20180860 Ver 1_PCN Form Submission_20180619

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 6/19/2018 5:19:26 PM (Start Event)
Accept by Carpenter,Kristi 6/20/2018 4:39:57 PM (DOT Initial Review)
. The task was assigned to Carpenter,Kristi. The due date is: June 22, 2018 5:00 PM
6/19/2018 5:20 PM

i i �� �
�����
�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:*
Warre n
Is this project a public transportation project?*
C Yes l' No
lhis is any publicly funded by rrunicipal,state or federal funds road, rail, airport transportation project.
Is this a NCDOT Project?*
f• Yes r No
(NCDOT only) T.I.P. or state project number:
WBS #
17BP.5. R.77
(for �ICDOT use only)
1a. Type(s) of approval sought from the Corps:*
fJ 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)
r 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
NWP Number Other:
List all MNnurrbers you are applying for not on the drop down list.
1c. Type(s) of approval sought from the DWR:*

check all that apply
r% 401 Water Quality Certification - Regular r 401 Water Quality Certification - Express
r Non-404 Jurisdictional General Permit �rJ Riparian Buffer Authorization
r Individual Permit
*
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:
f Yes C' 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 a- in-lieu fee program
C Yes l" No
Acceptance Letter Attachment
C7ick the upload button or drag and drop files here to attach docurrent
SR 1640 - Bridge 77 - Division 5- Buffer - TP 02.pdf 67.96KB
F1LE lYFE MJST BE FDF
1f. Is the project located in any of NC's twenty coastal counties?'�
f Yes �' No
1h. Is the project located in a designated trout watershed?*
f Yes r No
Link to trout information: http://wvwv.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 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
C7ty
Durham
Fbstal / Zip Code
27704
2e. Telephone Number:
(xxx)xxx-�axx
[phone]
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
State / Rovince / Region
NC
Country
USA
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Replacement of Bridge 77 over Fishing Creek on SR 1640 (Richardson
Road) in Warren County
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 GPS rrapping system Rease provide directions.
From Louisburg, travel northeast on NC 561 to Centerville. From Centerville, travel east/northeast staying on NC 561 until it converges with
NC 43. Travel north on NC 561/NC 43 to Essex and travel west on SR 1640 (Richardson Road) to project site.
2. Project Identification
2a. Propertyldentification Number:
(tax RN or parcel ID)
2980439339, 2990078950 and 2980893866
2b. Propertysize:
(in acres)
1.7 ac
2c. Project Address
Street Address
near 705 Richardson Road
Address Line 2
a�y
Warrenton
Fbstal / Zip Code
27589
2d. Site coordinates in decimal degrees
State / Rrnince / F�gion
NC
Country
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 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:* Longitude:*
36.23991 -78.02676
ex:34.208504 -77.796371
3. SurFace Waters
3a. Name of the nearest body of water to proposed project:*
Fishing Creek
3b. Water Resources Classification of nearest receiving water:*
28-79-(1) Class C; NSW
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Tar-Pamlico
River Basin 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:*
Project area is comprised of wooded land.
4b. Attach an 8 7/2 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.77 usgs map.pdf 1.53MB
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)
Click the upload button or drag and drop files here to attach docurrent
176P.5.R.77 soil survey.pdf
Fle type rrust be pdF
4d. List the total estimated acreage of all existing wetlands on the property:
0.01 ac
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
110 linear feet of Fishing Creek, 170 linear feet of unnamed tributary to
Fishing Creek in NE quadrant and 75 linear feet of unnamed tributary to
Fishing Creek in SE quadrant
5.62MB
4f. Explain the purpose of the proposed project:*
Proposed replacement of Bridge 77 due to poor condition including sufficiency rating of 20.27 in January 2018.
4g. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
Ebsting structure is a multi span bridge (2 @ 17.5 ft, 4@ 17.0 ft, 2@ 17.25 ft) with four ewsting in-stream timber
bents. Replacement structure is a three span bridge (2 @ 70.0 ft, 1@ 25.0 ft) cored slab bridge. There are no
known indirect impacts from the project as the design replaces the bridge along exsting alignment. The proposed
project has been designed to current standards and will not increase the traffic volume at the roadway. Equipment
may include crane, bull dozer, grader, mini excavator, paving equipment, 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? *

