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Home My WebLink About20130614 Ver 2_Application_20131112U.S. Department of Transportation Federal Highway Administration FEDERAL EXPRESS Eastern Federal Lands 21400 Ridgetop Circle Highway Division Sterling, VA 20166 -6511 NOV 2 0 2013 In Reply Refer to: HFPP -15 Ms. Sonia G. Carrillo Transportation Permitting Unit North Carolina Division of Water Resources 1650 Mail Service Center Raleigh, NC 27699 -1650 Subject: Project NC ERFO FSR 2011 -1(1), Replace Bridge and Six Culverts Croatan National Forest DWR Project No. 20130614 Submittal of Permit Fee Dear Ms. Carrillo: 2013 - r 3 - G (o�`fv.2 The Eastern Federal Lands Highway Division, of the Federal Highway Administration (FHWA), submitted revised project plans to your office on November 8, 2013. There are additional impacts associated with the project; therefore, submission of the $240 fee is required. Enclosed you will find a check for the fee amount. If you have any questions concerning this matter, please contact Ms. Lisa Landers, Environmental Protection Specialist, at Lisa.Landers @dot.gov or (571) 434 -1592. Sincerely yours, Kevin S. Rose Environmental Compliance Specialist Enclosure U.S. Department of Transportation Federal Highway Administration FEDERAL EXPRESS Mr. Tom Steffens U.S. Army Corps of Engineers Washington Regulatory Field Office 2407 West Fifth Street Washington, NC 27889 Eastern Federal Lands 21400 Ridgetop Circle Highway Division Sterling, VA 20166 -6511 In Reply ,' Refer to: HFPP -15 Mr. Garcy Ward North Carolina Division of Water Quality Wetlands, Buffers, Stormwater Compliance and Permitting Unit 512 North Salisbury Street Archdale Building, 9th Floor Raleigh, NC 27604 Subject: Project NC ERFO FSR 2011 -1(1), Replace Bridge and Six Culverts Croatan National Forest DWR Project No. 20130614 Re- Submittal of Pre - Construction Notification Dear Mr. Steffens and Mr. Ward: 4013 VZ O The Eastern Federal Lands Highway Division, of the Federal Highway Administration (FHWA), in cooperation with the USDA Forest Service - Croatan National Forest, is in receipt of the Division of Water Resources (DWR) letter dated October 17, 2013, providing 401 Water Quality Certification and Neuse Buffer Authorization. After negotiations with the construction contractor, it was determined that it would be advantageous to replace the existing culverts with pre -cast concrete box culverts instead of pipe culverts at Black Swamp Road — MP 0.630, Black Swamp Road — MP 4.076, Brown Road — MP 0. 10, Millis Road — MP 7.3 0, and Petiford Creek Road — MP 0.394. The larger box culverts will be less prone to debris, have slower outfall velocities, provide a larger hydraulic opening and provide further improvement to aquatic organism passage. In addition, box culverts have shorter construction durations because they have pre -cast wingwalls, as compared to pipe culvert headwalls that have to be cast in place. An inspection of the bridge located at Middle Little Road — MP 3.517 found that the bridge has a deficient deck. We are now proposing to replace the structure with a pre -cast concrete box culvert. The project has been redesigned to incorporate the above changes. The pre - construction notification has also been revised to reflect the changes to the impacts of the project. Channel modification through the excavation of material at the inlet and outlet of the culverts will be necessary at all of the sites except for the bridge at Middle Little Road milepost 3.517. 01 FHWA requests a waiver from Nationwide Permit 14 Regional Condition 4.5.6, "Excavation of existing stream channels shall be limited to the minimum necessary to construct or install the proposed culvert. The final width of the impacted streams at the culvert inlet and outlet should be no greater than the original stream width. A waiver from this condition may be requested in writing. The waiver will be issued if it can be demonstrated that it is not practicable to limit the final width of the culvert to that of the impacted stream at the culvert inlet and outlet and the proposed design would result in less impacts to the aquatic environment." 