20170970 Ver 1_PCN Form Submission_20170804

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 8/4/2017 4:29:44 PM (Start Event)
Accept by Carpenter,Kristi 8/4/2017 5:20:24 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: August 9, 2017 5:00 PM
8/4/2017 4:30 PM

�� �
6fvlslaa of Water 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 ab/e to submit the form until all mandatory questions are ans�red.
Below is a link to the DRAFT online help file. http://edocs.deq.nc.gov/WaterResources/0/doc/549884/Page1.aspx
A. Processing Information
County (or Counties) where the project is located:*
Union
Is this a NCDOT Project?*
C� Yes �' No
(NCDOT only) T.I.P. or state project number:
B-5374
WBS #
46089.1.1
(for NCDOT 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?*
fJ Nationwide Permit (NWP)
r Regional General Permit (RGP)
Nationwide Permit (NWP) Number:
Nationwide Permit (NWP) Number:
Nationwide Permit (NWP) Number
NWP Number Other:
List all MNnurrbers you are applying for not on the drop down list.
13 - Bank Stabilization
23 - Categorical Exclusions
33 - Temporary Construction
1c. Type(s) of approval sought from the DWR:*
check all that apply
�7 401 Water Quality Certification - Regular
r Non-404 Jurisdictional General Permit
r 401 Water Quality Certification - Express
r Riparian Buffer Authorization
*
1d. Is this notification solelyfor the record because written approval is not required?
For the record only for DWR 401 Certification: �' Yes C� No

1d. Is this notification solelyfor the record because written approval is not required?
I For the record only for Corps Permit:
1e. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
IF so, attach the acceptance letter from rritigation bank or in-lieu fee program
r Yes l" No
Acceptance Letter Attachment
Gick the upload button or drag and drop files here to attach docurrent
B-5374 DMS Acceptance 2017-06-01.pdf 136.21 KB
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1f. Is the project located in anyof NC's twentycoastal counties?*
C' Yes C•' No
B. Applicant Information
1a. Who is the Primary Contact?*
NCDOT
1b. Primary Contact Email:*
[e-mail]
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
�J Owner r Applicant (other than owner) r Agent/Consultant
(Check all that apply)
i 2. Owner I nformation
2a. Name(s) on recorded deed:
2b. Deed book and page no.:
2c. Responsible party:
(for Corporations)
2d.Address
Street Address
Address Line 2
Qty
Fbstal / Zip Code
2e. Telephone Number:
(xxx)xxx-xxxx
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
State / FYovince / F�gion
Country
C. Project Information and Prior Project History
*
C' Yes C•' No

1. Project Information
� 1a. Name of project:*
B-5374 Replacement of Bridge 448 over Buffalo Creek on SR 2154
(Gulledge Parker Road)
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Alton
I 1d. Driving directions*
I IF it is a new project and can not easily be found in a C�5 rrepping system Rease provide directions.
GPS Mapping
2. Project Identification
2a. Property Identification Number:
(tac RN or parcel ID)
2b. Propertysize:
(in acres)
2c. Project Address
Street Address
Address Line 2
aty
Wstal / Zip Code
SYate / Rovince / F�gion
Cauntry
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:*
35.844574
ex:34.208504
3. Surface Waters
Longitude:*
-80.532757
-77.796371
3a. Name of the nearest body of water to proposed project:*
Buffalo Creek
3b. Water Resources Classification of nearest receiving water:*
C
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Yadkin-PeeDee
RiverBasin Lookup
4. Project Description

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 land use is farmland with maintained disturbed dispersed throughout.
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)
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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)
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4d. List the total estimated acreage of all existing wetlands on the property:
0.18
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
190
4f. Explain the purpose of the proposed project:
The purpose of the project is to replace a structurally deficient and functionally obsolete bridge, built in 1965 that
is approaching the end of its useful life.
4g. Describe the overall project in detail, including the type of equipment to be used:
The project involves replacing a 40-foot long, two span bridge with a 40-foot, triple barrel box culvert structure at
the same location. Traffic will be maintained on site (as Gulledge Parker Road is a dead-end facility) using phased
construction.
Standard bridge and road building equipment, such as trucks, dozers, and cranes will be used.
4h. Please upload project drawins for the proposed project.
Qick the upload button or drag and drop files here to attach docurrent
I B-5374 All Drawings for PCN.pdf
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5. Jurisdictional Determinations
2.94M6
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
C' Yes C' No �' Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
C' Preliminary l" Approved r Unknown
Corps AID Number:
Exarrple: SAV�2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.

