20190455 Ver 1_Pre-Construction Notification (PCN) Form_20190520

DWR
Division of water Resources
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
September 29, 2018 Ver 3
Please note: fields marked with a red asterisk below are required. You will not be able to submit the form until all mandatory questions are answered.
Also, if at any point you Nish to print a copy of the E-PCN, all you need to do is right -click on the document and you can print a copy of the form.
Below is a link to the online help file.
https://edocs.deq. nc.gov/WaterResources/0/edoc/624704/PCN % 2OHeip%20F ile%202018-1-30. pdf
A. Processing Information
County (or Counties) where the project is located:*
Beaufort
Is this project a public transportation project?
r Yes r No
This is any publicly funded by rrunicipaistate or federal funds road, rail, airport transportation project.
Is this a NCDOT Project? *
r Yes r No
(NCDOT only) T.I.P. or state project number:
WBS#*
17. BP.2. R.86
(for NCOOT use only)
la. Type(s) of approval sought from the Corps:*
9 Section 404 Permit (wetlands, streams and waters, Clean Water Act)
F Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What type(s) of permit(s) do you wish to seek authorization?*
V Nationwide Permit (NWP)
I` Regional General Permit (RGP)
I— Standard (IP)
This form may be used to initiate the standard/individual permit process with the Corps. Please contact your Corps representative concerning submittals for standard permits. All required items that
are not provided in the E-PCN can be added to the miscellaneous upload area located at the bottom of this form.
1c. Has the NWP or GP number been verified by the Corps?*
r Yes (" No
Nationwide Permit (NWP) Number: 03 - Maintenance
NWP Numbers (for multiple NW1l
List all WV nurrbers you are applying for not on the drop down list.
1d. Type(s) of approval sought from the DWR:*
check all that apply
W 401 Water Quality Certification - Regular r 401 Water Quality Certification - l
f— Non-404 Jurisdictional General Permit W Riparian Buffer Authorization
I— Individual Permit
le. Is this notification solelyfor the record because written approval is not required?
*
For the record only for DWR401 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?
If so, attach the acceptance letter from mitigation bank or in -lieu fee program
C Yes r No
Acceptance Letter Attachment
Clickthe upload button a drag and drop files here to attach document
F ENFEIut14f BEFCF
1 h. lathe project located in any of NC's twenty coastal counties?*
0' Yes O No
11. lathe project located within a NC DCM Area of Environmental Concern (AEC)?*
[•S Yes O No O Unknown
1j. Is the project located in a designated trout watershed?*
6Yes rNo
Link to trout information: http://www.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Agency-Coordination/-rrout.aspx
B. Applicant Information
1a. Who is the Primary Contact?*
NCDOT (Attn: Michael C. Anan, PE)
1 b. Primary Contact Email:*
[e-mail]
1d. Who is applying for the permit?*
V Owner
(Check all that apply)
1e. Is there an Agant/Conaultant for this project?*
E Yes O No
2. Owner Information
2a. Name(s) on recorded deed:*
NCDOT
2b. Deed book and page no.:
2c. Responsible party:
(fa Corporations)
2d. Address*
Street Address
1037 W.H. Smith Boulevard
Address Line 2
P.O. Box 1587
City
Greenville
Postal / Zip Code
27834
2e. Telephone Number:*
(xxx)xxx-xxxx
[phone]
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:*
Robert Turnbull
4b. Business Name:
(if applicable)
Environmental Services, Inc.
4c. Address*
1c. Primary Contact Phone:*
(xxx)xxx-xxxx
[phone]
r" Applicant (other than owner)
State / Bovine / Region
NC
Country
USA

Street Address
4901 Trademark Drive
Address Line 2
(lty
State / F o irce / Riagion
Raleigh
NC
Postal / Zip Code
Country
27610
US
4d. Telephone Number:*
[phone] 4e. Fax Number:
4f. Email Address:*
[e-mail]
Agent Authorization Letter*
Beale provide the Agent Aufi rEabcn Letter if you are sul witting tlti docunent.
Beaufort159_AgentAuth_ESl.pdf 226.4KB
FLETYFEK&STBEFCF
C. Project Information and Prior Project History
1. Project Information U
1a. Name of project:*
Beaufort Bridge 159
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality /town:*
Pinetown, NC
2. Project Identification U
2a. Property Identification Number:
(tax RN or parcel Q 2b. Property size:
WA (in acres)
2c. Project Address
Street Address
Jones Bridge Road (SR 1611)
Address Line 2
C7ty State / Frovinoe / Region
Pinetown NC
Postal / Zip Code (buntry
27865 USA
2d. Site coordinates in decimal degrees
Please collect site coordinates in decimal degrees. Use between 4-6 digits (unless you are using a survey -grade GPS device) after the decimal place as appropriate, based on howthe location was
determined. (For example, most mobile phones with GPS provide locational precision in decimal degrees to map coordinates to 5 or 6 digits after the decimal place.)
Latitude: * Longitude:*
35.53603-76.77418
ex: 34.208504-77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Pungo Creek
3b. Water Resources Classification of nearest receiving water:*
C;Sw,NSW
Surface Water Lookup
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.*
030201040602
River Basin Lookup

