20220086 Ver 1_ePCN Application_20220114

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Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
December 6, 2021 Ver 4.2
Initial Review
Has this project met the requirements for acceptance in to the review process?*
Yes
No
Is this project a public transportation project?*
Yes No
Change only if needed.
BIMS # Assigned*
20220086
Is a payment required for this project?
No payment required
Fee received
Fee needed - send electronic notification
Select Project Reviewer*
Robert Tankard:eads\rbtankard
Information for Initial Review
1a. Name of project:
COURTESY COPY Grabtown Telecommunications Tower
la. Who is the Primary Contact?*
Robert Turnbull
1 b. Primary Contact Email: *
[e-mail]
Date Submitted
1/14/2022
Nearest Body of Water
Roanoke River
Basin
Roanoke
Water Classification
WS-Iv
Site Coordinates
Latitude:
35.92405
A. Processing Information
County (or Counties) where the project is located:
Bertie
Is this a NCDMS Project
Yes No
Longitude:
-78.00580
Is this project a public transportation project?*
Yes No
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)
Version# *
1
Reviewing Office*
Washington Regional Office - [phone]
1c. Primary Contact Phone:*
[phone]
u

Has this PCN previously been submitted?"
Yes
No
1 b. What type(s) of permit(s) do you wish to seek authorization?
Nationwide Permit (NWP)
Regional General Permit (RGP)
Standard (IP)
1c. Has the NWP or GP number been verified by the Corps?
Yes No
Nationwide Permit (NWP) Number:
NWP Numbers (for multiple NWPS):
1d. Type(s) of approval sought from the DWR:
401 Water Quality Certification - Regular
Non-404 Jurisdictional General Permit
Individual 401 Water Quality Certification
39 - Commercial/Institutional Developments
le. 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:
401 Water Quality Certification - Express
Riparian Buffer Authorization
1f. Is this an after -the -fact permit application?*
Yes No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
Yes 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 i. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
Yes No Unknown
1j. Is the project located in a designated trout watershed?
Yes No
B. Applicant Information
1d. Who is applying for the permit?
Owner Applicant (other than owner)
le. Is there an Agent/Consultant for this project?"
Yes No
2. Owner Information
2a. Nani on recorded deed:
Brad Ward
2b. Deed book and page no.:
2c. Contact Person:
2d.Address
Street Address
603 US 13/17
Address Line 2
City
State / Province / Region
Windsor
NC
Postal / Zip Code
Country
27983
USA
2e. Telephone Number:
2f. Fax Number:
[phone]
Yes No
Yes No

2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
3a. Name:
Franz Miller
3b. Business Name:
Verizon Wireless
3c.Address
Street Address
8921 Research Drive
Address Line 2
City
State / Province / Region
Charlotte
NC
Postal / Zip Code
Country
28262
USA
3d. Telephone Number:
3e. Fax Number:
[phone]
3f. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Robert Turnbull
4b. Business Name:
Terracon Consultants, Inc.
4c. Address
Street Address
2401 Brentwood Road
Address Line 2
Suite 107
City
State / Province / Region
Raleigh
NC
Postal / Zip Code
Country
27615
USA
4d. Telephone Number:
4e. Fax Number:
[phone]
4f. Email Address:
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality / town:
Windsor
2. Project Identification
2a. Property Identification Number:
2b. Property size:
5799-08-3909
0.230
2c. Project Address
Street Address
1228 US Highway 13/17
Address Line 2
City
State / Province / Region
Windsor
NC
Postal / Zip Code
Country
27983
USA

