20211579 Ver 1_Modification_20211102

Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
June 1, 2021 Ver 4.1
Please note: fields marked with a red asterisk * below are required. You will not be able to submit the form until all mandatory questions are answered.
Also, if at any point you wish to print a copy of the E-PCN, all you need to do is right-click on the document and you can print a copy of the form.
Below is a link to the online help file.
https://edocs.deq.nc.gov/WaterResources/0/edoc/624704/PCN%20Help%20File%202018-1-30.pdf
County (or Counties) where the project is located:*
Is this a NCDMS Project *
Is this project a public transportation project?*
Is this a NCDOT Project?*
(NCDOT only) T.I.P. or state project number:
WBS #*
1a. Type(s) of approval sought from the Corps:*
Has this PCN previously been submitted?*
1b. What type(s) of permit(s) do you wish to seek authorization?*
1c. Has the NWP or GP number been verified by the Corps?*
Nationwide Permit (NWP) Number:
NWP Numbers (for multiple NWPS):
1d. Type(s) of approval sought from the DWR:*
Pre-Filing Meeting Information
A. Processing Information
Hertford
Yes No
Click Yes, only if NCDMS is the applicant or co-applicant.
Yes No
This is any publicly funded by municipal,state or federal funds road, rail, airport transportation project.
Yes No
17BP.1.R.98
(for NCDOT use only)
Section 404 Permit (wetlands, streams and waters, Clean Water Act)
Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
Yes
No
Nationwide Permit (NWP)
Regional General Permit (RGP)
Standard (IP)
Yes No
03 - Maintenance
List all NW numbers you are applying for not on the drop down list.
check all that apply
401 Water Quality Certification - Regular 401 Water Quality Certification - Express
Non-404 Jurisdictional General Permit Riparian Buffer Authorization
Individual 401 Water Quality Certification
Before submitting this form please ensure you have submitted the Pre-Filing Meeting Request Form as we will not be able to accept your application without this important first step. The Pre-Filing Meeting
Request Form is used in accordance with 40 C.F.R. Section 121.4(a) “At least 30 days prior to submitting a certification request, the project proponent shall request a pre-filing meeting with the certifying
1e. Is this notification solely for the record because written approval is not required?
*
For the record only for DWR 401 Certification:
For the record only for Corps Permit:
1f. Is this an after-the-fact permit application?*
1g. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
Acceptance Letter Attachment
1h. Is the project located in any of NC's twenty coastal counties?*
1i. Is the project located within a NC DCM Area of Environmental Concern (AEC)?*
1j. Is the project located in a designated trout watershed?*
Link to trout information: http://www.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Agency-Coordination/Trout.aspx
1a. Who is the Primary Contact?*
1b. Primary Contact Email:*
1c. Primary Contact Phone:*
1d. Who is applying for the permit?*
1e. Is there an Agent/Consultant for this project?*
2. Owner Information
agency” and in accordance with 40 C.F.R. Section 121.5(b)(7), and (c)(5) all certification requests shall include documentation that a pre-filing meeting request was submitted to the certifying authority at
least 30 days prior to submitting the certification request. Click here to read more information on when this form is needed prior to application submission or here to view the form.
Is this a courtesy copy notification?*
ID#Version
Pre-fling Meeting or Request Date *
Attach documentation of Pre-Filing Meeting Request here:*
Yes No
10/8/2021
Click the upload button or drag and drop files here to attach document
Site Visit.pdf 100.32KB
File type must be PDF
Yes No
Yes No
Yes No
If so, attach the acceptance letter from mitigation bank or in-lieu fee program.
Yes No
Click the upload button or drag and drop files here to attach document
FILE TYPE MUST BE PDF
Yes No
Yes No Unknown
Yes No
B. Applicant Information
Paul Williams
[e-mail]
(xxx)xxx-xxxx
[phone]
Owner Applicant (other than owner)
(Check all that apply)
Yes No
2a. Name(s) on recorded deed:*
2b. Deed book and page no.:
2c. Contact Person:
NCDOT ROW SR 1311 Boones Bridge Road
(for Corporations)
Paul Williams
1a. Name of project:*
1b. Subdivision name:
1c. Nearest municipality / town:*
2a. Property Identification Number:
2b. Property size:
2c. Project Address
2d. Site coordinates in decimal degrees
Please collect site coordinates in decimal degrees. Use between 4-6 digits (unless you are using a survey-grade GPS device) after the decimal place as appropriate, based on how the location was
determined. (For example, most mobile phones with GPS provide locational precision in decimal degrees to map coordinates to 5 or 6 digits after the decimal place.)
