20181268 Ver 1_PCN Form Submission_20180914

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 9/14/2018 9:42:12 AM (Start Event)
Accept by Carpenter,Kristi 9/17/2018 4:06:48 PM (DOT Initial Review)
. The task was assigned to Carpenter,Kristi. The due date is: September 19, 2018 5:00 PM
9/14/2018 9:43 AM

i i �� �
�����
�ivislan af Water Resour�es
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:*
Macon
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:
B-6029
WBS #
48224.1.1
(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: 03 - Maintenance
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: f Yes C' No
For the record onlyfor Corps Permit: 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
l" Yes f' No
1f. Is the project located in anyof NC's twentycoastal counties?*
f Yes C•' No
1h. Is the project located in a designated trout watershed?*
C•' Yes f' No
Link to trout information: http://�wvw.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
(Checkall that apply)
2. Owner Information
2a. Name(s) on recorded deed:
NCDOT Division 14
2b. Deed book and page no.:
2c. Responsible party:
(for Corporations)
2d. Address
Street Address
256 Webster Road
Address Line 2
aty
Sylva
Fbstal / Zip Code
28779
2e. Telephone Number:
(xxx)xxx-xxxx
[phone]
State / Rovince / F�gion
North Carolina
Cauntry
United States

2f. Fax Number:
[phone]
(xxx)xxx-xxxx
2g. Email Address:*
pjbreed [e-mail]
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Macon County B9
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Franklin
1d. Driving directions*
IF it is a new project and can not easily be found in a GPS rrapping system Rease provide directions.
From Franklin take US 441 f�llUS 64 E for appro�mately 1.9 miles. Take right onto NC 28 S/US 64 E. Go approwmately 3.1 miles, take left
onto Ellijay Road. Go approximately 5.2 miles project is in roadway.
2. Project Identification
2a. Propertyldentification Number:
(tax RN or parcel ID)
2b. Propertysize:
(in acres)
2c. Project Address
Street Address
Address Line 2
a�y
Wstal / Zip Code
State / FYovince / F�gion
Country
2d. Site coordinates in decimal degrees
Please collect site coordinates in decimal degrees. Use bet�en 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.)
Latitude:* Longitude:*
35.204923 -83.267978
ex:34.208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
North Prong Ellijay Creek
3b. Water Resources Classification of nearest receiving water:*
Class C; 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:*
Existing land use is an existing 41' L x 20' W timber floor on steel I-Beam bridge on a tvv�o lane secondary road. Site
is located in a rural residential housing area with agriculture fields and forested areas.
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
Macon County - B9 - USGS Topo Map.pdf
Fle type rrust be pdF
1.21 MB
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 docurrem
Macon County - B9 - 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)
300
444.68KB
4f. Explain the purpose of the proposed project:*
Project is to replace an obsolete and deteriorating wood floor, steel I-Beam bridge structure.
4g. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
NCDOT contractor will install erosion and sediment control measures. NCODT contractor will install diversion and
by-pass pipe. An on-site detour will be utilized by staged construction of the bridge structure. Contractor will
remove one lane of the e�asting bridge, construct half of the new bridge structure. Traffic will be placed on the
newly construed bridge structure and the remainder of the bridge structure will be constructed. Backfill material will
placed on slopes and rip-rap for bank stabilization. Bank stabilization materials will be permanently installed once
final grading allows. By-pass pipe will be removed. The proposed bridge structure will be constructed utilizing the
follow equipment: crane, excavator, dump trucks and hand tools.
4h. Please upload project drawings for the proposed project.
Qick the upload button or drag and drop files here to attach docurrent
Macon County - B9 - Permit Plans (Final).pdf
Macon County - B9 - Hydro Report.pdf
Fle type rrust be pdF
5. Jurisdictional Determinations
16.79MB
3.87MB
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
f Yes f' No �' Unknown
Comme nts:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
l' Preliminary f" Approved �' Unknown C' f�llA
Corps AID Number:
Exarrple: SAVw2017-99999

