20221086 Ver 1_Pre-Construction Notification (PCN) Form-DWR_20220506

Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
April 13, 2022 Ver 4.3
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
A. Processing Information
Pre -Filing Meeting Date Request was submitted on: *
I met with Emily Thompson and Chris Pullinger at the property on 25 Jan 2022.
If this is a courtesy copy, please fill in this with the submission date.
County (or Counties) where the project is located: *
Pamlico
Is this a NCDMS Project*
0Yes ONo
Click Yes, only if NCDMS is the applicant or co -applicant.
Is this project a public transportation project?*
0Yes ®No
This is any publicly funded by municipal,state or federal funds road, rail, airport transportation project.
la. Type(s) of approval sought from the Corps: *
O✓ Section 404 Permit (wetlands, streams and waters, Clean Water Act)
O Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
Has this PCN previously been submitted?*
0 Yes
J No
1b. What type(s) of permit(s) do you wish to seek authorization?*
Nationwide Permit (NWP)
[I Regional General Permit (RGP)
O Standard (IP)
lc. Has the NWP or GP number been verified by the Corps?*
OYes ONo
Nationwide Permit (NWP) Number:
Nationwide Permit (NWP) Number:
Nationwide Permit (NWP) Number:
NWP Numbers (for multiple NWPS):
List all NW numbers you are applying for not on the drop down list.
Id. Type(s) of approval sought from the DWR: *
check all that apply
O 401 Water Quality Certification - Regular
0 Non-404 Jurisdictional General Permit
O Individual 401 Water Quality Certification
14 - Linear transportation
57 - Electric Utility Line and Telecommunications Activities — (frequently used)
58 - Utility Line Activities for Water and Other Substances (frequently used)
le. Is this notification solely for the record because written approval is not required?
O 401 Water Quality Certification - Express
0 Riparian Buffer Authorization
For the record only for DWR 401 Certification:
For the record only for Corps Permit:
OYes 0No
OYes 0No

lf. Is this an after -the -fact permit application?*
O Yes O No
lg. 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.
O Yes O No
Acceptance Letter Attachment
Click the upload button or drag and drop files here to attach document
FILE TYPE MUST BE PDF
lh. Is the project located in any of NC's twenty coastal counties?*
O Yes O No
li. Is the project located within a NC DCM Area of Environmental Concern (AEC)?*
0 Yes
O No 0 Unknown
1j. Is the project located in a designated trout watershed?*
0Yes ®No
Link to trout information: http://www.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Agency-Coordination/Trout.aspx
B. Applicant Information
la. Who is the Primary Contact?*
Chet Ratcliffe
lb. Primary Contact Email:*
[e-mail]
Id. Who is applying for the permit?*
fi Owner
(Check all that apply)
le. Is there an Agent/Consultant for this project?*
0 Yes ® No
2. Owner Information
2a. Name(s) on recorded deed: *
Chester Ratcliffe and Diane McMahon
2b. Deed book and page no.:
BK 696 PG 409-412
2c. Contact Person:
(for Corporations)
2d. Address*
Street Address
2748 Brown Creek Rd
Address Line 2
City
Merritt
Postal / Zip Code
28556
2e. Telephone Number: *
(xxx)xxx-xxxx
[phone]
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1c. Primary Contact Phone:*
(xxx)xxx-xxxx
[phone]
O Applicant (other than owner)
State / Province / Region
NC
Country
USA
1. Project Information
1a. Name of project: *
RV Driveway

lb. Subdivision name:
(if appropriate)
Whorton Harbor
lc. Nearest municipality / town: *
Merritt
2. Project Identification
2a. Property Identification Number: 2b. Property size:
(tax PIN or parcel ID) (in acres)
1K07-24-12 2.1
2c. Project Address
Street Address
2748 Brown Creek Rd
Address Line 2
City
Merritt
Postal / Zip Code
28556
State / Province / Region
NC
Country
USA
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: *
35.1104564 -76.6363207
ex: 34.208504-77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project: *
Brown Creek
3b. Water Resources Classification of nearest receiving water: *
SA;HQW,NSW
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Neuse
3d. Please provide the 12-digit HUC in which the project is located.*
03020204
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: *
Area to be filled in is at the end of a wetland/lowland area that takes on a few inches of water when it rains. It is next to and drains into a marshy area on the next lot over and might be an
avenue for run-off water from the ditches along the access road. It is dry for the most part when it does not rain for a few weeks. It was delineated by Emily Thompson from USACE in
January of 2022. Kent Vaughan from DCM also looked at it and said "DCM does not have a play in it" and that I should deal with USACE and DWR.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
0 Yes O No 0 Unknown
4f. List the total estimated acreage of all existing wetlands on the property:
08 acre
4g. List the total estimated linear feet of all existing streams on the property:
(intermittent and perennial)
0
4h. Explain the purpose of the proposed project: *
To provide a driveway with access to the property on the other side of a small lowland (wetland) area where I can park my RV.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used: *
Small Subdivision. The wetland/lowland area is a narrow strip sitting 10-20 foot from a drainage ditch and access road and runs parallel to it in a North/South direction on the lot. Project
will include putting in a 20' or 30' culvert running North/South within the wetland/lowland area in the approximate center of the lot to allow any water to flow to either side of the lot and an
identical culvert parallel to the other culvert, running North/South and within the ditch next to the access road. Clean fill sand, dirt and rock will be used to cover both culverts. The RV
driveway will be approximately 15'-20' wide and run back over non -wetland area approximately 100 foot. In addition, the plan will include cutting a 1 foot ditch across the access road
approximately 2-3 foot deep to run 3 utility/water lines (One 3-4-inch conduit for electric, One 4 inch metal pipe for future use if ever needed for a 2 inch sanitation line running back to a
mounded repair area 200 foot from any wetland area, and a 1.5 inch water line from the main county water line running along brown creek road.). All 3 lines will run under the road and
under both culverts, then across the wetland/lowland area right next to and along the RV driveway.

