20180964 Ver 1_PCN Form Submission_20180711

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 7/11/2018 5:14:54 PM (Start Event)
Accept by Carpenter,Kristi 7/12/2018 4:43:44 PM (DOT Initial Review)
. The task was assigned to Carpenter,Kristi. The due date is: July 16, 2018 5:00 PM 7/11/2018 5:16 PM

�� �
�ivislan af Water Resour�es
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:*
Wake
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:
WBS #
17BP.5. C. PE
(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
Nationwide Permit (NWP) Number
03 - Maintenance
73 - Bank Stabilization
NWP Number Other:
List all MN nurrbers 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
Acceptance Letter_DMS SR 1379 Penny Rd.pdf 73.73KB
F1LE lYFE MJST BE FDF
1f. Is the project located in any of NC's twenty coastal counties?'�
f Yes �' No
1h. Is the project located in a designated trout watershed?*
f Yes r No
Link to trout information: http://wvwv.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Agency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact? *
Heather Montague
1b. PrimaryContact 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.:
2c. Responsible party:
(for Corporations)
2d. Address

Street Address
2612 N Duke Street
Address Line 2
C7ty
Durham
Fbstal / Zip Code
27704
2e. Telephone Number:
(xxx)xxx-�axx
[phone]
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
State / Rovince / Region
NC
Country
USA
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Replacement of pipe on SR 1379 (Penny Road) carrying UT to Swift Creek
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Raleigh
1d. Driving directions*
IF it is a new project and can not easily be found in a GPS rrapping system Rease provide directions.
From south side of Raleigh at the belt line, take Lake Wheeler Road south for 3.1 mi, make a right onto SR 1379 (Penny Road). Travel
0.35mi to project site.
2. Project Identification
2a. Propertyldentification Number:
(tvc RN or parcel ID)
0791146990 inlet, 0791241883 outlet
2b. Propertysize:
(in acres)
0.27
2c. Project Address
Street Address
5100 Penny Road
Address Line 2
a�y
Raleigh
Fbstal / Zip Code
27606
2d. Site coordinates in decimal degrees
State / Rovince / f�gion
NC
Country
USA
Please collect site coordinates in decimal degrees. Use bet�en 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�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:* Longitude:*
35.713926 -78.690225
ex:34208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
UT to Swift Creek
3b. Water Resources Classification of nearest receiving water:*
27-43-5-(1.5)
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Neuse
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:*
Adjacent area is comprised of road shoulder and 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)
dick the upload button or drag and drop files here to attach docurrent
SR 1379 Penny Road USGS map.pdf
Fle type rrust be pdf
1.29MB
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
SR 1379 soils map.pdf
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)
163
4f. Explain the purpose of the proposed project:*
Pipe structure has deteriorated and is non-functional
628.25KB
4g. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
Replacement of e�asting double line of 66" CMPs that are 44.5' long with a new structure 1@10'3" x 6'9" Aluminum
Structural Pipe-Arch that is 58.5' long with headwalls. There is a proposed dissipator pad at the outlet of the
proposed pipe in the ewsting scour hole. There will also be rip rap placed on the banks for bank stabilization at the
inlet and the outlet. Project will require dewatering of the work site. Equipment could include an excavator,
backhoe, crane, grader, mini excavator, etc.
4h. Please upload project drawings for the proposed project.
C7ick the upload button or drag and drop files here to attach docurrent
Fle type rrust be pdf
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes r No �' Unknown
Comme nts:

5b. If the Corps made a jurisdictional determination, what type of determination was made?*
l' Preliminary l" Approved �' Unknown
Corps AID Number:
6carrple: SAV�2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:
Greg Price
Carolina Ecosystems, Inc.
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
No wetlands were observed during site investigation, pre-JD request was sent to Jamie Lastinger (USACE) signed 06/18/18 regarding two
side tributaries feeding the main stem crossing
5d1. Jurisdictional determination upload
dick the upload button or drag and drop files here to attach docurrem
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 �' Unknawn
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 activit�/? 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):
r Wetlands r% Streams-tributaries r7 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. 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 Site 7 T Dewatering UT to Swift Creek Perennial Both 70 33 3
N�p label (e.g. Fd�ad Qossing F2rrranem (Fj or F�rennial (FH� or Average (linear feet) 3
1) Terrporary (� interrrittent (IfVn (feet) �
g2 Site 1 P Culvert UT to Swift Creek Perennial Both 10 14 1
N�p label (e.g. F�ad C7ossing F�rrranent (Fj or F�rennial (�2) or Average (linear feet) 4
1) Terrporary (lj interrrittent (If� (feet) �

