20180095 Ver 1_PCN Form Submission_20180122

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 1/22/2018 3:02:25 PM (Start Event)
Accept by Carpenter,Kristi 1/22/2018 4:05:34 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: January 25, 2018 5:00 PM
1 /22/2018 3:03 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:*
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:
WBS #
15BPR.2
(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: 13 - Bank Stabilization
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 �' 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?*
Heather W. Montague
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 DIV 5
2b. Deed book and page no.:
N/A
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

(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:*
Repairs to Bridge No. 139 and causeway over Lake Gaston on NC 903/SR
1344 (Eaton Ferry 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.
From Warrenton take US 158 E northeast for 8.5mi, then make left onto Dennis Harris Road, then a right onto Old Macon Highway. Then
after 1 mi take the 2nd left onto Eaton Ferry Rd and travel 7mi to project site.
2. Project Identification
2a. Property Identification Number:
(t�vc RN or parcel ID)
2b. Propertysize:
(in acres)
2c. Project Address
Street Address
Bridge No 139 and causeway over Lake Gaston on NC 903/SR 1344 (Eaton Ferry Road)
Address Line 2
��
Littleton
Fbstal / Zip Code
27850
2d. Site coordinates in decimal degrees
State / FYovince / F�gion
NC
Country
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:*
36.517845
ex:34.208504
3. SurFace Waters
Longitude:*
-77.960443
-77.796371

3a. Name of the nearest body of water to proposed project:*
Lake Gaston/Roanoke River
3b. Water Resources Classification of nearest receiving water:*
C
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Roanoke
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:*
Site consists of e�asting bridge and existing causeway over Lake Gaston, surrounded by open waters.
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
NC 903 topo map.pdf
Fle type rrust be pdF
4.29M6
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)
Gick the upload button or drag and drop files here to attach docurrent
Fle type rrust be pdF
4d. List the total estimated acreage of all existing wetlands on the property:
N/A
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
Project is surrounded by open waters of Lake Gaston.
4f. Explain the purpose of the proposed project:*
Bridge No. 139 requires preservation measures for maintaining the structure. Additionally collapsed/scoured
sections of the causeway have left the causeway unstable and guardrail by these areas must be
repaired/replaced.
4g. Describe the overall project in detail, including indirect imapacts and the type of equipment to be used:*
Bridge No. 139 preservation measures include items such as new overlay on the deck, new deck joints, cleaning
and painting of the girders and some concrete repair to the columns and caps. Collapsed/scoured sections of the
causeway will be improved by repairing the slope and adding geotextile fabric rip rap,
for long term stabilization to recreate the existing toe, the causeway will not be e�anded. Where necessary the
guardrail will be repaired or replaced. Equipment used will include, dump trucks, excavator, backhoe, crane,
barge, jon boat or some sort of floating platform, along with support over the bridge rails and beneath the bridge
for access for repairs and for containment and protection of the open water.
4h. Please upload project drawings for the proposed project.
Gick the upload button or drag and drop files here to attach docurrent
15BPR2_GEO_Slope_Repair_1.pdf 199.32KB
15BPR2_GEO_Slope_Repair_2.pdf 389.43KB
15BPR2_GEO_Slope_Repair_3.pdf 352.75KB
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5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
C' Yes C' No f 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:
Exarrple: SAV�2017-99999
wa
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
i N/A
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 �' No C' Unknown
6b. If yes, please give the DWR Certification number or the Corps Action ID (exp. SAW-0000-00000).
SAW-2012-01264
NCDWQ Project No. 20120233
Project History Upload
Qick the upload button or drag and drop files here to attach docurrent
AID SAW-2012-01264.pdf 831.91 KB
NCDWQ Project No. 20120233.pdf 1.17MB
Fle type rrust be FDF
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.
i f�UA
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 r Streams-tributaries r Buffers
r% Open Waters r Pond Construction

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.
4a. Site #- Reason for 4b. Impact type * 4c. Name of waterbody* 4d. Activity type * 4e. Waterbody type *4f. Impact
i impact* area*
Causeway Repair 7 P Lake Gaston/Roanoke River Stabilization Lake 0.06
N�p label (e.g. Road Qossing 1) F2rrrsnent (F) or (if applicable) (acres)
Terrporary (�
Causeway Repair 2 P Lake Gaston/Roanoke River Stabilization Lake 0.07
N�p label (e.g. 13�ad CXossing 1) F�rrranent (� or (if applicable) (acres)
Terrporary (�
I Causeway Repair 3 P Lake Gaston/Roanoke River Stabilization Lake 0.11
N�p label (e.g. F�ad Qassing 1) F2rrranent (P� or (iF applicable) (acres)
Terrporary (�
4g. Total temporary open water Impacts:
0.00
4g. Total permanent open water impacts:
0.24
4g. Total open water impacts:
0.24
4h. Comments:
i Bridge repairs will result in no impacts. Proposal to recreate the existing toe of fill in failed spots not to expand the
footprint of the causeway. Site 1(288FT bank stabilization/2,880SF), Site 2(325FT bank stabilization/3,250SF),
and Site 3(250FT bank stabilization/5,OOOSF).
, 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:*
This project involves maintenance to e�asting causeway and existing bridge. No new impacts are proposed. Only
the minimal amount slope repair and rip rap will be used to restore the causeway for long term stability and so that
the guardrail above these areas can be repaired/replaced.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Standard BMPs will be followed. A turbidity curtain will be use to isolate causeway repairs and containment and
protective measures will be used during the bridge repairs to prevent impacts to open waters.
� 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 C•' No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
This project requires maintenance to existing causeway and e�asting bridge. No new impacts are proposed.
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?
f Yes C•' No
For a list of options to meet the diffuse flow requirements, click here.
If no, explain why:
This project is within the Roanoke River 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)?*
G Yes C' No
1c. If you answered "yes" to the above, has the document review been finalized by the State Clearing House? (If so, attach a copy of the
NEPAor SEPAfinal approval letter.)*
C' Yes C•' No
Comments:*
MCDC will be 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 C•' No
2b. Is this an after-the-fact permit application?*
C' Yes r 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 qualit�i?*
C' Yes �' No
3b. If you answered "no," provide a short narrative description.
I The project is limited to maintenance on the ewsting bridge structure and e�asting causeway.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project? *
C' Yes C' No r 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?*
�' Yes l" 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.
Raleigh
5d. Is another Federal agency involved?*
C� Yes �' No
What Federal Agency is involved?
I US Coast Guard will be sent the in-water traffic control plan for review
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?*
https://ncnhde.natureserve.org/ NLEB protocol for DIV 5 is in place. Site conditions and NHP data reveals there is
no habitat for BE, TSM, DWM, nor Atlantic Pigtoe within the project limits. Additionally no elements of occurrences
e�asts near the project.
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?*
https://vwwv.habitat.noaa.gov/protection/efh/efhmapper/indexhtml
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?*
http://gis.ncdcr.gov/hpoweb/ Additionally since this project is within e�sting previously disturbed area, there is no
risk to Archaeological resources. The project is limited to maintenance on the ebsting bridge and e�sting
causeway.
7c. Historic or Prehistoric Information Upload
aick the upload button or drag and drop files here to attach docurrent
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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 �' No
8c. What source(s) did you use to make the floodplain determination?*
http://�wwv.ncfloodmaps.com/

Miscellaneous
Miscellaneous attachments not previously requested.
C7ick the upload button or drag and drop files here to attach docurrent
NC 903 causeway example photo.pdf 2.38M6
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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:*
� Heather Williams Montague
Signature
f�{�A�- N�+�9+J1".46t��
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*
20180095
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