20170117 Ver 2_PCN Form Submission_20180108

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 1/8/2018 11:49:00 AM (Start Event)
Accept by Carpenter,Kristi 1/8/2018 3:11:25 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: January 11, 2018 5:00 PM
1 /8/2018 11:49 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:*
M oore
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-5758
WBS #
45714.1.1
(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: 14 - Linear transportation
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 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 l" No
Acceptance Letter Attachment
Gick the upload button or drag and drop files here to attach docurrent
ILF SR 1102 - Bridge 13 (B-5758) - Division 8- STR - RW - LU 03.pdf 59.49KB
FlLE TYFE MJST BE FflF
1f. Is the project located in anyof NC's twentycoastal counties?*
C' Yes �' No
1h. Is the project located in a designated trout watershed?*
C' Yes C' No
Link to trout information: http://www.saw.usace.army.mil/Missions/Regulatory-Permit-PrograrrUAgency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact?*
Art King
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 Highway Div.8
2b. Deed book and page no.:
NA
2c. Responsible party:
(for Corporations)
2d.Address

Street Address
902 North Sandhills Blvd.
Address Line 2
Qty
Aberdeen
Fbstal / Zip Code
28315
2e. Telephone Number:
(xxx)xxx-xxxx
[phone]
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
If other please specify.
3b. Name:
3c. Business Name:
(if applicable)
3d.Address
Street Address
Address Line 2
Qty
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
State / Rovince / F�gion
Country
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Moore County Bridge #13
1b. Subdivision name:
(rf appropriate)
1c. Nearest municipality/town:*

Pinebluff
1d. Driving directions*
If it is a new project and can not easily be found in a GPS rrapping system Rease provide directions.
HWY. US 1 South approx. 1 mile past Pinebluff, then left on to Addor Rd. The bridge is approx. 1.3 miles from the intersection.
2. Project Identification
2a. Propertyldentification Number:
(tax RN or parcel ID)
2b. Propertysize:
(in acres)
2c. Project Address
Street Address
Address Line 2
�Y
Fbstal / Zip Code
State / Rovince / 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�mple, 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:*
35.0817
ex:34.208504
3. Surface Waters
Longitude:*
-79.4624
-77.796371
3a. Name of the nearest body of water to proposed project:*
Aberdeen Creek
3b. Water Resources Classification of nearest receiving water:*
C
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:*
Structurally deficient bridge in a rural residential area.
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
Moore Bridge #13 topo.pdf 1.18M6
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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
Bridge 13 Moore Soil Map.pdf 7.48MB
Fle type rrust be pdF
4d. List the total estimated acreage of all existing wetlands on the property:
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
4f. Explain the purpose of the proposed project:*
To replace a structurally deficient bridge with a cast in place two barrel box culvert.
4g. Describe the overall project in detail, including indirect imapacts and the type of equipment to be used:*
Traffic will be detoured off-site and erosion and sedimentation control measures will be installed. Water will be
diverted around the construction area and the old bridge will be removed and replaced with a 3@14'x9' re-
enforced concrete boxed culvert. The channel will then be excavated and realigned for lowflowshaping, and a
floodplain bench with stabilization will be established on each bank. Water will be pumped around the work area
during construction by installed impervious dikes upstream and downstream of the existing bridge. Pumped water
between dikes will be directed into a stilling basin. Equipment to be used include a track, hoe, dump, truck, paving
equipment, pumps, and various hand tools.
4h. Please upload project drawings for the proposed project.
Gick the upload button or drag and drop files here to attach docurrent
02 B-5758 Complete Set.pdf 2.6MB
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5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
C� Yes �' No �' Unknown
Comments:
I Data form attached
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
C' Preliminary C' Approved C' Unknown C' f�UA
Corps AID Number:
I Exarrple: SAV�2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:
K. Hamlin, E. Webster
SEPI Engineering
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
March 1, 2016
I Sd1. Jurisdictional determination upload
aick 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
6b. If yes, please give the DWR Certification number or the Corps Action ID (exp. SAW-0000-00000).
SAW-2017-00418
Project History Upload
Gick the upload button or drag and drop files here to attach docurrent
Fle type rrust be FDF
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 I m pacts I nventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
� Wetlands fJ Streams-tributaries r 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 * 2d. Wetland name *Ze. 2f. Type of 2g. Impact
Forested* Jurisdicition* area*
i Fill P Bottomland Hardwood Unknown Yes Corps 0.010
N�p label (e.g. I�ad Qossing 1- Qalvert, F�rrranent (P� or Forest (404, 10) or D�NR(401, (acres)
dewatering, etc) Terrporary (� other)
Clearing T
N�p label (e.g. Fd�ad Q-ossing 1- Qalvert, F2rrranerd (P� or
dewatering, etc) Terrporary (�
2g. Total Temporary Wetland Impact
0.020
2g. Total Permanent Wetland Impact
0.010
2g. Total Wetland Impact
0.030
Bottomland Hardwood Unknown Yes Corps 0.020
Forest (404, 10) or aNF2(401, (acres)
other)
2h. Comments:
: 0.03 acres of wetland impacts for construction of toe protection on the upstream side of the culvert -<0.01 acres
of permanent v�tland fill and 0.02 acres of temporary hand clearing of wetlands for a w+ork area.
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 *
1 P
N�p label (e.g. Id�ad Qossing 1) F�rrranent (Fj or
Terrporary (�
3 T
N�p label (e.g. Road Qassing 1) F2rrranent (Fj or
Terrporary (�
4 P
N�p label (e.g. Id�ad Q'ossing 1) F2rrrenent (Pj or
Terrporary (�
3c. Type of impact* 3d. Stream name *
Culvert
Dewatering
Aberdeen Creek
Aberdeen Creek
Bank Stabilization Aberdeen Creek
3e. Stream
Type *
Perennial
F�rennial (�2) or
interrrittent (IfVn
Perennial
F�rennial (F�Z) or
interrrittent (IfV�
Perennial
F�rennial (FH�) or
interrrdtent (If�
"" 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:
126
3i. Total temporarystream impacts:
95
3i. Total stream and tributary impacts:
221
3f. Type of
Jurisdiction *
Corps
Corps
Corps
3j. Comments:
42 LF of permanent stream impacts for culvert installation, and 84 LF of impacts for bank stabilization with rip rap.
95 LF of temporary stream impact from dewatering to install the culvert.
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 proposed project will remove and replace a structurally deficient bridge with a culvert on the same alignment.
I Roadway approach work is minimized as much as is practical to reduce the overall project footprint. An off-site
detour will be used to avoid the need for a temporary parallel structure. Bank stabilization will be minimized to
I those areas where deemed necessary.
3g. Stream 3h. Impact
width* length*
30 42
Average(feet) (linearfeet)
30 95
Average (feet) (linear feet)
30 84
Average (feet) (linear feet)
1b. Specificallydescribe measures taken to avoid or minimize the proposed impacts through construction techniques:*
I Erosion and sedimentation BMPs will be installed prior to construction. Impacts will be minimized by strict
enforcement of Best Management Practices for the protection of surface waters and restrictions against the
staging of equipment in or adjacent to water of the US, and coordination with the Division Environmental Officer.
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?
�' Yes C' No
2c. If yes, mitigation is required by (check all that apply):
r7 DWR �J Corps
2d. If yes, which mitigation option(s) will be used for this project?
� Mitigation bank r% Payment to in-lieu fee program
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached.
�J Yes
r Permittee Responsible Mitigation

