20180839 Ver 1_PCN Form Submission_20180807

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 8/7/2018 8:24:52 AM (Start Event)
Accept by Carpenter,Kristi 8/8/2018 2:09:53 PM (DOT Initial Review)
. The task was assigned to Carpenter,Kristi. The due date is: August 10, 2018 5:00 PM
8/7/2018 8:26 AM

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�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:*
Dare
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:
R-5014 Widening of SR1217 (Colington Road) from Dead End to US 158
(Central)
WBS #
41162.1.1
(for NCL)OT 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?*
r 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.
Regional General Permit (RGP) Number: 198200031 - NCDOT Bridges, Widening Projects 2015
RGP Number Other:
List all RGPnurrbers 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 r 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
R-5014 Revised - RW - CM - PS 05.pdf 63.31 KB
F1LE lYFE MJST BE FDF
1f. Is the project located in any of NC's twenty coastal counties?'�
C Yes l" No
1g. Is the project located within a NC DCM Area of Environmental Concern (AEC)?*
C' Yes �' No �' Unknown
1h. Is the project located in a designated trout watershed?*
C' Yes C No
Link to trout information: http://�wvw.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Agency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the PrimaryContact?*
NCDOT
1b. PrimaryContact Email:*
[e-mail]
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
r Owner r P,pplicant (other than owner) r Agent/Consultant
(Checkall that apply)
2. Owner I nformation
2a. Name(s) on recorded deed:
2b. Deed book and page no.:
2c. Responsible party:
(for Corporations)
2d. Address

Street Address
Address Line 2
aiy
Rxstal / Zip Code
2e. Telephone Number:
(xxx)xxx-xxxx
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
State / FYovince / F�gion
Country
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
R-5014 Widening of SR1217 (Colington Road) from Dead End to US 158
(Central)
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:'�
Colington
1d. Driving directions*
IF it is a new project and can not easily be found in a GPS rrapping system Rease provide directions.
36.009155, -75.700069
2. Project Identification
2a. Propertyldentification Number:
(tax RN or parcel ID)
2b. Propertysize:
(in acres)
2c. Project Address
Street Address
Address Line 2
aty
Fbstal / Zip Code
State / Rovince / FZegion
Caurdry
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 how the location was determined. (For e�cample, most mobile phones with GPS provide locational precision in decimal degrees to
map coordinates to 5 or 6 digits after the decimal place.)
Latitude: *
36.009155
ex:34.208504
3. Surface Waters
Longitude:*
-75.700069
-77.796371

3a. Name of the nearest body of water to proposed project:*
Colington Creek
3b. Water Resources Classification of nearest receiving water:*
Class SC north of Colington Road, Class SA south of Colington Road
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Pasquotank
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:*
Residential and commercial development along roadway, with coastal marsh 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)
C]ick the upload button or drag and drop files here to attach docurrent
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
Fle type rrust be pdF
4d. List the total estimated acreage of all existing wetlands on the property:
3.0 acre
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
500 linear feet
4f. Explain the purpose of the proposed project:*
NCDOT proposes to construct two bike lanes along SR 1217. This project w�ould address safety issues along the
route and raise the grade in areas that suffer from flooding during storm events and high wind driven tides.
4g. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
The project involves the widening of SR1217 to accommodate bike lanes and to raise the grade in sections that
are subject to flooding. Standard road building equipment, such as trucks, dozers, and cranes will be used.
4h. Please upload project drawings for the proposed project.
aick the upload button or drag and drop files here to attach docurrent
R-5014_Permit Drawings_20180427.pdf
R3825B roadway.pdf
R-5014_Utility Drawings.pdf
Fle type rrust be pdf
5. Jurisdictional Determinations
15.1 MB
15.44MB
3.95MB
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
C Yes r No �' Unknown
Comme nts:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
f' Preliminary C•' Approved C' Unknown f' f�UA
Corps AID Number:
6carrple: SAV�2017-99999
SAW-2015-00970

5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:
Chris Sheats
Three Oaks Engineering (formerlyThe Catena
Group)
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Field verification on August 28, 2012. Approved jurisdictional determination issued on June 5, 2015.
5d7. Jurisdictional determination upload
aick the upload button or drag and drop files here to attach docurrent
Signed Copy Collington Road NCSR 1217 from US 158 to Dead End TIP # R-5014 SAW-
2015-00970 JD.pdf 131.84KB
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6. Project History
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past? *
C•' Yes f' No C' Unknown
6b. If yes, please give the DWR Certification number or the Corps Action ID (exp. SAW-0000-00000).
An Individual Permit application was submitted on June 19, 2018. Since the submittal, the USACE has determined
that the project meets the criteria for GP 31.
Project History Upload
Click the upload button or drag and drop files here to attach docurrent
Fle type rrust be FDF
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 r% Streams-tributaries r Buffers
rJ 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 *2e. 2f. Type of 2g. Impact
Forested* Jurisdicition* area*
1-Roadwayfill P Salt/Brackish Marsh WA No Both 0.040
N�p label (e.g. FUad Qossing 1- Qalvert, F2rrranent (� or (404, 10) or D✓VR(401, (acres)
dewatering, etc) Terrporary (� other)
2-Culvert extension P Salt/Brackish Marsh WB No Both 0.001
N�p label (e.g. Finad Qossing 1- Qilvert, F2rrranent (Pj or (404, 10) or G/U�(401, (acres)
dewatering, etc) Terrporary (� other)

