20220953 Ver 1_ePCN Application_20220714

DWR
Division of Water Resources
Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
April 13,2022 Ver 4.3
Initial Review
Has this project met the requirements for acceptance in to the review process?*
Yes
No
Is this project a public transportation project?*
Yes No
Change only if needed.
Pre-Filing Meeting Date Request was submitted on:
4/16/2022
BIMS#Assigned* Version#*
20220953 1
Is a payment required for this project?*
No payment required
Fee received Reviewing Office*
Fee needed-send electronic notification Central Office-[phone]
Select Project Reviewer*
Ryan Conchilla:eads\rjconchilla
Information for Initial Review
1a.Name of project:
Richmond County Bridge 140
1a.Who is the Primary Contact?*
Art C.King
1 b.Primary Contact Email:* lc.Primary Contact Phone:*
[e-mail] [phone]
Date Submitted
7/14/2022
Nearest Body of Water
Solomons Creek
Basin
Yadkin-PeeDee
Water Classification
Class:C
Site Coordinates
Latitude: Longitude:
34.884230 -79.805031
A. Processing Information
County(or Counties)where the project is located:
Richmond
Is this a NCDMS Project
Yes No
Is this project a public transportation project?*
Yes No
Is this a NCDOT Project?*
Yes No

(NCDOT only)T.I.P.or state project number:
BP8.R013
WBS#(H)
BP8.R013
1a.Type(s)of approval sought from the Corps:
Section 404 Permit(wetlands,streams and waters,Clean Water Act)
Section 10 Permit(navigable waters,tidal waters,Rivers and Harbors Act)
Has this PCN previously been submitted?*
Yes
No
lb.What type(s)of permit(s)do you wish to seek authorization?
Nationwide Permit(NWP)
Regional General Permit(RGP)
Standard(IP)
1c.Has the NWP or GP number been verified by the Corps?
Yes No
Nationwide Permit(NWP)Number: 03-Maintenance
NWP Numbers(for multiple NWPS):
13-Bank Stabilization
Id.Type(s)of approval sought from the DWR:
401 Water Quality Certification-Regular 401 Water Quality Certification-Express
Non-404 Jurisdictional General Permit Riparian Buffer Authorization
Individual 401 Water Quality Certification
le.Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification: Yes No
For the record only for Corps Permit: Yes No
1f.Is this an after-the-fact permit application?*
Yes No
1g.Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
Yes No
1g.Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
Yes No
lh.Is the project located in any of NC's twenty coastal counties?
Yes No
1j.Is the project located in a designated trout watershed?
Yes No
B. Applicant Information
1d.Who is applying for the permit?
Owner Applicant(other than owner)
1e.Is there an Agent/Consultant for this project?*
Yes No
2.Owner Information
2a.Name(s)on recorded deed:
NCDOT Highway Division 8
2b.Deed book and page no.:
2c.Contact Person:
Art C.King

2d.Address
Street Address
121 DOT Drive
Address Line 2
City State/Province/Region
Carthage NC
Postal/Zip Code Country
28327 Moore
2e.Telephone Number: 2f.Fax Number:
[phone] [phone]
2g.Email Address:*
[e-mail]
3.Applicant Information(if different from owner)
3a.Name:
NCDOT
3b.Business Name:
NCDOT
3c.Address
Street Address
121 DOT Dr.
Address Line 2
City State/Province/Region
Carthage NC
Postal/Zip Code Country
28327 Moore
3d.Telephone Number: 3e.Fax Number:
[phone]
3f.Email Address:*
[e-mail]
C. Project Information and Prior Project History
1.Project Information
1b.Subdivision name:
(if appropriate)
lc.Nearest municipality/town:
Rockingham
2.Project Identification
2a.Property Identification Number: 2b.Property size:
1.5 ac
2c.Project Address
Street Address
Sandhi!!Rd.
Address Line 2
City State/Province/Region
Rockingham NC
Postal/Zip Code Country
3. Surface Waters
3a.Name of the nearest body of water to proposed project:*
Solomons Creek
3b.Water Resources Classification of nearest receiving water:*
Class:C
3c. What river basin(s)is your project located in?*
Yadkin-PeeDee

