20210923 Ver 1_ePCN Application_20210623

DWR
Division of Water Resources
Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
June 1,2021 Ver4.1
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?*
R Yes r No
Change only if needed.
BIMS#Assigned* Version#*
20210923 1
Is a payment required for this project?*
✓ No payment required
6' Fee received Reviewing Office*
✓ Fee needed-send electronic notification Central Office-[phone]
Select Project Reviewer*
Ryan Conchilla:eads\rjconchilla
Information for Initial Review
la.Name of project:
Wentworth Street Bridge Replacement
1a.Who is the Primary Contact?*
Jerry Parker
lb.Primary Contact Email:* 1c.Primary Contact Phone:*
[e-mail] [phone]
Date Submitted
6/23/2021
Nearest Body of Water
Wolf Island Creek
Basin
Roanoke
Water Classification
Class C
Site Coordinates
Latitude: Longitude:
36.372160 79.685917
A. Processing Information
County(or Counties)where the project is located:
Rockingham
Is this a NCDMS Project
✓ Yes ( 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#(?)
17BP.7.R.140
Pre-Filing Meeting Information
Is this a courtesy copy notification?*
✓ Yes G No
ID# Version
20210923 1
Pre-fling Meeting or Request Date
5/4/2021
Attach documentation of Pre-Filing Meeting Request here:
Click the upload button or drag and drop files here to attach document
Wentworth Pre-filing App.pdf 56.68KB
Re type oust be FCF
1a.Type(s)of approval sought from the Corps:
I7 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
✓ No
lb.What type(s)of permit(s)do you wish to seek authorization?
fJ Nationwide Permit(NWP)
✓Regional General Permit(RGP)
✓Standard(IP)
1c.Has the NWP or GP number been verified by the Corps?
✓ Yes 6 No
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
✓Non-404 Jurisdictional General Permit r Riparian Buffer Authorization
✓ 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 6' No
For the record only for Corps Permit: r Yes 6 No
If.Is this an after-the-fact permit application?*
✓ Yes f No
1g.Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
✓ Yes ( No
1g.Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
✓ Yes rNo
lh.Is the project located in any of NC's twenty coastal counties?
✓ Yes 6 No
1j.Is the project located in a designated trout watershed?
✓ Yes f No
B. Applicant Information
1d.Who is applying for the permit?
17 Owner r Applicant(other than owner)
le.Is there an Agent/Consultant for this project?*
✓ Yes f No
2.Owner Information

2a.Name(s)on recorded deed:
NCDOT
2b.Deed book and page no.:
2c.Contact Person:
2d.Address
Street Address
1584 Yanceyville Street
Address Line 2
P.O.Box 14996
City State/Province/Region
Greensboro NC
Postal/Zip aide 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:
Wentworth
2. Project Identification
2a.Property Identification Number: 2b.Property size:
2c.Project Address
Street Address
Address Line 2
Qty State/Ft /Region
Postal/Zip Code Country
3.Surface Waters
3a.Name of the nearest body of water to proposed project:*
Wolf Island 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.
030101030904
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 area can be described as a rural residential neighborhood on the outskirts of a municipality with sparse residences.
4b.Have Corps permits or DWR certifications been obtained for this project(including all prior phases)in the past?*
C Yes f No 6 Unknown
4f.List the total estimated acreage of all existing wetlands on the property:
Approximately 0.01 acres
4g.List the total estimated linear feet of all existing streams on the property:
Approximately 75 linear feet
4h.Explain the purpose of the proposed project:*

