20201815 Ver 1_ePCN Application_20210528

I I DWR
Division of Water Resources
Pre-Construction Notification (PCN) Form
April 4,2021 Ver 4
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#*
20201815 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*
Robert Patterson:eads\rdpatterson
Information for Initial Review
1a.Name of project:
Replacement of Bridge 63 over Reedy Creek on SR-1472(Welcome-Arcadia Road)
1a.Who is the Primary Contact?*
AMY EULISS
lb.Primary Contact Email:* 1c.Primary Contact Phone:*
[e-mail] [phone]
Date Submitted
5/28/2021
Nearest Body of Water
Reedy Creek
Basin
Yadkin-PeeDee
Water Classification
C
Site Coordinates
Latitude: Longitude:
35.760218 -80.224191
A. Processing Information
County(or Counties)where the project is located:
Davidson
Is this a NCDMS Project
✓ Yes G No
Is this project a public transportation project?*
6 Yes r No
Is this a NCDOT Project?*
6' Yes r No
(NCDOT only)T.I.P.or state project number:
17.BP.9.R.57

WBS#(?)
SF-280063
Pre-Filing Meeting Information
Is this a courtesy copy notification?*
✓ Yes G No
ID# Version
Pre-fling Meeting or Request Date
11/20/2020
Attach documentation of Pre-Filing Meeting Request here:
Click the upload button or drag and drcp files here to attach docunsnt
DWR Pre-Filing Meeting Request Form.pdf 49.59KB
File type nest be FCF
1a.Type(s)of approval sought from the Corps:
[7 Section 404 Permit(wetlands,streams and waters,Clean Water Act)
f-Section 10 Permit(navigable waters,tidal waters,Rivers and Harbors Act)
Has this PCN previously been submitted?*
✓ Yes
✓ No
lb.What type(s)of permit(s)do you wish to seek authorization?
f-Nationwide Permit(NWP)
f7 Regional General Permit(RGP)
f-Standard(IP)
1c.Has the NWP or GP number been verified by the Corps?
✓ Yes 6 No
Regional General Permit(RGP)Number: 201902350-Work associated with bridge construction,widening,replacement,and
interchanges
RGP Numbers(for multiple RGPS):
ld.Type(s)of approval sought from the DWR:
fJ 401 Water Quality Certification-Regular 1 401 Water Quality Certification-Express
f-Non-404 Jurisdictional General Permit f- Riparian Buffer Authorization
f- Individual 401 Water Quality Certification
le.Is this notification solely for the record because written approval is not required? *
For the record only for DWR 401 Certification: r Yes t No
For the record only for Corps Permit: r Yes t No
If.Is this an after-the-fact permit application?*
✓ Yes ( No
1g.Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
6 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
I h.Is the project located in any of NC's twenty coastal counties?
✓ Yes r No
1j.Is the project located in a designated trout watershed?
0 Yes C' No
B.Applicant Information U
Id.Who is applying for the permit?
)7 Owner f-Applicant(other than owner)
le.Is there an Agent/Consultant for this project?*

C Yes a No
2. Owner Information
2a.Name(s)on recorded deed:
NCDOT Division 9
2b.Deed book and page no.:
2c.Contact Person:
2d.Address
Street Address
375 Silas Creek Parkway
Address Line 2
Coy State/Province/Region
Winston-Salem NC
Postal/Zip Code Country
27127 USA
2e.Telephone Number: 2f.Fax Number:
[phone]
2g.Email Address:*
[e-mail]
� I
C. Project Information and Prior Project History
1. Project Information
lb.Subdivision name:
(if appropriate)
1c.Nearest municipality/town:
Lexington NC
2. Project Identification
2a.Property Identification Number: 2b.Property size:
0.2
2c.Project Address
Street Address
Address Line 2
CRY State/Province/Region
Postal/Zip Code Country
3.Surface Waters
3a.Name of the nearest body of water to proposed project:*
Reedy Creek
3b.Water Resources Classification of nearest receiving water:*
C
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.
030401011502
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:*
The land surrounding the project area consists of forest and rural farmland.
4b.Have Corps permits or DWR certifications been obtained for this project(including all prior phases)in the past?*
r Yes 6. No r 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)
Topo_Map.pdf 4.49MB
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)

