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20140341
Office Use Only:
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
1 b. Specify Nationwide Permit (NWP) number: 3 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps?
® Yes
❑ 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
J
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.
®Ye s
❑ No
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
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 #29
2b. County:
Randolph
2c. Nearest municipality / town:
Lassiter Mill
2d. Subdivision name:
2e. NCDOT only, T.I.P. or state
project no:
17BP•8.R.57
3. Owner Information
3a. Name(s) on Recorded Deed:
NA
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)
4a. Applicant is:
❑ Agent ® Other, specify: Division Engineer
4b. Name:
Robert W. Stone II, PE
4c. Business name
(if applicable):
NCDOT Highway Division 8
4d. Street address:
902 North Sandhill Blvd
4e. City, state, zip:
Aberdeen NC 28315
4f. Telephone no.:
910 - 944 -2344
4g. Fax no.:
910 - 944 -5623
4h. Email address:
robstone @ncdot.gov
5. Agent/Consultant Information (if applicable)
5a. Name:
Art C.Xing
51J. Business name
(if applicable):
NCDOT Highway Division 8
5c. Street address:
902 North Sandhill Blvd.
5d. City, state, zip:
Aberdeen NC 28315
5e. Telephone no.:
910- 944 -2344
5f. * Fax no.:
910- 944 -5623
5g. Email address:
acking @ncdot.gov `
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: 35.523550
Longitude: - 79.985944
(DD.DDDDDD) (- DD.DDDDDD)
1 c. Property size:
acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
proposed project:
Uwharrie River
2b. Water Quality Classification of nearest receiving water:
B
2c. River basin:
Yadkin- PeeDee
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:
Bridge is a on secondary road in an rural /agricultural area
3b. List the total estimated acreage of all existing wetlands on the property:
NA
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
1 00f
3d. Explain the purpose of the proposed project:
to replace a deficient, outdated bridge with a new updated, safer structure.
3e. Describe the overall project in detail, including the type of equipment to be used:
To replace the existing bridge with a new structure which will completely span the existing channel. Equipment used:
Track Loader, Tire(rubber wheeled) loader, Dump truck , Crane, Backhoe, Shaft Drilling Rig.
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?
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 El Unknown
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project?
❑ Yes ® No
6If 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 —
Permanent (P) or
Type of impact
Type of wetland
(if known)
Forested
(Corps - 404, 10
DWQ
Area of impact
Temporary T
— non -404, other)
(acres)
W1 ❑ P ❑ T
NA
❑ Yes
❑ Corps
❑ No
❑ DWQ
W2 ❑ P ❑ T
❑ 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
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.
Stream impact
Type of impact
Stream name
Perennial
Type of jurisdiction
Average
Impact
number -
Permanent (P) or
(PER) or
intermittent
(Corps - 404, 10
DWQ — non -404,
stream
width
length
(linear
Temporary (T)
(INT)?
other)
(feet)
feet)
S1 ❑ PET
Causeway
Uwharrie River
® PER
❑ INT
® Corps
® DWQ
gift
83ft
S2 ❑ P ❑ T
❑ PER
❑ Corps
1:11 NT
❑ DWQ
S3 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S4 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S5 ❑ PMT
❑ PER
❑ Corps
❑ INT
❑ DWQ
S6 ❑ P ❑ T
❑ PER
❑ Corps
[:11 NT
❑ DWQ
3h. Total stream and tributary impacts
83 ft
3i. Comments: Causeway is needed to access the south bank of the channel to install an interior bent and to set box beams.
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 Name of waterbody
impact number - (if applicable) Type of impact Waterbody type Area of impact (acres)
Permanent (P) or
Temporary T
01 ❑P ❑T NA
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,
5a. I 5b.
Pond ID
number
then complete the chart below.
5c.
Wetland Impacts (acres)
Proposed use or purpose
of pond
5d. 5e.
Stream Impacts (feet) I Upland
Flooded I Filled I Excavated I Flooded I Filled I 'Excavated I Flooded
P1 NA
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 individually 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?
6b. 6c. 6d.
Buffer impact
number- Reason
Permanent (P) or for
Temporary (T) impact
61 ❑P ❑T I NA
62 ❑P ❑T
63 ❑P ❑T
6i. Comments:
❑ Neuse ❑ Tar - Pamlico ❑ Other:
❑ Catawba ❑ Randleman
6e. 6f. 6g.
