20151208 Ver 1_Application_20151117

,....
Transportation
US Army Corps of Engineers
Raleigh Regulatory Field Office
Attn: Mr. David Bailey
3331 Heritage Trade Dr., Ste. 105
W ake Forest, NC 27587
PAT McCRORY
Gavernor
NICHOLASJ.TENNYSON
Seo'efary
November17,2015
NC Division of Water Resources
Winston-Salem Regional Office
Attn: Mr. Dave Wanucha
450 W. Hanes Mill Rd, Ste. 103
Winston-Salem, NC 27105
Subject: Nationwide 14 Permi[ and Neuse River Basin Buffer Application for the
Replacement of Bridge No. 60 on SR 1002 (Saint Marys Road) over UT to Buckwater Creek.
Orange County, North Carolina, WBS Element No. 17BP9.R.63
Dear Mr. Bailey and Mr. Wanucha:
The North Carolina Department of Transportation (NCDOT) is proposing to replace a functionally obsolete
19.2Y x 12" single span timber deck bridge with a new 1T x S.Y bottomless culvert with a concrete
footing keyed into bedrock. An off-site detour will be used to convey traffic during construction. The
project will also include some minor approach wodc on the existing roadway.
Please Fuid enclosed a PCN application, Stonnwater Mavagement Plan, Culvert Survey Report, pernut
drawuigs, buffer drawings, a USGS quad map, SHPO Concurrence Foims, and photographs.
The North Carolina Natural Heritage Database was checked for records of tlueatened and endangered
species. The database lists four species for Orange County that have federal status. Bald eagle (Haliaeetus
lee�cocephalus) is protected in every counry in North Carolina under the Bald and Golden Eagle Protection
Act. Dwarf wedgemussel (Alasmido�7ta hekerodon), Michaux's sumac (Rhus michauzii), and smooth
coneflower (Echinacea lnerignta) are listed as endangered.
Habitat for bald eagle prunarily consists of mature forest in proxinuty to large bodies of open water for
foraging. Large dominant trees are utilized for nesting sites, typically within 1.0 nule of open water. A
desktop-GIS assessment of the project study area, as well as the area within a 1.13-mile radius (1.0 mile
plus 660 feet) of the project limits, was performed on September 1, 2015 using 2010 color aerials. No
water bodies large enough or sufficiently open to be considered potentia] feeding sources were identified.
Since there was no foraging habitat within the review area, a survey of the project study area and tlie area
within 660 feet of the project limits was �ot conducted. Additionally, a review of the NCNHP database on
September 1, 2015 revealed no known occmrences of this species within 1.0 mile of the project study area.
The closest known occurrence is approximately 10.2 miles southwest of the project Due to the lack of
habitat, known occuirences, and minimal impac[ anticipated for this projec[, it has been detennined that the
subject project will not affect this species.
Dwarf wedgemussel are small freshwater bivalves found in small streams less than five meters wide to
large rivers more than 100 meters wide. The closest record of dwarf wedgemussel is an historic occunence
in the Eno River approximately 7.1 miles west of the subject bridge. Therefore, the subject project will
have No Effect on tliis species.
Michaux's sumac grows in saudy or rocky open woods in association with basic soils. Severa] populations
in North Carolina are on lughway rights-of-way, roadsides, or on the edges of artificially maintained
clearings. A review of the NCNHP database on September 1, 2015 revealed no known occurrences of tliis
�Nothing Compares�-
StatcofNOrthCamiina I DeparhnentofTransportztian � Divisionof'Highways.Divisian70ffice
1584 Yanceyville Slreei, Greensboro, NC 27405I P. O. Box 14996, Greensboro, NC 27415-499G
336-487-0000

