20191452 Ver 1_PCN Form Submission_20191021

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#*
20191452 1
Is a payment required for this project?*
r No payment required
• Fee received
Reviewing Office*
r Fee needed - send electronic notification
Central Office - [phone]
Select Project Reviewer*
April Norton:eads\arnorton
Information for Initial Review
1a. Name of project:
Richmond County Bridge #7
1a. Who is the Primary Contact?*
Art C. king
1b. Primary Contact Email:*
1c. Primary Contact Phone:*
[e-mail]
[phone]
Date Submitted
10/21 /2019
Nearest Body of Water
Gum Swamp Creek
Basin
Lumber
Water Classification
Class C
Site Coordinates
Latitude: Longitude:
34.929435-79.572987
FA. Processing Information U
County (or Counties) where the project is located:
Richmond
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:
SF-760007
WBS # (?)
17.BP.8.R.138
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?
f 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?*
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
ILF approval Bridge 7 - Richmond Co - Division 8 - RW - LU 04.pdf
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?
r^ Yes r No
B. Applicant Information
1d. Who is applying for the permit?
P Owner r Applicant (other than owner)
le. Is there an bent/Consultant for this project?*
r Yes r No
2. Owner Information
2a. Name(s) on recorded deed:
NCDOT Highway Division 8
2b. Deed book and page no.:
2c. Responsible party:
2d.Address
Street Address
121 DOT Dr.
Address Line 2
City
Carthage
Postal / Zip Cade
28327
2e. Telephone Number:
[phone]
State / Frovince / Ragion
NC
Country
Moore
2f. Fax Number:
[phone]
68.5KB
*
r Yes r No
r Yes r No

2g. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Art King
4b. Business Name:
NCDOT
4c.Address
Street Address
121 DOT Dr.
Address Line 2
City
Carthage
Postal / Zip Code
28327
4d. Telephone Number:
[phone]
4f. Email Address:*
[e-mail]
State / province / Figim
NC
Country
Moore
4e. Fax Number:
[phone]
Agent Authorization Letter*
Agent Authorization. pdf 28.11 KB
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality / town:
Marston
2. Project Identification
2a. Property Identification Number:
2b. Property size:
2 ac.
2c. Project Address
Street Address
Boyd Lake Rd.
Address Line 2
CKY
State / province / Region
Fbstal / Zip Cade
Country
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Gum Swamp Creek
3b. Water Resources Classification of nearest receiving water:*
Class C
3c. What river basin(s) is your project located in?*
Lumber
3d. Please provide the 12-digit HUC in which the project is located.
030402040101
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:
The site is an eAsting roadway stream crossing with a damaged timber deck bridge. The area is rural residential/ agricultural, timberland.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
r Yes s 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)

PDF Richmond 7 Topo.pdf
172.22KB
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)
Richmond Bridge_7_Soil _Map.pdf 406.64KB
4f. List the total estimated acreage of all existing wetlands on the property:
<0.25 acres
4g. List the total estimated linear feet of all existing streams on the property:
200Ft
4h. Explain the purpose of the proposed project:*
Replacing a timber deck bridge that was damaged by a storm event. The road is currently closed for public safety.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
This project replaces existing bridge #007 which has an overall length of 46'-1". The bridge consists of timber floor on I -beams. The bridge is 21.3' wide out -to -out. The proposed bridge
will be a 60' single span utilizing 24" cored slab. The bridge width is 30' out to out. The proposed bridge will incorporate vertical abutments skewed at 60 degrees to the roadway. There
is a slight increase in the impervious area of the project, however there is no significant increase in the discharge from the roadway runoff.
Typical bridge construction equipment will be used which will include: Dump trucks, track excavator, crane, compactor, paving equipment, dozer/grader.
4j. Please upload project drawings for the proposed project.
760007_Permit Drawings.pdf 3.67MB
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes r No
Comments:
Wetland data forms attached
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
(' Preliminary r Approved r Not Verified r Unknown r WA
Corps AID Number:
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Matt Martin, Josh Tuft
Agency/Consultant Company: RK&K
Other:
5d1. Jurisdictional determination upload
Wetland Data Richmond 7 3010_001.pdf
6. Future Project Plans
1.01 MB
O Unknown
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?
None
D. Proposed Impacts Inventory
1. Impacts Summary
la. Where are the impacts associated with your project? (check all that apply):
P Wetlands r Streams -tributaries
i— Open Waters i— Pond Construction
2. Wetland Impacts
r Buffers
2a1 Reason (?)
2b. Impact type * (?)
2c. Type of W. *
d. W. name *
2e. Forested*
f. Type of
2g. Impact
f
�Jurlscllcltlon*(?)
area*
Fill
P
Bottomland Hardwood Forest
gum swamp crk.
Yes
Corps
0.010
(acres)
mech. clearing
P
Bottomland Hardwood Forest
gum swamp crk.
Yes
Corps
0.010
(acres)
Fill
P
Bottomland Hardwood Forest
gum swamp crk.
Yes
Corps
0.040
(acres)

