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PCN Form – Version 1.3 December 10, 2008 Version
Office Use Only:
Corps action ID no. _____________
DWQ project no. _______________
Form Version 1.3 Dec 10 2008
PreConstruction 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:
1c. Has the NWP or GP number been verified by the C orps? Yes No
1d. Type(s) of approval sought from the DWQ (check all that apply):
401 Water Quality Certification – Regular Non8404 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
1f. Is payment into a mitigation bank or in8lieu fe e program proposed for mitigation
of impacts? If so, attach the acceptance letter fr om mitigation bank or in8lieu
fee program.
Yes No
1g. Is the project located in any of NC’s twenty co astal counties. If yes, answer 1h
below.
Yes No
1h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? Yes No
2. Project Information
2a. Name of project: SR 2623 over Little Meadow Cre ek
2b. County: Cabarrus
2c. Nearest municipality / town: Mount Pleasant
2d. Subdivision name: NA
2e. NCDOT only, T.I.P. or state
project no: 17BP.10.R.26
3. Owner Information
3a. Name(s) on Recorded Deed:
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 2 of 13
PCN Form – Version 1.3 December 10, 2008 Version
4. Applicant Information (if different from owner)
4a. Applicant is: Agent Other, specify: NCDOT Division 10
4b. Name: Larry Thompson, PWS, LSS; Division Enviro nmental Officer
4c. Business name
(if applicable): NCDOT Division 10
4d. Street address: 716 West Main Street
4e. City, state, zip: Albemarle, NC 28001
4f. Telephone no.: 704898384400
4g. Fax no.: 704898283146
4h. Email address: lthompson@ncdot.gov
5. Agent/Consultant Information (if applicable)
5a. Name: Brandon Phillips, CHMM
5b. Business name
(if applicable): STV/Ralph Whitehead Associates
5c. Street address: 1000 West Morehead Street, Suit e 200
5d. City, state, zip: Charlotte, NC 28208
5e. Telephone no.: 704837281885
5f. Fax no.: 704837283393
5g. Email address: brandon.phillips@stvinc.com
Page 3 of 13
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): WBS 17BP.10.R.26
1b. Site coordinates (in decimal degrees):
Latitude: 35.327894 Longitude: 8
80.428175
(DD.DDDDDD) (8DD.DDDDDD)
1c. Property size: ~2.45 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, e tc.) to
proposed project: Little Meadow Creek
2b. Water Quality Classification of nearest receivi ng water: C
2c. River basin: Yadkin8Pee Dee
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PCN Form – Version 1.3 December 10, 2008 Version
3. Project Description
3a. Describe the existing conditions on the site an d the general land use in the vicinity of the proje ct at the time of this
application:
Existing conditions include SR 2623 (County Line Ro ad) and Bridge No. 120293, agricultural land, and d isturbed
(maintained) right8of8way
3b. List the total estimated acreage of all existin g wetlands on the property:
No wetlands were identified during the February 28, 2012 field review.
3c. List the total estimated linear feet of all exi sting streams (intermittent and perennial) on the p roperty:
~483 lf of perennial stream channel.
3d. Explain the purpose of the proposed project:
To replace Bridge No. 120293 with an improved, mode rn structure.
3e. Describe the overall project in detail, includi ng the type of equipment to be used:
The project involves the replacement of the existin g bridge that crosses over Little Meadow Creek on S R 2623 with a
double, reinforced concrete box culvert. Approximat ely 124 linear feet (0.02 acre) of Little Meadow Cr eek would be
permanently impacted (designated by the symbol “S” on Attachment C – Sheets 4 and 4A). Permanent impac ts would
result from the placement of the double, reinforced concrete box culvert within the stream channel tha t is currently
bridged (approximately 40 linear feet), and the rip rap lining of the eastern stream bank at the inlet and outlet of the double
culvert for the creation of the flood bench and ban k stabilization (approximately 84 linear feet total ). The amount of stream
bank impacts from the riprap for the bank stabiliza tion and flood bench creation was dictated by the e xisting geometry of
the stream in order to provide a smooth transition from the proposed 25 feet of culvert width to the a pproximate seven
foot stream channel width.
