20180028 Ver 1_PCN Form Submission_20180105

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 1/5/2018 4:02:30 PM (Start Event)
Accept by Carpenter,Kristi 1/5/2018 4:16:50 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: January 10, 2018 5:00 PM
1 /5/2018 4:02 PM

E-PCN Submittal
���
�lulslaa af Water Resources
Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
December 15, 2017 Ver 2.2
*
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.
Also, if at any point you wish to print a copy of the E-PCN, all you need to do is right-click on the document and you can print a copy of the form.
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:*
Jackson
Is this project a public transportation project? *(')
C�' Yes C' No
Is this a NCDOT Project?*
r Yes C' No
(NCDOT only) T.I.P. or state project number:
14.204911
WBS #
(for NCDOT use only)
1a. Type(s) of approval sought from the Corps:*
fJ 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?*
�7 Nationwide Permit (NWP)
r Regional General Permit (RGP)
Nationwide Permit (NWP) Number: 14 - Linear transportation
NWP Number Other:
List all MNnurrbers you are applying for not on the drop down list.
1c. Type(s) of approval sought from the DWR:*

check all that apply
r% 401 Water Quality Certification - Regular r 401 Water Quality Certification - E�ress
r Non-404 Jurisdictional General Permit 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: �' 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 �' No
1f. Is the project located in anyof NC's twentycoastal counties?*
C' Yes C•' No
1h. Is the project located in a designated trout watershed?*
C•' Yes C' No
Link to trout information: http://w�nn�v.saw.usace.army.mil/Missions/Regulatory-Permit-PrograrrUAgency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact?*
Patrick J. Breedlove
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:
NCDOT Division 14
2b. Deed book and page no.:
2c. Responsible party:
(for Corporations)
NCDOT Division 14
2d.Address
Street Address
253 Webster Road
Address Line 2
��
Sylva
Fbstal / Zip Code
28779
2e. Telephone Number:
State / R-ovince / F�gion
North Carolina
Country
USA

(xxx)xxx-x�cx
[phone]
2f. Fax Number:
i [phone]
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
I Dillard Road (SR 1344) culvert replacement-extension
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Sylva
1d. Driving directions*
IF it is a new project and can not easily be found in a G� rrapping system Rease provide directions.
From Sylva take Webster Road for 1.6 miles. Take left onto Old Settlement Road. Go .6 miles take left onto Dillard Road. Site is
approwmately 250 linear feet on Dillard Road.
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
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 example, 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:*
35.339879
ex:34208504
3. Surface Waters
Longitude:*
-83.215315
-77.796371
3a. Name of the nearest body of water to proposed project:*
Tuskasegee River

3b. Water Resources Classification of nearest receiving water:*
B; Tr
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 site is an e�asting gravel secondary road. The surrounding land is primarily residential.
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 1344 Dillard Topo.pdf 704.82KB
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
20171214_14370402722_88_Hydric_Rating_by_Map_Unit.pdf 320.41 KB
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)
60 ROW
4f. Explain the purpose of the proposed project:*
There is a need to replace deteriorating corrugated metal culvert under the e�asting gravel secondary road (Dillard
i Road) prior to minor widening and paving.
4g. Describe the overall project in detail, including indirect imapacts and the type of equipment to be used:*
I The road will be closed and an off-site detour will be used during construction. Temporary dewatering structure
such as a dike and diversion pipe will be used to divert stream flow around the culvert site. The culvert will be
replaced with an excavator, dump truck and hand tools.
4h. Please upload project drawings for the proposed project.
C7ick the upload button or drag and drop files here to attach docurrent
Dillard_Rdy_psh_xsec.pdf 26.22KB
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5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
C' Yes r No �' Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
C' Preliminary l" Approved C' Unknown C� f�UA
Corps AID Number:
Exarrple: 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
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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 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 I7 Streams-tributaries r Buffers
� Open Waters � Pond Construction
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 for 3b.lmpact
impact * type *
1 P
N�p label (e.g. 13�ad Q'ossing 1) F�rrrenent (P'j or
Terrporary (�
1A T
N�p label (e.g. Id�ad Qossing 1) F2rrranent (Fj or
Terrporary (�
3c. Type of impact* 3d. Stream name *
Cubert
De wate ri ng
UT into the
Tuckasegee River
UT into the
Tuckasegee River
3e. Stream
Type *
Perennial
F�rennial (FH�) or
interrrittent (If�
Perennial
F2rennial (�) or
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
3f. Type of
Jurisdiction *
Both
Both
3g. Stream 3h. Impact
width* length*
2 5
Average(feet) (linearfeet)
2 60
Average(feet) (linearfeet)

