20190396 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#*
20190396 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 #030234 over Cabbage Branch
1a. Who is the Primary Contact?*
Larry Thompson - NCDOT Division 10
1b. Primary Contact Email:*
[e-mail]
Date Submitted
5/10/2019
Nearest Body of Water
Cabbage Branch
Basin
Yadkin-PeeDee
Water Classification
C
Site Coordinates
Latitude: Longitude:
35.080920-80.120924
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.128
1a. Type(s) of approval sought from the Corps:

W Section 404 Permit (wetlands, streams and waters, Clean Water Act)
F 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)
F' Regional General Permit (RGP)
F' Standard (IP)
1c. Has the NWP or GP number been verified by the 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:
rJ 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:
F 401 Water Quality Certification - Express
F 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?
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
Acceptance Letter Attachment
DIMS SR 1637 - Bridge 030234 - Division 10 - STIR - YD 104.pdf
1h. Is the project located in anyof NC's twentycoastal counties?
r Yes r No
1j. Is the project located in a designated trout watershed?
r^ Yes r No
B. Applicant Information
1d. Who is applying for the permit?
W Owner F Applicant (other than owner)
le. Is there an Agent/Consultant for this project?
r Yes r- 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
aty
Albemarle
Rbstal / Zip Code
28001
2e. Telephone Number:
[phone]
Sate / Province / Region
NC
( ountry
USA
2f. Fax Number:
[phone]
67.61 KB
*
r Yes r No
r Yes r No

2g. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(i appropriate)
1c. Nearest municipality/town:
Ansonville
2. Project Identification
2a. Property Identification Number:
2b. Property size:
WA
4.9
2c. Project Address
Street Address
SR 1637 (Jack's Branch Road)
Address Line 2
CKY
State / Rovince / ftim
Ansonville
NC
Postal / Zip Cide
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:*
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:*
Existing 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?*
r Yes r No F 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_128_Bridge234_Figure1 _USGSMap. pdf
2.31 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_Bridge234_Figure2_SoilsMap.pdf 3.24MB
4f. List the total estimated acreage of all existing wetlands on the property:
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 LF to Cabbage Branch may result from the
dewatering required for the installation of the culvert and water line. Bridge to culvert replacement construction using heavy equipment from the upland roadway approaches. A two-step
stream flow -through operation will be installed to restrict the flow of Cabbage Branch to one side of the stream to devoter the east side where the high flow culvert will be placed. When
the high flow culvert has been completed, stream flow will 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 water line open cut located upstream (north) of the bridge will then be dewatered with an impervious dike prior to the installation of the water line and the stream bed and
banks will be restored to original contours after installation. The proposed culvert will be built on the same alignment with a temporary off -site detour. Permanent impacts of 50 LF will
result from the culvert and 91 LF of streambank will be impacted for the stabilization of the streambank.
4j. Please upload project drawings for the proposed project.

SF030234_HYD_SMPv2.07_20180329(Oct 2016).pdf 178.71 KB
R.128_Permit_Plans_2019-05-09.pdf 4.1 MB
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
r Yes r No
Comments:
See attached Wetland Determination Form, Stream Form, Photographs 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): Brandon Phillips, CHMM
Agency/Consultant Company: STV Engineers, Inc.
Other:
5d1. Jurisdictional determination upload
Jacks Branch Road R128 upland data sheet.pdf 418.46KB
NCDWQ RPW A- Cabbage Branch.pdf 72.89KB
R_128_Bridge234_Figure3_WatersMap.pdf 3.72MB
R.128 Photopages.pdf 15.2MB
6. Future Project Plans
O 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 9 Streams -tributaries
F Open Waters r Pond Construction
3. Stream Impacts
r Buffers
3a. Reason for impact (?)
3b.lmpact type *
3c. Type of impact*
3d. S. name*
3e. Stream Type *
Type of
3gSwidth *
3h. Impact(9)
F
�[3f.
urisdiction*
length*
S1Bridge
replacement
Culvert ]ff�age
BranchBoth
15
50
Average (feet)
(linear fed)
S2
Bridge replacement
9 P
Permanent
Stabilization
Cabba a Branch
9
Perennial
Both
15
91
Average (feet)
(linearfed)
S3
Bridge replacement
Temporary
Other
Cabbage Branch
Perennial
Both
15
93
AveraC7e (feet)
(linear fed)
�
Water line installation
Tem ora
P ry
Dewaterin g
Cabbage Branch
9
Perennial
Both
15
36
AveraC7e (fed)
(linearfed)
31. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts: 3i. Total temporary stream impacts:
141 129
3i. Total stream and ditch impacts:
270
3j. Comments:
Temporary impacts are overlapping and associated with the demolition of the existing bridge and the dewatering of the stream for the construction of
the proposed culvert and water line installation. Permanent impacts are associated with the bank stabilization of Cabbage Branch and the double box
culvert installation.

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:
Replacing the bridge to culvert in -place was incorporated to minimize impacts. The culvert length was minimized to reduce impacts. Riprap bank
stabilization for protection of the bridge abutments is being placed only on the stream banks and will not disturb the stream bed. Work will be
conducted from the upland roadway approaches.
1b. 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
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
2c. If yes, mitigation is required by (check all that apply):
F DWR
W Corps
2d. If yes, which mitigation option(s) will be used for this project?
F Mitigation bank W Payment to in -lieu fee r 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.
r Yes r No
4b. Stream mitigation requested:
(linear feet)
50
4d. Buffer mitigation requested (DWR only):
(square feet)
4f. Non -riparian wetland mitigation requested:
(acres)
4h. Comments
4c. If using stream mitigation, what is the stream temperature:
warm
4e. Riparian wetland mitigation requested:
(acres)
4g. Coastal (tidal) wetland mitigation requested:
(acres)
Permanent impacts of 50 LF to the bed and banks of Cabbage Branch is proposed for the double box culvert installation. The stabilization of the
proposed flood benches will permanently impact 91 LF 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?
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 (' No
Comments:
Please see attached Stormwater Management Plan for details on the minimization of water quality impacts.
G. Supplementary Information
1. Environmental Documentation
la. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
r Yes
(' No
U
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
Comments:
r No

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)? *
f 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?*
f Yes r Nor N/A
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
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
r Yes r- No
5c. If yes, indicate the USFWS Field Office you have contacted.
Asheville
5d. Is another Federal agency involved?*
r Yes r No
5e. Is this a DOT project located within Division's 1-8?
f 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
5h. 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.?
f 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. See Supplemental Information attached under Miscellaneous for threatened and endangered
species write-ups and biological conclusions.
Consultation Documentation Upload
NCNHP_ project _report_division_10_bridge _ 234_03082019.pdf 892.57KB
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
r 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)
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
18-10-0039_NoSurvey.pdf 3.04MB
R.128 No Archaeological Survey Required Form.pdf 723.44KB
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
Additional Miscellaneous attachments include Supplemental Information regarding the Threatened and Endangered Species that are listed in Anson County.
Miscellaneous attachments not previously requested.
T&E Supplemental info for R128 ePCN Form.pdf
Signature
W By checking the box and signing below, I certify that:
89.36KB
• 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
lzmv=
Date
5/10/2019