20170081 Ver 1_17BP.10.R.13 PCN (Bridge 52 - Anson County)_20170120

Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification (PCN) Form
A. A licant Information
1. Processing
1 a. Type(s) of approval sought from the
Corps: � Section 404 Permit ❑ Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number: 14 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps? ❑ Yes � No
1d. 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 401 For the record only for Corps Permit:
because written approval is not required? Certification:
� Yes ❑ No ❑ Yes � No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation 0 Yes � No
of impacts? If so, attach the acceptance letter from mitigation bank 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 � No
below.
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ❑ Yes � No
2. Project Information
2a. Name of project: Replacement of Bridge No. 30052 over U/T to Jones Creek on SR1822 (Thomas
Road).
2b. County: Anson
2c. Nearest municipality / town: Morven
2d. Subdivision name: not applicable
2e. NCDOT only, T.I.P. or state
project no: 176P.10.R.13
3. Owner Information
3a. Name(s) on Recorded Deed: North Carolina Department of Transportation - Division 10
3b. Deed Book and Page No. not applicable
3c. Responsible Party (for LLC if not applicable
applicable):
3d. Street address: 716 West Main Street
3e. City, state, zip: Albemarle, NC 28001
3f. Telephone no.: 704-983-4400
3g. Fax no.: 704-982-3146
3h. Email address:
Page 1 of 10
PCN Form — Version 1.3 December 10, 2008 Version

4. Applicant Information (if different from owner)
4a. Applicant is: ❑ Agent ❑ Other, specify:
4b. Name:
4c. Business name
(if applicable):
4d. Street address:
4e. City, state, zip:
4f. Telephone no.:
4g. Fax no.:
4h. Email address:
5. Agent/Consultant Information (if applicable)
5a. Name: Alderman Environmental Services, Inc.
5b. Business name
(if applicable):
5c. Street address: 244 Red Gate Road
5d. City, state, zip: Pittsboro, NC 27312
5e. Telephone no.: 919-542-5331
5f. Fax no.:
5g. Email address: [e-mail]
Page 2 of 10
PCN Form — Version 1.3 December 10, 2008 Version

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): not applicable
1 b. Site coordinates (in decimal degrees): Latitude: 34.880631 Longitude: - 80.00414
(DD.DDDDDD) (-DD.DDDDDD)
1 c. Property size: acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to U/T to Jones Creek
proposed project:
2b. Water Quality Classification of nearest receiving water: C
2c. River basin: Yadkin-Pee Dee (HUC 030401)
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:
Primarily wooded - Mesic Mixed Hardwood Forest with Disturbed/Maintained along roadsides and sewer line cut.
3b. List the total estimated acreage of all existing wetlands on the property:
0
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
60
3d. Explain the purpose of the proposed project:
To replace a functionally obselete and deficient structure.
3e. Describe the overall project in detail, including the type of equipment to be used:
The project involves replacing one 17 foot bridge with a triple 7'X7' concrete box culvert at existing location over U/T to
Jones Creek; an off-site detour will be utilized. Standard road building equipment, such as cranes, dozers, and trucks will
be used.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property / � Yes � No ❑ Unknown
project (including all prior phases) in the past?
Comments:
4b. If the Corps made the jurisdictional determination, what type
of determination was made? ❑ Preliminary ❑ Final
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company:
Name (if known): Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5. Project History
5a. Have permits or certifications been requested or obtained for � Yes � 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 � No
6b. If yes, explain.
Page 3 of 10
PCN Form — Version 1.3 December 10, 2008 Version

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
❑ Wetlands � Streams - tributaries ❑ Buffers
❑ Open Waters ❑ Pond 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 jurisdiction
number — Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWQ — non-404, other) (acres)
Tem ora T
W 1 ❑ P❑ T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W2 � P� T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W3 ❑ P❑ T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W4 ❑ P❑ T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W5 ❑ P 0 T ❑ Yes ❑ Corps
❑ No ❑ DWQ
W6 ❑ P❑ T ❑ Yes ❑ Corps
❑ No ❑ DWQ
2g. Total wetland impacts N/A Permanent
N/A Temporary
2h. Comments:
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 Type ofjurisdiction Average Impact
number - (PER) or (Corps - 404, 10 stream length
Permanent (P) or intermittent DWQ — non-404, width (linear
Temporary (T) (INT)? other) (feet) feet)
S1 � P� T Bridge to culvert U/T to Jones � PER � Corps 10
Creek ❑ INT ❑ DWQ
S2 ❑ P❑ T ❑ PER ❑ Corps
❑ INT ❑ DWQ
S3 ❑ P❑ T ❑ PER ❑ Corps
❑ INT ❑ DWQ
S4 ❑ P❑ T ❑ PER ❑ Corps
❑ INT ❑ DWQ
S5 ❑ P❑ T ❑ PER ❑ Corps
❑ INT ❑ DWQ
S6 ❑ P❑ T ❑ PER ❑ Corps
❑ INT ❑ DWQ
3h. Total stream and tributary impacts
3i. Comments:
Page 4 of 10
PCN Form — Version 1.3 December 10, 2008 Version

