20171542 Ver 1_PCN Form Submission_20171130

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 11/30/2017 12:44:11 PM (Start Event)
Accept by Carpenter,Kristi 11/30/2017 4:13:49 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: December 5, 2017 5:00 PM
11 /30/2017 12:44 PM

�� �
6fvlslaa of Water Resources
Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
November 25, 2017 Ver 2.1
*
Please note: fields marked with a red asterisk below are required. You will not be able to submit the form until all mandatory questions are ans�red.
Below is a link to the online help file.
http://edocs.deq.nc.gov/WaterResources/0/doc/603610/Page1.aspx
A. Processing Information
County (or Counties) where the project is located:*
Transylvania
Is this project a public transportation project? (?)
r Yes C' No
Is this a NCDOT Project?
C� Yes C' No
(NCDOT only) T.I.P. or state project number:
14.208711
WBS #
14.208711
(for NCDOT use only)
1a. Type(s) of approval sought from the Corps:
ri 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?
rJ 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
For the record only for Corps Permit:
*
C•' Yes C' No
C' Yes r 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
i 1f. Is the project located in anyof NCs twentycoastal counties?*
C' Yes �' No
1h. Is the project located in a designated trout watershed?*
C' No
C' Yes
Link to trout information: http://v�uwv.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Agency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact?*
Dave McHenry
1b. PrimaryContact 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:
i NCDOT. Division 14
2b. Deed book and page no.:
2c. Responsible party:
(for Corporations)
2d.Address
Street Address
253 Webster Road
Address Line 2
�Y
Sylva
Fbstal / Zip Code
28779
2e. Telephone Number:
(xxx)xxx-xxxx
2f. Fax Number:
State / Rovince / Region
NC
Country
USA

(xxx)xxx-x�cx
2g. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
SR 1100 Island Ford Wet Pipe Resplacements
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Brevard
1d. Driving directions*
If it is a new project and can not easily be found in a G� rrapping system Rease provide directions.
Take US 64 west to Brevard. Turn right on US 276 heading south from Brevard. Take right on SR 1100 to culvert sites about 0.3-0.4 mile
west.
2. Project Identification
I 2a. Property Identification Number:
(tax RN or parcel ID)
2b. Propertysize:
(in acres)
0.1
2c. Project Address
Street Address
Address Line 2
�Y
Fbstal / Zip Code
State / FYovince / 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 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.)
I Latitude:*
35.1833
ex:34.208504
3. SurFace Waters
Longitude:*
-82.7317
-77.796371
3a. Name of the nearest body of water to proposed project:*
French Broad River
3b. Water Resources Classification of nearest receiving water:*
� B 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 The e�asting land use at the sites is rural paved secondary road. The general land use in the area is mixed
residential and agricultural.
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
SR 1100 Topo.pdf 807.79KB
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)
C7ick the upload button or drag and drop files here to attach docurrent
20171130_10213810448_176_Hydric_Rating_by_Map_Unit.pdf 522.79KB
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)
150
4f. Explain the purpose of the proposed project:
I The purpose of the project is to replace two failing corrugated metal culverts under SR 1100.
4g. Describe the overall project in detail, including the type of equipment to be used:
I Traffic will be rerouted around the site. Temporary dikes and pumps will be set-up and used to route stream flow
around the work areas. The culverts will be excavated and the new culverts bedded. Any bare soils will be
stabilized immediately with seed and matting.
4h. Please upload project drawings for the proposed project.
C7ick the upload button or drag and drop files here to attach docurrent
SR 1100 aerial and photos.pdf 335.3KB
Fle type rrust be pdF
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
f Yes C•' No f" Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
C' Preliminary C' Approved C' Unknown C•' fWA
Corps AID Number:
6carrple: SAV�2017-99999

