20151209 Ver 2_PCN Form Submission_20180221

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 2/21/2018 11:59:52 AM (Start Event)
Accept by Carpenter,Kristi 2/21/2018 12:45:13 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: February 26, 2018 5:00 PM
2/21 /2018 12:00 PM

E-PCN Submittal
���
�lulslaa af Water Resources
Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
January 31, 2018 Ver 2.3
*
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.
Also, if at any point you wish 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%20Help%20File%202018-1-30. pdf
A. Processing Information
County(or Counties) where the project is located:*
Haywood
Is this project a public transportation project? *(')
C�' Yes C' No
Is this a NCDOT Project?*
r Yes C' No
(NCDOT only) T.I.P. or state project number:
WBS #
(for NCDOT use only)
1a. Type(s) of approval sought from the Corps:*
fJ 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?*
�7 Nationwide Permit (NWP)
r Regional General Permit (RGP)
Nationwide Permit (NWP) Number: 03 - Maintenance
NWP Number Other:
List all MNnurrbers you are applying for not on the drop down list.
1c. Type(s) of approval sought from the DWR:*

check all that apply
ri 401 Water Quality Certification - Regular r 401 Water Quality Certification - E�ress
r Non-404 Jurisdictional General Permit 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:
�' Yes C•' No
C' Yes �' No
1e. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
If so, attach the acceptance letter from rritigation bank or in-lieu fee program
C' Yes �' No
1f. Is the project located in anyof NC's twentycoastal counties?*
C' Yes C•' No
1h. Is the project located in a designated trout watershed?*
C•' Yes C' No
Link to trout information: http://w�nn�v.saw.usace.army.mil/Missions/Regulatory-Permit-PrograrrUAgency-Coordination/Trout.aspx

B. Applicant Information
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?
fJ Owner r Applicant (other than owner) r Agent/Consultant
(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)
Dave McHenry
2d.Address
Street Address
253 Webster Road
Address Line 2
Qty
Sylva
Fbstal / Zip Code
28779
2e. Telephone Number:
(xxx)xxx-xxxx
[phone]
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
State / Rovince / F�gion
NC
Country
US

C. Project Information and Prior Project History
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Haytirood Bridge 273 Replacement - Permit Renewals
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Maggie Valley
1d. Driving directions*
IF it is a new project and can not easily be found in a C�5 rrapping system Rease provide directions.
Take I-40 west to Fines Creek Exit in Haytirood County. Turn left on Fines Creek Road then right on White Oak Road and travel about 2
miles to bridge location.
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 / FYovince / F�gion
Country
2d. Site coordinates in decimal degrees
I 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 e>cample, 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:*
35.665729 -83.013682
ex:34208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Messer Branch
3b. Water Resources Classification of nearest receiving water:*
C
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 a currently under construction 3-sided culvert that is replacing an old timber bridge on a paved
secondary road in rural Haywood County.
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
Haywood 273 Topo.pdf 1.79M6
Fle type rrust be pdF
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)
qick the upload button or drag and drop files here to attach docurrent
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4d. List the total estimated acreage of all existing wetlands on the property:
0
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
200
4f. Explain the purpose of the proposed project:*
The project purpose is to replace a deteriorating timber bridge with a new 3-sided culvert.
4g. Describe the overall project in detail, including indirect imapacts and the type of equipment to be used:*
The project involves temporary dewatering of a section of Messer Branch and removal, in stages, of an old timber
bridge. Also in stages will be excavation for footers along the stream channel for pre-cast concrete bottomless
culvert sections . Track-hoes, cranes, and other heavy equipment will be used.
4h. Please upload project drawings for the proposed project.
qick the upload button or drag and drop files here to attach docurrent
HAY 273 plan modification Feb 2018a.pdf 651.19KB
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5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
C� Yes C' No �' Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
C' Preliminary c" Approved C' Unknown C� N/A
Corps AID Number:
Exarrple: SAV�2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Mark Davis

Sc. If 5a is yes, who delineated the jurisdictional areas?
Agency/Consultant Company:
Other
NCDOT, Division 14
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
January 8, 2016
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 C' No C' Unknown
6b. If yes, please give the DWR Certification number or the Corps Action ID (exp. SAW-0000-00000).
SAW-2015-02590 and DWR Project No. 2015-1209
Project History Upload
Gick the upload button or drag and drop files here to attach docurrent
Bridge No. 273 - NW 3 Permit Application - Haywood County.pdf 13.03MB
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7. Future Project Plans
7a. Is this a phased project?*
f 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.

