20180118 Ver 1_PCN Form Submission_20180125

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 1/25/2018 12:20:59 PM (Start Event)
Accept by Carpenter,Kristi 1/25/2018 12:56:54 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: January 30, 2018 5:00 PM
1 /25/2018 12:21 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:*
Perquimans
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-5604
WBS #
45559.1.1
(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
Nationwide Permit (NWP) Number: 12 - Utility Lines
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
ri 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 �' No
1g. Is the project located within a NC DCM Area of Environmental Concern (AEC)?*
C•' Yes C' No C' Unknown
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?*
Clay Willis
1b. Primary Contact Email:*
[e-mail]
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
fJ Owner r Applicant (other than owner) r Agent/Consultant
(Check all that apply)
2. Owner I nformation
2a. Name(s) on recorded deed:
NCDOT - ROW US 17 Business
2b. Deed book and page no.:
NCDOT ROW
2c. Responsible party:
(for Corporations)
i NCDOT - Division One
2d.Address

Street Address
113 Airport Drive
Address Line 2
Qty
Edenton
Fbstal / Zip Code
27932
2e. Telephone Number:
(xxx)xxx-xxxx
[phone]
2f. Fax Number:
[phone]
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
State / R-ovince / I�gion
NC
Country
USA
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
B-5604 Bridge # 19 over Brights Mills Creek
1b. Subdivision name:
(if appropriate)
wa
1c. Nearest municipality/town:*
Hertford
1d. Driving directions*
If it is a new project and can not easily be found in a G� rrapping system Rease provide directions.
Take US 17 North into Hertford (Perquimans County), turn left on US 17 Business, travel through the town of Herford and the bridge is
approximately 2.18 miles from the intersection with US 17 Bypass.
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)
US 17 Business - NCDOT - ROW
2b. Propertysize:
I(in acres)
1.25 acres
2c. Project Address
Street Address
US 17-Business (1 mile north of the town of Hertford)
Address Line 2
��
Hertford
Fbstal / Zip Code
27944
2d. Site coordinates in decimal degrees
State / Rovince / I�gion
NC
Country
USA

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:*
36.2029 -76.4571
ex:34.208504 -77.796371
3. SurFace Waters
3a. Name of the nearest body of water to proposed project:*
Brights Mill Creek
3b. Water Resources Classification of nearest receiving water:*
SC
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Pasquotank
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:*
E�sting land use in the vicinity of the project is characterized by residential homes (east side), commercial
property (west side), timberland and row crop agriculture. Bridge # 19 and US 17 Business connect this route
through the town of Hertford and US 17 by-pass.
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)
Gick the upload button or drag and drop files here to attach docurrent
LocationMap_Perquimans19. pdf
Fle type rrust be pdf
fi�i[:l��I 3
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
NRCS_Soil_Map.pdf 797.6KB
Fle type rrust be pdF
4d. List the total estimated acreage of all existing wetlands on the property:
0.50 acres
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
100 ft
4f. Explain the purpose of the proposed project:*
The purpose of this project is to maintain US 17 Business and the bridge crossing over Brights Mill Creek. This
highway is a connector to a major US highway and is used extensively by local citizens and visitors to the town of
Hertford. The current bridge has received low sufficiency ratings, making it eligible for replacement. The current
structure was built in 1939 and nearing the end of a serviceable structure.
4g. Describe the overall project in detail, including indirect imapacts and the type of equipment to be used:*

This project will replace an existing 8 span bridge, measuring 160 ft. X28 ft. , which is comprised of a reinforced
concrete deck on steel I-Beams, with timber caps and piles. The new bridge will be a 4 span precast concrete
structure supported by concrete bents and piles. The new bridge will be 170 ft. X 30 ft. and replaced on the
e�asting alignment. The old bridge will be removed in its entirety following NCDOT's procedures for bridge
demolition and removal. The new bridge will be installed using a top down construction technique and will utilize an
off-site detour to maintain traffic. In conjunction with the bridge replacement the relocation of a 8 inch waterline will
take place on the south side of the bridge. This waterline will be bored under Brights Mill Creek, from high ground
to high ground. There will be no indirect impacts from this bridge replacement. The project is maintaining an
e�asting roadway and will not increase vehicular service or expand access to undeveloped property. Equipment
used during construction will include a crane, excavator, backhoe, dump truck, paving equipment and small tools
typically associated with bridge construction.
4h. Please upload project drawings for the proposed project.
Gick the upload button or drag and drop files here to attach docurrent
B-5604_Permit_Drawing_2017_12_07.pdf 2.25M6
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
Comme nts:
delineated by Clay Willis on Sept. 29, 2016. Wetland lines followthe old fill
slope through the causeway until the topo begins to grade up, out of the
floodplain.
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
C�' Preliminary C' Approved C' Unknown C' WA
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:
Clay Willis
NCDOT - Environmental Supervisor
Sd. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
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
7. Future Project Plans
7a. Is this a phased project?*
C' Yes �' No
C•' No
C' Unknown
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 activit�/? This includes other separate and distant crossing for linear projects that require Department of the
Army authorization but don't require pre-construction notification.

