20171427 Ver 1_PCN Form Submission_20171106

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 11/6/2017 3:50:00 PM (Start Event)
Accept by Carpenter,Kristi 11/6/2017 4:24:27 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: November 9, 2017 5:00 PM
11 /6/2017 3:50 PM

�� �
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:*
Bertie
Is this project a public transportation project? (?)
r Yes C' No
Is this a NCDOT Project?
C� Yes C' No
(NCDOT only) T.I.P. or state project number:
17BP.1. R.84
WBS #
SF-070034
(for NCDOT use only)
7a. Type(s) of approval sought from the Corps:
ri 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?
rJ Nationwide Permit (NWP)
r Regional General Permit (RGP)
Nationwide Permit (NWP) Number:
NWP Number Other:
NW 3
List all MNnurrbers you are applying for not on the drop down list.
03 - Maintenance
1c. Type(s) of approval sought from the DWR:*
check all that apply
rJ 401 Water Quality Certification - Regular
� 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
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
1f. Is the project located in anyof NC's twentycoastal counties?*
�' Yes [" No
1g. Is the project located within a NC DCM Area of Environmental Concern (AEC)?*
C' Yes C•' No C' Unknown
1h. Is the project located in a designated trout watershed?*
r No
C' Yes
Link to trout information: http://v�uwv.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Agency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact?*
Clay Willis
1b. Primary Contact Email:*
[e-mail]
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
�J Owner r Applicant (other than owner) r Agent/Consultant
(Check all that apply)
2. Owner I nformation
2a. Name(s) on recorded deed:
NCDOT Division One
2b. Deed book and page no.:
NCDOT ROW
2c. Responsible party:
(for Corporations)
NCDOT - Division One
2d.Address
Street Address
118 Airport Drive
Address Line 2
Qty
Edenton
Fbstal / Zip Code
27932
State / Rovince / F�gion
North Carolina
Country
USA

2e. Telephone Number:
(xxx)xxx-x�cx
I [phone]
2f. Fax Number:
[phone]
(xxx)xxx-xxxx
2g. Email Address:*
i [e-mail]
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Bridge # 34 on SR 1361 (Jeff White Road)
1b. Subdivision name:
(if appropriate)
, wa
1c. Nearest municipality/town:*
� Merry Hill
1d. Driving directions*
IF it is a new project and can not easily be found in a GPS rrapping system Rease provide directions.
Traveling North on US 17, turn left at the intersection of SR 1361 (Jeff White Road) and US 17. Travel appro�amately 2.3 miles and you will
arrive at Bridge # 37 over Eastmost Swamp
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)
NCDOT ROW
2b. Propertysize:
(in acres)
1.5 acres
2c. Project Address
Street Address
SR 1361 Jeff White Road
Address Line 2
�Y
Fbstal / Zip Code
State / Rovince / I�gion
NC
Country
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
map coordinates to 5 or 6 digits after the decimal place.)
I Latitude:* Longitude:*
36.0598 -76.7713
I ex:34.208504 -77.796371