Soils_Map.pdf 2.28MB
4f.List the total estimated acreage of all existing wetlands on the property:
0.05
4g.List the total estimated linear feet of all existing streams on the property:
453
4h.Explain the purpose of the proposed project:*
The project is to replace the existing bridge with a new bridge and to provide the associated improvements to the approach roadway.
4i.Describe the overall project in detail,including indirect impacts and the type of equipment to be used:*
NCDOT Project No.17BP.9.R.57 proposes to replace Bridge No.63 on S.R.1472(Welcome-Arcadia Road)over Reedy Creek in Davidson County.Bridge No.63,functionally obsolete,
will be replaced with a new bridge approximately 55 feet long providing a minimum 27-ft 10-inch clear deck width.The bridge will include two 11-foot lanes and 2-foot 11-inch offsets.
The bridge length is based on preliminary design information and is set by hydraulic requirements.The roadway grade of the new structure will be approximately the same as the
existing structure.Project construction will extend approximately 141 feet from the west end of the new bridge and 154 feet from the east end of the new bridge.The approaches will be
widened to provide two 11-foot lanes with six-foot shoulders on both sides(two-foot paved,nine-foot shoulders Mere guardrail is included).The roadway will be designed as a local
route using sub-regional tier guidelines with a 50mph design speed.Traffic will be detoured offsite during construction.Standard road and bridge construction equipment will be used
including track hoes,cranes and other grading equipment.
4j.Please upload project drawings for the proposed project.
17BP9R57_Hyd_DRN_PERMIT(02-26-2021).pdf 1.55MB
5.Jurisdictional Determinations
5a.Have the wetlands or streams been delineated on the property or proposed impact areas?*
6 Yes r No f Unknown
Comments:
5b.If the Corps made a jurisdictional determination,what type of determination was made?*
6 Preliminary r Approved r Not Verified r Unknown r N/A
Corps AID Number:
SAW-2019-01111
5c.If 5a is yes,who delineated the jurisdictional areas?
Name(if known):
Agency/Consultant Company: Three Oaks Engineering
Other:
5d.List the dates of the Corp jurisdiction determination or State determination if a determination was made by the Corps or DWR
8/2/2019 PJD
5d1.Jurisdictional determination upload
SAW-2019-01111(signed PJD).pdf 2.34MB
6. Future Project Plans
6a.Is this a phased project?*
r Yes 6 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
la.Where are the impacts associated with your project?(check all that apply):
I7 Wetlands fJ Streams-tributaries r Buffers
r Open Waters r Pond Construction
2.Wetland Impacts
2a.Site#*(7) 2a1 Reason(?) 2b.Impact type*(?) 2c.Type of W.* 2d.W.name* 2e.Forested* 2f.Type of 2g.Impact
Jurisdicition*(?) area*
1 Driveway,30"pipe& P Headwater Forest WA Yes Both 0.010
waterline (acres)
2 Driveway,30"pipe& P Headwater Forest WB Yes Both 0.010
waterline (acres)

