20180073 Ver 1_PCN Form Submission_20180112

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 1/12/2018 9:00:33 AM (Start Event)
Accept by Carpenter,Kristi 1/12/2018 5:24:10 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: January 17, 2018 5:00 PM
1/12/2018 9:01 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:*
Montgomery
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:
WBS #
WBS # 17BP.8.R.122
(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:
NA
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 �' 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?*
Art King-Division 8 DEO
1b. Primary Contact 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 Division 8
2b. Deed book and page no.:
2c. Responsible party:
(for Corporations)
Brandon H. Jones, PE Division 8 Engineer
2d.Address
Street Address
I 902 N. Sandhills Blvd.
Address Line 2
��
Aberdeen
Fbstal / Zip Code
28315
2e. Telephone Number:
State / R-ovince / F�gion
North Carolina
Country
United States

(xxx)xxx-x�cx
[phone]
2f. Fax Number:
[phone]
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Replace Bridge 124 over the Little River on SR 1340 (Okeewemee Star
Road).
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Star, North Carolina
1d. Driving directions*
If it is a new project and can not easily be found in a G� rrapping system Rease provide directions.
Take I-40 west to I-73 south; Take I-73/74 south to the town of Star, NC. Take I-73/74 ebt onto SR 1002 (Spies Rd.) and turn right. Take
Spies Rd. to intersection of Alt 220 (Main St.) and turn left. Take Main St. south and turn right onto SR 1340 (Okeewemee Star Rd.); Bridge
124 is located approx. 3.15 miles from intersection of Main St. and Okeev�mee Star Rd.
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)
2b. Propertysize:
(in acres)
1.27
2c. Project Address
Street Address
Address Line 2
�'
Fbstal / Zip Code
State / Rovince / F�gion
Country
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 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:*
35.387250
ex:34.208504
3. Surface Waters
Longitude:*
-79.831314
-77.796371

3a. Name of the nearest body of water to proposed project:*
Little River (From Suggs Creek to Densons Creek) Index #13-25-(11.5)
3b. Water Resources Classification of nearest receiving water:*
C; HQW
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Yadkin-PeeDee
River Basin 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:*
General land use in the project vicinity consists of undeveloped forests, agriculture land, and rural residential
areas.
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)
C7ick the upload button or drag and drop files here to attach docurrent
Bridge124_Topo_20171120.pdf
Fle type rrust be pdf
958.55KB
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
Brid ge 124_Soi Is_20171120. pdf
Fle type rrust be pdf
4d. List the total estimated acreage of all existing wetlands on the property:
0
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
165
�'Z1�:L�:/3
4f. Explain the purpose of the proposed project:*
I Purpose: Replacing a structurally deficient bridge with a new bridge (1 @ 90'; 1@ 50'; 33: Box beam on 4' CAPS)
in place.
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. E�sting bridge
demolition will occur using NCDOT best management practices. The proposed structure will be replaced on its
e�asting alignment with a new 1@ 90'; 1@ 50'; 33: Box beam on 4' CAPS. Water will be pumped around in-stream
areas of new and existing bent construction and demolition by installed impervious dikes. Pumped water between
dikes will be directed in a stilling basin. A temporary causeway will be installed for new interior bent construction.
The causeway will be removed on completion of construction and the stream bed restored to preconstruction
elevations. Equipment to be used includes a track hoe, cranes, dump trucks, 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
610124_Permit Drawings_20171215.pdf 1.94M6
Fle type rrust be pdf
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
C' Yes C' No C' Unknown

