20190839 Ver 1_PCN Form Submission_20190623

DWR
MOM— 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?*
G Yes r No
Change mly if needed.
BIMS # Assigned
20190839
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:
Hannah Ford Road culvert
1a. Who is the Primary Contact?*
Dave McHenry
1b. Primary Contact Email:*
[e-mail]
Date Submitted
6/23/2019
Nearest Body of Water
French Broad River
Basin
French Broad
Water Classification
B Tr
Site Coordinates
Version# *
1
Reviewing Office*
Asheville Regional Office - [phone]
1c. Primary Contact Phone:*
[phone]
Latitude: Longitude:
35.174607-82.762597
FA. Processing Information u
County (or Counties) where the project is located:
Transylvania
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
14.208711
1a. Type(s) of approval sought from the Corps:

W Section 404 Permit (wetlands, streams and waters, Clean Water Act)
r 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)
r' Regional General Permit (RGP)
r' Standard (IP)
1c. Has the NWP or GP number been verified by the Corps?
t' Yes r No
Nationwide Permit (NWP) Number:
NWP Numbers (for multiple NWPS):
1d. Type(s) of approval sought from the DWR:
fJ 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:
r 401 Water Quality Certification - Express
r 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
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
F. Applicant Information
1d. Who is applying for the permit?
[J Owner r Applicant (other than owner)
le. Is there an Agent/Consultant for this project?
f 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
Postal / Zip Aide
28779
2e. Telephone Number:
[phone]
2g. Email Address:*
State / Frwinre / R�gion
NC
Q�untry
USA
2f. Fax Number:
*
r Yes r No
r Yes r No

[e-mail]
C. Project Information and Prior Project History U
1. Project Information
1b. Subdivision name:
(i appropriate)
1c. Nearest municipality/ town:
Brevard
2. Project Identification
2a. Property Identification Number:
2c. Project Address
Street Address
Address line 2
Oty
Fbstal / Zip 03de
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
French Broad River
3b. Water Resources Classification of nearest receiving water:*
B Tr
3c. What river basin(s) is your project located in?*
French Broad
3d. Please provide the 12-digit HUC in which the project is located.
060101050100
4. Project Description and History
2b. Property size:
State / Frovince / Fbgion
O�untry
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:*
Failing culvert in UT French Broad River under paved secondary road in agricultural region of Transylvania County.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
C 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)
SR 1109_Maps.pdf
339.32KB
4e. Attach an 81/2 X 11 excerpt from the most recent version of the published County NRCS Soil Survey map depicting the project site. (for DWR)
SR 1109_soils.pdf 191.45KB
4f. List the total estimated acreage of all existing wetlands on the property:
0
4g. List the total estimated linear feet of all existing streams on the property:
100
4h. Explain the purpose of the proposed project:*
To replace a failing drainage culvert.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
A temporary flow diversion will be install and the old road, fill, and culvert removed with a track -hoe then the new culvert will be installed, backfilled, and repaved over.
4j. Please upload project drawings for the proposed project.
SR 1109_Impact Drawing.pdf 248.78KB
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 NIA

Corps AID Number:
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Dave McHenry
Agency/Consultant Company: NCDOT
Other:
5d1. Jurisdictional determination upload
6. Future Project Plans
6a. Is this a phased project?*
(' 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 activity?
D. Proposed Impacts Inventory
1. Impacts Summary
la. Where are the impacts associated with your project? (check all that apply):
r Wetlands W 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* 3f. Type of 3g. S. width * 3h. Impact
(?) Jurisdiction* length*
S1
S1 culvert
Permanent
Culvert
lJT French Broad River
Perennial
Both
1
Average (feet)
50
(linearfeet)
gp
S1Atemporary dewater
Temporary
Dewatering
ffrench Broad River
Perennial
Both
1
Average (feet)
75
(linear feet)
31. Total jurisdictional ditch impact in square feet:
0
31. Total permanent stream impacts:
50
31. Total stream and ditch impacts:
125
3j. Comments:
FE.
Impact Justification and Mitigation
1. Avoidance and Minimization
3i. Total temporary stream impacts:
75
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
Same length culvert will be used - no added channel loss.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Dewatering and erosion controls will be used to minimize downstream siltation.
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?
( Yes 6 No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
minimal impact and no loss of stream channel
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
v
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?
r Yes r No
If no, explain why:
Not in buffer rule 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
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
Comments:*
It does not exceed NCEPA 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)? *
f 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.
This is maintenance of existing work.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
f 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
5d. Is another Federal agency involved?*
r- Yes r No r- Unknown
5e. 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
5h. Does this project involve the construction/installation of a wind turbine(s)?*
r- 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.?
r Yes r No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
NHP data and field surveys by me.

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?*
f Yes r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
NMFS
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?*
NCHPO data and scope falls under PA agreement.
7c. Historic or Prehistoric Information Upload
SR 1109_PA screening Form.pdf 320.68KB
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
r Yes r No
8c. What source(s) did you use to make the floodplain determination?*
NC Floodmaps
Miscellaneous
Comments
Please see attached NWP cover letter and photographs for more information.
Miscellaneous attachments not previously requested.
SR 1109_Maps.pdf 339.32KB
SR 1109_NWP Cover Letter.pdf 390.19KB
Signature
*
W 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 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:
Dave McHenry
Signature
0"& 011421Mt<1
Date
6/23/2019
u