20171190 Ver 1_PCN Form Submission_20170919

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 9/19/2017 3:16:44 PM (Start Event)
Accept by Carpenter,Kristi 9/19/2017 4:11:44 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: September 22, 2017 5:00 PM
9/19/2017 3:17 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:*
Lenoir
Is this a NCDOT Project?*
C� Yes �' No
(NCDOT only) T.I.P. or state project number:
17BP.2. R.72
WBS #
SF-530072
(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 �' No
B. Applicant Information
1a. Who is the Primary Contact?*
Hon Yeung
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:
I North Carolina Department of Transportation
i 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:
C' Agent
�' Other �roject Engineer
IF other please specify.
State / FYovince / F�gion
NC
Country
USA

3b. Name:
Hon Yeung
3c. Business Name:
(if applicable)
3d.Address
Street Address
P.O. Box 1587
Address Line 2
�Y
Greenville
F�stal / Zip Code
27835
3e. Telephone Number:
[phone]
(xxx)xxx-xxxx
3f. Fax Number:
[phone]
(xxx)xxx-x�cx
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:*
Lenoir 72
1b. Subdivision name:
(if appropriate)
wa
1c. Nearest municipality/town:*
La Grange
1d. Driving directions*
If it is a new project and can not easily be found in a G� rrapping system Rease provide directions.
Take NC 903 La Grange exit off US 70. Proceed north on NC 903 approximately 4 miles to SR 1501 Old Jason Road. Turn left and proceed
in a westerly direction for approximately 1.1 miles to SR 1502 Frink School Rd. Turn right and proceed in a northerly direction approximately
1.3 miles to the project bridge in Lenoir County,
2. Project Identification
2a. Propertyldentification Number:
(tax RN or parcel ID)
Lenoir 72 Bridge to Bridge Replacement
2b. Propertysize:
(in acres)
wa
2c. Project Address

Street Address
Address Line 2
��
Fbstal / Zip Code
2d. Site coordinates in decimal degrees
State / R-ovince / 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�mple, 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:�
35.363642 -77.817 856
ex:34208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
I BearCreek
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 1502 Frink School Rd is a paved secondary road. Woodlands and agriculture dominate the landscape.
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)
C7ick the upload button or drag and drop files here to attach docurrent
Lenoir 72 Quad.pdf 3.13MB
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
20160617_07495707163_22_Soil_Map.pdf 584.71 KB
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:
I The ewsting 55' long bridge will replaced with a two span 21" cored slab bridge: 1@ 50' and 1@ 25'.

4h. Please upload project drawins for the proposed project.
C7ick the upload button or drag and drop files here to attach docurrent
SF530072_Permit Drawings_Buffer_2017_O8_24.pdf 1.47M6
SF530072_Permit Drawings_Surface Water_2017_08_18.pdf 1.41 MB
I Fle lype rrust be pdF
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
C�' Yes C' No [" Unknown
Comments:
No wetlands on site
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
C' Preliminary C' Approved C•' Unknown
Corps AID Number:
6carrple: SAVw2017-99999
Sc. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:
N/A
Sd. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
I 5d1. Jurisdictional determination upload
Gick the upload button or drag and drop files here to attach docurrent
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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 r No !' 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.
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 �J Streams-tributaries rJ 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.
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 1 T Other Bear Creek Perennial Both Average 31
N�p label (e.g. F2rrranent (F) or F2rennial (FB� or � g (linear feet)
Fd�ad Q-ossing 1) Terrporary (� interrrittent (IN� (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:
0
3i. Total temporarystream impacts:
31
3i. Total stream and tributary impacts:
31
3j. Comments:
Temporary impacts are for removal of bents in stream. 123sf of temporary impacts.
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.
rJ Neuse
r Catawba
r Goose Creek
r Other
6b. Impact Type
r Tar-Pamlico
r Randleman
r Jordan Lake
6c. Per or 6d. Stream name
Te mp
6e. Buffer
mitigation
required?
6f. Zone 1 6g. Zone 2
impact impact
1 P Bear Creek No 1,025 585
Location and 5cerrpt, Allowable, allowable w/ rritigation F2rrranent (Fj or (square feet) (square feet)
Terrporary (�

6b. Impact Type
6c. Per or 6d. Stream name
Te mp
2 P Bear Creek
Location and 6cerrpt, Allowable, allowable w/ rritigation F�rrranent (F) or
Terrporary (�
3 P Bear Creek
I Location and 6cerrpt, Allowable, allowable w/ rritigation F�rrranent (F) or
Terrporary (�
4 P Bear Creek
Location and C errpt, Allowable, allowable w/ rritigation F2rrranent (F) or
Terrporary (�
6h. Total buffer impacts:
Temporary impacts
Permanent impacts:
Total buffer impacts
6i. Comments:
Zone 1
0.00
Zone 1
5,647.00
Zone 1
5,647.00
Zone 2
0.00
Zone 2
3,573.00
Zone 2
3,573.00
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
Gick 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 1,330 815
(squarefeet) (squarefeet)
i.n
No
1,961 1,369
(squarefeet) (squarefeet)
1,331 804
(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 partially in the stream. The proposed bridge has one bent in the stream bank.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Use of existing 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
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1a. Does this project require a Stormwater Management Plan?
C� Yes l" No
1b. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:

The total project length is 650 feet along the existing SR1502 roadway alignment. The project is located within a
16.2 square mile Bear Creek drainage area which has a classification of C;Sw,NSW. The projecYs drainage
system consists of four (4) proposed catch basins that direct runoff to the creek through a pipe network to an
outfall. A rip rap pad is proposed at the pipe outlet to provide diffuse flow before runoff enters Buffer Zone 2. The
outfall and rip rap pad are located on the upstream side of the bridge and outside of the buffer zones.
1c. What is the overall percent imperviousness of this project?
%
1d. Who will be responsible for the review of the Stormwater Management Plan?*
� 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?
�' 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
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
C7ick 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 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?*
�' 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
Comments:*
N/A
�' No
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.
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 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?*
�' Yes
C' No
5i. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
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 C•' 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 history and archaeology)? *
C' Yes C 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
Gick the upload button or drag and drop files here to attach docurrent
16-07-0007ArchLenoir72 (NSR).pdf 7.15M6
16-07-0007HA Lenoir72 NSR.pdf 1.94M6
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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 �' 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.
C7ick the upload button or drag and drop files here to attach docurrent
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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:*
Hon Yeung
� Signature
�fi A�/ � ��i�'�r�'�
� Date
9/19/2017
i Initial Review
Is this project a public transportation project?
C� Yes C' 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
i BIMS#Assigned*
20171190
Version#*
Reviewing Office *
Washington Regional Office - [phone]
Select Project Reviewer*
Garcy Ward:eads\gpward