20090290 Ver 1_Application_20090320

'e 2 2009
Office Use Only:
Corps action ID no.
DWQ project no. n cl ? G'2 5
Form Version 1.3 Dec 10 2008
Pre-Construction Notification (PCN) Form
A. Applicant Information
1. Processing
1 a, Type(s) of approval sought from the
Corps:
X Section 404 Permit ? Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number: 3 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps? X Yes No
1d. Type(s) of approval sought from the DWQ (check all that apply):
X 401 Water Quality Certification - Regular Nan-404 Jurisdictional General Permit
? 401 Water Quality Certification - Express X Riparian Buffer Authorization
le. Is this notification solely for the record
because written approval is not required? For th e record only for DWQ 401
Certification:
? Yes X No For the record only for Corps Permit:

? Yes X No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation
of impacts? If so; attach the acceptance letter from mitigation bank or in-lieu
fee program. ? Yes X No
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 In
below. X Yes ? No
1h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ? Yes X No
2. Project Information
2a. Name of project: Pitt 118 B-4235
2b. County: Pitt
2c. Nearest municipality / town: Greenville
2d. Subdivision name: N/A
2e. NCDOT only, T.I.P. or state
project no: 33578
3. Owner Information N/A
3a. Name(s) on Recorded Deed:
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if
applicable):
3d. Street address:
3e. City, state; zip:
3f. Telephone no.:
3g. Fax no.:
3h. Email address:
Page 1 of 11
PCN Form - Version 1.3 December 10, 2008 Version
4. Applicant Information (if different from owner)
4a. Applicant is: X Agent ? Other, specify:
4b. Name: Jay B. Johnson
4c. Business name
(if applicable):
North Carolina Department of Transportation
4d. Street address: P.O. Box 1587
4e. City, state, zip: Greenville, NC 27835
4f. Telephone no.: 252-830-3490
4g. Fax no.: 252-8303341
4h. Email address: [e-mail]
5. Agent/Consultant Information (if applicable) N/A
5a. Name:
5b. Business name
(if applicable):
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. Fax no.:
5g. Email address:
Page 2 of 11
B. Project Information and Prior Project History
1. Property Identification
la . Property identification no. (tax PIN or parcel ID): Pitt 118 84235

1b
. Site coordinates (in decimal degrees): Latitude: N 35.656141 Degrees Longitude:
- W 77.268107 Degrees
(DD.DDDDDD) (-DD.DDDDDD)
1c . Property size: N/A acres
2. Surface Waters
2a . Name of nearest body of water (stream, river, etc.) to
proposed project: Grindle Creek
2b . Water Quality Classification of nearest receiving water: C;NSW
2c. River basin: Tar-Pamlico
3. Project Description
3a . Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
Agriculture,Woodlands,and Residential
3b. List the total estimated acreage of all existing wetlands on the property:
N/A
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
60'
3d. Explain the purpose of the proposed project:
Bridge to Bridge Replacement
3e. Describe the overall project in detail, including the type of equipment to be used:
The Existing Timber Bridge will be replaced with a 21" Cored Slab Bridge with BST Riding Surface.
Excavators,Dump Trucks, Cranes, and Front End Loaders
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations bythe
Corps or State been requested or obtained for this property /
project (including all prior phases) in the past?
Comments:

? Yes X No ? Unknown
4b. If the Corps made the jurisdictional determination, what type
of determination was made? N/A
? Preliminary ? Final
4c. If yes, who delineated the jurisdictional areas?
Name (if known): Agency/Consultant Company:
Other: NCDOT And NCDWQ
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5. Project History
5a. Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
? Yes X No ? Unknown
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project? ? Yes X No
6b. If yes, explain.
Page 3 of 11
. PCN Form -Version 1.3 December 10, 2008 Version
C. Proposed Impacts Inventory
1. Impacts Summary
I a. Which sections were completed below for your project (check all that apply):
Wetlands Streams - tributaries X Buffe rs
Open Waters ? Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this questio n for each wetland area impacted.
2a. 2b. 2c.
Wetland impact 2d. 2e. 2f.

