20180755 Ver 1_PCN Form Submission_20180601

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 6/1/2018 3:02:16 PM (Start Event)
Accept by Carpenter,Kristi 6/1/2018 4:03:42 PM (DOT Initial Review)
. The task was assigned to Carpenter,Kristi. The due date is: June 6, 2018 5:00 PM 6/1/2018 3:03 PM

�� �
6fvlslaa of Water Resources
Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
January 31, 2018 Ver 2.3
*
Please note: fields marked with a red asterisk below are required. You will not be able to submit the form until all mandatory questions are ans�red.
Also, if at any point you wish to print a copy of the E-PCN, all you need to do is right-click on the document and you can print a copy of the form.
Below is a link to the online help file.
https://edocs. deq. nc.gov/WaterResources/0/edoc/624704/PCN%20Help%20File%202018-1-30. pdf
A. Processing Information
County(or Counties) where the project is located:*
Perquimans
� Is this project a public transportation project?*
�' Yes C' No
This is any publicly funded by rrunicipal,state or federal funds road, rail, airport transportation project.
Is this a NCDOT Project?*
�' Yes C' No
(NCDOT only) T.I.P. or state project number:
B-5606
WBS #
45561.1.1
(for NCDOT use only)
1a. Type(s) of approval sought from the Corps:*
rJ Section 404 Permit (wetlands, streams and waters, Clean Water Act)
r Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What type(s) of permit(s) do you wish to seek authorization?*
�J Nationwide Permit (NWP)
r Regional General Permit (RGP)
� Standard (IP)
This form may be Corps to initiate the standard/individual permit process. Please contact your Corps representative for submittal of standard permits.
All required items that are not provided in the E-PCN and be added to the miscellaneous upload located at the bottom of this form.
Nationwide Permit (NWP) Number: 03 - Maintenance
Nationwide Permit (NWP) Number: 12 - Utility Lines
NWP Number Other:
List all MN nurrbers you are applying for not on the drop dow n list.

1c. Type(s) of approval sought from the DWR:*
check all that apply
N7 401 Water Quality Certification - Regular
r Non-404 Jurisdictional General Permit
� Individual Permit
r 401 Water Quality Certification - Express
r Riparian Buffer Authorization
*
1d. Is this notification solelyfor the record because written approval is not required?
For the record only for DWR 401 Certification: f Yes C•' No
For the record onlyfor Corps Permit: C' Yes C•' No
1e. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
If so, attach the acceptance letter from rritigation bank or in-lieu fee program
C' Yes �' No
1f. Is the project located in anyof NC's twentycoastal counties?*
C� Yes �' No
1g. Is the project located within a NC DCM Area of Environmental Concern (AEC)?*
C' Yes C' No C' Unknown
7h. Is the project located in a designated trout watershed?*
C' Yes G No
Link to trout information: http://�wwv.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Agency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact?*
Clay Willis
1b. Primary Contact Email:*
i [e-mail]
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
7d. Who is applying for the permit?
fJ Owner r Applicant (other than owner) r AgenUConsultant
(Check all that apply)
2. Owner I nformation
2a. Name(s) on recorded deed:
NCDOT - ROW on SR 1338 Wynne Fork Road
2b. Deed book and page no.:
n/a
2c. Responsible party:
� (for Corporations)
NCDOT - Division One
2d.Address

Street Address
113 Airport Drive Suite 100
Address Line 2
Qty
Edenton
Fbstal / Zip Code
27932
2e. Telephone Number:
(xxx)xxx-xxxx
[phone]
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
State / R-ovince / I�gion
NC
Country
USA
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Bridge # 11 on SR 1333 Wynne Fork Road
1b. Subdivision name:
(if appropriate)
n/a
1c. Nearest municipality/town:*
Hertford
1d. Driving directions*
If it is a new project and can not easily be found in a GPS rrapping system Rease provide directions.
Take US 17 North into Perquimans County. Continue on US 17 N, just before the town of Hertford, turn left on to SR 1338 (Wynne Fork Rd).
The bridge is approximately 0.3 miles down SR 1338.
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)
B-5606
I 2b. Propertysize:
(in acres)
1 acre
2c. Project Address
Street Address
SR 1338 Wynne Fork Road
Address Line 2
��
Hertford
Fbstal / Zip Code
27944
2d. Site coordinates in decimal degrees
State / Rovince / I�gion
NC
Country
US

