20180326 Ver 1_PCN Form Submission_20180307

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 3/7/2018 11:00:13 AM (Start Event)
Accept by Carpenter,Kristi 3/7/2018 4:32:41 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: March 12, 2018 5:00 PM
3/7/2018 11:00 AM

�� �
�ivislan af Water Resour�es
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 beloware required. You will not be able 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:*
Franklin
Is this project a public transportation project?* (')
C Yes l' No
Is this a NCDOT Project?*
f• Yes r No
(NCDOT only) T.I.P. or state project number:
WBS #
17BP.5. R.69
(for f�D�T use only)
1a. Type(s) of approval sought from the Corps:*
I7 Section 404 Permit (wetlands, streams and waters, Clean Water Act)
I-' 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
NWP Number Other:
List all MN nurrbers you are applying for not on the drop down list.
03 - Maintenance
1c. Type(s) of approval sought from the DWR:*
check all that apply
fJ 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?
For the record onlyfor DWR 401 Certification:
For the record onlyfor Corps Permit:
*
C' Yes r No
C' Yes f' 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
l' Yes r No
1f. Is the project located in anyof NC's twentycoastal counties?*
f Yes �' No
1h. Is the project located in a designated trout watershed?*
C' Yes C No
Link to trout information: http://www.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Agency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact?*
Chris Murray
1b. PrimaryContact Email:*
[e-mail]
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
fJ Owner r P,pplicant (other than owner) r Agent/Consultant
(Check all that apply)
2. Owner I nformation
2a. Name(s) on recorded deed:
NCDOT
2b. Deed book and page no.:
Not available
2c. Responsible party:
(for Corporations)
2d. Address
Street Address
2612 N. Duke Street
Address Line 2
aty
Durham
Fbstal / Zip Code
27704
2e. Telephone Number:
(xxx)xxx-xxxx
[phone]
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
State / Rovince / Region
NC
Cauntry
USA

C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Replacement of Bridge 340020 on SR 1114 (Peach Orchard Road) over
Cedar Creek
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Louisburg
1d. Driving directions*
If it is a new project and can not easily be found in a GP� rrapping system Rease provide directions.
From Raleigh, travel north on US 401. Once in Louisburg, turn left and travel west on NC 56 to SR 1114. Turn left and travel southwest on
SR 1114 to project site.
2. Project Identification
2a. Propertyldentification Number:
(tvc RN or parcel ID)
Parcel ID numbers: 008847, 008587, 027551 and 007448
2b. Propertysize:
(in acres)
1.3 ac
2c. Project Address
Street Address
near 948 Peach Orchard Road
Address Line 2
aty
Louisburg
Fbstal / Zip Code
27549
2d. Site coordinates in decimal degrees
State / Rovince / FZegion
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�mple, most mobile phones with GPS provide locational precision in decimal degrees to
map coordinates to 5 or 6 digits after the decimal place.)
Latitude: *
36.07039
ex:34208504
3. Surface Waters
Longitude:*
-78.38154
-77.796371
3a. Name of the nearest body of water to proposed project:'�
Cedar Creek
3b. Water Resources Classification of nearest receiving water:*
28-29-(2); 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:*
Ewsting conditions include �nrooded land, maintained shoulder and crop land.
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
17BP.5.R.69 USGS map.pdf 177.91K6
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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
17BP.5.R.69 Soil Survey.pdf 197.42K6
Fle type rrust be pdf
4d. List the total estimated acreage of all existing wetlands on the property:
0.06
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
100 linear feet of Cedar Creek
4f. Explain the purpose of the proposed project:*
Replacement of Bridge 20 over Cedar Creek on SR 1114 (Peach Orchard Road). Bridge is structurally deficient
and will be replaced.
4g. Describe the overall project in detail, including indirect imapacts and the type of equipment to be used:*
Replacement of Bridge 20. Ebsting bridge (8 @ 20 ft) spans Cedar Creek and open water channel. Temporary
causeways will be used on the project to facilitate removal of existing piers and concrete apron as well as install
new interior drilled shafts. The proposed structure is a two span bridge (1 @ 91.2 ft and 1@ 86.2 ft) that will span
Cedar Creek. Equipment includes bull dozer, grading equipment, drill rig, crane, etc.
4h. Please upload project drawings for the proposed project.
Qick the upload button a- drag and drop files here to attach document
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5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
C Yes r No �' Unknown
Comme nts:
Delineated by Axiom Environmental on 9/26/16.
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
f" Preliminary �' Approved C•' Unknown f" f�UA
Corps AID Number:
6carrple:SAW-2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Phillip Perkinson
Agency/Consultant Company: Auiom Environmental, Inc.

