20130039 Ver 1_Application_20130115

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 Applicant Information
1
Processing
la
Type(s) of approval sought from the
Corps
®Section 404 Permit ❑Section 10 Permit
lb 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
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
1e
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
17BP 2 R 23 Jones 28
2b
County
Jones
2c
Nearest municipality / town
Trenton
2d
Subdivision name
N/A
2e
NCDOT only, T I P or state
project no
17BP 2 R 23
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 -439 -2800
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

NO' IURVI?1'REQUIRL,Dt0101
I'ROJI (..T 1NFOR4tATION
Pr(yecr A'e)
fPB% A`6 1713P.2.11.23
h 4 Vo
P edei al (US 4 C L) 1'ernut Reyttti ed -'
Pr tees Tea kr+i M) /A re r? lit f <t
(HA)11 -12 -0001
( numv Jones
Oot untetu
1- 1111rht g X State Federal
X Ye N0 Permit 13/)k NWP 3
Ptoject Description Replace Bridge No. 28 on SR 1123 (Francks Field Road) over
Crooked Run (no off -site detour planned).
SI.iiV MARY OF CUI 'I UItAL ItESOUR(.LS REVIEW
13t ref de5c rrlttuut of t e� tc a acttvttte s re'sult� of revte 1t curd r-onchmom HPOWeb reviewed on 4 January
2012 and yielded no NR, SL, Lb, DE, or SS properties in the Area of Potential Effects (APE) Jones
County current GIS mapping, aerial photography, and tax information indicate an APE of cultivated fields,
woodland, and wetland (viewed 4 January 2012) The APE intersects a large parcel containing resources
dated to the 1940s, located over a mile to the east beyond any possible project impact Constructed in
1958, Bridge No 28 is a three -span, 46- foot -long, timber, stringer /multi -beam structure and is not
eligible for the National Register according to the NCDOT Historic Bridge Survey as it is not historically,
architecturally, or technologically significant Googie Maps `Street View" confirmed absence of critical
historic structures /landscapes in APE (viewed 4 January 2012)
No architectural survey is required for the project as currently defined.
Brief rvplc.nation of whi, the available a fogy numon tiro► tde it reltrthh, ha%tc for reasonahll' prethc ting
that there ure no utttdenttlied lit tortc properttes in the PIPE APE extends 600 feet from each end of the
existing bridge (E -W) and 100 feet to ether side of the SR 1123 (Francks Feld Road) center line (N -S) to
encompass proposed construction The comprehensive county architectural survey is recent (3996 -7)
and reliable County GIS/tax materials and other visuals support the absence of significant architectural
resources No National Register -listed or - eligible properties are located within the APE
SUPI'OR -r DOCUNIFITATION
SOL auaLhLd location map
I,I,NDIIN , BY NCDOT CULTIiR41. RFSOURCES PROFESSIONAL
NO SURVEY REQUIRED — Historic Structures
NCD0I Cultural ResOUrccs Spceiahst
Sri �unr t.wmt nre f P ttwe Au.t fir tUV, i ri�,tr. 0, th rlrt 1wth,h- t'_g ^nn1,-141 vnn
%( tX); 4`xB.rcO1r7,� .t i, 011 1 1 0111 "r I , wp.
Datl.