number - Type of impact Type of wetland
Forested Type of jurisdiction
(Corps - 404, 10 Ar
ea of impact
Permanent (P) or (if known)
Temporary (T DWQ - non-404, other) (acres)

W1 X P? T
Wetland Bottomland
Hardwood
X Yes
X Corps
Fill Forest ? No ? DWQ 0.0
W2 ? P ? T ? Yes ? Corps
? No ?DWQ
W3 ? P ? T ? Yes ? Corps
No
?
El DWQ
W4 ? P ? T ? Yes ? Corps
? No ?DWQ
W5 El P ? T 10 Yes El Corps
? No ? DWQ
W6 ? P ? T ? Ye-s---7E] corps
? No ? DWQ
2g. Total wetland impacts 0 Sq.Ft.
2h. Comments: 425 Square Feet of Existing Fill Will Be Removed; 425 Sq.Ft. Credit
3. Stream Impacts N/A
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. 3b. 3c, 3d. f .
' 3g.
Stream impact Type of Impact Stream name Perennial verage
A Impact
number -
Permanent (P) or (PER) or stream length

Temporary (T) intermittent
(INT)? M [
width (linear
(feet) feet)
S1 P ? T PER
? INT
S2 ? P ? T ? PER ? Corps
? INT ? DWQ
S3 ? P ? T ? PER ? Corps
? INT ? DWQ
S4 ? P ? T ? PER ? Corps
? INT ? DWQ
S5 ? P ? T ? PER ? Corps
? INT El DWQ
S6 E] P F-1 T ? PER ? Corps
? INT ?DWQ
3h. Total stream and tributaryimpacts 0.0
3i. Comments:
Page 4 of 11
PCN Form - version 1.3 December 10, 2008 version
4. Open Water Impacts NIA
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individual) list all open water impacts below.'
4a.
Open water
impact number -
Permanent (P) or
Temporary T 4b.
Name of waterbody
(if applicable) 4c.

Type of impact. 4d.

Waterbody type 4e.

Area of impact (acres)
01 ?P?T
02 ?P?T
03 ?P?T
04 ?P?T
4f. Total open water impacts 0.0
4g. Comments:
5. Pond or Lake Construction NIA
If pond or lake construction proposed, then complete the chart below.
5a.

Pond ID 5b.

Proposed use or purpose 5c.
Wetland Impacts (acres) 5d.
Stream Impacts (feet) 5e.
Upland
(acres)
number of pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
5f. Total 0.0
5g. Comments:
5h. Is a dam high hazard permit required?
? Yes ? No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
Page 5 of 11
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If an impacts require mitigation, then you MUST fill out Section D of this form.
6a.
Neuse X Tar-Pamlico ? Other:
Project is in which protected basin? ? Catawba ? Randleman
6b. 6c. 6d. 6e: 6f. 6g.
Buffer impact
number - Reason Buffer Zone 1 impact Zone 2 impact
Permanent (P) or for Stream name mitigation (square feet) (square feet)
Temporary T impact required?

B1 X P ? T Bridge
Constru
Grindle Creek ? Yes
10
725 7,192
ction
X No ,

B2 POT Bridge
Constru ? Yes
ction No
B3 ?P?T ?Yes
? No
6h. Total buffer impacts 10,725 7,192
6i. Comments:
Page '6.of'11
D. Impact Justification and Mitigation
1. Avoidance and Minimization
I a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
The Proposed Bridge Will Be Longer Than The Existing Bridge And Proposed Alignment Is In The Same
Footprint As The Existing Alignment.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Slopes will be Vegetated instead of Rip Rap for Slope Stabilization and Protection and a longer structure
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? ? Yes X No
2b. If yes, mitigation is required by (check all that apply): ? DWQ ? Corps

2c. If yes, which mitigation option will be used for this
project? ? Mitigation bank
? Payment to in-lieu fee program

? Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank N/A
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter) Type Quantity
3c. Comments:
4. Complete if Making a Payment to In-lieu Fee Program NIA
4a. Approval letter from in-lieu fee program is attached. ? Yes
4b. Stream mitigation requested: linear feet
4c. If using stream mitigation, stream temperature: ? warm ? cool ?cold
4d. Buffer mitigation requested (DWQ only): square feet
4e. Riparian wetland mitigation requested: acres
4f. Non-riparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requested: acres
4h. Comments:
5. Complete if Using a Pennittee Responsible Mitigation Plan NIA
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 7 of 11
PCN Form - Version 1.3 December 10, 2008 Version
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) - required by DWQ N/A
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation? ? Yes X No
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.

