20171306 Ver 1_PCN Form Submission_20171016

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 10/16/2017 7:55:23 AM (Start Event)
Accept by Carpenter,Kristi 10/16/2017 2:40:01 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: October 19, 2017 5:00 PM
10/16/2017 7:56 AM

�� �
6fvlslaa of Water Resources
Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
June 28, 2017 Ver 1.8
*
Please note: fields marked with a red asterisk below are required. You will not be ab/e to submit the form until all mandatory questions are ans�red.
Below is a link to the DRAFT online help file. http://edocs.deq.nc.gov/WaterResources/0/doc/549884/Page1.aspx
A. Processing Information
County (or Counties) where the project is located:*
Tyrrell
Is this a NCDOT Project?*
C� Yes �' No
(NCDOT only) T.I.P. or state project number:
WBS #
35492.4.S2
(for f�1CDOT use only)
� 1a. Type(s) of approval sought from the Corps:*
rJ Section 404 Permit (wetlands, streams and waters, Clean Water Act)
r Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What type(s) of permit(s) do you wish to seek authorization?*
fJ Nationwide Permit (NWP)
fJ Regional General Permit (RGP)
Nationwide Permit (NWP) Number:
NWP Number Other:
List all MN nurrbers you are applying for not on the drop down list.
Regional General Permit (RGP) Number:
RGP Number Other:
13 - Bank Stabilization
198200277 - Man-made Basins and Canals
List all RGP nurrbers you are applying for not on the drop dow n list.
1c. Type(s) of approval sought from the DWR:*
check all that apply
ri 401 Water Quality Certification - Regular
� Non-404 Jurisdictional General Permit
r 401 Water Quality Certification - E�ress
r Riparian Buffer Authorization

*
1d. Is this notification solelyfor the record because written approval is not required?
IFor the record only for DWR 401 Certification: �' Yes C' No
i For the record only for Corps Permit: C' Yes C� No
1e. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
If so, attach the acceptance letter from rritigation bank or in-lieu fee program
C' Yes C•' No
1f. Is the project located in anyof NC's twentycoastal counties?*
�' Yes �' No
1g. Is the project located within a NC DCM Area of Environmental Concern (AEC)?*
C� Yes C' No C' Unknown
B. Applicant Information
1a. Who is the Primary Contact?*
Paul Williams
1b. Primary Contact Email:*
[e-mail]
1c. PrimaryContact Phone:*
(xxx)x�c-x�cx
[phone]
1d. Who is applying for the permit?
r Owner rJ Applicant (other than owner) r Agent/Consultant
(Check all that apply)
2. Owner I nformation
2a. Name(s) on recorded deed:
NCDOT Right-of-Way SR 1225 - Tyrrell County
2b. Deed book and page no.:
2c. Responsible party:
I(for Corporations)
2d.Address
Street Address
Address Line 2
a�y
Fbstal / Zip Code
2e. Telephone Number:
(xxx)x�c-�ocx
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
State / R-ovince / F�gion
Country

3a. Applicant is:
C' Agent
C� Other NCDOT Division 1 Environmental Specialist
If other please specify.
3b. Name:
I Paul Williams
3c. Business Name:
(if applicable)
i NCDOT
3d.Address
Street Address
113 Airport Dr.
Address Line 2
��
Edenton
Fbstal / Zip Code
27932
3e. Telephone Number:
[phone]
(xxx)xxx-x�cx
3f. Fax Number:
[phone]
(xxx)xxx-xxxx
3g. Email Address:*
[e-mail]
State / FYovince / F�gion
NC
Country
USA
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Palmetto Peartree Preserve Canal Maintenance
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Columbia
1d. Driving directions*
If it is a new project and can not easily be found in a GPS rrapping system Rease provide directions.
At the end of SR 1225 Pledger Harbor Road.
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)
2b. Propertysize:
(in acres)
1

