20211364 Ver 1_401 Request Attachment_20211108

Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
June 1, 2021 Ver 4.1
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 Counties) where the project is located:*
Is this a NCDMS Project *
Is this project a public transportation project?*
Is this a NCDOT Project?*
(NCDOT only) T.I.P. or state project number:
WBS #*
1a. Type(s) of approval sought from the Corps:*
Has this PCN previously been submitted?*
1b. What type(s) of permit(s) do you wish to seek authorization?*
1c. Has the NWP or GP number been verified by the Corps?*
Nationwide Permit (NWP) Number:
NWP Numbers (for multiple NWPS):
1d. Type(s) of approval sought from the DWR:*
Pre-Filing Meeting Information
A. Processing Information
Lenoir
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
17BP.2.R90
38413.1.2
(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
03 - Maintenance
List all NW numbers you are applying for not on the drop down 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
1e. Is this notification solely for the record because written approval is not required?
*
For the record only for DWR 401 Certification:
For the record only for Corps Permit:
1f. Is this an after-the-fact permit application?*
1g. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
Acceptance Letter Attachment
1h. Is the project located in any of NC's twenty coastal counties?*
1j. Is the project located in a designated trout watershed?*
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 permit?*
1e. Is there an Agent/Consultant for this project?*
2. Owner Information
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 authority at
least 30 days prior to submitting the certification request. Click here to read more information on when this form is needed prior to application submission or here to view the form.
Is this a courtesy copy notification?*
ID#Version
Pre-fling Meeting or Request Date *
Attach documentation of Pre-Filing Meeting Request here:*
Yes No
10/15/2021
Click the upload button or drag and drop files here to attach document
DWR Pre-Filing Meeting Request Form.pdf 50.88KB
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
Click the upload button or drag and drop files here to attach document
FILE TYPE MUST BE PDF
Yes No
Yes No
B. Applicant Information
Nancy Oberle
[e-mail]
(xxx)xxx-xxxx
[phone]
Owner Applicant (other than owner)
(Check all that apply)
Yes No
2a. Name(s) on recorded deed:*
2b. Deed book and page no.:
2c. Contact Person:
NCDOT Highway Division 2
(for Corporations)
Michael Aman, PE
4. Agent/Consultant (if applicable)
1a. Name of project:*
1b. Subdivision name:
1c. Nearest municipality / town:*
2a. Property Identification Number:2b. Property size:
2c. Project Address
2d. Site coordinates in decimal degrees
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:*
2d. Address *
2e. Telephone Number:*
2f. Fax Number:
2g. Email Address:*
City
Kinston
State / Province / Region
NC
Postal / Zip Code
28504
Country
USA
Street Address
2815 Rouse Road Extension
Address Line 2
(xxx)xxx-xxxx
[phone]
(xxx)xxx-xxxx
[e-mail]
4a. Name:*
4b. Business Name:
4c. Address *
4d. Telephone Number:*
4e. Fax Number:
4f. Email Address:*
Nancy Oberle
(if applicable)
Three Oaks Engineering, Inc.
City
Durham
State / Province / Region
NC
Postal / Zip Code
27701
Country
USA
Street Address
324 Blackwell Street, Suite 1200
Address Line 2
[phone]
(xxx)xxx-xxxx (xxx)xxx-xxxx
[e-mail]
C. Project Information and Prior Project History
1. Project Information
Replacement of Bridge No. 530068 on SR 1515 (Aldridge Store Rd) over Groundnut Creek
(if appropriate)
La Grange
2. Project Identification
(tax PIN or parcel ID)(in acres)
City State / Province / Region
Postal / Zip Code Country
Street Address
Address Line 2
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
3b. Water Resources Classification of nearest receiving water:*
Surface Water Lookup
3c. What river basin(s) is your project located in?*
3d. Please provide the 12-digit HUC in which the project is located.*
River Basin Lookup
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:*
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
4f. List the total estimated acreage of all existing wetlands on the property:
4g. List the total estimated linear feet of all existing streams on the property:
4h. Explain the purpose of the proposed project:*
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
Corps AID Number:
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
6. Future Project Plans
6a. Is this a phased project?*
35.325579
ex: 34.208504
-77.746634
-77.796371
Groundnut Creek
27-77-2-2
Neuse
030202020205
The project study area is comprised of mostly maintained roadway with hardwood forest along the stream and roadway. There are riparian wetlands on either side of the stream. Land use
in the vicinity of the project study area is residential, forested, and agricultural. There is an existing 60 foot long, 2-span bridge that has a sufficiency rating of 29.3.
Yes No Unknown
0.09
(intermittent and perennial)
88
The purpose of the proposed project is to replace a structurally deficient bridge. Existing Bridge No. 68 is 61 feet long, with a clear roadway width of 26 feet. The bridge has an asphalt
wearing surface over concrete channel beams. The substructure consists of timber piles and concrete caps. NCDOT Structures Management Unit Records indicated Bridge No. 68
currently has a sufficiency rating of 22.01 out of a possible 100 for a new structure (as of 2019). The bridge is posted with a weight limit of 19 tons for single vehicles and 22 tons for truck
tractor semitrailers. The bridge is considered structurally deficient due to a structural appraisal of 4 out of 9.
