20170969 Ver 1_PCN Form Submission_20170804

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 8/4/2017 4:26:10 PM (Start Event)
Accept by Carpenter,Kristi 8/4/2017 5:11:15 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: August 9, 2017 5:00 PM
8/4/2017 4:26 PM

�� �
6fvlslaa of Water Resources
Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
June 28, 2017 Ver 1.8
*
Please note: fields marked with a red asterisk below are required. You will not be ab/e to submit the form until all mandatory questions are ans�red.
Below is a link to the DRAFT online help file. http://edocs.deq.nc.gov/WaterResources/0/doc/549884/Page1.aspx
A. Processing Information
County (or Counties) where the project is located:*
Mitchell
Is this a NCDOT Project?*
C� Yes �' No
(NCDOT only) T.I.P. or state project number:
B-5170
WBS #
42328.1.1
(for NCDOT use only)
� 1a. Type(s) of approval sought from the Corps:*
rJ Section 404 Permit (wetlands, streams and waters, Clean Water Act)
r Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What type(s) of permit(s) do you wish to seek authorization?*
fJ Nationwide Permit (NWP)
r Regional General Permit (RGP)
Nationwide Permit (NWP) Number:
Nationwide Permit (NWP) Number:
Nationwide Permit (NWP) Number
NWP Number Other:
List all MNnurrbers you are applying for not on the drop down list.
13 - Bank Stabilization
33 - Temporary Construction
23 - Categorical Exclusions
1c. Type(s) of approval sought from the DWR:*
check all that apply
�7 401 Water Quality Certification - Regular
r Non-404 Jurisdictional General Permit
r 401 Water Quality Certification - Express
r Riparian Buffer Authorization
*
1d. Is this notification solelyfor the record because written approval is not required?
For the record only for DWR 401 Certification: �' Yes C� No

1d. Is this notification solelyfor the record because written approval is not required?
I For the record only for Corps Permit:
1e. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
IF so, attach the acceptance letter from rritigation bank or in-lieu fee program
r Yes l" No
Acceptance Letter Attachment
Gick the upload button or drag and drop files here to attach docurrent
B-5170 - STR - FB 08 Cold.pdf 57.8KB
FlLE 7YFE MJST BE f�F
1f. Is the project located in anyof NC's twentycoastal counties?*
C' Yes C•' No
B. Applicant Information
1a. Who is the Primary Contact?*
William Barrett
1b. Primary Contact Email:*
[e-mail]
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
�J Owner r Applicant (other than owner) r Agent/Consultant
(Check all that apply)
i 2. Owner I nformation
2a. Name(s) on recorded deed:
NCDOT
2b. Deed book and page no.:
2c. Responsible party:
(for Corporations)
2d.Address
Street Address
Address Line 2
Qty
Fbstal / Zip Code
2e. Telephone Number:
(xxx)xxx-xxxx
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
State / FYovince / F�gion
Country
C. Project Information and Prior Project History
*
C' Yes C•' No

1. Project Information
1a. Name of project:*
Replacement of Bridge 29 over Big Rock Creek on NC 226
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Buladean
1d. Driving directions*
If it is a new project and can not easily be found in a C� rrapping system Rease provide directions.
GPS
2. Project Identification
2a. Property Identification Number:
(tax RNor parcel ID)
2b. Propertysize:
(in acres)
2c. Project Address
Street Address
Address Line 2
Qty
Fbstal / Zip Code
State / Rovince / F�gion
Country
2d. Site coordinates in decimal degrees
I Please collect site coordinates in decimal degrees. Use between 4-6 digits (unless you are using a survey-grade GPS device) after the decimal place as
appropriate, based on howthe location was determined. (For example, most mobile phones with GPS provide locational precision in decimal degrees to
map coordinates to 5 or 6 digits after the decimal place.)
Latitude:* Longitude:*
36.107332 -82.194224
ex:34.208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Big Rock Creek
3b. Water Resources Classification of nearest receiving water:*
C;Tr
Surface Water Lookup
3c. What river basin(s) is your project located in?*
French Broad
RiverBasin Lookup
4. Project Description

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:*
I Rural farmland with some residential properties.
4b. Attach an 8 7/2 X 11 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for
DWR)
C7ick the upload button or drag and drop files here to attach docurrent
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4c. 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)
aick the upload button or drag and drop files here to attach docurrent
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4d. List the total estimated acreage of all existing wetlands on the property:
0
4e. List the total estimated linear feet of all existing streams on the property:
I(interrrdtent and perennial)
958
4f. Explain the purpose of the proposed project:
To replace a structure that is a functionally obsolete bridge (Deck Geometry appraisal of 2 out of 9).
4g. Describe the overall project in detail, including the type of equipment to be used:
i The project involves replacing a 52-foot bridge with a 65-foot, 24-inch cored slab, single-span bridge on the
epsting alignment with an on-site detour. Standard road building equipment, such as trucks, dozers, and cranes
will be used.
4h. Please upload project drawins for the proposed project.
Qick the upload button or drag and drop files here to attach docurrent
I B-5170_Permit Drawings_20170307.pdf 3MB
65170_rdy.pdf 5.O8M6
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5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
C' Yes C•' No !' Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
C' Preliminary �' Approved C' Unknown
Corps AID Number:
Exarrple: SAVu2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Sd1. Jurisdictional determination upload

