20171595 Ver 1_PCN Form Submission_20171214

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 12/14/2017 8:09:27 AM (Start Event)
Accept by Carpenter,Kristi 12/14/2017 12:01:14 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: December 19, 2017 5:00 PM
12/14/2017 8:09 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:*
Jones
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 #
17BP.2.R.77
(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?*
NCDOT (attn: Heather Lane)
1b. PrimaryContact Email:*
[e-mail]
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
I7 Owner rJ Applicant (other than owner) rJ AgenUConsultant
(Check all that apply)
2. Owner I nformation
2a. Name(s) on recorded deed:
i NCDOT
2b. Deed book and page no.:
2c. Responsible party:
(for Corporations)
2d.Address
Street Address
1037 W.H. Smith Boulevard
Address Line 2
�Y
Greenville
Fbstal / Zip Code
27835
2e. Telephone Number:
(xxx)xxx-xxxx
[phone]
State / Rovince / Region
NC
Country
USA

2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
3a. Applicant is:
C' Agent
C� Other N_
If other please specify.
3b. Name:
NCDOT (attn: Heather Lane)
3c. Business Name:
(if applicable)
3d.Address
Street Address
1037 W.H. Smith Boulevard
Address Line 2
��
Greenville
Fbstal / Zip Code
27835
3e. Telephone Number:
i [phone]
(xxx)xxx-xxxx
3f. Fax Number:
(xxx)xxx-xxxx
3g. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Robert Turnbull
4b. Business Name:
(if applicable)
Environmental Services, Inc.
4c. Address
Street Address
4901 Trademark Drive
Address Line 2
��
Raleigh
Fbstal / Zip Code
27610
4d. Telephone Number:
[phone]
(xxx)x�c-x�cx
State / R-ovince / F�gion
NC
Country
USA
State / Rovince / f�gion
NC
Country
USA

4e. Fax Number:
[phone]
(xxx)xxx-xxxx
4f. Email Address:*
I rturnbull@esinacc
AgentAuthorization Letter*
Rease provide the Agent Authorization Letter if you are subrritting this docurrent.
17BP.2.R.77_Signed Agent Authorization.pdf
FlLE NFE M.15T BE FDF
223.09KB
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Jones County Bridge 32
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Trenton, NC
1d. Driving directions*
If it is a new project and can not easily be found in a GPS rrapping system Rease provide directions.
Weyerhaeuser Road (SR 1142) over Tuckahoe Creek, west of Trenton in Jones County.
2. Project Identification
i 2a. Property Identification Number:
(tax RNor parcel ID)
2b. Propertysize:
(in acres)
approx. 1.2 acres
2c. Project Address
Street Address
Weyerhaeuser Road (SR 1142)
Address Line 2
��
Trenton
Fbstal / Zip Code
28585
2d. Site coordinates in decimal degrees
State / Rovince / 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 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:*
35.03210
ex:34208504
Longitude:*
-77.57945
-77.796371

3. SurFace Waters
3a. Name of the nearest body of water to proposed project:*
Tuckahoe Creek
3b. Water Resources Classification of nearest receiving water:*
C;Sw, NSW
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Neuse
RiverBasin Lookup
4. Project Description
4a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this application:*
The project study area and vicinity consist of agricultural and rural residential areas, silvicultural areas, and
undeveloped forested communities. The proposed project and associated impacts are within and immediately
adjacent to e�sting NCDOT right-of-way.
4b. Attach an 8 1/2 X 11 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for
DWR)
Gick the upload button or drag and drop files here to attach docurrent
17BP.2.R.77_Jones 32_USGS topo.pdf
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452.33KB
4c. Attach an 8 1/2 X 11 excerpt from the most recent version of the published County NRCS Soil Survey map depicting the project site.
(for DWR)
C7ick the upload button or drag and drop files here to attach docurrent
17BP.2.R.77_Jones 32_Soils.pdf
Fle type rrust be pdf
4d. List the total estimated acreage of all existing wetlands on the property:
<0.25 acre
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
300 feet
453.74KB
4f. Explain the purpose of the proposed project:
� Replace existing Bridge 32 on SR 1142 (Weyerhaeuser Road) over Tuckahoe Creek. The sufficiency rating of the
epsting bridge is 27.12.
4g. Describe the overall project in detail, including the type of equipment to be used:
The proposed project will replace the e�asting bridge on Weyerhaeuser Road (SR 1142) over Tuckahoe Creek in
Jones County. The project will replace the existing timber floor bridge on continuous I-beams, timber caps, and
timber piles with a cored slab bridge. The project work will consist of grading, widening, drainage improvements,
bridge replacement, paving, and pavement markings. An off-site detour is proposed during construction.
4h. Please upload project drawings for the proposed project.
C7ick the upload button or drag and drop files here to attach docurrent
176P.2.R.77_permit drawings.pdf 1.93M6
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5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
�' Yes �' No �' Unknown

Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
C�' Preliminary C' Approved C' Unknown C' WA
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:
Robert Turnbull
Environmental Services, Inc.
Sd. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
I Documentation not available.
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.
No.
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
r Wetlands rJ Streams-tributaries rJ 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.
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*
W2 - Drainage
Improv e me nts
N�p label (e.g. Fd�ad
Qossing 1)
W2 - Drainage
Improve me nts
N�p label (e.g. Fd�ad
Qossing 1)
P Relocatio UTtoTuckahoe Creek
F2rrranent (P� n
or Terrporary
��
T Relocatio UTto Tuckahoe Creek
F�rrranent (F) n
or Terrporary
��
3e. Stream Type * 3f. 3g. Stream 3h. Impact
Jurisdictior�idth* length*
type *
Intermittent Corps 3 88
F2rennial (F8� or interrrittent Average (feet) (linear feet)
(If�
Intermittent Corps 3 28
F�rennial (FS2) or interrrittent Average (feet) (linear feet)
(IMj
** 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:
88
3i. Total temporary stream impacts:
28
3i. Total stream and tributary impacts:
116
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.
�J Neuse
� Catawba
r Goose Creek
r Other
r Tar-Pamlico
r Randleman
r Jordan Lake
6b. Impact Type * 6c. Per or 6d. Stream name *
Te mp *
B1 -Allowable P Tuckahoe Creek
Location and 6cerrpt, Allowable, allowable w/ rritigation F�rrranent (F) or
Terrporary (�
62 - Allowable P Tuckahoe Creek
Location and C errpt, Allowable, allowable w/ rritigation F2rrranent (Fj or
Terrporary (�
6e. Buffer 6f. Zone 1 6g. Zone 2
mitigation impact* impact*
required?*
No 535 227
(squarefeet) (squarefeet)
No 563 261
(squarefeet) (squarefeet)

6b. Impact Type * 6c. Per or 6d. Stream name *
Te mp *
63 - Allowable P Tuckahoe Creek
Location and C errpt, Allowable, allowable w/ rritigation F2rrranent (P� or
Terrporary (�
64 - Allowable P Tuckahoe Creek
Location and 6cerrpt, 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
2,446.00
Zone 1
2,446.00
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
Gick the upload button or drag and drop files here to attach docurrent
176P.2.R.77_permit drawings.pdf
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Zone 2
0.00
Zone 2
1,190.00
Zone 2
1,190.00
E. Impact Justification and Mitigation
1. Avoidance and Minimization
6e. Buffer 6f. Zone 1 6g. Zone 2
mitigation impact* impact*
required?*
No 518 351
(squarefeet) (squarefeet)
No
1.93M6
830 351
(squarefeet) (squarefeet)
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
The proposed bridge replacement will occur as much as practicable within the footprint of the existing bridge.
Stream impacts have been minimized as much as practicable and are necessary to improve drainage of the site.
No wetland impacts are proposed for this project. Riparian buffer impacts have been minimized as much as
practicable.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
No in-stream work will occur on Tuckahoe Creek during this bridge replacement. All work performed to relocate the
UT to Tuckahoe Creek will be performed in the dry. All necessary sediment and erosion control BMPs will be
installed and maintained through construction. Disturbed ground will be restored and stabilized with permanent
vegetative cover. NCDOT Best Management Practices will be implemented throughout construction.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for impacts to Waters of the U.S. or Waters of the State?
C' Yes �' No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
Stream impacts are less than 150 feet of intermittent channel. No impacts to wetlands are proposed. Buffer impacts are allowable and do not
require mitigation.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)

