20120098 Ver 1_Application_20120203

STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
BEVERLY EAVES PERDUE
GOVERNOR
U S Army Corps of Engineers
Wilmington Regulatory Field Office
69 Darlington Avenue
Wilmington North Carolina 28403
ATTENTION Mr Brad Shaver
NCDOT Coordinator
February 2 2012
EUGENE A CONTI JR.
SECRETARY
FEB _ D
2012
DENR WATER QUALITY
WE TLAND� AND S T0&4WAT�R op
ANCI{
SUBJECT Nationwide 14 Permit Application for Secondary Road Improvement on SR 1570
Jack and Jill Road Brunswick County WBS# 3C 010061 (DWQ Permit Fee $240)
Dear Mr Shaver
Please find enclosed a PCN application from the North Carolina Department of Transportation ( NCDOT)
for a Nationwide 14 permit for the secondary road improvement project on SR 1570 Jack and Jill Road in
Brunswick County
The scope of the project will be to widen grade drain add base and pave the 0 37 mile of existing
unpaved road to current NCDOT secondary road standards to improve the roadway safety stability and
mobility These standards include 20 feet of travel lanes and 5 feet of grassed shoulders on both sides
within the 50 feet of right of way Also enclosed are wetland data forms stream form and maps for the
issuance of a jurisdictional determination based on a field review on April 15 2011 The jurisdictional
forms have been supplied to you electronically
By copy of this letter and enclosures NCDOT is also requesting issuance of 401 Water Quality
Certification (WQC) #3820 from the Division of Water Quality (DWQ) A method of debiting $240 to
process the WQC permit request has been provided as noted in the subject line of this application
If you have any questions or need any additional information please contact me at [phone]
SAneS Mathis
Division Environmental Officer
Enclosures
cc (without wetland forms)
MP -Mason Herndon DWQ - Fayetteville (1 copy) -
Mr Brian Wrenn DWQ Raleigh (5 copies)
5501 BARBADOS BLVD CASTLE HAYNE NC 28429
PHONE [phone] FAx [phone]

o�oF w,arF9Qc
Office Use Only
Corps action ID no
DWQ protect no
Form Version 13 Dec 10 2008
Page 1 of 11
PCN Form — Version 1 3 December 10 2008 Version
Pre-Construction Nohf cahon PC Form
A Applicant 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 14 or General Permit (GP) number
1 c
Has the NWP or GP number been venfied by the Corps?
® Yes
❑ No
Id
Type(s) of approval sought from the DWQ (check all that apply)
® 401 Water Quality Certification — Regular ❑ Non -404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
1 e
Is this nobficabon solely for the record
because written approval is not required?
For the record only for DWQ 401
Certification
❑ Yes ® No
For the record only for Corps Permit
❑ Yes ® No
1f
Is payment into a mitigation bank or in lieu fee program proposed for mitigation
of impacts? If so attach the acceptance letter from mitigation bank or in lieu
fee program
❑ Yes
® No
1g
Is the protect located in any of NC s twenty coastal counties If yes answer 1 h
below
® Yes
❑ No
1h
Is the protect located within a NC DCM Area of Environmental Concern (AEC)
❑ Yes
® No
2
Project Information
2a
Name of project
Jack and Jill Road SR 1570
2b
County
Brunswick
2c
Nearest municipality / town
Boding Spring Lakes
2d
Subdivision name
n/a
2e
NCDOT only T I P or state
project no
3C 010061
3
Owner Information
3a
Name(s) on Recorded Deed
NC Department of Transportation
3b
Deed Book and Page No
n/a
3c
Responsible Party (for LLC if
applicable)
n/a
3d
Street address
n/a
3e
City state zip
n/a
3f
Telephone no
n/a
3g
Fax no
n/a
_3h _Email address ---,-n/a
Page 1 of 11
PCN Form — Version 1 3 December 10 2008 Version

