20190508 Ver 1_PCN Form Submission_20190418

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 *
20190508
Is a payment required for this project?*
f No paymentrequired
� Fee received
f Fee needed - send electronic notification
Select Project Reviewer"
Joanne Steenhuis:eads\jhsteenhuis
Information for Initial Review
1a. Name of project:
Intersection of US 13 and SR 1809 Culvert EMension
1a. Who is the PrimaryContact?*
Sean Farrell
1b. PrimaryContact Email:*
[e-mail]
Date Submitted
4/18/2019
Nearest Body of Water
Jurisdictional Tributary to Sevenmile Swamp
Basin
Cape Fear
Water Classification
C;Sw
Site Coordinates
Latitude:
35203940
A. Processing Information
County (or Counties) where the project is located:
Sampson
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 *
Wilmington Regional Office - [phone]
1c. PrimaryContact Phone:*
[phone]
Longitude:
-78.432008
::
WBS # (�)
44866.1.1
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?
r Nationwide Permit (NWP)
rJ Regional General Permit (RGP)
� Standard (IP)
1c. Has the NWP or GP number been verified bythe Corps?
C' Yes r No
Regional General Permit (RGP) Number:
RGP Numbers (for multiple RGPS):
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:
N/A- NC. Dept. of Transportation R/W
2b. Deed book and page no.:
2c. Responsible party:
2d. Address
Street Address
5501 Barbados BLVD
Address Line 2
�Y
Castley Hayne
Fbstal / Zip Code
28429
2e. Telephone Number:
[phone]
2g. Email Address:*
r 401 Water Quality Certification - E�ress
r Riparian Buffer Authorization
State / Aovince I F�gion
NC
Country
USA
2f. Fax Number:
x
C' Yes R No
G Yes C' No

[e-mail]
C. Project Information and Prior Project History " I
1. Project Information
1b. Subdivision name:
(rf appropriate)
1c. Nearest municipality/town:
Newton Grove, NC 28366
2. Project Identification
2a. Propertyldentification Number:
N/A
2c. Project Address
Street Address
Intersection of US-13 and SR 1809 Wrye Branch Road
Address Line 2
�Y
Newton Grove
Fbstal I Zip Code
28366
3. SurFace Waters
2b. Property size:
N/A
State / Rovince I f�gion
NC
Country
USA
3a. Name of the nearest body of water to proposed project:*
Jurisdictional Tributary to Sevenmile Swamp
3b. Water Resources Classification of nearest receiving water:*
C;Sw
3c. What river basin(s) is your project located in?*
Cape Fear
3d. Please provide the 12-digit HUC in which the project is located.
030300060401
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:*
Exsting twn-lane roadway SR 1 S09 Wrye Branch Road Intersection with US-13 two-lane roadway within an existing R/W. Land use in the vicinity of the project is primarily agricuttural
and forested.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
� Yes r No � 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)
US13&SR1809TOP0 MAP. pdf
1.64 MB
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 1.96MB
4f. List the total estimated acreage of all existing wetlands on the property:
fWA
4g. List the total estimated linear feet of all existing streams on the property:
N/A
4h. Explain the purpose of the proposed project:*
The purpose of the proposed project is to address spot safety and preserve the safety and mobility of the traveling public by increasing the width of the shoulder at the intersection of
US-13 and SR 1 S09 Wrye Branch Road so that the shoulder is wide enough to install new guardrail according to NCDOT Standard Specifications. In order to accomplish the shoulder
widening and guardrail installation, the ewsting 18" RCP which crosses SR 1809 near the Intersection with US-13 will need to be e#ended approximately 12' on the outlet end.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
The project will involve temporary dewatering impacts to the existing jurisdictional tributary in order to install the the new 12' of 18" CMP which will eMend out from the outlet of the
existing 18" RCP. The culvert eMension will result in permanent surface water impacts measuring less than 0.1 acres in area. An excavator and dump hucks will be required.
4j. Please upload project drawings for the proposed project.
US13SR1 S09_SITEPLAN.pdf
US13GuardRailPlan.pdf
Wetland Impact Summary Sheet20190418.pdf
670.33KB
121.89KB
75.14KB
5. Jurisdictional Determinations

Sa. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
C' Yes r No C' Unknown
Comments:
5b. 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:
Sc. If Sa 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?*
� 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�/?
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
r Wetlands I� Streams-tributaries r Buffers
fJ Open Waters Ir Pond Construction
4. Open Water Impacts
4g. Total open water impacts:
0.02
4h. Comments:
See Wetland Impact Summary Table for Impact station locations and square footage impact numbers.
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:
Slopes of 2:1 have been utilized to minimize the extension of the culvert to the the minimum necessary to meet standard specifications of shoulder
width for guardrail installation.
1b. Specificallydescribe measures taken to avoid or minimize the proposed impacts through construction techniques:
Strict implementation of sediment and erosion control BMPs will be utilized to protect water of the US. AII permit conditions will be adhered to.
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:
Proposes less than 0.01 acres of temporary and less than 0.01 acres of permanent surface water impacts.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
4g. Total temporary open water Impacts: 4g. Total permanent open water impacts:
0.01 0.01

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:
Not located within one of the NC Riparian Buffer Areas
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
C' Yes r No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?
r Yes r No
Comments:
No BUA �nnll be added and project will not change the existing conveyance of stormwater.
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?*
� 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)?*
f Yes r No
Comments:
x
Project will utilize state funds and will meet minimum criteria under 19A NCAC 02F.0102
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? *
f Yes r No
3b. If you answered "no," provide a short narrative description.
Project is only to improve safety of an existing roadway shoulder and will not result in any change in use.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
C' Yes r No r 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
Sb. Have you checked with the USFWS concerning Endangered Species Act impacts?*
f Yes r No
Sd. Is another Federal agency involved?*
f Yes r No
r Unknown
Se. Is this a DOT project located within Division's 1-8?
r Yes r No
S. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
NC Natural Heritage Program Site and NOAA Critical Habitat
Consultation Documentation Upload
NCNHP_report.pdf 3.14MB

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? *
NOAA Essential Fish Habitat GIS data
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?*
NC HPO Web Map
7c. Historic or Prehistoric Information Upload
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?"
� Yes r No
8c. What source(s) did you use to make the floodplain determination?*
Rood Risk Information System (FRIS) Web Map. Culvert e�Qension will not occur within FEMA 100-year floodplain but guardrail installation will.
Miscellaneous
Comments
Miscellaneous attachments not previouslyrequested.
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 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 transaction 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:
Sean Farrell
Signature
�x'l/N l�/��t tls�/
Date
4/18/2019