3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
i Eastmost Swamp
3b. Water Resources Classification of nearest receiving water:*
Class C, NSW
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Chowan
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:*
Land use within the project vicinity is characterized primarily by agriculture and forestry practices. There are rural
single family residential homes along SR 1361, but none within the immediate project boundaries. The immediate
project area is a hardwood bottomland forested area, associated with Eastmost Swamp. This community grades
into an upland pine forest managed for timberland.
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
Bridge34_Bertie_location.pdf 1.07M6
Fle lype 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
Bridge34_Soil_Map. pdf
Fle type rrust be pdf
4d. List the total estimated acreage of all existing wetlands on the property:
0.25 acres
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
80 feet
4f. Explain the purpose of the proposed project:
696.39KB
The purpose of this project is to continue maintaining SR 1361 (Jeff White Rd.) as a functional part of the
secondary road system in Bertie County. The replacement of bridge # 34 on SR 1361 is vital to maintaining SR
1361 in the secondary road system. The current bridge was built 1972 and has a deficiency rating 47, making it
eligible for replacement. The current bridge substructure is wooden and has reached a deteriorated state, which
� creates ongoing maintenance and e�ense, along with safety concerns.
4g. Describe the overall project in detail, including the type of equipment to be used:
The e�asting bridge is 69 ft. long X 25 ft. wide and comprised of a reinforced concrete deck on timber joist,
supported by timber caps and piles. This bridge will be removed in iYs entirety following NCDOT BMP's for bridge
removal. This will include the removal of approximately 0.02 acres of old approach fill, wfiich will be graded down to
restore floodplain along Eastmost swamp. The proposed bridge will be 90 ft. long X 30 ft. wide and made from
precast concrete members. The bridge will be built utilizing top down techniques and an off-site detour will be used
to route traffic around the project site. Equipment used to construct the bridge and roadway approaches include a
crane, excavator, backhoe, dump trucks and paving equipment.
4h. Please upload project drawings for the proposed project.

C7ick the upload button or drag and drop files here to attach docurrent
Final_PermitDrawingPackage.pdf 1.65MB
Fle type rrust be pdF
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
C� Yes C' No C' Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
C� Preliminary �' Approved C' Unknown C' N/A
Corps AID Number:
Exarrple: SAV�2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:
Clay Willis
NCDOT Division One
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Delineated by Clay Willis on October 2nd, 2017
Sd1. Jurisdictional determination upload
qick the upload button or drag and drop files here to attach docurrent
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 c' 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):
� Wetlands r Streams-tributaries r 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.

2a. Site # - Reason for
i impact*
i Bridge approach
N�p label (e.g. F�ad Qassing 1)
Bridge approach HC
N�p label (e.g. F�ad Qossing 1)
Bridge approach
N�p label (e.g. I�ad CXossing 1)
Bridge approach HC
N�p label (e.g. F�ad Qassing 1)
Bridge approach
N�p label (e.g. Finad Qossing 1)
Bridge approach HC
fv�p label (e.g. I�ad CXossing 1)
Bridge approach
N�p label (e.g. I�ad Qassing 1)
Bridge approach
N�p label (e.g. Fd�ad Q-ossing 1)
2b. Impact type * 2c. Type of wetland *
P Bottomland Hardwood
F2rrranent (P� or Terrporary Forest
��
T Bottomland Hardwood
F2rrranent (F) or Terrporary FOP2St
��
P Bottomland Hardwood
F�rrrenent (� or Terrporary Forest
��
T Bottomland Hardwood
F�rrranent (P� or Terrporary Forest
��
P Bottomland Hardwood
F2rrrsnent (F) or Terrporary FOPeSt
��
T Bottomland Hardwood
F2rrrenent (�j or Terrporary Forest
��
P Bottomland Hardwood
F�rrranent (P� or Terrporary Forest
i�
T Bottomland Hardwood
F�rrranent (P� or Terrporary Fol'est
��
2g. Total Temporary Wetland Impact
0.152
2d. Wetland name * Ze. 2f. 2g. Impact
Forested* Jurisdiction area*
type *
Site 1 Yes Both 0.012
(404, 10) or CMR (acres)
(401, other)
Site 7 Yes Both 0.052
(404, 10) or CMR (acres)
(401, other)
Site 2 Yes Both 0.000
(404, 10) or CMR (acres)
(401, other)
Site 2 Yes Both 0.039
(404, 10) or CANR (acres)
(401, other)
Site 3 Yes Both 0.003
(404, 10) or DJVR (acres)
(401, other)
Site 3 Yes Both 0.028
(404, 10) or C7JVR (acres)
(401, other)
Site 4 Yes Both 0.028
(404, 10) or D�NR (acres)
(401, other)
Site 4 Yes Both 0.033
(404, 10) or DdVR (acres)
(401, other)
2g. Total Permanent Wetland Impact
0.043
2g. Total Wetland Impact
0.195
2h. Comments:
Temporary Hand Clearing Impacts will be allowed to revert back to vegetated area, after project completion.
There will be approximately 0.02 acres of old approach fill removed and graded down to the e�asting
wetland/floodplain elevation.
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.
E. Impact Justification and Mitigation
I 1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
The project has designed a bridge structure which is 30 ft. longer than the ebsting, allowing more spanning over
Eastmost swamp and riparian wetlands. NCDOT will be able to restore 0.02 acres of riparian floodplain, which will
be graded down to adjacent wetland elevation. The side slopes on the approach fills have been pulled in to a 3:1
slope which reduces the overall foot print of fill in the wetlands. Storm water on the bridge will be routed off the
bridge deck, so as to avoid direct discharge to surface waters.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
NCDOT will use top down construction technique and an off-site detour, which removes any potential wetland
impact from an on-site detour and work trestle. NCDOT will followour erosion and sediment control plans for this
project, silt fence will be installed and maintained, along with e�osed soils stabilized in accordance with statewide
NPDES permit.
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:
i NCDOT total permanent wetland fill for this project is 0.04 acres. That wetland impact has been avoided and minimized to the maximum
extent practicable. The temporary hand clearing impacts will be allowed to revert back to a vegetated state following project completion. The
new bridge design is 30 feet longer, which allows NCDOT to span more of the riparian floodplain. The old approach fill will be removed (0.02
acres) from the floodplain and restored to the adjacent wetland elevations.
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 project will follow our storm water management plan and associated BMPs in compliance with NCDOT NPDES
permit.
1c. What is the overall percent imperviousness of this project?
0
%
1d. Who will be responsible for the review of the Stormwater Management Plan?*
� Certified Local Government
� DWR 401 & Buffer Permitting Branch
2. Diffuse Flow Plan
r DEMLR Stormwater Review
rJ 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
If no, explain why:
Located in the Chowan River Basin
C•' No
5. DWR 401 Stormwater Review

