Loading...
HomeMy WebLinkAbout20161078 Ver 1_BLRI 2A15 PCN 11 03 16_20161108 CD-00 Eastern Federal Lands 21400 Ridgetop Circle U.S.Department Highway Division Sterling, VA 20166-6511 of Transportation Federal Highway Administration NOV -4 2016 In Reply Refer to: HF((PP-15 FEDERAL EXPRESS Ms. Karen Higgins I'40 V 0 8 Z 016 North Carolina Division of Water Resources DENR-%PATER RESOURCES Transportation Permitting Unit TRANSPORTATION PERMITTING UNIT 512 North Salisbury Street Raleigh, NC 27604 Subject: FHWA Project No. FTNP-BLRI 2A15, Parkway Rehabilitation Blue Ridge Parkway, Milepost 217.17 to Milepost 229.68 401 Water Quality Certification Dear Ms. Higgins: The Eastern Federal Lands Highway Division, of the Federal Highway Administration (FHWA), in cooperation with the National Park Service, has prepared plans for the subject project. The project is located in the Blue Ridge Parkway, in Alleghany County, North Carolina. The proposed work includes 11.32 miles of road rehabilitation, which includes mill and overlay, spot reconstruction, drainage repairs, striping, and other miscellaneous work. Drainage repair work includes the placement of riprap in waters of the United States. The FHWA respectfully requests certification of the proposed improvements. Please provide us with your response within thirty(30)days of the receipt of this letter. Enclosed you will find five copies of the Pre-Construction Notification Application Form, one hard copy of the Categorical Exclusion and one hard copy of the project plans for your review. You will also find four CDs which contain an electronic copy of the Categorical Exclusion and the project plans. A check in the amount of$240.00 for the permit fee is also enclosed. A Pre-Construction Notification Application Form with supporting documentation has also been submitted to the Asheville Field Office of the U.S. Army Corps of Engineers requesting verification that the repairs are authorized under Nationwide Permit#3 —Maintenance, and to the Wildlife Resources Commission. If you have any questions concerning this matter,please contact Ms. Lisa Landers, Environmental Protection Specialist, at Lisa.LandersAdot.gov or(571) 434-1592. Sincerely, Kevin S. Rose Environmental Protection Specialist Enclosures 2 cc: Mr. Larry Hultquist, Project Manager,NPS, Denver Service Center Mr. Andy Otten, Project Specialist,NPS, Denver Service Center Ms. Suzette Molling, Environmental Specialist,NPS, Southeast Regional Office Mr. Michael Molling, Chief of Maintenance and Engineering, Blue Ridge Parkway, NPS o�wn � 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 Permit 1 b. Specify Nationwide Permit(NWP) number: 3 or General Permit(GP) number: 1c. Has the NWP or GP number been verified by the Corps? ❑ Yes NX 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 X❑ No ❑Yes ❑X 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 N Yes ❑X 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 NX 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: FTNP-BLRI 2A15, Rehab of Blue Ridge Parkway MP 217.17 to MP 229.68 2b. County: Alleghany 2c. Nearest municipality/town: Galax 2d. Subdivision name: 2e. NCDOT only, T.I.P. or state project no: 3. Owner Information 3a. Name(s)on Recorded Deed: National Park Service 3b. Deed Book and Page No. 3c. Responsible Party(for LLC if applicable): 3d. Street address: 199 Hemphill Knob Road 3e. City, state, zip: Asheville, NC 28803 3f. Telephone no.: 828-348-3400 3g. Fax no.: 3h. Email address: Page 1 of 10 PCN Form—Version 1.4 January 2009 4. Applicant Information (if different from owner) 4a. Applicant is: ❑ Agent ❑X Other, specify: Federal Partner 4b. Name: Kevin Rose, Federal Highway Administration 4c. Business name (if applicable): 4d. Street address: 21400 Ridgetop Circle 4e. City, state, zip: Sterling, VA 20166 4f. Telephone no.: 571-434-1592 4g. Fax no.: 703-404-6217 4h. Email address: Kevin.Rose@dot.