20171134 Ver 1_PCN Form Submission_20170907

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 9/7/2017 8:05:44 AM (Start Event)
Accept by Carpenter,Kristi 9/7/2017 4:32:26 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: September 12, 2017 5:00 PM
9/7/2017 8:06 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:*
Alamance
Is this a NCDOT Project?*
C� Yes �' No
(NCDOT only) T.I.P. or state project number:
B-5347 (Bridge 170 over a Prong of Big Alamance Creek [Alamance Creek]
on SR 1145 [Pond Road])
WBS #
46061.1.1
(for NCDOT use only)
1a. Type(s) of approval sought from the Corps:*
�J 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?*
r% Nationwide Permit (NWP)
� Regional General Permit (RGP)
Nationwide Permit (NWP) Number:
Nationwide Permit (NWP) Number:
Nationwide Permit (NWP) Number:
NWP Number Other:
List all MN nurrbers you are applying for not on the drop dow n list.
13 - Bank Stabilization
23 - Categorical Exclusions
33 - Temporary Construction
1c. Type(s) of approval sought from the DWR:*
check all that apply
N7 401 Water Quality Certification - Regular
� Non-404 Jurisdictional General Permit
r 401 Water Quality Certification - E�ress
rJ Riparian Buffer Authorization

1d. Is this notification solelyfor the record because written approval is not required?
IFor 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?
If so, attach the acceptance letter from rritigation bank or in-lieu fee program
�' Yes C' No
Acceptance Letter Attachment
C7ick the upload button or drag and drop files here to attach docurrent
B-5347 - STR - Buffer - CF 02 (Haw).pdf 101.45KB
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1f. Is the project located in any of NC's twenty coastal counties?*
C' Yes �' 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?
r% Owner r Applicant (other than owner) r AgenUConsultant
(Check all that apply)
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
�'
Fbstal / Zip Code
2e. Telephone Number:
(xxx)xxx-xxxx
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
State / Rovince / F�gion
Country
*
C' Yes C•' No
C' Yes C� No

C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
� B-5347 (Bridge 170 over a Prong of Big Alamance Creek [Alamance Creek]
on SR 1145 [Pond Road])
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Alamance
1d. Driving directions*
If it is a new project and can not easily be found in a C�S rrapping system Rease provide directions.
Lat: 36.03566, Long: -79.489986; From Raleigh, take I-40 W to Exit 143 (NC 62/Alamance Rd); Go south on NC 62 to Pond Rd, take right
(approx 2.5 miles from E�t); 1 st bridge on Pond Road.
2. Project Identification
2a. Property Identification Number:
(tac RN or parcel ID)
2b. Propertysize:
(in acres)
2c. Project Address
Street Address
Address Line 2
�Y
Wstal / Zip Code
SYate / Rovince / F�gion
Country
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:*
36.03566
ex:34.208504
3. Surface Waters
Longitude:*
-79.489986
-77.796371
3a. Name of the nearest body of water to proposed project:*
Big Alamance Creek (Alamance Creek)
3b. Water Resources Classification of nearest receiving water:*
WS-V, NSW
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Cape Fear

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:*
Pond Road is classified as a Local Road in the Statewide Functional Classification System and is not a National
Highway System Route. Land use within the vicinity primarily consists of forested land, agriculture, and lov� to
medium-density residential.
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)
aick the upload button or drag and drop files here to attach docurrent
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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)
C7ick the upload button w drag and drop files here to attach docurrent
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4d. List the total estimated acreage of all existing wetlands on the property:
0.00
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
� 428 (314 Prong of Big Alamance Cr, 114 Big Alamance Cr)
4f. Explain the purpose of the proposed project:
� To replace a structurally deficient bridge.
4g. Describe the overall project in detail, including the type of equipment to be used:
The project will consist of replacing the ebsting one-span, 36-foot structure with a 13-foot by 7-foot single-barrel
I Reinforced Concrete Box Culvert (RCBC) on roughly the existing alignment. An on-site detour will be employed.
Standard road building equipment, such as trucks, dozers, and cranes will be used.
4h. Please upload project drawins for the proposed project.
Gick the upload button or drag and drop files here to attach docurrent
B-5347 Permit Package_20170404_revised by Jim_FINAL.pdf 4.81 MB
B-5347 Roadway_Full 11x17.pdf 2.28M6
B-5347_Utilities_Buffer Drawings_FINAL.pdf 711.62KB
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5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
�' Yes C' No c' Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
G Preliminary C' Approved C' Unknown
Corps AID Number:
Exarrple: SAV�2017-99999
SAW-2013-01042
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Beth Reed and Jason Hartshorn