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:* Longitude:*
36.1737 -76.4724
ex:34208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Raccon Creek
3b. Water Resources Classification of nearest receiving water:*
C, Sw
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Pasquotank
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:*
Existing conditions on the site consist of Bridge # 11 over Raccoon Creek and SR 1338, which is a secondary road
connecting US 17 and US 17 Business. The surrounding area is woodland located along the floodplain of Raccoon
Creek and residential development. The project proposes to replace an aging bridge structure built in 1960. This
current structure is a 4 span 150 ' X 26.5 ' with concrete piles supporting steel I-beams and a concrete deck. This
structure will be removed in iYs entirety following NCDOT BMP's for bridge removal. The new bridge will be a
precast concrete structure that is 160' X 30' wide. The bridge will have 3 spans, supported by two interior concrete
pile/bents. The bridge approach will have to be widening to accommodate the wider bridge deck. This will result in
some minor wetland impacts associated with road shoulder fill. There will also be utility relocations associated with
the bridge project. A century link communication line, county water line and county sewer line will need to be
relocated, to prevent impact to the bridge construction project. These relocations are illustrated on the provided
permit drawings.
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)
aick the upload button or drag and drop files here to attach docurrent
USGS_Topo_LocationMap.pdf 1.17MB
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
Bridge11_Soil_Map. pdf
Fle type rrust be pdf
4d. List the total estimated acreage of all existing wetlands on the property:
0.20 acres
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
60 feet
4f. Explain the purpose of the proposed project:*
r���ry:�:

The purpose of this project is to replace a 58 year old bridge that has received a deficient rating, qualifying it for
bridge replacement. The new bridge structure will retain access across Raccoon creek and connectivity along SR
1338.
4g. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
The project will remove the e�asting 150 ft. bridge in its entirety, utilizng NCDOT's BMP for bridge removal. The
new 160 ft. X 30 ft. bridge will be built using top down construction techniques. The two interior bents, with
concrete piles will be driven in place. During the bent cap installation a coffer dam may be required to isolate the
work area around the interior bent. This would be sheet pile placed around the bent, that v�rould also need a
dewatering operation. The bridge approaches will need to be widened on either end of the bridge to account for
the wider bridge. This will involve the placement of fill along the existing road shoulders to widen the approaches,
resulting in minor wetland impacts along the shoulder section. There will also be the relocation of 3 utilities. The
century link and sewer line located on the north side of the roadway will be bored appro�amately 350-400 ft. under
Raccoon Creek. The waterline on the south side of the project area will also be bored, appro�mately 400-450 ft.
under Raccoon Creek. Because of surrounding constraints the bore pits and tie in points for the century link &
sewer line, will require temporary excavation impacts in the wetland areas. These impacts areas are shown on the
provided drawings. In addition, the sewer line will need a new gate valve installed which will require permanent fill
in the wetland. The impacts are detailed on the provided drawings and impact spread sheet. Type of equipment
used on this project includes a crane, excavator, dump trucks, paving equipment and various other tools, typically
associated with a bridge construction project.
4h. Please upload project drawings for the proposed project.
aick the upload button or drag and drop files here to attach docurrent
Final_Permit_Drawings_2018-05-23.pdf
G ate_Valve_Sewer. pdf
Final_Wetland Impact Summary Sheet.pdf
Fle type rrust be pdf
5. Jurisdictional Determinations
1.53MB
2.81 MB
42.16K6
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
C� Yes �' No �' Unknown
Comments:
Delineated by Clay Willis Sept. 2016
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
C� Preliminary
Corps AID Number:
6carrple: SAV�2017-99999
C' Approved
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:
C' Unknown
�' N/A
Clay Willis - NCDOT Environmental Supervisor
NCDOT - Division One
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5d1. Jurisdictional determination upload
Qick the upload button or drag and drop files here to attach docurrent
Wetland Sketch.pdf
Wetland_Delineation_Form.pdf
Fle type rrust be FDF
6. Project History
22.64K6
87.38KB

