20210958 Ver 1_ePCN Application_20211118

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Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
June 1,2021 Ver 4.1
Initial Review
Has this project met the requirements for acceptance in to the review process?*
Yes
No
Is this project a public transportation project?*
Yes No
Change only if needed.
BIMS#Assigned* Version#*
20210958 1
Is a payment required for this project?*
No payment required
Fee received Reviewing Office*
Fee needed-send electronic notification Central Office-[phone]
Select Project Reviewer*
Rob Ridings:eads\rgridings
Information for Initial Review
1a.Name of project:
Bridge 91 over Tar River on NC581(B-5947-Central)
la.Who is the Primary Contact?*
NCDOT
1 b.Primary Contact Email:* 1c.Primary Contact Phone:*
[e-mail] [phone]
Date Submitted
11/18/2021
Nearest Body of Water
Tar River
Basin
Tar-Pamlico
Water Classification
WS-V;NSW
Site Coordinates
Latitude: Longitude:
35.882188 -78.089448
A. Processing Information
County(or Counties)where the project is located:
Nash
Is this a NCDMS Project
Yes No
Is this project a public transportation project?*
Yes No
Is this a NCDOT Project?*
Yes No
(NCDOT only)T.I.P.or state project number:
B-5947

WBS#(,
45983.1.1
Pre-Filing Meeting Information
Is this a courtesy copy notification?"
Yes No
ID# Version
20210958 1
Pre-fling Meeting or Request Date
6/17/2021
Attach documentation of Pre-Filing Meeting Request here:
Click the upload button or drag and drop files here to attach document
20210958 Ver 1—Meeting Request Review_20210517.pdf 623.86KB
File type must be PDF
1a.Type(s)of approval sought from the Corps:
Section 404 Permit(wetlands,streams and waters,Clean Water Act)
Section 10 Permit(navigable waters,tidal waters,Rivers and Harbors Act)
Has this PCN previously been submitted?*
Yes
No
1 b.What type(s)of permit(s)do you wish to seek authorization?
Nationwide Permit(N W P)
Regional General Permit(RGP)
Standard(IP)
1c.Has the NWP or GP number been verified by the Corps?
Yes No
Regional General Permit(RGP)Number: 201902350-Work associated with bridge construction,widening,replacement,and
interchanges
RGP Numbers(for multiple RGPS):
1d.Type(s)of approval sought from the DWR:
401 Water Quality Certification-Regular 401 Water Quality Certification-Express
Non-404 Jurisdictional General Permit 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: Yes No
For the record only for Corps Permit: Yes No
1f.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?
Yes No
1g.Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
Yes No
1 h.Is the project located in any of NC's twenty coastal counties?
Yes No
1j.Is the project located in a designated trout watershed?
Yes No
B. Applicant Information
1d.Who is applying for the permit?
Owner Applicant(other than owner)
le.Is there an Agent/Consultant for this project?
Yes No
2.Owner Information

2a.Name(s)on recorded deed:
NCDOT
2b.Deed book and page no.:
2c.Contact Person:
2d.Address
Street Address
1000 Birch Ridge Drive
Address Line 2
City State/Province/Region
Raleigh NC
Postal/Zip Code Country
27610 USA
2e.Telephone Number: 2f.Fax Number:
[phone]
2g.Email Address:
[e-mail]
C. Project Information and Prior Project History
1.Project Information
1b.Subdivision name:
(if appropriate)
1c.Nearest municipality/town:
Spring Hope
2. Project Identification
2a.Property Identification Number: 2b.Property size:
2c.Project Address
Street Address
Address Line 2
City State/Province/Region
Postal/Zip Code Country
3. Surface Waters
3a.Name of the nearest body of water to proposed project:
Tar River
3b.Water Resources Classification of nearest receiving water:*
WS-V;NSW
3c. What river basin(s)is your project located in?*
Tar-Pamlico
3d.Please provide the 12-digit HUC in which the project is located.
030201010603
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:*
Land use in the project vicinity consists primarily of forested communities with minor residential development and
agricultural fields.
4b.Have Corps permits or DWR certifications been obtained for this project(including all prior phases)in the past?
Yes No Unknown
4f.List the total estimated acreage of all existing wetlands on the property:
2.3
4g.List the total estimated linear feet of all existing streams on the property:
400
4h.Explain the purpose of the proposed project:
The purpose of this project is to replace a structurally deficient bridge.

4i.Describe the overall project in detail,including indirect impacts and the type of equipment to be used:
This project involves replacing 311-foot,10 span bridge with a 330-foot,3 span bridge on a new alignment
approximately 45 feet upstream of the existing structure.The existing bridge will remain open during construction of
the new bridge.Standard road building equipment,such as trucks,dozers and cranes will be used.
5. Jurisdictional Determinations
5a.Have the wetlands or streams been delineated on the property or proposed impact areas?*
Yes No Unknown
Comments:
5b.If the Corps made a jurisdictional determination,what type of determination was made?*
Preliminary Approved Not Verified Unknown N/A
Corps AID Number:
SAW-2018-02174
5c.If 5a is yes,who delineated the jurisdictional areas?
Name(if known): Eric Black
Agency/Consultant Company: North State Engineering
Other:
5d.List the dates of the Corp jurisdiction determination or State determination if a determination was made by the Corps or DWR
PJD received dated 5/31/2019
6.Future Project Plans
6a.Is this a phased project?*
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?
N/A
D. Proposed Impacts Inventory
1. Impacts Summary
1a.Where are the impacts associated with your project?(check all that apply):
Wetlands Streams-tributaries Buffers
Open Waters Pond Construction
2.Wetland Impacts
2a1 Reason(?) 2b.Impact type*(?) 2c.Type of W.* 2d.W.name* 2e.Forested* 2f.Type of Jurisdicition*2g.Impact
?) area*
Roadway Fill P Bottomland Hardwood Forest WA,WB,WC.WD,WF Yes Both 0.510
(acres)
Mach.Clearing P Bottomland Hardwood Forest �WAXF Yes Both 0.110
(acres)
2g.Total Temporary Wetland Impact 2g.Total Permanent Wetland Impact
0.000 0.620
2g.Total Wetland Impact
0.620
2i.Comments:
4. Open Water Impacts
4a. Site# 4a1.Impact Reason 4b.Impact type 4c.Name of waterbody 4d.Activity type :114e.Waterbody type 4f.Impact area
Ditch Ouffall P Tar River Stabilization Tributary 0.01
Bridge Removal T Tar River Causeway Tributary 0.08
Work Bridge T Tar River Bridge Tributary 0.01