3-Roadwayfill P Small-Basin Wetland WC
N�p label (e.g. F3�ad C7ossing 1- Qalvert, F2rrranent (� or
dewatering, etc) Terrporary (�
4-Roadwayfill P Estuarine Woody WD
N�p label (e.g. f3�ad Qossing 1- Qalvert, F�rrranent (Fj or WetlBnd
dewatering, etc) Terrporary (�
5-Roadwayfill/Culvert P Small-Basin Wetland WE
extension F�rrrenent (F) or
N�p label (e.g. F3�ad Qossing 1- Qalvert, Terrporary (�
dewatering, etc)
6-Culvert/Roadwayfill P Small-Basin Wetland WG
fv�p label (e.g. f3�ad Qossing 1- Qalvert, F�rrranent (Fj or
dewatering, etc) Terrporary (�
7-Roadwayfill P Salt/Brackish Marsh WL
N�p label (e.g. Fd�ad Qossing 1- Qalvert, F�rrranent (Fj or
dewatering, etc) Terrporary (�
8-Roadwayfill P Salt/Brackish Marsh WM
N�p label (e.g. Fd�ad Qossing 1- CLlvert, F2rrranent (F) or
dewatering etc) Terrporary (�
9-Culvert extension P Salt/Brackish Marsh WO
Nbp label (e.g. 13�ad Qossing 1- Qilvert, F2rrranent (P) or
dewatering, etc) Terrporary (�
11-Roadwaydtich P Estuarine Woody WP
N�p label (e.g. Finad Qossing 1- Qilvert, F2rrranent (� or Wetland
dewatering, etc) Terrporary (�
12-Culvert P Estuarine Woody WQ
extension/Roadwayfill �rrranent(�jor Wetland
N�p label (e.g. f�ad C7ossing 1- Qilvert, Terrporary (�
dewatering, etc)
13-Roadwayfill P Estuarine Woody WR
fv�p label (e.g. Fd�ad Qossing 1- CLlvert, F2rrranent (� or Wetland
dewatering, etc) Terrporary (lj
14-Roadwayfill P Salt/Brackish Marsh WS
N�p label (e.g. F3�ad Q'ossing 1- Qalvert, F2rrranent (Pj or
dewatering, etc) Terrporary (�
15-Roadwayfill P Salt/Brackish Marsh WT
fv�p label (e.g. f3�ad C7ossing 1- Qalvert, F�rrranent (Fj or
dewatering, etc) Terrporary (�
16-Roadwayfill P Salt/Brackish Marsh WW
N�p label (e.g. f�ad CYossing 1- CUlvert, F�rrranent (Fj or
dewatering, etc) Terrporary (�
17-Roadwayfill P Salt/Brackish Marsh WV
N�p label (e.g. Fd�ad CYossing 1- CLlvert, F2rrranent (P) or
dewatering, etc) Terrporary (�
18-Roadwayfill P Salt/Brackish Marsh WW
Nbp label (e.g. I�ad Qossing 1- CLlvert, F2rrranent (Pj or
dewatering, etc) Terrporary (�
19-Roadway fill P Estuarine Woody WY
N�p label (e.g. Fd�ad Qossing 1- Qalvert, F2rrranent (� or Wetland
dewatering, etc) Terrporary (�
20-Roadwayfill P Small-Basin Wetland WX
N�p label (e.g. F3�ad Qossing 1- Qalvert, �rrranent (� or
dewatering, etc) Terrporary (�
21-Roadwayfill P Small-Basin Wetland WZ
N�p label (e.g. f3�ad Qossing 1- Qalvert, F2rrrenent (P� or
dewatering, etc) Terrporary (�
2g. Total Temporary Wetland Impact
0.000
2g. Total Permanent Wetland Impact
0.821
2g. Total Wetland Impact
No Both 0.001
(404, 10) or GNR(401, (acres)
other)
Yes Both 0.220
(404, 10) or CI✓VR(401, (acres)
other)
Yes Both 0.280
(404, 10) or D✓�ft(401, (acres)
other)
Yes Both 0.020
(404, 10) or C)✓vR(401, (acres)
other)
No Both 0.040
(404, 10) or [7✓�R(401, (acres)
other)
No Both 0.070
(404, 10) or CM�R(401, (acres)
other)
No Both 0.001
(404, 10) or GJ�R(401, (acres)
other)
No Both 0.001
(404, 10) or D✓VR(401, (acres)
other)
No Both 0.001
(404, 10) or D✓�R(401, (acres)
other)
Yes Both 0.001
(404, 10) or CXNR(401, (acres)
other)
No Both 0.001
(404, 10) or [7✓�ft(401, (acres)
other)
No Both 0.001
(404, 10) or C)✓vR(401, (acres)
other)
No Both 0.020
(404, 10) or GNR(401, (acres)
other)
No Both 0.001
(404, 10) or CM�R(401, (acres)
other)
No Both 0.070
(404, 10) or Cr✓VR(401, (acres)
other)
Yes Both 0.050
(404, 10) or D✓VR(401, (acres)
other)
Yes Both 0.001
(404, 10) or C!✓VR(401, (acres)
other)
Yes Both 0.001
(404, 10) or D✓VR(401, (acres)
other)

