20180117 Ver 1_PCN Form Submission_20180125

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 1/24/2018 5:10:07 PM (Start Event)
Accept by Carpenter,Kristi 1/25/2018 10:17:37 AM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: January 29, 2018 5:00 PM
1 /24/2018 5:10 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:*
Pitt
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-4789
WBS #
38559.1.2
(for NCDOT use only)
1a. Type(s) of approval sought from the Corps:*
rJ Section 404 Permit (wetlands, streams and waters, Clean Water Act)
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 MN nurrbers you are applying for not on the drop down list.

Regional General Permit (RGP) Number: 198200031 - NCDOT Bridges, Widening Projects 2015
RGP Number Other:
List all RGP nurrbers you are applying for not on the drop dow n list.
1c. Type(s) of approval sought from the DWR:*
check all that apply
�7 401 Water Quality Certification - Regular
r Non-404 Jurisdictional General Permit
r 401 Water Quality Certification - Express
�J Riparian Buffer Authorization
1d. Is this notification solelyfor the record because written approval is not required?
I For the record only for DWR 401 Certification:
For the record only for Corps Permit:
*
C' Yes C•' No
�' 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 C•' No
1f. Is the project located in any of NC's twenty coastal counties?*
f Yes C•' No
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?*
HeatherLane
1b. Primary Contact Email:*
[e-mail]
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
�J Owner r Applicant (other than owner) r Agent/Consultant
(Check all that apply)
2. Owner I nformation
2a. Name(s) on recorded deed:
2b. Deed book and page no.:
2c. Responsible party:
(for Corporations)
NCDOT
2d.Address

Street Address
Address Line 2
��
Fbstal / Zip Code
2e. Telephone Number:
(xxx)xxx-xxxx
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
State / R-ovince / F�gion
Country
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
B-4789
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Bethel
1d. Driving directions*
If it is a new project and can not easily be found in a C� rrepping system Rease provide directions.
The project is located on Alpine-Taylor Road just southwest of NC-11.
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)
Pitt PIN # 4783224968
2b. Propertysize:
(in acres)
2c. Project Address
Street Address
Allpine-Taylor Rod
Address Line 2
��
Bethel
Fbstal / Zip Code
State / R-ovince / F�gion
NC
Country
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 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:* Longitude:*
i 35.747465 -77.384564
ex:34208504 -77.796371
3. SurFace Waters
3a. Name of the nearest body of water to proposed project:*
Grindle Creek
3b. Water Resources Classification of nearest receiving water:*
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:*
The bridge on Allpine Taylor Road (SR 1424) is being replaced. The ebsting 50' long bridge will be replaced with
a 2 span cored slab bridge with an overall length of 85 feet.
The bridge services an unmarked gravel road that is primarily used for agricultural equipment. The land use in the
vicinity of the bridge replacement project is agricultural crop fields.
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
B-4789 Topo Map.pdf
Fle type rrust be pdf
119.69KB
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-4789 Soil Map.pdf
Fle type rrust be pdF
4d. List the total estimated acreage of all existing wetlands on the property:
NA
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
160
4f. Explain the purpose of the proposed project:*
The project will replace a structurally deficient bridge.
211.72KB
4g. Describe the overall project in detail, including indirect imapacts and the type of equipment to be used:*
The e�sting 50 foot long bridge will be replaced with a 2 span cored slab bridge with an overall length of 85 feet.
Typical heavy construction equipment will be used to remove the e�asting bridge and construct the new bridge.
Rev�rorked driveways will be constructed of earthen material limiting the addition of impervious area to the project
site.
4h. Please upload project drawings for the proposed project.

