20210557 Ver 1_ePCN Application_20210430

I I DWR
Division of Water Resources
Pre-Construction Notification (PCN) Form
April 4,2021 Ver 4
Initial Review
Has this project met the requirements for acceptance in to the review process?*
✓ Yes
✓ No
Is this project a public transportation project?*
0 Yes r No
Change only if needed.
BIMS#Assigned* Version#*
20210557 1
Is a payment required for this project?*
✓ No payment required
G Fee received Reviewing Office*
✓ Fee needed-send electronic notification Mooresville Regional Office-[phone]
Select Project Reviewer*
Donna Hood:eads\drhood
Information for Initial Review
1a.Name of project:
W-5710AI Roundabout at NC 218 and SR 1606(Sikes Mill Road),Union County
1a.Who is the Primary Contact?*
Joel M.Howard
lb.Primary Contact Email:* 1c.Primary Contact Phone:*
[e-mail] [phone]
Date Submitted
4/30/2021
Nearest Body of Water
Grassy Creek
Basin
Yadkin-PeeDee
Water Classification
C
Site Coordinates
Latitude: Longitude:
35.130673 -80.478338
A. Processing Information U
County(or Counties)where the project is located:
Union
Is this a NCDMS Project
✓ Yes G No
Is this project a public transportation project?*
6 Yes r No
Is this a NCDOT Project?*
(7 Yes r No
(NCDOT only)T.I.P.or state project number:
W-5710A1

WBS#(9)
44856.3.37
Pre-Filing Meeting Information
Is this a courtesy copy notification?*
✓ Yes G No
ID# Version
Pre-fling Meeting or Request Date
3/11/2021
Attach documentation of Pre-Filing Meeting Request here:
Click the upload button or drag and drop files here to attach document
DWR Pre-Filing Meeting Request Form.pdf 54.99KB
Pie type nest be FCF
1a.Type(s)of approval sought from the Corps:
I7 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
✓ No
lb.What type(s)of permit(s)do you wish to seek authorization?
fJ Nationwide Permit(NWP)
✓Regional General Permit(RGP)
✓Standard(IP)
1c.Has the NWP or GP number been verified by the Corps?
✓ Yes 6 No
Nationwide Permit(NWP)Number: 14-Linear transportation
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
✓Non-404 Jurisdictional General Permit r Riparian Buffer Authorization
✓ Individual 401 Water Quality Certification
le.Is this notification solely for the record because written approval is not required? *
For the record only for DWR 401 Certification: r Yes 6' No
For the record only for Corps Permit: r Yes 6 No
If.Is this an after-the-fact permit application?*
✓ Yes f No
1g.Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
✓ Yes 6' No
1g.Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
✓ Yes rNo
Acceptance Letter Attachment
1h.Is the project located in any of NC's twenty coastal counties?
✓ Yes 6' No
1j.Is the project located in a designated trout watershed?
✓ Yes f 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 f No

2. Owner Information
2a.Name(s)on recorded deed:
Brett D.Canipe,Division Engineer
2b.Deed book and page no.:
2c.Contact Person:
2d.Address
Street Address
716 West Main Street
Address Line 2
(]ly State/Bovine/Region
Albemarle North Carolina
Postal/Zip Code Country
28001 USA
2e.Telephone Number: 2f.Fax Number:
[phone] [phone]
2g.Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1b.Subdivision name:
(rf appropriate)
1c.Nearest municipality/town:
Fairview
2. Project Identification
2a.Property Identification Number: 2b.Property size:
2c.Project Address
Street Address
Address Line 2
CHy State/Province/legion
Postal/Zip lode Country
3.Surface Waters
3a.Name of the nearest body of water to proposed project:*
Grassy Creek
3b.Water Resources Classification of nearest receiving water:*
C
3c. What river basin(s)is your project located in?*
Yadkin-PeeDee
3d.Please provide the 12-digit HUC in which the project is located.
03040105
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:*
This project is located at the intersection of NC 218 and SR 1606(Sikes Mill Road),Union County.This area of Union County is primarily rural with single family homes located sparsely
through out the country side with most land being used for farming.
4b.Have Corps permits or DWR certifications been obtained for this project(including all prior phases)in the past?*
C Yes f• No C 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)
A-5710A1-TOPO.pdf 202.84KB
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)