1. Millis Road milepost 7.300 and Petiford Creek Road milepost 0.394. The culverts at Millis Road milepost 7.300 will be shortened from 48 to 27 feet in length. The culverts at Petiford Creek Road milepost 0.394 will be reduced from 41 to 25 feet in length. The reduction in culvert length requires excavation at the inlet and outlet of the new culvert to ensure drainage and aquatic passage. The width of the stream channel will not change. 2. Black Swamp Road milepost 0.630 and Black Swamp Road milepost 4.076. The culverts at Black Swamp Road milepost 0.630 will be shortened from 34 to 33 feet in length. The culverts at Black Swamp Road milepost 4.076 will be shortened from 37 to 30 feet in length. The reduction in culvert length requires excavation at the inlet and outlet of the new culvert to ensure drainage and aquatic passage. The width of the stream channel will not change. 3. Middle Little Road milepost 3.517, Middle Little Road milepost 3.953, and Brown Road milepost 0.100. Middle Little Road milepost 3.953 would be shortened from 29.67 to 23.75 feet in length. No excavation will be done at Middle Little Road milepost 3.517. The culverts at Brown road would be shortened from 38.5 feet to 26 feet in length. The reduction in culvert length requires excavation at the inlet and outlet of the new culvert to ensure drainage and aquatic passage. The width of the stream channel will not change. Enclosed you will find the revised project plans and the revised PCN form. Please provide us with your response within thirty (30) days of the receipt of this letter. If you have any questions concerning this matter, please contact Ms. Lisa Landers, Environmental Protection Specialist, at Lisa.Landersgdot. og_v or (571) 434 -1592. Sincerely yours, - Kevin S. Rose Environmental Compliance Specialist Enclosures cc: Ms. Rachelle Powell, Croatan and Uwharrie National Forests, USDA Forest Service Mr. Cliff Northrop, National Forests in North Carolina, USDA Forest Service Mr. Lynn Hicks, National Forests in North Carolina, USDA Forest Service In of YJAll /J 105 IV 0 (A I Lf v - 7. Office Use Only: Corps action ID no. DWQ project no. Form Version 1 4 January 2009 Page 1 of 10 PCN Form — Version 1.4 January 2009 Pre - Construction fVotification (PCN) Form A. Applicant Information 1. Processing 1 a. Type(s) of approval sought from the Corps: ❑X Section 404 Permit ❑ Section 10 Permit 1 b. Specify Nationwide Permit (NWP) number: 14 or General Permit (GP) number: 1c. Has the NWP or GP number been verified by the Corps? ❑ Yes ❑X No 1 d. Type(s) of approval sought from the DWQ (check all that apply): ❑X 401 Water Quality Certification — Regular ❑ Non -404 Jurisdictional General Permit ❑ 401 Water Quality Certification — Express ❑X Riparian Buffer Authorization 1 e. Is this notification solely for the record because written approval is not required? For the record only for DWQ 401 Certification: ❑ Yes ❑X No For the record only for Corps Permit: ❑ Yes ❑X No 1f. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts? If so, attach the acceptance letter from mitigation bank or in -lieu fee program. ❑ Yes ❑X No 1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h below. ❑X Yes ❑ No 1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ❑ Yes ❑X No 2. Project Information 2a. Name of project: NC ERFO FSR 2011 -1 (1) 2b. County: Carteret, Craven, Jones 2c. Nearest municipality / town: Croatan National Forest - Swansboro, Newport, New Bern 2d. Subdivision name: n/a 2e. NCDOT only, T.I.P. or state project no: n/a 3. Owner Information 3a. Name(s) on Recorded Deed: USDA Forest Service 3b. Deed Book and Page No. n/a 3c. Responsible Party (for LLC if applicable): Kevin Rose, Federal