Sc. If 5a is yes, who delineated the jurisdictional areas?
Agency/Consultant Company:
Other
Kimley-Horn
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
6/6/2013 (USACE); 6/24/2013 (DWQ)
5d1. Jurisdictional determination upload
aick the upload button or drag and drop files here to attach docurrent
i B-5347 Prelim JD_USACE.pdf
65347_DWQ Stream Call letter.pdf
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6. Project History
8.2MB
509.17KB
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.
No
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
r Wetlands �J Streams-tributaries fJ Buffers
r 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.
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
3a. Site # - 3b.lmpact
Reason for type
impact
1-RCBC P
N�p label (e.g. F�rrranent (P� or
Raad Q'ossing 1) Terrporary (�
3c. Type of 3d. Stream 3e. Stream 3f. 3g. Stream 3h. Impact
impact name Type Jurisdiction width length
type
Fill Prong of Perennial Corps Average 101
Big f�rennial (F�2) or 30 (linear feet)
Alamance interrrittent (�rvr) (feet)
Creek

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 2 1-Bank P Bank Prong of Perennial Corps Average 88
Stablllzatio F2rrrenent (� or Stabilizatio Blg F2rennial (�) or 30 (linear feet)
I n Terrporary (� n AlemanC2 interrrittent (IN� (feet)
Nt�p label (e.g. Cre e k
RDad Q'ossing 1)
Row 3 1- T Fill Prong of Perennial Corps Average 117
Te mporary F2rrranent (F) or Blg F2rennial (FB� or 30 (linear feet)
Fill Terrporary (� Alamance interrrittent (IN� (feet)
N�p label (e.g. Cre e k
13�ad Qossing 1)
Row4 2-Bank P Bank Big Perennial Corps Average 8
Stabilizatio F2rrranent (F'� or Stabilizatio AlamanCe F2rennial (FH� or 90 (linear feet)
n Terrporary(� n Creek interrrittent(IfV� (feet)
fv�p label (e.g.
R�ad Qossing 1)
Row 5 2- T Fill Big Perennial Corps Average 50
Te mporary F�rrranent (P� or AlamanCe F�rennial (� or 90 (linear feet)
Fill Terrporary(� Creek interrrittent(Ifvl) (feet)
fv�p label (e.g.
Fd�ad Qossing 1)
"" 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:
197
3i. Total temporarystream impacts:
167
3i. Total stream and tributary impacts:
364
3j. Comments:
No impacts are directly attributed to the temporary on-site detour. Site 1: 88 linear ft. of Bank Stabilization is
concurrent with 88 linear ft. of the 117 linear ft. of temporary impact at site.
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.
r Neuse r Tar-Pamlico
r Catawba r Randleman
I r Goose Creek �J Jordan Lake
r Other

6b. Impact Type
6c. Per or 6d. Stream name
Te mp
Site 1- Road Crossing P Prong of Big Alamance
Location and C errpt, Allowable, allowable w/ rritigation F2rrranent (F) or Cree k
Terrporary (�
Site 2- Impacts Other Than Road P Big Alamance Creek
Crossing F�rrranent (Pj or
Location and 6cerrpt, Allowable, allowable w/ rritigation Terrporary (�
Utility Site 1- Utility, Electric, Aerial, P Prong of Big Alamance
PerpendicularCrossings F2rrranent(P�or Creek
I Location and Exerrpt, Allowable, allowable w/ rritigation Terrporary (�
6h. Total buffer impacts:
Temporary impacts
Permanent impacts:
Total buffer impacts
6i. Comments:
Zone 1
0.00
Zone 1
12,498.00
Zone 1
12,498.00
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
aick the upload button or drag and drop files here to attach docurrerrt
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Zone 2
0.00
Zone 2
7,643.00
Zone 2
7,643.00
E. Impact Justification and Mitigation
1. Avoidance and Minimization
6e. Buffer
mitigation
required?
Yes
Yes
No
6f. Zone 1 6g. Zone 2
impact impact
7,678 2,381
(squarefeet) (squarefeet)
3,997 4,028
(squarefeet) (squarefeet)
823 1,234
(squarefeet) (squarefeet)
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
One ebsting ditch will be impacted, located to the south-east of the bridge. The existing ditch has a steep slope
with head-cutting present at the outlet. The proposed ditch reduced the slope and widens the ditch base allowing
a vegetative liner to be retained. This ditch meets the criteria for a grass swale. E�asting drainage patterns are
maintained. 2:1 roadway fill slopes are used to minimize stream impacts and the culvert is buried 1 foot to maintain
natural bed material through completed culvert. Additional impacts are minimized by the use of 3-foot grassed
shoulders (6-foot where guardrail is present). The impacts due to the temporary on-site detour are by the use of a
single lane detour.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
i Due to the projecYs location within the Jordan Lake Watershed, Design Standards in Sensitive Watersheds will be
employed; NCDOT Best Management Practices for Construction and Maintenance Activities and Best
Management Practices for the Protection of Surface Waters will be employed.
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

