20171597 Ver 1_PCN Form Submission_20171215

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 12/15/2017 10:52:06 AM (Start Event)
Accept by Carpenter,Kristi 12/15/2017 3:16:54 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: December 20, 2017 5:00 PM
12/15/2017 10:52 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:*
Chatham
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:
41665.3 H
WBS #
(for NCDOT use only)
1a. Type(s) of approval sought from the Corps:
I7 Section 404 Permit (wetlands, streams and waters, Clean Water Act)
� Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What type(s) of permit(s) do you wish to seek authorization?
�J 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
rJ 401 Water Quality Certification - Regular
r Non-404 Jurisdictional General Permit
r 401 Water Quality Certification - E�ress
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?*
Art C. King
1b. PrimaryContact Email:*
[e-mail]
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
� Owner r Applicant (other than owner) rJ AgenUConsultant
(Check all that apply)
2. Owner I nformation
2a. Name(s) on recorded deed:
i NCDOT Highway Division 8
2b. Deed book and page no.:
NA
2c. Responsible party:
(for Corporations)
NCDOT
2d.Address
Street Address
902 North Sand Hills Blvd
Address Line 2
��
Aberdeen
Fbstal / Zip Code
27281
2e. Telephone Number:
(xxx)xxx-xxxx
[phone]
State / Ftovince / F�gion
NC
Country

2f. Fax Number:
[phone]
(xxx)x�c-�ocx
2g. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
4b. Business Name:
(if applicable)
4c. Address
Street Address
Address Line 2
��
Fbstal / Zip Code
4d. Telephone Number:
(xxx)xxx-xxxx
4e. Fax Number:
(xxx)xxx-xxxx
4f. Email Address:*
[e-mail]
SYate / Rovince / F�gion
Country
AgentAuthorization Letter*
Rease provide the Agent Authorization Letter if you are subrritting this docurrent.
I Agent Authori�tion.pdf 28.11 KB
FlLE 7YF� MJST BE f�F
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Bridge #19 Chatham County
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Carbonton
1d. Driving directions*
IF it is a new project and can not easily be found in a GPS rrapping system Rease provide directions.
Take Hwy NC 42 west from Sanford approx. 9.5 miles. The bridge is located at the Lee, Chatham county line.
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)

2b. Propertysize:
(in acres)
2c. Project Address
Street Address
Address Line 2
Qty
Fbstal / Zip Code
State / FYovince / F�gion
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 e>cample, 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:*
35.51985 -79.34835
I ex:34.208504 -77.796371
3. SurFace Waters
3a. Name of the nearest body of water to proposed project:*
Deep River
3b. Water Resources Classification of nearest receiving water:*
WS-IV, HQW
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:*
� Rural agricultural, residential. Adjacent to a Railroad crossing, and a public area with a conservation easement.
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)
qick the upload button or drag and drop files here to attach docurrent
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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
Fle type rrust be pdF
4d. List the total estimated acreage of all existing wetlands on the property:
none
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
200ft
4f. Explain the purpose of the proposed project:

Bridge #19 in Chatham County is considered structurally deficient and functionally obsolete according to Federal
Highway Administration standards. NCDOT proposes to replace Bridge #19 with a new structure that is in
compliance with currents standards for safety and drivability.
4g. Describe the overall project in detail, including the type of equipment to be used:
The project involves replacing a 6 span 330-foot bridge with a 3 span 340-foot concrete girder bridge on ebsting
alignment. All traffic will be detoured off-site during construction. Standard road building equipment, such as
i trucks, dozers, cranes, drilling rigs, track hoe, and motor grader will be used.
4h. Please upload project drawings for the proposed project.
Gick the upload button or drag and drop files here to attach docurrent
I Chatham 19 full plan set.pdf 21.91 MB
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5. Jurisdictional Determinations
Sa. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
C� Yes C' No !' Unknown
Comme nts:
A Wetland and stream Delination was done. Data forms attached.
Sb. If the Corps made a jurisdictional determination, what type of determination was made? *
C' Preliminary C' Approved C' Unknown C' WA
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:
R. Sullivan & W. Sullivan
Kimley Horne & Asso.
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5d1. Jurisdictional determination upload
C7ick 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 �' 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.
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 r Buffers
� Open Waters � 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*
Bank Stabilization P Fill Deep River
I N�p label (e.g. Road F2rrranent (F)
CYossing 1) or Terrporary
��
Causeway
construction
N�p label (e.g. Fd�ad
Qossing 1)
T Dewaterin "
F2rrranent (F) g
or Terrporary
��
3e. Stream Type * 3f. 3g. Stream 3h. Impact
Jurisdictior�idth* length*
type *
Perennial Both
F2rennial (F82) or interrrittent
(If�
Perennial Both
F2rennial (F8� or interrrittent
QfVn
"" 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:
35
3i. Total temporarystream impacts:
84
3i. Total stream and tributary impacts:
119
3j. Comments:
75 35
Average (feet) (linear feet)
75 84
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.
E. Impact Justification and Mitigation

