20160052 Ver 1_Application_20160114

Office Use Only:
Corps action ID no.
DWQ projed no.
Fomi Version 1.4 January 2009
Pre-Construction Notification (PCN) Form
A. Applicant Information
1. Processing
1 a. Type(s) of approval sought from the Corps: �X Section 404 Permit
❑ Section 10 Permit
tb. Specify Nationwide Permil (NWP) number: 73 or General Permit (GP) number:
tc. Has the NWP or GP number been verified by the Corps? ❑X Yes ❑ No
1d. Type(s) ot approval sought (rom the DWQ (check all that apply):
� 401 Water Quality Certification — Regular ❑ Non-404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Exptess ❑ Riparian Buffer Aulhorization
1e. Is this notification solely for the record For ihe record only for DWQ For ihe record only for Corps Permit:
because written approval is nol required? 401 CeAification:
❑ Yes X❑ No ❑ Yes ❑X No
iL Is payment into a mitigation bank or in-lieu fee program proposed for
mitigation oi impacts? If so, allach the acceptance letler from mitigation bank ❑ Yes XO No
or in-lieu fee program.
1g. Is the project located in any of NC's iwenty coastal counties. If yes, answer 1h � Yes ❑ No
below.
1 h. Is the project located within a NC DCM Area of Environmental Concem (AEC)? �x Yes ❑ No
2. Project Information
2a. Name of projed: US 70 Shoulder Reconstruclion
26. County: Carieret
2c. Nearest municipaliry / town: Davis
2d. Subdivision name: N/A
2e. NCDOT onty, T.I.P. or state project no: 2.101611
3. Owner Information
3a. Name(s) on Recorded Deed: North Carolina �epartment of Transportation
3b. Deed Book and Page No. N/A
3c. Responsible PaAy (for LLC if N/A
applicable):
3d. Street address: 105 Pactolus Highway NC 33 P.O. Box 1587
3e. City, state, zip: Greenville, NC 27835
3f. Telephone no.: 252-439-2800
3g. Fax no.: 252-830-3341
3h. Email address: [e-mail]
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PCN Form — Version 1.4 January 2009

4. Applicant Information (if different from owner)
4a. Appiicant is: ❑ Agent �X Olher, specify: Division 2 Environmental O�cer
4b_ Name: Jay B.Johnson
4c. Business name North Carolina Department of Transportalion
(if applicable):
4d. Streetaddress: P.O. Box1587
4e_ Ciry, state, zip: Greenville, NC 27835
4f. Telephone no.: 252-439-2800
4g. Fax no.: 252-830-3341
4h. Email address: [e-mail]
5. Agent/ConsulWnt Information (if appNcable)
Sa. Name: N/A
5b. Business name
(if applicable):
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. Fax no.:
5g. Email address:
Page 2 of 10

B. Project Information and Prior Project History
t. Property Identlfication
1a. Property identificalion no. (taz PIN or parcel ID): US 70 Shoulder Reconstruction
1 b. Site coordinates (in decimal degrees): Latitude: Longitude:
ic. Property size: acres
2. Surface Waters
2a. Name of nearest body of water to proposed project: Core Sound
2b. Water Quality Classifiration of nearesl receiving water: SA; ORW
2c. River basin: White Oak
3. ProJect DescHpdon
3a. Describe the existing conditions on the site and tha general land use in fhe vicinify of the project at the time ot this
application:
US 701s a paved Primery Hlphway. Coastal marsh and residences dominate the landsape.
3b. List the total estimated acreage of all existing wetlands on the property: 0.03
3c. List the total estimated linear feet af all existing streams (intermittent and perennial) on the property: 1,065
3d. Explaln the purpose of the proposed project:
The existirg roadside shoulder has heen compromised anA Is collapsing. The shaulder reconstrucllon will keep the roatlway from coliapsing.
3e. Describe the overall project in detail, induding the type of equipment to be used:
The existing roatlside shoultler witl be reCOnsWGed wNh granite riprep.
4. Jurisdictional Determinadona
4a. Have jurisdicfional wetiand or stream determinations by the � yes � No ❑ Unknown
Corps or State been requested or obtained for lhis property / CommeMs:
ro'ect includin all rior hases inthe st?
4b. If the Corps made the jurisdictional determination, what rype
af determinalion was made? ❑ P�eliminary ❑ Final
4c. If yes, who delineated the jurisdidional areas? AgencylConsultanl Company:
Name (if known): Olher:
4d. I( yes, lisl tne dates of the Corps jurisdidional determinations or State determinalions and attach documentation.
5. Project Hlstory
5a. Have permits or ceAifications been requested or oblained tor �Yes X❑ No ❑ Unknown
this project (including all prior phases) in ihe pasf?
5b. If yes, explain in detail according to °help file" insVudions.
6. Future Project Plans
6a. Is this a phased projecl7 ❑ Yes �X No
6b. If yes, explain.
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PCN Form — Version 1.4 January 2009

