20171540 Ver 1_PCN Form Submission_20171130

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 11/30/2017 11:34:43 AM (Start Event)
Accept by Carpenter,Kristi 11/30/2017 3:55:05 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: December 5, 2017 5:00 PM
11 /30/2017 11:35 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:*
Pitt
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:
SF-730113
WBS #
17. BP.2.81
(for NCDOT use only)
1a. 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:
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
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
i 1f. Is the project located in anyof NCs twentycoastal counties?*
C' Yes �' No
1h. Is the project located in a designated trout watershed?*
C� 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?*
HeatherLane
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) rJ AgenUConsultant
(Check all that apply)
2. Owner I nformation
2a. Name(s) on recorded deed:
I North Carolina Department of Transportation
2b. Deed book and page no.:
2c. Responsible party:
(for Corporations)
2d.Address
Street Address
1037 W.H. Smith Blvd.
Address Line 2
P.O. Box 1587
a�
Greenville
Fbstal / Zip Code
27835
2e. Telephone Number:
(xxx)xxx-xxxx
State / R-ovince / F�gion
NC
Country

2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Eleni Riggs
4b. Business Name:
(if applicable)
RK&K Engineers
4c. Address
Street Address
900 Ridgefield Drive
Address Line 2
Suite 350
a�
Raleigh
Fbstal / Zip Code
27609
4d. Telephone Number:
[phone]
(xxx)xxx-xxxx
4e. Fax Number:
(xxx)xxx-xxxx
4f. Email Address:*
[e-mail]
State / Rovince / I�gion
NC
Country
AgentAuthorization Letter*
Rease provide the Agent Authorization Letter if you are subrritting this docurrent.
730113_AGENT AUTHORIZATION Signed.pdf 237.3K6
FlLE IYFE M 1ST BE FDF
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
� Replace bridge #0113 on SR 1500 over Suggs Branch
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Bethel
1d. Driving directions*
If it is a new project and can not easily be found in a G� rrapping system Rease provide directions.
From Greenville, NC, drive north on US13. Turn right on SR 1500 (Big Oak Road) after passing Highway 30 and before reaching US 64 ALT.
2. Project Identification

2a. Property Identification Number:
(t�vc RN or parcel ID)
wa
2b. Propertysize:
(in acres)
0.6 acres
2c. Project Address
Street Address
Big Oak Road
Address Line 2
Qty
Bethel
Fbstal / Zip Code
27812
State / R-ovince / F�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.)
� Latitude:*
35.800501
ex:34.208504
3. Surface Waters
Longitude:*
-77.365446
-77.796371
3a. Name of the nearest body of water to proposed project:*
Suggs Branch
3b. Water Resources Classification of nearest receiving water:*
C; NSW
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Tar-Pamlico
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:*
Existing conditions consist of v�tlands within w+oods. There are also agricultural fields with crops adjacent to
project.
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
730113_USGS Map.pdf 630.07KB
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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
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4d. List the total estimated acreage of all existing wetlands on the property:
1.73 acres
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
285 linear feet
4f. Explain the purpose of the proposed project:
i Replace a structurally deficient bridge over Suggs Branch
4g. Describe the overall project in detail, including the type of equipment to be used:
Remove ewsting bridge #0113, a single span, 31'-2" bridge on SR 1500 over Suggs Branch. Replace with a single
span, 45'-0" cored slab bridge. Typical construction equipment such as track hoe, dump trucks and cranes will be
utilized.
4h. Please upload project drawings for the proposed project.
Gick the upload button or drag and drop files here to attach docurrent
730113 - 90% Roadway Plans.pdf 3.83M6
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5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
C•' Yes C' No f" Unknown
Comments:
Jurisdictional areas identified in the study area were verified on August 22,
2017 by Tom Steffens (USACE) and Garcy Ward (DWR). Documentation of
this jurisdictional determination has not been received.
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
�' Preliminary l" Approved C' Unknown f' 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:
Other
Hal Bain
RK&K Engineers
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Jurisdictional areas identified in the study area were verified on August 22, 2017 by Tom Steffens (USACE) and Garcy Ward (DWR).
Documentation of this jurisdictional determination has not been received.
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 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.
No
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
r Wetlands �J Streams-tributaries �J 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 #- Reason 3b.lmpact 3c. Type of 3d. Stream name *
for impact* type* impact*
1
fv�p label (e.g. I�ad
Qossing 1)
1
N�p label (e.g. I�ad
Qossing 1)
2
N�p label (e.g. I�ad
Qossing 1)
2
fv�p label (e.g. Id�ad
Qossing 1)
P Bank
F2rrranent(F7j Stabilizati
orTerrporary on
m
T Bank
F�rrrenent (� Stablllzatl
orTerrporary On
m
P Bank
F�rrrenent(F7j Stabilizati
orTerrporary On
��
T Bank
F2rrranent(F7j Stabilizati
orTerrporary On
��
Suggs Branch
Suggs Branch
Suggs Branch
Suggs Branch
3e. Stream Type * 3f. 3g. Stream 3h. Impact
Jurisdictior�idth* length*
type *
Perennial Corps 16 17
F2rennial (FS2) or interrrittent Average (feet) Qinear feet)
(If�
Perennial Corps
F2rennial (FS2) or interrrittent
(If�
Perennial Corps
F2rennial (Fff2) or interrrittent
(If�
Perennial Corps
F2rennial (F62) or interrrittent
(IfV�
�' 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:
22
3i. Total temporary stream impacts:
12
3i. Total stream and tributary impacts:
34
3j. Comments:
16 2
Average(feet) (linearfeet)
15 5
Average (feet) (linear feet)
15 10
Average (feet) (linear feet)

