20190233 Ver 1_PCN Form Submission_20190225

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 *
20190233
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:
17BP.10.R.107
1a. Who is the PrimaryContact?*
Larry Thompson
1b. PrimaryContact Email:*
[e-mail]
Date Submitted
2/25/2019
Nearest Body of Water
Polecat Creek
Basin
Yadkin-PeeDee
Water Classification
C: Aquatic Life, Secondary Recreation, Fresh Water
Site Coordinates
Latitude:
34.854215
A. Processing Information
County (or Counties) where the project is located:
Union
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:
WA
WBS # (�)
17BP.10.R.107
1a. Type(s) of approval sought from the Corps:
Ve rsion# *
1
Reviewing Office *
Mooresville Regional Office - [phone]
1c. PrimaryContact Phone:*
[phone]
Longitude:
-80.601333
::

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:
03 - Maintenance
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:
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?
F 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
SR 2169 - Bridge 159 - Division 10 - STR - YD 202 (SIP).pdf
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?
rJ Owner r Applicant (other than owner)
1e. Is there an Agent/Consultant for this project?
� 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
716 W. Main Street
Address Line 2
�Y
Albemarle
Fbstal / Zip Code
28001
2e. Telephone Number:
[phone]
S[ate / FYovince I Region
NC
Cauntry
USA
2f. Fax Number:
74.66KB
x
C' Yes R No
C' Yes G No
�,

2g. Email Address:*
[e-mail]
C. Project Information and Prior Project History "
1. Project Information
1b. Subdivision name:
(rf appropriate)
1c. Nearest municipality/town:
Waxhaw, NC
2. Project Identification
2a. Propertyldentification Number:
2c. Project Address
Street Address
Bridge No. 159 on SR 2169 over Polecat Creek, 0.8 miles west of SR 2146 (Plyler Mill Road)
Address Line 2
�Y
Postal I Zip Code
2b. Property size:
12
State / Rovince I f�gion
NC
Country
USA
3. SurFace Waters
3a. Name of the nearest body of water to proposed project:*
Polecat Creek
3b. Water Resources Classification of nearest receiving water:*
C: Aquatic Life, Secondary Recreation, Fresh Water
3c. What river basin(s) is your project located in?*
Yadkin-PeeDee
3d. Please provide the 12-digit HUC in which the project is located.
030402020102
4. Project Description and History
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:*
Project 17BP.10.R.107 proposes to replace Bridge No. 159 (Union Bridge) on SR 2169 (Prospect Road) over Polecat Creek in Union County, North Carolina. The purpose of the
proposed project is to replace a deficient and funciionally obsolete bridge. The latest inspection report, performed in August of 2014, dassifies the condition of Bridge No. 159 as "fair."
The bridge replacement will be constructed on the same location and alignment using an offsite detour. The current bridge is small, and the replacement is likely to be larger in width.
The proposed length of the new bridge is 500 feet.
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)
17BP10R107 USGS Quad Map.pdf
1.05 MB
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)
17BP10R107_Soil_Map.pdf
280.84KB
4f. List the total estimated acreage of all existing wetlands on the property:
02
4g. List the total estimated linear feet of all existing streams on the property:
606
4h. Explain the purpose of the proposed project:*
The project proposes to replace Bridge No. 159 on SR 2169 (Prospect Road) in place over Polecat Creek in Union County due to the existing bridge being deficient and functionally
obsolete.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
The new bridge will overlap the e�sting facility and will be constructed over previously disturbed soils. Additional right-of-way (ROW) and a temporary construction easement will be
required. The proposed project consists of the following components:
1. Reconstruct approwmately 0.08 miles of roadway to connect to newly replaced bridge.
2. Reconstruct appropmately 0.02 miles of bridge over Polecat Creek.
3. Reconstruct the road at-grade to accommodate the modifications to the replaced bridge.
4. Reconstruct the drainage system to accommodate the modifications of the replaced bridge and reconstructed road.
4j. Please upload project drawings for the proposed project.

