20240501 Ver 1_ePCN Application_20240402

i 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# *
20240501 1
Is a payment required for this project?*
No payment required
Fee received
Fee needed - send electronic notification
Select Project Reviewer*
Ryan Conchilla:ryan.conchilla
Information for Initial Review
la. Name of project:
Replace structure no. 292085 on SR 1436 (Pinebrook School Road) over UT to Sugar Creek
1a. Who is the Primary Contact?*
Stephanie Braquet-NCDOT Div 9 Environmental Specialist
1b. Primary Contact Email: *
[e-mail]
Date Submitted
4/2/2024
Nearest Body of Water
UT to Sugar Creek
Basin
Yadkin-PeeDee
Water Classification
C
Site Coordinates
Latitude: Longitude:
35.9655-80.5123
A. Processing Information
Is this project connected with ARPA funding?
Yes No
County (or Counties) where the project is located:
Davie
Is this a NCDMS Project
Yes No
Reviewing Office*
Central Office - [phone]
1c. Primary Contact Phone:*
[phone]
Is this project a public transportation project?*
Yes No

Is this a NCDOT Project?*
Yes No
(NCDOT only) T.I.P. or state project number:
BP9.0002
WBS # (1)
BP9.0002.1
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: 03 - Maintenance
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
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:
NCDOT Division 9
2b. Deed book and page no.:
2c. Contact Person:
Stephanie Braquet
401 Water Quality Certification - Express
Riparian Buffer Authorization
Yes No
Yes No

2d. Address
Street Address
375 Silas Creek Parkway
Address Line 2
city
Winston-Salem
Postal / Zip Code
27127
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(If appropriate)
1c. Nearest municipality I town:
Redland, NC
2. Project Identification
2a. Property Identification Number:
2c. Project Address
Street Address
Pinebrook School Road
Address Line 2
City
Redland
Postal / Zip Code
27028
3. Surface Waters
3a. Name of the nearest body of water to proposed project:
UT to Sugar Creek
3b. Water Resources Classification of nearest receiving water:
C
3c. What river basins) is your project located in?*
Yadkin-PeeDee
3d. Please provide the 12-digit HUC in which the project is located.
030401011402
4. Project Description and History
State / Province / Region
North Carolina
Country
United States
2f. Fax Number:
[phone]
2b. Property size:
State / Province / Region
North Carolina
Country
United States
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: *
Structure number 292085 on SR 1436 (Pinebrook School Road) over UT to Sugar Creek is located in Davie County. NCDOT proposes to replace the existing 60" corrugated metal pipe
(CMP) with a 72" corrugated aluminum pipe (CAP). The project study area totals approximately 1.88 acres with the majority of the project located in forested open space. There is prime
farmland soil within the project area and NRCS was consulted. Land use in the surrounding area consists of residential development, agriculture fields, and undeveloped forest. Two
streams were delineated in the project study area, Sugar Creek and UT to Sugar Creek, with the latter being impacted by BP9.0002. There are no wetlands in the project study area.
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:
120
4h. Explain the purpose of the proposed project: *
The purpose of the project is to replace structure 292085 which is structurally deficient. The pipe is considered structurally deficient due to deterioration, erosion, and being under -sized.
L

