20180965 Ver 1_PCN Form Submission_20180712

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 7/12/2018 12:37:10 PM (Start Event)
Accept by Carpenter,Kristi 7/12/2018 4:48:06 PM (DOT Initial Review)
. The task was assigned to Carpenter,Kristi. The due date is: July 17, 2018 5:00 PM
7/12/2018 12:38 PM

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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:*
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: 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 - Express
r Non-404 Jurisdictional General Permit �rJ 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
f' 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 a- in-lieu fee program
l" Yes f' No
1f. Is the project located in anyof NC's twentycoastal counties?*
f Yes C•' No
1h. Is the project located in a designated trout watershed?*
C' Yes C No
Link to trout information: http://�wvw.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
(Checkall 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
2612 N Duke Street
Address Line 2
aty
Durham
Fbstal / Zip Code
27704
2e. Telephone Number:
(xxx)xxx-xxxx
[phone]
State / FYovince / F�gion
NC
Caurdry
USA

2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Replacement of pipe on SR 2763 (Maude Stewart Road) carrying Little
Black Creek
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/ town:*
Fuquay-Varina
1d. Driving directions*
IF it is a new project and can not easily be found in a GPS rrapping system Rease provide directions.
From Fuquay-Varina, at 401, take NC 55 South for 4.10mi, make a left onto SR 2763 and travel 0.41 mi to project site.
2. Project Identification
2a. Propertyldentification Number:
(tax RN or parcel ID)
0675539562 & 0675630881 @ inlet, 0675734932 & 0675631104 @ outlet
2b. Propertysize:
(in acres)
0.34
2c. Project Address
Street Address
8128 Maude Stewart Road
Address Line 2
a�y
Fuquay-Varina
Rutal / Zip Code
27526
2d. Site coordinates in decimal degrees
State / Rovince / FZegion
NC
Courdry
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 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: *
35.545547
ex:34208504
3. Surface Waters
Longitude:*
-78.743854
-77.796371
3a. Name of the nearest body of water to proposed project:'�
Little Black Creek
3b. Water Resources Classification of nearest receiving water:*

27-43-3, Class C
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 7/2 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
Maude Stewart topo map.pdf 512.78KB
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)
Qick the upload button or drag and drop files here to attach docurrent
SR 2763 soils map.pdf 656.06KB
Fle type rrust be pdF
4d. List the total estimated acreage of all existing wetlands on the property:
0.044
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
80
4f. Explain the purpose of the proposed project:*
Pipe structure has deteriorated and is non-functional.
4g. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
Replacement of the e�sting 84" CMP that is 50' long with a new structure 1@112" x 75" Aluminum Structural Plate
Pipe-Arch that is 54' long with headwalls. Project will require dewatering of stream and installation of bank
stabilization. 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?*
C•' Yes r No C' Unknown
Comme nts:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
C' Preliminary C' Approved C•' Unknown C' f�UA
Corps AID Number:
6carrple: SAV�2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): J. Mathis and G. Price

Agency/Consultant Company:
Othe r:
Carolina Ecosystems, Inc.
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Pre-JD request was sent to James Lastinger (USACE) signed 06/18/18.
5d7. Jurisdictional determination upload
aick the upload button or drag and drop files here to attach docurrent
Fle 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? *
f Yes C No l" Unknown
7. Future Project Plans
7a. Is this a phased project?'�
C' Yes �' 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):
r% Wetlands rJ Streams-tributaries �T 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 *Ze. 2f. Type of 2g. Impact
Forested* Jurisdicition* area*
Site 7-const P Headwater Forest WA Yes Both 0.044
access/dewatering F2rrranent (� or (aon, 10) or CUUR(4o1, (acres) i
N�p label (e.g. f3�ad Qossing 1- Qalvert, Terrporary (� other)
dewatering, etc)
2g. Total Temporary Wetland Impact
0.000
2g. Total Permanent Wetland Impact
0.044
2g. Total Wetland Impact
0.044
2h. Comments:
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 *
g� Site 1-pipe T Dewatering Little Black Creek
repl'ment F2rrranent(Fjor
N�p label (e.g. I�ad Qossing Terrporary (lj
1)
gp Site 1-pipe P Culvert Little Black Creek
repl'ment F2rrranent(�or
fv�p label (e.g. Fd�ad CYossing Terrporary (lj
1)
S3 Site 1-pipe P Bank Little Black Creek
repl'ment r�rrranent(Fjor Stabilization
Nbp label (e.g. Fd�ad Q-ossing Terrporary (�
1)
3e. Stream 3f. Type of 3g. Stream 3h. Impact sqfe�
Type * Jurisdiction * width * length *
Perennial Both 10 24 2
F2rennial (FH2) or Average (linear feet) 4
intermittent (If� (feet) 0
Perennial Both
F2rennial (� or
irderrcittent (If�
Perennial Both
F2rennial (Fffl) or
ir�terrcittent (IfVn
*' 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:
39
3i. Total temporary stream impacts:
24
3i. Total stream and tributary impacts:
63
3j. Comments:
Although the new pipe is shorter, 4ft of SW fill is reported at the outlet since the new pipe shifted that way 4ft.
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.
fJ Neuse r Tar-Pamlico
r Catawba r Randleman
r Goose Creek r Jordan Lake
r Other
6b. Impact Type * 6c. Per or
Te mp *
Site 1 - Allowable T
Location and 6cerrpt, Allowable, allowable w/ F�rrranent (Fj or
rritigation Terrporary (�
6h. Total buffer impacts:
Zone 1
Temporary impacts: 3,917.00
Permanent impacts:
Zone 1
0.00
6d. Stream name *
Little Black Creek
Zone 2
2,593.00
Zone 2
0.00
Zone 1 Zone 2
Total buffer impacts: 3,917.00 2,593.00
6e. Buffer mitigation
required?*
No
10 4 4
Average (linearfeet) 0
(feet)
10 35 3
Average (linearfeet) 5
(feet) 0
6f. Zone 1
impact*
3,917
(square feet)
6g. Zone 2
impact*
2,593
(squarefeet)

