20190104 Ver 1_PCN Form Submission_20190123

D1�VR
�irlslan af Water Resources
Initial Review
Pre-Construction Notification (PCN) Form
September 29, 2018 Ver 3
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 *
20190104
Is a payment required for this project?*
f No paymentrequired
� Fee received
f Fee needed - send electronic notification
Select Project Reviewer"
Garcy Ward:eads\gpward
Information for Initial Review
1a. Name of project:
B-4916 Replacement of Bridge No. 57 over Quioccoson Swamp on US 13 (Central)
1a. Who is the PrimaryContact?*
Gordon Cashin
1b. PrimaryContact Email:*
[e-mail]
Date Submitted
1 /23/2019
Nearest Body of Water
Quioccoson Swamp
Basin
Chowan
Water Classification
C; NSW
Site Coordinates
Latitude:
36200622
A. Processing Information
County (or Counties) where the project is located:
Bertie
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:
B-4916
WBS # (�)
40089.3.1
1a. Type(s) of approval sought from the Corps:
Longitude:
-76.950994
Ve rsion# *
1
Reviewing Office *
Washington 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:
23 - Categorical Exclusions
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
1e. Is this notification solelyfor the record because written approval is not required?
Forthe record onlyfor DWR401 Certification:
For the record onlyfor Corps Permit:
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?
� Yes r No
1i. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
� Yes r No r Unknown
1j. Is the project located in a designated trout watershed?
C' 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?
C' 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
1000 Birch Ridge Drive
Address Line 2
�ty
Raleigh
Postal / Zip Code
27610
r 401 Water Quality Certification - E�ress
r Riparian Buffer Authorization
S[ate / Awince I Region
NC
Country
USA
x
C' Yes R No
C' Yes G No

2e. Telephone Number:
[phone]
2g. Email Address:*
gcashin@ncdotgov
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(rf appropriate)
1 c. Nearest municipality / town:
Powellsville
2. Project Identification
2a. Propertyldentification Number:
2c. Project Address
Street Address
Address Line 2
�ty
Postal / Zip Code
3. SurFace Waters
3a. Name of the nearest body of water to proposed project:"
Quioccoson Swamp
3b. Water Resources Classification of nearest receiving water:*
C; NSW
3c. What river basin(s) is your project located in?*
Chowan
3d. Please provide the 12-digit HUC in which the project is located.
030102030303
4. Project Description and History
2f. Fax Number:
2b. Propertysize:
State / Fovince I Region
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:*
The project is in a rural area of Bertie County. Land use in the project vicinity consists of agriculture, forestland along stream corridors, and low density rural residences.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
C' Yes r No C' Unknown
4d. 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)
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)
4f. List the total estimated acreage of all existing wetlands on the property:
1.87
4g. List the total estimated linear feet of all existing streams on the property:
200
4h. Explain the purpose of the proposed project:*
Replacement of a substandard bridge.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
The bridge will be replaced on the existing alignment. Traffic will be maintained using an on-site detour during construction. The onsite temporary detour will be south of the existing
bridge. Standard road building equipment will be used.
4j. Please upload project drawings for the proposed project.
B4916 utilities.pdf 1.12MB
B-4916 permit drawings.pdf 3.3MB
5. Jurisdictional Determinations
_;
�
Sa. Have the wetlands or streams been delineated on the property or proposed impact areas?*
f• Yes �' No r Unknown

Comments
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
C' Preliminary r Approved C' Not Verified � Unknown C' WA
Corps AID Number:
Sc. If Sa is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
Sd1. Jurisdictional determination upload
6. Future Project Plans
Veronica Barnes and Tyler Stanton
NCDOT staff
6a. Is this a phased project?*
� 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�/i
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
CJ Wetlands r Streams-tributaries
fJ Open Waters I� Pond Construction
2. Wetland Impacts
r Buffers
2g. Total Temporary Wetland Impact 2g. Total Permanent Wetland Impact
0.313 0.064
2g. Total Wetland Impact
0.377
2h. Comments:
Utility relocations will require an additional 028 acre of hand dearing. A portion of this hand clearing will occur in the temporary detour area.
4. Open Water Impacts
Site # I4a1. Impact Reason
replacement
Impact type II4c. Name of waterbody
Activitytype I�4e. Waterbodytype
Impact area
Swamp
Bridge

4g. Total temporary open water Impacts: 4g. Total permanent open water impacts:
0.01 0.00
4g. Total open water impacts:
0.01
4h. Comments:
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:
The bridge will be replaced on the exsting alignment, and 3:1 slopes are used adjacent to wetlands.
1b. Specificallydescribe measures taken to avoid or minimize the proposed impacts through construction techniques:
Best Management Practices for Construction and Maintenance Activities will be adhered to. The temporary detour excavation/fill will be restored to
pre-construction contours and then replanted.
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:
Permanent impacts are minimal.
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?
f Yes r No
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
� Yes r No
Comments:
G. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federallstate/local) funds or the use of public (federallstate) 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)?*
G Yes r No
1c. If you answered "yes" to the above, has the document review been finalized by the State Clearing House?*
f• Yes r No
NEPAor SEPAFinal Approval Letter
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)? *
f Yes r No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality?*
� Yes r No
3b. If you answered "no," provide a short narrative description.

Due to the minimal transportation impact resulting from this bridge replacement, this project will neither influence nearby land uses nor stimulate
grow[h. Therefore, a detailed indirect or cumulative effects study �nnll not be necessary.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
f Yes r No � fWA
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?*
� Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
� Yes r No
Sc. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
Sd. Is another Federal agency involved?*
C' Yes r No
Se. Is this a DOT project located within Division's 1-8?
� Yes r No
C' Unknown
S. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
USFWS County list, GIS data, site visits.
Consultation Documentation Upload
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
C' Yes r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
NOAA online database
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 status? *
C' Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
NEPA documentation
7c. Historic or Prehistoric Information Upload
8. Flood Zone Designation (Corps Requirement)
Sa. Will this project occur in a FEMA-designated 100-year floodplain? *
G Yes �' No
8b. If yes, explain how project meets FEMA requirements:
Hydraulics Unit coordination with FEMA.
Sc. What source(s) did you use to make the floodplain determination7*
FEMAfloodplain mapping.
Miscellaneous
Comments
Miscellaneous attachments not previouslyrequested.
Signature
*
�J 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, Artide 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:
Mack Christopher Rivenbark, III
Signature
X� e. �i,�6�.111
Date
1 /23/2019