20171353 Ver 1_PCN Form Submission_20171023

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 10/23/2017 10:06:15 AM (Start Event)
Accept by Carpenter,Kristi 10/24/2017 11:49:13 AM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: October 26, 2017 5:00 PM
10/23/2017 10:06 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:*
Lenoir
Is this a NCDOT Project?*
C� Yes �' No
(NCDOT only) T.I.P. or state project number:
SF-530055
WBS #
176P.2.R.78
(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?*
William Sullivan
1b. PrimaryContact Email:*
[e-mail]
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
r% Owner r Applicant (other than owner) rJ AgenUConsultant
(Check all that apply)
2. Owner I nformation
2a. Name(s) on recorded deed:
�llA (Linear Transportation Project)
2b. Deed book and page no.:
f�UA
2c. Responsible party:
(for Corporations)
Heather Lane, PE
2d.Address
Street Address
NC Department of Transportation, Division 2
Address Line 2
PO Box1587
aty
Greenville
Fbstal / Zip Code
27835
� 2e. Telephone Number:
(xxx)xxx-x�cx
[phone]
2f. Fax Number:
(xxx)x�c-�ocx
2g. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
William Sullivan
4b. Business Name:
State / R-ovince / F�gion
NC
Country
USA

(if applicable)
Kimley-Horn
4c. Address
Street Address
421 Fayettevile Street
Address Line 2
Suite 600
a�
Raleigh
Fbstal / Zip Code
27609
4d. Telephone Number:
[phone]
(xxx)xxx-xxxx
4e. Fax Number:
(xxx)xxx-xxxx
4f. Email Address:*
[e-mail]
AgentAuthorization Letter
Rease provide the Agent Authorization Letter if you are subrritting this docurrent.
Fwd Lenoir 55 PCN.pdf
FlLE TYFE MJST BE FiJF
State / R-ovince / F�gion
NC
Country
USA
188.15KB
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Bridge No. 55 over Whitelace Creek on SR 1324 (Kennedy Home Road)
1b. Subdivision name:
(if appropriate)
n/a
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.
See Figure 1: Vicinity Map
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)
wa
2b. Propertysize:
(in acres)
4.7
2c. Project Address

Street Address
2301 Kennedy Home Road
Address Line 2
Qty
La Grange
Fbstal / Zip Code
28551
2d. Site coordinates in decimal degrees
State / R-ovince / I�gion
NC
Country
USA
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:*
35.243086
ex:34.208504
3. Surface Waters
Longitude:*
-77.707727
-77.796371
3a. Name of the nearest body of water to proposed project:*
Neuse River
3b. Water Resources Classification of nearest receiving water:*
C; 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:*
The site is comprised of an existing bridge, one residential yard, two agricultural farms, a timber tract, and a length
of Whitelace Creek that appears to have been historically straightened for agricultural purposes. The land in the
project vicinity is comprised primarily of agricultural fields interspersed with residences.
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)
qick the upload button or drag and drop files here to attach docurrent
Fig2_USGS.pdf 773.27KB
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)
Qick the upload button or drag and drop files here to attach docurrent
Fig4_NRCS.pdf 1.13M6
Fle type rrust be pdf
4d. List the total estimated acreage of all existing wetlands on the property:
0 acres
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
204 linear feet

4f. Explain the purpose of the proposed project:
The purpose of the proposed project is to replace a bridge on Kennedy Home Road over Whitelace Creek.
4g. Describe the overall project in detail, including the type of equipment to be used:
The e�sting bridge overall length (31') and width (25.33') will be replaced with a bridge having an overall length of
50' and a width of 33'. The new bridge is wider than the existing bridge to provide the required shoulders and lane
width necessary for roadway and drainage. Equipment typical of bridge projects, including excavators, pavers, and
skid-steers will be used during construction.
4h. Please upload project drawins for the proposed project.
aick the upload button or drag and drop files here to attach docurrent
B-55_PlanSet_011036379.pdf 4.23M6
Fle type rrust be pdf
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
C�' Yes C' No �' Unknown
Comments:
Kimley-Horn staff conducted a wetland and stream delineation on the
property on March 6, 2017.
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
C' Preliminary C' Approved C•' Unknown
Corps AID Number:
6carrple: SAV�2017-99999
n/a
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:
Beth Reed and William Sullivan
Kimley-Horn
n/a
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
A field review with Tom Steffens of the USACE and Garcy Ward of NCDWR was conducted on August 22, 2017. A Preliminary Jurisdictional
Determination request based on the field review has been included as part of this permit submittal.
Sd1. Jurisdictional determination upload
qick the upload button or drag and drop files here to attach docurrent
05b_Bridge55_Preliminary_JD_Request.pdf 2.8MB
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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.

