20201818 Ver 1_ePCN Application_20220311

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Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
December 6,2021 Ver 4.2
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#*
20220386 1
Is a payment required for this project?
No payment required Reviewing Office*
Fee received Winston-Salem Regional Office-(336)776-
Fee needed-send electronic notification 9800
Select Project Reviewer*
Dave Wanucha:eads\djwanucha
Information for Initial Review
1a.Name of project:
Replacement of Bridge#790248 on SR 1211 over Grants Creek
la.Who is the Primary Contact?*
Amy Euliss-NCDOT Div 9 EO
1 b.Primary Contact Email:* 1c.Primary Contact Phone:*
[e-mail] [phone]
Date Submitted
3/11/2022
Nearest Body of Water
Grants Creek
Basin
Yadkin-PeeDee
Water Classification
C
Site Coordinates
Latitude: Longitude:
35.564287 -80.601288
A. Processing Information u
County(or Counties)where the project is located:
Rowan
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:

WBS#(')
17BP.9.R.82
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 Division 9
2b.Deed book and page no.:
2c.Contact Person:

2d.Address
Street Address
375 Silas Creek Parkway
Address Line 2
city State/Province/Region
Winston-Salem NC
Postal/Zip Code Country
27127 USA
2e.Telephone Number: 2f.Fax Number:
[phone] [phone]
2g.Email Address:*
[e-mail]
C. Project Information and Prior Project History
1.Project Information
1 b.Subdivision name:
(if appropriate)
1c.Nearest municipality I town:
Landis
2.Project Identification
2a.Property Identification Number: 2b.Property size:
N/A 7.1
2c.Project Address
Street Address
SR 1211(Kimball Road)
Address Line 2
City State/Province/Region
China Grove NC
Postal/Zip Code Country
28023 USA
3. Surface Waters
3a.Name of the nearest body of water to proposed project:
Grants 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.
030401030101
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 SR 1211(Kimball Road),municipal recreational facilities,residential development,undeveloped forest and the disturbed/maintained right-of-way.
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:
0.38
4g.List the total estimated linear feet of all existing streams on the property:
324
4h.Explain the purpose of the proposed project:
To remove Bridge#790248 and replace with a new modern triple box culvert structure.
41.Describe the overall project in detail,including indirect impacts and the type of equipment to be used:
Erosion and sedimentation control measures will be installed at the beginning of the project.Bridge demolition will include the removal of the bridge deck and removal of the bridge
abutments and relocation of the water and sewer lines.Temporary dewatering of Grants Creek will be done for the open cut water and sewer line installations to be performed in dry
conditions.The culvert will be constructed using heavy construction equipment.The proposed culvert will be built on the same alignment with a temporary off-site detour.The culvert will
consist of two low flow barrels with one foot sills which will be buried.The high flow barrel will be buried and will have two foot sills.Bank stabilization will be installed at drainage outfalls
located upstream of the culvert and along the banks on the downstream end of the culvert.Minor temporary wetland impacts will be necessary for the relocation of a sewer line.

5. Jurisdictional Determinations
5a.Have the wetlands or streams been delineated on the property or proposed impact areas?*
Yes No Unknown
Comments:
Please see attached forms and mapping
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): Joshua Kotheimer,PWS
Agency/Consultant Company: STV Engineers,Inc.
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?
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*
Site 3 Utilities T Bottomland Hardwood Forest Wetland B LA
Both 0.010
acres)
2g.Total Temporary Wetland Impact 2g.Total Permanent Wetland Impact
0.010 0.000
2g.Total Wetland Impact
0.010
21.Comments:
Temporary impacts to a herbaceous wetland located within an existing maintained utility corridor are necessary to connect an 8 inch sanitary sewer to an
existing line located in the southeastern quadrant of the site.The 0.01 acres of wetland that will be temporarily excavated will be restored upon
completion.The wetland soils will be excavated and stockpiled on filter fabric outside of the wetland boundaries.The wetland impact area will be
returned to preconstruction contours with the excavated wetland soils,and revegetated with native riparian seed mix.
3.Stream Impacts
11
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 site 1a:Culvert Permanent Culvert Grants Creek Perennial Both 12 79
Average(feet) (linear feet)
S2 site 1b:Bank Stabilization Temporary Bank Stabilization J
Grants Creek Perennial Both 12 59
Average(feet) (linear feet)
S3 site 1c:Dewatering Temporary Dewatering Grants Creek Perennial Both 12 11
Average(feet) pinearfeeq
9-ite 2a:Culvert Permanent Culvert Flat Rock Branch Perennial Both 10 17
Average(feet) (linear feet)
S5 site 2b:Bank Stabilization Permanent Bank Stabilization J
Flat Rock Branch Perennial Both 10 35
Average(feet) (linear feet)

