20201560 Ver 1_ePCN Application_20201211

I I DWR
Division of Water Resources
Pre-Construction Notification (PCN) Form
October 26,2020 Ver 3.3
Initial Review
Has this project met the requirements for acceptance in to the review process?*
6 Yes
✓ No
Is this project a public transportation project?*
0 Yes r No
Change only if needed.
BIMS#Assigned* Version#*
20201560 1
Is a payment required for this project?*
✓ No payment required Reviewing Office*
6 Fee received Winston-Salem Regional Office-(336)776-
✓ Fee needed-send electronic notification 9800
Select Project Reviewer*
Dave Wanucha:eads\djwanucha
Information for Initial Review
1a.Name of project:
Smith Rd Bridge Replacement
1a.Who is the Primary Contact?*
Jerry Parker
lb.Primary Contact Email:* 1c.Primary Contact Phone:*
[e-mail] [phone]
Date Submitted
12/11/2020
Nearest Body of Water
Paw Paw Creek
Basin
Roanoke
Water Classification
WS-IV 22-30-6(2)
Site Coordinates
Latitude: Longitude:
36.504625 79.962531
Pre-Filing Meeting Information
ID# Version
20201560 1
Pre-fling Meeting or Request Date*
11/5/2020
Attach documentation of Pre-Filing Meeting Request here:*
Smith Rd Pre-Filing Meeting Request Form.pdf 55.81KB
A. Processing Information C^U
County(or Counties)where the project is located:
Rockingham

Is this a NCDMS Project
C- Yes f No
Is this project a public transportation project?*
6 Yes r No
Is this a NCDOT Project?*
6 Yes r No
(NCDOT only)T.I.P.or state project number:
WBS#(7)
17BP.7.R.109
1a.Type(s)of approval sought from the Corps:
fJ Section 404 Permit(wetlands,streams and waters,Clean Water Act)
r Section 10 Permit(navigable waters,tidal waters,Rivers and Harbors Act)
Has this PCN previously been submitted?*
C- Yes
6 No
lb.What type(s)of permit(s)do you wish to seek authorization?
fJ Nationwide Permit(NWP)
r Regional General Permit(RGP)
r Standard(IP)
1c.Has the NWP or GP number been verified by the Corps?
C Yes (' No
Nationwide Permit(NWP)Number: 14-Linear transportation
NWP Numbers(for multiple NWPS):
Id.Type(s)of approval sought from the DWR:
17 401 Water Quality Certification-Regular r 401 Water Quality Certification-Express
r Non-404 Jurisdictional General Permit r Riparian Buffer Authorization
r Individual Permit
le.Is this notification solely for the record because written approval is not required? *
For the record only for DWR 401 Certification: C' Yes 6 No
For the record only for Corps Permit: C' Yes 6 No
If.Is this an after-the-fact permit application?*
C- Yes f No
1g.Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
(' Yes C No
1g.Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
C- Yes r No
Acceptance Letter Attachment
Smith Rd Mitigation Letter.pdf 71.71KB
lh.Is the project located in any of NC's twenty coastal counties?
C- Yes C No
1j.Is the project located in a designated trout watershed?
C- Yes (- No
B. Applicant Information
Id.Who is applying for the permit?
17 Owner r Applicant(other than owner)
le.Is there an Agent/Consultant for this project?*
✓ Yes (- No
2.Owner Information
2a.Name(s)on recorded deed:
NCDOT

2b.Deed book and page no.:
2c.Responsible party:
2d.Address
Street Address
P.O.Box 14996
Address Line 2
(Sty State/Province/Region
Greensboro NC
Fbstal/Zip Code Country
27415 USA
2e.Telephone Number: 2f.Fax Number:
[phone]
2g.Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1b.Subdivision name:
(if appropriate)
1c.Nearest municipality/town:
Stoneville
2. Project Identification
2a.Property Identification Number: 2b.Property size:
2c.Project Address
Street Address
Address Line 2
(DIY State/Bovine/Region
Fbstal/Zip Code Country
3.Surface Waters
3a.Name of the nearest body of water to proposed project:*
Paw Paw Creek
3b.Water Resources Classification of nearest receiving water:*
WS-IV 22-30-6(2)
3c. What river basin(s)is your project located in?*
Roanoke
3d.Please provide the 12-digit HUC in which the project is located.
030101030408
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:*
Project is a structurally deficient,poorly functioning bridge located in a sparsely wooded rural area with low density housing.
4b.Have Corps permits or DWR certifications been obtained for this project(including all prior phases)in the past?*
r Yes F 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)
Hampton Rd Topo Map.pdf 1.89MB
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)
Smith Rd(Bridge 166)Soil Survey.pdf 2.23MB
4f.List the total estimated acreage of all existing wetlands on the property:
0.13
4g.List the total estimated linear feet of all existing streams on the property:
86

