20171170 Ver 1_PCN Form Submission_20170912

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 9/12/2017 2:00:21 PM (Start Event)
Accept by Carpenter,Kristi 9/13/2017 2:55:24 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: September 15, 2017 5:00 PM
9/12/2017 2:00 PM

�� �
6fvlslaa of Water Resources
Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
June 28, 2017 Ver 1.8
*
Please note: fields marked with a red asterisk below are required. You will not be ab/e to submit the form until all mandatory questions are ans�red.
Below is a link to the DRAFT online help file. http://edocs.deq.nc.gov/WaterResources/0/doc/549884/Page1.aspx
A. Processing Information
County (or Counties) where the project is located:*
Beaufort
Is this a NCDOT Project?*
C� Yes �' No
(NCDOT only) T.I.P. or state project number:
B-5620
WBS #
45575.1.1
(for NCDOT use only)
� 1a. Type(s) of approval sought from the Corps:*
rJ Section 404 Permit (wetlands, streams and waters, Clean Water Act)
fJ Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What type(s) of permit(s) do you wish to seek authorization?*
fJ Nationwide Permit (NWP)
r Regional General Permit (RGP)
Nationwide Permit (NWP) Number:
NWP Number Other:
List all MN nurrbers you are applying for not on the drop dow n list.
14 - Linear transportation
1c. Type(s) of approval sought from the DWR:*
check all that apply
� 401 Water Quality Certification - Regular
� Non-404 Jurisdictional General Permit
r 401 Water Quality Certification - Express
�7 Riparian Buffer Authorization
1d. Is this notification solelyfor the record because written approval is not required?
For the record only for DWR 401 Certification:
I For the record only for Corps Permit:
1e. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
*
l" Yes C•' No
C' Yes C•' No

If so, attach the acceptance letter from rritigation bank or in-lieu fee program
C' Yes C•' No
1f. Is the project located in any of NC's twenty coastal counties?*
C� Yes l" No
1g. Is the project located within a NC DCM Area of Environmental Concern (AEC)?*
C� Yes �' No C' Unknown
B. Applicant Information
1a. Who is the Primary Contact?*
NCDOT (attn: Hon Yeung)
1b. Primary Contact Email:*
[e-mail]
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
fJ Owner �J Applicant (other than owner) �J Agent/Consultant
(Check all that apply)
� 2. Owner I nformation
2a. Name(s) on recorded deed:
NCDOT (attn: Hon Yeung)
2b. Deed book and page no.:
2c. Responsible party:
(for Corporations)
2d.Address
Street Address
105 Pactolus Highway NC 33
Address Line 2
�Y
Greenville
Fbstal / Zip Code
27835
2e. Telephone Number:
(xxx)xxx-xxxx
[phone]
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
3a. Applicant is:
State / Rovince / f�gion
NC
Country
USA

C' Agent
C' Other
If other please specify.
3b. Name:
NCDOT (Attn: Hon Yeung)
3c. Business Name:
(if applicable)
3d.Address
Street Address
105 Pactolus Highway NC 33
Address Line 2
��
Greenville
Fbstal / Zip Code
27835
3e. Telephone Number:
[phone]
(xxx)xxx-xxxx
3f. Fax Number:
(xxx)xxx-xxxx
3g. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Robert Turnbull
4b. Business Name:
(if applicable)
Environmental Services, Inc.
4c. Address
Street Address
4901 Trademark Drive
Address Line 2
Qty
Raleigh
Fbstal / Zip Code
27610
4d. Telephone Number:
[phone]
(xxx)xxx-xxxx
4e. Fax Number:
[phone]
(xxx)xxx-xxxx
4f. Email Address:*
[e-mail]
AgentAuthorization Letter
State / R-ovince / F�gion
NC
Country
USA
State / Rovince / F�gion
NC
Country
USA

Rease provide the Agent Authorization Letter if you are subrritting this docurrent.
B-5620_ESI Agent Authorization.pdf
FlLE TYFE MJST BE FflF
241.42KB
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Beaufort Bridge 30
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Aurora
1d. Driving directions*
If it is a new project and can not easily be found in a GPS rrapping system Rease provide directions.
NC Highway 33 over Campbell Creek, east of Aurora, NC
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)
wa
2b. Propertysize:
(in acres)
2.19
2c. Project Address
Street Address
NC Highway 33
Address Line 2
��
Aurora
Fbstal / Zip Code
27806
State / R-ovince / I�gion
NC
Country
USA
2d. Site coordinates in decimal degrees
Please collect site coordinates in decimal degrees. Use between 4-6 digits (unless you are using a survey-grade GPS device) after the decimal place as
appropriate, based on howthe location was determined. (For example, most mobile phones with GPS provide locational precision in decimal degrees to
map coordinates to 5 or 6 digits after the decimal place.)
Latitude:*
35.28707
ex:34.208504
3. Surface Waters
Longitude:*
-76.68652
-77.796371
3a. Name of the nearest body of water to proposed project:*
Campbell Creek
3b. Water Resources Classification of nearest receiving water:*

