20190907 Ver 1_PCN Form Submission_20190708

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
20190907
Is a payment required for this project?*
r No payment required
r Fee received
r Fee needed - send electronic notification
Select Project Reviewer*
Rob Ridings:eads\rgridings
Information for Initial Review
1a. Name of project:
Replacement of pipe on SR 1715 (Helena-Moriah Road) carrying Ur to Deep Creek
1a. Who is the Primary Contact?*
Heather W. Montague
1b. Primary Contact Email:*
[e-mail]
Date Submitted
7/8/2019
Nearest Body of Water
Uf to Deep Creek
Basin
Neuse
Water Classification
27-3-4; WS-III; ORW; NSW
Version# *
1
Reviewing Office*
Central Office - [phone]
1c. Primary Contact Phone:*
[phone]
Site Coordinates
Latitude: Longitude:
36.26465-78.84991
FA. Processing Information U
County (or Counties) where the project is located:
Person
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 # (?)
513.207311
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: 03 - Maintenance
NWP Numbers (for multiple NWPS):
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:
North Carolina Department of Transportation
2b. Deed book and page no.:
2c. Responsible party:
2d.Address
Street Address
2612 N. Duke Street
Address Line 2
city
Durham
Postal / Zip Code
27704
2e. Telephone Number:
[phone]
2g. Email Address:*
State / Frovinre / R�gion
NC
0buntry
us
2f. Fax Number:
*
r Yes r No
r Yes r No

[e-mail]
C. Project Information and Prior Project History U
1. Project Information
1b. Subdivision name:
(d appropriate)
1c. Nearest municipality/ town:
Roxboro
2. Project Identification
2a. Property Identification Number:
Parcel 1: A98 179, Parcel 2: A98 93, Parcel 3:
2b. Property size:
A98 119, Parcel 4: A98 11
0.18
2c. Project Address
Street Address
6600 Helena-Moriah Road
Address Line 2
City
State / F rovince/ Fbgion
Rougemont
NC
Fbstal / Zip Code
Cbuntry
27252
US
3. Surface Waters
3a. Name of the nearest body of water to proposed project:"
UT to Deep Creek
3b. Water Resources Classification of nearest receiving water:*
27-3-4; WS-III; ORW; NSW
3c. What river basin(s) is your project located in?*
Neuse
3d. Please provide the 12-digit HUC in which the project is located.
030202010103
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 pipe structure has deteriorated and the roadway failed. The general land use in the vicinity of the project is grassy shoulders/slopes, wooded and residential land.
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)
SR 1715 Helena Moriah Topo PDF.pdf 2.44MB
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)
SR 1715 Helena Moriah Soils PDF.pdf 823.73KB
4f. List the total estimated acreage of all existing wetlands on the property:
0.0
4g. List the total estimated linear feet of all existing streams on the property:
60.0
4h. Explain the purpose of the proposed project:*
The existing pipe structure have deteriorated and needs replacing.
41. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
The existing structure is a 72" x 42" oblong corrugated metal pipe that is 36 ft long. The proposed structure is a 103" x 71" corrugated aluminum pipe arch 40ft long with headwalls. Rip
will be installed underlined with geotextile along the stream banks at the tie in points for long term stability. In order to maintain a dry work area temporary dewatering and pump around
will be necessary. Equipment to be used includes an excavator, backhoe, grader, crane, etc.
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?*
F Yes C No O Unknown

