20210723 Ver 1_Modification Request Attachment_20210510 (4)

Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
April 4, 2021 Ver 4
Please note: fields marked with a red asterisk * below are required. You will not be able to submit the form until all mandatory questions are answered.
Also, if at any point you wish to print a copy of the E-PCN, all you need to do is right-click on the document and you can print a copy of the form.
Below is a link to the online help file.
https://edocs.deq.nc.gov/WaterResources/0/edoc/624704/PCN%20Help%20File%202018-1-30.pdf
County (or Countie s) where the proje ct is locate d:*
Is this a NCDM S Proje ct *
Is this project a public transportation project?*
Is this a NCDOT Proje ct?*
(NCDOT only) T.I.P. or state proje ct numbe r:
WBS #*
1a. Type (s) of approv al sought from the Corps:*
Has this PCN pre v iously be e n submitte d?*
1b. What type (s) of pe rmit(s) do you wish to se e k authorization?*
1c. Has the NWP or GP numbe r be e n v e rifie d by the Corps?*
Nationwide Pe rmit (NWP) Numbe r:
NWP Numbe rs (for multiple NWPS):
1d. Type (s) of approv al sought from the DWR:*
Pre-Filing Meeting Information
A. Processing Information
Buncombe
Yes No
Click Yes, only if NCDMS is the applicant or co-applicant.
Yes No
This is any publicly funded by municipal,state or federal funds road, rail, airport transportation project.
Yes No
13C.011024
(for NCDOT use only)
Section 404 Permit (wetlands, streams and waters, Clean Water Act)
Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
Yes
No
Nationwide Permit (NWP)
Regional General Permit (RGP)
Standard (IP)
Yes No
14 - Linear transportation
List all NW numbers you are applying for not on the drop dow n list.
check all that apply
401 Water Quality Certification - Regular 401 Water Quality Certification - Express
Non-404 Jurisdictional General Permit Riparian Buffer Authorization
Individual 401 Water Quality Certification
Before submitting this form please ensure you have submitted the Pre-Filing Meeting Request Form as we will not be able to accept your application without this important first step. The Pre-Filing
Meeting Request Form is used in accordance with 40 C.F.R. Section 121.4(a) “At least 30 days prior to submitting a certification request, the project proponent shall request a pre-filing meeting with the
certifying agency” and in accordance with 40 C.F.R. Section 121.5(b)(7), and (c)(5) all certification requests shall include documentation that a pre-filing meeting request was submitted to the certifying
1e . Is this notification sole ly for the re cord be cause writte n approv al is not re quire d?
*
For the re cord only for DWR 401 Ce rtification:
For the re cord only for Corps Pe rmit:
1f. Is this an afte r-the -fact pe rmit application?*
1g. Is payme nt into a mitigation bank or in-lie u fe e program propose d for mitigation of impacts?
Acce ptance Le tte r Attachme nt
1h. Is the proje ct locate d in any of NC's twe nty coastal countie s?*
1j. Is the proje ct locate d in a de signate d trout wate rshe d?*
You must submit a copy of the appropriate Wildlife Re source Commission Office .
Link to trout information: http://www.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Agency-Coordination/Trout.aspx
1a. Who is the Primary Contact?*
1b. Primary Contact Email:*
1c. Primary Contact Phone :*
1d. Who is applying for the pe rmit?*
1e . Is the re an Age nt/Consultant for this proje ct?*
2. Owner Information
authority at least 30 days prior to submitting the certification request. Click he re to read more information on when this form is needed prior to application submission or he re to view the form.
Is this a courte sy copy notification?*
ID#Ve rsion
Pre -fling M e e ting or Re que st Date *
Attach docume ntation of Pre -Filing M e e ting Re que st he re :*
Yes No
20210723 1
4/28/2021
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DWR Pre-Filing Meeting Request Form.pdf 55.39KB
File type must be PDF
Yes No
Yes No
Yes No
If so, attach the acceptance letter from mitigation bank or in-lieu fee program.
