20210067 Ver 1_ePCN Application_20210111

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Division of Water Resources
Pre-Construction Notification (PCN) Form
October 26,2020 Ver 3.3
Initial Review
Has this project met the requirements for acceptance in to the review process?*
6 Yes
✓ No
Is this project a public transportation project?*
✓ Yes r No
Change only if needed.
BIMS#Assigned* Version#*
20210067 1
Is a payment required for this project?*
6' No payment required
✓ Fee received Reviewing Office*
✓ Fee needed-send electronic notification Washington Regional Office-[phone]
Select Project Reviewer*
Garcy Ward:eads\gpward
Information for Initial Review
1a.Name of project:
Davis Mill Culvert
la.Who is the Primary Contact?*
Jay Johnson
lb.Primary Contact Email:* 1c.Primary Contact Phone:*
[e-mail] [phone]
Date Submitted
1/11/2021
Nearest Body of Water
Trent River
Basin
Neuse
Water Classification
C,Sw,NS W
Site Coordinates
Latitude: Longitude:
35.11141 77.69076
Pre-Filing Meeting Information
ID# Version
Pre-fling Meeting or Request Date*
1/5/2021
Attach documentation of Pre-Filing Meeting Request here:*
10-1285-Lenoir DB00487 Proposed Diversion Pipe Detail.pdf 354.15KB
A. Processing Information
County(or Counties)where the project is located:
Lenoir

Is this a NCDMS Project
C Yes r: No
Is this project a public transportation project?*
s Yes r No
Is this a NCDOT Project?*
s Yes r No
(NCDOT only)T.I.P.or state project number:
DF15402.2054808
WBS#(?)
DF15402.2054808
1a.Type(s)of approval sought from the Corps:
17 Section 404 Permit(wetlands,streams and waters,Clean Water Act)
r Section 10 Permit(navigable waters,tidal waters,Rivers and Harbors Act)
Has this PCN previously been submitted?*
✓ Yes
✓ No
lb.What type(s)of permit(s)do you wish to seek authorization?
17 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
Id.Type(s)of approval sought from the DWR:
17 401 Water Quality Certification-Regular r 401 Water Quality Certification-Express
r Non-404 Jurisdictional General Permit p7 Riparian Buffer Authorization
✓ Individual Permit
le.Is this notification solely for the record because written approval is not required? *
For the record only for DWR 401 Certification: 6' Yes r No
For the record only for Corps Permit: r Yes r No
If.Is this an after-the-fact permit application?*
✓ Yes ( No
1g.Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
✓ Yes a No
1g.Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
✓ Yes rNo
Acceptance Letter Attachment
lh.Is the project located in any of NC's twenty coastal counties?
✓ Yes 6 No
1j.Is the project located in a designated trout watershed?
✓ Yes G No
B. Applicant Information
Id.Who is applying for the permit?
r Owner 17 Applicant(other than owner)
le.Is there an Agent/Consultant for this project?*
✓ Yes a No
2.Owner Information
2a.Name(s)on recorded deed:
NCDOT

2b.Deed book and page no.:
2c.Responsible party:
2d.Address
Street Address
SR 1121 Davis Mill Rd 200'south of junction with SR 1129 Nathan Hill Rd Lenoir County
Address Use 2
City State/Rovince/Region
Deep Run NC
Postal/Zp Code Country
N/A USA
2e.Telephone Number: 2f.Fax Number:
[phone]
2g.Email Address:*
[e-mail]
3. Applicant Information(if different from owner)
3a.Name:
3b.Business Name:
3c.Address
Street Address
N/A
Address Line 2
City State/Rovince/Region
N/A N/A
Rstal/Zp Code Country
N/A N/A
3d.Telephone Number: 3e.Fax Number:
[phone]
3f.Email Address:*
[e-mail]
C. Project Information and Prior Project History -
1. Project Information
lb.Subdivision name:
(if appropriate)
1c.Nearest municipality/town:
Deep Run
2. Project Identification
2a.Property Identification Number: 2b.Property size:
2c.Project Address
Street Address
Address Use 2
CRY State/Rovince/legion
Postal/Zip Code Country
3. Surface Waters
3a.Name of the nearest body of water to proposed project:*
Trent River
3b.Water Resources Classification of nearest receiving water:*
C,Sw,NSW
3c. What river basin(s)is your project located in?*

