20171650 Ver 1_PCN Form Submission_20171221

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 12/21/2017 10:58:35 AM (Start Event)
Accept by Carpenter,Kristi 12/21/2017 2:39:15 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: December 26, 2017 5:00 PM
12/21 /2017 10:59 AM

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:*
Warre n
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-5687
WBS #
45641.1.1
(for NCDOT use only)
1a. Type(s) of approval sought from the Corps:*
rJ Section 404 Permit (wetlands, streams and waters, Clean Water Act)
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?*
fJ Nationwide Permit (NWP)
r Regional General Permit (RGP)
Nationwide Permit (NWP) Number: 03 - Maintenance
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
r% 401 Water Quality Certification - Regular r 401 Water Quality Certification - E�ress
r Non-404 Jurisdictional General Permit rJ 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 C•' No
1h. Is the project located in a designated trout watershed?*
f Yes C•' No
Link to trout information: http://w�nn�v.saw.usace.army.mil/Missions/Regulatory-Permit-PrograrrUAgency-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:
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
��
Durham
Fbstal / Zip Code
27704
2e. Telephone Number:
State / R-ovince / F�gion
NC
Country
USA

(xxx)x�c-xxxx
[phone]
2f. Fax Number:
(xxx)x�c-�ocx
2g. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Replacement of Bridge 920043 over Shocco Creek on SR 1620 (Lickskillet
i Road)
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Warrenton
1d. Driving directions*
If it is a new project and can not easily be found in a GPS rrapping system Rease provide directions.
Take US 1 north from Raleigh, take US 501 north to Louisburg, turn right and take NC 561 north/east in Louisburg, turn left an take NC 58
north, turn left and travel north west on Parktown Road and turn left and travel south on Lickskillet Road to project site.
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)
2951533861, 2951785866 and 2951690870
2b. Propertysize:
(in acres)
1.96
2c. Project Address
Street Address
near 1853 Lickskillet Road
Address Line 2
��
Warrenton
Fbstal / Zip Code
27589
2d. Site coordinates in decimal degrees
State / Rovince / F�gion
NC
Country
USA
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:*
36.27072
ex:34208G04
Longitude:*
-78.13063
-77.796371

3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Shocco Creek
3b. Water Resources Classification of nearest receiving water:*
28-79-22; Class C NSW
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Tar-Pamlico
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:*
Wooded land and scattered residential housing.
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
B-5687 usgs topo.pdf 145.84KB
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
B-5687 soil map.pdf 223.9K6
Fle type rrust be pdF
4d. List the total estimated acreage of all existing wetlands on the property:
0.09 ac
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
140 feet perennial
4f. Explain the purpose of the proposed project:*
Replacement of Bridge 920043 (eight-span) 121 foot long bridge due to bridge deterioration. Bridge currently has
a sufficiency rating of 53.2 out of 100 and is considered functionally obsolete. Replacement bridge is a three-span
bridge that is 135 feet long. The new bridge will span Shocco Creek.
4g. Describe the overall project in detail, including indirect imapacts and the type of equipment to be used:*
Replacement of Bridge 920043 with a newthree span bridge. Equipment will include backhoe, mini excavator,
dump trucks, crane, etc.
4h. Please upload project drawings for the proposed project.
C7ick the upload button or drag and drop files here to attach docurrent
B-5687 FINAL Culled plans for environmental permitting.pdf 4.4MB
Fle type rrust be pdf
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
C•' Yes �' No !' Unknown
Comments:
Yes by A�dom Environmental, Inc. on 9/19/16.

5b. If the Corps made a jurisdictional determination, what type of determination was made? *
C' Preliminary C' Approved �' Unknown C' fWA
Corps AID Number:
Exarrple: SAV�2017-99999
SAW-2016-02509
Sc. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:
Sandy Smith
Auiom Environmental, Inc.
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
I Delineation visit w/ Eric Alsmeyer on 12/13/16
5d1. Jurisdictional determination upload
C7ick 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 r No !' 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 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):
rJ Wetlands rJ Streams-tributaries rJ Buffers
r 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 *
Site 1 P
N�p label (e.g. Road Qossing 1- Qalvert, F2rrrnnent (P� or
dewatering, etc) Terrporary (�
Site 1 P
N�p label (e.g. I�ad Qossing 1- CLlvert, F2rrranent (P� or
dewatering, etc) Terrporary (�
Bottomland Hardwood
Forest
Bottomland Hardwood
Forest
2d. Wetland name *2e. 2f. Type of 2g. Impact
Forested* Jurisdicition* area*
Fill Yes Both 0.070
(404, 10) or CMR(401, (acres)
other)
Mech. Clear Yes Both 0.080
(404, 10) or L7�ft(401, (acres)
other)