5c. If 5a is yes, who delineated the jurisdictional areas?
Othe r:
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Delineation verification visit conducted w/ USACE on December 13, 2016 with Phillip Perkinson and Sandy Smith.
5d7. Jurisdictional determination upload
Qick the upload button or drag and drop files here to attach docurrent
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6. Project History
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past? *
f Yes r No �' Unknown
7. Future Project Plans
7a. Is this a phased project?*
l" Yes l•' 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):
I7 Wetlands �J Streams-tributaries rJ Buffers
� 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*
Site 7 P Bottomland Hardwood
N�p label (e.g. Fd�ad Qossing 1- QaNert, F�rrranent (Pj or Forest
dewatering, etc) Terrporary (�
Site 7 P Bottomland Hardwood
N�p label (e.g. Finad Qossing 1- CLlvert, F�rrranent (P� or Forest
dewatering, etc) Terrporary (�
2g. Total Temporary Wetland Impact
0.000
2d. Wetland name *Ze. 2f. Type of 2g. Impact
Forested* Jurisdicition* area*
Fill Yes Both 0.010
(404, 10) or [7J�R(401, (acres)
other)
Mech. Clear Yes Both 0.050
(404, 10) or C7J�R (401, (acres)
other)
2g. Total Permanent Wetland Impact
0.060
2g. Total Wetland Impact
0.060
2h. Comments:
Small permanent fill impacts where bridge embankment covers wetland. Small permanent mechanized clearing
impacts for utility work and installation of EC devices.
3. Stream Impacts

ff 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 P
N�p label (e.g. Finad Qossing 1) F�rrranent (P� or
Teir��orary (�
3c. Type of impact* 3d. Stream name *
Bank Stabilization Cedar Creek
Site 7 T Dewatering Cedar Creek
N�p label (e.g. Fd�ad Qossing 1) F�rrranent (P� or
Teirporary (�
Site 1 T Workpad/Causew Cedar Creek
fV�p label (e.g. f�ad Qossing 1) F2rrrenent (F) or ay
Terrporary (�
3e. Stream
Type'�
Perennial
F2rennial (�) or
interrrittent (IfV�
Perennial
F2rennial (FS2) or
interrrittent (IfV�
Perennial
�rennial (�) or
interrrittent (IfVn
"' All Perennial or Intermittent streams must be verified by DWR or delegated local government.
3f. Type of 3g. Stream 3h. Impact sqfe�
Jurisdiction* width* length*
Both 30 57 1
Average(feet) Qinearfeet) ,
7
7
0
Both 30 10 3
Average(feet) (linearfeet) 0
0
Both 30 36 1
Average(feet) (linearfeet) ,
0
8
0
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
57
3i. Total temporary stream impacts:
46
3i. Total stream and tributary impacts:
103
3j. Comments:
Note the following: 57 linear feet of permanent stream impacts for installation of Class II rip rap bank stabilization;
10 linear feet of temporary stream impacts for upstream/downstream dewatering to install rip rap bank stabilization;
36 linear feet of temporary stream impacts that are concurrent inside of the 57 feet of rip rap bank stabilization.
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 1
N�p label (e.g. Fd�ad Qossing 1)
Site 7
N�ip label (e.g. Fd�ad Oossing 1)
4b. Impact type * 4c. Name of waterbody*
T Open water next to Cedar
F2rrranent(Fjor C�eek
Terrporary (� (if applicable)
P Open water next to Cedar
F2rrranent(Fjor C�eek
Terrporary (� (if applicable)
4g. Total temporary open water Impacts:
0.04
4g. Total permanent open water impacts:
0.01
4g. Total open water impacts:
0.05
4h. Comments:
4d. Activity type * 4e. Waterbody type *4f. Impact
area*
Causeway Other 0.04
(acres)
Stabilization Other 0.01
(acres)