17BP10R107_Permit Package Wetland 20181220.pdf
5. Jurisdictional Determinations
1.51 MB
Sa. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes r No C' Unknown
Comments:
Sb. If the Corps made a jurisdictional determination, what type of determination was made?*
r Preliminary r Approved C' Not Verified C' Unknown C' WA
Corps AID Number:
SAW-2018-01931
Sc. If Sa is yes, who delineated the jurisdictional areas7
Name (if known): Chris Sheats
Agency/Consultant Company: Three Oaks Engineering
Other:
Sd. List the dates of the Corp jurisdiction determination or State determination if a determination was made by the Corps or DWR
10/15/18
Sd1. Jurisdictional determination upload
17BP10R107 SAW-2018-01931 PJD SIGNED.pdf 996.SKB
6. Future Project Plans
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�/?
There are no other NWPs, RGPs, or IPs used or intended to be used to authorize any part of the proposed project.
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
r Wetlands 117 Streams-tributaries � Buffers
� Open Waters I� Pond Construction
3. Stream Impacts
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts: 3i. Total temporary stream impacts:
88 0
3i. Total stream and ditch impacts:
88
3j. 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:
Project plans were designed to minimize impacts. No deck drains will be used on this structure, reducing stream pollution associated with roadway
runoff. Additional measures implemented to reduce impacts to the stream and surrounding properties include, maintaining existing drainage patterns,
using special lateral'V' ditches, and using 3:1 fill slopes and discharging stormwater runoff as far away from the stream as is practicable. Further, rip
rap is used at drainage outlets to dissipate energy and reduce erosion.
1b. Specificallydescribe measures taken to avoid or minimize the proposed impacts through construction techniques:
Typical sediment and erosion control measures will be taken on site. Temporary special stilling basins and temporary rock sediment dams will be
utilized to prevent sediment from entering the stream.
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?
G Yes r No
2c. If yes, mitigation is required by (check all that apply):
fJ DWR �J Corps
2d. If yes, which mitigation option(s) will be used for this project?
r Mitigation bank rJ Payment to in-lieu fee I� Permittee Responsible
program Mitigation
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached.
� Yes r No
4b. Stream mitigation requested:
(linear feet)
4d. Buffer mitigation requested (DWR only):
(square feet)
4f. Non-riparian wetland mitigation requested:
(aores)
4h. Comments
4c. If using stream mitigation, what is the stream temperature:
4e. Riparian wetland mitigation requested:
(acres)
4g. Coastal (tidal) wetland mitigation requested:
(aores)
6. Buffer mitigation (State Regulated Riparian Buffer Rules) - required by DWR
6a. Will the project result in an impact within a protected riparian buffer that requires buffer mitigation? If yes, you must fill out this entire form - please contact DWR for more
information.
C' Yes r No
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?
C' Yes r No
If no, explain why:
This project is located in the Yadkin — PeeDee River Basin�.. therefore, streamside riparian zones within the study area are not currently protected under provisions of any Riparian
Buffer Rules administered by NCDWR.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
C' Yes r No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?
F 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?*
F 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)
Environme ntal Policy Act (NEPAISEPA)? *
r Yes r No
1c. If you answered "yes" to the above, has the document review been finalized by the State Clearing House?*
G Yes r No
NEPAor SEPAFinal Approval Letter
VBP10R107 FINAL MCDC - Signed.pdf
2. Violations (DWR Requirement)
9.37MB
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?'�
f Yes r No
3b. If you answered "no," provide a short narrative description.
The proposed project is replacing an existing bridge, so impacts are limited to only those necessary for adequate bank stabilization for the
replacement structure. No additional development is anticipated as a result of the project.
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)
5a. Will this project occur in or near an area with federally protected species or habitat? *
� Yes r No
Sb. Have you checked with the USFWS concerning Endangered Species Act impacts?*
C' Yes r No
Sd. Is another Federal agency involved?*
C' Yes � No
Se. Is this a DOT project located within Division's 1-8?
f Yes r No
Sf. Will you cut anytrees in order to conduct the work in waters of the U.S.?
C' Yes r No
Sg. Does this project involve bridge maintenance or removal?
� Yes r No
Sg(1). If yes, have you inspected the bridge for signs of bat use such as staining, guano, bats, etc.?
r Yes r No
If you answered "Yes" to Sg(1), did you discover any signs of bat use?
� Yes r No � Unknown
Sh. Does this project involve the construction/installation of a wind turbine(s)?*
C' Yes r No
r Unknown
Si. Does this project involve (1) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhammers, mechanized pile drivers, etc.?
� Yes r No
If yes, please provide details to include type of percussive activity, purpose, duration, and specific location of this activity on the property.
17BP10R107 Supplementary Information for PCN.pdf 88.18KB
Sj. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
US Fish and Wildlife Service (USFWS) Threatened and Endangered Species in North Carolina: Union County was used to determine that the site
wnuld not impact Threatened and Endangered Species or Critical Habitat.
Consultation Documentation Upload
17BP10R107_Union_FINAL_NRTM_October 2018.pdf
6. Essential Fish Habitat (Corps Requirement)
62MB
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?*
United States Geological Survey (USGS) Tradesville, North Carolina, Topographic Quadrangle (124,000 scale) was used to determine that the
project site is not Essential Fish Habitat.
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?*
A review of HPO quad maps, HPO GIS information, historic designations roster, and indexes was used to determine impacts on historic resources.
Based on the review, there were are no ewsting historical properties in the Area of Potential Effects (APE). The Historic Architecture and Landscapes
No Survey Required form was signed on April 27, 2018 by the NCDOT Architectural Historian.
A review of USGS maps, Union County soil survey, aerial photography, GIS data, and archaeological mapping at the Office of State Archaeology was
used to determine impacts on archaeological resources. Based on the review, it was determined that the context doesn't indicate a high probability for
archaeological sites �nnthin the small, altered APE. The No Archaelogical Survey Required form was signed on October 12, 2018 by the NCDOT
Archaeologist.
7c. Historic or Prehistoric Information Upload
17BP10R107 PA 18-04-0016 No Archaeological Survey Required Form Br No 159 SR 2169 over Pole Cat Cr
455.76KB
Union.pdf
17BP10R107 18-04-0016NoSurveyReq.pdf 2.63MB
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?"
� Yes r No
Sc. What source(s) did you use to make the floodplain determination?*
FEMA Rood Map Service Center
Miscellaneous
Comments
Miscellaneous attachments not previouslyrequested.
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 thls 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 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:
Larry Thompson
Signature
�irt tJ �/lrrrr�o�r
Date
2/25/2019