SA;HQW, NSW
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Tar-Pamlico
RiverBasin Lookup
4. Project Description
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:*
The project study area and vicinity consist of silvicultural areas and undeveloped forested communities. The
proposed project and associated impacts are within and immediately adjacent to existing NCDOT right-of-way.
4b. Attach an 8 1/2 X 11 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for
DWR)
Gick the upload button or drag and drop files here to attach docurrent
B-5620_USGStopo.pdf 497.33KB
Fle type rrust be pdf
4c. Attach an 8 1/2 X 11 excerpt from the most recent version of the published County NRCS Soil Survey map depicting the project site.
(for DWR)
C7ick the upload button or drag and drop files here to attach docurrent
B-5620_soils.pdf
Fle type rrust be pdf
4d. List the total estimated acreage of all existing wetlands on the property:
1.0
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
1,100
537.23KB
4f. Explain the purpose of the proposed project:
Replace existing Bridge 30 on NC 33 over Campbell Creek. Sufficiency rating of existing bridge is 46.65.
4g. Describe the overall project in detail, including the type of equipment to be used:
The proposed project will replace the bridge on NC 33 over Campbell Creek in Beaufort County. The project will
replace the existing reinforced concrete floor bridge with a cored slab bridge. The project work will consist of
grading, widening, drainage improvements, bridge replacement, and pavement markings. This work will be
conducted using standard road construction equipment. Approximately half of the epsting bridge will be removed
initially, allowing one lane to remain open for maintenance of traffic. The new bridge will be constructed 13 feet
downstream of the existing bridge crossing. The remaining lane will be removed one the new bridge is completed.
4h. Please upload project drawins for the proposed project.
aick the upload button or drag and drop files here to attach docurrent
B-5620_Beaufort_030_Permit_Drawings. pdf 2.38M6
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5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
r Yes C' No c' Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
G Preliminary C' Approved l' Unknown
Corps AID Number:

Exarrple: SAV�2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:
NCDOT
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Not available
Sd1. Jurisdictional determination upload
qick the upload button or drag and drop files here to attach docurrent
Fle type rrust be FDF
6. Project History
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past?*
C' Yes C�' No c' Unknown
7. Future Project Plans
7a. Is this a phased project?*
C' Yes C•' 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? This includes other separate and distant crossing for linear projects that require Department of the
Army authorization but don't require pre-construction notification.
D. Proposed I m pacts I nventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
fJ Wetlands r Streams-tributaries rJ Buffers
fJ Open Waters r Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. Site #- Reason for 2b. Impact type * 2c. Type of wetland
impact
W1
fv�p label (e.g. R�ad Qossing 1)
W2
N�p label (e.g. f�ad Qossing 1)
W3
N�p label (e.g. Fd�ad Q-ossing 1)
P Tidal Freshwater Marsh
F2rrrenent (F) or Terrporary
i�
P Tidal Freshwater Marsh
F�rrranent (P� or Terrporary
��
P Tidal Freshwater Marsh
F2rrranent (Pj or Terrporary
��
2d. Wetland name 2e. Forested 2f. 2g. Impact
Jurisdiction area
type
W1 No Corps 0.180
(404, 10) or C7�VR (acres)
(401, other)
W2 No Corps 0.220
(404, 10) or C7�NR (acres)
(401, other)
W3 No Corps 0.020
(404, 10) or C�NR (acres)
(401, other)

