20150160 Ver 2_Application_20150921

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(]ffice Use {?nfy:
Carps acti�n I� na.
DWQ proxect nv.
Form Version 1.4 January 2{l{l9
Pre-Corrstruction [�otificatic�n �PCNj Fvrm
A. Appli�an# Infarma#ian
1. f�rocessing
1 a. Type{s) of apprc�vaf saught from the Car�as: � SeetEan 4D4 Permit ❑ Sectinn 10 Permik
1 b. Spec"sfy+ Natianwide Permit �NWP] number: 14 or General Permit (GPj num�er:
ic. Has the NWP ar GP number been ver�fied by the Carps? � Yes ❑ Na
1 d. iype(sJ af approval soug�t from the DWQ (check aIl that apply):
❑x 4(}1 Water C�uaZity C�rtificatian — Regular ❑ Non-4�4 Jurisdictivnal Ger�eral Permit
❑ 401 Water Quality Certification — Ex�ress ❑ Riparian Buffer Authorization
ie. Is this notification sole4y f€�r the record Far the record anly for �WQ �'ar fhe record only for Carps Permit:
�iecause written appr�val is nat required? 4�1 Certification:
❑ Yes ❑x Nd ❑ Yes 0 i�n
1f. Is payment int� a rt�itigatic�n hank or irs-lieu fee program pr�posed far
mitigation af irnpa�ts? kf so, attach the acceptance letter from m'stig�tian hank � Yes � Na
ar in-lieu fee prc�gram.
1 g. ls tt�e project located in any af NC's twenty coastal counties. IF yes, answer 1 h � Yes ❑ Na
below.
1h. Is the pr�ject lacated within a NC [�CM Area o# Environmental Concerrr {AEC)? ❑ Yes ❑X No
�, Project Informatlan
2a. hiame af proj�ct: R-50�3 B&� - NC F#ighway 53 Improvements
2b. County: {Dnslow
2c. �Vearest municipality 1 town: Jacksor�ville
2d. Subdivisian name: NIA
2e. NC[]dT orsly, T.I.P. +or state prajsct no: F�-5023 �&C, WBS No. 41922.3.1
3. Quvner Informatian
3a. Name(s� an Recorded ❑eed: iVJA
3b. peed Bonk and Page t�o. I�IA
3c. Ftesponsible Party (for LLC if NC�DT Fiis�hway Divisic�n 3 c!o Da�id L�anard
applicable):
3d. Str�ei address: 55Q1 $arbados 6lvtf.
3e. City, state, zip: �ast�e Hayne, �'+IC 28429
3f. Telephane na,: (91Q}341-2�a0
9g. Fax n�.:
3h. Ernail address: [e-mail]�v
Pag� 1 af 10
�CN Farm � Version 'i.4 January 2{}�9

4. Ap�l�cant Informatlan {if different from awner)
4a. Applicant is: ❑ Agent [J �iher, specify:
4h, Name:
4c. BusEness name
qif applicabl�):
4d. 5treet address:
4e, City, skat:e, zip:
4f. Telephane no.:
, 4g. Fax na.:
' 4h. Em�il address:
5. Ag��UCansuitant Infarma#i�n (lf appliaable)
5a. Name: Roberk �um5ull
5b. Busir�ess name ��Wironmentaf Servi�es, Inc.
(i# applicable}:
5�. Street address: 49(}1 Trademark DriVe
5d. Ciry, state, Ztj}: R�I�O�Y1, h1C
5e. Telephone n�.: (9i9) 212-11fif�
5f. Fax r�o.: (919j 21�-1707
5g. Email address: �#umbull a�,7eainc.cc
Page 2 oi` 7p

B. Pr�oject Informatlon and Priar Project Histary
1. Property Ide�ti�catian
1a, Property rdentifi��tion nr�, (tax PIN ar pascal IDJ; NIA
1h. Site cv�rdinat�s �in decimal degrees�: Latitude: ���7���� Longitude: -77-5iBt3
1c. Property size: 1fl•5 scres
2. Surface 11Vaters
2a. Name r�f nearest bady af water to proposed proj�ct. Sout�tw�5t Cre�k ! Blue Creek
Zb. Waker C�uallty Ciassificatian aF nearest rec�iving water: �����+° ���;ry��
2c. River basin; Vlfhite Oa�C
3, Proj�c# �es�riptian
3a. Describe the existing conditi�ns on fhe site and the general fan�i use in the vic�nity oi the praject at the time �f this
appl�catian:
T�he study �raa is d�mina[ed by mainta�nedldiskvrhed araas including residentia! areas wiih scatiered commercial areas, sucr�essienal communikles,
and farested communilies. ihe pm�e�i vicinity ds su6ur6an in nalure.
