20170185 Ver 2_PCN Form Submission_20171213

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 12/13/2017 10:23:48 AM (Start Event)
Accept by Carpenter,Kristi 12/13/2017 12:46:03 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: December 18, 2017 5:00 PM
12/13/2017 10:24 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:*
Rockingham
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:
WBS #
WBS 17BP.7.R.104
(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.
14 - Linear transportation
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: C' Yes C•' No
For the record only for Corps Permit: 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
SR 2686 - Bridge 283 - Division 7- STR - CF 02.pdf 59KB
SR 2686 - Bridge 283 - Division 7- STR - CF 02 - Rockingham.pdf 141.02KB
FlLE IYFE MJST BE FDF
1f. Is the project located in any of NC's twenty coastal counties?*
C' Yes �' No
1h. Is the project located in a designated trout watershed?*
C� No
C' Yes
Link to trout information: http://ww�.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Agency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact?*
Mr. Jerry Parker
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) r AgenUConsultant
(Check all that apply)
2. Owner I nformation
2a. Name(s) on recorded deed:
NC Department of Transportation
2b. Deed book and page no.:
n/a
2c. Responsible party:
(for Corporations)
I Division Engineer NC DOT Division 7, Mr. Mike Mills, PE
2d.Address

Street Address
PO Box14996
Address Line 2
C7ty
Greensboro
Fbstal / Zip Code
27415
2e. Telephone Number:
(xxx)xxx-xxxx
[phone]
2f. Fax Number:
[phone]
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
3a. Applicant is:
f Agent
C� Other
If other please specify.
3b. Name:
I Mr. Jerry Parker
3c. Business Name:
(if applicable)
NC DOT Highway Division 7, Division Environmental Supervisor
3d.Address
Street Address
PO Box14996
Address Line 2
��
Greensboro
Fbstal / Zip Code
27415
3e. Telephone Number:
[phone]
(xxx)xxx-xxxx
3f. Fax Number:
[phone]
(xxx)xxx-xxxx
3g. Email Address:*
[e-mail]
State / R-ovince / I�gion
NC
Country
USA
State / Rovince / F,'egion
NC
Country
USA
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*

Bridge 283 on SR 2686 (Richardson Drive) over Little Troublesome Creek
1b. Subdivision name:
(if appropriate)
n/a
1c. Nearest municipality/town:*
Reidsville
1d. Driving directions*
If it is a new project and can not easily be found in a G� rrapping system Rease provide directions.
From Raleigh, take I-40 West to ebt 138 for NC-61 toward Gibsonville. Follow NC 61 approximately 14 miles, turn left onto Chrismon Road,
turn right onto Friendship Church Road, turn left onto Candy Creek Road, turn right at the 1 st cross street onto US-29 BUS N, turn left onto
Freeway Dr, take the U.S 158 S ramp, turn right onto Richardson Dr and continue 1 mile to the project site.
2. Project Identification
2a. Property Identification Number:
(tax RNor parcel ID)
n/a
2b. Propertysize:
(in acres)
n/a
2c. Project Address
Street Address
Richardson Drive
Address Line 2
��
Reidsville
Fbstal / Zip Code
27320
2d. Site coordinates in decimal degrees
State / Rovince / Region
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:*
36.3429390
ex:34208504
3. Surface Waters
Longitude:*
-79.6774680
-77.796371
3a. Name of the nearest body of water to proposed project:*
Little Troublesome Creek & UT to Little Troublesome Creek
3b. Water Resources Classification of nearest receiving water:*
WS-V; NSW; 16-17-(1); 03-06-01; HUC 03030002
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Cape Fear
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 is comprised of mostly maintained right of way. The immediate surrounding area is mostly
single family residential housing and a business as well as maintained utilities (i.e. power and sewer).
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
Bridge Maps 283_USGS.pdf
Fle type rrust be pdf
2.31 MB
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)
Gick the upload button or drag and drop files here to attach docurrent
Bridge Maps 283_Soil.pdf
Fle type rrust be pdf
4d. List the total estimated acreage of all existing wetlands on the property:
There are 4 wetland pockets within the project study area totalling
appro�amately 1 acre, however, this project proposes no wetland impacts.
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
—300 LF within the project study area
fi��]uI 3
4f. Explain the purpose of the proposed project:
The purpose of the project is to replace a structurally deficient and functionally obsolete timber bridge.
