20171165 Ver 1_PCN Form Submission_20170911

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 9/11/2017 9:13:08 AM (Start Event)
Accept by Carpenter,Kristi 9/13/2017 1:48:06 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: September 14, 2017 5:00 PM
9/11/2017 9:13 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:*
Cabarrus
Is this a NCDOT Project?*
C� Yes �' No
(NCDOT only) T.I.P. or state project number:
17BP.10.R.144
WBS #
46084.1.1
(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:
13
List all MNnurrbers you are applying for not on the drop down list.
33 - Temporary Construction
1c. Type(s) of approval sought from the DWR:*
check all that apply
� 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:
*
C•' Yes C' No
� For the record only for Corps Permit: C' Yes C� No

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
C' Yes C•' No
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?*
Larry Thompson
1b. Primary Contact Email:*
[e-mail]
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
r Owner � Applicant (other than owner) r AgenUConsultant
(Check all that apply)
2. Owner I nformation
2a. Name(s) on recorded deed:
NC Department of Transportation
2b. Deed book and page no.:
f�UA
2c. Responsible party:
(for Corporations)
Louis Mithchell, PE
2d.Address
Street Address
I 716 W. Main Street
Address Line 2
��
Albemarle
Fbstal / Zip Code
28001
2e. Telephone Number:
(xxx)xxx-xxxx
[phone]
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
3a. Applicant is:
State / FYovince / F�gion
NC
Country
Stanly

C' Agent
C� Other
If other please specify.
3b. Name:
Larry Thompson
3c. Business Name:
(if applicable)
NCDOT
3d.Address
Street Address
716 W. Main Street
Address Line 2
��
Albemarle
Fbstal / Zip Code
28001
3e. Telephone Number:
� [phone]
(xxx)xxx-x�cx
3f. Fax Number:
(xxx)xxx-xxxx
3g. Email Address:*
[e-mail]
State / Rovince / F�gion
NC
Country
USA
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Bridge No. 53 (Centergrove Road over Cold Water Creek)
1b. Subdivision name:
(if appropriate)
wa
1c. Nearest municipality/town:*
Kannapolis
1d. Driving directions*
If it is a new project and can not easily be found in a GPS rrapping system Rease provide directions.
From Mooresville, take NC 3 to Centergrove Road in Kannapolis. Bridge crossing v�cll be approximately 1.43 miles from the intersection of
Centergrove Road and NC 3.
2. Project Identification
2a. Propertyldentification Number:
(tax RN or parcel ID)
2b. Propertysize:
(in acres)
2c. Project Address

Street Address
Centergrove Road over Cold Water Creek
Address Line 2
(�ty State / FYovince / F�gion
Fbstal / Zip Code
2d. Site coordinates in decimal degrees
Country
i 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.)
i Latitude:* Longitude:*
35.481092 -80.579867
ex:34.208504 -77.796371
3. SurFace Waters
3a. Name of the nearest body of water to proposed project:*
Cold Water Creek
3b. Water Resources Classification of nearest receiving water:*
C
Surface Water Lookup
3c. What river basin(s) is your project located in?*
i 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:*
There are residences located on all four corners of the project limits. There is a vegetated buffer along Cold
Water Creek and an agricultural field located in the northwest quadrant of the crossing.
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
B-5369 Topo.pdf 1.46M6
Fle type rrust be pdF
4c. Attach an 8 1/2 X 11 ezcerpt from the most recent version of the published County NRCS Soil Survey map depicting the project site.
(for DWR)
C7ick the upload button or drag and drop files here to attach docurrent
I B-5369 Soil Map.pdf 1.01 MB
Fle type rrust be pdf
4d. List the total estimated acreage of all existing wetlands on the property:
f�UA
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
100 linear feet (perennial)
4f. Explain the purpose of the proposed project:
Replacing e�asting bridge (24 feet wide x 121 feet long) with a new spanning structure (43 feet wide x 135 feet
long).

