20190199 Ver 1_PCN Form Submission_20190213

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 *
20190199
Is a payment required for this project?*
f• No payment required
f Fee received
f Fee needed - send electronic notification
Select Project Reviewer"
Donna Hood:eads\drhood
Information for Initial Review
1a. Name of project:
17BP.10.R.112
1a. Who is the PrimaryContact?*
Larry Thompson
1b. PrimaryContact Email:*
[e-mail]
Date Submitted
2/13/2019
Nearest Body of Water
Cedar Creek
Basin
Yadkin-PeeDee
Water Classification
C: Aquatic Life, Secondary Recreation, Fresh Water
Site Coordinates
Latitude:
35.030333
A. Processing Information
County (or Counties) where the project is located:
Anson
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:
WA
WBS # (�)
17BP.10.R.112
1a. Type(s) of approval sought from the Corps:
Ve rsion# *
1
Reviewing Office *
Mooresville Regional Office - [phone]
1c. PrimaryContact Phone:*
[phone]
Longitude:
-80.008270
::

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?
C' 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
716 W. Main Street
Address Line 2
�Y
Albemarle
Fbstal / Zip Code
28001
2e. Telephone Number:
[phone]
2g. Email Address:*
r 401 Water Quality Certification - E�ress
r Riparian Buffer Authorization
State / Aovince I F�gion
NC
Country
USA
2f. Fax Number:
x
C' Yes R No
C' Yes G No

[e-mail]
C. Project Information and Prior Project History "
1. Project Information
1b. Subdivision name:
(rf appropriate)
1c. Nearest municipality/town:
Wadesboro, NC
2. Project Identification
2a. Property Identification Number:
2b. Property size:
2c. Project Address
Street Address
Bridge No. 19 on SR 1710 (Allen Road) over Cedar Creek, 0.8 miles east of NC 109
Address Line 2
(]ty S[ate I Rovince I Region
Postal / Zip Code Country
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Cedar Creek
3b. Water Resources Classification of nearest receiving water:*
C: Aquatic Life, Secondary Recreation, Fresh Water
3c. What river basin(s) is your project located in?*
Yadkin-PeeDee
3d. Please provide the 12-digit HUC in which the project is located.
030401040501
4. Project Description and History
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 17BP.10.R.112 proposes to replace Bridge No. 19 on SR 1710 (Allen Road) over Cedar Creek in Anson County, North Carolina. The purpose of the proposed project is to
replace a deficient and functionally obsolete bridge. The latest inspection report, performed in January of 2015, classifies the condition of Bridge No. 19 as "fair." The bridge
replacement will be wnstructed on the same location and alignment using an offsite detour. The current bridge is small, and the proposed length of the newbridge will be approximately
70 feet long.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
� Yes r No � 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)
17BP10R112 USGS Quad Map.pdf
1.11 MB
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)
17BP10R112 USDA Soils Map.pdf 379.81 KB
4f. List the total estimated acreage of all existing wetlands on the property:
03
4g. List the total estimated linear feet of all existing streams on the property:
571
4h. Explain the purpose of the proposed project:*
The project proposes to replace Bridge No. 19 on SR 1710 (Allen Road) in place over Cedar Creek in Anson County due to the existing bridge being deficient and functionally obsolete.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
The new bridge will overlap the e�tisting facility and will be constructed over previously disturbed soils. Additional right-of-way (ROW), a temporary construction easement, and a
permanent utility easement wll be required. The proposed consists of the following components:
1. Reconstruct approximately 0.14 miles of roadv✓ay to connect to newiy replaced bridge.
2. Reconstruct approwmately 0.01 miles of bridge over Cedar Creek.
3. Reconstruct the road at-grade to accommodate the modifications to the replaced bridge
4. Reconstruct the drainage system to accommodate the modifications of the replaced bridge and reconstructed road.
4j. Please upload project drawings for the proposed project.
VBP10R112_Permit Package Wetland_20190128.pdf 1.04MB
5. Jurisdictional Determinations

Sa. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
r Yes r No
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
r Preliminary r Approved C' Not Verified C' Unknown C' WA
Corps AID Number:
SAW-2018-01899
Sc. If Sa is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
Chris Sheats
Three Oaks Engineering
C' Unknown
Sd. List the dates of the Corp jurisdiction determination or State determination if a determination was made by the Corps or DWR
10/12/18
Sd1. Jurisdictional determination upload
17BP10R112 SAW-2018-01899 PJD signed.pdf 1.45MB
6. Future Project Plans
6a. Is this a phased project?"
� Yes r No
Ne 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�/?
There are no other NWPs, RGPs, or IPs used or intended to be used to authorize any part of the proposed project.
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
r Wetlands 117 Streams-tributaries
r Open Waters I� Pond Construction
3. Stream Impacts
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
9
3i. Total stream and ditch impacts:
9
3j. Comments:
E. Impact Justification and Mitigation
1. Avoidance and Minimization
� Buffers
3i. Total temporary stream impacts:
0
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
Project plans were designed to minimize impacts. No deck drains will be used on this structure, reducing stream pollution associated with roadway
runoff. Additional measures implemented to reduce impacts to the stream and surrounding properties include, maintaining exsting drainage pattems,
using 3:1 fill slopes, and discharging stormwater runoff as far away from the stream as is practicable. Further, rip rap is used at drainage outlets to
dissipate energy and reduce erosion.
1b. Specificallydescribe measures taken to avoid or minimize the proposed impacts through construction techniques:
Typical sediment and erosion control measures will be taken on site. Temporary special stilling basins and temporary rock sediment dams will be
utilized to prevent sediment from entering the stream.

