20180220 Ver 1_PCN Form Submission_20180215

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 2/15/2018 10:18:45 AM (Start Event)
Accept by Carpenter,Kristi 2/15/2018 5:23:20 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: February 20, 2018 5:00 PM
2/15/2018 10:19 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)
January 31, 2018 Ver 2.3
*
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.
https://edocs. deq. nc.gov/WaterResources/0/edoc/624704/PCN%20Help%20File%202018-1-30. pdf
A. Processing Information
County(or Counties) where the project is located:*
Johnston
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-5667
WBS #
45619.3.1
(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 rJ 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?*
Chad Coggins
1b. Primary Contact Email:*
I [e-mail]
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
i � Owner rJ Applicant (other than owner) r AgenUConsultant
(Check all that apply)
2. Owner I nformation
2a. Name(s) on recorded deed:
State of North Carolina(NCDOT)
2b. Deed book and page no.:
2c. Responsible party:
(for Corporations)
2d.Address
Street Address
Address Line 2
�'
Fbstal / Zip Code
I 2e. Telephone Number:
(xxx)xxx-xxxx
2f. Fax Number:
(xxx)xxx-xxxx
State / Rovince / F�gion
Country

2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
3a. Applicant is:
C•' Agent
�' Other
If other please specify.
3b. Name:
Chad Coggins
3c. Business Name:
(if applicable)
3d.Address
Street Address
P.O. Box 3165
Address Line 2
��
Wilson
Fbstal / Zip Code
27828
3e. Telephone Number:
I [phone]
(xxx)xxx-xxxx
3f. Fax Number:
(xxx)xxx-xxxx
3g. Email Address:*
[e-mail]
State / R-ovince / F�gion
NC
Country
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Bridge 500231 SR 2159 Johnston Co.
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Kenly
1d. Driving directions*
If it is a new project and can not easily be found in a C� rrepping system Rease provide directions.
Take NC 222 northwest out of Kenly, drive northwest to Old Stancil Road, turn left driving southwest on Old Stancil Road to intersection with
Bay Valley Road, turn right driving northwest for 1.5 miles to Bridge 500231 over Little Buffalo Creek.
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)

2b. Propertysize:
(in acres)
2c. Project Address
Street Address
Address Line 2
�Y
Fbstal / Zip Code
2d. Site coordinates in decimal degrees
State / FYovince / F�gion
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.)
I Latitude:* Longitude:*
35.64782 -78.1782
ex: 34208504 -77.796371
3. SurFace Waters
3a. Name of the nearest body of water to proposed project:*
Little Buffalo Creek
3b. Water Resources Classification of nearest receiving water:*
C; NSW
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Neuse
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:*
Forestry and Agriculture are the predominate land uses in the vicinity of this project.
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)
Qick the upload button or drag and drop files here to attach docurrent
Wayne 53 topo map.pdf 2.17MB
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)
aick the upload button or drag and drop files here to attach docurrent
Wayne 53 soil map.pdf 1.15M6
Fle lype rrust be pdF
4d. List the total estimated acreage of all existing wetlands on the property:
0.11
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
100

4f. Explain the purpose of the proposed project:*
i Replace bridge 500231 which is structurally deficient for current NCDOT standards.
4g. Describe the overall project in detail, including indirect imapacts and the type of equipment to be used:*
Replace ewsting bridge 500231 which is structurally deficient for current NCDOT standards with an new bridge
meeting these current standards in the existing right-of-way. Heavy road and bridge building equipment will be
used in the construction of this project.
4h. Please upload project drawings for the proposed project.
Gick the upload button or drag and drop files here to attach docurrent
B-5667_PERMIT_DRAWINGS_20180207.pdf 2.14M6
Fle type rrust be pdF
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
G 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:
6carrple: SAVw2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:
Chad Coggins
NCDOT
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
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 �' Unknown
7. Future Project Plans
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 Impacts Inventory

