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Home My WebLink About20110940 Ver 1_Application_20111115 OF wATF9 o�, qG Office Use Only � � Corps action ID no � , , � p � DWQ pro�ect no Form Version 1 3 Dec 10 2008 Pre-Construchon Noti�cation PCN Form A A hcant Information 1 Processing 1a Type(s)of approval sought from the Corps � Section 404 Permit ❑Section 10 Permit 1b Specify Nationwide Permit(NWP)number 14 or General Permit(GP)number 1c Has the NWP or GP number been venfied by the Corps� ❑Yes � No 1d Type(s)of approval sought from the DWQ(check all that apply) �401 Water Quality Certification—Regular ❑ Non 404 Junsdictional General Permit ❑401 Water Quality Certification—Express ❑ Ripanan Buffer Authorization 1 e Is this notification solely for the record For the record oniy for DWQ 401 For the record only for Corps Permit because wntten 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 1 g Is the pro�ect located in any of NC s twenty coastal counties If yes answer 1 h ❑Yes � No below 1 h Is the pro�ect located within a NC DCM Area of Environmental Concern (AEC)� ❑Yes ❑ No 2 Pro�ect Information 2a Name of pro�ect Foster Rd (SR 1282) 2b County Moore 2c Nearest muniapality/town Biscoe 2d Subdivision name N/A 2e NCDOT only T I P or state gC 063028 pro�ect no 3 Owner Information 3a Name(s)on Recorded Deed NCDOT 3b Deed Book and Page No 3c Responsible Party(for LLC if applicable) 3d Street address 902 N Sandhdls Blvd 3e City state zip Aberdeen N C 28315 3f Telephone no 910 944 2344 3g Fax no 910 944 5623 3h Email address t�ohnson@ncdot gov Page 1 of 10 PCN Form—Version 1 3 December 10 2008 Version ) 4 Appl�cant Information(if different from owner) 4a Applicant is ❑Rgent � Other specify 4b Name Timothy Johnson 4c Business name North Carolina Department of Transportation (if applicable) 4d Street address 902 N Sandhdls Blvd 4e City state zip Aberdeen N C 28315 4f Telephone no 910 944 2344 4g Fax no 910 944 5623 4h Email address t�ohnson@ncdot gov 5 Agent/Consultant Information(if applicable) 5a Name Sarah Foster 5b Busmess name North Carolina Department of Transportation (if apphcable) 5c Street address 993 Priest Hill Rd 5d City state zip Carthage N C 28327 5e Telephone no 910 947 2233 5f Fax no 910 947 6195 5g Emad address sfoster@ncdot gov Page 2 of 10 PCN Form—Version 1 3 December 10 2008 Version B Pro�ect Information and Pr�or Pro�ect History 1 Property Identification 1a Property identification no (tax PIN or parcel ID) N/A 1b Site coordinates (in decimal degrees) Latitude 35 20N Longitude 79 42W (DD DDDDDD) (DD DDDDDD) 1 c Property size acres 2 Surface Waters 2a Name of nearest body of water(stream nver etc)to Mill Creek proposed pro�ect 2b Water Quality Ciassification of nearest receiving water WS III 2c River basin Capr Fear 3 Pro�ect Description 3a Describe the existing conditions on the site and the general land use in the vicinity of the pro�ect at the time of this application Unpaved Secondary Road Crossing 3b List the total estimated acreage of all existing wetlands on the property 0 3c list the total estimated linear feet of all existmg streams(intermittent and perennial}on the property 60 3d Explam the purpose of the proposed pro�ect Replace existing 36 rcp to meet current standards in con�unction with Secondary Roads Pro�ect 3e Describe the overall pro�ect in detail including the type of equipment to be used Grade Drain Base Pave and Erosion Control Utilizmg backhoe pan dozer motor grader and excavator 4 Junsdictional Determinations 4a Have Junsdictional wetland or stream determinations by the Corps or State been requested or obtained for this property/ pro�ect(mcluding all pnor phases)in the past� ❑Yes � No ❑ Unknown Comments 4b If the Corps made the�urisdictional determination what type � Preliminary ❑ Final of determination was made� 4c If yes who delineated the�unsdictional areas� Agency/Consultant Company Name (if known) Other 4d if yes list the dates of the Corps�unsdictional determmations or State determinations and attach documentation 5 Pro�ect History 5a Have permits or certifications been requested or obtained for �Yes � No ❑ Unknown this pro�ect(including all pnor phases)in the past� 5b If yes explain in detad according to help file instructions 6 Future Pro�ect Plans 6a Is this a phased pro�ect� �Yes ❑ No 6b If yes explain Temporary erosion control measures installed pnor to ciearing and grubbing phase Ditchline measures placed as finai grade is established Seeding as work progresses Page 3 of 10 PCN Form—Version 1 3 December 10 2008 Version C Proposed Impacts inventory 1 Impacts Summary 1a Which sections were completed below for your pro�ect(check all that apply) ❑Wetlands � Streams tnbutanes ❑ Buffers ❑ Open Waters ❑ 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�unsdiction number— Type of impact Type of wetland Forested (Corps 404 10 Area of�mpact Permanent(P)or (if known) DWQ—non 404 other) (acres) Tem ora T W1 ❑ P❑T NA ❑Yes ❑ Corps ❑ No ❑ DWQ W2 ❑ P�T ❑Yes ❑ Corps ❑ No ❑ DWQ W3 ❑ P❑T ❑Yes ❑ Corps ❑ No ❑ DWQ W4 ❑ P❑T ❑Yes ❑ Corps ❑ No ❑ DWQ W5 ❑ P�T ❑Yes ❑ Corps ❑ No ❑ DWQ W6 ❑ P❑T ❑Yes ❑ Corps ❑ No ❑ DWQ 2g Total wetland impacts 2h Comments 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 3b 3c 3d 3e 3f 3g Stream impact Type of impact Stream name Perennial Type of�urisdiction Average Impact number (PER)or (Corps 404 10 stream length Permanent(P)or intermittent DWQ—non 404 width (linear Temporary(T) (INT)� other) (feet) feet) S1 � P �T pipe UT of Mdl Creek � PER � Corps 5 8 26 mh � INT � DWQ S2 ❑ P �T Dewatering ❑ PER � Corps 25 � INT � DWQ S3 ❑ P ❑T ❑ PER ❑ Corps ❑ INT ❑ DWQ S4 ❑ P ❑T ❑ PER ❑ Corps ❑ INT ❑ DWQ S5 ❑ P ❑T ❑ PER ❑ Corps ❑ INT ❑ DWQ S6 ❑ P�T ❑ PER ❑ Corps ❑ INT ❑ DWQ 3h Total stream and tr�butary�mpacts 51 mh 3i Comments Page 4 of 10 PCN Form—Version 1 3 December 10 2008 Version 4 Open Water Impacts If there are proposed impacts to lakes ponds estuanes tnbutaries sounds the Atlantic Ocean or any other open water of the U S then mdividually list all open water impacts below 4a 4b 4c 4d 4e Open water Name of waterbody impact number— (if applicable) Type of impact Waterbody type Area of impact(acres) Permanent(P)or Tem ora T 01 ❑ P�T NA 02 ❑ P�T 03 ❑ P�T 04 ❑ P❑T 4f Total open water�mpacts 4g Comments 5 Pond or Lake Construction If ond or lake construction ro osed then com lete the chart below 5a 5b 5c 5d 5e Wetland Impacts(acres) Stream Impacts (feet) Upland Pond ID Proposed use or purpose (acres) number of pond Flooded Fdled Excavated Flooded Fdled Excavated Flooded P1 NA P2 Sf Total 5g Comments 5h Is a dam high hazard permit required� ❑Yes ❑ No If yes permit►D no 5i Expected pond surface area (acres) 5� Size of pond watershed (acres) 5k Method of construction 6 Buffer Impacts(for DWQ) If pro�ect will impact a protected nparian buffer then complete the chart below If yes then individually list all buffer impacts below If any impacts require mitigation then you MUST fdl out Section D of this form 6a ❑ Neuse ❑Tar Pamlico ❑ Other Pro�ect is in which protected basin� ❑ Catawba ❑ Randleman 6b 6c 6d 6e 6f 6g Buffer impact number— Reason Buffer Zone 1 impact Zone 2 impact Permanent(P)or for Stream name mitigation (square feet) (square feet) Tem ora T im act re uired� B1 ❑ P❑T NA ❑Yes ❑ No 62 ❑ P�T ❑Yes ❑ No B3 ❑ P❑T ❑Yes ❑ No 6h Total buffer�mpacts 6i Comments Page 5 of 10 PCN Form—Version 1 3 December 10 2008 Version D Impact Justification and Mitigation 1 Avoidance and Mmimizat�on 1a Specifically descnbe measures taken to avoid or mirnmize the proposed impacts in desigrnng pro�ect Minimum pipe length installed to provide adequite flow and stability and to provide a safe shoulder and roadway 1 b Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques Current version of NCDOT BMP s wdl be utdized dunng ali phases of construction on this pro�ect 2 Compensatory Mitigation for Impacts to Waters of the U S or Waters of the State 2a Does the pro�ect reqwre Compensatory Mitigation for ❑Yes � No impacts to Waters of the U S or Waters of the State� 2b If yes mitigaUOn is reqwred by(check all that apply) ❑ DWQ ❑ Corps ❑ Mitigation bank 2c If yes which mitigation option wdl be used for this � payment to in lieu fee program pro�ect� ❑ Permittee Responsible Mitigation 3 Complete if Using a Mitigation Bank 3a Name of Mitigation Bank NA 3b Credits Purchased (attach receipt and letter) Type Quantity 3c Comments 4 Complete if Making a Payment to In I�eu Fee Program 4a Approval letter from in lieu fee program is attached ❑Yes 4b Stream mitigation requested Imear feet 4c If using stream mitigation stream temperature ❑warm ❑cooi ❑cold 4d Buffer mitigation requested (DWQ only) square feet 4e Ripanan wetland mitigation requested acres 4f Non riparian wetland mitigation requested acres 4g Coastal (tidal)wetland mitigation requested acres 4h Comments 5 Complete if Using a Permittee Responsible Mitigation Plan 5a If using a permittee responsible mitigation plan provide a descnption of the proposed mitigation plan Page 6 of 10 PCN Form—Version 1 3 December 10 2008 Version 6 Buffer Mitigation (State Regulated Riparian Buffer Rules)—required by DWQ 6a Will the pro�ect result in an impact within a protected npanan buffer that requires ❑Yes � No buffer mitigation� 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 6c 6d 6e Zone Reason for impact Total impact Multiplier Required mitigation (square feet) (square feet) Zone 1 3(2 for Catawba) Zone 2 1 5 6f Total buffer mitigation required 6g If buffer mitigation is required discuss what type of mitigation is proposed (e g payment to pnvate mitigation bank permittee responsible nparian buffer restoration payment into an approved in lieu fee fund) 6h Comments Page 7 of 10 PCN Form—Version 1 3 December 10 2008 Version E Stormwater Management and Diffuse Flow Plan(required by DWQ) 1 Diffuse Flow Plan 1 a Does the pro�ect include or is it ad�acent 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 explam why ❑Yes ❑ No Comments 2 Stormwater Mana ement Plan 2a What is the overall percent imperviousness of this pro�ect� 33 % 2b Does this pro�ect require a Stormwater Management Plan� ❑Yes � No 2c If this pro�ect DOES NOT require a Stormwater Management Plan explam why pro�ect out side of HQW ORW Buffer 2d if this pro�ect DOES require a Stormwater Management Plan then provide a brief narrative description of the plan ❑ Certified Local Government 2e Who will be responsible for the review of the Stormwater Management Plan� ❑ DWQ Stormwater Program ❑ DWQ 401 Unit 3 Certified Local Government Stormwater Review 3a In which local government s�urisdiction is this pro�ect� Moore County ❑ Phase II 3b Which of the following locally implemented stormwater management programs ❑ NSW apply(check all that apply) ❑ USMP ❑Water Supply Watershed ❑ Other 3c Has the approved Stormwater Management Plan with proof of approval been ❑Yes ❑ No attached� 4 DWQ Stormwater Pro ram Review ❑ Coastal counties ❑ HQW 4a Which of the following state implemented stormwater management programs apply � ORW (check all that apply) ❑ Session Law 2006 246 ❑ Other 4b Has the approved Stormwater Management Plan with proof of approval been attached� ❑Yes ❑ No 5 DWQ 401 Urnt Stormwater Review 5a Does the Stormwater Management Plan meet the appropnate requirements� ❑Yes ❑ No 5b Have all of the 401 Unit submittal reqwrements been met� ❑Yes ❑ No Page 8 of 10 PCN Form—Version 1 3 December 10 2008 Version F Supplementary Information 1 Environmental Documentation (DWQ Requirement) 1a Does the pro�ect invoive an expenditure of public(federal/state/local)funds orthe �Yes ❑ No use of public(federal/state)land� 1 b If you answered yes to the above does the pro�ect require preparation of an environmental document pursuant to the requirements of the National or State ❑Yes � No (North Carolma)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 letter) ❑Yes ❑ No Comments 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 Ripanan Buffer Rules(15A NCAC 2B 0200)� 2b Is this an after 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) 3 Cumulative Impacts(DWQ Requirement) 3a Wdl this pro�ect(based on past and reasonably anticipated future impacts)result m �Yes � No additional development which could impact nearby downstream water quality� 3b If you answered yes to the above submit a qualitative or quantitative cumulat�ve impact analysis in accordance with the most recent DWQ policy If you answered no provide a short narrative descnption 4 Sewage D�sposal (DWQ Requirement) 4a Clearly detail the ultimate treatment methods and disposition (non discharge or discharge)of wastewater generated from the proposed pro�ect or available capacity of the sub�ect facility NA Page 9 of 10 PCN Form—Version 1 3 December 10 2008 Version 1 5 Endangered Species and Designated Cntical Habitat(Corps Requirement) 5a Wili this pro�ect occur in or near an area with federally protected species or �Yes � No { habitat� z 5b Have you checked with the USFWS concerrnng Endangered Species Act �Yes ❑ No 4 impacts� ❑ Raleigh 5c If yes indicate the USFWS Field Office you have contacted ❑ Ashevdle 5d What data sources did you use to determme whether your site would impact Endangered Species or Designated Cntical Habitat� ArcMap and on site survey by NCDOT personnel 6 Essential Fish Habitat(Corps Requirement) 6a Will this pro�ect occur m or near an area designated as essential f�sh habitat� ❑Yes � No 6b What data sources did you use to determine whether your site would impact Essential Fish Habitat� ArcMap and USF&W website 7 Historic or Prehistor�c Cultural Resources(Corps Requirement) 7a Wdl this pro�ect occur in or near an area that the state federal or tnbal governments have designated as having historic or cultural preservation �Yes � No status(e g National Histonc Trust designation or properties significant m North Carolina history and archaeology)� 7b What data sources did you use to determine whether your site would impact histonc or archeological resources� SHPO survey 8 Flood Zone Designation (Corps Requirement) 8a Will this pro�ect occur in a FEMA designated 100 year floodplain� ❑Yes � No 8b If yes explain how pro�ect meets FEMA requirements 8c What source(s)did you use to make the floodplain determination� Moore GIS Flood map Applicant/Agent s Printed Name Applicant/Agent s Signature Date (Agent s signature is valid only if an authorization letter from the applicant is rowded Page 10 of 10 PCN Form—Version 1 3 December 10 2008 Version � ,o fl � w J L]J r � u� w �n > r. 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