20141132 Ver 2_PCN Form Submission_20171030

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 10/30/2017 3:30:27 PM (Start Event)
Accept by Carpenter,Kristi 10/30/2017 5:16:33 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: November 2, 2017 5:00 PM
10/30/2017 3:31 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:*
Richmond
Is this a NCDOT Project?*
C� Yes �' No
(NCDOT only) T.I.P. or state project number:
i R-2501 C
WBS #
34437.2.3
(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:
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
�' Yes C' No
Acceptance Letter Attachment
C7ick the upload button or drag and drop files here to attach docurrent
R-2501C EEP Letter.pdf 330.3KB
FlLE IYFE MJST BE FDF
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?*
NCDOT
1b. Primary Contact Email:*
[e-mail]
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
rJ Owner r Applicant (other than owner) r AgenUConsultant
(Check all that apply)
2. Owner I nformation
2a. Name(s) on recorded deed:
2b. Deed book and page no.:
2c. Responsible party:
(for Corporations)
2d.Address
Street Address
Address Line 2
��
Fbstal / Zip Code
2e. Telephone Number:
(xxx)xxx-xxxx
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
State / Rovince / F�gion
Country
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*

Widening of US 1 from 1.2 miles north of SR 1606 to south of SR 1001
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Rockingham
1d. Driving directions*
If it is a new project and can not easily be found in a C�5 rrapping system Rease provide directions.
Coordinates: 34.973921, -79.624365
2. Project Identification
i 2a. Property Identification Number:
(tax RN or parcel ID)
2b. Propertysize:
(in acres)
2c. Project Address
Street Address
Address Line 2
a�y
Fbstal / Zip Code
State / FYovince / 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:*
34.973921
ex:34208G04
3. Surface Waters
Longitude:*
-79.624365
-77.796371
3a. Name of the nearest body of water to proposed project:*
UT Chock Creek
3b. Water Resources Classification of nearest receiving water:*
WSIII
i Surface Water Lookup
3c. What river basin(s) is your project located in?*
I Yadkin-PeeDee
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:*
Land use within the vicinity is predominately residential but includes some areas of general commercial use.

4b. Attach an 8 1/2 X 17 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
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
Fle type rrust be pdF
4d. List the total estimated acreage of all existing wetlands on the property:
0.25 acres
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
0 feet
4f. Explain the purpose of the proposed project:
To reduce congestion in downtown Rockingham by diverting through traffic and truck traffic from local streets and
improve mobility on the designated US 1 Strategic Highway Corridor.
4g. Describe the overall project in detail, including the type of equipment to be used:
The project involves widening US 1 to a five-lane facility from north of Fox Road (SR 1606) to the northern
terminus at Marston Road (SR 1001). The proposed project is approximately 3.6 miles long. Standard road
building equipment, such as trucks, dozers, and cranes 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
R-2501C Permit Plans Package.pdf 16.92MB
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 C' 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:
6carrple: SAV�2017-99999
SAW-1995-00459
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:
Jeff Benton
ESI
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
August 17, 2011
5d1. Jurisdictional determination upload

C7ick the upload button or drag and drop files here to attach docurrent
R-2501 USACE JD.pdf
Fle type rrust be FDF
6. Project History
883.65KB
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past?*
C� Yes C' No C' Unknown
6b. If yes, please give the DWR Certification number or the Corps Action ID (exp. SAW-0000-00000).
DWR - 20141132v.1
USACE - SAW-1995-00459
Project History Upload
C7ick the upload button or drag and drop files here to attach docurrent
R-2501 C 401 Permit.pdf
R-2501 C 404 NW 14 Permit.pdf
Fle type rrust be FDF
7. Future Project Plans
7a. Is this a phased project?*
C' Yes C•' No
238.3KB
720KB
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 r Streams-tributaries r Buffers
r 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.
2a. Site # - Reason for
impact
1 - mechanized clearing
N�p label (e.g. 13�ad CYossing 1)
1- fill
N�p label (e.g. Fd�ad Qossing 1)
2 - mechanized clearing
N�p label (e.g. Road Qassing 1)
2 - fill
fv�p label (e.g. I�ad CYossing 1)
2b. Impact type * 2c. Type of wetland
P Headwater Forest
F�rrranent (� or Terrporary
��
P Headwater Forest
F�rrranent (P� or Terrporary
��
P Headwater Forest
F2rrranent (Pj or Terrporary
��
P Headwater Forest
F2rrranent (� or Terrporary
��
2g. Temporary Wetland Impact
0.000
2d. Wetland name 2e. Forested 2f. 2g. Impact
Jurisdiction area
type
Yes Corps 0.040
(404, 10) or CT�NR (acres)
(401, other)
Yes Corps 0.030
(404, 10) or C1�NR (acres)
(401, other)
Yes Corps 0.100
(404, 10) or CMR (acres)
(401, other)
Yes Corps 0.080
(404, 10) or C7JVR (acres)
(401, other)