State Project involves the replacement of NCDOT Bridge 530068 over Groundnut Creek on SR 1515 in Lenoir County. The existing structure is an approximately 61-foot long, 2 span
(2@30') prestressed concrete channel bridge with a sufficient rating of 22.01. The proposed structure will be a single span (1@70') 24 inch girder bridge with an out to out deck width of 30
feet. The existing bridge has deck drains. The proposed bridge will collect bridge runoff with four TB 2GIs without deck drains and outlets the runoff outside Buffer Zone 2. Rip-rap pads will
be utilized at each outlet to dissipate flow and minimize erosion. The proposed bridge maintains the existing level of service with a single span bridge, so no bents will be placed in the
water. The bridge utilizes 4.0' caps, so the rip-rap key in ties in outside the existing top of bank under the bridge. Grassy 3:1 fill slopes are utilized with a low roadway profile to minimize
impacts to the wetland areas.
Equipment to be used includes typical construction equipment, such as track hoe, dump truck, paving equipment, pumps, various hand tools, and crane.
Yes No Unknown
Preliminary Approved Not Verified Unknown N/A
Example: SAW-2017-99999
Tina Sekula
EEE Consulting
Reviewed by Jim Mason, Three Oaks Eng.
Yes 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? This includes other
separate and distant crossing for linear projects that require Department of the Army authorization but don’t require pre-construction notification.
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
"W." will be used in the table below to represent the word "wetland".
2a. Site #*(?)2a1 Reason *(?)2b. Impact type *(?)2c. Type of W.*2d. W. name *2e. Forested *2f. Type of Jurisdicition *
(?)
2g. Impact
area *
2g. Total Temporary Wetland Impact
2g. Total Permanent Wetland Impact
2g. Total Wetland Impact
2i. 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.
"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. Stream Type *
(?)
3f. Type of
Jurisdiction *
3g. S. width *3h. Impact
length *
S1
S2
S3
** All Perennial or Intermittent streams must be verified by DWR or delegated local government.
3i. Total jurisdictional ditch impact in square feet:
3i. Total permanent stream impacts:
3i. Total temporary stream impacts:
3i. Total stream and ditch impacts:
3j. Comments:
6. Buffer Impacts (for DWR)
If project will impact a protected riparian buffer, then complete the chart below. Individually list all buffer impacts below.
D. Proposed Impacts Inventory
Wetlands Streams-tributaries Buffers
Open Waters Pond Construction
1 Bridge and Fill Slope P Bottomland Hardwood Forest WA Yes Both 0.001
(acres)
1 Bridge and Fill Slope P Bottomland Hardwood Forest WD Yes Both 0.001
(acres)
0.000
0.002
0.002
Permanent fill in wetland = 50.0 square feet
Mechanized clearing in wetland = 8.8 square feet
Turbidity Curtain Temporary Other Groundnut Creek Perennial Both 38
Average (feet)
71
(linear feet)
Bridge and Fill Slope Permanent Bank Stabilization Ditch B/C Jurisdictional Ditch Corps 4
Average (feet)
16
(linear feet)
Bridge and Fill Slope Temporary Dewatering Ditch B/C Jurisdictional Ditch Corps 4
Average (feet)
21
(linear feet)
148
16
92
108
Ditch B/C is a roadside ditch. Although we do not believe that this feature would be claimed by USACE, since we are pursuing a PJD, impacts to this
feature were included as a precaution.
6a. Project is in which protect basin(s)?*
6b. Impact Type *(?)6c. Per or Temp *(?)6d. Stream name *6e. Buffer mitigation required?*6f. Zone 1 impact *6g. Zone 2 impact *
6h. Total buffer impacts:
Zone 1 Zone 2
Total Temporary impacts:
Zone 1 Zone 2
Total Permanent impacts:
Zone 1 Zone 2
Total combined buffer impacts:
6i. Comments:
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
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?
2b. If this project DOES NOT require Compensatory Mitigation, explain 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. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
1b. All buffer impacts and high ground impacts require diffuse flow or other form of stormwater treatment. If the project is subject to a state implemented riparian buffer protection program,
include a plan that fully documents how diffuse flow will be maintained.
All Stormwater Control Measures (SCM)s must be designed in accordance with the NC Stormwater Design Manual. Associated supplement forms and other documentation shall be
provided.
Check all that apply.