One barrel of the reinforced concrete box culvert (on the west side) will be used as the low flow conv eyance for Little
Meadow Creek, and will be buried one foot below the stream bed. Baffles will be placed within the low flow conveyance
culvert to create a meandering thalweg through the low flow culvert. The other barrel (on the east sid e) will be a high flow
culvert that will have a sill at the inlet side and will be perched above the low flow elevations to o nly convey the higher
flows that may occur. Additionally, the floodplain bench created at the inlet and outlet of the high f low barrel for
streambank stabilization will consist of Class I ri prap, as opposed to bioengineered methods, to promo te long term
stability with low maintenance. This floodplain ben ch will impact a portion of the stream bank (approx imately 84 linear feet
total). No channel realignment or armoring of the c hannel bottom is proposed.
Minor temporary impacts (designated by the symbol “TS” on Attachment C 8 Sheets 4 and 4A) may also ext end 47 feet
upstream and 40 feet downstream of the proposed cul vert for a total length of 87 linear feet (< 0.01 a cre) along perennial
RPW Stream A (Little Meadow Creek). Temporary impa cts may occur as a result of the demolition of the existing bridge
and the removal of the existing timber bridge abutm ents and piles that may potentially cause incidenta l debris to fall into
the channel. Note: these potential demolition relat ed temporary impacts may also occur to that portion of the stream
channel (40 linear feet) that would be subject to t he permanent impacts associated with the culvert pl acement. In addition,
temporary impacts may also occur as a result of the temporary diversion ditch installation (see below) and the bank
stabilization measures (See Attachment C – Sheets 4 and 4A). Roadway approach work has been minimized to that
which is absolutely necessary within the scope of r eplacing the bridge and will result in no additiona l impacts to waters of
the U.S. No major utility relocations would be requ ired as part of the bridge replacement; no addition al impacts would
occur as a result of utility relocations.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determina tions by the
Corps or State been requested or obtained for this property /
project (including all prior phases) in the past?
Comments:
Yes No Unknown
4b. If the Corps made the jurisdictional determina tion, what type
of determination was made? Preliminary Final
4c. If yes, who delineated the jurisdictional area s?
Name (if known):
Agency/Consultant Company:
Other:
4d. If yes, list the dates of the Corps jurisdictio nal determinations or State determinations and atta ch documentation.
NCDWQ representative Polly Lespinasse provided verb al determinations during initial scoping meetings o n October 27,
2012.
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PCN Form – Version 1.3 December 10, 2008 Version
5. Project History
5a. Have permits or certifications been requested o r obtained for
this project (including all prior phases) in the pa st? Yes No Unknown
5b. If yes, explain in detail according to “help fi le” instructions.
6. Future Project Plans
6a. Is this a phased project? Yes No
6b. If yes, explain.
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PCN Form – Version 1.3 December 10, 2008 Version
C. Proposed Impacts Inventory
1. Impacts Summary
1a. Which sections were completed below for your pr oject (check all that apply):
Wetlands Streams 8 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 i mpacted.
2a.
Wetland impact
number –
Permanent (P) or
Temporary (T)
2b.
Type of impact
2c.
Type of wetland
(if known)
2d.
Forested
2e.
Type of jurisdiction
(Corps 8 404, 10
DWQ – non8404, other)
2f.
Area of impact
(acres)
W1 P T Yes
No
Corps
DWQ
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
W6 P T Yes
No
Corps
DWQ
2g . Total wetland impacts
2h. Comments:
3. Stream Impacts
If there are perennial or intermittent stream impac ts (including temporary impacts) proposed on the si te, then complete this
question for all stream sites impacted.
3a.
Stream impact
number 8
Permanent (P) or
Temporary (T)
3b.
Type of impact
3c.
Stream name
3d.
Perennial
(PER) or
intermittent
(INT)?
3e.
Type of jurisdiction
(Corps 8 404, 10
DWQ – non8404,
other)
3f.
Average
stream
width
(feet)
3g.
Impact
length
(linear
feet)
S1 P T Incidental debris
from demolition
Little Meadow
Creek
PER
INT
Corps
DWQ 7 87
S2 P T
Installation of
double reinforced
concrete box
culvert and riprap
channel banks
Little Meadow
Creek
PER
INT
Corps
DWQ 7 124
S3 P T PER
INT
Corps
DWQ
S4 P T PER
INT
Corps
DWQ
S5 P T PER
INT
Corps
DWQ
S6 P T PER
INT
Corps
DWQ
3h. Total stream and tributary impacts 124
3i. Comments: Stream impacts from culvert installat ion, riprap on stream banks are permanent and the t emporary impacts
resulting from the incidental debris from bridge de molition are located within the reach of permanent impacts.
