20180538 Ver 1_PCN Form Submission_20180417

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 4/17/2018 10:41:55 AM (Start Event)
Accept by Carpenter,Kristi 4/17/2018 12:07:46 PM (DOT Initial Review)
. The task was assigned to Carpenter,Kristi. The due date is: April 20, 2018 5:00 PM
4/17/2018 10:43 AM

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Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
January 31, 2018 Ver 2.3
*
Please note: fields marked with a red asterisk beloware required. You will not be able 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.
https://edocs.deq. nc.gov/WaterResources/0/edoc/624704/PCN%20Help%20File%202018-1-30.pdf
A. Processing Information
County (or Counties) where the project is located:*
Cherokee
Is this project a public transportation project?*
C Yes l' No
lhis is any publicly funded by rrunicipal,state or federal funds road, rail, airport transportation project.
Is this a NCDOT Project?*
f• Yes r No
(NCDOT only) T.I.P. or state project number:
WBS #
14SP.20201.1
(for �ICDOT 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?*
fJ Nationwide Permit (NWP)
r Regional General Permit (RGP)
r Standard (IP)
This form may be Corps to initiate the standard/individual permit process. Please contact your Corps representative for submittal of standard permits.
All required items that are not provided in the E-PCN and be added to the miscellaneous upload located at the bottom of this form.
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 - Express
r Non-404 Jurisdictional General Permit r Riparian Buffer Authorization
r Individual Permit
*
1d. Is this notification solelyfor the record because written approval is not required?
For the record onlyfor DWR 401 Certification:
For the record onlyfor Corps Permit:
f Yes C' No
C' Yes f' 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 a- in-lieu fee program
C Yes l" No
Acceptance Letter Attachment
C7ick the upload button or drag and drop files here to attach docurrent
B163 - Cherokee County - Mitigation Acceptance Letter.pdf 63.19KB
F1LE lYFE MJST BE FDF
1f. Is the project located in any of NC's twenty coastal counties?'�
f Yes �' No
1h. Is the project located in a designated trout watershed?*
f Yes r No
Link to trout information: http://wvwv.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Agency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact? *
Patrick J. Breedlove
1b. PrimaryContact Email:*
pjbreed [e-mail]
1c. PrimaryContact Phone:�
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
fJ Owner r Applicant (other than owner) r Agent/Consultant
(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
C7ty
Sylva
Fbstal / Zip Code
28779
2e. Telephone Number:
(xxx)xxx-�axx
[phone]
2f. Fax Number:
[phone]
(xxx)xxx-xxxx
2g. Email Address:*
pjbreed [e-mail]
State / Rovince / Region
North Carolina
Country
United States
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Cherokee County - Bridge Number 163
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Murphy
1d. Driving directions*
IF it is a new project and can not easily be found in a GPS rrapping system Rease provide directions.
From Murphy take Joe Brown Highway. Go approxmately 2.9 miles take right onto Hanging Dog Road. Go approwmately .3 miles take right
onto Bates Creek Road. Go approximately .1 miles to bridge replacement site.
2. Project Identification
2a. Propertyldentification Number:
(tax RN or parcel ID)
2b. Propertysize:
(in acres)
2c. Project Address
Street Address
Address Line 2
Qty
Fbstal / Zip Code
State / Rovince / Fdegion
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 how the 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:* Longitude:*