S3 Site 1 P Bank
N�p label (e.g. I�ad C7ossing F2rrranent (Fj or StBbilization
1) Terrporary (lj
S4 Site 2 P Rip Rap Fill
fvbp label (e.g. Finad CYossing F2rrranem (Fj or
1) Terrporary (�
S5 Site 3 P Rip Rap Fill
N�p label (e.g. Finad Qossing F2rrranem (Fj or
1) Terrporary (�
S6 Site 3 T Dewatering
N�p label (e.g. Fd�ad Q-ossing F�rrranem (Fj or
1) Terrporary (�
UT to Swift Creek
UT to Swift Creek
UT to Swift Creek
UT to Swift Creek
Perennial Both
F2rennial (� or
intermittent (If�
Intermittent Both
F�rennial (Fff2) or
imerrrittent (IfVn
Intermittent Both
F�rennial (� or
interrrittent (IIVn
Intermittent Both
F2rennial(� or
interrrittent (IfVT)
"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:
128
3i. Total temporary stream impacts:
48
3i. Total stream and tributary impacts:
176
3j. Comments:
Site 1 impacts involve the main stem with bank stabilization inlet and outlet and counter sunk rip rap at the outlet
within an ebsting scour hole. Site 2 and Site 3 involves putting these tributaries segments into a rip rap lined ditch
in order to protect the roadway fill slope from water eating away at the toe of fill. Left unarmored the fill slope in this
area would continue to take eroding pressure and fail, threatening the roadway.
6. Buffer Impacts (for DWR)
ff 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)?*
C�eck all that apply.
�J Neuse
r Catawba
r Goose Creek
r Other
6b. Impact Type *
Site 1
Location and Exerrpt, Allowable, allowablewl
rritigation
Site 2
Location and Exerrpt, Allowable, allowable w/
rritigation
6h. Total buffer impacts:
6c. Per or
Temp*
P
F2rrranent (Fj or
Terrporary (�
P
F2rrranent (Fj or
Terrporary (lj
Zone 1
Temporary impacts: 0.00
Zone 1
r Tar-Pamlico
r Randleman
r Jordan Lake
6d. Stream name * 6e. Buffer mitigation
required?*
UTto Swift Creek No
UTto Swift Creek Yes
Zone 2
0.00
Zone 2
10
Average
(feet)
5
Average
(feet)
7
Average
(feet)
7
Average
(feet)
45 4
(linearfeet) 5
0
56 2
Qinearfeet) $
0
73 9
(linearfeet) 1
75 7
(linearfeet) 0
5
6f. Zone 1 6g. Zone 2
impact* impact*
2,833 2,931
(squarefeet) (squarefeet)
545 0
(squarefeet) (squarefeet)

Permanent impacts: 3,378.00 2,931.00
Zone 1 Zone 2
Total buffer impacts: 3,378.00 2,931.00
6i. Comments:
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
aick the upload button or drag and drop files here to attach docurrent
SR 1379 FULL PERMIT PACKAGE incl SWMP.pdf 1.3MB
Fle rrust be FDF
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:*
Failing pipes are being replaced with the minimal length pipe to fit current roadway standards which will also
provide for safe shoulders.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Construction will be overseen by NCDOT Division 5 Environmental Staff and CEI Personnel who will be onsite to
identify ways to reduce proposed impacts.
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
2c. If yes, mitigation is required by (check all that apply):
fJ DWR rJ Corps
2d. If yes, which mitigation option(s) will be used for this project?
r Mitigation bank r% 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)
69
4c. If using stream mitigation, what is the stream temperature:
warm
4d. Buffer mitigation requested (DWR only):
(squarefeet)
545
4e. Riparian wetland mitigation requested:
(acres)
0
4f. Non-riparian wetland mitigation requested:
(acres)
0

