20171622 Ver 1_PCN Form Submission_20171219

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 12/18/2017 5:40:52 PM (Start Event)
Accept by Carpenter,Kristi 12/19/2017 11:07:01 AM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: December 21, 2017 5:00 PM
12/18/2017 5:41 PM

E-PCN Submittal
���
�lulslaa af Water Resources
Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
December 15, 2017 Ver 2.2
*
Please note: fields marked with a red asterisk below are required. You will not be ab/e to submit the form until all mandatory questions are ans�red.
Also, if at any point you wish to print a copy of the E-PCN, all you need to do is right-click on the document and you can print a copy of the form.
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:*
Washington
Is this project a public transportation project? *(')
C�' Yes C' No
Is this a NCDOT Project?*
r Yes C' No
(NCDOT only) T.I.P. or state project number:
B-5601
WBS #
45556.1.1
(for NCDOT use only)
1a. Type(s) of approval sought from the Corps:*
rJ Section 404 Permit (wetlands, streams and waters, Clean Water Act)
fJ Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What type(s) of permit(s) do you wish to seek authorization?*
fJ Nationwide Permit (NWP)
r Regional General Permit (RGP)
Nationwide Permit (NWP) Number: 03 - Maintenance
Nationwide Permit (NWP) Number: 12 - Utility Lines
NWP Number Other:
List all MNnurrbers you are applying for not on the drop down list.
1c. Type(s) of approval sought from the DWR:*

check all that apply
ri 401 Water Quality Certification - Regular r 401 Water Quality Certification - E�ress
r Non-404 Jurisdictional General Permit 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: �' Yes C•' No
For the record only for Corps Permit: �' Yes C�' 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 �' No
1f. Is the project located in anyof NC's twentycoastal counties?*
C� Yes �' No
1g. Is the project located within a NC DCM Area of Environmental Concern (AEC)?*
C•' Yes C' No C' Unknown
1h. Is the project located in a designated trout watershed?*
C' Yes �' No
Link to trout information: http://�wwv.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Agency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact?*
Clay Willis
1b. Primary Contact Email:*
[e-mail]
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
r Owner rJ Applicant (other than owner) r Agent/Consultant
(Check all that apply)
2. Owner I nformation
2a. Name(s) on recorded deed:
NCDOT
2b. Deed book and page no.:
NC State ROW
2c. Responsible party:
(for Corporations)
i NCDOT Division One
2d.Address

Street Address
118 Airport Drive Suite 100
Address Line 2
Qty
Edenton
Fbstal / Zip Code
27932
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:
3c. Business Name:
(if applicable)
3d.Address
Street Address
Address Line 2
�Y
Fbstal / Zip Code
3e. Telephone Number:
(xxx)xxx-xxxx
3f. Fax Number:
(xxx)xxx-xxxx
3g. Email Address:*
[e-mail]
State / R-ovince / I�gion
NC
Country
USA
State / Rovince / F�gion
Country
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Washington Bridge # 11
1b. Subdivision name:
(if appropriate)
n/a

