20120612 Ver 1_Application_20120621

MICHAFL F EASLEY
GOVERNOR
ST
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
DIVISION OF HIGHWAYS
June 18 2012
Ms Sonia Carrillo
NCDWQ
401 Wetlands Unit
1650 Mail Service Center
Raleigh NC 27699 1650
Subject Nationwide Permit # 14
SR -1452 Hoke County
Project # 8B 204721
Ms Carrillo
o�
✓&/V I
20
1
�a0s4* °s , ?64 '?
LYNDO TIPPETI'�fl
SECRETARY
The North Carolina Department of Transportation Highway Division 8 is requesting a Nationwide
Permit Numbers 14 for project # 8B 204721 on SR 1452 (McNeil l s Lake Rd ) in Hoke County
The proposed project will replace the existing deficient bridge as follows
Site 1 Replace existing 36 long x 18 wide bridge with a 27 10 x 5 10 aluminum box culvert
The bridge is being replaced due to its deficient weight rating and deteriorating structural integrity There are no
plans to pave the road
The total percentage of impervious surface within the project area will be unchanged All erosion control devices
used on the project will be appropriate to the location and in compliance with the current version of the NCDOT
Best Management Practices Manual (BMP) The crossing is located on McNeill s Mill Creek a Class C,SW stream
withm the Lumber River basm All construction activities on this project will be done in compliance with conditions
listed in the current BMP manual for projects built within areas of Class C SW streams Construction will be done
under dry conditions whenever possible There were no threatened or endangered species observed within the project
area during the required nu mum criteria check The site has been screened for Prehistoric and Historic properties
The survey was conducted by NCDOT staff This project is on a dead end road but will not require that access be
maintained during construction because there no residences beyond the bridge
If you require any additional information please contact me
Smcer
C in�
g
Division Environmen icer
Highway Division 8
cc Richard W Hancock PE
Dean Garner
Barry Harrington
P O BOX 1067 ABERDEEN NORTH CAROLINA 28315
PHONE [phone] FAX [phone]

Office Use Only
Corps action ID no
h k ')` DWQ project no
Form Version 1 0 November 2008
Page 1 of 11
PCN Form — Version 1 0 November 2008 Version
Pre - Construction Notification (PCN) Form
A
Applicant Information
1
Processing
1 a
Type(s) of approval sought from the
Corps
®Section 404 Permit ❑Section 10 Permit
1 b Specify Nationwide Permit (NWP) number 14 or General Permit (GP) number
1c
Has the NWP or GP number been verified by the Corps?
❑ Yes
® No
1 d
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
1 e
Is this notification solely for the record
because wntten approval is not required?
For the record only for DWQ 401
Certification
❑ Yes ® No
For the record only for Corps Permit
❑ Yes ® 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
1h
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
® No
2
Project Information
2a
Name of project
SR 1452 Bridge # 97
2b
County
Hoke
2c
Nearest municipality / town
Raeford
2d
Subdivision name
N/A
2e
NCDOT only T I P or state
project no
8B 204721
3
Owner Information
3a
Name on Recorded Deed
NC DOT
3b
Deed Book and Page No
3c
Responsible Party (for LLC if
applicable)
3d
Street address
PO BOX 1067
3e
City state zip
Aberdeen NC 28315
3f
Telephone no
910 944 2344
3g
Fax no
910 944 5623
3h
Email address
rwhancock @ncdot gov
Page 1 of 11
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 Division Engineer
4b
Name
Richard W Hancock
4c
Business name
(if applicable)
North Carolina Department of Transportation
4d
Street address
PO BOX 1067
4e
City state zip
Aberdeen NC 28315
4f
Telephone no
910 944 2344
4g
Fax no
910 944 5623
4h
Email address
rwhancock @ncdot gov
5
Agent/Consultant Information (if applicable)
5a
Name
Dean R Garner
5b
Business name
(if applicable)
North Carolina Department of Transportation/ Bridge Maintenance
5c
Street address
1404C East Raleigh St PO Box 289
5d
City state zip
Sder City NC 27344
5e
Telephone no
919 742 5649
5f
Fax no
919 663 0214
5g
Email address
drgarner @ncdot gov
Page 2 of 11
PCN Form — November 2008 Version

B Project Information and Prior Project History
1 Property Identification
1a Property identification no (tax PIN or parcel ID)
lb Site coordinates (in decimal degrees)
35 9028 N 79 1408 W
1c Property size
acres
2 Surface Waters
2a Name of nearest body of water (stream river etc ) to
proposed project
McNedis Mill Creek
2b Water Quality Classification of nearest receiving water
C SW
2c River basin
Lumber
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
Rural /Residential Area
3b List the total estimated acreage of all existing wetlands on the property
0
3c List the total estimated linear feet of all existing streams (intermittent and perennial) on the property
300 ft
3d Explain the purpose of the proposed project
Replace deficient bridge with aluminum box culvert (27 10 x 5 10 )
3e Descnbe the overall project in detail including the type of equipment to be used
Remove existing bridge with excavator and replace with aluminum box culvert utilizing truck crane and excavator
4 Jurisdictional Determinations
4a Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (including all prior phases) in the past
❑ Yes ® No ❑ Unknown
4b If the Corps made the jurisdictional determination what type
of determination was made?
❑ preliminary ❑ Final
4c If yes who delineated the jurisdictional areas?
Name (if known)
Agency /Consultant Company
Other
4d If yes list the dates of the Corps jurisdictional determinations or State determinations and attach documentation
5 Project History
5a Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
❑ Yes ® No ❑ Unknown
5b If yes explain in detail according to help file instructions
6 Future Project Plans
6a Is this a phased project?
❑ Yes ® No
6b If yes explain
Page 3 of 11
PCN Form — Version 1 0 November 2008 Version

