20180923 Ver 1_PCN Form Submission_20180703

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 7/3/2018 8:52:12 AM (Start Event)
Accept by Carpenter,Kristi 7/3/2018 3:48:12 PM (DOT Initial Review)
. The task was assigned to Carpenter,Kristi. The due date is: July 6, 2018 5:00 PM 7/3/2018 8:53 AM

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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 beloware 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:*
Northampton
Is this project a public transportation project?*
C Yes l' No
lhis is any publicly funded by rrunicipal,state or federal funds road, rail, airport transportation project.
Is this a NCDOT Project?*
f• Yes r No
(NCDOT only) T.I.P. or state project number:
WBS #
17BP.1. R.80
(for �ICDOT use only)
1a. Type(s) of approval sought from the Corps:*
fJ 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?*
fJ Nationwide Permit (NWP)
r Regional General Permit (RGP)
r 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
NWP Number Other:
List all MNnurrbers you are applying for not on the drop down list.
1c. Type(s) of approval sought from the DWR:*

check all that apply
r% 401 Water Quality Certification - Regular r 401 Water Quality Certification - Express
r Non-404 Jurisdictional General Permit r Riparian Buffer Authorization
r Individual Permit
*
1d. Is this notification solelyfor the record because written approval is not required?
For the record onlyfor DWR 401 Certification: C' Yes C' No
For the record onlyfor Corps Permit: C' Yes f' 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 a- in-lieu fee program
l" Yes f' No
1f. Is the project located in anyof NC's twentycoastal counties?*
f Yes C•' No
1h. Is the project located in a designated trout watershed?*
C' Yes C No
Link to trout information: http://�wvw.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Agency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact?*
Paul Williams
1b. PrimaryContact Email:*
pcwi I I i a ms2 @n cd ot. g ov
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
r Owner r7 Applicant (other than owner) r Agent/Consultant
(Check all that apply)
2. Owner Information
2a. Name(s) on recorded deed:
NCDOT Right-of-Way SR 1300 - Northampton County
2b. Deed book and page no.:
2c. Responsible party:
(for Corporations)
2d. Address
Street Address
Address Line 2
a�y
Fbstal / Zip Code
2e. Telephone Number:
(xxx)xxx-xxxx
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
State / Fhovince / I�gion
Country

[e-mail]
3. Applicant Information (if different from owner)
3a. Applicant is:
C' Agent
G Other �u�� ��������� � ����������������a��N���a����
If other please specrfy.
3b. Name:
Paul Williams
3c. Business Name:
(if applicable)
NC Department of Transportation - Division 1
3d. Address
Street Address
113 Airport Dr.
Address Line 2
a�y
Edenton
Fbstal / Zip Code
27932
3e. Telephone Number:
[phone]
(xxx)xxx-xxxx
3f. Fax Number:
[phone]
(xxx)xxx-xxxx
3g. Email Address:*
[e-mail]
State / Rovince / I�gion
NC
Country
USA
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Northampton Bridge #49 Replacement Project
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Pleasant Hill, NC
1d. Driving directions*
IF it is a new project and can not easily be found in a GPS rrapping system Rease provide directions.
The bridge is located on SR 1300 Big John's Store Road, appro�amately 1 mile west of SR 1317.
2. Project Identification
2a. Propertyldentification Number:
(tax RN or parcel ID)
2b. Propertysize:
(in acres)

2c. Project Address
Street Address
Address Line 2
aty
Pleasant Hill
Fbstal / Zip Code
27866
2d. Site coordinates in decimal degrees
State / FYovince / F�gion
NC
Cauntry
USA
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 how the 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: *
36.5129
ex:34208504
3. Surface Waters
Longitude:*
-77.5061
-77.796371
3a. Name of the nearest body of water to proposed project:*
Corwells Millpond
3b. Water Resources Classification of nearest receiving water:*
C;NSW
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Chowan
RiverBasin Lookup
4. Project Description
4a. Describe the existing conditions on the site and the general land use in the vicinityof the project at the time of this application:*
Project area consists of NCDOT Northampton County SR 1300 and Bridge #49. The general land use in the
vicinity is wooded, rural residential, and agricultural.
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)
Qick the upload button or drag and drop files here to attach docurrent
Bridge#49_Northampton.pdf 1.26MB
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)
aick the upload button or drag and drop files here to attach docurrem
Soil_Map.pdf 1.2MB
Fle type rrust be pdF
4d. List the total estimated acreage of all existing wetlands on the property:
.5
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
75
4f. Explain the purpose of the proposed project:*
Replace deteriorating Bridge #49 and maintain a stable road way along SR 1300 for the safety of the traveling
public.

