20160939 Ver 1_610224_PCN Form_2016_08_22_20160929

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Corps action ID no.
DWQ project no.
Form Version 1.4 January 2009
Pre-Construction Notification (PCN) Form
A. Applicant Information
1. Processing
1 a. Type(s) of approval sought from the Corps: ❑X Section 404 Permit Section 10 ❑ rmit
1b. Specify Nationwide Permit (NWP) number: 3 or General Permit (GP) number:
1 c. Has the NWP or GP number been verified by the Corps? ❑ Yes ❑X No
1 d. Type(s) of approval sought from the DWQ (check all that apply):
❑ 401 Water Quality Certification — Regular ❑ Non-404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
1 e. Is this notification solely for the record For the record only for DWQ For the record only for Corps Permit:
because written approval is not required? 401 Certification:
❑X Yes ❑ No ❑X Yes ❑ No
1f. 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 � Yes ❑X No
or in-lieu fee program.
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h � Yes ❑X No
below.
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ❑ Yes ❑X No
2. Project Information
2a. Name of project: Replacement of Bridge 224 over Big Creek on McCallum Pond Road (SR 1562)
2b. County: Montgomery
2c. Nearest municipality / town: Candor
2d. Subdivision name:
2e. NCDOT only, T.I.P. or state project no: 176P.8.R.102
3. Owner Information
3a. Name(s) on Recorded Deed: NCDOT
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if
applicable):
3d. Street address: 902 North Sandhill Blvd
3e. City, state, zip: Aberdeen, NC, 28315
3f. Telephone no.: 901-944-2344
3g. Fax no.: 910-944-5623
3h. Email address:
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PCN Form — Version 1.4 January 2009

4. Applicant Information (if different from owner)
4a. Applicant is: ❑X Agent ❑ Other, specify:
4b. Name: Art C. King
4c. Business name NCDOT Highway Division 8
(if applicable):
4d. Street address: 902 North Sandhill Blvd.
4e. City, state, zip: Aberdeen, NC, 28315
4f. Telephone no.: 910-944-2344
4g. Fax no.: 910-944-5623
4h. Email address: [e-mail]
5. Agent/Consultant Information (if applicable)
5a. Name: Ben Furr
5b. Business name ICA Engineering, Inc.
(if applicable):
5c. Street address: 5121 Kingdom Way, Suite 100
5d. City, state, zip: Raleigh, NC 27607
5e. Telephone no.: 919.630.1680
5f. Fax no.:
5g. Email address: [e-mail]
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B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): NCDOT ROW along SR 1562 over Big Creek
1 b. Site coordinates (in decimal degrees): Latitude: 35.28155 Longitude: -79.77065
1 c. Property size: acres
2. Surface Waters
2a. Name of nearest body of water to proposed project: Big Creek
2b. Water Quality Classification of nearest receiving water: C
2c. River basin: Yadkin
3. Project Description
3a. 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 vicinity of the project is currently forested or maintained roadside/residential. One stream (Big Creek) and one wetland (W1) are
located in the project limits. Big Creek is perennial with sand/gravel/cobble substrate, consistent bed and banks, and riffle/pool profile. McCallum
Pond is located approximately 200 feet upstream of bridge 224. W1 is a forested wetland seep in the floodplain of Big Creek.
3b. List the total estimated acreage of all existing wetlands on the property: 0.09
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 400
3d. Explain the purpose of the proposed project:
To replace a deficient obsolete bridge with a new structure that meet currents standards for safety and functionality.
3e. Describe the overall project in detail, including the type of equipment to be used:
To remove the current structure and replace it in place with the new bridge using: track loader/ excavator, trucks, crane, paver, compactor
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the 0 Yes ❑ No ❑ Unknown
Corps or State been requested or obtained for this property / Co171ments: �A/etland delineation b consultant at NCDOT re uest
ro ect includin all rior hases in the ast? y q
4b. If the Corps made the jurisdictional determination, what type � Preliminary ❑ Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company: H�R/�C,4
Name (if known): Benjamin N. Furr Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Wetland data forms completed 2/19/16 (attached)
5. Project History
5a. Have permits or certifications been requested or obtained for �Yes ❑X No ❑ Unknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project? ❑ Yes ❑X No
6b. If yes, explain.
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PCN Form — Version 1.4 January 2009

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
❑X Wetlands Strea� — tributaries Buffers Open 1�ters PQd Construction ❑
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type of impact Type of wetland Forested Type of jurisdiction Area of
number Corps (404,10) or impact
Permanent (P) or DWQ (401, other) (acres)
Tem ora T
W 1 P Fill Seep Yes Corps 0.01
W2 P Excavation Seep Yes Corps 0.01
W3 - -
W4 - -
W5 - -
W6 - Y -
2g. Total Wetland Impacts: 0.02
2h. Comments:
Unavoidable impacts due to the proximity of the proposed toe of slope to the wetland seep. There will also be 0.02 acre of hand clearing for relocation
of an aerial power line on the east side of SR 1562.
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.
3a. 3b. 3c. 3d. 3e. 3f. 3g.
Stream impact Type of impact Stream name Perennial (PER) or Type of Average Impact
number intermittent (INT)? jurisdiction stream length
Permanent (P) or width (linear
Temporary (T) (feet) feet)
S1 - Choose one - -
$2 - Choose one - -
S3 - Choose one - -
S4 - Choose one - -
S5 - Choose one - -
S6 - Choose one - -
3h. Total stream and tributary impacts
3i. Camments:
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PCN Form — Version 1.4 January 2009

