20100145 Ver 1_Application_20100224

STATE OF NORTH CAROLINA
R
DEPARTMENT OF TRANSPORTATION
BEVERLY EAVES PERDUE EUGENE A. C t7R?L IR.
GOVERNOR SECRETARY "'"'+++YYY
February 22, 2010
Ms. Amy Euliss
NC DENR Division of Water Quality
585 Waughtown Street
Winston-Salem, NC 27107
Mr. Andrew Williams
US Army Corps of Engineers
6508 Falls of the Neuse Suite 120
Raleigh, NC 27615-6814
(Two Copies)
Subject: Guilford County, Rambling Road (SR 2295)
Project Number # 7B.204111
To Whom It May Concern:
1®0145
The North Carolina Department of Transportation (NCDOT) proposes to remove sediment at the inlet and
outlet end of a pipe on Rambling Road (SR 2295) in Guilford County. The sediment will be removed in
order to restore stream flow to conditions prior to the sediment build up. This activity will result in
permanent impacts to Moores Creek. The NCDOT anticipates that the activity will be authorized under
Nationwide Permit (NWP) 3 and 33. This application is intended as a request for written authorization from
the US Army Corps of Engineers for the Nationwide 3 and 33. This package is also being forwarded to the
NC Division of Water Quality for written authorization as prescribed under General Water Quality
Certification #3687 (NW 3) and #3688 (NW 33). The following information is being provided to satisfy
conditions of the Nationwide Permit and General Water Quality Certification.
i,
P.O. Box 14996 Greensboro, NC 27415-4996 Telephone No. [phone] Fax No. [phone]
PROJECT INFORMATION
Road Name SR Number Project Length
miles Classification
Rambling Road SR 2295 N/A Subdivision
River Basin: DWQ
ID Water Quality
Designation % Impervious Surface
Cape Fear 16-11-3 WS-Ill; NSW N/A
Buffer Rules'* Buffer Rule Conditions (where applicable)
Yes Jordan Lake Buffer
n
Protected Species Present Mapped Historic

Pro ertiesc CAMA

AEC Essential Fishery Habitat
No No No No
'Separate documentation attached as needed: See the attached Endangered Species.Review Sheet for further information: 'When
Applicable - See the attached Historic Review Letter for further information
SEDIMENT REMOVAL
Site Station N/A Stream Type Perennial
Existing Stream 5 to 10 feet Proposed 5 to 10 feet
Width Stream Width
Construction Dewater stream to allow removal of Dewatering Pump around utilizing sandbags
Method sediment in the dry by using a trackhoe or Device' with filter fabric
backhoe and transporting sediment offsite
Burial Depth N/A E/C Plan NIA
Date
Construction As soon as practicable Duration one week
Date
Impacts ft. Approximately 20 total linear feet of permanent stream impacts.
Special
Conditions
Restoration Plan Within 15 working days of the project completion any disturbed area adjacent to the stream will be
restored and seeded.
RCP = reinforced concrete pipe; CMP = Corrugated metal pipe; CMPA = Corrugated metal pipe arch; E/C = Erosion control. 'A less intrusive
dewatering device may be used in lieu of the one proposed.
MINIMIZATION INFORMATION
Impacts will be minimized by strict enforcement of Best Management Practices for the protection of
surface waters and wetlands, restrictions against the staging of equipment in or adjacent to waters of
the US, and coordination (including a pre-construction meeting) with the Division Environmental
Officer.
MITIGATION INFORMATION
Stream mitigation is not anticipated, as the impacts to any individual stream do not exceed 150 feet
Wetland mitigation is not anticipated, as wetland impacts do not exceed 0.10 acres and do not occur
in a unique natural wetland.
APPLICATION INFORMATION
Enclosed please find the Pre-construction Notification Form and supporting documentation for the
above referenced project. If you have any questions or need any additional information, please
contact Jeremy DeLapp [phone] or Jerry Parker at [phone]. Your time and effort are
appreciated.
Sincerely,
(:;visi .on Engineer, Division 7
Enclosures
CC: Tim Powers, Bridge Maintenance NCDOT
Barry Harrington, NCDOT
S. Lane Hall, NCDOT
020 WA7F9
y
I 1 >
Ir®?I o <
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification (PCN Form
A. Applicant Information
1. Processing
la. Type(s) of approval sought from the
Corps: ? Section 404 Permit ? Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: 3 and 33 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps? ? Yes ® No
1d. Type(s) of approval sought from the DWQ (check all that apply):
® 401 Water Quality Certification - Regular ? Non-404 Jurisdictional General Permit
? 401 Water Quality Certification - Express ? Riparian Buffer Authorization
le. Is this notification solely for the record
because written approval is not required? For the record only for DWQ 401
Certification:
El Yes ® No For the record only for Corps Permit:

? Yes ®No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program. ? Yes ®No
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below. ? Yes ® No
1h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ? Yes ® No
2. Project Information
2a. Name of project: Rambling Road
2b. County: Guilford
2c. Nearest municipality / town: Summerfield
2d . Subdivision name: N/A
2e . NCDOT only, T.I.P. or state
project no: 76.204111
3. Owner Information
3a . Name(s) on Recorded Deed:
3b . Deed Book and Page No.
3c . Responsible Party (for LLC if
applicable):
3d . Street address:
3e . City, state, zip:
3f. Telephone no.:
3g . Fax no..
3h . Email address:
Page 1 of 10
PCN Form - Version 1.3 December 10, 2008 Version
4. Applicant Information (if different from owner)
4a. Applicant is: ® Agent ? Other, specify:
4b. Name: J. M. Mills
4c. Business name
(if applicable): Division Engineer NCDOT Division Seven
4d. Street address: P.O. Box 14996
4e. City, state, zip: Greensboro, NC 27415
4f. Telephone no.: 336 334-3297
4g. Fax no.:
4h. Email address:
5. Agent/Consultant Information (if applicable)
5a. Name: Jerry Parker
5b. Business name
(if applicable): Division Environmental Supervisor
5c. Street address: P.O. Box 14996
5d. City, state, zip: Greensboro, NC 27415
5e. Telephone no.: 336 256-2063
5f. Fax no.:
5g. Email address:
Page 2 of 10
PCN Form - Version 1.3 December 10, 2008 Version
B. Project Information and Prior Project History
1. Property Identification
I a. Property identification no. (tax PIN or parcel ID): N/A

1 b. Site coordinates (in decimal degrees): Latitude: See attached USGS map
Longitude: -
(DD.DDDDDD) (-DD.DDDDDD)
1c. Property size: acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
proposed project: Moores Creek
2b. Water Quality Classification of nearest receiving water: WS-III ; NSW
2c. River basin: Cape Fear
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
Residential Subdivision
3b. List the total estimated acreage of all existing wetlands on the property:
0
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
60
3d. Explain the purpose of the proposed project:
Removal of accumulated sediment at the outlet and inlet end of one of the culverts to allow for increased stream flow
3e.. Describe the overall project in detail, including the type of equipment to be used:
The site will be de-watered and then by use of a backhoe and/or trackhoe, sediment will be removed and transported
offsite.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (including all prior phases) in the past?
Comments:

? Yes ®No ? Unknown
4b. If the Corps made the jurisdictional determination, what type
of determination was made?
El Preliminary ? Final
4c. If yes, who delineated the jurisdictional areas?
Name (if known): Agency/Consultant Company:
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5. Project History
5a. Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past? ? Yes ® No ? Unknown
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project? ? Yes ® No
6b. If yes, explain.
Page 3 of 10
PCN Form - Version 1.3 December 10, 2008 Version
C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
? Wetlands ® Streams - tributaries ? Buffers
? Open Waters ? Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. 21b. 2c. 2d. 2e. 2f.
Wetland impact Type of jurisdiction
number- Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWQ - non-404, other) (acres)
Temporary T
W1 ? P ? T ? Yes ? Corps
? No ? DWQ
W2 ? P ? T ? Yes ? Corps
? No ? DWQ
W3 ? P ? T ? Yes ? Corps
? No ? DWQ
W4 ? P ? T ? Yes ? Corps
? No ? DWQ
W5 ? P ? T ? Yes ? Corps
? No ? DWQ
W6 ? P ? T ? Yes ? Corps
? No ? DWQ
2g. Total wetland impacts
2h. Comments:
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. 3b. 3c. 3d. 3e. 3f. 3g.
Stream impact Type of impact Stream name Perennial Type of jurisdiction Average Impact
number- (PER) or (Corps-404,10 stream length
Permanent (P) or intermittent DWQ - non-404, width (linear
Temporary (T) (INT)? other) (feet) feet)
Sediment ® PER ® Corps
S1 ® P ? T Removal at inlet Moores Creek INT ®DWQ 5 to 10 ft 10
end
S2 El P El T Sediment removal
at outlet end Moores Creek E] PER
? INT E] Corps
El DWQ 5 to 10 ft 10
S3 ? P ? T ? PER ? Corps
? INT ? DWQ
S4 ? P ? T El PER ? Corps
? INT ? DWQ
? PER ? Corps
S5 ? P ? T ? INT ? DWQ
S6 ? P ? T ? PER ? Corps
? INT ? DWQ
3h. Total stream and tributary impacts 20 linear
ft
3i. Comments:
Page 4 of 10
PCN Form -Version 1.3 December 10, 2008 Version
4. Open Water Impacts
If there are proposed. impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list all open water impacts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number - (if applicable) Type of impact Waterbody type Area of impact (acres)
Permanent (P) or
Temporary T
01 ?P?T
02 ?P?T
03 ?P?T
04 ?P?T
41. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If and or lake construction proposed, then complete the chart below.
5a. 5b. 5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or purpose (acres)
number of pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
5f. Total
5g. Comments:
5h. Is a dam high hazard permit required?
? Yes ? No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWC)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If an impacts require mitigation, then you MUST fill out Section D of this form.
6a.
? Neuse ?Tar-Pamlico ? Other: Jordan
Project is in which protected basin? ? Catawba ? Randleman
6b. 6c. 6d. Be. 6f. 6g.
Buffer impact
number- Reason Buffer Zone 1 impact Zone2 impact
Permanent (P) or for Stream name mitigation (square feet) (square feet)
Temporary (T) impact required?
?Yes
B1 ?P?T ? No
?Yes
B2 ?P?T ? No
?Yes
B3 ?P?T El No
6h. Total buffer impacts
6i. Comments:
Page 5 of 10
PCN Form - Version 1.3 December 10, 2008 Version
D. Impact Justification and Mitigation
1. Avoidance and Minimization
Ia. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Impacts will be minimized by utilization of Best Management Practices and by performing work in the dry.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Best Management Practices will be utilized during construction. Pre-construction meeting with Environmental Superevisor will
take place prior to commencing construction
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 ® No
2b. If yes, mitigation is required by (check all that apply): ? DWQ ? Corps

2c. If yes, which mitigation option will be used for this
project? ? Mitigation bank
? Payment to in-lieu fee program

? Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter) Type Quantity
3c. Comments:
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached. ? Yes
4b. Stream mitigation requested: linear feet
4c. If using stream mitigation, stream temperature: ? warm ? cool ?cold
4d. Buffer mitigation requested (DWQ 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:
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 6 of 10
PCN Form - Version 1.3 December 10, 2008 Version
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) - required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation? ? Yes ®No
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.