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.
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number — (if applicable) Type of impact Waterbody type Area of impact (acres)
Permanent (P) or
Tem ora T
01 ❑P❑T
02 ❑P❑T
03 ❑P❑T
04 ❑P❑T
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.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or purpose (acres)
number of pond
Flooded Filled Excavated Flooded Filled Excavated Flooded
P1
P2
Sf. 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 impacts require miti ation, then ou MUST fill out Section D of this form.
6a.
❑ Neuse ❑ Tar-Pamlico ❑ Other:
Project is in which protected basin? ❑ Catawba ❑ Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number — Reason Buffer Zone 1 impact Zone 2 impact
Permanent (P) or for Stream name mitigation (square feet) (square feet)
Tem ora T im act re uired?
B1 ❑P❑T ❑Yes
❑ No
B2 ❑P❑T ❑Yes
❑ No
B3 ❑P❑T ❑Yes
❑ No
6h. Total buffer impacts
6i. Comments:
Page 5 of 10
PCN Form — Version 1.3 December 10, 2008 Version

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
An off site detour will be used.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Standard construction techniques apply. Best Management Practices for Bridge Demolition and Removal and Best
Management Practices for Construction and Maintenance Activities will be used.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for ❑ Yes � 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 Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter) Type Quantity
3c. Comments:
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached. ❑ Yes
4b. Stream mitigation requested: linear feet
4c. If using stream mitigation, stream temperature: ❑ warm ❑ cool ❑cold
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.
Page 6 of 10
PCN Form — Version 1.3 December 10, 2008 Version

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 � 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:
Page 7 of 10
PCN Form — Version 1.3 December 10, 2008 Version

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 � No
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
❑ Yes ❑ No
Comments:
2. Stormwater Mana ement Plan
2a. What is the overall percent imperviousness of this project? N/A %
2b. Does this project require a Stormwater Management Plan? ❑ 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:
Will implement NCDOT's Construction Program to prevent pollutant runoff from construction activities
❑ Certified Local Government
2e. Who will be responsible for the review of the Stormwater Management Plan? ❑ DWQ Stormwater Program
� DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local governmenYs jurisdiction is this project? not applicable
❑ 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: NPDES NCS000250
4b. Has the approved Stormwater Management Plan with proof of approval been
attached? ❑ Yes ❑ No
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
Page 8 of 10
PCN Form — Version 1.3 December 10, 2008 Version

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the project involve an expenditure of public (federal/state/local) funds or the � 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 ❑ No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
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 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 � No
or Riparian Buffer Rules (15A NCAC 26 .0200)?
2b. Is this an after-the-fact permit application? ❑ Yes � 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 � 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.
not applicable
Page 9 of 10
PCN Form — Version 1.3 December 10, 2008 Version

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 ❑ No
impacts?
❑ Raleigh
5c. If yes, indicate the USFWS Field Office you have contacted.
� Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
NCNHP, field surveys, NCWRC aquatics database of common and rare taxa, NCDWQ fish database
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? ❑ Yes � No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
NCWRC data records
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 � 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 State Historic Preservation Office HPOWEB GIS Service (2/12/2012)
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:
8c. What source(s) did you use to make the floodplain determination? FEMA Maps
Larry Thompson 01-20-17
Applicant/Agent's Printed Name Applicant/Agent's Signature Date
(AgenYs signature is valid only if an authorization letter from the applicant
is provided.)
Page 10 of 10
PCN Form — Version 1.3 December 10, 2008 Version

5ource: U5G51 :24,000 scale VUadesboro, NC quadrangle. 2010
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PJVSON COUNTY North Carolina
�epartment of
Proposed Replacement of Transportation
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Jurisdictional Resources
UT Jones Creek ,�`,�
SYudyArea 0
BR I DG E 30052
Anson County
Proposed Replarement of
Bridge over UT Jones Creek
on 5R 1822
FIGURE 3
North Carolina Departmerit
ofTransportation

Figure 4. Pacolet gravelly sandy loam (Pgc) associated with Thomas Road (SR 1822) Bridge
No. 30052 over U/T Jones Creek
Figure 5. Bridge No. 30052 over U/T Jones Creek on Thomas Road (SR 1822)