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 individuall list all o en water im acts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number (if applicable) Type of impact Waterbody Area of impact (acres)
Permanent (P) or type
Tem ora T
01 - Choose one Choose
O2 - Choose one Choose
03 - Choose one Choose
04 - Choose one Choose
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If ond or lake construction ro osed, then com lete the chart below.
5a. 5b. 5c. 5d. 5e.
Pond ID number Proposed use or Wetland Impacts (acres) Stream Impacts (feet) Upland
purpose of pond (acres)
Flooded Filled Excavated Flooded Filled Excavated
P1 Choose one
P2 Choose one
5f. Total:
5g. Comments:
5h. Is a dam high hazard permit required? ❑ Yes ❑ No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If an im acts re uire miti ation, then ou MUST fill out Section D of this form.
6a. Project is in which protected basin? ❑ Neuse � Tar-Pamlico �tawba �ndleman Oth�
6b. 6c. 6d. 6e. 6f. 6g.
Buffer Impact Reason for impact Stream name Buffer Zone 1 Zone 2
number — mitigation impact impact
Permanent (P) or required? (square (square
Tem ora T feet feet
B� - Yes/No
g2 - Yes/No
g3 - Yes/No
B4 - Yes/No
B5 - Yes/No
gg - Yes/No
6h. Total Buffer Impacts:
6i. Comments:
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D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Sub Regional Tier Design Guidelines with reduced speeds were used to maintain grade close to existing to minimize fill associated with roadside
embankments. In addition, 2:1 slopes were used on embankments to minimize fill in wetlands. 1.5:1 slopes were considered but would have still
impacted wetlands due to the required rock plating on 1.5:1 slopes. Excavation was kept to a minimum and outside of the existing stream channel.
The bridge stormwater outlet was designed on the west side to avoid wetland impacts.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Appropriate BMP's will be utilized during construction to control sediment. Vegetation will be removed by hand clearing as opposed to mechanized
clearing to avoid impacts in the wetland. The bridge will span the stream and construction will be conducted outside of the top of bank to avoid stream
impacts.
2. Compensato Miti ation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for � Yes ❑X No
impacts to Waters of the U.S. or Waters of the State?
2b. If yes, mitigation is required by (check all that apply): ❑ DWQ ❑ Corps
❑ Mitigation bank
2c. If yes, which mitigation option will be used for this
project? ❑ Payment to in-lieu fee program
❑ Permittee Responsible Mitigation
3. Complete if Usin a Miti ation Bank
3a. Name of Mitigation Bank:
Type: Choose one Quantity:
3b. Credits Purchased (attach receipt and letter) Type: Choose one Quantity:
Type: Choose one Quantity:
3c. Comments:
4. Com lete if Makin a Pa ment to In-lieu Fee Pro ram
4a. Approval letter from in-lieu fee program is attached. ❑ Yes
4b. Stream mitigation requested: linear feet
4c. If using stream mitigation, stream temperature: Choose one
4d. Buffer mitigation requested (DWQ only): square feet
4e. Riparian wetland mitigation requested: acres
4f. Non-riparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requested: acres
4h. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
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PCN Form — Version 1.4 January 2009

6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires � Yes ❑X No
buffer mitigation?
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.
6c. 6d. 6e.
Zone Reason for impact Total impact Multiplier Required mitigation
(square feet) (square feet)
Zone 1 3(2 for Catawba)
Zone 2 1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund).
6h. Comments:
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E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers identified � Yes ❑X No
within one of the NC Ri arian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
❑ Yes � No
2. Stormwater Mana ement Plan
2a. What is the overall percent imperviousness of this project? 33 %
2b. Does this ro'ect re uire a Stormwater Mana ement Plan? ❑X Yes ❑ No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
See attached
2e. Who will be responsible for the review of the Stormwater Management Plan? NCDOT
3. Certified Local Government Stormwater Review
3a. In which local overnmenYs 'urisdiction is this ro'ect?
❑ Phase II
3b. Which of the following locally-implemented stormwater management programs ❑ NSW
apply (check all that apply): ❑ USMP
� Water Supply Watershed
� Other:
3c. Has the approved Stormwater Management Plan with proof of approval been ❑Yes ❑ No
attached?
4. DWQ Stormwater Pro ram Review
�Coastal counties
❑ HQW
4a. Which of the following state-implemented stormwater management programs apply �ORW
(check all that apply):
❑ Session Law 2006-246
❑ Other:
4b. Has the approved Stormwater Management Plan with proof of approval been � Yes ❑ No
attached?
5. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements? ❑ Yes ❑ No
5b. Have all of the 401 Unit submittal requirements been met? � Yes � No
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PCN Form — Version 1.4 January 2009

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the project involve an expenditure of public (federal/state/local) funds or the 0 Yes ❑ No
use of public (federal/state) land?
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 ❑ Yes ❑X No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1 c. 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 NEPA or SEPA final approval
letter.) ❑ Yes ❑ No
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ SurFace Water or Wetland Standards, ❑Yes ❑X No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after-the-fact permit application? ❑Yes ❑X No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in �Yes ❑X No
additional development, which could impact nearby downstream water quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
N/A
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PCN Form — Version 1.4 January 2009

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or � Yes ❑ No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act � Yes ❑X No
impacts?
5c. If yes, indicate the USFWS Field Office you have contacted. -
5d. 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 Montgomery County. Habitat for Helianthus
schweinitzii and Echinacea laevigata is present along the roadside ROW; however, no endangered plants were observed during site investigations.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? ❑ Yes ❑X No
6b. What data sources did you use to determine whether your site would impact 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 � Yes ❑X No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
NC SHPO screening
NCDOT PEDA Cultural resources screening
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? ❑ Yes ❑X No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?
Montgomery County FIS
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Applicant/AgenYs Printed Name ApplicanUAgent's Signature Date
(AgenYs signature is valid only if an authorization
letter from the a licant is rovided.
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