20180027 Ver 1_PCN Form Submission_20180105

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 1/5/2018 1:48:56 PM (Start Event)
Accept by Carpenter,Kristi 1/5/2018 2:58:54 PM (DOT Initial Review)
* Lat/Long provided is set in BIMS as outside North Carolina. Emailed Clay Willis requesting a
verification of that information.
• The task was assigned to Carpenter,Kristi . The due date is: January 10, 2018 5:00 PM
1 /5/2018 1:49 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:*
Perquimans
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:
R-5716
WBS #
50212.1.1
(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 �' No
1f. Is the project located in anyof NC's twentycoastal counties?*
C� Yes �' No
1g. Is the project located within a NC DCM Area of Environmental Concern (AEC)?*
f Yes C•' No C' Unknown
1h. Is the project located in a designated trout watershed?*
C' Yes �' No
Link to trout information: http://�wwv.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Agency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact?*
Clay Willis
1b. Primary Contact Email:*
[e-mail]
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
fJ Owner r Applicant (other than owner) r Agent/Consultant
(Check all that apply)
2. Owner I nformation
2a. Name(s) on recorded deed:
NCDOT
2b. Deed book and page no.:
NCDOT ROW on SR 1300 New Fbpe Road
2c. Responsible party:
(for Corporations)
i NCDOT - Division One
2d.Address

Street Address
118 Airport Drive, Suite 100
Address Line 2
Qty
Edenton
Fbstal / Zip Code
27932
2e. Telephone Number:
(xxx)xxx-xxxx
[phone]
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
State / R-ovince / I�gion
NC
Country
USA
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
i R-5716 widening SR 1300 New Hope Road
1b. Subdivision name:
(if appropriate)
none
1c. Nearest municipality/town:*
Hertford
1d. Driving directions*
If it is a new project and can not easily be found in a GPS rrapping system Rease provide directions.
Travel North on US 17 to Hertford, turn right on SR 1300 New Flope Road. Project begins at the intersection of SR 1300 and SR 1302, then
extends to SR 1303.
2. Project Identification
2a. Propertyldentification Number:
(tax RN or parcel ID)
NCDOT ROW on SR 1300
2b. Propertysize:
(in acres)
10 acres
2c. Project Address
Street Address
SR 1300 New Hope Road, between the intersection of SR 1302 and SR 1303
Address Line 2
��
Hertford
Fbstal / Zip Code
27944
2d. Site coordinates in decimal degrees
State / Rovince / F�gion
NC
Country
USA

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:*
39.1916 -76.3916
ex:34208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Sutton Creek
3b. Water Resources Classification of nearest receiving water:*
C, Sw
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Pasquotank
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 land use in the area is primarily agriculture and silviculture with rural residential housing. SR 1300 (New Hope
Road) is currently a 18 ft. wide paved surface with 2-4 shoulders. This route carries most of the traffic accessing
this portion of Perquimans County and provides access to US Highway 17. The project area also contains Sutton
Creek, which drains to the Perquimans river, approximately 2 miles down stream.
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
location_topo_map. pdf
Fle type rrust be pdF
984.16KB
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
NRCS_Soil_Map.pdf
Fle type rrust be pdf
4d. List the total estimated acreage of all existing wetlands on the property:
0.40 acres
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
100 feet
803.95KB
4f. Explain the purpose of the proposed project:*
The purpose of this project is to improve safety by widening an existing 18 ft. paved surface roadway to 22 ft. This
route is the primary corridor for citizens in this part of Perquimans county. The road e�eriences tractor trailer
usage associated with the agriculture industry and the current narrow roadway creates unsafe conditions for the
volume of traffic.
4g. Describe the overall project in detail, including indirect imapacts and the type of equipment to be used:*

This project involves the widening of a tv�ro lane secondary road from 18 feet to 22 feet of asphalt surface, for a
distance of 1.4 miles. This will begin at the intersection of SR 1302 & SR 1300 and extend east to SR 1303. This
will include some minor shoulder widening to accommodate the wider travel lanes. Some minor drainage
improvements to roadside ditches will be made to retain and improve drainage of the roadway. This will include
one culvert replacement at site # 2 indicated on the permit drawings. There are no proposed improvements to the
bridge crossing at Sutton Creek. The e�sting bridge structure is relatively new and does not need replacement.
There is one 8 inch waterline that will need to be directional bored under Sutton Creek, but there will be no
impacts associated with that bore.
4h. Please upload project drawings for the proposed project.
C7ick the upload button or drag and drop files here to attach docurrent
R-5716_Permit Set_HS.pdf 925.25KB
Fle type rrust be pdf
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
�' Yes C' No �' Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
r Preliminary l" Approved l" Unknown f' N/A
Corps AID Number:
Exarrple: SAVu2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other
Clay Willis
NCDOT- Division 1 Environmental Supervisor
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 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 �' No f" 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 Impacts Inventory