3b. List ihe ��tal estfm-ated acreag� of aYl existing wetlands on the pmper#y: D,�
3c. List the takal esiimated lirrear feet �rf ail �xisting streams (int�rmittant and persnnialJ on l3te property: ��'�
3d. Ex�lain the purpose af the prop4sed proaect:
The p�rpase of thls pmject is to widen a 1.� mile portian aF tJC 53 and Impmve the hIC 53fSR i ifl9 intersect�on in order ko i�rnprz�wa traiflc sa{ety.
3e, Describe the ave�rall pr°aject in d�kaii, incsuding the type af equipment to be used;
Sea Attachment A.
4. .��risdictinna! Qeterminatians
4a. Have jurisdictic�rsal welland ar st►eam detemninations by the Q Yes ❑�lo � Unknown
�orps ar 5tate �een re�uested or abtaine� ior this property !
rdect in�ciudin all ri�r hases in khe a�t? �°m�����' sAw"-2aog-o�s�3
4h_ IF the Carps made the ju�isdictional dekermir�ation, what ty,�e � preliminary � Fina!
aS determinatic�n was made?
4c. If yes, whv d�lineated ihe jurisdiciipnal areas7 AgencylConsultant Company: Envirorrmental 5ervices, Ine.
Name (if kr�t�wn): �. �umbu�i �ther:
4d_ I� yes, fist the dates c�f the Corps jurisdictionsl det�rminatians or Stat€� determin�tions ar'id at#aGh dcacumenta:tian.
NG53 widening appro�al USACE-3{2811A, iVC�WR-517l1�1; NC531Hofly 5hellar Raad Interseciian revi�wed ar� T11212D1 �{no doeumanfakian re�elved).
5. Praject History
5a. Mave permits or certi%cations heers req�ested or obtained for ��,e� 0�o Q Llra�Cnown
this prajeci {includirsg al� prior phases} in the past7
5b. If yes, explain in de#ail accarding to "he�p file" instructians.
B. �wtur� I'roject Plans
6a. Is this � phased project? ❑ Yes Q No
6h„ if yes, explain.
Page 3 aP 1 f}
PCN Form — Version 'i.� January 20U9

C, prop�sed Impacts Inventory
1. Impacts 5ummary
ia. Which sectivns wer� completed �elow for your praject (ehack all that appiy);
�X Wetlands 0 Stre�ms — tributaries � 8uff�rs 0 C}pen Wakers ❑ Pond Cvn�truction
2. Wetla�d lmpacts
If there are wetland impacts pro�osed on the site, then co�nplete this questian for each wetland area irnpacted.
2a. 2b. 2c. 2d. 2e. 2f.
W�tfand impact Ty�r� of impaci Typ� r�f wetland Farested Type oFjurisdiction Area of
number Carps (4[}4,1fl) c�r imp�ct
Permaner�t {P) Qr DW4� �401, ather} {acres}
Tem ara �
W1 �' Fill Headwater Wetland Yes Corps 0.41
�� P Exr.avation Headwater Wetlarad Yes Corps �.U1
�'� � Frll Headwater Wetfar�d �lo Corps 0.43
W4 P Exca�vatio� Headwater WetEand Na Corps D.OS I
�ly�a P Land Clearing Headwaler WetEand tJa Carps [}.flA
W6 - Choase ane Choase one YeslNa
2g. �vtal Wetland Impacts: Q.15
2h. Comments:
Impacts W1 and '!N2 are located at Site 1 an the attaclied dr�wings. These impacts an� both �4.01, +xhi�h is why the total in �g is �.15 acre {6,827 sq.
ft. ).
