20180331 Ver 1_PCN Form Submission_20180308

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 3/8/2018 9:40:48 AM (Start Event)
Accept by Carpenter,Kristi 3/8/2018 10:41:49 AM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: March 13, 2018 5:00 PM
3/8/2018 9:41 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.71
(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.
14 - Linear transportation
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: C' Yes �' No
For the record onlyfor Corps Permit: 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
C Yes l" No
Acceptance Letter Attachment
Qick the upload button or drag and drop files here to attach docurrent
17BP.5.R.71 FINAL DMS acceptance letter.pdf
RLE TYFE MJST BE FDF
1f. Is the project located in anyof NC's twentycoastal counties?'�
f Yes r No
64.15KB
1h. Is the project located in a designated trout watershed?*
f Yes r No
Link to trout information: http://wrwv.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?
rJ Owner r Applicant (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.:
2c. Responsible party:
(for Corporations)
2d. Address
Street Address
2612 N. Duke Street
Address Line 2
a�y
Durham
Fbstal / Zip Code
27704
2e. Telephone Number:
(xxx)xxx-xxxx
[phone]
2f. Fax Number:
State / Rovince / f�gion
NC
Country
USA

(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Replacement of Bridge 340025 over Middle Creek on SR 1203 (Green Hill
Road)
1b. Subdivision name:
('rf appropriate)
1c. Nearest municipality/ town:*
Franklinton
1d. Driving directions*
IF it is a new project and can not easily be found in a GPS rrapping system Rease provide directions.
From Franklinton, drive west on NC 56. Turn right on SR 1203 (Green Hill Road) and travel to project site.
2. Project Identification
2a. Propertyldentification Number:
(tax F1N or parcel ID)
Parcel Numbers: 006933. 008653 and 009445.
2b. Propertysize:
(in acres)
2.2 acre
2c. Project Address
Street Address
near 1988 Green Hill Road
Address Line 2
a�y
Franklinton
Fbstal / Zip Code
27525
2d. Site coordinates in decimal degrees
State / Fhovince / F�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 how the location was determined. (For example, most mobile phones with GPS provide locational precision in decimal degrees to
map coordinates to 5 or 6 digits after the decimal place.)
Latitude:'�
36.17234
ex:34.208504
3. Surface Waters
Longitude:*
-78.48706
-77.796371
3a. Name of the nearest body of water to proposed project:*
Middle Creek
3b. Water Resources Classification of nearest receiving water:*
28-15; 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:*
Existing conditions include �nrooded land and maintained shoulder.
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.71 usgs map.pdf 172.68K6
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)
C7ick the upload button or drag and drop files here to attach docurrent
17BP.5.R.71 soil survey.pdf
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4d. List the total estimated acreage of all existing wetlands on the property:
0.05 ac
4e. List the total estimated linear feet of all existing streams on the property:
(interrritterd and perennial)
180 linear feet
198.34K6
4f. Explain the purpose of the proposed project:*
Replacement of Bridge 340025 over Middle Creek on SR 1203. The ebsting bridge is structurally deficient and will
be replaced on a new alignment to the south of the existing bridge and adjacent roadway. This is done to provide
for a safer facility and eliminates a sharp curve at the bridge. The existing bridge is a two span bridge (1 @ 35.5 ft,
1@ 30.5 ft) with interior steel piles in the stream channel and will be replaced with a t�nro span bridge (1 @ 35 ft, 1
@ 85 ft) that completely spans Middle Creek.
4g. Describe the overall project in detail, including indirect imapacts and the type of equipment to be used:*
Replacement of Bridge 340025 over Middle Creek on SR 1203 (Green Hill Road). Roadway and bridge are to be
constructed on new location to the south of the ebsting bridge and roadway. There should be no indirect impacts
to the stream or wetlands from this project. Equipment may include grader, bull dozer, crane, drill rig, etc.
4h. Please upload project drawings for the proposed project.
C7ick the upload button or drag and drop files here to attach docurrent
Fle type rrust be pdf
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas? *
l•' Yes f" No C' Unknown
Comme nts:
Delineated by A>dom Environmental on 9/29/16.
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
C' Preliminary f Approved f' Unknown C' f�UA
Corps AID Number:
6carrple: SAW-2017-99999

