20180997 Ver 1_PCN Form Submission_20180719

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 7/19/2018 4:32:54 PM (Start Event)
Accept by Carpenter,Kristi 7/19/2018 4:43:43 PM (DOT Initial Review)
. The task was assigned to Carpenter,Kristi. The due date is: July 24, 2018 5:00 PM 7/19/2018 4:35 PM

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�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:*
Halifax
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-5725
WBS #
50162.1.1
(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
U-5725 - Division 4- STR - RW - RO 07.pdf 63KB
F1LE lYFE MJST BE FCF
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? *
Chad Coggins; NCDOT Division 4
1b. PrimaryContact Email:*
[e-mail]
1c. PrimaryContact Phone:�
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
fJ Owner rJ Applicant (other than owner) r Agent/Consultant
(Check all that apply)
2. Owner I nformation
2a. Name(s) on recorded deed:
NCDOT Right-of-Way
2b. Deed book and page no.:
f�/A (Linear Transportation Project)
2c. Responsible party:
(for Corporations)
Chad Coggins; NCDOT Division 4
2d. Address

Street Address
509 Ward Blvd
Address Line 2
PO Box 3165
a�y
Wilson
Fbstal / Zip Code
27895
2e. Telephone Number:
(xxx)xxx-xxxx
[phone]
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
3a. Applicant is:
G' Agent
f' Other
IF other please specify.
3b. Name:
Jason Hartshorn
3c. Business Name:
(if applicable)
Kimley-Horn
3d. Address
Street Address
421 Fayetteville Street
Address Line 2
Suite 600
a�y
Raleigh
Fbstal / Zip Code
27601
3e. Telephone Number:
[phone]
(xxx)xxx-xxxx
3f. Fax Number:
(xxx)xxx-xxxx
3g. Email Address:*
[e-mail]
State / Rovince / F�gion
NC
Country
USA
State / Fhovince / REgion
NC
Country
USA
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Widening of NC-125
1b. Subdivision name:

(if appropriate)
1c. Nearest municipality/town:*
Roanoke Rapids
1d. Driving directions*
IF it is a new project and can not easily be found in a GPS rrapping system Rease provide directions.
See Figure 1: Vicinity Map
2. Project Identification
2a. Propertyldentification Number:
(tax RN or parcel ID)
rUA (Linear Transportation Project)
2b. Propertysize:
(in acres)
92
2c. Project Address
SYreet Address
234 Old Farm Rd Extd
Address Line 2
a�y
Roanoke Rapids
Rutal / Zip Code
27870
2d. Site coordinates in decimal degrees
State / Rovince / Region
NC
Country
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: *
34.416213
ex:34208504
3. Surface Waters
Longitude:*
-77.646492
-77.796371
3a. Name of the nearest body of water to proposed project:'�
Chockoyotte Creek
3b. Water Resources Classification of nearest receiving water:*
C
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Roanoke
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:*
The majority of the project corridor consists of undeveloped land and low-density residential areas. The project
corridor is bounded by agricultural land to the east and south, undeveloped forestland and residential areas to the
west, and commercial development to the north. The project vicinity is primarily composed of undeveloped
agricultural and rural 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
U5725_Figure_2_USGS. pdf
Fle type rrust be pdF
1.87MB
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
U5725_Figure_4_NRCS.pdf 1.76MB
Fle type rrust be pdF
4d. List the total estimated acreage of all existing wetlands on the property:
1.93 acres
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
396 linear feet
4f. Explain the purpose of the proposed project:*
The purpose of this project is to reduce congestion and improve highway access for residents and businesses
along the NC 125 corridor.
4g. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
This project proposes to widen NC 125 to a 4-lane divided curb and gutter roadway with 12-foot wide lanes, a 23-
foot raised median, and 12-foot wide grassed shoulders (14-foot wide with guardrail) from I-95 to Old Farm Road
(SR 1752) (1.53 miles). The project vv�ould reduce congestion and improve highway access along NC-125, a
primary connector for residents and business traffic. Typical roadway construction equipment will be used,
including cranes, track hoes, back hoes, graders, dump trucks, bulldozers, and pavers.
4h. Please upload project drawings for the proposed project.
Qick the upload button or drag and drop files here to attach docurrent
U5725_Pla n_Sheets. pdf
2018-04-12_U-5725. pdf
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5. Jurisdictional Determinations
6.9MB
12.07MB
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
f' Yes �' No �' Unknown
Comme nts:
Kimley-Horn staff delineated the project area in May, July, and September
2017.
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
C' Preliminary !' Approved �' Unknown 6' f�llA
Corps AID Number:
6carrple: SAV�2017-99999
Sc. If Sa is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:
Jason Hartshorn and Willie Sullivan
Kimley-Horn
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
A preliminary jurisdictional determination request was submitted to Tom Steffens of the USACE and Rob Ridings of NCDWR on October 10,
2017 and documentation is currently pending.
5d7. Jurisdictional determination upload