4g. Describe the overall project in detail, including the type of equipment to be used:
Traffic will be detoured off-site. Erosion and sedimentation control measures will be installed. Water will be diverted
around the construction area. The old bridge will be removed. The proposed structure will be replaced on its
e�asting alignment. The new culvert structure will be a 2@ 12'X7' reinforced concrete box culvert (RCBC). The
channel will be excavated and realigned for lowflowshaping. The constructed benches on the upstream and
downstream ends of the high flow barrel proposes class II rip rap on the flood bench borders with coir fiber matting
between (see typical). Water will be directed around the worksite during construction by a 24 inch temporary pipe.
Equipment to be used includes a track hoe, dump truck, paving equipment, pumps and various hand tools.
4h. Please upload project drawings for the proposed project.
Gick the upload button or drag and drop files here to attach docurrent
780283_hyd_permit package.pdf 3.49M6
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5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
G Yes C' No f" Unknown
Comments:
Sb. If the Corps made a jurisdictional determination, what type of determination was made? *
C' Preliminary C' Approved C' Unknown C' f�UA
Corps AID Number:
6carrple: SAV�2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Mr. Robert Lepsic

Sc. If 5a is yes, who delineated the jurisdictional areas?
Agency/Consultant Company:
Other
Arcadis (however Mr. Lepsic is nowwith EPR)
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
The USACE and DWR reviewed the project study area in June 2016; it is anticipated that a JD will be issued with the 404 Authorization.
5d1. Jurisdictional determination upload
aick the upload button or drag and drop files here to attach docurrent
DWR Stream determinations.pdf
283 revised_REDUCED.pdf
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6. Project History
1.07M6
596.63KB
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past?*
�' Yes C' No �' Unknown
6b. If yes, please give the DWR Certification number or the Corps Action ID (exp. SAW-0000-00000).
This project was originally submitted and approved early in 2017 (USACE SAW-2017-00378, DWR Project No.
20170185). NCDOT was unable to complete the project prior to the final e�iration date (03/18/2018) of the
authorization due to the need to secure additional Right of Way from the City of Reidsville. The municipal
negotiations are e�ected to be concluded soon so the bridge replacement project may commence. NCDOT is
therefore respectfully requesting a reauthorization of the project as originally submitted. The design remains the
same.
Project History Upload
Gick the upload button or drag and drop files here to attach docurrent
2017-00378 NWP 14.pdf
Bridge 283.pdf
SR 2686 - Bridge 283 - Division 7- STR - CF 02 - Rockingham.pdf
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7. Future Project Plans
7a. Is this a phased project?*
C' Yes C•' No
235.63KB
1.14M6
141.02KB
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 I m pacts I nventory
1. Impacts Summary
� 1a. Where are the impacts associated with your project? (check all that apply):
� Wetlands rJ Streams-tributaries
� Open Waters r Pond Construction
�J Buffers
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*
i S1 P Culvert Little Troublesome
N�p label (e.g. f�ad F�rrranent (P� Creek
Qossing 1) or Terrporary
��
I S1 P Bank Little Troublesome
N�plabel(e.g.l�ad F2rrranent(P� Stabilizati Creek
Qossing1) orTerrporary on
��
S1 T Dewaterin Little Troublesome
N�p label (e.g. f�ad F2rrranent (P� g Creek
Qossing 1) or Terrporary
��
3e. Stream Type * 3f. 3g. Stream 3h. Impact
Jurisdictior�idth* length*
type *
Perennial Both 10 57
F�rennial (FS2) or interrrittent Average (feet) (linear feet)
(IfVT)
Perennial Both
F�rennial (FS2) or interrrittent
(If�
Perennial Both
F2rennial (� or 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:
127
3i. Total temporarystream impacts:
23
3i. Total stream and tributary impacts:
150
3j. Comments:
Of the 150 LF of stream impacts, only 57 LF are associated with permanent impacts to the stream for the purpose
of the culvert installation. The other 70 LF of impact is associated with streambank protection (i.e. the rip rap is
restricted to the banks of the channel and will not encroach within the thalweg). The 23 LF of temporary impacts
are associated with the impervious dikes that will be used upstream and downstream of the proposed crossing.
The dewatering of the stream will run concurrently with the construction activities (i.e. the temporary impacts
associated with dewatering are within the permanent stream impact footprint location).