C7ick the upload button or drag and drop files here to attach docurrent
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6. Project History
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past?*
C' Yes �' No �' Unknown
7. Future Project Plans
� 7a. Is this a phased project?*
C' Yes C•' 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? This includes other separate and distant crossing for linear projects that require Department of the
Army authorization but don't require pre-construction notification.
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
r Wetlands �J Streams-tributaries r Buffers
r Open Waters r Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
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.
Row 1
Row 2
Row 3
Row 4
Row 5
3a. Site #- 3b.lmpact 3c. Type of 3d. Stream 3e. Stream 3f. 3g. Stream 3h. Impact
Reason for type impact name Type Jurisdiction width length
impact type
Site 1 T Fill Bif Rock Perennial Corps average 29
wOrkpad F2rrranerd (F'j or Cree k F2rennial (� or 30 (linear feet)
N�p label (e.g. Terrporary (� interrrittent (INT) (feet)
13�ad (7ossing 1)
Site 2 P Bank UT Big Perennial Corps Average 10
fv�p label (e.g. F2rrranent (F) or Stabilizatlo RoCk Creek F2rennial (FB� or 3 (linear feet)
F�ad Q-ossing 1) Terrporary (� n interrrittent (IIVT) (feet)
Site 2- RCP P Fill UT Big Perennial Corps Average 20
N�p label (e.g. F2rrranent (Pj or
f3�ad Qossing 1) Terrporary (�
Site 2- RCP T Fill
N�p label (e.g. F�rrranent (P� or
f3�ad Q'ossing 1) Terrporary (�
Site 2 RCP T Fill
N�p label (e.g. F2rrranerd (� or
R�ad Qossing 1) Terrpa'ary (�
RoCk Creek F2rennial (FH� or
interrrittent (IfV�
UT Big Perennial Corps
RoCk Creek F�rennial (� or
interrrittent (IfV�
UT Big Perennial Corps
RoCk Creek F2rennial (� or
interrrittent (INT)
"" All Perennial or Intermittent streams must be verified by DWR or delegated local government.
3i. Total jurisdictional ditch impact in square feet:
3 (linear feet)
(feet)
Average 13
3 (linear feet)
(feet)
Average 41
3 (linear feet)
(feet)

0
3i. Total permanent stream impacts:
30
3i. Total temporary stream impacts:
83
3i. Total stream and tributary impacts:
113
3j. Comments:
10 feet of permanent impacts are bank stabilization and no mitigation is proposed.
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.
5. Pond or Lake Construction
If pond or lake construction is proposed, then complete the chart below.
6. Buffer Impacts (for DWR)
If project will impact a protected riparian buffer, then complete the chart below. Individually list all buffer impacts below.
, E. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
The proposed bridge is 13 feet longer than the existing bridge, and is a single-span stucture that spans the creek
with no bents in the water; the proposed bridge will be at appro�amately the same grade as the e�asting structure;
3:1 fill slopes where practicable. An off-site detour was not feasible given the traffic volume and limited connectivity
to other major routes in the vicinity.
The proposed bridge does not have deck drains, therefore, direct discharge into the stream is eliminated. Bridge
deck drainage will be collecteted into TB 2GIs at each end of the bridge on the downswtream side that outlets to
the downstream side of the bridge, onto riprap pads, and then disperses into the floodplain before entering the
creek.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Design Standards in Sensitive Waters will be adhered to throughout project construction to reduce storm water
impacts to the receiving stream.
A trout moratorium prohibiting in-stream work and land disturbance within the 25-foot buffer will be adhered to from
October 15 to April 15
' 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 l" No
2c. If yes, mitigation is required by (check all that apply):
r DWR �J Corps
2d. If yes, which mitigation option(s) will be used for this project?
r Mitigation bank r7 Payment to in-lieu fee program r 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
4b. Stream mitigation requested:
Qinear feet)
20
4c. If using stream mitigation, stream temperature:
cold
4d. Buffer mitigation requested (DWR only):
(squarefeet)
4e. Riparian wetland mitigation requested:
(acres)
4f. Non-riparian wetland mitigation requested:
(acres)
4g. Coastal (tidal) wetland mitigation requested:
(acres)
4h. Comments
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1a. Does this project require a Stormwater Management Plan?
C� Yes C' No
1b. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
See permit drawings attached
1c. What is the overall percent imperviousness of this project?
%
1d. Who will be responsible for the review of the Stormwater Management Plan?*
r Certified Local Government
r% DWR 401 & Buffer Permitting Branch
� 2. Diffuse Flow Plan
r DEMLR Stormwater Review
r DWR Transportation Permitting Branch
2a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection
Rules?
C' Yes C' No
5. DWR 401 Stormwater Review
5a. Is the Stormwater Management Plan (including BMP Supplemental Forms and Operation and Maintenance Agreements) attached?
C' Yes �' No
Stormwater Management Plan Upload
aick the upload button or drag and drop files here to attach docurrent
file type rrust be pdf
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?*
C•' Yes �' No
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 PolicyAct (NEPA/SEPA)?*
C� Yes C' No
1c. 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
NEPAor SEPAfinal approval letter.)*
C� Yes C' No
NEPAor SEPAFinal Approval Letter
aick the upload button or drag and drop files here to attach docurrem
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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)? *
C' Yes �' No
2b. Is this an after-the-fact permit application?*
C' Yes C•' No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWR Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in additional development, which could impact
nearby downstream water quality?*
C' Yes �' No
3b. If you answered "no," provide a short narrative description.
Due to the minimal transportation impact resulting from this bridge replacement, this project will neither influence
nearby land uses nor stimulate growth. Therefore, a detailed indirect or cumulative effects study will not be
necessary.
4. Sewage Disposal (DWR Requirement)
4a. Describe, in detail, the treatment methods and dispositions (non-discharge or discharge) of wastewater generated from the
proposed project. If the wastewater will be treated at a treatment plant, list the capacity available at that plant.
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? *
r Yes C' No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
�' Yes �' No
5c. If yes, indicate the USFWS Field Office you have contacted.
Asheville
5d. Is this a DOT project located within Division's 1-8?*
C' Yes
C•' No

