20190734 Ver 1_PCN Form Submission_20190605

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?*
G Yes r No
Change only if needed.
BIMS # Assigned
20190734
Is a payment required for this project?*
r No payment required
r Fee received
r Fee needed - send electronic notification
Select Project Reviewer*
Donna Fbod:eads\drhood
Information for Initial Review
1a. Name of project:
W-5710Y
1a. Who is the Primary Contact?*
Joel Howard
1b. Primary Contact Email:*
[e-mail]
Date Submitted
6/5/2019
Nearest Body of Water
East Fork Twelve Mile Creek
Basin
Catawba
Water Classification
C
Site Coordinates
Version# *
1
Reviewing Office*
Mooresville Regional Office - [phone]
1c. Primary Contact Phone:*
[phone]
Latitude:
Longitude:
34.983968
-80.706052
AProcessing Information
U
County (or Counties) where the project is located:
Union
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:
W-5710Y
WBS # (?)
44856.3.25
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?
r Yes r No
Nationwide Permit (NWP) Number: 14 - Linear transportation
NWP Numbers (for multiple NWPS):
14
1d. Type(s) of approval sought from the DWR:
fJ 401 Water Quality Certification - Regular
F Non-404 Jurisdictional General Permit
F 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
r 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
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?
C Yes r No
FB. Applicant Information
1d. Who is applying for the permit?
[J Owner r 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:
Scott Cole, Division Engineer
2b. Deed book and page no.:
2c. Responsible party:
NCDOT
2d.Address
Street Address
716 West Main Street
Address Line 2
city
Albemarle
Fbstal / Zip Oide
28001
2e. Telephone Number:
[phone]
2g. Email Address:*
State / Frwinee / R�gion
NC
Country
USA
2f. Fax Number:
[phone]
*
r Yes r No
r Yes r No

[e-mail]
C. Project Information and Prior Project History U
1. Project Information
1b. Subdivision name:
(i appropriate)
1c. Nearest municipality/ town:
Wesley Chapel
2. Project Identification
2a. Property Identification Number: 2b. Property size:
2c. Project Address
Street Address
Address line 2
City State / ftovince / Fbgion
Fbstal / Zip 03de 0�untry
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
East Fork Twelve Mile Creek
3b. Water Resources Classification of nearest receiving water:*
3c. What river basin(s) is your project located in?*
Catawba
3d. Please provide the 12-digit HUC in which the project is located.
03050103
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:*
The land surrounding the intersection of New Town and Waxhaw Indian Trail Roads has historically been used for farming. There are open fields with the SW quadrant being used for
cattle farming. The SE quadrant was once the site of a store. The store however has been closed for sometime now. The building is still standing but has no cultural resources value.
There are some single family homes that can be seen from the project site but none are within the project limits.
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.pdf
1.18MB
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)
20181210_12535512587_70_Soil_Map.pdf 1.07MB
4f. List the total estimated acreage of all existing wetlands on the property:
0 ac.
4g. List the total estimated linear feet of all existing streams on the property:
150
4h. Explain the purpose of the proposed project:*
SR 1008 (New Town Road) and SR 1315 (Waxhax Indian Trail Road) are paved Secondary Roads in Union County. The NCDOT Proposes to construct a Roundabout to improve the
serviceability and safety at this intersection. This work will improve the flow of traffic while decreasing the chance of vehicular crashes.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
Erosion control measures will be installed prior to any ground disturbing activities. As part of this Roundabout project NCDOT will be removing an eAsting (24" x50') RCP and replacing it
with a new (48")90') RCP. The new pipe will be placed apprommately 45' wrest of its emsting location. A new roadside ditch will be constructed totaling 45' along the northwest side of New
Town Road. This ditch will carry the eAsting stream to the inlet of the new pipe. The newly constructed ditch will have embedded rock placed in the thalvmg of the stream to help reduce
scour and head cutting. (See detail F in the plan sheets). On the southwest side of New Town Road there will be 65' of stream loss caused by the new alignment. All stream work will be
conducted in the dry by dewatering the permitted site prior to construction. The water will be pumped off site or into an approved silt bag adhering to NCDOT's best management
practices for pipe construction/replacement. The equipment that will be used to construct this Roundabout and Pipe Replacement project includes, but is not limited to: dewatering
pump, trackhoe, dumptrucks, vibratory roller, motor grader and paving equipment.
4j. Please upload project drawings for the proposed project.
W-5710Y_Permit Drawings_20190531.pdf 1.88MB
W5710Y Roadway and Pipe Pictures.pdf 6.53MB

