20150641 Ver 1_401 Application_20150615

A. Applicant Information
50641
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.4 January 2009
Pre - Construction Notification (PCN) Form
1. Processing
1a. Type(s) of approval sought from the Corps: Section 404 Permit ❑ Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number: 3 or General Permit (GP) number:
1c, Has the NWP or GP number been verified by the Corps? ( ❑X Yes ❑ No
1d. Type(s) of approval sought from the DWQ (check all that apply):
401 Water Quality Certification — Regular ❑ Non -404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
le. Is this notification solely for the record For the record only for DWQ For the record only for Corps Permit:
because written approval is not required? 401 Certification:
❑ Yes . 0 No
1f. Is payment into a mitigation bank or in -lieu fee program proposed for
mitigation of impacts? If so, attach the acceptance letter from mitigation bank
or in -lieu fee program.
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1h
below.
1h. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
2. Project Information
2a. Name of project:
Black Bear Tract Bridge (Crossing #1)
2b. County:
McDowell
2c. Nearest municipality / town:
Marion
2d. Subdivision name:
n/a
2e. NCDOT only, T.I.P. or state project
no:
3. Owner Information
3a. Name(s) on Recorded Deed:
State of North Carolina
3b. Deed Book and Page No.
866/704
3c. Responsible Party (for LLC if
n/a
applicable):
3d. Street address:
1 116 West Jones Street
3e. City, state, zip:
I Raleigh, NC 27611
3f. Telephone no.:
1 919 - 733 -1431
3g. Fax no.:
1 919 - 733 -1431
3h. Email address:
I david.keeley @doa.nc.gov
❑ Yes ❑X No
❑ Yes ❑X No
❑ Yes Q No
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❑ Yes ❑x No
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Page 1 of 10
PCN Form —Version 1.4 January 2009

4. Applicant Information (if different from owner)
4a. Applicant is:
❑X Agent ❑ Other, specify:
4b. Name:
Mark Hamlett, PE
4c. Business name
(if applicable):
I North Carolina Wildlife Resources Commission
4d. Street address:
1720 Mail Service Center
4e. City, state, zip:
I Raleigh, NC 27699
4f. Telephone no.:
! 919 - 707 -0155
4g. Fax no.:
919 - 707 -0162
4h. Email address:
I mark.hamlett @ncwildlife.org
5. Agent/Consultant Information (if applicable)
5a. Name:
same as above
5b. Business name
(if applicable):
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. Fax no.:
5g. Email address:
Page 2 of 10

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): I PIN: 171400543361
1 b. Site coordinates (in decimal degrees): I Latitude: 35.753622 Longitude: - 81.972511
1 c. Property size: 812.93 acres
2. Surface Waters
2a. Name of nearest body of water to proposed project: Bear Creek
2b. Water Quality Classification of nearest receiving water: C
2c. River basin: Catawba
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
Entire property is part of the Pisgah Game Land. This land is used for wildlife habitat, hunting and logging.
t
3b. List the total estimated acreage of all existing wetlands on the property:
i
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
3d. Explain the purpose of the proposed project:
This project will replace an existing culvert road crossing with a bridge. This will reestablish the natural channel an minimize the impact on the existing stream
3e. Describe the overall project in detail, including the type of equipment to be used:
This project will involve the removal of an existing arch culvert and construction of a new bridge. This bridge will require the installation of concrete footers on
each side and a pre - fabricated bridge being placed across the stream. The stream banks will be stabilized with rip rap. Equipment to be used will include a
trackho, backho and a crane to set the bridge. Concrete and dump trucks will also need to access the site.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the ❑ Yes 9 No ❑ Unknown
Corps or State been requested or obtained for this property /
project (including all prior phases) in the past? Comments:
4b. If the Corps made the jurisdictional determination, what type ❑ Preliminary ❑ Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas? Agency /Consultant Company:
Name (if known): Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5. Project History
5a. Have permits or certifications been requested or obtained for I ❑ Yes ❑X No ❑ Unknown
i this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project? I ❑ Yes ❑x No
6b. If yes, explain.
Page 3 of 10
PCN Form — Version 1.4 January 2009

C. Proposed Impacts Inventory
1. Impacts Summary
1a. Which sections were completed below for your project (check all that apply):
❑ Wetlands ❑X Streams — tributaries ❑ Buffers ❑ Open Waters ❑ Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type of impact Type of wetland Forested Type of jurisdiction Area of
number Corps (404,10) or impact
Permanent (P) or DWQ (401, other) (acres)
Temporary (T)
W1
W2
W3
W4
W5
W6
2g. Total Wetland Impacts:
2h. Comments:
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 impacted.
3a. 3b.
3c. 3d. 3e. 3f.
3g.
Stream impact Type of impact
Stream name Perennial (PER) or Type of Average
Impact
number
intermittent (INT)? jurisdiction stream
length
Permanent (P) or
width
(linear
Temporary (T)
(feet)
feet)
S1 P
Stabilization
I Bear Creek PER Corps 13 I
25
S2
S3
S4
S5
I I
S6
3h. Total stream and tributary impacts I
25
3i. Comments:
Page 4 of 10
PCN Form — Version 1.4 January 2009