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
� Other
6b. Impact Type *
6c. Per or 6d. Stream name *
Te mp *
Site 1, Allowable P Suggs Branch
Location and C errpt, Allowable, allowable w/ rritigation F2rrranent (� or
Terrporary (�
Site 2, Allowable P Suggs Branch
Location and Exerrpt, Allowable, allowable w/ rritigation F2rrranent (P) or
Terrporary (�
Site 3, Allowable P Suggs Branch
Location and 6cerrpt, Allowable, allowable w/ rritigation F�rrranent (F) or
Terrporary (�
Site 4, Allowable P Suggs Branch
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
3,493.00
Zone 1
3,493.00
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
Zone 2
0.00
Zone 2
2,120.00
Zone 2
2,120.00
6e. Buffer 6f. Zone 1 6g. Zone 2
mitigation impact* impact*
required?*
No 875 528
(squarefeet) (squarefeet)
No 1,773 1,106
(squarefeet) (squarefeet)
No 375 218
(squarefeet) (squarefeet)
No 470 268
(squarefeet) (squarefeet)

C7ick the upload button or drag and drop files here to attach docurrent
730113_Permit Drawings.pdf
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E. Impact Justification and Mitigation
1. Avoidance and Minimization
3.04MB
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
Slopes were steepened when necessary to avoid sliver fills and minimize the footprint, especially on the driveway.
Driveway was located to ensure that no impacts were made to the wetlands in the northwest quadrant.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Appropriate Erosion Control measures shall be in place so that the surrounding wetlands and surface waters are
not disturbed.
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:
Stream impacts are belowthe minimum criteria threshold.
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:
Please see attached SMP
1c. What is the overall percent imperviousness of this project?
45
%
1d. Who will be responsible for the review of the Stormwater Management Plan?*
r Certified Local Government
�7 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
�' 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?
� Level Spreader
�J Other BMP
(check all that apply)
Diffused Flow Documentation

C7ick the upload button or drag and drop files here to attach docurrent
I SF-730113_Swale_BMP.pdf 131.81 KB
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5. DWR 401 Stormwater Review
5a. Is the Stormwater Management Plan (including BMP Supplemental Forms and Operation and Maintenance Agreements) attached?
�' Yes l' No
Stormwater Management Plan Upload
C7ick the upload button or drag and drop files here to attach docurrent
SF-730113_HYD_SMPv2.07_20171002 (Oct 2016).pdf 261.42KB
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?*
�' Yes �' 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
Comments:*
I Project does not meet the minimum criteria threshold to require an environmental document.
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
I DWR Surface Water or Wetland Standards or Riparian Buffer Rules (15A NCAC 2B .0200)? *
C' Yes r 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 G No
3b. If you answered "no," provide a short narrative description.
The project is one which qualifies as a 23 CFR 771.117. As such, the project is in a category of projects that add
either no or a minor amount of new impervious surface directly, indirectly or cumulatively. Consequently, the
project will not result in cumulative impacts that cause or will cause a violation of downstream water quality
standards.
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.
f�UA

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 �' No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
C' Yes C•' No
5d. Is another Federal agency involved?*
C' Yes C•' No
5e. Is this a DOT project located within Division's 1-8?*
C� Yes �' No
c' Unknown
Sj. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
USFWS Endangered Species website (list by county), Preliminary Ground Survey, Natural Heritage GIS layer.
The US Fish and Wildlife Service proposal for listing the Northern Long-eared Bat (Myotis septentrionalis) as an
Endangered species was published in the Federal Register in October 2013. The listing became effecitve April
2015. NCDOT is working closely with the USFWS to understand howthis listing may impact NCDOT projects.
NCDOT continue to corrdinate appropriately with USFWS to determine if this project will incur potential effects to
the Northern Long-eared bat, and how to address these potential effects, if necessary.
, 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?*
USFWS website
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 �' No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources? *
NCDOT Cultural Resources office performed an internal reviewthrough the Programmatic Agreement between
State Historic Preservation Office and NCDOT.
7c. Historic or Prehistoric Information Upload
C7ick the upload button or drag and drop files here to attach docurrent
16-10-0007Pitt 113 HA NoSurveyReq.pdf 2.45MB
PA 16-10-0007 Pitt 113 Arch (NSR).pdf 7.13M6
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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:

wa
8c. What source(s) did you use to make the floodplain determination?*
i NC Floodplain Mapping website (Tile No. 4784)
Miscellaneous attachments not previously requested.
aick the upload button or drag and drop files here to attach docurrent
730113_UT_Final_UBO_Plans.pdf 278.09KB
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Signature
*
rJ 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
i 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.
IFull Name:*
Eleni Riggs
Signature
r���°vrr':�r���
Date :
current date
Initial Review
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?*
C•' Yes
�' No
BIMS # Assigned*
20171540
Version#*
1
Reviewing Office *
Washington Regional Office - [phone]
Select Project Reviewer*
� Garcy Ward:eads\gpward