i�.
Transportatlon
PAT McCRORY
co�e��or
NICHOLAS J. TENNYSON
Secreiary
species within I.0 mile of the project study area. The closest known occurrence is approxima[ely 8.0 miles
southwest of the project. Therefore, the subject project will have No Effect on this species.
Smooth coneflower is t}pically found in open woods, glades, cedar barrens, roadsides, clearcuts, dry
limestone bluffs, and power line rights-of-way, usually on magnesium and calcium rich soils. Smooth
coneflower occurs in plant cominunities that have been described as xeric hardpan forests, diabase glades
or dolomite woodlands. Optimal sites are characterized by abundant sunlight and little competition in the
herbaceous layer. Natural fires, as well as large herbivores, historically influenced the vegetatiou in this
species' range. A review of NCNHP database on September I, 2015 revealed no known occurrences of
smooth coneflower within 1.0 mile of the study area. The closest known occurrence is approxima[ely 7.2
miles from the project. Therefore, the subject project will have No Effec[ on this species.
This project was reviewed by NCDOT's Human Environment Unit in 2012 for potential affects to
historical architecture and archaeology. It was determived that no surveys were required for historical
architecture or archaeologicalresources.
The project study area is comprised mostly of maintained/residential land with hardwood forest along the
streain banks. There are no additional jurisdictional features associated with Bridge 60 other than the UT
to Buckwater Creek.
NCDOT best management practices (BMPs) will be used to minimize and contro] sedimentation and
erosion. The cons[ivction foreman will review the BMPs daily to ensure erosion and sedimentation is
being effectively controlled. If the foreman determines the devices are not functioning as intended, they
will be replaced immediately with better devices.
Impacts to Waters of the United States
UT to Buckwater Creek (DWR Class: WS-IV, NSW) is shown on the USGS topographic map as a
pereimial stream. The channel is well defined with a substrate primarily composed of sand, silt, and gravel
and is approximately 13-16 feet in width. From the project site, UT to Buckwater Creek flows 012-mile to
its confluence with Buckwater Creek. Buckwater Creek then flows approximately 3.27-miles to its
confluence with the Eno River. The Eno River meets the defmi[ion of a Traditional Navigable Water. For
these reasons, we believe UT to Buckwater Creek is a Relatively Peimanent Water and is under the
jurisdiction of the U.S. Army Corps of Engineers. In order [o const�uct the project, it will be necessary to
impact waters of the United States in the Neuse River Basin (HiJC 03020201). Specifically, NCDOT is
reques[ing to replace Bridge No. 60 with a reinForced concrete bottomless culvert. The impacts are listed in
the table below:
Jarisdictional Impact Summary
Perm. Temp. Perm. Temp.
E7cisting ��cisting
Station Strncture Size/ Type I pacts I pacts Channel Channel
(ac) ( Ac) Impacts Impacts
��� ���
11+70 to 13+20 —LT- Channel realignment for bottomless
11+75 to 13+25 —RT- culvert, temporary pipe, and impeivious 0.01 0.01 83 100
dikes
�Nothing Compares�-
Slatc of Notlh Carolina � Deparhnent ofTranspurtalion I Divisian of Highways. Division 7 ORce
1584 Yanceyville Sveet, Grecnabom, NC 274051 �'� n� Box 14996, Grcensboro, NC 27415-4996
336-487-0000

S.
Transportation
PAT McCRORY
covemor
NfCHOLAS J.'IENNYSON
Secretpry
Neuse River Buffer Impact Summary
Stafton Type Zone 1(ft�) Zone 2(ft�)
11+75 to 12+50 —LT-
12+75 to 13+25 —LT- Road Fill and Clearing 2,079 941
11+90 to 12+50 —RT-
12+75 to 13+25 —RT-
l 1+g9 to 12+11—LT- Bridge Fill and Cleanng 156 0
11+96to12+18 —RT-
Total 2,235 941
Permits Requested
NCDOT is hereby requesting authorization under Section 404 of the Clean Water Act to proceed with the
constmction project outlined above. We are also requesting a 401 Water Quality Certification and Neuse
River Basin Buffer Authorization from the North Carolina Department of Environment and Natural
Resources (DENR), Division of Water Resources (DWR).
If you l�ave any questions or need additional information, please contact Jerry Parker at [phone] or
inarker(ii:ncdoteoc. Your review and consideration are greatly appreciated.
Sincerely,
�.�i�` —
J.M. ills, PE
Did ion Engineer, Division 7
Enclosures
cc: Tim Powers, NCDOT
Barry Harrington, Roadside Enviromnental Field Operations Engineer
Jeremy Warren, NCDOT
Chuck Edwards, District 1, District Engineer
Travis Wilson, Wildlife Resources Commision (elec[ronic copy)
Gary Jordan, US Fish & Wildlife Service (electronic copy)
File Copy
�Nothing Compares���..
SlaleofNOrthCamlina � Departmen�ofTnnsponation � DivisionofHighways,Division70�ce
1584 Yanceyviile Stree4 Greensboro, NC 27405� P. O. Box 14996, Greensbom, NC 27415-4996
336467-0000

