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20130066
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1 3 Dec 10 2008
Page 1 of 10
PCN Form — Version 1.3 December 10, 200�/ersion
Pre - Construction Notification (PCN) Form
A. Applicant Information
1.
Processing
1 a.
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:
1c.
Has the NWP or GP number been verified by the Corps?
❑ Yes
N No
1 d.
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
1 e.
Is this notification solely for the record
because written approval is not required?
For the record only for DWQ 401
Certification:
❑ Yes ® No
For the record only for Corps Permit:
❑ 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
fee program.
N Yes
❑ No
1g.
Is the project located in any of NC's twenty coastal counties. If yes, answer 1h
below.
❑ Yes
® No
1 h.
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
® No
2.
Project Information
2a.
Name of project:
Bridge #177 on SR 1137
2b. County:
Watauga
2c.
Nearest municipality 1 town:
Foscoe
2d.
Subdivision name:
2e.
NCDOT only, T.I.P. or state
project no:
17BP.11.R26
3.
Owner Information
3a.
Name(s) on Recorded Deed:
NCDOT
3b.
Deed Book and Page No.
3c.
Responsible Party (for LLC if
applicable):
3d.
Street address:
801 Statesville Road
3e.
City, state, zip:
North Wilkesboro, NC 28659
3f.
Telephone no.:
336- 903 -9202
3g.
Fax no.:
336 - 667 -4549
3h.
Email address:
[e-mail]
Page 1 of 10
PCN Form — Version 1.3 December 10, 200�/ersion

4. Applicant Information (if different from owner)
4a. Applicant is:
❑ Agent ❑ Other, specify:
4b. Name:
4c. Business name
(if applicable):
4d. Street address:
4e. City, state, zip:
4f. Telephone no.:
4g. Fax no.:
4h. Email address:
5. Agent/Consultant Information (if applicable)
5a. Name:
5b. Business name
(if applicable):
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
�-
5f. Fax no.:
5g. Email address:
Page 2 of 10
PCN Form — Version 1.3 December 10, 2008 Version

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
1 b. Site coordinates (in decimal degrees):
Latitude: 36.17926 Longitude: - 81.78128
(DD DDDDDD) ( -DD DDDDDD)
1c. Property size:
0.1 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
proposed project:
UT to Clark Creek
2b. Water Quality Classification of nearest receiving water:
C
2c. River basin:
Watauga
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:
Substandard bridge to be replaced in a rural area
3b. List the total estimated acreage of all existing wetlands on the property:
0 acres
3c. List the total estimatetl linear feet of all existing streams (intermittent and perennial) on the property:
100 linear feet
3d. Explain the purpose of the proposed project:
Upgrade substandard stream crossing
3e. Describe the overall project in detail, including the type of equipment to be used:
See attached cover letter.
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) inthe past?
Comments:
❑ Yes'- ® No ❑ Unknown
4b. If the Corps made the jurisdictional determination, what type
of determination was made?
❑ Preliminary ❑ Final
4c. If yes, who delineated the jurisdictional areas?
Name (if known):
Agency /Consultant Company:
Other.
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.
6. Future Project Plans
6a. Is this a phased project?
❑ Yes ® No
6b. If yes, explain.
Page 3 of 10
PCN Form — Version 1.3 December 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
W-1 ❑ P ❑ T
❑ Yes
❑ No
❑ Corps
❑ DWQ
W2 ❑ P ❑ T
❑ Yes
❑ No
❑ Corps
❑ DWQ
❑ Yes
❑ Corps
W3 ❑ P ❑ T
❑ No
❑ DWQ
W4 ❑ P ❑ T
❑'Yes
❑ No
❑ Corps
❑ DWQ
W5 ❑ P ❑ T
❑ Yes
❑ No
❑ Corps
❑ DWQ
W6 ❑ P ❑ T
❑ Yes
❑ No
❑ Corps
❑ DWQ
2g. Total wetland impacts
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,
3g.
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)
S1 ®P ®T
Pipe, Riprap &
Dewatering
UT to Clark Creek
® PER
❑ INT
® Corps
® DWQ
3 - g
115
❑ PER
❑ Corps
S2 ❑ P ❑ T
❑ INT
❑ DWQ
❑ PER
❑ Corps
S3 ❑ P ❑ T
❑ INT
❑ DWQ
S4 ❑ P ❑ T
❑ PER
❑ INT
❑ Corps
❑ DWQ
❑ PER
❑ Corps
S5 ❑ P ❑ T
❑ INT
❑ DWQ
❑ PER
❑ Corps
S6 ❑ P ❑ T
❑ INT
❑ DWQ
3h. Total stream and tributary impact's
3i. Comments: 40 linear feet of the impacts are temporary
Page 4 of 10
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
impact number —
Name of waterbody
(if applicable)
Type of impact
Waterbody type
Area of impact (acres)
Permanent (P) or
Temporary T
01 ❑P ❑T
02 ❑P ❑T
03 ❑P ❑T
04 ❑P ❑T
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If pond or lake construction proposed, the complete the chart below.
5a.
5b.
5c.
Wetland Impacts (acres)
5d.
Stream Impacts (feet)
5e.
Upland
Pond ID
Proposed use or purpose
(acres)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded 4
number
of pond
P1
P2__t
5f. Total
5g. Comments: N/A
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 any impacts require mitigation, then you MUST fill out Section D of this form.
6a.
❑ Neuse ❑ Tar - Pamlico ❑ Other:
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 T
impact
re uired?
❑Yes
B1 ❑P ❑T
❑ No
❑ Yes
B2 ❑P ❑T
❑ No
❑ Yes
B3 ❑ P ❑ T
❑ No
6h. Total buffer impacts
6i. Comments:
Page 5 of 10
PCN Form — Version 1.3 December 10, 2008 Version