4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list all open water impacts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number (if applicable) Type of impact Waterbody Area of impact (acres)
Permanent (P) or type
Temporary (T)
O1
O2
03
O4
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If pond or lake construction proposed, then complete the chart below.
5a. 5b. 5c. 5d. 5e.
Pond ID number Proposed use or Wetland Impacts (acres) Stream Impacts (feet) Upland
purpose of pond (acres)
Flooded Filled Excavated Flooded Filled Excavated
P1 I I
P2
5f. Total:
5g. Comments:
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond.watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer,
then complete the chart below. If yes, then individually list all buffer
impacts
below. If any impacts require mitigation, then
you MUST fill out Section D of this form.
6a. Project is in which protected basin?
❑ Neuse ❑ Tar - Pamlico ❑ Catawba ❑ Randleman
❑ Other:
6b. 6c.
6d. 6e. 6f.
6g.
Buffer Impact Reason for impact
Stream name Buffer
Zone 1
Zone 2
number —
mitigation
impact
impact
Permanent (P) or
required?
(square
(square
Temporary (T)
feet)
feet)
B1
B2 I
I I
I
I B4 I
I I
I
B5 I I
B6 I
6h. Total Buffer Impacts:
6i. Comments:
Page 5of10

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
This project improves the quality of the stream. It removes an existing culvert and returns it back to a natural channel. Rip rap will be added to
stabilize the shoreline above the normal water line.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Grading and impacts to the stream have been kept to a minimum. Rip rap will only be added to stabilize the shoreline above the normal water line
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for ❑ Yes ❑X No
impacts to Waters of the U.S. or Waters of the State?
2b. If yes, mitigation is required by (check all that apply):
2c. If yes, which mitigation option will be used for this
project?
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
Type:
3b. Credits Purchased (attach receipt and letter) Type:
Type:
3c. Comments:
4. Complete if Making a Payment to In -lieu Fee Program
4a. Approval letter from in -lieu fee program is attached.
4b. Stream mitigation requested:
4c. If using stream mitigation, stream temperature:
4d. Buffer mitigation requested (DWQ only):
4e. Riparian wetland mitigation requested:
Ij 4f. Non - riparian wetland mitigation requested: Ij
4g. Coastal (tidal) wetland mitigation requested:
4h. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
❑ DWQ ❑ Corps
❑ Mitigation bank
❑ Payment to in -lieu fee program
❑ Permittee Responsible Mitigation
❑ Yes
linear feet
square feet
acres
acres
acres
Quantity:
Quantity:
Quantity:
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 6 of 10
PCN Form — Version 1.4 January 2009

6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires E] Yes F No
buffer mitigation?
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.
6c. 6d. 6e.
Zone Reason for impact Total impact Multiplier Required mitigation
(square feet) (square feet)
Zone 1 I 3 (2 for Catawba)
Zone 2 I 1.5
6f, Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in -lieu fee fund).
6h. Comments:
Page 7 of 10

E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified ❑ Yes ❑X No
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
❑ Yes ❑ No
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project? 0
2b. Does this project require a Stormwater Management Plan? ❑ Yes Z No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
The project does not increase impervious surface.
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
2e. Who will be responsible for the review of the Stormwater Management Plan?
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project? I
3b. Which of the following locally- implemented stormwater management programs
apply (check all that apply):
3c. Has the approved Stormwater Management Plan with proof of approval been
attached?
4. DWQ Stormwater, Program Review
4a. Which of the following state - implemented stormwater management programs apply
(check all that apply):
4b. Has the approved Stormwater Management Plan with proof of approval been
attached?
5. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements?
5b. Have all of the 401 Unit submittal requirements been met?
❑ Phase II
❑ NSW
❑ USMP
❑ Water Supply Watershed
❑ Other:
❑ Yes ❑ No
❑Coastal counties
❑HQW
❑ORW
❑Session Law 2006 -246
❑ Other:
❑ Yes
❑ Yes
Page 8 of 10
PCN Form — Version 1.4 January 2009
❑ No
❑ No

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1a. Does the project involve an expenditure of public (federal /state /local) funds or the M Yes ❑ No
use of public (federal /state) land?
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 ❑ Yes ❑X No
(North Carolina) Environmental Policy Act (NEPA /SEPA)?
1 c. If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
letter.) ❑ Yes ❑ No
Comments:
2. Violations (DWQ Requirement)
2a. is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H.1300), DWQ Surface Water or Wetland Standards, ❑ Yes ❑X No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after - the -fact permit application? ❑ Yes X❑ No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in I ❑Yes Q No
additional development, which could impact nearby downstream water quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non - discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
Page 9 of 10
PCN Form — Version 1.4 January 2009

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or Yes X No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act ❑ Yes X❑ No
impacts?
5c. If yes, indicate the USFWS Field Office you have contacted.
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
WRC Biological Staff
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? I ❑ Yes ❑X No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
WRC Biological Staff
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 ❑ Yes ❑ No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
NCSHPO on -line GIS.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA- designated 100 -year floodplain?
X❑ Yes ❑ No
8b. If yes, explain how project meets FEMA requirements:
Per FEMA Firm Panel 1714J, the culvert replacement will occur at the beginning of the 100 -year flood plain. The project will reduce fill in the stream
and improve flow by restoring a natural system by removing the culvert. This project will not cause any rise in the 100 -year flood elevation.
8c. What source(s) did you use to make the floodplain determination?
FEMA Flood Map
Mark Hamlett, PE � � � %��� � 06 -17 -2015
Applicant/Agent's Printed Name Applicant/Agent's Signature Date
(Agent's signature Is valid only if an authorization
letter from the applicant is provided.)
Page 10 of 10

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SNOT RELEASED FOR CONSTRUCTION
DATE: MAY 16, 2015
NORTH CAROLINA WILDLIFE RESOURCES COMMISSION
DIVISION OF ENGINEERING SERVICES
1720 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699 -1720
(919) 707 -0150 FAX: [phone]
PROJECT
BLACK BEAR TRACT BRIDGE (CROSSING #1)
PISGAH CAME LAND
BURKE COUNTY, NC
SHEET INDEX
SD -1.0 EXISTING CONDITIONS AND DEMOLITION PLAN
SD -3.0 GRADING PLAN
PERMIT DRAWINGS
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GPS COORDINATES OF SITE:
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81. 58' 21.0" W
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