20190668 Ver 1_PCN Form Submission_20190522

DWR
IDIOM n of Water Resources
Pre -Construction Notification (PCN) Form
September 29, 2018 Ver 3
21nitial Review
Has this project met the requirements for acceptance in to the review process?*
r Yes
r No
Is this project a public transportation project?*
C Yes r No
Change only if needed.
BIMS # Assigned
20190668
Is a payment required for this project?*
r No payment required
r Fee received
r Fee needed - send electronic notification
Select Project Reviewer*
Kevin Barnett:eads\khbarnett
Information for Initial Review
1a. Name of project:
Polk County - Bridge 29
1a. Who is the Primary Contact?*
Patrick J. Breedlove
1b. Primary Contact Email:*
[e-mail]
Date Submitted
5/22/2019
Nearest Body of Water
South Branch Little White Oak Creek
Basin
Broad
Water Classification
Class C
Version# *
1
Reviewing Office*
Asheville Regional Office - [phone]
1c. Primary Contact Phone:*
[phone]
Site Coordinates
Latitude: Longitude:
35.285886-82.121607
AProcessing Information U
County (or Counties) where the project is located:
Polk
Is this project a public transportation project?*
r Yes r' No
Is this a NCDOT Project?*
r Yes r No
(NCDOT only) T.I.P. or state project number:
WBS#M
41665.3D
1a. Type(s) of approval sought from the Corps:

W Section 404 Permit (wetlands, streams and waters, Clean Water Act)
F Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What types) of permit(s) do you wish to seek authorization?
W Nationwide Permit (NWP)
F' Regional General Permit (RGP)
F' Standard (IP)
1c. Has the NWP or GP number been verified by the Corps?
f Yes r No
Nationwide Permit (NWP) Number: 03 - Maintenance
NWP Numbers (for multiple NWPS):
1d. Type(s) of approval sought from the DWR:
rJ 401 Water Quality Certification - Regular
F Non-404 Jurisdictional General Permit
F Individual Permit
le. 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:
F 401 Water Quality Certification - Express
F Riparian Buffer Authorization
1f. Is this an after -the -fact permit application?*
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
Acceptance Letter Attachment
Polk County - B 29 - Mitigation Acceptance Letter.pdf
1h. Is the project located in any of NC's twenty coastal counties?
r Yes r No
1j. Is the project located in a designated trout watershed?
r^ Yes r No
B. Applicant Information
1d. Who is applying for the permit?
W Owner F Applicant (other than owner)
le. Is there an Agent/Consultant for this project?
r Yes r- No
2. Owner Information
2a. Name(s) on recorded deed:
NCDOT Division 14
2b. Deed book and page no.:
2c. Responsible party:
2d.Address
Street Address
253 Webster Road
Address Line 2
city
Sylva
Bbstal / Zip Code
28779
2e. Telephone Number:
[phone]
Sate / Province / Region
North Carolina
(buntry
United States
2f. Fax Number:
[phone]
66.17KB
*
r Yes r No
r Yes r No

2g. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(d appropriate)
1c. Nearest municipality/town:
Mill Spring
2. Project Identification
2a. Property Identification Number:
2c. Project Address
Street Address
Address Line 2
oty
Fbstal / Zip CDde
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
South Branch Little White Oak Creek
3b. Water Resources Classification of nearest receiving water:*
Class C
3c. What river basin(s) is your project located in?*
Broad
3d. Please provide the 12-digit HUC in which the project is located.
030501050202
4. Project Description and History
2b. Property size:
State / ftovince / Pagion
0xuntry
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 three span pre -stressed concrete channel bridge on a two lane secondary road. Project site is located in a rural residential area with large agriculture
field near Polk County School facility.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
r Yes r' No r Unknown
4d. 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)
Polk County - B 29 - USGS Topo Map.pdf 399.43KB
4e. 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)
Polk County - B 29 - NRCS Soil Survey.pdf 350.96KB
4f. List the total estimated acreage of all existing wetlands on the property:
0.0
4g. List the total estimated linear feet of all existing streams on the property:
150
4h. Explain the purpose of the proposed project:*
Project is to replace an obsolete and deteriorating three span pre -stressed concrete channel bridge with a two span pre -stressed girder bridge.
41. 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. NCDOT contractor Will install diversion and by-pass pipe. An on -site detour Will be constructed utilizing a double
84" pipe structure with sand bag headwalls. Contractor will remove existing bridge structure, drill interior bent piles and install new two span concrete girder bridge. Traffic will be placed
onto new bridge and detour pipe structure will be removed. Rip -rap will be placed for bank stabilization above the normal high water mark. Rip -rap materials will be permanently installed
once final grading allows. By-pass pipe structure will be removed and temporary impact areas will be restored, including Little White Oak Creek mitigation area. Bridge structure will be
constructed utilizing the follow equipment: crane, excavator, dump truck, paving equipment, pump and hand tools.
4j. Please upload project drawings for the proposed project.
Polk County - B 29 - Final Permit Plans.pdf 5.11 MB
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*

