20211607 Ver 1_Application Returned Email with Attachments_20211117

Carpenter,Kristi
From:Carpenter,Kristi
Sent:Wednesday, November 17, 2021 4:55 PM
To:[e-mail]; [e-mail]; Conchilla, Ryan
Subject:Application Rejection - TPB NCDOT - Improvements to Future I-73/U.S. 220 (I-5898)
DWR 20211607 Version 1
Attachments:TPB NCDOT - Improvements to Future I-73 U.S. 220 (I-5898) Incomplete
Application.pdf
All,
This email is coming to you as a listed email on a severely incomplete application for the subject project.
The application received was so incomplete that it cannot be accepted into our system. I have attached a PDF of the
incomplete application that shows each required section that was left unfilled.
In order for us to review this project you will need to complete all required fields in the application and resubmit.
Project is currently not under review.
Please feel free to contact me with any questions or concerns on the administrative process of submitting the project
application.
Thanks,
Kristi Lynn

Kristi Lynn Carpenter
Administrative Assistant
401 & Buffer Transportation Permitting Branch
Department of Environmental Quality
Division of Water Resources

919.707.3872 office
[e-mail]

th
512 N Salisbury Street, 12 Floor
1617 Mail Service Center
Raleigh, NC 27699-1617

Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
Based on the current guidance to minimize the spread of COVID-19, the Department of Environmental Quality has
adjusted operations to protect the health and safety of the staff and public. Many employees are working remotely or
are on staggered shifts. To accommodate these staffing changes, all DEQ office locations are limiting public access to
appointments only. Please check with the appropriate staff before visiting our offices, as we may be able to handle your
requests by phone or email. We appreciate your patience as we continue to serve the public during this challenging
time.

