20171135 Ver 1_PCN Form Submission_20170907

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 9/7/2017 12:49:15 PM (Start Event)
Accept by Carpenter,Kristi 9/7/2017 5:22:15 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: September 12, 2017 5:00 PM
9/7/2017 12:49 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:
17BP.13.R.127
WBS #
176P.13.R.127
(for f�1CDOT 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:
NWP Number Other:
List all MN nurrbers you are applying for not on the drop dow n list.
14 - Linear transportation
1c. Type(s) of approval sought from the DWR:*
check all that apply
� 401 Water Quality Certification - Regular
� 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:
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?
*
l" Yes C•' No
C' Yes C•' No

If so, attach the acceptance letter from rritigation bank or in-lieu fee program
�' Yes C' No
Acceptance Letter Attachment
C7ick the upload button or drag and drop files here to attach docurrent
Bridge 167 Yancey mitigation acceptance.pdf 62.85KB
FlLE IYFE MJST BE FDF
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?*
Yates Allen
1b. Primary Contact Email:*
[e-mail]
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
rJ Owner r Applicant (other than owner) r AgenUConsultant
(Check all that apply)
2. Owner I nformation
2a. Name(s) on recorded deed:
NC Department of Transportation
2b. Deed book and page no.:
2c. Responsible party:
(for Corporations)
J. J. Swain, Jr., P.E., Division Engineer
2d.Address
Street Address
55 Orange Street
Address Line 2
�Y
Asheville
Fbstal / Zip Code
28802
2e. Telephone Number:
(xxx)xxx-xxxx
[phone]
2f. Fax Number:
[phone]
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
State / R-ovince / F�gion
NC
Country
US
C. Project Information and Prior Project History

1. Project Information
� 1a. Name of project:*
Bridge 167 over Shoal Creek on SR 1323 in Yancey County
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Windom
1d. Driving directions*
If it is a new project and can not easily be found in a C� rrapping system Rease provide directions.
Begin at the intersection of US 19 and NC 197S in Burnsville. Drive east towards Spruce Pine on US 19 for 2.4 miles. Turn left on to SR
1323 Shoal Creek Rd. Go appro�mately 0.7 mile to bridge 167.
2. Project Identification
2a. Property Identification Number:
(tac RN or parcel ID)
2b. Propertysize:
(in acres)
0.17
2c. Project Address
Street Address
Address Line 2
��
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 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:*
35.92476
ex:34.208504
3. Surface Waters
Longitude:*
-82.25226
-77.796371
3a. Name of the nearest body of water to proposed project:*
Shoal 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
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:*
Existing timber bridge on 2-lane asphalt road surrounded by low density housing, farmland, and forests in rural
setting
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)
C7ick the upload button or drag and drop files here to attach docurrent
Bridge 167 Yancey topo.pdf 1.89M6
Fle type rrust be pdF
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)
qick the upload button or drag and drop files here to attach docurrent
Fle lype rrust be pdf
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)
96
4f. Explain the purpose of the proposed project:
Replace the e�asting 17' 10" long timber bridge with a double barrel reinforced concrete box culvert; each barrel is
8' wide x 6' high x 45' long with low flow sills/baffels
4g. Describe the overall project in detail, including the type of equipment to be used:
A permanent impact to 96 linear feet (LF) of Shoal Creek will be necessary: 45 LF for culvert installation; 51 LF for
floodplain bench/stabilization. A temporary impact to 67 LF will be necessary for an impervious dike/diversion to
dewater the work area during construction. Equipment used will include excavator, crane, and trucks.
4h. Please upload project drawins for the proposed project.
Qick the upload button or drag and drop files here to attach docurrent
SWMP Yancey 167.pdf 1.23M6
Yancey 167 Permit Drawings (3).pdf 1.06M6
Fle type rrust be pdf
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 C' Approved C' Unknown
Corps AID Number:
Exarrple: 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.
5d1. Jurisdictional determination upload
aick the upload button or drag and drop files here to attach docurrent
Fle lype rrust be F�F
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 r7 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.
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
Row 1 Site 1 P Culvert Shoal Perennial Both Average 45
N�p label (e.g. F2rrranent (F'� or CPee k F2rennial (FB� or $ (linear feet)
F3�ad Qossing 1) Terrporary (� interrrittent (If�
Row 2 Site 1 P Bank Shoal Perennial Both
N�p label (e.g. F2rrranent (F'� or Stabilizatio Creek F�rennial (Fff� or
RDad (7ossing 1) Terrporary (� n interrrittent (IfV�
Row 3 Site 1 T Dewatering Shoal Perennial Both
N�p label (e.g. F�rrranent (P� or Creek F�rennial (� or
Id�ad (7ossing 1) Terrporary (� interrrittent (IfVn
"" 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:
(feet)
Average
8
(feet)
Average
8
(feet)
51
(linear feet)
67
(linear feet)

