20171524 Ver 1_PCN Form Submission_20171129

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 11 /29/2017 4:50:37 PM (Start Event)
Accept by Carpenter,Kristi 11/29/2017 5:30:15 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: December 4, 2017 5:00 PM
11 /29/2017 4:51 PM

�� �
6fvlslaa of Water Resources
Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
November 25, 2017 Ver 2.1
*
Please note: fields marked with a red asterisk below are required. You will not be able to submit the form until all mandatory questions are ans�red.
Below is a link to the online help file.
http://edocs.deq.nc.gov/WaterResources/0/doc/603610/Page1.aspx
A. Processing Information
County(or Counties) where the project is located:*
Johnston
Is this project a public transportation project? (?)
r Yes C' No
Is this a NCDOT Project?
C� Yes C' No
(NCDOT only) T.I.P. or state project number:
W-5601 DO
WBS #
50138.1.120
(for NCDOT use only)
7a. Type(s) of approval sought from the Corps:
ri 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?
rJ 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: C' Yes C•' No
For the record only for Corps Permit: r Yes r 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
i 1f. Is the project located in anyof NCs twentycoastal counties?*
C' Yes �' No
1h. Is the project located in a designated trout watershed?*
C� No
C' Yes
Link to trout information: http://v�uwv.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Agency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact?*
Chad Coggins
1b. PrimaryContact Email:*
I [e-mail]
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
� Owner rJ Applicant (other than owner) r AgenUConsultant
(Check all that apply)
2. Owner I nformation
2a. Name(s) on recorded deed:
State of North Carolina (NCDOT)
2b. Deed book and page no.:
2c. Responsible party:
(for Corporations)
2d.Address
Street Address
Address Line 2
��
F�stal / Zip Code
2e. Telephone Number:
(xxx)xxx-xxxx
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
State / Rovince / Region
Country

[e-mail]
3. Applicant Information (if different from owner)
3a. Applicant is:
C•' Agent
C' Other
If other please specify.
3b. Name:
Chad Coggins
3c. Business Name:
(if applicable)
NCDOT Div 4
3d.Address
Street Address
P.O. Box 3165
Address Line 2
��
Wilson
Fbstal / Zip Code
27828
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
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Intersection improvements US 70 and US 301 in Selma, Johnston Co.
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�5 rrapping system Rease provide directions.
Intersection of US 70 and US 301 in Selma, Johnston Co., NC
2. Project Identification
2a. Propertyldentification Number:
(tax RN or parcel ID)
2b. Propertysize:

i (in acres)
2c. Project Address
Street Address
Address Line 2
��
Fbstal / Zip Code
2d. Site coordinates in decimal degrees
SYate / R-ovince / Region
Country
I 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 example, most mobile phones with GPS provide locational precision in decimal degrees to
map coordinates to 5 or 6 digits after the decimal place.)
I Latitude:*
35.52498
ex:34208504
3. Surface Waters
Longitude:*
-78.29967
-77.796371
3a. Name of the nearest body of water to proposed project:*
Buffalo 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:*
Commercial retail development and community cemetery within the limits of the town of Selma
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)
C7ick the upload button or drag and drop files here to attach docurrent
W-5601 DO TOPO.pdf 837.94KB
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)
aick the upload button or drag and drop files here to attach docurrent
W-5601 DO Soils Map.pdf 522.73KB
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)
25
4f. Explain the purpose of the proposed project:

There have been an excessive number of angle (203), rear-end(193), sideswipe(93), and
left turn crashes(57). Safety improvements are expected to decrease the number of
crashes.
4g. Describe the overall project in detail, including the type of equipment to be used:
Construct a right turn lane on eastbound US 70 at US 301, improve radii in
southwest and southeast quadrants, replace distressed asphalt, install "To I-95 and To US
i to" route shield pavement markings on northbound US 301 approach, improve guide and
route signage.
4h. Please upload project drawings for the proposed project.
Gick the upload button or drag and drop files here to attach docurrent
Fle type rrust be pdf
5. Jurisdictional Determinations
5a. 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? *
f' Preliminary c" Approved r Unknown l" N/A
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
.[d�Z�SI
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5d1. Jurisdictional determination upload
aick the upload button or drag and drop files here to attach docurrem
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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 C' 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):
r Wetlands rJ Streams-tributaries rJ 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.
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 #- Reason 3b.lmpact 3c. Type of 3d. Stream name *
for impact* type* impact*
Site 1 existing 54" T Dewaterin Buffalo Creek
RCP F2rrranent (Fj g
Nt�p label (e.g. Id�ad or Terrporary
C7ossing 1) ��
3e. Stream Type * 3f. 3g. Stream 3h. Impact
Jurisdictior�idth* length*
type *
Intermittent Both 5 25
F2rennial (F8� or interrrittent Average (feet) (linear feet)
QfVn
"" 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:
0
3i. Total temporarystream impacts:
25
3i. Total stream and tributary impacts:
25
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.
6a. Project is in which protect basin(s)?*
Check all that apply.
fJ Neuse
r Catawba
r Goose Creek
r Other
r Tar-Pamlico
r Randleman
r Jordan Lake