Neuse
3d.Please provide the 12-digit HUC in which the project is located.
03020204
4. Project Description and History
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 paved road SR 1121 Davis Mill Rd had hurricane florence flood damage to existing culvert.
4b.Have Corps permits or DWR certifications been obtained for this project(including all prior phases)in the past?*
• Yes r No r Unknown
4c.If yes,please give the DWR Certification number or the Corps Action ID(exp.SAW-0000-00000).
Non reporting NWP3
Project History Upload
DB00487 permits.pdf 3.88MB
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)
SKM_364e21011110480.pdf 108.07KB
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)
SKM_364e21011110470.pdf 76.18KB
4f.List the total estimated acreage of all existing wetlands on the property:
less than 1 acre
4g.List the total estimated linear feet of all existing streams on the property:
100'
4h.Explain the purpose of the proposed project:*
Existing paved road SR 1121 Davis Mill Rd had hurricane florence flood damage to existing culvert.Purpose is to replace pipe.
41.Describe the overall project in detail,including indirect impacts and the type of equipment to be used:*
Replace culvert using a diversion pipe to reduce erosion and sedimentation into stream.
4j.Please upload project drawings for the proposed project.
10-1285-Lenoir DB00487 Proposed Diversion Pipe Detail.pdf 354.15KB
DB00487 PLANS.pdf 9.51161E
DB00487 PERMIT DRAWING.pdf 177.84KB
5.Jurisdictional Determinations
5a.Have the wetlands or streams been delineated on the property or proposed impact areas?*
s Yes r No C Unknown
Comments:
Sb.If the Corps made a jurisdictional determination,what type of determination was made?*
✓ Preliminary r Approved r Not Verified r Unknown a N/A
Corps AID Number:
5c.If 5a is yes,who delineated the jurisdictional areas?
Name(if known): Jay Johnson
Agency/Consultant Company: NCDOT
Other:
5d1.Jurisdictional determination upload
6. Future Project Plans
6a.Is this a phased project?*
✓ Yes 6 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?
N/A
D. Proposed Impacts Inventory
1. Impacts Summary

la.Where are the impacts associated with your project?(check all that apply):
T Wetlands fiJ Streams-tributaries TJ Buffers
r Open Waters 1- Pond Construction
3. Stream Impacts
3a.Reason for impact(?) 3b.Impact type* 3c.Type of impact* 3d.S.name* 3e.Stream Type* 3f.Type of 3g.S.width* 3h.Impact
(?) Jurisdiction* length*
s1 culvert replacement Temporary Culvert trib to trent Perennial Both 15 80
JAverage Ifeet) linear feet)
3i.Total jurisdictional ditch impact in square feet:
31 Total permanent stream impacts: 3i.Total temporary stream impacts:
0 u0
31.Total stream and ditch impacts:
80
3j.Comments:
6. Buffer Impacts(for DWR)
6a.Project is in which protect basin(s)?
Check all that apply
TJ Neuse 1-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
culvert replace T trib to trent No 0 0
6h. Total buffer impacts:
Zone 1 Zone 2
Total Temporary impacts: 0.00 0.00
Zone 1 Zone 2
Total Permanent impacts: 0.00 0.00
Zone 1 Zone 2
Total combined buffer impacts: 0.00 0.00
6i.Comments:
Supporting Documentation
E. Impact Justification and Mitigation
1.Avoidance and Minimization
la.Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
Replace culvert using a diversion pipe to reduce erosion and sedimentation into stream.
lb.Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Replace culvert using a diversion pipe to reduce erosion and sedimentation into stream.
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 ( No
2b.If this project DOES NOT require Compensatory Mitigation,explain why:

Does not trigger any thresholds
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
la.Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
✓ Yes r No
2. Stormwater Management Plan
2a.Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
✓ Yes C No
26.Does this project meet the requirements for low density projects as defined in 15A NCAC 02H.1003(2)?
✓ Yes C No
2c.Does this project have a stormwater management plan(SMP)reviewed and approved under a state stormwater program or state-approved local government stormwater
program?
✓ Yes r' No
r N/A-project disturbs<1 acre
3. Stormwater Requirements
3a.Select whether a completed stormwater management plan(SMP)is included for review and approval or if calculations are provided to document the project will not cause
degradation of downstream surface waters.*
• Stormwater Management r Antidegradation
Plan Calculations
3b.Stormwater Management Plan
3c.Antidegradation Calculations:
Comments:
NVA
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?*
F Yes r No
lb.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)?*
✓ Yes rz No
Comments:
*
IC/A
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)?*
✓ 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?*
✓ Yes r No C 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?*

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 s No r Unknown
5e.Is this a DOT project located within Division's 1-8?
• Yes r No
5j.What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
On site 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?*
✓ Yes r: No
6b.What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
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 6 No
7b.What data sources did you use to determine whether your site would impact historic or archeological resources?*
NIA.
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
8b.If yes,explain how project meets FEMA requirements:
8c.What source(s)did you use to make the floodplain determination?*
N/A
Miscellaneous
Comments
Miscellaneous attachments not previously requested.
Signature
• By checking the box and signing below,I certify that:
• The project proponent hereby certifies that all information contained herein is true,accurate,and complete to the best of my knowledge and belief;and
• The project proponent hereby requests that the certifying authority review and take action on this CWA 401 certification request within the applicable reasonable period of time.
• 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
£ 074r
Date
1/11/2021