20190118 Ver 1_PCN Form Submission_20190125

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 * Version#"
20190118 1
Is a payment required for this project?*
f No paymentrequired
� Fee received Reviewing Office *
f Fee needed - send electronic notification Central Office -[phone]
Select Project Reviewer"
Rob Ridings:eads\rgridings
Information for Initial Review
1a. Name of project:
Replacement of Franklin County Bridge #50 on SR 1412 (Pete Smith Road) over Devils Cradle Creek
1a. Who is the PrimaryContact?*
Heather W. Montague
1b. PrimaryContact Email:* 1c. PrimaryContact Phone:*
[e-mail] [phone]
Date Submitted
1 /25/2019
Nearest Body of Water
Devils Cradle Creek
Basin
Tar-Pamlico
Water Classification
28-78-1-12 B; NSW: +
Site Coordinates
Latitude: Longitude:
3620115 -7823832
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.66
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?
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:
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?
F 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
DMS letter SR 1412 - Bridge 50 - Division 5.pdf
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?
rJ Owner r Applicant (other than owner)
1e. Is there an Agent/Consultant for this project?
� 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 Sheet
Address Line 2
�Y
Durham
Fbstal / Zip Code
27704
2e. Telephone Number:
[phone]
S[ate / FYovince I Region
NC
Cauntry
US
2f. Fax Number:
70.35KB
x
C' Yes R No
C' Yes G No
�,

2g. Email Address:*
[e-mail]
C. Project Information and Prior Project History "
1. Project Information
1b. Subdivision name:
(rf appropriate)
1c. Nearest municipality/town:
Louisburg
2. Project Identification
2a. Propertyldentification Number:
Parcel 1: 012374, Parcel 2: 012375, Parcel 3:
026309, Parcel 4: 012057, Parcel 5: 012060,
Parce16:028367
2c. Project Address
Street Address
1224 Pete Smith Road
Address Line 2
�Y
Louisburg
Fbstal / Zip Code
27549
3. SurFace Waters
3a. Name of the nearest body of water to proposed project:*
Devils Cradle Creek
3b. Water Resources Classification of nearest receiving water:*
28-78-1-12 B; 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:
1.38
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 r Unknown
4d. Attach an 8 7/2 X 17 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for DWR)
17BP.5.R.66_GOLD SAND_Quad Map.pdf 1.53MB
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.R.66_Soils Map.pdf 3.4MB
4f. List the total estimated acreage of all existing wetlands on the property:
0.12
4g. List the total estimated linear feet of all existing streams on the property:
100
4h. Explain the purpose of the proposed project:*
The existing 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 ewsting structure is a six span bridge (1 @10'2"; 1@10'3"; 1@9'6"; 1@10'6"; 1@14'9"; 1@15'5") 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 single span (1@90'), 33" box beam with 4' deep caps. This structure has been designed to have as little environmental, wetland,
and surface water impacts as possible. 2:1 roadway fill slope will be used in the wetland areas to minimize wetland impacts. Geotex[ile and Class II rip-rap was utilized for bank
stabilization 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 property or proposed impact areas?*
r Yes r No
Comments:
Sb. If the Corps made a jurisdictional determination, what type of determination was made?"
� Preliminary r Approved � Not Verified � Unknown r WA
Corps AID Number:
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Perkinson, Jernigan
Agency/Consultant Company: Ndom
Other:
Sd1. Jurisdictional determination upload
6. Future Project Plans
6a. Is this a phased project?*
f 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 activiq/?
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
�J Wetlands 117 Streams-tributaries
r Open Waters V� Pond Construction
2. Wetland Impacts
2a. Site #* (') 2a7 Reason (?) 26. Impact type *(') 2a Type of W. * 2d. W. name * 2e. Forested * 2f. Type of 2g. Impact
Jurisdicition*(') area*
� bridge project P Riverine Swamp Forest WA-WB Yes Both 0.030
(aCres)
� bridge project P Riverine Swamp Forest WA-WB Yes Both 0.090
(acres)
2g. Total Temporary Wetland Impact
0.000
2g. Total Wetland Impact
0.120
2h. Comments:
3. Stream Impacts
r Unknown
�J Buffers
2g. Total Permanent Wetland Impact
0.120
Reason for impact (:�) 3b.lmpact type" 3c. Type of impact" 3d. S. name * 3e. Stream Type * 3f. Type of 3g. S. width" 3h. Impact
(?) Jurisdiction* length*
replacement
Stabilization IlDevils Cradle Creek IlPerennial
Average(feet) I� Qinearfeet)
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
69
3i. Total stream and ditch impacts:
3i. Total temporary stream impacts:
0