D. Proposed Impacts Inventory
D. Proposed I m pacts I nventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
� Wetlands �7 Streams-tributaries r Buffers
r Open Waters r Pond Construction
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
I impacted.
3a. Site #- Reason for 3b.lmpact
� impact* type*
1 P
N�p label (e.g. Finad Qossing 1) F2rrranent (Pj or
Terrporary (�
I 1A T
fv�ip label (e.g. f3�ad Q'ossing 1) F2rrraner�t (Fj or
Terrporary (�
1B P
N�p label (e.g. Fd�ad Qossing 1) f�rrranent (Fj or
Terrporary (�
3c. Type of impact* 3d. Stream name *
Culvert
De wate ri ng
Messer Branch
Messer Branch
Bank Stabilization Messer Branch
3e. Stream
Type *
Perennial
F2rennial (F�Z) or
interrrittent (If�
Perennial
F2rennial (FH�) or
interrrittent (If�
Perennial
F�rennial (� 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:
0
3i. Total permanent stream impacts:
108
3i. Total temporary stream impacts:
120
3i. Total stream and tributary impacts:
228
3j. Comments:
3f. Type of
Jurisdiction *
Both
Both
Both
3g. Stream 3h. Impact
width* length*
6 0
Average (feet) Qinear feet)
6 120
Average(feet) (linearfeet)
6 108
Average(feet) (linearfeet)

E. Impact Justification and Mitigation
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:*
A bottomless culvert was used, which minimized stream bed permanent fill.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Dewatering has been used to help avoid downstream sedimentation
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
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
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?
C' Yes r No
For a list of options to meet the diffuse flow requirements, click here.
If no, explain why:
not in buffer rule area
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
C•' Yes C' No

G. Supplementary Information
G. Supplementary Information
1. Environmental Documentation
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 �' No
Comments:*
Meets Minimum Criteria Rules
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 �' No
2b. Is this an after-the-fact permit application?*
C' Yes �' 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?*
C' Yes C•' No
3b. If you answered "no," provide a short narrative description.
This is just a simple secondary road stream crossing structure replacement.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project? *
C' Yes r No C' f�/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?*
C' Yes C•' No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
f Yes C•' No
5d. Is another Federal agency involved?*
C' Yes C•' No
5e. Is this a DOT project located within Division's 1-8?*
C' Yes C•' No
Sf. Will you cut anytrees in order to conduct the work in waters of the U.S.?*
C' Yes C� No
[' Unknown

5g. Does this project involve bridge maintenance or removal?*
C' Yes C' No
Sg(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 5g(1), did you discover any signs of bat use?*
C' Yes r No C' Unknown
"'"�" If yes, please show the location of the bridge on the permit drawings/project plans.
5h. Does this project involve the construction/installation of a wind turbine(s)?�*
C' Yes C•' No
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.?*
C� Yes C' No
If yes, please provide details to include type of percussive activity, purpose, duration, and specific location of this activity on the
pro pe rty.
Gick the upload button or drag and drop files here to attach docurrent
Haywood 273 Percussive activity.pdf
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5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
Available NHP data and site visits by qualified biologists.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
C' Yes C•' 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?*
NCHPO - Review by NCDOT HEU
7c. Historic or Prehistoric Information Upload
qick the upload button or drag and drop files here to attach docurrent
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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?*

r Yes r No
8c. What source(s) did you use to make the floodplain determination?*
i NC Floodmaps
Miscellaneous
Miscellaneous attachments not previously requested.
Gick the upload button or drag and drop files here to attach docurrent
Hayvwod 273 NWP 3 renewal cover letter1.pdf 270.82KB
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Signature Page
Signature
rJ 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:*
i Dave McHenry
Signature

Initial Review
Is this project a public transportation project? *(?)
C� Yes C' No
Change only if needed.
Has this project met the requirements for acceptance in to the review process?*
C� Yes
C' No
BIMS # Assigned*
20151209
Version#*
2
Reviewing Office *
Asheville Regional Office - [phone]
Select Project Reviewer*
Kevin Barnett:eads\khbarnett
Is a payment required for this project?*
C' No payment required
�' Fee received
C' Fee needed - send electronic notification