20190240 Ver 1_PCN Form Submission_20190225

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�irlslan af Water Resources
Pre-Construction Notification (PCN) Form
September 29, 2018 Ver 3
Initial Review
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 *
20190240
Is a payment required for this project?*
f No paymentrequired
� Fee received
f Fee needed - send electronic notification
Select Project Reviewer"
Rob Ridings:eads\rgridings
Information for Initial Review
1a. Name of project:
Replacement of pipe structure on SR 1703 (Lucy Garrett Road) carrying UT to Flat River
1a. Who is the PrimaryContact?*
Heather Montague
1b. PrimaryContact Email:*
[e-mail]
Date Submitted
2/25/2019
Nearest Body of Water
UT to Flat River
Basin
Neuse
Water Classification
27-3-2 WS-III; NSW
Site Coordinates
Latitude: Longitude:
36.33589 -78.95746
A. Processing Information
County (or Counties) where the project is located:
Person
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:
WBS # (�)
5B.207314.4
1a. Type(s) of approval sought from the Corps:
Ve rsion# *
1
Reviewing Office *
Central Office - [phone]
1c. PrimaryContact Phone:*
[phone]
::

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?
F 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?
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?
fJ Owner r Applicant (other than owner)
1e. Is there an Agent/Consultant for this project?
f 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
2612 North Duke Street
Address Line 2
�Y
Durham
Fbstal / Zip Code
27704
2e. Telephone Number:
[phone]
2g. Email Address:*
r 401 Water Quality Certification - E�ress
rJ Riparian Buffer Authorization
State / Aovince I F�gion
NC
Country
USA
2f. Fax Number:
x
C' Yes R No
G Yes C' No

hwmontag ue@ncdot. gov
C. Project Information and Prior Project History "
1. Project Information
1b. Subdivision name:
(rf appropriate)
1c. Nearest municipality/town:
Roxboro
2. Project Identification
2a. Propertyldentification Number:
Pulliam: 0914-17-11-7947 & 0914-17-22-
3023; Hicks: 0914-18-21-9704; Clayton:
0914-17-20-2571
2c. Project Address
Street Address
1742 Lucy Garrett Road
Address Line 2
�Y
Ro�oro
Fbstal / Zip Code
27574
3. SurFace Waters
3a. Name of the nearest body of water to proposed project:*
UT to Flat River
3b. Water Resources Classification of nearest receiving water:*
27-3-2 WS-III; NSW
3c. What river basin(s) is your project located in?*
Neuse
3d. Please provide the 12-digit HUC in which the project is located.
030202010101
4. Project Description and History
2b. Property size:
0.45
State / Rovince 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:*
Pipe structure has deteriorated and is non-functional. The land use surrounding the pipe is agricultural and wooded areas.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
C' Yes r No r Unknown
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)
SR 1703 topo.pdf 2.93MB
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)
SR1703 soils.pdf 37SMB
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:
100
4h. Explain the purpose of the proposed project:*
Pipe structure has deteriorated and is non-functional.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
Replacement of existing structure (3@84" that are 72LF) with new a structure 1@22'-9" X 8'x10" aluminum box culvert that is 58.5' long with headwalls. Project construction will require
dewatering. Bank stabilization is proposed for long term stability. Equipment will include excavator, backhoe, crane, grader, etc.
4j. Please upload project drawings for the proposed project.
5. Jurisdictional Determinations
Sa. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
F Yes f No C' Unknown

Comments:
Yes, PJD sent to USACE dated OS/08/18
Sb. If the Corps made a jurisdictional determination, what type of determination was made?*
f' Preliminary (' Approved r Not Verified r Unknown f' WA
Corps AID Number:
Sc. If Sa is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
5d1. Jurisdictional determination upload
6. Future Project Plans
G. Price and J. Mathis
Carolina Ecosystems, Inc.
6a. Is this a phased project?*
C' Yes r No
Are any other NWP(s), regional generel 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 IIJ Streams-tributaries
r Open Waters I� Pond Construction
3. Stream Impacts
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
45
3i. Total stream and ditch impacts:
81
3j. Comments:
6. Buffer Impacts (for DWR)
6a. Project is in which protect basin(s)?
Check all that apply.
CJ Neuse
r Catawba
r Goose Creek
r Other
Impact Type
i crossing- allowable
6h. Total buffer impacts:
Zone 1
fJ Buffers
3i. Total temporary stream impacts:
36
� Tar-Pamlico
r Randleman
r Jordan Lake
Per or Temp 6d. Stream name
� UT to Flat River
Zone 2
Buffer mitigation required? Il6f. Zone 1 impact II6g. Zone 2 impact
2,859 1,849

