20181652 Ver 1_PCN Form Submission_20181205

D1�VR
�irlslan af Water Resources
Pre-Construction Notification (PCN) Form
September 29, 2018 Ver 3
Initial Review
Has this project met the requirements for acceptance in to the review process?*
F Yes
C' No
Is this project a public transportation project?"
� Yes r No
Change only rf needed.
BIMS # Assigned *
20181652
Is a payment required for this project?*
f No paymentrequired
� Fee received
f Fee needed - send electronic notification
Select Project Reviewer"
Donna Hood:eads\drhood
Information for Initial Review
1a. Name of project:
Replacement of Bridge #309 on SR 1627 (Pruett Road), Cleveland County
1a. Who is the PrimaryContact?*
Trish Beam
1b. PrimaryContact Email:*
[e-mail]
Date Submitted
12/5/2018
Nearest Body of Water
Bald Knob Creek
Basin
Broad
Water Classification
C
Site Coordinates
Latitude:
35.523613
A. Processing Information
County (or Counties) where the project is located:
Cleveland
Is this project a public transportation project?*
r Yes r No
Is this a NCDOT Project?*
G Yes r No
(NCDOT only) T.I.P. or state project number:
WBS # (�)
17BP.12.R.58
1a. Type(s) of approval sought from the Corps:
Longitude:
-81.599957
Ve rsion# *
1
Reviewing Office *
Mooresville Regional Office - [phone]
1c. PrimaryContact Phone:*
[phone]

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?
fJ Nationwide Permit (NWP)
r Regional General Permit (RGP)
r Standard (IP)
1c. Has the NWP or GP number been verified bythe Corps?
C' Yes r No
Nationwide Permit (NWP) Number:
NWP Numbers (for multiple NWPS):
1d. Type(s) of approval sought from the DWR:
fJ 401 Water Quality Certification - Regular
r' Non-404 Jurisdictional General Permit
r Individual Permit
03 - Maintenance
1e. Is this notification solelyfor the record because written approval is not required?
Forthe record onlyfor DWR401 Certification:
For the record onlyfor Corps Permit:
r 401 Water Quality Certification - E�ress
r Riparian Buffer Authorization
1f. Is this an after-the-fact permit application?*
� Yes r No
1g. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
C' Yes r No
1g. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
� Yes r No
Acceptance LetterAttachment
1h. Is the project located in any of NC's twenty coastal counties?
C' Yes r No
1j. Is the project located in a designated trout watershed?
� Yes r No
B. Applicant Information
1d. Who is applying for the permit?
fJ Owner r Applicant (other than owner)
1e. Is there an Agent/Consultant for this project?
f Yes r No
2. Owner Information
2a. Name(s) on recorded deed:
NCDOT
2b. Deed book and page no.:
2c. Responsible party:
2d. Address
Street Address
1710 East Marion Street
Address Line 2
�Y
Shelby
Fbstal / Zip Code
28151
2e. Telephone Number:
[phone]
2g. Email Address:*
State / Aovince I F�gion
NC
Country
United States
2f. Fax Number:
[phone]
x
C' Yes R No
G Yes C' No

[e-mail]
C. Project Information and Prior Project History " I
1. Project Information
1b. Subdivision name:
(rf appropriate)
1c. Nearest municipality/town:
Casar
2. Project Identification
2a. Property Identification Number:
2c. Project Address
Street Address
Address Line 2
ary
Fbstal I Zip Code
3. SurFace Waters
3a. Name of the nearest body of water to proposed project:*
Bald Knob Creek
3b. Water Resources Classification of nearest receiving water:*
C
3c. What river basin(s) is your project located in?*
Broad
3d. Please provide the 12-digit HUC in which the project is located.
030501050605
4. Project Description and History
2b. Property size:
State / Aovince / Re3ion
Country
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 bridge on paved secondary road. Land us in vicinity is mostly cropland and pasture.
46. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
f Yes �' No r Unknown
4d. Attach an 8 1/2 X 77 excerpt from the most recent version of the USGS topogrephic map indicating the location of the project site. (for DWR)
topo.pdf 128.17KB
4e. 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)
soil_map. pdf 444.97KB
4f. List the total estimated acreage of all existing wetlands on the property:
0.50
4g. List the total estimated linear feet of all existing streams on the property:
200
4h. Explain the purpose of the proposed project:*
To replace a deteriorating bridge for the safety of the traveling public
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
NCDOT proposes to replace an exsting three span 90-foot long timber deck bridge with a single span 90 ft long prestressed concrete channel bridge on SR 1627 (Pruett Road) in
Cleveland County. NCDOT proposes to place 58 feet of rip rap bank stabilization under the bridge. The bridge construction will also require the hand clearing of 0.03 acres of
streamside v�,�tland located under and adjacent to the existing bridge. There will be 36 feet of temporary impacts associated with the ebsting bridge end bent removal.
Equipment to be used is typical heavy construction equipment trackhoes, backhoes, cranes, etc.
4j. Please upload project drawings for the proposed project.
17BP.12.R.58_Permit drawings_20181116.pdf 1.49MB
5. Jurisdictional Determinations
Sa. Have the wetlands or streams been delineated on the property or proposed impact areas?*
G Yes �' No C' Unknown
Comments:
By NCDOT and/or consultants