Comments:
I Delineations performed on June 1, 2017. No wetlands were identified, Two
perennial streams were identified.
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
C' Preliminary l" Approved C' Unknown C•' N/A
Corps AID Number:
6carrple: SAV�2017-99999
NA
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other
Eric Black, Wendee Smith
SEPI Engineering
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
NA
5d1. Jurisdictional determination upload
aick 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 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.
NA
D. Proposed I m pacts I nventory
1. Impacts Summary
i 1a. Where are the impacts associated with your project? (check all that apply):
� Wetlands I7 Streams-tributaries r Buffers
r Open Waters r Pond Construction
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 3c. Type of impact* 3d. Stream name *
impact * type *
I Bridge crossing P Fill Little River
N�p label (e.g. I�ad Qossing 1) F�rrranent (Fj or
Terrporary (�
Bridge crossing P Bank Stabilization Little River
N�p label (e.g. Road Qassing 1) F2rrranent (Fj or
Terrporary (�
Bridge crossing T Bank Stabilization Little River
N�p label (e.g. I�ad Q'ossing 1) F2rrrenent (Pj or
Terrporary (�
I Bridge crossing T Dewatering Little River
N�p label (e.g. F�ad Qossing 1) F�rrranent (P� or
Terrporary (�
Bridge crossing T Workpad/Causew Little River
N�p label (e.g. Fd�ad Q-ossing 1) F2rrranent (P� or ay
Terrporary (�
3e. Stream 3f. Type of
Type* Jurisdiction*
Perennial Both
F�rennial (�2) or
interrrittent (IfVn
Perennial Both
F�rennial (F�Z) or
interrrittent (IfV�
Perennial Both
F�rennial (FH�) or
interrrdtent (If�
Perennial Both
F�rennial (�) or
interrrittent (IfVn
Perennial Both
F2rennial (F�2) or
irderrrittent (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:
120
3i. Total temporary stream impacts:
88
3i. Total stream and tributary impacts:
208
3j. Comments:
Permanent stream impacts include 32' of fill associated with interior bent construction and 88' of bank stabilization.
Stream bank stabilization typically does not require mitigation.
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 1@90', 1@50' 33" Box Beam
Bridge. Roadway approach work is minimized to reduce the overall project footprint. An offsite detour will be
employed to avoid the need for a temporary parallel structure. Permanent stream impacts are limited to the
installation of a 32' in-channel interior bent and 88' of bank stabili�tion. Temporary stream impacts (total 79') are
associated with causeway construction, dewatering during new in-stream bent construction and ebsting end bent
demolition. and minimal disturbance associated with bank stabilization.
3g. Stream 3h. Impact
width* length*
52 32
Average(feet) (linearfeet)
52 88
Average (feet) (linear feet)
52 15
Average (feet) (linear feet)
52 51
Average(feet) (linearfeet)
52 22
Average (feet) (linear feet)
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Erosion and sedimentation BMPs will be installed prior to construction. Water will be diverted around the work
areas to prevent sedimentation of downstream aquatic resources. Impacts will be minimized by strict enforcement
of Best Management Practices for the protection of surface waters, restrictions against the staging of equipment in
or adjacent to waters of the US and coordination (including a pre-construction meeting) with the Division
Environmental Supervisor.
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:

Total permanent stream impacts do not exceed 150 linear feet threshold. Additionally, stream impacts associated with bank stabilization do
not typically require 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
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
For a list of options to meet the diffuse flow requirements, click here.
If no, explain why:
� Project falls within the Yadkin-PeeDee River Basin which is not a NCDWR Buffer Basin.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
r 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 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:*
I Project meets criteria for Minimum Criteria Determination Checklist (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
I 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.
The proposed project is a bridge replacement project and will not increase access to nearby properties.
4. Sewage Disposal (DWR Requirement)

4a. Is sewage disposal required by DWR for this project? *
C' Yes C' No C•' �1/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?*
G Yes C' No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
C' Yes �' No
5d. Is another Federal agency involved?*
C' Yes �' 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?*
US Fish and Wildlife and NC Natural Heritage Program Data for Schv�init�s sunflov�r, smooth coneflower, red-
cockaded woodpecker (RCW) and bald eagle. RCW surveys were conducted on 3/21/2017, no habitat or RCWs
were observed. Surveys for Schweinitz's sunflower and smooth coneflower were conducted on 8/14/17. No
Schweinit�s sunflov�rs or smooth coneflower were found. Bald eagle surveys were conducted on 8/14/17. No bald
eagles or nests v�re found. No surveys for NLEB were performed. Per the USFWS programmatic biological
opinion (PBO) for NCDOT Divisions 1-8, the programmatic determination for NLEB is May Affect, Likely to
Adversely Affect. The PBO provides incidental take coverage for NLEB and will ensure compliance with Section 7
of the Endangered Species Act for five years.
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?*
i The proposed project takes place in Montgomery County which is not near any coastal or tidal habitat that would
support EFH (i.e. salt marshes, oyster reefs, etc.).
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? *
See attached Historic Architecture and Landscapes "No Survey Required Form" and Archeological resources "No
Survey Required" Form.
7c. Historic or Prehistoric Information Upload
C7ick the upload button or drag and drop files here to attach docurrent
17-03-0021 NoSurveyReq.pdf
AR17-03-0021 NoSurvey2.pdf
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8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https://msc.fema.gov/portal/search
2.87M6
1.35M6

8a. Will this project occur in a FEMA-designated 100-year floodplain?*
r Yes l" No
8b. If yes, explain how project meets FEMA requirements:
MOA Type 2B
8c. What source(s) did you use to make the floodplain determination?*
FEMA FIRM Maps: http://fris.nc.gov/fris/Index.asp�C?FIPS=063&ST=NC&user=General Public
Miscellaneous
Miscellaneous attachments not previously requested.
C7ick the upload button or drag and drop files here to attach docurrent
610124 2017 SF-610124 LITTLE RIVER SR1340.PDF 3.98M6
610124_HYD_SMPv2.07_20170906. pdf 45.41 KB
Cover letter_Bridge 124 over Little River_20171215.pdf 100.92KB
Fle rrust be F�F
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*
20180073
Version#*
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