Highway Administration 3d. Street address: .21400 Ridgetop Circle 3e. City, state, zip: Sterling, VA 20166 3f. Telephone no.: 571 -434 -1541 3g. Fax no.: 571 -434 -1577 3h. Email address: Kevin. Rose @dot.gov Page 1 of 10 PCN Form — Version 1.4 January 2009 T t� 4. Applicant Information (if different from owner) 4a. Applicant is: ❑ Agent ❑ Other, specify: 4b. Name: Kevin Rose 4c. Business name (if applicable): Federal Highway Administration 4d. Street address: 21400 Ridgetop Circle 4e. City, state, zip: Sterling, VA 20166 4f. Telephone no.: 571 -434 -1541 4g. Fax no.: 571 -434 -1577 4h. Email address: Kevin.Rose @dot.gov 5. Agent/Consultant Information (if applicable) 5a. Name: n/a 5b. Business name (if applicable): — - — 5c. Street address: 5d. City, state, zip: 5e. Telephone no.: 5f. Fax no.: 5g. Email address: Page 2of10 B. Project Information and Prior Project History 1. Property Identification 1a. Property identification no. (tax PIN or parcel ID): n/a 1 b. Site coordinates (in decimal degrees): Latitude: Longitude. 1 c. Property size: 2,250 acres 2. Surface Waters 2a. Name of nearest body of water to proposed project: White Oak River, Petlford Creek, Brice Creek 2b. Water Quality Classification of nearest receiving water: SA, NSW; SA, HQW; SC, SW, NSW 2c. River basin: White Oak, Neuse 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: The area surrounding project sites in within the Croatan National Forest and is undeveloped vegetated area. 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: 3d. Explain the purpose of the proposed project: The project will replace damaged culverts. 3e. Describe the overall project in detail, including the type of equipment to be used: The project includes the replacements of multiple culverts, and the repair of a bridge abutment. 4. Jurisdictional Determinations ' 4a. Have jurisdictional wetland or stream determinations by the Corps or State been requested or obtained for this property / fo•ect includin all riot hases In the aSt? ❑ Yes 0 No. ❑ Unknown Comments: The draft wetland delineation is attached. 4b. If the Corps made the jurisdictional determination, what type of determination was made? El Preliminary El Final 4c. If yes, who delineated the jurisdictional areas? Name (if known): Agency /Consultant Company: Aquaeter 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 0 No ❑ Unknown 5b. If yes, explain in detail according to "help file" instructions. 6. Future Project Plans 6a. Is this a phased project? ❑ Yes Q No 6b. If yes, explain. Page 3 of 10 PCN Form — Version 1.4 January 2009 C. Proposed Impacts Inventory Petiford Creek Road Milepost 0.394 1. Impacts Summary 1a. Which sections were completed below for your project (check all that apply): ❑X Wetlands X❑ 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 2d. Forested 2e. Type of jurisdiction Corps (404,10) or DWQ (401, other) 2f. Area of impact (acres) W1 T Diversion Berm Pocosin Yes Corps 0 016 W2 P Embankment Pocosin Yes Corps 0.010 W3 P Wingwall Pocosin Yes Corps 0.005 W4 Choose one Choose one Yes /No W5 Choose one Choose one Yes /No W6 Choose one Choose one Yes /No - 2g. Total Wetland Impacts: 0.031 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. Stream impact number Permanent (P) or Temporary (T) 3b. Type of impact 3c. Stream name 3d. Perennial (PER) or intermittent (INT)? 