Latitude:*Longitude:*
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
3b. Water Resources Classification of nearest receiving water:*
Surface Water Lookup
3c. What river basin(s) is your project located in?*
3d. Please provide the 12-digit HUC in which the project is located.*
River Basin Lookup
2d. Address *
2e. Telephone Number:*
2f. Fax Number:
2g. Email Address:*
City
Edenton
State / Province / Region
NC
Postal / Zip Code
27932
Country
USA
Street Address
113 Airport Dr.
Address Line 2
(xxx)xxx-xxxx
[phone]
[phone]
(xxx)xxx-xxxx
[e-mail]
C. Project Information and Prior Project History
1. Project Information
Hertford Bridge 97 Replacement Project
(if appropriate)
Como
2. Project Identification
(tax PIN or parcel ID)
(in acres)
3.79
City
Como
State / Province / Region
NC
Postal / Zip Code
27818
Country
USA
Street Address
Bridge 97 on Boones Bridge Road, 0.2 mi. west of Whitley Road and Boone Bridge Road intersection
Address Line 2
36.5237
ex: 34.208504
-77.0751
-77.796371
UT to the Meherrin River
C;NSW
Chowan
030102040905
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:*
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
4f. List the total estimated acreage of all existing wetlands on the property:
4g. List the total estimated linear feet of all existing streams on the property:
4h. Explain the purpose of the proposed project:*
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
Corps AID Number:
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
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?*
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? This includes other
separate and distant crossing for linear projects that require Department of the Army authorization but don’t require pre-construction notification.
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
"W." will be used in the table below to represent the word "wetland".
2a. Site #*(?)2a1 Reason *(?)2b. Impact type *(?)2c. Type of W.*2d. W. name *2e. Forested *2f. Type of Jurisdicition *
(?)
2g. Impact
area *
Project area consists of NCDOT Hertford County SR 1311 and Bridge #97. The general land use in the vicinity is rural residential, farmland, and forests.
Yes No Unknown
0.75
(intermittent and perennial)
729
To replace the aging Bridge #97 that has received deficiency ratings, qualifying it for replacement. NCDOT wants to maintain SR 1311 as a safe and reliable travel route for the public.
Replace an existing 2-span 34 ft. long X 25 ft. wide bridge with a new single span bridge structure measuring 50 ft. long X 30 ft. wide. Upon completion of the structure, NCDOT will have
to rebuild the roadway approaches on either end of the bridge. This will involve some minor widening of the roadway bridge approaches and some along the roadway shoulders . The
project will result in approx. 0.01 acres of permanent fill in wetlands, approx. 0.08 acres of temporary hand clearing in wetlands, approx. <0.01 acres of permanent surface water impacts,
approx. <0.01 acres of temp. surface water impacts, approx. 50 linear feet of permanent stream impacts, and approx. 55 linear feet of temp. stream impacts.
Yes No Unknown
Preliminary Approved Not Verified Unknown N/A
Example: SAW-2017-99999
SAW-2019-00783
Cogdell/Gresham
Atkins
February 16, 2021 by the Corps
Yes No
D. Proposed Impacts Inventory
Wetlands Streams-tributaries Buffers
Open Waters Pond Construction
1 Roadway Fill and Toe
Protection
P Riverine Swamp Forest WA Yes Corps 0.003
(acres)
2g. Total Temporary Wetland Impact
2g. Total Permanent Wetland Impact
2g. Total Wetland Impact
2i. Comments:
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.
"S." will be used in the table below to represent the word "stream".
3a. Reason for impact *(?)3b.Impact type *3c. Type of impact *3d. S. name *3e. Stream Type *
(?)
3f. Type of
Jurisdiction *
3g. S. width *3h. Impact
length *
S1
S2
** All Perennial or Intermittent streams must be verified by DWR or delegated local government.
3i. Total jurisdictional ditch impact in square feet:
3i. Total permanent stream impacts:
3i. Total temporary stream impacts:
3i. Total stream and ditch impacts:
3j. Comments:
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. Site #*(?)4a1. Impact Reason 4b. Impact type *(?)4c. Name of waterbody (?)4d. Activity type *4e. Waterbody type *4f. Impact
area *
4g. Total temporary open water Impacts:
4g. Total permanent open water impacts:
4g. Total open water impacts:
1 Hand Clearing T Riverine Swamp Forest WA Yes Corps 0.026
(acres)
2 Roadway Fill and Toe
Protection
P Riverine Swamp Forest WB Yes Corps 0.002
(acres)
2 Hand Clearing T Riverine Swamp Forest WB Yes Corps 0.024
(acres)
4 Roadway Fill and Toe
Protection
P Riverine Swamp Forest WC Yes Corps 0.009
(acres)
4 Hand Clearing T Riverine Swamp Forest WC Yes Corps 0.032
(acres)
0.082
0.014
0.096
Bank Stabilization Permanent Bank Stabilization SA Perennial Corps 20
Average (feet)
50
(linear feet)
Bank Stabilization Temporary Bank Stabilization SA Perennial Corps 20
Average (feet)
55
(linear feet)
0
50
55
105
3 Bank Stabilization P UT to Meherrin River Stabilization Tributary 0.01
(acres)
3 Bank Stabilization T UT to Meherrin River Stabilization Tributary 0.01
(acres)
0.01
0.01
0.02
4h. Comments:
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
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?