1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
rJ Wetlands rJ Streams-tributaries r 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.
2a. Site #- Reason for impact* 2b. Impact type * 2c. Type of wetland *
I Rip-rap & Shoulder fill
N�p label (e.g. F�ad Qossing 1- Qalvert,
dewatering, etc)
Hand Clearing
fv�p label (e.g. 13�ad CYossing 1- CLlvert,
dewatering, etc)
Shoulder fill
N�p label (e.g. 13�ad Qossing 1- Qalvert,
dewatering, etc)
Shoulder fill
N�p label (e.g. Road Q-ossing 1- Qalvert,
dewatering, etc)
Hand Clearing
N�p label (e.g. I�ad CYossing 1- Qilvert,
dewatering, etc)
Mechanized Clearing
N�p label (e.g. f�ad Qossing 1- Qalvert,
dewatering, etc)
Excavation
N�p label (e.g. Road Qassing 1- Qalvert,
dewatering, etc)
riprap fill
N�p label (e.g. Finad Q�ossing 1- Qalvert,
dewatering, etc)
Excavation
N�p label (e.g. f�ad Qossing 1- QaNert,
dewatering, etc)
P Bottomland Hardwood
F�rrranent (P) or Forest
Terrporary (�
T Bottomland Hardwood
F2rrranent (P� or Forest
Terrporary (�
P Bottomland Hardwood
F�rrrenerd(P�or Forest
Terrporary (�
P Bottomland Hardwood
F2rrranerd (P) or Fol'est
Terrporary (�
T Bottomland Hardwood
F2rrrnnent (P� or Forest
Terrporary (�
T Pine Flat
F� rrenerd (P� or
Terrporary (�
P Pine Flat
F2rrranent (P'j or
Terrporary (�
P NON-NCWAM TYPES
F2rrrenent (Pj or
Terrporary (�
P NON-NCWAM TYPES
FBrrrenerd (P� or
Tei7porary (�
2g. Total Temporary Wetland Impact
0.070
2g. Total Permanent Wetland Impact
0.007
2g. Total Wetland Impact
0.077
2h. Comments:
2d. Wetland name *2e. 2f. Type of 2g. Impact
Forested* Jurisdicition* area*
Site 1A No Both 0.001
(404, 10) or D�NR(401, (acres)
other)
Site 1A No Both 0.030
(404, 10) or C7�NR(401, (acres)
other)
Site 1 B No Both 0.001
(404, 10) or D�R(401, (acres)
other)
Site 1 C No Both 0.001
(404, 10) or C7�R(401, (acres)
other)
Site 1 D No Both 0.020
(404, 10) or CT�NR(401, (acres)
other)
Site 2B Yes Both 0.020
(404, 10) or D�R(401, (acres)
other)
Site 2B Yes Both 0.001
(404,10) or aNFt(401, (acres)
other)
Site 2A Yes Both 0.001
(404, 10) or C7�NR(401, (acres)
other)
Site 2A Yes Both 0.002
(404, 10) or C7�NR(401, (acres)
other)
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 for 3b.lmpact
impact * type *
Site 2B stream/ditch T
re a I i g n F�rrranent (Fj or
N�p label (e.g. Road Qassing 1) Terrporary (�
Site 2Aculvert install P
N�p label (e.g. f�ad Qossing 1) F2rrranent (Fj or
Terrporary (�
Site 2A T
N�p label (e.g. F3�ad Q-ossing 1) F2rrraner�t (P� or
Terrporary (�
3c. Type of impact* 3d. Stream name *
Excavation
Culvert
Culvert
unnamed trib.
unnamed trib
unnamed trib
3e. Stream
Type *
Intermittent
F�rennial (�2) or
interrrittent (IfVn
Intermittent
F�rennial (�) or
interrrittent (IfVn
Intermittent
F�rennial (F�2) or
interrrittent (IfV�
'� 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:
11
3i. Total temporary stream impacts:
195
3i. Total stream and tributary impacts:
206
3j. Comments:
E. Impact Justification and Mitigation
� 1. Avoidance and Minimization
3f. Type of
Jurisdiction *
Both
Both
Both
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
I Proposed fill slopes in wetlands have been set at 3:1 or less, to reduce the impact foot print. Waterline relocation
will be bored from high ground to high ground. The overall project widening has been established at the minimum
distance to provide for the projects safety improvements. The alignment of the road will remain as it currently is,
reducing any new impact to adjacent properties.
3g. Stream 3h. Impact
width* length*
2 170
Average(feet) (linearfeet)
2 11
Average (feet) (linear feet)
2 25
Average (feet) (linear feet)
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
The project will follow NCDOT guidelines and BMP's for culvert installation and we will implement an erosion control
plan, prior to any land disturbing activities.
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:
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?

r Yes r No
For a list of options to meet the diffuse flow requirements, click here.
If no, explain why:
Located in the Pasquotank River Basin
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
�' 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?*
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
Comments:*
This project fits under the minimum criteria checklist guidelines for NCDOT projects
� 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?*
f Yes C•' 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 C•' No
3b. If you answered "no," provide a short narrative description.
I This project is widening an existing roadway from 18' to 22' and will not result in access to new lands or create
potential development interest along the 1.4 mile widening area.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project? *
�' Yes C•' No C' �1/A
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
Sa. Will this project occur in or near an area with federally protected species or habitat?*
C� Yes C' No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*

r Yes r No
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. Is another Federal agency involved?*
C' Yes �' No
5e. 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?*
USFWS county listing for Perquimans County
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?*
National Marine Fisheries - NOAA
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?*
State Historic Preservation Office
i 7c. Historic or Prehistoric Information Upload
aick the upload button or drag and drop files here to attach docurrent
Archaeology_Review.pdf 145.41 KB
CulturalResources16-02-0137_EffectsSigned.pdf 1 MB
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?*
�' Yes C' No
8b. If yes, explain how project meets FEMA requirements:
project has been designed and reviewed by a professional engineer service, including hydraulic engineers, wtiich
reviewforfloodplain impacts.
8c. What source(s) did you use to make the floodplain determination?*
Fema floodplain maps
Miscellaneous
Miscellaneous attachments not previously requested.

C7ick the upload button or drag and drop files here to attach docurrent
location_aerial_map.pdf 1.03MB
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:*
Clay Willis
Signature
��.l.�r� ���rr�
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*
20180027
Version#*
1
Reviewing Office *
Washington Regional Office - [phone]
Select Project Reviewer*
Garcy Ward:eads\gpward
Is a payment required for this project?*
C� No payment required
f Fee received
C' Fee needed - send electronic notification