20191401 Ver 1_PCN Form Submission_20191014

DWR
MOM— 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
Oange only if needed.
BIMS # Assigned
20191401
Is a payment required for this project?*
r No payment required
r Fee received
r Fee needed - send electronic notification
Select Project Reviewer*
Rob Ridings:eads\rgridings
Information for Initial Review
1a. Name of project:
Replacement of Bridge 22 over Town Creek on US258, Edgecombe Co. (B-4931 Central)
1a. Who is the Primary Contact?*
NCDOT
1b. Primary Contact Email:*
[e-mail]
Date Submitted
10/14/2019
Nearest Body of Water
Town Creek
Basin
Tar -Pamlico
Water Classification
QNSW
Site Coordinates
Version# *
1
Reviewing Office*
Central Office - [phone]
1c. Primary Contact Phone:*
[phone]
Latitude:
Longitude:
35.798438
-77.591584
AProcessing Information
U
County (or Counties) where the project is located:
Edgecombe
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:
B-4931
WBS # (?)
40134.1.1
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:
F 401 Water Quality Certification - Express
W Riparian Buffer Authorization
1f. Is this an after -the -fact permit application?*
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
Acceptance Letter Attachment
1h. Is the project located in any of NC's twenty coastal counties?
r Yes r No
1j. Is the project located in a designated trout watershed?
C Yes r No
FB. 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 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
city
Raleigh
Fbstal / Zip Oide
27610
2e. Telephone Number:
[phone]
2g. Email Address:*
State / Frovinre / R�gion
NC
Q�untry
USA
2f. Fax Number:
*
r Yes r No
r Yes r No

[e-mail]
C. Project Information and Prior Project History U
1. Project Information
1b. Subdivision name:
(i appropriate)
1c. Nearest municipality/ town:
Pinetops
2. Project Identification
2a. Property Identification Number:
2c. Project Address
Street Address
Address line 2
Oty
Postal / Zip 03de
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Town Creek
3b. Water Resources Classification of nearest receiving water:*
C;NSW
3c. What river basin(s) is your project located irl
Tar -Pamlico
3d. Please provide the 12-digit HUC in which the project is located.
030201030107
4. Project Description and History
2b. Property size:
State / ftovince / Ibgion
O�untry
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:*
Land use in the project vicinity consists primarily of forested floodplains and low -density residential sites interspersed with agricultural fields.
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)
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:
0.2
4g. List the total estimated linear feet of all existing streams on the property:
1200
4h. Explain the purpose of the proposed project:*
The purpose of this project is to replace a structurally deficient bridge.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
This project involves replacing the eAsting 4 span,160-foot bridge with a two span, 170-foot bridge on the eAsting alignment. Traffic will be maintained on an off -site detour. Standard
road building equipment, such as trucks, dozers and cranes will be used.
4j. Please upload project drawings for the proposed project.
B-4931 Buffer Drawings.pdf 1.14MB
B-4931 Permit Drawings.pdf 1.16MB
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
r Yes r No O Unknown
Comments:
A preliminary JD package is attached.
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): Beth Reed
Agency/Consultant Company: Kimley Horn
Other:
SM. Jurisdictional determination upload
B4931 _PreliminaryJD_Request. pdf 2.52 MB
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?
D. Proposed Impacts Inventory
1. Impacts Summary
la. Where are the impacts associated with your project? (check all that apply):
r Wetlands r Streams -tributaries W Buffers
r Open Waters r Pond Construction
6. Buffer Impacts (for DWR)
6a. Project is in which protect basin(s)?
Check all that apply.
r Neuse fJ Tar -Pamlico
r Catawba r Randleman
r Goose Creek r Jordan Lake
r Other
6b. Impact Type 6c. Per or Temp 6d. Stream name 6e. Buffer mitigation required? 6f. Zone 1 impact 6g. Zone 2 impact
Bridge -Allowable
P
Town Creek
No
5,137
2,481
Road Crossing -Allowable
P
Town Creek
No
640
1,257
6h. Total buffer impacts:
Zone 1 Zone 2
Total Temporary impacts: 0.00 0.00
Zone 1 Zone 2
Total Permanent impacts: 5,777.00 3,738.00
Zone 1 Zone 2
Total combined buffer impacts: 5,777.00 3,738.00
61. Comments:
Supporting Documentation
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:
The bridge will be replaced on the wasting alignment. The new bridge will have no bents inside the creek. The proposed project will have no impact to
streams or wetlands. See stormwater management plan for additional minimization measures.

1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
An offsite detour will be used during construction. NCDOT's Design Standards for Sensitive Watersheds will be employed.
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:
There will be no impact to streams or wetlands. All buffer impacts are deemed allowable and do not require mitigation.
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
What type of SCM are you providing?
r- Level Spreader
r- Vegetated Conveyance (lower SHWT)
r- Wetland Swale (higher SHWT)
r- Other SCM that removes minimum 30 % nitrogen
r- Proposed project will not create concentrated stormwater flow through the buffer
Diffuse Flow Documentation
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
la. Does the project involve an expenditure of public (federal/state/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
1c. If you answered `yes" to the above, has the document review been finalized by the State Clearing House?*
r 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)?*
r 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.
Due to the minimal transportation impact resulting from this bridge replacement, this project will neither influence nearby land uses nor stimulate
growth. Therefore, a detailed indirect or cumulative effects study will not be necessary.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
r 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.
Raleigh
5d. Is another Federal agency involved?*
r Yes r No r Unknown
5e. Is this a DOT project located within Division's 1-8?
r Yes r- No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
N.C. Natural Heritage Program database; USFWS-Raleigh Field Office website; biological surveys for protected species listed for Edgecombe County,
which include Tar River spinymussel, yellow lance, Dwarf wedgemussel, red -cockaded woodpecker. All current listed species received biological
conclusions of "No Effect" with the exception of Tar River spinymussel which received a biological conclusion of "May Affect, Not Likely to Adversely
Affect". NCDOT proposes to satisfy impacts to Section 7 for the species by making payment to the N.C. Non -game Aquatic Species Fund as set in the
Programmatic Biological Opinion for freshwater mussels.
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?*
r Yes r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
NMFS County Index
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?*
NEPA documentation
7c. Historic or Prehistoric Information Upload
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
r Yes r No
8b. If yes, explain how project meets FEMA requirements:
NCDOT Hydraulics Unit coordination with FEMA
8c. What source(s) did you use to make the floodplain determination?*
FEMA maps
Miscellaneous
Comments
Miscellaneous attachments not previously requested.
Signature
*
W 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 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:
Mack Christopher Rivenbark III

Signature
)04 6. RiuWoAb ,1J/
Date
10/14/2019