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STATE OF NORTH CAROLINA
DEPAR� OF TRANSPORTATION
PAT McCRORY
GovExrrox
February 24, 2015
Mr Dave Wanucha
NC DENR Division of Water Qualtty
585 Waughtown Street
Wmston-Salem, NC 27107
Mr Dave Bailey
US Army Corps of Engineers
6508 Falls of the Neuse Surte 120
Raleigh, NC 27615-6814
(Two Copies)
Subject: Guilford County, Bali Road (SR 3365)
Project Number # WBS #7B.204111
To Whom It May Concern
ANTHONY J. TATA
SECRETARY
oCC�CaMC
- D
MAR 0 5 2015
DENR - WATER RESOURCES
TRqNSPORTATION PERMITTING UNIT
The North Carohna Department of Transportation (NCDOTj proposes to pave and widen the shoulder of Bah
Road (SR 3365) in Guilford County. The proposed work is necessary in order to reduce future maintenance
needs and mcrease traffic safety. An e�ustmg culvert will also be replaced during the proposed pro�ect.
Replacement of the culvert is anticipated to be done under a Nationwide 3 Permit authonzed by the USACE.
However, the culvert is in Chocolate Creek which is within the Jordan Lake watershed. Since the road will be
widened to meet NCDOT standards, the drtch lines will be reahgned which will necessitate the requirement
for a buffer authorization from the Division of Water Resources Although the ditch lines are proposed to be
realigned, they are proposed to retain the dunensions of the e�cisting ditches which mean that mitigation
should not be necessary Total new permanent impacts to the jurisdictional stream are anticipated to be 15
linear feet with temporary unpacts of 20 feet. This package is being sent to the USACE as a courtesy
notification for a Nationwide 3 authorization. This package is also being forwarded to the NC Division of
Water Quahty for authorization as prescnbed under General Water Quahty Certif'ication #3883 (NW 3) and a
wntten buffer authonzation. The following information is being provided to satisfy conditions of the
Nationv�nde Permit and General Water Quahty Certiiication.
P.O. Box 14996 Greensboro, NC 27415-4996 Telephone No. (336) 334-3192 Fax No. (336) 334-3637
PROJECT INFORMATION
Road Name SR Number Pro�ect Length Classification
(miles)
Bah Road SR 3365 N/A Subdivision
River Basm• DWQ Water Quality % Impervious Surface
ID Desi ation
Chocolate Creek
Cape Fear 16-19-8-1-1 WS-V; NSW, N/A
Buffer Rulesa" Buffer Rule Conditions (where apphcable)
Yes Jordan Lake
Protected Species Presentb Mapped Historic CAMA Essenrial Fishery Habitat
Pro erties� �c
No No No No
a Separate documentation attached as needed. See the attached Endangered Species Review Sheet for further informarion: ` When
Apphcable - See the attached Histaric Review Letter for further u�formation
PIPE REPLACEMENT INFORMATION
Site (Station) N/A Stream Type Intermittent
Existin Pi e 82 inch X 40 ft Re lace 128" X 83" X 50 ft
Construction Pump around Dewatering ABC aggregate or less
Method Device* intrusive device
Burial Depth At least 20 % of diameter of pipe E/C Plan
Date
Construction As soon as practicable Duration One week
Date
Impacts (ft.j 15 feet of permanent stream impacts and approximately 20 sf of temporary
stream im acts for dewaterin
Special Realignment of roadside ditches, but will retain the design dimensions of the
Conditions existin draina e ditches.
Restoration Within 15 working days of the pipe extension the natural stream contours will
Plan be restored and seeded. Temporary silt screens will be cleaned and removed
followin ve etation establishment.
RCP = reinforced concrete pipe; CMP = Corrugated metal pipe; CMPA = Corrugated metal pipe arch; E1C = 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 aad wetlaads, 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 mitigatioa is not aaticipated, 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 aatural wetland.
APPLICATION INFORMATION
Enclosed please find the Pre-construction NotiScation Form and supporting documeatation for the
above referenced project. If you have any questions or need any additional iaformation, please
contact Jerry Parker at (336) 256-2063. Your time and effort are appreciated.
