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Corps action ID no.
DWQ project no.
Form Version 1.0 November 2008
Pre-Construction Notification (PCN) Form
A. Applicant Information
i
1. Processing j
la. Type(s) of approval sought from the
Corps: I
® Section 404 Permit ? Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: NW 14 or General Permit (GP) number:
tc. Has the NWP or GP number been verified by the Corps? ® Yes ? No
to. Type(s) of approval sought from the DWQ (check all that apply):
1
® 401 Water Quality Certification - Regular ? Non-404 Jurisdictional General Permit
? 401 Water Quality Certification - Express ? Riparian Buffer Authorization
le. Is this notification solely for the record
because written approval is not required? For the record only for DWQ 401
Certification:
? Yes ® No For the record only for Corps Permit:
1
? Yes ® No
If. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program. ® Yes ? No
tg. Is the project located in any of NC's twenty coastal counties. If yes, answer 1h
below. ® Yes ? No
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ® Yes ? No
2. Project Information
2a. Name of project: 8-4520 Bridge Replacement # 32 over Trotman?Creek
(FEDERAL STIMULUS PROJECT)
2b. County: Gates
2c. Nearest municipality / town: Powell Crossroads
2d. Subdivision name: n/a
2e. NCDOT only, T.I.P. or state
project no: B - 4520 WBS # 33744. 1.1 federal stimulus project - ARRA
3. Owner Information
3a. Name on Recorded Deed: NCDOT
3b. Deed Book and Page No. n/a
3c. Responsible Party (for LLC if
applicable): NCDOT Division One
3d. Street address: 113 Airport Drive Suite 100
3e. City, state, zip: Edenton, NC 27932
3f. Telephone no.: 252-482-5889
3g. Fax no.: 252-482-8722
3h. Email address: [e-mail]
Page 1 of 12
PCN Form - Version 1.0 November 2008 Version
Section A. Applicant Information, continued
4. Applicant Information (if different from owner)
4a. Applicant is: ? Agent ? Other, specify:
4b. Name:
4c. Business name
(if applicable):
4d. Street address:
4e. City, state, zip:
4f. Telephone no.:
4g. Fax no.
4h. Email address:
5. Agent/Consultant Information (if applicable)
5a. Name:
5b. Business name
(if applicable):
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. Fax no.:
5g. Email address:
Page 2 of 12
PCN Form - November 2008 Version
B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
1 b. Site coordinates (in decimal degrees): 36.3473365'N - 76.663169'W
1 c. Property size: 3 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to Trotman Creek
proposed project:
2b. Water Quality Classification of nearest receiving water: class C, NSW
2c. River basin: Chowan
3. Project Description
3a. 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 existing bridge is a 22' X 70' wooden bridge with 3 interior bents supported by wood piles and two end bents. The
existing roadway is an 18 ft. asphalt surface roadway with 4-8 ft. grassed shoulders. This bridge crosses Trotman Creek
and the associated riverine hardwood swamp. Trotman Creek is classified as a Class "C, NSW" water by the Division of
Water Quality and anadromous fish spawning waters by the Wildlife Resource Commission. Landuse within the project
area is dominated by forestry and row crop agriculture.
3b. List the total estimated acreage of all existing wetlands on the property:
2 acres
3c. List the total estimated linear feet of all existing streams (intermittent and perennial] on the property:
100 feet
3d. Explain the purpose of the proposed project:
Replace bridge # 32, which has been identified as structurally eligible for the federal bridge replacement program
3e. Describe the overall project in detail, including the type of equipment to be used:
The existing wooden bridge deck and piles will be removed in accordance with NCDOT guidelines for bridge demolition
and removal. The new bridge will be 120 feet in length by 30 feet wide. The new bridge will be a three span cored slab
concrete structure supported by concrete piles. The old fill approaches will be removed and graded to the adjacent
wetland elevation. The new roadway approaches will be widened to accommodate the bridge structure. Equipment used
during this project will include a crane, excavator, grading equipment, and dump trucks.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
?
Corps or State been requested or obtained for this property / , No ? Unknown
® Yes ?
project (including all prior phases) in the past?
4b. If the Corps made the jurisdictional determination, what type
®Preliminary ? Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas? Agency/Consultarit Company:
Name (if known): Clay Willis / Ryan Shook Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
9/29/09
5. Project History
5a. Have permits or certifications been requested or obtained for ? Yes ® No ? Unknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
Page 3 of 12
PCN Form - Version 1.0 November 2008 Version
B. Project Information and Prior Project History
6. Future Project Plans
6a. Is this a phased project? ? Yes ® No
6b. If yes, explain.
Page 4 of 12
PCN Form - November 2008 Version
i
C. Proposed Impacts Inventory
1. Impacts Summary
la. Which sections were completed below for your project (check all that apply):
® Wetlands ? Streams - tributaries ? Buffers
? Open Waters ? Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact type of jurisdiction
number - Type of Type of wetland Forested (Corps - 404, 10 Area of impact (acres)
Permanent (P) or impact (if known) DWQ - non-404, other)
Temporary T

