20211528 Ver 1_ePCN Application_20211122

DW R
Divi.ha of ware.Resources
Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
June 1,2021 Ver 4.1
Initial Review
Has this project met the requirements for acceptance in to the review process?*
Yes
No
Is this project a public transportation project?*
Yes No
Change only if needed.
BIMS#Assigned* Version#*
20211528 1
Is a payment required for this project?*
No payment required
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:
Bridge 560166 Madison
1a.Who is the Primary Contact?*
Roger Bryan
1 b.Primary Contact Email:* 1c.Primary Contact Phone:*
[e-mail] [phone]
Date Submitted
11/22/2021
Nearest Body of Water
Terry Fork Creek
Basin
French Broad
Water Classification
WS_II,HOW
Site Coordinates
Latitude: Longitude:
35.802547 -82.747286
A. Processing Information u
County(or Counties)where the project is located:
Madison
Is this a NCDMS Project
Yes No
Is this project a public transportation project?*
Yes No
Is this a NCDOT Project?*
Yes No
(NCDOT only)T.I.P.or state project number:

WBS#(?)
17BP.13.PE.161
Pre-Filing Meeting Information
Is this a courtesy copy notification?"
Yes No
ID# Version
20211528 1
Pre-fling Meeting or Request Date
Attach documentation of Pre-Filing Meeting Request here:
Click the upload button or drag and drop files here to attach document
File type must be PDF
1a.Type(s)of approval sought from the Corps:
Section 404 Permit(wetlands,streams and waters,Clean Water Act)
Section 10 Permit(navigable waters,tidal waters,Rivers and Harbors Act)
Has this PCN previously been submitted?"
Yes
No
1 b.What type(s)of permit(s)do you wish to seek authorization?
Nationwide Permit(NWP)
Regional General Permit(RGP)
Standard(IP)
1c.Has the NWP or GP number been verified by the Corps?
Yes No
Nationwide Permit(NWP)Number: 14-Linear transportation
NWP Numbers(for multiple NWPS):
1d.Type(s)of approval sought from the DWR:
401 Water Quality Certification-Regular 401 Water Quality Certification-Express
Non-404 Jurisdictional General Permit 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: Yes No
For the record only for Corps Permit: Yes No
1f.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 No
1 h.Is the project located in any of NC's twenty coastal counties?
Yes No
1j.Is the project located in a designated trout watershed?
Yes No
B. Applicant Information
1d.Who is applying for the permit?
Owner Applicant(other than owner)
le.Is there an Agent/Consultant for this project?"
Yes No
2.Owner Information

2a.Name(s)on recorded deed:
NC DOT
2b.Deed book and page no.:
2c.Contact Person:
2d.Address
Street Address
55 Orange Street
Address Line 2
City State/Province/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
1 b.Subdivision name:
(if appropriate)
1c.Nearest municipality/town:
Mars Hill
2.Project Identification
2a.Property Identification Number: 2b.Property size:
2c.Project Address
Street Address
Address Line 2
City State/Province/Region
Postal/Zip Code Country
3. Surface Waters
3a.Name of the nearest body of water to proposed project:
Terry Fork Creek
3b.Water Resources Classification of nearest receiving water:
WS_II,HQW
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.
060101050802
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:*
The site has an existing single span bridge that will be replaced with a double barrel box culvert.Land use in the area is low density residential surrounded by farmland and forest.
4b.Have Corps permits or DWR certifications been obtained for this project(including all prior phases)in the past?*
Yes No Unknown
4f.List the total estimated acreage of all existing wetlands on the property:
0.0
4g.List the total estimated linear feet of all existing streams on the property:
150
4h.Explain the purpose of the proposed project:
The project will replace a structurally deficient bridge with a box culvert.

4i.Describe the overall project in detail,including indirect impacts and the type of equipment to be used:*
The bridge will be replaced with a double barrel box culvert with low flow sills.Excavator and trucks will be used to complete project.Impervious dikes will be used to divert the water
during construction.
5. Jurisdictional Determinations
5a.Have the wetlands or streams been delineated on the property or proposed impact areas?*
Yes No Unknown
Comments:
5b.If the Corps made a jurisdictional determination,what type of determination was made?
Preliminary Approved Not Verified Unknown 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):
Wetlands Streams-tributaries Buffers
Open Waters 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 Culvert Permanent Culvert Terry Fork Perennial Both 10 85
Average(feet) pinear feet)
S2
Bank Stabilization Permanent Bank Stabilization J
Ter Fork Perennial Both 10 20 Terry
Average(feet) (linear feet)
S3 Impervious dikes Temporary Dewatering Terry Fork Perennial Both 10 55
Average(feet) Qinear feet)
31.Total jurisdictional ditch impact in square feet:
0
31.Total permanent stream impacts: 3i.Total temporary stream impacts:
105 55
31.Total stream and ditch impacts:
160
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:
Culvert length is the minimum necessary to meet safety standards for road and shoulder width.

1 b.Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Dewatering via impervious dikes will be used to reduce sedimentation potential during construction.Erosion control measures will be installed as well to
reduce sediment loss into the stream.
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
2c.If yes,mitigation is required by(check all that apply):
DWR Corps
2d.If yes,which mitigation option(s)will be used for this project?
Mitigation bank Payment to in-lieu fee program Permittee Responsible Mitigation
4. Complete if Making a Payment to In-lieu Fee Program
4a.Approval letter from in-lieu fee program is attached.
Yes No
4b.Stream mitigation requested:
(linear feet) 4c.If using stream mitigation,what is the stream temperature:
85 cold
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)
1. Diffuse Flow Plan
la.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:
No regulated buffer in area.
2. Stormwater Management Plan
2a.Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?
Yes No
Comments:
SMP plan attached in permit drawings.
G. Supplementary Information
1. Environmental Documentation
la.Does the project involve an expenditure of public(federal/state/local)funds or the use of public(federal/state)land?"
Yes No
1 b.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 No
Comments:*
The project falls under 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)?*
Yes 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.
No change in road configuration or capacity.
4. Sewage Disposal (DWR Requirement)
4a.Is sewage disposal required by DWR for this project?*
Yes No 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 No
5b.Have you checked with the USFWS concerning Endangered Species Act impacts?*
Yes No
5d.Is another Federal agency involved?*
Yes No Unknown
5e.Is this a DOT project located within Division's 1-8?
Yes No
5f.Will you cut any trees in order to conduct the work in waters of the U.S.?
Yes No
5g.Does this project involve bridge maintenance or removal?
Yes No
5g(1).If yes,have you inspected the bridge for signs of bat use such as staining,guano,bats,etc.?
Yes No
If you answered"Yes"to 5g(1),did you discover any signs of bat use?
Yes No Unknown
5h.Does this project involve the construction/installation of a wind turbine(s)?*
Yes 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 No
5j.What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
Site survey and review of current distribution data.
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?
Mapping
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?*
Mapping
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?*
Mapping
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 document
Bridge 560166 Madison Environmental Documentation.pdf 3.41 MB
18-12-0029NoSurveyReq.pdf 3.23MB
Bridges 560166 and 560353 Madison Tribal Consultation.pdf 2.39MB
No Archaeoloigcal Survey Required PA 18-12-0029.pdf 1.65MB
File must be PDF or KMZ
Comments
Tribal consultation was performed(letter attached).No comments were received within the 30 day comment period.
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:
Roger D.Bryan
Signature
IF 0.
Date
11/22/2021