20171171 Ver 1_PCN Form Submission_20170912

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 9/12/2017 5:38:25 PM (Start Event)
Accept by Carpenter,Kristi 9/13/2017 3:27:00 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: September 15, 2017 5:00 PM
9/12/2017 5:38 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:*
Macon
Is this a NCDOT Project?*
C� Yes �' No
(NCDOT only) T.I.P. or state project number:
WBS #
(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?*
�J Nationwide Permit (NWP)
r Regional General Permit (RGP)
Nationwide Permit (NWP) Number:
NWP Number Other:
List all MNnurrbers you are applying for not on the drop down list.
03 - Maintenance
1c. Type(s) of approval sought from the DWR:*
check all that apply
� 401 Water Quality Certification - Regular
r Non-404 Jurisdictional General Permit
r 401 Water Quality Certification - E�ress
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:
For the record only for Corps Permit:
1e. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
*
C' Yes C•' No
�' Yes C� No

If so, attach the acceptance letter from rritigation bank or in-lieu fee program
C' Yes C•' No
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?*
Dave McHenry
1b. Primary Contact Email:*
[e-mail]
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
r% Owner r% Applicant (other than owner) r AgenUConsultant
(Check all that apply)
2. Owner I nformation
2a. Name(s) on recorded deed:
NCDOT, Division 14
2b. Deed book and page no.:
2c. Responsible party:
(for Corporations)
2d.Address
Street Address
253 Webster Road
Address Line 2
��
Sylva
Fbstal / Zip Code
28779
2e. Telephone Number:
(xxx)xxx-xxxx
[phone]
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
3a. Applicant is:
�' Agent
C' Other
If other please specify.
3b. Name:
State / R-ovince / F�gion
NC
Country
USA

3c. Business Name:
(if applicable)
3d.Address
Street Address
Address Line 2
Qty
Fbstal / Zip Code
3e. Telephone Number:
(xxx)xxx-xxxx
3f. Fax Number:
(xxx)xxx-xxxx
3g. Email Address:*
[e-mail]
State / Rovince / F�gion
Country
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
i Replace Macon Bridge 17- TIP B-4775, WBS 38546.1.1, F.A. No. BRZ-
1309(8)
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Fraklin
1d. Driving directions*
If it is a new project and can not easily be found in a C�5 rrapping system Rease provide directions.
Head west from Franklin on Hwy 64 towards Hayesville. Turn right on SR 1470, travel about 1.3 miles, then left on SR 1309 for about 0.1
mile to bridge,
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)
2b. Propertysize:
(in acres)
� 0.1
2c. Project Address
Street Address
Address Line 2
(�ty
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>cample, 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:*
35.1543 -83.4894
ex:34.208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Wayah Creek
3b. Water Resources Classification of nearest receiving water:*
WS-III Tr
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Little Tennessee
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:*
The site is a timber bridge on a gravel secondary road over a large stream. General land-use in the area is rural
with mix of scattered farms, single-family homes, and extensive forest.
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
Tran 28 Topo.pdf 383.2K6
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)
aick the upload button or drag and drop files here to attach docurrent
Tran 28 soils.pdf 771.02KB
Fle type 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)
125
4f. Explain the purpose of the proposed project:
The purpose of the project is to replace a deteriorating timber bridge.
4g. Describe the overall project in detail, including the type of equipment to be used:
The road will be closed and off-site detour used. Erosion Controls will be set-up and the temporary water
diversions put-in. The old bridge will then be demolished with a track-hoe, which will excavate the old road fill up to
the bridge. Piles will be driven and end caps poured and finally the deck will be installed with a crane. The new
� bridge approach grading will be finished with a dozer and the road paved.
4h. Please upload project drawins for the proposed project.