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
The culvert length is the minimum needed to improve safety at this location.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
All appropriate BMPs will be used'during 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?
® Yes ❑ No
❑ DWQ ® Corps
2b. If yes, mitigation is required by (check all that apply):
❑ Mitigation bank
2c. If yes, which mitigation option will be used for this
® Payment to in -lieu fee program
project?
❑ 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:
4c. If using stream mitigation, stream temperature:
50 linear feet
❑ warm ❑ cool ®cold
4d. Buffer mitigation requested (DWQ only):
square feet
4e. Riparian wetland mitigation requested:
acres
4f. Non - riparian wetland mitigation requested:
acres
acres
4g. Coastal (tidal) wetland mitigation requested:
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 6 of 10
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 Z 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.
Zone
6c.
Reason for impact
6d
Total impact
Multiplier
6e.
Required mitigation
(square feet)
(square feet)
Zone 1
3 (2 for Catawba)
Zone 2
1.5
6f. Total buffer mitigation required:
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).
6h. Comments:
Page 7 of 10
PCN Form — Version 1.3 December 10, 2008 Version

E. Stormwater Management and Diff use Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers identified
❑ Yes ® No
within one of the NC Riparian Buffer Protection Rules?
1b. If yes, then is a diffuse flow plan included? If no, explain why.
❑ Yes ❑ No
Comments:
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this 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:
2d. If this project DOES require a Stormwater 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?
❑ DWQ Stormwater Program
-
❑ DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project?
❑ Phase II
❑ NSW
3b. Which of the following locally - implemented stormwater management programs
❑ USMP
apply (check all that apply):
❑ 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
l
❑ Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
5. DWQ 401 Unit Stormwater Review
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 8 of 10
PCN Form — Version 1.3 December 10, 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
® Yes
❑ No
use of 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)?
1 c.
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
❑ Yes
❑ No
letter.)
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 the
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.
N/A
Page 9 of 10
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?
51b. 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?
GIS and visual observation
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?
W RC will comment
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?
Project was submitted to OHE.
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:
8c. What source(s) did you use to make the floodplain determination? ncfloodmaps
J. Heath Slaughter
1123/13
Applicant/Agent's Printed Name
s Sre
r Applicant/AgentJPA
( Agent's s nature is valid only if an authori tter from the applicant
Date
is provide d.
Page 10 of 10
PCN Form — Version 1.3 December 10, 2008 Version