Impacts W3, W4, and W5 are located at Slte S orr the attached drawings.
3. S#ream Impacts
It th�re are perennial ar inl�rmittent stream impacts (inctuding temporary impacts) praposed on the site, then Garn�lete t�`vi�
qa�esti�n for all stream sites irr�pacted,
3a. 3b. 3c. 3d. 3e. 3f. 3g.
�tr+��m im�act Ty�e �rf impact Stream name Perennia! �PER� ar Typ� aF Average Impact
num�er intermittent �Ih1T�? jurisdiciion strearn length
Perman�:nt (Pj ar width (linear
7emporarl+' �T) ffe�t} f��t�
S� - Chaose ons - -
52 - Chans� t�ne . _
S3 - Choase �ne - -
S4 - Choose ane - -
�5 - Choosa ane -
S6 - Choose one - -
3h. Total s#ream and trfbu#ary im�acts 195
3i, C�rmments:
5ee Attachment B. Total stream im,pacis inr}ude 13i feet of perinanent fmpacis and B4 feet oF 4emparary impacts.
Page 4 af 1Q
PCN Fr�rm — Versso� 1.4 January 20�}9

4. L1pen Water fmpacts
If khere are proposed impacts ta lakes, ponds, estuaries, tributaries, scaunds, the Atlankic Ocea�, or any other apen wak�r af
tYse U.S. �hen individuall list all a en waker im acis below.
4a, 4b. 4e. 4d. 4e.
Qp�n w�ier Name of waterbody
Errtpact number �if appli��ble) Type �f im�act Waterhady Area of impact [�cres�
Permanenk {P) or type
Tem ara T
i]1 - Choc�se one Cho4se
�� - Choose ane Chd�se
p3 - Choose �ne Choase
Q4 - Choasa ane Chooss
�lf. 7o�al open water impacts � 4d
4g. C�omments:. �Q ac men o a open wa sr imgac s in u e sq. . a peFinanen impac s an sq. . o empar�ry dmpac s.
rmpacted ap�n v�ater Features ara degraded trih�t�ries passessing an OHWM khat provide no funetiorr �eyond movinc� watee.
5. Pand or Lake Car�structian
If �nd or I�ke cc�nstn.�ction r4 ased, th�n cam lete the ctrart be3crw.
5a. 5b. 5c. 5d. 5�.
�'ond I� numher Propased use or Wetland Impacts (acres) 5trearsi lmpacts �feet} lJpland
purpas$ of pond {acres}
Flaoded Fiiled Exca�ated Floaded Filled Exca�+ated
P1 Chaase �ne
P2 Chaose one
5f. Tatal:
5g. Cc�rr�ments;
5h. Is a dam high hazard penmit r�quired? ❑ Yes ❑ Nfl {f yes, permit II� no:
5i. �xp�ected pond sur�ace ar�a (acres}:
5j. Size a# pond wa#ershed (acresy:
5k. Methad oF Ganstruciion:
6. Buffer Impacts {far �]WDy
If praject will irnpact a protecied nparian bufFer, then complete !he chart below. if yes, khen individually list all buffer impacfs
helow. df an im acts re uire rniti alfon, ihen ou MliST fII out Sectian D oi this form.
fia, Praject is in which protected basin? ❑�etise � Tar-�amllca � Catawba 0 Randleman ❑ Qther:
6b_ Bc. Bd. 6e. 6F. fig.
Buifer impact Reason for impact Stream name 6uf{er �one 1 Zane 2
nurnber— miisgatian impact impact
Permanent {P} ar r�quired? (squar� (square
Tem ora T feet �eet
B1 - Yesll�o
B� - YeslNv
83 _ YeslNo
B4 - YesJl��
65 - YsslNa
B6 - Yesf�to
6h. Total 8uffer Impae#s:
6i. Comments:
Page 5 af 1�

p. Impact Jus#i�cation and MitigatiQn
1. A�ai�danc� and Minimiaatio�
��. Specifically describe measvres taken io av�id or minimize the praposed im�acts in designrng projecta
Thi� proposed mad�vay irnperavements occ€�r as much as prackicahle +nrithin tha Faotprint ad the exisling roadway and the existing NC[]C]T righk-of-way.