W1 ®P ? T Earthen
Fill Hardwood
swamp/ utility
® Yes ? No ® Corps
® DWO
0.006
corridor

W2 ®P ? T
Earthen
Fill Hardwood
swamp/ utility
® Yes ? No
® Corps
®DWQ
0.003
corridor
W3 ®P E] T Earthen
Fill Hardwood swamp/ utility Z Yes ? No ®Corps
® DWQ 0.185
corridor

W4 ®P ? T
Earthen
Fill Hardwood
swamp/ utility
® Yes ? No
® Corps
®DWQ
0.048
corridor
W5 ? P ? T ? Yes ? No ? Corps
? DWO

W6 E] P ® T
hand
l
i Hardwood
swamp/ utility
® Yes El No
® Corps
® DWO
0.24
ear
ng
c corridor
2g. Total wetland impacts 0.48
2h. Comments: Hand cleared area will not be maintained and allowed to revegetate after project completion
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a. 3b. 3c. 3d. 3e. 3f.
Stream impact Type of Stream name Perennial (PER) or Average stream width (feet) Impact
number- impact intermittent(INT)? length
Permanent (P) or (linear feet)
Temporary (T)
S1 ? P ? T ? PER ? INT
S2 ? P ? T ? PER ? INT
S3 ? P ? T ? PER ? INT
S4 ? P ? T ? PER ? INT
S5 ? P ? T ? PER ? INT
S6 ? P ? T ? PER ?INT
3g. Total stream and tributary impacts 0
3h. Comments:
Page 5 of 12
PCN Form - Version 1.0 November 2008 Version
C. Proposed Impacts Inventory, continued
4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individual) list all o en water impacts below.
4a. 41b. 4c. 4d. 4e.
Open water Name of
impact number waterbody Type of impact . Waterbody type Area of impact (acres)
- Permanent (if
(P) or applicable)
Tem orar T
01 ?P?T
02 ?P?T
03 ?P?T
04 ?P?T
4f. Total open water impacts 0
4g. Comments:
Page 6 of 12
PCN Form - November 2008 Version
C. Proposed Impacts Inventory, continued
5. Pond or Lake Construction
If and or lake construction pro osed, then complete the chart below.
__
5a. 5b. 5c. 5d. 1e
Wetland Impacts (acres) Stream Impacts (feet) [
Upland
Pond ID Proposed use or (acres)
number purpose of pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
5f. Total
5g. Comments:
51h. Is a dam high hazard permit required?
? Yes ? No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If an impacts require miti ation, then ou MUST fill out Section D of this form.
6a.
? Neuse ? Tar-Pamlico ? Other:
Project is in which protected basin? ? Catawba ? Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number- Reason Buffer Zone 1 impact (square Zone 2 impact
Permanent (P) for impact Stream name mitigation feet) (square feet)
or Temporary required?
T
B1 ?P?T ?Yes ?No
B2 ?P?T ?Yes ?No
B3 ?P?T ?Yes ?No
6h. Total buffer impacts 0
6i. Comments:
Page 7 of 12
PCN Form - November 2008 Version
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Impacts to wetlands have been minimized through the reduction in the roadway footprint. The bridge approach shoulders
are set at a width that allows for safety concerns to be met. The new bridge will be 50 ft. longer, which will enhance the
ability of the floodplain to function. This will also allow us to restore 0.034 acres of wetlands, by removing the old
approach fill and grading it to adjacent wetland elevation. The road will be closed during the building process, which
avoids the need for an on-site detour that would impact wetlands. The unavoidable wetland impacts are being mitigated
through the Ecosystem Enhancement Program.
The 0.24 acres of temporary impact results from hand clearing for construction clearance and erosion control installation.
This area will not be maintained after construction is complete. It will be allowed to revert back to a vegetated wetland.
Therefore, no mitigation is being requested for the temporary hand cleared zone.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
The bridge is being built using top-down construction technique and a off-site detour is being utilized.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for ® Yes ? No
impacts to Waters of the U.S. or Waters of the State?
2b. If yes, mitigation is required by (check all that apply): ® DWQ ® Corps
? Mitigation bank
2c. If yes, which mitigation option will be used for this
®Payment to in-lieu fee program
project?
® Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter) Type Quantity
3c. Comments:
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached. ? Yes
4b. Stream mitigation requested: n/a linear feet
4c. If using stream mitigation, stream temperature: n/a 'warm, cool, cold
4d. Buffer mitigation requested (DWQ only): n/a square feet
4e. Riparian wetland mitigation requested: 0.206 acres
4f. Non-riparian wetland mitigation requested: .acres
4g. Coastal (tidal) wetland mitigation requested: acres
4h. . Comments: Not requesting mitigation for temporary hand cleared area