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): 1 b. Site coordinates (in decimal degrees): Latitude: 36.52467 Longitude: 80.934545 1c. Property size: 88,000 acres 2. Surface Waters 2a. Name of nearest body of water to proposed project: Mill Creek, Big Pine Creek, Brush Creek 2b. Water Quality Classification of nearest receiving water: (WS-II; Tr; HQW)- (C; Tr;)- (C; Tr) 2c. River basin: Yadkin, Pee-Dee, New 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: The project is located within the Blue Ridge Parkway,a unit of the National Park System. The land is generally forested with the exception of the parkway motor road and shoulders. 3b. List the total estimated acreage of all existing wetlands on the property: 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: The project is needed to repair deterioration of the pavement and drainage structures. 3e. Describe the overall project in detail, including the type of equipment to be used: The project will mill and overlay the mainline with areas of spot reconstruction and repair drainage in addition to striping and signing. 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/ project(includingall prior phases) in the past? 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 MP 220 Station 31+10 1 a. Which sections were completed below for your project(check all that apply): ❑ Wetlands ❑X Streams—tributaries ❑ Buffers ❑ Open Waters ❑ Pond 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) Temporary T W1 - Choose one Choose one Yes/No - W2 - Choose one Choose one Yes/No W3 - Choose one Choose one Yes/No W4 - Choose one Choose one Yes/No W5 - Choose one Choose one Yes/No W6 - Choose one Choose one Yes/No 2g. Total Wetland Impacts: 2h. Comments: 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 Fill Trib to Mill Creek PER 4 6 S2 T Temporary Diversion 4 79 S3 - Choose one - S4 - Choose one - S5 - Choose one - S6 - Choose one - 3h. Total stream and tributary impacts 85 3i. Comments: The headwall will be replaced in-kind,resulting in no permanent impacts. Riprap will be placed at the outlet. A flexible tubing temporary diversion will be used during construction to divert stream flow. 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 indivi ually list all open water impacts 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 Temporary T 01 - Choose one Choose 02 - Choose one Choose 03 - Choose one Choose 04 - Choose one Choose 4f. Total open water impacts 4g. Comments: 5. Pond or Lake Construction If pond or lake construction proposed, the complete 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 Choose one 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 any impacts require mitigation, then you MUST fill out Section D of this form. 6a. Project is in which protected basin? ❑ Neuse ❑ Tar-Pamlico ❑ Catawba ❑ Randleman ❑ Other: 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 Temporary(T) feet) feet B1 Yes/No B2 - Yes/No B3 - Yes/No B4 - Yes/No B5 - Yes/No B6 - Yes/No 6h. Total Buffer Impacts: 6i. Comments: Page 5 of 10 C. Proposed Impacts Inventory 1. Impacts Summary Milepost 224 Station 19+34 1 a. Which sections were completed below for your project(check all that apply): ❑ Wetlands ❑X Streams—tributaries ❑ Buffers ❑ Open Waters ❑ Pond 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) Temporary T W1 - Choose one Choose one Yes/No - W2 - Choose one Choose one Yes/No W3 - Choose one Choose one Yes/No W4 - Choose one Choose one Yes/No W5 - Choose one Choose one Yes/No W6 - Choose one Choose one Yes/No 2g. Total Wetland Impacts: 2h. Comments: 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 Fill Trib to Big Pine Creek PER Corps 10 10.5 S2 T Diversion Berm 46 S3 - Choose one - S4 - Choose one - S5 - Choose one - S6 - Choose one - 3h. Total stream and tributary impacts 56.5 3i. Comments: Stone masonry headwall will be reset,resulting in no permanent impacts. Riprap will be placed. A temporary diversion berm will be installed during construction. 