35.114785 -84.05142
ex:34.208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Bates Creek
3b. Water Resources Classification of nearest receiving water:*
Class C
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Hiwassee
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:*
Current ewsting bridge is a 25' 6" timber floor on steel I-Beam two lane structure located on a paved secondary
road. Site is located within a rural residential housing community.
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)
Qick the upload button or drag and drop files here to attach docurrent
B163 - Cherokee County - Topo Map.pdf 1.29MB
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)
dick the upload button or drag and drop files here to attach docurrem
B163 - Cherokee County - NRCS Soil Map.pdf
Fle type rrust be pdf
4d. List the total estimated acreage of all existing wetlands on the property:
0.0
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
200
4f. Explain the purpose of the proposed project:*
Replace an obsolete and deteriorating bridge structure.
499.18KB
4g. Describe the overall project in detail, including indirect imapacts and the type of equipment to be used:*
NCDOT contractor will install diversion dike and by-pass pipe. Once diversion is in place the construction of an on-
site detour will be completed by utilizing a double 60" diameter pipe structure. Contractor will remove bridge
structure and end bents and new reinforced concrete box culvert structure will be installed. Backfill material will be
place onto culvert and rip-rap will be placed for bank stabilization. Bank stabilization materials will be permanently
installed once final grading allows. Box culvert structure will be constructed by utilization of the following
equipment: crane, excavator, dump truck and hand tools.
4h. Please upload project drawings for the proposed project.
Qick the upload button or drag and drop files here to attach docurcent
B163 - Cherokee County - Permit Plans.pdf 964.95KB
B163 - Cherokee County - Hydro Report.PDF 3.2MB
Fle type rrust be pdF
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*

r Yes C No r Unknown
Comme nts:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
f Preliminary l" Approved �' 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:
f" f�UA
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Sd1. Jurisdictional determination upload
Gick the upload button or drag and drop files here to attach docurcent
B163 - Cherokee County - JD Request.pdf
Fle type rrust be FDF
6. Project History
186.79KB
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past? *
f Yes �' No �' Unknown
7. Future Project Plans
7a. Is this a phased project?'�
f Yes l•' 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 �J Streams-tributaries r Buffers
r Open Waters r 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. Reason for impact*3b.lmpact 3c. Type of impact*3d. Stream name * 3e. Stream 3f. Type of 3g. Stream 3h. Impact sqfe�
type * Type'� Jurisdiction * width * length *

g1 Site 1 T Dewatering
N�p label (e.g. I�ad C7ossing F2rrranent (Fj or
1) Terrporary (lj
g2 Site 1A T Culvert
fv�p label (e.g. f3�ad Qossing F2rrranent (P� or
1) Terrporary (�
S3 Site 2 P Culvert
fv�p label (e.g. Road Qossing F2rrranent (Fj or
1) Terrporary (lj
S4 Site 2A P Bank
Nl�p label (e.g. Road Qossing F2rrranem (Fj or Stabilization
1) Terrporary (�
S5 Site 26 P Bank
N�p label (e.g. F3�ad Qossing F2rrrenent (P) or StBbilization
1) Terrporary (�
Bates Creek
Bates Creek
Bates Creek
Bates Creek
Bates Creek
Perennial Both
F2rennial (� or
intermittent (If�
Perennial Both
F�rennial (� or
intermitterd (If�
Perennial Both
F2rennial (� or
irderrcittent (IfVn
Perennial Both
F2rennial (� or
interrrittent (IfVn
Perennial Both
F�rennial (� or
interrritterd (If�
*" 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:
129
3i. Total temporary stream impacts:
234
3i. Total stream and tributary impacts:
363
3j. Comments:
E. Impact Justification and Mitigation
1. Avoidance and Minimization
8
Average
(feet)
8
Average
(feet)
8
Average
(feet)
8
Average
(feet)
8
Average
(feet)
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
The existing bridge is being replaced with a structure that is adequate for traffic need in the same disturbed
location as the ewsting bridge structure. Reinforced concrete box culvert was designed for the minimum size to
ensure conveyance of traffic on the current secondary road.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
The on-site stream (Bates Creek) will be diverted while the on-site detour is constructed and while the ebsting
bridge is removed and constructed. Erosion and sedimentation control measures will be installed prior to ground
disturbance. Both of these measures will aid in the prevention of sediment in downstream habitats.
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?
f• 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 �J Payment to in-lieu fee program r Permittee Responsible Mitigation
4. Complete if Making a Payment to In-lieu Fee Program
190 1
(linearfeet) ,
5
2
0
44 3
Qinearfeet) 5
2
64 5
Qinearfeet) 7
2
25 2
(linearfeet) 0
0
40 3
(linearfeet) 2
0

