20171049 Ver 1_PCN Form Submission_20170818

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 8/18/2017 1:11:27 PM (Start Event)
Accept by Carpenter,Kristi 8/18/2017 3:02:22 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: August 23, 2017 5:00 PM
8/18/2017 1:12 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:*
� Yancey
Is this a NCDOT Project?*
�' Yes �' No
(NCDOT only) T.I.P. or state project number:
B-5864
WBS #
48058.1.1
(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:
NWP Number Other:
List all MNnurrbers you are applying for not on the drop down list.
23 - Categorical Exclusions
33 - Temporary Construction
1c. Type(s) of approval sought from the DWR:*
check all that apply
fJ 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:
*
C' Yes C•' No
For the record only for Corps Permit: �' Yes C� No

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
C' Yes C' No
Acceptance Letter Attachment
Qick the upload button or drag and drop files here to attach docurrent
I B-5864 DMS Acceptance 2017-03-20.pdf 98.38KB
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1f. Is the project located in any of NC's twenty coastal counties?*
C' Yes �' No
B. Applicant Information
1a. Who is the Primary Contact?*
NCDOT
I 1b. Primary Contact Email:*
[e-mail]
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
I7 Owner r Applicant (other than owner) r AgenUConsultant
(Check all that apply)
2. Owner I nformation
2a. Name(s) on recorded deed:
2b. Deed book and page no.:
I 2c. Responsible party:
(for Corporations)
2d.Address
Street Address
Address Line 2
��
Fbstal / Zip Code
2e. Telephone Number:
(xxx)xxx-xxxx
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
State / Rovince / F�gion
Country
C. Project Information and Prior Project History
1. Project Information

1a. Name of project:*
IReplacement of Bridge 49 over Brown Creek on NC 80.
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Burnsville
1d. Driving directions*
If it is a new project and can not easily be found in a GPS rrapping system Rease provide directions.
GPS Mapping
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)
2b. Propertysize:
(in acres)
2c. Project Address
Street Address
Address Line 2
�Y
Fbstal / Zip Code
State / Rovince / F�gion
Country
2d. Site coordinates in decimal degrees
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 e�mple, 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:*
35.856249 -82.199455
ex:34.208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Brown Creek
3b. Water Resources Classification of nearest receiving water:*
C;TR;ORW
Surface Water Lookup
3c. What river basin(s) is your project located in?*
French Broad
River Basin 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:*
Residential and commercial development along the roadway with forestland along Brown Creek.

4b. Attach an 8 1/2 X 11 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for
DWR)
Gick 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)
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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:
(interrrittent and perennial)
848
4f. Explain the purpose of the proposed project:
To replace a structurally deficient and functionally obsolete bridge that has reached the end of its useful life.
4g. Describe the overall project in detail, including the type of equipment to be used:
The project involves replacing a 30.5-foot bridge with a 50-foot, single-span bridge on the existing alignment with
an on-site detour. The temporary detour bridge will be 55 feet in length. Standard road building equipment, such
as trucks, dozers, and cranes will be used.
4h. Please upload project drawins for the proposed project.
C7ick the upload button or drag and drop files here to attach docurrent
B-5864 Hydro & Roadway Drawings 2017-03-01.pdf 5.24MB
B-5864 Roadway Plans.pdf 5.98M6
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5. Jurisdictional Determinations
Sa. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
C' Yes C•' No C' Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
C' Preliminary C' Approved C' Unknown
Corps AID Number:
6carrple: SAV�2017-99999
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.
I 5d1. Jurisdictional determination upload
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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 C' No �' Unknown
7. Future Project Plans
7a. Is this a phased project?*
f 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 I m pacts I nventory
1. Impacts Summary
i 1a. Where are the impacts associated with your project? (check all that apply):
r Wetlands rJ 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.
I3a. 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
Row 1 Site 1- P Rip Rap Fill Brown Perennial Corps Average 5
Bridge F�rrranent (P� or Cree k F�rennial (� or 25 (linear feet)
Abutment Terrporary (� interrrittent (IfVn (feet)
Fill
N�p label (e.g.
Finad Qossing 1)
Row 2
Row 3
Row 4
Site 1- T Rip Rap Fill Brown
Bridge F�rrranent(P�or Creek
Abutment Terrporary(�
Fill
N�p label (e.g.
Road Qossing 1)
Site 2 - P Fill
Roadway F2rrranent (F'� or
Fill Terrporary (�
I�p label (e.g.
Finad Qossing 1)
Site 2 - T Fill
Roadway F�rrranerd (P� or
Fill Terrporary (�
N�p label (e.g.
Fd�ad Qossing 1)
UT 1 to
Brown
Creek
UT 1 to
Brown
Creek
Perennial Corps
F�rennial (� or
interrrittent (IfV�
Perennial Corps
F�rennial (Fff� or
interrrittent (IfV�
Perennial Corps
F�rennial (� or
interrrittent (IfVn
Average 68
25 (linear feet)
(feet)
Average $3
3 (linear feet)
(feet)
Average 10
3 (linear feet)
(feet)

