20161028 Ver 1_PCN bridge 248_20161026

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Corps action ID no.
DWQ project no.
Form Version 1.4 January 2009
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
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 Certification — Regular ❑ Non-404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
1 e. Is this notification solely for the record For the record only for DWQ For the record only for Corps Permit:
because written approval is not required? 401 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 mitigation bank or in-lieu
fee program.
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h ❑ Yes � No
below.
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ❑ Yes � No
2. Project Information
2a. Name of project: Replace Bridge No. 248 on SR 2009 over Carroll Creek
2b. County: Rockingham
2c. Nearest municipality / town: Reidsville
2d. Subdivision name: N/A
2e. NCDOT only, T.I.P. or state 17BP.7.R.103
project no:
3. Owner Information
3a. Name(s) on Recorded Deed: North 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.: [phone]
3h. Email address: [e-mail]
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PCN Form — Version 1.4 January 2009

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. Em811 8dd�ess: [e-mail]*note: p/ease a/so copy Mr. Jerry Parker, Highway Division 7 Environmental
Supervisor on all correspondence - jparker(i�j�cdot.gov
5. Agent/Consultant 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]
5f. Fax no.: [phone]
5g. Email address: [e-mail]
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B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): N/A
1 b. Site coordinates (in decimal degrees): Latitude: 36.397581 Longitude: - 79.727378
1 c. Property size: N/A acres
2. Surface Waters
2a. Name of nearest body of water to proposed project: Carroll Creek (22-48-1); 03-02-03
2b. Water Quality Classification of nearest receiving water: C
2c. River basin: Roanoke River (HUC 03010103)
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 hardwood forest and some residential. There is one, small wetland within
the project area associated with Bridge 248 in addition to Carroll Creek.
3b. List the total estimated acreage of all existing wetlands on the property: <0.10
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: � 120 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:
Traffic will be detoured off-site. Erosion and sedimentation control measures will be installed. Water will be diverted around
the construction area. The old single-span, timber deck on I beams bridge with timber caps, piles and bulkhead will be
removed. The new culvert structure will be a double barrel, 10'X9' RCBC. Impervious dikes will be utilized as needed to divert
stream flow culvert installation (see attached construction sequencing). Floodplain benches will be created at both the upstream and
downstream ends for the high flow barrel which will include coir fiber matting and seed. Equipment to be used includes a track hoe,
dum truck, avin e ui ment, um s and various hand tools.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the � Yes ❑ No ❑ Unknown
Corps or State been requested or obtained for this property / Comments: The USACE and DWR visited the site to
project (including all prior phases) in the past? confirm the delineation in July 2016
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: EPR
Name (if known): Robert Lepsic Other:
4d. If yes, list 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.
6. Future Project Plans
6a. Is this a phased project? ❑ Yes � No
6b. If yes, explain.
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PCN Form — Version 1.4 January 2009

