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Home My WebLink About20130336 Ver 1_Application_20130328 Page 1 of 11 PCN Form – Version 1.3 December 10, 2008 Version Office Use Only: Corps action ID no. _____________ DWQ pro ject no. _______________ Form Version 1.3 Dec 10 2008 Pre -Construction Notification (PCN) Form A. Applicant Information 1. Processing 1a. Type(s) of approval sought from the Corps: Section 404 Permit Section 10 Permit 1b. Specify Nationwide Permit (NWP) number: 1 4 (GC 3886, Riparian Buffer Impacts) 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): 401 Water Quality Certification – Regular Non -404 Jurisdictional General Permit 401 Water Quality Certification – Express Riparian Buffer Authorization 1e. Is this notification solely for the record because written approval is not required? For the record on ly 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 propose d for mitigation of impacts ? If so, attach the acceptance letter from mitigation bank or in -lieu fee program. Yes No 1g. Is the project located in any of NC’s twenty coastal counties. If yes, answer 1h below. Yes No 1h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? Yes No 2. Project Information 2a. Name of project: SR 1 529 (Sulphur Springs Road) 2b. Co unty: Catawba 2c. Nearest municipality / town: Hickory 2d. Subdivision name: 2e. NCDOT only, T.I.P. or state project no: 17BP.12.R.101 3. Owner Information 3a. Name(s) on Recorded Deed: NC DOT Right of Way 3b. Deed Book and Page No. 3c. Responsible Party (for LLC if applicable): 3d. Street address: 3e. City, state, zip: 3f. Telephone no.: 3g. Fax no.: 3h. Email address: Page 2 of 11 PCN Form – Version 1.3 December 10, 2008 Version 4. Applicant Information (if different from owner) 4a. Applicant is: Agent Other, specify: 4b. Name: Mike Holder 4c. Business name (if applicable): N.C. Department of Transportation, Division 12 4d. Street address: 1710 East Marion Street 4e. City, state, zip: Shelby, NC 28151 4f. Tele phone no.: 704 -480 -9020 4g. Fax no.: 704 -480 -5401 4h. Email address: mholder@ncdot.gov 5. Agent/Consultant Information (if applicable) 5a. Name: Trish Beam 5b. Business name (i f applicable): N.C. Department of Transportation, Division 12 5c. Street address: 1710 East Marion Street 5d. City, state, zip: Shelby, NC 28151 5e. Telephone no.: 704 -480 -9044 5f. Fax no.: 704 -480 -5401 5g. Email address: pdbeam @ncdot.gov Page 3 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): NA 1b. Site coordinates (in dec imal degrees): Latitude: 35.7993 Longitude: - 81.2417 (DD.DDDDDD) (-DD.DDDDDD) 1c. Property size: <.1 0 acres 2. Surface Waters 2a. Name of nearest body of water (stream, river, etc.) to proposed project: Long Shoals Creek 2b. Water Quality Classification of nearest receiving water: WS -V & B 2c. River basin: Catawba 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 deteriorating three span bridge to be replaced with a three span bridge . L anduse in the vicinity of the pro ject is designated forested and urban . Bridge is on a paved secondary road. 3b. List the total estimated acreage of all existing wetlands on the property: 3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 1 00 feet 3d. Explain the purpose of the proposed project: The purpose of the proposed work is to replace the deteriorating bridge for the safety of the travelling public. 3e. Describe the overall project in detail, including the type of equipment to be used: NCDOT proposes to replace the deteriorating 90 ft x 25 ft three span bridge with a 92.5 ft x 30 ft three span bridge. New impacts in buffer zones 1 and 2 are necessary for the construction of a t emporary workpad and a permanent driveway . Approximately 35 feet of permanent riprap bank stabilization will be installed under the bridge on both si des of the stream. There will be ~35 feet of temporary workpad impacts in the same area as the permanent impacts. The Project will be constructed using typical heavy equipment (trackhoe, backhoe, etc.) 4. Jurisdictional Determinations 4a. Have jurisdictio nal wetland or stream determinations by the Corps or State been requested or obtained for this property / project (including all prior phases) in the past? Comments: Jurisdictional stream determination made by Division 12 DEO. Yes No Unknown 4b. If the Corps made the jurisdictional determination, what type of determination was made? Preliminary Final 4c. If yes, who delineated the jurisdiction al areas? Name (if known): Agency/Consultant Company: Other: 4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation. 5. Project History 5a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past? Yes No Unknown 5b. If yes, explain in detail according to “help file” instructions. Page 4 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 5 of 11 PCN Form – Version 1.3 December 10, 2008 Version C. Proposed Impacts Inventory 1. Impacts Summary 1a. 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. Wetland impact number – Permanent (P) or Temporary (T) 2b. Type of impact 2c. Type of wetland (if known) 2d. Forested 2e. Type of juri sdiction (Corps - 404, 10 DWQ – non -404, other) 2f. Area of impact (acres) W1 P T Yes No Corps DWQ W2 P T Yes No Corps DWQ W3 P T Yes No Corps DWQ W4 P T Yes No Corps DWQ W5 P T Yes No Corps DWQ W6 P T Yes No Corps DWQ 2g . Total wetla nd impacts 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. 3a. Str eam impact number - Permanent (P) or Temporary (T) 3b. Type of impact 3c. Stream name 3d. Perennial (PER) or intermittent (INT)? 