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:*
The project area and vicinity consist of rural residential and agricultural areas, silvicultural areas, and undeveloped forested communities. The proposed project and associated impacts
are within and immediately adjacent to ebsting NCDOT 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 81/2 X 11 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for DWR)
nick the upload button or drag and drop files here to attach document
Beaufort159_USGS_Topo.pdf
File type must be pdf
431.2KB
4e. Attach an 81/2 X 11 excerpt from the most recent version of the published County NRCS Soil Survey map depicting the project site. (for DWR)
dick the upload button a drag and drop files here to attach document
Beaufort159_NRCS_Soils.pdf 502.58KB
File type must be pdr
4f. List the total estimated acreage of all existing wetlands on the property:
0.5 acre
4g. List the total estimated linear feet of all existing streams on the property:
(intermttent and perennial)
125
4h.Explain the purpose of the proposed project:*
Replace ebsting Bridge 159 on SR 1611 (Jones Bridge Street) over Pungo Swamp. The sufficiency rating of the ebsting bridge is 37.36.
41. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
The proposed project Will replace the wasting bridge on Jones Bridge Road (SR 1611) over Pungo Creek in Beaufort County. The project will replace the ebsting prestressed concrete
channels, concrete caps, and timber piles with a cored slab bridge at the same location. The project work will consist of grading, widening, drainage improvements, bridge replacement,
and pavement markings. The work will be conducted using standard road construction equipment. Equipment will be stored on -site in upland areas. No in -water construction moratoria
Will apply to this project.
4j. Please upload project drawings for the proposed project.
dickthe upload button a drag and drop files here to attach docunent
17BP.2.R.86_Beaufort 159_Permit Package.pdf 3.75MB
File type mist be pdr
5. Jurisdictional Determinations
Sa. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes
Comments:
r No
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
r Preliminary f Approved r Not Verified r Unknown r WA
Corps AID Number:
B(ample: SAW-2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Robert Turnbull
Agency/Consultant Company: Environmental Services, Inc.
Other:
f Unknown
5d. List the dates of the Corp jurisdiction determination or State determination if a determination was made by the Corps or DWR.
Documentation not available.
5dl. Jurisdictional determination upload
dick the upload button or drag and drop files here to attach document
File type must be FLF
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? This
includes other separate and distant crossing for linear projects that require Department of the Army authorization but don't require pre -construction notification.
D. Proposed Impacts Inventory

1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
rd Wetlands 17 Streams -tributaries
r Open Waters r Pond Construction
P Buffers
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
"W." will be used in the table below to represent the word "wetland".
2al Reason * (?)
2b. Impact type * (?)
2c. Type of W. *
2d. W. name"
2e. Forested"
f. Type of
Impact
�Jurlsdlcltlon*M J12g.
area*
Fill
P
Bottomland Hardwood Forest
W1
Yes
Corps
0.028
(acres)
Fill
P
Bottomland Hardwood Forest
W3
Yes
Corps
0.007
(acres)
Fill
P
Bottomland Hardwood Forest
W1
0.000
_Jorps
(acres)
2g. Total Temporary Wetland Impact
0.000
2g. Total Permanent Wetland Impact
0.035
2g. Total Wetland Impact
0.035
2h. Comments:
Impact area at Site 2 is 15 square feet (0.0003 acre).
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this question for all stream sites impacted.
"S." will be used in the table below to represent the word "stream".
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
lu M Jurisdiction* length*
gt
Drainage Improvements
Permanent
Rip Rap Fill
Pungo Swamp
Perennial
Both
60
Average (feet)
18
(linear feet)
S2
Drainage Improvements
Temporary
Rip Rap Fill
Pungo Svvamp
Perennial
Both
60
Average (feet)
38
(linear feet)
** All Perennial or Intermittent streams must be verified by DWR or delegated local government.
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
18
31. Total temporary stream impacts:
38
31. Total stream and ditch impacts:
56
3j. Comments:
6. Buffer Impacts (for DWR)
If project will impact a protected riparian buffer, then complete the chart below. Individually list all buffer impacts below.
6a. Project is in which protect basin(s)?*
[]lack all that apply.
f Neuse V Tar -Pamlico
r Catawba r Randleman
r Goose Creek r Jordan Lake
r Other