Impac[s ere af the minimal s�ze nec�ssary t� provida structural stability and t� avnid erosive valaciiy
1t�. Specificat9y descrihe measures taken ta avoid or minEmize the prapased impacts through canstructian techniques.
A!f in-skream vuarlc will be done '"in lhe dry" or using a temptarary coFl�r dam. All neeassary s�diment and erosion ��nteof �h,1Ps will be instaaled ar�d
maintained ttrraugh rarsstruction. Disturhed grnund wifl he restor�d and stabilkzed with permanen! vegetat��e cover. NCDDT �est Maraagement
F'ractices will he imp�emented during ald phaaes af cons#ruction.
2. Com ensat�a Mi#i atlan far Im acts tc� Waters af the U.S. ar Waters af the 5tate
Za. Does the projec� require Compensalary �vlitigatian for []X Yes � i�o
impacts tp Waters vF the U.S. or Wat�rs of the State?
�b. IF yes, mi�igation is requir�d by (check all that apply�: Q[?W� ❑X C�rps
❑ Mikig�ati�n banit
2c. If y�s, wf�i�h mEtigation aption wiil be used #ar this []X payrnent to in-lieu fee prograrn
praject7
❑ Pe�ittee Respansi�le Mi#igatian
3. Gom lete if l.lsin � Mit1 aticn �ank
3a, IVame of Mitigatfon Bank:
Typ�; Ghoose ar�e Quantity�
3b. �redits Purchase� (attach recei�t an� letter) Type; Choose one Quanti#y:
Type: Choase ane Quant9ty:
3c. Comments:
4. Cam lete if Mafcin a Pa ment to In-�ieu Fee Pro ram
Qa. Approval letter from in-lieu iee pragr�m is attached. ❑x Yes
4h. Stream mitigati4n r�quested: 137 Iinear feet
4c. !f using stream mitigatian, stream temper�ture: warm
4d� Buf��r miti�ati�n requested {UWC� anly); squ�re feet
4e. f�ipariar� wetland mitigati�n reqs�esied: �,95 acres
4#. Nos�-�iparfan wetland rnitigation requested; acres
�g. Caasta! f�idal) wet9and mitigatipn request�d: acres
4h. COR1R1Ef1tS: Mltigatian is nat provided fflr irnpaets to degraded tributari�s wilh OHWAAs that do not provide a�y tunctian beyand moving wat�r.
5. Complete If Using a Permittee Respansit�le Mitigatinn Plan
5a. If using a perrr�it�ee r�sparrsib�e m3tigatiQn plan, provide a descriptl�n of the praposed miijgakian plan.
Page fi of 1�
PCN Farm — Version 1.4 January 2fl09

fi. 6uffar Mitigatian (5tste Rcgulated Riparian Buif+�r Rulesj — requlred by pWC!
6a. Wili the proje�t tesult in an impa�t withir� a protected riparian bufFer that requires ��,�$ � N�
buffer mitigatian?
Bb. If yes, lhen identify the square fee# �F impact #o each z�r�e af the riparian �uffer that requires mitigator�r�. Calculate tl7e
�mc�un4 af mifigak+�n required.
fic. �id, fie.
Z��� Reason for impact Total 'smpaci Multiplier Flequired mitigatia�
�square Feetj {square feet}
Zcsrse 1 3{2 for Catawbaj
ZQne 2 1.5
Bf. Total buff�r mitlgativn required:
Fg. If buffer rraitigation is required, dis�uss what #ype af rnitigallon is �ropased (e,g., payment to privat� mitigation b�nk,
permittee resporrsibie riparaan 6ufFer restorstian, paymenk ¢ntv an approved in-lieu fee func�j.
6h. Cammer�ts:
Page l af 9fl

E. Stormwater Management and aiffuse Flcw Plan �required hy DWQj
1. Diff�se Fla+w Plan
i a, Daes th� praject include ar is it adjacerst !o pracect�d r'rparian huffers iden3�fied � y,�� ��o
within one of 4he NC i�i arian BuFfer Protection '�ules?
