20190396 Ver 1_PCN Form Submission_20190401

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 *
20190396
Is a payment required for this project?*
f No paymentrequired
� 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 #030234 over Cabbage Branch
1a. Who is the PrimaryContact?*
Larry Thompson - NCDOT Division 10
1b. PrimaryContact Email:*
[e-mail]
Date Submitted
4/1 /2019
Nearest Body of Water
Cabbage Branch
Basin
Yadkin-PeeDee
Water Classification
C
Site Coordinates
Latitude:
35.080920
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:
-80.120924
::
WBS # (�)
17BP.10.R.128
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:
14 - Linear transportation
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?*
� 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
SR 1637 - Bridge 030234 - Division 10 - STR - YD 104.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 Division 10
2b. Deed book and page no.:
fWA
2c. Responsible party:
2d. Address
Street Address
716 Main Street
Address Line 2
�Y
Albemarle
Fbstal / Zip Code
28001
2e. Telephone Number:
[phone]
S[ate / FYovince I Region
NC
Cauntry
USA
2f. Fax Number:
[phone]
67.61 KB
x
C' Yes R No
C' Yes G 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:
Ansonville
2. Project Identification
2a. Propertyldentification Number:
N/A
2c. Project Address
Street Address
SR 1637 (Jack's Branch Road)
Address Line 2
�Y
Ansonville
Postal I Zip Code
2b. Property size:
4.9
State / Rovince I f�gion
NC
Country
USA
3. SurFace Waters
3a. Name of the nearest body of water to proposed project:*
Cabbage Branch
3b. Water Resources Classification of nearest receiving water:*
C
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.
030401040105
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:*
Exsting conditions include SR 1637 (Jack's Branch Road), agricultural land, residential property, undeveloped forest, 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 G 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_12S_Bridge234_Figurel_USGSMap.pdf 231 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_128_Brid ge234_F igu re2_Soi IsMap. pdf 324 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:
335
4h. Explain the purpose of the proposed project:"
To remove Bridge #030234 and replace with a new, modern double box culvert 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. Temporary impacts to 93 linear feet to Cabbage Branch may result from the
dewatering of the stream that is required for the conshuction of the culvert. Bridge to culvert replacement construction using heavy equipment from the upland roadway approaches. A
tv�o-step stream flow-through operation v�,ill be installed to restrict the flow of Cabbage Branch to one side of the stream to dewater the east side where the high flow box culvert will be
placed. When the high flow box culvert has been completed, sheam flowwill be routed into the culvert and the west side of Cabbage Branch will be dewatered prior to the installation of
the low flow box culvert. The proposed double box culvert will be built on the same alignment with a temporary off-site detour. Permanent impacts of 50 linear feet to Cabbage Branch
will resutt from the culvert construction and 91 linear feet of the Cabbage Branch streambank will be impacted for the excavation and stabilization of the proposed flood benches.
4j. Please upload project drawings for the proposed project.
SF030234_HYD_SMPv2.07_20180329(Oct 2016).pdf 17871 KB
R.128_Permit_Plans_2019-03-21.pdf 3.12MB

5. Jurisdictional Determinations
Sa. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
� Yes r No
Comments:
See attached Wetland Determination Form, Stream Form, Photographs and Waters Map
Sb. If the Corps made a jurisdictional determination, what type of determination was made?*
C' Preliminary r Approved r Not Verified r Unknown r WA
Corps AID Number:
Sc. If Sa is yes, who delineated the jurisdictional areas?
Name (if known): Brandon Phillips, CHMM
Agency/Consultant Company: STV Engineers, Inc.
Other:
r Unknown
Sd1. Jurisdictional determination upload
Jacks Branch Road R12S upland data sheet.pdf 418.46KB
NCDWQ RPW A- Cabbage Branch.pdf 72.89KB
R_12S_Bridge234_Figure3_WatersMap.pdf 372MB
R.128 Photopages.pdf 15.2MB
6. Future Project Plans
6a. Is this a phased project?*
� 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�/i
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
r Wetlands II� Streams-tributaries
r Open Waters I� Pond Construction
3. Stream Impacts
� Buffers
Reason for impad (:�) 3b.lmpact type" 3c. Type of impact" 3d. S. name * 3e. Stream Type * 3f. Type of 3g. S. width" 3h. Impact
(?) Jurisdiction* length*
replacement
replacement
replacement
Branch Perennial
Branch Perennial
Branch Perennial
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts: 3i. Total temporary stream impacts:
141 93
3i. Total stream and ditch impacts:
234
3j. Comments:
Temporary impacts are associated with the demolition of the ewsting bridge, and the dewatering of Cabbage Branch for the construction of the
proposed double box culvert. Permanent impacts are associated with the installation of the double box culvert and the excavation and stabilization of
the flood benches that will impact Cabbage Branch.
E. Impact Justification and Mitigation
1� 50
Average (feet) Qinear feet)
1� 91
Average (feet) (linear feet)
1� 93
Average (feet) (linear feet)
1. Avoidance and Minimization