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
NCDOT will restore 0.034 acres wetland by removing of old approach fill and grading the area to adjacent wetland
elevation. This will also restore some of the active floodplain for Trotman Creek. -'
Page 8 of 12
PCN.Form -Version 1.0 November 2008 Version
D. Impact Justification and Mitigation, continued
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) -required by DWQ.
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation? ? Yes ® No
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.
Zone Reason for impact Total impact
(square feet) Multiplier Required mitigation
(square feet)
Zone 1 3 (2 for Catawba)
Zone 2 1.5
Total buffer mitigation required:
6c. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund).
6d. Comments:
Page 9 of 12
i PCN Form - November 2008 Version
I
E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified ? Yes ® No
within one of the NC Riparian Buffer Protection Rules?
1b. If yes, then is a diffuse flow plan included? ? Yes ? No
2. Determination if the Project Requires a Stormwater Management Plan
2a. Does the project require a Non-404 Jurisdictional General Permit? ? Yes ® No
2b. Is the project subject to General Certification 3704 or 3705? ® Yes ? No
3. Determination of Stormwater Review Jurisdiction
3a. Is this project subject to any of the following state-implemented stormwater ? Coastal counties
management programs (check all that apply)? ? HOW
? ORW
If so, attach one copy of the approval letter from the DWQ and one copy of the ? Session Law 2006-246
approved stormwater management plan. ® Other: NCDOT 01000
3b. In which local government's jurisdiction is this project? n/a
3c. Is this local government certified to implement a state stormwater program? ? Yes ®No
If so, attach one copy of the approval letter from the local government and one copy
of the approved stormwater management plan (or one copy of the approved
Stormwater management plan stamped as approved).
4. Information Required for DWQ 401 Unit Stormwater Review
4a. What is the overall percent imperviousness according to the most current site plan? 0.23
4b. Does this project contain any areas that meet the criteria for "high density" per ? Yes ®No
General Certifications 3704 and 3705?
4c. If the site is over 24% impervious and/or contains high density areas, then provide a brief narrative description of the
stormwater management plan.
n/a
4d. Has a completed BMP Supplement Form with all required items been submitted. ? Yes ®No
for each stormwater BMP?
Page 10 of 12
PCN Form - Version 1.0 November 2008 Version
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
la. Does the project involve an expenditure of public (federal/state/local) funds or the. ® Yes ? No
use of public (federal/state) land?
1 b. 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 ? Yes ®No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1c. If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
? Yes
® No
letter.)
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards, ? Yes ® No
or Riparian Buffer Rules (15A NCAC 2B.0200)?
2b. Is this an after-the-fact permit application? ? Yes ® No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in ? Yes ® No
additional development, which could impact nearby downstream water quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
Page 11 of 12
PCN Form - Version 1.0 November 2008 Version
F. Supplementary Information, continued
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or ? Yes No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act ? Yes No
impacts?
L] Raleigh
5c. If yes, indicate the USFWS Field Office you have contacted.
heville
? A
s
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
Natural Heritage Database and USFWS information for Gates County
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? ? Yes ® No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
Marine Fisheries
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 ? Yes ® No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
SHPO information
8. Flood Zone Designation (Corps Requirement)
Sa . Will this project occur in a FEMA-designated 100-year floodplain? ® Yes ? No
8b . If yes, explain how project meets FEMA requirements: n/a
8c. What source(s) did you use to make the floodplain determination? FEMA maps

Clay Willis
lNe " 10/1/09
Applicant/Agent's Printed Name A plica Agent's Signature
(Agent's signature is valid o y if an authorization letter from the applicant
Date
is rovided.
Page 12 of 12
PCN Form - November 2008 Version