0.821
2h. Comments:
Many sites above were listed as impacts of <0.01 ac. Rounding of the actual totals results in a total of 0.83 ac.
There will be 0.33 acre of hand clearing. There will be an additional <0.01 acre of permanent impact to coastal
wetlands due to overhead power pole installations. Please see attached utility permit drawings.
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 *
type *
S1 2-Culvert extension P Culvert UT to Blount Bay
fv�p label (e.g. f3�ad Qossing F2rrranent (P) or
1) Terrporary (�
g2 2-Culvert extension T Culvert UT to Blount Bay
fv�p label (e.g. f3�ad Qossing F2rrranem (Pj or
1) Terrporary (�
3e. Stream 3f. Type of 3g. Stream 3h. Impact sqfe�
Type* Jurisdiction* width* length*
Jurisdictiona Both 20 4 8
I Ditch Average (linearfeet) 0
F�rennial (� or (feet)
intermittent (IMj
Jurisdictiona Both 20 8 1
I DitCh Average (linearfeet) 6
F2rennial (� or �feet� 0
intermi[tent (If�
"* All Perennial or Intermittent streams must be verified by DWR or delegated local government.
3i. Total jurisdictional ditch impact in square feet:
240
3i. Total permanent stream impacts:
4
3i. Total temporary stream impacts:
8
3i. Total stream and tributary impacts:
12
3j. Comments:
4. Open Water Impacts
ff 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 *
2-Culvert extension
N�p label (e.g. Fd�ad Qossing 1)
2-Culvert extension
fv�p label (e.g. F3�ad Qossing 1)
9-Culvert extension
N�p label (e.g. f3�ad C7ossing 1)
9-Culvert extension
N�p label (e.g. f�ad CYossing 1)
12-Culve rt
extension/Roadway fill
N�p label (e.g. f�ad C7ossing 1)
4b. Impact type * 4c. Name of waterbody*
P UTto Blount Bay
F2rrranerd (P� or (rf applicable)
Terrporary (�
T UTto Blount Bay
F�rrranent (P� or ('rf applicable)
Terrporary (�
P UTto Blount Bay
F�rrranent (P� or (if applicable)
Terrporary (�
T UTto Blount Bay
F2rrrenent (P� or (if applicable)
Terrporary (Tj
P UTto Colington Creek
F2rrranent (P� or (rf applicable)
Terrporary (�
4d.Activitytype* 4e.Waterbodytype*4f.lmpact
area*
Culverts Bay 0.02
(acres)
Culverts Bay
Culverts Ditch
Culverts Ditch
Fill Ditch
0.02
(acres)
0.02
(acres)
0.02
(acres)
0.02
(acres)

