20190452 Ver 1_PCN Form Submission_20190410

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 *
20190452
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 970091 on SR 1339 with cuvert.
1a. Who is the PrimaryContact?*
Chad Coggins
1b. PrimaryContact Email:*
[e-mail]
Date Submitted
4/10/2019
Nearest Body of Water
Town Creek
Basin
Tar-Pamlico
Water Classification
C;NSW
Site Coordinates
Latitude:
35.81673
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 970091 (State funded project)
WBS # (�)
17BP.4.R.94
1a. Type(s) of approval sought from the Corps:
Ve rsion# *
1
Reviewing Office *
Central Office - [phone]
1c. PrimaryContact Phone:*
[phone]
Longitude:
-77.86994
::

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:
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:
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:
Elm City
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:"
Town Creek
3b. Water Resources Classification of nearest receiving water:*
C;NSW
3c. What river basin(s) is your project located in?*
Tar-Pamlico
3d. Please provide the 12-digit HUC in which the project is located.
030201030102
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 91 topo map.pdf 2.14MB
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 91 soils map.pdf 2MB

4f. List the total estimated acreage of all existing wetlands on the property:
0.20
4g. List the total estimated linear feet of all existing streams on the property:
200
4h. Explain the purpose of the proposed project:"
Replace existing Bridge 970091 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 ebsting Bridge 970091 which is structurally deficient for current NCDOT standards with a two barrel box culvert (2@12'x5' RCBC) meeting these current standards in the
existing right-of-way. Heavy road and culvert building equipment will be used.
4j. Please upload project drawings for the proposed project.
17BP.4.R.94_Permit Drawings_20190401.pdf 3.43MB
17BP.4.R.94_Permit Drawings_BUFFER_20190222.pdf 1.31 MB
5. Jurisdictional Determinations
Sa. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes r No
Comments:
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
r Open Waters Ir Pond Construction
2. Wetland Impacts
rJ Buffers
2a. Site #* (') 2a1 Reason ("?) 2b. Impact type * C') 2a Type of W. * 2d. W. name * 2e. Forested *�f. Type of 2g. Impact
Jurisdicition*(�) area*
site 1 roadway fill P Riverine Swamp Forest Town Creek No Both 0.030
(acres)
site 1 roadway excavation P Riverine Swamp Forest Town Creek No Both 0.040
(acres)
site 1 tail ditch excavation P Riverine Swamp Forest Town Creek No Both 0.020
(acres)
site 1 mechanized clearing P Riverine Swamp Forest Town Creek Yes Both 0.090
(acres)
2g. Total Temporary Wetland Impact 2g. Total Permanent Wetland Impact
0.000 0.180
2g. Total Wetland Impact

0.180
2h. Comments:
Mechanized clearing not included in threshold of impacts requiring compensatory mitigation (i.e. 0.09 acre of inechanized clearing). Construction site
also includes 0.02 acre of hand clearing.
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
culvertfill Permanent Culvert TownCreek Perennial Both 25 41
Average(feet) (linearfeet)
S2
culvert stabilization Permanent Stabilization Town Creek Perennial Both 25 26
Average(feet) (linearfeet)
S3 dewatering Temporary Dewatering Town Creek Perennial Both 25 12
Average(feet) Qinearfeet)
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
67
3i. Total stream and ditch impacts:
79
3j. Comments:
6. Buffer Impacts (for DWR)
6a. Project is in which protect basin(s)?
Check all that apply.
r Neuse
r Catawba
r Goose Creek
r Other
I6b. Impact Type Il6c. Per or Temp
I Allowable culvert construction IP
�
6h. Total buffer impacts:
Zone 1
Total Temporary impacts: 0.00
Stream name
m Creek
3i. Total temporary stream impacts:
12
rJ Tar-Pamlico
r Randleman
r Jordan Lake
Zone 2
0.00
Zone 1 Zone 2
Total Permanent impacts: 3,242.00 1,186.00
Buffer mitigation required? I�6f. Zone 1 impact
Zone 1 Zone 2
Total combined buffer impacts: 3,242.00 1,186.00
6i. Comments:
Supporting Documentation
17BP.4.R.94_Permit Drawings_BUFFER_20190222.pdf 1.31 MB
17BP.4.R.94_Permit Drawings_20190401.pdf 3.43MB
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 with offsite detours.
1b. Specificallydescribe measures taken to avoid or minimize the proposed impacts through construction techniques:
6g. Zone 2 impact
1,186
�

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 projecL Safety fencing will be used to delineate jurisdictional and environmentally 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:
Roadway fill and tail ditch / roadway excavation ( i.e. fill / 0.03 acre & excavation / 0.06 acre; total 0.09 acre of wetland impacts) fall below MNP condition threshold of impacts /
requirement for compensatory mitigation. Also, stream channel impacts (i.e. 67 linear feet ) fall below Regional condition threshold of 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?
F Yes r No
What type of SCM are you providing?
r Level Spreader
�J Vegetated Conveyance (lowar SFIWf)
r Wetland Swale (higher SMNf)
r Other SCM that removes minimum 30 % nitrogen
r Proposed project will not create concentrated stormwater flow through the buffer
Diffuse Flow Documentation
17BP.4.R.94_Permit Drawings_BUFFER_20190222pdf
SMP Wilson 91.pdf
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
r Yes r No
Comments:
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?*
� Yes r No
n�
�I
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)?*
f Yes r No
Comments:
x
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 (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 quality? *
f Yes r No
3b. If you answered "no," provide a short narrative description.
Replacing existing two lane bridge with a newtwo lane boxculvert.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
r Yes r No r WA
1.31 MB
200.41 KB
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?*
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
Se. Is this a DOT project located within Division's 1-8?
� Yes r No
r No
r Unknown
S. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
Red-cockaded wvodpecker is listed as Historic for Wilson Co. Foraging or nesting habitat was not found adjacent to the project area. NCNHP
database records no element occurrence within a mile of the project area. (No Affect) / Tar River Spinymussel is included Ihe IPaC TE list letter dated
April 9, 2019. However review of the 12 digit HIIC GiS element occurrence layer shows this speices is not included for the identified 12 digit HUC.
Therefore, this project meets the Section 7 Mussel Programmatic protocols of a Programmatic BO of No Affect for this species. NCNHP database
records no element occurrence within a mile of the project area. (No Affect) // Atlantic Pigtoe is listed as Historic for Wilson Co. This species is
currently listed as proposed and not current for Wilson County. NCNHP database records no element occurrence within a mile of the project area. (No
Affect) /// Michauxs sumac is listed as Historic for Wilson Co. NCNHP 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 occurrence letter.pdf
Wilson Co. TE List.pdf
Bridge to Culvert PBO Key.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? *
GIS / NOAA AUantic Sturgeon proposed rule dated 06/03/2016
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
218.91 KB
691.09KB
183.59KB
74.9KB
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
V-08-OOP No Archaeological Survey Required Form Br No 091 on SR 1339 Sharpe Store Rd over Town Creek
690.53KB
Wilson.pdf
17-08-0017NoSurvey.pdf 2.06MB
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
r Yes �' No
Sb. If yes, explain how project meets FEMA requirements:
FEMA MOA.......New 2 barrel culvert (2@12'XS' RCBC) in compliance with FEMA MOA requirements for no impacts to 100 year flood plain.
8c. What source(s) did you use to make the floodplain determination?*
FRIS
Miscellaneous
Comments
Miscellaneous attachments not previouslyrequested.
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, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
. I agree to conduct this hansaction 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
�%/rCr� Af/�i%s!<I
Date
4/10/2019