20180705 Ver 1_401 Application_20180522

Action History (UTC -05:00) Eastern Time (US & Canada)
Submit by Anonymous User 5/22/2018 2:01:55 PM (Start Event)
Accept by Montalvo, Sheri A 5/23/2018 12:35:29 PM (Non DOT Initial Review)
The task was assigned to Montalvo, Sheri A. The due date is: May 25, 2018 5:00 PM
5/22/2018 2:03 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:*
Robeson
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:*
V Section 404 Permit (wetlands, streams and waters, Clean Water Act)
F 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: 03 - Maintenance
Nationwide Permit (NWP) Number: 13 - Bank Stabilization
NWP Number Other:
List all MN nunbers you are applying for not on the drop down list.
1c. Type(s) of approval sought from the DWR:*
check all that apply
V 401 Water Quality Certification - Regular r 401 Water Quality Certification - Express
r Non -404 Jurisdictional General Permit r Riparian Buffer Authorization
F Individual Permit
*
1d. Is this notification solely for the record because written approval is not required?
For the record onlyfor DWR 401 Certification: r Yes G No

For the record only for Corps Permit:
r Yes r No
1e. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
ff so, attach the acceptance letter from n itigation bank or in -lieu fee program
f Yes r No
1f. Is the project located in anyof NC's twenty coastal counties?*
O Yes r No
1h. Is the project located in a designated trout watershed?*
t' Yes r No
Link to trout information: http://wvvw.saw.usace.army.mil/Missions/Regulatory-Permit-ProgranVAgency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact?*
Amy Black
1b. Primary Contact Email:*
[e-mail]
1c. Primary Contact Phone:*
()XXX -max
[phone]
1d. Who is applying for the permit?
r Owner r Applicant (other than owner) IJ Agent/Consultant
(Check all that appy)
2. Owner Information
2a. Name(s) on recorded deed:
Lumbee Tribe of NC
2b. Deed book and page no.:
Book 1949, Page 149
2c. Responsible party:
(for Corporations)
2d. Address
Street Address
6984 NC Hwy 711 West
Address Line 2
City
Pembroke
Postal / Zip Code
28372
2e. Telephone Number:
(XXX)XXX-XXXX
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
2a. Name(s) on recorded deed:
David Layne Deese
2b. Deed book and page no.:
State/ Province/ Fbgion
NC
Country
USA

Book 611, Page 516
2c. Responsible party:
(for Corporations)
2d. Address
Street Address
977 Old Red Springs Rd.
Address Line 2
Qty
State / Province/ Fbgion
Maxton
NC
Postal / Zip Code
Country
28364
USA
2e. Telephone Number:
(xxx)xxx-xxxx
2f. Fax Number:
(XXX)XXX-XXXX
2g. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Amy Black, PE
4b. Business Name:
(if applicable)
Jewell Engineering Consultants
4c. Address
Street Address
311 S. Main Street
Address Line 2
Suite A
Qty
State / Province / Region
Kernersville
NC
Postal / Zip Code
Country
27284
USA
4d. Telephone Number:
[phone]
(xxx)xxx-xxxx
4e. Fax Number:
(XXX)XXX-XXXX
0. Email Address:*
[e-mail]
Agent Authorization Letter*
Rease provide the Agent Authorization Letter if you are sulxritting this docurrent.
AgentAuth_Signed.pdf 19.41 KB
RLE TYPE MUST BE RDF
C. Project Information and Prior Project History
1. Project Information

