20171357 Ver 1_PCN Form Submission_20171024

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 10/24/2017 2:52:08 PM (Start Event)
Accept by Carpenter,Kristi 10/24/2017 3:52:36 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: October 27, 2017 5:00 PM
10/24/2017 2:52 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:*
Jackson
Is this a NCDOT Project?*
C� Yes �' No
(NCDOT only) T.I.P. or state project number:
14.204911
WBS #
14.204911
(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:
NWP Number Other:
List all MN nurrbers you are applying for not on the drop dow n list.
03 - Maintenance
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?
*
C•' Yes !" No
C' 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:*
Shoal Creek Road culvert replacements
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Whittier
1d. Driving directions*
IF it is a new project and can not easily be found in a C�5 rrepping system Rease provide directions.
Take US 74, NC 19 west past Sylva in Jackson County, e�at at Whittier e�at heading north on River Road SR 1531, take right on Shoal Creek
Road (SR 1416)
� 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 / FYovince / 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:*
35.4409 -83.3395
ex:34.208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Crooked Creek
3b. Water Resources Classification of nearest receiving water:*
C
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Little Tennessee
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:*
The e�asting conditions are a rural paved secondary road through rural residential area.
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)
aick the upload button or drag and drop files here to attach docurrent
SR 1416 Topo.pdf 756K6
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)
Gick the upload button or drag and drop files here to attach docurrent
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)
120
4f. Explain the purpose of the proposed project:
The purpose of the project is to maintain the road by replacing deteriorating culvert pipes in streams in advance of
repaving work.
4g. Describe the overall project in detail, including the type of equipment to be used:
The project involves installing dikes or other dewatering devices, excavating with a track-hoe the existing culverts,
placement of gravel bedding and the new culverts, replacement and compaction of the roadway fill followed by
i repaving.
4h. Please upload project drawins for the proposed project.
Gick the upload button or drag and drop files here to attach docurrent
SR 1416 plans and pictures.pdf 1013.23KB
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 C' Unknown

Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
�' Preliminary �' 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.
Sd1. Jurisdictional determination upload
qick 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.
no
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 r% 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 1 P Culvert UT Perennial Both Average 10
N�p label (e.g. F2rrrenent (F) or Tuckase ge F2rennial (� or � (linear feet)
Finad C7ossing 1) Tenporary (� e River interrrittent (IN� (feet)
i Row 2 1A T Dewatering UT Perennial Both Average 20
N�p label (e.g. F2rrranent (F) or TuCkase ge F2rennial (� or � (linear feet)
F�ad Q-ossing 1) Terrporary (� e River interrrittent (IN� (feet)
Row 3 3 P Culvert UT Crooked Perennial Both Average 0
N�p label (e.g. F2rrranent (F'� or Cree k F2rennial (Fff� or � (linear feet)
f3�ad Qossing 1) Terrporary (� interrrittent (IfV� (feet)
Row 4 3A T Dewatering UT Crooked Perennial Both Average 20
N�p label (e.g. F�rrranent (P) or Cree k f�rennial (� or � (linear feet)
f�ad C7ossing 1) Terrporary (� interrrittent (IfV� (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:
10
3i. Total temporarystream impacts:
40
3i. Total stream and tributary impacts:
50
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:*
A minimal amount of culvert extension is proposed at site 1 to reduce road shoulder sloughing.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
The streams will be temporarily dewatered in the construction area to reduce the potential for downstream
i siltation, which should be minimal due to the small size of the affected streams.
, 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 C•' No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
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:
i NCSG00250
1c. What is the overall percent imperviousness of this project?
75
%
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:
There are no protected riparian buffer rule areas in Jackson County
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
C7ick 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?*
�' 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
Comments:*
This project falls under minimum criteria.
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.
This is maintenance project that will not faster or otherwise enable secondary impacts.
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.
none 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?*
�' 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?*
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?*
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.pctf
If you answered "Yes" to 5f(1), did you discover any signs of bat use?*
C' 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
Fle rrust be FDF
5g. Does this project involve the construction/installation of a wind turbine(s)?**

C' Yes r 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
Fle rrust be FDF
Sh. 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.
aick the upload button or drag and drop files here to attach docurrent
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Si. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
Site survey by Division 14 Environmental Officer and review of available NHP data.
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?*
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 C•' No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources? *
HPO Web server. Moreover, all v�rork involves in-kind replacement of inetal culverts within ewsting disturbed right of
ways, so this falls under NCDOT's Programmatic Agreement with the NC Historic Property Office.
7c. Historic or Prehistoric Information Upload
Gick the upload button or drag and drop files here to attach docurrent
PA screening form SR 1416a.pdf 132.04KB
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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?*
NC Floodmaps.com
Miscellaneous attachments not previously requested.

C7ick the upload button or drag and drop files here to attach docurrent
SR 1416 MNP 3 cover letter.pdf 274.02KB
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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:*
Dave McHenry
Signature
Date
10/24/2017
� Initial Review
Is this project a public transportation project?
C� Yes C' No
Qily 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*
20171357
Version#*
1
Reviewing Office *
i Asheville Regional Office -[phone]
Select Project Reviewer*
Kevin Barnett:eads\khbarnett