20210578 Ver 1_ePCN Application_20210317

I I DWR
Division of Water Resources
Pre-Construction Notification (PCN) Form
October 26,2020 Ver 3.3
Initial Review
Has this project met the requirements for acceptance in to the review process?*
6 Yes
✓ No
Is this project a public transportation project?*
0 Yes r No
Change only if needed.
BIMS#Assigned* Version#*
20210578 1
Is a payment required for this project?*
✓ No payment required
6 Fee received Reviewing Office*
✓ Fee needed-send electronic notification Asheville Regional Office-[phone]
Select Project Reviewer*
Kevin Mitchell:eads\rkmitchell
Information for Initial Review
1a.Name of project:
Henry Bird Road-Culvert Failure
1a.Who is the Primary Contact?*
Patrick J.Breedlove
lb.Primary Contact Email:* 1c.Primary Contact Phone:*
[e-mail] [phone]
Date Submitted
3/17/2021
Nearest Body of Water
Unamed tributary to Tuckasegee River
Basin
Little Tennessee
Water Classification
Class B
Site Coordinates
Latitude: Longitude:
35.426731 -83.347196
Pre-Filing Meeting Information
ID# Version
Pre-fling Meeting or Request Date*
2/10/2021
Attach documentation of Pre-Filing Meeting Request here:*
Henry Bird Road-District 2 Office-Notification.pdf 74.1KB
A. Processing Information C^U
County(or Counties)where the project is located:
Jackson

Is this a NCDMS Project
✓ Yes r No
Is this project a public transportation project?*
✓ Yes r No
Is this a NCDOT Project?*
✓ Yes r No
(NCDOT only)T.I.P.or state project number:
WBS#(2)
DF 16014.2050012
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)
Has this PCN previously been submitted?*
✓ Yes
r No
lb.What type(s)of permit(s)do you wish to seek authorization?
fJ Nationwide Permit(NWP)
r Regional General Permit(RGP)
r Standard(IP)
1c.Has the NWP or GP number been verified by the Corps?
C Yes 6' No
Nationwide Permit(NWP)Number: 03-Maintenance
NWP Numbers(for multiple NWPS):
Id.Type(s)of approval sought from the DWR:
17 401 Water Quality Certification-Regular r 401 Water Quality Certification-Express
r Non-404 Jurisdictional General Permit r Riparian Buffer Authorization
r Individual Permit
le.Is this notification solely for 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 (' No
If.Is this an after-the-fact permit application?*
✓ Yes 6' No
1g.Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
CYes rNo
1g.Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
✓ Yes rNo
Acceptance Letter Attachment
lh.Is the project located in any of NC's twenty coastal counties?
CYes rNo
1j.Is the project located in a designated trout watershed?
6' Yes r No
B. Applicant Information
Id.Who is applying for the permit?
7 Owner r Applicant(other than owner)
le.Is there an Agent/Consultant for this project?*
✓ Yes 6' No
2.Owner Information
2a.Name(s)on recorded deed:
NCDOT Division 14

2b.Deed book and page no.:
2c.Responsible party:
2d.Address
Street Address
253 Webster Road
Address Line 2
aty State/Bovine/Raglan
Sylva North Carolina
Postal/Zip Corte Country
28779 United States
2e.Telephone Number: 2f.Fax Number:
[phone]
2g.Email Address:*
[e-mail]
....__.........
C. Project Information and Prior Project History
1. Project Information
lb.Subdivision name:
(if appropriate)
1c.Nearest municipality I town:
Whittier
2. Project Identification
2a.Property Identification Number: 2b.Property size:
2c.Project Address
Street Address
Address Line 2
atY State/Bovine/Ftgion
Postal/Zip Code Country
3.Surface Waters
3a.Name of the nearest body of water to proposed project:*
Unamed tributary to Tuckasegee River
3b.Water Resources Classification of nearest receiving water:*
Class B
3c. What river basin(s)is your project located in?*
Little Tennessee
3d.Please provide the 12-digit HUC in which the project is located.
060102030304
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:*
Existing land use is a partially collapsed culvert under a secondary road(Henry Bird Road).Project is located in a rural residential area with the NCDOT District 2 office adjacent to the
site.
4b.Have Corps permits or DWR certifications been obtained for this project(including all prior phases)in the past?*
r Yes t 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)
Henry Bird Road-District 2 Office-TOPO Map.pdf 306.29KB
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)
Henry Bird Road-District 2 Office-NRCS Soil Survey.pdf 530.32KB
4f.List the total estimated acreage of all existing wetlands on the property:
0.00
4g.List the total estimated linear feet of all existing streams on the property:

300
4h.Explain the purpose of the proposed project:*
Project is to replace a deteriorating and partially collapsed CMP culvert with a new CMP,foot for foot,in the same disturbed location.
4i.Describe the overall project in detail,including indirect impacts and the type of equipment to be used:*
NCDOT Maintenance forces will install dewatering/pump around device.NCDOT Maintenance will then excavate and remove existing deteriorated CMP culvert and embed and replace
culvert with a new CMP culvert.Disturbed areas will be seeded and matted once final grading allows.Construction timeframe will take 1 day due to road closure.NCDOT environmental
staff will be on-site during replacement.
4j.Please upload project drawings for the proposed project.
Henry Bird Road-District 2 Office-Culvert Design.pdf 19.91KB
5.Jurisdictional Determinations
5a.Have the wetlands or streams been delineated on the property or proposed impact areas?*
6 Yes r No C Unknown
Comments:
5b.If the Corps made a jurisdictional determination,what type of determination was made?*
r Preliminary r Approved r Not Verified 6 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
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?
D. Proposed Impacts Inventory
1. Impacts Summary
1a.Where are the impacts associated with your project?(check all that apply):
r Wetlands rJ Streams-tributaries r Buffers
r Open Waters r Pond Construction
3.Stream Impacts
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 Foot for Foot Culvert Permanent Culvert UT to Tuckasegee River Perennial Both 2 148
Average(feet) (linear feet)
32 Dewatering Device Temporary Dewatering UT to Tuckasegee River Perennial Both 2 160
Average(feet) (linear feet)
3i.Total jurisdictional ditch impact in square feet:
0
3i.Total permanent stream impacts: 3i.Total temporary stream impacts:
148 160
3i.Total stream and ditch impacts:
308
3j.Comments:
E. Impact Justification and Mitigation U

1.Avoidance and Minimization
1a.Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
The existing culvert is being replaced with a structure that is adequate for stream flows in the same disturbed location.The replacement will take 1
calendar day to complete.
lb.Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
The on-site stream will be dewatering and pumped around project site while the replacement is occurring.Erosion and sedimentation control
measures will be installed prior to ground disturbance.Both of these measures will aid in the prevention of sediment into downstream habitats.
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?
✓ Yes ( No
2b.If this project DOES NOT require Compensatory Mitigation,explain why:
Foot for foot culvert replacement.
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?
✓ Yes 6' No
If no,explain why:
Project is not located within a N.C.Riparian Buffer Protection Area.
2.Stormwater Management Plan
2a.Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
r: Yes C No
Comments:
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?*
(' Yes rNo
lb.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)?*
6 Yes rNo
lc.If you answered"yes"to the above,has the document review been finalized by the State Clearing House?*
✓ Yes (' No
Comments:*
NCDOT MCDC Completed.
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)?*
✓ Yes n No
3. Cumulative Impacts(DWR Requirement)
3a.Will this project result in additional development,which could impact nearby downstream water quality?*
✓ Yes ( No
3b.If you answered"no,"provide a short narrative description.
The project is only to replace existing culvert and does not increase capacity of road in the area.The proposed project is not a road widening or
improvement project.
4.Sewage Disposal(DWR Requirement)
4a.Is sewage disposal required by DWR for this project?*
✓ Yes G 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?*
M Yes r No
5b.Have you checked with the USFWS concerning Endangered Species Act impacts?*
M Yes r No
5c.If yes,indicate the USFWS Field Office you have contacted.
Asheville
5d.Is another Federal agency involved?*
a Yes r No r Unknown
What Federal Agency is involved?
FEMA-Funded
5e.Is this a DOT project located within Division's 1-8?
✓ Yes r No
5f.Will you cut any trees in order to conduct the work in waters of the U.S.?
✓ Yes G No
5g.Does this project involve bridge maintenance or removal?
✓ Yes r No
5h.Does this project involve the construction/installation of a wind turbine(s)?*
✓ Yes G 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.?
✓ Yes r No
5j.What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
U.S.Fish&Wildlife-ECOS-Online Mapper
Consultation Documentation Upload
6. Essential Fish Habitat(Corps Requirement)
6a.Will this project occur in or near an area designated as an Essential Fish Habitat?*
✓ Yes M No
6b.What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
NOAA-Essential Fish Habitat
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?*
✓ Yes ( No
7b.What data sources did you use to determine whether your site would impact historic or archeological resources?*
NCDOT 106 PA
7c.Historic or Prehistoric Information Upload
Henry Bird Road-District 2 Office-106 PA Screening.pdf 350.54KB
8. Flood Zone Designation(Corps Requirement)
8a.Will this project occur in a FEMA-designated 100-year floodplain?*
✓ Yes ( No
8c.What source(s)did you use to make the floodplain determination?*
N.C.Flood Maps-Flood Risk Information System
Miscellaneous
Comments
Miscellaneous attachments not previously requested.
Henry Bird Road-District 2 Office-Cover Letter(Final).pdf 39.36KB
Henry Bird Road-District 2 Office-GIS Map.pdf 324.62KB
Henry Bird Road-District 2 Office-NC Hertiage Program.pdf 3.14MB
Henry Bird Road-District 2 Office-Site Photos.pdf 1.08MB
Henry Bird Road-District 2 Office-Notification.pdf 74.1KB

Signature
R By checking the box and signing below,I certify that:
• The project proponent hereby certifies that all information contained herein is true,accurate,and complete to the best of my knowledge and belief;and
• The project proponent hereby requests that the certifying authority review and take action on this CWA 401 certification request within the applicable reasonable period of time.
• 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:
Patrick J.Breedlove
Signature
c`�attla&[7c3i
Date
3/17/2021