20180221 Ver 1_PCN Form Submission_20180216

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 2/16/2018 9:54:52 AM (Start Event)
Accept by Carpenter,Kristi 2/16/2018 12:59:35 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: February 21, 2018 5:00 PM
2/16/2018 9:55 AM

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)
January 31, 2018 Ver 2.3
*
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.
https://edocs. deq. nc.gov/WaterResources/0/edoc/624704/PCN%20Help%20File%202018-1-30. pdf
A. Processing Information
County(or Counties) where the project is located:*
Granville
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:
WBS #
17BP.5.C.04
(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: 03 - Maintenance
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
r% 401 Water Quality Certification - Regular r 401 Water Quality Certification - E�ress
r Non-404 Jurisdictional General Permit rJ 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 C•' No
1h. Is the project located in a designated trout watershed?*
f Yes C•' No
Link to trout information: http://w�nn�v.saw.usace.army.mil/Missions/Regulatory-Permit-PrograrrUAgency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact?*
Chris Murray
1b. PrimaryContact Email:*
[e-mail]
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
I7 Owner r Applicant (other than owner) r AgenUConsultant
(Check all that apply)
2. Owner I nformation
2a. Name(s) on recorded deed:
NCDOT
2b. Deed book and page no.:
Not available
2c. Responsible party:
(for Corporations)
2d.Address
Street Address
2612 N. Duke Street
Address Line 2
��
Durham
Fbstal / Zip Code
27704
2e. Telephone Number:
State / R-ovince / F�gion
NC
Country
USA

(xxx)x�c-xxxx
[phone]
2f. Fax Number:
(xxx)x�c-�ocx
2g. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Replacement of pipe structure on SR 1160 (Shock Overton Road)
conveying Cattail Creek
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Butner
1d. Driving directions*
If it is a new project and can not easily be found in a GPS rrapping system Rease provide directions.
From Butner, travel north on I-85 to the NC 15 e�at. Turn left at end of off-ramp and travel north on NC 15 and take next left onto SR 1133
(Belltown Road). Travel south on SR 1133 (Belltown Road) and turn right on SR 1160 (Shock Overton Road) to project site.
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)
Granville County Record Numbers: 30764 and 1138
2b. Propertysize:
(in acres)
1.0 acre
2c. Project Address
Street Address
near 4108 Shock Overton Road
Address Line 2
��
Oxford
Fbstal / Zip Code
27565
2d. Site coordinates in decimal degrees
State / Rovince / F�gion
NC
Country
USA
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 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:*
36.23731
ex:34208G04
Longitude:*
-78.64978
-77.796371

3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Cattail Creek
3b. Water Resources Classification of nearest receiving water:*
28-8; C; NSW
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Tar-Pamlico
River Basin 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:*
Site is comprised of wooded land.
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)
aick the upload button or drag and drop files here to attach docurrent
Granville Shock Overton usgs topo map.pdf 386.68KB
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)
C7ick the upload button or drag and drop files here to attach docurrent
Granville Shock Overton soil survey map.pdf 438.11 KB
Fle type rrust be pdF
4d. List the total estimated acreage of all existing wetlands on the property:
0.0
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
89 linear feet
4f. Explain the purpose of the proposed project:*
Replacement of failed 2@ 72 inch CMPAs. The left e�sting pipe structure (looking downstream) is 83 feet long
and the right existing pipe structure (looking downstream) is 87 feet long. The proposed structure is a 1@ 16 foot
x 11 foot corrugated metal pipe arch (CMPA) (that will be 81 feet long) with headwall and endwall.
4g. Describe the overall project in detail, including indirect imapacts and the type of equipment to be used:*
Replacement of failed 2@ 72 inch CMPAs. The left e�sting pipe structure (looking downstream) is 83 feet long
and the right e�sting pipe structure (looking downstream) is 87 feet long. The proposed structure is a 1@ 16 foot
x 11 foot corrugated metal pipe arch (CMPA) (that will be 81 feet long) with headwall and endwall.
4h. Please upload project drawings for the proposed project.
Qick the upload button or drag and drop files here to attach docurrent
Granville Shock Overton inlet and outlet detail.pdf 885.62KB
Granville Shock Overton pipe and stream profile.pdf 1.64M6
Granville Shock Overton Road roadway profile.pdf 1.19M6
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 C' Unknown

