20171168 Ver 1_PCN Form Submission_20170911

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 9/11/2017 2:49:31 PM (Start Event)
Accept by Carpenter,Kristi 9/13/2017 2:04:05 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: September 14, 2017 5:00 PM
9/11/2017 2:49 PM

�� �
6fvlslaa of Water Resources
Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
June 28, 2017 Ver 1.8
*
Please note: fields marked with a red asterisk below are required. You will not be ab/e to submit the form until all mandatory questions are ans�red.
Below is a link to the DRAFT online help file. http://edocs.deq.nc.gov/WaterResources/0/doc/549884/Page1.aspx
A. Processing Information
County (or Counties) where the project is located:*
Transylvania
Is this a NCDOT Project?*
�' Yes �' No
(NCDOT only) T.I.P. or state project number:
WBS #
(for NCDOT use only)
1a. Type(s) of approval sought from the Corps:*
rJ Section 404 Permit (wetlands, streams and waters, Clean Water Act)
r Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What type(s) of permit(s) do you wish to seek authorization?*
�J Nationwide Permit (NWP)
r Regional General Permit (RGP)
Nationwide Permit (NWP) Number:
NWP Number Other:
List all MNnurrbers you are applying for not on the drop down list.
14 - Linear transportation
1c. Type(s) of approval sought from the DWR:*
check all that apply
� 401 Water Quality Certification - Regular
r Non-404 Jurisdictional General Permit
r 401 Water Quality Certification - E�ress
r Riparian Buffer Authorization
1d. 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:
1e. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
*
C' Yes C•' No
�' Yes C� No

If so, attach the acceptance letter from rritigation bank or in-lieu fee program
�' Yes C' No
Acceptance Letter Attachment
Qick the upload button or drag and drop files here to attach docurrent
i SR 1316 - Bridge 28 - Division 14 - STR - FB 05 (cold).pdf 60.85KB
FlLE IYFE MJST BE FDF
1f. Is the project located in any of NC's twenty coastal counties?*
C' Yes �' No
B. Applicant Information
1a. Who is the Primary Contact?*
Dave McHenry
1b. Primary Contact Email:*
[e-mail]
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
rJ Owner r Applicant (other than owner) r AgenUConsultant
(Check all that apply)
2. Owner I nformation
2a. Name(s) on recorded deed:
NCDOT. Division 14
2b. Deed book and page no.:
2c. Responsible party:
(for Corporations)
2d.Address
Street Address
253 Webster Road
Address Line 2
��
Sylva
Fbstal / Zip Code
28779
2e. Telephone Number:
(xxx)x�c-�oc
[phone]
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
State / R-ovince / F�gion
NC
Country
USA
C. Project Information and Prior Project History

1. Project Information
� 1a. Name of project:*
Transylvania Bridge 28 Replacement
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
I Rosman
1d. Driving directions*
If it is a new project and can not easily be found in a C� rrapping system Rease provide directions.
Take 64 west from Rosman to Reid Road (SR 1316) on right and travel about 0.5 mile to bridge.
2. Project Identification
2a. Property Identification Number:
(tax RNor parcel ID)
2b. Propertysize:
(in acres)
0.1
2c. Project Address
Street Address
Address Line 2
�Y
Fbstal / Zip Code
State / Rovince / F�gion
Country
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:*
35.132024
ex:34.208504
3. Surface Waters
Longitude:*
-82.900922
-77.796371
3a. Name of the nearest body of water to proposed project:*
Morton Creek
3b. Water Resources Classification of nearest receiving water:*
C Tr
Surface Water Lookup
3c. What river basin(s) is your project located in?*
French Broad
RiverBasin Lookup
4. Project Description