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 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 Type of impact Type of Forested Corps (404, 10) or Area of impact
Permanent (P) or wetland DWQ (401, other) (acres)
Tem ora T if known
W1 Choose one Choose One Choose one Yes/No -
2g. Total wetland impacts 0
2h. Comments: While there are wetlands within the project boundaries, they will not be impacted for this bridge replacement.
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. 3f. 3g.
Stream impact Type of impact Stream name Perennial (PER) Type of Average stream Impact
number or intermittent jurisdiction width length
Permanent (P) or (INT)? (feet) (linear
Temporary (T) feet)
S1 P Culvert Carroll Creek PER Corps 15-18 43
S1 P Bank Carroll Creek PER Corps 15-18 59
Stabilization
S1 T Construction/ Carroll Creek PER Corps 15-18 62
Dewatering
3h. Total stream and tributary impacts 164
3i. Comments: Of the 164 LF of stream impacts, only 43 LF are associated with permanent impacts to the stream due to the
installation of a 10'X9' double barrel culvert. The other 59 LF of impact is associated with streambank protection (i.e. the rip
rap is restricted to the banks of the channel and will not encroach within the thalweg). The 62 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 with the construction activities (i.e. the temporary impacts associated with dewatering are
within the permanent 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 individuall list all o en water im acts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of
impact number — waterbody Type of impact Waterbody type Area of impact (acres)
Permanent (P) or (if applicable)
Tem ora T
01 Choose one Choose One Choose
4f. Total open water impacts
4g. Comments: No open water imapcts
5. Pond or Lake Construction
If ond or lake construction ro osed, then com lete the chart below.
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5a. 5b. 5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or (acres)
number purpose of pond Excavat
Flooded Filled ed Flooded Filled Excavated Flooded
P1 Choose One
P2 Choose One
5f. Total
5g. Comments: There are no ponds created for this project
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 an im acts re uire miti ation, then ou MUST fill out Section D of this form.
6a.Project is in which protected basin? ❑ Neuse ❑ Tar-Pamlico ❑ Catawba ❑ Randleman ❑ Other:
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number — Reason Buffer mitigation Zone 1 impact Zone 2 impact
Permanent (P) or for Stream name required? (square feet) (square feet)
Tem orar T im act
61 - No
6h. Total buffer impacts
6i. Comments:
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D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. 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 10X9, double barrel
culvert. Roadway approach work is minimized as much as is practical to reduce the overall project footprint. An off-site
detour will be employed to avoid the need for a temporary parallel structure. Please see the attached Bridge to Culvert
justification letter from NCDOT Division 7 Bridge Program Manager.
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 Best
Management Practices for the protection 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.
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 bank
2c. If yes, which mitigation option will be used for this
project? � Payment to in-lieu fee program
❑ Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
Type: Choose one Quantity
3b. Credits Purchased (attach receipt and letter) Type: Choose one Quantity
Type: Choose one Quantity
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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: 102 linear feet @ 1:1; typically, USACE requires 2:1
mitigation for permanent stream impacts due to culvert
installation, however, they do not require compensatory
mitigation for streambank stabilization. Conversely, NC DWR
does require 1:1 mitigation for rip rap bank stabilization.
Therefore, NCDOT is proposing to mitigate for the entire 102
LF of stream impact at a 1:1 ratio which will satisfy both the
USACE 2:1 ratio for the culvert (43 LF X 2= 86) and the
additional 59 LF of bank stabilization at a 1:1 ratio per DWR
requirements.
4c. If using stream mitigation, stream temperature: Choose one
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:
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.
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 ❑ Yes � No
buffer mitigation?
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.
6c. 6d. 6e.
Zone Reason for impact Total impact Multiplier Required mitigation
(square feet) (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:
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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 � 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.
❑ Yes � No
Comments:
2. Stormwater Mana ement Plan
2a. What is the overall percent imperviousness of this project? N/A °/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
2e. Who will be responsible for the review of the Stormwater Management Plan? �WQ
3. Certified Local Government Stormwater Review
3a. In which local governmenYs 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
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PCN Form — Version 1.3 December 10, 2008 Version

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1a. Does the project 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 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 � 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. there is an existing road and bridge structure and thus, the area already contains impervious
surfaces) and the project drains to Carroll Creek which is Class C(i.e. not ORW, HQW, or 303(d) listed waters). We
anticipate the NC DWR 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.
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 � Yes � No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act � yes ❑ No
impacts?
5c. If yes, indicate the USFWS Field Office you have contacted.
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
Robert Lepsic with EPR surveyed the project reach for Roanoke logperch (Percinia rex) and James spinymussel
(Pleurobema collina) habitat in February 2016, as well as searching the NC Natural Heritage Program (NHP) database.
The database search indicated that there are no known occurrences of either species within the project study area or in
Carroll Creek. Further, no species were observed during the site survey. Email correspondence with Mr. Gary Jordan
(USFWS) indicated that he was comfortable with a"No Effect" biological conclusion for both species, especially due to
the fact that Carroll Creek flows into a lake.
Mr. Lepsic also conducted a survey for smooth coneflower at the subject site on June 28, 2016. Marginal roadside habitat
exists on all four quadrants of the bridge but no specimens were found. The biological conclusion for smooth coneflower
at the Brid e 248 site is No Effect; Habitat Present.
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 Rockingham 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
2015. It was determined that no survey was required for historical architecture and archaeological resources.
8. Flood Zone Designatian (Corps Requirement)
Sa. Will this project occur in a FEMA-designated 100-year floodplain? � Yes ❑ No
8b. If yes, explain how project meets FEMA requirements: NCDOT MOA
8c. What source(s) did you use to make the floodplain determination? NC Floodplain Mapping Program
Mr. Mike Mills, PE �� ��� �� �o �• ��
ApplicanUAgenYs Printed Name ApplicanUAgenYs Signat re Date
(Agent's signature is valid only if an authorization letter from the applicant
is rovided.
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