20191030 Ver 1_PCN Form Submission_20190802

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
20191030
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:
US 158 - Pipe Replacement in Nags Head - Fire Department
1a. Who is the Primary Contact?*
Paul Williams
1b. Primary Contact Email:*
[e-mail]
Date Submitted
8/2/2019
Nearest Body of Water
Unnamed canal to the Roanoke Sound
Basin
Pasquotank
Water Classification
SA;HOW
Site Coordinates
Version# *
1
Reviewing Office*
Washington Regional Office - [phone]
1c. Primary Contact Phone:*
[phone]
Latitude: Longitude:
35.934834-75.613641
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#M
2019CPT.01.16.10
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: 03 - Maintenance
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
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?
C 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 Right -of -Way US 158 - Dare County
2b. Deed book and page no.:
2c. Responsible party:
Paul Williams
2d. Address
Street Address
113 Airport Dr.
Address Line 2
City
State / Rovince / fagion
Edenton
NC
Postal / Zip Code
Country
27932
USA
*
r Yes r No
r Yes r No

2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
2f. Fax Number:
[phone]
3a. Name:
Paul Williams
3b. Business Name:
NC Department of Transportation
3c.Address
Street Address
113 Airport Dr.
Address Line 2
City
State / Province / legion
Edenton
NC
Postal / Zip CDde
0�untry
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:
Nags Head
2. Project Identification
2a. Property Identification Number:
2b. Property size:
0.5
2c. Project Address
Street Address
US 158, APPROX 0.1 MILES TO E. EPSTEIN ST.
Address Une 2
City
State / Province / Region
Nags Head
NC
Postal / Zip Aide
Q:untry
27959
USA
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Unnamed canal to the Roanoke Sound
3b. Water Resources Classification of nearest receiving water:*
SA;HOW
3c. What river basin(s) is your project located in?*
Pasquotank
3d. Please provide the 12-digit HUC in which the project is located.
030102051404
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:*
Project area consists of NCDOT US 158 and culvert. The adjacent property is a coastal marsh and a public park.
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 8 112 X 11 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for DWR)
Topo.pdf
1.05MB
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:
150
4h. Explain the purpose of the proposed project:*
Replace deteriorating culvert and maintain a stable roadway along US 158 for the safety of the traveling public and residents of Nags Head.
41. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
The existing 42" X29" X 125' CAPA will be removed and replaced with the proposed 64" X43" X 125' CAPA on the same alignment. This work will be accomplished using tracked
excavator, backhoe, and dump trucks.
4j. Please upload project drawings for the proposed project.
US 158 Pipe 5 Cross Section.pdf
US 158 Pipe 5 End View.pdf
US 158 Pipe 5 Plan View.pdf
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or 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 WA
Corps AID Number:
5c. If 5a 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
178.24KB
166.17KB
144.18KB
f 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?
Yes, there are 3 additional pipes on this roadway resurfacing project that will require a NAP 3. An ePCN will be submitted for each. Only 2 of the total of 4 pipes will require LAMA
Permits, which will be permitted by separate CAMA General Permits.
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
E. Impact Justification and Mitigation
1. Avoidance and Minimization
❑ Buffers
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
Culvert replacement will stay on the existing alignment and the pipe length will not be extended. The pipe replacement will be phased and traffic will be
shifted to keep the road open.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
NCDOT BMP's will be followed during culvert removal/installation and erosion control devices will be installed to prevent sediment loss from the project
site.

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 permanent jurisdictional impacts for the project.
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?
r Yes r No
If no, explain why:
Buffer Rules do not apply to the 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 (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:*
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 (15ANCAC 21-1.1300), 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.
Project replaces an eAsting culvert with a culvert.
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
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?
NC Natural Heritage Data Explorer Website
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?*
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 Website
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 AE
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:
Paul Collins Williams, Jr.
Signature
Date
8/2/2019
U