6b. Impact Type *
6c. Per or 6d. Stream name *
Te mp *
Site 1 existing 54"RCP P Buffalo Creek
Location and C errpt, Allowable, allowable w/ rritigffiion F2rrranent (P) or
Terrporary (�
6h. Total buffer impacts:
Temporary impacts
Permanent impacts:
Total buffer impacts:
6i. Comments:
Zone 1
0.00
Zone 1
1, 572.00
Zone 1
1,572.00
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
C7ick the upload button or drag and drop files here to attach docurrent
W-5601D0 PERMIT 11-29-2017.pdf
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Zone 2
0.00
Zone 2
1,084.00
Zone 2
1,084.00
E. Impact Justification and Mitigation
� 1. Avoidance and Minimization
6e. Buffer 6f. Zone 1 6g. Zone 2
mitigation impact* impact*
required? *
No 1,572 1,084
(squarefeet) (squarefeet)
970.15KB
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
Used e�sting right-of-way and e�sting 54" RCP culvert without extending culvert or new road shoulder
encroachment into jurisdictional waters.
1b. Specificallydescribe measures taken to avoid or minimize the proposed impacts through construction techniques:*
All construction equipment will be staged and operated from upland areas. DOT will also install silt fencing to
protect the streams and wetlands adjacent to project, and safety fencing will be used to delineate
jurisdictional/environmentally sensitive areas.
' 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 r No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
i Belowthresholds for more than minor impact. Project includes only temporary stream channel impact for dewatering during project
construction.
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:
W-5601 DO is a state safety improvement project which involves the addition of a right-turn lane on US 70 through
Selma between I-95 and Wilson Mills. The e�asting facility is a four-lane divided roadway. The project includes an
ebsting jurisdictional stream crossing, closed system drainage, and roadside ditches. EC matting should be placed
along toe of fill through ewsting ditches to allow for swale treatment for flow entering jurisdictional area right of US
70 Business.
The proposed system (Str. 0416) could not outlet outside of the buffers because of insufficient fall into the existing
RT ditch. Deepening the ditch was not an option due to R/W constraints of this safety improvement project. The
e�asting outlet pipe could also not be retained due to insufficient drop. The outlet location inside the buffers is the
same as the existing condition, and a standard rip rap pad was used at outlet to dissipate energy and promote
diffuse flow into jurisdictional area.
The e�asting base ditch on the left of US 70 Business will replaced with 48" RCP-III to correct e�sting erosion and
slope degradation observed in the field.
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?
�' Yes
�' No
� 2b. All buffer impacts and high ground impacts require diffuse flow or other form of stormwater treatment. Include a plan that fully
documents how diffuse flow will be maintained.
If, due to site constraints, a BMP other than a level spreader is proposed, please provide a plan for stormwater treatment as outlined
in Chapter 8 of the NC Stormwater BMP Manual and attach a BMP Supplement Form
What documentation are you providing?
� Level Spreader
rJ Other BMP
(check all that apply)
Diffused Flow Documentation
Gick the upload button or drag and drop files here to attach docurrent
W.5601 DO Diffuse Flow Plan.pdf
Fle type rrust be FDF
5. DWR 401 Stormwater Review
145.62KB
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
W-5601 DO_HYD_SMP_20171128.pdf
file type rrust be pdf
G. Supplementary Information
I 1. Environmental Documentation
66.5KB
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
C' Yes C' 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
Comments:*
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 �' 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.
W-5601 DO is a state safety improvement project. There have been an excessive number of angle (203), rear-
end(193), sideswipe(93), and left turn crashes(57). Safety improvements are expected to decrease the number of
crashes. The project will not result in additional development or impact downstream water quality.
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? *
f Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
C' Yes �' No
5d. Is another Federal agency involved?*
C' Yes �' No
Se. Is this a DOT project located within Division's 1-8?*
C' Yes C' No
�' Unknown
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
GIS
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?*
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 historyand archaeology)?*
C' Yes C•' No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
NCHPO GIS web page
Impact are all in existing right-of-way.
7c. Historic or Prehistoric Information Upload
Qick the upload button or drag and drop files here to attach docurrent
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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 C•' No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?*
FEMA Flood Map Service Center
Miscellaneous attachments not previously requested.
qick the upload button or drag and drop files here to attach docurrent
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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:*
Chad Coggins
Signature
��r����o�r�r.�r.J
Date

� current date
Initial Review
Is this project a public transportation project? *(')
C� Yes C' No
Change only if needed.
Has this project met the requirements for acceptance in to the review process?*
r Yes
C' No
BIMS # Assigned*
20171524
Version#*
Reviewing Office *
Central Office - [phone]
Select Project Reviewer*
I Rob Ridings:eads\rgridings