20221561 Ver 1_ePCN Application_20221107

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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:
4/22/2022
BIMS # Assigned*
20221561
Is a payment required for this project?
No payment required
Fee received
Fee needed - send electronic notification
Select Project Reviewer*
Amy Chapman:eads\aschapman
Information for Initial Review
1a. Name of project:
17BP.12.R.64
1a. Who is the Primary Contact?*
M. Caleb BrabbleRose
1 b. Primary Contact Email: *
[e-mail]
Date Submitted
11 /7/2022
Nearest Body of Water
Gilliam Creek
Basin
Broad
Water Classification
C
Site Coordinates
Latitude: Longitude:
35.34822-81.38836
A. Processing Information
County (or Counties) where the project is located:
Gaston
Is this a NCDMS Project
Yes No
Is this project a public transportation project?*
Yes No
Version#*
1
Reviewing Office*
Mooresville Regional Office - [phone]
1c. Primary Contact Phone:*
[phone]
Is this a NCDOT Project?*
Yes No

(NCDOT only) T.I.P. or state project number:
WBS # (1)
17BP.12.R.64
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
1 b. What type(s) of permit(s) do you wish to seek authorization?
Nationwide Permit (N W P)
Regional General Permit (RGP)
Standard (IP)
1c. Has the NWP or GP number been verified by the Corps?
Yes No
Regional General Permit (RGP) Number:
RGP Numbers (for multiple RGPS):
1d. Type(s) of approval sought from the DWR:
401 Water Quality Certification - Regular
Non-404 Jurisdictional General Permit
Individual 401 Water Quality Certification
201902350 - Work associated with bridge construction, widening, replacement, and
interchanges
le. Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification:
For the record only for Corps Permit:
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
1 h. 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)
le. Is there an Agent/Consultant for this project?"
Yes No
2. Owner Information
2a. Name(s) on recorded deed:
NCDOT
2b. Deed book and page no.:
2c. Contact Person:
401 Water Quality Certification - Express
Riparian Buffer Authorization
Yes No
Yes No

2d.Address
Street Address
P O Box 47
Address Line 2
City
Shelby
Postal / Zip Code
28151-0047
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
3a. Name:
M. Caleb BrabbleRose
3b. Business Name:
3c. Address
Street Address
2312 Kings Road Ext
Address Line 2
City
Shelby
Postal / Zip Code
28152
3d. Telephone Number:
(980)5524219
3f. Email Address:*
[e-mail]
C. Project Information and Prior Project History
State / Province / Region
NC
Country
USA
2f. Fax Number:
State / Province / Region
NC
Country
US
3e. Fax Number
1. Project Information
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality / town:
Cherryville
2. Project Identification
2a. Property Identification Number: 2b. Property size:
2c. Project Address
Street Address
Address Line 2
City State / Province / Region
Postal / Zip Code Country
3. Surface Waters
3a. Name of the nearest body of water to proposed project:
Gilliam Creek
3b. Water Resources Classification of nearest receiving water:*
C
3c. What river basin(s) is your project located in?*
Broad
3d. Please provide the 12-digit HUC in which the project is located.
030501050803
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:*
Existing Conditions: 2-lane rural transportation facility crossing waterbody.
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:
0
4g. List the total estimated linear feet of all existing streams on the property:
100
4h. Explain the purpose of the proposed project:
Replace obsolete Gaston County Bridge No. 350354 on SR 1422 over Gilliam Creek.
41. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:
Bridge No. 350354 is 76 feet long. The replacement structure will be a bridge approximately 90 feet long providing a minimum 27 feet — 10 inch clear deck width. The bridge will include
two 10-foot lanes and 3-foot 11 inch offsets. The bridge length is based on preliminary design information and is set by hydraulic requirements. The roadway grade will be raised slightly to
provide sufficient hydraulic opening. Standard road and bridge building equipment such as trucks, dozers, and cranes will be used.
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): Caleb BrabbleRose and Jeff Wyatt
Agency/Consultant Company: NCDOT Division 12
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?
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
3. Stream Impacts
S1
3a. Reason for impact (?)
Class II RipRap
P
3b.lmpact type*
Permanent
3c. Type of impact* �ff.name*
Bank Stabilization �F�,
��3e.
Gilliam Creek
Stream Type*
(?)
Perennial
3f. Type of
Jurisdiction*
Both
3g. S. width
20
Average (feet)
3h. I11 mpact
length*
72
(linear feet)
gy
Cofferdams
Temporary
Dewatering
UT to Gilliam Creek
Perennial
Both
20
Average (feet)
100
(linear feet)
31. Total jurisdictional ditch impact in square feet:
0
31. Total permanent stream impacts:
72
31. Total stream and ditch impacts:
172
31. Total temporary stream impacts:
100

