20181642 Ver 1_PCN Form Submission_20181203

D1�VR
�irlslan af Water Resources
Pre-Construction Notification (PCN) Form
September 29, 2018 Ver 3
Initial Review
Has this project met the requirements for acceptance in to the review process?*
F Yes
C' No
Is this project a public transportation project?"
� Yes r No
Change only rf needed.
BIMS # Assigned *
20181642
Is a payment required for this project?*
f No paymentrequired
� Fee received
f Fee needed - send electronic notification
Select Project Reviewer"
Rob Ridings:eads\rgridings
Information for Initial Review
1a. Name of project:
Bridge 96 SR 1006 (Grantham School Road), Wayne County
1a. Who is the PrimaryContact?*
Chad Coggins
1b. PrimaryContact Email:*
[e-mail]
Date Submitted
12/3/2018
Nearest Body of Water
Thoroughfare Swamp
Basin
Neuse
Water Classification
C;Nsw
Site Coordinates
Latitude:
3523249
A. Processing Information
County (or Counties) where the project is located:
Wayne
Is this project a public transportation project?*
r Yes r No
Is this a NCDOT Project?*
G Yes r No
(NCDOT only) T.I.P. or state project number:
B-4839
WBS # (�)
17BP.4.R.103
1a. Type(s) of approval sought from the Corps:
Longitude:
-78.17665
Ve rsion# *
1
Reviewing Office *
Central Office - [phone]
1c. PrimaryContact Phone:*
[phone]

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?
fJ Nationwide Permit (NWP)
r Regional General Permit (RGP)
r Standard (IP)
1c. Has the NWP or GP number been verified bythe Corps?
F Yes r No
Nationwide Permit (NWP) Number:
NWP Numbers (for multiple NWPS):
1d. Type(s) of approval sought from the DWR:
fJ 401 Water Quality Certification - Regular
r' Non-404 Jurisdictional General Permit
r Individual Permit
03 - Maintenance
1e. Is this notification solelyfor the record because written approval is not required?
Forthe record onlyfor DWR401 Certification:
For the record onlyfor Corps Permit:
r 401 Water Quality Certification - E�ress
rJ Riparian Buffer Authorization
1f. Is this an after-the-fact permit application?*
� Yes r No
1g. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
C' Yes r No
1g. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
� Yes r No
Acceptance LetterAttachment
1h. Is the project located in any of NC's twenty coastal counties?
C' Yes r No
1j. Is the project located in a designated trout watershed?
� Yes r No
B. Applicant Information
1d. Who is applying for the permit?
r Owner fJ Applicant (other than owner)
1e. Is there an Agent/Consultant for this project?
f Yes r No
2. Owner Information
2a. Name(s) on recorded deed:
State of North Carolina (NCDOT)
2b. Deed book and page no.:
2c. Responsible party:
NCDOT Div 4
2d. Address
Street Address
P.O. Box 3165
Address Line 2
�Y
Wilson
Fbstal / Zip Code
27528
2e. Telephone Number:
[phone]
2g. Email Address:*
State / Aovince I F�gion
NC
Country
USA
2f. Fax Number:
x
C' Yes R No
C' Yes G No

[e-mail]
3. Applicant Information (if different from owner)
3a. Name:
Chad Coggins
3b. Business Name:
NCDOT Div 4
3c.Address
Street Address
P.O. Box 3165
Address Line 2
ary
Wilson
Postal / Zip Code
27828
3d. Telephone Number:
[phone]
3f. Email Address:"
[e-mail]
S[ate / Awince I Region
NC
Country
USA
3e. Fax Number:
C. Project Information and Prior Project History �
1. Project Information �
1b. Subdivision name:
(rf appropriate)
1 c. Nearest municipality l town:
Grantham
2. Project Identification
2a. Propertyldentification Number:
2c. Project Address
Street Address
Address Line 2
ary
Postal / Zip Code
3. SurFace Waters
3a. Name of the nearest body of water to proposed project:"
Thoroughfare Swamp
3b. Water Resources Classification of nearest receiving water:*
C;Nsw
3c. What river basin(s) is your project located in?*
Neuse
3d. Please provide the 12-digit HUC in which the project is located.
030202011402
4. Project Description and History
2b. Property size:
S[ate I Rovince I Region
Country
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:*
Forestry and Agriculture are the predominant land uses with some rural single-family residential housing in the vicinity of this project.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
C' Yes r No r Unknown
4d. 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)
Wayne 96 Topo map.pdf 2.15MB
4e. 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)
Wayne 96 Soils map.pdf 222MB

4f. List the total estimated acreage of all existing wetlands on the property:
0.13
4g. List the total estimated linear feet of all existing streams on the property:
200
4h. Explain the purpose of the proposed project:"
Replace Bridge 96 which is sUucturally deficient for current NCDOT standards.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
Replace Bridge 96 which is structurally deficient for current NCDOT standards with a new bridge meeting these current standards in the ebsting right-of-way. Heavy road and bridge
building equipment will be used.
4j. Please upload project drawings for the proposed project.
17BP.4.R.103_PermitDrawings_(2018-11-28).pdf 1.71 MB
17BP.4.R.103_PermitDrawings_BUFFERS_(2018-11-28).pdf 1.16MB
5. Jurisdictional Determinations
Sa. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes r No C' Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
C' Preliminary r Approved C' Not Verified � Unknown C' WA
Corps AID Number:
Sc. If Sa is yes, who delineated the jurisdictional areas7
Name (if known): Chad Coggins
Agency/Consultant Company: NCDOT Div 4 DEO
Other:
Sd1. Jurisdictional determination upload
6. Future Project Plans
6a. Is this a phased project?*
C' Yes r 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�R
No, single and complete linear transportation project with independent utility.
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
CJ Wetlands II� Streams-tributaries rJ Buffers
r Open Waters Ir Pond Construction
2. Wetland Impacts
Site #* (') � 2a1 Reason ("?) � 2b. Impact type * C') � 2a Type of W. * � 2d. W. name * � 2e. Forested *� 2f. Type of
Jurisdicition * (�)
Site 1 Roadway Fill
Site 1 Mechanized Clearing
Site 1 Hand Clearing
2g. Total Temporary Wetland Impact
0.040
2g. Total Wetland Impact
0.130
Hardwnod Forest
Hardv�rood Forest
p
Hard�nrood Forest
Swamp
Swamp
Swamp
2g. Total Permanent Wetland Impact
0.090
g. Impact
rea*
030
(acres)
060
(3CfPS)
040
(acres)

