HomeMy WebLinkAbout20181664 Ver 1_PCN Form Submission_20181207D1�VR
�irlslan af Water Resources
Initial Review
Pre-Construction Notification (PCN) Form
September 29, 2018 Ver 3
Has this project met the requirements for acceptance in to the review process?*
F Yes
C' No
Is this project a public transportation project?"
� Yes r No
Change only rf needed.
BIMS # Assigned *
20181664
Is a payment required for this project?*
f No paymentrequired
� Fee received
f Fee needed - send electronic notification
Select Project Reviewer"
Dave Wanucha:eads\djwanucha
Information for Initial Review
1a. Name of project:
Replace Bridge #23 w�th RCBC
1a. Who is the PrimaryContact?*
Heath Slaughter
1b. PrimaryContact Email:*
hslaughter@ncdot.gov
Date Submitted
12/7/2018
Nearest Body of Water
Old Field Branch
Basin
New
Water Classification
C; Trout, HQW
Site Coordinates
Latitude:
36.49926
A. Processing Information
County (or Counties) where the project is located:
Ashe
Is this project a public transportation project?*
r Yes r No
Is this a NCDOT Project?*
G Yes r No
(NCDOT only) T.I.P. or state project number:
Ve rsion# *
1
Reviewing Office *
Winston-Salem Regional Office - (336) 776-
9800
1c. PrimaryContact Phone:*
(336)903-9202
Longitude:
-81.51116
::
WBS # (�)
17BP.11.R.182
1a. Type(s) of approval sought from the Corps:
rJ 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)
1c. Has the NWP or GP number been verified bythe Corps?
C' Yes r No
Nationwide Permit (NWP) Number:
14 - Linear transportation
NWP Numbers (for multiple NWPS):
1d. Type(s) of approval sought from the DWR:
fJ 401 Water Quality Certification - Regular
r' Non-404 Jurisdictional General Permit
r Individual Permit
1e. Is this notification solelyfor the record because written approval is not required?
Forthe record onlyfor DWR401 Certification:
For the record onlyfor Corps Permit:
r 401 Water Quality Certification - E�ress
r Riparian Buffer Authorization
1f. Is this an after-the-fact permit application?*
� Yes r No
1g. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
F Yes r No
1g. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
� Yes r No
Acceptance LetterAttachment
Bridge 23 Mitigation.pdf
1h. Is the project located in any of NC's twenty coastal counties?
C' Yes r No
1j. Is the project located in a designated trout watershed?
� Yes r No
B. Applicant Information
1d. Who is applying for the permit?
rJ Owner r Applicant (other than owner)
1e. Is there an Agent/Consultant for this project?
� Yes r No
2. Owner Information
2a. Name(s) on recorded deed:
NCDOT
2b. Deed book and page no.:
2c. Responsible party:
2d. Address
Street Address
801 Statesville Road
Address Line 2
�Y
North Wilkesboro
Fbstal / Zip Code
28659
2e. Telephone Number:
(336)903-9202
S[ate / FYovince I Region
NC
Cauntry
USA
2f. Fax Number:
66.64KB
x
C' Yes R No
C' Yes G No
�,
2g. Email Address:*
hslaughter@ncdot.gov
C. Project Information and Prior Project History "
1. Project Information
1b. Subdivision name:
(rf appropriate)
1c. Nearest municipality/town:
Lansing
2. Project Identification
2a. Property Identification Number:
2c. Project Address
Street Address
Address Line 2
ary
Postal I Zip Code
2b. Property size:
State / Aovince / Region
Country
3. SurFace Waters
3a. Name of the nearest body of water to proposed project:*
Old Field Branch
3b. Water Resources Classification of nearest receiving water:*
Q Trout, HQW
3c. What river basin(s) is your project located in?*
New
3d. Please provide the 12-digit HUC in which the project is located.
050500010105
4. Project Description and History
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:*
See attached Cover Letter
46. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
f Yes �' No r Unknown
4d. Attach an 8 1/2 X 77 excerpt from the most recent version of the USGS topogrephic map indicating the location of the project site. (for DWR)
Ashe #23 Topo.pdf 1.75MB
4e. 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)
4f. List the total estimated acreage of all existing wetlands on the property:
0
4g. List the total estimated linear feet of all existing streams on the property:
140
4h. Explain the purpose of the proposed project:*
Replace bridge
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
See cover letter
4j. Please upload project drawings for the proposed project.
