20210923 Ver 2_ePCN Application_20221006

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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:
5/4/2021
BIMS#Assigned" Version#*
20210923 2
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:
Wentworth Street Bridge Replacement
1a.Who is the Primary Contact?*
Jerry Parker
1 b.Primary Contact Email:* 1c.Primary Contact Phone:*
[e-mail] [phone]
Date Submitted
10/6/2022
Nearest Body of Water
Wolf Island Creek
Basin
Roanoke
Water Classification
Class C
Site Coordinates
Latitude: Longitude:
36.372160 -79.685917
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:
WBS#(1)
17BP.7.R.140
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
Please provide the date of the previous submission.*
6/3/2021
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 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
1584 Yanceyville Street
Address Line 2
P.O.Box 14996
City State/Province/Region
Greensboro NC
Postal/Zip Code Country
27415 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:
Wentworth
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:
Wolf Island Creek
3b.Water Resources Classification of nearest receiving water:*
Class 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.
030101030904
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:
The existing conditions include rural residential neighborhood on the outskirts of a municipality with sparse residences.
4b.Have Corps permits or DWR certifications been obtained for this project(including all prior phases)in the past?
Yes No Unknown
If yes,please give the DWR Certification number or the Corps Action ID(exp.SAW-0000-00000).
4f.List the total estimated acreage of all existing wetlands on the property:
0.01
4g.List the total estimated linear feet of all existing streams on the property:
75'
4h.Explain the purpose of the proposed project:
The purpose of this project is to replace a structurally deficient bridge with a new one.The bridge lanes and shoulders will be and guardrail will be added along side the road approaching
the new bridge.This project does not involve buffered stream;likewise stream impacts will be minimized.Wetland impacts will only be associated with hand clearing which will also be kept
minimal.
41.Describe the overall project in detail,including indirect impacts and the type of equipment to be used:
This project entails complete removal of the existing bridge and installation of structure.Permanent surface water impacts will not exceed 0.01 acres,only approximately 54 linear feet
should be considered.Typical roadway construction equipment will be utilized such as dozers,backhoes,cranes,and tamps.

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): David Cooper
Agency/Consultant Company: VHB
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?*
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?
No
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 2 Handclearing T Bottomland Hardwood Forest Wolf Island Creek No 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:
3. Stream Impacts
E3a.Reason for impact(?) 3b.lmpact type* 3c.Type of impact* ffi.name* 3e.Stream Type* Jurisype ofdiction* 3g.S.width lengthpact
S7
Bank Stabilization Permanent Bank Stabilization Wolf Island Creek Perennial Both 9 54
Average(feet) (linear feet)
Bank Stabilization Tem ore Bank Stabilization Wolf Island Creek ff
Both 9 65
S2 P rY
Average(feet) (linear feet)
3i.Total jurisdictional ditch impact in square feet:
0
31.Total permanent stream impacts: 3i.Total temporary stream impacts:
54 65

31.Total stream and ditch impacts:
119
3j.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:
Roadway approach work was minimized as much as possible to reduce the overall footprint.BMP practices will also be utilized throughout the
construction period.The project will be a bridge to bridge construction.
1 b.Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Erosion and sediment control devices will be installed according to BMP's and monitored for compliance for the duration of construction.
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:
Project does not meet or exceed the thresholds for requiring mitigation.
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
If no,explain why:
N/A
2. Stormwater Management Plan
2a.Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?
Yes No
2b.Does this project meet the requirements for low density projects as defined in 15A NCAC 02H.1003(2)?
Yes No
Comments:
N/A
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
Comments:*
Project does not meet the thresholds for requiring a NEPA/SEPA document.
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 the minimal size and impact of this project,additional development is not anticipated as a result of construction.

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?
USFWS IPAC
Environmental Consultants
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?*
NCDOT Cultural Resource personnel
8. Flood Zone Designation (Corps Requirement)
8a.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 Flood 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
Wentworth NW 3 Permit.pdf 2.56MB
Wentworth St Bridge Replacement Concurrence.pdf 238.47KB
Wentworth St Aquatic Survey.pdf 4MB
Wentworth St.Permit Drawings.pdf 1.9MB
Wentworth Rd Approved MCA from Cultural Resources.pdf 90.73KB
Wentworth St.Topo Map.pdf 684.62KB
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:
W.R.Archer III,PE
Signature
Date
10/6/2022