20201585 Ver 1_ePCN Application_20231024

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Division of Water Resources
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
October 2, 2023 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:
10/24/2022
Does this project involve maintenance dredging funded by the Shallow Draft Navigation Channel Dredging and Aquatic Weed Fund or involve the distribution or transmission of energy or
fuel, including natural gas, diesel, petroleum, or electricity?
Yes No
BIMS # Assigned *
20201585
Is a payment required for this project?*
No payment required
Fee received
Fee needed - send electronic notification
Select Project Reviewer*
Mary Plummer:mary.plummer
Information for Initial Review
1a. Name of project:
17BP.12.R.78
1a. Who is the Primary Contact?*
Jeff Wyatt
1b. Primary Contact Email: *
[e-mail]
Date Submitted
10/24/2023
Nearest Body of Water
Third Creek
Basin
Yadkin-PeeDee
Water Classification
C
Site Coordinates
Latitude:
35.802309
A. Processing Information
Is this project connected with ARPA funding?
Yes No
County (or Counties) where the project is located:
Iredell
Longitude:
-80.974866
Version#*
1
Reviewing Office*
Mooresville Regional Office - [phone]
1c. Primary Contact Phone: *
[phone]
O
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#M
17BP.12.R.78
la. 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
1b. 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
Regional General Permit (RGP) Number:
RGP Numbers (for multiple RGPS):
1d. Type(s) of approval sought from the DWR:
401 Water Quality Certification - Regular
Non-404 Jurisdictional General Permit
Individual 401 Water Quality Certification
201902350 - Work associated with bridge construction, widening, replacement, and
interchanges
le. 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:
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
1h. 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 AgentlConsultant for this project?
Yes No
2. Owner Information
2a. Name(s) on recorded deed:
NCDOT
2b. Deed book and page no.:
401 Water Quality Certification - Express
Riparian Buffer Authorization
Yes No
Yes No
2c. Contact Person:

2d. Address
Street Address
1710 E. Marion Street
Address Line 2
City
Shelby
Postal / Zip Code
28151
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
3a. Name:
Jeff Wyatt
3b. Business Name:
3c. Address
Street Address
1710 E. Marion Street
Address Line 2
City
Shelby
Postal / Zip Code
28151
3d. Telephone Number:
[phone]
3f. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality / town:
Statesville
2. Project Identification
2a. Property Identification Number:
2c. Project Address
Street Address
Address Line 2
City
Postal / Zip Code
3. Surface Waters
3a. Name of the nearest body of water to proposed project:
Third 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.
030401020301
4. Project Description and History
State / Province / Region
NC
Country
USA
2f. Fax Number:
State / Province / Region
NC
Country
USA
3e. Fax Number:
2b. Property size:
State / Province / Region
Country

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: 2-lane rural transportation facility crossing waterbody.
General land use: intermixed forested and agricultural.
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:
150
4h. Explain the purpose of the proposed project:"
To replace a functionally obsolete bridge.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:
Bridge No. 254 is a triple -span, 105- foot long, two lane bridge with a clear roadway width of 24 feet. The replacement structure will be a bridge approximately 125 feet long at
approximately the same grade and elevation. The new bridge will be slightly wider at 29ft and have variable -width shoulders, and a barrier rail.
Standard road and bridge 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 O Unknown
Comments:
Delineated by NCDOT staff
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):
Agency/Consultant Company:
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
0
u
3a. Reason for impact (?)
3b.lmpact type*
3c. Type of impact*
��name*
3e. Stream Type*F]
3f. Type of
3g. S. width
3h. Impact
(?)
Jurisdiction*
length*
gt
Bridge Bank Stabilization
Permanent
Bank Stabilization J
Third Creek
Perennial
Both
40
Averege (feet)
(linear feet)
S2
Side Ditch Bank Stabilization
Permanent
Bank Stabilization J
Third Creek
Perennial
Both
Average (feet)
(linear feet)
S3
Side Ditch Bank Stabilization
Temporary
Other
Third Creek
Perennial
Both
10
Averege (feet)
(linear feet)
31. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts: 3i. Total temporary stream impacts:
48 10

3i. Total stream and ditch impacts:
58
3j. Comments:
S3 - Side Ditch Bank Stabilization temporary impacts will be used to prevent bank de -stabilization and will only be used if necessary.
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:
Design Mitigations for streams include:
1. Stormwater was designed to avoid direct discharge into jurisdictional features to the maximum extent possible.
2. Stormwater design velocities entering jurisdictional features have been mitigated to be non -erosive (less than 2 fps).
3. Open shoulder sections were maximized to promote sheet flow from the roadway.
4. Diffuse flow provided at outlets that do not have a well defined outfall.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Class II rip rap will be used as bank stabilization, no piers in the stream. Project site contains no buffer or wetlands. Equipment will be kept from entering
the stream channel and appropriate erosion and sediment controls will be installed and maintained. All other NCDOT best management practices will be
utilized.
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 due to bank stabilization are not subject to compensatory mitigation requirements.
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:
This project is not a part of the Catawba river basin or any other protected buffers.
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
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)?*
Yes No
Comments:*
This project qualifies as a minimum criteria project, and as such, an MCDC is attached.
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? *
L
Yes No

3b. If you answered "no," provide a short narrative description.
Minimal transportation impact resulting from this bridge replacement, this project will not
stimulate growth.
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
What Federal Agency is involved?
USACE
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
Unknown
5i. 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 Information for Planning and Consultation (IPaC), NC Natural Heritage Program
database and on -site surveys.
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?
Per Natural Heritage database no salt marshes, oyster reefs, or seagrass beds located in
vicinity of project.
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 Resources review conducted 2022.
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 coordination.
8c. What source(s) did you use to make the floodplain determination?
Flood map website, http://fris.nc.gov/fris.

Miscellaneous
0
u
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
17BP.12.R.78 Arch NSR 8_24_2022.pdf
2.84MB
17BR12.R.78 Bat Survey CB 6_24_2022.pdf
52.83KB
17BP.12.R.78 Bat Survey JW 1_9_2019.pdf
45.74KB
17BP.12.R.78 Flood Map.pdf
362.28KB
17BR12.R.78 Hist NSR 9_2_2022.pdf
219.62KB
17BP.12.R.78 IPaC 10_19_23.pdf
518.46KB
17BR12.R.78 MCDC 5_14_19.pdf
2.43MB
17BP.12.R.78 MCDC Consultation 10_26_2022.pdf
2.24MB
17BR12.R.78 NHP Report.pdf
869.5KB
17BP.12.R.78 NRTM WoodBridgeRoad FINAL.pdf
227.59KB
17BR12.R.78 Permit Drawings Revised 10_19_2023.pdf
2.56MB
17BP.12.R.78 Soil Map.pdf
319.44KB
Figl.pdf
116.47KB
Fig2.pdf
141.29KB
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:
Jeffrey L. Wyatt
Signature
Date
10/24/2023
a