20100522 Ver 1_Application_20100702

otr? wnrE? 0 ®5 2 2 Office Use Only:
Corps action ID no.
DWQ project no.
Form Versi 1.3 Dec 10 2008

,1. Pre-Construction Notification (PCN) Gor
Processing A. \pplic.nllnformation
2 //
1a. Type(s) of approval sought from the

Corps
:
®Section 404 Permit L] Section 1TL? Wq?
1b. Specify Nationwide Permit (NWP) number: 3 and 13 or General Permit (GP) number: A%CN
1c. 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
1e. 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
11. 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. ? Yes ® No
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1h
below. ? Yes Z,No
1h. Is the project located within a INC DCM Area of Environmental Concern (AEC)? ? Yes -. ,:®-Noy..., . ,.,
2. . Project Information .' .., :--::•+?n!
2a. Name of project' B-5219 Replacement of Bridge No. 139 over Grassy Creek on SR 1413
2b. County: Granville
2c. Nearest municipality / town: Cornwall
2d. Subdivision name:
2e. NCDOT only, T.I.P. or state
project no: g_5219
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:
3e. City, state, zip:
3f. Telephone no.:
3g. Fax no.:
3h. Email address:
Page 1 of 10
PCN Form - Version 1.3 December 10, 2008 Version
4. Applicant Information (if different from owner)
1 4.
4a. Applicant is: ? Agent ? Other, specify:
4b. Name:
4c. Business name
(if applicable): -- ''
4d. Street address.
4e. City, state, zip:, j '
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. Properly Identification
1a. Property identification no. (tax PIN or parcel ID): N/A
1 b. Site coordinates (in decimal degrees): Latitucle: 36.46962 Longitude: - 78.66674
(DD.DDDDDD) (-DD.DDDDDD)
1c. Property size: 0.5 acres
2. Surface Waters
2a. Name of nearest body of water (stream. river, etc.) to Grassy Creek
proposed project:
2b. Water Quality Classification of nearest receiving water: C
2c. River basin: Roanoke
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:
Existing bridge is structurally deficient and must be replaced. Land use in vicinity of project is comprised of wooded land .
and farm land.
3b. List the total estimated acreage of all existing wetlands on the property:
0.0
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:

,z
60 ft in 60 ft Right-Of-Way
3d. Explain the purpose of the proposed project:
Replacement of structurally deficient bridge.
3e. Describe the overall project in detail, including the type of equipment to be used:
Repalacement of existing bridge with a new bridge. Equipment will include excavator, back hoe' "crane, etc., :..
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
? Yes ®No ? Unknown.
project (including all prior phases) in the past?
Comments:
4b. If the Corps made the jurisdictional determination, what type
? Preliminary ? Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company: -
Name (if known): 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
? Yes ®No ? Unknown
this project (including all prior phases) in the past?
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
1a. 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 irnpacl Type or 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)
Temporal
W1 ? P ? T ? Yes ? Corps
? No ? DWQ
W2 ? P ? T EJ Yes ? Corps
? No ? DWQ
W3 ? P ? T ? Yes ? Corps
? No ? DWQ
W4 ? P ? T ? Yes .? Corps
? No ? DWQ
W5 ? P ? T ? Yes ? Corps
? No ? DWQ
W6 ? P ? T ? Yes ? Corps
? No ? DWQ
2g. Total wetland impacts 0.0
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 feet)
Temporary (T) (INT)? other) (feet)
S1 ? P ®T Temporary
causeway Grassy Creek ® PER
? INT ® Corps
® DWQ 30 ft 56 ft
S2 ® P ? T Rip rap bank Grassy Creek ® PER ® Corps 30 fl 56 ft
stabilization ? INT ® DWQ (Concurrent)
S3 ? P ? T ? PER ? Corps
? INT ? DWQ
S4 ? P ? T ? PER ? Corps
? INT ? DWQ
S5 ? P ? T ? PER ? Corps
? INT ? DWQ
S6 ? P ? T ? PER ? Corps
? INT ? DWQ
3h. Total stream and tributary impacts 56 ft
3i. Comments: Construction of bridge will require construction of drilled shafts along western streambank. This will require
installation of a temporary rip rap causeway to support the drill rig. Rip rap in the water will be removed after construction of
the drilled shafts is completed. However, to provide permanent stability, rip rap will remain on streambank only. Note that the
56 It of temporary impacts for causeway is concurrent with the limits of the permanent streambank impact.
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.
Open water
impact number -
Permanent (P)
or Temporary
(T 4b.
Name of
waterbody
(if applicable) 4c.

Type of impact 4d.

Waterbody type 4e.

Area of impact (acres)
01 ?P?T
P? P r T
03?P?r
04 ?P?T
4f. Total open Nvater impacts 0.0
4g. Comments:
5. Pond or Lake Construction -
If and or lake construction proposed, then complete the chart below.
5a.

Pond ID 5b.