3e. Type of jurisdiction 3f. Average stream width (feet) 3g. Impact length (linear feet) S1 T Diversion Berm trib to Petiford Creek PER Corps 6 37.6 S2 P Excavation trib to Petiford Creek PER Corps 6 20 S3 P Culvert trib to Petiford Creek PER Corps 6 17 S4 Choose one S5 Choose one S6 Choose one 3h. Total stream and tributary impacts 746 3i. Comments: Page 4 of 10 PCN Form — Version 1.4 January 2009 4. Open Water Impacts If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of the U.S. then indivii ually list all o en 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) 01 - Choose one Choose 02 - Choose one Choose 03 - Choose one Choose 04 - Choose one Choose 4f. Total open water impacts 4g. Comments: _ 5. Pond or Lake Construction If pond or lake construction proposed, the 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) Flooded Filled Excavated Flooded Filled Excavated P1 Choose one P2 Choose one 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: 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 miti ation, then you MUST fill out Section D of this form. 6a. Project is in which protected basin? ❑ Neuse ❑ Tar - Pamlico ❑ Catawba ❑ Randleman ❑ Other: 6b. Buffer Impact number — Permanent (P) or Tempo ra 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 - Yes /No B2 - Yes /No B3 - Yes /No B4 - Yes /No B5 - Yes /No B6 - Yes /No 6h. Total Buffer Impacts: 6i. Comments: Page 5 of 10 C. Proposed Impacts Inventory Brown Road Milepost 0.100 1. Impacts Summary 1 a. Which sections were completed below for your project (check all that apply): ❑X Wetlands ❑X Streams — tributaries ❑X Buffers ❑X 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 2d. Forested 2e. Type of jurisdiction Corps (404,10) or DWQ (401, other) 2f. Area of impact (acres) W1 T Diversion Berm Pine Flat Yes Corps 0.011 W2 P Embankment Pine Flat Yes Corps 0.006 W3 P Wingwall Pine Flat Yes Corps 0.003 W4 P Road Embankment Pine Flat Yes Corps 0.002 W5 Choose one Choose one Yes /No W6 Choose one Choose one Yes /No 2g. Total Wetland Impacts: 0.022 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. Stream impact number Permanent (P) or Temporary (T) 3b. Type of impact 3c. Stream name 3d. Perennial (PER) or intermittent (INT)? 3e. Type of jurisdiction 3f. Average stream width (feet) 3g. Impact length (linear feet) S1 T Diversion Berm trib to E Prong Brice Cr PER Corps 6.5 29.8 S2 P Excavation trib to E Prong Brice Cr PER Corps 6.5 8.2 S3 P Culvert trib to E Prong Brice Cr PER Corps 6.5 2.76 S4 Choose one S5 Choose one S6 Choose one 3h. Total stream and tributary impacts 40.76 3i. Comments: Page 4 of 10 PCN Form —Version 1.4 January 2009 4. Open Water Impacts If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of the U.S. then indivii ually 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) 01 T n/a Diversion Berm Other 0 010 O2 P n/a Embankment Other 0.00009 03 P n/a Wingwall Other 0.0001 04 Choose one Choose 4f. Total open water impacts 0.01019 4g. Comments: 5. Pond or Lake Construction If pond or lake construction proposed, the 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) Flooded Filled Excavated Flooded Filled Excavated P1 Choose one P2 Choose one 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: 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 miticiation, then vou MUST fill out Section D of this form. 6a. Project is in which protected basin? ❑X Neuse ❑ Tar - Pamlico ❑ Catawba ❑ Randleman ❑ Other: 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 61 T Diversion Berm tributary to East Prong Brice Creek No 970 0 B2 P Embankment tributary to East Prong Brice Creek No 299 0 B3 P Wingwall tributary to East Prong Brice Creek No 140 0 B4 Yes /No B5 Yes /No B6 I Yes /No 6h. Total Buffer Impacts: 1409 0 6i. Comments: Page 5 of 10 C. Proposed Impacts Inventory Middle Little Road Milepost 3.517 1. Impacts Summary 1a. Which sections were completed below for your project (check all that apply): ❑ Wetlands ❑X Streams — tributaries, ❑X Buffers ❑X 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 2d. Forested 2e. Type of jurisdiction Corps (404,10) or DWQ (401, other) 2f. Area of impact (acres) W1 Choose one Choose one Yes /No W2 Choose one Choose one Yes /No W3 Choose one Choose one Yes /No W4 Choose one Choose one Yes /No - W5 Choose one Choose one Yes /No W6 Choose one Choose one Yes /No - 2g. Total Wetland 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. I 3a. Stream impact number Permanent (P) or Temporary (T) 3b. Type of impact 3c. Stream name 3d. Perennial (PER) or intermittent (INT)? 