Sc. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:
Sd. 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
Fle type rrust be FDF
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 C' Unknown
7. Future Project Plans
7a. Is this a phased project?*
C' Yes �' 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 activit�/? 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
1a. Where are the impacts associated with your project? (check all that apply):
r Wetlands �J Streams-tributaries r Buffers
� 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 #- Reason 3b.lmpact 3c. Type of 3d. Stream name *
for impact* type* impact*
1 P Culvert UT French Broad River
N�p label (e.g. Fd�ad F2rrranent (F)
Qossing1) orTerrporary
i�
3e. Stream Type * 3f. 3g. Stream 3h. Impact
Jurisdictior�idth* length*
type *
Perennial Both
F2rennial (Fff�) or interrrittent
(If�
2 0
Average (feet) (linear feet)
1A P Dewaterin UT French Broad River Perennial Both 2 20
N�p label (e.g. Fd�ad F2rrranent (F) g F�rennial (Fff� or interrrittent Average (feet) (linear feet)
Qossing1) orTerrporary (IfVn
i�

3a. Site #- Reason 3b.lmpact 3c. Type of 3d. Stream name * 3e. Stream Type * 3f. 3g. Stream 3h. Impact
for impact* type* impact* Jurisdictior�idth* length*
type *
2 P Culvert UT French Broad River Perennial Both
N�p label (e.g. Fd�ad F2rrranent (F'� F2rennial (F8� or interrrittent
Qossing 1) or Terrporary (If�
rn
2A P Dewaterin UT French Broad River Perennial Both
N�p label (e.g. Fd�ad F2rrranent (F'� g F2rennial (F9� or interrrittent
Qossing1) orTerrporary (IfV�
i�i
" 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:
40
3i. Total temporary stream impacts:
0
3i. Total stream and tributary impacts:
40
3j. Comments:
2 0
Average (feet) (linear feet)
2 20
Average (feet) (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:*
Only the minimal amount of pipe will be used.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
The culvert sites will be temporarily dewatered to reduce downstream sedimentation. The work will be done in less
I than a day and bare soils in and near the stream immediately stabilized to minimize erosion.
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 �' No
1e. If this project DOES NOT require a Stormwater Management Plan, explain why:
Replacement of existing structures
2. Diffuse Flow Plan
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 �' No
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?*
G 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)?*
C' Yes C•' No
Comments:*
This project meets minimal criteria thresholds.
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 �' 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
i nearby downstream water quality?*
C' Yes C•' No
3b. If you answered "no," provide a short narrative description.
This is a maintenance project so no increase in capacity.
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?*
r Yes l" No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
C' Yes C•' No
5d. Is another Federal agency involved?*
C' Yes �' No
5e. Is this a DOT project located within Division's 1-8?*
C' Yes �' No
5f. Will you cut anytrees in order to conduct the work in waters of the U.S.?*
C' Yes C•' No
5g. Does this project involve bridge maintenance or removal?*
f Yes �' No
f' Unknown
Link to the NLEB SLOPES document: http://sav�reg.usace.army.mil/NLEB/1-30-17-signed_NLEB-SLOPES&apps.pdF
5h. Does this project involve the construction/installation of a wind turbine(s)?**
C' Yes C•' No
5i. 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
Sj. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
On site visit by NCDOT biologist 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 �' 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? *
i This project meets the PA agreement between NCHPO and NCDOT for review by field staff. Review the HPO
viewer for proximity of project sites to NR properties.
7c. Historic or Prehistoric Information Upload
aick the upload button or drag and drop files here to attach docurrent
Island Ford RMIP_SHP01.pdf 222.63KB
SR 1100 PA.pdf 224.96KB
Fle rrust be FDF
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?*
i NC Floodmaps
Miscellaneous attachments not previously requested.
C7ick the upload button or drag and drop files here to attach docurrent
Fle rrust be FDF
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
I 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:*
I Dave McHenry
Signature
� ��
Date :
i current_date
Initial Review
Is this project a public transportation project? *(?)
C' Yes C' No
Change only if needed.
Has this project met the requirements for acceptance in to the review process?*
G Yes
C' No
BIMS # Assigned*
20171542
Version#*
1
Reviewing Office*
Asheville Regional Office - [phone]
Select Project Reviewer*
Kevin Barnett:eads\khbarnett