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
NC Stream Temperature Classification Maps can be found under the Mitigation Concepts tab on the Wilmington District's RIBITS website.
*** Recent changes to the stormwater rules have required updates to this section .***
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?
For a list of options to meet the diffuse flow requirements, click here.
If no, explain why:
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT’s Individual NPDES permit NCS000250?*
Comments:
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the 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 (North Carolina)
Environmental Policy Act (NEPA/SEPA)?*
Comments:*
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)?*
Permanent Impact = 0.003 acre
Temp. Impact = 0.008
E. Impact Justification and Mitigation
NCDOT minimized the roadway width by narrowing the shoulders and bridge width to the minimal amount allowable with the design speed and roadway
geometry. There are no deck drains located on the bridge. The existing bridge demolition will follow NCDOT BMP’s for bridge demolition work. Erosion
and Sediment control plans have been designed and will be followed to retain any runoff from construction activities. An offsite detour is being utilized to
eliminate any additional wetland and surface water impacts.
Utilizing BMPs for bridge demolition will capture all components of the old structure. Erosion and Control measures will be placed along the entire project
area to reduce soil runoff. A turbidity curtain can be utilized along the banks to capture any siltation that may occur during project construction. The
utilization of precast concrete materials, reduces the potential for uncured concrete entering the adjacent waters.
Yes No
Impacts are below thresholds for mitigation.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
Yes No
NC Riparian Buffer Rules do not apply to the Chowan River Basin.
Yes No
NCDOT will follow best management practices for soil and erosion control in compliance with N.C. Sediment and Pollution Control Act and NCDOT NPDES permit. Erosion control devices
will be installed and maintained during the project. A grated drop inlet on the SW side will route storm water to vegetated buffers prior to entering surface waters. No deck drains will be
located over surface waters.
G. Supplementary Information
Yes No
Yes No
Activity and impacts covered by Minimum Criteria Checklist or Categorical Exclusion.
Yes No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in additional development, which could impact nearby downstream water quality?*
3b. If you answered “no,” provide a short narrative description.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
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?*
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
5d. Is another Federal agency involved?*
5e. Is this a DOT project located within Division's 1-8?*
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data: http://gis.ncdcr.gov/hpoweb/
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 (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?*
8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https://msc.fema.gov/portal/search
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?*
Comments
Yes No
Project replaces an existing bridge with a bridge.
Yes No N/A
Yes No
Yes No
Yes No Unknown
Yes No
NC Natural Heritage Data Explorer Website
Yes No
National Marine Fisheries Database
Yes No
NCDOT Cultural Resources Unit. Reports attached.
Yes No
FEMA Approved through NCDOT Hydraulics Units
NC DOT Hydraulics Unit, Zone AE
Miscellaneous
CAMA Major Permit will be not be required for this project. (Email 5/1/2018)
A moratorium on in-water construction will be not be required. (Email 4/1/2018)
Tribal Notifications submitted 9/27/2021 and 9/29/2021. No responses to date.
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.
*
· 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:*
Signature *
Date
Click the upload button or drag and drop files here to attach document
19-01-0018NoSurvey.pdf 3.1MB
NCWRC Email.pdf 291.53KB
450097_Permit Drawings_20211012.pdf 1.71MB
Hertford Bridge 97 - Tribal Coordination Letter - Meherrin.pdf 124.07KB
Hertford Bridge 97 - Tribal Coordination Letter - Tuscarora.pdf 124.07KB
Hertford Bridge 97 - Tribal Coordination Letter - Catawba.pdf 124.07KB
SAW-2019-00783 NCDOT Hertford Bridge 97_PJD.pdf 9.83MB
SAW-2019-00783 NCDOT Hertford Bridge 97.pdf 251.44KB
PA 19-01-0018 No Archaeological Survey Required Str No 97 on SR 1311 Hertford.pdf 1.31MB
Topo.pdf 1.2MB
Soil_Map.pdf 661.89KB
File must be PDF or KMZ
Signature
By checking the box and signing below, I certify that:
Paul Collins Williams, Jr.
10/22/2021