20190859 Ver 1_PCN Form Submission_20190628

DWR
MOM— 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
Oange only if needed.
BIMS # Assigned
20190859
Is a payment required for this project?*
r No payment required
r Fee received
r Fee needed - send electronic notification
Select Project Reviewer*
Garcy Ward:eads\gpward
Information for Initial Review
1a. Name of project:
Repair and Maintenance of Martin ST. Outfall no.5
1a. Who is the Primary Contact?*
Steve Trowell
1b. Primary Contact Email:*
[e-mail]
Date Submitted
6/28/2019
Nearest Body of Water
Atlantic Ocean
Basin
Pasquotank
Water Classification
SB
Site Coordinates
Version# *
1
Reviewing Office*
Washington Regional Office - [phone]
1c. Primary Contact Phone:*
[phone]
Latitude: Longitude:
36.005852-75.650111
FA. Processing Information U
County (or Counties) where the project is located:
Dare
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:
WBS # (?)
1 SP.1028.5
1a. Type(s) of approval sought from the Corps:

r Section 404 Permit (wetlands, streams and waters, Clean Water Act)
W 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:
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
7 - Outfall Structures/ Intake
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
1i. 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?
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:
Kill Devil Hills
2b. Deed book and page no.:
2c. Responsible party:
2d. Address
Street Address
P O Box 1719
Address Line 2
City
State / Rovince / Fbgion
Kill Devil Hills
NC
Postal / Zip Code
Country
27948
USA
*
r Yes r No
r Yes r No

2e. Telephone Number: 2f. Fax Number:
[phone]
2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
3a. Name:
Steve Trowell
3b. Business Name:
NC Department of Transportation
3c.Address
Street Address
113 Airport Drive
Address Line 2
City
State / Province / legion
Edenton
NC
Postal / Zip CDde
O�ntry
27932
USA
3d. Telephone Number: 3e. Fax Number:
[phone] [phone]
3f. Email Address:*
[e-mail]
C. Project Information and Prior Project History U
1. Project Information
1b. Subdivision name:
(if apprgxiate)
1c. Nearest municipality/ town:
Kill Devil Hills
r
2. Project Identification
2a. Property Identification Number:
2c. Project Address
Street Address
Address Line 2
City
Kill Devil Hills
Postal / Zip Cade
27948
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Atlantic Ocean
3b. Water Resources Classification of nearest receiving water:*
SB
3c. What river basin(s) is your project located in?*
Pasquotank
3d. Please provide the 12-digit HUC in which the project is located.
030102051704
4. Project Description and History
2b. Property size:
1
State / Province / legion
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:*
Project area consists of the existing Martin Street Ocean Outfall no. 5. The adjacent property use consists of vacation homes.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
r Yes r No F 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 - Martin Street.pdf 1.61 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 1.01 MB
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:
0
4h. Explain the purpose of the proposed project:*
Repair damaged section of ocean outfall to maintain drainage from INC 12.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
The outlet at Ocean Outfall no. 5 at Martin Street is in need of repair, and NCDOT proposes to replace the last 36' of existing 27" RCP with 36' of 27" RCP. An excavator, loader,
trailers, and light trucks will be used.
4j. Please upload project drawings for the proposed project.
Beach Access.pdf
MARTIN ST OUTFALL PERMrr(5-17-2019).pdf
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
f 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 Sa is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
5d1. Jurisdictional determination upload
6. Future Project Plans
6a. Is this a phased project?*
r Yes r No
1.32MB
179.31 KB
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 project or related activity?
D. Proposed Impacts Inventory
1. Impacts Summary
la. 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
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
Outfall repairs and pipe replacement will undertaken in the existing/current alignment with no dimensional changes.
r Buffers
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Work will be performed during daylight hours and during lowtides. Work area will be limited to 100' on either side of the ocean outfall. Due to work
occurring during turtle nesting season, turtle crawl surveys will be conducted every morning before work begins.
v
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:
No impacts.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
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:
Pasquotank River Basin.
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:
G. Supplementary Information
1. Environmental Documentation
la. Does the project involve an expenditure of public (federallstate/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: *
Activity and impacts covered by Minimum Criteria 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)? *
f 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.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
r Yes r No r 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.
Raleigh
5d. Is another Federal agency involved?*
r Yes r No r Unknown
Se. Is this a DOT project located within Division's 1-8?
r Yes r No

5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
USFWS Raleigh Office
Consultation Documentation Upload
20190530_letter _Service to NCDOT_IGIIDevilHillsOceanOutfalls #5 and #8.pdf 44.02KB
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
Are there submerged aquatic vegetation (SAV) around the project vicinity?*
r Yes r No r Unknown
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
National Marine Fisheries Database
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?*
State Historic Preservation Office Historic Properties 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?*
r Yes r No
8b. If yes, explain how project meets FEMA requirements:
N/A
8c. What source(s) did you use to make the floodplain determination?*
NCFloodmaps.com. Zone VE
Miscellaneous
Comments
Coordination with Kill Devil Hills is attached.
Miscellaneous attachments not previously requested.
KDH Letter.pdf 248.73KB
Signature
*
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:
Steve John Trowell
Signature
Date
6/28/2019
u