20180465 Ver 1_PCN Form Submission_20180402

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 3/29/2018 4:48:31 PM (Start Event)
Accept by Carpenter,Kristi 4/2/2018 2:13:22 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: April 3, 2018 5:00 PM 3/29/2018 4:49 PM

�� �
6fvlslaa of 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 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:*
Person
� Is this project a public transportation project?*
�' Yes C' No
This is any publicly funded by rrunicipal,state or federal funds road, rail, airport transportation project.
Is this a NCDOT Project?*
�' Yes C' No
(NCDOT only) T.I.P. or state project number:
B-5145
WBS #
42306.1.1
(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?*
�J Nationwide Permit (NWP)
r Regional General Permit (RGP)
Nationwide Permit (NWP) Number:
NWP Number Other:
List all MNnurrbers 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
� 401 Water Quality Certification - Regular
r Non-404 Jurisdictional General Permit
r 401 Water Quality Certification - E�ress
r Riparian Buffer Authorization

*
1d. Is this notification solelyfor the record because written approval is not required?
I For the record only for DWR 401 Certification: C•' Yes C' No
i For the record only for Corps Permit: r 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 C•' 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?*
C' Yes C•' No
Link to trout information: http://w�wv.saw.usace.army.mil/Missions/Regulatory-Permit-PrograrrUAgency-Coordination/Trout.aspx
6. Applicant Information
1a. Who is the Primary Contact?*
Chris Murray
1b. Primary Contact Email:*
[e-mail]
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
r Owner r Applicant (other than owner) r Agent/Consultant
(Check all that apply)
� 2. Owner I nformation
2a. Name(s) on recorded deed:
i 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
a�y
Durham
Fbstal / Zip Code
27704
I 2e. Telephone Number:
(xxx)xxx-xxxx
[phone]
2f. Fax Number:
I(x�c)�oc-xxxx
State / R-ovince / F�gion
NC
Country
USA

2g. Email Address:*
I [e-mail]
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
IReplacement of Bridge 50 over South Hyco Creek/Hyco Lake on SR 1343
(John Brewer Road)
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Ro�oro
1d. Driving directions*
IF it is a new project and can not easily be found in a GPS rrepping system Rease provide directions.
From Ro�oro, travel west on US 158, turn right and travel north on SR 1305 (Gardner Road), turn left and travel west on SR 1343 (John
Brewer Road) to project site.
2. Project Identification
2a. Property Identification Number:
(tac RN or parcel ID)
Parcels A15 64; A16 43, A17 58 and A16 44.
2b. Propertysize:
(in acres)
1.1 ac
2c. Project Address
Street Address
near 1670 John Brewer Road
Address Line 2
City State / FYovince / I�gion
Ro�oro NC
Fbstal / Zip Code Country
27574 USA
2d. Site coordinates in decimal degrees
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 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:* Longitude:*
36.4197 7 -79.10421
ex: 34.208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
South Hyco Creek/Hyco Lake

3b. Water Resources Classification of nearest receiving water:*
22-58-(0.5); Class WS-V B
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Roanoke
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 wooded land, maintained shoulder, rock causeway and open water.
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)
Gick the upload button or drag and drop files here to attach docurrent
B-5145 USGS map.pdf 1.69M6
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
B-5145 soil survey.pdf 475.2K6
Fle type rrust be pdf
4d. List the total estimated acreage of all existing wetlands on the property:
0.0
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
75 linear feet along open water banks of South Hyco Creek/Hyco Lake
4f. Explain the purpose of the proposed project:*
Replacement of existing bridge that is structurally deficient. Ewsting structur is a five-span bridge (1 @ 40.9', 3@
i 40', 1@ 40.9'). Replacement structure is a three-span bridge (3 @ 70').
4g. Describe the overall project in detail, including indirect imapacts and the type of equipment to be used:�
I Replacement of existing bridge. No indirect impacts are expected since the project only replaces a tvuo lane bridge
with a two lane bridge. Equipment may include back hoe, bull dozer, crane, mini excavator, excavator, 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 propertyor proposed impact areas?*
�' Yes �' No �' Unknown
Comments:
Delineated by Sara Easterly and Jessica Tisdale on March 10, 2016.
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
C' Preliminary l" Approved �' Unknown f' N/A
Corps AID Number:
Exarrple: SAV�2017-99999