1a. Name of project.*
Lumbee Tribe Cultural Center Lake Dam Repair
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/ town:*
Maxton, NC
1d. Driving directions*
If it is a new project and can riot easily be found in a CPS crapping system Reese provide directions.
From Maxton, take 1-74 East to ALT -74 East. Turn left on Recreation Center Road. Cross over the Lumber River and turn left on Terry
Sanford Drive. Enter the Cultural Center property through the gate and the lake and dam will be on the right.
2. Project Identification
2a. Property Identification Number:
(tax PIN or parcel ID)
932406504400
2b. Property size:
(in acres)
384
2c. Project Address
Street Address
678 Terry Sanford Drive
Address Line 2
aty
State/ Province/ Region
Maxton
NC
Postal / Zip Code
Country
28364
USA
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:*
34.708156 -79.268416
ex: 34.208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Lumber River
3b. Water Resources Classification of nearest receiving water:*
B, Sw, HQW
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Lumber
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:*
The dam and lake are a central part of the Lumbee Cultural Center, providing recreation and fishing opportunities
for the community. The dam was overtopped and damaged during Hurricane Matthew in 2016 and does not have
adequate outlet capacity to pass the 1/3 PMP. The land around the dam is mowed grass. Land around the
discharge outlet areas are wooded at the concrete spillway outlet and grass lawn around the secondary spillway
outlet.
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)
Click the upload button or drag and drop files here to attach docurrent
USGS_Map. pdf
File type mist be pdf
3.25MB
4c. Attach an 8 1/2X11 excerpt from the most recent version of the published County NRCS Soil Survey map depicting the project site.
(for DWR)
Click the upload button or drag and drop files here to attach docurrent
Soils_Map.pdf 126.84KB
File type mast be pdf
4d. List the total estimated acreage of all existing wetlands on the property:
0.18
4e. List the total estimated linear feet of all existing streams on the property:
(intermittent and perennial)
500
4f. Explain the purpose of the proposed project:*
This project will repair the damaged embankment and spillway as well as provide improvements to increase the
outlet capacity allowing the dam to safely pass the 1/3 PMP event.
4g. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:
This project will repair the damaged embankment, raise the crest elevation to 169.5 along the whole length of the
dam, repair the existing concrete spillway with a gabion structure, stabilize the headcut/channel area, add an
emergency spillway with outlet protection, and replace the slide gates & lower trash racks at the primary
riser/barrel structure.
i. Prior to the start of soil or sediment disturbing work, erosion control measures will be installed. Erosion control
measures will be temporary, and are to be removed after the project is complete.
ii. All channel work will be done in dry conditions using coffer dam / diversion swale / pump around operation for
flow diversion, if needed.
iii. Clearing and debris removal will be conducted as needed to execute the goals of the project, however great
care will be exercised not to disturb the stream or to unnecessarily damage existing vegetation beyond that
necessary for the project work. All debris generated through this work will be removed from the site.
iv. Energy dissipaters will be installed at the discharge outlet area at the concrete and emergency spillway. Areas
with exposed soil will be planted to stabilize the soil after the work is complete.
4h. Please upload project drawings for the proposed project.
Click the upload button or drag and drop files here to attach docurrent
Full Set May9.pdf 12.46MB
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?
f Preliminary r Approved r Unknown r N/A
Corps AID Number:

Bcample: SAW -2017-99999
SAW -2018-00511
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Wes Fryar
Agency/Consultant Company: Land Management Group
Other:
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Rachel Capito with Army Corps of Engineers visited the Site on March 6 and issued an Approved Jurisdictional Determination on March 29,
2018. (attached)
5d1l. Jurisdictional determination upload
Cick the upload button or drag and drop files here to attach docurrent
SAW -2018-00511 AJD.pdf 475KB
File type mist be PDF
6. Project History
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past?*
r Yes G 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):
V Wetlands V 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 *
2d. Wetland name
*2e.
2f. Type of
2g. Impact
Forested*
Jurisdicition*
area*
Stabilize headcut area
T Unknown
Headcut Wetland
Yes
Both
0.030
Nbp label (e.g. tbad Grossing 1 - Calvert,
Fbrrranent (F� or
(404, 10) or DAR (401,
(acres)
dewatering, etc)
Temporary (T)
other)
Emergency Spillway
P Unknown
EmSpwy
No
Both
0.060
Discharge
FL-rmanent (P) or
Wetland
(404, 10) or DAR (401,
(acres)
tvbp label (e.g. Imad Grossing 1 - Calvert,
Temporary (T)
other)
dewatering, etc)
2g. Total Temporary Wetland Impact
0.030
2g. Total Permanent Wetland Impact