5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
U Yes
Comments:
No 0 Unknown
this was accomplished by Emily Thomson from USACE. Chris Pullinger from DWR also came out for the pre -filing meeting (25 Jan 2022)
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
O Preliminary 0 Approved 0 Not Verified 0 Unknown 0 N/A
Corps AID Number:
Example: SAW-2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
Emily Thompson
USACE
5d. List the dates of the Corp jurisdiction determination or State determination if a determination was made by the Corps or DWR.
25 January 2022
6. Future Project Plans
6a. Is this a phased project?*
O 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.
D. Proposed Impacts Inventory
1. Impacts Summary
la. Where are the impacts associated with your project? (check all that apply):
Wetlands O Streams -tributaries
O Open Waters O Pond Construction
0 Buffers
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 #* (9)
2a1 Reason* (?)
2b. Impact type* (9)
2c. Type of W.*
2d. W. name*
2e. Forested*
2f. Type of Jurisdicition*
(?)
2g. Impact
area*
W1
Culvert/Fill
P
Unknown
lowland
Yes
Both
0.010
(acres)
2g. Total Temporary Wetland Impact
0.000
2g. Total Permanent Wetland Impact
0.010
2g. Total Wetland Impact
0.010
2i. Comments:
E. Impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project: *
A culvert will be placed in the wetland area to allow drainage to either side of the driveway. The 2 foot deep and 1 foot wide ditch will run across the
wetland/lowland on either side of the driveway and will be filled back in with the same wetland/lowland dirt that was taken out of the ditch originally.
Ramps for heavy equipment will be placed over the wetland/lowland if needed to minimize disturbance of the area.

lb. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques: *
Clean fill dirt, sand and rock will be used to cover the culvert. Any wetland/lowland dirt dug up will be replaced in the same area. Ramps for heavy
equipment will be placed over the wetland/lowland area if needed to minimize disturbance of the area.
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?
0 Yes • No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
Very minimal if any impact to wetlands. Very small area being filled in for RV driveway for access to back half of property
NC Stream Temperature Classification Maps can be found under the Mitigation Concepts tab on the Wilmington District's RIBITS website.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
*** Recent changes to the stormwater rules have required updates to this section .***
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?
0 Yes * No
For a list of options to meet the diffuse flow requirements, click here.
If no, explain why:
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)7 *
GYes 0No
To look up low density requirement click here 15A NCAC 02H .1003(2).
Comments:
Link would not load. I do not understand the difference between high and low density. This project should have very little if any impact.
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 O 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)?*
O Yes O No
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?*
O Yes J No
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?*
0Yes 0No®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?*
OYes i•;No

5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
O Yes O No
5d. Is another Federal agency involved?*
0 Yes
5e. Is this a DOT project located within Division's 1-8?*
0 Yes ® No
0• No O Unknown
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?*
OYes 0No
5g. Does this project involve bridge maintenance or removal?*
0 Yes ® No
Link to the NLEB SLOPES document: http://saw-reg.usace.army.mil/NLEB/1-30-17-signed_NLEB-SLOPES&apps.pdf
5h. Does this project involve the construction/installation of a wind turbine(s)?**
0 Yes ® 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.?*
OYes 0No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat? *
https://www.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Agency-Coordination/ESA/
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
O Yes O No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
https://www.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Agency-Coordination/ESA/
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data: httpJ[gis.ncdcr.ga,thpoweb
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)?*
0 Yes No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
http://www.hpo.dcrstate.nc.us/
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?*
C) Yes 0 No
8b. If yes, explain how project meets FEMA requirements:
Zone AE(Elevation 5). Project will install culverts and clean fill sand, dirt, rock at ground level
8c. What source(s) did you use to make the floodplain determination?*
https://msc.fema.gov/portal/search#searchresultsanchor
Miscellaneous
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.
Click the upload button or drag and drop files here to attach document
File must be PDF or KMZ
Signature
LA 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:*
Chester Ratcliffe
Signature *
Date
5/6/2022