20171598 Ver 1_PCN Form Submission_20171215

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 12/15/2017 12:15:57 PM (Start Event)
Accept by Carpenter,Kristi 12/15/2017 3:33:41 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: December 20, 2017 5:00 PM
12/15/2017 12:16 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:*
Person
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.5. R.61
(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
r 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?*
Chris Murray
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) r AgenUConsultant
(Check all that apply)
2. Owner I nformation
2a. Name(s) on recorded deed:
i NCDOT
2b. Deed book and page no.:
Not available
2c. Responsible party:
(for Corporations)
2d.Address
Street Address
2612 N. Duke Street
Address Line 2
�Y
Durham
Fbstal / Zip Code
27704
2e. Telephone Number:
(xxx)xxx-xxxx
[phone]
State / Rovince / Region
NC
Country
USA

2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
� Replacement of Bridge 720025 over North Flat River on SR 1144 (Flat River
Church Road)
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Ro�oro
1d. Driving directions*
If it is a new project and can not easily be found in a C� rrapping system Rease provide directions.
Travel north on US 501 towards Ro�oro, turn left on SR 1144 (Flat River Church Road) and drive to project site.
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)
includes A51 20 and A51 80
2b. Propertysize:
(in acres)
1.9 acres
2c. Project Address
Street Address
near 1549 Flat River Church Road
Address Line 2
��
Ro�oro
Fbstal / Zip Code
27574
State / Rovince / F�gion
NC
Country
USA
2d. Site coordinates in decimal degrees
I 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.)
Latitude:*
36.32945
ex:34.208504
3. SurFace Waters
Longitude:*
-79.00201
-77.796371
3a. Name of the nearest body of water to proposed project:*

North Flat River
3b. Water Resources Classification of nearest receiving water:*
27-3-2; WS-III 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:*
Site is comprised of wooded land and residential house with yard.
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
17BP.5.R.61 us topo map.pdf 1.62M6
Fle type rrust be pdF
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.5.R.61 soil survey.pdf 551.71 KB
Fle type rrust be pdf
4d. List the total estimated acreage of all existing wetlands on the property:
0.0
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
120 linear feet of North Flat River
4f. Explain the purpose of the proposed project:
Replacement of Bridge 720025 over North Flat River on SR 1144 (Flat River Church Road)
4g. Describe the overall project in detail, including the type of equipment to be used:
Replacement of two span bridge with new single span bridge
4h. Please upload project drawings for the proposed project.
C7ick the upload button or drag and drop files here to attach docurrent
Fle type rrust be pdF
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
r Yes �' No �' Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
C' Preliminary l" Approved r Unknown l" N/A
Corps AID Number:
Exarrple: SAV�2017-99999

Sc. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:
David Cooper
Ecological Engineering
Sd. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
I Pre-JD request sent by Ecological Engineering to USACE via email on 8/15/16.
5d1. Jurisdictional determination upload
Gick 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 �' 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.
D. Proposed I m pacts I nventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
r Wetlands �J Streams-tributaries N7 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*
Site 1 P Bank North Flat River
N�p label (e.g. Fd�ad F2rrranent (F) StablllZatl
Qossing1) orTerrporary On
��
Site 1 T Workpad/ North Flat River
N�p label (e.g. Fd�ad F2rrranent (F) Cduse Wdy
Qossing1) orTerrporary
i�
3e. Stream Type * 3f. 3g. Stream 3h. Impact
Jurisdictior�idth* length*
type *
Perennial Both
F2rennial (Fff�) or interrrittent
(If�
Perennial Both
F�rennial (Fff� or interrrittent
QfVn
" All Perennial or Intermittent streams must be verified by DWR or delegated local government.
40 72
Average (feet) (linear feet)
40 42
Average (feet) (linear feet)