I ' o�oF wA7F9pl Offce Use Only:
, �,�,� i � 9 Corps action ID no.
Ji '
o � DW Q project no.
re-Construction l�loti�cation (P ���n 1.3 Dec 10 2008
A. A licant Information
1. Processing
1 a. 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 Corps? � Yes ❑ No
1d. Type(s) of approval sought from the DWQ (check all that apply):
� 401 Water Quality Certifcation — Regular ❑ Non-404 Jurisdictional General Permit
❑ 401 Water Qualily Certification — Express � Riparian Buffer Authorization
1e. Is this noiification solely for the record For the record only for DWQ 401 For the record only for Corps Permit:
because written approval is not required? Certification:
❑ Yes � No ❑ Yes � No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation � Yes ❑ No
of impacts? If so, attach the acceptance letter from mitigalion bank or in-lieu
fee program.
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h ❑ Yes � No
below.
1h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ❑ Yes � No
2. Peoject Informa4ion
2a. Name of project: Replace Bridge No. 60 on SR 1002 over UT to Buckwater Creek
2b. County: Orange
2c. Nearest municipality / town: Hillsborough
2d. Subdivision name: N/A
2e. NCDOT only, T.I.P. or state 176P.7.R.63
projecl no:
3. Owner Information
3a. Name(s) on Recorded Deed: NoRh Carolina Department of Transportation
3b. Deed Book and Page No. N/A
3c. Responsible Party (for LLC if Division Engineer NC DOT Division 7, Mr. Mike Mills, PE
applicable):
3d. Street address: PO Box 14996
3e. City, state, zip: Greensboro, NC 27415
3f. Telephone no.: [phone]
3g. Fax no.: (336) 3343637
3h. Email address: [e-mail]
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PCN Form — Version 1.3 December 10, 2008 Version

4. Applicant Information (if different from owner)
4a. Applicant is: ❑ Agent � Other, specify: NC DOT Highway Division 7
4b. Name: Division Engineer NC DOT Division 7, Mr. Mike Mills, PE
4c. Business name NC DOT
(if applicable):
4d. Street address: PO Box 14996
4e. City, state, zip: Greensboro, NC 27415
4f. Telephone no.: [phone]
4g. Fax no.: [phone]
4h. Email address: [e-mail] 'note: please also copy Mr. Jerry Parker, Highway Division 7 Environmental
Supervisoronallconespondence-jparkera� cdot.gov
5. AgentlConsultant Information (if applicable)
5a. Name: Mr. Jerry Parker
5b. Business name NC DOT Highway Division 7, Division Environmental Supervisor
(if applicable):
5c. Street address: PO Box 14996
5d. City, state, zip: Greensboro, NC 27415
5e. Telephone no.: [phone]
Sf. Fax no.: [phone]
5g. Email address: [e-mail]
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PCN Form — Version 1.3 December 10, 2008 Version

B. Project Information and Prior Project History
1. Property Identi£cation
1a. Property identification no. (tax PIN or parcel ID): N/A
1b. Site coordinates (in decimal degrees): Latitude 36.108787 Longitude: -79.02208
(DD.DDDDDD) (-DD.DDDDDD)
1c. Property size: N/A acres
2. Surtace Waters
2a. Name of nearest body of water (stream, river, etc.) to UT to Buckwater Creek
proposed project:
2b. Water Quality Classification of nearest receiving water: 27-2-12; WS-IV; NSW; 03-04-01
2c. River basin: Neuse River (HUC 03020201)
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:
The project study area is comprised of mostly maintained/residential with hardwood forest along the stream banks.
Immediately north of the bridge is an existing Duke Power easement which is coincident with the riparian buffer area (i.e.
vegetation is maintained down to the stream bank). There are no additional jurisdictional features associated with Bridge
No. 60 other than UT to Buckwater Creek.
3b. List the total estimated acreage of all existing wetlands on the property:
N/A
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
— 145 LF of stream within the project boundaries
3d. Explain the purpose of the proposed project:
To replace a structurally deficient and functionally obsolete timber bridge.
3e. Describe the overall project in detail, including the type of equipment to be used:
Tra�c will be detoured off-site. Erosion and sedimentation control measures will be installed. Water will be diverted around the
construction area. The old bridge will be removed. The proposed stucture will be replaced on its existing alignment. The new
culvert structure will be a 17' by 8.5' bottomless culvert. The channel will be excavated and realigned for low flow shaping.
Water will be pumped around lhe woik area during construction by installed impervious dikes upstream and downstream of the
existing bridge. Water will be directed into special stilling bains. Equipment to be used includes a track hoe, dump truck, paving
equipment, pumps, and various hand tools.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for fhis property / � yes � No ❑ Unknown
project (including all prior phases) in the past?
Comments: N/A
4b. If the Corps made the jurisdictional determination, what type
of determination was made? ❑ Preliminary ❑ Final
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company: N/A
Name (if known): N/A Other: N/A
4d. If yes, lisl the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
N/A
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.
N/A
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PCN Form — Version 1.3 December 10, 2008 Version

