20191387 Ver 1_PCN Form Submission_20191011

DWR
IDIOM n of Water Resources
Pre -Construction Notification (PCN) Form
September 29, 2018 Ver 3
21nitial Review
Has this project met the requirements for acceptance in to the review process?*
r Yes
r No
Is this project a public transportation project?*
G Yes r No
Change only if needed.
BIMS # Assigned * Version#*
20191387 1
Is a payment required for this project?*
r No payment required
r Fee received Reviewing Office*
r Fee needed - send electronic notification Mooresville Regional Office - [phone]
Select Project Reviewer*
Donna Fbod:eads\drhood
Information for Initial Review
1a. Name of project:
Replacement of Bridge #120 on SR 1121 (Herman Road), washed out June 1019
1a. Who is the Primary Contact?*
Trish Beam
1b. Primary Contact Email:*
[e-mail]
Date Submitted
10/11/2019
Nearest Body of Water
Spring Creek
Basin
Catawba
Water Classification
C
Site Coordinates
Latitude:
35.911291
Longitude:
-81.228273
1c. Primary Contact Phone:*
[phone]
FA. Processing Information U
County (or Counties) where the project is located:
Alexander
Is this project a public transportation project?*
r Yes r No
Is this a NCDOT Project?*
r Yes r No
(NCDOT only) T.I.P. or state project number:
WBS # (?)
17BP.12.R.95
1a. Type(s) of approval sought from the Corps:

W Section 404 Permit (wetlands, streams and waters, Clean Water Act)
r Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What types) of permit(s) do you wish to seek authorization?
W Nationwide Permit (NWP)
r' Regional General Permit (RGP)
r' Standard (IP)
1c. Has the NWP or GP number been verified by the Corps?
t' 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
F Non-404 Jurisdictional General Permit
F Individual Permit
le. Is this notification solelyfor the record because written approval is not required?
For the record only for DWR 401 Certification:
For the record only for Corps Permit:
r 401 Water Quality Certification - Express
r Riparian Buffer Authorization
1f. Is this an after -the -fact permit application?*
C 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?
C Yes t No
Acceptance Letter Attachment
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?
C Yes r No
F. Applicant Information
1d. Who is applying for the permit?
[J Owner r Applicant (other than owner)
le. Is there an Agent/Consultant for this project?
r Yes C No
2. Owner Information
2a. Name(s) on recorded deed:
NCDOT
2b. Deed book and page no.:
2c. Responsible party:
Mark Stafford
2d.Address
Street Address
1710 East Marion Street
Address Line 2
city
Shelby
Fbstal / Zip Code
28151
2e. Telephone Number:
[phone]
2g. Email Address:*
State / Frovinee / R�gion
NC
0�untry
USA
2f. Fax Number:
[phone]
*
C Yes r No
r Yes C No

[e-mail]
C. Project Information and Prior Project History U
1. Project Information
1b. Subdivision name:
(d appropriate)
1c. Nearest municipality/ town:
Taylorsville
2. Project Identification
2a. Property Identification Number: 2b. Property size:
2c. Project Address
Street Address
Address line 2
City State / Frovince /region
Fbstal / Zip 03de O�untry
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Spring 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.
030501011003
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:*
Washed out bridge (June 2019) on paved secondary road
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
r Yes r No r 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)
bRIDGE120_TOPO.pdf
360.64KB
4e. Attach an 81/2 X 11 excerpt from the most recent version of the published County NRCS Soil Survey map depicting the project site. (for DWR)
Bridge120_Soil _Map.pdf 391.39KB
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:
100
4h. Explain the purpose of the proposed project:*
To replace a bridge which was washed out during storm events June 2019.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
The previous bridge was a 31 foot long, 22 foot vide timber, single span bridge. New bridge is a 60-foot long, 30 ft wide single span cored slab bridge. Fifty feet of permanent bank
stabilization impacts as well as 27 feet of temporary impacts are anticipated for the new bridge construction. Typical heavy construction equipment (trackhoes, backhoes, cranes) will be
utilized for the construction of the new bridge.
4j. Please upload project drawings for the proposed project.
SF-010120_Permit Drawings_20191008.pdf 1.75MB
SF-010120_100 % Hydraulic Plans_20191002.pdf 2.33MB
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
F Yes r No f Unknown
Comments