Project Tracking Alo (Internal Use)
I 11 -12 -0001 1
NO SURVEY REQUIRED FORM
PROJECT INFORMATION
Project No BRIDGE NO. 28 County Jones
WBS No 17BP 2 R 23 Document Minimum Criteria Sheet
FA No n/a Funding ® State ❑ Federal
Federal (USACE) Permit Required? ® Yes ❑ No Permit Type Nationwide
Project Description Replace Bridge No 28 over Crooked Run on SRI 123 (Franks Field Rd) in Jones
County, North Carolina Replace the existing 46ft long by 20 Ift wide timber bridge with a proposed
cored slab bridge The archaeological APE is defined as a 500ft long (250fl from each bridge endpoint)
and 60ft wide corridor (row) centered upon the bridge location and SRI 123 center -line
SUMMARY OF CULTURAL RESOURCES REVIEW
Brief description of review activities, results of review, and conclusions
A map review and site file search was conducted at the Office of State Archaeology on Tuesday,
December 13, 2011 No previously recorded archaeological sites were situated within the currently
defined APE, project study area, or general vicinity A review of NRHP (National Register of Historic
Places) listed archaeological properties/districts within Jones County was completed utilizing resources
available on the NCSHPO website This search identified no NRHP, State Study Listed (SL), Locally
Designated (LD), Determined Eligible (DE), or Surveyed Site (SS) properties within or adjacent to the
presently defined APE Furthermore, topographic maps, historic maps (NCMaps website), USDA soil
survey maps (primarily [MKJ), archaeological reference materials, and aerial photographs
(Google/BiNG) were utilized /inspected by the cultural resource specialist to evaluate factors that may
have contributed to historic or prehistoric occupation within the project area, and to aseess the level of
modern, hydrological, agricultural, or other erosive disturbances that may have impacted any potential
resources contained within the project construction footprint
Brief Explanation of why the available information provides a reliable basis for reasonably predicting
that there are no unidentified historic properties in the APE
Aerial images and soil data illustrate that the project area is largely characterized by wetland conditions
and frequently flooded, poorly drained, & hydric soils 1 he presence of channelized drainage ditches
throughout the agricultural fields surrounding SRI 123 and the bndge location evidence the reclaiming of
marginal wetland areas Because of the diminuitive scope of the proposed project and relatively minute
construction footprint subsuming only the existing right -of -way, significant archaeological or cultural
resources are unlikely to be affected by the project as currently proposed No further archaeological work
is recommended for this Division 2 bridge replacement project
SUPPORT DOCUMENTATION
See attached ® Map(s) ® Previous Survey Info ❑ Photos ❑Correspondence
❑ Photocopy of County Survey Notes
No Survey Required farm for Minor Transportation Projects as Qualified in the 1007 Programmatic Agreement
KDOT 4rchaeology & Historic Architecture Groups

Response Moratorium Jones 28 txt
From Wilson, Travis W
sent Wednesday, November 30, 2011 11 46 AM
To Sutton, Michael W
Cc Rogerson, Maria A, Johnson, Jay B
subject RE Jones 28
WRC does not have any specific concerns with this project
- - - -- original Message---- -
From Sutton, Michael W
Sent Tuesday, November 29, 2011 2 01 PM
To Wilson, Travis w
Cc Rogerson, Maria A, Johnson, Jay B
subject Jones 28
Hey Mr Travis we would like to know if a Moratorium exists at the Jones 28
Location and if aso, the dates of that Moratorium Thank You mike
Email correspondence to and from this sender is subject to the N C Public Records
Law and may be disclosed to third parties
Page 1

FINDING BY NCDOT CULTURAL RESOURCES PROFESSIONAL
NO SURVEY RE U1RED
NCDOT Cultural Resources Specialist
No Survey Required form for Mmor rronsportatton Projects as Qualified to the 1007 Programmatic Agreement
NCOOrAmhaeology & Historic Areimecture Groups