4g.Total temporary open water Impacts: 4g.Total permanent open water impacts:
0.09 0.01
4g.Total open water impacts:
0.10
4h.Comments:
Causeways to be used to remove interior bents of existing bridge.Work bridge used to install
the center span of new bridge.
6. Buffer Impacts (for DWR)
6a.Project is in which protect basin(s)?
Check all that apply.
Neuse Tar-Pamlico
Catawba Randleman
Goose Creek Jordan Lake
Other
6b.Impact Type 6c.Per or Temp 6d.Stream name 6e.Buffer mitigation required? 6f.Zone 1 impact 6g.Zone 2 impact
1-Bridge,Allowable P Tar River No 8,889 6,270
6h. Total buffer impacts:
Zone 1 Zone 2
Total Temporary impacts: 0.00 0.00
Zone 1 Zone 2
Total Permanent impacts: 8,889.00 6,270.00
Zone 1 Zone 2
Total combined buffer impacts: 8,889.00 6,270.00
6i.Comments:
E. Impact Justification and Mitigation
1.Avoidance and Minimization
la.Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
The bridge will be replaced on a new alignment while maintaining traffic on the existing bridge.The new bridge will have no bents in the water.See
stormwater management plan for additional minimization measures.
1 b.Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Existing bridge will be used to maintain traffic during construction of new bridge.NCDOT's Design Standards in Sensitive Watersheds will be adhered to.
The temporary work bridge will have an opening and not completely span the river.
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
2c.If yes,mitigation is required by(check all that apply):
DWR Corps
2d.If yes,which mitigation option(s)will be used for this project?
Mitigation bank Payment to in-lieu fee program Permittee Responsible Mitigation
4. Complete if Making a Payment to In-lieu Fee Program
4a.Approval letter from in-lieu fee program is attached.
Yes No

4b.Stream mitigation requested:
(near fast) 4c.If using stream mitigation,what is the stream temperature:
0
4d.Buffer mitigation requested(DWR only): 4e.Riparian wetland mitigation requested:
(square feet) (acres)
0 0.62
4f.Non-riparian wetland mitigation requested: 4g.Coastal(tidal)wetland mitigation requested:
(acres) (acres)
0 0
4h.Comments
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
la.Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
Yes No
What type of SCM are you providing?
Level Spreader
Vegetated Conveyance(lower SHWT)
Wetland Swale(higher SHWT)
Other SCM that removes minimum 30%nitrogen
Proposed project will not create concentrated stormwater flow through the buffer
2. Stormwater Management Plan
2a.Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?
Yes 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?
Yes No
1 b.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)?*
Yes No
1c.If you answered"yes"to the above,has the document review been finalized by the State Clearing House?*
Yes No
Comments:*
Type I or II CEs do not require review by the State Clearing House.
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 No
3b.If you answered"no,"provide a short narrative description.
Due to minimal transportation impact resulting from this bridge replacement,this project will neither influence nearby land uses nor stimulate growth.
Therefore,a detailed indirect or cumulative effects study will not be necessary.
4. Sewage Disposal (DWR Requirement)
4a.Is sewage disposal required by DWR for this project?*
Yes No 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?*
Yes No
5c.If yes,indicate the USFWS Field Office you have contacted.
Raleigh
5d.Is another Federal agency involved?*
Yes No Unknown
5e.Is this a DOT project located within Division's 1-8?
Yes No
51.What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
NC NHP database;USFWS-IPAC review for protected species which include Neuse River waterdog,Carolina madtom,Atlantic pigtoe,Tar River
spinymussel,yellow lance,and Michaux's sumac.Surveys were conducted for sumac updated 6/25/2020,no specimens observed-biological conclusion
of No Effect.Due to this project occurring within an Identified Stream Reach for all the listed aquatic species,biological conclusions of May Affect,Likely
to Adversely Affect were rendered.To satisfy Section 7,NCDOT will make payment to the NC Nongame Aquatic Species Fund for both freshwater
mussels and Neuse River waterdog/Carolina madtom as detailed in the Programmatic Biological Opinions(PBOs)for the species.Adherence to the
construction conditions detailed in the PBOs will be adhered to.
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?*
NEPA documentation
8. Flood Zone Designation (Corps Requirement)
Be.Will this project occur in a FEMA-designated 100-year floodplain?*
Yes No
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 maps
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 document
B-5947 General Nash November 18 2021.pdf 5.88MB
File must be PDF or KMZ
Comments
Signature U
*
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:
Mack Christopher Rivenbark,III

Signature
J04 t
Date
11/18/2021