20190653 Ver 1_PCN Form Submission_20190517

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?*
G Yes r No
Change only if needed.
BIMS # Assigned
20190653
Is a payment required for this project?*
r No payment required
r Fee received
r Fee needed - send electronic notification
Select Project Reviewer*
Dave Wanucha:eads\djwanucha
Information for Initial Review
1a. Name of project:
Replace Bridge 105 over Yadkin River Overflow on US 421 Northbound Lane
1a. Who is the Primary Contact?*
NCDOT
1b. Primary Contact Email:*
[e-mail]
Date Submitted
5/17/2019
Nearest Body of Water
Deep Creek
Basin
Yadkin-PeeDee
Water Classification
WS-IV
Site Coordinates
Version# *
1
Reviewing Office*
Winston-Salem Regional Office - (336) 776-
9800
1c. Primary Contact Phone:*
[phone]
Latitude: Longitude:
36.105545-80.515655
FA. Processing Information U
County (or Counties) where the project is located:
Yadkin
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:
B-5389
WBS # (?)
46104.1.1
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 r 401 Water Quality Certification - Express
F Non-404 Jurisdictional General Permit F Riparian Buffer Authorization
F' Individual Permit
*
le. Is this notification solelyfor the record because written approval is not required?
For the record only for DWR 401 Certification: r Yes r No
For the record only for Corps Permit: r Yes r No
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
B-5389 DIMS Acceptance.pdf 67.76KB
1h. Is the project located in any of NC's twenty coastal 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 r 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:
NC Department of Transportation
2b. Deed book and page no.:
2c. Responsible party:
2d. Address
Street Address
1598 Mail Service Center
Address Line 2
aty
State / Rovince / Region
Raleigh
NC
Fbstal / Zip Code
Country
27699
USA
2e. Telephone Number: 2f. Fax Number:
[phone]

2g. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(i appropriate)
1c. Nearest municipality/town:
Lewisville
2. Project Identification
2a. Property Identification Number:
2c. Project Address
Street Address
Address Line 2
Oty
Postal / Zip CDde
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Deep Creek
3b. Water Resources Classification of nearest receiving water:*
WS-IV
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.
030401011103
4. Project Description and History
2b. Property size:
State / Frwince / Pagion
O�untry
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:*
Surrounding land use is primarily agricultural land, With a rowof trees along the unnamed tributary.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
r Yes 6 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)
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)
4f. List the total estimated acreage of all existing wetlands on the property:
0.03
4g. List the total estimated linear feet of all existing streams on the property:
209
4h. Explain the purpose of the proposed project:*
The B-5389 project is needed to replace bridge 105 because it is functionally obsolete. Its sufficiency rating is 64.7. The project purpose is to replace the functionally obsolete bridge
with one that meets current NCDOT design standards.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
The proposed project will replace the eAsting two-lane bridge (Bridge No. 105) with another two-lane bridge in the same location. The proposed replacement structure will be a multi -
span structure that is approAmately 455 feet in length, with a 38-foot wide clear deck width. The project's total length is 1,500 feet. The ebsting northbound lane bridge will be replaced
with a new structure at the wasting location. Traffic on the northbound lanes will be maintained during construction with an on -site detour located north of the wasting bridge location.
Standard road building equipment such as trucks, dozers, and cranes will be used.
4j. Please upload project drawings for the proposed project.
B-5389 Permit Drawngs.pdf 2.13MB
B-5389 Roadway Plans.pdf 2.27MB
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r: Yes
f No
r Unknown

