20190436 Ver 1_PCN Form Submission_20190408

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 *
20190436
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:
Replace Bridge No. 130 over Big Branch on Lower White Store Road
1a. Who is the PrimaryContact?*
Larry Thompson, Environmental Supervisor II, NCDOT Division 10
1b. PrimaryContact Email:*
[e-mail]
Date Submitted
4/8/2019
Nearest Body of Water
Big Branch
Basin
Yadkin-PeeDee
Water Classification
C
Site Coordinates
Latitude:
34.946138
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:
17BP.10.R.115
WBS # (�)
17BP.10.R.115
1a. Type(s) of approval sought from the Corps:
Longitude:
-80271734
Ve rsion# *
1
Reviewing Office *
Mooresville 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?
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:
North Carolina Department of Transportation
2b. Deed book and page no.:
IWA
2c. Responsible party:
fWA
2d. Address
Street Address
716 W Main St.
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
Stanly
2f. Fax Number:
[phone]
x
C' Yes R No
C' Yes G No

[e-mail]
C. Project Information and Prior Project History " I
1. Project Information
1b. Subdivision name:
(if appropriate)
WA
1c. Nearest municipalityl town:
Peachland
2. Project Identification
2a. Propertyldentification Number:
N/A
2c. Project Address
Street Address
SR 1252 (Lower White Store Road
Address Line 2
wn
�ry
Peachland
Postal / Zip Code
28133
2b. Property size:
3.6
State / Rovince / Re3ion
NC
Country
Anson
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Big 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.
030401040102
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:*
Land use in the project vicinity consists primarily of agriculture, forests, and single family residential homes.
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 17 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for DWR)
Fig_2_17BP_10_R_115_USGS_topo_map.pdf 255.71KB
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)
10.R.115 Soil Map.pdf 198.25KB
4f. List the total estimated acreage of all existing wetlands on the property:
0.31
4g. List the total estimated linear feet of all existing streams on the property:
475
4h. Explain the purpose of the proposed project:*
To replace Anson County No. 130 on SR 1252 (Lower White Store Road) over Big Branch.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
The proposed replacement structure is a single span bridge (1 @55') 21" cored slab deck with 2.5' deep caps. This structure has been designed to minimize environmental impacts by
using 2:1 slopes with guardrail adjacent to jurisdictional features. Standard construction equipment will be used including trucks, bulldozers, and cranes.
4j. Please upload project drawings for the proposed project.
17 B P.10. R.115_HYD_PRM_W ET_SET_20190404. p df
5. Jurisdictional Determinations
Sa. Have the wetlands or streams been delineated on the property or proposed impact areas?*
G Yes r No
1.76 MB
r Unknown

Comments:
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:
WA
Sc. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Sara Easterly
Agency/Consultant Company: HDR
Other:
Sd1. Jurisdictional determination upload
17BP.10.R.115 WA-UP.pdf
17BP.10.R.115 WA-Wet.pdf
90.43KB
91.67KB
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 activit�/?
No
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 r Buffers
r Open Waters Ir Pond Construction
2. Wetland Impacts
2g. Total Temporary Wetland Impact 2g. Total Permanent Wetland Impact
0.000 0.040
2g. Total Wetland Impact
0.040
2h. Comments:
There will be less than 0.01 acres of permanent fill in weUand, as well as 0.02 acres of excavation, and 0.01 in mechanized clearing for Site 1(WA).
Permanent fill will be limited to area of new roadside ditch to prevent erosion.
3. Stream Impacts
❑ 3a. Reason for impact (?) 3b.lmpact type * 3c. Type of impact" 3d. S. name * 3e. Stream Type" 3f. Type of 3g. S. width" 3h. Impact
(?) Jurisdiction�` length*
S1 Rip-Rap at Embankment Permanent Bank Stabilization Big Branch Perennial Corps 25 40
nverage(feeq pinearfeet)
gp Construction impacts Temporary Other Big Branch Perennial Corps 25 100
Average(feet) Qinearfeet)
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts: 3i. Total temporary stream impacts:
40 100
3i. Total stream and ditch impacts:
140
3j. Comments:

Permanent existing channel impacts at Site 1(Big Branch) are e�ected to be 40 feet, with 100 feet of temporary impacts. Site 1(Big Branch) is the
only stream onsite with impacts.
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:
The project has been designed to minimize wetland and sheam impacts by utilizing 2:1 fill slopes with guardrail adjacent to jurisdictional features.
Channel improvements were made for the proposed bridge design, the excavation associated with the channel improvements was kept to a minimum
to reduce stream impacts. Also, three ditches are proposed on the site, all of the proposed ditches are to be rip-rap lined to stabilize the ditches and
minimize the chance of erosion.
1b. Specificallydescribe measures taken to avoid or minimize the proposed impacts through construction techniques:
NCDOT Best Management Practices for bridge replacement projects will be followed as well as Sedimentation and Erosion Control measures.
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 State7
C' Yes r No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
The impacts are belowthe NW 3 threshold.
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?
f Yes r No
If no, explain why:
The project is in the Yadkin-Pee Dee River basin. No buffer rules exist for this river basin.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
� Yes r No
Comments:
See attached
� 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?*
� 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
Comments:
*
An environmental document was not required for this project.
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)?*
� 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.
This is a bridge replacement projecL No additional development will resutt from this bridge replacement.
4. Sewage Disposal (DWR Requirement)

4a. Is sewage disposal required by DWR for this project?*
C' Yes r No C' 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?"
� Yes r No
Sc. If yes, indicate the USFWS Field Office you have contacted.
Asheville
Sd. Is another Federal agency involved?"
� Yes � 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?
G 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 �' No r 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.?
G Yes �' No
If yes, please provide details to include type of percussive activity, purpose, duration, and specific location of this activity on the property.
Sj. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
USFWS IPAC
Consultation Documentation Upload
17BP.10.R.115_NHP Report.pdf
17 BP.10. R.115_Self_Certification_Package_032819. 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?*
National Marine Fisheries Service (NMFS) Mapper
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
835.28KB
122MB
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?*
The State Historic Preservation Office (SHPO).
7c. Historic or Prehistoric Information Upload
18-12-0025NoSu rveyReq. pdf 3.52 MB
AR18-12-0025NoSitesPresent.pdf 4.14MB
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?*
NC Roodplain Mapping
Miscellaneous

Comments
Please note NLEB is not listed for Mson County per the USFWS county list last updated on June 27, 2018. Also, the field visit for 17BP.10.R.115 was conducted on November 1, 2018,
just one day outside of the optimal survey window of October 31 for Sch�initz's sunflower (Helianthus schweinitai). There v,�re no stems of Helianthus noted during the site visit.
Surveys for Carolina Heelsplitter (Lasmigona decorata) have been requested; however may be deemed unnecessary.
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 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
�rt tJ �'/lrcrrr�rhxo�r
Date
4/8/2019