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 �' 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):
rJ Wetlands r Streams-tributaries r Buffers
r% 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 impact* 2b. Impact type * 2c. Type of wetland*
Roadway Fill
N�p label (e.g. F�ad Qossing 1- Qalvert,
dewatering, etc)
Utility (sewer/century link)
fv�p label (e.g. Finad Qossing 1- Qilvert,
dewatering, etc)
Utility (sewer - gate valve)
N�p label (e.g. f�ad Qossing 1- Qilvert,
dewatering, etc)
Hand Clearing
N�p label (e.g. F�ad Qossing 1- Qalvert,
dewatering, etc)
Roadway Fill
fV�p label (e.g. Fd�ad Qossing 1- Qalvert,
dewatering, etc)
Hand Clearing
N�p label (e.g. Fd�ad Qossing 1- Qilvert,
dewatering, etc)
Utility (sewer/century link)
fV�p label (e.g. F�ad Qossing 1- Qalvert,
dewatering etc)
P
F2rrranent (� or
Terrporary (�
T
F2rrranent (Fj or
Terrporary (�
P
F�rrranent (F) or
Terrporary (lj
T
F2rrranent (F) or
Terrporary (�
P
F2rrranent (F) or
Terrporary (�
T
F�rrrenent (P� or
Terrporary (�
T
F�rrranent (� or
Terrporary (�
2g. Total Temporary Wetland Impact
0.094
2g. Total Permanent Wetland Impact
0.034
2g. Total Wetland Impact
0.128
2h. Comments:
Bottomland Hardwood
Forest
Bottomland Hardwood
Forest
Bottomland Hardwood
Forest
Bottomland Hardwood
Forest
Bottomland Hardwood
Forest
Bottomland Hardwood
Forest
Bottomland Hardwood
Forest
2d. Wetland name *2e. 2f. Type of 2g. Impact
Forested* Jurisdicition* area*
Site 2 No Both 0.022
(404, 10) or D✓�R(401, (acres)
other)
Site 2 Yes Both 0.019
(404, 10) or �R(401, (acres)
other)
Site 2 Yes Both 0.000
(404, 10) or G/UR (401, (acres)
other)
Site 2 Yes Both 0.031
(404, 10) or D✓�R(401, (acres)
other)
Site 3 Yes Both 0.012
(404, 10) or D✓�R(401, (acres)
other)
Site 3 Yes Both 0.034
(404, 10) or GJ�R(401, (acres)
G R
other)
Slte 3 Yes Both 0.010
(404, 10) or D✓UR(401, (acres)
other)

