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Home My WebLink About20091040 Ver 1_Application_20091001091040 ?0?01? r ot'° \oyr<h'gTFk 9 Office Use Only: > r SVgL?? Corps action ID no. DWQ project no. Form Version 1.3 Dec 10 2008 Pre-Construction Notification (PCN) Form _ - A. Applicant Information _ 1. Processing - - - - 1a. Type(s) of approval sought from the Corps: ®Section 404 Permit ? Section 10 Permit 1b. Specify Nationwide Permit (NWP) number: 14 or General Permit (GP) number. 1 c. Has the NWP or GP number been verified by the Corps? ® Yes ? No 1d. Type(s) of approval sought from the DWQ (check all that apply): ® 401 Water Quality Certification - Regular ? Non-404 Jurisdictional General Permit ? 401 Water Quality Certification - Express ? Riparian Buffer Authorization le. Is this notification solely for the record For the record only for DWQ 401 For the record only for Corps Permit: because written approval is not required? Certification: ? Yes ® No ? Yes ® No 1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu Yes No fee program. 1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h ? Yes ® No below. 1h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ? Yes ® No 2. Project Information 2a. Name of project: SR 1573, Kiri<man Road Station 17+15 2b. County: pi 2c. Nearest municipality / town' Greenville 2d. Subdivision name: N/A 2e. NCDOT only, T.I.P. or state project no: 2C.074080 3. Owner Information 3a. Name(s) on Recorded Deed: North Carolina Department of Transportation 3b. Deed Book and Page No. N/A - 3c. Responsible Party (for LLC if NIA applicable): 3d. Street address: 105 Pactolus Highway NC 33 P.O. Box 1587 3e. City, state, zip: Greenville, NC 27835 3f. Telephone no.: 252-830-3490 -- 3g. Fax no.: 252-830-3341 3h. Email address: jbjohnson@ncdot.gov Page l of 11 PCN Form - Version 1.3 December 10, 2003 Version 4. Applicant Information (if different from owner) 4a. Applicant is: ? Agent ® Other, specify: Division 2 Environmental Officer 4b. Name: Jay B. Johnson 4c_ Business name (if applicable): North Carolina Depratment of Transportation 4d. Street address: P.O. Box 1587 4e. City, state, zip: Greenville, NC 27835 4f. Telephone no.: 252-830-3490 4g. Fax no.: 252-830-3341 4h. Email address: jbjohnson@ncdot.gov 5. AgenMonsultant Information (If applicable) 5a. Name: N/A 5b. Business name (if applicable): 5c. Street address: 5d. City, state, zip: 5e. Telephone no.: 5f. Fax no.: 5g. Email address: Page 2 of 11 PCN Form - Version 1.3 December 10, 2008 Version H. Project Information and Prior Project History 1. Property Identification 1a. Property identification no. (tax PIN or parcel ID): SR 1573,Kirkman Road 1 b. Latitude: N 35.745010 Longitude: - W Site coordinates (in decimal degrees): 77.204168 _-? - - - (DD.DDDDDD) (-DD.DDDDDD) 1c. Property size.- _ N/A acres 2. Surface Waters - 2a. Name of nearest body of water (stream, river, etc.) to proposed project: Tranter's Creek 2b. Water Quality Classification of nearest receiving water: _ C;Sw:NSW 2c. River basin: Tar-Pamlico - 3. Project Description -- 3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this application: SR 1573, Kirkman Road is a soil road. Woodlands and dominate the landscape. 3b. List the total estimated acreage of all existing wetlands on the property: 0.08 Acres This site is part of a larger adjacent wetland system 3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 60' This site is part of a longer adjacent stream system 3d. Explain the purpose of the proposed project: Pipe To Pipe Replacement; due to the age and condition of the existing pipe, it will be replaced by a new pipe. Shoulders will be built and existing ditches moved and widened; thus the need for the 404 Wetland Impacts. 