5e. Will you cut anytrees in order to conduct the work in waters of the U.S.?*
C' Yes C' No
5f. Does this project involve bridge maintenance or removal?*
�' Yes C' No
5f(1). If yes, have you inspected the bridge for signs of bat use such as staining, guano, bats, etc.? Representative photos of signs of bat
use can be found in the NLEB SLOPES, Appendix F, pages 3-7.
C•' Yes C' No
Link to the NLEB SLOPES document: http://sav�reg.usace.army.mil/NLEB/1-30-17-signed_NLEB-SLOPES&apps.pdF
If you answered "Yes" to 5f(1), did you discover anysigns of bat use?*
�' Yes �' No C' Unknown
If yes, please show the location of the bridge on the permit drawings/project plans.
Gick the upload button or drag and drop files here to attach docurrent
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5g. Does this project involve the construction/installation of a wind turbine(s)?**
C' Yes �' No
If yes, please show the location of the wind turbine(s) on the permit drawings/project plans.
Gick the upload button or drag and drop files here to attach docurrent
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5h. 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 C' No
If yes to either, please provide details to include type of percussive activity, purpose, duration, and specific location of this activity on
the property.
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5i. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
USFWS and NHP website were used, along with on-site surveys.
A Memo, dated November 2, 2016, was submitted to USFWS-Asheville on March 20, 2017, regarding the northern
long-eared bat (NLEB), noting that NCDOT has detemined that the proposed action does not require separate
consultation on the grounds that the proposed action is consistent with the final Section 4(d) rule, codified at 50
C.F.R. 17.40(0) and effective February 16, 2016. A No Effect determination for gray bat was included with the
Memo submitted to USFWS.
One species, Virginia spiraea, has habitat at the project site. An initial survey for this species was conducted on
June 26, 2010, and subsequent surveys were conducted on July 9, 2013 and May 21, 2015. During these three
surveys, no individuals of this species were identified, resulting in a No Effect determination.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
f Yes r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
NMFS County Index
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data: http://gis.ncdcr.gov/hpoweb/
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 (e.g., National Historic Trust designation or properties significant in North Carolina history and archaeology)?*
C' Yes �' No

7b. What data sources did you use to determine whether your site would impact historic or archeological resources? *
NEPA Documentation
7c. Historic or Prehistoric Information Upload
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8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https://msc.fema.gov/portal/search
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
C' Yes C•' No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?*
NCDOT Hydraulics Unit coordination with FEMA
I FEMA Maps
Miscellaneous attachments not previously requested.
C7ick the upload button or drag and drop files here to attach docurrent
B-5170 Cover Letter.pdf 255.62KB
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Signature
*
ri By checking the box and signing below, I certify that:
■ 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 AcY');
■ I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic
Transactions AcY');
■ 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:*
Colin Mellor
Signature
Col� �i�llc�r
Date
i 8/4/2017
Initial Review
Is this project a public transportation project?
C� Yes C' No
Only change this if the project has been reassigned.
Has this project met the requirements for acceptance in to the review process?*

C� Yes
C' No
i BIMS#Assigned*
20170969
Version#*
Reviewing Office *
Asheville Regional Office - [phone]
Select Project Reviewer*
Kevin Barnett:eads\khbarnett