20181102 Ver 1_PCN Form Submission_20180809

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 8/9/2018 1:01:53 PM (Start Event)
Accept by Carpenter,Kristi 8/9/2018 4:07:07 PM (DOT Initial Review)
. The task was assigned to Carpenter,Kristi. The due date is: August 14, 2018 5:00 PM
8/9/2018 1:02 PM

i i �� �
�����
�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:*
Duplin
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 #
36.203111
(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 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
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?*
Mason Herndon
1b. PrimaryContact Email:*
[e-mail]
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
r Owner r7 Applicant (other than owner) r Agent/Consultant
(Check all that apply)
2. Owner Information
2a. Name(s) on recorded deed:
North Carolina Department of Transportation
2b. Deed book and page no.:
f�UA
2c. Responsible party:
(for Corporations)
Karen E. Collette, P.E.
2d. Address
Street Address
5501 Barbados Blvd.
Address Line 2
aty
Castle Hayne
Fbstal / Zip Code
28429
2e. Telephone Number:
(xxx)xxx-xxxx
[phone]
State / Rovince / Region
North Carolina
Cauntry
USA

2f. Fax Number:
[phone]
(xxx)xxx-xxxx
2g. Email Address:*
kecol lette@ncdot. gov
3. Applicant Information (if different from owner)
3a. Applicant is:
C' Agent
r Other ,is���� 3 tnvironmental Unit
IF other please spec'rfy.
3b. Name:
Mason Herndon
3c. Business Name:
(if applicable)
North Carolina Department of Transportation
3d. Address
Street Address
5501 Barbados Blvd.
Address Line 2
a�y
Caslte Hayne
Fbstal / Zip Code
28429
3e. Telephone Number:
[phone]
(xxx)xxx-xxxx
3f. Fax Number:
[phone]
(xxx)xxx-xxxx
3g. Email Address:*
[e-mail]
State / Rovince / f�gion
North Carolina
Country
USA
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
SR 1136 Chicken Neck Road - Site 2
1b. Subdivision name:
(if appropriate)
wa
1c. Nearest municipality/town:*
Wallace
1d. Driving directions*
IF it is a new project and can not easily be found in a GPS rrapping system Rease provide directions.
Take I-40 West to ebt 390 toward U.S. 117 N in Union. Turn left onto US-117 N, Turn left onto NC-41 S/E Main St., Turn right onto Butterball
Road., slight left onto chicken neck road for 1.6 mi. Destination will be on your right.

2. Project Identification
2a. Propertyldentification Number:
(tax RN or parcel ID)
wa
2b. Propertysize:
(in acres)
f�UA
2c. Project Address
Street Address
Address Line 2
aiy
Fbstal / Zip Code
2d. Site coordinates in decimal degrees
State / FYovince / F�gion
Country
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:*
34.208504 -78.796371
ex:34.208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Rock Fish Creek
3b. Water Resources Classification of nearest receiving water:*
C;Sw
SurFace Water Lookup
3c. What river basin(s) is your project located in?*
Cape Fear
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 site consists of an unpaved NCDOT Maintained Secondary two-lane roadway with maintained shoulders. Land
use in the vicinity of the project is primarily residential, agricultural and forested.
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 docurrent
USGS.pdf 386.65KB
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
20180801 _09281409177_1 _Soil_Map. pdf 542.07KB
Fle type rrust be pdF