Proposed use or purpose 5c.
Wetland Impacts (acres) 5d.
Stream Impacts (feet) 5e.
Upland
(acres)
number of pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
Sf. Total
5g. Comments:
5h.as 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:
Page 5 of 10
PCN Form - Version 1.3 December 10, 2008 Version
i
•i
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:
Project is in which protected basin? ? Catawba ? Randleman
61b. 6c. 6d 6e. - 61. - - 6a. - -
Buffer impact
number - Reason Buffer Zone 1. impact Zone 2 impact
Permanent (P) for Shearn name mitigation (square feet) (square feet)
or Temporary impact required?
f
B1 ?P?T ?Yes
? No
B2 ?P?T ?Yes
? No
B3 ?P?T ?Yes
? No
. 6h. "Total buffer impacts
6i. Comments:
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project..
Construction of, bridge will require installation of drilled shafts along western streambank. This will require a -temporary
causeway'to support' the drill rig: The ri'l rap in the water (i.e. cadseway)'will be removed after constructiomofA6drilled'.
shafts. Rip rap will remain on bank only for permanent stability. Only the smallest amount of rip rap necessary to support the
drill rig.will.be installed during construction. .
1b Specifically describe'measures taken to avoid or minimize the proposed impacts through construction techniques. .. r
The contractorwill"review site.;conditions.to determine how much of the temporary. cau seway is necessary', to,install the drilled
:shafG-AtGefforts will be made during con-structionlto minimize impacts: ' :
.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for ? Yes ® No
impacts to Waters of the U.S. or Waters of the State?
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
El 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

Page 6 of 10
PCN Form - Version 1.3 December 10, 2008 Version
3c. Comments:
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached. ? Yes
41b. Stream mitigation requested. linear feet
4c.
4d. If uslnu stream mitigation. stream temperature:
Buffer mitigation requested (DWQ only): 1 warm ? cool ?cold
square feet
4e. 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.
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 buffer mitigation? ? Yes ® No
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.

Zo
ne 6c.
Reason for impact 6d
Total impact
(square feet)
Multiplier 6e.
Required mitigation
(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
1
i
,I
7f
i
I}
E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified
Yes No
El ©
within one of the NC Riparian Buffer Protection Rules?
i
1b. If yes, then is a diffuse flow plan included? If no, explain why.
? Yes ? No
Comments:
2. Stonnwoter Management Plan
2a. What is the overall percent imperviousness of this project? 33 %
2b. Does this project require a Stormwater Management Plan? IN 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, na rrative description of the plan:
Construction of this project WILL NOT add any additional impervioius surface at the project. Stormwater runoff from the
project will be discharged at three sites: (1) Sta 10+60 Lt and (2) Ste 10+60 Rt: Runo ff will be discharged into existing
grass-lined ditches.- The tail end of the ditches will be stabilized with rip rap. (3) Sta 1 2+90 Lt: Runoff will be discharged
into a rip rap-lined pad located in a vegetated portion of the project.
? 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 j6risdiction is this project? N/A

? Phase II
3b. Which of the following locally-implemented Stormwater management programs ? NSW
r] 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
? HOW
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
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
nx rx .....,.. c..

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
la. Does the project involve an expenditure of public (federal/state/local) funds or the ® Yes ? No
use of public (federal/slate) land?
I h. If you answered "yes' to the above, does tilt project require preparation or all
environmental document pursuant to the requirements of the National or State ? Yes ? No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?

ic. li you arisweico yes to one above, hes ride documeni renew been ?walizei oy uie i I
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
Welland Rules (15A NCAC 2H .1300), DWQ Surface Water or Welland 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.
Project will not generate sewage disposal.
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?
5b. Have yuu ch,CCKed with the USF?'vo KuiiGui iiy EndamClcd SpEOIe8 "'Cl
? Yes EX] NO
Impacts?

Raleigh
?
5c. If yes. indicate the USFWS Field Office you have contacted.

5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
Consultation with PDEA-NEU mussel biologists.
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?
Available mapping.
-7i - 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)? .
71b : What data sources did you use to determine whether your-site would-impact historic or archeological resources?
Consultation with NCDOT Cultural Resources Expert (Mary Pope Furr).
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? Available mapping.
Chris Murray for J.W. Bowman,

PE July 1, 2010
Applicant/Agent's Signature Date
Applicant/Agent's Printed Name (Agent's signature is valid only if an authorization letter from the applicant
. is provided.)
Page 10 of 10
PCN Form - Version 1.3 December 10, 2008 Version

? Ir{S ^ ILiT?_Yy} ?... j. 4T k?,M••5. I{ fJI ?,., '. ???1. ?`??? 1??F.:=?.,('YA ???I ?: tf }? ?S`?'"+? fix' ?.?'?"
+c?
+?}
i f?
?Y -_,,
S 3
} ? ?` r
-!
? y\4t
f `1

?
{,
,
? 1
? r
{
J
[
l ?
s
!
)
`
V
_1
i f,?+^ t-_.. ?' ?...{}l.Il?l.?.^--. i ? avt f1 ? b ??..?.?
?
4 L G t?. .._
ll.
...?
?Y'i ,
}
?
h
.
.
[
.
..
t t +? ? ? lli J: u 7 y-y
1.1? 4 .. ?. 15 # , ? _` xi.?7 j,i tr f''.y ?f 4
{t? '? J?'ir ?ttlY.?
? Z

iJ

f

aC
rrw?a
_J
rr\
TJ
a
ab?Ae
o? s? ?E1
a= 5B ?•?BIE
z> e R 'E
Z-- a i`q!
?eq