4
Applicant Information (if different from owner)
4a
Applicant is
❑ Agent ® Other specify NCDOT Division 3 Engineer
4b
Name
Karen Fussell
4c
Business name
(if applicable)
NC Department of Transportation
4d
Street address
5501 Barbados Blvd
4e
City state zip
Castle Hayne NC 28429
4f
Telephone no
910 341 2000
4g
Fax no
910 -675 0143
4h
Email address
n/a
6
Agent/Consultant Information (if applicable)
5a
Name
Stonewall Mathis
5b
Business name
(if applicable)
NC Department of Transportation
5c
Street address
5501 Barbados Blvd
5d
City state zip
Castle Hayne NC 28429
5e
Telephone no
910 341 2000
5f
Fax no
910 675 0143
5g
Email address
smathis @ncdot gov
Page 2 of 11
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)
Jack and Jill Road SR 1570
Latitude 34 0994437N Longitude
1b Site coordinates (in decimal degrees)
78 0256291W
(DD DDDDDD) ( DD DDDDDD)
1c Property size
-2 3 acres
2 Surface Waters
2a Name of nearest body of water (stream river etc ) to
Dews Creek
proposed project
2b Water Quality Classification of nearest receiving water
C Sw
2c River basin
Cape Fear
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
The site is currently an unpaved secondary road and the general land use is residential and woodland
3b List the total estimated acreage of all existing wetlands on the property
066
3c List the total estimated linear feet of all existing streams (intermittent and perennial) on the property
-90 perennial
3d Explain the purpose of the proposed project
To improve the existing roadway by bringing it up to NCDOT standards to include paving to provide a better and safer
roadway for citizens land owners and school buses that utilize this facility
3e Describe the overall project in detail including the type of equipment to be used
This project will widen grade drain add base pave and stabilize the existing road to NCDOT secondary road standards
to 20 feet of travel lanes and 5 feet of grassed shoulders using standard road construction equipment
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) in the pasty
Comments
4b If the Corps made the jurisdictional determination what type
Preliminary Final
of determination was made
4c If yes who delineated the jurisdictional areas?
Agency /Consultant Company
Name (if known) Stonewall Mathis
Other NCDOT
4d If yes list the dates of the Corps jurisdictional determinations or State determinations and attach documentation
Field visit on April 15 2011
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?
5b If yes explain in detail according to help file instructions
Page 3 of 11
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
Page 4 of 11
PCN Form —Version 1 3 December 10 2008 Version

C Proposed Impacts Inventory
1 Impacts Summary
la 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 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)
DWQ - non -404 other)
(acres)
Temporary
W1 ® P ❑ T
Fill
Bottomland
❑ Yes
® Corps
01
Hardwood Forest
® No
® DWQ
W2 ®P ❑ T
Fill and
Bottomland
❑ Yes
® Corps
01 Fill & 0 1
Excavation
Hardwood Forest
® No
® DWQ
Excavation
W3 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W4 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W5 ❑ P [IT
❑ Yes
❑ Corps
❑ No
❑ DWQ
W6 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
2g Total wetland impacts
2h Comments W1 is Wetland A and W2 is Wetland B
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 jurisdiction
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
Channel Impacts
Dewatenng and
Dews Creek
❑ PER
® Corps
�4
17 perm
& 70
Channel
® INT
® DWQ
temp
Reconstruction
S2 ❑ P ❑ T
❑ PER
❑ Corps
❑ 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 0 T
—
- —
_❑ P_ER
_❑ Corps-----I
—
❑ INT
❑ DWQ
3h Total stream and tributary impacts
31 Comments 15 feet of permanent impacts are for the headwall at the floodplain pipes at station 20 +33 LT essentially
becoming the new JS line 2 feet of permanent impacts are for the extension of pipe length beyond existing length at Station
20 +75 The 70 feet of temporary impacts are for construction purposes of dewatenng and channel reconstruction given the
Page 5 of 11
PCN Form - Version 1 3 December 10 2008 Version

unique configuration of this stream and how it runs along the location of the proposed headwall on the downstream side for
construction purposes it will likely be necessary to impact a substantial length for dewatenng purposes and also the
installation of the headwall will likely result in the need to reconstruct a portion of the channel bank between station 20 +33 LT
and station 20 +75 LT adjacent to the headwall
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
Temporary
01 ❑P ❑T
02 ❑P ❑T
03 ❑P ❑T
04 ❑P ❑T
417 Total open water impacts
4g Comments
5 Ponca or Lake Construction
If pond or lake construction proposed then complete the chart below
5a
5b
Sc
5d
5e
Wetland Impacts (acres)
Stream Impacts (feet)
Upland
Pond ID
Proposed use or purpose
(acres)
number
of pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
5f Total
5g Comments
5h Is a dam high hazard permit required
❑ Yes ❑ No If yes permit ID no
51 Expected pond surface area (acres)
5j Size of pond watershed (acres)
5k Method of construction
Page 6 of 11
PCN Form — Version 1 3 December 10 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 mitigation then you 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)
Temporary
impact
re uired�
B1 ❑ P ❑ T
❑ Yes
❑ No
B2 ❑P ❑T
El Yes
❑ No
63 ❑P ❑T
El Yes
El No
6h Total buffer impacts
61 Comments
D Impact Justification and Mitigation
7 Avoidance and Minimization
1a Specifically describe measures taken to avoid or minimize the proposed impacts in designing project
NCDOT has attempted to minimize impacts by proposing fills of 31 slopes and even 2 1 in environmentally sensitive areas
NCDOT worked closely with the regulatory agencies to minimize the size of the main channel pipe and utilize the existing
floodplain by proposing two floodplain pipes in effort to better imitate the natural system and help avoid potential impacts to
the main channel
1 b Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
Strict implementation of sediment and erosion control BMPs will be utilized to protect waters of the US
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 If yes mitigation is required by (check all that apply)
❑ DWQ ❑ Corps
❑ Mitigation bank
2c If yes which mitigation option will be used for this
El Payment to in lieu fee program
projects
❑ Permittee Responsible Mitigation
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
PCN Form —Version 13 December 10 2008 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
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 description of the proposed mitigation plan
6 Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWO
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
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 private mitigation bank
permittee responsible riparian buffer restoration payment into an approved in lieu fee fund)
6h Comments
Page 8 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
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
2
Stormwater Management Plan
2a
What is the overall percent imperviousness of this project?
40%
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 s BMPs for Construction and Maintenance Activities will be utilized to manage stormwater runoff during
construction Grass swales will be used to the maximum extent possible in compliance with NCDOT's NPDES Permit No
NCS000250 Post Construction Stormwater Program Grassed swales are proposed at specific locations as shown in the
attached plan sheets
❑ 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 II
3b
Which of the following locally implemented stormwater management programs
❑ NSW
❑ USMP
apply (check all that apply)
❑ Water Supply Watershed
❑ Other
3c Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
4
DWQ Stormwater Program 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
❑ Yes ® No
attached?
5
DWQ 401 Unit Stormwater 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 9 of 11
PCN Form — Version 13 December 10 2008 Version