5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes r No
Comments:
This site was visited on 12/17/2018 by the USACE and NCDWR
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): Joel Howard
Agency/Consultant Company: NCDOT
Other:
5d1. Jurisdictional determination upload
Stream Identification Form.pdf 395.88KB
Copy of Copy of NC SAM Rating Calculator v2.12.pdf 240.05KB
6. Future Project Plans
6a. Is this a phased project?*
r Yes r No
r Unknown
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 projector related activity?
VA
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 ❑ Buffers
r Open Waters r Pond Construction
3. Stream Impacts
3a. Reason for impact (?)
3b.lmpact type *
3c. Type of impact*
3d. S. name*
3e. Stream Type *
3f. Type of
3g. S. width *
3h. Impact
F
(?)
Jurisdiction*
length*
F
Pipe Replacement
Permanent
Relocation
LIT to East Fork Twelve Mile
Intermittent
Both
6
150
Creek
Average (feet)
(linearfeet)
g2
Pipe Replacement
Temporary
Dewatering
LIT to East Fork Twelve Mile
Intermittent
Both
6
18
Creek
Average (feet)
(lin�rfeet)
31. Total jurisdictional ditch impact in square feet:
0
31. Total permanent stream impacts:
150
31. Total stream and ditch impacts:
168
3j. Comments:
Site 1 will have 150' of permanent impacts and 18' of temporary impacts.
E. Impact Justification and Mitigation
1. Avoidance and Minimization
3i. Total temporary stream impacts:
18
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
NCDOT's best management practices for the installation of pipe in jurisdictional waters will be adherred to thorughout the life of the project.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
All erosion control devises will be maintained and monitored and inspected as dictated by the NPDES permit. Permit Site 1 will be dewatered prior to
the beginning of construction and all work will be completed in the dry.

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
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
It has not yet been determined by the USACE what ratio of mitigation if any will be required. I have spoken with Ms. Nicholle Braspennickx and have agreed upon that if mitigation is
required, NCDOT will provide the needed information prior to permit authorization.
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:
UT to East Fork of Twelve Mile Creek does not fall under any NC Riparian Buffer Protection Rules.
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:
NPDES records will be keep on site and inspected as need by an NCDOT representative.
G. Supplementary Information
1. Environmental Documentation
la. 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
1c. If you answered "yes" to the above, has the document review been finalized by the State Clearing House?*
r Yes r No
Comments:*
This project is federal funded and has been reviewed under the Categorical Exclusion 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)?*
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.
This is a stand alone project. NCDOT does not anticiapate any additional land development within the project limits or future impacts to the
downstream water quality of East Fort Twelve Mile Creek.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
rYes r Nor WA
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

5d. Is another Federal agency involved?*
r Yes r No r Unknown
Se. 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
Si. 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.?
f Yes r No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
The North Carolina Natural Heritage Program (NCNHP) Database.
Consultation Documentation Upload
NHP Report.pdf 3.07MB
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?*
South Atlantic Fishery Management Council.
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?*
NCDOT's Cultrual Resources Staff.
7c. Historic or Prehistoric Information Upload
18-05-0022_%Survey.pdf 5.01 MB
AR18-05-0022NoSurveyRevised.pdf 785.41 KB
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year flood plain?*
f Yes r No
8c. What source(s) did you use to make the floodplain determination?*
Fema Floodplain Maps website.
Miscellaneous
Comments
Miscellaneous attachments not previously requested.
75 0/6W-5710Y_RDY_ROW.pdf 4.66MB
Signature u
*
W 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:
Joel M. Howard
Signature

Date
6/5/2019