C. Proposed Impacts Inventory
1. Impacta Summary
1 a. Which sections were completed below for your projed (check all that apply):
� Wellands ❑ Streams—tributaries ❑ Buffers ❑X Open Waters ❑ Pond Construction
2. Wetland Impacts
If there are wetiand impacts proposed on the site, lhen complete this question for each wetland area impaded.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type ot impad Type of welland Forested Type otjurisdiction Area of
number Corps (404,10) or impad
Pertnanent (P) ar DWQ (401, olher) (acres)
Tem ora
W1 P ShoultlerMaintenance Chooseone No Corps 0.03
yyZ - Choose one Chaose one Ves/No -
yy3 - Choose one Choose ane Yes/No -
W4 - Choose one Chaose one Yes/No -
yy5 - Choose one Choose one Yes/No -
� - Choose one Choose one Yes/No -
2g. Total Wetland Impacts: 0.03
2h. Comments:
3. Stream Impacts
If there are perennial or intermittent stream impads (including temporary impacts) propased on the site, then complete this
question for all stream sdes impacted.
3a. 3b. 3c. 3d. 3e. 3f. 3g.
Stream impact Type ot impacl Stream name Perennial (PER) or Type of Average Impad
number intermirient (INT)? jurisdiction stream length
Permanent (P) or width (linear
Temporary (n (feet) feet)
$� - cnoose one - -
$p - Choose one - -
S3 - Choou one - -
$4 - Chaose one - -
S5 - Choose one - -
S6 - Choose one - -
� 3h. Total stream and tributary impacffi
3i. Commenis:
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PCN form — Version 1.4 January 2009

4. Open Water Impacta
If there are proposed impacts lo fakes, ponds, estuaries, tributaries, sounds, the Allantic Ocean, or any other open water of
the U.S. then individuall list all o n water im ads below.
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number (if applicable) Type of impacl Waterbody Area of impad (acres)
Permanent(P)or type
Tem ora
01 P Fill Olhe�
02 - Choose one Choose
03 - cnoose one choose
04 - Choose one Choose
4f. Total open water impacts
4g. Comments: re re cu y s o pa s s.
5. Pond or Lake ConsVuction
If ond or lake construction ro osed, then com lete the chart below.
5a. 5b. 5c. 5d. 5e.
Pond ID number Proposed use or Wetland Impads (acres) Stream Impacts (feet) Upland
purpose of pond (acres)
Flooded Filled Excavated Ftooded Filled Excavated
p1 Chooseone
p2 Choose one
5E ToWI:
5g. Comments:
5h. Is a dam high hazard permit required? ❑ Yes ❑ No If yes, permit ID no:
5i. Expected pond surface area (acres):
6. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWQ)
I( project will impad a protected riparian buffer, then complete the chart below. It yes, then individually list all buffer impads
below. tl an im ads re uire miti ation, then ou MUST fill out Section D of this farm.
6a. Project is in which protecled basin? ❑ Neuse ❑ Tar-Pamlico ❑ Catawba ❑ Randleman ❑ Other:
6b. 6c. 6d. Be. Bf. Bg.
Buffer Impact Reason (or impact Stream name Buffer Zone t Zone 2
number— mitigation impaIX impact
Permanent (P) or required? (square (square
Tem ora feet feet
B1 ' YeslNo
B2 - YeslNo
63 - veslNo
Bq - YesJNo
g5 • veslNo
gg - YeslNo
6h. Total Buffer Impacts:
6i. Comments:
rage 5 ot �u