3e. Describe the overall project in detail, including the type of equipment to be used: The Existing 38"x5T'x36' Currugated Metal Pipe will be replaced with a Proposed 36"x40' Corrugated Metal Pipe. Shoulders will be built and existing roadside ditches moved and widened. Excavators,Dump Trucks,and Crane Trucks 4. Jurisdictional Determinations 4a. Have jurisdictional wetland or stream determinations by the Corps or State been requested or obtained for this property / project (including all prior phases) in the past? ? Yes ®No ? Unknown Comments: 4b. If the Corps made the jurisdictional determination, what type of determination was made? ? Preliminary ? Final 4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company: Name (if known).- Jay Johnson Other: NCDOT 4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation 5. Project History 5a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past? ? Yes ®No ? Unknown 5b. If yes, explain in detail according to "help file" instructions. Page 3 of 11 PCN Form - Version 1.3 December 10, 2008 Version 6. Future Project Plans 6a. Is this a phased project? ? Yes ® No 6b. If yes, explain. Page 4 of 11 PCN Form - Version 1.3 Decornber 10. 2008 Version C. Proposed Impacts Inventory 1. Impacts Summary 1 a. Which sections were completed below for your project (check all that apply): ® Wetlands ? Streams - tributaries ? Buffers ? open waters ? Pond Construction 2. Wetland Impacts If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted. 2a. 2b. 2c_ 2d. 2e. 2f. Wetland impact Type of jurisdiction number - Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact Permanent (P) or (if known) DWQ - non-404, other) (acres) Temporary (T) W1 ®P ? T Fill Bottomland Hardwood Forest ® Yes ? No Corps ? DWQ 0.08 W2 ? P ? T ? Yes ? No ? Corps ? DWQ W3 ? P ? T ? Yes ? No ? Corps ? DWQ W4 ? P ? T ? Yes ? No ? Corps ? DWQ W5 ? P ? T ? Yes ? No ? Corps ? DWQ ? Yes ? Corps W6 ? P ? T ? No ? DWQ 0.Acres 2g. Total wetland impacts (3415 q ) 2h. Comments: 3. Stream Impacts If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this question for all stream sites impacted. _ 3a. 3b. 3c. 3d. 3e. 3f. 39. Stream impact Type of impact Stream name Perennial Type of jurisdiction Average Impact number - (PER) or (Corps - 404, 10 stream length Permanent (P) or intermittent DWQ - non-404, width (linear Temporary (T) (INT)? other) (feet) feet) ? PER ? Corps S1 ? P ? T ? INT ? DWQ ? PER ? Corps S2 ? P ? T ? INT ? DWQ ? PER ? Corps S3 ? P ? T ? INT ? DWQ ? PER ? Corps S4 ? P ? T ? INT ? DWQ ? PER ? Corps S5 ? P ? T ? INT ? DWQ ? PER ? Corps S6 ? P ? T E] INT ?DWQ I, 3h. Total stream and tributary impacts 3i. Comments: The Stream is not a Blue Line Stream per Garcy Ward,NCDWQ December 31, 2008 Page 5 of 11 PCN Form -Version 1.3 December 10, 2008 Version 4. Open Water Impacts If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of the U.S. then individually list all open water impacts below. 4a. 4b. 4c. 4d. 4e. Open water Name of waterbody impact number - (if applicable) Type of impact Waterbody type Area of impact (acres) Permanent (P) or Temporary 01 ?P?T 02 ?P?T 03 ?P?T 04 ?P?T 4L Total open water impacts None 4g. Comments: 5. Pond or Lake Construction If pond or lake construction proposed, then complete the chart below. 5a. 5b. 5c_ 5d. 5e. Wetland Impacts (acres) Stream Impacts (feet) Upland Pond ID Proposed use or purpose (acres) number of pond Flooded Filled Excavated Flooded Filled Excavated Flooded P1 P2 5f. Total None 5g. Comments: 5h. Is a dam high hazard permit required? ? Yes ? No If yes, permit ID no: 5i. Expected pond surface area (acres): 5j. Size of pond watershed (acres): 5k. Method of construction: 6. Buffer Impacts (for DWQ) If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts below. If an impacts require mitigation, then you MUST fill out Section D of this form. 6a. ? Neuse ?Tar-Pamlico ? Other: None Project is in which protected basin? ? Catawba ? Randleman 6b. 6c. 6d. 6e. 6f. 6g. Buffer impact number- Reason Buffer Zone 1 impact Zone 2 impact Permanent (P) or for Stream name mitigation (square feet) (square feet) Temporary impact _.._required? ?Yes B1 ?P?T ? No -- - ? Yes B2 ? P ? T ? No ?Yes B3 ?P?T ? No 6h. Total buffer impacts None -? 