20120712 Ver 1_Application_20120719

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Office Use Only
Corps action ID no
DWQ project no
Form Version 1 3 Dec 10 2008
Page 1 of 11
PCN Form — Version 1 3 December 10 2008 Version
Pre - Construction Notification (PCN ) Form
A Apphcant Information
1
Processing
la
Type(s) of approval sought from the
Corps
®Section 404 Permit ®Section 10 Permit
1b Specify Nationwide Permit (NWP) number 23 or General Permit (GP) number We request that all utilities on this
project that will cross Slocum Creek in over under through be covered under the section 10 permit
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 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
B 4488 Craven 176
WBS Element Number 33725 1 2
2b
County
Craven
2c
Nearest municipality / town
Havelock
2d
Subdivision name
N/A
2e
NCDOT only T I P or state
project no
B 4488
3
Owner Information
3a
Name(s) on Recorded Deed
North Carolina Department of Transportation
3b
Deed Book and Page No
N/A
3c
Responsible Party (for LLC if
applicable)
N/A
3d
Street address -
105 Pactolus Highway NC 33 P O Box 1587
3e
City state zip
Greenville NC 27835
3f
Telephone no
252 830 3490
3g
Fax no
252 830 3341
3h
Email address
jbjohnson @ncdot gov
Page 1 of 11
PCN Form — Version 1 3 December 10 2008 Version

4
Applicant Information (if different from owner)
4a
Applicant is
❑ Agent ® Other specify Division 2 Environmental Officer
4b
Name
Jay B Johnson
4c
Business name
(if applicable)
North Carolina Department of Transportation
4d
Street address
P O Box 1587
4e
City state zip
Greenville NC 27835
4f
Telephone no
252 830 3490
4g
Fax no
252 830 3341
4h
Email address
jbjohnson @ncdot gov
5
Agent/Consultant Information (if applicable)
5a
Name
N/A
5b
Business name
(if applicable)
5c
Street address
5d
City state zip
5e
Telephone no
5f
Fax no
5g
Email address
Page 2 of 11
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)
B 4488 Craven 176
Latitude N 34 891253 Longitude W
lb Site coordinates (in decimal degrees)
76 923405
(DD DDDDDD) (DD DDDDDD)
1c Property size
N/A acres
2 Surface Waters
2a Name of nearest body of water (stream river etc ) to
Southwest Prong of Slocum Creek a Tributary of Neuse
proposed project
River
2b Water Quality Classification of nearest receiving water
C Sw 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
SR 1763 Church Street is a paved secondary state road Woodlands dominate the landscape
3b List the total estimated acreage of all existing wetlands on the property
32 509 Square Feet (0 75 Acres) of 404 Wetland Impacts For The Bridge Replacement on new Alignment
3c List the total estimated linear feet of all existing streams (intermittent and perennial) on the property
This site is part of a longer adjacent stream system Southwest Prong Slocum Creek = 320 Linear Feet U/T = 402 Linear
Feet
3d Explain the purpose of the proposed project
Due to age and condition of the existing structure Craven 176 will be replaced with a new bridge on a new location to
serve as a better service road access along the Highway 70 corridor The old bridge will be removed and designed to tie
into the new service road by new location No Detour
3e Describe the overall project in detail including the type of equipment to be used
The Existing 116 Long By 25 Wide Concrete Bridge will be replaced with a Proposed 300 Long by 42 Wide Concrete
Bridge on New Alignment A 10 x 6 reinforced box culvert will be installed on the church street realignment
Excavators Dump Trucks and Crane Trucks will be used for the Bridge To Bridge Replacement
4 Jurisdictional Determinations
4a Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
El Yes ❑ No Unknown
project (including all prior phases) in the pasty
Comments
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 NCDCM
Name (if known) Stephen Lane and Jay B Johnson
Other NCDOT
4d If yes list the dates of the Corps jurisdictional determinations or State determinations and attach documentation
March 2011
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
CAMA Mayor Permit pending NCDWQ 401 and Buffer Aurhorization pending NCDWQ Stormwater Permit Exclusion
issued 6/6/2012 see attached
Page 3 of 11
PCN Form — Version 1 3 December 10 2008 Version

6 Future Project Plans
6a Is this a phased project* ❑ Yes ® No
6b If yes explain
Page 4 of 11
PCN Form — Version 1 3 December 10 2008 Version