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.
5d7. Jurisdictional determination upload
aick the upload button or drag and drop files here to attach docurrent
Macon County - B9 - JD (Final).pdf
Fle type rrust be F�F
6. Project History
164.15KB
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 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 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 Impacts Inventory
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
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 *
type *
S1 Site 7 T Dewatering North Prong Ellijay
N�p label (e.g. Finad CYossing F2rrranem (Fj or Cre e k
1) Terrporary (�
g2 Site 2 P Bank North Prong Ellijay
nh�p �abe� (e.g. FUad O-ossing r�rrranent (Fj or Stabilization Creek
1) Terrporary (�
3e. Stream 3f. Type of
Type* Jurisdiction*
Perennial Both
F�rennial (Fff2) or
imerrrittent (IfVn
Perennial Both
F2rennial (Fff2) or
interrrittent (IfV�
�" All Perennial or Intermittent streams must be verified by DWR or delegated local government.
3i. Total jurisdictional ditch impact in square feet:
0
3g. Stream 3h. Impact sqfe�
width * length *
20 200 4
Average Qinearfeet)
(feet) 0
0
0
20 140 2
Average (linearfeet) ,
(feet) $
0
0

3i. Total permanent stream impacts:
140
3i. Total temporary stream impacts:
200
3i. Total stream and tributary impacts:
340
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 existing bridge is being replaced with a structure that is adequate for traffic needs in the same disturbed
location. The cored slab bridge 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 (North Prong Ellijay Creek) will be diverted while the staged detour is constructed and while the
existing bridge is removed and replaced with a cored slab bridge unit. Erosion and sedimentation control
measures will be installed prior to ground disturbance. Both of these measures will aid in the prevention of
sediment into 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?
C' Yes f• No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
Project impacts (rip-rap for bank stabilization) do not require mitigation.
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 r No
For a list of options to meet the diffuse flow requirements, click here.
If no, explain why:
Project is not located within a NC Riparian Buffer Protection Area.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250? *
C' 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?*

r Yes r 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
1c. If you answered "yes" to the above, has the document review been finalized by the State Clearing House? (If so, attach a copy of the
NEPAor SEPAfinal approval letter.)*
f Yes l•' No
Comme nts: *
FHWA CE 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 (75A NCAC 2B .0200)?*
f Yes C 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 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.
The project is only to replace e�asting bridge due to deterioration and does not increase the capacity of roads in
the area. Project is not a road widening or improvement project.
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? *
f• Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
r Yes C' No
5c. If yes, indicate the USFWS Field Office you have contacted.
Asheville
5d. Is another Federal agency involved?*
C•' Yes f' No
What Federal Agency is involved?
FHWA
5e. Is this a DOT project located within Division's 1-8?*
C' Yes r No
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?
G Yes r No
5g. Does this project involve bridge maintenance or removal?
G' Yes r 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.
G Yes r No
Link to the NLEB SLOPES document: http://saw-reg.usace.arrny.mil/NLEB/1-30-17-signed_NLEB-SLOPES&apps.pdf
If you answered "Yes" to 5g(7), did you discover anysigns of bat use?*
f 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 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.?
G' Yes f No
If yes, please provide details to include type of percussive activity, purpose, duration, and specific location of this activity on the
property.
Qick the upload button or drag and drop files here to attach docurrem
Macon County - B9 - NWP 3 Cover Letter.pdf 37.58KB
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?*
l" Yes l•' No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat? *
NOAA- Essential Fish Habitat 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
reservation status e. National Historic Trust desi nation or ro erties si nificant in North Carolina histor and archaeolo *
p � 5•, 9 p p 5 Y 9Y)�
C' Yes r 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
C7ick the upload button or drag and drop files here to attach document
Macon County - B9 - Historic Archaeological.pdf 3.55MB
Macon County - B9 - Historic Architecture.pdf 7.53MB
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 �' No
8b. If yes, explain how project meets FEMArequirements:

NCDOT agreement with NC Floodplain Mapping.
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 docurrent
Macon County - B9 - FHWA CE Form (Signed).pdf 401.66KB
Macon County - B9 - NC Hertiage Program.pdf 3.09MB
Macon County - B9 - SMP.pdf 579.82KB
Macon County - B9 - GIS Map.pdf 739.89KB
Macon County - B9 - Site Photos.pdf 757.69KB
Fle rrust be FDF or IWQ
Signature
rJ 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 Act°);
■ 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
F%�ut�� �,�t���.�5't,�r'��
Date Submitted:
9/14/2018
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? *
C•' Yes
C' No
BIMS # Assigned *
20181268
Version#*
1
Reviewing Office *
Asheville Regional Office - [phone]
Select Project Reviewer*
Kevin Barnett:eads\khbarnett
Is a payment required for this project?*

l' No payment required
G' Fee received
C' Fee needed - send electronic notification