4g. Describe the overall project in detail, including the type of equipment to be used:
Existing bridge will be removed with saws, trackhoe and crane. Debris will be taken to an approved demolition
landfill for disposal. A temporary causeway measuring 52 linear feet will be required to construct the new structure.
� Temporary causeway will disturb less than half the stream width and will be removed after bridge construction.
Causeway material will be clean rip rap placed on geotextile fabric.
Drill rig, trackhoe, crane and other equipment will be required for new bridge construction. Causeway will be
removed after drilled shafts are completed and disturbed bank will be stabilized with rip rap (approximately 30
linear feet).
4h. Please upload project drawins for the proposed project.
Qick the upload button or drag and drop files here to attach docurrent
i B-5369_Permit_Drawings_20170808.pdf 2.29MB
Fle type rrust be pdf
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
�' Yes �' No �' Unknown
Comments:
NCDOT delineation/stream assessment.
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
C' Preliminary l" Approved r Unknown
Corps AID Number:
Exarrple: SAVu2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other
Larry Thompson
NCDOT
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
B-5369 PJD.pdf 107.5KB
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?*
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 I m pacts I nventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
r Wetlands rJ Streams-tributaries r Buffers
r 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.
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 Road P Bank Cold Water Perennial Corps Average 30
Crossing F�rrrenent(P�or Stabilizatio Creek F2rennial(�)or 25 (linearfeet)
N�p label (e.g. Terrporary (� n interrrittent (IN� (feet)
I�ad Q'ossing 1)
Row 2 Road T Other
Crossing F2rrranent (Pj or
fv�p label (e.g. Terrporary (�
F�ad Qossing 1)
Cold Water Perennial Corps Average 50
Cree k F2rennial (FB� or 25 (linear feet)
interrrittent (If�
(feet)
"" 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:
30
3i. Total temporarystream impacts:
50
3i. Total stream and tributary impacts:
80
3j. Comments:
I Proposed bank stabilization activity will be limited to 30 linear feet where stormwater conveyances tie back into
Cold Water Creek. Temporary causeway will be removed prior to completion of bridge.
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:*
Proposed structure spans Cold Water Creek and opens up more of the flood prone area than the e�sting
structure. Permanent impacts are limited to bank stabilization wtiere the proposed stormwater conveyances are
connecting back to Cold Water Creek.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Existing structure demolition will take place outside of Cold Water Creek. Temporary causeway will prevent
unintentional releases of soil, slurry, etc. from drilled shaft construction and will be removed when drilling operation
is complete. Causeway material will be clean rip rap placed on top of geotextile fabric.
Sediment and erosion control for sensitive watersheds will be implemented and maintained for the life of the
project.
� 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
2b. If this project DOES NOT require Compensatory M itigation, explain why:
Proposed permanent impacts are limited to 30 linear feet for bank stabilization at tv�ro stormwater outfalls. NCDOT considers the proposed
stabilization necessary and one that will prevent stability issues that might arise from concentrated stormwater flow. There is evidence of
past impacts in these areas from utility construction.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1a. Does this project require a Stormwater Management Plan?
C� Yes
�' No
1b. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
State project B-5369 involves the replacement of the existing NCDOT Bridge #120053 on SR 2114 over Cold
Water Creek. Bridge #120053 consists of 1@30'-3", 2@30'-0", 1@30'-3" steel plank deck on I-beams on steel
caps and timber piles. Piped stormwater outfalls are proposed which will outlet a distance from the stream in order
to minimize disturbance to the stream. Rip Rap pads will be utilized to dissipate the energy. No deck drains are
required for the proposed bridge. Rip rap lined roadside ditches are proposed in order to aid in stabilization and to
regulate velocity. Replacement bridge will be a 45" PSCG 1@80', 1@55' structure with no bents in the stream.
1c. What is the overall percent imperviousness of this project?
50
%
1d. Who will be responsible for the review of the Stormwater Management Plan?*
r Certified Local Government
r DWR 401 & Buffer Permitting Branch
2. Diffuse Flow Plan
r DEMLR Stormwater Review
�J 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
�' No
If no, explain why:
Project does not occur within an area regulated by the NC Riparian Buffer Protection Rules.
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
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 C' No
1b. If you answered "yes" to the above, does the project require preparation of an environmental document pursuant to the
I requirements of the National or State (North Carolina) Environmental PolicyAct (NEPA/SEPA)?*
f Yes C•' No
Comments:*
i Project is state funded and a Minimum Criteria Determination Checklist has been prepared as part of our due
diligence process.
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 C•' No
3b. If you answered "no," provide a short narrative description.
This bridge replacement project is not anticipated to have any additional future impacts.
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.
i f�UA
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.
Asheville
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 anysigns of bat use?*
C' Yes �' No C' Unknown
If yes, please show the location of the bridge on the permit drawings/project plans.
Gick the upload button or drag and drop files here to attach docurrent
Fle rrust be FDF
5g. Does this project involve the construction/installation of a wind turbine(s)?**
C' Yes �' No
If yes, please show the location of the wind turbine(s) on the permit drawings/project plans.
Gick the upload button or drag and drop files here to attach docurrent
Fle rrust be FDF
5h. 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 �' 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.
Gick the upload button or drag and drop files here to attach docurrent
Fle rrust be FDF
5i. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
NC Natural Fleritage Program GIS data
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
f Yes C•' No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
NC Natural Heritage Program GIS data
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? *
i NCDOT GIS data layer and the State Historic Preservation Office Historic Properties Map.
7c. Historic or Prehistoric Information Upload
Qick the upload button a' drag and drop files here to attach docurrent
Fle rrust be FDF
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:
8c. What source(s) did you use to make the floodplain determination?*
FEMA Floodplain Maps (AE Zone)
Miscellaneous attachments not previously requested.
qick the upload button or drag and drop files here to attach docurrent
B-5369 Bat Habitat Assessment.pdf 50.06KB
B-5369 FEMA Map.pdf 341.87KB
B-5369 Pictures.pdf 2.06M6
B-5369 Stream Assessment.pdf 130.16KB
Fle rrust be F�F
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:*
Larry Thompson
Signature
r� �'��/ -'���'f9r�d�r!
Date
9/11 /2017
Initial Review
� Is this project a public transportation project?
G Yes C' No
IOnly 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*
20171165
Version#*
Reviewing Office *
Mooresville Regional Office - [phone]
Select Project Reviewer*
i Donna Hood:eads\drhood