20171000 Ver 1_PCN Form Submission_20170810

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 8/10/2017 8:31:22 AM (Start Event)
Accept by Carpenter,Kristi 8/10/2017 12:19:04 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: August 15, 2017 5:00 PM
8/10/2017 8:32 AM

�� �
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:*
Craven
Is this a NCDOT Project?*
C� Yes �' No
(NCDOT only) T.I.P. or state project number:
B-5617
WBS #
45572.1.1
(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:
NWP Number Other:
List all MN nurrbers you are applying for not on the drop dow n list.
03 - Maintenance
1c. Type(s) of approval sought from the DWR:*
check all that apply
� 401 Water Quality Certification - Regular
� Non-404 Jurisdictional General Permit
r 401 Water Quality Certification - Express
�7 Riparian Buffer Authorization
1d. Is this notification solelyfor the record because written approval is not required?
For the record only for DWR 401 Certification:
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?
*
l" Yes C•' No
C' Yes C•' No

If so, attach the acceptance letter from rritigation bank or in-lieu fee program
C' Yes C•' No
1f. Is the project located in any of NC's twenty coastal counties?*
C� Yes l" No
1g. Is the project located within a NC DCM Area of Environmental Concern (AEC)?*
C' Yes �' No C' Unknown
B. Applicant Information
1a. Who is the Primary Contact?*
Jay B. Johnson
1b. Primary Contact Email:*
[e-mail]
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
r Owner �J Applicant (other than owner) r Agent/Consultant
(Check all that apply)
2. Owner I nformation
2a. Name(s) on recorded deed:
North Carolina Department of Transportation
2b. Deed book and page no.:
f�UA
2c. Responsible party:
(for Corporations)
wa
2d.Address
Street Address
105 Pactolus Highway
Address Line 2
��
Greenville
Fbstal / Zip Code
27835
2e. Telephone Number:
(xxx)xxx-xxxx
[phone]
2f. Fax Number:
[phone]
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
3a. Applicant is:
State / Rovince / F�gion
NC
Country
USA

� C' Agent
C� Other
If other please specify.
3b. Name:
Jay B. Johnson
3c. Business Name:
(if applicable)
3d.Address
Street Address
P.O. Box 1587
Address Line 2
��
Greenville
Fbstal / Zip Code
27835
3e. Telephone Number:
[phone]
(xxx)xxx-xxxx
3f. Fax Number:
(xxx)xxx-xxxx
3g. Email Address:*
[e-mail]
State / FYovince / F�gion
NC
Country
USA
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Craven 41
1b. Subdivision name:
(if appropriate)
f�UA
1c. Nearest municipality/town:*
Vanceboro
1d. Driving directions*
If it is a new project and can not easily be found in a C� rrapping system Rease provide directions.
From Vanceboro proceed west on NC 118 approbmately 6.7 miles to SR 1931. Turn right and proceed in a northerly direction on SR 1931
for approwmately 1.1 miles to SR 1930. Turn left and proceed in a west northwest direction for appro�amately 1.1 miles on SR 1930 to
project site. Bridge 41 in Craven County.
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)
i Craven 41 Bridge to Bridge Replacement
2b. Propertysize:
(in acres)
wa

2c. Project Address
Street Address
Address Line 2
�Y
Fbstal / Zip Code
2d. Site coordinates in decimal degrees
State / FYovince / F�gion
Country
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 e>cample, 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:*
35.364981 -77.268303
ex:34208504 -77.796371
3. SurFace Waters
3a. Name of the nearest body of water to proposed project:*
Swift Creek
3b. Water Resources Classification of nearest receiving water:*
C; Sw, NSW
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Neuse
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:*
SR 1464 Pughtown Rd is a paved secondary road. Woodlands and agriculture dominate the landscape.
4b. Attach an 8 1/2 X 17 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for
DWR)
C7ick the upload button or drag and drop files here to attach docurrent
i Craven 41 Vicinity.pdf 179.69KB
Fle type rrust 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)
aick the upload button or drag and drop files here to attach docurrent
map2.pdf 2.01 MB
Fle type rrust 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:
(interrrittent and perennial)
60
4f. Explain the purpose of the proposed project:
Bridge to bridge replacement, the e�sting bridge has deteriorated and needs replacement.
4g. Describe the overall project in detail, including the type of equipment to be used:

The ewsting 135' long bridge will be replaced with a 1@30', 1@70' and 1@40' cored slab bridge.
4h. Please upload project drawins for the proposed project.
aick the upload button or drag and drop files here to attach docurrent
65617_Permit Drawings_20170802.pdf 1.09M6
B5617_Permit Drawings_Buffers_20170802.pdf 757.28KB
Fle type rrust be pdF
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
C� Yes �' No �' Unknown
Comments:
No v�tlands on site
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:
N/A
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5d1. Jurisdictional determination upload
aick the upload button or drag and drop files here to attach docurrent
Fle type rrust 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 C•' No f" Unknown
7. Future Project Plans
7a. Is this a phased project?*
C' 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? 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 I m pacts I nventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
� Wetlands �7 Streams-tributaries r% Buffers
r Open Waters r Pond Construction

