HomeMy WebLinkAbout20161008 Ver 1_PCN for 610228_20161019Q�oF wArF9Qc
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Office Use Only:
Corps action ID no.
DWQ project no.
Form 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 ❑ rmit
1b. Specify Nationwide Permit (NWP) number: �4 or General Permit (GP) number:
1 c. Has the NWP or GP number been verified by the Corps? ❑ Yes ❑X No
1 d. Type(s) of approval sought from the DWQ (check all that apply):
❑X 401 Water Quality Certification — Regular ❑ Non-404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
1 e. Is this notification solely for the record For the record only for DWQ For the record only for Corps Permit:
because written approval is not required? 401 Certification:
❑ Yes ❑ No ❑ Yes ❑ No
1f. 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 ❑X Yes ❑ No
or in-lieu fee program.
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h � Yes ❑X No
below.
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ❑ Yes ❑X No
2. Project Information
2a. Name of project: Bridge #228 SR 1320 over Suck Branch
2b. County: Montgomery
2c. Nearest municipality / town: Troy
2d. Subdivision name: N/A
2e. NCDOT only, T.I.P. or state project no: 176P.8.R.58
3. Owner Information
3a. Name(s) on Recorded Deed: NCDOT Highway Division 8
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if
applicable):
3d. Street address: 902 North Sandhills Blvd.
3e. City, state, zip: Aberdeen, NC 28315
3f. Telephone no.: 910-944-2344
3g. Fax no.: 910-944-5623
3h. Email address: acking@ncdot.gov
Page 1 of 10
PCN Form — Version 1.4 January 2009
4. Applicant Information (if different from owner)
4a. Applicant is: ❑X Agent ❑ Other, specify:
4b. Name: Art King
4c. Business name NCDOT Highway Division 8
(if applicable):
4d. Street address: 902 North Sandhills Blvd.
4e. City, state, zip: Aberdeen, NC 28315
4f. Telephone no.: 910-944-2344
4g. Fax no.: 910-944-5623
4h. Email address: acking@ncdot.gov
5. Agent/Consultant Information (if applicable)
5a. Name:
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
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): SR 1320 (Williamson Street)
1 b. Site coordinates (in decimal degrees): Latitude: 35.379747 Longitude: -79.890285
1 c. Property size: 0.5 acres
2. Surface Waters
2a. Name of nearest body of water to proposed project: Suck Branch
2b. Water Quality Classification of nearest receiving water: C
2c. River basin: Yadkin - Pee Dee
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
Existing conditions include SR 1320 (Williamson Street) and Bridge #610228, undeveloped forest and disturbed/maintained right-of-way.
3b. List the total estimated acreage of all existing wetlands on the property: 0
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
3d. Explain the purpose of the proposed project:
To replace deficient Bridge #610228 with an improved, modern, and safer structure.
3e. Describe the overall project in detail, including the type of equipment to be used:
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the � Yes ❑X No ❑ Unknown
Corps or State been requested or obtained for this property /
ro'ect includin all rior hases in the ast? Comments:
4b. If the Corps made the jurisdictional determination, what type � Preliminary ❑ Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company:
Name (if known): Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5. Project History
5a. Have permits or certifications been requested or obtained for �Yes ❑X No ❑ Unknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project? ❑ Yes ❑X No
6b. If yes, explain.
Page 3 of 10
PCN Form — Version 1.4 January 2009
C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
❑ Wetlands Strea X� — tributaries Buffers Open 1�ters PQd Construction ❑
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type of impact Type of wetland Forested Type of jurisdiction Area of
number Corps (404,10) or impact
Permanent (P) or DWQ (401, other) (acres)
Tem ora T
W 1 Choose one Choose one Yes/No -
W2 Yes/No -
W3 Yes/No -
W4 Yes/No -
W5 Yes/No -
Wg Yes/No -
2g. Total Wetland Impacts: 0
2h. Comments:
No wetlands present.
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a. 3b. 3c. 3d. 3e. 3f. 3g.
Stream impact Type of impact Stream name Perennial (PER) or Type of Average Impact
number intermittent (INT)? jurisdiction stream length
Permanent (P) or width (linear
Temporary (T) (feet) feet)
S1 P Culvert Suck Branch PER Corps 12 41
$2 P Stabilization Suck Branch PER Corps 12 69
S3 T de-watering Suck Branch PER Corps 12 7
S4 T detour pipe Suck Branch PER Corps 12 50
S5
S6
3h. Total stream and tributary impacts �s�
3i. Camments:
110 feet of permanent impacts that requires mitigation. 57 feet of temporary impact for the on-site detour and de-watering
Page 4 of 10
PCN Form — Version 1.4 January 2009
4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individuall list all o en water im acts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number (if applicable) Type of impact Waterbody Area of impact (acres)
Permanent (P) or type
Tem ora T
01 Choose one Choose
02
03
04
4f. Total open water impacts o
4g. Comments: o open a ers.
5. Pond or Lake Construction
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 Impacts (acres) Stream Impacts (feet) Upland
purpose of pond (acres)
Flooded Filled Excavated Flooded Filled Excavated
P1 Choose one
P2
5f. Total:
5g. Comments:
5h. Is a dam high hazard permit required? ❑ Yes ❑ No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If an im acts re uire miti ation, then ou MUST fill out Section D of this form.
6a. Project is in which protected basin? ❑ Neuse � Tar-Pamlico �tawba �ndleman Oth�
6b. 6c. 6d. 6e. 6f. 6g.
