20180874 Ver 1_PCN Form Submission_20180622

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 6/22/2018 11:36:49 AM (Start Event)
Accept by Carpenter,Kristi 6/22/2018 4:09:22 PM (DOT Initial Review)
. The task was assigned to Carpenter,Kristi. The due date is: June 27, 2018 5:00 PM
6/22/2018 11:37 AM

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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 beloware required. You will not be able 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:*
Mecklenburg
Is this project a public transportation project?*
C Yes l' No
lhis is any publicly funded by rrunicipal,state or federal funds road, rail, airport transportation project.
Is this a NCDOT Project?*
f• Yes r No
(NCDOT only) T.I.P. or state project number:
U-5114
WBS #
42376.2.FR1
(for �ICDOT use only)
1a. Type(s) of approval sought from the Corps:*
fJ 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)
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: 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
r% 401 Water Quality Certification - Regular r 401 Water Quality Certification - Express
r Non-404 Jurisdictional General Permit r Riparian Buffer Authorization
r Individual Permit
*
1d. Is this notification solelyfor the record because written approval is not required?
For the record onlyfor DWR 401 Certification:
For the record onlyfor Corps Permit:
f Yes C' No
C' Yes f' 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 a- in-lieu fee program
C Yes l" No
Acceptance Letter Attachment
C7ick the upload button or drag and drop files here to attach docurrem
RLE NFE MJST BE FDF
1f. Is the project located in anyof NC's twentycoastal counties?*
l' Yes r No
1h. Is the project located in a designated trout watershed?*
l" Yes C No
Link to trout information: http://w�wv.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Agency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact?*
Larry Thompson, PWS, LSS
1b. PrimaryContact Email:*
[e-mail]
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
rJ Owner r Applicant (other than owner) r Agent/Consultant
(Check all that apply)
2. Owner I nformation
2a. Name(s) on recorded deed:
NCDOT Division 10
2b. Deed book and page no.:
f�UA
2c. Responsible party:
(for Corporations)
Larry Thompson, PWS, LSS
2d. Address
Street Address
716 Main Street
Address Line 2
aty
Albemarle
Rutal / Zip Code
27127
State / Rovince / Region
NC
Country
USA

2e. Telephone Number:
(xxx)xxx-xxxx
[phone]
2f. Fax Number:
[phone]
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
US 21 and Gilead Road Intersection Improvements
1b. Subdivision name:
(if appropriate)
wa
1c. Nearest municipality/ town:*
Huntersville
1d. Driving directions*
If it is a new project and can not easily be found in a GPS rrapping system Rease provide directions.
From I-77 take exit #23 to Gilead Road. Take Gilead Road east to the intersection of US 21 and Gilead Road.
2. Project Identification
2a. Propertyldentification Number:
(tan RN or parcel ID)
wa
2b. Propertysize:
(in acres)
114.1
2c. Project Address
Street Address
US 21 (Statesville Road) and SR 2136 (Gilead Road)
Address Line 2
aty
Huntersville
Fbstal / Zip Code
28078
2d. Site coordinates in decimal degrees
State / FYovince / F�gion
NC
Cauntry
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 how the location was determined. (For e�mple, most mobile phones with GPS provide locational precision in decimal degrees to
map coordinates to 5 or 6 digits after the decimal place.)
Latitude: *
35.409855
ex:34.208504
3. Surface Waters
Longitude:*
-80.854916
-77.796371

3a. Name of the nearest body of water to proposed project:*
Unnamed tributary to Torrence Creek
3b. Water Resources Classification of nearest receiving water:*
WS-IV
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Catawba
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:*
Existing conditions include US 21 (Statesville Road), Gilead Road, Dallas Street, commercial property, residential
property and disturbed/maintained right-of-way.
4b. Attach an 8 7/2 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 document
Figure 2_USGS_Gilead.pdf 3.53MB
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)
aick the upload button or drag and drop files here to attach docurrent
Figure 3_Soils_Gilead.pdf
Fle type rrust be pdF
4d. List the total estimated acreage of all existing wetlands on the property:
0.1
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
1, 543
2.51 MB
4f. Explain the purpose of the proposed project:*
The purpose of this project is to improve traffic operations at the US 21 and Gilead Road intersection. The project
is intended to provide operational improvements that enhance traffic mobility and conform to goals and objectives
in existing adopted state and local transportation plans.
4g. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
Roadway intersection improvements using heavy construction equipment. Refer to Project Description in
supplemental information for details on the improvements.
4h. Please upload project drawings for the proposed project.
Gick the upload button or drag and drop files here to attach docurcent
1L5114_Hyd_Prm_Permit Drawings_2018-05-25.pdf 1.86MB
Fle type rrust be pdF
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
f• Yes �' No �' Unknown
Comme nts:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
f•' Preliminary l" Approved �' Unknown f' f�llA
Corps AID Number:

Exarrple:SAV�2017-99999
SAW-2014-01064
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:
Brandon Phillips, CHMM
SN Engineers, Inc.
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
SAW-2014-01064 issued on October 21, 2016.
5d1. Jurisdictional determination upload
Qick the upload button or drag and drop files here to attach docurcent
SAW-2014-01064 JD US21 Gilead.pdf 985.83KB
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? *
f Yes C' No �' Unknown
7. Future Project Plans
7a. Is this a phased project?*
l" Yes l•' 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):
I7 Wetlands �J 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*
W1 - Fill P
N�p label (e.g. f�ad CYossing 1- Qalvert, F�rrranent (Fj or
dewatering, etc) Terrporary (�
W2 - Excavation P
Nbp label (e.g. Fd�ad Q-ossing 1- CLlvert, F2rrranent (� or
dewatering, etc) Terrporary (�
W3 - Hand Clearing T
Nbp label (e.g. Fd�ad Qossing 1- CLlvert, F2rrranent (� or
dewatering, etc) Terrporary (�
2g. Total Temporary Wetland Impact
0.010
Headwater Forest
Headwater Forest
Headwater Forest
2d. Wetland name *2e. 2f. Type of 2g. Impact
Forested* Jurisdicition* area*
Wetland B Yes Both 0.010
(404, 10) or DJUR(401, (acres)
other)
Wetland B Yes Both 0.010
(404, 10) or C�JVR(401, (acres)
other)
Wetland B Yes Both 0.010
(404, 10) or C�R(401, (acres)
other)

2g. Total Permanent Wetland Impact
0.020
2g. Total Wetland Impact
0.030
2h. Comments:
Wetland impacts include 0.01 acre of fill used for the bank stabilization/flood bench (W1), <0.01 acre of excavation
to direct the stream flow into the pipe culvert (W2) and <0.01 acre of temporary hand clearing of vegetation (W3).
3. Stream Impacts
ff 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 sqfe�
type * Type � Jurisdiction * width * length *
S1 Pipe culvert P Culvert U.T. to Torrence Cr. Perennial Both 4 189 7
N�p label (e.g. F3�ad Qossing F2rrranent (Fj or F2rennial (� or Average (linear feet) 5
1) Terrporary (� interrritterd (If� (feet) 6
*" 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:
189
3i. Total temporary stream impacts:
0
3i. Total stream and tributary impacts:
189
3j. Comments:
Permanent stream impacts of 189 linear feet (0.02 acre) will result from the placement of the pipe culvert. Impacts
associated with temporary dewatering of the stream will occur within the permanent impact areas.
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:*
See attached Supplemental Information.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
See attached Supplemental Information.
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?
G Yes C' No
2c. If yes, mitigation is required by (check all that apply):
r DWR �J 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)
189
4c. If using stream mitigation, what is the stream temperature:
warm
4d. Buffer mitigation requested (DWR only):
(square feet)
4e. Riparian wetland mitigation requested:
(acres)
4f. Non-riparian wetland mitigation requested:
(acres)
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?
l" Yes l•' No
For a list of options to meet the diffuse flow requirements, click here.
If no, explain why:
Project is located in the Catawba River Basin, but not on the main stem of the river which has 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 r 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?*
f• 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 (NEPAISEPA)?'�
C•' Yes l" 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 C•' No
Comme nts: *

This is a federally funded project that has prepared a Categorical Exclusion to meet NEPA requirements and does
not require review by the State Clearing House, however, coordination with state agencies was completed as part
of the NEPA process.
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 �' No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project (based on past and reasonablyanticipated 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.
Project involves improvements to an exsting roadway intersection and will not result in additional development.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
l' Yes C' No f� 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? *
C Yes l" No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
G Yes �' No
5c. If yes, indicate the USFWS Field Office you have contacted.
Asheville
5d. Is another Federal agency involved?*
f Yes r No
5e. Is this a DOT project located within Division'S 1-8?*
C' Yes C No
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?
l•' Yes f No
Sg. Does this project involve bridge maintenance or removal?
C' Yes C No
�' Unknown
Link to the NLEB SLOPES document: http://saw-reg.usace.army.mil/NLEB/1-30-17-signed_NLEB-SLOPES&apps.pdf
5h. Does this project involve the construction/installation of a wind turbine(s)?*
f Yes C•' No
5i. Does this project involve (7) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhammers,
mechanized pile drivers, etc.?
f Yes f• No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
USFWS and NCNHP website data and site specific surveys. A mussel survey was performed by the NCDOT.
Biological conclusions are attached as Supplemental Information.

6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
C' Yes r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat? *
NOAA EFH mapper
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 f•' No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources? *
NC State Historic Preservation Office.
7c. Historic or Prehistoric Information Upload
C7ick the upload button or drag and drop files here to attach docurrent
SHPO Itr ER 14-1632.pdf 98.73KB
Fle rrust be F�F
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?*
G Yes C' No
8b. If yes, explain how project meets FEMArequirements:
NCDOT Hydraulics Unit coordination with FEMA.
8c. What source(s) did you use to make the floodplain determination?*
FEMA Firm maps
Miscellaneous
Miscellaneous attachments not previously requested.
aick the upload button or drag and drop files here to attach docurrem
T&E Supplemental info for PCN Form.pdf 122.88KB
Fle rrust be FDF or VWQ
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:*
Larry Thompson

Signature
� �
Date Submitted:
6/22/2018
Initial Review
Is this project a public transportation project?* (')
r Yes f' No
C�ange only 'rf needed.
Has this project met the requirements for acceptance in to the review process?*
G' Yes
C' No
BIMS # Assigned *
20180874
Version#*
Reviewing Office *
Mooresville Regional Office - [phone]
Select Project Reviewer*
Donna Fbod:eads\drhood
Is a payment required for this project?*
l" No payment required
C Fee received
C' Fee needed - send electronic notification