2c. Project Address
Street Address
Address Line 2
�Y
Fbstal / Zip Code
2d. Site coordinates in decimal degrees
State / R-ovince / F�gion
Country
Please collect site coordinates in decimal degrees. Use between 4-6 digits (unless you are using a survey-grade GPS device) after the decimal place as
appropriate, based on howthe location was determined. (For e�mple, most mobile phones with GPS provide locational precision in decimal degrees to
map coordinates to 5 or 6 digits after the decimal place.)
Latitude:* Longitude:*
35.990188 -76.069588
ex:34208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Albemarle Sound
3b. Water Resources Classification of nearest receiving water:*
SB
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Pasquotank
River Basin Lookup
4. Project Description
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:*
' Project area consist of NCDOT SR 1225 and roadside canal. The adjacent property use is conservation land
(Palmetto Peartree Preserve). Site is on the shore of the Albemarle Sound.
4b. Attach an 8 1/2 X 11 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for
DWR)
qick the upload button or drag and drop files here to attach docurrent
Location Map.pdf 943.03KB
Fle type rrust be pdf
4c. Attach an 8 1/2 X 11 excerpt from the most recent version of the published County NRCS Soil Survey map depicting the project site.
(for DWR)
Gick the upload button or drag and drop files here to attach docurrent
Soil Map.pdf 460.33KB
Fle type rrust be pdf
4d. List the total estimated acreage of all existing wetlands on the property:
.5
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
200
4f. Explain the purpose of the proposed project:

Restore drainage for this part of Palmetto Peartree Preserve to protect RCW habitat and prevent flooding in the
nearby Goat Neck community.
4g. Describe the overall project in detail, including the type of equipment to be used:
Excavate appro�amately 174.2 yards of sand, soil, and root mass to reconnect the roadside canal to the Albemarle
Sound. Excavation will be limited to 2 feet below NHW to match the bed of the Albemarle Sound. In order to
stabilize the canal banks connecting to the sound, Class II stone will be placed on a total of 60 linear feet of the
canal. This work will be accomplished using tracked excavator, backhoe, and dump trucks.
4h. Please upload project drawins for the proposed project.
C7ick the upload button or drag and drop files here to attach docurrent
P3 Canal Maintenance.pdf 66.02KB
Fle type rrust be pdf
5. Jurisdictional Determinations
Sa. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
C� Yes C' No !' Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
C� Preliminary C' Approved C' Unknown
Corps AID Number:
Exarrple: SAV�2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:
NCDOT
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5d1. Jurisdictional determination upload
C7ick the upload button or drag and drop files here to attach docurrent
Fle type rrust be FDF
6. Project History
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past?*
C' Yes C' No f Unknown
7. Future Project Plans
7a. Is this a phased project?*
C' Yes C•' 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? This includes other separate and distant crossing for linear projects that require Department of the
Army authorization but don't require pre-construction notification.
D. Proposed Impacts Inventory

1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
� Wetlands r Streams-tributaries r Buffers
r7 Open Waters r Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
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.
*' All Perennial or Intermittent streams must be verified by DWR or delegated local government.
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 individually list
all open water impacts below.
4a. Site #- Reason for 4b. Impact 4c. Name of waterbody 4d. Activity 4e. Waterbody4f. Impact area
impact type type type
Canal excavation P unnamed roadside canal Excavation Ditch 0.03
fv�p label (e.g. 13�ad CXossing 1) F�rrrenent (�j or (if applicable) (acres)
Terrporary (�
Excavation on P Albemarle Sound
Shoreline F�rrranent(P)or (ifapplicable)
N�p label (e.g. Road Qassing 1) Terrporary (�
Canal bank stabilization P unnamed roadside canal
N�p label (e.g. fd�ad Qossing 1) F�rrranerd (P� or (if applicable)
Terrporary (�
Shoreline stabilization P Albemarle Sound
N�p label (e.g. Road Qassing 1) F2rrranent (Pj or (if applicable)
Terrporary (Tj
4g. Total temporary open water Impacts:
0.00
4g. Total permanent open water impacts:
0.06
4g. Total open water impacts:
0.06
Excavation Sound
Stabilization Ditch
Stabilization Sound
4h. Comments:
Bank stabilization will be total of 60 linear feet on both canal banks and total of 12 linear feet on the sound
shoreline.
5. Pond or Lake Construction
If pond or lake construction is proposed, then complete the chart below.
0.01
(acres)
0.01
(acres)
0.01
(acres)
6. Buffer Impacts (for DWR)
If project will impact a protected riparian buffer, then complete the chart below. Individually list all buffer impacts below.

