20211105 Ver 1_ePCN Application_20210816

DWR
Division of Water Resources
Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
June 1,2021 Ver4.1
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?*
• Yes r No
Change only if needed.
BIMS#Assigned* Version#*
20211105 1
Is a payment required for this project?*
✓ No payment required
6' Fee received Reviewing Office*
✓ Fee needed-send electronic notification Central Office-[phone]
Select Project Reviewer*
Kevin Mitchell:eads\rkmitchell
Information for Initial Review
la.Name of project:
Jackson County-Bridge 203
1a.Who is the Primary Contact?*
Patrick J.Breedlove
lb.Primary Contact Email:* 1c.Primary Contact Phone:*
[e-mail] [phone]
Date Submitted
8/16/2021
Nearest Body of Water
Caney Fork
Basin
Little Tennessee
Water Classification
Class WS Ill;Tr.
Site Coordinates
Latitude: Longitude:
35.30503 -83.13793
A. Processing Information L)
County(or Counties)where the project is located:
Jackson
Is this a NCDMS Project
✓ Yes ( 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:
B-6035

WBS#(?)
17BP.14.R.145
Pre-Filing Meeting Information
Is this a courtesy copy notification?*
✓ Yes G No
ID# Version
20211105 Version 1
Pre-fling Meeting or Request Date
7/9/2021
Attach documentation of Pre-Filing Meeting Request here:
Click the upload button or drag and drop files here to attach document
Jackson County-B203-NCDWR Pre Filing Approval.pdf 48.41KB
Pie type must be FCF
1a.Type(s)of approval sought from the Corps:
[7 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?
r Nationwide Permit(NWP)
f7 Regional General Permit(RGP)
r Standard(IP)
1c.Has the NWP or GP number been verified by the Corps?
✓ Yes 6 No
Regional General Permit(RGP)Number: 201902350-Work associated with bridge construction,widening,replacement,and
interchanges
RGP Numbers(for multiple RGPS):
ld.Type(s)of approval sought from the DWR:
fJ 401 Water Quality Certification-Regular r 401 Water Quality Certification-Express
r Non-404 Jurisdictional General Permit r Riparian Buffer Authorization
r 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 r No
For the record only for Corps Permit: r Yes r No
If.Is this an after-the-fact permit application?*
✓ Yes (' No
1g.Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
✓ Yes (' No
1g.Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
✓ Yes r No
1h.Is the project located in any of NC's twenty coastal counties?
✓ Yes (' No
1j.Is the project located in a designated trout watershed?
6 Yes r No
B. Applicant Information
Id.Who is applying for the permit?
f7 Owner r Applicant(other than owner)
le.Is there an Agent/Consultant for this project?*
✓ Yes ( No

2.Owner Information
2a.Name(s)on recorded deed:
NCOT Division 14
2b.Deed book and page no.:
2c.Contact Person:
2d.Address
Street Address
253 Webster Road
Address Line 2
aty State/Bovine/Region
Sylva North Carolina
Postal/Zip Code Country
28779 United States
2e.Telephone Number: 2f.Fax Number:
[phone]
2g.Email Address:*
[e-mail]
C. Project Information and Prior Project History C^U
1. Project Information
1b.Subdivision name:
(if apprgxiate)
1c.Nearest municipality/town:
Cullowtee
2. Project Identification
2a.Property Identification Number: 2b.Property size:
2c.Project Address
Street Address
Address Line 2
Qly State/Bovine/Region
Postal/Zip Code Country
3.Surface Waters
3a.Name of the nearest body of water to proposed project:*
Caney Fork
3b.Water Resources Classification of nearest receiving water:*
Class WS It;Tr.
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.
060102030105
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 an existing wood floor on steel I-beam bridge on a single lane gravel road.Project site is located in a rural residential area with large agriculture fields nearby.
4b.Have Corps permits or DWR certifications been obtained for this project(including all prior phases)in the past?*
C Yes C No 6 Unknown
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 an obsolete and deteriorating wood floor on steel I-beam bridge with a cored slab bridge unit directly upstream of exiting bridge.
4i.Describe the overall project in detail,including indirect impacts and the type of equipment to be used:*
NCDOT contractor will install erosion and sediment control measures.NCDOT contractor will install diversion device prior to the construction of the new cord slab bridge and the
demolition of the existing bridge.Bank stabilization materials will be permanently installed once final grading allows.Diversion device will be removed and temporary impacts will be
restored.The proposed project will be constructed utilizing the following equipment:crane,excavator,dump trucks,paving equipment,pumps and hand tools.
5.Jurisdictional Determinations
5a.Have the wetlands or streams been delineated on the property or proposed impact areas?*
✓ Yes r No C Unknown
Comments:
5b.If the Corps made a jurisdictional determination,what type of determination was made?*
✓ Preliminary r Approved r Not Verified a Unknown r N/A
Corps AID Number:
5c.If 5a is yes,who delineated the jurisdictional areas?
Name(if known):
Agency/Consultant Company:
Other:
6. Future Project Plans
6a.Is this a phased project?*
✓ Yes ( 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):
n Wetlands fJ Streams-tributaries r Buffers
n 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 Site#1 Diversion Temporary Dewatering Caney Fork Creek Perennial Both 30 96
Avenge(feet) (linear feet)
$2 Site#2 RR Bank Stabilization Permanent Bank Stabilization Caney Fork Creek Perennial Both 30 40
Average(feet) (linear feet)
S3 Site#3 RR Culvert Outlet Permanent Bank Stabilization Caney Fork Creek Perennial Both 30 7
Average(feet) (linear feet)
3i.Total jurisdictional ditch impact in square feet:
0
3i.Total permanent stream impacts: 3i.Total temporary stream impacts:
47 96
3i.Total stream and ditch impacts:
143
3j.Comments:
E. Impact Justification and Mitigation
1.Avoidance and Minimization
la.Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:

The existing bridge is being replaced with a structure that is adequate for the traffic needs on the existing gravel road.The bridge was designed for
the minimum size criteria to ensure conveyance of traffic on the secondary road.
lb.Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
The on-site stream(Caney Fork Creek)will be temporary diverted while the existing bridge is removed and bank stabilization materials are installed.
Erosion and sediment 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 (7 No
2b.If this project DOES NOT require Compensatory Mitigation,explain why:
Project is a bridge to bridge replacement.No mitigation is required.
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 ( 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?*
c 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?*
✓ Yes rNo
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(NEPAISEPA)?*
(z Yes r No
1c.If you answered"yes"to the above,has the document review been finalized by the State Clearing House?*
✓ Yes 6No
Comments:*
FHWA CE 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 RNo
3. Cumulative Impacts(DWR Requirement)
3a.Will this project result in additional development,which could impact nearby downstream water quality?*
✓ Yes 6 No
3b.If you answered"no,"provide a short narrative description.
The project is only to replace subject bridge and does not increase the capacity of roads 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 0Nor 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 r No
5c.If yes,indicate the USFWS Field Office you have contacted.
Asheville
5d.Is another Federal agency involved?*
(' Yes r No r Unknown
What Federal Agency is involved?
FHWA
5e.Is this a DOT project located within Division's 1-8?
✓ Yes a No
5f.Will you cut any trees in order to conduct the work in waters of the U.S.?
IT Yes r No
5g.Does this project involve bridge maintenance or removal?
( Yes r No
5g(1).If yes,have you inspected the bridge for signs of bat use such as staining,guano,bats,etc.?
(' Yes r No
If you answered"Yes"to 5g(1),did you discover any signs of bat use?
✓ Yes ( No r Unknown
5h.Does this project involve the construction/installation of a wind turbine(s)?*
✓ Yes t: 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 Service IPac
6. Essential Fish Habitat(Corps Requirement)
6a.Will this project occur in or near an area designated as an Essential Fish Habitat?*
✓ Yes ( 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 Cultural Resource Specialist
8. Flood Zone Designation(Corps Requirement)
8a.Will this project occur in a FEMA-designated 100-year floodplain?*
( Yes r No
8b.If yes,explain how project meets FEMArequirements:
NCDOT Programmatic Agreement
8c.What source(s)did you use to make the floodplain determination?*
FMIS NC Flood Maps
Miscellaneous
Please use the space below to attach all required documentation or any additional information you feel is helpful for application review.Documents should be combined into one
file when possible,with a Cover Letter,Table of Contents,and a Cover Sheet for each Section preferred.

Click the upload button or drag and drop files here to attach docurrent
Jackson County-B203-GP 50 Cover Letter(Final).pdf 38.23KB
Jackson County-B203-FHWA CE Form(Signed).pdf 411.89KB
Jackson County-B203-USGS Topo&GIS Map.pdf 1.1MB
Jackson County-B203-NRCS Soil Survey.pdf 392.88KB
Jackson County-B203-Permit Plans.pdf 2.08MB
Jackson County-B203-Site Photos.pdf 1.21MB
Jackson County-B203-Architecture Screening(Update).pdf 76.03KB
Jackson County-B203-Archaeological Screening(Update).pdf 18.45MB
Jackson County-B203-Hydro Report.pdf 3.29MB
Jackson County-B203-SMP.pdf 540.83KB
Jackson County-B203-PJD(Final-Signed).pdf 232.77KB
Jackson County-B203-NC Hertiage Program.pdf 3.13MB
Jackson County-B203-Bat Habitat Assessment Form.pdf 38.14KB
Jackson County-B203-USFWS Concurrence Request.pdf 160.82KB
Fle mast be FIT or BcE
Comments
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:
Patrick Jeremy Breedlove
Signature
Date
8/16/2021