F
Supplementary Information
7
Environmental Documentation (DWQ Requirement)
la
Does the project involve an expenditure of public (federal /state /local) funds or the
® Yes ❑ No
use of public (federal /state) land?
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
❑ 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
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
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 10 of 11
PCN Form — Version 1 3 December 10 2008 Version

5 Endangered Species and Designated Critical Habitat (Corps Requirement)
5a Will this project 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?
E:1 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 Species or Designated Critical
Habitat?
I used the USFWS website ArcGIS layers and performed on site investigations
6 Essential Fish Habitat (Corps Requirement)
---t-
6a WIII this project 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?
NOAA Fisheries Website Mapper
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
❑ 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?
NCDOT Cultural Resources Review documentation is attached
8 Flood Zone Designation (Corps Requirement)
8a WIII this project occur in a FEMA designated 100 -year floodplain?
❑ Yes ® No
8b If yes explain how project meets FEMA requirements
8c What source(s) did you use to make the floodplain determination? NC Floodmaps website
Stonewall D Mathis
02/02/2012
Applicant/Agent s Printed Name
Date
Applicant/Agents Sign ure
(Agents signature is valid only if an authorization letter from the applicant
is provided
Page 11 of 11
PCN Form – Version 1 3 December 10 2008 Version

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NC DWO Stream Identificat;<on Form Version 4 11
Date 77 1 -2-01 2—
Project/Site Tc(< 4*7 4 1?o( n )SlD
Latitude 3y p l3 y0 N
Evaluator f �a.�lt t
County Gk
Longitude -78 07-3g40 In(
Total Points
Stream is at least intermittent 2—r)
Stream Detenininatio ircle one)
Ephemera ntermittent Perennial
Other
e g Quad Name ��,•�10•,�
if >_ 19 or perennial if �: 30
2 Sinuosity of channel along thalweg
0
A Geomorphology (Subtotal = / -2--)
Absent
Weak
Moderate
Strong
1a Continuity of channel bed and bank
0
1
2
3
2 Sinuosity of channel along thalweg
0
1
2
3
3 In- channel structure ex We pool step pool
ripple-pool se uence
0
/ \1
0
2
3
4 Particle size of stream substrate
0
1
1
3
5 Active /relict floodplain
0
1
3
6 Depositional bars or benches
0
1
2
3
7 Recent alluvial deposits
0
1
2
3
8 Headcuts
05
1
2
3
9 Grade control
0
05
0
15
10 Natural valley
1
05
1
1 5
11 Second or greater order channel
No = 0
es =
artificial ditches are not rated see discussions in manual
B Hvdroloav (Subtotal= 8 )
12 Presence of Baseflow
0
1
2
3
13 Iron oxidizing bacteria
0
1
2
3
14 Leaf litter
15
1
0 5
0
15 Sediment on plants or debris
0
0
1
15
16 Organic debris lines or piles
0
1 05
1
1 5
17 Sod based evidence of high water tables
No = 0
ITes = 3
C Bloloviv (Subtotal = -1 _)
18 Fibrous roots in streambed
3
2
1
0
19 Rooted upland plants in streambed
Cy
2
1
0
20 Macrobenthos (note diversity and abundance)
0
1
2
3
21 Aquatic Mollusks
0
1
2
3
22 Fish
0
05
1
15
23 Crayfish
0
0 5
1
15
24 Amphibians
OF—
05
1
15
25 Algae
0
0
1
15
26 Wetland plants in streambed
FACW = 0 75 OBL = 1 5 Other =
perennial streams may also be identified using other methods See p 35 of manual
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