20190352 Ver 1_PCN Form Submission_20190320

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 *
20190352
Is a payment required for this project?*
f No paymentrequired
� Fee received
f Fee needed - send electronic notification
Select Project Reviewer"
Dave Wanucha:eads\djwanucha
Information for Initial Review
1a. Name of project:
Caldwell Bridge #115
1a. Who is the PrimaryContact?*
Heath Slaughter
1b. PrimaryContact Email:*
[e-mail]
Date Submitted
3/20/2019
Nearest Body of Water
Greasy Creek
Basin
Catawba
Water Classification
C
Site Coordinates
Latitude:
35.905745
A. Processing Information
County (or Counties) where the project is located:
Caldwell
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:
Ve rsion# *
1
Reviewing Office *
Winston-Salem Regional Office - (336) 776-
9800
1c. PrimaryContact Phone:*
[phone]
Longitude:
-81.566545
::
WBS # (�)
17BP.11.R.183
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?
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
Caldwell #115, Mitigation.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
801 Statesville Road
Address Line 2
�Y
North Wilkesboro
Fbstal / Zip Code
28659
2e. Telephone Number:
[phone]
S[ate / FYovince I Region
NC
Cauntry
USA
2f. Fax Number:
67.48KB
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:
Lenoir
2. Project Identification
2a. Property Identification Number:
2c. Project Address
Street Address
Address Line 2
ary
Postal I Zip Code
2b. Property size:
State / Aovince / Region
Country
3. SurFace Waters
3a. Name of the nearest body of water to proposed project:*
Greasy Creek
3b. Water Resources Classification of nearest receiving water:*
C
3c. What river basin(s) is your project located in?*
Catawba
3d. Please provide the 12-digit HUC in which the project is located.
030501010702
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:*
Bridge replacement project in an urban/residential area.
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 11 excerpt from the most recent version of the USGS topogrephic map indicating the location of the project site. (for DWR)
Caldwall #115 Topo.pdf 1.79MB
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:
0
4g. List the total estimated linear feet of all existing streams on the property:
120
4h. Explain the purpose of the proposed project:*
Bridge Replacement.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
See attached cover letter.
4j. Please upload project drawings for the proposed project.
130115_Final Permit_Drawings.pdf 16.15MB
5. Jurisdictional Determinations
Sa. Have the wetlands or streams been delineated on the property or proposed impact areas?*
� Yes r No r Unknown
Comments:
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:
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Heath Slaughter
Agency/Consultant Company:
Other:
Sd1. Jurisdictional determination upload
6. Future Project Plans
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�/i
No
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
� Wetlands 17 Streams-tributaries � Buffers
r' Open Waters � Pond Construction
3. Stream Impacts
�
❑ 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*
Road Crossin Permanent Fill UT to Greas Creek Perennial Both 4 40
S1 9 Y
Average (feet) pinear feet)
32 Road Crossing Permanent Bank Stabilization Greasy Creek Perennial Both 10 26
Average (feet) (linear feet)
S3 Road Crossing Temporary Dewatering Greasy Creek Perennial Both 10 30
Average (feet) (linear feet)
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts: 3i. Total temporary stream impacts:
66 30
3i. Total stream and ditch impacts:
96
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:
Replacing bridge with bridge.
16. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
See attached cover letter.
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
2c. If yes, mitigation is required by (check all that apply):
r DWR 17 Corps
2d. If yes, which mitigation option(s) will be used for this project?
n�

r Mitigation bank fJ 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.
f• Yes r No
4b. Stream mitigation requested:
(linear feet)
40
4d. Buffer mitigation requested (DWR only):
(square feet)
4f. Non-riparian wetland mitigation requested:
(acres)
4h. Comments
4c. If using stream mitigation, what is the stream temperature:
warm
4e. Riparian wetland mitigation requested:
(acres)
4g. Coastal (tidal) wetland mitigation requested:
�acres)
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?
l' Yes r No
If no, explain why:
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
r Yes r No
Comments:
G. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federallstate) land?*
r 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)? *
� Yes r No
Comments:
x
MCDC
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 (15ANCAC 2B .0200)? *
C' 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.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
C' Yes r No r fWA
5. Endangered Species and Designated Critical Habitat (Corps Requirement)

Sa. Will this project occur in or near an area with federelly protected species or habitat?*
� Yes r No
Sb. Have you checked with the USFWS concerning Endangered Species Act impacts?*
C' Yes r No
5d. Is another Federal agency involved?*
r Yes r No
What Federal Agency is involved?
Corps
Se. Is this a DOT project located within Division's 1-8?
C' Yes r No
5f. Will you cut anytrees in order to conduct the work in waters of the U.S.?
r Yes r No
Sg. Does this project involve bridge maintenance or removal?
F Yes r No
5g(1). If yes, have you inspected the bridge for signs of bat use such as staining, guano, bats, etc.?
� Yes r No
If you answered "Yes" to 5g(1), did you discover any signs of bat use?
f Yes r No r Unknown
5h. Does this project involve the construction/installation of a wind turbine(s)?*
C' Yes r No
r 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.?
F 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.
Sj. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
NHP and visual observation
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?"
� Yes r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
NOAA
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?*
Project was reviewed by HEU.
7c. Historic or Prehistoric Information Upload
130115 17-06-0006_NoSurveyReq.pdf 2.07MB
Caldwell 115 No Survey form.pdf 527.62KB
8. Flood Zone Designation (Corps Requirement)
Sa. Will this project occur in a FEMA-designated 100-year floodplain? *
C' Yes r No
Sc. What source(s) did you use to make the floodplain determination?*
Above Link
Miscellaneous
Comments
Mechanized pile driving is likely.
Miscellaneous attachments not previously requested.
NHP project_report_caldwell_bridge_115.pdf 756.35KB
Caldwell #115, Letter.pdf 942.91 KB

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, 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:
Heath Slaughter
Signature
��r�� Q 5'larr�«�t
Date
3/20/2019