20171062 Ver 2_20171062 Ver 1_PCN Form Submission_20170824_20230817

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 8/24/2017 8:20:38 AM (Start Event)
Accept by Carpenter, Kristi 8/24/2017 3:48:48 PM (DOT Initial Review)
• The task was assigned to Carpenter, Kristi . The due date is: August 29, 2017 5:00 PM
8/24/2017 8:21 AM

DWR
DWI= of Wader Resources
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
June 28, 2017 Ver 1.8
Please note: fields marked with a red asterisk below are required. You will not be able to submit the form until all mandatory questions are answered.
Below is a link to the DRAFT online help file. http://edoes.deq.nc.gov/WaterResources/0/doc/549884/Pagel.aspx
A. Processing Information
County (or Counties) where the project is located:*
Chatham
Is this a NCDOT Project?*
r Yes r No
(NCDOT only) T.I.P. or state project number:
SF-180094
WBS #
17BP.8.R.124
(for NCD0T use only)
1a. Type(s) of approval sought from the Corps:*
rJ Section 404 Permit (wetlands, streams and waters, Clean Water Act)
r Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What type(s) of permit(s) do you wish to seek authorization?*
rJ Nationwide Permit (NWP)
r Regional General Permit (RGP)
Nationwide Permit (NWP) Number: 03 - Maintenance
NWP Number Other:
List all MN numbers you are applying for not on the drop down list.
1c. Type(s) of approval sought from the DWR:*
check all that apply
r 401 Water Quality Certification - Regular
r- Non-404 Jurisdictional General Permit
r 401 Water Quality Certification - Express
rJ Riparian Buffer Authorization
1d. Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification:
For the record only for Corps Permit:
*
r Yes r No
r Yes r No
le. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?

If so, attach the acceptance letter from mitigation bank or in -lieu fee program
r Yes r No
1f. Is the project located in any of NC's twenty coastal counties?*
r Yes r No
B. Applicant Information
........ ........ ..... ... . ........ ........ ..... ... . ....... .........
1a. Who is the Primary Contact?*
Benjamin Furr
1b. Primary Contact Email:*
[e-mail]
1c. Primary Contact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
r Owner r Applicant (other than owner) W Agent/Consultant
(Check all that apply)
2. Owner Information
2a. Name(s) on recorded deed:
NCDOT - Division 8
2b. Deed book and page no.:
2c. Responsible party:
(for Corporations)
Art King
2d.Address
Street Address
Address Line 2
City
Pbstal / Zip Code
2e. Telephone Number:
(xxx)xxx-xxxx
[phone]
2f. Fax Number:
(XXX)XXX-XXXX Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Ben Furr
4b. Business Name:
(if applicable)
ICA Engineering, Inc.
4c. Address
State / Rovince / Fbgion
Country

Street Address
5121 Kingdom Way, Suite 100
Address Line 2
City
State / Province / legion
Raleigh
NC
Rbstal/Zip Code
Country
27607
us
4d. Telephone Number:
[phone]
(XXX)XXX-XXXX Fax Number:
4f. Email Address:*
[e-mail]
Agent Authorization Letter
Rease provide the Agent Authorization Letter if you are submtting this docurrent.
agent authorization form_signed.pdf 47.9KB
RLETYFE MJST BE RJF
C. Project Information and Prior Project History
1. Project Information
la. Name of project:*
Bridge Replacement over Dry Creek (Bridge 94 on SR 1520)
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality / town:
*
Pittsboro
1d. Driving directions*
If it is a new project and can not easily be found in a GPS napping system Rease provide directions.
From Pittsboro, take NC-87 N for 0.2 miles then at the traffic circle take the 2nd exit onto Old Graham Rd/Old NC 87, drive 6.3 miles to
project site.
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)
N/A
2b. Property size:
(in acres)
N/A
2c. Project Address
Street Address
Bridge No. 94 over Dry Creek on Old Graham Road (SR 1520)
Address Line 2
City State / Province / Fbgion
Rbstal/Zip Code Country