2g. Total Temporary Wetland Impact
0.000
2g. Total Permanent Wetland Impact
0.090
2g. Total Wetland Impact
0.090
2h. Comments:
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 for 3b.lmpact
impact * type *
Site 1 P
N�p label (e.g. Fd�ad Q-ossing 1) F2rrranent (Fj or
Terrporary (�
Site 1 T
N�p label (e.g. I�ad Qossing 1) F2rrrenent (P'j or
Terrporary (�
3c. Type of impact* 3d. Stream name *
Bank Stabilization Shocco Creek
Dewatering Shocco Creek
3e. Stream
Type *
Perennial
F�rennial (F�2) or
interrrittent (IfV�
Perennial
F2rennial (FH�) or
interrrittent (INn
"" 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:
142
3i. Total temporarystream impacts:
20
3i. Total stream and tributary impacts:
162
3j. Comments:
3f. Type of
Jurisdiction *
Both
Both
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.
r Neuse
r Catawba
r Goose Creek
r Other
6b. Impact Type *
Site 1 allowable bridge
Location and C errpt, Allowable, allowable w/
rritigation
6c. Per or
Temp*
P
F�rrranerd (P� or
Terrporary (�
�J Tar-Pamlico
r Randleman
r Jordan Lake
6d. Stream name * 6e. Buffer mitigation
required?*
Shocco Creek No
3g. Stream 3h. Impact
width* length*
20 142
Average (feet) (linear feet)
20 20
Average(feet) (linearfeet)
6f. Zone 1
impact*
5,159
(square feet)
6g. Zone 2
impact*
214
(squarefeet)

6b. Impact Type *
Site 1 allowable road crossing
Location and Exerrpt, Allowable, allowable w/
rritigation
6h. Total buffer impacts:
Temporary impacts:
Permanent impacts:
Total buffer impacts
6i. Comments:
6c. Per or
Temp*
P
F�rrranerd (P� or
Terrporary (�
Zone 1
0.00
Zone 1
5,572.00
Zone 1
5,572.00
6d. Stream name *
Shocco Creek
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
aick the upload button or drag and drop files here to attach docurrent
B-5687_Permit_Drawings_20171017. pdf
Fle rrust be FDF
Zone 2
0.00
Zone 2
1,830.00
Zone 2
1,830.00
E. Impact Justification and Mitigation
1. Avoidance and Minimization
6e. Buffer mitigation
required?*
No
4.28M6
6f. Zone 1
impact*
413
(square feet)
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
Project involves removal of e�asting eight span bridge and replacement with a three span bridge that will span
Shocco Creek. Minimization efforts are fully outlined in attached NCDOT-prepared Biological Assessment.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
I Department will attempt to minimize wetland and stream impacts during construction inspection of project.
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:
Use of Nationwide Permit 3 does not require compensatory mitigation.
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
6g. Zone 2
impact*
1,616
(square feet)
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 C' No

1 b. All buffer impacts and high ground impacts require diffuse flow or other form of stormwater treatment. If the project is subject to a
state implemented riparian buffer protection program, include a plan that fully documents how diffuse flow will be maintained.
All Stormwater Control Measures (SCM)s must be designed in accordance with the NC Stormwater Design Manual. Associated
supplement forms and other documentation shall be provided.
What type of SCM are you providing?
� Level Spreader
rJ Vegetated Conveyance (lower SMNT)
r Wetland Swale (higher SMNT)
r Other SCM that removes minimum 30% nitrogen
(check all that apply)
For a list of options to meet the diffuse flow requirements, click here.
Diffus Flow Documentation
Gick the upload button or drag and drop files here to attach docurrent
B-5687 stormwater management plan.pdf
Fle type rrust be FDF
2. Stormwater Management Plan
143.48KB
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?*
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:*
MCDC completed for the 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 r No
2b. Is this an after-the-fact permit application?*
C' Yes C•' 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 C•' No

3b. If you answered "no," provide a short narrative description.
I Project only involves replacement of deficient bridge.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project? *
C' Yes G No C' f�/A
� 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
5c. If yes, indicate the USFWS Field Office you have contacted.
I Raleigh
5d. Is another Federal agency involved?*
C' Yes C� No
5e. Is this a DOT project located within Division's 1-8?*
C•' 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?*
I Tree clearing impacts will be reported on the department-maintained database for compliance with Northern long-
eared bat. Project has biolocical conclusions of MALTAA for dwarf wedgemussel and MANLTAA for Tar River spiny
mussel, yellow lance and Atlantic pigtoe. Project went through formal consultation with USACE and USFWS.
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)
I 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)?*
f Yes C•' No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
State HPO coordination
7c. Historic or Prehistoric Information Upload
aick the upload button or drag and drop files here to attach docurrent
16-06-0061 Hist Arch NoSurvey.pdf 1.75M6
B-5687 Warren No Archaeological Survey Required Form.pdf 5.08M6
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8. Flood Zone Designation (Corps Requirement)
I Link to the FEMA Floodplain Maps: https://msc.fema.gov/portal/search

8a. Will this project occur in a FEMA-designated 100-year floodplain?*
G Yes C' No
8b. If yes, explain how project meets FEMA requirements:
Bridge designed by NCDOT Hydraulics Unit
8c. What source(s) did you use to make the floodplain determination?*
Available mapping
Miscellaneous
Miscellaneous attachments not previously requested.
aick the upload button or drag and drop files here to attach docurrent
B-5687 BA_Final.pdf 9.23M6
USFWS signed BO.pdf 433.26KB
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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:*
Christopher A. Murray
Signature
Gh�JS �t/�r4Y
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*
20171650
Version#*
Reviewing Office*
Central Office - [phone]
Select Project Reviewer*
Rob Ridings:eads\rgridings
Is a payment required for this project?*
C� No payment required
f Fee received
C' Fee needed - send electronic notification