20160380 Ver 2_401 Application_20180430

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 4/30/2018 3:34:30 PM (Start Event)
Accept by Carpenter,Kristi 4/30/2018 4:13:22 PM (DOT Initial Review)
. The task was assigned to Carpenter,Kristi. The due date is: May 3, 2018 5:00 PM 4/30/2018 3:35 PM

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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:*
Haywood
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:
17BP.14.R.128
WBS #
(for �ICDOT use only)
1a. Type(s) of approval sought from the Corps:*
I7 Section 404 Permit (wetlands, streams and waters, Clean Water Act)
I-' 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 docurrem
17BP.14.R.128_Haywood 309 DMS.pdf 598.94KB
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?*
C' 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? *
Dave McHenry
1b. PrimaryContact Email:*
[e-mail]
1c. PrimaryContact Phone:�
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
r Owner rJ 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:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
3a. Applicant is:
f' Agent
f•' Other ;DOT Employee
IF other please spec'rfy.
3b. Name:
Dave McHenry
3c. Business Name:
(if applicable)
3d. Address
Street Address
Address Line 2
aiy
Rzstal / Zip Code
3e. Telephone Number:
(xxx)xxx-xxxx
3f. Fax Number:
(xxx)xxx-xxxx
3g. Email Address:*
[e-mail]
State / Rovince / Region
NC
Country
USA
State / FYovince / F�gion
Country
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Haywood Bridge 309 Replacement - Certification Renewal
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/ town:*
Waynesville
1d. Driving directions*

IF it is a new project and can not easily be found in a GPS rrapping system Rease provide directions.
Take US23/73 west in Haywood, ebt NC 209 , take NC 209 north, left on Access Road, Right on Country Road, and right on Kudzu Loop to
bridge location.
2. Project Identification
2a. Propertyldentification Number:
(tax RN or parcel ID)
2b. Propertysize:
(in acres)
0.1
2c. Project Address
Street Address
Address Line 2
a�y
Rutal / Zip Code
2d. Site coordinates in decimal degrees
State / FYovince / F�gion
Country
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:*
35.533472 -82.970725
ex:34208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:'�
Rogesr Cove Branch
3b. Water Resources Classification of nearest receiving water:*
C
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:*
Rural residential area with timber bridge on small secondary road.
4b. Attach an 8 7/2 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
176P.14.R.128_Haywood 309 Topo.pdf 1.45MB
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
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)
200
4f. Explain the purpose of the proposed project:*
Replace a deteriorating timber bridge with a culvert.
4g. Describe the overall project in detail, including indirect imapacts and the type of equipment to be used:*
Heavy equipment will be used to pull a small timber bridge after setting up an off-site detour and temporary
dewatering to �nrork in the dry. Heavy equipment will then be used to install the culvert and rebuild the roadway
over it.
4h. Please upload project drawings for the proposed project.
aick the upload button or drag and drop files here to attach docurrent
176P.14.R.128_Haywood 309 Plans.pdf 4.91MB
Fle type rrust be pdF
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
f• Yes f" No C' Unknown
Comme nts:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
C•' Preliminary f Approved C' Unknown C' f�UA
Corps AID Number:
Exarrple: S4V�2017-99999
SAW-2016-00984
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:
Dave McHenry
NCDOT
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
June 6, 2016
5d1. Jurisdictional determination upload
Click the upload button or drag and drop files here to attach docurrent
176P.14.R.128_Haywood 309 404.pdf 1.95MB
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 f' No !' Unknown
6b. If yes, please give the DWR Certification number or the Corps Action ID (exp. SAW-0000-00000).
SAW-2016-00984
DWR-2016-0380
Project History Upload

