20190666 Ver 1_PCN Form Submission_20190520

DWR
MOM— of Water Resources
Pre -Construction Notification (PCN) Form
September 29, 2018 Ver 3
tial Review
Has this project met the requirements for acceptance in to the review process?*
r Yes
r No
Is this project a public transportation project?*
G Yes r No
Oiange only if needed.
BIMS # Assigned
20190666
Is a payment required for this project?*
r No payment required
r Fee received
r Fee needed - send electronic notification
Select Project Reviewer*
Paul Wojoski:EADS\pawojoski
Information for Initial Review
1a. Name of project:
Culvert
1a. Who is the Primary Contact?*
Joshua cooper
1b. Primary Contact Email:*
[e-mail]
Date Submitted
5/20/2019
Nearest Body of Water
Harrison creek
Basin
Cape Fear
Water Classification
Cape fear
Version# *
1
Reviewing Office*
Central Office - [phone]
1c. Primary Contact Phone:*
[phone]
Site Coordinates
Latitude: Longitude:
34.38609 077.74149
FA. Processing Information U
County (or Counties) where the project is located:
Fender
Is this project a public transportation project?*
r Yes r No
1a. Type(s) of approval sought from the Corps:
* 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?
F Nationwide Permit (NWP)
F- Regional General Permit (RGP)
W Standard (IP)

1c. Has the NWP or GP number been verified by the Corps?
r Yes r No
1d. Type(s) of approval sought from the DWR:
F_ 401 Water Quality Certification - Regular r 401 Water Quality Certification - Express
r Non -404 Jurisdictional General Permit r Riparian Buffer Authorization
17 Individual Permit
*
1e. Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification: r Yes r No
For the record only for Corps Permit: r Yes r No
1f. Is this an after -the -fact permit application?*
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
Acceptance Letter Attachment
1h. Is the project located in any of NC's twenty coastal counties?
r Yes r No
11. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
r Yes r No r Unknown
1j. Is the project located in a designated trout watershed?
r Yes r No
B. Applicant Information
1d. Who is applying for the permit?
I7 Owner r Applicant (other than owner)
1e. Is there an Agent/Consultant for this project?
r Yes r No
2. Owner Information
2a. Name(s) on recorded deed:
Joshua cooper
2b. Deed book and page no.:
2c. Responsible party:
2d. Address
Street Address
243 derby downs dr
Address Line 2
City
Sneads ferry
F stal / Zip Cade
28460
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
[Project Information and Prior Project History
'I. Project Information
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:
State / Rovin / Region
Nc
Country
USA
2f. Fax Number:

Hampstead
2. Project Identification
2a. Property Identification Number:
2c. Project Address
Street Address
Address Line 2
City
P stal / Zip Cade
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Harrison creek
3b. Water Resources Classification of nearest receiving water:*
Cape fear
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.
030300070611
4. Project Description and History
2b. Property size:
State / province / ftion
Country
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:*
Replacing culvert with larger one. Current one is plugged up from beaver activity
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
r Yes r No r Unknown
4d. Attach an 8 1/2X11 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for DWR)
4e. Attach an 8 1/2X11 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:
4g. List the total estimated linear feet of all existing streams on the property:
4h. Explain the purpose of the proposed project:*
Properly let water flow down creek
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
N/a
4j. Please upload project drawings for the proposed project.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes r No
Comments
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
r Preliminary r Approved r Not Verified R Unknown r N/A
Corps AID Number:
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
5d1. Jurisdictional determination upload
R Unknown

6. Future Project Plans
6a. Is this a phased project?*
r 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 activity?
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
[ Wetlands r Streams -tributaries
[ Open Waters r Pond Construction
FE. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
Only replacing what is already present
F Buffers
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Only replacing what is currently present
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?
r Yes r No
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
1a. Does the project include oris it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
r Yes r No
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
r^ 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:
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?*
r Yes r No
2. Violations (DWR Requirement)
U
u
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 2B.0200)?*
r Yes r No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality?*
r Yes r No
3b. If you answered "no," provide a short narrative description.
N/a

4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR forth is project?*
r Yes r Nor N/A
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?*
f Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
f Yes r No
5d. Is another Federal agency involved?*
f Yes r No
5e. Is this a DOT project located within Division's 1-8?
r Yes r No
5f. Will you cut anytrees in order to conduct the work in waters of the U.S.?
f Yes r No
5g. Does this project involve bridge maintenance or removal?
r Yes r No
5h. Does this project involve the construction/installation of a wind turbine(s)?*
r Yes r No
r- Unknown
5i. 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.?
r Yes r No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
N/a
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?*
r Yes r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
N/a
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?*
r- Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
N/a
7c. Historic or Prehistoric Information Upload
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA designated 100 -year floodplain?*
r Yes r' No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?*
Gis
Miscellaneous
Comments
Miscellaneous attachments not previously requested.
Signature

m 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 Act');
. 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:
Joshua cooper
Signature
Date
5/20/2019