Zone 6c.
Reason for impact 6d.
Total impact
(square feet)
Multiplier 6e.
Required mitigation
(square feet)
Zone 1 3 (2 for Catawba)
Zone 2 1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund).
6h. Comments:
Page 8 of 11
E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1 a . Does the project include or is it adjacent to protected riparian buffers identified X Yes ? No
within one of the NC Riparian Buffer Protection Rules?
1 b . If yes, then is a diffuse flow plan included? If no, explain why.
Comments: Existing Side Ditches are not Relocated and will diffuse flow ? Yes . X No
through vegetated uplands before entering wetlands
2. Stormwater Management Plan
2a . What is the overall percent imperviousness of this project? 1%
2b. Does this project require a Stormwater Management Plan? X Yes No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
There Are No Drain Holes On The Proposed Bridge. Stormwater Will Be Directed To Drop Inlets At Station 9+65
'
And Station 11+55 And Then Filtered
Through Vegetation and Rip Rap.
? Certified Local Government
2e. Who will be responsible for the review of the Stormwater Management Plan? ? DWQ Stormwater Program
? DWQ 401 Unit
3. Certified Local Government Stormwater Review N/A
3a. In which local governments jurisdiction is this project? . N/A
? Phase II
M. Which of the following locally-implemented stormwater management programs ' NSW
? USMP
apply (check all that apply): ? Water Supply Watershed
? Other:
3c. Has the approved Stormwater Management Plan with proof of approval been ? Yes ? No
attached?
4. DWQ Stormwater Program Review
Coastal counties
? HOW
4a. Which of the following state-implemented stormwater management programs apply ? ORW
(check all that apply):
? Session Law 2006-246
X Other: NPDES Permit
4b. Has the approved Stormwater Management Plan with proof of approval been
attached? ? Yes X No
5. , DWQ.401 Unit Stormwater Review N/A
5a. Does the Stormwater Management, Plan meet the appropriate requirements? X Yes ? No
5b. Have all of the 401 Unit submittal requirements been met? X Yes ? No
Page -9 Pf 11
P.CN Form - Version 1.3 December 10, 2008,Versiori
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
la. Does the project involve an expenditure of public (federal/state/local) funds or the N Yes ? No
use of public (federal/state) land?
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 ? Yes ® No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1 c. 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.) ? Yes ? No
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards, ? Yes N No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after-the-fact permit application? ? Yes O No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in ? Yes N No
additional development, which could impact nearby downstream water quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
N/A
Page 10 of 11
PCN Form - Version 1.3 December 10, 2008 Version
S. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or
Yes ® No
?
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act ? Yes ® No
impacts?
El Raleigh
Sc. If yes, indicate the USFWS Field Office you have contacted.
? Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
North Carolina Department of Transportation Biologists
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? ? Yes ® No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
NC Wildlife Resources Commission
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
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 ? Yes ® No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
North Carolina State Historic Preservation Office
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? ® Yes ? No
8b. If yes, explain how project meets FEMA requirements: The Proposed Bridge is Longer and a Portion of the Existing
Causeway Will Be Removed; Thus Creating a Larger Hydraulic Opening. Reduces Chance of Up-Stream Flooding
8c. What source(s) did you use to make the floodplain determination? NC Flood Mapping

Jay B. Johnson February 25,
2009
Applicant/Agent's Printed Name A C AgerWq Signature Date
(Agent's signature is a id o ly i an a rization letter from the applicant
provided.)
Page 11 of 11
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SHEET NUMBER 28-A OF THE
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W 77.268107 DEGREES
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