20171597 Ver 2_PCN Form Submission_20190322

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 *
20171597
Is a payment required for this project?*
f No paymentrequired
� Fee received
f Fee needed - send electronic notification
Select Project Reviewer"
April Norton:eads\arnorton
Information for Initial Review
1a. Name of project:
Chatham Bridge #19
1a. Who is the PrimaryContact?*
Art King
1b. PrimaryContact Email:*
[e-mail]
Date Submitted
3/22/2019
Nearest Body of Water
Deep River
Basin
Cape Fear
Water Classification
WS-IV, HQW
Site Coordinates
Latitude:
35.51985
A. Processing Information
County (or Counties) where the project is located:
Chatham
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:
41665.3h
WBS # (�)
41665.3h
1a. Type(s) of approval sought from the Corps:
Ve rsion# *
2
Reviewing Office *
Central Office - [phone]
1c. PrimaryContact Phone:*
[phone]
Longitude:
-79.34835
::

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
r Riparian Buffer Authorization
1f. Is this an after-the-fact permit application?*
r 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
ILF revision NC 42 - Bridge 19 - Division S- STR - CF 03.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 Highway Div.8
2b. Deed book and page no.:
2c. Responsible party:
NCDOT
2d. Address
Street Address
121 Dot Drive
Address Line 2
�Y
Carthage
Fbstal / Zip Code
28327
2e. Telephone Number:
[phone]
S[ate / FYovince I Region
NC
Cauntry
Moore
2f. Fax Number:
[phone]
65.92KB
x
C•' Yes C' No
G Yes C' No
�,

2g. Email Address:*
[e-mail]
C. Project Information and Prior Project History " I
1. Project Information
1b. Subdivision name:
(rf appropriate)
1c. Nearest municipality/town:
Carbonton
2. Project Identification
2a. Propertyldentification Number:
NA
2c. Project Address
Street Address
NC 42
Address Line 2
�Y
Carbonton
Postal I Zip Code
3. SurFace Waters
3a. Name of the nearest body of water to proposed project:*
Deep River
3b. Water Resources Classification of nearest receiving water:*
WS-IV, HQW
3c. What river basin(s) is your project located in?*
Cape Fear
3d. Please provide the 12-digit HUC in which the project is located.
030300030604
4. Project Description and History
2b. Property size:
NA
State / Rovince I f�gion
NC
Country
Chatham
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 bridge is currently under construction. all other conditions are the same as submitted in the original PCN.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
G Yes �' No C' Unknown
4c. If yes, please give the DWR Certification number or the Corps Action ID (exp. SAW-0000-00000).
SAW-2018-00212
Project History Upload
submitted document.pdf 13.19KB
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)
submitted document.pdf 13.19KB
4e. Attach an 8 7/2 X 11 excerpt from the most recent version of the published County NRCS Soil Survey map depicting the project site. (for DWR)
submitted documenLpdf 13.19KB
4f. List the total estimated acreage of all existing wetlands on the property:
NA
4g. List the total estimated linear feet of all existing streams on the property:
500
4h. Explain the purpose of the proposed project:*
Same as in the original PCN.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
Same as in the original PCN.
4j. Please upload project drawings for the proposed project.
submitted document.pdf 13.19KB

5. Jurisdictional Determinations
Sa. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes r No
Comments:
Same as original PCN
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:
Same as original PCN
5c. If 5a is yes, who delineated the jurisdictional areas?
r Unknown
Name (if known): Same as original PCN
Agency/Consultant Company:
Other:
Sd1. Jurisdictional determination upload
submitted documenLpdf 13.19KB
6. Future Project Plans
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 ,I� Streams-tributaries
r Open Waters I� Pond Construction
3. Stream Impacts
❑ 3a. Reason for impact (') 3b.lmpact type * 3c. Type of impact
cl � I conseroation easement Permanl ent I Othel r
S. name
River
r Buffers
3e. Stream Type" 3f. Type of * 3g. S. width" 3h. Imp* ct
(�) Jurisdiction length
Perennial Both 71 5 1251 9
Average(feet) I� Qinearfeet)
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts: 3i. Total temporary stream impacts:
259 0
3i. Total stream and ditch impacts:
259
3j. Comments:
This is a revision to the original PCN. The 259 ft. of stream impacts listed are due to the loss stream mitigation credits associated with the ROW
ex[ension (62 feet), the utility easement relocation (30 feet), and the temporary construction easement (37.5 feet) as shown on the design plan
provided to the IRT. The IRT has required a compensation ratio of 2:1 for these impacts, resulting in a total credit purchase of 259 feet from NCDMS
in Hydrologic Unit 03030003.
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:
Same as original PCN
1b. Specificallydescribe measures taken to avoid or minimize the proposed impacts through construction techniques:
Same as original PCN
�
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?
r Yes r No
2c. If yes, mitigation is required by (check all that apply):
r DWR �J Corps
2d. If yes, which mitigation option(s) will be used for this project?
r Mitigation bank rJ Payment to in-lieu fee � Permittee Responsible
program Mitigation
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached.
C' Yes �' No
4b. Stream mitigation requested:
Qinear feet)
259
4d. Buffer mitigation requested (DWR only):
(square feet)
NA
4f. Non-riparian wetland mitigation requested:
(acres)
NA
4h. Comments
Same as in the original PCN.
4c. If using stream mitigation, what is the stream temperature:
warm
4e. Riparian wetland mitigation requested:
(acres)
NA
4g. Coastal (tidal) wetland mitigation requested:
(acres)
NA
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:
Same as in the original PCN.
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:
Same as original PCN
G. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land? *
G 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 (NEPA/SEPA)?*
C' Yes r No
Comme nts: *
Same as in the original PCN.
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)? *
f Yes r No
2b Provide an explanation of the violation(s):
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.
Same as original PCN
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
� 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?*
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 r Unknown
Se. Is this a DOT project located within Division's 1-8?
F Yes r No
Sj. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
Same as original PCN
Consultation Documentation Upload
submitted documenLpdf 13.19KB
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?"
� Yes r No
Are there submerged aquatic vegetation (SA� around the project vicinity?*
� Yes r No r Unknown
Will this project affect submerged aquatic vegetation?"
C' Yes
C' No
� Unknown
r• E�lain Same as in the original PCN.
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?'�
Same as original PCN
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?*
Same as original PCN
7c. Historic or Prehistoric Information Upload
submitted document.pdf 13.19KB
8. Flood Zone Designation (Corps Requirement)
Sa. Will this project occur in a FEMA-designated 100-year floodplain?*
F Yes r No
Sb. If yes, explain how project meets FEMA requirements:
Same as in the original PCN.
Sc. What source(s) did you use to make the floodplain determination?*
Same as original PCN
Miscellaneous
Comments

THIS IS A REQUEST FOR A PERMIT MODIFICATION TO ADDRESS THE CHANGES TO THE BIOLOGICAL OPINION CAUSED BY A MODIFICATION TO THE CAUSEWAY
CONFIGURATION, AND LEGNTH OF TIME THEY WILL REMAIN IN THE WATER. THIS MODIFICATION REQUEST WILL ALSO ADDRESS THE MITIGATION REQUIREMENT MADE
NECESSARY BY THE PERMANENT IMPACTS WITHIN THE CONSERVATION EASEMENT AROUND THE BRIDGE (259 FT.)
Miscellaneous attachments not previouslyrequested.
submitted documenLpdf
13.19KB
Signature
�J 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:
Art C. King
Signature
,��r c ����
Date
3/22/2019