5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:
Phillip Perkinson
Axiom Environmental, Inc.
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
PJD package sent to USACE and NCDENR DWR via email on 11/15/16. Site visit conducted by A�dom Environmental personnel and Eric
Alsmeyer (USACE) on 12/16/16. Info from Axiom indicates that the delineation was verbally approved during the site visit.
5d1. Jurisdictional determination upload
C7ick the upload button or drag and drop files here to attach docurrent
Fle type rrust be FCF
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 C' 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 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.
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
fJ Wetlands fJ Streams-tributaries �7 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*
Site 1 P Bottomland Hardwood
Nbp label (e.g. F�ad Qossing 1- CLlvert, F2rrranent (F'� a Forest
dewatering, etc) Terrporary (�
Site 1 P Bottomland Hardwood
N�p label (e.g. Fd�ad C7ossing 1- CLlvert, F2rrranent (P) or Forest
dewatering, etc) Terrporary (�
2g. Total Temporary Wetland Impact
0.000
2g. Total Permanent Wetland Impact
0.050
2g. Total Wetland Impact
0.050
2h. Comments:
Project will result in both permanent fill and mechanized clearing impacts.
2d. Wetland name *2e. 2f. Type of 2g. Impact
Forested* Jurisdicition* area*
Fill Yes Both 0.040
(404, 10) or CM�R(401, (acres)
other)
Mech. Clear Yes Both 0.010
(404, 10) or GNR(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 3c. Type of impact* 3d. Stream name *
impact * type *
Site 1 P Bank Stabilization Middle Creek
N�p label (e.g. Finad Qossing 1) F�rrranent (P� or
Terrporary (�
Site 7 T Dewatering Middle Creek
N�p label (e.g. Finad Qossing 1) F2rrranent (P� or
Terrporary (�
3e. Stream 3f. Type of 3g. Stream 3h. Impact sqfe�
Type* Jurisdiction* width* length*
Perennial Both 30 92 2
F2rennial (�) or Average (feet) Qinearfeet) ,
interrrittent (IfV� �
6
0
Perennial Both 30 20 6
F2rennial (FS2) or Average (feet) (linear feet) 0
interrrittent (IfVn �
"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:
92
3i. Total temporary stream impacts:
20
3i. Total stream and tributary impacts:
112
3j. Comments:
Project will require installation of Class II rip rap bank stabilization which results in both permanent and temporary
stream impacts.
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
r Other
6b. Impact Type * 6c. Per or
Temp*
Site 1 allowable bridge P
Location and 6cerrpt, Allowable, allowable w/ F�rrranent (�) or
rritigation Terrporary (�
Site 7 allowable road crossing P
Location and Exerrpt, Allowable, allowable w/ F�rrranent (P� a-
rritigation Terrporary (�
6h. Total buffer impacts:
6d. Stream name *
Middle Creek
Middle Creek
Zone 1 Zone 2
Temporary impacts: 0.00 0.00
6e. Buffer mitigation
required?*
No
No
6f. Zone 1
impact*
6,337
(squarefeet)
7,047
(squarefeet)
6g. Zone 2
impact *
7,666
(squarefeet)
2,028
(square feet)