1a. Does this project require a Stormwater Management Plan?
C� Yes
C' No
1b. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
The proposed bridge does not contain deck drains. Stormwater will discharge into the proposed drainage ditches
in the northeast, northwest, southeast, and southv�st quadrants, where it will follow existing drainage patterns.
The roadside ditches in the northeast, northwest, southeast, and southwest quadrants will be impacted. The
redesigned ditches, with the exception oof the ditch in the northeast quadrant, will tie into Tuckahoe Creek, and
match the existing drainage patterns. The proposed ditch in the southwest quadrant will begin as a V-ditch with 3:1
slopes, and transition into a 4' special lateral base dtich with 2:1 slopes and Class I rip rap lining. The rip rap is
proposed on the southwest ditch to stabilize the side slopes. The northwest and southeast ditches will be special
later V-ditches with 3:1 slopes and will tie into the e�asting wetlands. The southeast ditch will be lined with Class I
rip rap at the end to minimize velocity and prevent erosion. The northeast ditch will be a special lateral V-ditch with
a 4:1 front slope and 3:1 back slope. The northeast ditch will flow north, away from the project.
1c. What is the overall percent imperviousness of this project?
36
%
1d. Who will be responsible for the review of the Stormwater Management Plan?*
r 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
�' 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?
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
17BP.2.R.77_SMP.pdf
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5. DWR 401 Stormwater Review
!yk'*�!]:/:3
5a. Is the Stormwater Management Plan (including BMP Supplemental Forms and Operation and Maintenance Agreements) attached?
�' Yes
�' No
Stormwater Management Plan Upload
C7ick the upload button or drag and drop files here to attach docurrent
17BP.2.R.77_SMP.pdf
file type rrust be pdf
G. Supplementary Information
1. Environmental Documentation
425.79KB
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*

r Yes r 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 l" No
1c. If you answered "yes" to the above, has the document review been finalized bythe State Clearing House? (If so, attach a copy of the
NEPAor SEPAfinal approval letter.)*
C' Yes �' No
Comments:*
MCDC finalized 12/1/2017.
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 �' No
3b. If you answered "no," provide a short narrative description.
The proposed project will result in minimum new impervious surface and will not result in any downstream impacts
or growth-stimulating effects. The existing use of Tuckahoe Creek (C) should not change as a result of this
project.
4. Sewage Disposal (DWR Requirement)
4a. Describe, in detail, the treatment methods and dispositions (non-discharge or discharge) of wastewater generated from the
proposed project. If the wastewater will be treated at a treatment plant, list the capacity available at that plant.
i No wastewater will be produced as a result of this project.
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or habitat? *
f Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
C' Yes �' No
5d. Is another Federal agency involved?*
C' Yes C•' No
Se. 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?*
North Carolina Natural Heritage Program Data and on-site evaluation by ESI Staff.

6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
C' Yes �' No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
http://owvw.habitat.noaa.gov/protection/efhmapper/
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data: http://gis.ncdcr.gov/hpoweb/
7a. Will this project occur in or near an area that the state, federal or tribal governments have designated as having historic or cultural
preservation status (e.g., National Historic Trust designation or properties significant in North Carolina historyand archaeology)?*
C' Yes C•' No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
Archaeology and historic architecture reviews were conducted by NCDOT. Documentation for those reviews is
attached.
7c. Historic or Prehistoric Information Upload
C7ick the upload button or drag and drop files here to attach docurrent
16-09-0028 Jones 32 HA NoSurveyReq.pdf 2.43M6
PA 16-09-0028 Jones 32 Arch (NSR).pdf 6.84M6
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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 �' No
8b. If yes, explain how project meets FEMA requirements:
Tuckahoe Creek is subject to MOA 1 Criteria. There is no change in water surface elevation.
8c. What source(s) did you use to make the floodplain determination?*
�wwv.ncfloodmaps.com
Miscellaneous attachments not previously requested.
C7ick the upload button w drag and drop files here to attach docurrent
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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:*
Robert Turnbull

Signature
��°t.r�tor��/l
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
C' No
� BIMS#Assigned*
20171595
Version#*
1
Reviewing Office *
Washington Regional Office - [phone]
Select Project Reviewer*
Garcy Ward:eads\gpward