Comments:
Two small wetland areas and one intermittent stream were identified in the study area. No JD site
visit was held.
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): Carolina Ecosystems, Inc.
Agency/Consultant Company:
Other:
5d1. Jurisdictional determination upload
6. Future Project Plans
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?
No.
CProposed Impacts Inventory
1. Impacts Summary
la. Where are the impacts associated with your project? (check all that apply):
W Wetlands W Streams -tributaries r Buffers
r- Open Waters r Pond Construction
2. Wetland Impacts
Reason (?) 2b. Impact type * ('i 2c. Type of W. * 2d. W. name * 2e. Forested* 2f. Type of 29. Impact
Jurisdicition*M area*E71
Bridge replacement P Headwater Forest �WA � FP.
0.020
(acres)
Bridge replacement JL
f�est ��]WB
�
Corps
0.010
(acres)
2g. Total Temporary Wetland Impact
0.000
2g. Total Wetland Impact
0.030
2h. Comments:
Both wetlands are a total take.
3. Stream Impacts
2g. Total Permanent Wetland Impact
0.030
3a. Reason for impact (?)
3b.lmpact type *
3c. Type of impact*
3d. S. name*
3e. Stream Type *
Type of
3g. S. width *
3h. Impact
❑
(?)
�3f.
Jurisdiction*
length*
S1
Site 1 -Ditch outlet
Permanent
Bank Stabilization
SA
Intermittent
Both
6
23
protection
Average (feet)
(linear feet)
S2
Site 2 -Bridge Replacement
Temporary
Dewatering JSA
Intermittent
Both
6
145
Average (feet)
(linearfeet)
S3
Site 5 -Temporary s
Dewatering
�SA
Intermittent
Both
31. Total jurisdictional ditch impact in square feet:
0
31. Total permanent stream impacts:
23
31. Total temporary stream impacts:
234

31. Total stream and ditch impacts:
257
3j. Comments:
Temporary impacts total 0.03 acre
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 proposed replacement bridge will be on the same alignment as the existing bridge. Deck drains on the proposed structure will not be discharged
over open water, reducing stream pollution associated with roadway runoff. The runoff from deck drains will be discharged onto a Class B rip rap
dissipator pad. Additional measures implemented to reduce impacts to the stream and surrounding properties include maintaining existing drainage
patterns and using rip rap at drainage outlets to dissipate energy and reduce erosion.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
NCDOT will adhere to Best Management Practices for Construction and Maintenance Activities.
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 V Corps
2d. If yes, which mitigation option(s) will be used for this project?
r 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)
0
4d. Buffer mitigation requested (DWR only):
(square feet)
0
4f. Non -riparian wetland mitigation requested:
(acres)
0
4c. If using stream mitigation, what is the stream temperature:
4e. Riparian wetland mitigation requested:
(acres)
0.03
4g. Coastal (tidal) wetland mitigation requested:
(acres)
0
4h. Comments
No mitigation is required for the stream bank stabilization or temporary stream impacts as these impacts do not constitute a loss of waters of the US.
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:
No buffered resources within project area.
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
u
1a. Does the project involve an expenditure of public (federal/state/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
1c. If you answered "yes" to the above, has the document review been finalized by the State Clearing House?*
r Yes r No
NEPAor SEPAFinal Approval Letter
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.
Due to the minimal transportation impact resulting from this bridge replacement, this project will neither influence nearby land uses nor stimulate
growth. Therefore, a detailed indirect or cumulative effects study will not be necessary.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
r 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?
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
If yes, please provide details to include type of percussive activity, purpose, duration, and specific location of this activity on the property.
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
As of June 27, 2018, the USFWS lists one protected species for Yadkin County, the northern long-eared bat (NLEB). Please see the attached
SLOPES memo dated December 11, 2018 for NLEB. While evidence of bat use was found at Bridge 105 during a May 2018 site visit, the neared
recorded NLEB hibernacula is 72 miles away and the closest red HUC is appropmately 70 miles away.
Consultation Documentation Upload
B-5389 NLEB SLOPES Yadkin.pdf 179.74KB

6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
f Yes r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
NMFS County Index
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?*
SEPA Documentation
7c. Historic or Prehistoric Information Upload
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 Maps
Mi lets laneous
Comments
There will be 0.97 acre of tree clearing on this project.
Miscellaneous attachments not previously requested.
B-5389 Signed Cover Letter.pdf 1.25MB
Signature
*
P 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:
Mack Christopher Rivenbark III
Signature
xO e- �(vIwxq 10
Date
5/17/2019