3. Surface Waters
3a. Name of the nearest body of water to proposed project:"
Roanoke River
3b. Water Resources Classification of nearest receiving water:"
WS-IV
3c. What river basin(s) is your project located in?*
Roanoke
3d. Please provide the 12-digit HUC in which the project is located.
030101070509
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:*
Existing conditions on the property consist primarily of mixed pine/hardwood forest and maintained roadside area along US Highway 13/17. The project vicinity consists primarily of
undeveloped forest, rural residential areas, agricultural areas in southern Bertie County, south of Windsor.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
Yes No Unknown
4f. List the total estimated acreage of all existing wetlands on the property:
0
4g. List the total estimated linear feet of all existing streams on the property:
0
4h. Explain the purpose of the proposed project: *
The purpose of the proposed project is to construct a telecommunications tower with an access road/utility easement extending from US Highway 13/17 to the tower compound.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used: *
A telecommunications tower and access road will be constructed within a leased easement and tower compound area within the parcel. The tower compound will be constructed entirely
on uplands. The access road construction will place a 24" RCP culvert in the jurisdictional ditch. Excavators and clearing equipment will be used. Equipment will be stored in upland areas.
See attached construction drawings.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
Yes No Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
Preliminary Approved Not Verified Unknown N/A
Corps AID Number:
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Robert Turnbull
Agency/Consultant Company: Terracon Consultants, Inc.
Other:
5d. List the dates of the Corp jurisdiction determination or State determination if a determination was made by the Corps or DWR
On -site review by USACE (Anthony Scarbraugh) on 12/16/2021.
6. Future Project Plans
6a. Is this a phased project?*
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?
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
4. Open Water Impacts
U

4a. Site #
Fall. Impact Reason
4b. Impact type
4c. Name of waterbody
_11
4d. Activity type :114e.
Waterbody type
4f. Impact area
Culvert
P
UT to Roanoke River
Culverts
Ditch
0.0t
4g. Total temporary open water Impacts:
0.00
4g. Total open water impacts:
0.01
4h. Comments:
E. Impact Justification and Mitigation
1. Avoidance and Minimization
4g. Total permanent open water impacts:
0.01
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
The access road crosses the ditch as close to perpendicular as possible while staying within the leased access easement. The tower compound was
sited to avoid impacts to other potential jurisdictional features within the parent parcel.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
All applicable erosion and sediment control measures will be put in place and maintained according to current regulations. Cleared areas will be
immediately re -vegetated as required. Spoil material will be placed in upland areas and any excess material will be removed from the site.
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
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
No permanent impacts to wetlands or streams are proposed.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
la. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
Yes No
If no, explain why:
Project is located in the Roanoke River Basin.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?"
Yes No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?
Yes No
2c. Does this project have a stormwater management plan (SMP) reviewed and approved under a state stormwater program or state -approved local government stormwater program?
Yes No
N/A - project disturbs < 1 acre
3. Stormwater Requirements
3a. Select whether a completed stormwater management plan (SMP) is included for review and approval or if calculations are provided to document the project will not cause degradation of
downstream surface waters.*
Stormwater Management Plan Antidegradation Calculations
Comments:
G. Supplementary Information
1. Environmental Documentation
la. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
Yes No
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
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality?*
Yes No
3b. If you answered "no," provide a short narrative description.
The proposed telecommunications tower will not result in any downstream impacts or growth -stimulating effects. The existing use of the Roanoke River
(WS-IV) should not change as a result of this project.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
Yes No N/A
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?
Yes No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
Yes No
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. Is another Federal agency involved?*
Yes No Unknown
5e. Is this a DOT project located within Division's 1-8?
Yes No
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?
Yes No
5g. Does this project involve bridge maintenance or removal?
Yes No
5h. Does this project involve the construction/installation of a wind turbine(s)?*
Yes No
51. 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.?
Yes No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
Onsite evaluation by Terracon staff, USFWS Ipac Review, NC Natural Heritage Program Data.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?
Yes No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?
https://www.habitat.noaa.gov/protection/efh/efhmapper
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
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
Online SHPO GIS mapping
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
Yes No
8c. What source(s) did you use to make the floodplain determination?
https://msc.fema.gov/portal/search
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
Grabtown Telecommunications Tower PCN Attachments.pdf 6.42MB
File must be PDF or KMZ
Comments
Signature
By checking the box and signing below, I certify that:
• 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:
Robert Turnbull
Signature
Date
1/14/2022