20210146 Ver 1_ePCN Application_20210225

I I DWR
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?*
0 Yes r No
Change only if needed.
BIMS#Assigned* Version#*
20210146 1
Is a payment required for this project?*
✓ No payment required Reviewing Office*
6 Fee received Winston-Salem Regional Office-(336)776-
✓ Fee needed-send electronic notification 9800
Select Project Reviewer*
Dave Wanucha:eads\djwanucha
Information for Initial Review
1a.Name of project:
Garrett Road Culvert Replacement
1a.Who is the Primary Contact?*
Jerry Parker
lb.Primary Contact Email:* 1c.Primary Contact Phone:*
[e-mail] [phone]
Date Submitted
2/25/2021
Nearest Body of Water
Matrimony Creek
Basin
Roanoke
Water Classification
WS-IV
Site Coordinates
Latitude: Longitude:
36.533206 79.805895
Pre-Filing Meeting Information
ID# Version
20210146 1
Pre-fling Meeting or Request Date*
2/2/2021
Attach documentation of Pre-Filing Meeting Request here:*
Garrett Rd DWR Pre-Filing Meeting Request Form.pdf 56.33KB
A. Processing Information C^U
County(or Counties)where the project is located:
Rockingham

Is this a NCDMS Project
✓ Yes r No
Is this project a public transportation project?*
✓ Yes r No
Is this a NCDOT Project?*
✓ Yes r No
(NCDOT only)T.I.P.or state project number:
WBS#(7)
17BP.7.C.7
1a.Type(s)of approval sought from the Corps:
fJ 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
r No
lb.What type(s)of permit(s)do you wish to seek authorization?
fJ Nationwide Permit(NWP)
r Regional General Permit(RGP)
r Standard(IP)
1c.Has the NWP or GP number been verified by the Corps?
C Yes rNo
Nationwide Permit(NWP)Number: 03-Maintenance
NWP Numbers(for multiple NWPS):
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 r Riparian Buffer Authorization
r Individual Permit
le.Is this notification solely for the record because written approval is not required? *
For the record only for DWR 401 Certification: r Yes r No
For the record only for Corps Permit: r Yes C No
If.Is this an after-the-fact permit application?*
✓ Yes rNo
1g.Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
C Yes r 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?
C Yes r No
1j.Is the project located in a designated trout watershed?
✓ Yes r No
B. Applicant Information
Id.Who is applying for the permit?
7 Owner r Applicant(other than owner)
le.Is there an Agent/Consultant for this project?*
✓ Yes r No
2.Owner Information
2a.Name(s)on recorded deed:
NCDOT

2b.Deed book and page no.:
2c.Responsible party:
2d.Address
Street Address
1584 Yanceyville Street
Address Line 2
P.O.Box 14996
aty State/Province/legion
Greensboro NC
Postal/Zip Code Country
27415-4996 USA
2e.Telephone Number: 2f.Fax Number:
[phone]
2g.Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
lb.Subdivision name:
(if appropriate)
1c.Nearest municipality/town:
Eden
2. Project Identification
2a.Property Identification Number: 2b.Property size:
2c.Project Address
Street Address
Address Line 2
C7ly State/Province/legion
Postal/Zlp Code Country
3.Surface Waters
3a.Name of the nearest body of water to proposed project:*
Matrimony Creek
3b.Water Resources Classification of nearest receiving water:*
WS-IV
3c. What river basin(s)is your project located in?*
Roanoke
3d.Please provide the 12-digit HUC in which the project is located.
030101030505
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:*
The project vicinity is a rural residential area with some agricultural fields and patches of wooded area.
4b.Have Corps permits or DWR certifications been obtained for this project(including all prior phases)in the past?*
r Yes r' No r Unknown
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)
Garrett Rd Revised Topo.pdf 566.96KB
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)
Garrett Rd Soil Survey Map.pdf 2.14MB
4f.List the total estimated acreage of all existing wetlands on the property:
0
4g.List the total estimated linear feet of all existing streams on the property:

