20171649 Ver 1_PCN Form Submission_20171221

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 12/20/2017 4:54:14 PM (Start Event)
Accept by Carpenter,Kristi 12/21/2017 2:34:54 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: December 25, 2017 5:00 PM
12/20/2017 4:54 PM

E-PCN Submittal
���
�lulslaa af Water Resources
Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
December 15, 2017 Ver 2.2
*
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.
Also, if at any point you wish to print a copy of the E-PCN, all you need to do is right-click on the document and you can print a copy of the form.
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? *(')
C�' Yes C' No
Is this a NCDOT Project?*
r Yes C' No
(NCDOT only) T.I.P. or state project number:
i U-5999
WBS #
� 47117.1.1
(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: 14 - Linear transportation
NWP Number Other:
List all MNnurrbers you are applying for not on the drop down list.
1c. Type(s) of approval sought from the DWR:*

check all that apply
ri 401 Water Quality Certification - Regular r 401 Water Quality Certification - E�ress
r Non-404 Jurisdictional General Permit 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: �' Yes C•' No
For the record only for Corps Permit: �' 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 l" No
Acceptance Letter Attachment
Gick the upload button or drag and drop files here to attach docurrent
i Kellie Dr Ext - Division 4- NS 01 - NWR (003).pdf 66.25KB
FlLE TYFE MJST BE FflF
1f. Is the project located in anyof NC's twentycoastal counties?*
C' Yes �' No
1h. Is the project located in a designated trout watershed?*
C' Yes C' No
Link to trout information: http://www.saw.usace.army.mil/Missions/Regulatory-Permit-PrograrrUAgency-Coordination/Trout.aspx
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 rJ Applicant (other than owner) r Agent/Consultant
(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
��
FUstal / Zip Code
State / Rovince / F�gion
Country

2e. Telephone Number:
(xxx)xxx-xxxx
2f. Fax Number:
(xxx)xxx-x�cx
2g. Email Address:*
[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)xxx-xxxx
3f. Fax Number:
(xxx)xxx-xxxx
3g. Email Address:*
i [e-mail]
State / Rovince / F�gion
NC
Country
USA
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Kellie Drive extension form Booker Dairy Road (SR 1923) to Buffalo Road
(SR 1003)
i 1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Smithfield
1d. Driving directions*

If it is a new project and can not easily be found in a GPS rrapping system Rease provide directions.
I Take US 70 north of Smithfield, NC to intersection with Buffalo Road (SR 1003). Turn west onto Buffalo Road (SR 1003) to intersection with
Booker Dairy Road (SR 1923). Turn east on Booker Dairy Road (SR 1923) and travel about 0.5 miles to a left hand turn onto Kellie Drive.
2. Project Identification
2a. Property Identification Number:
(t�vc RN or parcel ID)
2b. Propertysize:
(in acres)
2c. Project Address
Street Address
Address Line 2
��
F�stal / Zip Code
2d. Site coordinates in decimal degrees
State / Rovince / 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 example, 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:*
35.53170 -78.32439
ex:34.208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
unnamed tributary to the Neuse River
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:*
The site is mostly wooded. Land use to the south and east of the site is school campuses and public parks. Land
use to the north and west is forestry and agriculture.
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
U-5999 Topo Map.pdf 190.01 KB
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.
I (for DWR)

