20180645 Ver 1_401 Application_20180511

Action History (UTC -05:00) Eastern Time (US & Canada)
Submit by Anonymous User 5/8/2018 4:29:18 PM (Start Event)
Accept by Montalvo, Sheri A 5/11/2018 10:06:32 AM (Non DOT Initial Review)
The task was assigned to Montalvo, Sheri A. The due date is: May 11, 2018 5:00 PM
5/8/2018 4:32 PM

DWR
Division of 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 able to submit the form until all mandatory questions are answered.
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.govMaterResources/0/edocl6247041PCN%20Help%20File%202018-1-30.pdf
A. Processing Information
County (or Counties) where the project is located:*
Pitt
Is this project a public transportation project?*
f Yes f• No
This is any publicly funded by nunicipal,state or federal funds road, rail, airport transportation project.
1a. Type (s) of approval sought from the Corps:*
r Section 404 Permit (wetlands, streams and waters, Clean Water Act)
Pr Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What type(s) of permit(s) do you wish to seek authorization?*
IJ Nationwide Permit (NWP)
r Regional General Permit (RGP)
r Standard (IP)
This form may be Corps to initiate the standard/individual permit process. Please contact your Corps representative for submittal of standard permits.
All required items that are not provided in the E -PCN and be added to the miscellaneous upload located at the bottom of this form.
Nationwide Permit (NWP) Number: 12 - Utility Lines
NWP Number Other:
List all IWV nurrbers you are applying for not on the drop down list.
1c. Type(s) of approval sought from the DWR:*
check all that apply
F- 401 Water Quality Certification - Regular r 401 Water Quality Certification - Express
fJ Non -404 Jurisdictional General Permit r Riparian Buffer Authorization
r Individual Permit
*
1d. Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification:
O Yes O No
For the record only for Corps Permit: O Yes O 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 mitigation bank or in -lieu fee program
f Yes C No
1f. Is the project located in anyof NC's twentycoastal counties?*
r Yes r No
1h. Is the project located in a designated trout watershed?*
f Yes f• No
Link to trout information: http://vmw.saw.usace.army.mil/Missions/Regulatory-Permit-ProgranVAgency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact?*
Justin Rice
1b. Primary Contact Email:*
[e-mail]
1c. Primary Contact Phone:*
(XXX)XXX-XXXX
[phone]
1d. Who is applying for the permit?
❑ Owner V Applicant (other than owner) r- Agent/Consultant
(Check all that apply)
2. Owner Information
2a. Name(s) on recorded deed:
NCDOT
2b. Deed book and page no.:
2c. Responsible party:
(for Corporations)
2d. Address
Street Address
Address Line 2
City
Fbstal / Zip Code
2e. Telephone Number:
(xxx)xxx-xxxx
2f. Fax Number:
(XXX)XXX-XXXX
2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
3a. Applicant is:
r Agent
f Other
If other please specify.
3b. Name:
State / Province / Fbgion
Country

Justin Rice
3c. Business Name:
(if applicable)
Utilis Engineering
3d. Address
Street Address
3733 National Drive, Suite 225
Address Line 2
City
Raleigh
Postal / Zip Code
27612
3e. Telephone Number:
[phone]
(Xxx)XXX-XXXX
3f. Fax Number:
(xxx)xxx-xxxx
3g. Email Address:*
[e-mail]
... ...................
State / Province / Pagion
NC
Country
USA
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
U03079 -Section 1
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/ town:*
Grimesland
1d. Driving directions*
ff it is a new project and can not easily be found in a GPS crapping system Please provide directions.
Beginning at the corner of US -264 and Cherry St.
2. Project Identification
2a. Property Identification Number:
(tax PIN or parcel ID)
2b. Property size:
(in acres)
2c. Project Address
Street Address
Address Line 2
aty State/ Province/ Region
Rbstal / Zip Code Country
2d. Site coordinates in decimal degrees
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 how the 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:*
35.574306 -77.175941
ex: 34.208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Tar River
3b. Water Resources Classification of nearest receiving water:*
B; 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:*
Currently there are NCDOT maintained roadways running parallel to the proposed project. The area is very rural
with fields for farming and scattered residential housing.
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)
Qick the upload button or drag and drop files here to attach document
USGS Topo Map.pdf
File type must be pdf
25.33MB
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)
nick the upload button or drag and drop files here to attach document
SOIL MAP UTILIS U03079-Section1 20180404.pdf 9.79MB
File type must 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:
(intermttent and perennial)
4f. Explain the purpose of the proposed project:*
To build upon the existing Conterra fiber optic network that is provided to the Pitt County School system. The
proposed route will enhance fault protection and provide a more secure internet network.
4g. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:
Placing conduit and fiber by means of horizontal directional drilling using a bore rig and hand digging where
necessary.
4h. Please upload project drawings for the proposed project.
Click the upload button or drag and drop files here to attach document
U03079 -Section 1-Grimesland Bridge Rd Ead (5-8-18).pdf 66.57MB
File type mast be pdf
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
r Yes r No r Unknown
Comments:

5b. If the Corps made a jurisdictional determination, what type of determination was made?*
r Preliminary r Approved r Unknown
Corps AID Number:
Exarrple: SAWt-2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
r N/A
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5d1. Jurisdictional determination upload
Click the upload button or drag and drop files here to attach docurrent
File type mist be FDF
6. Project History
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past?*
r Yes C No r Unknown
7. Future Project Plans
7a. Is this a phased project?*
f Yes r 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):
F Wetlands V Streams -tributaries r Buffers
r- Open Waters G 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. Reason for impact*3b.lmpact 3c. Type of impact*3d. Stream name*
type
S1 fiber installation T Other
Ivbp label (e.g. Fbad (Drossing F2rrrerent (F') or
1) Terrporary (T)
S2 fiber installation T Other
Ivbp label (e.g. Fbad Qossing Fbrrranent (F9 or
1) Tenporary (T)
3e. Stream 3f. Type of 3g. Stream 3h. Impact
Type* Jurisdiction* width* length*
Unnamed Jurisdictiona DWR
15 15
1 Ditch
Average (linear feet)
Perennial (F6� or
(feet)
intermttent (INT)
Unnamed Jurisdictiona DWR
6 6
1 Ditch
Average (linear feet)
Perennial (Fff� or
(feet)
internittent (INT)

S3 fiber installation T Other
Nbp label (e.g. Fbad Crossing Permanent (F� or
1) Temporary (T)
S4 fiber installation T Other
Ivbp label (e.g. Fbad Crossing Permanent (P') or
1) Terrporary (T)
S5 fiber installation T Other
Ivbp label (e.g. Fbad Crossing Permanent (F) or
1) Terrporary (T)
S6 fiber installation T Other
Ivbp label (e.g. Fbad Crossing Permanent (F) or
1) Tenporary (T)
S7 fiber installation T Other
Nbp label (e.g. Road Crossing Fbrnanent (F) or
1) Tenporary (T)
Unnamed
Jurisdictiona
DWR
I Ditch
Perennial (FIEI:� or
intermttent (INT)
Unnamed
Jurisdictiona
DWR
I Ditch
Perennial (F$� or
intermttent (INT)
Unnamed
Jurisdictiona
DWR
I Ditch
Perennial (F$� or
intermittent (INT)
Unnamed
Intermittent
DWR
Perennial (PER or
intermittent (INT)
Tar River Perennial Corps
Perennial (F$� or
intermittent (INT)
S8 fiber installation T Other Unnamed Intermittent DWR
Nbp label (e.g. Fbad Crossing Pernanent (F) or Perennial (PER or
1) Tenporary (T) intermittent (INT)
* All Perennial or Intermittent streams must be verified by DWR or delegated local government.
3i. Total jurisdictional ditch impact in square feet:
433
3i. Total permanent stream impacts:
0
3i. Total temporarystream impacts:
454
3i. Total stream and tributary impacts:
454
3j. Comments:
E. Impact Justification and Mitigation
10 10
Average (linear feet) I
(feet)
6 6
Average (linear feet) I
(feet)
6 6
Average (linear feet) I
(feet)
125 125
Average (linear feet)
(feet)
280 280
Average (linear feet)
(feet)
6 6
Average (linear feet) I
(feet)
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
Directionally boring will cause the least amount of impact out of all the available installation methods.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Using horizontal directional drilling to cause minimal environmental disturbance. Getting down to a depth of at least
10 feet underneath river bed to avoid future construction or dredging.
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 r No
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?
f Yes r No
For a list of options to meet the diffuse flow requirements, click here.
If no, explain why:
Existing drainage ditches.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?
r Yes r No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?*
r Yes
f No
To look up low density requirement click here 15A NCAC 02H.1003(2)
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?
f• Yes r 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 Policy Act (NEPA/SEPA)?*
r Yes r No
Comments:*
Requires 16.1 encroachment permitting through NCDOT, which has already been obtained.
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)?
r Yes r No
2b. Is this an after -the -fact permit application?*
r Yes r 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?*
r Yes r No
3b. If you answered "no," provide a short narrative description.
Fiber/conduit will not move after being placed.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*

f Yes r Nor N/A
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?*
r Yes r No
5d. Is another Federal agency involved?*
f Yes f• No r Unknown
5e. Is this a DOT project located within Division's 1-8?*
f• Yes fNo
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
www.fws.gov
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
r^ Yes r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
www. habitat.noaa.gov
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)?*
f Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
hftp://gis.ncdcr.gov/hpo\tveb/
7c. Historic or Prehistoric Information Upload
Click the upload button or drag and drop files here to attach docurrent
File mist be FDF
8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https:/Imsc.fema.gov/portal/search
8a. Will this project occur in a FEMA -designated 100 -year floodplain?*
r Yes r^ No
8b. If yes, explain how project meets FEMA requirements:
The project will not increase the flood hazard on other properties.
8c. What source(s) did you use to make the floodplain determination?*
www.fema.gov
Miscellaneous
Miscellaneous attachments not previously requested.
pick the upload button or drag and drop files here to attach document
File rrust be FDF or 109

Signature
m 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 Act');
■ I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic
Transactions Act');
■ 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:*
Justin Rice
Signature
Initial Review
Is this project a public transportation project? * (?
f Yes r No
Change only if needed.
Has this project met the requirements for acceptance in to the review process?*
r Yes
r No
BIMS # Assigned*
20180645
Version#*
Reviewing Office*
Washington Regional Office - [phone]
Select Project Reviewer*
Robert Tankard: eads\rbtankard
Is a payment required for this project?*
f No payment required
f Fee received
r Fee needed - send electronic notification
What amout is owed?*
f $240.00
r $570.00