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Dlalslon of Water Resources
Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
June 1, 2021 Ver 4.1
Initial Review
Has this project met the requirements for acceptance in to the review process?*
QQ Yes
Q No
Is this project a public transportation project?*
QQ Yes 0 No
Change only if needed.
BIMS#Assigned* Version#*
20211607 1
I
Is a payment required for this project?*
o No payment required What amout is owed?*
o Fee received 0 $240.00
QQ Fee needed -send electronic notification 0 $570.00
Reviewing Office* Select Project Reviewer*
Central Office - (919) 7( \/ Ryan Conchilla:eads\rjconchilla
Information for Initial Review
1a. Name of project:
Proposed Improvements to Future I-73/U.S. 220 at the, U.S. 311 and /N.C. 135 Interchange an(
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1a. Who is the Primary Contact?*
NCDOT
1 b. Primary Contact Email:* lc. Primary Contact Phone:*
[e-mail] [phone]
Date Submitted
11/12/2021
Nearest Body of Water
UT Dan River
Basin
Roanoke
Water Classification
Ws-Iv
Site Coordinates
Latitude: Longitude:
36.416767 R9.938086
A. Processing Information
County (or Counties) where the project is located:
Rockingham
Add another county
Is this a NCDMS Project
O Yes O� No
Is this project a public transportation project?*
® Yes 0 No
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Is this a NCDOT Project?*
QQ Yes 0 No
(NCDOT only) T.I.P. or state project number:
1-5898
WBS #(?)
46860.1.1
Pre-Filing Meeting Information
Is this a courtesy copy notification?*
0 Yes ONo
ID# Version
20211607 1
Pre-fling Meeting or Request Date
11/3/2021
Attach documentation of Pre-Filing Meeting Request here:
Click the upload button or drag and drop files here to attach document
Upload
DWR Pre-Filing Meeting Request Form.pdf 116.65KB X
File type must be PDF
1a. Type(s) of approval sought from the Corps:
Section 404 Permit (wetlands, streams and waters, Clean Water Act)
Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
Has this PCN previously been submitted?*
0 Yes
QQ No
lb. What type(s) of permit(s) do you wish to seek authorization?
Nationwide Permit (NWP)
Regional General Permit (RGP)
Standard (IP)
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1c. Has the NWP or GP number been verified by the Corps?
Yes No
Nationwide Permit (NWP) Number: 14 - Linear transportation
Add additional NWP
NWP Numbers (for multiple NWPS):
Id. Type(s) of approval sought from the DWR:
401 Water Quality Certification - Regular 401 Water Quality Certification - Express
Non-404 Jurisdictional General Permit Riparian Buffer Authorization
Individual 401 Water Quality Certification
le. Is this notification solely for the record because written approval is *
not required?
For the record only for DWR 401 Certification: 0 Yes OQ No
For the record only for Corps Permit: 0 Yes 0 No
If. Is this an after-the-fact permit application?*
0 Yes QQ No
1g. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
O Yes 0 No
1g. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
Yes No
1 h. Is the project located in any of NC's twenty coastal counties?
Yes No
1 j. Is the project located in a designated trout watershed?
Yes No
B. Applicant Information
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Id. Who is applying for the permit?
Owner Q Applicant (other than owner)
le. Is there an Agent/Consultant for this project?*
0 Yes 0 No
2. Owner Information
2a. Name(s) on recorded deed:
NCDOT
2b. Deed book and page no.:
2c. Contact Person:
r
2d. Address
Street Address
Address Line 2
City State/Province/Region
Postal/Zip Code Country
2e. Telephone Number: 2f. Fax Number:
L
2g. Email Address:*
[[e-mail]
Add another owner
3. Applicant Information (if different from owner)
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3a. Name:
NCCDOT
3b. Business Name:
r
3c. Address
Street Address
Address Line 2
City State/Province/Region
Postal/Zip Code Country
3d. Telephone Number: 3e. Fax Number:
C L
3f. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Ray Bode
4b. Business Name:
JMT
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4c. Address
Street Address
1130 Situs Court
Address Line 2
Suite 200
City State/Province/Region
Raleigh NC
Postal/Zip Code Country
27606 USA
4d. Telephone Number: 4e. Fax Number:
ft984)269-4923
4f. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1 . Project Information
lb. Subdivision name:
(if appropriate)
1 c. Nearest municipality/town:
Mayodan
2. Project Identification
2a. Property Identification Number: 2b. Property size:
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2c. Project Address
Street Address
Address Line 2
City State/Province/Region
Postal/Zip Code Country
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
[UT Dan River
3b. Water Resources Classification of nearest receiving water:*
WS-Iv 1
3c. What river basin(s) is your project located in?*
Roanoke
Add another river basin
3d. Please provide the 12-digit HUC in which the project is located.
030101030503
4. Project Description and History
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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:*
The project is to improve future I-73/U.S. 220 at the U.S. 311 and N.C. 135 interchange and
replace bridge No. 780074 in Rockingham County (STIP No. I-5898). The bridge is over US
220.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the
past?*
O Yes 0 No ® Unknown
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:*
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4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
n
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
• Yes • No n Unknown
Value is required.
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
• Preliminary • Approved 0 Not Verified Unknown 0 N/A
Value is required.
Corps AID Number:
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant
Company:
Other:
6. Future Project Plans
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6a. Is this a phased project?*
r_JIYes ® No
Value is required.
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?
D. Proposed Impacts Inventory
1 . Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
Wetlands Streams-tributaries Buffers
Open Waters Pond Construction
E. Impact Justification and Mitigation
1 . Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
1 b. 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
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2a. Does the project require Compensatory Mitigation for impacts to Waters of the U.S. or Waters of the State?
Yes No
F. Stormwater Management and Diffuse Flow Plan (required
by DWR)
1 . Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC
Riparian Buffer Protection Rules?
Yes No
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
Yes No
Value is required.
Comments:
G. Supplementary Information
1 . Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public
(federal/state) land?*
• Yes ® No
Value is required.
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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)?*
• Yes No
Value is required.
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality?*
• Yes • No
Value is required.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
C Yes • No N/A
Value is required.
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?*
11 Yes No
Value is required.
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
® Yes No
Value is required.
5d. Is another Federal agency involved?*
• Yes No C Unknown
Value is required.
5e. Is this a DOT project located within Division's 1-8?
Yes 0No
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5f. Will you cut any trees in order to conduct the work in waters of the U.S.?
O Yes 0 No
5g. Does this project involve bridge maintenance or removal?
O Yes 0 No
5h. Does this project involve the construction/installation of a wind turbine(s)?*
O Yes 0 No
5i. Does this project involve (1) blasting, and/or(2) other percussive activities that will be conducted by
machines, such as jackhammers, mechanized pile drivers, etc.?
O Yes 0No
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?*
• Yes rNo
Value is required.
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
Value is required.
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal governments have designated as
having historic or cultural preservation status?*
® Yes • No
Value is required.
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7b. What data sources did you use to determine whether your site would impact historic or archeological
resources?*
Value is required.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
31 Yes alE No
Value is required.
8c. What source(s) did you use to make the floodplain determination?*
Value is required.
Miscellaneous
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.
Click the upload button or drag and drop files here to attach document
Upload
File must be PDF or KMZ
Comments
Signature
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® By checking the box and signing below, I certify that:
Value is required.
• 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:
Ray Bode
Signature
Sign
Date
11/12/2021
Comments
Application not complete - Cannot process without required fields being populated.
Accept Reject
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