Zone 6c.
Reason for impact 6d.
Total impact
(square feet)
Multiplier 6e.
Required mitigation
(square feet)
Zone 1 3 (2 for Catawba)
Zone 2 1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
pennittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund).
6h. Comments:
Page 7 of 10
PCN Form - Version 1.3 December 10, 2008 Version
E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers identified ® Yes ? No
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
Comments: All work will be performed in the streambed and will result in no increase ? Yes ® No
in stormwater flow within the buffer area.
2. Stor mwater Management Plan
2a. What is the overall percent imperviousness of this project? N/A %
2b. Does this project require a Stormwater Management Plan? ? Yes N No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: Proposed work will be in the stream to
restore to flow capacities prior to sediment build up. Stormwater flow should not increase more than the original flow prior
to the build up.
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
? Certified Local Government
2e. Who will be responsible for the review of the Stormwater Management Plan? N DWQ Stormwater Program
? DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project? N/A
? Phase II
? NSW
3b . Which of the following locally-implemented stonmwater management programs El USMP
apply (check all that apply): ? Water Supply Watershed
? Other:
3c. Has the approved Stormwater Management Plan with proof of approval been ? Yes H No
attached?
4. DWQ Stormwater Program Review
? Coastal counties
? HOW
4a . Which of the following state-implemented stormwater management programs apply ? ORW
(check all that apply): ? Session Law 2006-246
? Other:
4b . Has the approved Stormwater Management Plan with proof of approval been
? Yes N No
attached?
5. DWQ 401 Unit Stormwater Review
5a . Does the Stormwater Management Plan meet the appropriate requirements? ? Yes ? No
5b . Have all of the 401 Unit submittal requirements been met? ? Yes ? No
Page 8 of 10
PCN Form -Version 1.3 December 10, 2008 Version
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
la. Does the project involve an expenditure of public (federal/state/local) funds or the ® Yes ? No
use of public (federaUstate) land?
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 ? Yes ® No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
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 NEPA or SEPA final approval
? Yes
? No
letter.)
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards, ? Yes ®No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after-the-fact permit application? ? Yes ® No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in ? Yes ® No
additional development, which could impact nearby downstream water quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
NA
Page 9 of 10
PCN Form - Version 1.3 December 10, 2008 Version
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or ? Yes ® No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act ? Yes ®No
impacts?
? Raleigh
5c. If yes, indicate the USFWS Field Office you have contacted.
? Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
US Fish and Wildlife Web Site
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habit ? Yes ®No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
N/A
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 ? Yes ® No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
National Historic Register Web Site
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? ? Yes ® No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination? NC Floodplain Mapping Information System
C5 J.M. Mills
Applicant/Agent's Printed Name Applicant/Agent's Signature Date
(Agent's signature is valid only a an authorization letter from the applicant
is provided.)
Page 10 of 10
PCN Form -Version 1.3 December 10, 2008 Version
N.C. D.O.T.
BRIDGE MAINT. DEPT.
EROSION CONTROL SEQUENCE
COUNTY Guilford
PIPE NO. 2184
S.R. No. 2295-Rambling Rd Lat-36-08-52N
Location-0.3 north of Sr 2269-Alcorn Rd
Br. No. NA Long.79-55-53W
PROJECT No. 7B.204111
DESCRIPTION: Removal of sand from inlet and outlet ends of pipe to allow for better
streamflow
Note:
All Erosion Control devices & proper installation plus maintenance of erosion control will be performed
by using - NCDOT Best Management Practices for Construction and Maintenance Activites Manual
1 Using sandbags wl filter fabric-construct impervious dam upstream and at inlet end if existing pipe
with stream flow.
2 Pump stream into north pipe.
3 Using backhoe-clean out inlet and oulet ends of south pipe-Some manuel shoveling will
be required.
4 If necessary for access-pump water from excavation into a silt bag
5 Remove sandbags to let stream flow into both pipes
APPROXIMATE PROJECT START DATE NA
PREPARED BY _ Alan Levers TSIII
APPROVAL f
TRANSPORTATION SUPE ?VIS-O17/ III / /2 ,'ti?i
DIV. BRIDGE ENG.
DATE 1219/2009
DATE ?Z ?7 C 7
DATE
COUNTY Guilford
S.R. No. 2295- Ramblina Rd
BRIDGE No 2184
SEOUENCEI
Using sandbags wl filter fabric-construct impervious dam upstream and at inlet end If existing pipe
with stream flow.
Pump stream into north pipe.
LEGENDS
_ ., ..
SANDBAGS . trees....
COUNTY Guilford
S.R. No. 2295-Rambling Rd
BRIDGE No NA
SEQUENCE2
3 Using backhoeclean out inlet and oulet ends of south pipe-Some manuel shoveling will
be required.
4 If necessary for access-pump water from excavation into a silt bag
"'yW''
-`VJ'
"'W'
-,W"
pump
11

o
backhoe
To Sr 2269
0
sandbags silt bag
LEGENDS
gar
trees
SEQUENCE 3
COUNTY Guilford
PIPE'NO. 2184
S.R. No. 2295-Rambling Rd
SEQUENCES
Remove sandbags to let stream flow into both pipes

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Rambling Road -Upstream view from road
Rambling Road- Inlet view from upstream side
Rambling Road- Downstream view from road -
Rambling Road- Outlet view trom downstream siae