4g. Coastal (tidal) wetland mitigation requested:
(acres)
0
4h. Comments
Proposing full mitigation for stream impacts at Site 2: 56LF and Site 3: 13LF, but no mitigation is proposed at Site
1 since those impacts involve only bank stabilization and countersunk rip rap. Site 2: Buffer mitigation is proposed
for parallel buffer impacts of 545SF in Zone 1
6. Buffer mitigation (State Regulated Riparian Buffer Rules) - required by DWR
6a. Will the project result in an impact within a protected riparian buffer that requires buffer mitigation? If yes, you must fill out this entire
form - please contact DWR for more information.
C•' Yes �' No
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation
calculate the amount of mitigation required in the table below.
Zone 1
Zone 2
6c. Reason for impact
pipe replacement; protection of
roadway
n/a
6d. Total impact Multiplier
(square feet)
545
0
6e. Required
mitigation (square
feet)
545
0
6f. Total buffer mitigation required
545
6g. If buffer mitigation is required, is payment to a mitigation bank or NC Division of Mitigation Services proposed?
C Yes r No
6h. Attach the acceptance letter from the mitigation bank or NC Division of Mitigation Services.
Acceptance Letter_DMS SR 1379 Penny Rd.pdf 73.73KB
(FDF only)
6j. 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?
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
fJ Vegetated Conveyance (lower SHWT)
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
Stormwater Mgt Plan SR1379 Penny Road Wake.pdf 540.12KB
Fle type rrust be FDF
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: *
Document has not be finalized by the State Clearing House.
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15A NCAC 2H .0500), Isolated Wetland Rules (75A NCAC 2H .7300), or
DWR Surface Water or Wetland Standards or Riparian Buffer Rules (15A NCAC 2B .0200)?*
f Yes �' 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 qualit�/?*
C' Yes C•' No
3b. If you answered "no," provide a short narrative description.
Replacing existing structures with newstructure on ebsting facility.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
f Yes C' No C' f�/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 C' No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
f• Yes l" No
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. Is another Federal agency involved?*
l" Yes C No
5e. Is this a DOT project located within Division's 1-8?*
G Yes r No
l" Unknawn
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
Carolina Ecosystems, Inc. 02/16/18 and 06/08/18 site visits by Phil May and Rob Crowther revealed no suitable
habitat for Bald Eagle and RCW, so Biological Conclusions of No Effect are rendered for each species. A plant
survey in marginal habitat for Michaux's sumac revealed no species observed and a Biological Conclusion of No
Effect is rendered. April 13, 2018 habitat assessment and survey by biologists Tom Dickinson and Liay Stokes-
Cawiey from Three Oaks Engineering was conducted and no aquatic specimens were found. Based on these
findings and following the steps of the newiy implemented PBO for aquatic species, Biological Conclusions of No
Effect are appropriate for listed aquatic species that are known from or have potential to occur in the county, or
petitioned species that could become listed with the project timeline.
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? *
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 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?'�
NCDOT HEU SHPO review: No surveys required from either group, Historic Structures nor Archaeology.
7c. Historic or Prehistoric Information Upload
Gick the upload button or drag and drop files here to attach docurrent
18-01-0019NoSurvey.pdf 1.8MB
PA 18-01-0019 No Archaeological Survey Required Pipe Replacement on SR 1379 Penny
628.81 KB
Rd, Wake.pdf
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?*
C' Yes C•' No
8c. What source(s) did you use to make the floodplain determination?*

FEMA mapping
Miscellaneous
Miscellaneous attachments not previously requested.
C7ick the upload button or drag and drop files here to attach docurrent
Fle rrust be FDF or IWQ
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:*
Heather W. Montague
Signature
f {€A7Ff�- bi{ �tdnl7".116v�
Date Submitted:
7/11 /2018
Initial Review
Is this project a public transportation project?* (?)
f• Yes r No
Change only rf needed.
Has this project met the requirements for acceptance in to the review process? *
f• Yes
f No
BIMS # Assigned *
20180964
Version#*
1
Reviewing Office *
Central Office - [phone]
Select Project Reviewer*
Rob Ridings:eads\rgridings
Is a payment required for this project?*
C' No payment required
r Fee received
r Fee needed - send electronic notification