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 -439 -2800
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
la Property identification no (tax PIN or parcel ID)
17BP 2 R 23 Jones 28 Bridge to Pipe Replacement SR
1123 Franck's Field Road over Crooked Run
Latitude 35 037078 Longitude -
1 b Site coordinates (in decimal degrees)
77 372451
(DD DDDDDD) ( -DD DDDDDD)
1 c Property size
N/A acres
2 Surface Waters
2a Name of nearest body of water (stream, river, etc ) to
Crooked Run, Tributary of Trent River
proposed project
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 1123, Franck's Field Road is a paved secondary highway Woodlands and agriculture dominate the landscape
3b List the total estimated acreage of all existing wetlands on the property
2,513 Sq Ft (0 06 Acres) of 404 Wetland Impacts for the bridge to pipe replacement
3c List the total estimated linear feet of all existing streams (intermittent and perennial) on the property
60' This site is part of a longer adjacent stream system
3d Explain the purpose of the proposed project
Bridge to pipe replacement, the existing bridge has deteriorated and needs replacing
3e Describe the overall project in detail, including the type of equipment to be used
The existing 46' long timber bridge on timber pilings will be replaced with a proposed 27' -10" x 5' -10" aluminum box
culvert
4 Jurisdictional Determinations
4a Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
❑Yes ®No El Unknown
project (including all prior phases) in the pasty
Comments
4b If the Corps made the jurisdictional determination, what type
❑ Preliminary [:1 Final
imina ry
of determination was made?
4c If yes, who delineated the jurisdictional areas?
Agency /Consultant Company
Name (if known)
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
❑ Yes ® No ❑ Unknown
this project (including all prior phases) in the past?
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 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
Page 4 of 11
PCN Form — Version 1 3 December 10, 2008 Version

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
Fill
® Yes
® Corps
Permanent 007
❑ No
❑ DWQ
Temporary 0094
® Yes
® Corps
Permanent
W2 ®P ®T
Fill
❑ No
❑ DWQ
0027
Temporary 0079
® Yes
® Corps
Permanent
W3 ®P ®T
Fill
El No
[:1 DWQ
0005
Temporary 011
®Yes
®Corps
Permanent
W4 ®P ®T
Fill
El No
El DWQ
0017
Temporary 0175
W5 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W6 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
Permanent
2g Total wetland impacts
0119
Temporary 0458
2h Comments 518 Sq Ft ( 0119 Acres) of Permanent Impacts, 1995 Sq Ft ( 0458 Acres) of Temporary 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)
Permanent
S1 ® P ® T
RipRap
Crooked Run
® PER
❑ INT
❑ Corps
® DWQ
40,
52'
Temporary
8'
S2 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S3 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
Permanent
S4 ® PIE T
RipRap
Crooked Run
® PER
❑ INT
❑ Corps
® DWQ
40,
44'
Temporary
6'
S5 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
❑ PER
❑ Corps
S6 ❑ P ❑ T
❑ INT
❑ DWQ
3h Total stream and tributary impacts
31 Comments 96 linear feet of Permanent Impacts, 14 linear feet of Temporary 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 ❑T
04 ❑P ❑T
4f Total open water impacts
none
4g Comments No open water impacts
5 Pond or Lake Construction
If pond or lake construction proposed, then 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
517 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)
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 you MUST fill out Section D of this form
6a
® Neuse El Tar-Pamlico El Other
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
required?
B1 ®P ❑ T
Fill
Crooked Run
® Nos
691
0
B2 ® P ❑ T
Fill
Crooked Run
® Yes s
321
0
B3 ®P ❑ T
Fill
Crooked Run
®Nos
416
0
6h Total buffer impacts
61 Comments See Sheet 6A for Total Buffer Impacts
Page 6 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 ❑ PEI T
04 ❑P ❑T
4f Total open water impacts
4g Comments
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
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 you MUST fill out Section D of this form
6a
❑ Neuse El Tar-Pamlico El Other
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
required?
131 ® P ❑ T
B4 Fill
Crooked Run
® Nos
89
108
B2 ❑ P ❑ T
❑ Yes
❑ No
B3 ❑P ❑T
El Yes
❑ No
6h Total buffer impacts
1517
108
61 Comments 0 035 Acres of Buffer Zone 1 Impacts and 003 Acres of Buffer Zone 2 Impacts
Page 6,1 0-
PCIN 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
There are 518 Sq Ft of Permanent 404 wetland impacts along with 96 linear feet of permanent stream impacts There are
also 1517 Sq Ft of buffer zone 1 impacts and 108 Sq Ft of buffer zone 2 impacts due to the installation of a 27' -10" x 5' -10"
aluminum box culvert
1 b Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
Use of existing roadway to operate construction equipment, no equipment will enter wetlands
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
El 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 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
3 (2 for Catawba)
Zone 2
15
6f Total buffer mitigation required
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)
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
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?
1b
If yes, then is a diffuse flow plan included? If no, explain why
Comments Stormwater will diffuse flow through vegetated uplands before entering
® Yes ❑ No
stream
2
Stormwater Management Plan
2a
What is the overall percent imperviousness of this project?
N/A 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
Stormwater will diffuse flow through vegetated uplands before entering stream
❑ 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
❑ NSW
3b
Which of the following locally - implemented stormwater management programs
❑ 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 NPDES Permit
4b Has the approved Stormwater Management Plan with proof of approval been
Yes No
®
attached?
5
DWQ 401 Unit Stormwater Review
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
Page 9 of 11
PCN Form — Version 1 3 December 10, 2008 Version