Yes No
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FILE TYPE MUST BE PDF
Yes No
Yes No
B. Applicant Information
Yates Allen
[e-mail]
(xxx)xxx-xxxx
[phone]
Owner Applicant (other than owner)
(Check all that apply)
Yes No
2a. Name (s) on re corde d de e d:*
2b. De e d book and page no.:
2c. Contact Pe rson:
2d. Addre ss *
NC Department of Transportation
(for Corporations)
1a. Name of proje ct:*
1b. Subdivision name :
1c. Ne are st municipality / town:*
2a. Prope rty Identification Numbe r:2b. Prope rty size :
2c. Proje ct Addre ss
2d. Site coordinate s in de cimal de gre e s
Please collect site coordinates in decimal degrees. Use between 4-6 digits (unless you are using a survey-grade GPS device) after the decimal place as appropriate, based on how the location was
determined. (For example, most mobile phones with GPS provide locational precision in decimal degrees to map coordinates to 5 or 6 digits after the decimal place.)
Latitude :*Longitude :*
3. Surface Waters
3a. Name of the ne are st body of wate r to propose d proje ct:*
3b. Wate r Re source s Classification of ne are st re ce iv ing wate r:*
Surface Water Lookup
3c. What riv e r basin(s) is your proje ct locate d in?*
3d. Ple ase prov ide the 12-digit HUC in which the proje ct is locate d.*
River Basin Lookup
4. Project Description and History
4a. De scribe the e xisting conditions on the site and the ge ne ral land use in the v icinity of the proje ct at the time of this application:*
2e . Te le phone Numbe r:*
2f. Fax Numbe r:
2g. Email Addre ss:*
City
Asheville
State / Province / Region
NC
Postal / Zip Code
28801
Country
USA
Street Address
55 Orange Street
Address Line 2
(xxx)xxx-xxxx
[phone]
(xxx)xxx-xxxx
[e-mail]
C. Project I nformation and Prior Project History
1. Project Information
SR 2793 Cedar Creek Road Buncombe
(if appropriate)
Old Fort
2. Project Identification
(tax PIN or parcel ID)(in acres)
City State / Province / Region
Postal / Zip Code Country
Street Address
Address Line 2
35.538638
ex: 34.208504
-82.200377
-77.796371
Cedar Creek
Class C, Tr
Broad
030501050304
One portion of SR 2793 Cedar Creek Rd is paved; the remainder is gravel. Surrounding land use is scattered residential and woodlands.
4b. Hav e Corps pe rmits or DWR ce rtifications be e n obtained for this project (including all prior phase s) in the past?*
4d. Attach an 8 1/2 X 11 e xce rpt from the most re ce nt v e rsion of the USGS topographic map indicating the location of the proje ct site . (for DWR)
4e . Attach an 8 1/2 X 11 e xce rpt from the most re ce nt v e rsion of the publishe d County NRCS Soil Surv e y map de picting the proje ct site . (for DWR)
4f. List the total e stimate d acre age of all e xisting we tlands on the prope rty:
4g. List the total e stimate d line ar fe e t of all e xisting stre ams on the prope rty:
4h. Explain the purpose of the propose d proje ct:*
4i. De scribe the ov e rall proje ct in de tail, including indirect impacts and the type of e quipme nt to be use d:*
4j. Ple ase upload proje ct drawings for the propose d proje ct.
5. Jurisdictional Determinations
5a. Hav e the we tlands or streams be e n de line ate d on the prope rty or propose d impact are as?*
Comme nts:
5b. If the Corps made a jurisdictional de te rmination, what type of de te rmination was made ?*
Corps AID Numbe r:
5c. If 5a is ye s, who de line ate d the jurisdictional are as?
Name (if known):
Age ncy/Consultant Company:
Othe r:
5d1. Jurisdictional de te rmination upload
6. Future Project Plans
6a. Is this a phase d proje ct?*
Are any othe r NWP(s), re gional ge ne ral pe rmit(s), or indiv idual pe rmits(s) use d, or intende d to be use d, to authorize any part of the propose d project or re lated activ ity? This
include s othe r se parate and distant crossing for line ar proje cts that re quire De partme nt of the Army authorization but don’t re quire pre -construction notification.
1. Impacts Summary
1a. Whe re are the impacts associate d with your proje ct? (che ck all that apply):
3. Stream Impacts
Yes No Unknown
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SR 2793 Buncombe topo.pdf 876.35KB
File type must be pdf
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File type must be pdf
0
(intermittent and perennial)
UT 1=25 LF; UT 2=465LF; UT 3=50LF
The project upgrade the gravel portion of SR 2793 to allow for the safe passage vehicular traffic. Large trucks get hung up in a sharp hairpin turn. Other vehicles fall down the slope
when passing oncoming traffic.