3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
72
3i. Total temporary stream impacts:
42
3i. Total stream and tributary impacts:
114
3j. Comments:
Temporary causway stream impacts are concurrent inside of permanent bank stabilization impacts
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.
rJ Neuse r Tar-Pamlico
r Catawba r Randleman
� Goose Creek r Jordan Lake
r Other
6b. Impact Type *
6c. Per or 6d. Stream name *
Te mp *
Site 1 allowable P North Flat River
Location and Exerrpt, Allowable, allowable w/ rritigation F�rrranent (F) or
Terrporary (�
Site 1 allowable P North Flat River
Location and C errpt, Allowable, allowable w/ rritigation F2rrranent (P) w
Terrporary (�
6h. Total buffer impacts:
� Temporary impacts
Permanent impacts:
Zone 1
0.00
Zone 1
3,710.00
Zone 2
0.00
Zone 2
7 ,848.00
6e. Buffer 6f. Zone 1 6g. Zone 2
mitigation impact* impact*
required?*
No 3,243 20
(squarefeet) (squarefeet)
No 467 1,828
(square feet) (square feet)

Total buffer impacts
6i. Comments:
Zone 1
3,710.00
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
Gick the upload button or drag and drop files here to attach docurrent
17BP.5.R.61 stream permit drawing.pdf
17BP.5.R.61 buffer permit drawing.pdf
Fle rrust be FDF
Zone 2
1,848.00
E. Impact Justification and Mitigation
1. Avoidance and Minimization
2.04M6
801.54KB
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
The ebsting bridge is a tw+o span bridge. The new design is a single span bridge that will span the North Fork
River. The amount of permanent stream bank stabilization and temporary stream causeway are the minimal
amount necessary to construct a stable roadway and bridge.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Efforts will be made to reduce the footprint of the temporary causeway and permanent streambank stabilization.
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 M itigation, explain why:
The project does not require compensatory mitigation.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1a. Does this project require a Stormwater Management Plan?
�' Yes
C' No
1b. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
Rip rap ditch in SE quadrant replaces and existing unstable ditch. Runoff in the NE quadrant will discharge froma
rip rap pad prior to BZ 2. See stormwater management plan attached to stream permit drawing set.
1c. What is the overall percent imperviousness of this project?
20
%
1d. Who will be responsible for the review of the Stormwater Management Plan?*
r Certified Local Government
ri 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?
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?
r Level Spreader
�J Other BMP
(check all that apply)
Diffused Flow Documentation
Qick the upload button or drag and drop files here to attach docurrent
Fle type rrust be f�F
5. DWR 401 Stormwater Review
5a. Is the Stormwater Management Plan (including BMP Supplemental Forms and Operation and Maintenance Agreements) attached?
r Yes c' No
Stormwater Management Plan Upload
C7ick the upload button or drag and drop files here to attach docurrent
i 176P.5.R.61 stream permit drawing.pdf 2.04M6
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 C' 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 C•' No
Comments:*
Document will be a MCDC.
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 C•' No
3b. If you answered "no," provide a short narrative description.
Project only involves replacement of an e�sting bridge.

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.
The project will not generate sewage.
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
Sc. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
Sd. Is another Federal agency involved?*
C' 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?*
Biological conclusion for Norther long eared bat is MALTAA; habitat may be at site since area contains wooded
land. Biolotical concluson for Dwarf wedgemussel is No Effect based on in-stream survey.
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?*
Available mapping.
' 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 r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources? *
Coordination with State HPO office
7c. Historic or Prehistoric Information Upload
C7ick the upload button or drag and drop files here to attach docurrent
17BP.5.R.61 NoSurveyReq.pdf 3.58M6
17BP.5.R.61 No Survey Required form.pdf 528.33KB
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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:
Detailed method
8c. What source(s) did you use to make the floodplain determination?*
Storwmater management plan
Miscellaneous attachments not previously requested.
Gick the upload button or drag and drop files here to attach docurrent
Fle rrust be FDF
Signature
*
fJ 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.
I Full Name:*
Christopher A. Murray
Signature
c�:� ��y
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*
20171598
Version#*
1
Reviewing Office *
Central Office - [phone]
Select Project Reviewer*
� Rob Ridings:eads\rgridings