20110744 Ver 1_Application_20110804

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Pre-Construction Notification (PCN) Form
A. A licant Information
1. Processing
1a. Type(s) of approval sought from the ®Section 404 Permit ^ Section 10 Permit
Corps: non-reporting nationwide permit
1b. Specify Nationwide Permit (NWP) number: NWP 3 and NWP 13 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps? ^Yes ®No
1d. Type(s) of approval sought from the DWO (check all that apply):
® 401 Water Quality Certification -Regular ^ Non-404 Jurisdictional General Permit
^ 401 Water Quality Certification -Express ^ Riparian Buffer Authorization
1e. Is this notification solely for the record For the record only for DWQ 401 For the record only for Corps Permit:
because written approval is not required? Certification:
® Yes ^ No ®Yes ^ No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation ^Yes ®No
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program.
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h ^Yes ®No
below.
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ^Yes ®No
2. Project Information
2a.

2b. Name of project:

County: Proposed pipe repair to the inlet of a structure (or total replacement of a pipe)
conveying an UT to Camping Creek along SR 1108 (Hart Road)
Franklin
2c. Nearest municipality /town: Louisburg
2d. Subdivision name:
2e. NCDOT only, T.LP. or state
project no: ~ -
3. Owner Information
3a. Name(s) on Recorded Deed: NCDOT Division 5
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if (/G A //
3d. Street address: 2612 N. Duke Street -~ -"~r• "'~~
3e. City, state, zip: Durham, NC 27704
3f. Telephone no.: [phone]
3g. Fax no.: [phone]
3h. Email address: wbowman(alncdot.gov
4. Applicant Information (if different from owner) N/A
5. Agent/Consultant Information (if applicable) N/A
Page 1 of 8
PCN Form -Version 1.3 December 10, 2008 Version

<~ ~. _'
B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
1 b. Coordinates (in decimal degrees):
Site: Latitude:36.03136 Longitude: -78.39309
(DD.DDDDDD) (-DD.DDDDDD)
1c. Property size: - < 0.01 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to Camping Creek
proposed project:
2b. Water Quality Classification of nearest receiving water: C NSW
2c. River basin: Tar-Pamlico
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
Two i e se menu from the inlet have disconnected. Site is surrounded b wooded land.
3b. List the total estimated acreage of all existing wetlands on the property:
NONE
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
60ft ri ht-of-wa to ri ht-of-wa
3d. Explain the purpose of the proposed project: Pipe ends have fallen off. As a result the shoulder section and fill slope
have collapsed. In order to rebuild the shoulder and fill slope the pipe ends must be reset. If these won't hold the entire
pipe will be replaced.
3e. Describe the overall project in detail, including the type of equipment to be used:
A backhoe and/or excavator will be used to lift out the disconnected pieces. Backfill of stone material will be used to prepare
the cross line bed and the pieces will be reset (or pipe will be replaced). The pipe will be covered with suitable material and.
shoulder(s) and slope section(s) over the pipe ends will be rebuilt. Filter fabric will be used surrounding the pipe end(s)
beneath ri ra armorin .Soil material used to re air the shoulders will rest a ainst the rock and area will be reve elated.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
^ Yes ®No ^ Unknown
project (including all prior phases);n the past?
~
Comments: N/A ~ i
4b. If the Corps made the jurisdictional determination, what type ^ preliminar ^ Final
y
of determination was made? ..
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company: N/A
Name (if known): N/A Other: N/A
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
N/A
5. Project History
5a. Have permits or certifications been requested or obtained for ^ yes ®No ^ Unknown
this project (including all prior phases) in the past?
Sb. If yes, explain in detail according to "help file" instructions.
N/A
Page 2 of 8
PCN Form -Version 1.3 December 10, 2008 Version