2a. Site #- Reason for 2b. Impact type * 2c. Type of wetland
impact
2d. Wetland name 2e. Forested 2f. 2g. Impact
Jurisdiction area
type
W4 P Tidal Freshwater Marsh W4 No Corps 0.010
N�p label (e.g. I�ad C7ossing 1) F2rrrenent (� or Terrporary (404, 10) or C7JVR (acres)
(� (401, other)
2g. Temporary Wetland Impact
0.000
2g. Permanent Wetland Impact
0.430
2g. Total Wetland Impact
0.430
2h. Comments:
See attached wetland impacts table.
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.
`� All Perennial or Intermittent streams must be verified by DWR or delegated local government.
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. Site # - Reason for
i impact
01
N�p label (e.g. Finad Q'ossing 1)
02
N�p label (e.g. f�ad Qossing 1)
4b. Impact 4c. Name of waterbody
type
P Campbell Creek
F2rrranent (F) or (if applicable)
Terrporary (�
T Campbell Creek
F2rrranerd (Pj or (if applicable)
Terrporary (�
4d. Activity 4e. Waterbody4f. Impact area
type type
Other Tributary 0.01
(acres)
Other Tributary 0.01
(acres)
4g. Total temporary open water Impacts:
0.01
4g. Total permanent open water impacts:
0.01
4g. Total open water impacts:
0.02
4h. Comments:
Open water impacts result from piling removal/installation. Total open water impacts are <0.01 acre.
5. Pond or Lake Construction
If pond or lake construction is proposed, then complete the chart below.
6. Buffer Impacts (for DWR)
If project will impact a protected riparian buffer, then complete the chart below. Individually list all buffer impacts below.
I 6a. Project is in which protect basin(s)?*

Check all that apply.
� Neuse
r Catawba
r Goose Creek
r Other
6b. Impact Type
rJ Tar-Pamlico
r Randleman
r Jordan Lake
6c. Per or 6d. Stream name
Te mp
61 -Allowable P Campbell Creek
Location and Exerrpt, Allowable, allowable w/ rritigation F�rrranent (F) or
Terrporary (�
62 -Allowable P Campbell Creek/UTto
Location and 6cerrpt, Allowable, allowable w/ rritigation F2rrranent (F) or Campbe II Creek
Terrporary (�
B3 - Allowable P Campbell Creek
Location and Exerrpt, Allowable, allowable w/ rritigation F�rrranent (� or
Terrporary (�
64 - Allowable P Campbell Creek
Location and 6cerrpt, Allowable, allowable w/ rritigation F�rrranent (Fj or
Terrporary (�
6h. Total buffer impacts:
Temporary impacts
Permanent impacts:
Total buffer impacts
Zone 1
0.00
Zone 1
4,745.00
Zone 1
4,745.00
Zone 2
0.00
Zone 2
4,407.00
Zone 2
4,407.00
6i. Comments:
62 impacts to Campbell Creek buffers: 1,111 sf in Zone 1, 664 sf in Zone 2
B2 impacts to UT to Campbell Creek buffers: 2,144 sf in Zone 1, 2,810 sf in Zone 2
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
Gick the upload button or drag and drop files here to attach docurrent
B-5620_Beaufort_030_Permit_Drawings. pdf
B-5620_Beaufort_030_Permit_Impact Tables.pdf
Fle rrust be FDF
� E. Impact Justification and Mitigation
1. Avoidance and Minimization
6e. Buffer 6f. Zone 1 6g. Zone 2
mitigation impact impact
required?
No 1,248 859
(squarefeet) (squarefeet)
No
No
No
2.38M6
111.27KB
3,255 3,474
(squarefeet) (squarefeet)
108 10
(squarefeet) (squarefeet)
134 64
(square feet) (square feet)
I 1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
The proposed bridge location will be 13 feet downstream of the e�asting bridge. In order to minimize wetland
impacts from on-site detour construction, approximately half of the existing bridge will be removed in order to use
the remaining lane to maintain traffic. The remaining lane of the epsting bridge will be removed following
construction of the new bridge. Construction of the new bridge on new location would significantly increase impacts
to wetland areas. An off-site detour is not viable because the shortest off-site detour is appro�amately 37.1 miles
long.

