HomeMy WebLinkAbout20111035 Ver 1_Application_20111130 . .
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��c�• , � Office Use Only:
_, { '' ^ Corps action ID no.
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� s � � � �� ' DWQ project no.
�* � �='���,; �"� Form Version 1.3 Dec 10 2008
Pre-Construction Notification (PCN) F'orm
A. A licant Information
1. Processing
1a. Type(s)of approval sought from the
Corps: � Section 404 Permit ❑ Section 10 Permit
1 b. Specify Nationwide Permit(NWP) number: NW 3 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 DWQ (check all that apply):
� �01 Water Quaiiiy Certification- Reguiar ❑ Non-404 Jurisdictional General Permit
❑ 401 Water Quality Certification - Express ❑ Riparian Buffer Authorization
1 e. 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 1h � Yes ❑ No
below.
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? � Yes ❑ No
2. Project Information
2a. Name of project: SR 1217 Colington Rd pipe replacement
I 2b. Counry: Dare
2c. Nearest municipality/town: Kill Devil Hills �
2d. Subdivision name: �
2e. NCDOT only, T.I.P. or state State Project no: DF13201.2028010 �
project no: �
3. Owner lnformation
3a. Name(s)on Recorded Deed: NCDOT
3b. Deed Book and Page No. n/a
3c. Responsible Party(for LLC if NCDOT Division One
applicable):
-,
3d. Street address: 113 Airport Drive, Suite 100 '
3e. City, state, zip: Edenton, NC 27932 '
3f. Telephone no.: 252-482-7977
3g. Fax no.: 252-482-8722 �
� -
� 3h. Email address: ; tcwillis@ncdot.gov �
!-- -- ---- — ----�-___—_ __ __ ._.- - ---- -- _ - -- ---_ _ _- --
Page I of 11
PCiV For�n - Version 1.3 December 10, 2008 Version
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4. Applicant Information (if dififerent from owner)
4a. Applicant is: ❑ Agent ❑ Other, specify:
4b. Name:
4c. Business name ;
(if applicable): �,
4d. Street address: '
4e. City, state, zip:
4f. Telephone no.:
4g. Fax no.:
4h. Emaii address:
5. Agent/Consultant Information (if applicable)
5a. Name: '
5b. Business name
(if applicable): �,;
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. Fax no.: �
�
5g. Email address:
Page ? of 11
PC�! Form — Version ?_3 �December 10, 2�G�8 Version
. ,
B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
1 b. Site coordinates (in decimal degrees): Latitude: 36.01489 Longitude: -75.69349
(DD.DDDDDD) (-DD.DDDDDD)
1 c. Property size: 0.01 acres
2. Surface Waters
2a. Name of nearest body of water(stream, river, etc.)to UT to Colington Creek
proposed project:
2b. Water Quality Classification of nearest receiving water: SC
2c. River basin: Pasquotank
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:
A secondary paved road with residential homes and mixed commercial businesses.
3b. List the total estimated acreage of all existing wetlands on the property:
< 1 acre
3c. List the total estimated linear feet of all existing streams (intermittent and perennial)on the property:
60 (canal)
3d. Explain the purpose of the proposed project: I
To replace 2 failing pipes on SR 1217. �;
3e. Describe the overall project in detail, including the type of equipment to be used:
The existing 2@ 24" x 50' corrugated metal pipes will be replaced with the proposed 3@ 30"x 55' corrugated aluminum
�
pipes with riprap on both ends on its current alignment. The current pipes will be removed entirely. This project will be
conducted in dry. Proper fill will be used to bring road to existing height. Heavy equipment that will be used will be an �,
excavator, backhoe, and dump trucks. .
4. Jurisdictional Determinations ;
4a. Have jurisdictional wetland or stream determinations by the 1
Corps or State been requested or obtained for this property/
project(including all prior phases)in the past? ❑ Yes � No ❑ Unknown
Comments:
4b. If the Corps made the jurisdictional determination, what type I
of determination was made? ❑ Preliminary ❑ Final
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company:
Name (if known): Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation. �
5. Project His+tory !
5a. Have permits or certifications been requested or obtained for � Yes � No ❑ Unknown '
this project(including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions. ��
---- -- -- -- -- —�
Page � of 11
PCN Form –Version 1.3 Decembe� 10. 2008 Version
. �
6. Future Project Plans
, 6a. Is this a phased project? � ❑ Yes � No
6b. If yes, explain.