Sc. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:
Sara Easterly and Jessica Tisdale
HDR Engineering
Sd. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
NRTR document indicates that South Hyco Creek was the only jurisdictional feature at the site. No field verification was held with USACE.
5d1. Jurisdictional determination upload
Gick 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 C•' No C' Unknown
7. Future Project Plans
7a. Is this a phased project?*
C' Yes �' 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.
No
D. Proposed I m pacts I nventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
� Wetlands r Streams-tributaries r Buffers
fJ Open Waters r Pond Construction
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. I�ad Qossing 1)
Site 1
fv�p label (e.g. I�ad Qossing 1)
Site 2
Nl�p label (e.g. Id�ad Qossing 1)
4b. Impact type * 4c. Name of waterbody*
P
F2rrrenent (P� or
Terrporary (�
T
F2rrrenent (P� or
Terrporary (�
P
F2rrranent (F) or
Terrporary (�
4g. Total temporary open water Impacts:
0.19
4g. Total permanent open water impacts:
South Hyco Creek/Hyco
Lake
(if applicable)
South Hyco Creek/Hyco
Lake
(iF applicable)
South Hyco Creek/Hyco
Lake
(iF applicable)
4d. Activitytype * 4e. Waterbodytype *4f. Impact
area*
Fill Other 0.03
(acres)
Fill Other
Fill Other
0.19
(acres)
0.01
(acres)

0.04
4g. Total open water impacts:
0.23
4h. Comments:
See permit drawing. Design firm (Ecological Engineering) determined that impacts v�rould be considered open
I water based on presence of Hyco Lake.
E. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
The new bridge will have fev�r in-stream bents than the ebsting bridge. The new bridge is slightly longer than the
e�asting bridge and will provide a larger hydraulic opening. The temporary causeway has been minimized to
provide access to install drilled shafts.
1b. Specificallydescribe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Construction inspection personnel and Division Environmental Specialist will monitor construction and will evaluate
opportunities to reduce the requested permanent and temporary open water impacts.
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
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
Bridge will be replaced using NWP 3 which does not require mitigation for open water 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
For a list of options to meet the diffuse flow requirements, click here.
If no, explain why:
' Project is located in Roakone River basin.
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)?*
�' 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 �' No
Comme nts: *
I Document has not been reviewed by SCH.
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 �' 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�i?*
C' Yes C•' No
3b. If you answered "no," provide a short narrative description.
No additional impacts are e�ected since the project only involves replacement of a two lane bridge with a newtwo
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
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
C•' Yes C' No
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
Sd. Is another Federal agency involved?*
C' Yes C� No
5e. Is this a DOT project located within Division's 1-8?*
G Yes C' No
C' Unknown
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
Site was evaluated by RK&K biologist Neil Medlin. No Effect for Dwarf Wedgemussel and Atlantic Pigtoe. No Effect
for Neuse River Waterdog as the species is not located in the Roanoke River basin. BC of MALTAA for Norhtern-
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?*
C' Yes �' 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 historyand archaeology)?*
C' Yes C•' No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
Consultation with State HPO office.
7c. Historic or Prehistoric Information Upload
Gick the upload button or drag and drop files here to attach docurrent
B-5145 No Survey for Arch.pdf 75.77KB
B-5145 No Survey Req for Hist Str.pdf 4.78MB
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 C' No
8b. If yes, explain how project meets FEMA requirements:
I Project has been designed by qualified PEF.
8c. What source(s) did you use to make the floodplain determination?*
FEMA mapping.
Miscellaneous
Miscellaneous attachments not previously requested.
Gick the upload button or drag and drop files here to attach docurrent
B-5145 Permit Package.pdf 1.33M6
B-5145 SW BMP.pdf 105.63KB
Fle rrust be FDF or IM�
Signature
r% 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:*
Christopher A. Murray
Signature
Grf��.s ,�tv�,.4Y
Initial Review
Is this project a public transportation project? *(')
�' Yes C' No
Change only if needed.
Has this project met the requirements for acceptance in to the review process?*
�' Yes
C' No
BIMS # Assigned*
20180465
Version#*
Reviewing Office*
Central Office - [phone]
Select Project Reviewer*
Rob Ridings:eads\rgridings
Is a payment required for this project?*
C' No payment required
C� Fee received
C' Fee needed - send electronic notification