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:
Total impacts are expected to be minimal (9 linear feet of stream impacts), so no mitigation is anticipated.
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?
C' Yes r No
If no, explain why:
This project is located in the Yadkin — PeeDee River Basin�.. therefore, streamside ripariam m�es withln the study area are not currently protected under provisions of any Riparian
Buffer Rules administered by NCDWR.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
C' Yes r No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?
� Yes r No
Comments:
G. Supplementary Information
1. Environmental Documentation
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)? *
G Yes r No
1c. If you answered "yes" to the above, has the document review been finalized by the State Clearing House?*
G Yes �' No
NEPAor SEPAFinal Approval Letter
17BP10R112 FINAL MCDC - Signed.pdf
9.69MB
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)?*
C' Yes r No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality? *
f Yes r No
3b. If you answered "no," provide a short narrative description.
The proposed project is replacing an existing bridge, so impacts are limited to only those necessary for adequate bank stabili�ation for the
replacement structure. No additional development is anticipated as a result of the project.
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)
5a. 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?*
C' Yes r No
Sd. Is another Federal agency involved?*
C' Yes �' No
Se. Is this a DOT project located within Division's 1-8?
� Yes r No
Sf. Will you cut anytrees in order to conduct the work in waters of the U.S.?
C' Yes r No
Sg. Does this project involve bridge maintenance or removal?
� Yes r No
Sg(1). If yes, have you inspected the bridge for signs of bat use such as staining, guano, bats, etc.?
C' Yes r No
If you answered "Yes" to Sg(1), did you discover any signs of bat use?
� Yes r No � Unknown
Sh. Does this project involve the construction/installation of a wind turbine(s)?*
C' Yes r No
C' Unknown
Si. Does this project involve (1) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhammers, mechanized pile drivers, etc.?
� Yes r No
If yes, please provide details to include type of percussive activity, purpose, duration, and specific location of this activity on the property.
17BP10R112 Supplementary Information for PCN.pdf 88.18KB
Sj. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
US Fish and Wildlife Service (USFWS) Threatened and Endangered Species in North Carolina: Anson County was used to determine that the site
would not impact Threatened and Endangered Species or Critical Habitat.
Consultation Documentation Upload
17BP10R112_Anson_FINAL NRTM_October 2018.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 � No
8.16MB
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat? *
United States Geological Survey (USGS) Ansonville, North Carolina, Topographic Quadrangle (124,000 scale) was used to determine that the project
site is not Essential Fish Habitat.
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?*
C' Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
A review of HPO quad maps, HPO GIS information, historic designations roster, and indexes was used to determine impacts on historic resources.
Based on the review, there were are no existing historical properties in the Area of Potential Effects (APE), wfiich is 300' from each end of the bridge
and 75' from the centerline. The Historic Architecture and Landscapes No Survey Required form was signed on May 15, 2018 by the NCDOT
Architectural Historian.
A review of topographic maps, Anson County soil survey, an aerial photograph, listings of previously recorded sites, previous archaeological surveys,
and previous environmental reviews at the Office of State Archaeology was used to determine impacts on archaeological resources. Based on the
review, it was determined that the tandforms within the APE have a low to moderate potential for archaeological sites. The No Archaelogical Survey
Required form was signed on August 17, 2018 by the NCDOT Archaeologist.
7c. Historic or Prehistoric Information Upload
17 BP 10R112 18-04-0017_NoSu rvey. pdf
17BP10R112 Anson 19 No Archaeological Survey form.pdf
8. Flood Zone Designation (Corps Requirement)
Sa. Will this project occur in a FEMA-designated 100-year floodplain?*
C' Yes r No
8c. What source(s) did you use to make the floodplain determination?*
FEMA Flood Map Service Center
Miscellaneous
2.09M6
701.67KB
Comments

Miscellaneous attachments not previouslyrequested.
Signature
�7 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 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 PCN form.
Full Name:
Larry Thompson
Signature
�t�ry �'/lrcrrr�rhxo�r
Date
2/11 /2019