10 70
Average (feet) (linear feet)
10 23
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)?*
I Check all that apply.
r Neuse
r Catawba
r Goose Creek
r Other
r Tar-Pamlico
r Randleman
�J Jordan Lake

6b. Impact Type *
6c. Per or 6d. Stream name *
Te mp *
Culvert Installation, Allowable P Little Troublesom
Location and C errpt, Allowable, allowable w/ rritigation F2rrranent (P� or Cree k
Terrporary (�
6h. Total buffer impacts:
Temporary impacts
Permanent impacts:
Total buffer impacts
6i. Comments:
Zone 1
0.00
Zone 1
5,219.00
Zone 7
5,219.00
Zone 2
0.00
Zone 2
1,945.00
Zone 2
1,945.00
6e. Buffer
mitigation
required?*
No
6f. Zone 1 6g. Zone 2
impact* impact*
5,219 1,945
(squarefeet) (squarefeet)
The impacts associated with the roadway crossing and culvert installation fall under the "potentially allowable"
category per the Jordan Lake Water Supply Buffer Rules Table of Uses {15A NCAC 02B .0267 (9)}.
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
C7ick the upload button or drag and drop files here to attach docurrent
780283_hyd_permitpackage.pdf
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E. Impact Justification and Mitigation
1. Avoidance and Minimization
3.49M6
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
Channel improvements were made for the proposed RCBC design. Excavation was kept to a minimum to produce
as little impact as possible. Where excavation is necessary, geo-textile and rip-rap were utilized for bank
stabilization in an attempt to reduce stream bank erosion. Floodplain benches with coir fiber matting will be
installed at upstream and downstream of the culvert. A low flow barrel on the east side of the culvert was designed
to match the stream width to maintain the normal flowwidth, depth and velocity of the stream. This will maintain
sediment transport to provide a stable stream during bankfull discharge. The barrel invert will be a minimum of 1'
belowthe stream bed to consider fish passage. 1' high sills will be installed at upstream and downstream face of
the low flow barrel. A high flow barrel on the west side of the culvert will provide flood conveyance during high flow
storm events. This will reduce shear stress on the stream bottom. 2' high sills will be installed at upstream and
downstream face of the high flow barrel. The NE quadrant has an ewsting roadside ditch lined with rip rap that
outlets to the stream. This ditch will be replaced with a special cut'V' ditch lined with class B rip rap. The newditch
has outlet to bank stabilization with class II rip rap to dissipate energy to provide a non-erosive outlet velocity to
the stream. The SW quadrant has an e�sting roadside ditch that has outlet to rip rap embankment to dissipate
energy to provide a non-erosive outlet velocity to the stream. This ditch will be retained. At NW and SE quadrant,
the roadway is fill section. This will promote sheet flow of pavement runoff through grassed fill slope to remove
pollutants via infiltration and settling. The existing road has two paved lanes (total 24' wide). The proposed road
has tv�ro paved lanes (total 24' wide) with 6' paved shoulder on each side. The total project length is only 150 feet.
The increases in impervious areas and stormwater discharges (post vs precondition) are insignificant and the
e�asting ditches do not need to be modified. Therefore, additional stormwater measures are not required. An off-
site detour will be employed to avoid the need for a temporary parallel structure. Bank stabilization will be
minimized to those areas where deemed necessary. Please see the attached Bridge to Culvert justification letter
from NCDOT Division 7 Bridge Program Manager.
1b. Specificallydescribe measures taken to avoid or minimize the proposed impacts through construction techniques:*

Erosion and sedimentation BMPs will be installed prior to construction. Water will be diverted around the work area
to prevent sedimentation of downstream aquatic resources. Impacts will be minimized by strict enforcement of Best
Management Practices for the protection of surface waters, restrictions against the staging of equipment in or
adjacent to waters of the US and coordination (including a pre-construction meeting) with the Division
Environmental Supervisor.
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
2c. If yes, mitigation is required by (check all that apply):
r DWR �J Corps
2d. If yes, which mitigation option(s) will be used for this project?
r Mitigation bank N7 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.
� Yes
4b. Stream mitigation requested:
(linear feet)
57 @ 2:1 ratio
4c. If using stream mitigation, what is the stream temperature:
warm
4d. Buffer mitigation requested (DWR only):
(square feet)
4e. Riparian wetland mitigation requested:
(acres)
4f. Non-riparian wetland mitigation requested:
(acres)
4g. Coastal (tidal) wetland mitigation requested:
(acres)
4h. Comments
The mitigation was previously secured, and debited, from the DMS ledger (see attached, completed Transfer
Form).
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1a. Does this project require a Stormwater Management Plan?
C� Yes l" No
1b. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
Plan is attached and was previously approved.
1c. What is the overall percent imperviousness of this project?
%
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 �J 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 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
r Other BMP
(check all that apply)
Diffused Flow Documentation
qick the upload button or drag and drop files here to attach docurrent
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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?
