20171577 Ver 1_PCN Form Submission_20171212

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 12/11 /2017 4:24:17 PM (Start Event)
Accept by Carpenter,Kristi 12/12/2017 11:03:28 AM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: December 14, 2017 5:00 PM
12/11/2017 4:24 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:
I-5786 Clearing
WBS #
53026.1. FS1
(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: C' 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 NC
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
PO Box 3165
Address Line 2
��
Wilson
Fbstal / Zip Code
27895
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:*
� I-5786 Clearing
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Micro
1d. Driving directions*
If it is a new project and can not easily be found in a C�5 rrapping system Rease provide directions.
I-95 Just North of Rest Area to Exit 105
2. Project Identification
2a. Propertyldentification Number:
(tax RN or parcel ID)
2b. Propertysize:

(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:*
35.54318
ex:34208504
3. Surface Waters
Longitude:*
-78.23637
-77.796371
3a. Name of the nearest body of water to proposed project:*
Burnt Stocking Branch, Little Creek, and Big Branch
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:*
I Rural
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
Sites 1-5.pdf 242.83KB
Site 1 Buffer.pdf 232.01KB
site 2 buffer.pdf 232.22KB
Site 3 wetland.pdf 211.7KB
Site 4 wetland and Buffer.pdf 191.21 KB
Site 5 Wetland and Buffer.pdf 196.23KB
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
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)
500
4f. Explain the purpose of the proposed project:
The I-5786 Project is a Interstate Paving Project along with median work. However NCDOT as an addition to this
project would like to clear and grub all vegetation 65' from edge of travel lane in order to provide a clear recovery
area for all vehicles that leave the transportation facility.
4g. Describe the overall project in detail, including the type of equipment to be used:
Forestry type equipment will be used
4h. Please upload project drawings for the proposed project.
C7ick the upload button or drag and drop files here to attach docurrent
I-5786 clearing Permit Drawings 12-11-2017.pdf 4.48MB
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:
NCDOT DEO delineation
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
C' Preliminary !' Approved C' Unknown C•' f�UA
Corps AID Number:
Exarrple: SAN�2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:
Chad Coggins
DEO
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
I Sd1. Jurisdictional determination upload
qick 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 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 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 r7 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.
i 2a. Site #- Reason for 2b. Impact type * 2c. Type of wetland * 2d. Wetland name * 2e. 2f. 2g. Impact
impact* Forested* Jurisdiction area*
type *
ISite 3 MC P Headwater Forest Site 3 Yes Both 0.030
Nl�p label (e.g. fd�ad Qossing 1) F2rrrsnent (Fj or Terrporary (404, 10) or C7JVR (acres)
(� (401, other)
Site 4 MC P Riverine Swamp Forest Site 4 Yes Both 0.020
N�p label (e.g. Finad C7ossing 1) F�rrranent (P) or Terrporary (404, 10) or C7�NR (acres)
(� (401, other)
Site 5 MC P Riverine Swamp Forest Site 5 Yes Both 0.090
N�p label (e.g. F�ad Qassing 1) F�rrranent (P) or Terrporary (404, 10) or GNR (acres)
(� (401, other)
site 5 HC T Riverine Swamp Forest Site 5 Yes Both 0.450
Nl�p label (e.g. Finad Qossing 1) F2rrranent (F) or Terrporary (404, 10) or dJVR (acres)
(� (401, other)
2g. Total Temporary Wetland Impact
0.450
2g. Total Permanent Wetland Impact
0.140
I 2g. Total Wetland Impact
0.590
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.
'* 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.
6a. Project is in which protect basin(s)?*
Check all that apply.
rJ Neuse r Tar-Pamlico
� Catawba r Randleman
� Goose Creek r Jordan Lake
r Other
6b. Impact Type * 6c. Per or 6d. Stream name * 6e. Buffer 6f. Zone 1 6g. Zone 2
Temp* mitigation impact* impact*
required? *
Site 1 Allowable P Burnt Stocking Branch No 2,476 1,800
Location and 6cerrpt, Allowable, allowable w/ rritigation F�rrranent (F) or (square feet) (square feet)
Terrporary (�
Site 2 Allowable P Little Creek No 1,262 2,385
Location and 6cerrpt, Allowable, allowable w/ rritigation F2rrranent (F) or (square feet) (square feet)
Terrporary (�
Site 4 Allowable P UT to Big Branch No 7,901 5,288
Location and 6cerrpt, Allowable, allowable w/ rritigation F2rrranent (Fj or (square feet) (square feet)
Terrporary (�
Site 5 Allowable P Big Branch No 10,125 7,083
Location and 6cerrpt, Allowable, allowable w/ rritigation F�rrrenent (F) or (square feet) (square feet)
Terrporary (�
6h. Total buffer impacts:
Temporary impacts:
Permanent impacts:
Total buffer impacts
6i. Comments:
Zone 1 Zone 2
0.00 0.00
Zone 1
21,764.00
Zone 1
21,764.00
Zone 2
16,556.00
Zone 2
16,556.00
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
qick the upload button or drag and drop files here to attach docurrent
I-5786 clearing Permit Drawings 12-11-2017.pdf
Fle rrust be FDF
E. Impact Justification and Mitigation
1. Avoidance and Minimization
4.48MB
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
Original idea was clear and grub to right of way wfiich would have triggered mitigation needs at site 5 so from there
we decided on 65' feet from travel lane wfiich satisfies The Policy on Geometric Design of Highways 2011 "The
Green Book." At Site 5 however mechanized clearing will be reduces to 50' from edge of travel lane in order to
stay below mitigation threshold.

1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
I 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 �' No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
Minimization efforts as described above will be implemented in order in remain under mitigation thresholds.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1a. Does this project require a Stormwater Management Plan?
C' Yes C•' No
1e. If this project DOES NOT require a Stormwater Management Plan, explain why:
Just clearing
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
Rules?
C' Yes �' No
If no, explain why:
Just Clearing
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?*
r Yes l" 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:*
CE 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
nearby downstream water quality?*
C' Yes �' No
3b. If you answered "no," provide a short narrative description.
Just clearing for safety
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.
na
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 G No
Sb. Have you checked with the USFWS concerning Endangered Species Act impacts?*
C' Yes �' No
5d. Is another Federal agency involved?*
C' Yes C•' No
5e. Is this a DOT project located within Division's 1-8?*
C� Yes C' No
C' Unknown
Sj. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
RCW foraging habitat was present within impact area. However no nesting habitat was found within impact area or
within 0.5 miles of the impact area. No NCNHP records are known within 1 mile of the project. Therefore Biological
conclusion is No affect.
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)? *
C' Yes C•' No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources? *
Within R/W
7c. Historic or Prehistoric Information Upload
C7ick 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?*
FRIS
Miscellaneous attachments not previously requested.
Gick the upload button or drag and drop files here to attach docurrent
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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.
� Full Name:*
Chad Coggins
Signature
[:•!r�l�����r�c�<I
Date :
current date
Initial Review
Is this project a public transportation project? *(')
�' 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*
20171577
Version#*
1
Reviewing Office *
Central Office - [phone]
Select Project Reviewer*
Rob Ridings:eads\rgridings