Smcerely, r
� �� /�
M Mills, P.E
iv�s�on Engineer, Division 7
Enclosures
CC Bany Harrington, NCDOT
Jeremy Warren, NCDOT
Antome White, NCDOT
NC Wetlands/401 Unrt
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o�OF W AT�c9QG
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> y
O T
Office Use Only
Corps action ID no
DWQ pro�ect no �� S��- y%
Form Version 1 3 Dec 10 2008
Pre-Construction Notification PC Form
A. A licant Information
1. Processing
1 a Type(s) of approval sought from the
Corps � Section 404 Permit ❑ Section 10 Perm�t
1 b Specify Nationwide Permit (NWP) number 3 or General Permit (GP) number NW 3
1 c Has the NWP or GP number been verified by the Corps� ❑ Yes � No
1 d Type(s) of approval sought from the DWQ (check all that apply)
� 401 Water Quality Certification — Regular ❑ Non-404 Junsdictional General Permit
❑ 401 Water Quality Certification — Express � Ripanan Buffer Authorization
1 e Is this notification solely for the record For the record only for DWQ 401 For the record only for Corps Permit
because written approval is not required� Certification
❑ Yes � No � Yes ❑ No
1f Is payment into a mitigation bank or in-lieu fee program proposed for mitigation � Yes � No
of impacts� If so, attach the acceptance letter from mitigation bank or m-lieu
fee program
1 g Is the pro�ect located in any of NC's twenty coastal counties If yes, answer 1 h ❑ Yes � No
below
1 h Is the pro�ect located withm a NC DCM Area of Environmental Concem (AEC)� ❑ Yes � No
2. Project Information
2a Name of pro�ect Bali Road
2b County Guilford
2c Nearest municipahty / town Kimesvdle, NC
2d Subdivision name N/A
2e NCDOT only, T I P or state WgS # 7B 204111
pro�ect no
3. Owner Information
3a Name(s) on Recorded Deed
3b Deed Book and Page No ��� 2a�5
3c Responsible Party (for LLC if
applicable} DENR -WATER RES61��
3d Street address
3e City, state, zip
3f Telephone no
3g Fax no
3h Emad address
Page 1 of 11
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 Mdls
4c Business name Division Engineer NCDOT Division Seven
(if applicabie)
4d Street address P O Box 14996
4e City, state, zip Greensboro, NC 27415
4f Telephone no 336 334-3297
4g Fax no
4h Emad address
5. AgenUConsultant Information (if applicable)
5a Name Jerry Parker
5b Business name Division Environmental Supervisor
(if applicable)
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 11
PCN Form — Version 1 3 December 10, 2008 Version
B. Project information and Prior Project History
1. Property Identification
1a Property identification no (tax PIN or parcel ID) N/A
Latitude 35 9562907° N Longitude -
1 b Site coordinates (in decimal degrees) 79 6244700° W
(DD DDDDDD) (-DD DDDDDD)
1 c Property size N/A acres
2. Surface Waters
2a Name of nearest body of water (stream, river, etc ) to Chocolate Creek
proposed pro�ect
2b Water Quality Classification of nearest receiving water WS-V, NSW
2c River basm Cape Fear
3. Project Description
3a Describe the existing conditions on the site and the general land use in the vicirnty of the pro�ect at the time of this
applicat�on
Rurai Farmland
3b List the total estimated acreage of all existmg wetiands on the property
0
3c List the total estimated linear feet of all existing streams (intermittent and perennial) on the property
50 ft
3d Explain the purpose of the proposed pro�ect
Pave road, repiace undersized and/or damaged pipe, and widen shoulder on the downstream side to decrease
maintenance and increase traffic safety
3e Describe the overall pro�ect m detad, mcluding the type of eqwpment to be used
The site wdl be de-watered, the old pipe removed and replaced Equipment utdized wdl include backhoe and/or trackhoe
The new pipe wdl be instalied at appropnate elevation
4. Jurisdictional Determinations
4a Have �unsdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
pro�ect (including ali pnor phases) in the past� ❑ Yes � No ❑ Unknown
Comments
4b If the Corps made the �urisdictional determination, what type � preliminary ❑ Final
of determination was made�
4c If yes, who delineated the �urisdictional areas� Agency/Consultant Company
Name (if known) Other
4d if yes, list the dates of the Corps �urisdictional determinations or State determinations and attach documentation
5. Project History
5a Have permits or certiflcations been requested or obtained for � Yes � No ❑ Unknown
this pro�ect (includmg all prior phases) in the past�
5b If yes, explain in detad according to "help file" instructions
Page 3 of 11
PCN Form — Version 1 3 December 10, 2008 Version
6. Future Pro�ect Plans
6a Is this a phased pro�ect� ❑ Yes � No
6b If yes, explain
Page 4 of 11
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 pro�ect (check all that apply)
❑ Wetlands � Streams - tributanes � 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 2b 2c 2d 2e 2f
Wetland impact Type of �unsdiction
number — Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWQ — non-404, other) (acres)
Tem ora T
W1 ❑ P � T ❑ Yes ❑ Corps
❑ No ❑ DWQ
WZ � 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 perenrnal 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 �unsdiction Average Impact
number - (PER) or (Corps - 404, 10 stream length
Permanent (P) or intermittent DWQ — non-404, width (linear
Temporary (T) (�Ni� other) (feet) feet)
S1 � P❑ T Chocolate Creek � PER � Corps 2�4ft 20ft
Culvert replacement ❑ INT � DWQ permanent
S2 ❑ P� T Dewatering Chocolate Creek � PER � Corps 15 ft temp
❑ INT � DWQ
S3 ❑ P 0 T ❑ PER ❑ Corps
❑ INT ❑ DWQ
S4 ❑ P 0 T ❑ PER ❑ Corps
❑ INT ❑ DWQ
S5 ❑ P � T ❑ PER ❑ Corps
❑ INT ❑ DWQ
S6 ❑ P � T ❑ PER ❑ Corps
❑ INT ❑ DWQ
20 ft
3h Total stream and tributary impacts permanent