69
3j. Comments:
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
CJ 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 Devils Cradle Creek No 2,550 8
allowable - road crossing P Devils Cradle Creek No 725 2,011
6h. Total buffer impacts:
Total Temporary impacts:
Total Permanent impacts:
Total combined buffer impacts:
Zone 1
0.00
Zone 1
3,275.00
Zone 1
3,275.00
Zone 2
0.00
Zone 2
2,019.00
Zone 2
2,019.00
6i. Comments:
Proposed wetland impacts and bank stabilization is limited to those needed to meet construction standards and minimum necessary for long term
stability.
Supporting Documentation
340050_Permit_Drawings_20190108.pdf 3.11 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:
Proposed wetland impacts and bank stabili�ation is limited to those needed to meet construction standards and 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 v�,211 as project inspectors who will help identify
circumstances where iYs feasible to reduce 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:
Wetland mitigation is proposed. See attached DMS letter. No stream mitigation is required for bank stabilization.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
n �
�,
1a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
� Yes r No
What type of SCM are you providing?

� Level Spreader
r Vegetated Conveyance (lowar SHWT)
r Wetland Swale (higher SM/Vf)
r Other SCM that removes minimum 30 % nitrogen
�J Proposed project will not create concentrated stormwater flow through the buffer
Diffuse Flow Documentation
SWMP 17BP.5.R.66.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:
see attached stormwater management plan
G. Supplementary Information
1. Environmental Documentation
115.29KB
1a. Does the project involve an expenditure of public (federallstate/local) funds or the use of public (federallstate) land?*
F 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)
Environme ntal Policy Act (NEPAISEPA)? *
r Yes r No
1c. If you answered "yes" to the above, has the document review been finalized by the State Clearing House?*
C' Yes r No
Comments:
*
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 2B .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 e�tisting structure within exsting facility.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
f Yes 6 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?*
r 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 Michauas sumac on September 29, 2016 resulted in no observation of this species with a Biological Conclusion No Effect rendered.
Northem long eared bat: BC of May Affect, Likely to Adversely Affect based on programmatic biological opinion with Ihe FHWA, NCDOT and USACE
that allows for incidental take for NLEB for projects with a federal nexus in Division 5. Mussel surveys conducted in November 2017 with Biological
Conclusions of No Effect for all four species: Dwarf Wedgemussel, Tar River Spinymussel, Yellow Lance, and Atlantic Pigtoe. Use of the Programmatic
Biological Opinion for Bridge and Culvert Replacements/Repairs/Rehabilitations in Eastern North Carolina, NCDOT Divisions 1-8 (June 13, 2018)
verifies this except for Yellow Lance is within a mussel HUC so it wnuld have a Biological Conclusion of MA-NLAA with no concurrence needed for
Ihese species. Since the PBO doesn't cover Atlantic Pigtoe, this biological conclusion 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? *
f Yes r No
66. 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
16-10-0008_NoSurveyReq.pdf 3.68MB
Structure 340050 Franklin No Archaeological Survey Required Form.pdf 127MB
8. Flood Zone Designation (Corps Requirement)
Sa. Will this project occur in a FEMA-designated 100-year floodplain?*
r 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
see attached USACE environmental summary
Miscellaneous attachments not previouslyrequested.
USACE summary_17BP.5.R.66.pdf
Signature
*
fJ By checking the box and signing below, I certify that:
84.34KB
• 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 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 Act");
. 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 PCNform.
Full Name:
Heather W. Montague
Signature
I�AYh`�- iA�+[R6+J%46tiF
�
Date
1 /25/2019