Soil Map_W-5710AI-Soil Map.pdf 546.46KB
4f.List the total estimated acreage of all existing wetlands on the property:
.02 acres
4g.List the total estimated linear feet of all existing streams on the property:
34'
4h.Explain the purpose of the proposed project:*
This is a roadway improvement project where NCDOT proposes to construct a roundabout at the intersection of NC 218 and SR 1606(Sikes Mill Rd),Union County.This Roundabout
will increase the serviceability and improve the overall safety at this intersection.There are 2 impact sites where impacts occur.Site 1 WA,impacts occur at a collar and extension of an
18"RCP into a wetland site.Site 2 impacts occur at another collar and extension of an 18"RCP.NCDOT will attempt to avoid and minimize impacts to the wetland and stream to the
greatest extent practicable during construction of this project.
4i.Describe the overall project in detail,including indirect impacts and the type of equipment to be used:*
Erosion control measures will be installed prior to any ground disturbing activities.As part of this project NCDOT will be extending an 18"pipe 34'and filling.02 acres(24'of new pipe
with fill)of wetland to construct this job.By extending the existing 18"pipe on both the inlet and outlet,NCDOT will obtain the necessary road width and road shoulder to construct the
proposed roundabout.This work will be conducted in the dry by dewatering(if necessary)the permitted sites prior to construction.The water will be pumped off site or into an approved
silt bag adhering to NCDOT's best management practices for pipe construction/replacement.The equipment that is required to construct this project includes but is not limit to:
dewatering pump,trackhoe,dumptruck,vibratory roller,motor grader and paving equipment.
4j.Please upload project drawings for the proposed project.
W-5710AI_Permit Drawings_20210412.pdf 958.22KB
5.Jurisdictional Determinations
5a.Have the wetlands or streams been delineated on the property or proposed impact areas?*
6 Yes C' No r Unknown
Comments:
The wetland associated with this project was delineated on 3/12/2021 by NCDOT Biologist
5b.If the Corps made a jurisdictional determination,what type of determination was made?*
C' Preliminary C' Approved C' Not Verified r Unknown f N/A
Corps AID Number:
5c.If 5a is yes,who delineated the jurisdictional areas?
Name(if known): Joel M.Howard
Agency/Consultant Company: NCDOT,Division 10
Other:
5d1.Jurisdictional determination upload
401-404 data sheets.pdf 5.52MB
6. Future Project Plans
6a.Is this a phased project?*
r Yes f No
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?
N/A
D. Proposed Impacts Inventory
1. Impacts Summary
1a.Where are the impacts associated with your project?(check all that apply):
fJ Wetlands 17 Streams-tributaries r Buffers
r Open Waters r Pond Construction
2.Wetland Impacts
2a.Site#*(?) 2a1 Reason(?) 2b.Impact type*(?) 2c.Type of W.* 2d.W.name* 2e.Forested* 2f.Type of 2g.Impact
Jurisdicition*(?) area*
WA Site-1 Fill P Small-Basin Wetland WA No Both 0.020
(acres)
2g.Total Temporary Wetland Impact 2g.Total Permanent Wetland Impact
0.000 0.020
2g.Total Wetland Impact