Buffer
Stream name mitigation
required?
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
6h. Total buffer impacts
Zone 1 impact I Zone 2 impact
(square feet) (square feet)
Page 5 of 10
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 or minimize the proposed impacts in designing project.
Minimum amount of causeway installed to allow access.Pipe and timber mats used to allow normal base flow in the stream.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
see la
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
2b. If yes, mitigation is required by (check all that apply):
❑ DWQ ❑ Corps
2c. If yes, which mitigation option will be used for this
project?
❑ Mitigation bank
❑ 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):
NA square feet
4e. Riparian wetland mitigation requested:
na acres
4f. Non - riparian wetland mitigation requested:
na acres
4g. Coastal (tidal) wetland mitigation requested:
na 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 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
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 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 Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1 a. 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:
Yes No
❑ ❑
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project?
33%
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 11
3b. Which of the following locally - implemented stormwater management programs
❑ NSW
apply (check all that apply):
❑ 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
4a. Which of the following state - implemented stormwater management programs apply
❑ HQW
❑ 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?
0 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
use of public (federal /state) land?
® Yes ❑ No
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
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
additional development, which could impact nearby downstream water quality?
❑ Yes ® No
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.
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
habitat?
® Yes ❑ No
5b. Have you checked with the USFWS concerning Endangered Species Act
impacts?
❑ Yes ® No
5c. If yes, indicate the USFWS Field Office you have contacted.
❑ Raleigh
❑ Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
On site survey by NCDOT staff, SDV natural heritage data (esri) review
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?
SDV natural heritage data (esri)
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 (e.g., National Historic Trust designation or properties significant in
El Yes 19 No
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
NCDOT staff and SHPO review
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?
Applicant/Ajenfs Printed Name
Applicant/Ag�nt's Sigjnature
(Agent's signature is valid only if an aut4ofiza ion letter from the applicant
Date
is rovided.)
Page 10 of 10
PCN Form — Version 1.3 December 10, 2008 Version

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HEC -RAS Output of Average Flow with Proposed Causeway culverts near the Existing Bridge
Bridge B750029 Division 8 Bridges
Reach
River Sta
Profile
W.S. Elev
(ft)
Reach -1
110828
Avg.
Flow
358.75
Reach -1
110000
Avg.
Flow
358.54
Reach -1
109004
Avg.
Flow
358.28
Reach -1
107850
Avg.
Flow
357.9
Reach -1
106751
Avg.
Flow
357.4
Reach -1
106044
Avg.
Flow
356.76
Reach -1
105171
Avg.
Flow
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Reach -1
104078
Avg.
Flow
355.37
Reach -1
103203
Avg.
Flow
355.25
Reach -1
102263
Avg. Flow
355.14
Reach
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101158
Avg.
Flow
355.03
Reach
-1
99760
Avg.
Flow
354.85
Reach
-1
98639
Avg.
Flow
354.59
Reach
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97718
Avg.
Flow
354.28
Reach
-1
96193
Avg.
Flow
352.51
Reach
-1
95166
Avg.
Flow
352.26
Reach
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94360
Avg.
Flow
352.13
Reach
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94320
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Reach
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Avg.
Flow
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Reach
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93618
Avg.
Flow
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Reach
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92753
Avg.
Flow
348.42
US XS of the Causeway
Causeway Crossing
DS XS of the Causeway

2/17/2014
R:\ Roadway \Proj \8750029- Rdy- tsh.dgn
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Wainwright, David
From: DeCola, Richard <Richard:DeCola @rsandh.com>
Sent: Tuesday, March 11, 2014 1:34 PM
To: Wainwright, David; King, Art C; Sarah.E.Hair @usace.army.mil
Cc: Bollinger, Richard; 'Chris Powers'
Subject: RE: Emailing: 17BP.8.R.57 Bridge 750029
David,
Please see below for responses to your questions. If you have any particular concern or want to discuss this matter any further,
please feel free to contact me.