Row 5
Row 6
3a. Site # - 3b.lmpact
Reasonfor type
impact
Site 2 - P
Roadway F2rrrenent (� or
Fill Terrporary (�
N�p label (e.g.
RDad Q'ossing 1)
3c. Type of 3d. Stream 3e. Stream 3f. 3g. Stream 3h. Impact
impact name Type Jurisdiction width length
type
Fill UT2to Perennial Corps Average 24
BI'OWn F2rennial (�) or 4 (linear feet)
Creek interrrittent(IMj (feet)
Site 2 - T Fill
Roadway F2rrranent (Fj or
Fill Terrporary (�
N�p label (e.g.
13�ad Qossing 1)
UT2to Perennial Corps Average 10
BPOWII F2rennial (FB� or 4 (linear feet)
Creek interrrittent(INTj (feet)
" All Perennial or Intermittent streams must be verified by DWR or delegated local government.
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
112
3i. Total temporary stream impacts:
88
3i. Total stream and tributary impacts:
200
3j. Comments:
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:*
I The proposed bridge is 20 feet longer than the ewsting bridge, and will be a single span structure. An on-site
detour will be used, and the temporary bridge will span Brown Creek; 3:1 fill slopes where practicable.
1b. Specificallydescribe measures taken to avoid or minimize the proposed impacts through construction techniques:*
I Design Standards in Sensitive Waters (15A NCAC 04B.0124) will be adhered to throughout the construction of the
project to reduce stormwater impacts to the receiving stream due to erosion and runoff.
A Trout Moratorium prohibiting in-stream work and land disturbance within the 25-foot trout buffer will be adhered
I 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?
G Yes C' No
2c. If yes, mitigation is required by (check all that apply):
� DWR �7 Corps
2d. If yes, which mitigation option(s) will be used for this project?
� Mitigation bank r% Payment to in-lieu fee program
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached.
fJ Yes
4b. Stream mitigation requested:
Qinear feet)
112
4c. If using stream mitigation, stream temperature:
cool
4d. Buffer mitigation requested (DWR only):
(square feet)
4e. Riparian wetland mitigation requested:
(acres)
4f. Non-riparian wetland mitigation requested:
(acres)
4g. Coastal (tidal) wetland mitigation requested:
(acres)
4h. Comments
r Permittee Responsible Mitigation
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 attached permit drawings.
1c. What is the overall percent imperviousness of this project?
%
1d. Who will be responsible for the review of the Stormwater Management Plan?*
� Certified Local Government
� DWR 401 & Buffer Permitting Branch
2. Diffuse Flow Plan
r DEMLR Stormwater Review
rJ 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
If no, explain why:

5. DWR 401 Stormwater Review
5a. Is the Stormwater Management Plan (including BMP Supplemental Forms and Operation and Maintenance Agreements) attached?
G Yes C' No
Stormwater Management Plan Upload
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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 C' 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)?*
�' Yes l" 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.)*
r Yes l" No
NEPAor SEPAFinal Approval Letter
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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 C•' 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 C•' No
3b. If you answered "no," provide a short narrative description.
i 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 l" No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
C•' 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
G 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?*
C� 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.
r Yes C' No
i 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 any signs of bat use?*
f Yes �' No C' Unknown
If yes, please show the location of the bridge on the permit drawings/project plans.
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5g. Does this project involve the construction/installation of a wind turbine(s)?"`*
!' Yes C•' No
If yes, please show the location of the wind turbine(s) on the permit drawings/project plans.
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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.?*
C•' 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 Website:
-The project will have no effect, due to lack of habitat, for spreading avens, Carolina northern flying squirrel, Rock
gnome
lichen, Roan Mountain bluet, Spruce-fir moss spider, and gray bat.
-The project will have no effect, but habitat is present, for Virginia spiraea.
-The project May Affect, but is Not Likely to Adversely Affect the Appalachian elktoe. Concurrence was requested
and
received (and is attached to this Application) from the USFWS on April 19, 2017.
-The project is consistent with the 4(d) rule for the Northern long-eared bat, as compliance documentation was
provided
in the Request for Concurrence to the USFWS. No comments v�re received from the USFWS."

6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
C' Yes �' 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 C•' 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:
NCDOT Hydraulics Unit coordination with FEMA.
8c. What source(s) did you use to make the floodplain determination?*
FEMA Maps.
Miscellaneous attachments not previously requested.
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B-5864 Application Cover Letter.pdf 269.39KB
B-5864 USFWS Concurrence 2017-04-19.pdf 179.27KB
171E�1�{i. a:� �
Signature
*
r% 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� �ella,�
i Date
8/18/2017
Initial Review
Is this project a public transportation project?
G 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?*
G Yes
C' No
BIMS # Assigned*
20171049
Version#*
i Reviewing Office *
Asheville Regional Office - [phone]
Select Project Reviewer*
Kevin Barnett:eads\khbarnett