1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
No deck drains will be used on the bridge to eliminate direct discharge into the stream. Grass shoulders and
slopes will be used to promote infiltration and sheet flow. The erosion control for the project has been designed to
sensitive watershed standards. See attached permit drawings and stormwater managment plan for additional
minimization measures.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Traffic will be maintained via an off-site detour during construction. Best Management Practices (BMPs) will be
utilized during construction to attempt to reduce the stormwater impacts to the receiving streams due to erosion
and runoff. Construction of the bridge will be accomplished using causeways, as no other practical option ebsts to
minimize disturbance to the river. Causeways will be constructed in phases to minimize the total concurrent impact
to the river. A shallow rockline precludes the use of temporary work bridges.
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:
All in stream impacts for causeway construction is temporary. Permanent are for bank stabilization only
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:
See Attached Storm-water Management plan, wtiich is part of the bridge survey report document .
1c. What is the overall percent imperviousness of this project?
33
%
1d. Who will be responsible for the review of the Stormwater Management Plan?*
r Certified Local Government
r DWR 401 & Buffer Permitting Branch
2. Diffuse Flow Plan
r DEMLR Stormwater Review
�J 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
C•' No
If no, explain why:
The project is within the Cape Fear River Basin. The project is outside of the B. Everett Jordan Lake watershed.
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 �' 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 �' No
1c. If you answered "yes" to the above, has the document review been finalized by the State Clearing House? (If so, attach a copy of the
NEPAor SEPAfinal approval letter.)*
C' Yes C•' No
Comments:*
Biological Opinion for Sec. 7 consultation Submitted to The US Army Corp of Engineers for the presence of the
Cape Fear Shiner (Notropis mekistocholas).
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.
Direct replacement of an existing structure with only a minor deviation in anticipated usage, and a reduction of in
I water structures (interior bents)..
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.
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?*
�' Yes l" No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
C� Yes �' No
5c. If yes, indicate the USFWS Field Office you have contacted.
I Raleigh
5d. Is another Federal agency involved?*
C' Yes C•' No �' Unknown

5e. Is this a DOT project located within Division's 1-8?*
C� Yes C' No
Sj. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
USF&W and NC Heritage data websites.
i Direct contact with USF&W Field Office (Raleigh)
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
Are there submerged aquatic vegetation (SA� around the project vicinity?*
C' Yes C' No C' Unknown
Will this project affect submerged aquatic vegetation?*
C' Yes
C' No
C' Unknown
�' E�lain
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
Consultation with USF&W.
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? *
� NCDOT PEDA Human Environment unit
NC SHPO
7c. Historic or Prehistoric Information Upload
Gick the upload button or drag and drop files here to attach docurrent
PA 17-07-0026 No Archaeology Survey Required Br No 19 Chatham Lee Cos NC 42
868.66KB
Deep River Carbonton Dam.pdf
17-07-0026_NoHistPropsAffected.pdf 6.78M6
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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:
The project has been coordinated through the Memorandum of Agreement between the North Carolina
Department of Transportation and the North Carolina Floodplain Mapping Program (FEMA delegated authority).
8c. What source(s) did you use to make the floodplain determination?*
NCDOT Hydraulics Unit Coordination with FEMA.
NCDOT Bridge Survey Report (BSR attached)

Miscellaneous attachments not previously requested.
Gick the upload button or drag and drop files here to attach docurrent
Plan_Sheets_Chatham 19.pdf
180019 2017 SF-180019 DEEP RIVER NC42.pdf
Data form location map.pdf
WA-UP.pdf
SA_NCDWR stream data form.pdf
20171205_BO_signed_Bridge 180019.pdf
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Signature
*
rJ By checking the box and signing below, I certify that:
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■ 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:*
Art C. King
Signature
�4r'1' C. �('f��
Date :
current_date
Initial Review
Is this project a public transportation project? *(')
r 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*
20171597
Version#*
1
Reviewing Office *
Central Office - [phone]
Select Project Reviewer*
April Norton:eads\arnorton