20190260 Ver 1_PCN Form Submission_20190227

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 *
20190260
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:
Replace Br 113 on SR 1514 Wilson Co.
1a. Who is the PrimaryContact?*
Chad Coggins
1b. PrimaryContact Email:*
[e-mail]
Date Submitted
2/27/2019
Nearest Body of Water
White Oak Swamp
Basin
Neuse
Water Classification
C;Sw,NSW
Site Coordinates
Latitude:
35.70699
Longitude:
-77.75428
A. Processing Information
County (or Counties) where the project is located:
Wilson
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:
BR 970113 (State funded project)
WBS # (�)
17BP.4.R.109
1a. Type(s) of approval sought from the Corps:
Ve rsion# *
1
Reviewing Office *
Raleigh Regional 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?
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
27548
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
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:
Wilson
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:"
White Oak Swamp
3b. Water Resources Classification of nearest receiving water:*
C;Sw,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.
030202030302
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 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)
Wilson 113 Topo map.pdf 1.6SMB
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)
Wilson 113 Soils map.pdf 225MB

4f. List the total estimated acreage of all existing wetlands on the property:
0.01
4g. List the total estimated linear feet of all existing streams on the property:
120
4h. Explain the purpose of the proposed project:"
Replace Bridge 113 which is structurally 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 113 wfiich is structurally deficient for current NCDOT standards with a new bridge meeting these current standards in the ewsting right-of-way. Heavy road and bridge
building equipment will be used.
4j. Please upload project drawings for the proposed project.
970113_hyd_wet_combined 10 30 2018.pdf 129MB
970113_hyd_buf_combined 10 30 2018.pdf 830.57KB
5. Jurisdictional Determinations
Sa. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes r No
Comments:
Chad Coggins, NCDOT Div 4 DEO conducted onsite jurisdictional delineation.
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):
Agency/Consultant Company:
Other:
Sd1. Jurisdictional determination upload
6. Future Project Plans
Chad Coggins
NCDOT Div 4 DEO
C' Unknown
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 Open Waters Ir Pond Construction
2. Wetland Impacts
2a. Site #* (') 2a1 Reason ("?)
Site 1 Bridge approach
2g. Total Temporary Wetland Impact
0.000
2g. Total Wetland Impact
0.000
2h. Comments:
0.01 acre of hand clearing
Impact type * C') II2a Type of W. *
Hardwood Forest
W.name*
te Oak Swamp
2g. Total Permanent Wetland Impact
0.000
rJ Buffers
Forested* Zf.Typeof I2g.lmpact
�Jurisdicition*(�) area*
000
(acres)
3. Stream Impacts

Reason for impact (?) 3b.lmpact type * 3c. Type of impact*
ae abutment fill Permanent Fill
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
65
3i. Total stream and ditch impacts:
65
3j. Comments:
4. Open Water Impacts
S. name * 3e. Stream Type * 3f. Type of
(J Jurisdiction*
te Oak Swamp Perennial Both
3i. Total temporary stream impacts:
0
S. width* 3h. Impact
'---"-*
Average (feet) I� Qinear feet)
4a. Site # 4a7. Impact Reason 4b. Impact type 4c. Name of waterbody 4d. Activitytype 4e. Waterbody type 4f. Impact area
Site 1 bridge abutment fill P White Oak Swamp Bridge Tributary OA2
Site 1 impervious dike T White Oak Swamp Dewatering Tributary 0.01
4g. Total temporary open water Impacts:
0.01
4g. Total open water impacts:
0.03
4h. Comments:
6. Buffer Impacts (for DWR)
6a. Project is in which protect basin(s)?
Check all Ihat apply.
�J Neuse
� Catawba
r Goose Creek
r Other
6h. Total buffer impacts:
Zone 1
Total Temporary impacts: 0.00
Total Permanent impacts:
Total combined buffer impacts:
6i. Comments:
Zone 1
2,258.00
Zone 1
2,258.00
4g. Total permanent open water impacts:
0.02
� Tar-Pamlico
� Randleman
r Jordan Lake
Zone 2
0.00
Zone 2
1, 716.00
Zone 2
1, 716.00
Supporting Documentation
970113_hyd_buf_wmbined 10 30 2018.pdf 830.57KB
970113_hyd_wet_combined 10 30 2018.pdf 129MB
SMP v2.01_64_20180523_Dec 2014.pdf 81.05KB
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 silt fencing to protect the streams and wetlands
adjacent to the project. Safety fencing will be used to delineate jurisdictional and environmentaly 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?
� 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?
� Yes r No
What type of SCM are you providing?
r Level Spreader
CJ Vegetated Conveyance (lower SMNT)
� Wetland Swale (higher SMNT)
r Other SCM that removes minimum 30 % nitrogen
r Proposed project will not create concentrated stormwater flow through the buffer
Diffuse Flow Documentation
SMP v2.01_64_20180523_Dec 2014.pdf
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
� Yes r No
Comments:
G. Supplementary Information
1. Environmental Documentation
81.OSKB
1a. Does the project involve an expenditure of public (federallstate/local) funds or the use of public (federal/state) 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)?*
C' Yes r No
Comments:
*
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 (15ANCAC 26.0200)?*
� Yes r No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water qualit�/? *
C' Yes r No
3b. If you answered "no," provide a short narrative description.
Replacing exsting 2 lane bridge with new2 lane bridge.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?"

r ves � No r wn
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? *
F 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?"
� Yes
Se. Is this a DOT project located within Division's 1-8?
r Yes r No
� No
� Unknown
Sj. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
Red-cockaded v�,nodpecker is listed as Historic for Wilson Co. Also, foraging or nesting habitat is not found adjacent to project area. NHP database
records no element occurrence within a mile of project area. (No Affect) / Michaux's sumac is listed as Historic for Wilson Co. NHP database records no
element occurrence within a mile of the project. area. (No Affect) // Programmatic BO of MALTAA for NLEB
Consultation Documentation Upload
FWS IPaC TE list.pdf
NCNHP element occurance letter.pdf
Wilson Co. TE Llstpdf
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 Atlantic Sturgeon proposed rule dated 06/03/2016
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
206.94K6
634.67KB
183.59KB
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
17-08-0023 No Archaeological Survey Required Form Br No 113 on SR 1514 Holdens Cross Rd over Whiteoak
489.64KB
Swamp Wilson.pdf
17-08-0023NoSurvey.pdf 1.74MB
8. Flood Zone Designation (Corps Requirement)
Sa. Will this project occur in a FEMA-designated 100-year floodplain?*
f Yes r No
Sc. What source(s) did you use to make the floodplain determination?*
FRIS
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 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
C�RCt L.. O�/�c%fc/-
Date
2/27/2019