C1ick the upload button or drag and drop files here to attach docurrent
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?*
C' Yes C No C' Unknown
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.
No
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
fJ 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*
Site 1- Road Crossing P
N�p label (e.g. fd�ad CYossing 1- Qalvert, F2rrranent (� or
dewatering, etc) Terrporary (�
Site 1- Mechanized Clearing P
(M C) F2rrranent (F) or
N�p label (e.g. I�ad Qossing 1- CLlvert, Terrporary (�
dewatering, etc)
2g. Total Temporary Wetland Impact
0.000
2g. Total Permanent Wetland Impact
0.460
2g. Total Wetland Impact
0.460
Riverine Swamp
Forest
Riverine Swamp
Forest
2d. Wetland name *2e. 2f. Type of 2g. Impact
Forested* Jurisdicition* area*
WX, WY, WZ Yes Both 0.310
(404, 10) or Cr✓VR(401, (acres)
other)
WX, WY, WZ Yes Both 0.150
(404, 10) or C!✓VR(401, (acres)
other)
2h. Comments:
Unavoidable impacts to riparian wetlands within the project corridor will result from the widening of the roadway.
Construction easements and permemanent maintenance easements will be cleared mechanically.
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 *

g1 Site 1 - Culvert
Extension
Nbp label (e.g. I�ad Qossing
1)
g2 Site 1 - Construction
Access
N�p label (e.g. Fd�ad Qossing
1)
S3 Site 1 - Road
Crossing
N�p label (e.g. FUad Qossing
1)
P Culvert
F2rrranent (Fj or
Terrporary (�
T Other
F2rrranent (P� or
Terrporary (�
P Fill
F�rrranent (� or
Terrporary (�
SY - UT to
Chockoyotte Creek
SY - UT to
Chockoyotte Creek
Perennial Both
F2rennial (� or
interrri[tent (If�
Perennial Both
F�rennial (� or
interrritterd (If�
JD 2 Jurisdictiona Corps
I Ditch
F2rennial (FB�) or
irderrrittent (IfVn
** All Perennial or Intermittent streams must be verified by DWR or delegated local government.
3i. Total jurisdictional ditch impact in square feet:
52
3i. Total permanent stream impacts:
163
3i. Total temporary stream impacts:
48
3i. Total stream and tributary impacts:
211
3j. Comments:
Unavoidable impacts to jurisdictional streams and ditches will result from the proposed roadway widening. Impacts
to streams will result from the extension of culverts and temporary construction access.
E. Impact Justification and Mitigation
`�_�1•7[' ._ �FTIT�Tr�►� � �fl'11' i1F•�iiC•7'i1
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
Impacts to jurisdictional wetlands and streams have been avoided and minimized to the extent practical. Impacts to
streams and wetlands in the project vicinity have been reduced overall by widening along the exsting road
alignment as opposed to a new location road to accommodate traffic demands. The footprint of the proposed
widening will occur mostly within existing rights-of-way. Where possible, fill slopes have been shortened to avoid
additional, unnecessary impacts to wetlands and streams, and e�sting culverts will be extended rather than
reconstructing additional crossings. In general, the project was designed to reduce the amount of stream and
wetland impacts by working within ebsting right-of-way and by reducing the width of the roadway facility when
crossing jurisdictional features.
10 137 1
Average (linearfeet) ,
(feet) 3
7
0
10 48 4
Average (linearfeet) $
(feet) 0
2 26 5
Average (linearfeet) 2
(feet)
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Impacts to streams and wetlands within the corridor will be minimized to the extent practical throughout the
construction process by avoiding stream and wetland features wtiere practical. Equipment staging and
construction access will be located in upland areas throughout the corridor, and silt fencing will be installed at the
permitted limits of disturbance to ensure all equipment is located within the project corridor at all times near stream
and wetland areas. Sediment control measures will be used to reduce stormwater impacts to receiving waters and
minimize runaff from the construction site.
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):
fJ 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)
274 linear feet
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)
0.77 acre
4f. Non-riparian wetland mitigation requested:
(acres)
4g. Coastal (tidal) wetland mitigation requested:
(acres)
4h. Comments
Stream mitigation is proposed at a 2:1 ratio for the 137 linear feet of permanent impacts resulting from the project.
Wetland impacts resulting from mechanized clearing, fill, and excavation are proposed for mitigation at a 2:1 ratio.
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.
f Yes �' 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 �' No
For a list of options to meet the diffuse flow requirements, click here.
If no, explain why:
See attached erosion control sheet.
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?*

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 PolicyAct (NEPA/SEPA)?*
l•' Yes C' 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 b' No
Comme nts: *
A Minimum Criteria Determination Checklist (MCDC) is being prepared for the proposed project.
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)?*
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 reasonably anticipated future impacts) result in additional development, which could impact
nearby downstream water quality?*
C' Yes C•' No
3b. If you answered "no," provide a short narrative description.
highway access for residents and businesses in the project area. No additional or cumulative impacts are
anticipated due to the construction of the proposed project.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
C' Yes r No C' rUA
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 �' No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
C' Yes �' No
5d. Is another Federal agency involved?*
f Yes r No
5e. Is this a DOT project located within Division's 1-8?*
C•' Yes f" No
�' Unknown
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?