3j. Comments:
Note: Permanent impacts are within the temporary impacts.
E. Impact Justification and Mitigation
1. Avoidance and Minimization
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
The runoff from 2GI will be dissipated by the Class B riprap pad at the pipe outlet. Provided Class II keyed in riprap for sloping abutment scour
protection. Also Class II riprap stream bank stabilization under the bridge. No piers in the stream. Project site contains no buffer or wetlands, impacts to
stream are minimized. The stream receives minimal concentrated runoff. Class B riprap pad at the outlet of TB 2GI.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
The stream will be diverted so that the work area will be isolated from the normal flow of the stream. Equipment will be kept from entering the stream
channel and appropriate erosion and sediment controls will be maintained. All other NCDOT Best Management Practices will be utilized to 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 impacts to Waters of the U.S. or Waters of the State?
Yes No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
Impacts due to bank stabilization are not subject to Compensatory Mitigation requirements.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
la. 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:
This project is not part of the Catawba River Basin or any other protected buffers.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?
Yes No
Comments:
G. Supplementary Information
1. Environmental Documentation
1a. 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 (North Carolina)
Environmental Policy Act (NEPA/SEPA)?*
Yes No
Comments: *
Project qualifies as a minimum impact project, an MCDC is attached.
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.
Due to the minimal transportation impact resulting from this bridge replacement, this project will not stimulate growth, but may influence nearby land use.
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
5e. Is this a DOT project located within Division's 1-8?
Yes No
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?
Yes No
5g. Does this project involve bridge maintenance or removal?
Yes No
5g(1). If yes, have you inspected the bridge for signs of bat use such as staining, guano, bats, etc.?
Yes No
If you answered "Yes" to 5g(1), did you discover any signs of bat use?
Yes No Unknown
5h. Does this project involve the construction/installation of a wind turbine(s)?*
Yes No
Unknown
5i. Does this project involve (1) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhammers, mechanized pile drivers, etc.?
Yes No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
USFWS Information for Planning and Consultation (IPaC).
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?
USFWS Information for Planning and Consultation (IPaC) and a review of online mapping sources.
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?*
Included Archaeology form/letter, and historic properties and landscapes form/letter
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?*
North Carolina Floodplain Mapping Program
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
17BP_12_R_64_NRTR.pdf
102.43KB
Carol Rd Soil Report.pdf
819.27KB
Carol Road CoverLeHer.pdf
85.71 KB
Carol RoaclPermitDrawings.pdf
1.51 MB
Figurel .pdf
1.53MB
Figure2.pdf
1.3MB
Figure3.pdf
1.78MB
Flood Risk Map.pdf
347.08KB
Gaston 354 17BP.12.R.64 State Minimum Criteria Final.pdf
1.52MB
Land No Sury CAROL RD.pdf
1.23MB
NCDOT_BSG_Bat_Habitat_Bridges_17bpl2r64.pdf
137.46KB
No Arch Req Carol Rd.pdf
542.19KB
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:
M. Caleb BrabbleRose
Signature
'm Caleh 5-abhlefwe
Date
1 v7/2022