
2f. Fax Number:
State / Province / Region
WA
Country
WA
3e. Fax Number:
2b. Property size:
State / Province / Region
Country
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:*
Undeveloped bottom area with 404 wetlands
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
r Yes f No r Unknown
4d. 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)
topo map.pdf 73.14KB

4e. 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)
soils map.pdf 79.78KB
4f. List the total estimated acreage of all existing wetlands on the property:
N/A
4g. List the total estimated linear feet of all existing streams on the property:
N/A
4h. Explain the purpose of the proposed project:*
Chocowinity OS 17 on -ramp crosses Maple Branch, upstream side of culvert bank has severely eroded causing the bank slope to fail. Maintenance proposes to straighten stream reach
to flow directly into culvert eliminating the scour on the slope and placing rip rap to stabilize slope.
41. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
Chocowinity OS 17 on -ramp crosses Maple Branch, upstream side of culvert bank has severely eroded causing the bank slope to fail. Maintenance proposes to straighten stream reach
to flow directly into culvert eliminating the scour on the slope. Dump truck, and Back hoe will be used.
4j. Please upload project drawings for the proposed project.
REV_2-24-2020permit_PSH.pdf 5.46MB
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
r Yes r No
Comments:
USACE and NCDWR reps have been onsite
5b. If the Corps made a jurisdictional determination, what type of determination was made?
r Preliminary r Approved f Not Verified r Unknown r N/A
Corps AID Number:
N/A
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
5d1. Jurisdictional determination upload
6. Future Project Plans
r Unknown
6a. 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?
D. Proposed Impacts Inventory
1. Impacts Summary
la. Where are the impacts associated with your project? (check all that apply):
W Wetlands W Streams -tributaries W Buffers
r Open Waters r Pond Construction
2. Wetland Impacts
Area A
2a1 Reason (?)
Excavate old stream
channel
2b. Impact type * (?)
P
2c. Type of W.*
Unknown
2d. W. name *
404
2e. Forested *
No
2f. Type of
Jurisdicition*(?)
Both
2g. Impact
area*
0.011
(acres)
Area C
Excavate for flood plain
bench
T
Unknown
404
No
Bo th
0.001
(acres)
2g. Total Temporary Wetland Impact 2g. Total Permanent Wetland Impact
0.001 0.011
2g. Total Wetland Impact
0.012

2h. Comments:
3. Stream Impacts
❑ 3a. Reason for impact (?) 3b.lmpact type * 3c. Type of impact* 3d. S. name* 3e. Stream Type * 3f. Type of 3g. S. width* 3h. Impact
(?) Jurisdiction* length*
Area B fill stream channel Permanent Relocation maple branch Intermittent Both ]�;;I;;]
S1 P
31. Total jurisdictional ditch impact in square feet:
0
31. Total permanent stream impacts:
3i. Total temporary stream impacts:
110
0
31. Total stream and ditch impacts:
110
3j. Comments:
6. Buffer Impacts (for DWR)
6a. Project is in which protect basin(s)?
Checkall that apply.
r Neuse
W Tar -Pamlico
r Catawba
r Randleman
r Goose Creek
r Jordan Lake
r Other
6b. Impact Type 6c. Per or Temp 6d. Stream name 6e. Buffer mitigation required? 6f. Zone 1 impact 6g. Zone 2 impact
Area A excavation for new stream channel
P
maple branch
No
473
0
Area C excavation for bench
T
maple branch
No
421
0
6h. Total buffer impacts:
Zone 1
Zone 2
Total Temporary impacts: 421.00
0.00
Zone 1
Zone 2
Total Permanent impacts: 473.00
0.00
Zone 1
Zone 2
Total combined buffer impacts: 594.00
0.00
6i. Comments:
Supporting Documentation
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:
Only straightening the section of stream that is causing the scour to the roadway slope.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Slope will be reestablished and rip rap will be placed on the slope.
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

2b. If this project DOES NOT require Compensatory Mitigation, explain why:
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
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
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
W Proposed project will not create concentrated stormwater flow through the buffer
Diffuse Flow Documentation
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 15ANCAC 02H .1003(2)?
r Yes r No
Comments:
G. Supplementary Information
1. Environmental Documentation
la. 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:*
None
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15ANCAC 21-1.0500), Isolated Wetland Rules (15ANCAC 2H .1300), or DWR Surface Water or Wetland Standards or
Riparian Buffer Rules (15ANCAC 2B .0200)? *
r Yes r No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality?*
/^ Yes r No
3b. If you answered "no," provide a short narrative description
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
r Yes r Nor N/A
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 1-87
r Yes r No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
Onsite field determination
Consultation Documentation Upload
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?*
Onsite field determination
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?*
r Yes
r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
Onsite field determination
7c. Historic or Prehistoric Information Upload
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? *
r Yes
r No
8c. What source(s) did you use to make the floodplain determination?*
Flood maps
Miscellaneous
Comments
Miscellaneous attachments not previously requested.
Signature u
*
W 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:
Jay Johnson
Signature
Date
2/24/2020