4b. Stream mitigation requested:
(linear feet)
42
4c. If using stream mitigation, what is the stream temperature:
4d. Buffer mitigation requested (DWR only):
(squarefeet)
4e. Riparian wetland mitigation requested:
(acres)
4f. Non-riparian wetland mitigation requested:
(acres)
4g. Coastal (tidal) wetland mitigation requested:
(acres)
4h. Comments
6. Buffer mitigation (State Regulated Riparian Buffer Rules) - required by DWR
6a. Will the project result in an impact within a protected riparian buffer that requires buffer mitigation? If yes, you must fill out this entire
form - please contact DWR for more information.
C' Yes C•' No
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:
Cape Fear River basin outside of the Jordan Lake watershed.
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 l" 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)?*

r Yes r No
Comments:*
I Project subject to NC minimum criteria rules.
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)?*
I 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 C•' No
3b. If you answered "no," provide a short narrative description.
In place replacement of an ewsting stream crossing structure that does not change the current roadway usage.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project? *
C' Yes �' 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
Sc. If yes, indicate the USFWS Field Office you have contacted.
i 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?*
Onsite survey by NCDOT staff. USF&W website data.
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?*
USF&W data
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? *
NCDOT PDEA Cultural Resources screening.
NC SHPO screening
7c. Historic or Prehistoric Information Upload
C7ick the upload button or drag and drop files here to attach docurrent
15-11-0014 PA B-5758 No Archaeological Survey Req Form Br 0013 on SR 1102
1.57M6
Addor Rd Moore County.pdf
15-11-0014NoSurveyReq.pdf 2.12M6
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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 �' No
8b. If yes, explain how project meets FEMA requirements:
E�sting roadway has a less than 2-yr hydraulic level of service. Roadway overflow occurs both line ahead and line
back of the ewsting bridge. Several insurable structures are located in the
floodplain both up and downstream of the crossing. In order to comply with all FEMA requirements, roadway
overflow sections must be maintained. In order to accomodate the stream channel,
2@14' lowflowbarrels must be provided, requiring a 17" top slab. Through an iterative process, a roaday profile
was set which approwmates the ewsting horizontal and vertical, and limits the
lowering of existing low chord. Minimal cover has been provided (6" at worst point). Low profile also limits impacts
to wetlands. Stream is well aligned with crossing.
8c. What source(s) did you use to make the floodplain determination?*
i NCDOT Hydraulics study storm water management plan
Miscellaneous
Miscellaneous attachments not previously requested.
C7ick the upload button or drag and drop files here to attach docurrent
04 B-5758_HYD_SMPv2.05_20160627 (Apr 2016).pdf 26.35KB
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Signature
*
rJ 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:*

Art C. King
Signature
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*
20170117
Version#*
2
Reviewing Office*
Central Office - [phone]
Select Project Reviewer*
April Norton:eads\arnorton
Is a payment required for this project?*
C� No payment required
f Fee received
C' Fee needed - send electronic notification