20210447 Ver 1_ePCN Application_20221003

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Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
April 13,2022 Ver 4.3
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.
Pre-Filing Meeting Date Request was submitted on:
2/19/2021
BIMS#Assigned" Version#*
20210447 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*
Ryan Conchilla:eads\rjconchilla
Information for Initial Review
1a.Name of project:
B-5721-Replacment of Bridge 124 on SR 2177 over Mayo River
1a.Who is the Primary Contact?*
NCDOT
1 b.Primary Contact Email:* 1c.Primary Contact Phone:*
[e-mail] [phone]
Date Submitted
10/3/2022
Nearest Body of Water
Dan River
Basin
Roanoke
Water Classification
C
Site Coordinates
Latitude: Longitude:
36.392433 -79.952831
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 No
Is this a NCDOT Project?*
Yes No

(NCDOT only)T.I.P.or state project number:
B-5721
WBS#r)
45677.1.1
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: 14-Linear transportation
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 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 NO
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
1 b.Subdivision name:
(if appropriate)
1c.Nearest municipality I town:
Madison
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:
Dan River
3b.Water Resources Classification of nearest receiving water:*
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.
030101030409
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 agriculture fields and forestland,interspersed with maintained commercial and residential areas.
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
4g.List the total estimated linear feet of all existing streams on the property:
500
4h.Explain the purpose of the proposed project:
The purpose of this project is to replace a structurally deficient bridge.
41.Describe the overall project in detail,including indirect impacts and the type of equipment to be used:
This project involves replacing the 235-foot,7 span bridge with a 270-foot,2 span on a new alignment,maintaining traffic on the existing bridge during construction.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:
5c.If 5a is yes,who delineated the jurisdictional areas?
Name(if known): Matt Cleary
Agency/Consultant Company: Carolina Ecosystems,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
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 Site2-bank stabilization Permanent Bank Stabilization SB Perennial Both 21
Average(feet) pinear feet)
gy Site2/3-dewatering Temporary::]Dewatering SB Perennial Both 2 28
Average(feet) (linear feet)
3i.Total jurisdictional ditch impact in square feet:
0
3i.Total permanent stream impacts: 3i.Total temporary stream impacts:
21 28
31.Total stream and ditch impacts:
49
3j.Comments:
4. Open Water Impacts
4a. Site# 4a1.Impact Reason 4b.Impact type 4c.Name of waterbody 4d.Activity type 4e.Waterbody type 4f.Impact area
E�Iworkpads T Mayo River Causeway Tributary 0.03
4g.Total temporary open water Impacts: 4g.Total permanent open water impacts:
0.03 0.00
4g.Total open water impacts:
0.03
4h.Comments:
E. Impact Justification and Mitigation v
1.Avoidance and Minimization

1a.Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
The new bridge will completely span the Mayo River,removing two bents from the water.The bridge will also have a larger hydraulic opening.Deck
water will not discharge into the river,and will have over 100 feet of of potential treatment before reaching the river.See stormwater management plan
for additional minimization measures.
1 b.Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
NCDOT's design standards in sensitive watersheds will be adhered to.A biological assessment was developed to address the Roanoke logperch,and a
subsequent biological opinion(BO)was rendered by USFWS.No specific"Reasonable and Prudent Measures"were recommended in the BO due to
minimization efforts developed during project design.However,the BO does have reporting requirements in the event of Roanoke logperch observance
or potential erosion control measures.
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:
Impacts to jurisdictional resources are minimal and are not considered a"Loss of Waters of the U.S."
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
If no,explain why:
The Mayo River is not a designated buffer basin regulated under NCDWR.
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(federallstatellocal)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.
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
5j.What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
N.C.Natural Heritage Program database;USFWS IPaC website query of project area which listed Roanoke logperch and James spinymussel.A
biological conclusion of"May Affect,Likely to Adversely Affect"was rendered for Roanoke logperch.A biological conclusion of"May Affect,Not Likely to
Adversely Affect"was rendered for James spinymussel.Formal consultation was initiated with USFWS and a Biological Opinion(BO)was issued on July
2022.No specific Reasonable or Prudent Measures were recommended in the BO.However there are reporting requirements within the BO in the event
of Roanoke logperch observance or potential erosion control failures.
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)
Sa.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-5721 Rockingham October 2022.pdf 7.47MB
File must be PDF or KMZ
Comments
Signature V
*
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:
Michael Turchy

Signature
T"
Date
10/3/2022