mech. clearing
P
Bottomland Hardwood Forest
gum swamp crk.
Yes
Corps
0.030
(acres)
mech clearing
P
Bottomland Hardwood Forest
gum swamp crk.
Yes
Corps
0.010
(acres)
2g. Total Temporary Wetland Impact
0.000
2g. Total Wetland Impact
0.100
2h. Comments:
E. Impact Justification and Mitigation
1. Avoidance and Minimization
2g. Total Permanent Wetland Impact
0.100
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
The bridge structure and roadway approaches were designed to minimize impacts and still meet current standards for safety.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Clearing and excavation in the stream and wetlands were minimized to only the amount necessary to construct the bridge structure.
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
2c. If yes, mitigation is required by (check all that apply):
r- DWR V Corps
2d. If yes, which mitigation option(s) will be used for this project?
r- Mitigation bank W Payment to in -lieu fee r 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.
IT Yes r No
4b. Stream mitigation requested:
(linear feet)
NA
4d. Buffer mitigation requested (DWR only):
(square feet)
NA
4f. Non -riparian wetland mitigation requested:
(acres)
NA
4h. Comments
4c. If using stream mitigation, what is the stream temperature:
4e. Riparian wetland mitigation requested:
(acres)
0.1
4g. Coastal (tidal) wetland mitigation requested:
(acres)
NA
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
la. 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:
Lumber River Basin
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 is attached to the permit drawings.
G. Supplementary Information
u
u

1. Environmental Documentation
1a. 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
Comments:
State minimum criteria check sheet.
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)? *
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.
Replacing an eAsting bridge structure with a new modern structure, with only minor deviations from the original, and no anticipated changes to the
roads usage.
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
5d. Is another Federal agency involved?*
r- Yes r No
5e. Is this a DOT project located within Division's 1-8?
r Yes r- No
r- Unknown
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
Onsite survey by NCDOT staff environmental specialist.
US&FW website.
Consultation Documentation Upload
Richmond 7 Endangered Species Survey Checklist.docxpdf 17.49KB
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?*
USF&W website
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?*
NC SHPO.
NCDOT Environmental Analysis Unit (Cultural resources unit)
7c. Historic or Prehistoric Information Upload

Bridge 7 Archaeology Screening Form.pdf 4.26MB
Bridge 7 HA Screening Form.pdf 769.26KB
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
r Yes r No
8c. What source(s) did you use to make the floodplain determination?*
NC Bridge Survey Report (attached)
Miscellaneous
Comments
Miscellaneous attachments not previously requested.
Bridge Survey Report 760007_2019_SF-760007_GUMSWAMPCREEK_SR1608.pdf 5.31VIB
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:
Art C. King
Signature
OAe G&-. rig
Date
10/21/2019
U