5b. If the Corps made a jurisdictional determination, what type of determination was made?*
r Preliminary r Approved r Not Verified r Unknown r N/A
Corps AID Number:
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): NCDOT Division 12 Environmental Office
Agency/Consultant Company:
Other:
5d1. Jurisdictional determination upload
6. Future Project Plans
6a. Is this a phased project?*
r 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 activity?
[Proposed Impacts Inventory
1. Impacts Summary
la. Where are the impacts associated with your project? (check all that apply):
r Wetlands W Streams -tributaries r Buffers
F Open Waters r Pond Construction
3. Stream Impacts
3a. Reason for impact (?)
3b.lmpact type *
3c. Type of impact*
3d. S. name *
3e. Stream Type *
Type of
3gSwidth
3h. Impact
❑
�[3f.
(?)
urisdiction*
length*
S1
L 14+04/14+42 Bridge
Permanent
Bank Stabilization
Spring Creek
Perennial
Both
20
50
construction
Average (feet)
(linear feet)
32
L 14+04/14+42 Bridge
Temporary
Bank Stabilization
Spring Creek
Perennial
Both
h�l�rfeet)]
construction
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
50
3i. Total stream and ditch impacts:
77
3j. Comments:
Permanent and temporary impacts are within the same impact area
3i. Total temporary stream impacts:
27
E. Impact Justification and Mitigation
1. Avoidance and Minimization
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
Previous bridge had direct discharge of stormwater from bridge. The proposed bridge has been designed to eliminate the direct discharge; stormwaater
runoff will be directed to two traffic bearing grated inlets at the south approach where they will be discharged through pipes to riprap pads. The
streambank under the bridge was washed out when the bridge failed and will be stabilized with Class II riprap.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Minimal impacts to stream when removing any remaining bridge components.
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?
r Yes r No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
Bridge to 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?
r 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?*
r Yes r- No
Comments:
Stormwater management plan attached
G. Supplementary Information
1. Environmental Documentation
la. Does the project involve an expenditure of public (federallstate/local) funds or the use of public (federal/state) 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)
Environmental Policy Act (NEPA/SEPA)? *
r Yes
r No
Comments:
The project qualifies as a non -major action; therefore, a Type VII ground disturbing CE form was completed for the project.
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (1 SA 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?*
r Yes r No
3b. If you answered "no," provide a short narrative description.
Washed out bridge being replaced with a bridge; little additional impacts from development are anticipated.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
f Yes r Nor 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?*
r' Yes
r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
r Yes r No
5c. If yes, indicate the USFWS Field Office you have contacted.
Asheville
5d. Is another Federal agency involved?*
r Yes r No
5e. Is this a DOT project located within Division's 1-8?
f Yes r No
5f. Will you cut anytrees in order to conduct the work in waters of the U.S.?
r Yes r No
r Unknown
5g. Does this project involve bridge maintenance or removal?
f Yes r No

5h. Does this project involve the construction/installation of a wind turbine(s)?*
C Yes r No
5i. 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.?
C Yes r No
5j. 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 white nose syndrome area; however there are no known northern long
eared bat hibernacula or roosting trees in the Division 12 counties.
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?*
f 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 NCDOT Division 12 counties.
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?*
r- Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
NCDOT cultural resources review and approval (tracking no. 19-06-0022)
7c. Historic or Prehistoric Information Upload
ARCH_no_survey.pdf
HA no_survey.pdf
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
r Yes C No
8b. If yes, explain how project meets FEMA requirements:
NCDOT hydraulic unit coordination
8c. What source(s) did you use to make the floodplain determination?*
NCDOT hydraulics unit
Miscellaneous
Comments
Miscellaneous attachments not previously requested.
cover_letter.pdf
Hazardous Spill Checklist.pdf
Pre -failure photos_010120-StructureSafetyReport-20181101.pdf
SF-010120_Post-failure Photos taken 190927.pdf
map.pdf
Signature
*
W By checking the box and signing below, I certify that:
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345.27KB
• 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 Act');
• 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:
Trish Beam
Signature
9/ tc6/G Ow1w,
Date

10/11/2019