20171386 Ver 1_PCN Form Submission_20171031

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 10/31/2017 10:55:09 AM (Start Event)
Accept by Carpenter,Kristi 10/31/2017 11:36:37 AM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: November 3, 2017 5:00 PM
10/31 /2017 10:55 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:
WBS #
176P.2.R.80
(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
r 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?*
� NCDOT (attn: Heather Lane)
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) rJ AgenUConsultant
(Check all that apply)
2. Owner I nformation
2a. Name(s) on recorded deed:
NCDOT
2b. Deed book and page no.:
2c. Responsible party:
(for Corporations)
2d.Address
Street Address
105 Pactolus Highway NC 33
Address Line 2
��
Greenville
Fbstal / Zip Code
27835
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:
�' Agent
r Other ,OT
If other please specify.
3b. Name:
State / Rovince / F�gion
NC
Country
USA

NCDOT (attn: Heather Lane)
3c. Business Name:
(if applicable)
3d.Address
Street Address
105 Pactolus Highway NC 33
Address Line 2
��
Greenville
Fbstal / Zip Code
27835
3e. Telephone Number:
[phone]
(xxx)xxx-�ocx
3f. Fax Number:
(xxx)xxx-xxxx
3g. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
I Robert Turnbull
4b. Business Name:
(if applicable)
Environmental Services, Inc.
4c. Address
Street Address
4901 Trademark Drive
Address Line 2
�Y
Raleigh
Fbstal / Zip Code
27610
4d. Telephone Number:
[phone]
(xxx)xxx-xxxx
4e. Fax Number:
[phone]
(xxx)xxx-xxxx
4f. Email Address:*
[e-mail]
Agent Authorization Letter
Rease provide the Agent Authorization Letter iF you are subrritting this docurrent.
AA letter not required.pdf
FlLE TYFE MJST BE FflF
State / Rovince / F�gion
NC
Country
USA
State / R-ovince / F�gion
NC
Country
USA
31.25K6
C. Project Information and Prior Project History

1. Project Information
1a. Name of project:*
Lenoir Bridge 143
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Kinston
1d. Driving directions*
I If it is a new project and can not easily be found in a GPS rrapping system Rease provide directions.
Vine Swamp Road (SR 1922) over Joshua Creek, south of Kinston.
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)
wa
2b. Propertysize:
(in acres)
approx. 1.0 acre
2c. Project Address
Street Address
Vine Swamp Road (SR 1922)
Address Line 2
��
Kinston
Fbstal / Zip Code
28504
State / R-ovince / I�gion
NC
Country
USA
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
i map coordinates to 5 or 6 digits after the decimal place.)
Latitude:*
35.12596
ex:34208504
3. Surface Waters
Longitude:*
-77.58346
-77.796371
3a. Name of the nearest body of water to proposed project:*
Joshua 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:*
The project study area and vicinity consist of rural residential and agricultural areas, silvicultural areas, and
undeveloped forested communities. The proposed project and associated impacts are within and immediately
adjacent to ewsting NCDOT right-of-way.
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)
Gick the upload button or drag and drop files here to attach docurrent
17BP.2.R.80_USGS topo.pdf 382.73KB
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)
C7ick the upload button or drag and drop files here to attach docurrent
17BP.2.R.80_soils.pdf 559.73KB
Fle type rrust be pdF
4d. List the total estimated acreage of all existing wetlands on the property:
<0.25 acre
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
200 feet (perennial stream)
4f. Explain the purpose of the proposed project:
I Replace existing Bridge 143 on SR 1922 (Vine Swamp Road) over Joshua Creek. The sufficiency rating of the
ebsting bridge is 36.80.
i 4g. Describe the overall project in detail, including the type of equipment to be used:
The proposed project will replace the bridge on Vine Swamp Road (SR 1922) over Joshua Creek in Lenoir County.
The project will replace the ewsting reinforced concrete floor on timber joists, caps, and piles with a cored slab
bridge. The project work will consist of grading, widening, drainage improvements, bridge replacement, and
paving, and pavement markings. An off-site detour is proposed during construction.
4h. Please upload project drawins for the proposed project.
C7ick the upload button or drag and drop files here to attach docurrent
17BP.2.R.80_permit drawings.pdf
Fle type rrust be pdf
5. Jurisdictional Determinations
1.53MB
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
C•' Yes �' No �' Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
C� Preliminary C' Approved C' Unknown
Corps AID Number:
Exarrple: SAV�2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Robert Turnbull