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
Area of impact (acres)
Permanent (P) or
impact
(if known)
DWQ — non -404 other)
Temporary
W1 ®P ❑ T
road fill
rivenne
❑ Yes ® No
® Corps
❑ DWQ
72 sqft
W2 ❑ P ❑ T
❑ Yes ❑ No
❑ Corps
❑ DWQ
W3 ❑ P ❑ T
❑ Yes ❑ No
❑ Corps
❑ DWQ
W4 ❑ P ❑ T
❑ Yes ❑ No
❑ Corps
❑ DWQ
W5 ❑ P ❑ T
❑ Yes ❑ No
❑ Corps
❑ DWQ
W6 ❑ P ❑ T
❑ Yes ❑ No
❑ Corps
❑ DWQ
2g Total wetland impacts
72 sqft
2h Comments
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)
Replace
S1 ®P ❑ T
bridge
McNeills Mill
®PER [:1 INT
28
54 ft
with
Creek
culvert
S2 ❑ P ® T
Dewater
McNeills Mill
Creek
® PER ❑ INT
28
40ft
S3 ❑ P ❑ T
❑ PER ❑ INT
S4 ❑P ❑T
[:1 PER ®INT
S5 ❑ P ❑ T
❑ PER ❑ INT
S6 ❑P ❑T
PER El INT
3g Total stream and tributary impacts
94 ft
3h Comments Replacing a deficient bridge with with aluminum culvert with floor
Page 4 of 11
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 in vidually list all o en water impacts below
4a
4b
4c
4d
4e
Open water
Name of
impact number
waterbody
Type of impact
Waterbody type
Area of impact (acres)
— Permanent
(if
(P) or
applicable)
Temporary
01 ❑P
NA
02 ❑P
03 ❑P ❑T
04 ❑P ❑T
M Total open water impacts
0
4g Comments
Page 5 of 11
PCN Form — November 2008 Version

C Proposed Impacts Inventory continued
5 Pond or Lake Construction
If pond or lake construction pro osed then complete the chart below
5a
Pond ID
number
5b
Proposed use or
purpose of pond
5c
Wetland Impacts (acres)
5d
Stream Impacts (feet)
5e
Upland
(acres)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
Pi
NA
P2
5f Total
5g Comments
5h Is a dam high hazard permit required
❑ Yes ❑ No If yes permit ID no
51 Expected pond surface area (acres)
51 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 any impacts require mitigation then y ou MUST fill out Section D of this form
6a
Project is in which protected basin?
❑ Neuse El Tar Pamlico El Other
❑ Catawba ❑ Randleman
6b
Buffer impact
number —
Permanent (P)
or Temporary
6c
Reason
for impact
6d
Stream name
6e
Buffer
mitigation
required?
6f
Zone 1 impact (square
feet)
6g
Zone 2 impact
(square feet)
B1 [:]PDT
NA
El Yes 0 N
B2 ❑ P ❑ T
❑ Yes ❑ No
B3 ❑ P ❑ T
❑ Yes ❑ No
6h Total buffer impacts
61 Comments Not in a buffer area
Page 6 of 11
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
Install temporary steel sheet piles and divert stream by pumping water around work area
1 b Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
Install erosion control devices and compliance with all current BMP
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
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
linear feet
4c If using stream mitigation stream temperature
warm cool cold
4d Buffer mitigation requested (DWQ only)
square feet
4e Riparian wetland mitigation requested
acres
4f Non riparian wetland mitigation requested
acres
4g Coastal (tidal) wetland mitigation requested
acres
4h Comments
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
Page 7 of 11
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
NA
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 8 of 11
PCN Form — November 2008 Version

E
Stormwater Management and Diffuse Flow Plan (required by DWQ)
1
Diffuse Flow Plan
la
Does the protect 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?
❑ 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
❑ HQW
management programs (check all that apply)?
❑ 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
3b
In which local governments jurisdiction is this project?
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?
<24%
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
4d
Has a completed BMP Supplement Form with all required items been submitted
❑ Yes ® No
for each stormwater BMP?
Page 9 of 11
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?
lb
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 213 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 10 of 11
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?
El 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?
On site survey and NCDOT SDV reference layer
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?
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?
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
8c What source(s) did you use to make the floodplain determination?
Applicant/Agent s Printed Name
Applicant/Agent s Signature
(Agent s signature is valid only if an authorization letter from the applicant
Date
is provided
Page 11 of 11
PCN Form — November 2008 Version

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