0.060
2g. Total Wetland Impact
0.090
2h. Comments:
Crossing the Headcut Wetlands will be required in order to access and stabilize the headcut area and eroded
channel. Temporary Wetland Crossing Mudmats will be used to minimize impacts. The wetlands at the emergency
spillway discharge are located at the secondary riser/barrel discharge outlet and remains under water. The riser
will be removed and an emergency spillway will be installed with a low flow drain that will continue to provide flow to
the ebsting channel. The channel will be armored with riprap for energy dissipation and erosion control in the
event of spillway activation.
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* 3e. Stream 3f. Type of 3g. Stream 3h. Impact s
type* Type* Jurisdiction* width* length*
S1 Emer Spwy T Stabilization Unnamed Trib Perennial Both 30 60 1
Discharge Fernenent (P) or Perennial (Ff3� or Average (linear feet) ,
Ift label (e.g. Road Crossing Temporary (T) intermttent (INT) (feet) 8
t) n
S2 Conc Spwy T Stabilization Unnamed Trib Perennial Both 45 95
Discharge Pernsnent (F� or Perennial (Fff� or Average (linear feet) ,
Ivbp label (e.g. Fbad Crossing Tenporary (T) intermittent (INT) (feet)
1) ,
S3 Headcut Eroded P Stabilization Unnamed Trib Perennial Both 15 100 1
Channel Permanent(F'or Fbrennial(FBF�or Average (linear feet) ,
[Vbp label (e.g. Finad Crossing Tenporary (T) internittent (INT) (feet) 5
�) 0
0
** 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:
100
31. Total temporary stream impacts:
155
3i. Total stream and tributary impacts:
255
3j. Comments:
Al proposed impacts are related to energy dissipation and channel stabilization. The temporary impacts will
include adding additional riprap to a discharge outlet with eAsting riprap. The permanent impact will be installing
gabions in a channel that is not currently armored in any way.
E. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*

Al proposed impacts to jurisdictional stream channels are related to stabilizing eroding channels and providing
energy dissipation at discharge outlets.
Work in the stream will be done will be done in dry conditions. Coffer dams, diversion swales, and/or sump pump
will be used, if needed.
Wetland crossing mudmats will be required to use wetlands for access.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
An Erosion and Sediment Control permit will be acquired for this project and appropriate erosion and sediment
control measures will be implemented.
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
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
The total length of stream permanently impacted at the headcut/eroded channel area is less than 500 LF, as allowed by NWP 13 for bank
stabilization. The area of stream and wetlands temporarily impacted is less than 1/2 acre and the least impact possible for adequate
stabilization for maintenance at the spillway discharge locations.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
— Recent changes to the storm ester 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:
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?*
r 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:*
The project will not contribute impervious surface to the watershed

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)?
f Yes r No
2b. Is this an after -the -fact permit application?*
f 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?*
f Yes r No
3b. If you answered "no," provide a short narrative description.
The project repairs an eAsting dam.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
r 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?
r Yes r 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?*
f Yes r No r Unknown
5e. Is this a DOT project located within Division's 1-8?*
r Yes r No
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?
r Yes f No
5g. Does this project involve bridge maintenance or removal?
r Yes r No
Link to the NLEB SLOPES document: http://saw-reg.usace.army.mil/NLEB/1-30-17-signed_NLEB-SLOPES&apps.pctf
5h. Does this project involve the construction/installation of a wind turbine(s)?*
f Yes r No
5i. Does this project involve (1) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhammers,
mechanized pile drivers, etc.?
f Yes r No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
Requested Threatened & Endangered Species Report from FWS website and spoke with Leigh Mann in Fish &
Wildlife Raleigh Field Office on 05/10/2018.
6. Essential Fish Habitat (Corps Requirement)

6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
r Yes C No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
Spoke with Leigh Mann at FWS-Raleigh Field Office. Project review was requested on May 10.
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?*
Used the spatial data from National Register of Historic Places from nps.gov website. Project is being initiated by
the Lumbee Tribe of NC on the Tribe's property.
7c. Historic or Prehistoric Information Upload
Click the upload button or drag and drop files here to attach docurrent
File must 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?*
f• Yes r No
8b. If yes, explain how project meets FEMA requirements:
A No -Rise Certification will be submitted to County Floodplain Administrator.
8c. What source(s) did you use to make the floodplain determination?*
Flood Risk Information System (http://w w.fris.nc.gov) and best engineering practices.
Miscellaneous
Miscellaneous attachments not previously requested.
Click the upload button or drag and drop files here to attach document
Project Narrative.pdf 4.07MB
File must be FDF or INR
Signature
rJJ 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:*
Amy Black, PE
Signature

Date Submitted:
5/22/2018
Initial Review
........................................ .............................................................................................................................................
Is this project a public transportation project?* (')
0 Yes f• No
Change only if needed.
Has this project met the requirements for acceptance in to the review process?*
f• Yes
f No
BIMS # Assigned*
20180705
Version#*
Reviewing Office *
Fayetteville Regional Office - [phone]
Select Project Reviewer*
Chad Turlington:eads\ccturlington
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