3d.Please provide the 12-digit HUC in which the project is located.
030402010302
4. Project Description and History
4a.Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this application:*
Replacing a deficient,outdated bridge with a new modern structure.
Rural,agricultural,residential,roadway.
4b.Have Corps permits or DWR certifications been obtained for this project(including all prior phases)in the past?*
Yes No Unknown
4f.List the total estimated acreage of all existing wetlands on the property:
lac.
4g.List the total estimated linear feet of all existing streams on the property:
200 ft
4h.Explain the purpose of the proposed project:*
Replacement of a deficient,outdated bridge with a safe modern structure.
4i.Describe the overall project in detail,including indirect impacts and the type of equipment to be used:*
Remove the existing bride and replace in place with a new structure.
Anticipated equipment used:Track Hoe,Dump Truck,Crane,Motor Grader,Compactor,Paving Equipment.
5.Jurisdictional Determinations
5a.Have the wetlands or streams been delineated on the property or proposed impact areas?*
Yes No Unknown
Comments:
5b.If the Corps made a jurisdictional determination,what type of determination was made?*
Preliminary Approved Not Verified Unknown N/A
Corps AID Number:
5c.If 5a is yes,who delineated the jurisdictional areas?
Name(if known): W.Sullivan
Agency/Consultant Company: Kimley-Horn
Other:
6.Future Project Plans
6a.Is this a phased project?*
Yes No
Are any other NWP(s),regional general permit(s),or individual permits(s)used,or intended to be used,to authorize any part of the proposed project or related activity?
No
D. Proposed Impacts Inventory
1. Impacts Summary
1a.Where are the impacts associated with your project?(check all that apply):
Wetlands Streams-tributaries Buffers
Open Waters Pond Construction
2.Wetland Impacts
2a.Site#*(?) 2a1 Reason(?) 2b.Impact type*(?) 2c.Type of W.* 2d.W.name 2e.Forested* 2f.Type of Jurisdicition*2g.Impact
(?) area*
1 construction P Bottomland Hardwood Forest Solomons Crk. Yes Both 0.070
(acres)
1 Mech.clearing P Bottomland Hardwood Forest Solomons Crk. Yes Both 0.110
(acres)
2 Hand clearing T Bottomland Hardwood Forest Solomons Crk. Yes Both 0.140
(acres)

2g.Total Temporary Wetland Impact 2g.Total Permanent Wetland Impact
0.140 0.180
2g.Total Wetland Impact
0.320
2i.Comments:
3.Stream Impacts
3a.Reason for impact(?) 3b.Impact type* 3c.Type of impact* 3d.S.name* 3e.Stream Type* 3f.Type of 3g.S.width 3h.Impact
(?) Jurisdiction* length*
S1 construction Permanent Stabilization Solomons Crk. Perennial Both 25 15
Average(feet) (linear feet)
S2 construction/dewatering Temporary Dewatering Solomon Crk. Perennial Both 25 15
Average(feet) (linear feet)
3i.Total jurisdictional ditch impact in square feet:
0
3i.Total permanent stream impacts: 3i.Total temporary stream impacts:
15 15
3i.Total stream and ditch impacts:
30
3j.Comments:
E. Impact Justification and Mitigation
1.Avoidance and Minimization
1a.Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
Minimum wetland and stream disturbance to effectively construct the new bridge structure and,provide safe roadway and approaches.
lb.Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Current NCDOT Best Management Practices will be utilized during all phases of 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
2c.If yes,mitigation is required by(check all that apply):
DWR Corps
2d.If yes,which mitigation option(s)will be used for this project?
Mitigation bank Payment to in-lieu fee program Permittee Responsible Mitigation
4. Complete if Making a Payment to In-lieu Fee Program
4a.Approval letter from in-lieu fee program is attached.
Yes No
4b.Stream mitigation requested:
(linear feet) 4c.If using stream mitigation,what is the stream temperature:
15 warm
4d.Buffer mitigation requested(DWR only): 4e.Riparian wetland mitigation requested:
(square feet) (acres)
NA 0.18
4f.Non-riparian wetland mitigation requested: 4g.Coastal(tidal)wetland mitigation requested:
(acres) (acres)
NA NA
4h.Comments
6. Buffer mitigation (State Regulated Riparian Buffer Rules)- required by DWR