114
4h.Explain the purpose of the proposed project:*
The purpose of the project is to replace a structurally deficient culvert with a new culvert to maintain the road at current NCDOT standards.
4i.Describe the overall project in detail,including indirect impacts and the type of equipment to be used:*
Project will involve dewatering the project area in order to work in the dry while removing the existing culvert and replacing it with a new culvert.All Best Management Practices will be
utilized and erosion and sedimentation control devices will be implemented.Standard road building equipment such as trucks,dozers,tamps and cranes will be used during
construction.
4j.Please upload project drawings for the proposed project.
Garrett Rd Permit Drawings and Summaries.pdf 1.19MB
5.Jurisdictional Determinations
5a.Have the wetlands or streams been delineated on the property or proposed impact areas?*
✓ Yes f No O Unknown
Comments:
5b.If the Corps made a jurisdictional determination,what type of determination was made?*
✓ Preliminary r Approved r Not Verified r Unknown F N/A
Corps AID Number:
5c.If 5a is yes,who delineated the jurisdictional areas?
Name(if known):
Agency/Consultant Company:
Other:
5d1.Jurisdictional determination upload
6. Future Project Plans
6a.Is this a phased project?*
✓ Yes 0No
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?
D. Proposed Impacts Inventory
1. Impacts Summary
1a.Where are the impacts associated with your project?(check all that apply):
r Wetlands rJ Streams-tributaries r Buffers
r Open Waters r Pond Construction
3.Stream Impacts
3a.Reason for impact(?) 3b.lmpact type* 3c.Type of impact* 3d.S.name* 3e.Stream Type* 3f.Type of 3g.S.width* 3h.Impact
(?) Jurisdiction* length*
S1 Bank Stabilization Permanent Bank Stabilization UT to Matrimony Cr Perennial Both 4 71
Average(feet) (linear feet)
S2 Culvert Replacement Permanent Culvert UT to Matrimony Cr Perennial Both 4 19
Average(feet) (linear feet)
S3 Dewatering Temporary Dewatering UT to Matrimony Cr Perennial Both 4 24
Average(feet) (linear feet)
3i.Total jurisdictional ditch impact in square feet:
0
3i.Total permanent stream impacts: 3i.Total temporary stream impacts:
90 24
3i.Total stream and ditch impacts:
114
3j.Comments:

E. Impact Justification and Mitigation
1.Avoidance and Minimization
1a.Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
The project will utilize an offsite detour.Best management practices will be utilized.
1b.Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Project is a culvert to culvert replacement within the same alignment.Dewatering will occur to ensure that all work is performed in the dry.
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
2b.If this project DOES NOT require Compensatory Mitigation,explain why:
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 ( No
If no,explain why:
2.Stormwater Management Plan
2a.Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
✓ Yes ( No
2b.Does this project meet the requirements for low density projects as defined in 15A NCAC 02H.1003(2)?
( Yes r No
Comments:
G. Supplementary Information U
1. Environmental Documentation
la.Does the project involve an expenditure of public(federal/state/local)funds or the use of public(federal/state)land?*
( Yes rNo
1b.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 ( No
Comments:*
Project qualifies as a Categorical Exclusion and does meet the threshold of requiring a NEPA/SEPA document.
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 ( No
3. Cumulative Impacts(DWR Requirement)
3a.Will this project result in additional development,which could impact nearby downstream water quality?*
✓ Yes ( 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 ( Nor 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 f• No
5b.Have you checked with the USFWS concerning Endangered Species Act impacts?*
✓ Yes r No
5c.If yes,indicate the USFWS Field Office you have contacted.
Raleigh
5d.Is another Federal agency involved?*
✓ Yes t No r Unknown
5e.Is this a DOT project located within Division's 1-8?
6 Yes r No
5j.What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
USFWS Website and consultation with USFWS representative
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 6 No
6b.What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
NMFS County Index
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?*
✓ Yes 6' No
7b.What data sources did you use to determine whether your site would impact historic or archeological resources?*
NCDOT Cultural Resource Personnel
7c.Historic or Prehistoric Information Upload
Garrett Rd Archaeological Report.pdf 6.73MB
Garrett Rd Archictectural Report.pdf 2.14MB
8. Flood Zone Designation(Corps Requirement)
8a.Will this project occur in a FEMA-designated 100-year floodplain?*
G' Yes r No
8b.If yes,explain how project meets FEMA requirements:
NCDOT Hydraulics Unit coordination with FEMA
8c.What source(s)did you use to make the floodplain determination?*
FEMA Maps
Miscellaneous C^U
Comments
Miscellaneous attachments not previously requested.
Signature U
*
fJ 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:
W.R.Archer Ill,PE

Signature
SlU�C3Jr�,z �'
Date
2/25/2021