040023_final permit drawings.pdf 323MB
5. Jurisdictional Determinations
Sa. Have the wetlands or streams been delineated on the property or proposed impact areas?*
� Yes r No r Unknown
Comments:
Sb. If the Corps made a jurisdictional determination, what type of determination was made?"
C' Preliminary r Approved C' Not Verified C' Unknown C•' WA
Corps AID Number:
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
Sd1. Jurisdictional determination upload
6. Future Project Plans
Heath Slaughter
NCDOT
6a. Is this a phased project?*
C' Yes r 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�/i
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
� Wetlands 17 Streams-tributaries
r' Open Waters � Pond Construction
3. Stream Impacts
� Buffers
❑ 3a. Reason for impact (?) 3b.lmpact type" 3c. Type of impact" 3d. S. name * 3e. Stream Type * 3f. Type of 3g. S. width" 3h. Impact
(�) Jurisdiction* length*
S1 Road Crossing Permanent Culvert Old Field Branch Perennial Both 10 58
Average (feet) pinear feet)
S2 Road Crossing Permanent Bank Stabilization Old Field Branch Perennial Both 10 76
Average (feet) (linear feet)
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
134
3i. Total stream and ditch impacts:
134
3j. Comments:
E. Impact Justification and Mitigation
1. Avoidance and Minimization
3i. Total temporary stream impacts:
0
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
CuNert was needed to avoid historic district. Sills were added to isolate flow to one barrel.
1b. Specificallydescribe measures taken to avoid or minimize the proposed impacts through construction techniques:
All appropriate BMPs will be used during construction.
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):
r DWR rJ Carps
2d. If yes, which mitigation option(s) will be used for this project?
� Mitigation bank 117 Payment to in-lieu fee I� Permittee Responsible
program Mitigation
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached.
F Yes r No
4b. Stream mitigation requested:
(linear feet)
58
4d. Buffer mitigation requested (DWR only):
(square feet)
4f. Non-riparian wetland mitigation requested:
(acres)
4h. Comments
4c. If using stream mitigation, what is the stream temperature:
cold
4e. Riparian wetland mitigation requested:
(acres)
4g. Coastal (tidal) wetland mitigation requested:
�acres)
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
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?
� Yes r No
If no, explain why:
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
r Yes r No
Comments:
G. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federallstate/local) funds or the use of public (federal/state) land?*
� 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)
Environme ntal Policy Act (NEPA/SEPA)? *
f Yes r No
Comme nts: *
MCDC
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 (15ANCAC 26.0200)?*
C' Yes r No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project 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.
Existing stream crossing being replaced with no additional capacity being added.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
r Yes r No C' fWA
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? *
r Yes r No
Sb. Have you checked with the USFWS concerning Endangered Species Act impacts?*
C' Yes r No
Sd. Is another Federal agency involved?*
F Yes �' No
What Federal Agency is involved?
Corps
Se. Is this a DOT project located within Division's 1-8?
� Yes r No
Sf. Will you cut anytrees in order to conduct the work in waters of the U.S.?
G Yes r No
Sg. Does this project involve bridge maintenance or removal?
� Yes r No
Sg(1). If yes, have you inspected the bridge for signs of bat use such as staining, guano, bats, etc.?
G Yes r No
If you answered "Yes" to Sg(1), did you discover any signs of bat use?
� Yes r No � Unknown
Sh. Does this project involve the construction/installation of a wind turbine(s)?*
C' Yes r No
r Unknown
Si. Does this project involve (1) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhammers, mechanized pile drivers, etc.?
� Yes r No
S. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
GIS and visual observation.
Consultation Documentation Upload
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
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
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? *
F Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
Project was reviewed by SHPO. No Effect form attached.
7c. Historic or Prehistoric Information Upload
040023 - Ashe Co AR17-06-0007noeligiblesites.pdf 7.34MB
Ashe 040023 No Effects.pdf 4.94MB
8. Flood Zone Designation (Corps Requirement)
Sa. Will this project occur in a FEMA-designated 100-year floodplain?"
� Yes r No
8b. If yes, explain how project meets FEMA requirements:
Project was reviewed by the NCDOT Hydraulics Unit
Sc. What source(s) did you use to make the floodplain determination?"
Above link
Miscellaneous
Comments
Miscellaneous attachments not previouslyrequested.
Ashe 23 CSR.pdf 3.13MB
Bridge 23 Letter.pdf 979.54K6
NHP project_report_ashe_bridge_23.pdf 3MB
.
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, Artide 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 AcP');
. 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:
Heath Slaughter
Signature
Sign
�
Date
12/7/2018