As of April 4, 2018, the USFWS lists five federally protected species known to occur in Halifax County: red-
cockaded woodpecker, Tar River spinymussel, dwarf wedgemussel, yellow lance, and bald eagle. According to the
NC Natural Heritage Program Element Occurrence Database (updated January 2018), no known occurrences of
any federally threatened or endangered species within the study area.
Suitable habitat for dwarf wedgemussel, Tar River spinymussel, and yellow lance does not e�st in the study area.
Streams within the project corridor have been historically impacted due to beaver and agricultural activity, and are
too small or intermittent in nature and prone to drying out completely. In addition, dwarf wedgemussel and Tar
River spinymussel are only known to occur within the Tar-Pamlico and Neuse River basins, and yellow lance is
only known to occur in the Tar-Pamlico, Neuse, and Chowan river basins. Due to the lack of suitable habitat, the
disconnect from known ranges, and lack of documented occurrences within 1.0 mile of the project area, it has
been determined that the proposed project will have "No EffecY' on dwarf wedgemussel, Tar River spinymussel,
and yellow lance.
Suitable habitat is not present within the project area for red-cockaded woodpecker. Forests in the study area are
successional mixed pine and hardwood forests with dense understories, and �nrould not support red-cockaded
woodpecker foraging or nesting habitat. Due to the lack of suitable habitat and the lack of documented
occurrences within 1.0 mile of the project area, it has been determined that the proposed project will have "No
EffecY' on red-cockaded woodpecker.
There is suitable roosting habitat for the northern long-eared bat within the project corridor, however the USFWS
has developed a programmatic biological opinion (PBO) in conjunction with the Federal Highway Administration
(FHWA), the USACE, and NCDOT for the northern long-eared bat (NLEB) in eastern North Carolina. The PBO
covers the entire NCDOT program in Divisions 1-8, including all NCDOT projects and activities. The programmatic
determination for NLEB for the NCDOT program is "May Affect, Likely to Adversely AffecY'. The PBO provides
incidental take coverage for NLEB and will ensure compliance with Section 7 of the Endangered Species Act for
five years for all NCDOT projects with a federal nexus in Divisions 1-8, which includes Halixfax County, wtiere TIP
R-3822 is located.
In addition, a desktop-GIS assessment performed in November 2017 using 2016 color aerials showed no potential
feeding sources or foraging habitat for bald eagle in the vicinity of the project. A review of the NCNHP database
revealed no known occurrences. Due to the lack of feeding or foraging habitat and the lack of known occurrences,
it has been determined that this project will have "No Effecf' on the Bald or Golden Eagle.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
f Yes f•' No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat? *
NOAA Essential Fish Habitat Mapper (Accessed March 27, 2018).
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)?*
G' Yes C' No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources? *
See attached NCSHPO coordination letter. Additionally, NewSouth Associates, Inc. (NewSouth), conducted
archaeological survey of U-5725 and R-3822A in Halifax County, North Carolina, between June 12-18, 2018. As a
result of the survey, four archaeological sites (31 HX520, 31 HX5210, 31 HX522, and 31 HX523) and one cemetery
(31 HX524) were identified. All four archaeological sites are recommended not eligible for the NRHP and no further
work is recommended. The known cemetery (31 HX524) is approbmately 10 meters outside the APE and will not be
affected by the current design. Therefore, no further work is recommended at this time. However, if that changed,
the cemetery would need to be considered under North Carolina General Statute 65.
7c. Historic or Prehistoric Information Upload
Qick the upload button or drag and drop files here to attach docurrent
04_NCSHPO_17-10-0024NHPA.pdf 5.29MB
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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:
The proposed project qualifies for MOA Type 2b.
8c. What source(s) did you use to make the floodplain determination?*
There are FEMA-designated 100-year floodplains, 500-year floodplains, and regulated floodways associated with
Chockoytte Creek in the project area. The project area appears on FEMA DFIRM Panels 3720490700J,
3720399700J, and 3720399600J (effective 7/3/2007).
Miscellaneous
Miscellaneous attachments not previously requested.
aick the upload button or drag and drop files here to attach docurrent
U5725_Figure_1_Vicinity Map.pdf 595.1 KB
U5725_Figure_3_Aerial Map.pdf 3M6
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Signature
rJ 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:*
Jason Hartshorn
Signature
C'�.c�ois' �r�I�t�cPilt�t�I
Date Submitted:
7/19/2018
Initial Review
Is this project a public transportation project?* ("')
C•' Yes f' 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 *
20180997
Version#*
1

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
f Fee needed - send electronic notification