15 ft temp
3i Comments
Page 5 of 11
PCN Form — Version 1 3 December 10, 2008 Version
4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuanes, tnbutaries, sounds, the Atlantic Ocean, or any other open water of
the U S then mdividually 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
Tem ora T
01 ❑P�T
02 ❑P�T
03 ❑P�T
04 ❑P❑T
4f. Total open water impacts
4g Comments
5. Pond or Lake Construction
If ond or lake construction ro osed, then com lete the chart below
5a 5b 5c 5d 5e
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or purpose of (acres)
number 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)
5� Size of pond watershed (acres)
5k Method of construction
Page 6 of 11
PCN Form — Version 1 3 December 10, 2008 Version
6. Buffer Impacts (for DWQ)
If pro�ect wdl impact a protected ripanan buffer, then complete the chart below If yes, then individually list all buffer impacts
below If an im acts re wre miti ation, then ou MUST fill out Section D of this form
6a.
❑ Neuse ❑ Tar-Pamlico � Other Jordan
Pro�ect is in which protected basin� ❑ Catawba ❑ Randleman
6b 6c 6d 6e 6f 6g
Buffer impact
number — Reason for Buffer Zone 1 impact Zone 2 impact
Permanent (P) impact Stream name mitigation (square feet) (square feet)
or Temporary reqwred?
T
Widen road
shoulder on
downstream ❑ Yes
61 ❑ P� T side to Chocolate Creek � No 600 sf 400 sf
increase
traffic safety
B2 ❑P�T , �Nos 0 0
B3 ❑P�T ❑Yes
❑ No
6h Total buffer impacts 0 0
6i Comments Although road shoulder wdl be widened and the drainage ditches w�ll be realigned, the proposed ditches will
retain the existing design dimensions No travel lanes wdl be added and the minimum reqwred roadway typical section will be
used based on traffic and safety considerations
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1 a Specifically descnbe measures taken to avoid or mirnmize the proposed impacts in designing pro�ect
Impacts will be minimized by utilization of Best Management Practices and by performing work in the dry
1 b Specifically describe measures taken to avoid or mmimize the proposed impacts through construction techniques
Best Management Practices will be utdized dunng construction Pre-construction meeting with Environmental Superevisor wdl
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 pro�ect require Compensatory Mitigation for ❑ Yes � No
impacts to Waters of the U S or Waters of the State�
2b If yes, mitigation is required by (check all that apply)• ❑ DWQ ❑ Corps
❑ Mitigation bank
2c If yes, which mitigation option wdl be used for this pro�ect? ❑ 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
Page 7 of 11
PCN Form — Version 1 3 December 10, 2008 Version
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 Ripanan wetland mitigation requested acres
4f Non-nparian 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 pian, provide a descnption of the proposed mitigation plan
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a Wdi the pro�ect result in an impact within a protected npanan buffer that requires ❑ Yes � No
buffer mitigation�
6b If yes, then identify the square feet of impact to each zone of the nparian buffer that requires mitigation Calculate the
amount of mitigation required
6c 6d 6e
Zone Reason for impact Total impact Multiplier Required mitigation
(square feet) (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,
permittee responsible nparian buffer restoration, payment into an approved in-lieu fee fund)
6h Comments
Page 8 of 11
PCN Form — Version 1 3 December 10, 2008 Version
5b Have all of the 401 Urnt submittal reqwrements been met� ❑ Yes ❑ No
F. Supplementary Information
1. Environmentai Documentation (DWQ Requirement)
1 a Does the pro�ect involve an expenditure of public (federal/state/local) funds or the � Yes ❑ No
use of public (federal/state) land�
1 b If you answered "yes" to the above, does the pro�ect 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 �eview been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
letter ) ❑ Yes ❑ No
Comments
2. Violations (DWQ Requirement)
2a Is the site in violation of DWQ Wetiand Rules (15A NCAC 2H 0500), Isolated
Wetland Rules (15A NCAC 2H 1300), DWQ Surface Water or Wetland Standards, ❑ Yes � No
or Ripanan Buffer Rules (15A NCAC 2B 0200)�
2b Is this an after-the-fact permit applicatGOn� ❑ 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 Wiil this pro�ect (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 detad the ultimate treatment methods and disposition (non-discharge or discharge) of wastewater generated from
the proposed pro�ect, or avadable capacity of the sub�ect facdity
NA
Page 10 of 11
PCN Form — Version 1 3 December 10, 2008 Version
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a Wdl this pro�ect 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 USFVVS Field Office you have contacted
❑ Ashewlle
5d What data sources did you use to determine whether your site wouid impact Endangered Species or Designated Cntical
Habitat�
US Fish and Wddlife Web S�te
6. Essential Fish Habitat (Corps Requirement)
6a Wdl this pro�ect occur in or near an area designated as essential fish habitat� ❑ 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 Wdl this pro�ect occur in or near an area that the state, federai or tnbal
governments have designated as having historic or cultural preservation � Yes � No
status (e g, National Histonc Trust designation or properties significant m
North Carolma history and archaeology)�
7b What data sources did you use to determine whether your site would impact historic or archeological resources?