6b. Impact Type*(?)
6c. Per or Temp* (?)
6d. Stream name*
6e. Buffer mitigation required?*
6f. Zone 1 impact*
6g. Zone 2 impact*
B1-Allowable
P
Pungo Swamp
No
1,779
2,155
(square feet)
(square feet)
B2-Allowable
P
Pungo Swamp
No
1,757
1,915
(square feet)
(squarefeet)
B3-Allowable
P
Pungo Swamp
No
2,925
2,150
(square feet)
(square feet)
B4-Allowable
P
Pungo Swamp
No
217
�t2
re feet)
(square feet)
6h. Total buffer impacts:
Zone 1 Zone 2
Total Temporary impacts: 0.00 0.00
Zone 1 Zone 2
Total Permanent impacts: 6,853.00 6,437.00
Zone 1 Zone 2
Total combined buffer impacts: 6,853.00 6,437.00
61. Comments:
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
pick the upload button a drag and drop files here to attach docurrent
17BP.2.R.86_Beaufort 159_Permit Package.pdf 3.75MB
File crust be PCF
E. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Spa cificallydescribe measures taken to avoid or minimize the proposed impacts in designing the project:*
The proposed bridge replacement will occur as much as practicable within the footprint of the eAsting bridge. Fill has been minimized as much as
practicable within the wetland areas and stream channel. Riparian buffer impacts have been minimized as much as practicable.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Al necessary sediment and erosion control BMPs will be installed and maintained through construction. Disturbed ground will be restored and
stabilized with permanent vegetative cover. NCDOT Best Management Practices will be implemented throughout construction.
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?
t Yes r No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
Stream and impacts are minimized as much as practicable and are <150 feet. Wetland impacts are minimized as much as practicable and area <0.1 acre in size. Buffer impacts result
from the perpendicular crossing of Pungo Swamp.
NC Stream Temperature Classification Maps can be found under the Mitigation Concepts tab on the Wilmington District's RIBITS website.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
— Recent changes to the stormwater rules have required updates to this section .***
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
1b. All buffer impacts and high ground impacts require diffuse flow or other form of stormwater treatment. If the project is subject to a state implemented riparian buffer protection
program, include a plan that fully documents how diffuse flow will be maintained.
All Stormwater Control Measures (SCM)s must be designed in accordance with the NC Stormwater Design Manual. Associated supplement forms and other documentation shall be
provided.
What type of SCM are you providing?

r Level Spreader
V Vegetated Conveyance (lower SHWT)
r Wetland Swale (higher SHWT)
fJ Other SCM that removes minimum 30 % nitrogen
r Proposed project will not create concentrated stormwater flow through the buffer
(check all that apply)
For a list of options to meet the diffuse flow requirements, click here.
Diffuse Flow Documentation
nick the upload button a drag and drop files here to attach document
17BP.2.R.86_Beaufort 159_SMP.pdf
File type must be FDF
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
426.34KB
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
1 b. 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? (If so, attach a copy of the NEPA or SEPAfinal approval letter.)*
r Yes r No
Comments:*
A Categorical Exclusion is being prepared.
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 (based on past and reasonably anticipated future impacts) 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.
The proposed project will result in minimum new impervious surface and will not result in any downstream impacts or growth -stimulating effects. The
existing use of Pungo Swamp (C) should not change as a result of this project.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
r Yes 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?*
r Yes t: No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
r 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
r Unknown
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
North Carolina Natural Heritage Program data and on -site evaluation by ESI staff.

Consultation Documentation Upload
dickthe upload button a drag and drop files here to attach document
File type must be FDF
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?*
vmw.habitat.noaa.gov/protection/efh/efhmapper
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data: http://gis.nGdcr.gov/hpoweb/
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 (e.g., National Historic
Trust designation or properties significant in North Carolina history and archaeology)?*
r Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
Archaeology and historic architecture reviews were conducted by NCDOT. Documentation for those reviews is attached.
7c. Historic or Prehistoric Information Upload
dickthe upload button a drag and drop files here to attach document
17-05-0039NoSurveyRevised.pdf 2.43MB
Beaufort 159 No NRHP form.pdf 1.85MB
File must be FDF
8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https://msc.fema.gov/portal/search
8a. Will this project occur in a FEMA-designated 100-year floodplairl
r Yes r No
8b. If yes, explain how project meets FEMA requirements:
A FEMA Preliminary Detailed Study was completed.
8c. What source(s) did you use to make the floodplain determination? *
www.ncfloodmaps.com
Miscellaneous
Comments
Miscellaneous attachments not previously requested.
dickthe upload button a drag and drop files here to attach document
File must be FDF a KKV
Signature
fJ 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:*
Robert Turnbull
Signature
Date
4/10/2019