20190327 Ver 1_PCN Form Submission_20190307

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�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 *
20190327
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:
Replacement of Bridge #030050 over North Fork Jones Creek
1a. Who is the PrimaryContact?*
Larry Thompson
1b. PrimaryContact Email:*
[e-mail]
Date Submitted
3/7/2019
Nearest Body of Water
North Fork Jones Creek
Basin
Yadkin-PeeDee
Water Classification
WS-II; HQW
Site Coordinates
Latitude:
34.909758
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:
Ve rsion# *
1
Reviewing Office *
Mooresville Regional Office - [phone]
1c. PrimaryContact Phone:*
[phone]
Longitude:
-80.130211
::
WBS # (�)
17BP.10.R.130
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?
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 Division 10
2b. Deed book and page no.:
N/A
2c. Responsible party:
2d. Address
Street Address
716 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:
[phone]
x
C•' Yes C' No
G Yes C' No

[e-mail]
C. Project Information and Prior Project History " I
1. Project Information
1b. Subdivision name:
(rf appropriate)
1c. Nearest municipality/town:
Wadesboro
2. Project Identification
2a. Propertyldentification Number:
N/A
2c. Project Address
Street Address
SR 1120 (Dickie Little Road)
Address Line 2
�Y
Wadesboro
Fbstal I Zip Code
3. SurFace Waters
3a. Name of the nearest body of water to proposed project:*
North Fork Jones Creek
3b. Water Resources Classification of nearest receiving water:*
WS-II; HQW
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.
030402010201
4. Project Description and History
2b. Property size:
4.S
State / Rovince I f�gion
NC
Country
USA
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:*
Exsting conditions include SR 1120 (Dickie Little Road), undeveloped forest, agricultural land, and the disturbed/maintained right-of-way.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
C' Yes �' 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)
R_130_Brid ge80_F ig u re 1_USGSMap. pdf 2.8 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)
R_130_Bridge80_Figure2_SoilsMap.pdf 321 MB
4f. List the total estimated acreage of all existing wetlands on the property:
0
4g. List the total estimated linear feet of all existing streams on the property:
32S
4h. Explain the purpose of the proposed project:*
To remove Bridge #030080 and replace with a newspanning structure.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
Erosion and sedimentation control measures will be installed. Bridge demolition will include the removal of the bridge deck and the removal of the top portion of the bridge abutments,
leaving the footer and approximately one foot of the masonry abutment to match the excavation elevation and temporary impacts to 121 linear feet to North Fork .bnes Creek may
result. Bridge replacement construction using heavy equipment from the upland roadway approaches. No deck drains are proposed on the bridge and runoff from the bridge will be
routed to a traffic bearing grated drop inlet located to the northeast of the bridge and discharged to the stream floodplain upstream of the bridge. The proposed bridge will be built on
the same alignment with a temporary off-site detour.
4j. Please upload project drawings for the proposed project.
SF030080_HYD_SMPv2.07_20150329(Oct 2016).pdf
R.130_Permit_Pla ns_03-05-2019. pdf
179.26KB
1.69 MB
5. Jurisdictional Determinations

Sa. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
r Yes r No
Comments:
See attached WeUand Determination Form, Photographs, Stream Form and Waters Mapping
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
C' Preliminary r Approved r Not Verified C' Unknown C' WA
Corps AID Number:
Sc. If Sa is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
Sd1. Jurisdictional determination upload
Anson 80 upland data sheet.pdf
NCDWQ RPW A- N Fork of Jones Cr.pdf
R_130_Bridge80_Figure3_WatersMa p. pdf
R.130 Photopages.pdf
6. Future Project Plans
406.27KB
74.46KB
3.4MB
15.24 MB
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 activity?
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
r Wetlands fJ Streams-tributaries
r Open Waters r Pond Construction
3. Stream Impacts
r Buffers
Reason for impact (�) 3b.lmpact type" 3a Type of impact" 3d. S. name" 3e. Stream Type" 3f. Type of
(�) Jurisdiction"
ge replacement Temporery Other North Fork Jones Creek Perennial Both
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts: 3i. Total temporary stream impacts:
0 121
3i. Total stream and ditch impacts:
121
3j. Comments:
Temporary impacts are associated with the demolition of the e�sting bridge and the construction of the proposed bridge. No permanent impacts are
proposed.
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 bridge in-place was incorporated to minimize impacts. The bridge span length was ex[ended to avoid permanent impacts. Riprap protection of
the abutments and drainage ditches will be placed outside of the jurisdictional stream boundary to avoid impacts. Work will be conducted from the
upland roadway approaches.
1b. Specificallydescribe measures taken to avoid or minimize the proposed impacts through construction techniques:
NCDOT Best Management Practices for Construction and Maintenance Activities will be employed. Demolition and construction methods from the
upland roadway approaches will be used to minimize potential temporary demolition related impacts and avoid construction related impacts.
Brandon Phillips, CHMM
STV Engineers, Inc.
S. width" II3h. Impact
.*
15 II121
Averege (feet) Qinear feet)
�

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:
No permanent impacts to North Fork Jones Creek will resutt from this bridge replacement project.
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
If no, explain why:
Project is located in the Yadkin-Pee Dee River Basin and is not subject to NC Riparian Buffer Protection Rules.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
� Yes r No
Comments:
Stormwater runoff from the proposed bridge will be routed to a traffic bearing grated drop inlet located to the northeast of the bridge and discharged to the sheam floodplain upstream
of the bridge. Please see attached Stormwater Management Plan for details on the minimization of water quality impacts.
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)? *
C' Yes r No
Comme nts: *
State Minimum Criteria Determination Checklist.
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 quality? *
C' Yes r No
3b. If you answered "no," provide a short narrative description.
Project involves the replacement of an existing bridge and is not anticipated to affect future development.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
f Yes f 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?*
C' 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.
Asheville
Sd. Is another Federal agency involved?*

r Yes
Se. Is this a DOT project located within Division's 1-8?
f Yes r No
r No
C' Unknown
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
Sh. Does this project involve the construction/installation of a wind turbine(s)?*
C' Yes r No
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
S. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
USFWS IPaC and NCNHP data and site specific surveys. See Supplemental Information attached under Miscellaneous for threatened and endangered
species write-ups and biological conclusions.
Consultation Documentation Upload
project_report_r130_13491 _13491. 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? *
NOAA EFH Mapper
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
639.47KB
7a. Will this project occur in or near an area that the state, federel 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?*
See attached "No Archaeological Survey Required Form" and "Historic Architecture and Landscapes No Survey Required Form."
7c. Historic or Prehistoric Information Upload
18-08-0007_NoSurvey.pdf
R.130 No Archaeological Survey Required Form.pdf
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:
NCDOT Hydraulics Unit Coordination with FEMA.
Sc. What source(s) did you use to make the floodplain determination?*
FEMA FIRM maps
Miscellaneous
5.33MB
3.46MB
Comments
Additional Miscellaneous attachments include Supplemental Information regarding the Threatened and Endangered species listed in Anson County.
Miscellaneous attachments not previouslyrequested.
T&E Supplemental info for R130 ePCN Form.pdf
Signature
*
fJ By checking the box and signing below, I certify that:
89.12KB
• I have given true., accurate, and complete information on this form;
. I agree that submission of thls 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 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
J
�
Signature

�t�J �'/lrrrr�o�r
Date
3/7/2019