3e. Type of jurisdiction 3f. Average stream width (feet) 3g. Impact length (linear feet) S1 T Diversion Berm trib to Brice Creek PER Corps 8 37.1 S2 P. Culvert w/ Wingwalls trib to Brice Creek PER Corps 8 20.25 S3 Choose one - S4 Choose one S5 Choose one S6 Choose one 3h. Total stream and tributary impacts 57.35 3i. Comments: Page 4 of 10 PCN Form — Version 1.4 January 2009 4. Open Water Impacts If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of the U.S. then indivii ually 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) 01 T n/a Diversion Berm Other 0.010 02 P n/a Embankment Other 0.002 03 P n/a Wingwall Other 0.001 04 Choose one Choose 4f. Total open water impacts 0.013 4g. Comments: 5. Pond or Lake Construction If pond or lake construction proposed, the 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) Flooded Filled Excavated Flooded Filled Excavated P1 Choose one P2 Choose one 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: 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? ❑X Neuse ❑ Tar - Pamlico ❑ Catawba ❑ Randleman ❑ Other: 6b. Buffer Impact number — Permanent (P) or Temporary 6c. Reason for impact 6d. Stream name 6e. Buffer mitigation required? 6f. Zone 1 impact (square feet ) 6g.- Zone 2 impact (square feet 61 T Diversion Berm unnamed tributary to Brice Creek No 437 0 B2 P Culvert w/ Wingwalls unnamed tributary to Brice Creek No 117 0 B3 Yes /No B4 Yes /No B5 Yes /No B6 - Yes /No 6h. Total Buffer Impacts: 554 0 61. Comments: The road crossing impacts less than 40 linear feet of riparian buffer. Page 5 of 10 C. Proposed Impacts Inventory Black Swamp Road Milepost 4.076 1. Impacts Summary 1 a. Which sections were completed below for your project (check all that apply): ❑X Wetlands ❑X 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 2d. Forested 2e. Type of jurisdiction Corps (404,10) or DWQ (401, other) 2f. Area of impact (acres) W1 T Diversion Berm Pocosin No Corps 0.006 W2 P Wingwall Pocosin No Corps 0.001 W3 Choose one Choose one Yes /No W4 _ Choose one Choose one Yes /No W5 Choose one Choose one Yes /No W6 - Choose one Choose one Yes /No 2g. Total Wetland Impacts: 0.007, 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. Stream impact number Permanent (P) or . Temporary (T) 3b. Type of impact 3c. Stream name 3d. Perennial (PER) or intermittent (INT)? 3e. Type of jurisdiction 3f. Average stream width (feet) 3g. Impact length (linear feet) S1 T Diversion Berm trib to Holston Creek PER Corps 14 22.9 S2 P Excavation trib to Holston Creek PER Corps 14 7.2 S3 P Culvert trib to Holston Creek PER Corps 14 11.25 S4 - Choose one S5 Choose one S6 Choose one 3h. Total stream and tributary impacts 41.35 3i. Comments: Page 4 of 10 PCN Form —Version 1.4 January 2009 4. Open Water Impacts If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of the U.S. then indivii ually 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) 01 Choose one Choose O2 Choose one Choose 03 Choose one Choose 04 Choose one Choose 4f. Total open water impacts 4g. Comments: 5. Pond or Lake Construction If pond or lake construction proposed, the 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) Flooded Filled Excavated Flooded Filled Excavated P1 Choose one P2 Choose one 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: 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 miticaiation. then vou MUST fill out Section D of this form. 6a. Project is in which protected basin? ❑ Neuse ❑ Tar-Pamlico Catawba E] Randleman ❑ Other: 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 Yes /No B2 Yes /No B3 Yes /No B4 Yes /No B5 Yes /No B6 Yes /No 6h. Total Buffer Impacts: 6i. Comments: Page 5of10 C. Proposed Impacts Inventory Black Swamp Road Milepost 0.630 1. Impacts Summary 1a. Which sections were completed below for your project (check all that apply): ❑X Wetlands ❑X 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 2d. Forested 2e. Type of jurisdiction Corps (404,10) or DWQ (401, other) 2f. Area of impact (acres) W1 P Embankment Pocosin No Corps 0.006 W2 P Wingwall Pocosin No Corps 0.003 W3 T Diversion Berm Pocosin No Corps 0.024 W4 _ Choose one Choose one Yes /No - — W5 Choose one Choose one Yes /No - W6 Choose one Choose one Yes /No 2g. Total Wetland Impacts: 0.033 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. Stream impact number Permanent (P) or Temporary (T) 3b. Type of impact 3c. Stream name 3d. Perennial (PER) or intermittent (I NT)? 