n/a
D. Proposed I m pacts I nventory
1. Impacts Summary
I 1a. Where are the impacts associated with your project? (check all that apply):
r Wetlands fJ 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 Site 1 P Rip Rap Fill Whitelace Perennial Both Average 11
N�p label (e.g. F�rrranent (F'� or Cree k F�rennial (Fff� or � 5 (linear feet)
RDad C7ossing 1) Terrporary (� interrrittent (IfV� f
Row 2 Site 1 T Other Whitelace Perennial Both
N�p label (e.g. F�rrranent (P� or Creek F�rennial (� or
13�ad Q�ossing 1) Terrporary (� interrrittent (IfVn
"" 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:
11
3i. Total temporarystream impacts:
70
3i. Total stream and tributary impacts:
81
( eet)
Average 70
15 (linear feet)
(feet)
3j. Comments:
Permanent impacts to Whitelace Creek will occur from the placement of rip rap within the channel to stabilize the
outfall of a vegetated swale in the northwestern quadrant of the project area. Temporary impacts to Whitelace
Creek will result from temporary construction access required to demolish the old and install the new bridge.
Temporary impacts will be returned to pre-existing conditions upon completion of the proposed project.
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.
� Neuse
� Catawba
� Goose Creek
r Other
6b. Impact Type
r Tar-Pamlico
r Randleman
r Jordan Lake
6c. Per or 6d. Stream name
Te mp
Road crossing; Allowable P Whitelace Creek
I Location and C errpt, Allowable, allowable w/ rritigation F2rrranent (P� or
Terrporary (�
Construction Access; Exempt T Whitelace Creek
Location and Exerrpt, Allowable, allowable w/ rritigffiion F2rrranent (F) or
Terrporary (�
6h. Total buffer impacts:
Temporary impacts
Permanent impacts:
Total buffer impacts
Zone 1
1,635.00
Zone 1
1,642.00
Zone 1
3,277.00
Zone 2
1,156.00
Zone 2
1,212.00
Zone 2
2,368.00
6e. Buffer
mitigation
required?
No
No
6f. Zone 1 6g. Zone 2
impact impact
1,642 1,212
(squarefeet) (squarefeet)
1,635 1,756
(squarefeet) (squarefeet)
6i. Comments:
Permanent buffer impacts will result from the perpendicular road crossing, which is considered Allowable under the
Neuse River Basin Buffer Table of Uses. Temporary impacts will result from temporary construction access. All
temporary impacts will be restored to pre-existing conditions upon completion of the project.
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
aick the upload button or drag and drop files here to attach docurrent
07b_B-55_Permit_Drawings_011036379.pdf 2.14M6
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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:*
Impacts to streams and regulated buffers were avoided and minimized to the extent possible during the designing
of the proposed project. The new bridge has been aligned to the extent feasible on the footprint of the existing
bridge, allowing the new structure to share roadway facilities and reduce unnecessary impacts. Limits of
disturbance and grading within the buffers have been minimized to the extent practical. Due to the protected
riparian buffers in the project area, Design Standards for Nutrient Sensitive Watersheds were implemented.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*

