20240440 Ver 1_ePCN Application_20240319

i DWR
Division of Water Resources
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
October 2, 2023 Ver 4.3
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.
Does this project involve maintenance dredging funded by the Shallow Draft Navigation Channel Dredging and Aquatic Weed Fund or involve the distribution or transmission of energy or
fuel, including natural gas, diesel, petroleum, or electricity?
Yes No
BIMS # Assigned Version# *
20240440 1
Is a payment required for this project?*
No payment required
Fee received
Fee needed - send electronic notification
Select Project Reviewer*
Ryan Conchilla:ryan.conchilla
Information for Initial Review
la. Name of project:
Bridge 36 on SR 1515 over Middle Fork Creek, Madison County
1a. Who is the Primary Contact?*
Yates Allen
1b. Primary Contact Email: *
[e-mail]
Date Submitted
3/19/2024
Nearest Body of Water
Middle Fork Creek/Middle Fork Little Ivy Creek
Basin
French Broad
Water Classification
WS-II, HOW
Site Coordinates
Latitude:
35.871948
A. Processing Information
Is this project connected with ARPA funding?
Yes No
County (or Counties) where the project is located:
Madison
Is this a NCDMS Project
Yes No
Longitude:
-82.482606
Reviewing Office*
Central Office - [phone]
1c. Primary Contact Phone:*
[phone]
O
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:
BP13.R020
W BS # (?)
BP13.R020
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
1b. 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
Regional General Permit (RGP) Number:
RGP Numbers (for multiple RGPS):
1d. Type(s) of approval sought from the DWR:
401 Water Quality Certification - Regular
Non-404 Jurisdictional General Permit
Individual 401 Water Quality Certification
201902350 - Work associated with bridge construction, widening, replacement, and
interchanges
1e. Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification:
For the record only for Corps Permit:
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
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?
Yes No
B. Applicant Information
1d. Who is applying for the permit?
Owner Applicant (other than owner)
Ile. Is there an Agent/Consultant for this project?
Yes No
2. Owner Information
2a. Name(s) on recorded deed:
NC Department of Transportation
2b. Deed book and page no.:
2c. Contact Person:
401 Water Quality Certification - Express
Riparian Buffer Authorization
Yes No
Yes No

2d. Address
Street Address
55 Orange Street
Address Line 2
City
Asheville
Postal / Zip Code
28801
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(If appropriate)
1c. Nearest municipality I town:
Mars Hill
2. Project Identification
2a. Property Identification Number
2c. Project Address
Street Address
Address Line 2
City
Postal / Zip Code
3. Surface Waters
3a. Name of the nearest body of water to proposed project: "
Middle Fork Creek/Middle Fork Little Ivy Creek
3b. Water Resources Classification of nearest receiving water:"
WS-II. HOW
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.
06010105-0802
4. Project Description and History
State / Province / Region
NC
Country
USA
2f. Fax Number:
2b. Property size:
State / Province / Region
Country
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 timber bridge on 2-lane paved rural road surrounded by pastures and scattered residences.
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:
0.1
4g. List the total estimated linear feet of all existing streams on the property:
Middle Fork (PER)-100'; UT to Middle Fork (PER)-130'
4h. Explain the purpose of the proposed project: *
To replace the existing single span timber bridge with a single span cored slab bridge
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used: *
Replace the existing single span 35' long by 21' wide timber bridge with a single span 55' long by 30' wide, 21" cored slab bridge. Permanent impacts include a total 71' of bank
stabilization in Middle Fork Creek and its UT and 124' channel relocation in the UT to avoid impacts to R-2518A Middle Fork Creek Site K Mitigation site. Temporary impacts total 52'
associated with the channel relocation, bank stabilization installation, and existing abutment removal. Equipment to be used includes trackhoes, dump trucks, and, possibly, a crane.
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): Ryan Elliot
Agency/Consultant Company: Sage Ecological Services
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 O Buffers
Open Waters Pond Construction
3. Stream Impacts
u
❑
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
Bridge replacement
Permanent
Bank Stabilization J
Middle Fork Creek
Perennial
Both
12
61
Average (feet)
(linear feet)
gy
Bridge replacement
Temporary
Bank Stabilization J
Middle Fork Creek
Perennial
Both
12
32
Averege (feet)
(linear feet)
S3
Stream relocation
Permanent
Relocation ]fft,
Middle Fork Creek
Perennial
Both
124
Averege (feet)
(linear feet)
S4
Stream relocation
Temporary
Relocation
UT to Middle Fork Creek
Perennial
Both
10
Average (feet)
(linear feet)
S5
Bridge replacement
Permanent
Bank Stabilization
UT to Middle Fork Creek
Perennial
Both
10
Averege (feeQ
(linear feet)
S6
Bridge replacement
Temporary
Bank Stabilization J
UT to Middle Fork Creek
Perennial
Both
10
_]
Average (feet)
(linear feet)
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts: 3i. Total temporary stream impacts:
195 52
3i. Total stream and ditch impacts:
247
3j. Comments:
Permanent impacts fall within the footprint of temporary impacts.
E. Impact Justification and Mitigation
1. Avoidance and Minimization
0
i1
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
Bridge was designed to meet current safety standards. Relocation of the UT is to avoid a stream mitigation site related to the widening of US 19.

1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Erosion control measures will be installed. The site will be dewatered as needed. The site will be stabilized once construction is complete.
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)
124
4d. Buffer mitigation requested (DWR only):
(square feet)
4f. Non -riparian wetland mitigation requested:
(acres)
4h. Comments
4c. If using stream mitigation, what is the stream temperature:
cold
4e. Riparian wetland mitigation requested:
(acres)
4g. Coastal (tidal) wetland mitigation requested:
(acres)
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:
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?
Yes 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 No
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.
O
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
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
Unknown
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?
https://ipac.ecosphere.fws.gov
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?'
maps
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?"
Coordination with NC DOT Cultural Resources personnel and SHPO
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?
Yes No
8b. If yes, explain how project meets FEMA requirements:
The proposed grade will be 1-1.5' above the existing grade.
8c. What source(s) did you use to make the floodplain determination?"
https://flood.nc.gov/ncflood/
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 36 Madison photos.pdf
1.47MB
BP13.R020 topo.pdf
326.09KB
21-12-0008_EffectsSigned.pdf
6.22MB
031522 NCDOT COR BP13-R020 Bridge 36.pdf
163.83KB
BP13.R020 HPO Concurrence.pdf
122.34KB
NCDOT Madison Tribal Consultation Request.pdf
2.18MB
No NRHP Eligible or Listed Archaeological Sites Present PA 21-12-0008.pdf
6.88MB
BP13.R020 Madison MYGR, MYSE,PESU,MYLU.pdf
241.28KB
BP13.R020_NRTR.pdf
1.01 MB
BP13.R020_PJDPackage.pdf
1.13MB
Bridge 36 Madison cover letter.pdf
219.25KB
Bridge 36 Madison MCCL.pdf
5.8MB
Questionnaire BP13.R020.pdf
119.35KB
SF-560036_Permit Drawings_20230706.pdf
1.54MB
File must be PDF or KMZ
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:
Yates Allen
Signature
YArKS ALLAW
Date
3/19/2024
O