5a. Is the Stormwater Management Plan (including BMP Supplemental Forms and Operation and Maintenance Agreements) attached?
G Yes C' No
Stormwater Management Plan Upload
Qick the upload button or drag and drop files here to attach docurrent
Final_PermitDrawingPackage.pdf 1.65MB
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?*
r 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 G No
Comme nts: *
I Project is covered under a NCDOT Minimum Criteria Checklist (SEPA)
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
nearby downstream water quality?*
C' Yes C•' No
3b. If you answered "no," provide a short narrative description.
I Project is a bridge replacement, associated with maintaining a DOT secondary road system in Bertie County. This
project will only maintain ebsting access in this part of the county.
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.
None
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 l" No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*

r Yes r No
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. Is another Federal agency involved?*
C' Yes �' No
5e. Is this a DOT project located within Division's 1-8?*
C� Yes C' No
�' Unknown
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
USFWS Database
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?*
NMFS listing and description
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?*
NC SHPO review
7c. Historic or Prehistoric Information Upload
aick the upload button or drag and drop files here to attach docurrent
AR16-08-0032NoSurvey.pdf 1.18MB
HistoricArch_Bertie34NoSurvey.pdf 1.67MB
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?*
�' Yes C' No
8b. If yes, explain how project meets FEMA requirements:
Hydraulic engineer design has incorporated FEMA flood zone requirements
8c. What source(s) did you use to make the floodplain determination?*
FEMA data sources and survey information
Miscellaneous attachments not previously requested.
Gick the upload button or drag and drop files here to attach docurrent
NCDMF_moratorium.pdf 286.6KB
Fle rrust be FDF
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:*
Clay Willis
Signature
C�a� l�i�ia
Date :
current_date
Initial Review
i Is this project a public transportation project? *(')
C•' Yes C' No
Change only if needed.
Has this project met the requirements for acceptance in to the review process?*
G Yes
C' No
BIMS # Assigned*
20171427
Version#*
Reviewing Office*
Washington Regional Office - [phone]
Select Project Reviewer*
Garcy Ward:eads\gpward