USACE indicated that this feature is open water.
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
r Other
6b. Impact Type *
Site 1 allowable bridge
Location and 6cerrpt, Allowable, allowable w/
rritigation
Site 1 allowable road crossing
Location and 6cerrpt, Allowable, allowable w/
rritigation
6h. Total buffer impacts:
Temporary impacts:
Permanent impacts:
Total buffer impacts:
6i. Comments:
6c. Per or
Temp*
P
F2rrranent ( F) or
Terrporary (�
P
F�rrranent (P� or
Terrporary (�
Zone 1
0.00
Zone 1
4,045.00
Zone 1
4,045.00
r% Tar-Pamlico
r Randleman
r Jordan Lake
6d. Stream name * 6e. Buffer mitigation
required?*
Cedar Creek No
Cedar Creek No
Zone 2
0.00
Zone 2
2,394.00
Zone 2
2,394.00
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
C7ick the upload button or drag and drop files here to attach docurrent
17BP.5.R.69 FINAL Permit drawings.pdf
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E. Impact Justification and Mitigation
`A_�1•7f' ._ �F1'T•�TiT'�►�i � �fl'11' i1F•�if•7i1
3.34M6
6f. Zone 1 6g. Zone 2
impact* impact*
3,693 1,669
(squarefeet) (squarefeet)
352 725
(squarefeet) (squarefeet)
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
New bridge structure effectively spans Cedar Creek. Fill slopes have been reduced to reduce fill in wetland
impacts. Temporary causeways have been reduced to reduce temporary fill in surface waters.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Construction inspection staff will monitor construction to only allow the minimal amount of rip rap to be placed on
the streambank to provide long-term stability. Fill in wetland impacts will be restricted to the amount depicted on
permit drawings. The footprint of the temporary causeways will be monitored to ensure only the minimal amount of
rip rap will be installed to provide access to interior piers.
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?
f Yes �' No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
Project is permitted using Nationwide Permit 3 with wetland and stream impacts less than the amount that requires mitigation.
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?
G 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. Associated
supplement forms and other documentation shall be provided.
What type of SCM are you providing?
r Level Spreader
r Vegetated Conveyance (lower SMNT)
r Wetland Swale (higher SHWT)
�7 Other SCM that removes minimum 30% nitrogen
(checkall that apply)
For a list of options to meet the diffuse flow requirements, click here.
Diffus Flow Documentation
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176P.5.R.69 SWMP.pdf 137.89K6
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2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250? *
f• Yes f 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?*
l•' Yes r 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.)*
f Yes r No
Comme nts: *
Document was not reviewed by State Clearing House
2. Violations (DWR Requirement)

2a. Is the site in violation of DWR Water Quality Certification Rules (15A NCAC 2H .0500), Isolated Wetland Rules (75A NCAC 2H .7300), or
DWR Surface Water or Wetland Standards or Riparian Buffer Rules (75A NCAC 2B .0200)?*
f Yes l•' 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�/?*
f Yes r No
3b. If you answered "no," provide a short narrative description.
Project involves replacement of ebsting bridge with a new bridge. No additional development will occur as a result
of this action.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
f Yes C No C' N/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 l" No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
G Yes �' No
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. Is another Federal agency involved?*
f Yes r 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? *
Informal consultation with USFWS regarding mussel issues. MANLTAA for dwarf wedgemussel and Yellow lance
and No Effect for Tar River spinymussel and Atlantic pigtoe. Surveys for Michau�s sumac indicated no individuals.
BC of MALTAA for Northern-long eared bat.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
f Yes r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat? *
Available mapping.
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 r No

7b. What data sources did you use to determine whether your site would impact historic or archeological resources? *
Coordination with State HPO office
7c. Historic or Prehistoric Information Upload
C7ick the upload button or drag and drop files here to attach docurrent
17BP.5.R.69 No NRHP Archaeological Sites Present Form.pdf 1.98MB
17BP.5.R.69 Historical Structure--NoSurveyReq.pdf 3.14MB
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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?*
f• Yes l" No
8b. If yes, explain how project meets FEMArequirements:
PEF consultation with NCDOT Hydro Unit
8c. What source(s) did you use to make the floodplain determination?*
Info provided by PEF.
Miscellaneous
Miscellaneous attachments not previously requested.
Qick the upload button or drag and drop files here to attach docurrent
176P.5.R.69 FINAL USFWS concurrence approval letter.pdf 44.53KB
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Signature
�7 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 Act°);
■ 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:*
Christopher A. Murray
Signature
cr{�r.s �tc�y
Initial Review
Is this project a public transportation project?* (�)
l•' Yes f No
Change only if needed.
Has this project met the requirements for acceptance in to the review process? *
C•' Yes
C' No

BIMS # Assigned *
20180326
Version#*
Reviewing Office *
Central Office - [phone]
Select Project Reviewer*
Rob Ridings:eads\rgridings
Is a payment required for this project?*
f No payment required
f• Fee received
f Fee needed - send electronic notification