6a.Will the project result in an impact within a protected riparian buffer that requires buffer mitigation?If yes,you must fill out this entire form-please contact DWR for more information.
Yes No
F. Stormwater Management and Diffuse Flow Plan (required by DWR) u
1. Diffuse Flow Plan
1a.Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
Yes No
If no,explain why:
Yadkin Pee Dee River basin
2. Stormwater Management Plan
2a.Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
Yes No
Comments:
Stormwater management plan attached to the included permit drawings.
G. Supplementary Information
1. Environmental Documentation
la.Does the project involve an expenditure of public(federal/state/local)funds or the use of public(federal/state)land?*
Yes No
lb.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(North Carolina)
Environmental Policy Act(NEPA/SEPA)?*
Yes No
1c.If you answered"yes"to the above,has the document review been finalized by the State Clearing House?*
Yes No
Comments:*
State Minimum Criteria Checklist
2.Violations (DWR Requirement)
2a.Is the site in violation of DWR Water Quality Certification Rules(15A NCAC 2H.0500),Isolated Wetland Rules(15A NCAC 2H.1300),or DWR Surface Water or Wetland Standards or
Riparian Buffer Rules(15A NCAC 2B.0200)?*
Yes No
3. Cumulative Impacts (DWR Requirement)
3a.Will this project result in additional development,which could impact nearby downstream water quality?*
Yes No
3b.If you answered"no,"provide a short narrative description.
The new structure is a minor deviation from the existing structure and is not anticipated to change the roadway usage.
4. Sewage Disposal (DWR Requirement)
4a.Is sewage disposal required by DWR for this project?*
Yes No N/A
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
5d.Is another Federal agency involved?*
Yes No Unknown
5e.Is this a DOT project located within Division's 1-8?
Yes No

5j.What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
USF&W website
Onsite survey by NCDOT environmental staff.
6. Essential Fish Habitat(Corps Requirement)
6a.Will this project occur in or near an area designated as an Essential Fish Habitat?*
Yes No
6b.What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
USF&W website
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?*
Yes No
7b.What data sources did you use to determine whether your site would impact historic or archeological resources?*
NCDOT Cultural Resources staff review
SHPO screening
8. Flood Zone Designation (Corps Requirement)
8a.Will this project occur in a FEMA-designated 100-year floodplain?*
Yes No
8c.What source(s)did you use to make the floodplain determination?*
FEMA Flood Map Service
Miscellaneous
Please use the space below to attach all required documentation or any additional information you feel is helpful for application review.Documents should be combined into one file when
possible,with a Cover Letter,Table of Contents,and a Cover Sheet for each Section preferred.
Click the upload button or drag and drop files here to attach document
WA-WB-UP.pdf 244.16KB
WA-W B-W ET.pdf 253.45KB
WD-UP.pdf 30.13KB
WD-WET.pdf 110.45KB
21-06-0007_NoSurvey.pdf 5.69MB
ILF Accept_SR 1971_Bridge 140_Div 8.pdf 278.51KB
PA 21-06-0007 Richmond(NSR).pdf 9.46MB
Richmond 140 NRTR final.pdf 4.04MB
StreamForm_SC.pdf 20.52KB
BP8.R013_Permit Drawings_(2022-04-28).pdf 2.81MB
File must be PDF or KMZ
Comments
Signature
By checking the box and signing below,I certify that:
• The project proponent hereby certifies that all information contained herein is true,accurate,and complete to the best of my knowledge and belief';and
• The project proponent hereby requests that the certifying authority review and take action on this CWA 401 certification request within the applicable reasonable period of time.
• I have given true,accurate,and complete information on this form;
• I agree that submission of this PCN form is a"transaction"subject to Chapter 66,Article 40 of the NC General Statutes(the"Uniform Electronic Transactions Act");
• I agree to conduct this transaction by electronic means pursuant to Chapter 66,Article 40 of the NC General Statutes(the"Uniform Electronic Transactions Act");
• I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature;AND
• I intend to electronically sign and submit the PCN form.
Full Name:
Art C.King
Signature
Date
7/14/2022