6. Future Project Plans
6a. Is this a phased project? ^ Yes ®No
6b. If yes, explain.
N/A
C. Proposed Impacts Inventory
1. Impacts Summary
1a. Which sections were completed below for your project (check all that apply):
^ Wetlands ®Streams -tributaries ®Buffers
^ Open `.Haters ^ Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type of jurisdiction
number- Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWO -non-404, other) (acres)
Tempora T
W 1 ^ P ^ T N/A N/A ^ Yes
^ No ^Corps
^ DWO N/A
2g. Total Wetland Impacts: NONE
2h. Comments: N/A
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a. 3 b. 3c. 3d. 3e. 3f. 3g.
Stream impact Type of impact Stream name Perennial Type of jurisdiction Average .Impact
number - (PER) or (Corps - 404, 10 stream length
Permanent (P) or intermittent DWO - non~04, width (linear
Temporary (T) (INT)? others (feet) feet)
Site 1 ^ P ®T UT to ®PER ®Corps
Oft s 40ft
Stream 1 dewatering Cam in creek
P g , ^INT ~ DWO
Site 1 ®P ^ T
i
i UT to ®PER ®Corps
Oft s 20ft
Stream 1 r
p rap armor
ng Camping Creek ^INT ®DWO concurrent
3h. Total stream and tributary impacts <_ 40ft
3i. Comments: 20ft RR = up to 10ft at inlet and outlet; 40ft of temporary dewatering to keep room for working
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. 4b. 4c. 4d. 4e.
Open water Name of
impact number- waterbody Type of impact Waterbody type Area of impact (acres)
Permanent (P) or (if applicable)
Tempora T
01 ^ P ^ T N/A N/A N/A N/A
4f. Total open water impacts NONE
4g. Comments: N/A

5. Pond or Lake Construction
If and or lake construction ro osed, then com lete the chart below.
Page 3 of 8
PCN Form -Version 1.3 December 10, 2008 Version

5a. 5b. Sc. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or purpose of (acres)
number pond
Flooded Filled Excavated Flooded Filled Excavated Flooded
P1 N/A N/A N/A N/A N/A N/A N/A N/A
P2
5f. Total NONE NONE NONE NONE NONE NONE NONE
5g. Comments: N/A
5h. Is a dam high hazard permit required?
^ Yes ®No If yes, permit ID no: N/A
Si. Expected pond surface area (acres): N/A
5j. Size of pond watershed (acres): N/A
5k. Method of construction: N/A
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If an impacts require miti ation, then ou MUST fill out Section D of this form.
6a.
^ Neuse ^Tar-Pamlico ^ Other:
Project is in which protected basin? ^ Catawba ^ Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number- Reason for Buffer Zone 1 impact Zone 2 impact
Permanent (P) or impact Stream name mitigation (square feet) (square feet)
Tem ora T required?
Site ®P ^ T UT to ^ Yes

Buffer Impact 1 Rip rap
Camping Creek
®No < 2400 SF 0 SF

6h. Total buffer impacts 5 2400 SF 0 SF
6i. Comments: No to exceed 40LF of new buffer impacts associated with rip rap and access for dewatedng.
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
This is a repair site and will require minimal disturbance. Site will be dewatered and the reset or replaced pipe will be armored
with rip rap underlined with filter fabric for long term stabiiization. Only the amount of rip rap necessary for stabilization will be
used not to exceed 10ft upstream and 1Gft downstream. Additionally impacts within the buffers will be reduced into dewatering
at best location and not clearing unless the vegetation conflicts with the pipe work.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Sediment and erosion control Best Management Practices for protection of surface waters will be enforced during project
construction.

Page 4 of 8
PCN Form -Version 1.3 December 10, 2008 Version

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? ^ Yes ®No
26. If yes, mitigation is required by (check all that apply): ^ DWQ ^ Corps

2c. If yes, which mitigation option will be used for this project? ^ Mitigation bank
^ Payment to in-lieu fee program
^ Perrnittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank: N/A
3b. Credits Purchased (attach receipt and letter) Type N/A Quantity N/A
3c. Comments: N/A
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached. ^ Yes
4b. Stream mitigation requested: N/A linear feet
4c. If using stream mitigation, stream temperature: ^ warm ^ cool ^cold
4d. Buffer mitigation requested (DWQ only): N/A square feet
4e. Riparian wetland mitigation requested: N!A acres
4f. Non-riparian wetland mitigatien requested: N/P, acres
4g. Coastal (tidal) wetland mitigation requested: N/A acres
4h. Comments: N/A
5. Complete if Using a permittee Responsible Mitigation Plan
Sa. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan. N/A
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) -required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation? ^ Yes ®No
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.