Permanent impacts:
Total buffer impacts:
6i. Comments:
Zone 1
7,378.00
Zone 1
7,378.00
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
Qick the upload button or drag and drop files here to attach docurrent
17BP.5.R.71 FINAL permit drawings.pdf
Fle mast be FDF
Zone 2
3,694.00
Zone 2
3,694.00
E. Impact Justification and Mitigation
1. Avoidance and Minimization
3.93MB
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
Ebsting bridge has timber abutments directlly adjacent to water's edge with steel piles in the middle of Middle
Creek. The new bridge completely spans Middle Creek on new alignment to the south. Fill slopes have been
minimized to reduce wetland fill impacts.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Removal of the e�sting bridge will require permanent stabilization with Class II rip rap on the west bank.
Construction of the new bridge placed new drilled shafts very near the top of east bank. The Department proposes
to install Class II rip rap bank stabilization to prevent future scour and erosion along the streambank at these
locations. All these activities will be monitored and reviewed by Department personnel and an attempt will be made
to reduce the amount of rip rap installed on the streambanks. Only the minimal amount of rip rap will be installed to
provide long-term stability.
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
2c. If yes, mitigation is required by (check all that apply):
r DWR rJ Corps
2d. If yes, which mitigation option(s) will be used for this project?
r Mitigation bank �J Payment to in-lieu fee program
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached.
fJ Yes
4b. Stream mitigation requested:
Qinear feet)
0
4c. If using stream mitigation, what is the stream temperature:
4d. Buffer mitigation requested (DWR only):
(square feet)
0
4e. Riparian wetland mitigation requested:
r Permittee Responsible Mitigation

(acres)
0.05 ac
4f. Non-riparian wetland mitigation requested:
(acres)
4g. Coastal (tidal) wetland mitigation requested:
(acres)
4h. Comments
Project will require mitigation of wetland 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?
f• Yes r 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 SM/VT)
r Wetland Swale (higher SMNT)
fJ 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
C7ick the upload button or drag and drop files here to attach docurrent
17BP.5.R.71 SWMP.pdf 140.87KB
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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? *
C•' Yes �' 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 (NEPAISEPA)?*
C Yes l" 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.)*
C' Yes C•' No

Comme nts: *
The document has not been reviewed by the 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 (15A NCAC 2H .1300), or
DWR Surface Water or Wetland Standards or Riparian Buffer Rules (15A NCAC 2B .0200)?*
l' Yes C•' No
2b. Is this an after-the-fact permit application?*
f 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 qualit�i?*
C' Yes b' No
3b. If you answered "no," provide a short narrative description.
Project only involves replacement of structurally deficient bridge. There is no anticipated growth in development as
a result of this action.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
f Yes f No f•' 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? *
G Yes �' No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
C•' Yes C' No
Sc. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. Is another Federal agency involved?*
C•' Yes f No
What Federal Agency is involved?
USFWS
5e. Is this a DOT project located within Division's 1-8?*
C•' Yes f No
f 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 federally protected species. Biological Conclusions of May Affect, Not
Likely to Adversely Affect the dwarf wedgemussel and proposed yellow lance and No Effect for Tar River
spinymussel. A BC of MALTAA has been reached for the northern long-eared bat. Surveys were conducted on site
for Michau�fs sumac with no individuals observed on site.
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? *
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)?*
f Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources? *
Evaluation by NCDOT personnel and consultation with State HPO office.
7c. Historic or Prehistoric Information Upload
C7ick the upload button or drag and drop files here to attach docurrent
Structure 340025 Franklin No Archaeological Survey Required Form.pdf 1.48M6
Structure 340025 Franklin No Historical Structure Survey Req.pdf 3.55MB
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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 FEMArequirements:
Consultation between PEF hydro design engineer and NCDOT hydraulics unit.
8c. What source(s) did you use to make the floodplain determination?*
FEMA mapping
Miscellaneous
Miscellaneous attachments not previously requested.
C7ick the upload button or drag and drop files here to attach docurrent
17BP.5.R.71 FINAL USFWS concurrence approval letter.pdf 42.58KB
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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:*
Christopher A. Murray
Signature
cr�r:s �t�y
Initial Review

Is this project a public transportation project?* (')
C•' 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 *
20180331
Version#*
Reviewing Office *
Central Office - [phone]
Select Project Reviewer*
Rob Ridings:eads\rgridings
Is a payment required for this project?*
C' No payment required
f• Fee received
f Fee needed - send electronic notification