2d. Site coordinates in decimal degrees
Please collect site coordinates in decimal degrees. Use between 4-6 digits (unless you are using a survey -grade GPS device) after the decimal place as
appropriate, based on howthe location was determined. (For example, most mobile phones with GPS provide locational precision in decimal degrees to
map coordinates to 5 or 6 digits after the decimal place.)
Latitude:* Longitude:*
35.802065-79.2067733
ex: 34.208504-77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Dry Creek
3b. Water Resources Classification of nearest receiving water:*
WS4V; NSW
Surface Water Lookup
3c. What river basin(s) is your project located in? *
Cape Fear
River Basin Lookup
4. Project Description
4a. Describe the existing conditions on the site and the general land use in the vicinityof the project at the time of this application:*
Land use in the vicinity of the project is currently forested or maintained roadside. Dry Creek is located within the
project limits. Dry Creek is a perennial tributary 20 to 30 feet wide with gravel/cobble substrate, consistent bed and
banks, and riffle/pool profile.
4b. Attach an 8 1/2 X 11 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for
DWR)
nick the upload button or drag and drop files here to attach document
Chatham_94_USGS_Topo.pdf 301.34KB
File type crust be pdf
4c. Attach an 8 1/2 X 11 excerpt from the most recent version of the published County NRCS Soil Survey map depicting the project site.
(for DWR)
Click the upload button or drag and drop files here to attach document
soil map_94.pdf 698.65KB
File type rust be pdf
4d. List the total estimated acreage of all existing wetlands on the property:
0
4e. List the total estimated linear feet of all existing streams on the property:
(intermttent and perennial)
100
4f. Explain the purpose of the proposed project:
The purpose of the project is to replace Bridge No. 94 over Dry Creek on SR 1520 with a single span bridge.
4g. Describe the overall project in detail, including the type of equipment to be used:

The existing three -span bridge will be replaced with a single -span bridge on existing alignment. The roadway
approaches will be widened to accommodate the new bridge and Class II rip rap will be placed around the bridge
abutments. A floodplain bench will be excavated between the right top of bank and the rip rap abutment protection.
2:1 roadway fill slopes with guardrail will be used to minimize buffer impacts. Standard heavy highway construction
equipment will be used to construct the project (excavators, dump trucks, etc.). Traffic will be maintained with an
off -site detour.
4h. Please upload project drawins for the proposed project.
Gick the upload button or drag and drop files hereto attach document
Chatham _094_buffer permit drawings.pdf 1.57MB
File type rrust be pdf
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
F Yes r No f Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
r Preliminary r Approved r Unknown
Corps AID Number:
Exarrple: SAW-2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
Ben Furr
ICA Engineering, Inc.
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Jurisdictional Determinations were not requested for this project.
5d1. Jurisdictional determination upload
Gick the upload button or drag and drop files here to attach docurrent
File type crust be FDF
6. Project History
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past?*
f Yes r No r Unknown
7. Future Project Plans
7a. Is this a phased project?*
r Yes r 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? This includes other separate and distant crossing for linear projects that require Department of the
Army authorization but don't require pre -construction notification.
No
D. Proposed Impacts Inventory
1. Impacts Summary

la. Where are the impacts associated with your project? (check all that apply):
F Wetlands F Streams -tributaries V Buffers
C Open Waters C Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this question for all stream sites
impacted.
— All Perennial or Intermittent streams must be verified by DWR or delegated local government.
4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of the U.S. then individually list
all open water impacts below.
5. Pond or Lake Construction
If pond or lake construction is proposed, then complete the chart below.
6. Buffer Impacts (for DWR)
If project will impact a protected riparian buffer, then complete the chart below. Individually list all buffer impacts below.
6a. Project is in which protect basin(s)?*
Check all that apply.
r- Neuse r- Tar -Pamlico
F Catawba r Randleman
r- Goose Creek Jordan Lake
F Other
6b. Impact Type
6c. Per or 6d. Stream name
Temp
Bridge -Allowable P Dry Creek
Location and Exempt, Allowable, allowable w/ mitigation F2rrranent (F� or
Temporary (T)
Road Crossing -Allowable P Dry Creek
Location and Exerrpt, Allowable, allowable w/ nitigation Fbrnanent (F) or
Temporary (T)
6h. Total buffer impacts:
Zone 1 Zone 2
Temporary impacts: 0.00 0.00
Zone 1 Zone 2
Permanent impacts: 4,264.00 1,303.00
6e. Buffer 6f. Zone 1 6g. Zone 2
mitigation impact impact
required?
No 4,171 104
(square feet) (square feet)
No 93 1,199
(square feet) (square feet)

