20210427 Ver 1_ePCN Application_20210222

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#*
20210427 1
Is a payment required for this project?*
✓ No payment required
6 Fee received Reviewing Office*
✓ Fee needed-send electronic notification Mooresville Regional Office-[phone]
Select Project Reviewer*
Donna Hood:eads\drhood
Information for Initial Review
1a.Name of project:
Replacement of Bridge#3 on Cheatham Ford Road in Alexander County
1a.Who is the Primary Contact?*
Jeff Wyatt
lb.Primary Contact Email:* 1c.Primary Contact Phone:*
jlwyatt©ncdot.gov [phone]
Date Submitted
2/22/2021
Nearest Body of Water
South Yadkin River
Basin
Yadkin-PeeDee
Water Classification
WS-II,CA,HQW/WS-IV
Site Coordinates
Latitude: Longitude:
35.896133 -81.054787
Pre-Filing Meeting Information
ID# Version
Pre-fling Meeting or Request Date*
12/11/2020
Attach documentation of Pre-Filing Meeting Request here:*
PFMRBr 3 Alexander Co.pdf 222.41 KB
A. Processing Information C^U
County(or Counties)where the project is located:
Alexander

Is this a NCDMS Project
✓ Yes r No
Is this project a public transportation project?*
✓ Yes r No
Is this a NCDOT Project?*
✓ Yes r No
(NCDOT only)T.I.P.or state project number:
WBS#(2)
DF17112.2002807
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?*
✓ Yes
r 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 rNo
Nationwide Permit(NWP)Number: 03-Maintenance
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: r Yes r No
For the record only for Corps Permit: r Yes C No
If.Is this an after-the-fact permit application?*
✓ Yes rNo
1g.Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
C Yes r No
1g.Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
✓ Yes rNo
Acceptance Letter Attachment
lh.Is the project located in any of NC's twenty coastal counties?
C Yes r No
1j.Is the project located in a designated trout watershed?
✓ Yes r No
B. Applicant Information
Id.Who is applying for the permit?
7 Owner r Applicant(other than owner)
le.Is there an Agent/Consultant for this project?*
✓ Yes r No
2.Owner Information
2a.Name(s)on recorded deed:
NC DOT R/W

2b.Deed book and page no.:
2c.Responsible party:
Mark Stafford
2d.Address
Street Address
1710 East Marion Street
Address Line 2
PO box 47
Coy State/Province/legion
Shelby NC
Fbstal/Zip Code Country
28151 USA
2e.Telephone Number: 2f.Fax Number:
[phone]
2g.Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
lb.Subdivision name:
(if appropriate)
1c.Nearest municipality/town:
Fiddenite
2. Project Identification
2a.Property Identification Number: 2b.Property size:
2c.Project Address
Street Address
Address Line 2
City State/Province/legion
Fbstal/Zlp Code Country
3.Surface Waters
3a.Name of the nearest body of water to proposed project:*
South Yadkin River
3b.Water Resources Classification of nearest receiving water:*
WS-II,CA,HQW/WS-IV
3c. What river basin(s)is your project located in?*
Yadkin-PeeDee
3d.Please provide the 12-digit HUC in which the project is located.
030401020103
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 conditions are a failed concrete deck bridge with sections of the deck in the water.The general land use around the project is mostly forested.An old water supply plant is
adjacent to the bridge.Bridge is on paved secondary road.
4b.Have Corps permits or DWR certifications been obtained for this project(including all prior phases)in the past?*
r Yes f• No C 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)
VicFigl.pdf 747.46KB
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)
Farmland_Classification.pdf 281.12KB
4f.List the total estimated acreage of all existing wetlands on the property:
0

4g.List the total estimated linear feet of all existing streams on the property:
400
4h.Explain the purpose of the proposed project:*
The purpose of the proposed work replace the failed bridge for the safety of the travelling public.
4i.Describe the overall project in detail,including indirect impacts and the type of equipment to be used:*
NC DOT proposes to replace Bridge No.3 on SR 1465(Cheatham Ford Road)over South Yadkin River in Alexander County east of Hiddenite.Existing is a failed 175'long by 28'vide
(reinforced concrete deck on I-beams)five-span bridge with piers located in the stream.The failed bridge is to be replaced with a 2@70',1@60'Cored Slab bridge three span bridge
with piers located outside normal stream flow.The proposed bridge will have no direct discharge into the water.The roadway grade and alignment will be approximately in the same
location as the existing structure.All Best Management Practices will be utilized during the course of the project.The Project will be constructed using typical heavy equipment
(trackhoe,backhoe,etc.)Any temporary disturbances will be restored back to previous project conditions.
4j.Please upload project drawings for the proposed project.
SF-010003_Permit Drawings_20210204.pdf 1.76MB
5.Jurisdictional Determinations
5a.Have the wetlands or streams been delineated on the property or proposed impact areas?*
6 Yes r No O Unknown
Comments:
Division 12 Environmental Office
5b.If the Corps made a jurisdictional determination,what type of determination was made?*
r Preliminary r Approved r Not Verified r Unknown O. N/A
Corps AID Number:
5c.If 5a is yes,who delineated the jurisdictional areas?
Name(if known): Division 12 Environmental Office
Agency/Consultant Company:
Other:
5d1.Jurisdictional determination upload
6. Future Project Plans
6a.Is this a phased project?*
C Yes ( 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):
r Wetlands 17 Streams-tributaries ❑Buffers
r Open Waters r Pond Construction
3.Stream Impacts
3a.Reason for impact(?) 3b.Impact type* 3c.Type of impact* 3d.S.name* 3e.Stream Type* 3f.Type of 3g.S.width* 3h.Impact
(?) Jurisdiction* length*
S1 Bank Stabilization Permanent Bank Stabilization South Yadkin River Perennial Both 40 105
Average(feet) (linear feet)
S2 Workpad Temporary Workpad/Causeway South Yadkin River Perennial Both 40 11
Average(feet) (linear feet)
3i.Total jurisdictional ditch impact in square feet:
0
3i.Total permanent stream impacts: 3i.Total temporary stream impacts:
105 11
3i.Total stream and ditch impacts:
116
3j.Comments:

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:
The proposed bridge will have no direct discharge into the water.The minimum number of deck drains necessary to maintain safe passage by the
traveling public will be installed over the overbank floodplain areas as far from the stream as possible and diffused on riprap dissipators.All proposed
stormwater runoff is discharged as far away from the stream and at the lowest velocities as practicable.
lb.Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Minimization of impacts by installing appropriate erosion control measures.Minimal impact to stream during old bridge removal.
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 rNo
2b.If this project DOES NOT require Compensatory Mitigation,explain why:
Five span bridge replacement with a three span bridge.
F. Stormwater Management and Diffuse Flow Plan (required by DWR) L)
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 rNo
If no,explain why:
South Yadkin River is not located in area with 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
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(North Carolina)
Environmental Policy Act(NEPA/SEPA)?*
✓ Yes f•No
Comments:*
The project is classified at Categorical Exclusion.CE documentation is attached.
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 r No
3. Cumulative Impacts(DWR Requirement)
3a.Will this project result in additional development,which could impact nearby downstream water quality?*
✓ Yes rNo
3b.If you answered"no,"provide a short narrative description.
The project is a categorical exclusion project with little anticipated future impacts.
4.Sewage Disposal(DWR Requirement)
4a.Is sewage disposal required by DWR for this project?*
✓ Yes r 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 rNo
5b.Have you checked with the USFWS concerning Endangered Species Act impacts?*
( Yes rNo
5c.If yes,indicate the USFWS Field Office you have contacted.
Asheville
5d.Is another Federal agency involved?*
( Yes r No r Unknown
What Federal Agency is involved?
USACE
5e.Is this a DOT project located within Division's 1-8?
✓ Yes ( No
5f.Will you cut any trees in order to conduct the work in waters of the U.S.?
( Yes r No
5g.Does this project involve bridge maintenance or removal?
( Yes r No
5g(1).If yes,have you inspected the bridge for signs of bat use such as staining,guano,bats,etc.?
( Yes r No
If you answered"Yes"to 5g(1),did you discover any signs of bat use?
✓ Yes ( No r Unknown
5h.Does this project involve the construction/installation of a wind turbine(s)?*
✓ Yes ( No
5i.Does this project involve(1)blasting,and/or(2)other percussive activities that will be conducted by machines,such as jackhammers,mechanized pile drivers,etc.?
( Yes r No
If yes,please provide details to include type of percussive activity,purpose,duration,and specific location of this activity on the property.
SF-010003_Permit Drawings_20210204.pdf 1.76MB
5j.What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
NC Natural Heritage Program database and on-site surveys.Division 12 is located in the white nose syndrome area;however,there are no known
hibernacula or roosting trees in the Division 12 counties;therefore,a NLEB consultation from was completed(see attached).
Consultation Documentation Upload
Bat2.pdf 34.37KB
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?*
Per Natural Heritage database no salt marshes,oyster reefs,or seagrass beds located in vicinity of project.
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?*
Cultural Resources review conducted 2020
7c.Historic or Prehistoric Information Upload
HistoricFull.pdf 298.86KB
ArchFulINSR.pdf 7.33MB
8. Flood Zone Designation(Corps Requirement)
8a.Will this project occur in a FEMA-designated 100-year floodplain?*
( Yes rNo
8b.If yes,explain how project meets FEMArequirements:
NCDOT hydraulic coordination
8c.What source(s)did you use to make the floodplain determination?*
Flood map website,http://fris.nc.gov/fris

Miscellaneous
Comments
Miscellaneous attachments not previously requested.
CoverLetter.pdf 52.16KB
Final CE_Cheatham_For_Road_bridge_washout_DF17112_2.pdf 509.33KB
FINAL NRTR.pdf 367.31 KB
Flood.pdf 410.8KB
Signature
I7 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:
Jeffrey L.Wyatt
Signature
Date
2/22/2021