Page -� of 11
PCN Forrn —Versio� 1.� �Jecem�er 10, 2�,�08 Version
. �
C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project(check all that apply):
❑ Wetlands ❑ Streams -tributaries ❑ Buffers
❑ Open Waters ❑ Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then compiete 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) DWQ—non-404, other) (acres)
Tem orar T
W 1 ❑ P � T ❑ Yes ❑ Corps
❑ No ❑ DWQ
w2 � P � T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W3 ❑ P ❑ T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W4 ❑ P ❑ T ❑ Yes ❑ Corps
f1 ni„ i—I rnn�n
u ' u " i
W5 ❑ P ❑ T ❑ Yes ❑ Corps
� ❑ No ❑ DWQ
W6 ❑ P ❑ T ❑ Yes ❑ Corps
❑ No ❑ DWQ
2g. Total wetland imp�cts p
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. i
3a. 3b. 3c. 3d. 3e. 3f. 3g.
Stream impact Type of impact Stream name Perennial Type of jurisdiction i Average Impact
number- (PER)or (Corps -404, 10 stream length �
Permanent(P) or � intermittent DWQ—non-404, width (linear �I
Temporary(T) (INT)? other) � (feet) feet)
S1 ❑ P ❑ T ❑ PER ❑ Corps �
❑ INT ❑ DWQ
S2 ❑ P ❑ T ❑ PER ❑ Corps
❑ i NT ❑ D'+N Q
S3 ❑ P ❑ T ❑ PER ❑ Corps '�
❑ INT ❑ DWQ
S4 ❑ P ❑ T ❑ PER ❑ Corps �'i
� ❑ INT ❑ DWQ
S5 ❑ P ❑ T ❑ PER ❑ Corps I
❑ INT ❑ DWQ j
S6 ❑ P ❑ T ❑ PER ❑ Corps �
❑ INT ❑ DWQ
3h. Total stream and tributar�impacts p �'��
�
_;
3i. Comments:
Paae � of �1
PCN Forn� — Versi�n 1.3 Decei�nber 10, 2008 Versior
. " �
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 waterbody
impact number— (if applicable) Type of impact Waterbody type Area of impact(acres)
Permanent(P)or
em orar T
�
UT to Colington
01 � P ❑ T Creek fill from additional length of pipe canal 0.0012 II
02 ❑ P � T
03 ❑ P � T
04 ❑ P ❑ T
4f. Total open water impacts 0.0012 '
4g. Comme�ts: 50 sq. ft. of open waTer impact wil! be the result of replacing the existing 2 pip2s with 3 proposed pipes that wii! I
be 5' longer.
5. Pond or Lake Construction
If ond or lake construction ro osed, then com lete the chart below.
5a. 5b. 5c. 5d. 5e.
1�fo.��.^ii, �^'�'�u'"'.tS�`.�.`�.r°$� viY°2iiTi �^"p�aC±c� ;foo4� I I�I�nr�
Pond ID Proposed use or purpose (acres)
number of pond
Flooded Filled Excavated Flooded Filled Excavated Flooded
i
P1
P2
Sf. Total '
5g. Comments:
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no: ;
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres): �
-,'
I 5k. Method of construction:
Page 6 of 1 1
PCN Form —Version 1 3 Cecember 1�, 2008 Version
, ` �
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 any 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 Buffer Zone 1 impact Zone 2 impact
Permanent (P)or for Stream name mitigation (square feet) (square feet)
Tem orar T im act re uired?
B1 ❑ P ❑ T ❑ Yes
❑ No
B2 ❑ P ❑ T ❑ Yes
❑ No
B3 ❑ P ❑ T ❑ Yes �
❑ No '
6h. Total buffer impacts
6i. Comments:
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Pipe replacement is going to stay on the existing alignment and the road will be closed during construction. This will reduce �
temporary impacts to wetlands and the stream by not using an on-site detour and keeping the road open. I
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Methods of construction will be concurrent with NCDOT Best Management Practices for replacement of pipes and for soil and �
erosion control .
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for ❑ Yes � No �'
impacts to Waters of the U.S. or Waters of the State? '
2b. [f yes, miti�ation is required by(check all that apply): ❑ DWQ ❑ COrpS
❑ Mitigation bank
2c. If yes, �hich mitigation option will be used for this � Payment to in-lieu fee program
project.
❑ Permittee Responsible Mitigation
i
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter) Type Quantity
Page 7 of 11
PC�; Forrr� —V�rsion 1.3 Decei�ber 10, 2�08 Version
• �.
