20171375 Ver 1_PCN Form Submission_20171030

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 10/30/2017 12:25:35 PM (Start Event)
Accept by Carpenter,Kristi 10/30/2017 12:53:21 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: November 2, 2017 5:00 PM
10/30/2017 12:26 PM

�� �
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:*
Johnston
Is this a NCDOT Project?*
C� Yes �' No
(NCDOT only) T.I.P. or state project number:
U-5795
WBS #
4366.1.1
(for NCDOT 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)
r Regional General Permit (RGP)
Nationwide Permit (NWP) Number:
NWP Number Other:
List all MN nurrbers you are applying for not on the drop dow n list.
14 - Linear transportation
1c. Type(s) of approval sought from the DWR:*
check all that apply
� 401 Water Quality Certification - Regular
� Non-404 Jurisdictional General Permit
r 401 Water Quality Certification - Express
r Riparian Buffer Authorization
1d. Is this notification solelyfor the record because written approval is not required?
For the record only for DWR 401 Certification:
I For the record only for Corps Permit:
1e. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
*
l" Yes C•' No
C•' Yes C' No

If so, attach the acceptance letter from rritigation bank or in-lieu fee program
C' Yes C•' No
1f. Is the project located in any of NC's twenty coastal counties?*
C' Yes �' No
B. Applicant Information
1a. Who is the Primary Contact?*
Chad Coggins
1b. Primary Contact Email:*
[e-mail]
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
r Owner r% Applicant (other than owner) r AgenUConsultant
(Check all that apply)
2. Owner I nformation
2a. Name(s) on recorded deed:
State of NC
i 2b. Deed book and page no.:
2c. Responsible party:
(for Corporations)
2d.Address
Street Address
Address Line 2
�'
R�stal / Zip Code
2e. Telephone Number:
I(xxx)xxx-xxxx
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
I [e-mail]
3. Applicant Information (if different from owner)
3a. Applicant is:
G Agent
C' Other
If other please specify.
3b. Name:
Chad Coggins
3c. Business Name:
State / Rovince / F�gion
Country

(if applicable)
3d.Address
Street Address
PO Box 3165
Address Line 2
��
Wilson
Fbstal / Zip Code
27893
3e. Telephone Number:
[phone]
(xxx)x�c-�ocx
3f. Fax Number:
(xxx)xxx-xxxx
3g. Email Address:*
[e-mail]
State / Rovince / F�gion
NC
Country
USA
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
U-5795
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Selma
1d. Driving directions*
If it is a new project and can not easily be found in a C� rrapping system Rease provide directions.
195 to US70 esit West on US 70 1 st right is Ricks road
2. Project Identification
2a. Property Identification Number:
(t�uc RN or parcel ID)
2b. Propertysize:
(in acres)
2c. Project Address
Street Address
Address Line 2
Qty
Fbstal / Zip Code
State / Rovince / F�gion
Country
2d. Site coordinates in decimal degrees
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�cample, 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:*
I 35.52358 -78.29215
ex:34.208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
UT to Bawdy Creek
3b. Water Resources Classification of nearest receiving water:*
C NSW
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Neuse
RiverBasin 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:*
Urban with some agriculture and forestry within vicinity
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)
Gick the upload button or drag and drop files here to attach docurrent
U-5795 TOPO.pdf 675.72KB
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)
C7ick the upload button or drag and drop files here to attach docurrent
Fle type rrust be pdf
4d. List the total estimated acreage of all existing wetlands on the property:
0
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
70
4f. Explain the purpose of the proposed project:
The purpose of the project is to increase mobility and safety through the corridor
4g. Describe the overall project in detail, including the type of equipment to be used:
The project will add a center turn lane wiiich will provide a designated area for left turning vehicles for This will
increase safety by providing a sanctuary to left turning vehicles thus preventing rear end collisions as well as
increasing the mobility by removing the turning vehicles from the through lanes. Typical heavy road building
equipment will be used.
4h. Please upload project drawins for the proposed project.
Gick the upload button or drag and drop files here to attach docurrent
i U-5795_Permit Drawings_20171025.pdf 2.07M6
Fle type rrust be pdf
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
C� Yes �' No �' Unknown

Comments:
i NCDOT Div 4 DEO
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
C' Preliminary c" Approved r 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:
Chad Coggins
NCDOT
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5d1. Jurisdictional determination upload
Qick the upload button or drag and drop files here to attach docurrent
Fle type rrust be f�F
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 !' Unknown
7. Future Project Plans
7a. Is this a phased project?*
C' 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? 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 I m pacts I nventory
1. Impacts Summary
� 1a. Where are the impacts associated with your project? (check all that apply):
r Wetlands rJ Streams-tributaries r Buffers
� 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.