6i. Comments: Stream is Non-Jurisdictional as per Garcy Ward, NCDWQ Page 6 of 11 PCN Form - Version 1.3 December 10, 2008 Version D. Impact Justification and 1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project. Wetland Impacts have been minimized to the extent feasible, with impacts occurring only where necessary to accommodate the proposed roadway fill. 1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques. Use of existing roadway to operate construction equipment; no equipment will enter wetlands. 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? ? Yos ® No 2b. If yes, mitigation is required by (check all that apply): ? DWQ ? Corps ? Mitigation bank 2c. If yes, which mitigation option will be used for this project? El Payment to in-lieu fee program ? Permittee Responsible Mitigation 3. Complete if Using a Mitigation Bank 3a. Name of Mitigation Bank: 3b. Credits Purchased (attach receipt and letter) Type Quantity 3c. Comments: 4. Complete if Making a Payment to In-lieu Fee Program 4a. Approval letter from in-lieu fee program is attached. ? Yes 4b. Stream mitigation requested: linear feet 4c. If using stream mitigation, stream temperature: ? warm ? cool ?cold 4d. Buffer mitigation requested (DWQ only): J square feet 4e. Riparian wetland mitigation requested: acres 4f. Non-riparian wetland mitigation requested: acres 4g. Coastal (tidal) wetland mitigation requested: acres 4h. Comments: 5. Complete if Using a Permittee Responsible Mitigation Plan 5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan. Page 7 of 11 PCN Form - Version 1.3 December 10, 2008 Version 6. Buffer Mitigation (State Regulated Riparian Buffer Rules) - required by DWQ 6a. Will the project result in an impact within a protected riparian buffer that requires ? Yes ® No buffer mitigation? 6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the amount of mitigation required. - - 6c. - 6d. -- - - -- 6e. Zone Reason for impact Total impact Multiplier Required mitigation (square feet) (square feet) Zone 1 3 (2 for Catawba) Zone 2 1.5 6f. Total buffer mitigation required: None 6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e-g., payment to private mitigation bank, permittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund). N/A 6h. Comments: Page 8of11 PCN Form -Version 1.3 December 10, 2008 Version E. Stornwater Management and Diffuse Flow Plan (required by DWQ) 1. Diffuse Flow Plan Ia. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules? ? Yes ® No 1 b. If yes, then is a diffuse flow plan included? If no, explain why. Comments: Pipe Replacements and Roadway fill projects are covered by NCDOT Statewide NPDES Permit _ ? Yes ® No 2. 5tormwater Management Plan _ 2a. What is the overall percent imperviousness of this project? NIA Roadway/Bridge Project % 2b. Does this project require a Stormwater Management Plan? ? Yes ® No 2c. If this project DOES NOT require a Stormwater Management Plan, explain why: Covered by NCDOT Statewide NPDES Permit La. it trns protect uura require a 5tormwater management Plan, then provide a brief, narrative description of the plan: ? Certified Local Government 2e. Who will be responsible for the review of the Stormwater Management Plan? El DWQ Stormwater Program ? DWQ 401 Unit Review 3a. In which local government's Jurisdiction is ibis project? 3b. Which of the following locally-implemented stormwater management programs apply (check all that apply): ? Phase II ? NSW ? USMP ? Water Supply Watershed ? Other: 3c. Has the approved Stormwater Management Plan with proof of approval been ? Yes ® No attached? 4. DWQ Stormwater Program Review ® Coastal counties ? HQW 4a. Which of the following state-implemented stormwater management programs apply ? ORW (check all that apply): ? Session Law 2006-246 ? Other: 4b. Has the approved Stormwater Management Plan with proof of approval been attached? ? Yes ® No 5a. Does the Stormwater Management Plan meet the appropriate requirements? ? Yes ? No 5b. Have all of the 401 Unit submittal requirements been met? ? Yes ? No Page 9 of 11 PCN Form - Version 1.3 December 1 0. 