20210632 Ver 1_ePCN Application_20210428

I I DWR
Division of Water Resources
Pre-Construction Notification (PCN) Form
April 4,2021 Ver 4
Initial Review
Has this project met the requirements for acceptance in to the review process?*
✓ Yes
✓ No
Is this project a public transportation project?*
0 Yes r No
Change only if needed.
BIMS#Assigned* Version#*
20210632 1
Is a payment required for this project?*
✓ No payment required
G 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:
SR 1164 Rock House Road
1a.Who is the Primary Contact?*
Yates Allen
lb.Primary Contact Email:* 1c.Primary Contact Phone:*
[e-mail] [phone]
Date Submitted
4/28/2021
Nearest Body of Water
UT to Sugar Camp Branch
Basin
French Broad
Water Classification
Class C,Tr,ORW
Site Coordinates
Latitude: Longitude:
35.740413 -82.898418
A. Processing Information
County(or Counties)where the project is located:
Madison
Is this a NCDMS Project
✓ Yes G No
Is this project a public transportation project?*
6 Yes r No
Is this a NCDOT Project?*
(7 Yes r No
(NCDOT only)T.I.P.or state project number:

WBS#(?)
13.105721
Pre-Filing Meeting Information
Is this a courtesy copy notification?*
✓ Yes G No
ID# Version
20210632 1
Pre-fling Meeting or Request Date
3/1/2021
Attach documentation of Pre-Filing Meeting Request here:
Click the upload button or drag and drop files here to attach docurrent
20210632 Ver 1_Meeting Request Review 20210325 No meeting required.pdf 633.23KB
Pie type nest be FCF
1a.Type(s)of approval sought from the Corps:
I7 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
✓ No
lb.What type(s)of permit(s)do you wish to seek authorization?
fJ Nationwide Permit(NWP)
✓Regional General Permit(RGP)
✓Standard(IP)
1c.Has the NWP or GP number been verified by the Corps?
G Yes r No
Nationwide Permit(NWP)Number: 14-Linear transportation
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
✓Non-404 Jurisdictional General Permit r Riparian Buffer Authorization
✓ Individual 401 Water Quality Certification
le.Is this notification solely for the record because written approval is not required? *
For the record only for DWR 401 Certification: r Yes 6' No
For the record only for Corps Permit: r Yes C.' No
If.Is this an after-the-fact permit application?*
✓ Yes f No
1g.Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
6 Yes rNo
1g.Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
✓ Yes r No
Acceptance Letter Attachment
SR 1164 Improvements-Division 13-STR-FB 05.pdf 390.53KB
1h.Is the project located in any of NC's twenty coastal counties?
✓ Yes 6. No
1j.Is the project located in a designated trout watershed?
R 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?*

C Yes t No
2. Owner Information
2a.Name(s)on recorded deed:
NC Department of Transportation
2b.Deed book and page no.:
2c.Contact Person:
2d.Address
Street Address
55 Orange Street
Address Line 2
atY State/Rovince/Region
Asheville NC
Postal/Zip Code Country
28801 USA
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/town:
Luck
2. Project Identification
2a.Property Identification Number: 2b.Property size:
2c.Project Address
Street Address
Address Line 2
CRY State/Province/Region
Postal/Zip Code Country
3.Surface Waters
3a.Name of the nearest body of water to proposed project:*
UT to Sugar Camp Branch
3b.Water Resources Classification of nearest receiving water:*
Class C,Tr,ORW
3c. What river basin(s)is your project located in?*
French Broad
3d.Please provide the 12-digit HUC in which the project is located.
060101051202
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:*
Non-maintained dirt road in scattered residential area dominated by forestland
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)
SR 1164-Rock House Road Topo.pdf 847.87KB
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)

4f.List the total estimated acreage of all existing wetlands on the property:
0
4g.List the total estimated linear feet of all existing streams on the property:
Sugar Camp Branch=700 LF;UT=479 LF;Total=1179 LF
4h.Explain the purpose of the proposed project:*
To widen and improve a section of SR 1164 that has not been maintained
4i.Describe the overall project in detail,including indirect impacts and the type of equipment to be used:*
The existing roadway will be widened by removing trees,cutting slopes,and grading the new roadbed.Stone will be added to the road's surface.
Equipment includes motor graders,track hoes,and dump trucks.
4j.Please upload project drawings for the proposed project.
SR 1164 Rock House-plan sheets.pdf 743.42KB
5.Jurisdictional Determinations
5a.Have the wetlands or streams been delineated on the property or proposed impact areas?*
G Yes r No r Unknown
Comments:
5b.If the Corps made a jurisdictional determination,what type of determination was made?*
r Preliminary r Approved r Not Verified r Unknown a N/A
Corps AID Number:
5c.If 5a is yes,who delineated the jurisdictional areas?
Name(if known): Yates Allen and Gabe Johnson
Agency/Consultant Company: NC DOT
Other:
5d1.Jurisdictional determination upload
6. Future Project Plans
6a.Is this a phased project?*
r Yes a 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 17 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 Dewater Temporary Dewatering UT to Sugar Camp Br Perennial Both 1 479
Average(feet) (linear feet)
S2 Relocation to construct road Permanent Relocation UT to Sugar Camp Br Perennial Both 1 165
Average(feet) (linear feet)
S3 Channel loss from relocation Permanent Fill UT to Sugar Camp Br Perennial Both 1 20
Average(feet) (linear feet)
3i.Total jurisdictional ditch impact in square feet:
0
3i.Total permanent stream impacts: 3i.Total temporary stream impacts:
185 479
3i.Total stream and ditch impacts:

664
3j.Comments:
479 LF are being dewatered to work in dry conditions.The seep inhere the stream originates will be piped across the roadway into Sugar Camp
Branch during construction.The existing stream will be relocated into the new ditch line when construction is complete.The existing stream length is
185 LF;the new stream will be 165 LF for a loss of 20 LF.
E. Impact Justification and Mitigation L)
1.Avoidance and Minimization
1a.Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
The overall project scope has been minimized to greatest practicable extent.
lb.Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
The site will be dewatered before construction begins.Erosion control measures will be installed and maintained.
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 r No
2c.If yes,mitigation is required by(check all that apply):
r DWR fJ Corps
2d.If yes,which mitigation option(s)will be used for this project?
n Mitigation bank fJ Payment to in-lieu fee r Permittee Responsible
program Mitigation
4. Complete if Making a Payment to In-lieu Fee Program
4a.Approval letter from in-lieu fee program is attached.
6 Yes r No
4b.Stream mitigation requested:
(linear feet) 4c.If using stream mitigation,what is the stream temperature:
185 cool
4d.Buffer mitigation requested(DWR only): 4e.Riparian wetland mitigation requested:
(square feet) (acres)
4f.Non-riparian wetland mitigation requested: 4g.Coastal(tidal)wetland mitigation requested:
(acres) (acres)
4h.Comments
F. Stormwater Management and Diffuse Flow Plan (required by DWR) L)
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:
2.Stormwater Management Plan
2a.Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
✓ Yes r 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?*
6 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)?*
✓ Yes f•No

Comments:*
Falls within State Minimum Criteria Checklist(MCCL)
2.Violations(DWR Requirement)
2a.Is the site in violation of DWR Water Quality Certification Rules(15ANCAC 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 No
3. Cumulative Impacts(DWR Requirement)
3a.Will this project result in additional development,which could impact nearby downstream water quality?*
✓ Yes CNo
3b.If you answered"no,"provide a short narrative description.
4.Sewage Disposal(DWR Requirement)
4a.Is sewage disposal required by DWR for this project?*
✓ Yes r No 6 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?*
✓ Yes r No
5b.Have you checked with the USFWS concerning Endangered Species Act impacts?*
✓ Yes 6* No
5d.Is another Federal agency involved?*
✓ Yes r: No r Unknown
5e.Is this a DOT project located within Division's 1-8?
✓ Yes f• No
5f.Will you cut any trees in order to conduct the work in waters of the U.S.?
s Yes r No
5g.Does this project involve bridge maintenance or removal?
✓ Yes (.7 No
5h.Does this project involve the construction/installation of a wind turbine(s)?*
✓ Yes r 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 6 No
5j.What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
https://www.fws.gov/raleigh/species/cntylist/madison.html
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 (7 No
6b.What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
Current maps/databases
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 6- No
7b.What data sources did you use to determine whether your site would impact historic or archeological resources?*
https://nc.maps.a rcgis.coma pps/weba ppviewer/index.html?id=79ea671 ebdcc45639f0860257d5f5ed7
7c.Historic or Prehistoric Information Upload
SR1164MadisonTribalCoordination signed.pdf 1.07MB
8. Flood Zone Designation(Corps Requirement)

8a.Will this project occur in a FEMA-designated 100-year floodplain?*
C Yes r. No
8c.What source(s)did you use to make the floodplain determination?*
https://fris.nc.gov/fris/Indexaspx?FIPS=115&ST=NC&user=General Public
Miscellaneous
Comments
Miscellaneous attachments not previously requested.
SR 1164 Madison signed cover letter.pdf 266.33KB
SR 1164 Madison photos.pdf 6.77MB
Signature
*
®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:
Yates Allen
Signature
YATFs 4t45-1J
Date
4/28/2021