5d1. Jurisdictional determination upload
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6. Project History
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past?*
C' Yes C•' No �' Unknown
7. Future Project Plans
7a. Is this a phased project?*
C' Yes C•' 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.
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
rJ Wetlands rJ Streams-tributaries r Buffers
� Open Waters r Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. Site #- Reason for 2b. Impact type * 2c. Type of wetland 2d. Wetland name 2e. Forested 2f. 2g. Impact
i impact Jurisdiction area
type
Site 1- Fill P Non-Tidal Freshwater
N�p label (e.g. Road Qassing 1) F2rrranent (F'� or Terrporary M arsh
��
2g. Temporary Wetland Impact
0.000
2g. Permanent Wetland Impact
0.020
2g. Total Wetland Impact
0.020
2h. Comments:
No Corps 0.020
(404, 10) or d�NR (acres)
(401, other)
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. Site #- 3b.lmpact 3c. Type of 3d. Stream 3e. Stream 3f. 3g. Stream 3h. Impact
Reason for type impact name Type Jurisdiction width length
impact type
Row 1 Site 2- Fill P Culvert Buffalo Perennial Corps Average 42
N�p label (e.g. F2rrrenent (F) or Cree k F2rennial (� or � Q (linear feet)
Finad Q-ossing 1) Terrporary (� interrrittent (IN�
i Row 2 Site 2 P Bank Buffalo
fv�p label (e.g. F2rrranent (F) or Stabilizatio CPeek
F�ad Qassing 1) Terrporary (� n
Row 3 Site 2 T Dewatering Buffalo
dewatering F�rrranent(P�or Creek
N�p label (e.g. Terrpwary (�
Fd�ad Qossing 1)
Perennial Corps
F2rennial (FB� or
interrrittent (IIVT)
Perennial Corps
F2rennial (FH� or
interrrittent (IfV�
"" All Perennial or Intermittent streams must be verified by DWR or delegated local government.
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
118
3i. Total temporarystream impacts:
52
3i. Total stream and tributary impacts:
170
3j. Comments:
(feet)
Average
10
(feet)
Average
10
(feet)
76
(linear feet)
52
(linear feet)
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.
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:*

A culvert was selected as the replacement structure due to the small size of the watershed (3.7 square miles), and
long term maintenance cost.
I The stream is unnaturally widened through the farm area at the project location. The newculvert will maintain
Buffalo Creek more natural steam width through the crossing by way of sills in the outer two barrels.
Gulledge Parker Road is a dead end road, so no off-site detour is possible.
Culvert will be constructed as close to the ebsting bridge as possible (almost touching) to minimize the project
footprint as much as practicable.
Traffic will be reduced to a one-lane pattern to minimize the project footprint. In the event that construction
equipment blocks "line of sighY' a temporary signal may be used.
Construction will be phased so that half of the culvert will built while traffic is maintained on the existing bridge,
then once half of the culvert is completed, traffic will be phased onto the culvert, the old bridge will be removed,
and the remaining part of the culvert will be constructed. Traffic will be reduced to a one lane pattern.
The wetland to the south has been completely avoided, but the wetland to the north was clipped due to roadway
slopes/ approaches to the new structure.
The culvert will have three barrels, two of which (outside barrels) will be high flow barrels with sills and bench work.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Best Management Practices (BMPs) will be utilized during construction to attempt to reduce the stormwater impacts
to the receiving streams due to erosion and runoff.
During culvert construction when dewatering is necessary, the watercourse will be maintain by the use of a
temporary pipe, NOT a bypass pump.
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?
C� Yes �' No
2c. If yes, mitigation is required by (check all that apply):
r DWR rJ Corps
2d. If yes, which mitigation option(s) will be used for this project?
r Mitigation bank rJ Payment to in-lieu fee program r Permittee Responsible Mitigation
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)
42
4c. If using stream mitigation, stream temperature:
warm
4d. Buffer mitigation requested (DWR only):
(squarefeet)
4e. Riparian wetland mitigation requested:
(acres)
0.02
4f. Non-riparian wetland mitigation requested:
(acres)