2c. If yes, mitigation is required by (check all that apply):
r7 DWR �J Corps
2d. If yes, which mitigation option(s) will be used for this project?
r Mitigation bank r7 Payment to in-lieu fee program
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached.
r7 Yes
4b. Stream mitigation requested:
(linear feet)
101 @ 2:1 = 202 linear feet
4c. If using stream mitigation, stream temperature:
warm
4d. Buffer mitigation requested (DWR only):
(squarefeet)
I 35,025 square feet Zone 1, 9,614 square feet Zone 2
4e. Riparian wetland mitigation requested:
(acres)
0
4f. Non-riparian wetland mitigation requested:
(acres)
0
4g. Coastal (tidal) wetland mitigation requested:
(acres)
0
4h. Comments
I Payment to in-lieu fee fund (DMS).
r Permittee Responsible Mitigation
6. Buffer mitigation (State Regulated Riparian Buffer Rules) - required by DWR
6a. Will the project result in an impact within a protected riparian buffer that requires buffer mitigation? If yes, you must fill out this entire
form - please contact DWR for more information.
C� Yes C' No
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 in the table below.
Zone 1
Zone 2
6c. Reason for impact 6d. Total impact Multiplier 6e. Required
(square feet) mitigation (square
feet)
Road Crossing/ Impacts Other Than 11,675 3 35,025
Road Crossings
Road Crossing/ Impacts Other Than 6,409 1.5 9,614
Road Crossings
6f. Total buffer mitigation required
44,639

6g. If buffer mitigation is required, is payment to a mitigation bank or NC Division of Mitigation Services proposed?
r Yes C' No
6h. Attach the acceptance letter from the mitigation bank or NC Division of Mitigation Services.
(FDF only)
6i. If no, then discuss what type of mitigation is proposed.
6j. Comments:
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:
i Please 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
fJ 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?
G Yes C' 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
in Chapter 8 of the NC Stormwater BMP Manual and attach a BMP Supplement Form
What documentation are you providing?
r Level Spreader
� Other BMP
(check all that apply)
Diffused Flow Documentation
Gick the upload button or drag and drop files here to attach docurrent
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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
aick the upload button or drag and drop files here to attach docurrent
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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?*
r 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)?*
�' Yes �' No
1c. If you answered "yes" to the above, has the document review been finalized bythe State Clearing House? (If so, attach a copy of the
NEPAor SEPAfinal approval letter.)*
�' Yes �' No
NEPAor SEPAFinal Approval Letter
Gick the upload button or drag and drop files here to attach docurrent
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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 qualit�i?*
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)
Sa. 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?*
r Yes c' No
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. Is this a DOT project located within Division's 1-8?*
C•' Yes
C' No

5i. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
i NC Natural Heritage Program data, USFWS website, NCDOT/Consultant field surveys; No nesting habitat, nests, or
individuals present for bald eagle; the northern long-eared bat (NLEB) is covered by the Programmatic Biological
Opinion for Divisions 1 through 8.
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)
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 C•' 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
Qick the upload button or drag and drop files here to attach docurrent
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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.
Qick the upload button or drag and drop files here to attach docurrent
B-5347_Cover Letter.doc.pdf 446.3K6
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Signature
*
r% 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
Col� �i�llor
Date
9/7/2017
Initial Review
Is this project a public transportation project?
�' Yes �' No
Only 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*
20171134
Version#*
Reviewing Office *
Central Office - [phone]
Select Project Reviewer*
April Norton:eads\arnorton