D. Impact Justificallon and Mitigation
1. Avoidance and Minimization
1 e. Specificaily describe measures taken to avoid or minimize the praposed impacts in designing projed.
Onty repaldng areas lhat are eroding/slumpirg.
1 b. Specifically describe measures taken to avoid or minimize the proposed impads lhrough construction techniques.
Rip rap under NWL is less than 1 cubic foot per finear toot.
2. Com nsato Mitf adon for Im acts to Waters of the U.S. or Waters of the 3tate
2a. Dces the project require Compensatory Mitigation for ❑ Yes X❑ No
impacts to Waters of the U.S. or Waters of fhe State?
2b. If yes, mitigation is required by (chedc all that apply): ❑ DW� ❑ Corps
❑ Miligation bank
2c. If yes, which miligation option will be used for this ❑ payment to in-lieu fee program
project?
❑ Permittee Responsible Mitigation
3. Com lete if Usin a Mitl ation Bank
3a. Name ot MOigation Bank:
7ype:Choose one Quantity:
3b. Credits Purchased (attach receipt and �etter) 7ype: Choose one �uantity:
Type: Choose one Quantity:
3c. Commenls:
4. Com �ete if Makin a Pa ment to In-lieu Fee Pro rem
4a. Approval letter from in-lieu tee program is atlached. ❑ Yes
4b. Stream mitigation requested: linear feet
4c. It using stream mNigation, stream temperature: Choose one -
4d. BuHer mitigation requested (DWQ onty): square feet
4e. Riparian wetland mitigation requested: acres
4f. Non-rfparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requested: acres
4h. Commenls:
5. Complete If Using a Pe�niltee Responsible Mitigation Plan
5a. If using a permiltee responsible miligatlon pfan, provide a description of the proposed midgation plan.
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PCN Form — Version 1.4 January 2009

6. Buffer Mitigation (SWte Regulated Riparian Buffer Ruies) — requfred by DWQ
6a. Will the project result in an impact within a protected riparian buHer thet requires � Yes � No
buHer mitigation?
6b. If yes, then identiy the square feet of impact to each zone of the riparian buHer that requires mitigation. Calculate the
amount of mitigation required.
6c. 8d. Be.
Zone Reason for impact Total impact Multiplier Required mitigation
(square feet) (square feet)
Zone 1 3 (2 (or Catawba)
Zone 2 1.5
Bf. Total bu(fer mitlgation requlred:
6g. If butfer mitigation is required, discuss what type ot mitigalion is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buHer restoratian, payment into an approved in-lieu fee fund).
6h. Comments:
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E. Stormwater Management and Diffuse Flow Plan (requlred by DWQ)
1. Diffuse Flow Plan
1a. Dces the project inGude or is it adjacent to protected riparian buffers identified � yes � No
within one of the NC Ri arian Buffer Protedion Rules?
1 b. It yes, then is a diNuse flow plan included? If no, explain why.
❑ Yes ❑ No
2. Stormwater Mana ement Plan
2a. What is the overall percent imperviousness of this project? %
2b. Dces this ro'ect re uire a Stormwater Mana ement Plan? ❑ Yes ❑X No
2c. Ii this project DOES NOT require a Stormwater Management Plan, explain why:
Emergency permit for maintenance to ezistirg transpoAalion facility.
2d. If this project DOES require a Stormwater Managemenl Plan, lhen provide a brief, nanative descriplion ot the plan:
2e. Who will be responsible for Ihe review of the Stormwater Management Plan?
3. Certified Local Govemment Storniwatar Raview
3a. In which local ovemmenYs'urisdidion is this ro'ect?
❑ Phase II
3b. Which of the following locally-implemented stormwater management programs ❑ NSW
� USMP
apply (check all that appty): � Water Supply Watershed
� Other:
3c. Has Ihe approved Stormwater Management Plan with proot of approval been ❑Yes ❑ No
atlached?
4. DWQ Stortnwater Pro rem Review
�Coastal counlies
❑HQW
4a. Which of the following sfate-implemented stortnwater management programs apply ORW
(check all that apply): �Session Law 2W6246
❑Other:
4b. Has the approved Stormwater Management Plan with proof of approval been ❑ Yes ❑ No
atlached?
5. DWq 401 Unft Stormwater Review
5a. Does the Stommvater Management Plan meet the appropriate requirements? ❑ Yes ❑ No
5b. Have all of the 401 Unit submittal requirements been met7 ❑ Yes ❑ No
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PCN Form — Version 1.4 January 2009