Comments:
Yes. Delineated by Heather Smith (Ecological Engineering) on July 18, 2017
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
C' Preliminary l" Approved l" 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
Heather Smith
Ecological Engineering
Site visit on July 18, 2017
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
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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?*
�' Yes C' No f" Unknown
6b. If yes, please give the DWR Certification number or the Corps Action ID (exp. SAW-0000-00000).
USACE and NCDENR-DWR provided info via email on prior repair work at the site on November 4, 2014. Work was
done using NWP 3 and 13 that did not require written permits from either agency. DWR replied via email on
November 6, 2014 that the work could proceed under GCs for NWP 3 and NWP 13. No response received from
USACE.
Project History Upload
aick the upload button or drag and drop files here to attach docurrem
Fle lype rrust be FDF
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 rJ Streams-tributaries rJ Buffers
r Open Waters r Pond Construction
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 3c. Type of impact* 3d. Stream name * 3e. Stream 3f. Type of
impact* type* Type* Jurisdiction*
i Site 1 P Bank Stabilization Cattail Creek Perennial Both
N�p label (e.g. Id�ad Qossing 1) F2rrrenent (Pj or F2rennial (Fffl) or
Terrporary (� interrrittent (If�
Site 1 T Dewatering Cattail Creek Perennial Both
N�p label (e.g. 13�ad CXossing 1) F2rrranent (Fj or F2rennial (�) or
Terrporary (� interrrittent (If�
Site 2 P Bank Stabilization Cattail Creek Perennial Both
N�p label (e.g. Fd�ad Qossing 1) F2rrranerd (P� or F2rennial (F�2) or
Terrporary (� interrrittent (IfVn
Site 2 T Dewatering Cattail Creek Perennial Both
N�p label (e.g. fd�ad Qossing 1) F2rrraner�t (P/ or F2rennial (F�Z) or
Terrporary (� interrrittent (If�
"" 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:
69
3i. Total temporarystream impacts:
20
3i. Total stream and tributary impacts:
89
3j. Comments:
Countersunk rip rap pad in streambed and rip rap on streambanks are required to permanently stabilize stream
above and below replacement structure and are comprised of the Site 1 permanent impacts and Site 2 permanent
impacts. Perennial and intermittent impacts noted above ARE NOT concurrent.
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.
r Neuse �7 Tar-Pamlico
r Catawba r Randleman
r Goose Creek r Jordan Lake
I r Other
6b. Impact Type * 6c. Per or
Temp*
Allowable P
Location and 6cerrpt, Allowable, allowable w/ F2rrranent (F') or
rritigation Terrporary (�
6h. Total buffer impacts:
6d. Stream name *
Cattail Creek
Zone 1 Zone 2
Temporary impacts: 0.00 0.00
6e. Buffer mitigation
required? *
No
3g. Stream 3h. Impact
width* length*
7 13
Average (feet) Qinear feet)
7 8
Average(feet) (linearfeet)
7 56
Average (feet) (linear feet)
7 12
Average (feet) (linear feet)
6f. Zone 1
impact*
4,304
(square feet)
6g. Zone 2
impact*
1,521
(square feet)

Zone 1 Zone 2
Permanent impacts: 4,304.00 1,521.00
Zone 1 Zone 2
Total buffer impacts: 4,304.00 1,521.00
6i. Comments:
Linear length of buffer impacts along stream are >40 linear feet.
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
Qick the upload button or drag and drop files here to attach docurrent
Shock Overton Permit Package.pdf
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E. Impact Justification and Mitigation
1. Avoidance and Minimization
1.3MB
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
i The left e�sting pipe structure (looking downstream) is 83 feet long and the right e�sting pipe structure (looking
downstream) is 87 feet long. The proposed structure is a 1@ 16 foot x 11 foot corrugated metal pipe arch (CMPA)
(that will be 81 feet long) with headwall and endwall. The new structure results in less "piped" impact to the stream.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
The amount of countersunk rip rap in the streambed and rip rap on the streamband above and below replacement
structure will be evaluated during construction. Only the minimal amount of rip rap required to stabilize the stream
will be installed by the contractor.
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?
f 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?
C•' Yes �' No
1b. All buffer impacts and high ground impacts require diffuse flow or other form of stormwater treatment. If the project is subject to a
state implemented riparian buffer protection program, include a plan that fully documents how diffuse flow will be maintained.
All Stormwater Control Measures (SCM)s must be designed in accordance with the NC Stormwater Design Manual. Associated
supplement forms and other documentation shall be provided.
What type of SCM are you providing?

r Level Spreader
r Vegetated Conveyance (lower SM/VT)
r Wetland Swale (higher SMNT)
r Other SCM that removes minimum 30% nitrogen
(check all that apply)
For a list of options to meet the diffuse flow requirements, click here.
Diffus Flow Documentation
aick the upload button or drag and drop files here to attach docurrent
Shock Overton Stormwater Plan.pdf 96.26KB
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2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
G 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
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 �' No
Comments:*
A MCDC will be completed for this project.
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
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.
Project only involves replacement of failed pipe structures.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project? *

C' Yes C' No r 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?*
�' Yes �' No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
C� Yes C' No
5c. If yes, indicate the USFWS Field Office you have contacted.
i Raleigh
5d. Is another Federal agency involved?*
C•' Yes C' No
What Federal Agency is involved?
USFWS
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?*
On-site surveys for terrestrial species resulted in BCs of No Effect for harperella and smooth coneflower. Northern
long-eared bat has a BC of MALTAA. Mussel surveys conducted on July 13, 2017 resulted in collection of Eastern
Elliptio, Eastern Floater and Asian Clam. BCs of No Effect for Dwarf Wedgemussel and May Affect, Not Likely to
Adversely Affect for both Yellow Lance and Atlantic Pigtoe.
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?*
Available mapping.
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 �' No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
I Review of NC State Historic Preservation Office HPO WEB GIS did not indicate any NRHP or eligible NRHP sites
at/near the project site. Project involves disturbance of previously impacted land.
7c. Historic or Prehistoric Information Upload
C7ick the upload button or drag and drop files here to attach docurrent
NC State historic preservation office HPOWEB GIS map.pdf 728.35KB
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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?*

r Yes r No
8c. What source(s) did you use to make the floodplain determination?*
Info from Private Engineering Firm.
Miscellaneous
Miscellaneous attachments not previously requested.
Gick the upload button or drag and drop files here to attach docurrent
USFWS Shock Overton Road concurrence letter.pdf 32.05KB
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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:*
Christopher A. Murray
Signature
�sTd��,4 ,y�u�.�,4r

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*
20180221
Version#*
Reviewing Office*
Central Office - [phone]
Select Project Reviewer*
Rob Ridings:eads\rgridings
Is a payment required for this project?*
C' No payment required
�' Fee received
C' Fee needed - send electronic notification