1b. If yes, then is a tiifiuse flaw ,plars included"d I� no, explain why.
[� Y�s � hlo
2. Starmwater Mana em�r�t Plan
2a. What is the evera�l percent im�aer�iousness of this pr��ect? 4� o��
2b. Da�s t�is ra eci re s�ire a 5karmwater Mana em�nt Plan? � Yes ❑ No
2c. If this project �C}ES �IDT require a Stormwater Managerrsent Plan, explain why:
�d. If this project pC7E5 �equire a Stormwater Manag�:ment Plan, ther� pr�rvide a bri�f, narrative des��p4ic�n af the plan:
Propms�d roadsida dit�hes were designed ta meet grass swale criteria �maxamum 3 1 side slQpes]. Grass s�vale da#a at lhe ;�ermit siles ha�e been
pravided wheee app[icabla.
The typical section from -L-7#]+54 t� 1f)4+5C1 is praposed io incCude a 2'-6" curb and gutter in arde� ta avoid im�acts tn a recenCly ccsnslructed 92" waler
lin�, avo�d WW impacts. and avoid impacts tcs identitied National f2egister Historic Praperties. There is no appartue�iky tn provide any typ� Qf treatmer�t
far stormwater drair�ing to the UT ka Blue Creek at approximately 87+50. Bfue Creek is nat lisled as an imp�6red water on the 303(dj Ilst.
2e. Who wil3 be responsible for the review �rf tF�e Stt��rnwa�ter Management Rfan7 NCCJWR - TPl!
3. Certified loca! Gorrernment Storrnwater Rer►iew
3a. In which lacal �verrsrnent's 'urisdicti4r� is this ra ect? ���'
� Phase II
3h. Which of the follc�uring lo�ally-implemented storrnv�ater managemant programs ��5�
� 4JSMP
apply {ci�eck all that appSy}; � Water 5upply Watershed
p C}ther:
3c. Has tt�e approved S4ormwater Management Plan wikh psaof o# appro�al b�en ❑Yes [j No
attached7
4. aWQ Stt�rmwater Pro ram Re�iew
�Caast�� c�urrties
�Fi(�W
4a. Which af the fc�llpwing state-impi�rr�ented stormwater management prograr�s apply p�y�y�
(check all t�at apply}: �Sessian Law �006-24fi
❑p Dther: r�pa�s
4b. �as the a,ppr�ved Starmwaier Management Plan wiih �aroof of appravai been 0 y�� Q�❑
attacFs�d7
5. �W[� 401 Unit 5tarmwater Fteuiew
5a. Qaes th� Starmwater Management Plan meek the appro�riake rsquirements? � Yes ❑ N�
5h. Have afl of #he 401 LPr�it submittal requirernents k�eer� met? � Yes [] No
Page 8 of 10
PCiV Farrn — V�rsi�n 1.4 January �i}09

F. Supplementary Inform�tion
1. En�ircanm�ntal Qacumentatlan (DWG! Req�irement)
1a. poes the project invalve arz expe�diture vf pu�lic (federallstateflc�cal) funds or the � Y�� ���
us� of public (federallstate) land?
1 b. If y�u a�swered "yes" to the above, does the project require preparatian af an
ersvironmen#al dQCUment pursuant t� the r�qu'sreme�ts of the Mational or State ❑Yes Q hlo
(Narth Caralina} Enviranmental Pc�!}cy Act (I�EPAfS�PA)?
1c. If you answered "yes" to the abowe, has lhe tic��uzr�ent reviaw been finalize� by the
State Clearing House7 (li so, attach a eopy of the �1�PA ar S�PA fnal approval
letter.) [] Yes ❑ h�o
Comments:
�. Vialations {�Wa Requiremen#J
2a. Is the site in violativn t�f QWQ Wetland Rules {15R �1GAC 2Fi .05(?0), isoiated
INetl�ntf I�uEes (15A iUGAC �H .130Qj, DW� 5urfac� Water ar Wetland Standards, [�Yes � hJa
or Rip�rian Buffer Rules (15A h1CAC 2B .02QD}?