Zone 6c.
Reason for impact 6d.
Total impact
(square feet)
Multiplier 6e.
Required mitigation
(square feet)
Zone 1 N/A N/A 3 (2 for Catawba) N/A
Zone 2 N/A N/A 1.5 N/A
6f. Total buffer mitigation required: NONE
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund). N/A
6h. Comments: N/A
Page 5 of 8
PCN Form -Version 1.3 December 10, 2008 Version

E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified ®Yes ^ No
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
^Yes ^ No
Comments: N/A
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project? N/A
2b. Does this project require a Stormwater Management Plan? ^Yes ®No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: NCDOT state Permit No. NCS000250
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan: N/A
^ Certified Local Government
2e. Who will be responsible for the review of the Stormwater Management Plan? ^ DWO Stormwater Program
^ DWO401 Unit
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project? Franklin County
^ Phase II
3b. Which of the following locally-implemented Stormwater management programs ^ NSW
^ USMP
apply (check all that apply): ^ V~Jater Su h Watershad
^ Other:
3c. Has the approved Stormwater Management Plan with proof of approval been ^Yes ^ No
attached? N/A
4. DWQ Stormwater Pro ram Review
^ Coastal counties
^ HOW
4a. Which of the following state-implemented Stormwater management programs apply ^ ORyy
(check all that apply): N/A ^ Session Law 2006-246
^ Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
attached? N/A ^Yes ^ No
5. DWQ 401 Unit Stormwater Review

5a.
Does the Stormwater Management Plan meet the appropriate requirements? N/A _
^Yes ^ No
5b. Have all of the 401 Unit submittal requirements been met? N/A ^Yes ^ No

Page 6 of 8
PCN Form -Version 1.3 December 10, 2008 Version

F. Supplementary Information
1. Environmental Documentation (DWl] Requirement)
1a. Does the project involve an expenditure of public (federal/state/local) funds or the ®Yes ^ No
use of public (federal/state) land?
1 b. 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 ^Yes ®No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1c. If you answered "yes' to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
^Yes
^ No
letter.)
Comments: N/A
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards, ^Yes ®No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this anafter-the-fact permit application? ^Yes ®No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s): N/A
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in ^Yes ®No
additional development, which could impact nearby downstream water quality?
3b. If you answered "yes' to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no;' provide a short narrative description.
N/A
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
N/A
Page 7 of 8
PCN Form -Version 1.3 December 10, 2008 Version

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
Sa. Will this project occur in or near an area with federally protected species or ^ Yes ®No
habitat?
Sb. Have you checked with the USFWS concerning Endangered Species Act ^ Yes ®No
impacts?
^ Raleigh
Sc. If yes, indicate the USFWS Field Office you have contacted.
^ Asheville
Sd. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat? Biologists from NCDOT O.N.E. has visited this site and rendered a biological conclusion of "No Effect"
http://www.fws.gov/nc-es/es/countvfr.html and NC Natural Heritage Program Database, Element Occurrences
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish ^ Yes ®No
habitat?
8b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
http://ocean.floridamarine.org/efh coral/ims/viewer.htm
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal er tribal
governments have designated as having historic or cultural preservation ^ yes ®No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
HPO's historic layer using GIS ArcView database and htto://ais.ncdcr.eov/hooweb/
8. Flood Zone Designation (Corps Requirement)
Sa. Will this project occur in aFEMA-designated 100-year floodplain? ^ Yes ®No
8b. If yes, explain how project meets FEMA requirements: N/A
8c. W hat source(s) did you use to make the floodplain determination? http://www.ncfloodmaps.com/

J. W. Bowman, P.E. Qom/'. ~„ / }~J,~ 08/03/11
ApplicanUAgent's Printed Name ApplicanUAgent's Signatur j Date
(Agents slgneture Is valid only If an aulhodzatlon let from the apptipnt
Is
Page 8 of 8
PCN Form -Version 1.3 December 10. 2008 Version

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Name: FRANKLINTON Location: 038.03)31a '' N 078. 39309 ° W
Date: 7/28/201 1 Caption: SR 1108 (Hart Road)
Scale: 1 inch equals 2000 feet Franklin County
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