4g. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:'�
The e�sting 2-span 35' L x 24.7' W timber bridge will be removed and replaced with the proposed 2-span 60' L X
30' W concrete cored slab bridge. The project will result in 0.01 acres of permanent fill in wetlands and 10 linear ft.
of permanent stream impacts from bank stabilization of ditch realignment. This work will be accomplished using
cranes, track excavators, backhoes, and dump trucks.
4h. Please upload project drawings for the proposed project.
Qick the upload button or drag and drop files here to attach docurrent
Permit Drawings.pdf 1.94MB
Fle type rrust be pdF
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
C•' Yes f' No C' Unknown
Comme nts:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
C•' Preliminary C' Approved C' Unknown C' f�UA
Corps AID Number:
6carrple: SAV�2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:
Paul Williams
NCDOT
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5d7. Jurisdictional determination upload
Qick the upload button or drag and drop files here to attach docurrem
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?*
f Yes r No �' Unknown
7. Future Project Plans
7a. Is this a phased project?*
f Yes l•' 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 Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
rJ Wetlands fJ 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* 2d. Wetland name *2e. 2f. Type of 2g. Impact
Forested* Jurisdicition* area*
Pocket B- fill slope P Riverine Swamp Pocket B Yes Corps 0.010
N�p label (e.g. R�ad Qossing 1- Qilvert, F2rrranent (� or Forest (404, 10) or D✓VR(401, (acres)
dewatering etc) Terrporary (� other) i
2g. Total Temporary Wetland Impact
0.000
2g. Total Permanent Wetland Impact
0.010
2g. Total Wetland Impact
0.010
2h. Comments:
See Impacts Summary in permit drawings.
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. Reason for impact*3b.lmpact 3c. Type of impact*3d. Stream name * 3e. Stream 3f. Type of 3g. Stream 3h. Impact sqfe�
type * Type * Jurisdiction * width * length *
S1 Bank stabilization P Stabilization Corwells Millpond Perennial Corps 25 10 2
for realigned F�rrranerit (Fj or F2rennial (F9� or Average (linearfeet) 5
roadside ditch Terrporary (� interrrdtent (IfVn (feet) �
N�p label (e.g. 13�ad Qossing
1)
"All Perennial or Intermittent streams must be verified by DWR or delegated local government.
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
10
3i. Total temporary stream impacts:
0
3i. Total stream and tributary impacts:
10
3j. Comments:
See Impacts Summary in permit drawings.
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:*
Bridge replacement will stay on the ebsting alignment and traffic will be detoured around the site by using an
offsite detour. This will reduce temporary impacts to open waters and wetlands by not utilizing an on-site detour
and keeping the road open.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*

NCDOT BMP's will be followed during bridge removal/installation and erosion control devices will be installed to
prevent sediment loss from the project site.
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?
f Yes �' No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
Impacts are belowthe threshold requiring mitigation.
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?
C' Yes C•' No
For a list of options to meet the diffuse flow requirements, click here.
If no, explain why:
Chowan River Basin not covered by NC Riparian Buffer Protection Rules.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250? *
f• 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? �`
l•' Yes f" 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
Comme nts: *
Activity and impacts covered by Minimum Criteria Checklist.
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15A NCAC 2H .0500), Isolated Wetland Rules (75A NCAC 2H .7300), or
DWR Surface Water or Wetland Standards or Riparian Buffer Rules (15A NCAC 2B .0200)?*
f Yes �' No
2b. Is this an after-the-fact permit application?*
f Yes r 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 qualit�/?*

r Yes r No
3b. If you answered "no," provide a short narrative description.
Project replaces an ebsting bridge with a bridge.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
C' Yes f" No f' N/A
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or habitat? *
C' Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
f Yes r No
5d. Is another Federal agency involved?*
C' Yes f•' No
5e. Is this a DOT project located within Division's 1-8?*
C Yes C' No
C' Unknown
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
NC Natural Heritage Data E�Iorer Website
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
C' Yes C•' No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat? *
National Marine Fisheries Database
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 history and archaeology)?*
f• Yes �' No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources? *
NCDOT Cultural Resources
7c. Historic or Prehistoric Information Upload
Qick the upload button or drag and drop files here to attach docurrent
16-08-0038_NHPA.pdf 3.95MB
AR16-08-0038NoSurvey.pdf 1006.56KB
Fle rrust be FDF
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?*
C Yes l" No

8b. If yes, explain how project meets FEMArequirements:
FEMA Approved
8c. What source(s) did you use to make the floodplain determination?*
NC DOT Hydraulics Unit - Zone AE
Miscellaneous
Miscellaneous attachments not previously requested.
Qick the upload button or drag and drop files here to attach docurrent
WRC_Bridge Replacements 2016-08-29 D-1.pdf 206.97KB
Site Photos.pdf 4.59MB
Fle rrust be FDF or KfVQ
Signature
�7 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:*
Paul Collins Williams, Jr.
Signature
�,7'�nc/C'r�/�r• I�J//r�v�rr.r, r�%`r.
Date Submitted:
7/3/2018
Initial Review
Is this project a public transportation project?* (')
G' Yes C' No
C�ange only 'rf needed.
Has this project met the requirements for acceptance in to the review process? *
G' Yes
C' No
BIMS # Assigned *
20180923
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