20180514 Ver 1_PCN Form Submission_20180411

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 4/11 /2018 12:27:04 PM (Start Event)
Accept by Carpenter,Kristi 4/11/2018 2:55:10 PM (DOT Initial Review)
. The task was assigned to Carpenter,Kristi. The due date is: April 16, 2018 5:00 PM
4/11/2018 12:27 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:*
Robeson
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:
176P.6. R.106
WBS #
(for NCDOT use only)
1a. Type(s) of approval sought from the Corps:*
�J 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)
� Standard (IP)
This form may be Corps to initiate the standard/individual permit process. Please contact your Corps representative for submittal of standard permits.
All required items that are not provided in the E-PCN and be added to the miscellaneous upload located at the bottom of this form.
Nationwide Permit (NWP) Number: 03 - Maintenance
i NWP Number Other:
List all MN nurrbers you are applying for not on the drop dow n list.
1c. Type(s) of approval sought from the DWR:*

check all that apply
ri 401 Water Quality Certification - Regular r 401 Water Quality Certification - E�ress
r Non-404 Jurisdictional General Permit r Riparian Buffer Authorization
r Individual Permit
*
1d. Is this notification solelyfor the record because written approval is not required?
For the record only for DWR 401 Certification:
For the record only for Corps Permit:
�' Yes C•' No
C' 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
r Yes �' No
Acceptance Letter Attachment
C7ick the upload button or drag and drop files here to attach docurrent
RLE NFE M..6T BE FDF
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
B. Applicant Information
1a. Who is the PrimaryContact?*
Mr. James Rerko
I 1b. Primary Contact 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:
2b. Deed book and page no.:
I 2c. Responsible party:
(for Corporations)
2d.Address
Street Address
Address Line 2
�Y
Wstal / Zip Code
SYate / Rovince / F�gion
Country

2e. Telephone Number:
(xxx)xxx-xxxx
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Replace Bridge No. 28 on NC 83 over Leith Creek
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Pembroke
1d. Driving directions*
If it is a new project and can not easily be found in a GPS rrapping system Rease provide directions.
https://www.google.com/maps/d ir//34.6254449,-79.4401367/@34.6252894,-79.439468,17z/data=! 4m2! 4m1 ! 3e0
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)
2b. Propertysize:
(in acres)
2c. Project Address
Street Address
Address Line 2
��
Fbstal / Zip Code
SYate / R-ovince / F�gion
Country
2d. Site coordinates in decimal degrees
I 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.)
I Latitude:*
34.625436
ex:34208504
3. Surface Waters
Longitude:�
-79.440171
-77.796371
3a. Name of the nearest body of water to proposed project:*
Leith Creek
3b. Water Resources Classification of nearest receiving water:*

C; Sw
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Lumbe r
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:*
The project study area is comprised of mostly maintained roadway with hardwood forest along the stream banks
and nearby agriculture and residences. Leith Creek is a swamp water, and there are associated wetlands
surrounding the bridge crossing.
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
Bridge28_Div6_Fig 1 _topo. pdf
Fle type rrust be pdf
2.95M6
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
Bridge28_Div6_Fig2_soils.pdf
Fle type rrust be pdf
4d. List the total estimated acreage of all existing wetlands on the property:
0.26
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
105
4f. Explain the purpose of the proposed project:*
I To replace a structurally deficient and functionally obsolete bridge.
699.47KB
4g. Describe the overall project in detail, including indirect imapacts and the type of equipment to be used:*
Traffic will be detoured off-site. Erosion and sedimentation control measures will be installed. The old bridge will be
removed using a top-down approach. The existing v�rooden bents will be removed by either pulling them out with a
crane or cutting them off just below the mud line. Each pile is 1.34 sq ft, with 6 piles per bent. The e�sting
structure is a reinforced concrete deck on I-Beams with a sufficiency rating of 54.33. The proposed structure is a
2@40', 1@55' 24" concrete cored slab bridge with 2'6" caps. The proposed structure will be replaced on its
epsting alignment. Equipment to be used includes a track hoe, dump truck, paving equipment, various hand tools,
and possibly a crane to move construction material.
4h. Please upload project drawings for the proposed project.
C7ick the upload button or drag and drop files here to attach docurrent
17BP.R.6.106_770028_Permit Drawings_022718.pdf 2.26MB
Fle type rrust be pdf
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
C� Yes �' No �' Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
C' Preliminary l" Approved C' Unknown C� N/A

Corps AID Number:
Exarrple: SAV�2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:
NCDOT
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Sd1. Jurisdictional determination upload
I aick 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 f" 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 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 I m pacts I nventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
ri Wetlands r Streams-tributaries r 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 - Roadway P
N�p label (e.g. F�ad Qossing 1- Q�Ivert, F2rrranent (� or
dewatering, etc) Terrporary (�
Site 1 - Roadway T
fV�p label (e.g. Fd�ad Qossing 1- Qilvert, F2rrranent (P) or
dewatering, etc) Terrporary (�
2g. Total Temporary Wetland Impact
0.170
2g. Total Permanent Wetland Impact
Riverine Swamp
Forest
Riverine Swamp
Forest
2d. Wetland name *2e. 2f. Type of 2g. Impact
Forested * Jurisdicition * area*
Leith Creek Yes Corps 0.090
(404, 10) or DJUR(401, (acres)
other)
Leith Creek Yes Corps 0.170
(404, 10) or D✓UR(401, (acres)
other)