3e. Type of jurisdiction 3f. Average stream width (feet) 3g. Impact length (linear feet) S1 T Diversion Berm Black Swamp Creek PER Corps 17.5 46.9 S2 P Excavation Black Swamp Creek PER Corps 17.5 0 S3 P Culvert Black Swamp Creek PER Corps 17.5 17.5 S4 Choose one S5 Choose one S6 Choose one 3h. Total stream and tributary impacts 64.4 3i. Comments: Page 4 of 10 PCN Form — Version 1.4 January 2009 4. Open Water Impacts If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of the U.S. then indivii ually 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) 01 Choose one Choose 02 Choose one Choose 03 Choose one Choose 04 Choose one Choose 4f. Total open water impacts 4g. Comments: 5. Pond or Lake Construction If pond or lake construction proposed, the 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) Flooded Filled Excavated Flooded Filled Excavated P1 Choose one P2 Choose one 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: 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 miti ation, then you MUST fill out Section D of this form. 6a. Project is in which protected basin? ❑ Neuse ❑ Tar - Pamlico ❑ Catawba ❑ Randleman ❑ Other: 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 Yes /No B2 Yes /No B3 Yes /No B4 Yes /No B5 Yes /No B6 Yes /No 6h. Total Buffer Impacts: 6i. Comments: Page' 5 of 10 C. Proposed Impacts Inventory Millis Road Milepost 7.300 1. Impacts Summary 1a. Which sections were completed below for your project (check all that apply): ❑X 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 2d. Forested 2e. Type of jurisdiction Corps (404,10) or DWQ (401, other) 2f. Area of impact (acres) W1 T Diversion Berm Pocosin Yes Corps 0 048 W2 P Embankment Pocosin Yes Corps 0.011 W3 P Wingwall Pocosin Yes Corps 0.005 W4 Choose one Choose one Yes /No - W5 Choose one Choose one Yes /No Wg Choose one Choose one Yes /No . - 2g. Total Wetland Impacts: 0.064 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. Stream impact number Permanent (P) or Temporary (T) 3b. Type of impact 3c. Stream name 3d. Perennial (PER) or intermittent (INT)? 3e. Type of jurisdiction 3f. Average stream width (feet) 3g. Impact length (linear feet) S1 T Diversion Berm trib to Petiford Creek PER Corps 11 19.4 S2 P Excavation trib to Petiford Creek PER Corps 11 20.4 S3 P Culvert trib to Petiford Creek PER Corps 11 0.75 S4 Choose one S5 Choose one S6 Choose one 3h. Total stream and tributary impacts 40.55 3i. Comments: Page 4 of 10 , PCN Form — Version 1.4 January 2009 4. Open Water Impacts If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of the U.S. then indivii ually 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 Choose one - Choose O2 - Choose one Choose 03 Choose one Choose 04 Choose one Choose 4f. Total open water impacts 4g. Comments: 5. Pond or Lake Construction If pond or lake construction proposed, the 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) Flooded Filled Excavated Flooded Filled Excavated P1 Choose one P2 Choose one 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: 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 miti ation, then vou MUST fill out Section D of this form. 6a. Project is in which protected basin? ❑ Neuse ❑ Tar - Pamlico ❑ Catawba ❑ Randleman ❑ Other: 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 Yes /No B2 Yes /No 63 Yes /No 134 Yes /No B5 Yes /No 136 