0.020
2i.Comments:
This impact is due to the extension of an 18"pipe and permanent fill to widen the road shoulder.
3.Stream Impacts
3a.Reason for impact(?) 3b.Impact type* 3c.Type of impact* 3d.S.name* 3e.Stream Type* 3f.Type of 3g.S.width* 3h.Impact
(?) Jurisdiction* length*
S1 Extension of an 18"pipe Permanent Culvert UT to Grassy Creek Intermittent Both 2 34
Average(feet) (linear feet)
3i.Total jurisdictional ditch impact in square feet:
0
3i.Total permanent stream impacts: 3i.Total temporary stream impacts:
34 0
3i.Total stream and ditch impacts:
34
3j.Comments:
This impact is due to the proposed extension of an existing 18"RCP
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:
NCDOT's best management practices for the installation of pipe and culverts in jurisdictional waters will be adhered to throughout the life of the
project.
lb.Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
During the project all erosion control measures will be maintained.Permit site 2 will be dewatered if necessary before construction of the pipe
extension starts.NPDES records will be kept throughout the life of the project stopping only when NCDOT Roadside Environmental personnel deem
the project compliant.
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:
The impacts that will be associated with this project fall under the USAGE and DWR thresholds for mitigation.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
1a.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:
Grassy Creek and it's unnamed tributaries do not fall under any NC Riparian Buffer Protection Rules.
2.Stormwater Management Plan
2a.Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
( Yes r No
Comments:
NPDES record will be kept throughout the life of the project.
G. Supplementary Information
1. Environmental Documentation
1a.Does the project involve an expenditure of public(federal/state/local)funds or the use of public(federal/state)land?*
( Yes rNo
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(North Carolina)
Environmental Policy Act(NEPA/SEPA)?*
( Yes rNo

1c.If you answered"yes"to the above,has the document review been finalized by the State Clearing House?*
✓ Yes f No
Comments:*
The project is federally funded and falls under the CE(categorical exclusion checklist).
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)?*
r Yes t 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.
This is a stand alone project.NCDOT does not anticipate any future impacts to natural resources or any additional land development in the vicinity of
this project.
4.Sewage Disposal(DWR Requirement)
4a.Is sewage disposal required by DWR for this project?*
C Yes C No 6 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?*
G Yes (' No
5b.Have you checked with the USFWS concerning Endangered Species Act impacts?*
✓ Yes (' No
5c.If yes,indicate the USFWS Field Office you have contacted.
Asheville
5d.Is another Federal agency involved?*
✓ Yes r No r Unknown
What Federal Agency is involved?
USACE
5e.Is this a DOT project located within Division's 1-8?
C Yes 0' No
5f.Will you cut any trees in order to conduct the work in waters of the U.S.?
✓ Yes t' No
5g.Does this project involve bridge maintenance or removal?
C Yes G No
5h.Does this project involve the construction/installation of a wind turbine(s)?*
CYes t' No
5i.Does this project involve(1)blasting,and/or(2)other percussive activities that will be conducted by machines,such as jackhammers,mechanized pile drivers,etc.?
C Yes G No
5j.What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
The USFW ipac review site and the Natural Heritage scoping web based review site.
Consultation Documentation Upload
NRTR.pdf 2.47MB
Ipac.pdf 460.28KB
NCNHP Report.pdf 1.7MB
Plans with project pictures.pdf 9.89MB
W-5710AI_Tribal Coordination Package_Signed.pdf 471.04KB
6. Essential Fish Habitat(Corps Requirement)
6a.Will this project occur in or near an area designated as an Essential Fish Habitat?*
C Yes 6- No
6b.What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
South Atlantic Fishery Management Council.

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?*
r Yes f• No
7b.What data sources did you use to determine whether your site would impact historic or archeological resources?*
NCDOT's Cultural Resources Staff
7c.Historic or Prehistoric Information Upload
18-10-0056_NoSurvey Archictecture.pdf 3.24MB
PA 18-10-0056 W-5710AI No Archaeological Survey Required Form roundabout NC 218 SR 1606 Union.pdf 1.06MB
8. Flood Zone Designation(Corps Requirement)
8a.Will this project occur in a FEMA-designated 100-year floodplain?*
rYes (7 No
8c.What source(s)did you use to make the floodplain determination?*
FEMA Floodplain Website.23
Miscellaneous
Comments
Miscellaneous attachments not previously requested.
Signature
*
7 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:
Joel M.Howard
Signature
ffFL�1 HOVA
Date
4/30/2021