F
Supplementary Information
1
Environmental Documentation (DWQ Requirement)
1a
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
letter )
❑ Yes ❑ No
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
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
habitat?
❑ Yes ® No
5b Have you checked with the USFWS concerning Endangered Species Act
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 investigation by Jay Johnson "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?
Mr Travis Wilson, NCWRC - See Attached Letter
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?
NCDOT HEU Historic Architecture and Archaeology - See Attached Letter
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 Designed to no -rise standards
8c What source(s) did you use to make the floodplain determination? FEMA FIRM Maps
Jay B Johnson
f
January 10,
2013
Applicant/Agent's Printed Name
Date
Applicaht/Agent's Signature
(Agents signature invalid only if an,authorization letter from the applicant
--is provided )
Page l 1 of 11
PCN Form — Version 1 3 December 10 2008 Version

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REQUEST FOR CULTURAL
RESOURCES REVIEW FORM
MEMORANDUM TO
ATTENTION
FROM
SUBJECT
COUNTY
DATE
Project Tracking No (internal Use)
11-12-t90011
Drew Joyner, Human Environment Unit tETERED �r u 1598 Mail Service Center, Raleigh, NC 27699 -1598 Matt Wilkerson, Archaeology Supervisor
Mary Pope Purr, Historic Architecture Supervisor Tirst Last Mike Sutton ) '� 20P Title Division 2 Environmental Specialist "'r
Request for Cultural Resources Review On Jones 28 &*112S`•"""'"''_' "__
Franks Field Road Over Crooked Run Bridge to Bridge Replacement
Jones
November 29, 2011
PROJECT INFORMATION
Project No 17BP 2 R 23 County Jones
WBS No l 7BP 2 R 23 Document Minimum Criteria Sheet
FA No N/A Funding ® State ❑ Federal
Trenton Lake USGS Quad Map Sheet Number 5 of The Soil Survey of Jones
USGS Quad County
Project Description Jones 28, Replace Existing 46' Long by 201 ' Wide Timber Bridge with a Proposed
Cored Slab Bridge , SR 1123, Franks Field Road Over Crooked Run
Purpose & Need The purpose ojthis project is to replace the Existing Bridge, built in 1958 with a
Proposed Cored slab Bridge
SCHEDULING AND CONTACT INFORMATION
o NQNP rb v�itt� i >�'�t.
Date Needed December, 2011
Engineer Maria Rogerson Tel [phone] Email marogerson @ncdot gov
DESIGN INFORMATION
Project Length 500 Feet From Each End or the Existing Bridge
Exist R/W 60'
Exist Speed Limit 55
Exist X- Section N/A
Detour Route None
Structure Type Timber Deck on Timber
Pilings
Proposed R/W 60'
Proposed Speed Limit 55
Year Built 1958

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