4d. List the total estimated acreage of all existing wetlands on the property:
0
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
(Perennial) 100 LF
4f. Explain the purpose of the proposed project:*
To preserve the safety and mobility of the traveling public by replacing the e�sting pipe culvert.
4g. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
NCDOT plans to replace one (1) @ 48" CMP with one (1) @ 66" CMP x 68' on a 142° skew with headwalls. The
new pipe skew and inlet relocation will cause permanent beneficial stream impacts to the ebsting channel.
Proposed impact figures are attached. Standard road construction and pipe replacement equipment such as
cranes, excavators, dump trucks, and similar vehicles would be used for the project. Proper erosion and
sedimentation control measures would be employed throughout the project. Once the pipe is replaced, the
roadway area disturbance would be repaved.
4h. Please upload project drawings for the proposed project.
Qick the upload button or drag and drop files here to attach docurrent
SR 1136 Permit Drawings.pdf 95.79KB
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 C•' 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):
Agency/Consultant Company:
Othe r:
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5d7. Jurisdictional determination upload
Qick 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?*
f Yes f•' No �' Unknown
7. Future Project Plans
7a. Is this a phased project?*
f 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):
r Wetlands fJ Streams-tributaries r 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 *
type �`
S1 Sheetpile T Dewatering
N�p label (e.g. F3�ad Qossing F�rrranent (P) or
1) Terrporary (�
g2 Pipe Relocation P Relocation
N�p label (e.g. Fbad Qossing F2rrranem (Fj or
1) Terrporary (�
UT to Rockfish
Creek
UT to Rockfish
Creek
3e. Stream 3f. Type of 3g. Stream 3h. Impact sqfe�
Type'� Jurisdiction* width* length*
Perennial Both
F�rennial (� or
interrrittent (IIVn
Perennial Both
F�rennial (FH� or
interrrittent (IIVn
S3 Rip Rap P Rip Rap Fill UT to Rockfish Perennial Both
fv�p label (e.g. f3�ad Qossing �rrranent (� or CrB@ k �rennial (� or
1) Terrporary (� intermittent (IMj
S4 Sheetpile T Dewatering UTto Rockfish Perennial Both
N�p label (e.g. F3�ad Qossing F2rrranent (Fj or Cre e k F�rennial (� or
1) Terrporary (� interrrittent (IIVn
"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:
51
3i. Total temporarystream impacts:
15
3i. Total stream and tributary impacts:
66
3j. Comments:
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:*
To avoid further scouring of the roadway shoulder the pipe inlet will be realigned to provide a better alignment with
the stream channel and will be buried at least 1 FT. belowthe natural stream bed elevation as determined from
upstream and downstream elevations away from the scour associated with the current pipe. The proposed outlet
rip rap placement is the minimum necessary to avoid further scour in the future.
5 10 5
Average (linearfeet) 0
(feet)
5 46 2
Average (linearfeet) 3
(feet) 0
5 5 2
Average (linearfeet) 5
(feet)
5 5 2
Average Qinearfeet) 5
(feet)
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*

Work in the dry to minimize aquatic impacts. Sediment fencing around limits of disturbance.
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:
proposed impacts fall within the permitted thresholds.
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 r No
For a list of options to meet the diffuse flow requirements, click here.
If no, explain why:
Stream is not located in the Neuse River Basin, Tar-Pamlico River Basin, Catawba River Basin, Randleman Lake Watershed, Jordan Lake
Watershed and Goose Creek Watershed.
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?*
G 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)?*
f Yes r No
Comme nts: *
Meets Minimum Criteria under 19A NCAC 02F.0102 (9) " Reconstruction of e�asting crossroad or railroad
separation and exsting stream crossings, including, but not limited to pipes, culverts, and bridges," for which
environmental documentation is not required.
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.
Due to the minimal transportation impact resulting from this roadway improvement, this project will neither influence
nearby land uses nor stimulate growth. Therefore, a detailed indirect or cumulative effects study will not be
necessary.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
C' Yes C 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 C•' No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
f Yes �' No
5d. Is another Federal agency involved?*
C' Yes C•' No
5e. Is this a DOT project located within Division's 1-8?*
l•' Yes r No
C' Unknown
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
SHPO GIS Data
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
C' Yes C•' No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat? *
NC Natural Heritage Program
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 �' No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources? *
NCHPO GIS Website
7c. Historic or Prehistoric Information Upload
C]ick the upload button or drag and drop files here to attach docurrent
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?*

r Yes r No
8c. What source(s) did you use to make the floodplain determination?*
FRIS Website
Miscellaneous
Miscellaneous attachments not previously requested.
Qick the upload button or drag and drop files here to attach docurrent
Fle rrust be FDF or KNQ
Signature
�7 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:*
Christopher Dustin
Signature
�`�/r�c�F�r���f ��rsdtr,�
Date Submitted:
8/9/2018
Initial Review
Is this project a public transportation project?* (')
G' Yes r 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 *
20181102
Version#*
1
Reviewing Office *
Wilmington Regional Office - [phone]
Select Project Reviewer*
Joanne Steenhuis:eads\jhsteenhuis
Is a payment required for this project?*
l" No payment required
l•' Fee received
C' Fee needed - send electronic notification