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 indivi ually list all open water impacts 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 Temporary T 01 - Choose one Choose 02 - Choose one Choose 03 - Choose one Choose 04 - Choose one Choose 4f. Total open water impacts 4g. Comments: 5. Pond or Lake Construction If pond or lake construction proposed, the complete 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 Choose one 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 any impacts require mitigation, then you MUST fill out Section D of this form. 6a. Project is in which protected basin? ❑ Neuse ❑ Tar-Pamlico ❑ Catawba ❑ Randleman ❑ Other: 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 Temporary(T) feet) feet B1 Yes/No B2 - Yes/No B3 - Yes/No B4 - Yes/No B5 - Yes/No B6 - Yes/No 6h. Total Buffer Impacts: 6i. Comments: Page 5 of 10 C. Proposed Impacts Inventory 1. Impacts Summary Milepost 224 Station 27+14 1 a. Which sections were completed below for your project(check all that apply): ❑ Wetlands ❑X Streams—tributaries ❑ Buffers ❑ Open Waters ❑ Pond 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) Temporary T W1 - Choose one Choose one Yes/No - W2 - Choose one Choose one Yes/No W3 - Choose one Choose one Yes/No W4 - Choose one Choose one Yes/No W5 - Choose one Choose one Yes/No W6 - Choose one Choose one Yes/No 2g. Total Wetland Impacts: 2h. Comments: 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 reset headwall/culvert Trib to Big Pine Creek PER Corps 2 0 S2 T Diversion Channel 43 S3 - Choose one - S4 - Choose one - S5 - Choose one - S6 - Choose one - 3h. Total stream and tributary impacts 43 3i. Comments: Stone masonry headwall will be reset and 18"culvert will be replaced with 24"culvert of the same length,resulting in no permanent impacts.A temporary diversion will be installed during construction.Countersinking of the outlet end of the pipe below channel profile would result in a steeply sloped pipe,which would increase velocity,exacerbate scour and not improve aquatic passage;therefore,it was not implemented. 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 indivi ually list all open water impacts 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 Temporary T 01 - Choose one Choose 02 - Choose one Choose 03 - Choose one Choose 04 - Choose one Choose 4f. Total open water impacts 4g. Comments: 5. Pond or Lake Construction If pond or lake construction proposed, the complete 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 Choose one 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 any impacts require mitigation, then you MUST fill out Section D of this form. 6a. Project is in which protected basin? ❑ Neuse ❑ Tar-Pamlico ❑ Catawba ❑ Randleman ❑ Other: 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 Temporary(T) feet) feet B1 Yes/No B2 - Yes/No B3 - Yes/No B4 - Yes/No B5 - Yes/No B6 - Yes/No 6h. Total Buffer Impacts: 6i. Comments: Page 5 of 10 C. Proposed Impacts Inventory 1. Impacts Summary Milepost 225 Station 24+18 1 a. Which sections were completed below for your project(check all that apply): ❑ Wetlands ❑X Streams—tributaries ❑ Buffers ❑ Open Waters ❑ Pond 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) Temporary T W1 - Choose one Choose one Yes/No - W2 - Choose one Choose one Yes/No W3 - Choose one Choose one Yes/No W4 - Choose one Choose one Yes/No W5 - Choose one Choose one Yes/No W6 - Choose one Choose one Yes/No 2g. Total Wetland Impacts: 2h. Comments: 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 Fill Trib to Big Pine Creek PER Corps 12 17 S2 T Diversion Berm 43 S3 - Choose one - S4 - Choose one - S5 - Choose one - S6 - Choose one - 3h. Total stream and tributary impacts 60 3i. Comments: Stone masonry headwall will be reset resulting in no permanent impacts. Riprap will be placed. A temporary diversion berm will be installed during construction. 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 indivi ually list all open water impacts 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 Temporary T 01 - Choose one Choose 02 - Choose one Choose 03 - Choose one Choose 04 - Choose one Choose 4f. Total open water impacts 4g. Comments: 5. Pond or Lake Construction If pond or lake construction proposed, the complete 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 Choose one 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 any impacts require mitigation, then you MUST fill out Section D of this form. 6a. Project is in which protected basin? ❑ Neuse ❑ Tar-Pamlico ❑ Catawba ❑ Randleman ❑ Other: 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 Temporary(T) feet) feet B1 Yes/No B2 - Yes/No B3 - Yes/No B4 - Yes/No B5 - Yes/No B6 - Yes/No 6h. Total Buffer Impacts: 6i. Comments: Page 5 of 10 C. Proposed Impacts