The purpose of the project is to replace a structurally deficient bridge with a new bridge.The bridge lanes will be widened,as well as,the shoulders.Guardrail will also be added.The
project does not involve a buffered stream and stream impacts have been kept to a minimum.Wetland impacts will also be minimal and will only involve hand clearing.
4i.Describe the overall project in detail,including indirect impacts and the type of equipment to be used:*
Project will involve the complete removal of the existing bridge.Permanent surface water impacts will not exceed 0.01 acres and temporary surface impacts are 0.01 acres.Permanent
linear feet of surface water impacts is 54 feet.Typical roadway construction equipment will be utilized,such as,dozers,backhoes,dump trucks,cranes and tamps.
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 r Unknown r N/A
Corps AID Number:
5c.If 5a is yes,who delineated the jurisdictional areas?
Name(if known): David Cooper
Agency/Consultant Company: VHB
Other:
5d.List the dates of the Corp jurisdiction determination or State determination if a determination was made by the Corps or DWR
6. Future Project Plans
6a.Is this a phased project?*
CYes 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):
17 Wetlands 17 Streams-tributaries 1 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 2 Hand Clearing T Bottomland Hardwood Forest Wolf Island Creek No Both 0.010
(acres)
2g.Total Temporary Wetland Impact 2g.Total Permanent Wetland Impact
0.010 0.000
2g.Total Wetland Impact
0.010
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 Bank Stabilization Permanent Bank Stabilization Wolf Island Creek Perennial Both 9 54
Average(feet) (linear feet)
32 Bank Stabilization Temporary Bank Stabilization Wolf Island Creek Perennial Both 9 65
Average(feet) (linear feet)

3i.Total jurisdictional ditch impact in square feet:
0
3i.Total permanent stream impacts: 3i.Total temporary stream impacts:
54 65
3i.Total stream and ditch impacts:
119
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 footprint.BMP practices will be utilized throughout the construction
period.The project will be a bridge to bridge construction.
lb.Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Erosion and sedimentation control devices will be utilized and maintained through utilization of BMP techniques.Coordination(including an onsite pre-
construction meeting with a Division Environmental staff person)prior to commencing the project
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 for requiring 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 r No
If no,explain why:
N/A
2.Stormwater Management Plan
2a.Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
✓ Yes r No
2b.Does this project meet the requirements for low density projects as defined in 15A NCAC 02H.1003(2)?
0. Yes r No
Comments:
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?*
rr 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(NEPAISEPA)?*
✓ Yes R No
Comments:*
Project does not meet the thresholds for requiring a NEPA/SEPA document.
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 ( No

3. Cumulative Impacts(DWR Requirement)
3a.Will this project result in additional development,which could impact nearby downstream water quality?*
✓ Yes 6- No
3b.If you answered"no,"provide a short narrative description.
Due to the minimal size and impact of this project,additional development is not anticipated as a result of the construction.
4.Sewage Disposal(DWR Requirement)
4a.Is sewage disposal required by DWR for this project?*
✓ Yes 6' Nor 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 f No
5b.Have you checked with the USFWS concerning Endangered Species Act impacts?*
6 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 IPAC
Environmental Consultants
6. Essential Fish Habitat(Corps Requirement)
6a.Will this project occur in or near an area designated as an Essential Fish Habitat?*
✓ Yes f• 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?*
6 Yes rNo
7b.What data sources did you use to determine whether your site would impact historic or archeological resources?*
NCDOT Cultural Resource Personnel
8. Flood Zone Designation(Corps Requirement)
8a.Will this project occur in a FEMA-designated 100-yearfloodplain?*
6 Yes rNo
8b.If yes,explain how project meets FEMA requirements:
NCDOT Hydraulics Unit coordination with FEMA
8c.What source(s)did you use to make the floodplain determination?*
FEMA Flood Maps
I
Miscellaneous
Please use the space below to attach all required documentation or any additional information you feel is helpful for application review.Documents should be combined into one
file when possible,with a Cover Letter,Table of Contents,and a Cover Sheet for each Section preferred.
Click the upload button or drag and drop files here to attach docurrent
Wentworth Rd Topo Map.pdf 556.16KB
Wentworth Rd Soil Map.pdf 1.12MB
Wentworth St.Permit Drawings.pdf 1.9MB
Wentworth St.Wetland Delineation.pdf 29.83MB
Wentworth St.No Archaeology Survey.pdf 780.63KB
Wentworth Rd Approved MOA from Cultural Resources.pdf 90.73KB
Wentworth St.Archictecture MOA Flnal.pdf 5MB
Wentworth St Aquatic Survey.pdf 4MB
Fle mast be HT or KW

Comments
Signature
R 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 knovAedge 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 III,PE
Signature
W.G(rotne '
Date
6/23/2021