20210451 Ver 1_ePCN Application_20210326

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#*
20210451 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:
Gatewvod Road Bridge Removal
1a.Who is the Primary Contact?*
NCDOT
lb.Primary Contact Email:* 1c.Primary Contact Phone:*
[e-mail] [phone]
Date Submitted
3/26/2021
Nearest Body of Water
Country Line Creek
Basin
Roanoke
Water Classification
Class C
Site Coordinates
Latitude: Longitude:
36.402818 79.298024
Pre-Filing Meeting Information
ID# Version
20210451 1
Pre-fling Meeting or Request Date*
3/4/2021
Attach documentation of Pre-Filing Meeting Request here:*
Gatewood Rd Pre-Filing Meeting Request Form.pdf 56.51KB
A. Processing Information C^U
County(or Counties)where the project is located:
Caswell

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#(7)
17BP.7.R.130
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 r No
If.Is this an after-the-fact permit application?*
✓ Yes r No
1g.Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
CYes rNo
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?
CYes rNo
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:
NCDOT

2b.Deed book and page no.:
2c.Responsible party:
2d.Address
Street Address
1584 Yanceyville Street
Address Line 2
P.O.Box 14996
aty State/Rovince/legion
Greensboro NC
Postal/Zip Code Country
27415-4996 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:
Yanceyville
2. Project Identification
2a.Property Identification Number: 2b.Property size:
2c.Project Address
Street Address
Address Line 2
C7ly State/Province/legion
Postal/Zlp Code Country
3.Surface Waters
3a.Name of the nearest body of water to proposed project:*
Country Line Creek
3b.Water Resources Classification of nearest receiving water:*
Class C
3c. What river basin(s)is your project located in?*
Roanoke
3d.Please provide the 12-digit HUC in which the project is located.
030101040203
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 site is an existing bridge that is proposed to be removed.No new bridge is proposed.Gatewood Road is a loop road.Entrance to Gatewood Road at the completion of the
project will be on either end from NC 158.The project area can be described as rural,wooded and agricultural with sparse residences.
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)
Gatewood Rd Soils Map.pdf 1.14MB
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)
Gatewood Rd Topo Map.pdf 673.47KB
4f.List the total estimated acreage of all existing wetlands on the property:
0.08

4g.List the total estimated linear feet of all existing streams on the property:
60 LF
4h.Explain the purpose of the proposed project:*
Purpose of the project is to remove an existing bridge with no plans to build a new bridge.
4i.Describe the overall project in detail,including indirect impacts and the type of equipment to be used:*
Project will involve complete removal of the existing bridge.A temporary causeway will be utilized to allow access to the bents in the stream for their removal.Typical roadway
construction equipment will be utilized,such as,dozers,backhoes,dump trucks,cranes and tamps.
4j.Please upload project drawings for the proposed project.
Gatewood Rd Permit Drawings.pdf 1.34MB
5.Jurisdictional Determinations
5a.Have the wetlands or streams been delineated on the property or proposed impact areas?*
6' Yes r No C Unknown
Comments:
5b.If the Corps made a jurisdictional determination,what type of determination was made?*
r Preliminary r Approved r Not Verified 6 Unknown C N/A
Corps AID Number:
5c.If 5a is yes,who delineated the jurisdictional areas?
Name(if known): Sandy Smith
Agency/Consultant Company: Axiom
Other:
5d1.Jurisdictional determination upload
Gatewood Rd Wetland Evaluation.pdf 2.3MB
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):
17 Wetlands 17 Streams-tributaries r Buffers
r Open Waters r Pond Construction
2.Wetland Impacts
2a.Site#*(?) 2a1 Reason(?) 2b.Impact type*(?) 2c.Type of W.* 2d.W.name* 2e.Forested* 2f.Type of 2g.Impact
Jurisdicition*(?) area*
Site 1 Temporary Fill T Bottomland Hardwood Forest Site 1 Yes Both 0.010
(acres)
Site 1 Excavation P Bottomland Hardwood Forest Site 1 Yes Both 0.049
(acres)
Site 1 Hand Clearing T Bottomland Hardwood Forest Site 1 Yes Both 0.020
(acres)
2g.Total Temporary Wetland Impact 2g.Total Permanent Wetland Impact
0.030 0.049
2g.Total Wetland Impact
0.079
2h.Comments:

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 Bridge Removal Temporary Workpad/Causeway Country Line Creek Perennial Both 30 33
Average(feet) (linear feet)
32 Bridge Removal Permanent Bank Stabilization Country Line Creek Perennial Both 30 30
Average(feet) (linear feet)
3i.Total jurisdictional ditch impact in square feet:
0
3i.Total permanent stream impacts: 3i.Total temporary stream impacts:
30 33
3i.Total stream and ditch impacts:
63
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:
Roadway approach work was minimized as much as possible to reduce the overall project footprint.BMP practices will be utilized throughout the
course of the project.Temporary causeway installed according to BMP standards to reduce permanent impacts to the stream.
1b.Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Erosion and sedimentation control will be managed through utilization of BMP techniques.Coordination(including a pre-construction meeting with a
Division Environmental staff person)prior to commencing removal of bridge.
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 this project DOES NOT require Compensatory Mitigation,explain why:
Project does not meet nor exceed the thresholds that would require mitigation.
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 ( No
If no,explain why:
Project is not adjacent to a stream that has protected buffers.
2.Stormwater Management Plan
2a.Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
( Yes r No
Comments:
This project does not add any new impervious surface,therefore there is no need to provide stormwater treatment.
G. Supplementary Information U
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 CNo
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(NEPAISEPA)?*
✓ Yes ( No
Comments:*
Project does not meet the thresholds necessary for NEPA/SEPA documentation

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)?*
r Yes f No
3. Cumulative Impacts(DWR Requirement)
3a.Will this project result in additional development,which could impact nearby downstream water quality?*
(' Yes G No
3b.If you answered"no,"provide a short narrative description.
The proposed project is a small scale public transportation project which by definition,has a"low potential"for resulting in additional development.
4.Sewage Disposal(DWR Requirement)
4a.Is sewage disposal required by DWR for this project?*
✓ Yes (7 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 (' No
5b.Have you checked with the USFWS concerning Endangered Species Act impacts?*
a Yes rNo
5c.If yes,indicate the USFWS Field Office you have contacted.
Raleigh
5d.Is another Federal agency involved?*
✓ Yes r• No r Unknown
5e.Is this a DOT project located within Division's 1-8?
6 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
Aquatic Species Survey Report by Environmental Consultants
Consultation Documentation Upload
Gatewood Rd T&E Survey.pdf 4.22MB
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?*
NCDOT Cultural Resource Personnel
7c.Historic or Prehistoric Information Upload
Gatewood Rd No Archaeology Survey.pdf 792.41KB
Gatewood Rd No Architectural Survey.pdf 2.66MB
8. Flood Zone Designation(Corps Requirement)
8a.Will this project occur in a FEMA-designated 100-year floodplain?*
✓ Yes r No
8b.If yes,explain how project meets FEMA requirements:
Coordination with NCDOT Hydraulics Unit
8c.What source(s)did you use to make the floodplain determination?*
FEMA Flood Maps

Miscellaneous
Comments
Miscellaneous attachments not previously requested.
Gatewood Rd Stormwater Plans.pdf 64.48KB
Signature
®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:
W.R.Archer Ill,PE
Signature
Date
3/26/2021