Sc. If 5a is yes, who delineated the jurisdictional areas?
Agency/Consultant Company:
Other
Environmental Services, Inc.
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
I Documentation not available.
5d1. Jurisdictional determination upload
aick the upload button or drag and drop files here to attach docurrent
Fle type rrust be F�F
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 C' 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 Impacts Inventory
1. Impacts Summary
� 1a. Where are the impacts associated with your project? (check all that apply):
� Wetlands r Streams-tributaries r7 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.
`� All Perennial or Intermittent streams must be verified by DWR or delegated local government.
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 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
B1 -Allowable P JoshuaCreek
Location and 6cerrpt, Allowable, allowable w/ rritigation F�rrranent (P� or
Terrporary (�
62 - Allowable P Joshua Creek
Location and C errpt, Allowable, allowable w/ rritigation F2rrranent (F) or
Terrporary (�
B3 - Allowable P Joshua Creek
Location and 6cerrpt, Allowable, allowable w/ rritigation F2rrranent (F) or
Terrporary (�
B4 - Allowable P Joshua Creek
Location and 6cerrpt, Allowable, allowable w/ rritigation F�rrrenent (F'j or
Terrporary (�
6h. Total buffer impacts:
Temporary impacts
Permanent impacts:
Total buffer impacts
6i. Comments:
Zone 1
0.00
Zone 1
3,172.00
Zone 1
3,172.00
Zone 2
0.00
Zone 2
1,894.00
Zone 2
1,894.00
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
aick the upload button or drag and drop files here to attach docurrent
17BP.2.R.80_permit drawings.pdf
Fle rrust be FDF
I E. Impact Justification and Mitigation
6e. Buffer 6f. Zone 1 6g. Zone 2
mitigation impact impact
required?
No 1,066 603
(squarefeet) (squarefeet)
No 535 181
(squarefeet) (squarefeet)
No 1,186 872
(squarefeet) (squarefeet)
No 385 238
(squarefeet) (squarefeet)
1.53M6
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
The proposed bridge replacement will occur as much as practicable within the footprint of the ebsting bridge. No
wetland or stream impacts are proposed for this project. Riparian buffer impacts have been minimized as much as
practicable.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*

All in-stream work will be surrounded by a turbidity curtain as shown on the permit drawings. All necessary
sediment and erosion control BMPs will be installed and maintained through construction. Disturbed ground will be
restored and stabilized with permanent vegetative cover. NCDOT Best Management Practices will be implemented
throughout construction.
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 M itigation, explain why:
No impacts to wetlands or streams are proposed. Buffer impacts are allowable and do not require mitigation.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1a. Does this project require a Stormwater Management Plan?
C� Yes
C' No
1b. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
The proposed bridge does not contain deck drains. Stormwater from the bridge and approach slabs will be
collected by a storm drainage system and discharged into a rip-rap pad at -L-23+86 RT, outside of the buffers.
Stormwater will discharge into the ebsting drainage ditch in the northeast quadrant, where it will follow existing
drainage patterns. The roadside ditches in the northwest and southwest quadrants will be impacted. The
redesigned ditches will tie into Joshua Creek to match the e�asting drainage patterns, with 3:1 front and back
slopes. Rip rap at embankment is proposed on the southv�st ditch to prevent headcutting while minimizing depth.
The northwest ditch ties to the towof bank, again to match e�asting drainage patterns. The roadside ditches in the
northeast and southeast quadrants will not be impacted, so the ewsting drainage patterns will be retained.
1c. What is the overall percent imperviousness of this project?
35
%
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?
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 howdiffuse flowwill 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
rJ Other BMP
(check all that apply)
Diffused Flow Documentation
Gick the upload button or drag and drop files here to attach docurrent
176P.2.R.80_SMP.pdf
Fle type rrust be FDF
5. DWR 401 Stormwater Review
424.42KB
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
17BP.2.R.80_SMP.pdf 424.42KB
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
requirements of the National or State (North Carolina) Environmental PolicyAct (NEPA/SEPA)?*
C' Yes �' No
Comments:*
State Minimum Criteria Checklist has been prepared.
� 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.
The proposed project will result in minimum new impervious surface and will not result in any downstream impacts
or growth-stimulating effects. The existing use of Joshua Creek (C) should not change as a result of this 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 will be produced as a result of this 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?*
C' Yes C•' No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
C' Yes �' 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
Si. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
North Carolina Heritage Program Data and on-site evaluation by ESI Staff.
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?*
http:Nntiw.habitat.noaa.gov/protection/efhmapper/
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? *
Archaeology and historic architecture reviews were conducted by NCDOT. Documentation for those reviews is
attached.
7c. Historic or Prehistoric Information Upload
aick the upload button or drag and drop files here to attach docurrent
16-09-0035NoSurveyReq.pdf 3.74M6
Lenoir 143 No Survey Required.pdf 444.78KB
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:
Joshua Creek meets MOA Type 1 criteria; max decrease of 0.1'.
8c. What source(s) did you use to make the floodplain determination?*
wv�w.ncfloodmaps.com
Miscellaneous attachments not previously requested.
Gick the upload button or drag and drop files here to attach docurrent
Fle rrust be FDF
Signature
*
fJ 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:*
Robert Turnbull
Signature
.��t.t ��to���/l
Date
10/31 /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*
20171386
Version#*
1
Reviewing Office*
Washington Regional Office - [phone]
Select Project Reviewer*
Garcy Ward:eads\gpward