20180148 Ver 1_PCN Form Submission_20180131

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 1/31/2018 7:52:46 AM (Start Event)
Accept by Carpenter,Kristi 1/31/2018 11:28:13 AM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: February 5, 2018 5:00 PM
1 /31 /2018 7:53 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:*
Columbus
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-5699
WBS #
45653.1.1
(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
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?*
Jim Rerko
1b. PrimaryContact 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 6
2b. Deed book and page no.:
N/A
2c. Responsible party:
(for Corporations)
wa
2d.Address
Street Address
500 Transportation Drive
Address Line 2
��
Fayetteville
Fbstal / Zip Code
28301
2e. Telephone Number:
State / Rovince / F�gion
NC
Country
USAS

(xxx)xxx-x�cx
[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:*
Bridge Replacement 230068
1b. Subdivision name:
(if appropriate)
� wa
1c. Nearest municipality/town:*
� Lake Waccamaw
1d. Driving directions*
IF it is a new project and can not easily be found in a G� rrapping system Rease provide directions.
From Whiteville take US 74 east to Hallsboro Rd. Turn right to go south on Hallsboro Rd. to Hallsboro. Turn left to go east on NC 214 for
approwmately 7.5 miles to bridge 230068.
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)
wa
2b. Propertysize:
(in acres)
4 acres
2c. Project Address
Street Address
wa
Address Line 2
�Y
Fbstal / Zip Code
State / Rovince / I�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 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:*
34.322010
ex:34.208504
3. SurFace Waters
Longitude:*
-78.468598
-77.796371

3a. Name of the nearest body of water to proposed project:*
Big Creek
3b. Water Resources Classification of nearest receiving water:*
C; Sw.+
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Lumbe r
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:*
Transportation facility with surrounding undeveloped swamp forest.
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
USGS_Quad_LWE_2016_Bridge_68.pdf 23.07MB
Fle type rrust be pdF
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)
Qick the upload button or drag and drop files here to attach docurrent
Soils_1990_Bridge68.pdf 3.27MB
Fle type rrust be pdf
4d. List the total estimated acreage of all existing wetlands on the property:
2.4 acres
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
147 LF
4f. Explain the purpose of the proposed project:*
Replacement of Bridge 230068
4g. Describe the overall project in detail, including indirect imapacts and the type of equipment to be used:*
Replace 27 span bridge with a 12 span bridge on the same alignment. An off-site detour will be used and top down
demolition and construction will be employed. Track hoes, cranes, dump trucks, bulldozers, paving equipment and
various hand tools will be used.
4h. Please upload project drawings for the proposed project.
C7ick the upload button or drag and drop files here to attach docurrent
I B-5699 Draft Permit Drawings.pdf 3M6
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 !' Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
�' Preliminary �' Approved C' Unknown �' N/A

Corps AID Number:
6carrple: SAV�2017-99999
SAW-2016-00626
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:
Jim Rerko
NCDOT
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
SAW-2016-00626 JD issued on June 27, 2016
5d1. Jurisdictional determination upload
aick the upload button or drag and drop files here to attach docurrent
USACE PJD B-5699.pdf 4.23M6
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
i 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):
r% Wetlands �7 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*
Fill in wetland for road
embankment
N�p label (e.g. Fd�ad Qassing 1- Qalvert,
dewatering, etc)
Excavation in wetland
fv�p label (e.g. I�ad Qossing 1- CLlvert,
dewatering, etc)
P
F�rrranent (P� or
Terrporary (�
P
F2rrranent (Pj or
Terrporary (�
Riverine Swamp
Forest
Riverine Swamp
Forest
2d. Wetland name *Ze. 2f. Type of 2g. Impact
Forested* Jurisdicition* area*
Wetland Aand B Yes Both 0.230
(404, 10) or C)�NR(401, (acres)
other)
Wetland Aand B Yes Both 0.070
(404, 10) or CT�NR(401, (acres)
other)

