20240493 Ver 1_ePCN Application_20240327

DWR
Division of Water Resources
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
October 2, 2023 Ver 4.3
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.
Does this project involve maintenance dredging funded by the Shallow Draft Navigation Channel Dredging and Aquatic Weed Fund or involve the distribution or transmission of energy or
fuel, including natural gas, diesel, petroleum, or electricity?
Yes No
BIMS # Assigned Version# *
20240493 1
Is a payment required for this project?*
No payment required
Fee received
Fee needed - send electronic notification
Reviewing Office*
Raleigh Regional Office - [phone]
Information for Initial Review
la. Name of project:
Structure 570/250 Foundation Repair
1a. Who is the Primary Contact? *
Kevin Fields
1b. Primary Contact Email: *
[e-mail]
Date Submitted
3/27/2024
Nearest Body of Water
Deep Creek
Basin
Roanoke
Water Classification
Ws -IV
Site Coordinates
Latitude:
36.456671
A. Processing Information
Is this project connected with ARPA funding?
Yes No
County (or Counties) where the project is located:
Halifax
Is this a NCDMS Project
Yes No
Longitude:
-77.838386
What amount is owed?*
$240.00
$323.00
Select Project Reviewer*
Kristina Morales: Kristina. Morales
1c. Primary Contact Phone:*
[phone]
$570.00
$767.00
O
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)
Has this PCN previously been submitted?*
Yes
No
1b. 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
57 - Electric Utility Line and Telecommunications Activities — (frequently used)
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:
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
1h. Is the project located in any of NC's twenty coastal counties?
Yes No
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. Name(s) on recorded deed:
Multiple (project within existing Dominion Energy North Carolina right-of-way)
2b. Deed book and page no.:
2c. Contact Person:
Kevin Fields
2d.Address
Street Address
5000 Dominion Blvd
Address Line 2
city
richmond
Postal / Zip Code
23060
401 Water Quality Certification - Express
Riparian Buffer Authorization
State / Province / Region
virginia
Country
USA
Yes No
Yes No

2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
3a. Name:
Kevin Fields
3b. Business Name:
Virginia Electric and Power Company d/b/a Dominion Energy North Carolina
3c.Address
Street Address
5000 Dominion Blvd
Address Line 2
City
Richmond
Postal / Zip Code
23060
3d. Telephone Number:
[phone]
3f. Email Address:
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Heather Kennedy
4b. Business Name:
Dominion Energy North Carolina
4c.Address
Street Address
120 TredegarSt
Address Line 2
City
Richmond
Postal / Zip Code
23019
4d. Telephone 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:
Thelma
2. Project Identification
2f. Fax Number:
State / Province / Region
VA
Country
USA
3e. Fax Number:
State / Province / Region
Virginia
Country
USA
4e. Fax Number:
2a. Property Identification Number: 2b. Property size:
0701716, 070040 & 070043 7.2

2c. Project Address
Street Address
Summit Town Road
Address Line 2
City
Littleton
Postal / Zip Code
27850
3. Surface Waters
3a. Name of the nearest body of water to proposed project:
Deep Creek
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.
030101060403
4. Project Description and History
State / Province / Region
NC
Country
USA
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: *
Dominion currently maintains and operates an overhead electric transmission line, Line #570,
as part of their regional transmission network. The existing maintained ROW generally runs
north northeast/south southwest between state route (SR) 158/903 and Roper Springs Road.
Deep Creek, a stream channel with a drainage area of approximately 6.8 square miles, cuts
into the ROW approximately 0.7 miles south of SR 158/903 near structure #570/250. The
structure is a steel lattice tower with four separate legs and foundations
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:
4g. List the total estimated linear feet of all existing streams on the property:
4h. Explain the purpose of the proposed project: *
The meander in Deep Creek just north of STIR 570/250 has resulted in ongoing bank erosion and exposure of the foundation of one of the tower legs.
The project is needed to provide bank stabilization at the tower leg foundation and to abate further erosion at this tower due to periodic high-water volumes and velocities in this reach of
Deep Creek.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:
The proposed treatment includes driving sheet pile to create a 1,554 SF protective box around the structure (Structure 570/250 Foundation Repair plan set, Appendix B). The installation of
the sheet pile will permanently impact approximately 18 LF of R2 stream channel and 1,481 SF (0.03 AC) of PEM wetland within the sheet pile perimeter. The sheet pile perimeter has
been configured with an opening in the southeast corner to allow for drainage way from the structure footings to prevent corrosion and degradation due to standing water. All work is
proposed to be done in the dry. Heavy equipment working in wetlands will be placed on mats to minimize soil disturbance. Appropriate erosion and sediment control measures will be
installed and maintained throughout the duration of the project.
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):
Agency/Consultant Company: C2 Environmental
Other:
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?
No
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
2. Wetland Impacts
I
2a1 Reason (?)
2b. Impact type" (?)
2c. Type of W."
2d. W. name
2e. Forested"
2f. Type of Jurisdicition *
?)
�2g. Impact
area
Fill/Grade
P
Non - Mars Tidal Freshwater h
W1
L-A
Corps
0.030
(acres)
2g. Total Temporary Wetland Impact 2g. Total Permanent Wetland Impact
0.000 0.030
2g. Total Wetland Impact
0.030
21. Comments:
The project is needed to provide protection to existing lattice tower foundations and to abate further erosion at this tower due to periodic high water
volumes and velocities in this reach of Deep Creek. The proposed treatment includes driving sheet pile to create a 1,554 SF protective box around the
structure. The installation of the sheet pile will permanently impact approximately 1,481 SF of PEM wetland.
3. Stream Impacts
❑
3a. Reason for impact (?)
3b.lmpact type"
3c. Type of impact"
3d. S. name"
3e. Stream Type*
?)
3f. Type of
Jurisdiction*
3g. S. width
3h. Impact
length*
fl
Sheet pile installation
Permanent
Fill
S1
Perennial::]
Corps
26
Average (feet)
18
(linear feet)
31. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts: 3i. Total temporary stream impacts:
18 0
3i. Total stream and ditch impacts:
18
3j. Comments:
The project is needed to provide protection to existing lattice tower foundations and to abate further erosion at this tower due to periodic high water
volumes and velocities in this reach of Deep Creek. The proposed treatment includes driving sheet pile to create a 1,554 SF protective box around the
structure. The installation of the sheet pile will permanently impact approximately 18 LF of R2 stream channel.
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:
The proposed installation of a sheet pile barrier and rip rap stabilization is the minimum necessary to repair ongoing erosion and protect existing
infrastructure.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Construction will be done in the dry and will utilize appropriate erosion and sediment control measures. Heavy equipment will be placed on mats to
minimize ground disturbance.
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:
O

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
If no, explain why:
There is no stormwater program requirement in Halifax County, NC. It is not a designated Phase II stormwater area.
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:
There is no stormwater program requirement in Halifax County, NC. It is not a designated Phase II stormwater area.
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
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.
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
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
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.?
Yes No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
USFWS IPaC database, NCDCR Natural Heritage Data Explorer
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?
NOAA Essential Fish Habitat Mapper
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?
NCHPO GIS data
8. Flood Zone Designation (Corps Requirement)
Be. 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?
FEMA Flood Insurance Rate Map
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
Structure 570_250 Foundation Repair—PCN Package.pdf 18.22MB
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:
Heather EB Kennedy
Signature
Date
3/27/2024