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:*
Excavation will match the width of the existing canal, and the depth of the excavation will only extend down to the
depth of the adjacent bed of the sound.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
NCDOT BMP's will be followed during project and erosion control devices will be installed to
prevent sediment loss from the project 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 impacts to Waters of the U.S. or Waters of the State?
C' Yes
C•' No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
Impacts are belowthe threshold requiring mitigation.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1a. Does this project require a Stormwater Management Plan?
C� Yes
�' No
1b. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
NCDOT will follow best management practices for soil and erosion control in compliance with N.C. Sediment and
Pollution Control Act and NCDOT NPDES permit. Erosion control devices will be installed and maintained during
the project.
1c. What is the overall percent imperviousness of this project?
%
1d. Who will be responsible for the review of the Stormwater Management Plan?*
r Certified Local Government
r DWR 401 & Buffer Permitting Branch
2. Diffuse Flow Plan
r DEMLR Stormwater Review
�J DWR Transportation Permitting Branch
2a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection
Rules?
C' Yes
C•' No
If no, explain why:
I Pasquotank River Basin not subject to NC Riparian Buffer Protection Rules.
5. DWR 401 Stormwater Review
5a. Is the Stormwater Management Plan (including BMP Supplemental Forms and Operation and Maintenance Agreements) attached?
C' Yes �' No
Stormwater Management Plan Upload
Gick the upload button or drag and drop files here to attach docurrent
file type rrust be pdf
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?*
C� 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 PolicyAct (NEPA/SEPA)?*
C' Yes C•' No
Comments:*
Activity and impacts covered by Minimum Criteria Checklist.
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)? *
C' Yes C•' No
2b. Is this an after-the-fact permit application?*
f Yes C•' No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWR Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in additional development, which could impact
nearby downstream water quality?*
C' Yes �' No
3b. If you answered "no," provide a short narrative description.
Adjacent property is Palmetto Peartree Preserve, and will not be developed.
4. Sewage Disposal (DWR Requirement)
4a. Describe, in detail, the treatment methods and dispositions (non-discharge or discharge) of wastewater generated from the
proposed project. If the wastewater will be treated at a treatment plant, list the capacity available at that plant.
No waste water will be generated from this project.
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?*
C� Yes C' No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
G Yes C' No
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. Is this a DOT project located within Division's 1-8?*
C� Yes
C' No
Si. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
NC Natural Heritage Data Explorer Website

6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
C' Yes �' No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
National Marine Fisheries Database
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data: http://gis.ncdcr.gov/hpoweb/
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 (e.g., National Historic Trust designation or properties significant in North Carolina historyand archaeology)?*
C' Yes C•' No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
State Historic Preservation Office Historic Properties Map Website
7c. Historic or Prehistoric Information Upload
Gick the upload button or drag and drop files here to attach docurrent
I B640120274104.pdf 8.91 MB
Fle rrust be F�F
8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https://msc.fema.gov/portal/search
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
C� Yes �' No
8b. If yes, explain how project meets FEMA requirements:
n/a
8c. What source(s) did you use to make the floodplain determination?*
NCFloodmaps.com
Miscellaneous attachments not previously requested.
C7ick the upload button or drag and drop files here to attach docurrent
P3 Canal Project Aerial - Canal Connections.pdf 1.37MB
USACE Request Letter.pdf 55.72KB
Comments.pdf 189.27KB
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Signature
*
rJ By checking the box and signing below, I certify that:
■ 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 AcY');
■ I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic
Transactions AcY');
■ 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:*

Paul Collins Williams, Jr.
Signature
c���,/C �/Ira...� 1/J.//r���r.; . r �.
Date
10/16/2017
Initial Review
Is this project a public transportation project?
C� Yes C' No
Only change this if the project has been reassigned.
Has this project met the requirements for acceptance in to the review process?*
C� Yes
C' No
BIMS # Assigned*
20171306
Version#*
Reviewing Office *
Washington Regional Office - [phone]
Select Project Reviewer*
Garcy Ward:eads\gpward