4a. Approval letter from in-lieu fee program is attached.
fJ Yes
4b. Stream mitigation requested:
(linear feet)
64
4c. If using stream mitigation, what is the stream temperature:
cold
4d. Buffer mitigation requested (DWR only):
(square feet)
4e. Riparian wetland mitigation requested:
(acres)
0
4f. Non-riparian wetland mitigation requested:
(acres)
0
4g. Coastal (tidal) wetland mitigation requested:
(acres)
0
4h. Comments
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?
f Yes �' No
For a list of options to meet the diffuse flow requirements, click here.
If no, explain why:
Area is not within NC Riparian Buffer Area.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250? *
G Yes r 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?*
f• 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 C•' No
Comme nts: *
Minimum Criteria Determination Checklist Completed

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 (75A NCAC 2B .0200)?*
f Yes r No
2b. Is this an after-the-fact permit application?*
l' Yes C•' No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project (based on past and reasonablyanticipated future impacts) result in additional development, which could impact
nearby downstream water quality?*
f Yes �' No
3b. If you answered "no," provide a short narrative description.
Project is only to replace ebsting bridge doe to deterioration and does not increase the capacity of roads in the
area.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
f Yes C No C' WA
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 r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
G Yes �' No
5c. If yes, indicate the USFWS Field Office you have contacted.
Asheville
5d. Is another Federal agency involved?*
f Yes f•' No
5e. Is this a DOT project located within Division'S 1-8?*
C' Yes C No
5f. Will you cut any trees 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?
C•' Yes f No
�' Unknown
5g(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://saw-reg.usace.army.mil/NLEB/1-30-17-signed_NLEB-SLOPES&apps.pdf
If you answered "Yes" to 5g(1), did you discover anysigns of bat use?*
C' Yes C No C' Unknown
*** If yes, please show the location of the bridge on the permit drawings/project plans.
5h. Does this project involve the construction/installation of a wind turbine(s)?*
f Yes f• 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.?
f• Yes r No
If yes, 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
B163 - Cherokee County - NUVP 14 Cover Lettter (Final).pdf 38.1 KB
Fle rrust be FDF
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
U.S. Fish & Wildlife - ECOS - Online Mapper
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
C' Yes
F 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)
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)?*
f Yes �' No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources? *
NCDOT Culture Resource Specialist
7c. Historic or Prehistoric Information Upload
aick the upload button or drag and drop files here to attach docurrent
B163 - Cherokee County - Arch. Clearance.pdf
B163- Cherokee County - Historic Architecture Clearance.pdf
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?*
l' Yes
r• No
8c. What source(s) did you use to make the floodplain determination?*
NC Flood Maps - Flood Risk Information System
Miscellaneous
Miscellaneous attachments not previously requested.
C7ick the upload button or drag and drop files here to attach document
B163 - Cherokee County - MCDC (Signed).pdf
B163 - Cherokee County - Natural Hertiage Program.pdf
B163 - Cherokee County - Stormwater Management Plan.pdf
B163 - Cherokee County - GIS Map.pdf
B163 - Cherokee County - Site Photos.pdf
Fle rrust be FDF or fWQ
4.31 MB
3.79MB
282.65KB
1.48MB
530.92KB
138.29KB
685.55KB

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 Act°);
■ 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
��r-tr.'ra� (�f r�?F��i��
Initial Review
Is this project a public transportation project?* (�)
C•' Yes f' No
C�ange only 'rf needed.
Has this project met the requirements for acceptance in to the review process? *
r Yes
C' No
BIMS # Assigned *
20180358
Version#*
Reviewing Office *
Asheville Regional Office - [phone]
Select Project Reviewer*
Kevin Barnett:eads\khbarnett
Is a payment required for this project?*
f No payment required
f• Fee received
f Fee needed - send electronic notification