r Yes r No r Unknown
Comme nts:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
f Preliminary l" Approved �' Unknown
Corps AID Number:
6carrple: SAV�2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:
David Cooper
Ecological Engineering
f" f�UA
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Pre-JD request sent via email to Eric Alsmeyer (USACE) on August 15, 2016. Site visit conducted by Eric Alsmeyer on September 15, 2016.
The Department has not received any other information from the USACE concerning this visit.
5d7. Jurisdictional determination upload
aick the upload button or drag and drop files here to attach docurrem
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? *
f Yes C•' No �' Unknown
7. Future Project Plans
7a. Is this a phased project?'�
f 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 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.
No
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
rJ 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* 2d. Wetland name *ze. 2f. Type of 2g. Impact
Forested* Jurisdicition* area*
Site 2 wetland P Headwater Forest mechanized Yes Both 0.010
N�p label (e.g. Fd�ad Qossing 1- Qalvert, F2rrranent (� or clearing (404, 10) or [7✓�R(401, (acres)
dewatering, etc) Terrporary (� other) i
2g. Total Temporary Wetland Impact

o.000
2g. Total Permanent Wetland Impact
0.010
2g. Total Wetland Impact
0.010
2h. Comments:
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. Reason for impact*3b.lmpact 3c. Type of impact*3d. Stream name * 3e. Stream 3f. Type of
type * Type * Jurisdiction *
S1 Site 7 T Workpad/Causew Fishing Creek Perennial Both
Nbp label (e.g. Finad Qossing F2rrranent (Fj or ay F�rennial (Fff2) or
1) Terrporary (� interrrittent (IfVi)
g2 Site 1 P Bank Fishing Creek Perennial Both
N�p label (e.g. f3�ad Qossing F2rrranent (Fj or Stabllization F2rennial (Fff2) or
1) Terrporary (� irderrrittent (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:
67
3i. Total temporary stream impacts:
76
3i. Total stream and tributary impacts:
143
3j. Comments:
Impacts at S1 also include small amount of temporary stream impacts on east bank to install bank stabilization in a
dewatered area.
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)? *
Checkall that apply.
r Neuse
r Catawba
r Goose Creek
r Other
fJ Tar-Pamlico
r Randleman
r Jordan Lake
3g. Stream 3h. Impact sqfe�
width * length *
68 76 5
Average (linearfeet) ,
(feet) 1
6
8
68 67 4
Average (linearfeet) ,
(feet) 5
5
6
6b. Impact Type * 6c. Per or 6d. Stream name * 6e. Buffer mitigation 6f. Zone 1 6g. Zone 2
Temp* required?* impact* impact*

Site 1 mitigable P
Location and 6cerrpt, Allowable, allowable w/ F2rrranent (Fj or
rritigation Terrporary (lj
Site 1 allowable P
Location and 6cerrpt, Allowable, allowable w/ F2rrranent (P) or
rritigation Terrporary (�
Slte 2 allowable P
Location and 6cerrpt, Allowable, allowable w/ F2rrranem (Fj or
rritigation Terrporary (�
Site 3 mitigable P
Location and 6cerrpt, Allowable, allowable w/ F2rrranem (Fj or
rritigation Terrporary (�
6h. Total buffer impacts:
Temporary impacts:
Permanent impacts:
Total buffer impacts:
6i. Comments:
zone 1
0.00
Zone 1
5,327.00
Zone 1
5,327.00
Fishing Creek Yes
Fishing Creek No
Fishing Creek No
Fishing Creek Yes
Zone 2
0.00
Zone 2
3,565.00
Zone 2
3,565.00
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
Gick the upload button or drag and drop files here to attach docurrent
920077_Permit Drawings_201800605.pdf
920077_Permit Drawings_Buffer_20180605.pdf
Fle rrust be FDF
E. Impact Justification and Mitigation
1.99MB
856.7KB
0
(square feet)
2,704
(squarefeet)
7,345
(squarefeet)
7,278
(square feet)
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
Existing bridge is a multi span bridge with four bents located in Fishing Creek. Due to FEMA regulations and
discussions with NCDOT Hydraulics Unit, the replacement structure is a three span bridge (2@70', 1@25'; 24"
Cored Slab Bridge) that places one bent in the water. Attempting to span the entire stream resulted in a deeper
superstructure that caused a reduction in bridge opening. The grade had to be held close to e�asting to minimize
impacts to the adjacent stream features in the NE an SE quadrants and to satisfy FEMA requirements. This
combination of criteria led us to the aforementioned span arrangement and structure type. A temporary rip rap
causeway will be constructed from the west stream bank to install the proposed in-stream interior bent. The
proposed in-stream interior bent is located +/-18' from water's edge.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Construction oversight and supervision will be conducted by the Division Environmental Specialist who will monitor
work along the Fishing Creek and the wetland to determine appropriate methods to further minimize jurisdictional
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 r No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
798
(square feet)
1,584
(squarefeet)
690
(squarefeet)
493
(squarefeet)

