20190687 Ver 1_PCN Form Submission_20190528

DWR
IDIOM n of Water Resources
Pre -Construction Notification (PCN) Form
September 29, 2018 Ver 3
21nitial 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?*
C Yes r No
Change only if needed.
BIMS # Assigned * Version#*
20190687 1
Is a payment required for this project?*
r No payment required
r Fee received Reviewing Office*
r Fee needed - send electronic notification Mooresville Regional Office - [phone]
Select Project Reviewer*
Donna Fbod:eads\drhood
Information for Initial Review
1a. Name of project:
Pipe installation on newaccess road to Alexander County Industrial Park, Alexander County
1a. Who is the Primary Contact?*
Trish Beam
1b. Primary Contact Email:*
[e-mail]
Date Submitted
5/28/2019
Nearest Body of Water
Bull Branch
Basin
Yadkin-PeeDee
Water Classification
WS-II/HQW
Site Coordinates
1c. Primary Contact Phone:*
[phone]
Latitude: Longitude:
35.916428-81.121326
FA. Processing Information U
County (or Counties) where the project is located:
Alexander
Is this project a public transportation project?*
r Yes r No
Is this a NCDOT Project?*
r Yes r No
(NCDOT only) T.I.P. or state project number:
R-5870
WBS # (�)
47917.1.1
1a. Type(s) of approval sought from the Corps:

W Section 404 Permit (wetlands, streams and waters, Clean Water Act)
r Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What types) of permit(s) do you wish to seek authorization?
W Nationwide Permit (NWP)
r-' Regional General Permit (RGP)
r-' Standard (IP)
1c. Has the NWP or GP number been verified by the Corps?
f Yes r No
Nationwide Permit (NWP) Number: 14 - Linear transportation
NWP Numbers (for multiple NWPS):
1d. Type(s) of approval sought from the DWR:
rJ 401 Water Quality Certification - Regular
r Non-404 Jurisdictional General Permit
r Individual Permit
le. Is this notification solelyfor the record because written approval is not required?
For the record only for DWR 401 Certification:
For the record only for Corps Permit:
r 401 Water Quality Certification - Express
F Riparian Buffer Authorization
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
Alexander Ind Park - Division 12 - STIR - YD 101.pdf
1h. Is the project located in any of NC's twenty coastal counties?
r Yes r No
1j. Is the project located in a designated trout watershed?
r Yes r No
B. Applicant Information
1d. Who is applying for the permit?
r" Owner W Applicant (other than owner)
le. Is there an Agent/Consultant for this project?
r 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
1710 East Marion Street
Address Line 2
City
State / Rovince / Region
Shelby
North Carolina
Fbstal / Zip Code
@untry
28151
us
2e. Telephone Number: 2f. Fax Number:
[phone]
68.47KB
*
r Yes r No
r Yes r No

2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
3a. Name:
Mark Stafford
3b. Business Name:
NC DOT
3c.Address
Street Address
1710 E Marion Street
Address Line 2
PO box 47
City
Shelby
Postal / Zip Code
28151
3d. Telephone Number:
[phone]
3f. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
State / Rovince / f�egion
NC
Country
USA
3e. Fax Number:
[phone]
1b. Subdivision name:
(if appropriate)
1 c. Nearest municipality / town:
Hiddenite
2. Project Identification
2a. Property Identification Number: 2b. Property size:
2c. Project Address
Street Address
Address Line 2
city State / Rovince / Pa ion
Postal / Zip Code Country
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Bull Branch
3b. Water Resources Classification of nearest receiving water:*
WS-II/HQW
3c. What river basin(s) is your project located in?*
Yadkin -Pee Dee
3d. Please provide the 12-digit HUC in which the project is located.
030401020101
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:*
Existing conditions in the study area consist of mostly forested and pasture areas.
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 1/2 X 11 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for DWR)
Topo Map.pdf 169.54KB
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 682.77KB
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:
200
4h. Explain the purpose of the proposed project:*
Construction of a new access road to Alexander Industrial park.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
The North Carolina Department of Transportation (NCDOT) proposes impacts to an unnamed tributary to Bull Branch (WS-IVHOW Waters) in Alexander County. An 83-foot long CMP
will be installed as part of the construction of a new access road to Alexander Industrial Park. The project will also require placement of 22-feet of rip rap on the banks at the outlet for
stabilization. Cofferdams/bypass pumping will be used to temporarily divert the stream around the work site. The area affected by temporary impacts will be restored back to pre -project
conditions. The project will be constructed utilizing typical heavy equipment: trackhoe, backhoe, crane
4j. Please upload project drawings for the proposed project.
Pipe Drawing.pdf 16KB
R5870_Hyd_prm_print _set.pdf 1.79MB
R5870_HYD_SMP.pdf 301.9KB
R5870_RDY_DID _PLAN _25preliminary.pdf 370.31KB
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes r No
Comments:
NCDOT Division Environmental Staff
5b. If the Corps made ajurisdictional 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): Jeff Wyatt
Agency/Consultant Company:
Other:
5d1. Jurisdictional determination upload
DWR Stream Form.pdf
JD Form.pdf
6. Future Project Plans
45.89KB
54.5KB
O Unknown
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
la. Where are the impacts associated with your project? (check all that apply):
r Wetlands W Streams -tributaries r Buffers
r Open Waters r Pond Construction
3. Stream Impacts
U3a. Reason for impact (?) 3b.lmpact type * 3c. Type of impact * 3d. S. name * 3e. Stream Type * 3f. Type of 3g. S. width * 3h. Impact
M Jurisdiction* length*
S1
L- 24+90/25+13, Pipe
Permanent
Culvert
Ui to Bull Branch
Perennial
Both
3average (feet)
8(31i xar feet)
S2
L- 25+13/25+15, Ri ra at
P P
pipe outlet
Permanent
Bank Stabilization
LIT to Bull Branch
Perennial
Both
3
average (Feet)
22
(linear feet)