Yes /No 6h. Total Buffer Impacts: 6i. Comments: Page 5 of 10 C. Proposed Impacts Inventory Middle Little Road Milepost 3.953 (Ephemeral) , 1. Impacts Summary 1 a. Which sections were completed below for your project (check all that apply): ❑X Wetlands X❑ 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 2d. Forested 2e. Type of jurisdiction Corps (404,10) or DWQ (401, other) 2f. Area of impact (acres) W1 T Diversion Berm Pine Flat Yes Corps 0.010 W2 P Wingwall Pine Flat Yes Corps 0.001 W3 Choose one Choose one Yes /No W4 Choose one Choose one Yes /No W5 - Choose one Choose one Yes /No W6 Choose one Choose one Yes /No 2g. Total Wetland Impacts: 0.006 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. Stream impact number Permanent (P) or Temporary (T) 3b. Type of impact 3c. Stream name 3d. Perennial (PER) or intermittent (INT)? 3e. Type of jurisdiction 3f. Average stream width (feet) 3g. Impact length (linear feet) S1 T Diversion Berm trib to Brice Creek PER Corps 14 162 S2 P Excavation trib to Brice Creek PER Corps 14 4 S3 P Culvert trib to Brice Creek PER Corps 14 -55 S4 Choose one S5 Choose one S6 Choose one 3h. Total stream and tributary impacts 14.7 3i. Comments: Page 4 of 10 PCN Form — Version 1.4 January 2009 4. Open Water Impacts If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of the U.S. then indivii ually 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) ' 01 Choose one Choose 02 Choose one Choose 03 Choose one Choose 04 Choose one Choose 4f. Total open water impacts 4g. Comments: 5. Pond or Lake Construction If pond or lake construction' ro osed, the 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) Flooded Filled Excavated Flooded Filled Excavated P1 Choose one P2 Choose one 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: 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 miti ation, then you MUST fill out Section D of this form. 6a. Project is in which protected basin? ❑ Neuse ❑ Tar - Pamlico ❑ Catawba ❑ Randleman ❑ Other: 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 Yes /No B2 Yes /No B3 Yes /No B4 Yes /No B5 Yes /No B6 I Yes /No 6h. Total Buffer Impacts: 6i. Comments: Page 5 of 10 D. Impact Justification and Mitigation 1. Avoidance and Minimization 1a: Specifically describe measures taken to avoid or minimize the proposed impacts in designing project. Culverts will be replaced in same location as the existing culvert, and were sized for the same hydraulic capacity after accommodating sinking them a foot below the substrate level per NCDWQ 1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques. Sedimentation of adjacent wetlands will be minimized through the use of silt fence. The area to be dewatered for construction was minimized 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 ❑X No 2b. 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 El Payment to in -lieu fee program ❑ Permittee Responsible Mitigation 3. Complete if Using a Mitigation Bank 3a. Name of Mitigation Bank: 3b. Credits Purchased (attach receipt and letter) Type: Choose one Type: Choose one Type: Choose one Quantity: Quantity: Quantity: 3c. Comments: 4. Complete if Making a Payment to In -lieu Fee Program 4a. Approval letter from in -lieu fee program is attached. ❑ Yes 4b. Stream mitigation requested: linear feet 4c. If using stream mitigation, stream temperature: Choose one 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. Page 6 of 10 PCN Form —Version 1.4 January 2009 6. Buffer Mitigation (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? E] Yes ❑X 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 required, 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 7 of 10 E. Stormwater 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 ❑ Yes ❑X No within one of the NC Riparian Buffer Protection Rules? 1 b. If yes, then is a diffuse flow plan included? If no, explain why. ❑ Yes ❑ No 2. Stormwater Management Plan 2a. What is the overall percent imperviousness of this project? 