Inventory 1. Impacts Summary Milepost 225, Station 34+33 1 a. Which sections were completed below for your project(check all that apply): ❑ Wetlands ❑X Streams—tributaries ❑ Buffers ❑ Open Waters ❑ Pond 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) Temporary T W1 - Choose one Choose one Yes/No - W2 - Choose one Choose one Yes/No W3 - Choose one Choose one Yes/No W4 - Choose one Choose one Yes/No W5 - Choose one Choose one Yes/No W6 - Choose one Choose one Yes/No 2g. Total Wetland Impacts: 2h. Comments: 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 Fill Trib to Big Pine Creek PER Corps 40 41 S2 T Temporary Diversion 95 S3 - Choose one - S4 - Choose one - S5 - Choose one - S6 - Choose one - 3h. Total stream and tributary impacts 136 3i. Comments: Riprap will be placed. A temporary diversion of flexible tubing will be installed during construction. 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 indivi ually list all open water impacts 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 Temporary T 01 - Choose one Choose 02 - Choose one Choose 03 - Choose one Choose 04 - Choose one Choose 4f. Total open water impacts 4g. Comments: 5. Pond or Lake Construction If pond or lake construction proposed, the complete 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 Choose one 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 any impacts require mitigation, then you MUST fill out Section D of this form. 6a. Project is in which protected basin? ❑ Neuse ❑ Tar-Pamlico ❑ Catawba ❑ Randleman ❑ Other: 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 Temporary(T) feet) feet B1 Yes/No B2 - Yes/No B3 - Yes/No B4 - Yes/No B5 - Yes/No B6 - Yes/No 6h. Total Buffer Impacts: 6i. Comments: Page 5 of 10 C. Proposed Impacts Inventory 1. Impacts Summary Milepost 226, Station 9+75 1 a. Which sections were completed below for your project(check all that apply): ❑ Wetlands ❑X Streams—tributaries ❑ Buffers ❑ Open Waters ❑ Pond 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) Temporary T W1 - Choose one Choose one Yes/No - W2 - Choose one Choose one Yes/No W3 - Choose one Choose one Yes/No W4 - Choose one Choose one Yes/No W5 - Choose one Choose one Yes/No W6 - Choose one Choose one Yes/No 2g. Total Wetland Impacts: 2h. Comments: 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 Fill Trib to Big Pine Creek PER Corps 9 11 S2 T Temporary Diversion 94 S3 - Choose one - S4 - Choose one - S5 - Choose one - S6 - Choose one - 3h. Total stream and tributary impacts 105 3i. Comments: The headwall will be reset, resulting in no permanent impacts. Riprap will be placed. A temporary diversion of flexible tubing will be installed during construction. 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 indivi ually list all open water impacts 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 Temporary T 01 - Choose one Choose 02 - Choose one Choose 03 - Choose one Choose 04 - Choose one Choose 4f. Total open water impacts 4g. Comments: 5. Pond or Lake Construction If pond or lake construction proposed, the complete 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 Choose one 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 any impacts require mitigation, then you MUST fill out Section D of this form. 6a. Project is in which protected basin? ❑ Neuse ❑ Tar-Pamlico ❑ Catawba ❑ Randleman ❑ Other: 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 Temporary(T) feet) feet B1 Yes/No B2 - Yes/No B3 - Yes/No B4 - Yes/No B5 - Yes/No B6 - Yes/No 6h. Total Buffer Impacts: 6i. Comments: Page 5 of 10 C. Proposed Impacts Inventory 1. Impacts Summary Milepost 226, Station 17+75 1 a. Which sections were completed below for your project(check all that apply): ❑ Wetlands ❑X Streams—tributaries ❑ Buffers ❑ Open Waters ❑ Pond 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) Temporary T W1 - Choose one Choose one Yes/No - W2 - Choose one Choose one Yes/No W3 - Choose one Choose one Yes/No W4 - Choose one Choose one Yes/No W5 - Choose one Choose one Yes/No W6 - Choose one Choose one Yes/No 2g. Total Wetland Impacts: 2h. Comments: 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 Fill Trib to Big Pine Creek PER Corps 10 10.5 S2 T Temporary Diversion 147 S3 - Choose one - S4 - Choose one - S5 - Choose one - S6 - Choose one - 3h. Total stream and tributary impacts 157.5 3i. Comments: The headwall will be extended and riprap will be placed. A temporary diversion of flexible tubing will be installed during construction. 