1c. Nearest municipality/town:*
I Roper
1d. Driving directions*
If it is a new project and can not easily be found in a C� rrapping system Rease provide directions.
I Take NC 32 east from Pea Ridge, then turn right on NC 308, travel appro�mately 1.2 miles and the bridge site is located over Kendrick
Creek (Mackeys Creek)
2. Project Identification
2a. Propertyldentification Number:
(t�vc RN or parcel ID)
NCDOT ROW
2b. Propertysize:
(in acres)
2 acres
2c. Project Address
Street Address
NC 308 , approximately 1.2 miles west of intersection with NC 32 and NC 308
Address Line 2
C7ty State / R-ovince / F�gion
Roper(Mackeys) NC
Fbstal / Zip Code Country
27970 USA
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:* Longitude:*
35.930139 -76.609811
ex:34.208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Kendrick Creek ( Mackeys Creek )
3b. Water Resources Classification of nearest receiving water:*
"SC"
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Pasquotank
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 e�asting conditions consist of NC 308 and the bridge structure over Kendrick Creek. The adjacent land use is
characterized by wooded floodplain, agriculture, rural residential, and a commercial saw mill operation. There is
also a marina and boat yard located 0.25 miles downstream of the bridge site.
4b. Attach an 8 1/2 X 17 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
Location Map.pdf
Fle type rrust be pdf
545.84KB
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)
aick the upload button or drag and drop files here to attach docurrent
B-5601 Soils Map.pdf
Fle lype rrust be pdF
4d. List the total estimated acreage of all existing wetlands on the property:
0.50 acres
4e. List the total estimated linear feet of all existing streams on the property:
(interrrdtent and perennial)
100 feet
4f. Explain the purpose of the proposed project:*
4.15M6
The purpose of this project is to replace an aging bridge structure that has received deficiency ratings, qualifying it
for replacement. NCDOT wants to maintain NC 308 as a safe and reliable travel way for the public. This route is an
important corridor for residents and commercial use in Washington County.
4g. Describe the overall project in detail, including indirect imapacts and the type of equipment to be used:*
This project will use a top down construction technique and stay within the footprint of the existing ROW. An off-
site detour route will be used during construction. A portion of the e�asting bridge will be used as a work bridge for
the project. This will be accomplished by adding 2 to 3 steel H-pile crutch bents within the foot print of the existing
bridge. Crane mats will then be placed on the bridge deck to even the weight load. The e�asting 7 span
wooden/concrete bridge @ 255 ft. X 26 ft. bridge will be replaced, with a new 5- span concrete bridge structure
measuring 300 ft. X 33 ft. Upon completion of the structure, NCDOT will have to rebuild the roadway approaches
on either end of the bridge. This will involve some minor widening of the roadway bridge approaches and some
bank stabilization along the roadway shoulder. There will be some utility relocations required with the bridge
replacement. This includes a 6" waterline, which will be bored from high ground to high ground, under Kendrick
Creek, on the north side of the bridge. There will also be a telephone and fiber optic line relocated in the shoulder
of the e�sting road, on the south side of the roadway, but no relocation within the boundary of Kendrick Creek (no
boring). There are no impacts associated with the utility relocations. The proposed bridge replacement is
illustrated on the attached permit drawings. The project will be built using cranes, excavators, backhoes, dump
trucks and small equipment associated with bridge construction.
4h. Please upload project drawings for the proposed project.
aick the upload button or drag and drop files here to attach docurrent
B5601_Permit Drawing_Wetland_171218.pdf 1.28M6
Fle type rrust be pdF
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
G 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' fWA
Corps AID Number:
6carrple: SAVu2017-99999

Sc. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:
RachelBeauregard
VHB
Sd. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Delineation was done by VHB consulting in May 2016, the delineation was reviewed by NCDOT (Clay Willis).
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.
None
D. Proposed I m pacts I nventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
rJ Wetlands r Streams-tributaries r 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.
2a. Site #- Reason for impact* 2b. Impact type * 2c. Type of wetland *
Approach fill
N�p label (e.g. Fd�ad Qossing 1- Qalvert,
dewatering, etc)
Hand Clearing
N�p label (e.g. 13�ad CXossing 1- CLlvert,
dewatering, etc)
Excavation
N�p label (e.g. F�ad Qassing 1- Qalvert,
dewatering, etc)
Approach fill
N�p label (e.g. Finad Qossing 1- CUNert,
dewatering, etc)
Hand Clearing
N�p label (e.g. I�ad Q�ossing 1- Qalvert,
dewatering, etc)
P
F�rrranent (P� or
Terrporary (�
T
F2rrranent (P� or
Terrporary (�
T
f�rrranent (P� or
Terrporary (�
P
F2rrranent (P� or
Terrporary (�
T
F2rrranent (P� or
Terrporary (�
Riverine Swamp
Forest
Riverine Swamp
Forest
Riverine Swamp
Forest
Riverine Swamp
Forest
Riverine Swamp
Forest
2d. Wetland name *2e. 2f. Type of 2g. Impact
Forested* Jurisdicition* area*
Site 1 Yes Both 0.001
(404, 10) or C7J�R(401, (acres)
other)
Site 1 Yes Both 0.010
(404, 10) or C7�NR(401, (acres)
other)
Site 1 No Both 0.001
(404, 10) or CJ�NR(401, (acres)
other)
Site 2 Yes Both 0.002
(404, 10) or DJVR(401, (acres)
other)
Site 2 Yes Both 0.020
(404, 10) or CXNR(401, (acres)
other)