12-Culvert
extension/Roadway fill
Nbp label (e.g. Id�ad Qossing 1)
16-Roadway fill
N�p label (e.g. F3�ad Qossing 1)
T
F2rrranent (P� or
Terrporary (�
P
F�rrranent (P� or
Terrporary (�
4g. Total temporary open water Impacts:
0.05
4g. Total permanent open water impacts:
0.07
4g. Total open water impacts:
0.12
4h. Comments:
UTto Colington Creek
(if applicable)
Colington Creek
('rf applicable)
Rounding results in permanent impacts totaling 0.08 ac.
E. Impact Justification and Mitigation
1. Avoidance and Minimization
Fill Ditch
Fill Tributary
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
-All of the proposed drainage has been designed to have as little environmental and surface water impacts
as possible.
-Roadway fill slopes have been designed to be 3:1 in jurisdictional areas except for in the SAV areas where
2:1 slopes with rock plating have been utilized to minimize impacts.
- Ditch side slopes have been designed to be 3:1 and where possible ditches have been designed to meet
grass swale criteria.
-Existing parking area at the Colington Cut mitigation site will be maintained.
-An in-water work moratorium from April 1 to September 30 will be adhered to.
-See Stormwater Management Plan for additional measures.
0.01
(acres)
0.01
(acres)
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
-No staging of construction equipment or storage of construction supplies will be allowed in wetlands or
near surface waters.
-NCDOT and its contractors will not excavate, fill, or perform land clearing activities within Waters of
the U.S. or any areas under the jurisdiction of the United States Army Corps of Engineers (USACE),
except as authorized by the USACE. To ensure that all borrowand waste activities occur on high ground,
except as authorized by permit, the NCDOT shall require its contractors to identify all areas to be used to
borrow material, or to dispose of dredged, fill or waste material. Documentation of the location and
characteristics of all borrowand disposal sites associated with the project will be available to the USACE
on request.
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?
f• Yes
l' No
2c. If yes, mitigation is required by (check all that apply):
�7 DWR fJ Corps
2d. If yes, which mitigation option(s) will be used for this project?
r Mitigation bank r% 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:
r Permittee Responsible Mitigation

(linear 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:
(acres)
0.67
4f. Non-riparian wetland mitigation requested:
(acres)
0
4g. Coastal (tidal) wetland mitigation requested:
(acres)
0.16
4h. Comments
6. Buffer mitigation (State Regulated Riparian Buffer Rules) - required by DWR
6a. Will the project result in an impact within a protected riparian buffer that requires buffer mitigation? If yes, you must fill out this entire
form - please contact DWR for more information.
f Yes b' No
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
For a list of options to meet the diffuse flow requirements, click here.
If no, explain why:
Water resources with the vicinity of the R-5014 are not within a protected buffer system.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250? *
l•' Yes f 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 (NEPAISEPA)?*
f• Yes �' 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.)*
G' Yes C' No
NEPA or SEPA Final Approval Letter
C7ick the upload button or drag and drop files here to attach docurrent
RLE NFE NL6T BE FOF
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 .7300), or
DWR Surface Water or Wetland Standards or Riparian Buffer Rules (75A NCAC 2B .0200)?*
f 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 reasonablyanticipated future impacts) result in additional development, which could impact
nearby downstream water quality?*
l" Yes �' No
3b. If you answered "no," provide a short narrative description.
Implementation of the proposed Build Alternative �nrould not contribute, in conjunction with past, present, or future
projects, to substantial adverse cumulative effects on resources in the study areas.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
f Yes C No C' N/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 l" 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?*
f Yes r No
5e. Is this a DOT project located within Division's 1-8?*
C•' Yes C' No
�' Unknown
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
N.C. Natural Heritage Program database; USFWS-Raleigh Field Office website;biological surveys for protected
species listed for Dare County. No habitat for the listed protected species is present within the study area with the
exception of the American alligator, which is listed due to similarity in appearance and does not require surveys.
Bald eagle surveys were updated on May 11, 2018 and no specimens or nests were observed within 660 feet of
the study area.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
f• Yes �' No

Are there submerged aquatic vegetation (SA� around the project vicinity?*
G Yes f' No �' Unknown
Will this project affect submerged aquatic vegetation?*
C Yes
f No
f' Unknown
f Explain
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat? *
NMFS County Index
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)?*
r Yes C' No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?'�
NEPA documentation
7c. Historic or Prehistoric Information Upload
aick the upload button or drag and drop files here to attach docurrent
R5014historic.pdf 3.66MB
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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 l" No
8b. If yes, explain how project meets FEMArequirements:
NCDOT Hydraulics Unit coordination with FEMA
8c. What source(s) did you use to make the floodplain determination?*
FEMA Maps
Miscellaneous
Miscellaneous attachments not previously requested.
Qick the upload button or drag and drop files here to attach docurrent
Fle rrust be FDF or IWQ
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:*
Mack Christopher Rivenbark III
Signature
h�c�k �. ����k. lll
Date Submitted:
8/7/2018
Initial Review
Is this project a public transportation project?* (')
C Yes C' No
Change only 'rf needed.
Has this project met the requirements for acceptance in to the review process? *
f• Yes
C' No
BIMS # Assigned �`
20180839
Version#*
Reviewing Office *
Washington Regional Office - [phone]
Select Project Reviewer'�
Garcy Ward:eads\gpward
Is a payment required for this project?*
C' No payment required
C•' Fee received
f Fee needed - send electronic notification