National Histonc Register Web Site and the Human Enwronment Unit of NCDOT
8. Flood Zone Designation (Corps Requirement)
8a Will this pro�ect occur in a FEMA-designated 100-year floodplain� ❑ Yes ❑ No
8b If yes, explain how pro�ect meets FEMA requirements
8c What source(s) did you use to make the floodplain determination�
�
J.M. Mills ��' / ��`� 2-24-15
Applicant/Agent's Printed Name Applicant/AgenYs Signature Date
(Ag s signature is valid only if an authonzation letter from the applicant
is rovided
Page 11 of 11
PCN Form — Version 1 3 December 10, 2008 Version
NC DOT
BRIDGE MAINT DEPT
EROSION CONTROL SEQUENCE
COUNTY Guilford
PIPE NO. NA
S.R. No. 3365 Bali Rd Location:0.3 mi.north of SR 3361-Phillippi Rd
Br. No. NA
PROJECT No.
DESCRIPTION:
7B.204111
Remove existing line of 82" CMP @ 40' long and replace and lengthen with 1@
128" x 83" aluminized CMPA - 50" Iong.Length to be added downstream
Note:
All Erosion Control devices 8� proper installation plus maintenance of erosion control will be performed
by using - NCDOT Best Management Practices for Construction and Maintenance Activites Manual
1
2
3
4
5
6
7
8
9
10
11
12
Using sandbags or ABC wrapped in filter fabris or other less intrusive devices construct
impervious dams up and downnstream of existing pipe.
Use water pump to pump water from upstream around work area.
Install traffic control to maintain traffic
Remove half of existing pipe and excavate to proper grade 1' below streambed.
Pump water from excavation into silt bag-- Install silt fence as needed on project.
Install 25' of 128" x 83" CMPA
Install traffic control to maintain traffic
Excavate remaining existing pipe and install remaining new pipe
25' of 128" x 83" CMPA
Backfill pipe to proper grade
Remove traffic controls
Stabilize banks with riprap as needed.
Seed and mulch as necessary.
APPROXIMATE PROJECT START DATE NA
PREPARED BY Alan Levens TSIII
APPROVAL
TRANSPORTATION SUPERVISOR III Alan Levens
DIV BRIDGE ENG Jeremy Warren
DATE
DATE
DATE
12/16/2014
COUNTY Guilford
S.R. No. 3365 Bali Rd
BRIDGE No NA
SEQUENCE1
Using sandbags or ABC wrapped in filter fabris or other less intrusive devices construct
impervious dams up and downnstream of existing pipe.
Use water pumps to pump water from upstream around work area.
install traffic control to maintain traffic
LEGENDS
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,RiabblE3;�,�}� �"�a���:wms�.,`�yp.�,tr es�c�°�rx .,���n�
COUNTY Guilford
S.R. No. 3365-Bali Rd
BRIDGE No NA
SEQUENCE2
4 Remove half of existing pipe and excavate to proper grade 1' below streambed.
5 Pump water from excavation into silt bag-- Install silt fence as needed on project.
Install 25' of 128" x 83" CMPA
..�
►ump
streamflow
ABC Dam
LEGENDS
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COUNTY Guilford
S.R. No. 3365-Bali Rd
BRIDGE No NA
SEQUENCE3
7 Install traffic control to maintain tra�c
8 Excavate remaining existing pipe and install remaining new pipe
25" of 128" x 83" CMPA
iump
streamflow
ABC Dam
LEGENDS
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SEQUENCE 4
COUNTY Guiiford
PIPE NO. na
S.R. No. 3365 Bali Rd
9 Backfill pipe to proper grade.
10 Remove traffic controis
11 Stabilize banks with riprap as needed.
12 Seed and mulch as necessary.
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Name: KIMESVILLE Location: 035.9565026° N 079.6245133° W
Date: 2/6/2015 Caption: Bali Road SR 3365
Scale: 1 inch equals 2000 feet Guilford County
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