2008 Version F. Supplementary Information 1. Environmental Documentation (DWQ Requirement) 1 a. Does the project involve an expenditure of public (federal/state/local) funds or the f ® Yes ? No use o public (federal/state) land? 1 b. 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 ? Yes ® No (North Carolina) Environmental Policy Act (NEPA/SEPA)? 1c. If you answered 'yes' to the above, has the document review been finalized by the State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval letter.) ? Yes ? No Comments: 2. Violations (DWQ Requirement) 2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards, ? Yes ® No or Riparian Buffer Rules (15A NCAC 2B .0200)? 2b_ Is this an after-the-fact permit application? ? Yes ® No 2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s): 3. Cumulative Impacts (DWQ Requirement) 3a. Will this project (based on past and reasonably anticipated future impacts) result in ? Yes ® No additional development, which could impact nearby downstream water quality? 3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with th e most recent DWQ policy. If you answered "no," provide a short narrative description. 4. Sewage Disposal (DWQ Requirement) 4a. Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of wastewater generated from the proposed project, or available capacity of the subject facility. NIA Page 10 of 11 PCN Form - Version 1.3 December 10, 2008 Version 5. Endangered Species and Designated Critical Habitat (Corps Requirement) 5a. Will this project occur in or near an area with federally protected species or ? Yes ® No habitat? 5b. Have you checked with the USFWS concerning Endangered Species Act ? Yes ® No impacts? ? Raleigh 5c. If yes, indicate the USFWS Field office you have contacted. ? Asheville 5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat? On-Site Habitat Investigation 6. Essential Fish Habitat (Corps Requirement) 6a. Will this project occur in or near an area designated as essential fish habitat? ? Yes ® No 6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat? 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 ? Yes ® No status (e.g., National Historic Trust designation or properties significant in North Carolina history and archaeology)? 7b. What data sources did you use to determine whether your site would impact historic or archeological resources? NCSHPO 8. Flood Zone Designation (Corps Requirement) 8a. Will this project occur in a FEMA-designated 100-year floodplain? ® Yes ? No 8b. If yes, explain how project meets FEMA requirements: Pipe designed to no-rise standards 8c. What source(s) did you use to make the floodplain determination? FEMA FIRM Maps n // 1 September 29, 2009 Applicant/Agent's Printed Name A ican A n-fs Signature (Agent's signature is rAd only if authorization letter from the applicant Date s vided. Page 11 of 11 PCN Form - Version 1.3 December 10, 2008 Version w I?Sl y M ? x z ? p 1?- ' • ? ? c ? Lu ti ,I ? ? WW d q 6 ? Y ~ ? ? 2 V 2N w W w ?? F w a JW LLJ W V- i• O ® O® Q, o p { N ?n =F ED I (^ W o? rn p z a aWd ysF ? w ? y. J ? y k LL Z a u 2 ? :7 p3p Q LL 1 < N 3 M F ?? ? ? D 1 z Ei ? O J V a W 1N3N3nvd d0 3003 n LtJ"7Y1'7nv,? 30 3703' _ (J J v41 N301 OHS Li LL- ? o T 2 K N ? g< 0 00 N ? w U a: k' N "o v 4 x to 9 IT w O u m W ai?o I 5 ^ i a + Y U W L? g ? r L.LJ J L J Q V) L~ z w Q N J " LL W •, z J 0 a 0 ? u o ? rc ? K w V 9 1 Q 1yy ` V x. 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PERMIT AREA Y= 730900.5936 Y E __ ?...._ T- --?..= ? --- - r - • --' - _ ---- X- 2532856.2884 N35 A_441_4211 •`.. 1, Ga It ?? ?^ N 35.745010 DEGREES i ' \ 4 '-' - - W 77.204168 DEGREES t 71 ,•ti •``i 7` •Ii `._ w \` :ri _-al„?I +1 ?y1 I ,. 1?. ??. -- _ ? \. ii• Vim-- _ - ?---,?-- Com BEGIN PROJECT { L-1 Y 729266.6662 X= 2533491.5356 N35^-44'-26" 7 W 77^42'-08" t`'r N 35.740490 DEGREES W 77.20212 DEGREES 'Bear Rd . ., ,? ? )551 ? 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