20211069 Ver 1_ePCN Application_20211213

DW R
Divi.ha of ware.Besourcrs
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#*
20211069 1
Is a payment required for this project?*
No payment required
Fee received Reviewing Office*
Fee needed-send electronic notification Washington Regional Office-[phone]
Select Project Reviewer*
Garcy Ward:eads\gpward
Information for Initial Review
1a.Name of project:
Replacement of Bridge No.730015 on SR 1565 over Chicod Creek
la.Who is the Primary Contact?*
Michael Amen
1 b.Primary Contact Email:* 1c.Primary Contact Phone:*
[e-mail] [phone]
Date Submitted
12/13/2021
Nearest Body of Water
Chicod Creek
Basin
Tar-Pamlico
Water Classification
C;NSW
Site Coordinates
Latitude: Longitude:
35.53330 -77.18790
A. Processing Information
County(or Counties)where the project is located:
Pitt
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:
BP2.R018.1

WBS#(?)
BP2.R018.1
Pre-Filing Meeting Information
Is this a courtesy copy notification?*
Yes No
ID# Version
Pre-fling Meeting or Request Date
7/6/2021
Attach documentation of Pre-Filing Meeting Request here:
Click the upload button or drag and drop files here to attach document
DWR Pre-Filing Meeting Request Forni 52.7KB
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(NWP)
Regional General Permit(RGP)
Standard(IP)
1c.Has the NWP or GP number been verified by the Corps?
Yes No
Nationwide Permit(NWP)Number: 03-Maintenance
NWP Numbers(for multiple NWPS):
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 It.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
1037 W.H.Smith Blvd
Address Line 2
City State/Province/Region
Greenville NC
Postal/Zip Code Country
27835 United States
2e.Telephone Number: 21.Fax Number:
[phone]
2g.Email Address:*
mcaman@ncdotgov
3.Applicant Information(if different from owner)
3a.Name:
Michael Aman
3b.Business Name:
NCDOT
3c.Address
Street Address
1037 W.H.Smith Blvd
Address Line 2
City State/Province/Region
Greenville NC
Postal/Zip Code Country
27835 United States
3d.Telephone Number: 3e.Fax Number:
[phone]
3f.Email Address:
[e-mail]
4.Agent/Consultant(if applicable)
4a.Name:
Sam Cullum
4b.Business Name:
Kisinger Campo&Associates
4c.Address
Street Address
301 Fayetteville Street
Address Line 2
Suite 1500
City State/Province/Region
Raleigh NC
Postal/Zip Code Country
27601 United States
4d.Telephone Number: 4e.Fax Number:
[phone]
4f.Email Address:*
[e-mail]
C. Project Information and Prior Project History
1.Project Information

1b.Subdivision name:
(if appropriate)
1c.Nearest municipality/town:
Grimesland
2.Project Identification
2a.Property Identification Number: 2b.Property size:
2c.Project Address
Street Address
S Grimesland Bridge Rd(SR 1565)
Address Line 2
City State/Province/Region
Grimesland NC
Postal/Zip Code Country
27837 United States
3. Surface Waters
3a.Name of the nearest body of water to proposed project:
Chicod Creek
3b.Water Resources Classification of nearest receiving water:*
C;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.
030201030603
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:*
Existing Conditions include a 2-lane bridge in a rural area
Agricultural 2.01.01
Residential 1.01.01.01
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:
0.23
4g.List the total estimated linear feet of all existing streams on the property:
100
4h.Explain the purpose of the proposed project:
Replcement of a 91'existing bridge originally built in 1960,by a 105'proposed bridge.
41.Describe the overall project in detail,including indirect impacts and the type of equipment to be used:
Impacts to the stream/wetland will result from construction activities required to deconstruct the existing bridge and to construct the proposed bridge.
Impacts for temporary work in existing end-bent removal is included in impacts to allow access for construction equipment.
the proposed grade will be at a slightly higher elevation than the original road.As a result,there will be minimal permanent fill in the wetland.
Bench elevations are required to end-bent stability
Construction equipment anticipated for construction included a small crane,excavators,and small soil compactors.
5. Jurisdictional Determinations
Sa.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:

5c.If 5a is yes,who delineated the jurisdictional areas?
Name(if known): Jay B.Johnson
Agency/Consultant Company: NCDOT Division 2
Other:
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 Unknown Chicod Creek No Both 0.006
(acres)
Roadway
Fill
T Unknown Chicod Creek No Both
(Mechanized Clearing) O(000)
Roadway Fill(Hand T Unknown Chicod Creek No Both 0.010
Clearing) (acres)
Bridge Begin T Unknown Chicod Creek No Both 0.000
(acres)
Roadway Fill P Unknown Chicod Creek No Both 0.010
(acres)
Roadway Fill P Unknown Chicod Creek No Both 0.000
(Excavation) (acres)
Roadway Fill
T Unknown Chicod Creek No Both
(Mechanized Clearing) O(000)
-A
2 Roadway Fill(Hand T Unknown Chicod Creek No Both 0.030
Clearing) (acres)
2g.Total Temporary Wetland Impact 2g.Total Permanent Wetland Impact
0.040 0.016
2g.Total Wetland Impact
0.056
21.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
Bridge Begin T Chicod Creek Bridge Tributary 0.01
Bridge Begin P Chicod Creek Bridge Tributary 0.00
4g.Total temporary open water Impacts: 4g.Total permanent open water impacts:
0.01 0.00
4g.Total open water impacts:
0.01
4h.Comments:

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
Roadway Crossing P Chicod Creek Yes 3,321 1,898
Proposed Bridge P Chicod Creek No 1,255 0
6h. Total buffer impacts:
Zone 1 Zone 2
Total Temporary impacts: 0.00 0.00
Zone 1 Zone 2
Total Permanent impacts: 4,576.00 1,898.00
Zone 1 Zone 2
Total combined buffer impacts: 4,576.00 1,898.00
61.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:
Proposed bridge is at the lowest grade elevation possible while still following NCDOT guidelines-resulting in minimized fill slope in wetland.
Bridge length is minimized while still meeting setback requirements required by NCDOT-resulting in minimized bench elevation excavation
Rip rap at end bent is required for slope stability of end-bent and cannot be avoided
1 b.Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Erosion Control measures will be taken to avoid significant deposition of sand/soil to be transported to the waterway
No construction activities will take place in the stream/wetland around 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:
Avoidance and minimization of waterway impacts were considered in design decisions for this bridge.The drainage impacs on the waterways nearby this project should be considered
insignificant
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?
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
1a.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
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.
The scope of this project does not include and additional travel lanes or impervious surfaces.Existing drainage patterns are maintained,therefore there
is no reason for a change in downstream water quality
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
What Federal Agency is involved?
NOAA-Division of Marine Fisheries(Contact:Twyla Cheatwood)
5e.Is this a DOT project located within Division's 1-8?
Yes No
5j.What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
Natural Resources Technical Report&PBO.PBO's included are as listed:
-NCDOT Program Effects on the Northern Long-eared Bat in Divisions 1-8
-Tar Rvier Spinymussel
-Dwarf Wedgemussel
-Atlantic Pigtoe
-Neuse River Waterdog
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?
Natural Resources Technical Report-Coordination with USFWS was maintained throughout the approval process for the NRTR document.

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?*
NCDOT Historic Architecture&Archaeology-No Survey Required
8. Flood Zone Designation (Corps Requirement)
Sa.Will this project occur in a FEMA-designated 100-year floodplain?*
Yes No
8b.If yes,explain how project meets FEMA requirements:
No increase of WSEL upstream/downstream of bridge.
8c.What source(s)did you use to make the floodplain determination?*
Floodplain determination came from adding proposed bridge layout and proposed roadway profile into HEC-RAS model acquired from FRIS.
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
BP2.R018.1_NRTR.pdf 8.25MB
BP2.R018.1_PERM ITS_BU FFER_11 x17.pdf 1.37MB
BP2.R018.1_PERM ITS_W ETLAN D_11 x17.pdf 2.1 MB
BP2.R018.1_Stage3Plans_3RD1.pdf 6.22MB
BP2.R018_CE_Type_I(A).pdf 5.54MB
BP2.R018_NoArchSurveyReq.pdf 920.64KB
BP2.R018_NoHistArchSurveyReq.pdf 259.43KB
File must be PDF or KMZ
Comments
Signature
*
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:
Sam Cullum
Signature
Date
12/13/2021