aick the upload button or drag and drop files here to attach docurrent
176P.14.R.128_Haywood 309 401.pdf
17BP.14.R.128_Haywood 309 404.pdf
17BP.14.R.128_Haywood 309 WRC.pdf
Fle type rrust be FDF
7. Future Project Plans
7a. Is this a phased project?*
f Yes l•' No
2.7MB
1.95MB
1.75MB
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
ff 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 *
type *
S7 1 P Culvert Rogers Cove
N�p label (e.g. Finad C7ossing F�rrranent (� or BranCh
1) Terrporary (lj
g2 1A T Dewatering Rogers Cove
Nbp label (e.g. 13�ad Qossing F�rrrenent (Fj or B�anch
1) Terrporary (�
S3 1B P Stabilization Rogers Cove
fv�p label (e.g. Fd�ad Qossing F2rrranent (Fj or Branch
1) Terrporary (�
3e. Stream 3f. Type of
Type* Jurisdiction*
Perennial Both
F�rennial (� or
interrri[tent (IMj
Perennial Both
F2rennial (Fff2) or
interrrdtent (IfVn
Perennial Both
F�rennial (FH� or
interrrittent (IfVn
S4 1C P Stabilization Rogers Cove Perennial Both
fv�p label (e.g. F�ad C7ossing F�rrranent (� or BranCh F�rennial (� or
1) Terrporary (lj intermi[tent (IMj
�" 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:
111
3i. Total temporary stream impacts:
115
3i. Total stream and tributary impacts:
226
3j. Comments:
3g. Stream 3h. Impact sqfe�
width * length *
5 38 1
Average (linearfeet) 9
(feet) 0
5 115 5
Average Qinearfeet) 7
(feet) 5
5 38 7
Average (linearfeet) 9
(feet) 0
5 35 1
Average (linearfeet) 7
(feet) 5

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 will be replaced on epsting alignment, wtiich will reduce stream impacts, and sills/baffles will be
installed in the culvert to facilitate bedload retention and aquatic life passage.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
The area will be dewatered and erosion controls placed and maintained to reduce downstream impacts.
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):
rJ DWR r% Corps
2d. If yes, which mitigation option(s) will be used for this project?
r Mitigation bank r% Payment to in-lieu fee program r Permittee Responsible Mitigation
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached.
fJ Yes
4b. Stream mitigation requested:
Qinear feet)
38
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)
4f. Non-riparian wetland mitigation requested:
(acres)
4g. Coastal (tidal) wetland mitigation requested:
(acres)
4h. Comments
6. Buffer mitigation (State Regulated Riparian Buffer Rules) - required by DWR
6a. Will the project result in an impact within a protected riparian buffer that requires buffer mitigation? If yes, you must fill out this entire
form - please contact DWR for more information.
f Yes r No
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 r No
For a list of options to meet the diffuse flow requirements, click here.
If no, explain why:
Not in a buffer area.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250? �
C•' Yes f' 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 (NEPAISEPA)?*
f Yes �' No
Comme nts:
*
This 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 C•' No
2b. Is this an after-the-fact permit application?*
f Yes f•' 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 C•' No
3b. If you answered "no," provide a short narrative description.
This is a replacement of exsting infrastructure with no capacity increase.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
f Yes r No C' f�/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? *
f Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*

r Yes r No
5d. Is another Federal agency involved?*
C' Yes C•' No
5e. Is this a DOT project located within Division's 1-8?*
l' Yes C No
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?
f Yes C No
5g. Does this project involve bridge maintenance or removal?
f' Yes f' No
C' 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.
f• Yes r 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?*
f Yes C No f" 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 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 r No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
USFWS data, NHP data, and field inspections by qualified biologists.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
f Yes �' No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat? *
NMFS website
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)?*
C' Yes C•' No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources? *
NCDOT cultural resources unit review
7c. Historic or Prehistoric Information Upload
C7ick the upload button or drag and drop files here to attach docurrent
17BP.14.R.128_Haywnod 309 Cultural Resources.pdf 10.67MB
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?*
f Yes C•' No
8c. What source(s) did you use to make the floodplain determination?*
NC Floodmaps
Miscellaneous
Miscellaneous attachments not previously requested.
C7ick the upload button or drag and drop files here to attach docurr�nt
176P.14.R.128_Haywood 309 Cover.pdf 3.18MB
17BP.14.R.128_Haywood 309 Pictures.pdf 1.54MB
Fle rrust be FDF or VWQ
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
i �
� � ���
Initial Review
Is this project a public transportation project?* (?)
f• Yes f' No
Change only rf needed.
Has this project met the requirements for acceptance in to the review process? *
f• Yes
f No
BIMS # Assigned *
20160380
Version#*
2
Reviewing Office *
Asheville Regional Office - [phone]
Select Project Reviewer*
Kevin Barnett:eads\khbarnett
Is a payment required for this project?*
f No payment required
C•' Fee received
C' Fee needed - send electronic notification