20190112 Ver 1_PCN Form Submission_20190125

D1�VR
�irlslan af Water Resources
Initial Review
Pre-Construction Notification (PCN) Form
September 29, 2018 Ver 3
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 *
20190112
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:
Replacement of Bridge #28 on SR 1210 (Montgomery Road)
1a. Who is the PrimaryContact?*
Heather W. Montague
1b. PrimaryContact Email:*
[e-mail]
Date Submitted
1 /25/2019
Nearest Body of Water
Billys Creek
Basin
Tar-Pamlico
Water Classification
28-20, WS-IV; NSW
Site Coordinates
Latitude:
36.14893
Longitude:
-78.41158
A. Processing Information
County (or Counties) where the project is located:
Franklin
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:
WBS # (�)
17BP.5.R.70
1a. Type(s) of approval sought from the Corps:
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:
03 - Maintenance
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
1e. Is this notification solelyfor the record because written approval is not required?
Forthe record onlyfor DWR401 Certification:
For the record onlyfor Corps Permit:
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?
fJ Owner r 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:
NCDOT
2b. Deed book and page no.:
2c. Responsible party:
2d. Address
Street Address
2612 N Duke Street
Address Line 2
�Y
Durham
Fbstal / Zip Code
27704
2e. Telephone Number:
[phone]
2g. Email Address:*
r 401 Water Quality Certification - E�ress
rJ Riparian Buffer Authorization
State / Aovince I F�gion
NC
Country
US
2f. Fax Number:
x
C' Yes R No
G Yes C' No

hwmontag ue@ncdot. gov
C. Project Information and Prior Project History "
1. Project Information
1b. Subdivision name:
(rf appropriate)
1c. Nearest municipality/town:
Franklinton
2. Project Identification
2a. Propertyldentification Number:
Parcel 1: 006923, Parcel 2: 008152
2c. Project Address
Street Address
963 Montgomery Road
Address Line 2
�Y
Franklinton
Fbstal I Zip Code
27525
3. SurFace Waters
3a. Name of the nearest body of water to proposed project:*
Billys Creek
3b. Water Resources Classification of nearest receiving water:*
25-20, WS-N; NSW
3c. What river basin(s) is your project located in?*
Tar-Pamlico
3d. Please provide the 12-digit HUC in which the project is located.
03020101
4. Project Description and History
2b. Property size:
1.03
State / Rovince I f�gion
NC
Country
US
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 general land use in the vicinity of the project is grassy shoulders/slopes and wooded land.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
C' Yes r No C' 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)
17BP.5.R70_KITTRELL_Quad_Map.pdf 1.49MB
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)
17BP.5.RJ0_Soils_Map.pdf 3.55MB
4f. List the total estimated acreage of all existing wetlands on the property:
0.0
4g. List the total estimated linear feet of all existing streams on the property:
100
4h. Explain the purpose of the proposed project:*
The ebsting bridge has deteriorated and needs replacing.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
The existing structure is a two span bridge (2@20'3") and is a timber deck on I-Beams supported by timber caps on timber piles for the interior and end bents. The proposed structure is
a one span (1 @55'), 21" cored slab with 4' deep caps. This structure has been designed to have as little environmental, and surface water impacts as possible. Geote#ile and rip-rap
was proposed for bank stabilization in an attempt to reduce stream bank erosion along the north and south bank of the channel underneath the bridge. Equipment to be used includes
an excavator, backhoe, bull dozer, crane, etc.
4j. Please upload project drawings for the proposed project.
5. Jurisdictional Determinations
Sa. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
F Yes f No C' Unknown