2g.Total Temporary Wetland Impact 2g.Total Permanent Wetland Impact
0.000 0.020
2g.Total Wetland Impact
0.020
2i.Comments:
3.Stream Impacts
3a.Reason for impact(?) 3b.lmpact type* 3c.Type of impact* 3d.S.name* 3e.Stream Type* 3f.Type of 3g.S.width* 3h.Impact
(?) Jurisdiction* length*
S1 bridge/bank stabilization Permanent Bank Stabilization Reedy Creek Perennial Both 8 89
Average(feet) (linear feet)
S2 waterline installation Temporary Other Reedy Creek Perennial Both 8 3
Average(feet) (linear feet)
3i.Total jurisdictional ditch impact in square feet:
0
3i.Total permanent stream impacts: 3i.Total temporary stream impacts:
89 3
3i.Total stream and ditch impacts:
92
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 existing single-span 40'7"bridge is being replaced with a proposed 55'single-span(21"cored-slab)structure.The bridge will be normal crown
with 2%cross slopes,with 11'travel lanes and 2'11"shoulders,27'10"clear width and 30'OTO width.Existing drainage patterns are being
maintained.Runoff is being discharged as far from the stream as practicable.No deck drains are used and,since the roadway has a vertical curve
that peaks in the middle of the bridge,a bridge approach drop inlet is provided at each corner of the proposed bridge.The two inlets on the west end
of the bridge discharge to the north into a proposed v-ditch.
The two inlets on the east end of the bridge discharge onto a riprap pad on the overbank and then into an existing stream.Bank protection is also
provided along both sides of the stream.
lb.Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
The Sediment&Erosion Control Plan has been designed in accordance with NCDOT Sediment&Erosion Control Manual.
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?
C Yes f•No
2b.If this project DOES NOT require Compensatory Mitigation,explain why:
Permanent impacts to the stream are for bank stabilization which are not a loss of waters.Impacts to the wetlands are less than 0.10 acres.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
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?
O Yes f' No
If no,explain why:
The project is not in a riparian buffer basin.
2.Stormwater Management Plan
2a.Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
( Yes C No
Comments:
Stormwater Management Plan is included in the permit drawings.
G. Supplementary Information

1. Environmental Documentation
la.Does the project involve an expenditure of public(federal/state/local)funds or the use of public(federal/state)land?*
( Yes 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(NEPAUSEPA)?*
✓ Yes No
Comments:*
The project meets the State Minimum Criteria Rules;MCDC has been prepared for the project(see attached).
2.Violations(DWR Requirement)
2a.Is the site in violation of DWR Water Quality Certification Rules(15ANCAC 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 ( No
3. Cumulative Impacts(DWR Requirement)
3a.Will this project result in additional development,which could impact nearby downstream water quality?*
✓ Yes ( No
3b.If you answered"no,"provide a short narrative description.
Project involves replacing a bridge on the same location in a rural setting.
4.Sewage Disposal(DWR Requirement)
4a.Is sewage disposal required by DWR for this project?*
✓ Yes ( 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 r No
5c.If yes,indicate the USFWS Field Office you have contacted.
Asheville
5d.Is another Federal agency involved?*
✓ Yes ( No r Unknown
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.
5j.What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
NC Natural Heritage Program;USFWS;Site surveys by biologists.
Consultation Documentation Upload
BRIDGE 63 PCN NCNHP USFWS IPAC.pdf 356.41KB
6. Essential Fish Habitat(Corps Requirement)

6a.Will this project occur in or near an area designated as an Essential Fish Habitat?*
C Yes 6' No
6b.What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
NOAA Fisheries Essential Fish Habitat Mapper
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?*
C Yes ( No
7b.What data sources did you use to determine whether your site would impact historic or archeological resources?*
NC Historic Preservation Office and NCDOT Cultural Resource Staff reviews.
7c.Historic or Prehistoric Information Upload
17BP9R57 CULTURAL HISTORIC RESOURCES SUMMARY.pdf 1.3MB
Tribal Coordination Bridge 63 Davidson.pdf 1.26MB
2020-193-169 Catawba Indian Nation Response.pdf 253.3KB
8. Flood Zone Designation(Corps Requirement)
8a.Will this project occur in a FEMA-designated 100-year floodplain?*
B Yes C No
8b.If yes,explain how project meets FEMA requirements:
The project is a Type Ilb MOA.
8c.What source(s)did you use to make the floodplain determination?*
FEMA Floodplain Maps(DFIRM)
M iscel Ianeous L)
Comments
Regarding the blasting and percussive sounds,standard bridge building practices may apply.This may involve blasting,pile driving and/or drilling.ESA documentation is included in the
attached cover letter.
Miscellaneous attachments not previously requested.
17BP9R57_Welcome-Acadia_Rd_Final_07-22-2019.pdf 5.52MB
NCDOT-17BP.9.R.57 Bridge PCN Cover Letter-Div 9_jkt.pdf 267.39KB
Signature
*
[J 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:
Amy Euliss
Signature
Date
5/28/2021