6i. Comments:
Equipment will be operated from the roadway. Buffer impacts are limited to foot traffic access for construction and
for installation of dewatering measures. The disturbed area will be minimized wfiere possible during construction.
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
C7ick the upload button or drag and drop files here to attach document
SR 2763 FULL PERMIT PACKAGE INCL SWMP.pdf 1.06MB
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:*
This failing pipe is being replaced with the minimal length pipe to fit the current roadway standards wfiich 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 Environmental Staff and Inspection 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?
C' Yes r No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
Project involves replacement of ebsting failed pipe with a new pipe structure that is designed to meet current roadway standards. The use of
a NWP 3 does not typically require mitigation. Mitigation is not proposed.
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?
G' Yes C' 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
rJ Vegetated Conveyance (lower SHWT)
r Wetland Swale (higher SHWT)
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
Qick the upload button or drag and drop files here to attach docurrent
Stormwater Mgt Plan SR 2763 Maude Road Wake.pdf 543.93KB
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 f 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? *
G Yes C' 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)?*
f• Yes �' 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.)*
l' Yes f' 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 (15A NCAC 2H .1300), or
DWR Surface Water or Wetland Standards or Riparian Buffer Rules (75A NCAC 2B .0200)?*
f 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 reasonablyanticipated future impacts) result in additional development, which could impact
nearby downstream water quality?*
f Yes �' No
3b. If you answered "no," provide a short narrative description.
Replacing e�sting structure with new structure on existing facility.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
C' Yes f No f' N/A
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
Sa. Will this project occur in or near an area with federally protected species or habitat? *
l•' Yes C' No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
f• Yes �' No
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. Is another Federal agency involved?*
f Yes f• No
5e. Is this a DOT project located within Division's 1-8?*
�' Unknown

r Yes r No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
Site visits by Carolina Ecosystems, Inc. revealed no suitable habitat for Bald Eagle and RCW during 02/16/18 and
06/08/18 site visits respectively. Additionally a plant survey by Phil May on 06/08/18 revealed no specimens.
Aquatic/mussel checks were conducted by Tim Savidge and Tom Dickinson on 02/14/18. No habitat was found for
Neuse River Waterdog. No fresh water mussels or other listed aquatic species were observed during the cursory
surveys. Additionally use of Programmatic Biological Opinion for Bridge and Culvert
Replacements/Repairs/Rehabilitations in Eastern North Carolina, NCDOT Divisions 1-8 (June 13, 2018) provides
for incidental take coverage for those projects which may have adverse effects to three species of mussels (Dwarf
Wedgemussel, Tar River Spinymussel, and Yellow Lance). It also provides automatic concurrence for those
projects which may affect, but are not likely to adversely affect (MA-NLAA) those species. The use of the steps of
the PBO indicates Biological Conclusions of No Effect for Dwarf Wedgemussel, Tar River Spinymussel and Yellow
Lance.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
f Yes �' 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)? *
l' Yes r 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
Qick the upload button or drag and drop files here to attach docurrent
18-01-0020NoSurvey.pdf 1.89MB
AR18-01-0020NoSurvey.pdf 900.54KB
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 INR
Signature
� 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
l�€A lFf�- iAr �VtOn�1'.116trE
Date Submitted:
7/12/2018
Initial Review
Is this project a public transportation project?* (')
G Yes l' No
C�ange only 'rf needed.
Has this project met the requirements for acceptance in to the review process? *
C Yes
C' No
BIMS # Assigned *
20180965
Version#*
Reviewing Office*
Central Office - [phone]
Select Project Reviewer*
Rob Ridings:eads\rgridings
Is a payment required for this project?*
f No payment required
f• Fee received
l' Fee needed - send electronic notification