2b. Is this an after-t'he-fact permit application? ❑Yes Q N�
2c. If yau answered "yes" t�a orse ar bath of the abQVe questians, provide an explanation af the violatian(sj:
3, Cur�ufatl�e Impacts {DW'Q Rec{ufrement)
3a. Wil6 this pro�ect (based on pasi and reasanably anticipated future impacts) result in �,��5 ���
additi�nal dev��opment, r�hich could 6mpact nearhy dawnstream water quallty?
3h, if ya� answ�red "yes" to the abave, su�mit a q�af ikative or quantitakive cumulative impact analysis in accnrdance wiih tFse
most recent �WQ policy. If you a�nswet�d "nc�," pr�vide a shc�rt narrative �escriptian.
The pr�posed praject will n4t resuft En downstream impacts or growth=stimulat4ng efiects, The exEstl�g uses aF 5outhwes# Greelc (C;NSW) ar+d Blue
Greek (SC;NSWj shoufd not ehango as a res�ll of this projec�.
4. 5ewage �I€spasal (DWQ Ret{ulrement)
�la. Clearly detai9 the uRtirrtaie treatm�nt methods and di�pasEtion {ns�n-discharge or discharge} of w�st�water generated frc�m
#t�e prQpos�d project, 4r available capacity of th� subJect facifity.
No wastewa#er will be pnr�du�d �s a rasult of this project.
Page 9 of 10
�CN Far�rs — V�rsit�r� 1.4 January ��09

5. Endangered 5�ec9es and Desfgnated Criticai Habi#at �Ct�rps Requirementj
5a. Will this prapect a�cur in ar near an area with federally pr�atected s�ecies ar � �,,�� � N�
habitat7
5b. Have yau cheeked with the USFWS canceming �ndangered �pecies Act �,��5 0��
impacts?
5c. If yes, indicake the U5FW5 Field C]ffi�e you have cantacied. ' -
5d. What data sourc�s r#id yau use to determine whether your �ite waufd irnpact Endangere� 5pecies or Designated GriGcal
Habii�k7
NaRh Caralina Naturaf Heritage Pmgram Data (u,pdated January 24i5y and an•site evalualions
F. Essential Fish Hahitat �Cnrps REquirementj
fia. WiII this praject acGUr in or near an area designated as essenkial fsh hat�itat? ❑ Yes ❑X Nc�
�ib. What data sources did yau use ta determine whether yc�ur site woufd impact Essential Fish Halaikat7
hlati�nal �ceanic and Atmaspher�� Administration :��9 List oF EFH Speeias 6y Waterbady in North Garolina
7. Historlc nr Prehistaric Cultural Resources �Carps Requirementj
7a. Will this projeci aceur in ar near en area that the state, fed�ral or tribal
gavernments ha�ve desigrtated as having historic or cultt�r�l preservatonn � Yes ❑ hlo
status (e.g., Natics�a! Fiisto�c Trust d�signatian or properties significant in
North Garolina histary arsd archaealagyj?
7b: What data saurces di� yau use to �etermine whether you� site would 'ompa�t histor'rc or areh�cr�ogEcal resnurces?
A culturai tesnurcas review was conducted by NCQO� in March 2Q1A. Documenta[ion fr�am that review is attached. A HisiQric Archite�ture effects
m�eting was held wilh SHFO an il2712015. Th@ project wi11 haue nv advvrse effe�ts an Histaric Register pmperties.
S. Flood Zone Oesigna#ion {Corps Requirementj
8a. Will this praject oGCUr ir� a FE�uIA-designate� 10�-year flQOdplain? [j Yes �x hlo
8b. 1f yes, explain hcaw project meets FEN1A r�quirements:
8�. What source�s} did you use to make the t�aodplain determ6r�ation?
wvrvu. ncflflvdma ps . ra m
�[���� �Luri�c. � � /
� i/ - � L �. �/ r a��4"� ! 3
C�y�ti;.�) � �- r �,��� �
Appli�anUAgent's Prirsted Name ApplicantlA�ent's 5i�nature ��t�
{Agent's signat�re is valld only iF an authorizatiar�
latter frorr� ttrB a lican[ is r�avidsd.
Page 10 �f 1 fl