Sb. If the Corps made a jurisdictional determination, what type of determination was made? *
C' Preliminary r Approved C' Not Verified C' Unknown C•' WA
Corps AID Number:
Sc. If Sa is yes, who delineated the jurisdictional areas7
Name (if known):
Agency/Consultant Company:
Other:
Sd1. Jurisdictional determination upload
6. Future Project Plans
NCDOT
6a. Is this a phased project?*
C' Yes r 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 activit�/?
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
�J Wetlands IIJ Streams-tributaries
r Open Waters Ir Pond Construction
2. Wetland Impacts
� Buffers
2a. Site #* (') 2a7 Reason (?) 2b. Impact type *(') 2c. Type of W. * 2d. W. name * 2e. Forested *�f. Type of 2g. Impact
Jurisdicition*(�) area*
1) 12+q5/12+7Z Bridge Construction P Bottomland Hardwnod Forest Wetland1 No Both 0.010
L (acres)
1 12+45/12+72 Hand Clearin T Bottomland Hard�nrood Forest Wetland1 Yes Both 0.030
L) 9 (acres)
2g. Total Temporery Wetland Impact
0.030
2g. Total Wetland Impact
0.040
2h. Comments:
Permanent fill is wetland is <0.01 acre. Wetland is partially forested (brush and small trees)
3. Stream Impacts
2g. Total Permanent Wetland Impact
0.010
❑ 3a. Reason for impact (') 3b.lmpact type * 3c. Type of impact* 3d. S. name * 3e. Stream Type * 3f. Type of 3g. S. width* 3h. Impact
(?) Jurisdiction* length*
Stabilization of bank under Permanent Bank Stabilization Bald Knob Creek Perennial Both 15 58
S1 newbfitlge Average(feet) Qinearfeet)
S2 Removal of epsting bridge Temporary Other Bald Knob Creek Perennial Both 15 36
SUpports Average(feet) Qinearfeet)
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
58
3i. Total stream and ditch impacts:
94
3j. Comments:
3i. Total temporary stream impacts:
36

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:
No direct stream discharge deck drains. The deck drains will discharge onto riprap berms below bridge. Roadway runoff is to be collected at sag
location on low side with shoulder berm gutter. Outlet at toe of fill into a 2'�' preformed scourhole.
1b. Specificallydescribe measures taken to avoid or minimize the proposed impacts through construction techniques:
Construction equipment to be operated from the stream banks
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 r No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
Timber bridge is being replaced with a concrete bridge.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
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?
� Yes r No
If no, explain why:
The bridge is not located in an area with protected riparian buffers.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
� Yes r No
Comments:
See attached stormwater management plan document
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?*
� Yes r 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)?*
f Yes r No
Comments:
x
The project is listed as a type and class of activity which qualifies as a non-major action under the minimum criteria rules; therefore, a minimum criteria
checklist was completed for the project.
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)?*
� Yes r No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality?*
C' Yes r No
3b. If you answered "no," provide a short narrative description.
Project is a minimum criteria project with little anticipated future impacts.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
f Yes r No � WA

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
Sa. Will this project occur in or near an area with federally protected species or habitat? *
F Yes r No
Sb. Have you checked with the USFWS concerning Endangered Species Act impacts?*
F Yes r No
Sc. If yes, indicate the USFWS Field Office you have contacted.
Asheville
Sd. Is another Federal agency involved?*
f• Yes r No
What Federal Agency is involved?
USACE
Se. Is this a DOT project located within Division's 1-8?
C' Yes r No
Sf. Will you cut anytrees in order to conduct the work in waters of the U.S.?
F Yes r No
Sg. Does this project involve bridge maintenance or removal?
r Yes r No
Sg(1). If yes, have you inspected the bridge for signs of bat use such as staining, guano, bats, etc.?
F Yes r No
If you answered "Yes" to 5g(1), did you discover any signs of bat use?
C' Yes r No C' Unknown
Sh. Does this project involve the construction/installation of a wind turbine(s)?*
f Yes r No
�' Unknown
Si. Does this project involve (7) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhammers, mechanized pile drivers, etc.?
C' Yes r No
Sj. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
NC Natural Heritage Database and on-site surveys. Division 12 is located in the Northem Long eared Bat, �+hiite nose syndrome area; however there
are no known hibernacula or roosting trees in any division 12 county.
Consultation Documentation Upload
bat_habitat_assessment. pdf
sig ned_NLEB_consu Itation_form. pdf
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat? *
� Yes r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat? *
Per Natural Heritage database, there are no salt marshes, oyster reefs or seagrass beds in the vicinity of the project.
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
65.11 KB
94.38KB
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?"
� Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
Cultural resources reviewand approval (Trecking No. 15-10-0011)
7c. Historic or Prehistoric Information Upload
15-10-0011 NoEligibleProps.pdf
AR15-10-0011 NoSurvey.pdf
8. Flood Zone Designation (Corps Requirement)
Sa. Will this project occur in a FEMA-designated 100-year floodplain?*
� Yes r No
3.9MB
3.59MB
Sb. If yes, explain how project meets FEMA requirements:
NCDOT hydraulic coordination
8c. What source(s) did you use to make the floodplain determination?*
NCDOT hydraulics and NC floodplain mapping site (https://fris.nagov/fris/Index.asp�FIPS=071 &ST=NC&user-General%20Public)
Miscellaneous �

Comments
Miscellaneous attachments not previously requested.
flood_map. pdf
B#309Pru ittTE. pdf
cover_letter.pdf
under_bridge.pdf
under_bridge2pdf
Signature
*
�J By checking the box and signing below, I certify that:
349.37KB
122.11 KB
81.34KB
394.35KB
420.12K6
. 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 hansaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• 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:
Trish Beam
Signature
Sign
Date
12/5/2018
