20190786 Ver 1_PCN Form Submission_20190614

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
20190786
Is a payment required for this project?*
r No payment required
r Fee received
r Fee needed - send electronic notification
Select Project Reviewer*
Donna Fbod:eads\drhood
Information for Initial Review
1a. Name of project:
Replacement of Bridge #830167 over Town Creek
1a. Who is the Primary Contact?*
Larry Thompson - NCDOT Division 10
1b. Primary Contact Email:*
[e-mail]
Date Submitted
6/14/2019
Nearest Body of Water
Town Creek
Basin
Yadkin-PeeDee
Water Classification
C
Site Coordinates
Version# *
1
Reviewing Office*
Mooresville Regional Office - [phone]
1c. Primary Contact Phone:*
[phone]
Latitude: Longitude:
35.394762-80.217513
FA. Processing Information U
County (or Counties) where the project is located:
Stanly
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.157
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:*
*
r Yes C 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:
Albemarle
2. Project Identification
2a. Property Identification Number:
2b. Property size:
WA
5
2c. Project Address
Street Address
SR 1421 (Bethany Road) at Town Creek
Address Une 2
C8y
State / Province / fagion
Albemarle
NC
Fbstal / Zip Oide
(Duntry
USA
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Town Creek
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.
030401050401
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:*
Ebsting conditions include SR 1421 (Bethany Road), agricultural land, residential property, undeveloped forest, an open water (pond) 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)
R_157_Bridge167_Figure1 _USGSMap. pdf
3.27MB
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_157_Bridge167_Figure2_SoilsMap.pdf 2.78MB
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:
337
4h. Explain the purpose of the proposed project:*
To remove Bridge #830167 and replace with a new, modern bridge 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 timber portion of the bridge
abutments, leaving the masonry footer to match the excavation elevation and temporary impacts to 105 linear feet to Town Creek may result. The relocation of the wasting water lines
will require temporary impacts of 25 linear feet to Town Creek for the dewatering, open cut installation of the water lines upstream of the bridge and restoration of the original contours.
Sediment laden water within the work area shall be filtered out using a special stilling basin. Bridge replacement construction using heavy equipment from the upland roadway
approaches. Runoff from the bridge will be routed to traffic bearing drainage inlets on both sides of the road on the begin side of the bridge. Deck drains are needed to prevent
stormwater spread from entering the roadway. Deck drains were placed on both sides of the stream and discharge onto the rip rap protected abutment so no dissipater pads are
required. 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.
SF830167_HYD_SMPv2.07_20180329(Oct 2016).pdf 179.22KB
R.157_Permit_Plans_2019-06-12.pdf 1.64MB

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 Wetland Determination Form, Stream Form, Waters Mapping and Photographs
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
Bethany Rd upland data sheet.pdf
NCDWQ RPW A- Town Cr. pdf
R_157_Bridge 167_F igure3_WatersMap. pdf
6. Future Project Plans
Brandon Phillips, CHMM
STV Engineers, Inc.
405.54KB
72.74KB
3.38MB
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
r Open Waters r Pond Construction
3. Stream Impacts
r Buffers
U
❑ 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
Bridge replacement
Temporary
Other
Town Creek
Perennial
Both
15
Average (feet)
105
(linear feet)
g2
Utility relocation
Temporary
Dewatering
Town Creek
Perennial
Both
15
Average (feet)
25
(linear feet)
3i. Total jurisdictional ditch impact in square feet:
0
31. Total permanent stream impacts: 31. Total temporary stream impacts:
0 130
31. Total stream and ditch impacts:
130
3j. Comments:
Temporary impacts of 105 If may occur to Town Creek associated with the demolition of the existing bridge and the construction of the proposed
bridge. An additional 25 If of temporary impacts will occur as a result of the dewatering of a portion of Town Creek for the open cut relocation of
e>asting water lines across Town Creek.
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 bridge in -place was incorporated to minimize impacts. The bridge span length was extended to avoid impacts. Rip rap protection of the bridge
abutments is being placed outside of the jurisdictional stream boundary of the perennial stream to avoid impacts. Work will be conducted from the
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
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 temporary impacts of 105 linear feet to Town Creek may occur during demolition and construction. An additional 25 linear feet of temporary impact to Town Creek will result from
the dewatering and open cut across Town Creek for the relocation of the ebsting water lines upstream of the proposed bridge.
F. Stormwater Management and Diffuse Flow Plan (required by DWR) t%
1. Diffuse Flow Plan
la. 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 directed into deck drains that will discharge to the rip rap abutment protection, or to drainage inlets located to the south of the bridge.
Deck drains are needed to prevent stormwater spread from entering the roadway. There will be no direct discharge into Town Creek. 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 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)? *
f Yes r No
Comments:*
Bridge replacement project that required 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 existing bridge and is not anticipated to affect future development.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
r Yes r' No r 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
5h. Does this project involve the construction/installation of a wind turbine(s)?*
r Yes r No
r Unknown
Si. 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 NNHP 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_167_03082019.pdf 872.33KB
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?*
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 National Register of Historic Places Eligible or Listed Archaeological Sites Present Form" and "Historic Architecture and Landscapes
No Survey Required Form."
7c. Historic or Prehistoric Information Upload
17BP.10.R.157 Historic Architecture NoSurveyReq.pdf 3.15MB
R.157 NoSitesPresent Archaeological Form.pdf 11.58MB
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 U
Comments
Additional Miscellaneous attachments include site photographs and Supplemental Information regarding the Threatened and Endangered Species that are listed in Stanly County.
Miscellaneous attachments not previously requested.
R.157 Photopages.pdf 13.32MB
T&E Supplemental info for ePCN Form R157.pdf 78.36KB

Signature v
17 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
6/14/2019