4h.Explain the purpose of the proposed project:*
The North Carolina Department of Transportation(NCDOT)is proposing to replace Rockingham County Bridge#166 on Smith Road(SR 1360)over Pawpaw Creek.The existing bridge
is structurally deficient and functionally obsolete.
4i.Describe the overall project in detail,including indirect impacts and the type of equipment to be used:*
The existing structure is a single span bridge(1 @40'4")steel plank deck on I-Beams.The end bents are timber caps and piles.The proposed structure is a single span(1@80'),33"
box beam with 4'deep caps.This structure has been designed to have as little environmental,wetland,and surface water impacts as possible.2:1 roadway fill slope will be used in the
wetland areas to minimize wetland impacts.Permanent drainage easement(PDE)will be set to have as little wetland impacts as possible.To avoid direct discharge of bridge storm water
into the receiving water,deck drains are not required for the proposed bridge.Storm water impacts to the stream have been minimized by utiliang grated inlets and pipes to collect
bridge storm water and use rip rap outlet protection to dissipate energy into a 3'ase ditch with Class B riprap.Typical road building equipment will be utilized including backhoes,dump
trucks,tamps,cranes and dozers.
4j.Please upload project drawings for the proposed project.
Smith Rd Permit Drawings.pdf 2.58MB
5.Jurisdictional Determinations
5a.Have the wetlands or streams been delineated on the property or proposed impact areas?*
s Yes r No C5 Unknown
Comments:
5b.If the Corps made a jurisdictional determination,what type of determination was made?*
r Preliminary r Approved r Not Verified s Unknown r N/A
Corps AID Number:
5c.If 5a is yes,who delineated the jurisdictional areas?
Name(if known): Robert Lepsic
Agency/Consultant Company: Arcadia
Other:
5d1.Jurisdictional determination upload
Smith Rd Wetland Delineation.pdf 2.32MB
6. Future Project Plans
6a.Is this a phased project?*
C Yes 0' 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
1a.Where are the impacts associated with your project?(check all that apply):
[Wetlands r Streams-tributaries r Buffers
[Open Waters r Pond Construction
E. Impact Justification and Mitigation
1.Avoidance and Minimization
1a.Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
This structure has been designed to have as little environmental,wetland,and surface water impacts as possible.2:1 roadway fill slope will be used in
the wetland areas to minimize wetland impacts.Permanent drainage easement(PDE)will be set to have as little wetland impacts as possible.
1b.Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
To avoid direct discharge of bridge storm water into the receiving water,deck drains are not required for the proposed bridge.Storm water impacts to
the stream have been minimized by utilizing grated inlets and pipes to collect bridge storm water and use rip rap outlet protection at 16+29 RT to
dissipate energy and discharge into the 3'base ditch with Class B Rip Rap.NCDOT Best Management Practices for Construction and Maintenance
Activities and Best Management Practices
for the Protection of Surface Waters 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?
C: Yes C- No
2c.If yes,mitigation is required by(check all that apply):

17 DWR 17 Corps
2d.If yes,which mitigation option(s)will be used for this project?
r Mitigation bank 17 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.
✓ Yes r No
4b.Stream mitigation requested:
(linear feet) 4c.If using stream mitigation,what is the stream temperature:
0
4d.Buffer mitigation requested(DWR only): 4e.Riparian wetland mitigation requested:
(square feet) (acres)
0 0.13
4f.Non-riparian wetland mitigation requested: 4g.Coastal(tidal)wetland mitigation requested:
(acres) (acres)
O 0
4h.Comments
6. Buffer mitigation(State Regulated Riparian Buffer Rules)-required by DWR
6a.Will the project result in an impact within a protected riparian buffer that requires buffer mitigation?If yes,you must fill out this entire form-please contact DWR for more
information.
✓ Yes rNo
F. Stormwater Management and Diffuse Flow Plan (required by DWR) u
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?
✓ Yes r No
If no,explain why:
Project is in the Roanoke River basin which is not subject to NC Riparian Buffer Protection Rules
2.Stormwater Management Plan
2a.Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
✓ Yes r No
Comments:
G. Supplementary Information
1. Environmental Documentation
1a.Does the project involve an expenditure of public(federal/state/local)funds or the use of public(federal/state)land?*
( 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(NEPAISEPA)?*
✓ Yes ( No
Comments:*
Project qualifies as a Categorical Exclusion
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)?*
✓ Yes ( No
3. Cumulative Impacts(DWR Requirement)
3a.Will this project result in additional development,which could impact nearby downstream water quality?*
✓ Yes ( No

3b.If you answered"no,"provide a short narrative description.
4.Sewage Disposal(DWR Requirement)
4a.Is sewage disposal required by DWR for this project?*
✓ Yes 6 No r 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?*
( Yes r No
5b.Have you checked with the USFWS concerning Endangered Species Act impacts?*
6 Yes rNo
5c.If yes,indicate the USFWS Field Office you have contacted.
Raleigh
5d.Is another Federal agency involved?*
✓ Yes f No r Unknown
5e.Is this a DOT project located within Division's 1-8?
F Yes r No
5j.What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
USFWS Website
NRTR Survey
Consultation Documentation Upload
Smith Rd Concurrence Letter.pdf 167.4KB
6. Essential Fish Habitat(Corps Requirement)
6a.Will this project occur in or near an area designated as an Essential Fish Habitat?*
✓ Yes ( 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?*
✓ yes ( 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
Smith Rd NoSitesPresent Archaeological.pdf 4.73MB
Smith Rd NoSurvey Architecture.pdf 4.45MB
8. Flood Zone Designation(Corps Requirement)
8a.Will this project occur in a FEMA-designated 100-yearfloodplain?*
( 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
M iscel Ianeous
Comments
Miscellaneous attachments not previously requested.
Signature
*
f7 By checking the box and signing below,I certify that:

• The project proponent hereby certifies that all information contained herein is true,accurate,and complete to the best of my knowledge and belief;and
• The project proponent hereby requests that the certifying authority review and take action on this CWA 401 certification request within the applicable reasonable period of time.
• 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:
Wright Archer
Signature
912,.oritancr�S'
Date
12/11/2020