2. Wetland Impacts
i 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.
Row 1
Row 2
3a. Site # - 3b.lmpact
Reason for type
impact
1 P
N�p label (e.g. F2rrranent (P� or
Finad Qossing 1) Terrporary (�
3c. Type of 3d. Stream 3e. Stream 3f. 3g. Stream 3h. Impact
impact name Type Jurisdiction width length
type
Culvert Swift Creek Perennial Both ,4verage 4
F2rennial (FH�) or 40 (linear feet)
interrrittent (IN�
2 T Culvert Swift Creek Perennial Both
N�p label (e.g. F2rrrenent (F) or F2rennial (FB� or
Fd�ad Q-ossing 1) Terrporary (� interrrittent (IN�
" 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:
� 4
3i. Total temporarystream impacts:
8
3i. Total stream and tributary impacts:
12
3j. Comments:
(feet)
Average $
40 (linear feet)
(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.
6a. Project is in which protect basin(s)?*
Check all that apply.
fJ Neuse
� Catawba
r Goose Creek
r Other
r Tar-Pamlico
r Randleman
r Jordan Lake

6b. Impact Type
6c. Per or 6d. Stream name
Te mp
1 P Swift Creek
Location and 6cerrpt, Allowable, allowable w/ rritigation F�rrranent (F� or
Terrporary (�
2 P Swift Creek
Location and 6cerrpt, Allowable, allowable w/ rritigation F�rrranent (P� or
Terrporary (�
3 P Swift Creek
Location and C errpt, Allowable, allowable w/ rritigation F2rrranent (� or
Terrporary (�
4 P Swift Creek
Location and 6cerrpt, Allowable, allowable w/ rritigffiion F2rrranent (P) or
Terrporary (�
6h. Total buffer impacts:
Zone 1
Temporary impacts: 0.00
Zone 1
Permanent impacts: 3,872.00
Zone 1
Total buffer impacts: 3,872.00
6i. Comments:
Zone 2
0.00
Zone 2
2,340.00
Zone 2
2,340.00
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
C7ick the upload button or drag and drop files here to attach docurrent
Fle rrust be FDF
E. Impact Justification and Mitigation
1. Avoidance and Minimization
6e. Buffer 6f. Zone 1 6g. Zone 2
mitigation impact impact
required?
No 631 434
(squarefeet) (squarefeet)
i.n
No
No
826 524
(squarefeet) (squarefeet)
1,861 691
(squarefeet) (squarefeet)
554 691
(squarefeet) (squarefeet)
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
The e�asting bridge had two bents in the stream, and while the proposed bridge has one bent in the stream and
one bent in the stream bank.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Use of e�asting roadway to operate construction equipment.
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 C•' No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
F. Stormwater Management and Diffuse Flow Plan (required by DWR)

1a. Does this project require a Stormwater Management Plan?
�' Yes
C' No
1b. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
The roadway grade of the new structure will be approximately the same as the existing structure. There will be no
direct discharge into the stream (deck drains on the bridge). All existing stormwater drainage patterns were
maintained on the project to the fullest extent. The storm drainage systems picking up the bridge deck drainage on
the east and west sides of the bridge will both be outleted outside of the Riparian Buffer onto dissipator pads. The
storm drain system that outlets to the west will drain into an e�asting draw in the northwest quadrant of the bridge.
The storm drain system that outlets to the east will drain into a proposed ditch that ties into a cross pipe just as the
e�asting drainage did in the northeast quadrant of the bridge. There were no ewsting or proposed ditches in the
southeast and southwest quadrants.
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
rJ DWR 401 & Buffer Permitting Branch
2. Diffuse Flow Plan
r DEMLR Stormwater Review
r 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?
C� Yes
l" 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
I in Chapter 8 of the NC Stormwater BMP Manual and attach a BMP Supplement Form
What documentation are you providing?
r Level Spreader
r Other BMP
(check all that apply)
Diffused Flow Documentation
Gick the upload button or drag and drop files here to attach docurrent
Fle type rrust be FDF
5. DWR 401 Stormwater Review
5a. Is the Stormwater Management Plan (including BMP Supplemental Forms and Operation and Maintenance Agreements) attached?
C' Yes C•' No
Stormwater Management Plan Upload
C7ick the upload button w drag and drop files here to attach docurrent
file type rrust be pdf
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?*
C� Yes
l" 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 C•' No

Comments:*
f�llA
, 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 �' 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
i nearby downstream water quality?*
C' Yes C•' No
3b. If you answered "no," provide a short narrative description.
i f�UA
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 �' No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
C' Yes C•' No
5c. If yes, indicate the USFWS Field Office you have contacted.
5d. Is this a DOT project located within Division's 1-8?*
G Yes
C' No
5i. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
I Onsite field investigation by Jay Johnson "No EffecY'
� 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?*
Mr. Travis Wilson. NCWRC
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/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 historyand archaeology)?*
C' Yes �' No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
NCDOT HEU Historic Architecture and Archaeology
7c. Historic or Prehistoric Information Upload
C7ick the upload button or drag and drop files here to attach docurrent
16-07-0026 HA NoEligibleProps.pdf 3.51 MB
Archaeology16-07-0026nosurvey.pdf 1.91 MB
Fle rrust be f�F
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?*
�' Yes C' No
8b. If yes, explain how project meets FEMA requirements:
Designed to no-rise standards
8c. What source(s) did you use to make the floodplain determination?*
FEMA FIRM Maps
Miscellaneous attachments not previously requested.
qick the upload button or drag and drop files here to attach docurrent
Fle rrust be FDF
Signature
*
rJ 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:*
Jay B. Johnson
Signature
C'��r�'. C��fr�r.Jr�dt
Date
8/10/2017
Initial Review

Is this project a public transportation project?
�' Yes C' No
Only change this if the project has been reassigned.
i Has this project met the requirements for acceptance in to the review process?*
�' Yes
C' No
BIMS # Assigned*
20171000
Version#*
Reviewing Office *
Washington Regional Office - [phone]
Select Project Reviewer*
Garcy Ward:eads\gpward