S6 Site 2c:Dewatering Temporary Dewatering Flat Rock Branch Perennial ::]Both h;;;J
(linear(eet)
--]
3i.Total jurisdictional ditch impact in square feet:
0
3i.Total permanent stream impacts: 3i.Total temporary stream impacts:
131 77
3i.Total stream and ditch impacts:
208
3j.Comments:
The culvert will consist of three barrels which include two barrels that will carry the normal flow and one high flow barrel.The culvert barrels will be
buried one foot below the existing channel with the left two barrels having one-foot sills and the right barrel having two-foot sills.Native bed material shall
be placed between sills in the low flow culvert barrels.Native material consists of material that is excavated from the stream bed or floodplain at the
project site during culvert construction.Rip rap may be used to supplement the native bed material.If riprap is used,native material will be placed on top
to facilitate animal passage.The top surface of the natural stream bed material will be placed and leveled to a flat surface to allow animal passage.The
high flow barrel will be backfilled with native bed material and/or rip rap.There will be excavation of the stream banks that will allow the stream to match
the downstream channel and will also form a flood bench that will tie into the right barrel sill height.There will be bank stabilization installed along Grants
Creek and Flat Rock Branch.Dewatering impacts will be necessary within Grants Creek and Flat Rock Branch to install utility lines on both sides of the
roadway.
E. Impact Justification and Mitigation U
1.Avoidance and Minimization
la.Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
Replace bridge to culvert in-place was incorporated to minimize impacts.Riprap at the embankments is minimized to reduce impacts to surface waters.
1 b.Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
NCDOT Best Management Practices(BMPs)for Construction and Maintenance Activities will be employed.Top down demolition and construction
methods will be used to minimize impacts.Dewatering of portions of the stream will be done to ensure the open cut installation of utility lines is done in
dry conditions.
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:
(linear feet) 4c.If using stream mitigation,what is the stream temperature:
96 warm
4d.Buffer mitigation requested(DWR only): 4e.Riparian wetland mitigation requested:
(square feet) (acres)
4f.Non-riparian wetland mitigation requested: 4g.Coastal(tidal)wetland mitigation requested:
(acres) (acres)
4h.Comments
Mitigation is not proposed for the permanent impacts associated with bank stabilization since the stabilization will result in no loss of waters.Mitigation
will be provided for the 96'of permanent impacts associated with the culvert installation at a 2:1 ratio.
6. Buffer mitigation (State Regulated Riparian Buffer Rules)- required by DWR
6a.Will the project result in an impact within a protected riparian buffer that requires buffer mitigation?If yes,you must fill out this entire form-please contact DWR for more information.
Yes No
F. Stormwater Management and Diffuse Flow Plan (required by DWR) U
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

If no,explain why:
Project is located in the Yadkin-Pee Dee River Basin.
2. Stormwater Management Plan
2a.Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?
Yes No
Comments:
Please see attached Stormwater Management Plan for details on the minimization of water quality impacts.
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
Comments:*
Bridge replacement required the preparation of a Minimum Criteria Determination Checklist.
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.
Project involves the replacement of an existing bridge and is not anticipated to affect future development.
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.
Asheville
5d.Is another Federal agency involved?*
Yes No 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 No
5g.Does this project involve bridge maintenance or removal?
Yes No
5g(1).If yes,have you inspected the bridge for signs of bat use such as staining,guano,bats,etc.?
Yes No
If you answered"Yes"to 5g(1),did you discover any signs of bat use?
Yes No Unknown
5h.Does this project involve the construction/installation of a wind turbine(s)?*
Yes No

51.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 No
5j.What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
USFWS IPaC and NCNHP data and site specific surveys.See Supplemental Information for threatened and endangered species write-ups and
biological conclusions.
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?
NOAA EFH 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?*
Yes No
7b.What data sources did you use to determine whether your site would impact historic or archeological resources?*
See attached"No Archaeological Survey Required Form","Historic Architecture and Landscapes No Survey Required Form",and documentation of no
concerns from the Catawba Indian Nation.
8. Flood Zone Designation (Corps Requirement)
8a.Will this project occur in a FEMA-designated 100-year floodplairi
Yes No
8b.If yes,explain how project meets FEMA requirements:
NCDOT Hydraulics Unit Coordination with FEMA.A MCA was approved by NC Floodplain Mapping in August 2019.
8c.What source(s)did you use to make the floodplain determination?*
FEMA FIRM 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
17BR9.R82_Bridge248_Cover_Letter_and_Supplemental_lnformation_V2.pdf 30.35MB
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:
Amy Euliss
Signature
�ycy(�u!_9A
Date
3/11/2022