The project will cut existing slopes, grade the roadway, re-establish ditches, pave the road surface, and add guardrail where needed. Two pipes will be replaced/extended. The first pipe
is at UT 1 which originates from a seep at the toe of slope in the existing ditch line about 20 feet above the pipe inlet. The second pipe carries UT 2.
Equipment used includes track hoes, graders, dump trucks, pavers, guardrail installers, and possibly a hoe ram.
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Erosion Control Plans Cedar Creek Rd SR 2793-3.pdf 11.59MB
Pipe Sheet Cedar Creek Rd SR 2793.pdf 32.73KB
File type must be pdf
Yes No Unknown
Site visit by NC DOT personnel
Preliminary Approved Not Verified Unknown N/A
Example: SAW-2017-99999
Yates Allen
NC DOT
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File type must be PDF
Yes No
A portion of SR 2793 was paved in approximately 2002. Work in jurisdictional areas was authorized under Action ID 199930645.
D. Proposed Impacts Inventory
Wetlands Streams-tributaries Buffers
Open Waters Pond Construction
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this question for all stream sites impacted.
"S." will be used in the table below to represent the word "stream".
3a. Reason for impact *(?)3b.Impact type *3c. Type of impact *3d. S. name *3e . Stre am Type *
(?)
3f. Type of
Jurisdiction *
3g. S. width *3h. Impact
le ngth *
S1
S2
S3
S4
** All Perennial or Intermittent streams must be verified by DWR or delegated local government.
3i. Total jurisdictional ditch impact in square fe e t:
3i. Total pe rmane nt stre am impacts:
3i. Total te mporary stre am impacts:
3i. Total stre am and ditch impacts:
3j. Comme nts:
1. Avoidance and Minimization
1a. Spe cifically de scribe me asure s take n to av oid or minimize the propose d impacts in de signing the proje ct:*
1b. Spe cifically de scribe me asure s take n to av oid or minimize the propose d impacts through construction te chnique s:*
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Doe s the proje ct re quire Compe nsatory M itigation for impacts to Wate rs of the U.S. or Wate rs of the State ?
2b. If this proje ct DOES NOT re quire Compe nsatory M itigation, e xplain why:
NC Stream Temperature Classification Maps can be found under the Mitigation Concepts tab on the Wilmington District's RIBITS website.
*** Recent changes to the stormwater rules have required updates to this section .***
1. Diffuse Flow Plan
1a. Doe s the proje ct include or is it adjace nt to prote cte d riparian buffers ide ntifie d within one of the NC Riparian Buffe r Prote ction Rule s?
For a list of options to meet the diffuse flow requirements, click here.
If no, e xplain why:
2. Stormw ater Management Plan
2a. Is this a NCDOT proje ct subje ct to compliance with NCDOT’s Indiv idual NPDES pe rmit NCS000250?*
Pipe replacement/extension Permanent Culvert UT 1 to Cedar Creek Perennial Both 1
Average (feet)
10
(linear feet)
Dewatering Temporary Dewatering UT 1 to Cedar Creek Perennial Both 1
Average (feet)
10
(linear feet)
Pipe replacement/extension Permanent Culvert UT 2 to Cedar Creek Perennial Both 3
Average (feet)
30
(linear feet)
Dewatering Temporary Dewatering UT 2 to Cedar Creek Perennial Both 3
Average (feet)
10
(linear feet)
0
40
20
60
Temporary impacts overlay permanent impacts.
UT 1 may be intermittent; the segment was too short to complete the perennial/intermittent ID form. Water was pooled at the pipe inlet and tadpoles
were present. A small amount of water was flowing from the pipe outlet.
E. Impact Justification and Mitigation
Road widening is minimal amount needed to meet current safety standards. The amount of widening determines how much pipe extension is needed.
Erosion control measures will be installed. Sites 1 and 2 will be dewatered during pipe replacement/extension. Amount of dewatering will be minimized
to what is necessary to do the pipe work.
