20191467 Ver 1_PCN Form Submission_20191029

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?*
C Yes r No
Change only if needed.
BIMS # Assigned * Version#*
20191467 1
Is a payment required for this project?*
r No payment required
r Fee received Reviewing Office*
r Fee needed - send electronic notification Central Office - [phone]
Select Project Reviewer*
Rob Ridings:eads\rgridings
Information for Initial Review
1a. Name of project:
Replacement of Bridge 143 over Johnson Creek (Kerr Reservoir) on SR 1442 (Dave Winston Road)
1a. Who is the Primary Contact?*
Chris Murray
1b. Primary Contact Email:* 1c. Primary Contact Phone:*
[e-mail] [phone]
Date Submitted
10/29/2019
Nearest Body of Water
Johnson Creek (John H. Kerr Reservoir)
Basin
Roanoke
Water Classification
B
Site Coordinates
Latitude: Longitude:
36.53397-78.61048
FA. Processing Information U
County (or Counties) where the project is located:
Granville
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-5323
WBS # (?)
17BP.5.R.92
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?
r 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
F 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
F. Applicant Information
1d. Who is applying for the permit?
rJ Owner r- Applicant (other than owner)
le. Is there an Agent/Consultant for this project?*
C Yes r No
2. Owner Information
2a. Name(s) on recorded deed:
United States of America (all parcels)
2b. Deed book and page no.:
2c. Responsible party:
Contact: Shannon Crews, Natural Resources Management Specialist
2d.Address
Street Address
John H. Kerr Reservoir, 1930 Mays Chapel Road
Address Line 2
City
Boyton
Postal / Zip Code
23917
2e. Telephone Number:
[phone]
2g. Email Address:*
State / Ftovince / fagion
VA
Country
USA
2f. Fax Number:
*
r- Yes r No
r Yes r- No

s h an non. 1. crews @u sa ce. army. mi I
C. Project Information and Prior Project History U
1. Project Information
1b. Subdivision name:
(d appropriate)
1c. Nearest municipality/ town:
Bullock
2. Project Identification
2a. Property Identification Number:
2b. Property size:
101001265658
3.4
2c. Project Address
Street Address
9572 Dave Winston Road
Address Line 2
City
State / Province / Region
Bullock
NC
Fbstal / Zip ODde
(Duntry
27507
USA
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Johnson Creek (John H. Kerr Reservoir)
3b. Water Resources Classification of nearest receiving water:*
B
3c. What river basin(s) is your project located in?*
Roanoke
3d. Please provide the 12-digit HUC in which the project is located
030101020803
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:*
Existing bridge 142 consists of a 4-span bridge (1 @ 34.9', 1 @ 45', 1 @ 35' and 1 @ 44.9' timber floor on I -Beams with timber/concrete caps and piers). Land use in the vicinity of the
project is comprised of wooded land owned by the US Army Corps of Engineers.
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)
B-5323 USGS MAP.pdf 969.59KB
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)
B-5323 soil survey info.pdf 476.97KB
4f. List the total estimated acreage of all existing wetlands on the property:
0.0 ac
4g. List the total estimated linear feet of all existing streams on the property:
0.0
4h. Explain the purpose of the proposed project:*
The purpose of the project is to replace a functionally obsolete bridge.
41. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
Replacement of existing bridge on existing location with traffic detoured off -site on adjacent roadways. There should be no indirect impacts as the roadway and bridge typical sections
are designed to meet current standards but are not providing additional travel lanes or new access to adjacent land/development.
4j. Please upload project drawings for the proposed project.
B5323_UTL_UBO.pdf 457.41KB
B-5323_Final_Structure_Plans.pdf 2.72MB
B-5323 Final Roadway Plans.pdf 6.82MB
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*

r Yes r No r 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:
SAW-2013-00251
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
Pete Stafford and Hal Bain
RK&K
5d. List the dates of the Corp jurisdiction determination or State determination if a determination was made by the Corps or DWR
PJD confirmed by desktop review and signed by Monte Matthews (August 25, 2017).
Sd1. Jurisdictional determination upload
17-08-24-NCDOT_B-5323 PJD.pdf 119.89KB
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?
None
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 r Buffers
W Open Waters r Pond Construction
4. Open Water Impacts
4a. Site # 4a1. Impact Reason 4b. Impact type 4c. Name of waterbody 4d. Activity type 4e. Wate rbody type 4f. Impact area
_11
Roadway fill
P
Johnson Creek/John H. Kerr Reservoir
Fill
-11
Lake
0.10
Barge access
T
Johnson Creek/John H. Kerr Reservoir
Causeway
Lake
0.41
4g. Total temporary open water Impacts:
0.41
4g. Total open water impacts:
0.51
4h. Comments:
E. Impact Justification and Mitigation
1. Avoidance and Minimization
4g. Total permanent open water impacts:
0.10
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
The roadway and bridge cross section has been designed to incorporate 11 foot travel lanes appropriate shoulders. Roadway cross sections through
the open water are 1.5:1 to minimize fill in the Kerr Reservoir. The Department proposes that a barge will be used to remove the existing piers and to
install the new concrete drilled shafts. The contractor will construct a temporary rip rap causeway to launch the barge.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Removal of unclassified structure excavation at existing abutments will be conducted behind an impervious dike following NCDOT Best Management
Practices. The excavated footprint will be permanently lined with Class II rip rap to prevent sediment loss. Inspection will be performed by NCDOT
inspectors and the Division Environmental Officer or her agent will provide environmental and permit oversight.
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:
Project will use Nationwide Permit No. 3 with no mitigation required for open water impacts at the project.
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:
Project is located in the Roanoke 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:
Project is designed to follow NCDOT NPDES permit.
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
Comments:*
Categorical Exclusion does not need to be finalized by the State Clearing House.
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.
There should be no new or additional development as the roadway and bridge typical sections are designed to meet current standards but are not
providing additional travel lanes.
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?

f• Yes f No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
Review of information provided by the USFWS and on -site surveys for potential habitat and individual species.
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?*
Project is not located in areas of EFH.
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?*
Historic Architecture: Historic Architecture and Landscapes No Survey Required Form dated March 27, 2017.
Archaeology: No Archaeological Survey Required Form dated March 16, 2017.
7c. Historic or Prehistoric Information Upload
17-03-0001 HANoSurvey.pdf 2.41 MB
PA 17-03-0001 Granville (NSR).pdf 10.66MB
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year flood plain?*
r Yes r No
8b. If yes, explain how project meets FEMA requirements:
The effective FEMA floodplain mapping indicates that the proposed crossing is located in Zone AE and was studied by Limited Detail Study methods.
8c. What source(s) did you use to make the floodplain determination?*
Consultation with design PEF.
Miscellaneous
Comments
Miscellaneous attachments not previously requested.
B5323_PermitDravdngs_20191024.pdf 1.7MB
B-5323 SWMP.pdf 1.68MB
Environmental summary for USACE.pdf 122.17KB
Signature
*
j7 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:
Christopher A. Murray, SPWS
Signature
C_W�16 44vI� 4r
Date
10/29/2019