Compensatory mitigation not required for stream or 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?
C•' 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
�7 Vegetated Conveyance (lower SHWT)
r Wetland Swale (higher SMNT)
r Other SCM that removes minimum 30% nitrogen
(check all that apply)
For a list of options to meet the diffuse flow requirements, click here.
Diffus Flow Documentation
Qick the upload button or drag and drop files here to attach docurrent
176P.5.R.77 Stormwater Plan.pdf
Fle type rrust be FDF
2. Stormwater Management Plan
117.5KB
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250? *
C Yes r 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?*
f• Yes l" 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 r No
Comme nts: *
Document has not been 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)?*
l" 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 reasonablyanticipated future impacts) result in additional development, which could impact
nearby downstream water qualit�/?*
f Yes �' No
3b. If you answered "no," provide a short narrative description.
Project involves removal of ebsting bridge and replacement with a new bridge on ebsting alignment. The bridge
and roadway are designed to meet current construction standards. The project will not result in additional
development and will not decrease downstream water quality.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
l" Yes C No C' WA
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? *
l•' Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
C Yes �' No
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. Is another Federal agency involved?*
r Yes r No
What Federal Agency is involved?
USFWS
5e. Is this a DOT project located within Division's 1-8?*
C Yes r No
C' Unknown
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
E�ensive consultation with USFWS and use of Programmatic Biological Opinion for Bridge and Culvert
Replacements/Repairs/Rehabilitations in Eastern North Carolina, NCDOT Divisions 1-8 (June 13, 2018). The PBO
provides for incidental take coverage for those projects wtiich may have adverse effects to three species of
mussels (Dwarf Wedgemussel, Tar River Spinymussel, and Yellow Lance). It also provides automatic concurrence
for those projects which may affect, but are not likely to adversely affect (MA-NLAA) those species. The findings of
the surveys and use of the PBO indicate the following Biological Conclusions: Dwarf Wedgemussel: May Affect,
Not Likely to Adversely Affect; Tar River Spinymussel: May Affect, Not Likely to Adversely Affect and Yellow Lance:
May Affect, Likely to Adversely Affect. The Department will follow obligations regarding reporting of results and
payment of $25,000 to the in-lieu fee program for the NC Nongame Aquatic Species Fund.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
f Yes l•' No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat? *
Appropriate 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? *
Consultation with NC State HPO office.
7c. Historic or Prehistoric Information Upload
Qick the upload button or drag and drop files here to attach docurrent
PA 16-09-0009 Warren No Archaeological Survey Required Form.pdf 1.28MB
PA 16-09-0009_Hist Str NoSurveyReq.pdf 4.86MB
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 r No
8b. If yes, explain how project meets FEMArequirements:
Design completed following Limited Detailed Study methods.
8c. What source(s) did you use to make the floodplain determination?*
Info from Stormwater Management Form provided by Private Engineering Firm.
Miscellaneous
Miscellaneous attachments not previously requested.
Qick the upload button or drag and drop files here to attach docurrent
Fle rrust be FDF or INR
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
""�.5T6�'9` 'd��j6.�,4Y
Date Submitted:
6/19/2018
Initial Review
Is this project a public transportation project?* (')
f• Yes C' No
Change only 'rf needed.
Has this project met the requirements for acceptance in to the review process? *

C Yes
r No
BIMS # Assigned *
20180860
Version#*
1
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