3a. Site #- 3b.lmpact 3c. Type of 3d. Stream 3e. Stream 3f. 3g. Stream 3h. Impact
Reason for type impact name Type Jurisdiction width length
impact type
Row1 Site1 P Fill UTto Intermittent Both Average 64
I�p label (e.g. F2rrrenent (� or Bawdy F2rennial (� or g (linear feet)
Finad C7ossing 1) Tenporary (� Creek interrrittent (IN� (feet)
*' All Perennial or Intermittent streams must be verified by DWR or delegated local government.
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
64
3i. Total temporary stream impacts:
0
3i. Total stream and tributary impacts:
64
3j. Comments:
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.
5. Pond or Lake Construction
If pond or lake construction is proposed, then complete the chart below.
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
I 1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
Leaving in existing crossing only extending pipe and fi�ang outlet conditions to contain increased flows.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Minimization efforts that will be implemented for this project include temporary
matting for slopes and ditchlines; ground cover and stabilization requirements meeting NPDES guidelines; and
minmizing drainage outlet velocities with minimal pipe slopes and rip-rap dissipator pads at pipe outlets, wtiere
applicable. Clearing and Grubbing as well as Final Grading erosion control plans have been prepared for this
project in order to minimize erosion and sediment during all phases of the project. Other erosion and sediment
control measures include using rock checks and wattles in ditchlines, installing rock inlet protection (or other
approved devices) at pipe and grate inlets, and installation of silt fence along slopes to contain runoff within the
project limits.
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:
under thresholds
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
� 1a. Does this project require a Stormwater Management Plan?
G Yes
C' No
1b. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
Minimization efforts that will be implemented for this project include temporary matting for slopes and ditchlines;
ground cover and stabilization requirements meeting NPDES guidelines; and minmiang drainage outlet velocities
with minimal pipe slopes and rip-rap dissipator pads at pipe outlets, where applicable. Clearing and Grubbing as
well as Final Grading erosion control plans have been prepared for this project in order to minimize erosion and
sediment during all phases of the project. Other erosion and sediment control measures include using rock checks
and wattles in ditchlines, installing rock inlet protection (or other approved devices) at pipe and grate inlets, and
installation of silt fence along slopes to contain runoff within the project limits.
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
�7 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
!•' No
If no, explain why:
no buffered stream present just an outfall ditch with an OHWM
5. DWR 401 Stormwater Review
5a. Is the Stormwater Management Plan (including BMP Supplemental Forms and Operation and Maintenance Agreements) attached?
�' Yes
C' No
Stormwater Management Plan Upload
C7ick the upload button or drag and drop files here to attach docurrent
U-5795_SMP.pdf
file type rrust be pdf
G. Supplementary Information
� 1. Environmental Documentation
33.1 KB
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 �' No
Comme nts: *
MCDC available upon request

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?*
C' 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
I nearby downstream water quality?*
C' Yes C•' No
3b. If you answered "no," provide a short narrative description.
just adding center turn lane to alleviate congestion and better through movements
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 wastewater generated
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 �' No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
C' Yes C•' No
5c. If yes, indicate the USFWS Field Office you have contacted.
5d. Is this a DOT project located within Division's 1-8?*
G Yes
C' No
5i. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
NCNHP and field surveys
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?*
GIS
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 history and archaeology)? *
�' Yes l" No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
NCDOT HEU Clearance
7c. Historic or Prehistoric Information Upload
C7ick the upload button or drag and drop files here to attach docurrent
Johnston SR 2302 No Survey form.pdf 4.O8MB
15-08-0017_NoEligibleProps.pdf 6.63M6
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:
8c. What source(s) did you use to make the floodplain determination?*
FRIS
Miscellaneous attachments not previously requested.
C7ick the upload button or drag and drop files here to attach docurrent
Fle rrust be FDF
Signature
___ ____ ___ ____ ___ _____.
*
fJ 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.
I Full Name:*
Chad Coggins
Signature
��r�1���Pjr,rlr�rJ
Date
10/30/2017
Initial Review
Is this project a public transportation project?

�' 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?*
�' Yes
C' No
BIMS # Assigned*
20171375
Version#*
Reviewing Office *
Central Office - [phone]
Select Project Reviewer*
Rob Ridings:eads\rgridings