20190908 Ver 1_PCN Form Submission_20190708

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
20190908
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:
Haywood County Bridge 276
1a. Who is the Primary Contact?*
Patrick J. Breedlove
1b. Primary Contact Email:*
[e-mail]
Date Submitted
7/8/2019
Nearest Body of Water
Burnett Creek
Basin
French Broad
Water Classification
WS III; Tr.
Version# *
1
Reviewing Office*
Asheville Regional Office - [phone]
1c. Primary Contact Phone:*
[phone]
Site Coordinates
Latitude: Longitude:
35.44011-82.83166
FA. Processing Information U
County (or Counties) where the project is located:
Haywood
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
17BP.14.R.176
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: 03 - Maintenance
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 Code
28779
2e. Telephone Number:
[phone]
2g. Email Address:*
State / Frwinre / R�gion
North Carolina
Q�untry
United States
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:
Waynesville
2. Project Identification
2a. Property Identification Number: 2b. Property size:
2c. Project Address
Street Address
Address line 2
City State / rtovince / Fbgion
Fbstal / Zip 03de O�untry
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Burnett Creek
3b. Water Resources Classification of nearest receiving water:*
WS III; 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.
060101060103
4. Project Description and History
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:*
EAsting land use is a 20' W x 25' 6" L timber floor on steel I-beam structure on an existing paved secondary road. Project site is located in a rural residential area with residential lawns
adjacent to project area.
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)
Haywood County - B276 - USGS Topo Map. pdf 1.11 MB
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)
Haywood County - B276 - NRCS Soil Map.pdf 475.19KB
4f. List the total estimated acreage of all existing wetlands on the property:
0.00
4g. List the total estimated linear feet of all existing streams on the property:
200
4h. Explain the purpose of the proposed project:*
Project is to replace an obsolete and deteriorating wood floor on steel I-beam structure with a cored slab 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 structure in Burnett Creek. Traffic will be staged while the new cored slab
bridge structure is constructed. Bank stabilization materials will be installed once final grading allows. The diversion structure will be removed and temporary impacts restored. The
bridge structure will be constructed utiliAng the following equipment: crane, dump trucks, excavator, paving equipment, pumps and hand tools.
4j. Please upload project drawings for the proposed project.
Haywood County - B276 - Permit Plan Set.pdf 2.34MB
Haywood County - B276 - Hydro Report.pdf 3.09MB
5. Jurisdictional Determinations
Sa. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes r No O 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):
Agency/Consultant Company:
Other:
5d1. Jurisdictional determination upload
Haywood County - B276 - PJD (Final).pdf
6. Future Project Plans
233.59KB
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?
LD. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
r Wetlands IW Streams -tributaries r Buffers
F Open Waters 17 Pond Construction
3. Stream Impacts
❑ 3a. Reason for impact (?) 3b.lmpact type * 3c. Type of impact* 3d. S. name * 3e. Stream Type * �[3f. Type of 3gSwidth 3h. Impact
(?) urisdiction* length*
81
Bridge 276
Temporary
Dewatering
Site 1
Perennial
Both
12
Average (feet)
60
(linear feet)
S2
Bridge 276
Permanent
Bank Stabilisation lff2BothAverage
(feet)
(linearfeet)
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts: 3i. Total temporary stream impacts:
40 60
3i. Total stream and ditch impacts:
100
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 existing bridge location. The structure was
designed for the minimum size criteria to ensure safe 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 (Burnett Creek) will be diverted while the new bridge structure is constructed, unclassified excavation occurs and the bank
stabilization materials are installed. 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 c No

2b. If this project DOES NOT require Compensatory Mitigation, explain why:
Proposed impacts do not require mitigation.
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 Wthin a N.C. 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
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:*
NCDOT MCDC 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 (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 epsting subject bridge due to deterioration and does not increase the capacity of roads in the area. The proposed
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
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
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
Sh. 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?
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 v 3.0
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
Haywood County - B276 - Archaeological Screening.pdf
Haywood County - B276 - Architecture Screening.pdf
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?*
N.C. Flood Maps - Flood Risk Information System
Miscellaneous
Comments
Miscellaneous attachments not previously requested.
Haywood County - B276 - MCDC(Signed).pdf
Haywood County - B276 - NC Hertiage Program.pdf
Haywood County - B276 - Site Photos.pdf
Haywood County - B276 - Full Plan Set.pdf
Haywood County - B276 - Bat Habitat Assessment.pdf
Signature
*
W By checking the box and signing below, I certify that:
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11.26MB
426.38KB
3.17MB
1.27MB
10AMB
37.49KB
. 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
,�^Vwo oz— y t e-w,
Date
7/8/2019