2g. Permanent Wetland Impact
0.250
2g. Total Wetland Impact
0.250
2h. Comments:
Impacts have not changed from the previously issued permits.
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
I 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.
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
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
Where possible shifting the alignment was incorporated to avoid water resources, crossing streams
perpendicularly, or crossing the narrowest areas of wetland systems. The project involves widening
an e�asting road. Other than no build the minimal effects to one wetland on this project is unavoidable.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
NCDOT Best Management Practices for Construction and Maintenance Activities and Best Management Practices
for the Protection of Surface Waters will be employed.
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?
�' Yes �' No
2c. If yes, mitigation is required by (check all that apply):
r DWR �J Corps
2d. If yes, which mitigation option(s) will be used for this project?
r Mitigation bank �J Payment to in-lieu fee program r Permittee Responsible Mitigation
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached.
�J Yes

4b. Stream mitigation requested:
(linear feet)
4c. If using stream mitigation, stream temperature:
4d. Buffer mitigation requested (DWR only):
(square feet)
4e. Riparian wetland mitigation requested:
(acres)
0.25
4f. Non-riparian wetland mitigation requested:
(acres)
4g. Coastal (tidal) wetland mitigation requested:
(acres)
4h. Comments
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1a. Does this project require a Stormwater Management Plan?
C�' Yes c' No
1b. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
See attached Permit Drawings
1c. What is the overall percent imperviousness of this project?
%
I 1d. Who will be responsible for the review of the Stormwater Management Plan?*
r Certified Local Government r DEMLR Stormwater Review
r DWR 401 & Buffer Permitting Branch �J DWR Transportation Permitting Branch
2. Diffuse Flow Plan
2a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection
i Rules?
C' Yes �' No
If no, explain why:
Not in a buffer basin - Yadkin Pee Dee
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
aick 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
1c. 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
NEPAor SEPAfinal approval letter.)*
C� Yes C' No
NEPAor SEPAFinal Approval Letter
aick the upload button or drag and drop files here to attach docurrem
FlLE TYFE MJST BE F�F
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 �' 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
nearby downstream water quality?*
C' Yes �' No
3b. If you answered "no," provide a short narrative description.
Due to the minimal transportation impact resulting from this widening, this project will neither influence nearby land
uses nor stimulate growth. Therefore, a detailed indirect or cumulative effects study will not be necessary.
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.
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
Sb. Have you checked with the USFWS concerning Endangered Species Act impacts?*
C� Yes C' No
Sc. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. Is this a DOT project located within Division's 1-8?*
�' Yes
C' No
5i. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*

NC Natural Heritage Program data, and USFWS website. NCDOT has received USFWS concurrence. National
Marine Fisheries and Division of Marine Fisheries agreed with the No Effect calls for the shortnose sturgeon and
Atlantic sturgeon made by NCDOT.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
C' Yes C•' No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
I NMFS County Index
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? *
NEPA Documentation
7c. Historic or Prehistoric Information Upload
qick the upload button or drag and drop files here to attach docurrent
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:
NCDOT Hydraulic Unit coordination with FEMA
8c. What source(s) did you use to make the floodplain determination?*
FEMA Maps
Miscellaneous attachments not previously requested.
C7ick the upload button or drag and drop files here to attach docurrent
USFWS Concurrence.pdf
Fle rrust be Ft7F
Signature
*
fJ By checking the box and signing below, I certify that:
913.13KB
. 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:*
Colin Mellor
Signature
Col� ��Ilc�r
Date
10/30/2017
Initial Review
Is this project a public transportation project?
r 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*
20141132
Version#*
2
Reviewing Office *
Central Office - [phone]
Select Project Reviewer*
April Norton:eads\arnorton