20171408 Ver 1_PCN Form Submission_20171103

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 11/3/2017 11:38:08 AM (Start Event)
Accept by Carpenter,Kristi 11/3/2017 12:01:34 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: November 8, 2017 5:00 PM
11 /3/2017 11:38 AM

�� �
6fvlslaa of Water Resources
Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
November 25, 2017 Ver 2.1
*
Please note: fields marked with a red asterisk below are required. You will not be able to submit the form until all mandatory questions are ans�red.
Below is a link to the online help file.
http://edocs.deq.nc.gov/WaterResources/0/doc/603610/Page1.aspx
A. Processing Information
County(or Counties) where the project is located:*
Franklin
Is this project a public transportation project? *(?)
C� Yes C' No
Is this a NCDOT Project?*
G Yes C' No
(NCDOT only) T.I.P. or state project number:
B-4750
WBS #
38522.1.2
(for NCDOT use only)
1a. Type(s) of approval sought from the Corps:*
�7 Section 404 Permit (wetlands, streams and waters, Clean Water Act)
� Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What type(s) of permit(s) do you wish to seek authorization?*
rJ Nationwide Permit (NWP)
r Regional General Permit (RGP)
Nationwide Permit (NWP) Number
� NWP Number Other:
List all MNnurrbers you are applying for not on the drop down list.
14 - Linear transportation
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
�J Riparian Buffer Authorization

1d. Is this notification solelyfor the record because
written approval is not required?
For the record only for DWR 401 Certification
For the record only for Corps Permit:
*
C' Yes C•' No
C' Yes r 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
Acceptance Letter Attachment
qick the upload button or drag and drop files here to attach docurrent
B-4750 signed and scanned DMS acceptance letter.pdf
FlLE TYFE MJST BE FDF
1f. Is the project located in any of NC's twenty coastal counties?*
C' Yes C•' No
1h. Is the project located in a designated trout watershed?*
G No
C' Yes
rL�T1:/:
Link to trout information: http://w�nn�v.saw.usace.army.mil/Missions/Regulatory-Permit-PrograrrUAgency-Coordination/Trout.aspx
6. Applicant Information
1a. Who is the Primary Contact?*
Chris Murray
1b. PrimaryContact Email:*
[e-mail]
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
I7 Owner r Applicant (other than owner) r AgenUConsultant
(Check all that apply)
� 2. Owner I nformation
2a. Name(s) on recorded deed:
i NCDOT
2b. Deed book and page no.:
I Not available
2c. Responsible party:
(for Corporations)
2d.Address
Street Address
2612 N. Duke Street
Address Line 2
a�y
Durham
Fbstal / Zip Code
27704
State / R'ovince / F�gion
NC
Country
USA

2e. Telephone Number:
(xxx)xxx-xxxx
[phone]
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Replacement of Bridge 340090 over Norris Creek on SR 1719 (Brannon
� Road)
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Zebulon NC
1d. Driving directions*
IIf it is a new project and can not easily be found in a C�S rrapping system Rease provide directions.
Travel west on US 64/US 264. E�t at NC 59 and travel north. Turn left on Johnson Town Road, Turn right on Brannon Road and travel to
project site.
2. Project Identification
2a. Property Identification Number:
(t�vc RN or parcel ID)
Parcels 006860, 030439, 023985, 001724 and 002219.
2b. Propertysize:
(in acres)
1.7
2c. Project Address
Street Address
near291 Brannon Road
Address Line 2
��
Zebulon
Fbstal / Zip Code
27597
2d. Site coordinates in decimal degrees
State / R-ovince / F�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 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.)

Latitude:* Longitude:*
i 35.92506 -78.27497
ex:34208504 -77.796371
3. SurFace Waters
3a. Name of the nearest body of water to proposed project:*
Norris Creek
3b. Water Resources Classification of nearest receiving water:*
28-30-3
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Tar-Pamlico
River Basin 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:*
E�sting conditions are comprised of wooded land and some limited private residence with maintained yard.
4b. Attach an 8 7/2 X 17 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
B-4750 topo map.pdf 390.27KB
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)
aick the upload button or drag and drop files here to attach docurrent
I B-4750 soil survey map.pdf 205.15KB
Fle type rrust be pdf
4d. List the total estimated acreage of all existing wetlands on the property:
0.23 in project limits
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
i 119 linear feet perennial (Norris Creek) and 150 linear feet intermittent (UT
to Norris Creek)
4f. Explain the purpose of the proposed project:
Replacement of substandard bridge and slight realignment of roadway and bridge to south to provide for safer
travel.
4g. Describe the overall project in detail, including the type of equipment to be used:
Replacement of bridge and slight realignment of roadway and bridge to south to provide for safer travel.
I Equipment includes bull dozer, crane, excavator, back hoe, etc.
4h. Please upload project drawings for the proposed project.
qick the upload button or drag and drop files here to attach docurrent
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5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
�' Yes C' No [' Unknown