C Proposed Impacts Inventory
1 Impacts Summary
1a 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 – non404 other)
(acres)
T
—Temporary
W1 ®P ❑ T
Fill
Riparian
❑ Yes
® Corps
0 006
Herbacious
® No
® DWQ
W2 ®P ❑ T
Fill
Bottomland
® Yes
® Corps
079
Hardwood Forest
❑ No
® DWQ
W3 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W4 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W5 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W6 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
2g Total wetland impacts
0 75 Acres
2h Comments 32 509 Sq Ft Impacts
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
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)
S1 ®P ❑ T
Relocation of
Stream
U/T Slocum Creek
® PER
❑ INT
® Corps
® DWQ
15
232
S2 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S3 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S4 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S5 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S6 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
3h Total stream and tnbutary impacts
232 LF
31 Comments 232 Linear Feet of Stream Impacts
Page 5 of 11
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
4b
4c
4d
4e
Open water
Name of waterbody
impact number —
(if applicable)
Type of impact
Waterbody type
Area of impact (acres)
Permanent (P) or
Temporary T
01 ❑P ❑T
02 ❑P ❑T
03 ❑P FIT
04 ❑P ❑T
4f Total open water impacts
None
4g Comments None
5 Pond or Lake Construction
If pond or lake construction proposed the complete the chart below
5a
5b
5c
5d
5e
Wetland Impacts (acres)
Stream Impacts (feet)
Upland
Pond ID
Proposed use or purpose
(acres)
number
of pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
5f Total
None
5g Comments None
5h Is a dam high hazard permit required?
❑ Yes ❑ No If yes permit ID no
51 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 any impacts require mitigation then you MUST fill out Section D of this form
6a
® Neuse El Tar Pamlico El Other None
Project is in which protected basin?
❑ Catawba ❑ Randleman
6b
6c
6d
6e
6f
6g
Buffer impact
number—
Reason
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P) or
for
Stream name
mitigation
(square feet)
(square feet)
Temporary T
impact
re uired�
61 ®P ❑ T
Fill
Southwest Prong Slocum
El Yes
0 Sq Ft
11 Sq Ft
Creek
® No
B2 ❑P ❑T
El Yes
❑ No
B3 ❑P ❑T
El Yes
❑ No
6h Total buffer impacts
11 Sq Ft
61 Comments 11 Sq Ft Impacts
Page 6 of 11
PCN Form — Version 1 3 December 10 2008 Version

D Impact Justification and Mitigation
1 Avoidance and Minimization
1 a Specifically describe measures taken to avoid or minimize the proposed impacts in designing project
See narrative
lb Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
See narrative
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
projects
® Mitigation bank
Payment to in lieu fee program
❑ Permittee Responsible Mitigation
3 Complete if Using a Mitigation Bank
3a Name of Mitigation Bank Croatan Mitigation Bank
3b Credits Purchased (attach receipt and letter)
Type
Quantity
3c Comments Croatan Mitigation Site will include stream mitigation as well (See verification attached)
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)
0 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
See plan attached
Page 7 of 11
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
❑ Yes ® No
buffer mitigation?
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
6c
6d
6e
Zone
Reason for impact
Total impact
Multiplier
Required mitigation
(square feet)
(square feet)
Zone 1
3 (2 for Catawba)
Zone 2
1 5
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
Page 8 of 11
PCN Form — Version 1 3 December 10 2008 Version

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? If no explain why
Comments Road on new alignment will discharge stormwater into vegetated
wetlands Existing road side ditches will discharge into wetlands outside the buffers
® Yes ❑ No
There are no weep holes in the proposed bridge thus eliminating stormwater run off
from the proposed bridge deck Stormwater from bridge deck is being carried out
side of buffers and being released onto a disipater pad into wetlands for treatment
2
Stormwater Management Plan
2a
What is the overall percent imperviousness of this project?
N/A Roadway /Bridge Project %
2b
Does this project require a Stormwater Management Plan?
® Yes ❑ No
2c
If this project DOES NOT require a Stormwater Management Plan explain why
2d
If this project DOES require a Stormwater Management Plan then provide a brief narrative description of the plan
Road on new alignment will discharge stormwater into vegetated wetlands Existing road side ditches will discharge into
wetlands outside the buffers There are no weep holes in the proposed bridge thus eliminating
stormwater run off from
the proposed bridge deck Stormwater from bridge deck is being carried out side of buffers and being released onto a
disipater pad into wetlands for treatment
❑ 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?
N/A
❑ Phase II
3b
Which of the following locally implemented stormwater management programs
❑ NSW
❑ USMP
apply (check all that apply)
❑ Water Supply Watershed
❑ Other N/A
3c
Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ® No
attached?
4
DWQ Stormwater Program Review
® Coastal counties
❑ HQW
4a
Which of the following state implemented stormwater management programs apply
❑ ORW
(check all that apply)
❑ Session Law 2006 246
❑ Other
4b
Has the approved Stormwater Management Plan with proof of approval been
attached?
❑ Yes ® No
5
DWQ 401 Unit Stormwater Review
Page 9 of 11
PCN Form — Version 1 3 December 10 2008 Version