Thanks,
Rick beCola
Rick DeCola, PE
Roadway Engineer
8601 Six Forks Rd, Suite 260
Raleigh, NC 27615
Phone- 919 - 926 -4104
mailto: Directory. Sender.mail
Visit our website at http : / /Directory.Sender.wWWHomePage
Connect with RS &H on https : / /www.facebook.comMeAreRSandH https:Htwitter.com /wearersandh
http: / /www.linkedin.com /company /rs %26h
- - - -- Original Message - - - --
From: King, Art C [mailto:acking @ncdot.gov]
Sent: Thursday, March 06, 2014 3:16 PM
To: DeCola, Richard
Subject: FW: Emailing: 17BP.8.R.57 Bridge 750029
FYI
- - - -- Original Message---- -
From: Wainwright, David
Sent: Thursday, March 06, 2014 2:53 PM
To: King, Art C; Hair, Sarah E SAW (Sarah.E.Hair @usace.army.mil)
Subject: RE: Emailing: 17BP.8.R.57 Bridge 750029
Art,
I have looked over the plans and information you sent for this project. I have a few questions:
- How long will the causeway need to be in place?
The ICT for this project is 180 days and the causeway will be in place for the majority of this time, approximately 5
months. This is due to the need for the causeway in removal of existing bents, drilling and construction of the proposed
bent and setting of the box beams.

- The causeway appears to be blocking the whole river, correct?
• This is correct. Due to the steep river banks, using this causeway is the only way to access the south side for
construction. While we acknowledge that placing the causeway throughout the entire -width of the river is not optimal, this
was the only solution in order to replace the deficient structure. During the design process, there were discussions at
length with Division 8 without a viable alternative to this causeway.
- How confident are you that 4 @48" will be ample to handle higher flows in the river?
The scenario shown on the permit drawings was modeled in HEC -RAS under the normal high water condition. The spillway
area was provided to assist with higher flows.
- I notice there is a spillway incorporated into the causeway, which dips about 2.5' below the actual work pad. Is the purpose of the
spillway to allow water to flow over it when the water level rises? If so, will this not potentially trap equipment on the work pad?
As stated above, the purpose of the spillway is to assist with higher flows. The contractor is aware of the risk in using a
causeway for construction, and will remove equipment from the causeway as it becomes necessary.
- How will the rock placed for the causeway be kept from being carried away during higher flow events? How would this be cleaned
up if rock does move from the causeway and off the fabric?
• There is no guarantee that rock will not be carried away during higher flow events, as that is an inherent risk with using
causeways. The contractor will make every effort to clean up any rock that is displaced. It should be noted that this
channel is currently full of rock and there are several rock dams just downstream of the bridge site.
Thanks,
David
- - - -- Original Message---- -
From: King, Art C
Sent: Tuesday, March 04, 2014 9:08 AM
To: Hair, Sarah E SAW ([e-mail]); Wainwright, David
Subject: FW: Emailing: 17BP.8.R.57 Bridge 750029 Permit Review 02- 24- 2014.zip, DWQ contacts _110612.pdf
Importance: High
Liz, David,
The attached zip file contains information related to project 17BP.8.R.57 , Bridge #29 in Randolph County.
This is a discussion I had started with Ronnie Smith several months ago about the need to install a large causeway on this project to
gain access to one side of the stream. Liz; Ronnie should have some information and pictures that I sent to him on file.
There is a high, sheer rock face at the south end bent that makes accessed from that side by equipment nearly impossible, without a
drastic removal of the rock, which would no doubt include extensive blasting. Due to the structure and size of the existing bridge it is
necessary to use heavy equipment to both remove the existing bents, and to drill and install the end bent and center bent for the
new bridge. Ronnie had tentatively agreed to this approach but was waiting to see the structure design, the causeway design, and
Hec -Ras data that is included in the zip file.

This causeway is needed in order for us to replace the existing structure, and to bring the bridge up to current safety standards. The
material used to construct the causeway will be placed on fabric and removed completely at the end of the project. We would like
to construct this bridge replacement under NWP #3.
Please let me know if you have difficulty with the zip file.
Thanks,
Art King
Subject: Emailing: 17BP.8.R.57 Bridge 750029 Permit Review 02- 24- 2014.zip, DWQ contacts _110612.pdf
17BP.8.R.57 Bridge 750029 Permit Review 02- 24- 2014.zip DWQ contacts _110612.pdf
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