1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
rJ Wetlands rJ Streams-tributaries rJ Buffers
� Open Waters � 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 *
I Site 1 P
N�p label (e.g. Fd�ad Qossing 1- Qalvert, F�rrranent (P) or
dewatering, etc) Terrporary (�
Site 1 P
fv�p label (e.g. I�ad Qossing 1- CLlvert, F2rrranent (P� or
dewatering, etc) Terrporary (�
Site 1 T
N�p label (e.g. F3�ad Q-ossing 1- Qalvert, F�rrrenerd (P� or
dewatering, etc) Terrporary (�
2g. Total Temporary Wetland Impact
0.030
2g. Total Permanent Wetland Impact
0.080
2g. Total Wetland Impact
0.110
2h. Comments:
Riverine Swamp
Forest
Riverine Swamp
Forest
Riverine Swamp
Forest
2d. Wetland name *2e. 2f. Type of 2g. Impact
Forested* Jurisdicition* area*
bridge roadway Yes Both 0.040
fill (404, 10) or D�NR(401, (acres)
other)
bridge roadway Yes Both 0.040
mechanized (aoa,lo)orGNR(4o1, (acres)
clearing other)
bridge roadway Yes Both 0.030
hand clearing (404, 10) or C�R(401, (acres)
other)
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 *
Site 1 bridge fill P
N�p label (e.g. Finad Qossing 1) F2rrranent (Fj or
Terrporary (�
Site 1 interior bent T
N�p label (e.g. f�ad Qossing 1) F2rrranent (P'j or
Terrporary (�
3c. Type of impact* 3d. Stream name *
Fill
De wate ri ng
Little Buffalo Creek
Little Buffalo Creek
3e. Stream
Type *
Perennial
F2rennial (F�Z) or
interrrittent (IfV�
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:
91
3i. Total temporarystream impacts:
40
3f. Type of
Jurisdiction *
Both
Both
3g. Stream 3h. Impact
width* length*
40 91
Average (feet) (linear feet)
40 40
Average(feet) (linearfeet)

3i. Total stream and tributary impacts:
131
3j. Comments:
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
r Catawba
r Goose Creek
I r Other
6b. Impact Type *
Site allowable
Location and C errpt, Allowable, allowable w/
rritigation
6h. Total buffer impacts:
Temporary impacts
Permanent impacts:
Total buffer impacts:
6i. Comments:
6c. Per or
Temp*
P
F2rrranerd (P) or
Terrporary (�
Zone 1
0.00
Zone 1
2,291.00
Zone 1
2,291.00
r Tar-Pamlico
r Randleman
r Jordan Lake
6d. Stream name * 6e. Buffer mitigation
required? *
Little Buffalo Creek No
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
Gick the upload button or drag and drop files here to attach docurrent
B-5667_BUFFER _PERMIT_DRAWINGS_20180213.pdf
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Zone 2
0.00
Zone 2
1,399.00
Zone 2
1,399.00
E. Impact Justification and Mitigation
1. Avoidance and Minimization
1.4MB
6f. Zone 1
impact*
2,291
(square feet)
I 1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
IReplace existing bridge in existing foot print with offsite detours.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
All construction equipment will be staged and operated from upland areas. DOT will also install silt fencing to
protect the streams and wetlands adjacent to the project. Safety fencing will be used to delineate jurisdictional and
environmentally sensitive areas.
6g. Zone 2
impact*
1,399
(squarefeet)

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:
Belowthreshold of significantjurisdictional 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?
C•' Yes C' No
1b. 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. Pssociated
supplement forms and other documentation shall be provided.
What type of SCM are you providing?
r Level Spreader
rJ Vegetated Conveyance (lower SM/VT)
r Wetland Swale (higher SMNT)
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
aick the upload button or drag and drop files here to attach docurrent
B-5667_HYD_SMPv2.07_(20170301) (Oct 2016)_20180213.pdf 46.66KB
Fle lype rrust be FDF
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:*
MCDC available on request.

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 quality?*
C' Yes r No
3b. If you answered "no," provide a short narrative description.
� Replacing ebsting 2 lane bridge with a new 2 lane bridge.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project? *
C' Yes �' No C' f�/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 �' No
Sb. Have you checked with the USFWS concerning Endangered Species Act impacts?*
C' Yes C•' No
5d. Is another Federal agency involved?*
C' Yes C•' No
5e. Is this a DOT project located within Division's 1-8?*
�' Yes �' No
c' Unknown
Sj. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
Freshwater Mussel and Fish Survey Report conducted by Three Oaks Engineering Bio conclusion of No Affect for
the Dwarf Wedgemussel, Tar River Spinymussel, and Yellow Lance. Programmatic BO of MA/LTAA for NLEB.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
C' Yes �' No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
GIS
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? *
HEU clearance
7c. Historic or Prehistoric Information Upload
Gick the upload button or drag and drop files here to attach docurrent
B-5667 16-01-0165_NoSu rveyReq. pdf 1.37M6
B-5667 PA 16-01-0165 Johnston (NSR).pdf 7.19M6
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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:
� MOA
8c. What source(s) did you use to make the floodplain determination?*
FRIS
Miscellaneous
Miscellaneous attachments not previously requested.
Qick the upload button or drag and drop files here to attach docurrent
B-5667 Little Buffalo Mussel & Fish Survey Report.pdf 5.72M6
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.
I Full Name:*
Chad Coggins
Signature
��r����o�r�r.�r.�I

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*
20180220
Version#*
Reviewing Office*
Central Office - [phone]
Select Project Reviewer*
Rob Ridings:eads\rgridings
Is a payment required for this project?*
C' No payment required
�' Fee received
C' Fee needed - send electronic notification