U� 1
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
PAT McCRORY P. O. Box 25201, Raleigh, NC 27611-5202 TONY TATA
GOVERNOR PHONE: [phone] SECRETARY
January 23, 2013
Mr. Monte Matthews
U. S. Army Corps of Engineers
Raleigh Regulatory Field Office
3331 Heritage Trade Drive, Suite 105
Wake Forest, NC 27587
Subject: Nationwide Permit #14
Replace Bridge #177 on SR 1137 with Pipe
Watauga County, North Carolina
Project Number: 17BP.11.R.26 (DWQ Permit Fee: $240)
Dear Mr. Matthews:
The North Carolina Department of Transportation is scheduled to replace existing Bridge #177
with 2 lines of 60" pipe at the same location. The existing bridge is 16.5 feet long. The pipe
option is not ideal but our right -of -way limitations along with this being a dead end road appear
to make our proposal the best option available. Stream slope is about 9 %. Flow will be isolated
to one barrel. Mitigation will be provided through EEP. No on -site detour is proposed. Stream
impacts are tabulated below.
Stream Impacts:
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Im (feet)S I
M;' i�ra: �...,,�. ..i�?:^' - <-{.
Station )
I Structure Size;,
?Struc'ture'Size,
D
acts
. nthisz -(ft
16.5' long
(2) @ 60" x
Bridge #177
bridge
50' CSPs w/
40
25
115
HWs
Perm. Fill/Riprap Impacts =
75 feet
Total Project Impacts =115
feet
The replacement of the existing bridge with the proposed new pipes will require temporary
dewatering. An impervious sandbag dike will be constructed approximately 20 feet upstream of
the existing structure to create a small pool. Clean water will temporarily be pumped around or
P. 0. Box 250, N. WILKESBORO, NC 28659
PHONE [phone] FAX [phone]

Mr. Monte Matthews
Bridge #177 on SR 1137
Page 2
January 23, 2013
piped through the construction area and will be discharged downstream. Any dirty water located
inside the construction area will be pumped into a silt bag if necessary. Once the new structure is
in place, the impervious dike will be removed and preconstruction streambed elevations will be
restored.
Construction of this project will require impacts to waters of the United States in the Watauga
River Basin. The existing bridge crosses a UT to Clark Creek (Class: C). This project was
reviewed for the-presence of threatened and endangered species in September 2012. The subject
project will have no effect on any federally listed endangered plant or animal species. Cultural
resources review is complete with no surveys required.
The project impacts are not significant in nature and should not alter the best usage for this
stream. All appropriate BMPs will be used during construction. Attached is a Preconstruction
Notification Form, plan sheets, a marked county map and a marked topography map.
By copy of this electronic letter, it is requested that Mrs. Marla Chambers with the North
Carolina Wildlife Resources Commission comment directly to you concerning the 404
Nationwide Permit application with a copy sent to me.
By copy of this electronic letter, it is requested that the Division of Water Quality, 401/Wetlands
Unit, issue the appropriate permit for construction of this project. It is requested that any
comments related to the 401 certification be forwarded directly to me with a copy sent to the US
Army Corps of Engineers.
We would like to begin construction as soon as possible. If further information is required,
please let me know. Your early review and consideration will be appreciated.
Sincerely,
Heath Slaughter
Division Environmental Officer
Enclosures
cc: Monte Matthews, US Army Corps of Engineers
Marla Chambers, NCWRC
Amy Chapman, Division of Water Quality
Amy Euliss, Division of Water Quality
Mike Pettyjohn, PE, Division Engineer
David Wayne, PE, Bridge Maintenance Engineer
Jami Guyrm, Division Bridge Program Manager
Heath Slaughter, Division Environmental Officer
Neil Trivette, Roadside Environmental Field Operations Engineer

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1
3.
1) Bridge #177 on SR 1137, Watauga.
2) Downstream view from bridge.
3) Upstream view from bridge.
2.
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