Neuse Tar-Pamlico
Catawba Randleman
Goose Creek Jordan Lake
Other
Site 1 - Bridge - Allowable without Authorization P Groundnut Creek No 99
(square feet)
167
(square feet)
0.00 0.00
99.00 167.00
99.00 167.00
E. Impact Justification and Mitigation
The proposed project is to remove and replace a structurally deficient bridge with a new bridge. Roadway approach work is minimized as much as is
practical to reduce the overall project footprint. The existing bridge has a bent in the creek, while the proposed bridge will span the creek and remove the
existing bent. The new bridge will also divert stormwater through a basin instead of releasing it directly into the stream. The bridge utilizes 4.0' caps, so
the rip-rap key in ties in outside the existing top of bank under the bridge. Grassy 3:1 fill slopes are utilized with a low roadway profile to minimize
impacts to the wetland areas.
Erosion and sedimentation BMPs will be installed prior to construction. Impacts will be minimized by strict enforcement of Best Management Practices
for the protection of surface waters, restrictions
against the staging of equipment in or adjacent to waters of the US and coordination with appropriate environmental staff.
Yes No
The impacts to jurisdictional features as a result of this bridge replacement will be minimal - 16 LF of permanent stream impact, <0.01 acre of wetland impact, and <0.01 acre of buffer
impact. Therefore, no mitigation is required.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
Yes No
What type of SCM are you providing?
For a list of options to meet the diffuse flow requirements, click here.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT’s Individual NPDES permit NCS000250?*
Comments:
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
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)?*
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.)*
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)?*
3. Cumulative Impacts (DWR Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in additional development, which could impact nearby downstream water quality?*
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?*
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?*
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
5c. If yes, indicate the USFWS Field Office you have contacted.
5d. Is another Federal agency involved?*
5e. Is this a DOT project located within Division's 1-8?*
Level Spreader
Vegetated Conveyance (lower SHWT)
Wetland Swale (higher SHWT)
Other SCM that removes minimum 30% nitrogen
Proposed project will not create concentrated stormwater flow through the buffer
(check all that apply)
Yes No
See Stormwater Management Plan in attached permit drawings package.
G. Supplementary Information
Yes No
Yes No
Yes No
Yes No
Yes No
Per the NC DWQ April 10, 2004 Version 2.1 Cumulative Impacts policy, small scale public transportation projects - such as widening projects, bridge
replacements and intersection improvements - have a "low potential for cumulative impacts since little (if any) new impervious surface is added and the
projects are usually in already developed locales." This proposed project is within a somewhat developed landscape (i.e. existing residential homes in
the vicinity), this is not a road on a new location (i.e. there is an existing road and bridge structure and thus, the area already contains impervious
surfaces), and the project drains to Groundnut Creek, which is a Class C, Swamp waters (i.e. not HQW, ORW or 303(d) listed waters). We anticipate the
NC DWR will advise us if a qualitative or quantitative analysis is needed.
Yes No N/A
Yes No
Yes No
Raleigh
Yes No Unknown
Yes No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
6b. What data sources did you use to determine whether your site would impact an Essential 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 project occur in or near an area that the state, federal or tribal governments have designated as having historic or cultural preservation 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?*
8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https://msc.fema.gov/portal/search
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?*
Comments
Please use the space below to attach all required documentation or any additional information you feel is helpful for application review. Documents should be combined into one file when
possible, with a Cover Letter, Table of Contents, and a Cover Sheet for each Section preferred.
*
· 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 *
IPaC; species surveys for the project. No habitat is present for the West Indian manatee or the American alligator. No foraging habitat is present within
1.0 mile for bald eagle. Carolina madtom, Atlantic pigtoe, and Neuse River waterdog surveys are scheduled and will be completed prior to Let. It is
anticipated, if the Biological Conclusion for madtom or waterdog is MANLAA or MALAA, the appropriate payment will be made for each species per the
existing PCO. If Atlantic pigtoe results in a Biological Conclusion that requires USFWS concurrence, appropriate documentation will be submitted to
USFWS and concurrence will be obtained prior to Let. NLEB is covered per the existing PBO for NCDOT Divisions 1-8.
Yes No
NOAA Essential Fish Habitat Mapper
Yes No
State Historic Preservation Office correspondence; SEPA review.
Yes No
MOA or CLOMR
NC Floodplain Map
Miscellaneous
Since the NRTR was completed, the Neuse River Waterdog has been listed as Threatened and the Carolina madtom has been listed as Endangered by the US Fish and Wildlife Service.
Surveys have not yet been done for these species, but are anticipated to be done over the 2021-2022 season. Since these species are covered under a PCO, we were hoping to acquire
the permit before the surveys are complete under the condition that surveys will be done before the project is underway and appropriate payment is made based on the Biological
Conclusion of each species.
Click the upload button or drag and drop files here to attach document
B-4569_Revised_MCDC_signed.pdf 2.18MB
17BP.2.R.90_Permit Drawings_BUFFER_20210923.pdf 1.12MB
17.BP.2.R.90_Rdy_RPC.pdf 2.7MB
17BP.2.R.90_Permit Drawings_20210922.pdf 1.85MB
File must be PDF or KMZ
Signature
By checking the box and signing below, I certify that:
Sign
Date
10/14/2021