2a. Site #- Reason for impact* 2b. Impact type * 2c. Type of wetland*
IApproach fill
N�p label (e.g. I�ad Qossing 1- Qalvert,
dewatering, etc)
Hand Clearing
N�p label (e.g. Road Qassing 1- Qalvert,
dewatering, etc)
Excavation
fv�p label (e.g. Id�ad Q�ossing 1- CLlvert,
dewatering, etc)
Approach fill
N�p label (e.g. F�ad Qossing 1- QaNert,
dewatering, etc)
Hand Clearing
N�p label (e.g. Fd�ad Q-ossing 1- Qalvert,
dewatering, etc)
P Riverine Swamp
F�rrranerd (P� or Forest
Terrporary (�
T Riverine Swamp
F2rrrenent (P'j or Fol'est
Terrporary (�
T Riverine Swamp
F2rrranent (Pj or Fol'est
Terrporary (�
P Riverine Swamp
F�rrrener�t (P� or Forest
Terrporary (�
T Riverine Swamp
FBrrranerd (P'j or Forest
Terrporary (�
2d. Wetland name *Ze. 2f. Type of 2g. Impact
Forested* Jurisdicition* area*
Site 4 Yes Both 0.001
(404, 10) or CANR(401, (acres)
other)
Site 4 Yes Both 0.008
(404, 10) or D�NR(401, (acres)
other)
Site 4 No Both 0.002
(404, 10) or C7�NR(401, (acres)
other)
Site 5 Yes Both 0.001
(404, 10) or C7�NR(401, (acres)
other)
Site 5 Yes Both 0.040
(404, 10) or d�NR(401, (acres)
other)
2g. Total Temporary Wetland Impact
0.081
2g. Total Permanent Wetland Impact
0.005
2g. Total Wetland Impact
0.086
2h. Comments:
The temporary Hand Clearing impacts and excavation areas will be allowed to revert back to vegetated wetland
status, following project completion.
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:*
The design of this bridge has incorporated avoidance and minimization through the use of 2:1 side slopes in the
wetland areas. This has reduce the fill footprint of the bridge approach. The new bridge is eliminating the need of
2 interior support bents in Kendrick Creek. The old bridge has 7 support bents and the new structure will have 5
support bents. The new bridge is 45 ft. longer than the e�sting one, which is allowing NCDOT to restore
appro�amately 0.06 acres of floodplain area. The new bridge design does not have storm water deck drains, the
storm water is routed off the bridge and discharged into the adjacent wetlands. The utility relocations have
avoided all wetland impacts by utiliang upland boring points for the water line relocation. NCDOT is using an off-
site detour to eliminate the need for an on-site secondary bridge to carry traffic during construction.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
NCDOT will use a Top Down construction technique to rebuild the bridge. They will also use the e�sting structure
as a temporary bridge to build the new structure. This will be done by adding 2-3 steel H-beam crutch bents under
the existing spans, and use crane mats on the bridge deck to disperse the crane load. This method eliminates the
need to build a v�rork bridge adjacent to the existing structure. The old bridge will be removed following NCDOT
guidelines for bridge removal. We will have an approved erosion control plan, which will be implemented and
maintained throughout the life of the project.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
i 2a. Does the project require Compensatory Mitigation for impacts to Waters of the U.S. or Waters of the State?
f Yes C•' No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
NCDOT has avoided and minimized to the maximum extent practicable and permanent impacts associated with this bridge replacement are
0.005 acres.

F. Stormwater Management and Diffuse Flow Plan (required by DWR)
"` Recent changes to the stormwater rules have required updates to this section ."*
1. Diffuse Flow Plan
1a. 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
For a list of options to meet the diffuse flow requirements, click here.
If no, explain why:
Project is in the Pasquotank River Basin
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
C� Yes C' No
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 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 �' No
Comments:*
Project is covered the Minimum Criteria Checklist - SEPA
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
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.
Project is a maintenance project, replacing an e�sting bridge on NC 308. The project will not increase activity in
the area, but only maintain the existence of NC 308 connectivity in Washington County
4. Sewage Disposal (DWR Requirement)

4a. Is sewage disposal required by DWR for this project? *
C' Yes C' No �' 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 c' 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 r No
5e. 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?*
USFWS - County Listings
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?*
NMFS - listing
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?*
i NC SHPO
7c. Historic or Prehistoric Information Upload
C7ick the upload button or drag and drop files here to attach docurrent
16-02-0141_NoSurvey.pdf 2.58M6
B-5601 Washington No Archaeological Survey Required Form.pdf 2.29M6
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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?*
�' Yes C' No
8b. If yes, explain how project meets FEMA requirements:

Hydraulic engineer designed to meet current standards and criteria.
8c. What source(s) did you use to make the floodplain determination?*
i NC Flood Map
Miscellaneous
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:*
Clay Willis
Signature
��.l.�r� �f�(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
C' No
BIMS # Assigned*
20171622
Version#*
1
Reviewing Office *
Washington Regional Office - [phone]
Select Project Reviewer*
Garcy Ward:eads\gpward
Is a payment required for this project?*
C� No payment required
f Fee received
C' Fee needed - send electronic notification