4g. Coastal (tidal) wetland mitigation requested:
(acres)
4h. Comments
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1a. Does this project require a Stormwater Management Plan?
�' Yes �' No
1b. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
See attached Permit Drawings
1c. What is the overall percent imperviousness of this project?
%
1d. Who will be responsible for the review of the Stormwater Management Plan?*
r Certified Local Government r DEMLR Stormwater Review
�7 DWR 401 & Buffer Permitting Branch r DWR Transportation Permitting Branch
2. Diffuse Flow Plan
2a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection
Rules?
C' Yes l" No
5. DWR 401 Stormwater Review
5a. Is the Stormwater Management Plan (including BMP Supplemental Forms and Operation and Maintenance Agreements) attached?
C' Yes l" No
Stormwater Management Plan Upload
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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 PolicyAct (NEPA/SEPA)?*
C� Yes �' 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 SEPAfinal approval letter.)*
C� Yes �' No
NEPAor SEPAFinal Approval Letter
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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)? *
C' Yes �' No
2b. Is this an after-the-fact permit application?*
C' Yes C•' 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?*
C' Yes �' No
3b. If you answered "no," provide a short narrative description.
Due to the minimal transportation impact resulting from this bridge replacement, this project will neither influence
nearby land uses nor stimulate growth. Therefore, a detailed indirect or cumulative effects study will not be
necessary.
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.
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?*
C•' Yes C' No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
C' Yes �' No
5c. If yes, indicate the USFWS Field Office you have contacted.
5d. Is this a DOT project located within Division's 1-8?*
C' Yes
C� No
5e. Will you cut anytrees in order to conduct the work in waters of the U.S.?*
C•' Yes C' No
5f. Does this project involve bridge maintenance or removal?*
C� Yes C' No
5f(1). If yes, have you inspected the bridge for signs of bat use such as staining, guano, bats, etc.? Representative photos of signs of bat
use can be found in the NLEB SLOPES, Appendix F, pages 3-7.
C•' Yes C' No
Link to the NLEB SLOPES document: http://sav�reg.usace.army.mil/NLEB/1-30-17-signed_NLEB-SLOPES&apps.pdF
If you answered "Yes" to 5f(1), did you discover any signs of bat use?*
�' Yes �' No C' Unknown
If yes, please show the location of the bridge on the permit drawings/project plans.
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5g. Does this project involve the construction/installation of a wind turbine(s)?**
C' Yes r No
If yes, please show the location of the wind turbine(s) on the permit drawings/project plans.
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Sh. 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.?*
C' Yes G No
If yes to either, please provide details to include type of percussive activity, purpose, duration, and specific location of this activity on
the property.
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Si. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
USFWS website:
Schv�init�s sunflower- No Effect, habitat present, last survey: 10/20/2015
Michau�s sumac — No Effect, habitat present, last survey: 10/20/2015
Carolina heelsplitter — No Effect due to "habitat quality, lack of any native mussel ta�, and the isolation of this
surveyed stream from known species occurrences."
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
C' 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)
I Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data: http://gis.ncdcr.gov/hpoweb/
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)? *
f Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
NEPA Documentation
7c. Historic or Prehistoric Information Upload
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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?*
C' Yes C•' 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 Maps

Miscellaneous attachments not previously requested.
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I Cover Letter.pdf 251.12KB
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Signature
*
� 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 AcY');
■ I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic
Transactions AcY');
■ 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:*
Colin Mellor
Signature
C�1� �ellc��
Date
8/4/2017
Initial Review
Is this project a public transportation project?
C� Yes C' No
Qily change this if the project has been reassigned.
Has this project met the requirements for acceptance in to the review process?*
C� Yes
C' No
BIMS # Assigned*
i 20170970
Version#*
1
Reviewing Office *
Mooresville Regional Office - [phone]
Select Project Reviewer*
Donna Hood:eads\drhood