Impacts to streams and buffers within the project area will be minimized and avoided throughout the construction
process. Where feasible, staging will occur on existing roadway or upland areas to avoid impacts to the buffer and
stream. Silt fencing will be installed around the limits of disturbance to reduce downstream sedimentation and to
confine construction activities to the permitted boundary. In addition, standard Best Management Practices (BMPs)
and Design Standards for Nutrient Sensitive Watersheds will be followed throughout the construction process.
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:
Due to the minimal impacts to jurisdictional waters and the pre-e�asting condition of the stream, no compensatory mitigation has been
proposed. Additionally, per the Neuse River Basin Buffer Table of Uses, mitigation is not required for perpendicular roadway crossings
impacting less than 1/3 acre of buffer.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1a. Does this project require a Stormwater Management Plan?
G Yes C' No
1b. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
The bridge replacement on SR 1324 (Kennedy Home Road) conveys Whitelace Creek from West to East and
ultimately drains into the Neuse River. The new bridge is wider than the epsting bridge to provide the required
shoulders and lane width necessary for roadway and drainage. The proposed bridge and roadway improvements
minimized the ebsting overtopping condition and will now convey the 100 yr storm event through the provided
bridge opening. No new roadside ditches were introduced as part of this project. The existing vegetated ditch will
treat the minimal increase in impervious area from the bridge widening. The proposed bridge replacement project
was not shown to cause an increase in the design year or base flood year levels along the study reach of
Whitelace Creek.
1c. What is the overall percent imperviousness of this project?
71
%
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?
�' 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
fJ Other BMP
(check all that apply)
Diffused Flow Documentation
C7ick the upload button or drag and drop files here to attach docurrent
B-55_PlanSet_011036379.pdf
Fle type rrust be f�F
5. DWR 401 Stormwater Review
4.23M6

5a. Is the Stormwater Management Plan (including BMP Supplemental Forms and Operation and Maintenance Agreements) attached?
C' Yes C' No
Stormwater Management Plan Upload
Qick the upload button or drag and drop files here to attach docurrent
02b_B-55_(SF530055)_HYD_SMPv2.pdf 37.55K6
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
Comme nts: *
The proposed project falls below the NEPA/SEPA minimum criteria.
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 C•' 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 r No
3b. If you answered "no," provide a short narrative description.
The proposed project intends to replace an existing bridge over Whitelace Creek on Kennedy Home Road. No
additional development is anticipated as a result of the proposed project.
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 No wastewater or sewage will be generated from the proposed project.
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? *
�' Yes l" 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?*
C•' Yes
C' No
5i. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
The NCNHP database records, updated July 2017, indicate no known occurrences of any federally protected
species within 1.0 mile of the study area (accessed August 28, 2017). Due to the lack of known occurrences and
the minimal impact resulting from this project, it is anticipated that the proposed project will not affect any federally
protected species.
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?*
The NOAA EFH Mapper was accessed August 29, 2017, and no EFH was found to occur within the project area.
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)?*
�' Yes �' No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources? *
See attached NCSHPO Coordination letters.
7c. Historic or Prehistoric Information Upload
Gick the upload button or drag and drop files here to attach docurrent
06b_Lenoir 55 No Survey Required.pdf
06c_16-09-0030NoSurveyReq. pdf
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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
421.55KB
3.22M6
8b. If yes, explain how project meets FEMA requirements:
Whitelace Creek is not a FEMA-regulated stream; therefore, no FEMA coordination is required for the proposed
project. The project area is within the 100-year floodplain of the Neuse River.
8c. What source(s) did you use to make the floodplain determination?*
The Flood Insurance Rate Map (FIRM) panel 3720358400J, dated April 16, 2013, was accessed August 28, 2017.
Miscellaneous attachments not previously requested.
Qick the upload button or drag and drop files here to attach docurrent
F ig 1_Vicin ity. pdf 279.74KB
Fig3_Aerial.pdf 1.39M6
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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.
I Full Name:*
William Sullivan
Signature
���'1.���r.. �S�r(l��r�
Date
10/23/2017
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
BIMS # Assigned*
20171353
Version#*
1
Reviewing Office *
Washington Regional Office - [phone]
Select Project Reviewer*
� Garcy Ward:eads\gpward