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 site is an ebsting timber bridge over a small creek on a paved secondary road. Surrounding land-use is mixed
forested, single family residential and small farms.
4b. 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)
Gick the upload button or drag and drop files here to attach docurrent
Tran 28 Topo.pdf
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383.2KB
4c. 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)
C7ick the upload button or drag and drop files here to attach docurrent
Tran 28 soils.pdf
Fle type rrust be pdf
4d. List the total estimated acreage of all existing wetlands on the property:
0.1
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
� 100
771.02KB
4f. Explain the purpose of the proposed project:
The purpose of this project is to replace a failing/deficient timber bridge on a secondary road.
4g. Describe the overall project in detail, including the type of equipment to be used:
The road will be closed. Erosion Controls, including a temporary flow diversion will be constructed with a track-hoe.
Then the ewsting bridge will be removed and the new culvert installed, probably after assembly on land, and lifted
into place with the track-hoe. The culvert will be backfilled as needed with native streambed materials and quarry
rock as needed to establish a low flow channel. The banks at the inlet and outlet of the culvert will be protected
with rock where disturbed. Then water will be turned in and the temporary bypass removed.
4h. Please upload project drawins for the proposed project.
C7ick the upload button or drag and drop files here to attach docurrent
Tran 28 selected plans.pdf
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5. Jurisdictional Determinations
5.9MB
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
�' Yes C� No �' Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
C' Preliminary l" Approved r Unknown
Corps AID Number:
Exarrple: SAV�2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:

5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5d1. Jurisdictional determination upload
aick the upload button or drag and drop files here to attach docurrent
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6. Project History
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past?*
C' Yes �' No �' Unknown
7. Future Project Plans
7a. Is this a phased project?*
C' Yes C•' 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.
none
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
r Wetlands r7 Streams-tributaries r Buffers
r Open Waters r Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
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.
Row 1
Row 2
Row 3
Row 4
3a. Site # - 3b.lmpact
Reason for type
impact
1 P
N�p label (e.g. F2rrranent (P� or
Id�ad Qossing 1) Terrporary (�
1A T
N�p label (e.g. F2rrranent (P� or
RDad (7ossing 1) Terrporary (�
3c. Type of 3d. Stream 3e. Stream 3f. 3g. Stream 3h. Impact
impact name Type Jurisdiction width length
type
Culvert Morton Perennial Both Average 45
Cree k F2rennial (FB� or s (linear feet)
interrrittent (If�
Dewatering Morton Perennial Both
Creek F�rennial (Fff� or
interrrittent (IfV�
1B P Bank Morton
N�p label (e.g. F�rrranent (P� or Stabilizatio Creek
Id�ad Q'ossing 1) Terrporary (� n
1C P Bank Morton
n�p �abe� (e.g. F�rrranent (� or Stabilizatio Creek
Finad Qossing 1) Terrporary (� n
Perennial Both
F�rennial (� or
interrrittent (IfVn
Perennial Both
F2rennial (FH�) or
interrrittent (IN�
�' All Perennial or Intermittent streams must be verified by DWR or delegated local government.
3i. Total jurisdictional ditch impact in square feet:
(feet)
Average 100
s (linear feet)
(feet)
Average 20
g (linear feet)
(feet)
Average 20
6 (linear feet)
(feet)

0
3i. Total permanent stream impacts:
i 85
3i. Total temporary stream impacts:
100
3i. Total stream and tributary impacts:
185
3j. Comments:
4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of the U.S. then individually list
all open water impacts below.
5. Pond or Lake Construction
If pond or lake construction is proposed, then complete the chart below.
6. Buffer Impacts (for DWR)
If project will impact a protected riparian buffer, then complete the chart below. Individually list all buffer impacts below.
, 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:*
i The culvert is being replaced on the ewsting road alignment, which will reduce newstream/buffer impacts. The
culvert was designed with sills and a baffle to promote bedload retention, maintain a lowflowchannel, and promote
aquatic life passage.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Effective erosion controls wills be used and maintained. The site will be effectively dewatered during bridge
demolition, excavation, and culvert placement and stabilization.
I 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?
C' Yes C' No
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1a. Does this project require a Stormwater Management Plan?
r Yes c' No
1b. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
Stormwater will be routed wfiere practical in vegetated ditches. See SMP attached to plans. The work is covered
by NCDOT NGS000250
1c. What is the overall percent imperviousness of this project?
50
%
1d. Who will be responsible for the review of the Stormwater Management Plan?*