Total Temporary impacts: 0.00 0.00
Zone 1 Zone 2
Total Permanent impacts: 2,859.00 1,849.00
Zone 1 Zone 2
Total combined buffer impacts: 2,859.00 1,849.00
6i. Comments:
Supporting Documentation
SR 1703 FULL PERMIT PACKAGE INCL SWMP.pdf
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:
Failing structure is being replaced with the minimal length pipe to fit current roadway standards wfiich will also provide for an appropriately sized road
shoulder.
1b. Specificallydescribe measures taken to avoid or minimize the proposed impacts through construction techniques:
Construction will be overseen by NCDOT Division 5 Environmental Specialist and Project Inspector wfio will be onsite to identify ways to reduce the
proposed stream impacts. We expect to see reduction of permanent and temporary impacts during construction.
n
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:
Exsting pipe is shortened in length and permanent impacts are limited to bank stabilization at the headwall tie in points.
I F. Stormwater Management and Diffuse Flow Plan (required by DWR) " I
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
What type of SCM are you providing?
r Level Spreader
rJ Vegetated Conveyance (lower SHWT)
� Wetland Swale (higher SHNrf)
r Other SCM that removes minimum 30 % nitrogen
r Proposed project will not create concentrated stormwater flow through the buffer
Diffuse Flow Documentation
PERSON SR 1703_HYD_SMPv2.08_20150620 (Apr 201 S). pdf
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
� Yes r 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?*
F Yes r No
745.99KB
76.78KB
�,
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)?*
G Yes r No

1c. If you answered "yes" to the above, has the document review been finalized by the State Clearing House?*
C' Yes r No
Comme nts: *
Document does not require State Clearing House review.
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)?*
� Yes r No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality? *
C' Yes r No
3b. If you answered "no," provide a short narrative description.
Pipe is being replaced in place within the ewsting transportation facility.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
f Yes r No � 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?*
r Yes r No
Sc. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
Sd. Is another Federal agency involved?*
C' Yes r No
Se. Is this a DOT project located within Division's 1-8?
� Yes r No
C' Unknown
S. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
Northern long eared bat: BC of May Affect, Likely to Adversely Affect based on programmatic biological opinion with the FHWA, NCDOT and USACE
that allows for incidental take for NLEB for projects with a federal nexus in Division 5. Use of the Programmatic Biological Opinion for Bridge and
Culvert Replacements/Repairs/Rehabilitations in Eastern North Carolina, NCDOT Divisions 1-8 (June 13, 2018) provides a biological conclusion of No-
Effect for Dwarf wedgemussel, which requires no additional concurrence from the USFWS. The nearest occurrence of proposed Atlantic Pigtoe is over
5 mi from the project location and the project construction is anticipated to be completed well before the Atlantic Pigtoe is listed.
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? *
available mapping
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?*
Use of NC Historic Preservation Office database. Disturbance is limited to ebsting roadside shoulder and stream channel.
7c. Historic or Prehistoric Information Upload
18-01-0027NoSurveyReq.pdf
AR18-01-0027 NoSu rvey. pdf
8. Flood Zone Designation (Corps Requirement)
226MB
916.44KB
8a. Will this project occur in a FEMA-designated 100-year floodplain?*

� Yes f No
Sb. If yes, explain how project meets FEMA requirements:
Project has been designed by PEF hydraulic design firm to meet FEMA requirements.
8c. What source(s) did you use to make the floodplain determination?*
FEMA mapping.
Miscellaneous
Comments
Miscellaneous attachments not previouslyrequested.
Signature
*
fJ 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 thls 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 hansaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• 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
N£.a rH€�- �!.v�+�rar,r,�
� �
Date
2/25/2019