2b. Does this project require a Stormwater Management Plan? ❑ Yes ❑X No 2c. If this project DOES NOT require a Stormwater Management Plan, explain why: The project will replace existing culverts and the total ground disturbance is approximately 0.26 acres. No new impervious area will be created by this project. 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 Management Plan? DWQ 3. Certified Local Government Stormwater Review 3a. In which local government's jurisdiction is this project? n/a ❑ Phase ►1 ❑ NSW 3b. Which of the following locally - implemented stormwater management programs El USMP apply (check all that apply): ❑ Water Supply Watershed ❑ Other: 3c. Has the approved Stormwater Management Plan with proof of approval been ❑ Yes ❑X No attached? 4. DWQ Stormwater Program Review E]Coastal counties ❑HQW 4a. Which of the following state - implemented stormwater management programs apply ❑ORW (check all that apply): ❑Session Law 2006 -246 ❑Other: 4b. Has the approved Stormwater Management Plan with proof of approval been ❑ Yes ❑X No attached? 6. 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 8 of 10 PCN Form — Version 1.4 January 2009 F. Supplementary Information 1. Environmental Documentation (DWQ Requirement) 1a. Does the project involve an expenditure of public (federal /state /local) funds or the ❑x Yes ❑ No use of public (federal /state) land? 1 b. 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 ❑X Yes ❑ No (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 ❑X Yes ❑ No letter.) Categorical Exclusion is attached. Comments: 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, ❑Yes ❑X No or Riparian Buffer Rules (15A NCAC 2B.0200)? 2b. Is this an after - the -fact permit application? El Yes ❑X No 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) result in El Yes ❑X No additional development, which could impact nearby downstream water quality? 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 generated from the proposed project, or available capacity of the subject facility. n/a Page 9 of 10 PCN Form — Version 1.4 January 2009 5. Endangered Species and Designated Critical Habitat (Corps Requirement) 5a. Will this project occur in or near an area with federally protected species or ❑x Yes ❑ No habitat? 5b. Have you checked with the USFWS concerning Endangered Species Act 0 Yes ❑ No impacts? 5c. If yes, indicate the USFWS Field Office you have contacted. Raleigh 5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat? Coordination with the Wildlife Biologist at the Croatan National Forest and the USFWS. 6. Essential Fish Habitat (Corps Requirement) 6a. Will this project occur in or near an area designated as essential fish habitat? ❑ Yes ❑X No 6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat? 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 ❑ Yes ❑X No 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? Coordination with the State Historic Preservation Office. 8. Flood Zone Designation (Corps Requirement) 8a. Will this project occur in a FEMA- designated 100 -year floodplain? ❑ Yes ❑ No 8b. If yes, explain how project meets FEMA requirements: The project replaces existing infrastructure and improves the hydrologic connectivity 8c. What source(s) did you use to make the floodplain determination? Kevin S. Rose A 11 -08 -2013 Applicant /Agent's Printed Name Date pri-cant4VMV's Si nature (Agent's signature d4alid only if an authorization letter from the applicant is provided.) Page 10 of 10 0 07- Na^2013 0149 PM *TINE* M,\PI W£GTSLFS\NC\=I- fIAP- I- DBV\CAODW -NC 2011-911J/lapn t z Z � 3 N O a O 0 n N n v w 61 D w v► N ul Zx D m M m 03 r rn � m T ' m m rn -1 c m r N O o A m' W Z D „ D .. (D o 5 X w m Q< O o v v D D O_q o O Cpf =� d ®® p W D n o m D 3 a� 0 m 2 < 0 -I v Z m D x O D D m < 0) 0 o0 c v �� a CL d CL z a? 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