3i. Total permanent stream impacts:
5
3i. Total temporarystream impacts:
60
3i. Total stream and tributary impacts:
65
3j. Comments:
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 minimum diameter and length of culvert was selected to convey storm flows and to provide a sufficient sub-
base for paving.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
i Erosion and sedimentation BMPs will be installed prior to construction. Impacts will be minimized by strict
enforcement of Best Management Practice for the protection of surface water, including temporary stream flow
diversions to avoid excavation in flowing water.
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:
Length of culvert e�hension is only 5 linear feet.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
""` Recent changes to the stormwater rules have required updates to this section .*'*
1. Diffuse Flow Plan
� 1a. 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
I For a list of options to meet the diffuse flow requirements, click here.
If no, explain why:
Not in a NC Riparian Buffer Area
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
C' Yes C•' No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?*
C•' Yes
C' No
To look up low density requirement click here 15A NCAC 02H .1003(2).

2c. Does this project have a stormwater management plan (SMP) reviewed and approved under a state stormwater program or state-
approved local government stormwater program?*
C' Yes
C� No
Fint: projects that have vested rights, exerrptions, or grandFathering fromstate or locally irrplerrented storrrwater prograrrs or projects that satisfy state or locally-irrplerrerrted storrrwater prograrrs
through use of comrunity in-lieu prograrrs should answer no to this question.
3. Stormwater Requirements
3a. Select whether a completed stormwater management plan (SMP) is included for review and approval or if calculations are provided
to document the project will not cause degradation of downstream surface waters. *
C� Stormwater Management Plan r Antidegradation Calculations
3b. Stormwater Management Plan: If submitting a SMP for review and approval, it shall complywith the high-density development
requirements set forth in 15A NCAC 02H .1003. Include all appropriate stormwater control measure supplemental forms and associated
items.
C7ick the upload button or drag and drop files here to attach docurrent
FlLE TYFE MJST BE FDF
3c. Antidegradation Calculations: If submitting calculations to document the project will not cause degradation of downstream surface
waters, the documentation shall include a detailed analysis of the hydrological impacts from stormwater runoff when considering the
volume and velocity of stormwater runoff from the project built upon area and the size and existing condition of the receiving
waterbody(ies).
Gick the upload button or drag and drop files here to attach docurrent
FlLE TYFE MJST BE FDF
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 l" 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:*
Environmental Review Document attached.
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
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 r No
3b. If you answered "no," provide a short narrative description.
Project is resurfacing of Dillard Road and upgrading culverts.

4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project? *
C' Yes r No C' �1/A
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?*
G Yes C' No
5c. If yes, indicate the USFWS Field Office you have contacted.
Asheville
Sd. Is another Federal agency involved?*
C' Yes C•' No
5e. Is this a DOT project located within Division's 1-8?*
C' Yes r No
5f. Will you cut anytrees in order to conduct the work in waters of the U.S.?*
C' Yes �' No
5g. Does this project involve bridge maintenance or removal?*
C' Yes C' No
C' Unknown
i 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 r 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?*
U.S. Fish & Wildlife Service (ECOS)
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?*
NOAA Essential Fish Habitat Mapper v3.0
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
I 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)?*
f Yes C•' No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
NCDOT Human Environment Unit (Clearance Letters Attached)
7c. Historic or Prehistoric Information Upload

aick the upload button or drag and drop files here to attach docurrent
17-10-0026NOSurveyReq.pdf 2.67M6
No Archaeoloigcal Survey Required PA 17-10-0026.pdf 3.74MB
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8. Flood Zone Designation (Corps Requirement)
I 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:
The road grade will not be raised appreciably and the culvert capacity will be increased.
8c. What source(s) did you use to make the floodplain determination?*
North Carolina Flood Maps (Flood Risk Information System)
Miscellaneous
Miscellaneous attachments not previously requested.
Gick the upload button or drag and drop files here to attach docurrent
Project Photos (Dillard Road).pdf 2.32M6
MCDC Final.pdf 921.47KB
Cover Letter (Dillard-Road).pdf 250.48KB
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Signature
*
ri 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:*
Patrick Jeremy Breedlove
Signature
��rttr'ra� (�/. . %��Prs�°�i�
Date :
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?*
C� Yes
C' No
BIMS # Assigned*
20180028
Version#*
Reviewing Office *
Asheville Regional Office - [phone]
Select Project Reviewer*
Kevin Barnett:eads\khbarnett
Is a payment required for this project?*
C� No payment required
f Fee received
C' Fee needed - send electronic notification