20190622 Ver 1_PCN Form Submission_20190510

DWR
IDIOM n of Water Resources
Pre -Construction Notification (PCN) Form
September 29, 2018 Ver 3
21nitial Review
Has this project met the requirements for acceptance in to the review process?*
r Yes
r No
Is this project a public transportation project?*
C Yes r No
Change only if needed.
BIMS # Assigned * Version#*
20190622 1
Is a payment required for this project?*
r No payment required
r Fee received Reviewing Office*
r Fee needed - send electronic notification Mooresville Regional Office - [phone]
Select Project Reviewer*
Donna Fbod:eads\drhood
Information for Initial Review
1a. Name of project:
Replacement of Bridge #030217 over Lanes Creek
1a. Who is the Primary Contact?*
Larry Thompson
1b. Primary Contact Email:*
[e-mail]
Date Submitted
5/10/2019
Nearest Body of Water
Lanes Creek
Basin
Yadkin-PeeDee
Water Classification
C
Site Coordinates
Latitude: Longitude:
35.107759-80.182607
1c. Primary Contact Phone:*
[phone]
FA. Processing Information U
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?*
r Yes r No
(NCDOT only) T.I.P. or state project number:
WBS # (?)
17BP.10.R.140
1a. Type(s) of approval sought from the Corps:

W Section 404 Permit (wetlands, streams and waters, Clean Water Act)
r Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What types) of permit(s) do you wish to seek authorization?
W Nationwide Permit (NWP)
r' Regional General Permit (RGP)
r' Standard (IP)
1c. Has the NWP or GP number been verified by the Corps?
t' 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
F Non-404 Jurisdictional General Permit
F Individual Permit
le. Is this notification solelyfor the record because written approval is not required?
For the record only for DWR 401 Certification:
For the record only for Corps Permit:
r 401 Water Quality Certification - Express
r Riparian Buffer Authorization
1f. Is this an after -the -fact permit application?*
C 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?
C Yes t No
Acceptance Letter Attachment
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?
C Yes r No
F. Applicant Information
1d. Who is applying for the permit?
[J Owner r Applicant (other than owner)
le. Is there an Agent/Consultant for this project?
r Yes C 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
City
State / Frwinee / R�gion
Albemarle
NC
Fbstal / Zip Code
Q�untry
28001
USA
2e. Telephone Number:
2f. Fax Number:
[phone]
[phone]
2g. Email Address:*
*
C Yes r No
r Yes C No

[e-mail]
C. Project Information and Prior Project History U
1. Project Information
1b. Subdivision name:
(i appropriate)
1c. Nearest municipality/ town:
Ansonville
2. Project Identification
2a. Property Identification Number:
2b. Property size:
WA
14.3
2c. Project Address
Street Address
SR 1654 (Morton Road)
Address Une 2
Cty
State / Province / %gion
Ansonville
NC
Fbstal / Zip Cide
Country
USA
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Lanes Creek
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.
030401050604
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:*
Existing conditions include SR 1654 (Morton Road), agricultural land, 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?*
r Yes r 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)
USGS Figure R140.pdf
2.54MB
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)
17BP10R140_Figure2_SoilsMap.pdf 3.52MB
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:
674
4h. Explain the purpose of the proposed project:*
To remove Bridge #030217 and replace with a new, modern bridge structure. The project was formerly designated as B-5795 due to the federal funding that was previously proposed
and was changed to 17BP.10.R.140 when state funding was proposed.
41. 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 including impervious dikes around the bridge piers for dewatering. Bridge demolition will include the removal of the bridge
deck and the removal of the piers and bridge abutments, and temporary impacts to 55 linear feet (If) to Lanes Creek may result from dewatering. Additional potential temporary
overlapping impacts to Lanes Creek of 108 If and the unnamed tributary to Lanes Creek of 74 If may result from demolition and construction activities. Permanent impact of 12 If to the
unnamed tributary to Lanes Creek will result from the riprap ouffall pad and 16 If of permanent impact will result from the excavation required for abutment protection. Bridge
replacement construction using heavy equipment from the upland roadway approaches. Deck drains are proposed on the ends of the bridge and runoff from the bridge will be
discharged to the stream floodplain bench as described in the stormwater management plan. 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.
SF-030217_HYD_SMPv2.07_20180531.pdf 178.72KB
R.140_Permit_Plans_2019-05-02.pdf 2.53MB