3e. Type of jurisdiction (Corps - 404, 10 DWQ – non -404, other) 3f. Average stream width (feet) 3g. Impact length (linear feet) S1 P T Riprap Bank Stabilization Long Shoals Creek PER INT Corps DWQ 15 33 S2 P T Work Pad Long Shoals Creek PER INT Corps DWQ 15 36 S3 P T PER INT Corps DWQ S4 P T PER INT Corps DWQ S5 P T PER INT Corps DWQ S6 P T PER INT Corps DWQ 3h. Total stream and tributary impacts 40 3i. Comments: Page 6 of 11 PCN Form – Version 1.3 December 10, 2008 Version 4. Open Water Impacts If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Oc ean, or any other open water of the U.S. then individually list all open water impacts below. 4a. Open water impact number – Permanent (P) or Temporary (T) 4b. Name of waterbody (if applicable) 4c. Type of impact 4d. Waterbody type 4e. Area of impact (acres) O1 P T O2 P T O3 P T O4 P T 4f. Total open water impacts 4g. Comments: 5. Pond or Lake Construction If pond or lake construction proposed, then complete the chart below. 5a. Pond ID number 5b. Proposed use or purpose of pond 5c. Wetland Impacts (acres) 5d. Stream Impacts (feet) 5e. Upland (acres) Floode d 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: 5i. Expected pond surface area (acres): 5j. Size of pond watershed (acres): 5k. Method of construction: Page 7 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 . Project is in which protected basin? Neuse Tar -Pamlico Other: Catawba Randleman 6b. Buffer impact number – Permanent (P) or Temporary (T) 6c. Reason for impact 6d. Stream name 6e. Buffer mitigation required? 6f. Zone 1 impact (square feet) 6g. Zone 2 impact (square feet) B1 P T Slope protection Long Shoals Creek Yes No 285 110 B2 P T Driv eway Construction Long Shoals Creek Yes No 10 585 B3 P T Yes No 6h. Total buffer impacts 295 695 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. Existing stormwater pipe to remain to avoid additional buffer impacts. 1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction tec hniques. 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 2 b. If yes, mitigation is required by (check all that apply): DWQ Corps 2c. If yes, which mitigation option will be used for this project? Mitigation bank Payment to in -lieu fee p rogram 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 8 of 11 PCN Form – Version 1.3 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 attache d. 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 Mi tigation (State Regulated Riparian Buffer Rules) – required by DWQ 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 req uired, 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 9 of 11 PCN Form – Version 1.3 December 10, 2008 Version E. Sto rmwater 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 within one of the NC Riparian Buffer Protection Rules? Yes No 1b. If yes, then is a diffuse flow plan included? If no, explain why. Comments: Yes No 2. Stormwater Management Plan 2a. What is the overall percent imperviousness of thi s project? 0 % 2b. Does this project require a Stormwater Management Plan? Yes No 2c. If this project DOES NOT require a Stormwater Management Plan, explain why: Complies with NCDOT ’s individual NPDES permit NCS000250 . 2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan: 2e. Who will be responsible for the review of the Stormwater Manag ement Plan? Certified Local Government DWQ Stormwater Program DWQ 401 Unit 3. Certified Local Government Stormwater Review 3a. In which local government’s jurisdiction is this project? NA 3b. Which of the following locally -implemented stormwater management programs apply (check all that apply): Phase II NSW USMP Water Supply Watershed Other: 3c. Has the approved Stormwater Management Plan with proof of approval been attached? Yes No 4. DWQ Stormwater Program Review 4a. Which of the following state -implemented stormwater management pr ograms apply (check all that apply): Coastal counties HQW ORW Session Law 2006 -246 Other: 4b. Has the approved Stormwater Management Plan w ith proof of approval been attached? Yes No 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 10 of 11 PCN Form – Version 1.3 December 10, 2008 Version F. Supplementary Information 1. Environmental Documentation (DWQ Requirement) 1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land? Yes No 1b. If you answered “yes” to the above, does the project require preparation of an environmental document pursuant to the requirements of the Nati onal or State (North Carolina) Environmental Policy Act (NEPA/SEPA)? Yes No 1c. If you answered “yes” to the above, has the document review been finalized by the State Clearing House? (If so, attach a copy o f the NEPA or SEPA final approval letter.) Comments: Yes No 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, or Riparian Buffer Rules (15A NCAC 2B .0200)? Yes No 2b. Is this an after -the -fact permit application? Yes N o 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) resu lt in additional development, which could impact nearby downstream water quality? Yes No 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 ge nerated from the proposed project, or available capacity of the subject facility. NCDOT HAZARDOUS SPILL BASIN CHECKLIST Division: 12 County: C atawba Project ID : 17BP.12.R.101 River Basin: _ Catawba Bridge No: 27 Route: SR 1 529 Stream: Long Shoals Creek Water Quality Criteri a : Yes No Roadway Criteria : Route Designation - Yes No Additional Site Information: Yes No Criteria Based Upon NCDOT “Best Management Practices for the Protection of Surfa ce Waters” (March, 1997). Stream Crossing Blue Line On USGS Quad ORW WSI WS II,III OR IV, Crossing Within 0.5mi of W.S. Critical Area Arterial Rural Arterial Urban Is a Hazardous Spill Basin Required?