4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used: *
BP9.0002 (previously 17BP.9.C.4) proposes to replace structure number 292085 on Pinebrook School Road (SR 1436) over UT to Sugar Creek in Davie County. The existing 60"
corrugated metal pipe (CMP) with a stone headwall will be replaced with a 72" corrugated aluminum pipe (CAP) buried one -foot with a headwall. The CAP will have one -foot sills inset at a
3-foot minimum on the inlet and outlet ends. The existing two (10-foot) travel lanes will stay the same width and the 7-foot grassed shoulders will also stay the same with the addition of
guardrail. The design follows sub regional tier guidelines.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?
Yes No O Unknown
Comments:
Delineations for potential jurisdictional resources occurred in October 2023 and are documented in
the Natural Resources Technical Report (NRTR).
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): Stephanie Braquet
Agency/Consultant Company: NCDOT
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?
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
3. Stream Impacts
V
F]
3a. Reason for impact (?)
3b.lmpact type*
3c. Type of impact*
3d. S. name*
3e. Stream Type*
3f. Type of
3g. S. width
3h. Impact
Jurisdiction *
length
S1
pipe
Permanent
Culvert
UT to Sugar Creek
Perennial
Both
13
Aveage (feet)
(linear feet)
S2
channel improvements
Permanent
Fill
UT to Sugar Creek
Perennial
Both
Average (feet)
(linear feet)
S3
dewatering for pipe
Temporary
Dewatering
UT to Sugar Creek
Perennial
Both
20
replacement
Average (feet)
(linear feet)
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts: 3i. Total temporary stream impacts:
21 20
31. Total stream and ditch impacts:
41
3j. Comments:
Total proposed permanent stream impacts include 21 (0.001 ac) linear feet of the culvert and channel improvements. Channel improvements include
bank excavation and fill to improve stream transition from the culvert outlet. Total proposed temporary impacts include 20 linear feet (0.0017 ac) of
dewatering for the pipe replacement and channel improvements. Mitigation is proposed at a 2:1 ratio for the 21 linear feet of permanent impacts totally
42-linear feet of stream mitigation associated with BP9.0002.
E. Impact Justification and Mitigation O
1. Avoidance and Minimization

1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
This project is a pipe replacement of a 60-inch corrugated metal pipe and deteriorating stone headwall. The existing pipe will be replaced with a 72-inch
corrugated aluminum pipe culvert and headwall and one -foot sills. New guardrail will also be added. Proposed culvert to be buried to facilitate aquatic
passage; proposed culvert will also be slightly realigned to better fit the existing channel with minor channel improvements at the culvert outlet end to
accommodate this realignment. Lower outlet stream velocities are anticipated due to the larger diameter of the culvert and the use of Class I riprap at the
outlet to stabilize the channel. Grassed shoulders and ditches to convey stormwater runoff from the roadway facility; ditch side slopes designed to match
the existing conditions or to be no steeper than 2: 1.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
All construction activities will be performed in accordance to the applicable requirements of the 2024 NCDOT Standard Specifications for Roads and
Structures. The erosion and sediment control plans will comply with the regulations set forth by the NCG-010000 General Construction Permit.
Erosion control measures will include placement of silt fences around the construction zone. Construction activities will be completed from upland areas.
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
2c. If yes, mitigation is required by (check all that apply):
DWR Corps
2d. If yes, which mitigation option(s) will be used for this project?
Mitigation bank Payment to in -lieu fee program Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
Scout Mitigation Site
3b. Credits Purchased/Requested (attach receipt and letter)
Type: Quantity:
Stream 42
3c. Comments
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:
The project is not in a state regulated riparian buffer basin.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?
Yes No
Comments:
The project is in compliance with NPDES permit NCS000250. Please see attached Stormwater Management Plan (SMP).
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
1b. If you answered "yes" to the above, does the project require preparation of an environmental document pursuant to the requirements of the National or State (North Carolina)
Environmental Policy Act (NEPA/SEPA)?*
Yes No
Comments:*
A Categorical Exclusion was prepared for environmental documentation under NEPA. It is attached for reference.
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
O

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.
No additional development is anticipated as a result of this project because the project is the replacement of a structurally deficient pipe in a rural area.
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.
Asheville
5d. Is another Federal agency involved?*
Yes No
What Federal Agency is involved?
FHWA
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
Unknown
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?
IPaC and 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?
National Oceanic and Atmospheric Administration 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?
The project was reviewed in accordance with the Section 106 Programmatic agreement by NCDOT cultural resource staff, and that the Catawba Nation
was consulted for impacts to tribal resources.
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?
FEMA Floodplain Maps
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
BP9.0002 ePCN and supporting documentation. pdf 13.83MB
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:
Stephanie Braquet
Signature
Date
4/2/2024
M