5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes r No
Comments:
See attached Stream Form and Waters Mapping
5b. If the Corps made a jurisdictional determination, what type of determination was made?
r Preliminary r Approved r Not Verified r Unknown r N/A
Corps AID Number:
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
5d1. Jurisdictional determination upload
DWR Stream Form SA.pdf
Waters Map R140.pdf
6. Future Project Plans
Pete Stafford, PWS
Rummel Klepper and Kahl, LLP
51.81 KB
3.17MB
r Unknown
6a. Is this a phased project?*
r 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
la. Where are the impacts associated with your project? (check all that apply):
r Wetlands W Streams -tributaries ❑ Buffers
r Open Waters r Pond Construction
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
F
(?)
Jurisdiction*
length*
S1
Bridge replacement
Temporary
Other
Lanes Creek
Perennial
Both
60
108
Average (feet)
(linearfeet)
gp
Bridge replacement
Temporary
Dewatering
Lanes Creek
Perennial
Both
60
55
Average (feet)
(linearfeet)
S3
Bridge replacement
Temporary
Other
U.T. to Lanes Creek
Intermittent
Both
7
74
Average (feet)
(linear feet)
�
Bridge replacement
g p
Permanent
Excavation
U.T. to Lanes Creek
Intermittent
Both
7
16
Average (feet)
(linearfeet)
SS
Bridge replacement
Permanent
Rip Rap Fill
U.T. to Lanes Creek
Intermittent
Both
7
12
Average (feet)
(linear feet)
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts: 3i. Total temporary stream impacts:
28 237
3i. Total stream and ditch impacts:
265
3j. Comments:
The 108 If of potential temporary demolition and construction impacts overlap the 55 If of dewatering impacts in Lanes Creek; due to this overlap, total
temporary stream impacts are 182 If and total stream and ditch impacts are 210 If.
E. Impact Justification and Mitigation

1. Avoidance and Minimization
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
Replace bridge in -place and extending the bridge span length to avoid impacts. Riprap protection of the bridge abutments is being placed outside of
the jurisdictional stream boundary of the perennial stream where possible to avoid impacts. Work will be conducted from the dewatered portion of the
stream and upland roadway approaches.
1 b. Specifically describe 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
dewatered portion of the stream and upland roadway approaches will be used to minimize potential temporary demolition related impacts and avoid
construction related impacts.
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
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
Minimal permanent impacts of 28 linear feet and 74 linear feet of potential temporary impacts to the unnamed tributary to Lanes Creek are proposed. The proposed 108 linear feet of
potential temporary demolition and construction related impact to Lanes Creek from will overlap the 55 linear feet of temporary dewatering impacts.
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?
r 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?*
r Yes r' No
Comments:
Stormwater runoff from the proposed bridge Will be routed to deck drains that discharge to the floodplain bench of Lanes Creek. Please see attached Stormwater Management Plan for
details on the minimization of voter quality impacts.
G. Supplementary Information
1. Environmental Documentation
la. Does the project involve an expenditure of public (federallstate/local) funds or the use of public (federal/state) land?*
r 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 Policy Act (NEPA/SEPA)? *
r Yes r No
Comments:*
Bridge 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?*
r Yes r No
3b. If you answered "no," provide a short narrative description.
Project involves the replacement of an eAsting bridge and is not anticipated to affect future development.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
rYes r Nor WA

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?
f Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
f Yes r No
5d. Is another Federal agency involved?*
r Yes r No
5e. Is this a DOT project located within Division's 1-8?
r- Yes r No
5f. Will you cut anytrees in order to conduct the work in waters of the U.S.?
r Yes r No
5g. Does this project involve bridge maintenance or removal?
r Yes r- No
5g(1). If yes, have you inspected the bridge for signs of bat use such as staining, guano, bats, etc.?
r Yes r No
If you answered "Yes" to 5g(1), did you discover any signs of bat use?
r- Yes r No r- Unknown
Sh. Does this project involve the construction/installation of a wind turbine(s)?*
r^ Yes r No
r Unknown
5i. 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.?
r- Yes r No
5j. 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 by STV Engineers, Inc., Environmental Scientist Brandon Phillips on September 27, 2018 that
found no Schweinit2s sunflower. The NRTR prepared by Rk&K in September 2016 for the project. See Mussel Survey Report attached for Carolina
heelsplitter write-up and biological conclusion.
Consultation Documentation Upload
NCNHP_Project_ Report _R140_Bridge217_03112019.pdf 826.42KB
B5795 NRTR.pdf 8.37MB
B-5795 Lanes Creek Mussel Survey Report _2018_Final.pdf 1.42MB
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
ryes 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)
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?*
r- 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
R.140 B-5795 Historic Architecure %SurveyReq.pdf 2.65MB
16-02-0049 PAW Archaeological Survey Required Form Br 0217 on SR 1654 Lee Creek Anson.pdf 561.16KB
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
r Yes r- No
8b. 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
Comments
Please see attached Photographs of the bridge and study area.

Miscellaneous attachments not previously requested.
R.140 Photopages.pdf
14.44MB
Signature u
m 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 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
Signature
Date
5/10/2019