20110525 Ver 1_Application_20110531

020E W ATF9OG
FMI 0
1 1 05 25
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification PCN Form
A. Applicant Information
1. Processing
la. Type(s) of approval sought from the
Corps: non-reporting

Section 404 Permit El Section 10 Permit
I
1 b. Specify Nationwide Permit (NWP) number: non-reportin NWP 3 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps? ? Yes ® No
1d. Type(s) of approval sought from the DWQ (check all that apply):
? 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 onl

® Yes y for Corps Permit:

? No
1f. 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
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
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: SR 1393 (Bass Lake Road)
2b. County: Wake
2c. Nearest municipality / town: Holly Springs U
2d. Subdivision name: N/A
2e. NCDOT only, T.I.P. or state
project no: MAY 3 j 2011
3. Owner Information dl):II?lIDSAfID OUaIITY
3a. Name(s) on Recorded Deed: NCDOT Division 5
3b. Deed Book and Page No. N/A
3c. Responsible Party (for LLC if
applicable): N/A
3d. Street address: 2612 N. Duke Street
3e. City, state, zip: Durham, NC 27704
3f. Telephone no.: [phone]
3g. Fax no.: [phone]
3h. Email address: wbowman(a)ncdot.gov
4. Applicant Information (if different from owner) N/A
5. Agent/Consultant Information (if applicable) N/A
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Page 1 of 8
PCN Form - Version 1.3 December 10, 2008 Version

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): N/A
1 b. Coordinates (in decimal degrees):
Latitude: 35.64229 Longitude: -78.80200
Site: (DD.DDDDDD) (-DD.DDDDDD)
1c. Property size: < 0.05 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to Basal Creek
proposed project:
2b. Water Quality Classification of nearest receiving water: B NSW
2c. River basin: Neuse
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: Existing bridge substructure needs repair. In order to access the underneath the bridge for the repair, it will
be necessary for the Bridge Maintenance to work from a temporary wooden mat positioned from the edge of bank out into
the stream channel.
3b. List the total estimated acreage of all existing wetlands on the property:
NONE - Although the area surrounding Basal Creek at this bridge is mapped with (Wehadkee) hydric soils, no wetland
impacts are proposed with this in channel work or associated work along the adjacent stream banks beneath the bridge where
there is only silt covered unve etated fill slopes.
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
60 ft
3d. Explain the purpose of the proposed project: The repair work to the bridge substructure is necessary to ensure this
structure is safe to cross. Without repairs such as this one the bridge would be closed to traffic and would remain closed
until the TIP project B-4659 goes.to construction here, which isn't set to let until 10/01/14.
3e. Describe the overall project in detail, including. the type of equipment to be used:
The North Carolina Department of Transportation (NCDOT) proposes to repair a portion of the substructure of existing bridge.
This work will require a 6' x 18'- wooden mat'to be placed in the stream channel. The mat will provide a secure surface onto
which scaffolding and bridge jack can be positioned to facilitate this work. This fill in surface water will be temporary and will
be approximately 108 SF and will be removed once the bridge repair work is complete.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
? Yes No ? Unknown
project (including all prior phases) in the past?
Comments: N/A
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/Consultant Company: N/A
Name (if known): N/A Other: N/A
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
N/A
Page 2 of 8
PCN Form - Version 1.3 December 10, 2008 Version
S. 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.
N/A
6. Future Project Plans
6a. Is this a phased project? ? Yes' ® No
6b. If yes, explain.
N/A
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 impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWQ - non-404, other) (acres)
Temporary T
W1 ? P ? T N/A N/A ? Yes ? Corps N/A
? No ? DWQ
2g. Total Wetland Impacts: NONE
21h. Comments: Although the area surrounding Basal Creek at this bridge is mapped with (Wehadkee) hydric soils, no wetland
impacts are proposed with this in channel work or associated work along the adjacent stream banks. Beneath the bridge there
is only silt covered unve etated fill slopes.
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. 31b. 3c. 3d. 3e. 3f. 3g.
Stream impact Type of impact Stream name Perennial Type of jurisdiction Average Impact
number - (PER) or (Corps - 404, 10 stream length
Permanent (P) or intermittent DWQ - non-404, width (linear
Temporary (T) (INT)? other) (feet) feet)
Site 1 ? P T
m fill Basal Creek ® PER ® Corps 40 6
Strea ? INT ® DWQ

3h. Total stream and tributary impacts 6
3i. Comments: At 6' by 18' timber mat will be placed within the stream under the bridge running length wise with the bridge
edge. This will total 110 SF of temporary surface water fill.
Page 3 of 8
PCN Form - Version 1.3 December 10, 2008 Version
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 individually list all open water impacts below.
4a.
Open water impact
number -
Permanent (P) or
Tem ora T 4b.
Name of waterbody
(if applicable) 4c.

Type of impact 4d.

Waterbody type 4e.

Area of impact (acres)
01 ? P ? T N/A N/A N/A N/A
4f. Total open water impacts NONE
4g. Comments: N/A

5. Pond or Lake Construction
If and or lake construction proposed, then complete the chart below.
5a.

Pond ID 5b.

Proposed use or purpose of 5c.
Wetland Impacts (acres) 5d.
Stream Impacts (feet) 5e.
Upland
(acres)
number pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1 N/A N/A N/A N/A N/A N/A N/A N/A
P2
5f. Total NONE NONE NONE NONE NONE NONE NONE
5g. Comments: N/A
5h. Is a dam high hazard permit required?
? Yes [E No if yes, permit ID no: N/A
5i. Expected pond surface area (acres): N/A
5j. Size of pond watershed (acres): N/A
5k. Method of construction: N/A
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 mitigation, then you MUST fill out Section D of this form.
6a.