3c. Comments:
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: linear feet
4c. If using stream mitigation, stream temperature: ❑warm ❑ cool ❑cold
4d. Buffer mitigation requested (DWQ only): square feet ,
4e. Riparian wetland mitigation requested: acres
4f. Non-riparian wetland mitigation requested: acres I
4g. Coastal (tidal)wetland mitigation requested: acres �
4h. Comments: 1
I
5. Complete if Using a Permittee Responsible Mitigation Plan !
—
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan. �,
I
6. Buffer Mitigation (State Regulated Riparian Buffer Rules)-required by DWQ �
1
oa. 'v"✓iii ihe project fesuii in ar� ir�ipaci wiihin a protecied riparian buffer i�iai reyuires I ❑ Ye5 � i�io '
buffer mitigation?
� ,
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the i
amount of mitigation required. i
6c. 6d. 6e. ��
Zone Reason for impact Total impact Multiplier Required mitigation �
(square feet) (square feet) i
Zone 1 3(2 for Catawba) �'
Zone 2 1.5
6f. Tota! buffer mitigation required: _I
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank, �,
permiitee responsible riparian buffer restoration, payment into an approved in-lieu fee fund).
�
6h. Comments: �
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Page �+ of 11
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 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: �
2. Stormwater Mana ement 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:
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
NCDOT state stormwater permit for highway system is applicable. NCDOT will follow guidelines for Erosion and
Sediment Control.
❑ 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 jurisdiction is this project? n/a
❑ Phase I! I�
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 I'
attached? I�
i
4. DWQ Stormwater Pro ram Review l
I ❑ Coastal counties
❑ �!�1�N
4a. Which of the following state-implemented stormwater management programs apply ❑ ORW
(check all that apply): ❑ Session Law 2006-246
� Other: NCDOT stormwater
permit, No. NCS000250
4b. Has the approved Stormwater Management Plan with proof of approval been ',
attached? ❑ Yes ❑ No �I
5. DWQ 401 Unit Storrrawater Review �
�
5a. Does the Stormwater Management Plan meet the appropriate requirements? � Yes ❑ No
5b. Have all of the 401 Unit submittal requirements been met? ❑ Yes ❑ No ,
Page �) of 11
PCN Forrr� — Version 1.3 Decem�er 10, 2008 Version
�
. .
F. Suppfemerosa�� irr"arr�aaei�o�a
1. Environmental Documentation (DWQ Requirement)
1 a. 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
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 Riparian 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. Cumusative Impacts(DVVQ Requirement) I
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.
4. Sewage Disposal (DWQ Requirement) I
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. ii
No wastewater will be created from this project.
Page 10 of 1 1
PCN Form —Version 1.3 December 10, 2008 Version
-.
y M �
5 Endangered Species and Designated Critical Habitat(Corps Requirement)
5a Will this pro�ect occur in or near an area with federally protected species or � Yes � No
habitat�
5b Have you checked with the USFWS concerning Endangered Species Act � Yes � No
impacts�
❑ Raleigh
5c If yes indicate the USFWS Field Office you have contacted
❑ Asheville
5d What data sources did you use to determine whether your site would impact Endangered Speaes or Designated Critical
Habitat�
Natural Heritage database
6 Essential Fish Habitat(Corps Requirement)
6a Wdl this pro�ect occur in or near an area designated as essential fish habitat� ❑Yes � No
6b What data sources did you use to determine whether your site would impact Essential Fish Habitat�
Marine Fisheries Essential Fish Habitat List
7 Historic or Prehistor�c Cultural Resources (Corps Requirement)
7a Will 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 Historic Trust designation or properties sigrnficant in
North Carolina history and archaeology)�
7b What data sources did you use to determine whether your site would impact historic or archeological resources�
North Carolina Natural Heritage List NCHPO GIS Web Service
8 Flood Zone Des�gnation (Corps Requirement)
8a Wdl this pro�ect occur in a FEMA designated 100 year floodplain� � Yes ❑ No
8b If yes explain how pro�ect meets FEMA requirements Based on pro�ect scope pro�ect was not reviewed for FEMA
requirements
8c What source(s)did you use to make the floodplain determination� NC Flood Mapping Information System
Clay Willis �� I//a' /�
,�/ � (
Applicant/Agent s Printed Name Applicant/A nt s Signature Date
(Agent s signature is valid only if n authorization letter from the applicant
is prowded
Page 11 of 11
PCN Form —Version 1 3 December 10 2008 Version
- � Dare County SR 1217 Colington Rd
� e re ��������� 2.y0, 7 r�i. �l1/ o� �!S � 58
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