1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
Replacing the bridge to a culvert in-place was incorporated to minimize impacts. The culvert length was minimized to avoid additional 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 minimize construction related impacts. The
flowaround operation will ensure that work within the stream is conducted in dry conditions.
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 Ir 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.
G Yes f No
4b. Stream mitigation requested:
Qinear feet)
50
4d. Buffer mitigation requested (DWR only):
(square feet)
4f. Non-riparian wetland mitigation requested:
(acres)
4c. If using stream mitigation, what is the stream temperature:
warm
4e. Riparian wetland mitigation requested:
(acres)
4g. Coastal (tidal) wetland mitigation requested:
(acres)
4h. Comments
Permanent impacts of 50 linear feet to the stream bed and bank of Cabbage Branch is proposed for the double box culvert installation. The
excavation and stabilization of the proposed flood benches will permanently impact appro�timately 91 linear feet of the streambank of Cabbage Branch.
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:
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?*
F Yes r No
Comments:
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 (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 (NEPAISEPA)?*
C' Yes
r No
Comme nts: *
Bridge to culvert replacement project that will require the preparation of a 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 (15A NCAC 2B .0200)? *
r Yes r No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality? *
� 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?*
r Yes r No r 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? *
F Yes r No
Sb. Have you checked with the USFWS concerning Endangered Species Act impacts?*
F Yes r No
Sc. If yes, indicate the USFWS Field Office you have contacted.
Asheville
Sd. Is another Federal agency involved?"
f Yes r No
Se. Is this a DOT project located within Division's 1-8?
C' Yes r No
Sf. Will you cut anytrees in order to conduct the work in waters of the U.S.?
� Yes r No
Sg. Does this project involve bridge maintenance or removal?
r Yes r No
Sg(1). If yes, have you inspected the bridge for signs of bat use such as staining, guano, bats, etc.?
� Yes r No
If you answered "Yes" to 5g(1), did you discover any signs of bat use?
C' Yes r No C' Unknown
Sh. Does this project involve the construction/installation of a wind turbine(s)?*
� Yes r No
�' Unknown
Si. Does this project involve (7) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhammers, mechanized pile drivers, etc.?
C' Yes r No
Sj. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
USFWS IPaC and NNHP data and site specific surveys. See Supplemental Information attached under Miscellaneous for threatened and endangered
species write-ups and biological conclusions.
Consultation Documentation Upload
NCNHP_project_report_d ivision_10_bridge_234_03082019. 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)
892.57KB
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 resources7*
See attached "No Archaeological Survey Required Form" and "Historic Architecture and Landscapes No Survey Required Form."
7c. Historic or Prehistoric Information Upload

18-10-0039_NoSurvey.pdf
R.128 No Archaeological Survey Required Form.pdf
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
G Yes �' No
Sb. If yes, explain how project meets FEMA requirements:
NCDOT Hydraulics Unit Coordination with FEMA.
8c. What source(s) did you use to make the floodplain determination?*
FEMA FIRM maps
Miscellaneous
3.04MB
723.44KB
Comments
Additional Miscellaneous attachments include Supplemental Information regarding the Threatened and Endangered Species that are listed in Anson County.
Miscellaneous attachments not previouslyrequested.
T&E Supplemental info for R128 ePCN Form.pdf 89.36KB
Signature
*
fJ 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, 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 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:
Larry Thompson
Signature
�l.�2, F'/f�F�fP�4R!
�
�I
Date
4/1 /2019