5a
Does the Stormwater Management Plan meet the appropriate requirements?
® Yes ❑ No
5b Have all of the 401 Unit submittal requirements been met?
® 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)?
1 c
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
N/A
Page 10 of 11
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
❑ Yes ® No
habitats L,
5b Have you checked with the USFWS concerning Endangered Species Act
❑ Yes ® No
impacts?
El Raleigh
5c If yes ind icate 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?
Onsite Field Determination No Effect
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?
Determination was made by Mr Travis Wilson NCWRC September 1 2009 Moratorium February 15 September 30
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?
NCSHPO
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 Bridge designed to no rise standards
8c What source(s) did you use to make the floodplain determination? FEMA FIRM Maps
Jay B Johnson
July 18 2012
Applicant/Agent s Printed Name
Date
p 0=�Oan ent s Signature
(Agents signa r is va authorization letter from the applicant
is provided
Page 11 of 11
PCN Form — Version 1 3 December 10 2008 Version

E ffl�
North Carolina Department of Environment and Natur �g��uurcees®
Division of Water Quality c:;
Beverly Eaves Perdue
Governor
Mr Dwayne H Alligood PE
NCDOT Division Two Operations
P O Box 1587
Greenville NC 27835
ti
Dear Mr Alligood
Coleen H Sullins JUN Dee Freeman
Director 2012 Secretary
NC DOT DIV OF r 1GhW ,4YS
June 6 2012 DIVISION 2 OPEk TONS
Subject Stormwater Permit Exclusion — NC DOT Activity
Replacement of Bridge No 176 over SW Prong of Slocum
Creek, Havelock, NC, B -4488
Stormwater Protect No SW7120503
Craven County
On May 2 2012 the Washington Regional Office of the Division of Water Quality received a Coastal Stormwater Permit
Application for project B-4488 the replacement of Bridge No 176 located over the Southwest Prong of Slocum Creek on
Church Street in Havelock Craven County Staff review of the plans and supporting documents has determined that the
protect proposes activities that are excluded from State Stormwater permitting requirements as set forth in Section 2 (d)(1)
of Session Law 2008 211 effective October 1 2008 and the stormwater rules under Title 15A NCAC 2H 1000 as
amended
Therefore the Director of the Division of Water Quality is hereby providing confirmation that the subject project is
excluded from State Stormwater permitting requirements being an activity of the NC DOT that is regulated in
accordance with the provisions of the NC DOT's National Pollutant Discharge Elimination System (NPDES)
Stormwater Permit
Under Section 15A NCAC 2H 1003 any future development or changes to the proposed development, including but not
limited to the locations of the built upon area and construction of additional built upon area, may require approval or a
Stormwater Management permit application and permit issuance from the Division of Water Quality prior to any
construction Any construction on the site prior to receipt of the required approval or permit will constitute a violation of
Title 15A NCAC 2H 1000 and Session Law 2008 211 and may result in the initiation of appropriate enforcement action
Please keep in mind that this determination does not affect your legal obligation to obtain other permits and approvals
which may be required by Federal State or local government agencies rule or law If you have any questions or need
additional information concerning this matter please contact either Roger Thorpe or me at [phone]
cc Washington Regional Office
North Carolina Division of Water Quality
943 Washington Square Mall
Washington NC 27889
An Equal Opportunity 1 Affirmative Action Employer
mcerely
Al Hoge
Regional Supervisor
Surface Water Protection Section
Internet www rimaterquairty org
Phone [phone] FAX [phone]
FAX [phone]
None Carolina
turall
Naturally