Comments:
No wetlands epst within the project footprint.
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
f Preliminary r Approved r Not Verified r Unknown r NIA
Corps AID Number:
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Heather W. Montague
Agency/Consultant Company: NCDOT
Other:
5d1. Jurisdictional determination upload
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
la. Where are the impacts associated with your project? (check all that apply):
)— Wetlands W Streams -tributaries
r Open Waters r Pond Construction
3. Stream Impacts
r Buffers
3a. Reason for impact (?)
3b.lmpact type *
3c. Type of impact*
3d. S. name*
3e. Stream Type *
3f. Type of
3g. S. width *
3h. Impa*ct
❑
(?)
Jurisdiction*
length
S1
Road Crossing
9
Permanent
Culvert
Ur to Dee Creek
p
Perennial
Both
5
4
Average (feet)
(linear feet)
gp
Dewatering
Temporary
Dewatering
Ur to Deep Creek
Perennial
Both
5
40
Average (feet)
(linear feet)
S3
Bank Stabilization
Permanent
Bank Stabilization
Ur to Dee Creek
p
Perennial
Both
5
10
Average (fee[)
(linear feet)
3i. Total jurisdictional ditch impact in square feet:
0
31. Total permanent stream impacts:
14
31. Total stream and ditch impacts:
54
3i. Total temporary stream impacts:
40
3j. Comments:
Note: although the site is within the Neuse River Basin, all work is performed from the roadway within the epsting transportation facility. Therefore
there are no buffer impacts. Stream fill and bank stabilization impacts are concurrent with dewatering
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:
Stream impacts will be minimized onsite including rip rap bank stabilization where possible. This pipe will be replaced in the same alignment by the new
pipe. Rip rap armoring along the stream will be limited to only amount necessary to ensure long term stability. This project involves replacement of
epsting structure within epsting facility so there are no buffer impacts proposed.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Sediment and erosion control Best Management Practices for protection of surface waters will be enforced during project construction.
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:
F. Stormwater Management and Diffuse Flow Plan (required by DWR) 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?
f Yes r No
If no, explain why:
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:
standard BMPs apply
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
Comments:
This project meets the criteria for MCDC which doesn't require review by the State Clearing House.
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.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this 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?
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 C Unknown
5e. 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?
Carolina Madtom: A US Fish and Wildlife Service (USFWS) proposal for listing the Carolina Madtom (Noturus furiosus) as a threatened species was
published in the Federal Register in May 22, 2019. The listing will likely become effective by May 22, 2020. Furthermore, this species is included in
USFWS' current list of protected species for this county. It is anticipated that this project will be completed before this species becomes officially listed.
However if not, consultation with the USFWS regarding Carolina Madtom will be addressed when this species becomes listed. Neuse River Waterdog:
A US Fish and Wildlife Service (USFWS) proposal for listing the Neuse River Waterdog (Necturus lewisi) as a threatened species was published in the
Federal Register in May 22, 2019. The listing will likely become effective by May 22, 2020. Furthermore, this species is included in USFWS' current list
of protected species for this county. It is anticipated that this project will be completed before this species becomes officially listed. However if not,
consultation with the USFWS regarding Neuse River Waterdog will be addressed when this species becomes listed.
Dwarf wedgemussel: Use of the Programmatic Biological Opinion for Culvert Replacements and Extensions in Eastern North Carolina, NCDOT
Divisions 1-8 (June 13, 2018) provides a Biological Conclusion of No Effect for this species. Tar River spinymussel: Use of the Programmatic Biological
Opinion for Culvert Replacements and Extensions in Eastern North Carolina, NCDOT Divisions 1-8 (June 13, 2018) provides a Biological Conclusion
of No Effect for this species. Yellow lance: Use of the Programmatic Biological Opinion for Culvert Replacements and Extensions in Eastern North
Carolina, NCDOT Divisions 1-8 (June 13, 2018) provides a Biological Conclusion of No Effect for this species. Atlantic pigtoe: A US Fish and Wildlife
Service (USFWS) proposal for listing the Atlantic pigtoe (Fusconaia masoni) as an threatened species was published in the Federal Register in
October 11, 2018. The listing will likely become effective by October 11, 2019. Furthermore, this species is included in USFWS' current list of
protected species for this county. NOTE: THIS PROJECT WILL BE COMPLETED IN THE FALL 2019 PRIOR TO PROPOSED LISTING.
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?*
Available mapping
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?*
Available mapping
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
8c. What source(s) did you use to make the floodplain determination?*
FEMA mapping
Miscellaneous
Comments
Miscellaneous attachments not previously requested.
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:
Heather W. Montague
Signature
HEA7*5�- ttC k&d146r-
Date
7/8/2019