6. Future Project Plans
6a. Is fhis a phased project? ❑ Yes � No
6b. If yes, explain.
N/A
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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 project (check all that apply):
❑ Wetlands � Streams - tributaries � Buffers
❑ Open Waters ❑ Pond Construction
2. Wetland Impacts
If lhere 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 — Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWQ — non-404, other) (acres)
Tem orar T
W 1 ❑ P❑ T ❑ Yes ❑ Corps 0
❑ No ❑ DWQ
2g. Total wetland impacts �
2h. Comments: N/A
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.
3 a. 3 b. 3 c. 3 d. 3 e. 3 f. 3 g.
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
Temporary (T) (INT)? other) (feet) feet)
Channel
realignment for
S1 � p� T bottomless culvert, UT to Buckwater � PER � Corps 13-16 P' 83
temporary pipe, Creek ❑ INT � DWQ T: 100
and impervious
dikes
S2 ❑ P❑ T ❑ PER ❑ Corps
❑ INT ❑ DWQ
3h. Total Permanent Stream and Tributary Impacts $3'
3i. Comments: Of the 183 LF of stream impacts, only 83 LF are associated with permanent impacts to the stream for lhe
purpose of stream alignment and stabilization with respect to the culvert installation. The 100 LF of temporary impacts are
associated with the impervious dikes that will be used upstream and downstream of the proposed crossing. The dewatering
of the stream will run concurrently wilh the construction activities (i.e. lhe temporary impacts associated wilh dewatering are
within the permanenl stream impact footprint location).
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 rype Area of impact (acres)
Permanent(P)
or Tem ora T
01 ❑P❑T
4f. Total open water impacts
4g. Comments: No open water impacts
5. Pond or Lake Construction
If ond or lake construction ro osed, then com lete the chart below.
Page 5 of 11
PCN Form — Version 1.3 December 10, 2008 Version

5a. 5b. 5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or purpose of (acres)
number pond
Flooded Filled Excavated Flooded Filled Excavated Flooded
P1
P2
5f. Total
5g. Comments: There are no ponds created for this project
5h. Is a dam high hazard permit required?
❑ Yes ❑ Na If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method af 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 an impacts re uire mili ation, then ou MUST fill out Section D of this form.
6a.
� Neuse ❑ Tar-Pamlico ❑ Other:
Project is in which protected basin? ❑ Catawba ❑ Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Bufferimpact
number— Reason Buffer Zone 1 impact Zone 2 impact
Permanent (P) for Stream name mitigation (square feet) (square feet)
or Tem ora T im act re uired?
Road fill ❑ Yes
B1 � P❑ T and UT to Buckwater Creek � No 2,079 941
clearing
Bridge ❑ Yes
B2 � P❑ T Fill and UT to Buckwater Creek � No 156 0
Clearing
6h. Total buffer impacts 2,235 941
6i. Comments: The impacts associated with the roadway crossing and culvert installation fall under the "potentially allowable"
category per the Neuse River Basin Buffer Rules Table of Uses {15A NCAC 028 .0233 (6)) It should also be noted that the
riparian area on the northeast side of the bridge is largely within an existing Duke Power utility easement and is therefore
maintained down to the top of bank (i.e. only grasses/scrub present).
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
The proposed project is to remove and replace a structurally deficient bridge and replace it with a bottomless culvert.
Roadway approach work is minimized as much as is practical to reduce the overall project footprint. Impacts to the
associated protected riparian buffers have also been reduced by promoting sheet flow as well as providing grass shoulders to
promote infiltration. An off-site detour will be employed to avoid the need for a temporary parallel structure. Bank stabilization
will be minimized to those areas where deemed necessary.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Erosion and sedimentation BMPs will be installed prior to construction. Water will be diverted around the work area to prevent
sedimentation of downstream aquatic resources. Impacts will be minimized by strict enforcement of Besl Management
Practices for the proteclion of surface waters, restrictions against the staging of equipment in or adjacent to waters of the US
and coordination (including a pre-construction meeting) with the Division Environmental Supervisor.
Page 6 of 11
PCN Form — Version 1.3 December 10, 2008 Version