F. Supplementary information
1. Environmental Documentation (DWQ Requirement)
1a. Dces the project involve an expenditure of pubfic (federaUstateAocal) funds or fhe 0 yes ❑ No
use of public (federaUstate) land?
tb. If you answered "yes" to the a6ove, dces the project require preparation of an
environmental document pursuant to the requirements of the National or State ❑Yes 0 No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1c. If you answered °yes" to the above, has the documeM review been finalized by the
State Clearing House? (If so, attach a capy ot the NEPA or SEPA final approval
letter.) ❑ Yes ❑ No
Comments:
2. Violations (DW� Requirement�
2a. Is the s8e in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (75A NCAC 2H .1300), DWQ Sur(ace Water or Wetfand Standards, ❑Yes � No
or Riparian Buffer Rules (15A NCAC ZB .0200)?
2b. Is this an after-fhe-fad permit application? ❑Yes ❑X No
2c. If you answered'yes' to one or both of lhe above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) resull in �Yes � No
addilional development, which could impact nearby downstream water quality?
36. If you answered "yes' to fhe above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative desaiption.
4. Sewage Disposal (DWQ Requirement)
4a. Clearty detail ihe uttimate treafinent methods and disposition (non-discharge or discharge) ot wastewater generated from
the proposed projed, or available capacity ot the subject facility.
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PCN Fortn — Version 1.4 January 2009

5. Endangered Speciea and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally proteded species or � Yes ❑ No
habitat?
5b. Have you checked with the USFWS conceming Endangered Species Act ❑ Yes 0 No
impads?
5c. If yes, indicate the USFWS Field O�ce you have contacted. '
5d. What data sources did you use ro determine whether your site would impad Endangered Species or Designated Critical
Habitat?
Onsite re�riew
6. Essential Fish Habifat (Corps Requirement�
6a. Will this project ocar in or near an area designated as essential fish habitat? OX Yes ❑ No
6b. Whal data sources did you use to determine whether your site would impact Essential Fish Habitat?
Onsite reiriew
7. Historic or Prehistoric Culturel Resources (Corps Requirement)
7a. Wi�l this project occur in or near an area that the state, federel or tribal
govemments have designated as having historic or cultural preservation � Yes � No
status (e.g., National Historic Trust designation or properties signficant in
North Carolina hiffiory and archaeology)?
7b. What data sources did you use to determine whether your sile would impact historic or archeologipl resources?
Onsi10 fBview
8. Flood Zone Designation (Corps Requirement)
Sa. Will this project occur in a FEMA-designated 100-year Ooodplain? � Yes ❑ No
Sb. I( yes, explain how project meets FEMA requirements:
Maintenance af ebsting traasporlallon facility.
Bc. What source(s) did you use to make the tloodp�ain determination?
FEMA FIRM Maps
Jay B.Johnson �_ 01-06-2016
ApplicantlAgenfs Printed Name ppl' anUAge Signature Date
(Ag n s sig ture is val" nly if en authonzalion
etter om Ihe a icant is rovided.
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