r Yes r No r Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
r Preliminary r Approved r Not Verified r Unknown r N/A
Corps AID Number:
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
5d1. Jurisdictional determination upload
Polk County - B 29 - JD (Final).pdf
6. Future Project Plans
243.51 KB
6a. Is this a phased project?*
r Yes r 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?
F. Proposed Impacts Inventory
1. Impacts Summary
la. Where are the impacts associated with your project? (check all that apply):
r Wetlands 9 Streams -tributaries
r Open Waters r Pond Construction
3. Stream Impacts
r Buffers
3a. Reason for impact (?)
3b.lmpact type *
3c. Type of impact*
3d. S. name*
3e. Stream Type*
Type of
3gSwidth *
3h. Impact(�)
F
�[3f.
urisdiction*
length*
S1
Site 1 - Bridge 29
9
Permanent
Other
South Branch Little White
Perennial
Both
15
4
Oak Creek
Average (feet)
(linear feet)
S2
Site 2 -Bridg a 29
Tem ora
p rY
Culvert
South Branch Little White
Perennial
Both
15
48
Oak Creek
Average (feet)
(linear feet)
S3
Site 3 - Bridge 29
Temporary
Dewatering
]
South Branch Little White
Perennial
Both
1Aver�e(feet)
14near
Oak Creek
fed)
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
4
3i. Total stream and ditch impacts:
192
3j. Comments:
E. Impact Justification and Mitigation
1. Avoidance and Minimization
3i. Total temporary stream impacts:
188
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
The eAsting bridge is being replaced with a structure that is adequate for traffic needs in the same disturbed location. The pre -stressed girder bridge
was designed for the minimum size to ensure conveyance of traffic on the secondary road.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
The on -site stream (South Branch Little White Oak Creek) will be diverted while the on -site detour is constructed and while the eAsting bridge is
removed and replaced. 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?
r Yes r No
2c. If yes, mitigation is required by (check all that apply):
rJ DWR W Corps
2d. If yes, which mitigation option(s) will be used for this project?
r Mitigation bank W Payment to in -lieu fee r- Permittee Responsible
program Mitigation
4. Complete if Making a Payment to In -lieu Fee Program
4a. Approval letter from in -lieu fee program is attached.
f- Yes r No
4b. Stream mitigation requested:
(linear feet)
23
4d. Buffer mitigation requested (DWR only):
(square feet)
4f. Non -riparian wetland mitigation requested:
(acres)
4h. Comments
4c. If using stream mitigation, what is the stream temperature:
cool
4e. Riparian wetland mitigation requested:
(acres)
4g. Coastal (tidal) wetland mitigation requested:
(acres)
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.
r Yes r No
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
la. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
r Yes r No
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?*
r Yes r No
Comments:
G. Supplementary Information
1. Environmental Documentation
la. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
r Yes r No
v
U
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 Policy Act (NEPA/SEPA)? *
r Yes r No
1c. If you answered "yes" to the above, has the document review been finalized by the State Clearing House?*
r Yes r No
Comments:
CE 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 (15ANCAC 2B .0200)?*
r Yes r No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality?*
r Yes r No
3b. If you answered "no," provide a short narrative description.
The project is only to replace the existing subject 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?*
r Yes r Nor N/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?
r Yes r' No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
r Yes r No
5c. If yes, indicate the USFWS Field Office you have contacted.
Asheville
5d. Is another Federal agency involved?*
r- Yes r No
Se. Is this a DOT project located within Division's 1-8?
r^ Yes r No
5f. Will you cut anytrees in order to conduct the work in waters of the U.S.?
r Yes r No
5g. Does this project involve bridge maintenance or removal?
r Yes r No
5g(1). If yes, have you inspected the bridge for signs of bat use such as staining, guano, bats, etc.?
r Yes r No
If you answered "Yes" to 5g(1), did you discover any signs of bat use?
r^ Yes r No r^ Unknown
5h. Does this project involve the construction/installation of a wind turbine(s)?*
r- Yes r No
r- Unknown
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.?
r 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.
Polk County - B 29 - MVP 3 Cover Letter (Final).pdf 511.59KB
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
Consultation Documentation Upload
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
r- Yes r 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)
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?*
r 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
Polk County - B 29 - Archaeological Screening.pdf
Polk County - B 29 - Archictecture Screening.pdf
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
F Yes r No
8b. If yes, explain how project meets FEMA requirements:
NCDOT Programmatic Agreement
8c. What source(s) did you use to make the floodplain determination?*
NC Flood Maps - Flood Risk Information System.
Miscellaneous
Comments
Miscellaneous attachments not previously requested.
Polk County - B 29 - Bat Assessment Form.pdf
Polk County - B 29 - Detour Hydro Report.pdf
Polk County - B 29 - GIS Floodplain Map.pdf
Polk County - B 29 - Hydro Report.pdf
Polk County - B 29 - Impact -Restoration Proposal Plan.pdf
Polk County - B 29 - NC Hertiage Program.pdf
Polk County - B 29 - Site Photos.pdf
Polk County - B 29 - Vicinity Map.pdf
Signature
*
W By checking the box and signing below, I certify that:
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• 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 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
Date
5/22/2019