Site 2- Sewer Line Gate Valve installation will require some permanent fill 5 X5 ft. square area (0.0005 acres)
I have included the utility drawing for the Gate Valve.
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 4b. Impact type * 4c. Name of waterbody*
impact *
Site 1 Coffer Dam at bents T
fV�p label (e.g. f�ad Qossing 1) F2rrranent (P� or
Terrporary (�
4g. Total temporary open water Impacts:
0.02
4g. Total permanent open water impacts:
0.00
4g. Total open water impacts:
0.02
4h. Comments:
Raccon Creek
(if applicable)
4d. Activitytype * 4e. Waterbodytype *4f. Impact
area*
Dewatering Tributary 0.02
(acres)
Construction of the interior bents may require a coffer dam to form the concrete bridge caps. If this is the case,
then a steel sheet pile coffer dam will be required around the bent v�rork area.
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:*
This bridge has been lengthened, with longer spans, which restores some of the nature floodway while reducing
the number of required interior bents. The e�asting bridge has 4 interior bents, and the new design has only two
interior bents. All storm water has been routed of the bridge structure and directed to outlet in the adjacent
wetland system, which provides a vegetated buffer for nutrient removal. Roadway fill slopes have been minimized
to the mapmum extent practicable for this bridge approach, resulting in 0.03 acres of wetland fill.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
This bridge will be utilizing top down construction techniques, eliminating the need for a temporary construction
trestle. SR 1338 (Wynn Fork Road) will be closed during construction, which eliminates the need for any on-site
detour, which v�rould greatly increase temporary wetland impacts. NCDOT will followour best management
practices for the removal of bridges. NCDOT will have an approved erosion control plan in place, which will
included silt fence installation around the project disturbance limits and turbidity curtains along the disturbed
shoreline. An in-water work moratorium will be adhered during fishery spawning time periods of Feb. 15 - June
30th per the Division of Marine Fisheries recommendation.
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?
C' Yes
C•' No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
Avoidance and minimization efforts on this project have resulted in 0.03 acres of permanent wetland fill
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
�"� Recent changes to the stormwater rules have required updates to this section ."'�

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?
f Yes C•' No
For a list of options to meet the diffuse flow requirements, click here.
If no, explain why:
i Project is located in the Pasquotank River Basin
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
C� Yes C' No
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?*
C•' 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 C•' No
Comments:*
The scope of this project qualifies it for documentation with a Minimum Criteria Checklist under SEPA guidelines.
� 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 C•' No
2b. Is this an after-the-fact permit application?*
C' Yes �' No
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 quality?*
C' Yes �' No
3b. If you answered "no," provide a short narrative description.
I Project is replacing and existing bridge structure on ewsting alignment. No additional roadway lanes or expansion
of traffic volume capacity will occur.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project? *
C' Yes C' No C' f�/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? *
C' Yes C' No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
�' Yes C' No
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. Is another Federal agency involved?*
C' Yes C•' No
5e. Is this a DOT project located within Division's 1-8?*
C� Yes C' No
[' Unknown
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
USFWS - County listing for Perquimans County, Project is located in an area that is considered habitat for the
Northern Long Eared Bat. NCDOT is operating under the Programmatic Agreement with the USFWS for the
Northern Long Eared Bat.
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
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
NMFS listing of EFH
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 C•' No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
SHPO review
7c. Historic or Prehistoric Information Upload
C7ick the upload button or drag and drop files here to attach docurrent
16-09-0017NoSu rveyReq. pdf 3.5MB
PA 16-09-0017 Perquimans (NSR).pdf 6.34M6
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8. Flood Zone Designation (Corps Requirement)
i Link to the FEMA Floodplain Maps: https://msc.fema.gov/portal/search
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
�' Yes l" No
8b. If yes, explain how project meets FEMA requirements:
Project has be designed by licensed hydraulic engineers following Fema coordination and guidelines
8c. What source(s) did you use to make the floodplain determination?*
FEMAfloodplain maps

Miscellaneous
Miscellaneous attachments not previously requested.
Qick the upload button or drag and drop files here to attach docurrent
NCDMF_moratorium.pdf 286.62KB
Fle rrust be FDF or IWQ
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:*
Clay Willis
Signature
C'.r.�� �r�rr�r
I Date Submitted:
6/1 /2018
Initial Review
Is this project a public transportation project? *(?)
C� Yes C' No
Change only if needed.
Has this project met the requirements for acceptance in to the review process?*
C� Yes
C' No
BIMS # Assigned*
20180755
Version#*
1
Reviewing Office *
Washington Regional Office - [phone]
Select Project Reviewer*
Garcy Ward:eads\gpward
Is a payment required for this project?*
C�' No payment required
C' Fee received
C' Fee needed - send electronic notification