Project is in which protected basin?
? Neuse ® Tar-Pamlico ? Other:
? Catawba ? Randleman
6b.
Buffer impact
number -
Permanent (P) or
Temporary T 6c.

Reason for
impact 6d.

Stream name 6e.

Buffer
mitigation
required? 6f.

Zone 1 impact
(square feet) 6g.

Zone 2 impact
(square feet)
Site ? P ? T
Buffer Impact 1 ? Yes
? No NONE NONE

6h. Total buffer impacts NONE NONE
6i. Comments: This bridge repair does not involve any impacts to the Neuse River Riparian Buffers since all work will be
performed within the existing transportation facility.
Page 4 of 8
PCN Form - Version 1.3 December 10, 2008 Version
D. Impact Justification and Mitigation - access to repair requires temporary timber mat within stream channel.
1. Avoidance and Minimization
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
These temporary impacts to stream are necessary to access the repair area.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
The mat will be temporary and the location between the edge of bank and situated a top of exposed rocks within the channel.
Disturbed edge of bank will be seeded and matted upon completion of this repair.
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? ? Yes ®No
2b. If yes, mitigation is required by (check all that apply): ? DWQ ? Corps

2c. If yes, which mitigation option will be used for this project? ? Mitigation bank
? Payment to in-lieu fee program
? Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank: N/A
3b. Credits Purchased (attach receipt and letter) Type N/A Quantity N/A
3c. Comments: N/A
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached. ? Yes
41b. Stream mitigation requested: N/A linear feet
4c. If using stream mitigation, stream temperature: ? warm ? cool ?cold
4d. Buffer mitigation requested (DWQ only): N/A square feet
4e. Riparian wetland mitigation requested: N/A acres
4f. Non-riparian wetland mitigation requested: N/A acres
4g. Coastal (tidal) wetland mitigation requested: N/A acres
4h. Comments: N/A
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.
N/A
Page 5 of 8
PCN Form - Version 1.3 December 10, 2008 Version
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 6c.
Reason for impact 6d.
Total impact
(square feet)
Multiplier 6e.
Required mitigation
(square feet)
Zone 1 N/A N/A 3 (2 for Catawba) N/A
Zone 2 N/A N/A 1.5 N/A
6f. Total buffer mitigation required: NONE
6g. 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). N/A
6h. Comments: N/A
E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers identified ? Yes ® No
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
? Yes No
Comments: this bridge repair will not alter storm water runoff at this site
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project? 20%
2b. Does this project require a Stormwater Management Plan? ? Yes ® No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: NCDOT state Permit No. NCS000250
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan: N/A
? Certified Local Government
2e . Who will be responsible for the review of the Stormwater Management Plan? ? DWQ Stormwater Program
? DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project? Wake County
? Phase II
? NSW
3b . Which of the following locally-implemented stormwater management programs ?
USMP
apply (check all that apply): ? Water Supply Watershed
? Other:
3c. Has the approved Stormwater Management Plan with proof of approval been ? Yes ? No
attached? N/A
Page 6 of 8
PCN Form - Version 1.3 December 10, 2008 Version
4. DWQ Stormwater Program Review
? Coastal counties
? HOW
4a . Which of the following state-implemented stormwater management programs apply ? ORW
(check all that apply): N/A
? Session Law 2006-246
? Other:
4b . Has the approved Stormwater Management Plan with proof of approval been
attached? N/A ? Yes ? No
5. DWQ 401 Unit Stormwater Review
5a . Does the Stormwater Management Plan meet the appropriate requirements? N/A ? Yes ? No
5b . Have all of the 401 Unit submittal requirements been met? N/A ? Yes ? No
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?
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 ? 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: N/A
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): N/A
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.
N/A
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non-discharge or discha rge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
N/A
Page 7 of 8
PCN Form - Version 1.3 December 10, 2008 Version
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? No DWM is known to occur within the segment of Basal Creek
between Bass Lake and Sunset Lake, per NEU survey report from ? yes ® No
07/14/05. A biological conclusion of No Effect was rendered with no
additional surveys needed. Additionally WRC indicates only common
species just below Bass Lake and Sunset Lake.
5b. Have you checked with the USFWS concerning Endangered Species Act ? Yes ® No
impacts?
? Raleigh
5c. If yes, indicate the USFWS Field Office you have contacted.
? Asheville

5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated
Critical Habitat? http://www.fws.gov/nc-es/es/countvfr.htmi and NC Natural Heritage Program Database, Element
Occurrences, and NEU mussel survey report with feedback from WRC concerning upcoming TIP project B-4659.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish ? yes No
habitat?
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
hftp://ocean.floridamarine.org/efh coral/ims/viewer.htm
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
? Yes ® No
governments have designated as having historic or cultural preservation
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?
HPO's historic layer using GIS ArcView database
8. Flood Zone Designation (Corps Requirement)
8a. 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? http://www.ncfloodmaps.com/

I W. Bowman, P.E. py? 05/26/11

Applicant/Agent's Printed Name ApplicanUAgent's Signatur
(Agent's signature is valid or If an authorization let from the applicant Date
is Provided.)
Page 8 of 8
PCN Form - Version 1.3 December 10, 2008 Version
Bridge Millntenance Repair
SR 1393 Sunset Lake Road
W,Ike County
Vie" looking upstream, at alignment of temporary wooden mat.
View looking downstream, at alignment of temporary wooden mat.