Comments:
No wetlands were observed during the 09/30/16 site visit.
Sb. If the Corps made a jurisdictional determination, what type of determination was made?*
f' Preliminary (' Approved r Not Verified r Unknown f' WA
Corps AID Number:
Sc. If Sa is yes, who delineated the jurisdictional areas?
Name (if known): Perkinson, Jernigan
Agency/Consultant Company: P,xiom
Other:
5d1. Jurisdictional determination upload
6. Future Project Plans
6a. Is this a phased project?*
C' Yes r No
Are any other NWP(s), regional generel permit(s), or individual permits(s) used, or intended to be used, to authorize any part of the proposed project or related activity?
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
r Wetlands IIJ Streams-tributaries
r Open Waters I� Pond Construction
3. Stream Impacts
Reason for impact (7)
replacement
type* II3c. Type of impact* II3d. S. name*
fJ Buffers
3e. Stream Type * 3f. Type of 3g. S. width* 3h. Impact
(?) �Jurisdiction* length'�
Permanent Bank Stabilization Billys Creek Perennial Both 15 54
Average (feet) Qinear feet)
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
54
3i. Total stream and ditch impacts:
54
3j. Comments:
Minimal bank stabilization is proposed for long term stability.
6. Buffer Impacts (for DWR)
6a. Project is in which protect basin(s)?
Check all that apply.
� Neuse
r Catawba
r Goose Creek
r Other
3i. Total temporary stream impacts:
0
� Tar-Pamlico
r Randleman
r Jordan Lake
6b. Impact Type 6c. Per or Temp 6d. Stream name 6e. Buffer mitigation required? 6f. Zone 1 impact 6g. Zone 2 impact
allowable - bridge P Billys Creek No 1,747 0
allowable - road crossing P Billys Creek No 1,586 2,014
6h. Total buffer impacts:
Zone 1
Zone 2

Total Temporary impacts: 0.00 0.00
Zone 1 Zone 2
Total Permanent impacts: 3,333.00 2,014.00
Zone 1 Zone 2
Total combined buffer impacts: 3,333.00 2,014.00
6i. Comments:
Supporting Documentation
340028_Permit_Drawings_20190107. pdf
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:
Proposed bank stabilization is limited to minimum necessary for long term stability.
1b. Specificallydescribe measures taken to avoid or minimize the proposed impacts through construction techniques:
Construction will be overseen by NCDOT staff from Division 5 and Roadside environmental as well as project inspectors who will help identify
circumstances where iYs feasible to reduce use of rip rap armoring.
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:
There are no wetland impacts associated with this project. Additionally stream impacts are for bank stabilization only.
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?
r Yes r No
What type of SCM are you providing?
r Level Spreader
r Vegetated Conveyance (low�r SHWT)
r Wetland Swale (higher SMNT)
r Other SCM that removes minimum 30 % nitrogen
fJ Proposed project will not create concentrated stormwater flow through the buffer
Diffuse Flow Documentation
SWMP 17BP.5.R.70.pdf 189.01KB
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
� Yes r No
Comments:
see attached stormwater management plan
G. Supplementary Information
1. Environmental Documentation
n
^� I
n
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federallstate) land?*
� Yes r 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)?"
� Yes r No
1c. If you answered "yes" to the above, has the document review been finalized by the State Clearing House?"
2.5SMB

C' Yes r No
Comme nts: *
This project does not require State Clearing House review.
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 26 .0200)? *
� 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.
This project involves replacement of existing structure within existing facility.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
f Yes r No � fWA
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? *
r Yes r No
Sb. 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?*
C' Yes r No
Se. Is this a DOT project located within Division's 1-8?
� Yes r No
C' Unknown
S. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
Onsite survey or Michau�Cs sumac on September 29, 2016 resulted in no observation of this species with a Biological Conclusion No Effect rendered .
Mussels surveys conducted in November 2017 with Biological Conclusions of No Effect for Dwarf Wedgemussel and Tar River Spinymussel. Biological
Conclusions of May Affect-Not Likely to Adversely Affect Yellow Lance and Atlantic Pigtoe. The use of the PBO verifies that this project is over 0.69mi
upstream from an identified stream reach for DWM, YL, with a No Effect for TSM. Atlantic Pigtoe is not covered under the PBO and is unresolved
pending informal consultation with the USFWS.
Consultation Documentation Upload
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? *
available mapping
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
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?"
available mapping
7c. Historic or Prehistoric Information Upload
16-10-0011 _NoSu rveyReq. pdf 32S MB
Structure 340025 Franklin Archaeological Survey Required Form.pdf 12SMB
8. Flood Zone Designation (Corps Requirement)
Sa. Will this project occur in a FEMA-designated 100-year floodplain?*
� Yes r No

Sb. If yes, explain how project meets FEMA requirements:
Project has been designed by PEF hydraulic design firm to meet FEMA requirements
Sc. What source(s) did you use to make the floodplain determination?*
FEMA mapping
Miscellaneous
Comments
Miscellaneous attachments not previously requested.
Signature
rJ 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, Artide 40 of the NC General Statutes (the "Uniform Electronic Transactions Acf');
• 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:
Heather W. Montague
Signature
ff�AiFf�- Nf �Gt6�JiA6v�
Date
1 /25/2019