C' Yes �' No
Stormwater Management Plan Upload
Gick the upload button or drag and drop files here to attach docurrent
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 C•' No
Comments:*
This project is a bridge replacement and does not meet the threshold criteria which triggers a NEPA document.
Further, the project was previously approved earlier in 2017 and there are no changes to the original 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 �' No
3b. If you answered "no," provide a short narrative description.
Per the NC DWQ April 10, 2004 Version 2.1 Cumulative Impacts policy, small scale public transportation projects —
such as widening projects, bridge replacements and intersection improvements — have a"low potential for
cumulative impact since little (if any) new impervious surface is added and the projects are usually in already
developed locales." This proposed project is within a somewhat developed landscape (i.e. ewsting businesses and
residences in the vicinity), this is not a road on a new location (i.e. there is an ebsting road and bridge structure
and thus, the area already contains impervious surfaces) and the project drains to Little Troublesome Creek,
which is Class WS-V; Nutrient Sensitive Waters (NSW). We anticipate the NC DWR will advise us if a qualitative or
quantitative analysis is needed.
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.
It is not anticipated that this project will generate any wastewater as it is a roadway 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?*
�' Yes C' No
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. Is another Federal agency involved?*
f 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?*
North Carolina Natural Heritage Database and onsite investigation. A desktop-GIS assessment of the project study
area, as v�ll as the area within a 1.13 mile radius (1.0 mile plus 660 feet) of the project limits, was performed using
2014 color aerials. No suitable feeding/water source is located within one mile of the project study area to support
Bald eagle habitat. A field scoping meeting on October 15, 2015 determined that the subject project would have
no effect on bald eagle. Additionally, a reviewof the NCNHP database revealed no known occurrences of this
species within 1.0 mile of the project study area.
Robert Lepsic with EPR surveyed the project reach for James spinymussel (Pleurobema collina) habitat in May
and June 2016, as well as searching the NC Natural Heritage Program (NHP) database. The database search
indicated that there are no known occurrences of this species within one mile of the project study area. Further, no
species were observed during the site survey; Little Troublesome Creek and the intermittent UT to Little
Troublesome Creek are severely impacted within the study area and are regularly maintained, providing poor
habitat for the James spinymussel. Email correspondence with Mr. Gary Jordan (USFWS) indicated that he was
comfortable with a"No EffecY' biological conclusion for the James spinymussel.
Mr. Lepsic also conducted a survey for smooth coneflov�r at the subject site on June 28, 2016. Marginal roadside
habitat e�asts on all four quadrants of the bridge but no specimens were found. The biological conclusion for
smooth coneflower at the Bridge 283 site is No Effect; Habitat Present.
Mr. Gary Jordan (USFWS) released the Programmatic Conference Opinion (PCO) for the listed Northern Long
Eared Bat (NLEB). This opinion, states in part, that "...it is the Service's conference opinion that NCDOT activities
in eastern North Carolina (Divisions 1-8), as proposed, are not likely to jeopardize the continued e�astence of the
NLEB."
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?*
This project takes place in Rockingham County which is not near any coastal or tidal habitat that would support
EFH (i.e. salt marshes, oyster reefs, etc.).
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 C•' No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
This project was submitted to the North Carolina Department of Transportation's Human Environment Unit for
review in 2015 and 2017. It was determined there would be no eligible architectural or archaeological resources
present within the project study area (see attached letters).
7c. Historic or Prehistoric Information Upload
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780283 Archaeology NO Survey Structure 780283 Rockingham No Survey Required
2.21 MB
Form.pdf
780283 Architecture SURVEY COMPLETE.pdf 3.68MB
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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:
Existing MOA
8c. What source(s) did you use to make the floodplain determination?*
NC Floodplain Mapping Program
Miscellaneous attachments not previously requested.
Gick the upload button or drag and drop files here to attach docurrent
780283_ut_rdy_UC04psh-Default-OOO.pdf 729.43KB
Bridge to Culvert Justifaction 780283_1-17-2017.pdf 113.48KB
Div 7-Bridge 283 over Little Troublesome Creek fish & mussel report.pdf 612.53KB
Division 7 LIBR TE Plant Memo (2).pdf 102.96KB
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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.
Full Name:*
James Michael Mills
Signature
� +�I,�+�� rr'l.As
Date :
current_date
Initial Review
Is this project a public transportation project? *(?)
G 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*
20170185
Version#*
2
Reviewing Office*
Central Office - [phone]
Select Project Reviewer*
April Norton:eads\arnorton