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 banlc
2c. If yes, which mitigation option will be used for this project? � Payment to in-lieu fee program
❑ Permittee Responsible Mitiga[ion
3. Complete if Using a Mitigation Bank
3a. Name of Mitigalion Bank:
3b. Credits Purchased (attach receipt and letter) Type Quanlity
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: 83 LF
4c. If using stream mitigation, stream temperature: � warm ❑ cool ❑cold
4d. Buffer mitigation requested (DWQ only): square feet
4e. Riparian wetland mitigation requested: acres
4f. Non-riparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requested: acres
4h. Comments: NCDOT proposes to provide 1:1 mitigation for the impacts to the stream with the installation of the bottomless
culvert. NCDOT does not believe a 2:1 mitigation ratio is required as the thalweg of the channel will not be permanently
impacted with structures or fill. The stream banks will be reshaped and floodplain benches will be built with streambank
stabilization to prevent sour/erosion around the footers of the 3-sided culvert.
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigalion plan.
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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
While lhere are impacts to the protected Neuse River Basin Buffer area, these
impacts are "allowable" per the Table of Uses {15A NCAC 02B.0233 (6)}
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer lhat requires mitigation. Calculate the
amount of mitigation required.
6c. 6d. 6e.
Zone Reason for impact Total impact Mulliplier Required mitigation
(square feet) (square feet)
Zone 1 3(2 for Catawba)
Zone 2 1.5
6t. Total buffer mitigation required:
6g. If buffer mitigalion 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 8 of 11
PCN Form — Version 1.3 December 10, 2008 Version

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
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
Comments: The proposed structure will be a 17' by 8.5' bottomless culvert. There is ❑ Yes � No
a slight increase in impervious surface but treatment is not required.
2. Stormwa4er Management Plan
2a. What is the overall percent imperviousness of this project? N/A %
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:
Plan is attached.
❑ 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 Governmen4 Stormwater Review
3a. In which local government's jurisdiction is this project?
❑ Phase II
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 Pro ram Review
❑ Coastal counties
❑ HQW
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 9 of 11
PCN Form — Version 1.3 December 10, 2008 Version

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the projecl involve an expenditure of public (federal/state/local) funds or the � Yes ❑ No
use of public (federal/state) land?
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 lhe NEPA or SEPA final approval
letter.) ❑ Yes ❑ No
Comments:
2. Vialations (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 lhis 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.
Per the NC DWQ April 10, 2004 Version 2.1 Cumulative Impacts policy, small scale public transportation projects — such
as widening projects, bridge replacements and intersection improvements — have a"low potential for cumulative impact
since little (if any) new impervious surface is added and the projects are usually in already developed locales." This
proposed project is within a somewhat developed landscape (i.e. existing residential homes in the vicinity), this is not a
road on a new location (i.e. lhere is an existing road and bridge structure and thus, the area already contains impervious
surfaces) and the project drains to UT to Buckwater Creek which is Class WS-IV; Nutrient Sensitive Waters (NSW) (i.e.
not HWQ or ORW or 303(d) listed waters). We anticipate the NC DW R will advise us if a qualitative or quantitative
analysis is needed.
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.
It is not anticipated that this project will generate any wastewater as it is a roadway project.
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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 you checked with the USFWS concerning Endangered Species Act � yes ❑ No
impacts?
� Raleigh
5c. If yes, indicate the USFWS Field Office you have contacted.
❑ Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
North Carolina Natural Heritage Database and onsite investigation.
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?
This bridge replacement project takes place in Orange County, which is not near any coastal or tidal habitat that would
support EFH (i.e. salt marshes, oyster reefs, etc.).
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 � Yes � No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
This project was submitted to the North Carolina Department of Transportation's Human Environment Unit for review in
2012. It was determined that no surveys were required, and that no historic or archaeological resources will be affected
by this project.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? � Yes ❑ No
Sb. If yes, explain how project meets FEMA requirements: MOA
8c. What source(s) did you use to make the floodplain determination? North Carolina Floodplain Mapping Program
Mr. Mike Mills, PE
ApplicanUAgenPs Printed Name �� �� �S
Ap licant/AgenYs Signature te
( enCs signat e is valid only if an authorization letter from the
applicant is provided.
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PCN Form — Version 1.3 December 10, 2008 Version