C7ick the upload button or drag and drop files here to attach docurrent
Tran 28 selected plans.pdf 5.9MB
550017 2016 B4775 WAYAH CREEK SR1309.pdf 3.71 MB
Fle type rrust be pdF
5. Jurisdictional Determinations
Sa. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
C' Yes C•' No C' Unknown
Comme nts:
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.
5d1. Jurisdictional determination upload
Gick 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 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.
none
D. Proposed I m pacts I nventory
1. Impacts Summary
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
i Row 1 1 P Stabilizatio Wayah Perennial Both Average 96
fv�p label (e.g. F2rrrsnent (Pj or n C1'ee k F2rennial (FB� or gg (linear feet)
F�ad Q-ossing 1) Terrporary (� interrrittent (IN�
Row 2
Row 3
1A T Dewatering Wayah
N�p label (e.g. F2rrranent (Fj or CPe e k
Id�ad Qossing 1) Terrporary (�
2 P Bank Wayah
fv�plabel(e.g. F�rrranent(P�or Stabilizatio Creek
13�ad Q'ossing 1) Terrporary (� n
Perennial Both
F2rennial (FB� or
interrrittent (IIV�
Perennial Both
F2rennial (Fff� or
interrrittent (IfVi)
"" 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 temporarystream impacts:
125
3i. Total stream and tributary impacts:
237
3j. Comments:
(feet)
Average
35
(feet)
Average
35
(feet)
125
(linear feet)
16
(linear feet)
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 bridge is being replaced in the existing road alignment, which will minimize stream and buffer impacts. Likewise
an off-site detour will be used which will reduce impacts associated with a temporary on-site detour. The cored
slab bridge will have an open bottom which should minimize aquatic life passage impediments.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Erosion controls will be set-up first and excavation will be avoided using the temporary water diversions.
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
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
This project will have minimal impact and permanent impacts are restricted to rip rap to protect stream banks. The structure, a cored slab
bridge, is also bottomless.
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:
NCDOT NCS000250.
Stormwater will not directly discharge from the bridge, but rather it will be routed with the road drainage to
vegetated areas or rip rap swales.
1c. What is the overall percent imperviousness of this project?
50
%
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
fJ 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?
f Yes
C•' No
If no, explain why:
Project is not in Neuse or Catawba Basins
5. DWR 401 Stormwater Review
5a. Is the Stormwater Management Plan (including BMP Supplemental Forms and Operation and Maintenance Agreements) attached?
C' Yes
C•' 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?*

r Yes r 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 �' No
Comments:*
A CE was prepared for the project. It is included in this submittal.
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 �' 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 qualit�i?*
C' Yes �' No
3b. If you answered "no," provide a short narrative description.
This project will replace an existing bridge with a similarly-sized without a roadway capacity increase which could
accommodate development.
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.
i Port-o-Jons - no permanent wastewater will be generated.
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?*
C' Yes C•' 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?*
f Yes
C� No
5e. Will you cut anytrees in order to conduct the work in waters of the U.S.?*
�' 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 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 C•' 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.?*
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.
qick the upload button or drag and drop files here to attach docurrent
Macon 17 NWP Cover Letter.pdf 255.84KB
CategoricalExclusion_B4775.pdf 1.23MB
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5i. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
NHP Mapserver, USFWS data, and site surveys by qualified NCDOT staffs
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
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 historyand archaeology)?*
C' Yes �' No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources? *
NCDOT Human Environment Review
7c. Historic or Prehistoric Information Upload
Gick the upload button or drag and drop files here to attach docurrent
Macon Hist Architecture and Archaeology Reports.pdf 346.85KB
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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?*
r Yes l" No
8b. If yes, explain how project meets FEMA requirements:
This is flood study area, reviewed by NCDOT Hydro Unit, and no map revision necessary - MOA Type 2B
8c. What source(s) did you use to make the floodplain determination?*
NCDOT Hydro Report - included in the plans
Miscellaneous attachments not previously requested.
qick the upload button or drag and drop files here to attach docurrent
Macon Pictures.pdf 401.45KB
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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:*
Dave McHenry
Signature
���
Date
9/12/2017
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
BIMS # Assigned*
20171171
Version#*
1
Reviewing Office *
Asheville Regional Office - [phone]
Select Project Reviewer*
Kevin Barnett:eads\khbarnett