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 indivi ually list all open water impacts 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 Temporary T 01 - Choose one Choose 02 - Choose one Choose 03 - Choose one Choose 04 - Choose one Choose 4f. Total open water impacts 4g. Comments: 5. Pond or Lake Construction If pond or lake construction proposed, the complete 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 Choose one 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 any impacts require mitigation, then you MUST fill out Section D of this form. 6a. Project is in which protected basin? ❑ Neuse ❑ Tar-Pamlico ❑ Catawba ❑ Randleman ❑ Other: 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 Temporary(T) feet) feet B1 Yes/No B2 - Yes/No B3 - Yes/No B4 - Yes/No B5 - Yes/No B6 - Yes/No 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. Repairs limited to what is needed to repair deterioration. 1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques. Diversion will be implemented and rolled erosion control product will be installed to minimize the transport of sediment from the site. 2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State 2a. Does the project require Compensatory Mitigation for ❑ Yes ❑X 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 ❑Corps ❑ Mitigation bank 2c. If yes, which mitigation option will be used for this El Payment to in-lieu fee program project? ❑ Permittee Responsible Mitigation 3. Complete if Using a Mitigation Bank 3a. Name of Mitigation Bank: Type: Choose one Quantity: 3b. Credits Purchased (attach receipt and letter) Type: Choose one Quantity: Type: Choose one Quantity: 3c. Comments: 4. Complete if Making a Payment to In-lieu Fee Program 4a.Approval letter from in-lieu fee program is attached. ❑ Yes 4b. Stream mitigation requested: linear feet 4c. If using stream mitigation, stream temperature: Choose one 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 ❑X 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 1a. Does the project include or is it adjacent to protected riparian buffers identified ❑ Yes X❑ No within one of the NC Riparian Buffer Protection Rules? 1 b. If yes, then is a diffuse flow plan included? If no, explain why. ❑ Yes ❑ No 2. Stormwater Management Plan 2a. What is the overall percent imperviousness of this project? 2b. Does this project require a Stormwater Management Plan? ❑Yes ❑X No 2c. If this project DOES NOT require a Stormwater Management Plan, explain why: No increase in impervious area. 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 localgovernment's jurisdiction is thisproject? n/a ❑ 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 Program 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 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 ❑X Yes ❑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. E]Yes ZNo Categorical exclusions for NPS and FHWA attached. 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. No wastewater will be generated from the proposed project. 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 ❑X Yes ❑ 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. - 5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat? National Park Service determined the project would have no effect on any federally-listed species. 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? 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 ❑X Yes ❑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? Blue Ridge Parkway is listed on the National Register. NPS determined the project meets criteria 3 for streamlined review under the 2008 Servicewide Programmatic Agreement. 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: 8c. What source(s)did you use to make the floodplain determination? FEMA Firm Map Applicant/Agent's Printed Name Applicant/Agent's Signature Date (Agent's signature is valid only if an authorization letter from the applicant is provided. Page 10 of 10