96
3i. Total temporarystream impacts:
67
3i. Total stream and tributary impacts:
163
3j. Comments:
I Permanent project footprint is 96LF; temporary and permanent impacts overlap
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:*
Minimized length of culvert and has lowflow sills to maintain natural stream channel bottom within the structure.
One barrel will serve as main flow channel with a 1' sill and second barrel serving high flows with a 2' sill across the
bottom.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Will dewater the site, erosion control measures, culvert and footprint of project minimized
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?
C•' Yes �' 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 rJ 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.
fJ Yes
4b. Stream mitigation requested:
(linear feet)
45
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
l" No
1b. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
The project will use BMP's to the Maximum Extent Practicable (MEP) in compliance with NCDOT's NPDES Permit
No. 000250 Post Construction Stormwater Program
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
�J 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?
C' Yes �' No
Stormwater Management Plan Upload
Gick 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 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)?*

r Yes r No
Comments:*
Minimum Criteria Checklist (MCCL)
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?*
�' Yes G No
3b. If you answered "no," provide a short narrative description.
Merely replacing existing bridge
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)
Sa. Will this project occur in or near an area with federally protected species or habitat? *
C' Yes �' No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
C' Yes C•' No
5c. If yes, indicate the USFWS Field Office you have contacted.
5d. Is this a DOT project located within Division's 1-8?*
�' Yes
�' 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.
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 any signs of bat use?*
C' Yes C' No �' Unknown
If yes, please show the location of the bridge on the permit drawings/project plans.
qick the upload button or drag and drop files here to attach docurrent
Fle rrust be FDF
5g. Does this project involve the construction/installation of a wind turbine(s)?"`*
f Yes �' No
If yes, please show the location of the wind turbine(s) on the permit drawings/project plans.
qick the upload button or drag and drop files here to attach docurrent
Fle rrust be FDF
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.
Gick the upload button or drag and drop files here to attach docurrent
Fle rrust be FDF
5i. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
https://�nv�vv.fws.gov/raleigh/species/cntylist/nc_counties.html. Field survey of the project area and evaluation of
current distribution data. With regards to Northern long-eared bats, the project is located outside of a red HUC.
The bridge could not be surveyed for bat presence/usage due to proximity to water level. No trees will
be removed during construction.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
C' Yes C•' No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
Current maps/database
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?*
http://gis.ncdcr.gov/hpoweb/
7c. Historic or Prehistoric Information Upload
aick the upload button or drag and drop files here to attach docurrent
167 Yancey no arch surv req.pdf
167 Yancey No Hist Props.pdf
Fle rrust be FDF
8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https://msc.fema.gov/portal/search
12.68MB
2.66MB

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?*
http://�.ncfloodmaps.com/
Miscellaneous attachments not previously requested.
Gick the upload button or drag and drop files here to attach docurrent
167 photos.pdf 7.88M6
Bridge 167 Yancey signed letter.pdf 679.34KB
Bridge 167 Yancey Corps cover sheet.pdf 19.87K6
Fle rrust be FDF
Signature
*
fJ 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:*
Yates Allen
Signature
1�,�F7�5 rQi-1-��1
i Date
9/7/2017
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?*
r Yes
C' No
BIMS # Assigned*
20171135
Version#*
1
Reviewing Office *
Asheville Regional Office - [phone]
Select Project Reviewer*

Kevin Barnett:eads\khbarnett