r Certified Local Government
fJ DWR 401 & Buffer Permitting Branch
2. Diffuse Flow Plan
r DEMLR Stormwater Review
r DWR Transportation Permitting Branch
2a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection
Rules?
C' Yes C•' No
If no, explain why:
I Not in Catawba or Neuse Basins
5. DWR 401 Stormwater Review
5a. Is the Stormwater Management Plan (including BMP Supplemental Forms and Operation and Maintenance Agreements) attached?
�' Yes
�' No
Stormwater Management Plan Upload
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Tran 28 SMP General.pdf
file type rrust be pdf
G. Supplementary Information
� 1. Environmental Documentation
!.'i��i1:/:
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
C' Yes C' 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 PolicyAct (NEPA/SEPA)?*
C' Yes C•' No
Comments:*
This is a minimum criteria qualifying project - MCC.
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)?*
C' Yes C•' No
2b. Is this an after-the-fact permit application?*
C' Yes �' No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
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?*
f Yes
C•' No
3b. If you answered "no," provide a short narrative description.
This is maintenance of existing road conditions and use without an increase in capacity which could facilitate
growth.

4. Sewage Disposal (DWR Requirement)
4a. Describe, in detail, the treatment methods and dispositions (non-discharge or discharge) of wastewater generated from the
proposed project. If the wastewater will be treated at a treatment plant, list the capacity available at that plant.
I Port-o-jons - no permanent wastewater generated.
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
Sa. Will this project occur in or near an area with federally protected species or habitat? *
C' Yes C•' No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
C' Yes �' No
5c. If yes, indicate the USFWS Field Office you have contacted.
5d. Is this a DOT project located within Division's 1-8?*
C' Yes
�' No
5e. Will you cut anytrees in order to conduct the work in waters of the U.S.?*
C•' Yes C' No
5f. Does this project involve bridge maintenance or removal?*
r Yes C' No
5f(1). If yes, have you inspected the bridge for signs of bat use such as staining, guano, bats, etc.? Representative photos of signs of bat
use can be found in the NLEB SLOPES, Appendix F, pages 3-7.
C' Yes C' No
Link to the NLEB SLOPES document: http://sav�reg.usace.army.mil/NLEB/1-30-17-signed_NLEB-SLOPES&apps.pdF
If you answered "Yes" to 5f(1), did you discover anysigns of bat use?*
C' Yes C� No C' Unknown
If yes, please show the location of the bridge on the permit drawings/project plans.
Gick the upload button or drag and drop files here to attach docurrent
Fle rrust be FiJF
5g. Does this project involve the construction/installation of a wind turbine(s)?**
C' Yes C•' No
If yes, please show the location of the wind turbine(s) on the permit drawings/project plans.
Gick the upload button or drag and drop files here to attach docurrent
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5h. 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.?*
C' Yes r No
If yes to either, please provide details to include type of percussive activity, purpose, duration, and specific location of this activity on
the property.
qick the upload button or drag and drop files here to attach docurrent
Tran 28 NWP 14 cover letter.pdf
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322.26KB
5i. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
� NHP, UWFWS, and personal knowiedge/surveys

6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
C' Yes �' No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
NMFS
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.ncdcr.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 historyand archaeology)?*
C' Yes C•' No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
NCDOT Human Environment Review
7c. Historic or Prehistoric Information Upload
Gick the upload button or drag and drop files here to attach docurrent
870028-11-08-0120.pdf 4.49M6
870028-Transylvania28NHPA.pdf 578.77KB
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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 floodplain?*
C' Yes C•' No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?*
NC Floodmaps
Miscellaneous attachments not previously requested.
C7ick the upload button or drag and drop files here to attach docurrent
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Signature
*
r% 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 AcY');
■ I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic
Transactions AcY');
■ 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:*
Dave McHenry
Signature

Date
9/11 /2017
Initial Review
Is this project a public transportation project?
C� Yes C' No
Only change this if the project has been reassigned.
� Has this project met the requirements for acceptance in to the review process?*
�' Yes
C' No
BIMS # Assigned*
20171168
Version#*
Reviewing Office *
Asheville Regional Office - [phone]
Select Project Reviewer*
Kevin Barnett:eads\khbarnett