C7ick the upload button or drag and drop files here to attach docurrent
U-5999 Soil Map.pdf
Fle type rrust be pdF
4d. List the total estimated acreage of all existing wetlands on the property:
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
223.96KB
4f. Explain the purpose of the proposed project:*
The purpose of the project is to provide additional roadway connectivity to improve access to the educational
facilities and community resources located in the northern portion of the Town of Smithfield. These facilities
include: Smithfield — Selma Senior High School, Smithfield Middle School, the Neuse Charter School, Smithfield
Community Park, and the Smithfield Recreation and Aquatics Center.
4g. Describe the overall project in detail, including indirect imapacts and the type of equipment to be used:*
The North Carolina Department of Transportation (NCDOT) proposes to extend Kellie Drive from north of SR 1923
(Booker Dairy Road) to SR 1003 (Buffalo Road). Proposed improvements include extending Kellie Drive
appro�amately 0.62 mile along a new location alignment. The new roadway would be constructed primarily as two-
lane curb and gutter facility with 16-foot wide lanes and 5-foot wide sidewalks in each direction. At the intersection
with Buffalo Road, Kellie Drive will be widened to a three-lane facility with 12-foot wide lanes and an exclusive
southbound left turn lane. The project will also make improvements along a 390-foot long section of
Buffalo Road. These improvements consist of the addition of a southbound left turn lane and a northbound right
turn lane. Heavy land clearing and road building equipment including constructions of a culverted wetland crossing
would be used.
4h. Please upload project drawings for the proposed project.
C7ick the upload button or drag and drop files here to attach docurrent
U-5999 Project Plan.pdf 373.22KB
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:
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
C' Preliminary C' Approved C' Unknown C' 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:
Other
Chad Coggins
�[y�Z�SI
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Sd1. Jurisdictional determination upload
aick the upload button or drag and drop files here to attach docurrem
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 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
7a. Where are the impacts associated with your project? (check all that apply):
� 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* 2b. Impact type * 2c. Type of wetland*
Site 1
N�p label (e.g. I�ad Qossing 1- Qalvert,
dewatering, etc)
Site 1
N�p label (e.g. Fd�ad Q-ossing 1- QaNert,
dewatering, etc)
Site 1
N�p label (e.g. I�ad CYossing 1- CLlvert,
dewatering, etc)
P Headwater Forest
F�rrrenem (P� or
Terrporary (�
P Headwater Forest
F2rrranerd (P� or
Terrporary (�
T Headwater Forest
F�rrranent (P� or
Terrporary (�
2g. Total Temporary Wetland Impact
0.100
2g. Total Permanent Wetland Impact
0.420
2g. Total Wetland Impact
0.520
2h. Comments:
E. Impact Justification and Mitigation
1. Avoidance and Minimization
2d. Wetland name *Ze. 2f. Type of 2g. Impact
Forested* Jurisdicition* area*
Roadway Fill Yes Both 0.330
(404, 10) or CANR(401, (acres)
other)
Roadway Yes Both 0.090
Mechanized (404,10)orCMR(401, (acres)
Clearing other)
Roadway Hand Yes Both 0.100
Clearing (404, 10) or �(401, (acres)
other)
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
The roadway was designed to cross wetlands at right angles and at the narrowest point practicable in meeting the
purpose and need of the project.

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 C' No
2c. If yes, mitigation is required by (check all that apply):
r DWR rJ 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.
fJ Yes
4b. Stream mitigation requested:
(linear feet)
4c. If using stream mitigation, what is the stream temperature:
4d. Buffer mitigation requested (DWR only):
(squarefeet)
4e. Riparian wetland mitigation requested:
(acres)
4f. Non-riparian wetland mitigation requested:
(acres)
0.420
4g. Coastal (tidal) wetland mitigation requested:
(acres)
4h. Comments
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
""* Recent changes to the stormwater rules have required updates to this section .*'�
1. Diffuse Flow Plan
1a. 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
For a list of options to meet the diffuse flow requirements, click here.
If no, explain why:
Project is not located adjacent to any protected riparian buffers.
2. Stormwater Management Plan

2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
C� Yes C' No
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 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 �' No
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.
The proposed roadway project addresses current connectivity concerns (i.e. level of service traffic demands)
associated with area facilities including Selma Senior High School, Smithfield Middle School, the Neuse Charter
School, Smithfield Community Park, and the Smithfield Recreation and Aquatics Center.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project? *
C' Yes C' No C•' f�UA
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? *
r Yes c' No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
�' Yes �' No
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. Is another Federal agency involved?*
C' Yes C•' No
�' Unknown

5e. Is this a DOT project located within Division's 1-8?*
C' Yes C' No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
� NLEB-Slopes & apps / signed 1-30-2017
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? *
HEU clearance
7c. Historic or Prehistoric Information Upload
Gick the upload button or drag and drop files here to attach docurrent
17-08-0026 no survey.pdf 487.98KB
PA 17-08-0026.pdf 129.14KB
U-5999 APE e-mail.pdf 88.42K6
Fle rrust be FDF
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
8c. What source(s) did you use to make the floodplain determination?*
I FEMA Flood Map Service Center
Miscellaneous
Miscellaneous attachments not previously requested.
C7ick the upload button or drag and drop files here to attach docurrent
47117.1.1_Permit Drawings final.pdf 2.66MB
U-5999-bufferDeterm.pdf 179.59KB
Fle rrust be Ft7F
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
[lr�� ��a fr fr�!�I
� 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?*
C� Yes
C' No
BIMS # Assigned*
20171649
Version#*
Reviewing Office*
Central Office - [phone]
Select Project Reviewer*
Rob Ridings:eads\rgridings
Is a payment required for this project?*
C� No payment required
f Fee received
C' Fee needed - send electronic notification