Yes No
F. Stormwater M anagement and Diffuse Flow Plan (required by DWR)
Yes No
Yes No
Comme nts:
1. Environmental Documentation
1a. Doe s the proje ct inv olv e an e xpe nditure of public (fe de ral/state /local) funds or the use of public (fe de ral/state ) land?*
1b. If you answe re d “ye s” to the abov e , doe s the proje ct re quire pre paration of an e nv ironme ntal docume nt pursuant to the re quireme nts of the National or State (North Carolina)
Env ironme ntal Policy Act (NEPA/SEPA)?*
Comme nts:*
2. Violations (DWR Requirement)
2a. Is the site in v iolation of DWR Wate r Quality Ce rtification Rule s (15A NCAC 2H .0500), Isolate d We tland Rule s (15A NCAC 2H .1300), or DWR Surface Wate r or We tland Standards or
Riparian Buffe r Rule s (15A NCAC 2B .0200)?*
3. Cumulative Impacts (DWR Requirement)
3a. Will this proje ct (base d on past and re asonably anticipate d future impacts) re sult in additional de v e lopme nt, which could impact ne arby downstre am wate r quality?*
3b. If you answe re d “no,” prov ide a short narrativ e de scription.
4. Sewage Disposal (DWR Requirement)
4a. Is se wage disposal re quire d by DWR for this proje ct?*
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this proje ct occur in or ne ar an are a with fe de rally prote cte d spe cie s or habitat?*
5b. Hav e you che cke d with the USFWS conce rning Endange re d Spe cie s Act impacts?*
5d. Is anothe r Fe de ral age ncy inv olv e d?*
5e . Is this a DOT proje ct locate d within Div ision's 1-8?*
5f. Will you cut any tre e s in orde r to conduct the work in wate rs of the U.S.?*
5g. Doe s this proje ct inv olv e bridge mainte nance or re mov al?*
Link to the NLEB SLOPES document: http://saw-reg.usace.army.mil/NLEB/1-30-17-signed_NLEB-SLOPES&apps.pdf
5h. Doe s this proje ct inv olv e the construction/installation of a wind turbine (s)?**
5i. Doe s this proje ct inv olv e (1) blasting, and/or (2) othe r pe rcussiv e activitie s that will be conducte d by machine s, such as jackhamme rs, me chanize d pile driv e rs, e tc.?*
If ye s, ple ase prov ide de tails to include type of pe rcussiv e activ ity, purpose , duration, and spe cific location of this activ ity on the prope rty.
5j. What data source s did you use to de te rmine whe the r your site would impact Endange re d Spe cie s or De signate d Critical Habitat?*
Consultation Docume ntation Upload
G. Supplementary Information
Yes No
Yes No
Falls within State Minimum Criteria Checklist
Yes No
Yes No
Yes No N/A
Yes No
Yes No
Yes No Unknown
Yes No
Yes No
Yes No
Yes No
Yes No
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Percussive activity.pdf 37.1KB
File must be PDF
https://www.fws.gov/raleigh/species/cntylist/buncombe.html
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File type must be PDF
6. Essential Fish Habitat (Corps Requirement)
6a. Will this proje ct occur in or ne ar an are a de signate d as an Esse ntial Fish Habitat?*
6b. What data source s did you use to de te rmine whe the r your site would impact an Esse ntial Fish Habitat?*
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data: http://gis.ncdcr.gov/hpoweb/
7a. Will this proje ct occur in or ne ar an are a that the state , fe de ral or tribal gov e rnme nts hav e de signate d as hav ing historic or cultural pre se rv ation status (e .g., National Historic
Trust de signation or prope rtie s significant in North Carolina history and archae ology)?*
7b. What data source s did you use to de te rmine whe the r your site would impact historic or arche ological re source s?*
7c. Historic or Pre historic Information Upload
8. Flood Zone Designation (Corps Requirement)
Link to the FEM A Floodplain M aps: https://msc.fema.gov/portal/search
8a. Will this proje ct occur in a FEM A-designate d 100-ye ar floodplain?*
8c. What source (s) did you use to make the floodplain de te rmination?*
Comme nts
M isce llane ous attachme nts not pre v iously re que ste d.
*
· 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 :*
Signature *
Date
Yes No
Current maps/data bases
Yes No
HPOWEB 2.0 (arcgis.com)
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File must be PDF
Yes No
https://fris.nc.gov/fris/Index.aspx?FIPS=021&ST=NC&user=General Public
M iscellaneous
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SR 2793 Buncombe photos.pdf 3.06MB
SR 2793 Buncombe signed cover letter.pdf 265.75KB
File must be PDF or KMZ
Signature
By checking the box and signing below, I certify that:
Yates Allen
4/21/2021