2a. Site #- Reason for impact* 2b. Impact type * 2c. Type of wetland*
Hand clearing in wetland T
N�p label (e.g. I�ad Qassing 1- Qalvert, F�rrranerd (P� or
dewatering, etc) Terrporary (�
2g. Total Temporary Wetland Impact
0.120
2g. Total Permanent Wetland Impact
0.240
2g. Total Wetland Impact
0.360
Riverine Swamp
Forest
2d. Wetland name *Ze. 2f. Type of 2g. Impact
Forested* Jurisdicition* area*
Wetland Aand B Yes Both 0.120
(404, 10) or CANR(401, (acres)
other)
2h. Comments:
The excavation of 0.6 acre of the central embankment will remove fill soils down to the wetland elevation. Wetland
restoration may result from the excavation to compensate for wetland impacts.
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 *
Bridge piers P
Nl�p label (e.g. Finad Qossing 1) F2rrranent (Pj or
Terrporary (�
Demolition T
N�p label (e.g. f3�ad Q'ossing 1) F2rrranent (P'j or
Terrporary (�
3c. Type of impact* 3d. Stream name *
Fill
Other
Big Creek
Big Creek
3e. Stream
Type *
Perennial
F2rennial (FB�) or
interrrittent (If�
Perennial
F�rennial (FH�) or
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:
82
3i. Total temporarystream impacts:
118
3i. Total stream and tributary impacts:
200
3j. Comments:
Stream permanent impacts from bridge piers are a non-regulated activity.
E. Impact Justification and Mitigation
1. Avoidance and Minimization
3f. Type of
Jurisdiction *
Both
Both
3g. Stream 3h. Impact
width* length*
75 82
Average(feet) (linearfeet)
75 118
Average (feet) (linear feet)
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
Replace bridge in-place was incorporated to minimize impacts. Bridge span lengths have been extended to reduce
number of piers required. Riprap at embankments is minimized to avoid impacts to wetlands and surface waters.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*

NCDOT Best Management Practices for Construction and Maintenance Activities will be employed. Top down
demolition and construction will be used to minimize impacts.
I 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:
Impacts resulting from embankment fill will be off-set by 0.6 acre of embankment removal to wetland elevation. Stream impacts from brige
piers is a non-regulated activity.
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
i Rules?
C' Yes C•' No
For a list of options to meet the diffuse flow requirements, click here.
If no, explain why:
Project is located in the Lumber River Basin
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?*
G 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
NEPA or SEPA final approval letter.) *
C' Yes C•' No
Comments:*
The project is a MCC which doesn't require submittal to the Clearing House
I 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?*

r 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 quality?*
C' Yes C•' No
3b. If you answered "no," provide a short narrative description.
Project involves the replacement of an existing bridge and is not anticipated to affect future development.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project? *
C' Yes C' No �' 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? *
C' Yes �' 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 C•' No
Se. 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?*
NCNHP data and site specific surveys.
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 EFH 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 historyand archaeology)?*
C' Yes �' No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources? *
i See attached "No Effects" determination
7c. Historic or Prehistoric Information Upload

C7ick the upload button or drag and drop files here to attach docurrent
16-01-0039 REVISED PA No Archaeological Survey Req Form, Br 0068 on NC 214
681.88KB
Columbus County.pdf
16-01-0039UPDATE NoSurveyReq.pdf 3.01 MB
Fle rrust be FDF
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:
NCDOT Hydraulics Unit Coordination with FEMA.
8c. What source(s) did you use to make the floodplain determination?*
FEMA FIRM maps
Miscellaneous
Miscellaneous attachments not previously requested.
Gick the upload button or drag and drop files here to attach docurrent
Fle rrust be FDF
Signature
*
fJ 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:*
James J. Rerko, PWS
Signature
� q�� � � �•�
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*
20180148
Version#*
1
Reviewing Office *
Wilmington Regional Office - [phone]
Select Project Reviewer*
Joanne Steenhuis:eads\jhsteenhuis
Is a payment required for this project?*
C� No payment required
f Fee received
C' Fee needed - send electronic notification