Zone 1 Zone 2
Total buffer impacts: 4,264.00 1,303.00
6i. Comments:
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
Click the upload button or drag and drop files hereto attach docurrent
Chatham_094_buffer permit drawings.pdf 1.57MB
File crust be FDF
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:*
The project has been designed to minimize environmental impacts. 2:1 roadway fill slopes were used to minimize
buffer impacts and there will be no grading or fill material placed below existing top of bank to avoid stream
impacts to Dry Creek. Grated inlets and pipes will be used to collect and discharge bridge storm water through rip
rap outlet protection to dissipate energy and provide diffuse flow. Existing concrete sills along the banks will be
retained to minimize impacts to the bank of the channel underneath the bridge.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Construction will be conducted from high ground on each side of the bridge. No temporary crossings will be used
to construct the new bridge. Erosion control measures will be installed to maintain sediment on -site during
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?
r Yes
f• No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
The project will not impact streams or wetlands.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1a. Does this project require a Stormwater Management Plan?
r Yes
r No
1b. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
See attached Stormwater Plan.
1c. What is the overall percent imperviousness of this project?
1d. Who will be responsible for the review of the Stormwater Management Plan?*
I- Certified Local Government
F- DWR 401 & Buffer Permitting Branch
2. Diffuse Flow Plan
F DEMLR Stormwater Review
W DWR Transportation Permitting Branch
2a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection
Rules?
6' Yes
r No
2b. All buffer impacts and high ground impacts require diffuse flow or other form of stormwater treatment. Include a plan that fully
documents how diffuse flow will be maintained.

If, due to site constraints, a BMP other than a level spreader is proposed, please provide a plan for stormwater treatment as outlined
in Chapter 8 of the NC Stormwater BMP Manual and attach a BMP Supplement Form
What documentation are you providing?
r- Level Spreader
fJ Other BMP
(check all that apply)
Diffused Flow Documentation
Click the upload button or drag and drop files here to attach document
Stormwater Plan_94.pdf 39.88KB
File type must be RDF
5. DWR 401 Stormwater Review
5a. Is the Stormwater Management Plan (including BMP Supplemental Forms and Operation and Maintenance Agreements) attached?
r Yes r No
Stormwater Management Plan Upload
Cick the upload button or drag and drop files hereto attach document
Stormwater Plan_94.pdf 39.88KB
CHATHAM_094_17BP-8-R-124_ESC_Package. pdf 3.42MB
file type rrust be pdf
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?
r Yes r No
1b. 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)?*
r Yes r' No
1c. If you answered "yes" to the above, has the document review been finalized by the State Clearing House? (If so, attach a copy of the
NEPAor SEPA final approval letter.)*
r Yes r No
NEPAor SEPA Final Approval Letter
Click the upload button or drag and drop files hereto attach document
AttachmentG.pdf 20.42KB
RLE TYPE WST BE PDF
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 (15ANCAC 213.0200)?*
r Yes r No
2b. Is this an after -the -fact permit application?*
r Yes r No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWR Requirement)

3a. Will this project (based on past and reasonably anticipated future impacts) result in additional development, which could impact
nearby downstream water quality?*
r Yes r No
3b. If you answered "no," provide a short narrative description.
The bridge is being replaced in its existing location as a two-lane bridge. Additional development is not expected
as a result of this project.
4. Sewage Disposal (DWR Requirement)
4a. Describe, in detail, the treatment methods and dispositions (non -discharge or discharge) of wastewater generated from the
proposed project. If the wastewater will be treated at a treatment plant, list the capacity available at that plant.
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?*
r Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
r Yes r No
5c. If yes, indicate the USFWS Field Office you have contacted.
5d. Is this a DOT project located within Division's 1-8?
r Yes
r No
5i. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
NC Natural Heritage Program database and USFWS List of Endangered Species known to occur in Chatham
County. Habitat for NLEB is present. Effects of NCDOT projects on NLEB in Chatham County have been
addressed through a Programmatic Biological Opinion (May 4, 2015).
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
C- Yes r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
EFH mapper
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data: http://gis.ncdcr.gov/hpovveb/
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 (e.g., National Historic Trust designation or properties significant in North Carolina history and archaeology)?*
r Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
SHPO
7c. Historic or Prehistoric Information Upload
Click the upload button or drag and drop files hereto attach docurrent
File must be FDF
8. Flood Zone Designation (Corps Requirement)

Link to the FEMA Floodplain Maps: https://msc.fema.gov/portal/search
8a. Will this project occur in a FEMA-designated 100-year floodplain?
r Yes r No
8b. If yes, explain how project meets FEMA requirements:
HEC-RAS models indicate that no structures or property owners will be adversely affected as a result of the
proposed bridge replacement.
8c. What source(s) did you use to make the floodplain determination?*
Chatham County FIS
Miscellaneous attachments not previously requested.
Qick the upload button or drag and drop files here to attach document
File rrust be FDF
Signature
*
fJ By checking the box and signing below, I certify that:
■ 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:*
Benjamin Nelson Furr
Signature
'1 t?
Date
8/24/2017
Initial Review
Is this project a public transportation project?
G Yes r No
Only change this if the project has been reassigned.
Has this project met the requirements for acceptance in to the review process?*
F Yes
r No
BIMS # Assigned*
20171062
Version#*
1
Reviewing Office*
Central Office - [phone]
Select Project Reviewer*

April Norton:eads\arnorton