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PCN Form – Version 1.3 December 10, 2008 Version
4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estu aries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list all open water impa cts 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)
O1 P T
O2 P T
O3 P T
O4 P T
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If pond or lake construction proposed, then complet e the chart below.
5a.
Pond ID
number
5b.
Proposed use or purpose
of pond
5c.
Wetland Impacts (acres)
5d.
Stream Impacts (feet)
5e.
Upland
(acres)
Flooded Filled Excavated Flooded Filled Excavated Flooded
P1
P2
5f. Total
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 indivi dually list all buffer impacts
below. If any impacts require mitigation, then you MUST fill out Section D of this form.
6a .
Project is in which protected basin?
Neuse Tar8Pamlico Other:
Catawba Randleman
6b.
Buffer impact
number –
Permanent (P) or
Temporary (T)
6c.
Reason
for
impact
6d.
Stream name
6e.
Buffer
mitigation
required?
6f.
Zone 1 impact
(square feet)
6g.
Zone 2 impact
(square feet)
B1 P T Yes
No
B2 P T Yes
No
B3 P T Yes
No
6h. Total buffer impacts
6i. Comments:
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PCN Form – Version 1.3 December 10, 2008 Version
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid o r minimize the proposed impacts in designing projec t.
The crossing of Little Meadow Creek will essentiall y remain in the same location within the existing S R 2623 R/W in order to
reduce the need for additional roadway fill and to avoid additional impacts to Little Meadow Creek. Th e placement of the
double, reinforced concrete box culvert from either of the stream embankments will eliminate the need for heavy equipment to
enter jurisdictional waters of the U.S. and will al low demolition of the existing structure with minim al temporary impacts to the
stream channel. The road will be closed during cons truction and work will be performed from the existi ng roadway
approaches..
1b. Specifically describe measures taken to avoid o r minimize the proposed impacts through constructio n techniques.
Construction of the culvert will take place from ro adway approches which will minimize stream impact. All work in or adjacent
to stream waters shall be conducted so that the flo wing stream does not come into contact with the dis turbed area. A
temporary diversion ditch shall be used to convey t he stream around the work site during construction activities. All necessary
measures shall be taken to prevent direct contact b etween uncured or curing concrete and waters of the state. Deck drains
shall not discharge directly into the stream. Matti ng that incorporates plastic mesh and/or plastic tw ine shall not be used in the
stream or floodplains. No temporary fills or access roads will be used. .
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigatio n for
impacts to Waters of the U.S. or Waters of the Stat e?
Yes No
2b. If yes, mitigation is required by (check all that apply): DWQ Corps
2c. If yes, which mitigation option will be used fo r this
project?
Mitigation bank
Payment to in8lieu fee program
Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter) T ype Quantity
3c. Comments:
4. Complete if Making a Payment to In5lieu Fee Prog ram
4a. Approval letter from in8lieu fee program is att ached. Yes
4b. Stream mitigation requested: linear feet
4c. If using stream mitigation, stream temperature: warm cool cold
4d. Buffer mitigation requested (DWQ only): s quare feet
4e. Riparian wetland mitigation requested: ac res
4f. Non8riparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requested: acres
4h. Comments:
5. Complete if Using a Permittee Responsible Mitiga tion Plan
5a. If using a permittee responsible mitigation pla n, provide a description of the proposed mitigation plan.
Debris will be removed from in and around the strea m during construction activities.
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PCN Form – Version 1.3 December 10, 2008 Version
6. Buffer Mitigation (State Regulated Riparian Buff er Rules) – required by DWQ
6a. Will the project result in an impact within a p rotected 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.
Zone
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 pr ivate mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in8lieu fee fund).
6h. Comments:
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PCN Form – Version 1.3 December 10, 2008 Version
E. Stormwater Management and Diffuse Flow Plan (re quired by DWQ)
1. Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buf fers identified
within one of the NC Riparian Buffer Protection Rul es? Yes No
1b. If yes, then is a diffuse flow plan included? I f no, explain why.
Comments:
Yes No
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of t his project? Minor deviations to original
impervious %
2b. Does this project require a Stormwater Managem ent Plan? Yes No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: The bridge upgrade an d replacement
process is considered a 're8development' procedure. For this consideration, the project does not requi re a state
stormwater permit. BMP's and runoff controls will b e implemented during construction to reduce the sto rmwater impacts
to the receiving stream due to erosion and runoff. Sediment and erosion control will adhere to "Design for Sensitive
Watershed" standards.