None
D. Proposed I m pacts I nventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
fJ Wetlands r Streams-tributaries r Buffers
fJ 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
Forested* Jurisdicition*
bridge approach fill/ outlet P
pad F�rrranent (P� or
N�p label (e.g. Fd�ad Q-ossing 1- Qalvert, Tenporary (�
dewatering, etc)
work zone hand clearing T
N�p label (e.g. Fd�ad Qossing 1- Qalvert, F2rrrnnent (P� or
dewatering, etc) Terrporary (�
bridge approach fill P
N�p label (e.g. f�ad Q'ossing 1- CLlvert, F2rrranent (P� or
dewatering, etc) Terrporary (�
work zone hand clearing T
N�p label (e.g. F�ad Qassing 1- Qalvert, F�rrranerd (P� or
dewatering, etc) Terrporary (�
bridge approach fill/outlet P
i pad F2rrranent (P� or
N�p label (e.g. F3�ad Q'ossing 1- CLlvert, Terrporary (�
dewatering, etc)
work zone hand clearing T
N�p label (e.g. I�ad Qassing 1- Qalvert, F�rrranent (P� or
dewatering, etc) Terrporary (l)
bridge approach fill/ outlet P
pdd F2rrranerd (P) or
fv�p label (e.g. Id�ad Q�ossing 1- Qalvert, Terrporary (�
dewatering, etc)
work zone hand clearing T
N�p label (e.g. f�ad Qossing 1- Qalvert, F�rrranent (P� or
dewatering, etc) Terrporary (�
Bottomland Hardwood Site 1 No Both
Fo re st (404, 10) or D,NR (401
other)
Bottomland Hardwood Site 1
Forest
Bottomland Hardwood Site 2
Forest
Bottomland Hardwood Site 2
Forest
Bottomland Hardwood Site 3
Forest
Bottomland Hardwood Site 3
Forest
Bottomland Hardwood Site 4
Forest
Bottomland Hardwood Site 4
Forest
2g. Total Temporary Wetland Impact
0.024
2g. Total Permanent Wetland Impact
0.016
2g. Total Wetland Impact
0.040
2h. Comments:
Hand cleared areas will be allowed to revert back a vegetated state, following project completion
2g.lmpact
area*
0.001
(acres)
No Both 0.002
(404, 10) or CMR(401, (acres)
other)
No Both 0.002
(404, 10) or CMR(401, (acres)
other)
No Both 0.008
(404, 10) or d�NR(401, (acres)
other)
No Both 0.009
(404, 10) or CMR(401, (acres)
other)
Yes Both 0.008
(404, 10) or CANR(401, (acres)
other)
Yes Both 0.004
(404, 10) or C�R(401, (acres)
other)
Yes Both 0.006
(404, 10) or C7�NR(401, (acres)
other)
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
impact *
Site 3
N�p label (e.g. Fd�ad Q-ossing 1)
Site 3
fv�p label (e.g. I�ad CYossing 1)
Site 4
N�p label (e.g. Finad Qossing 1)
4b. Impact type * 4c. Name of waterbody*
P Brights Mill Creek
F2rrranent (Fj or (iF applicable)
Terrporary (�
T Brights Mill Creek
F2rrranent (�j or (iF applicable)
Terrporary (�
P Brights Mill Creek
F�rrranent (P� or (iF applicable)
Terrporary (�
4d.Activitytype* 4e.Waterbodytype*4f.lmpact
area*
Stabilization Tributary 0.01
(acres)
Dewatering Tributary
Fill Tributary
4g. Total temporary open water Impacts:
0.03
4g. Total permanent open water impacts:
0.02
4g. Total open water impacts:
0.05
4h. Comments:
temporary surface water impacts are associated with coffer dams around interior bents. These will likely be
needed during forming for concrete work.
E. Impact Justification and Mitigation
I 1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
I This project has avoided and minimized as much as practicable. The fill slopes have been designed to mostly stay
within the existing road shoulders, minimizing wetland impact. The span length of the bridge limits the amount of
interior bents in the water body, reducing the number from the e�asting 7 interior bents to the proposed 3 bents.
Storm water has been routed off the bridge deck onto road shoulders and adjacent wetlands, helping to allowfor
vegetated conveyance.
0.03
(acres)
0.01
(acres)
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
The project will utilize top down construction technique, which eliminates the need for a work bridge. The project
will have an off-site detour set up to maintain traffic. This reduces impact from a on-site detour bridge. During
demolishment of the ebsting bridge, NCDOT follow our BMP's for bridge demolition and removal. An approved
erosion control design will be implemented and maintained on the project, during construction.
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:
wetland impacts have been avoided and minimized to the mawmum extent practicable, resulting in a permanent wetland fill of 0.016 acres
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:
Located in the Pasquotank 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)?*
C' Yes C•' No
Comments:*
Project is covered under the State Minimum Criteria Checklist outlined in NC SEPA.
' 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 �' 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.
Project is only maintaining and existing level of service and will not increase or add vehicle access to adjacent
lands within the project area.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project? *
C' Yes C' No C•' 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 C' No

5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
�' Yes l" 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
�' Unknown
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
USFWS - County List for T& E species
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?*
NOAA -NMFS EFH waters
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?*
SHPO reviewfor archaeological and architecture resources.
7c. Historic or Prehistoric Information Upload
aick the upload button or drag and drop files here to attach docurrent
16-09-0019NoSurveyReq.pdf 2.83M6
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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 C' No
8b. If yes, explain how project meets FEMA requirements:
I Designed by professional hydraulic engineers and the design incorporates all the required FEMA design
requirements.
8c. What source(s) did you use to make the floodplain determination?*
i NC FEMAfloodplain maps
i Miscellaneous
Miscellaneous attachments not previously requested.

C7ick the upload button or drag and drop files here to attach docurrent
NCDMF_moratorium.pdf 286.62KB
WRC_comments.pdf 49.88KB
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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:*
Clay Willis
Signature
C'��y ���rr�r
� 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*
20180118
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