0.090
2g. Total Wetland Impact
0.260
2h. Comments:
Of the permanent impacts to wetlands, there will be 0.08 acre of permanent fill and <0.01 acre excavation. There
will be 0.03 acre of temporary fill and 0.14 acre of hand clearing. See permit drawings for more details on these
impacts.
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 proposed project is to remove and replace a structurally deficient bridge with a new bridge. Roadway
approach work is minimized as much as is practical to reduce the overall project footprint. Excavation was kept to a
minimum to produce as little impact as possible while designing to current standards. To reduce impacts for the
proposed roadway grade to tie quicker, a vertical crest was placed on the bridge. In doing so, four outlets for the
bridge deck drainage are used to facilitate spread for safety. Rip rap outlet pads will be utilized to dissipate the
flow and minimize erosion at these outlets. Replacement in place will minimize disturbance in the surrounding
wetland areas and stream crossing. No ditches were replaced, and roadway embankment has grassy fill slopes.
The project proposes a small amount of new pavement, which will contribute very little to the existing drainage
area and the ditch velocities.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
� Erosion and sedimentation BMPs will be installed prior to construction. Impacts will be minimized by strict
enforcement of Best Management Practices for the protection of surface waters, restrictions against the staging of
equipment in or adjacent to waters of the US and coordination (including a pre-construction meeting) with the
Division Environmental Supervisor.
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 �' No
2c. If yes, mitigation is required by (check all that apply):
r DWR r Corps
2d. If yes, which mitigation option(s) will be used for this project?
r Mitigation bank rJ Payment to in-lieu fee program r Permittee Responsible Mitigation
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:
(linear feet)
4c. If using stream mitigation, what is the stream temperature:
4d. Buffer mitigation requested (DWR only):
(square feet)
4e. Riparian wetland mitigation requested:
(acres)
0.09
4f. Non-riparian wetland mitigation requested:

(acres)
4g. Coastal (tidal) wetland mitigation requested:
(acres)
4h. Comments
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:
The proposed project is a bridge replacement with another bridge. There is a slight increase in impervious surface but treatment is not
required.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
C' Yes r No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?*
�' Yes
C' No
To look up low density requirement click here 15A NCAC 02H .1003(2).
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 C•' No
Comments:*
I The proposed project is the replacement of an existing bridge on location and will have limited environmental
impact. Therefore, an environmental document is not required.
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 C•' No
3b. If you answered "no," provide a short narrative description.
Per the NC DWQ April 10, 2004 Version 2.1 Cumulative Impacts policy, small scale public transportation projects —
such as widening projects, bridge replacements and intersection improvements — have a"low potential for
cumulative impact since little (if any) new impervious surface is added and the projects are usually in already
developed locales." This proposed project is within a somewhat developed landscape (i.e. existing residential
homes in the vicinity), this is not a road on a new location (i.e. there is an e�sting road and bridge structure and
thus, the area already contains impervious surfaces) and the project drains to Leith Creek, which is Class C;
Swamp Waters (Sw) (i.e. not HQW, ORW or 303(d) listed waters). We anticipate the NC DWR will advise us if a
qualitative or quantitative analysis is needed.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project? *
C' Yes C' No C•' f�UA
� 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?*
�' Yes �' No
5c. If yes, indicate the USFWS Field Office you have contacted.
I Raleigh
5d. Is another Federal agency involved?*
C' Yes C•' No
5e. Is this a DOT project located within Division's 1-8?*
r Yes C' No
�' Unknown
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
USFWS County list of threatened and endangered species and the NC Natural Heritage Program species
database. Additionally, surveys v�re conducted to determine presence of v�rood stork. A survey memo was
submitted to USFWS and a concurrence letter of those findings is attached.
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?*
EFH Mapper from NOAA
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 �' No

7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
HPOWEB GIS Service, Field Scoping Meeting
7c. Historic or Prehistoric Information Upload
C7ick the upload button or drag and drop files here to attach docurrent
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:
MOA
8c. What source(s) did you use to make the floodplain determination?*
NC Floodplain Mapping Program
Miscellaneous
Miscellaneous attachments not previously requested.
C1ick the upload button or drag and drop files here to attach docurrent
20180322_letter_Service to NCDOT_RobesonCoBridges_Woodstorks.pdf 33.68KB
Fle rrust be FDF or VWQ
Signature
r7 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:*
James J. Rerko, PWS
Signature
��:wzr�%:C'rte�. r�"/�'�S
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*
20180514
Version#*
Reviewing Office *
Wilmington Regional Office - [phone]
Select Project Reviewer*
Joanne Steenhuis:eads\jhsteenhuis
Is a payment required for this project?*
�' No payment required
C� Fee received
C' Fee needed - send electronic notification