Buffer Impact Reason for impact Stream name Buffer Zone 1 Zone 2
number — mitigation impact impact
Permanent (P) or required? (square (square
Tem ora T feet feet
B � Yes/No
62
63
B4
65
B6
6h. Total Buffer Impacts:
6i. Comments:
Page 5 of 10
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Permanent and potential temporary impacts to Suck Branch are unavoidable due to the requirement to replace the bridge with a culvert, stabilize the
stream banks and the removal of the existing bridge and abutments. The placement of the culvert from the stream embankments will eliminate the
need for heavy equipment to enter the jurisdictional waters of the U.S. and will allow demolition of the existing structure with minimal temporary
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Construction of the culvert will take place from roadway approaches which will minimize stream impact. The temporary pipe culvert and stabilization
for the detour roadway will be removed after construction is complete and the area will be restored to its original condition.
2. Compensato Miti ation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for ❑X Yes ❑ No
impacts to Waters of the U.S. or Waters of the State?
2b. If yes, mitigation is required by (check all that apply): ❑ DWQ ❑X Corps
❑ Mitigation bank
2c. If yes, which mitigation option will be used for this ❑X payment to in-lieu fee program
project?
❑ Permittee Responsible Mitigation
3. Complete if Usin a Miti ation Bank
3a. Name of Mitigation Bank:
Type: Quantity:
3b. Credits Purchased (attach receipt and letter) Type: Quantity:
Type: Quantity:
n- ieu o ee approva etter is inc u e in t e permit pac age
3c. Comments:
4. Com lete if Makin a Pa ment to In-lieu Fee Pro ram
4a. Approval letter from in-lieu fee program is attached. ❑X Yes
4b. Stream mitigation requested: 110 linear feet
4c. If using stream mitigation, stream temperature: warm
4d. Buffer mitigation requested (DWQ only): square feet
4e. Riparian wetland mitigation requested: acres
4f. Non-riparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requested: acres
4h. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 6 of 10
PCN Form — Version 1.4 January 2009
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires � Yes ❑ No
buffer mitigation?
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.
6c. 6d. 6e.
Zone Reason for impact Total impact Multiplier Required mitigation
(square feet) (square feet)
Zone 1 3(2 for Catawba)
Zone 2 1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund).
6h. Comments:
Page 7 of 10
E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers identified � Yes ❑X No
within one of the NC Ri arian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
❑ Yes � No
2. Stormwater Mana ement Plan
2a. What is the overall percent imperviousness of this project? 33 %
2b. Does this ro'ect re uire a Stormwater Mana ement Plan? ❑ Yes ❑X No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
This bridge replacement is considered a're-developmenY procedure. For this consideration, the project does not require a state stormwater permit.
BMP's and runoff controls will be implemented during construction to reduce the stormwater impacts to the receiving stream due to erosion and runoff.
Sediment and erosion control will adhere to "Design for Sensitive Watershed" standards.
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
2e. Who will be responsible for the review of the Stormwater Management Plan?
3. Certified Local Government Stormwater Review
3a. In which local overnmenYs 'urisdiction is this ro'ect?
❑ Phase II
3b. Which of the following locally-implemented stormwater management programs ❑ NSW
apply (check all that apply): ❑ USMP
� Water Supply Watershed
� Other:
3c. Has the approved Stormwater Management Plan with proof of approval been ❑Yes ❑ No
attached?
4. DWQ Stormwater Pro ram Review
�Coastal counties
❑ HQW
4a. Which of the following state-implemented stormwater management programs apply �ORW
(check all that apply):
❑ Session Law 2006-246
❑ Other:
4b. Has the approved Stormwater Management Plan with proof of approval been � Yes ❑ No
attached?
5. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements? ❑ Yes ❑ No
5b. Have all of the 401 Unit submittal requirements been met? � Yes � No
Page 8 of 10
PCN Form — Version 1.4 January 2009
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the project involve an expenditure of public (federal/state/local) funds or the 0 Yes ❑ No
use of public (federal/state) land?
1 b. 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 ❑ Yes 0 No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1 c. If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
letter.) ❑ Yes 0 No
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ SurFace Water or Wetland Standards, ❑Yes ❑X No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after-the-fact permit application? ❑Yes ❑X No
2c. If you answered "yes" to one or both of the 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) result in �Yes ❑X No
additional development, which could impact nearby downstream water quality?
3b. If you answered "yes" to the 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 description.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
Page 9 of 10
PCN Form — Version 1.4 January 2009
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or � Yes ❑X No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act � Yes ❑X No
impacts?
5c. If yes, indicate the USFWS Field Office you have contacted. Raleigh
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
Surveys pertormed by NCDOT James Mason, and concurrence with the USFWS.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? ❑ Yes ❑X No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
NOAA EFH Webpage
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 � Yes ❑X No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
Screened by NCDOT PDEA cultural resources. Please see attached "No-Survey Required" forms.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? ❑ Yes ❑X No
8b. If yes, explain how project meets FEMA requirements:
Hydraulic calculations have been prepared based on the placement of the culvert. No increase in upstream flood elevations is anticipated based on
these calculations. Based on the results of the HEC-RAS model for SR 1320 over Suck Branch, the existing bridge can be replaced without causing
a rise to the established 100-year flood elevations and meets the requirements of Federal Highway Administration, Federal-Aid Policy Guide, 23 CFR
650A "Location and H draulic Desi n of Encroachments on Flood lains and the NCDOT MOA.
8c. What source(s) did you use to make the floodplain determination?
FEMA FIRM maps on-line
Art King DEO - Division 8 DigiGllysi9nedbyArlC.King 10-17-2016
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Da�e: 2016.10.17 082925 -04'00'
Applicant/AgenYs Printed Name ApplicanUAgent's Signature Date
(AgenYs signature is valid only if an authorization
letter from the a licant is rovided.
Page 10 of 10