Comments:
I Delineated by Heather Smith of Ecological Engineering on 2/1/16
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
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:
Heather Smith
Ecological Engineering
�' WA
Sd. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
USACE conducted site visit on 4/21/16. Pre-JD package sent via email on 2/11/16.
5d1. Jurisdictional determination upload
Qick 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 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 activit�/? 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):
rJ Wetlands I7 Streams-tributaries N7 Buffers
� 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.
2a. Site #- Reason for 2b. Impact type * 2c. Type of wetland *
impact *
Site 1 P Floodplain Pool
fv�p label (e.g. I�ad Qossing 1) F2rrrenent (F'� or Terrporary
��
2d. Wetland name * 2e•
Forested *
Fill and Mech. Yes
Clear.
2f. 2g. Impact
Jurisdiction area*
type �r
Both 0.050
(404, 10) or C7�VR (acres)
(401, other)

2a. Site # - Reason for
impact *
Site 2
N�p label (e.g. Fd�ad Qossing 1)
Site 3
N�p label (e.g. I�ad Qossing 1)
Site 4
N�p label (e.g. f�ad Qossing 1)
2b. Impact type * 2c. Type of wetland *
P Floodplain Pool
F2rrranent (Pj or Terrporary
��
P Isolated Wetlands
F2rrrenent (P� or Terrporary
��
P Headwater Forest
F2rrranent (P� or Terrporary
i�
2g. Total Temporary Wetland Impact
0.000
2g. Total Permanent Wetland Impact
0.240
2g. Total Wetland Impact
0.240
2h. Comments:
Wetland at Site 3 is considered Isolated per information from USACE.
2d. Wetland name * 2e. 2f. 2g. Impact
Forested* Jurisdiction area*
type *
Fill and Mech. Yes Both 0.070
Clear. (404, 10) or � (acres)
(401, other)
Fill and Mech. Yes DWR 0.060
Clear'. (404, 10) or GNR (acres)
(401, other)
Fill and Mech. No Both 0.060
Clear. (404, 10) or D�R (acres)
(401, other)
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 #- Reason 3b.lmpact 3c. Type of 3d. Stream name * 3e. Stream Type * 3f. 3g. Stream 3h. Impact
for impact* type* impact* Jurisdictior�idth* length*
*
i tYpe
Site 1 P Fill UTto Norris Creek Intermittent Both 2 7
N�p label (e.g. Fd�ad F�rrranent (F) F2rennial (Fff� or interrrittent Average (feet) (linear feet)
Qossing1) orTerrporary (IfV�
i�
`� 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:
7
3i. Total temporarystream impacts:
0
3i. Total stream and tributary impacts:
7
3j. Comments:
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 �J Tar-Pamlico
r Catawba r Randleman
r Goose Creek r Jordan Lake
r Other
6b. Impact Type * 6c. Per or 6d. Stream name *
Te mp *
Site 1 allowable P Norris Creek
Location and C errpt, Allowable, allowable w/ rritigation F2rrranent (� or
Terrporary (�
Site 1 mitigable P Norris Creek
Location and Exerrpt, Allowable, allowable w/ rritigation F2rrranent (P) or
Terrporary (�
Site 2 allowable P Norris Creek
Location and 6cerrpt, Allowable, allowable w/ rritigation F�rrranent (F) or
Terrporary (�
Site 2 mitigable P Norris Creek
Location and C errpt, Allowable, allowable w/ rritigation F2rrranent (F) or
Terrporary (�
Site 3 allowable P UT to Norris Creek
Location and 6cerrpt, Allowable, allowable w/ rritigation F2rrranent (P) or
Terrporary (�
Site 3 mitigable P UTto Norris Creek
Location and 6cerrpt, Allowable, allowable w/ rritigation F�rrrenent (P� or
Terrporary (�
6h. Total buffer impacts:
Temporary impacts
Permanent impacts:
Total buffer impacts
6i. Comments:
Zone 1
0.00
Zone 1
7,184.00
Zone 1
7,184.00
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
qick the upload button or drag and drop files here to attach docurrent
64750 Buffer Impacts Permit Package REVISED.pdf
64750 Wetland Impacts Permit Package.pdf
Fle rrust be FDF
Zone 2
0.00
Zone 2
9,388.00
Zone 2
9,388.00
6e. Buffer 6f. Zone 1 6g. Zone 2
mitigation impact* impact*
required?*
No 802 0
(squarefeet) (squarefeet)
Yes 1,606 6,651
(squarefeet) (squarefeet)
No 1,931 514
(squarefeet) (squarefeet)
Yes 401 1,427
(squarefeet) (squarefeet)
No 5 0
(squarefeet) (squarefeet)
Yes 2,439 796
(squarefeet) (squarefeet)
1.41 MB
3.06MB