2h. Comments:
3. Stream Impacts
Reason for impact (?)
ge Bent construction
ting pile removal
type "` 3c. Type of impact�` 3d. S. name * 3e. Stream Type" 3f. Type of 3g. S. width" 3h. Impact
(?) Jurisdiction* length*
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
33
3i. Total stream and ditch impacts:
66
3j. Comments:
6. Buffer Impacts (for DWR)
6a. Project is in which protect basin(s)?
Check all that apply.
fJ Neuse
� Catawba
r Goose Creek
r Other
Bank Stabilization Thoroughfare Swamp Perennial Both 30 33
Average(feet) (linearfeet)
Other Thoroughfare Swamp Perennial Both 30 33
Average (feet) Qinear feet)
3i. Total temporary stream impacts:
33
r Tar-Pamlico
r Randleman
r Jordan Lake
I6b. Impact Type II6c. Per or Temp II6d. Stream name
Roadway Construction P Thoroughfare Swamp
6h. Total buffer impacts:
Zone 1 Zone 2
Total Temporery impacts: 0.00 0.00
Zone 1 Zone 2
Total Permanent impacts: 2,783.00 1,676.00
Buffer mitigation required? Il6f. Zone 1 impact II6g. Zone 2 impact
2,783 1,676
Zone 1 Zone 2
Total combined buffer impacts: 2,783.00 1,676.00
6i. Comments:
Supporting Documentation
17BP.4.R.103_PermitDrawings_(2018-11-28).pdf 1.71 MB
17 BP.4. R.103_PermitDrawings_BUF F ERS_(2018-11-28). pdf 1.16 MB
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:
Replace in place bridge with offsite detours.
1b. Specificallydescribe measures taken to avoid or minimize the proposed impacts through construction techniques:
All construction equipment will be staged and operated from upland areas. DOT will also install fencing to protect the streams and wetlands adjacent
to the project. Safety fencing will be used to delineate jurisdictional and environmentally sensitive areas.
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:
Jurisdictional waters and wetlands impacts fall belowthresholds of significant impacts/requirement for compensatory mitigation.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
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
What type of SCM are you providing?
r Level Spreader
�J Vegetated Conveyance (lowar SHWf)
r Wetland Swale (higher SMNf)
r Other SCM that removes minimum 30 % nitrogen
r Proposed project will not create concentrated storrrrv✓ater flow through the buffer
Diffuse Flow Documentation
Wayne 96 SMP.pdf
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
F Yes r No
Comments:
G. Supplementary Information
1. Environmental Documentation
129.8KB
1a. Does the project involve an expenditure of public (federallstate/local) funds or the use of public (federallstate) land?*
r Yes �' 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)?*
C' Yes r No
Comme nts: *
MCDC available on request.
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)? *
f Yes r No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality?*
C' Yes r No
3b. If you answered "no," provide a short narrative description.
Replacing existing 2 lane bridge with new2 lane bridge.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
f Yes r No � WA
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
Sa. Will this project occur in or near an area with federally protected species or habitat?*
� Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
� Yes r No
Sc. If yes, indicate the USFWS Field Office you have contacted.

Raleigh
Sd. Is another Federal agency involved?*
f Yes r No
Se. Is this a DOT project located within Division's 1-8?
r Yes r No
� Unknown
Sj. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
Red-cockaded woodpecker foraging or nesting habitat is not found adjacent to the project area. NCNHP database records no element occurrence
within a mile of project area. (No Affect) / Programmatic Bo for NLEB MALAA
Consultation Documentation Upload
FWS IPaC TE list.pdf
NCNHP element occurence letter.pdf
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
C' Yes r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
GIS / NOAA AUantic Sturgeon proposed rule dated 06/03/2016
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
197.99KB
1.09 MB
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?"
� Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
HEU Clearance
7c. Historic or Prehistoric Information Upload
15-03-0054 B-4839 No Archaeological Survey Required Br No 96 on SR 1006 over Thoroughfare Swamp Wayne.pdf 603.69K6
15-03-0054NoSurvey.pdf 1.69MB
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
� Yes r No
Sb. If yes, explain how project meets FEMA requirements:
FEMA MOA (see details of FEMA requirements on attached Wayne 96 SMP)
8c. What source(s) did you use to make the floodplain determination?*
FRIS
Miscellaneous
Comments
Miscellaneous attachments not previouslyrequested.
Wayne 96 SMP.pdf
Signature
*
�7 By checking the box and signing below, I certify that:
129.8KB
• 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 AcP');
. 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:
Chad Coggins
Signature
Sign
Date
12/3/2018