S3L- 24+85/24+90 and -L- Tem ora Dewaterin UT to Bull Branch Perennial Both 3 20
P ry 9
24+85/24+90 Average (feet) (linearfeet)
31. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
105
3i. Total stream and ditch impacts:
125
3j. Comments
E. Impact Justification and Mitigation
1. Avoidance and Minimization
3i. Total temporary stream impacts:
20
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
Approbmately 1,100 linear feet of grass swales have been incorporated in roadside ditches, where possible, to reduce the velocity and promote the
infiltration of runoff. Riprap from ditcheline will tie into the riprap streambank stabilization at outlet to minimize erosion on streambank.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
No work in flow stream.
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
2c. If yes, mitigation is required by (check all that apply):
r DWR V Corps
2d. If yes, which mitigation option(s) will be used for this project?
r Mitigation bank W Payment to in -lieu fee r 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.
r Yes r No
4b. Stream mitigation requested:
(linear feet)
83
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:
warm
4e. Riparian wetland mitigation requested:
(acres)
4g. Coastal (tidal) wetland mitigation requested:
(acres)
F. Stormwater Management and Diffuse Flow Plan (required by DWR) C^U
1. Diffuse Flow Plan
la. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
r Yes r No
If no, explain why:
Not in buffer zone
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:
See attached plan.
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
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 Policy Act (NEPA/SEPA)? *
r Yes r No
Comments:
The project is listed as a type and class of activity which qualifies as a non -major action under the Minimum Criteria Rules; therefore a minimum
criteria checklist was completed.
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)?*
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
3c. Upload a qualitative or quantitative cumulative impact analysis.
R-5870 LUSA Short-Form.pdf 1.24MB
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
f 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?*
r Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
r Yes r' No
5c. If yes, indicate the USFWS Field Office you have contacted.
Asheville
5d. Is another Federal agency involved?*
r Yes r No
What Federal Agency is involved?
USACE
5e. Is this a DOT project located within Division's 1-8?
f Yes r No
5f. Will you cut anytrees in order to conduct the work in waters of the U.S.?
r Yes r' No
5g. Does this project involve bridge maintenance or removal?
f 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?
NC Natural Heritage database and on -site surveys. Division 12 is located in the white nose syndrome area; however, there are no known hibernacula
or roosting trees in division 12 counties. Streamlined consultation form completed.
Consultation Documentation Upload
StreamlinedConsultationForm.pdf 99.84KB
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?*
Per Natural Heritage database, there are no salt marshes, oyster reefs of seagrass beds in the vicinity of the project.
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?*
Cultural resources review and approval (Internal Tracking No. 19-01-0017).
7c. Historic or Prehistoric Information Upload
19-01-0017NoSurveyReq.pdf
AR19-01-0017noeligiblesites.pdf
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
f Yes r No
8c. What source(s) did you use to make the floodplain determination?*
NCDOT hydraulics and NC floodplain mapping site (http://fris.nc.gov)
Miscellaneous
Comments
Miscellaneous attachments not previously requested.
Features Map.pdf
Flood Map.pdf
Hazardous Spill Checklist.pdf
Natural Resources Evaluation.pdf
Stream Photos.pdf
cover_letter.pdf
Signature
*
j7 By checking the box and signing below, I certify that:
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• 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:
Trish Beam
Signature
PrIXWIWI
Date
5/28/2019
U