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:*
I Project has been designed to use 2:1 slopes throughout most of project to reduce wetland and stream impacts.
Slopes further reduced to 1.5:1 from 17+50 to 19+00 Lt to further reduce wetland and stream impacts.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Project will be inspected by NCDOT and CEI firms to ensure that project is constructed following permit drawings
and plan sheets. Further minimi�tion not expected during 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 l" No
2c. If yes, mitigation is required by (check all that apply):
r7 DWR fJ Corps
2d. If yes, which mitigation option(s) will be used for this project?
r Mitigation bank r7 Payment to in-lieu fee program r Permittee Responsible Mitigation
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)
7 ft for stream loss
4c. If using stream mitigation, what is the stream temperature:
warm
4d. Buffer mitigation requested (DWR only):
(squarefeet)
4,446 in BZ 1 and 8,874 in BZ 2
4e. Riparian wetland mitigation requested:
(acres)
0.17
4f. Non-riparian wetland mitigation requested:
(acres)
4g. Coastal (tidal) wetland mitigation requested:
(acres)
4h. Comments
Mitigation not proposed or provided for Isolated Wetland at Site 3.
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 �' 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.
I Zone 1
Zone 2
6c. Reason for impact
Roadwayfill and mechanized
clearing
Roadwayfill and mechanized
clearing
6d. Total impact Multiplier 6e. Required
(square feet) mitigation (square
feet)
4,446 3
8,874 1.5
13,338
13,311
6f. Total buffer mitigation required
26649
6g. If buffer mitigation is required, is payment to a mitigation bank or NC Division of Mitigation Services proposed?
C' Yes �' 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.
� Payment to in lieu fee program.
6j. Comments:
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1a. Does this project require a Stormwater Management Plan?
�' Yes [" No
1b. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
Stormwater outfal is proposed in a wetland and outside of Buffer Zone 2. Rip rap pad used to dissipate energy. No
deck drains allowed over wetland or stream.
1c. What is the overall percent imperviousness of this project?
20
%
1d. Who will be responsible for the review of the Stormwater Management Plan?*
r Certified Local Government r DEMLR Stormwater Review
r DWR 401 & Buffer Permitting Branch fJ 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?
C•' 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
in Chapter 8 of the NC Stormwater BMP Manual and attach a BMP Supplement Form
What documentation are you providing?

r Level Spreader
�J Other BMP
(check all that apply)
Diffused Flow Documentation
aick the upload button or drag and drop files here to attach docurrent
64750 Buffer Impacts Permit Package REVISED.pdf 1.41 MB
Fle lype 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 �' No
Stormwater Management Plan Upload
Gick the upload button or drag and drop files here to attach docurrent
I B4750 Buffer Impacts Permit Package REVISED.pdf 1.41 MB
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 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)?*
�' Yes C' No
1c. If you answered "yes" to the above, has the document review been finalized by the State Clearing House? (If so, attach a copy of the
NEPAor SEPAfinal approval letter.)*
C' Yes C•' No
Comments:*
CE will be completed for this project.
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 C•' No
3b. If you answered "no," provide a short narrative description.
Project discharges stormwater runoff into wetland and in rip rap pad outside of Buffer Zone 2.

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 Project will not generate sewage.
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?*
r 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.
Raleigh
Sd. Is another Federal agency involved?*
C' Yes C•' No
5e. Is this a DOT project located within Division's 1-8?*
�' Yes C' No
C' Unknown
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
Informal consultation with USFWS. MALTAAfor NLEB; MANLTAAfor Dwarf Wedgemussel, Tar River spinymussel
and Yellow Lance. No Effect for Michau�s sumac.
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 database
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? *
Coordination with State HPO.
7c. Historic or Prehistoric Information Upload
C7ick the upload button or drag and drop files here to attach docurrent
16-06-0015NoSurvey from historic architecture.pdf 1.69M6
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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:
i Project designed with Limited Detailed methods.
8c. What source(s) did you use to make the floodplain determination?*
NCDOT hydro unit.
Miscellaneous attachments not previously requested.
Qick the upload button or drag and drop files here to attach docurrent
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Signature
*
� 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:*
Christopher A. Murray
Signature
��j� i�" /�L�r`r'��
Date :
current_date
Initial Review
Is this project a public transportation project? *(')
�' Yes C' No
Change only if needed.
� Has this project met the requirements for acceptance in to the review process?*
�' Yes
C' No
BIMS # Assigned*
20171408
Version#*
1
Reviewing Office *
Central Office - [phone]
Select Project Reviewer*
i Rob Ridings:eads\rgridings