20190053 Ver 1_PCN Form Submission_20190111

D1�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 *
20190053
Is a payment required for this project?*
f• No payment required
f Fee received
f Fee needed - send electronic notification
Select Project Reviewer"
Garcy Ward:eads\gpward
Information for Initial Review
1a. Name of project:
NC 12 MP 6675 in Frisco - Pipe replacement
1a. Who is the PrimaryContact?*
Paul Williams
1b. PrimaryContact Email:*
pcwill iams2@ncd ot. gov
Date Submitted
1/11/2019
Nearest Body of Water
UT to Pamlico Sound
Basin
Tar-Pamlico
Water Classification
SA;HQW
Site Coordinates
Latitude:
35242043
A. Processing Information
County (or Counties) where the project is located:
Dare
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 *
Washington Regional Office - [phone]
1c. PrimaryContact Phone:*
[phone]
Longitude:
-75.617324
::
WBS # (�)
1.1028111
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:
03 - Maintenance
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:
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?
C' 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
1h. Is the project located in any of NC's twenty coastal counties?
� Yes r No
1i. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
� Yes r No r Unknown
1j. Is the project located in a designated trout watershed?
C' Yes r No
B. Applicant Information
1d. Who is applying for the permit?
r Owner rJ Applicant (other than owner)
1e. Is there an Agent/Consultant for this project?
C' Yes r No
2. Owner Information
2a. Name(s) on recorded deed:
NCDOT Right-of-Way NC 12 in Frisco - Dare County
2b. Deed book and page no.:
2c. Responsible party:
Paul Williams
2d. Address
Street Address
113 Airport Dr.
Address Line 2
�ty
Edenton
Postal / Zip Code
27932
r 401 Water Quality Certification - E�ress
r Riparian Buffer Authorization
S[ate / Awince I Region
NC
Country
USA
x
C•' Yes C' No
C' Yes G No

2e. Telephone Number:
[phone]
2g. Email Address:*
pcwill [e-mail]
3. Applicant Information (if different from owner)
3a. Name:
Paul Williams
3b. Business Name:
NC Department of Transportation
3c.Address
Street Address
113 Airport Dr.
Address Line 2
�Y
Edenton
Fbstal / Zip Code
27932
3d. Telephone Number:
[phone]
3f. Email Address:*
pcwill iams2@ncd ot. gov
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(rf appropriate)
1c. Nearest municipality/town:
Frisco
2. Project Identification
2a. Propertyldentification Number:
2c. Project Address
Street Address
NC 12, 0.10 mi. S of SR 1523
Address Line 2
�Y
Frisco
Fbstal I Zip Code
27953
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
UT to Pamlico Sound
3b. Water Resources Classification of nearest receiving water:*
SA; HQ W
3c. What river basin(s) is your project located in?*
Tar-Pamlico
3d. Please provide the 12-digit HUC in which the project is located.
030201050305
4. Project Description and History
2f. Fax Number:
[phone]
State / Rovince I F�gion
NC
Country
USA
3e. Fax Number:
[phone]
2b. Property size:
0.5
State / Aovince I F�gion
NC
Country
USA
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:*
Project area consists of NCDOT NC 12 and culvert. The adjacent property is residential, commercial, and vacant.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
C' Yes r No C' Unknown
n

4d. 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)
Topo - NC 12 Pipe 2 RMIP 2019 - Dare.pdf 1.17MB
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)
Soil_Map.pdf 919.6KB
4f. List the total estimated acreage of all existing wetlands on the property:
1
4g. List the total estimated linear feet of all existing streams on the property:
80
4h. Explain the purpose of the proposed project:*
Replace deteriorating culvert and maintain a stable roadway along NC 12 for the safety of the traveling public and residents of Hatteras Island.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
The existing 30" X 60' CMP will be removed and replaced with the proposed 30" X 60' CAP on the same alignment This v�rk will be accomplished using tracked excavator, backhoe,
and dump trucks.
4j. Please upload project drawings for the proposed project.
NC 12 Pipe 2 Permits.pdf 426.57KB
5. Jurisdictional Determinations
Sa. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
f Yes �' No �' Unknown
Comments:
Wetland boundaries were marked by surveyor. WLB follows toe of slope of roadway shoulder.
Sb. If the Corps made a jurisdictional determination, what type of determination was made?*
f' Preliminary � Approved r Not Verified � Unknown r WA
Corps AID Number:
Sc. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
Sd1. Jurisdictional determination upload
6. Future Project Plans
6a. 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?
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 r Buffers
r Open Waters � Pond Construction
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:
Culvert replacement will stay on the existing alignment and the pipe length will not be extended, avoiding any stream or wetland impacts. The roadway
will be dosed to traffic and an offsite detour will be utilized. This will reduce temporary impacts to open waters by not utilizing an on-site detour and
keeping the road open. The closure will be coordinated with Dare County EMS.
1b. Specificallydescribe measures taken to avoid or minimize the proposed impacts through construction techniques:
NCDOT BMP's will be followed during culvert removal/installation and erosion control devices will be installed to prevent sediment loss from the project
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?
C' Yes r No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
No permanent jurisdictional impacts for the project.
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?
C' Yes r No
If no, explain why:
Site is in Dare County, and administratively not subject to buffer rules.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
r Yes �' No
Comments:
I G. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federallstate/local) funds or the use of public (federallstate) land?*
G Yes �' No
1b. If you answered "yes" to the above, does the project require preparetion of an environmental document pursuant to the requirements of the National or State (North Carolina)
Environme ntal Policy Act (NEPAISEPA)? *
C' Yes r No
Comme nts: *
Activity and impacts covered by Minimum Criteria Checklist.
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 (15A NCAC 2B .0200)? *
f Yes r No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water qualit�/?*
C' Yes r No
3b. If you answered "no," provide a short narrative description.
Project replaces an existing culvert with a culvert.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
C' Yes r No � WA
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?*
C' Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
C' Yes r No
5d. Is another Federal agency involved?*
C' Yes r No
C' Unknown
Se. Is this a DOT project located within Division's 1-8?
F Yes r No
Sj. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
NC Natural Heritage Data Explorer Website

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? *
f Yes r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
National Marine Fisheries Database
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?*
� Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
State Historic Preservation Office Historic Properties Map Website
7c. Historic or Prehistoric Information Upload
SHPO Map.pdf
8. Flood Zone Designation (Corps Requirement)
Sa. Will this project occur in a FEMA-designated 100-year floodplain?*
� Yes r No
Sb. If yes, explain how project meets FEMA requirements:
n/a
Sc. What source(s) did you use to make the floodplain determination?"
NCFloodmaps.com, Zone AE
Miscellaneous
Comments
NC Division of Coastal Management determined this site to be non-jurisdictional at this culvert location.
Miscellaneous attachments not previouslyrequested.
Signature
*
rJ By checking the box and signing below, I certify that:
251.56KB
• 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:
Paul Collins Williams, Jr.
Signature
Sign
�
Date
1/11/2019