1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
A turbidity curtain will be used during the removal of existing bridge pilings and installation of new pilings. All
necessary sediment and erosion control BMPs will be installed and maintained through construction. Disturbed
ground will be restored and stabilized with permanent vegetative cover. NCDOT Best Management Practices will
be implemented throughout 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
l" No
2c. If yes, mitigation is required by (check all that apply):
r DWR
fJ Corps
i 2d. If yes, which mitigation option(s) will be used for this project?
r Mitigation bank
r Payment to in-lieu fee program fJ Permittee Responsible Mitigation
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 including mitigation credits
generated.
All mitigation for this project will be provided by NCDOT's Campbell Creek Mitigation Site, located immediately
downstream of this project site. All buffer impacts coincide with wetland impacts; therefore, no riparian buffer
mitigation is required.
5b. Mitigation Plan Upload
C7ick the upload button or drag and drop files here to attach docurrent
Campbell CreekBridge30_Debit Ledger.pdf
Fle type rrust be pdF
129.99KB
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
I 1a. Does this project require a Stormwater Management Plan?
C�' Yes
l' No
1b. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
The proposed bridge does not contain deck drains. All stormwater from the bridge and approaches will be
collected by a storm drainage system and discharged into the wetlands. The drainage system will outlet outside of
buffer limits in the west quadrant at -L- station 16+75 RT with the outlet pipe set at 0.3% to reduce velocity into the
wetlands. No rip rap pad was specified at the outlet due to lowvelocity and efforts to minimize impacts to
jurisdictional areas.
1c. What is the overall percent imperviousness of this project?
56
%
1d. Who will be responsible for the review of the Stormwater Management Plan?*
r Certified Local Government
r DWR 401 & Buffer Permitting Branch
2. Diffuse Flow Plan
r DEMLR Stormwater Review
�J DWR Transportation Permitting Branch
2a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection
Rules?
C�' Yes
l' No
2b. All buffer impacts and high ground impacts require diffuse flow or other form of stormwater treatment. Include a plan that fully
documents how diffuse flow will be maintained.
If, due to site constraints, a BMP other than a level spreader is proposed, please provide a plan for stormwater treatment as outlined
in Chapter 8 of the NC Stormwater BMP Manual and attach a BMP Supplement Form

What documentation are you providing?
� Level Spreader
�7 Other BMP
(check all that apply)
Diffused Flow Documentation
qick the upload button or drag and drop files here to attach docurrent
B-5620_Beaufort_030_SMP.pdf 79.47K6
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5. DWR 401 Stormwater Review
5a. Is the Stormwater Management Plan (including BMP Supplemental Forms and Operation and Maintenance Agreements) attached?
C' Yes C' No
Stormwater Management Plan Upload
aick the upload button or drag and drop files here to attach docurrent
B-5620_Beaufort_030_SMP.pdf 79.47K6
file type rrust be pdf
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?*
r Yes c" No
1b. 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 PolicyAct (NEPA/SEPA)?*
C' Yes �' No
Comments:*
State Minimum Criteria Checklist has been prepared.
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)? *
C' Yes �' No
2b. Is this an after-the-fact permit application?*
C' Yes C•' No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWR Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in additional development, which could impact
nearby downstream water qualit�i?*
C' Yes �' No
3b. If you answered "no," provide a short narrative description.
The proposed project will result in minimum new impervious surface and will not result in any downstream impacts
or growth-stimulating effects. The existing use of Campbell Creek (SA) should not change as a result of this
project.

4. Sewage Disposal (DWR Requirement)
4a. Describe, in detail, the treatment methods and dispositions (non-discharge or discharge) of wastewater generated from the
proposed project. If the wastewater will be treated at a treatment plant, list the capacity available at that plant.
No wastewater will be produced as a result of this project.
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?*
C' Yes C•' No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
C' Yes C•' No
5c. If yes, indicate the USFWS Field Office you have contacted.
Sd. Is this a DOT project located within Division's 1-8?*
�' Yes
C' No
Si. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
Evaluation by NCDOT Staff.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
C� Yes �' No
Are there submerged aquatic vegetation (SA� around the project vicinity?*
C' Yes
C' No
C•' Unknown
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
http://�wwv.habitat.noaa.gov/protection/efh/efhmapper/
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data: http://gis.ncdcr.gov/hpoweb/
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 North Carolina historyand archaeology)?*
C' Yes �' No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources? *
A cultural resources reviewwas conducted by NCDOT. Documentation for these reviews is attached.
7c. Historic or Prehistoric Information Upload
Gick the upload button or drag and drop files here to attach docurrent
16-07-0033 NoSu rvey. pdf
PA 16-07-0033 Beaufort (NSR).pdf
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8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https://msc.fema.gov/portal/search
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
1.78MB
8.46M6

r Yes r No
8b. If yes, explain how project meets FEMA requirements:
i No FEMA Study is required.
8c. What source(s) did you use to make the floodplain determination?*
�nnru�v.ncfloodmaps.com
Miscellaneous attachments not previously requested.
aick the upload button or drag and drop files here to attach docurrent
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Signature
*
rJ By checking the box and signing below, I certify that:
■ 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 AcY');
■ I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic
Transactions AcY');
■ 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:*
Robert Turnbull
Signature
.i��:°�t.r ��t�t!CS!�/�
Date
9/12/2017
Initial Review
Is this project a public transportation project?
C�' Yes C' No
Only change this if the project has been reassigned.
Has this project met the requirements for acceptance in to the review process?*
G Yes
C' No
BIMS # Assigned*
20171170
Version#*
1
Reviewing Office*
Washington Regional Office - [phone]
Select Project Reviewer*
Garcy Ward:eads\gpward