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Figure 6. Thomas Road (SR 1822) associated with Bridge No. 30052 over U/T Jones Creek
Figure 7. U/T Jones Creek; upstream from Bridge 30052

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Mr. Larry Thompson, PWS, LSS
NCDOT Division 10 Environmental Supervisor
North Carolina Department of Transportation
716 West Main Street
Albemarle, North Carolina 28001
Dear Mr. Thompson:
PROGRAM
November 27, 2012
Subject: EEP Mitigation Acceptance Letter:
Division 10 Project, Replace Bridge 52 over N. Fork Jones Creek on SR 1822, Anson
County
The purpose of this letter is to notify you that the Ecosystem Enhancement Program (EEP) will provide the
compensatory stream mitigation for the subject project. Based on the information received on November 21, 2012,
the impacts are located in CU 03040201 of the Yadkin River basin in the Southern Piedmont (SP) Eco-Region, and
are as follows:
Yadkin Stream Wetlands Buffer (Sq. Ft.)
03040201 Non- Coastal
Sp Cold Cool Warm Riparian Zone 1 Zone 2
Riparian Marsh
Impacts 0 0 78 0 0 0 0 0
(feet/acres)
This impact and associated mitigation need were under projected by the NCDOT in the 2012 impact data.
EEP will commit to implement sufficient compensatory stream mitigation credits to offset the impacts associated
with this project as determined by the regulatory agencies using the delivery timeline listed in Section F.3.c.iii of the
N.C. Department of Environment and Natural Resources' Ecosystem Enhancement Program In-Lieu Fee Instrument
dated July 28, 2010. If the above referenced impact amounts are revised, then this mitigation acceptance letter will
no longer be valid and a new mitigation acceptance letter will be required from EEP.
1929.
cc:
If you have any questions or need additional information, please contact Ms. Beth Harmon at 919-715-
Sincerely,
Suzann limek
EEP Ac ' g Director
Ms. Liz Hair, USACE — Asheville Regulatory Field Office
Mr. Alan Johnson, Division of Water Quality, Wetlands/401 Unit
Ms. Linda Fitzpatrick, NCDOT — PDEA
File: SR 1822 — Bridge 52 — Division 10
R.P�StO�'l�L�... � � ... Z�f�Ot"P,C,tGK� Ol�Lf'' StG{,tP.
�
p''�L,
NCDENR
North Carolina Ecosystem Enhancement Program, 1652 Mail Service Center, Raleigh, NC 27699-1652 / 919-707-8976 / www.nceep.net

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See Sheet 1-A For Index of Sheets
See Sheet 9-B For Conventional Symbols
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TO US
NCDOT CONTACT:
GREG JONES — DIVISION 10 BRIDGE
PROJECT MANAGER
[phone]
THIS PROJECT IS WITHIN THE MUNCIPAL BOUNDARIES OF MORVEN.
CLEARING ON THIS PROJECT SHALL BE PERFORMED
TO THE LIMITS ESTABLISHED BY METHOD II.
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LOCATION: BRIDGE #030052 OVER 11tORTH FORK J011tES CREEK
ON SR 1822 (COVI11lGT0111 THOMAS ROAD)
TYPE OF WORK PAVI11lG, GRADIIVG, DRAINAGE £� STRUCTURE
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ADT 2012 = NA � 6annettF/em/ng 'o� s.,�<nowFi.�, srasxr, surrF �ooa
CNAALOITE,NORIH C9ROLINA 28204-2644
PHOh'F.: ]04-Ji5-2438 FAX: ]04-332-936/
2 � � 0 0 2 Q 40 GF PROJEf,T NO. - 055335.052
ADT 2009 = 350 N� ��� ^�� F_���� �� A� o�r" c,
DHV = NA TOTAL LENGTH OF PROJECT 17BP.10.R.13 = 0.063 MILES z°iz STA"DAR° srEcrFicnzroNs �� ��'
PLANS rE �
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T— NA * RIGHT OF WAY DATE: ALLISON C. 10HNSON, P.E. �
V— 40 MPH TBD PROJECT ENGINEER ROADWAY DESIGN f'4�°�,� o���
PROFILE (HORIZONTAL) * TTST —17ton DUAL 9 ton ENGINEER o� pWwNeQ
4 2 0 4 $ FUNC CLASS = RURAL LOCAL LETTING DATE: CANDICE L. LATSON, P.E.
TBD PROJECT DESIGN ENGINEEA
PROFILE (VERTICAL) PE
S7GNATURE:

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