C7ick the upload button or drag and drop files here to attach docurrent
64789_Permit Drawings_20170913.pdf 1.43MB
B4789_RPC_171211.pdf 2.1 MB
Fle type rrust be pdF
5. Jurisdictional Determinations
Sa. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
C' Yes C' No C' Unknown
Comme nts:
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:
6carrple: SAV�2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:
Sara Easterly
HDR Engineering, Inc.
Jackson Garvey
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Garcy Ward reviewed the project site during the on-site scoping meeting on 1/17/17.
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 �' Unknown
7. Future Project Plans
7a. Is this a phased project?*
f 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):
r Wetlands rJ Streams-tributaries rJ 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 * 3e. Stream 3f. Type of
impact* type* Type* Jurisdiction*
1 T Excavation Grindle Creek Perennial Both
N�p label (e.g. Id�ad Qossing 1) F2rrrenent (Pj or F2rennial (Fffl) or
Terrporary (� interrrittent (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:
0
3i. Total temporarystream impacts:
28
3i. Total stream and tributary impacts:
28
3j. Comments:
Excavation due to existing bridge removal
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 �J Tar-Pamlico
r Catawba r Randleman
r Goose Creek r Jordan Lake
� Other
6b. Impact Type * 6c. Per or
Temp*
Allowable T
Location and 5cerrpt, Allowable, allowable w/ F�rrranerrt (P� or
rritigation Terrporary (�
Allowable T
Location and 6cerrpt, Allowable, allowable w/ F2rrrenent (P'j or
rritigation Terrporary (�
Allowable T
Location and Exerrpt, Allowable, allowable w/ F2rrrenent (Fj or
rritigation Terrporary (�
Allowable T
Location and 5cerrpt, Allowable, allowable w/ F�rrranent (P� or
rritigation Terrporary (�
6h. Total buffer impacts:
6d. Stream name *
Grindle Creek
Grindle Creek
Grindle Creek
Grindle Creek
Zone 1 Zone 2
Temporary impacts: 5,287.00 5,325.00
6e. Buffer mitigation
required?*
No
No
No
No
3g. Stream 3h. Impact
width* length*
20 28
Average (feet) (linear feet)
6f. Zone 1
impact*
401
(square feet)
2,628
(square feet)
858
(square feet)
1,400
(square feet)
6g. Zone 2
impact*
309
(square feet)
1,674
(square feet)
575
(square feet)
2,767
(square feet)

Zone 1 Zone 2
Permanent impacts: 0.00 0.00
Zone 1 Zone 2
Total buffer impacts: 5,287.00 5,325.00
6i. Comments:
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
aick the upload button or drag and drop files here to attach docurrent
64789_Permit Drawings_BUFFER_20170913.pdf 891.68KB
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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:*
Impacts were minimized by maintaining ebsting drainage ditches where feasible. Also, the bridge is being replaced
in place in order to avoid new alignment impacts.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
The two-span arrangement will allowthe substructure to be located out of the main channel flow.
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:
I The project only contains temporary surface water impacts.
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?
r 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?
r Level Spreader
� Vegetated Conveyance (lower SHVVf)
r Wetland Swale (higher SHWT)
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
Fle type rrust be FDF
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?*
r 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)?*
C' Yes C•' No
Comme nts: *
A minimum criteria checklist was prepared for this project, per NCDOT procedures.
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 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 qualit�i?*
C' Yes �' No
3b. If you answered "no," provide a short narrative description.
The e�asting bridge is being replaced in place with no anticipated additional development impacts.
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? *
C' 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?*
�' 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?*
The North Carolina Natural Heritage data base.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
�' Yes �' No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
The National Oceanic and Atmospheric Administration Habitat Conservation Essential Fish Habitat Mapper
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 history and archaeology)? *
C' Yes C•' No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources? *
North Carolina State Historic Preservation Office Web Mapping Application
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
8b. If yes, explain how project meets FEMA requirements:
The bridge opening was enlarged and the proposed road grade was minimally altered to help meet FEMA
requirements.
8c. What source(s) did you use to make the floodplain determination?*
NC Floodplain Mapping flood map service
Miscellaneous
Miscellaneous attachments not previously requested.
C7ick the upload button or drag and drop files here to attach docurrent
Fle rrust be FDF
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:*
John Jamison
Signature
Sign
i 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*
20180117
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