2d. If this project DOES require a Stormwater Mana gement Plan, then provide a brief, narrative descri ption of the plan:
2e. Who will be responsible for the review of the Stormwater Management Plan?
Certified Local Government
DWQ Stormwater Program
DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local government’s jurisdiction is th is project?
3b. Which of the following locally8implemented stor mwater management programs
apply (check all that apply):
Phase II
NSW
USMP
Water Supply Watershed
Other:
3c. Has the approved Stormwater Management Plan wit h proof of approval been
attached?
Yes No
4. DWQ Stormwater Program Review
4a. Which of the following state8implemented storm water management programs apply
(check all that apply):
Coastal counties
HQW
ORW
Session Law 20068246
Other:
4b. Has the approved Stormwater Management Plan wit h proof of approval been
attached? Yes No
5. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the ap propriate requirements? Yes No
Page 11 of 13
PCN Form – Version 1.3 December 10, 2008 Version
5b. Have all of the 401 Unit submittal requirements been met? Yes No
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1a. Does the project involve an expenditure of publ ic (federal/state/local) funds or the
use of public (federal/state) land? Yes No
1b. If you answered “yes” to the above, does the pr oject require preparation of an
environmental document pursuant to the requirements of the National or State
(North Carolina) Environmental Policy Act (NEPA/SEP A)?
Yes No
1c. If you answered “yes” to the above, has the doc ument review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
letter.)
Comments:
Yes No
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 Wate r or Wetland Standards,
or Riparian Buffer Rules (15A NCAC 2B .0200)?
Yes No
2b. Is this an after8the8fact permit application? Yes No
2c. If you answered “yes” to one or both of the ab ove questions, provide an explanation of the violat ion(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in
additional development, which could impact nearby d ownstream water quality? Yes No
3b. If you answered “yes” to the above, submit a qu alitative or quantitative cumulative impact analysi s in accordance with the
most recent DWQ policy. If you answered “no,” provi de a short narrative description.
Project involves the replacement of an existing str ucture.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods a nd disposition (non8discharge or discharge) of wast ewater generated from
the proposed project, or available capacity of the subject facility.
NA
Page 12 of 13
PCN Form – Version 1.3 December 10, 2008 Version
5. Endangered Species and Designated Critical Habit at (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or
habitat? Yes No
5b. Have you checked with the USFWS concerning Enda ngered Species Act
impacts? Yes No
5c. If yes, indicate the USFWS Field Office you hav e contacted.
Raleigh
Asheville
5d. What data sources did you use to determine whet her your site would impact Endangered Species or De signated Critical
Habitat?
Cabarrus County is not a listed county with Designa ted Critical Habitat. Endangered species informatio n was obtained
from the NCNHP and USFWS websites.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area desi gnated as essential fish habitat? Yes No
6b. What data sources did you use to determine whet her your site would impact Essential Fish Habitat?
Marla Chambers with the NCWRC, was present during i nitial scoping meetings for confirmation. NOAA webs ite.
7. Historic or Prehistoric Cultural Resources (Corp s Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or c ultural preservation
status (e.g., National Historic Trust designation o r properties significant in
North Carolina history and archaeology)?
Yes No
7b. What data sources did you use to determine whet her your site would impact historic or archeologica l resources?
Please see NCDOT letter of 'No Survey Required' and "No Prehistoric or Historic Properties Present/Aff ected" Forms,
Attachment D.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA8designated 10 08year floodplain? Yes No
8b. If yes, explain how project meets FEMA requirem ents: Hydraulic calculations have been prepared bas ed on the
placement of the new double, reinforced concrete bo x culvert. No increase in the upstream flood elevat ions is anticipated
based on these calculations. Based on the results o f the HEC8RAS model for SR 2623 over Little Meadow Creek, the
existing bridge can be replaced with a double, rein forced concrete box culvert without causing a rise to the established
1008year flood elevations and meets the requirement s of Federal Highway Administration, Federal8Aid Po licy Guide, 23
CFR 650A, “Location and Hydraulic Design of Encroac hments on Floodplains,” and the Memorandum of Agree ment
between the NCDOT and the North Carolina Floodplain Mapping Program.
8c. What source(s) did you use to make the floodpla in determination? FEMA on8line FIRM maps
Larry Thompson, PWS
Applicant/Agent's Printed Name
_______________________________
Applicant/Agent's Signature
(Agent's signature is valid only if an authorizatio n letter from the applicant
is provided.)
Date
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PCN Form – Version 1.3 December 10, 2008 Version