20240407 Ver 1_ePCN Application_20240308

DWR
Division of Water Resources
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
October 2, 2023 Ver 4.3
Initial Review
Has this project met the requirements for acceptance in to the review process?
Yes No
Is this project a public transportation project?*
Yes No
Change only If needed.
Does this project involve maintenance dredging funded by the Shallow Draft Navigation Channel Dredging and Aquatic Weed Fund or involve the distribution or transmission of energy or
fuel, including natural gas, diesel, petroleum, or electricity?
Yes No
BIMS # Assigned Version# *
20240407 1
Is a payment required for this project?*
No payment required
Fee received
Fee needed - send electronic notification
Reviewing Office*
Winston-Salem Regional Office - (336) 776-
9800
Information for Initial Review
la. Name of project:
Norfolk Southern Bridge at K-35.2
la. Who is the Primary Contact?*
Cody Pugh
1b. Primary Contact Email: *
[e-mail]
Date Submitted
3/8/2024
Nearest Body of Water
Grassy Creek
Basin
Yadkin-PeeDee
Water Classification
C
Site Coordinates
Latitude:
36.201660
A. Processing Information
Is this project connected with ARPA funding?
Yes No
County (or Counties) where the project is located:
Forsyth
Is this a NCDMS Project
Yes No
Longitude:
-80.291345
What amount is owed?*
$240.00
$323.00
Select Project Reviewer*
Rebecca Chandler:rebecca.chandler
1c. Primary Contact Phone:*
[phone]
$570.00
$767.00
a

Is this project a public transportation project?*
Yes No
1a.Type(s)of approval sought from the Corps:
Section 404 Permit (wetlands, streams and waters, Clean Water Act)
Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
Has this PCN previously been submitted?*
Yes
No
1b. What type(s) of permit(s) do you wish to seek authorization?
Nationwide Permit (NWP)
Regional General Permit (RGP)
Standard (IP)
1c. Has the NWP or GP number been verified by the Corps?
Yes No
Nationwide Permit (NWP) Number:
Nationwide Permit (NWP) Number:
NWP Numbers (for multiple NWPS):
NWP 14 may also apply
1d. Type(s) of approval sought from the DWR:
401 Water Quality Certification - Regular
Non-404 Jurisdictional General Permit
Individual 401 Water Quality Certification
03 - Maintenance
14 - Linear transportation
le. Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification:
For the record only for Corps Permit:
1f. Is this an after -the -fact permit application? *
Yes No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
Yes No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
Yes No
1h. Is the project located in any of NC's twenty coastal counties?
Yes No
1j. Is the project located in a designated trout watershed?
Yes No
B. Applicant Information
1d. Who is applying for the permit?
Owner Applicant (other than owner)
le. Is there an Agent/Consultant for this project?
Yes No
2. Owner Information
2a. Name(s) on recorded deed:
Norfolk Southern
2b. Deed book and page no.:
NA
2c. Contact Person:
Cody Pugh
401 Water Quality Certification - Express
Riparian Buffer Authorization
Yes No
Yes No

2d. Address
Street Address
650 West Peachtree Street NW Box 45
Address Line 2
city
Atlanta
Postal / Zip Code
30308
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Ron Johnson
4b. Business Name:
AECOM
4c.Address
Street Address
5438 Wade Park Boulevard
Address Line 2
Suite 200
city
RAleigh
Postal / Zip Code
27607
4d. Telephone Number:
[phone]
4f. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(if appropriate)
NA
1c. Nearest municipality I town:
Rural Hall
2. Project Identification
State / Province / Region
GA
Country
USA
2f. Fax Number:
State / Province / Region
NC
Country
USA
4e. Fax Number:
2a. Property Identification Number: 2b. Property size:
NA NA
2c. Project Address
Street Address
NA
Address Line 2
City State / Province / Region
Postal / Zip Code Country
3. Surface Waters
3a. Name of the nearest body of water to proposed project:
Grassy Creek
3b. Water Resources Classification of nearest receiving water:
C
3c. What river basin(s) is your project located in?*
Yadkin -Peel
a

3d. Please provide the 12-digit HUC in which the project is located.
030401011301
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: "
Rail road over Grassy Creek - site is within the interchange of US 52 and NC 74. Surrounding area is wooded. See attached Project History
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?
Yes No Unknown
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:
500
4h. Explain the purpose of the proposed project:"
Replacement of a rail road bridge that collapsed
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:
The temporary pipes will be removed. Three precast concrete box culverts with head and wing walls will be installed. The culverts will be 60 feet long and 12 ft wide and 8 feet tall. All three
box culverts will be countersunk 1 foot. The culverts and associated structures will be placed using a crane.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
Yes No O Unknown
Comments:
Stream was delineated following installation of the temporary pipes
5b. If the Corps made a jurisdictional determination, what type of determination was made?
Preliminary Approved Not Verified Unknown N/A
Corps AID Number:
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Ron Johnson
Agency/Consultant Company: AECOM
Other:
6. Future Project Plans
6a. Is this a phased project?*
Yes 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
1a. Where are the impacts associated with your project? (check all that apply):
Wetlands Streams -tributaries Buffers
Open Waters Pond Construction
3. Stream Impacts
O
❑
3a. Reason for impact O
3b.lmpact type*
3c. Type of impact*
3d. S. name*
3e. Stream Type*
(?)
f. Type of
*
[Juriscliction
3g. S. width
3h. Impact
length*
S1
Culvert
Permanent
Culvert
Grassy Creek
Perennial
Both
20
Average (feet)
60
(linear feet)
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
60
3i. Total stream and ditch impacts:
60
3i. Total temporary stream impacts:
0

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:
Culvert length was designed to be the shortest possible length
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Best Management Practices will be implemented to minimize sediment from entering the stream during 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 this project DOES NOT require Compensatory Mitigation, explain why:
Impacts do not exceed requirements of Nationwide Permit
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
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?
Yes No
If no, explain why:
Project in Yadkin -Pee Dee basin
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?
Yes No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?
Yes No
Comments:
G. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?'
Yes No
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)? *
Yes No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality?
Yes No
3b. If you answered "no," provide a short narrative description.
Rail road already in place
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?
Yes No N/A
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
O
N

5a. Will this project occur in or near an area with federally protected species or habitat?
Yes No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?
Yes No
5c. If yes, indicate the USFWS Field Office you have contacted.
Asheville
5d. Is another Federal agency involved?*
Yes No
5e. Is this a DOT project located within Division's 1-8?
Yes No
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?
Yes No
5g. Does this project involve bridge maintenance or removal?
Yes No
5g(1). If yes, have you inspected the bridge for signs of bat use such as staining, guano, bats, etc.?
Yes No
If you answered "Yes" to 5g(1), did you discover any signs of bat use?
Yes No Unknown
5h. Does this project involve the construction/installation of a wind turbine(s)?*
Yes No
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.?
Yes No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
Review of iPaC and NC Natural Heritage Program files
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?
Yes No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?
NOAA EFH Mapper
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?
Yes No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
Area is already extensively disturbed
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:
Hydrologic and Hydraulic modeling shows no -rise
8c. What source(s) did you use to make the floodplain determination?
See attached Hydrologic and Hydraulic Analysis
Miscellaneous

Please use the space below to attach all required documentation or any additional information you feel is helpful for application review. Documents should be combined into one file when
possible, with a Cover Letter, Table of Contents, and a Cover Sheet for each Section preferred.
Click the upload button or drag and drop files here to attach document
Figure1_NS_VicinityMap.pdf
4.09MB
Figure2_NS_Ortho.pdf
1.87MB
Figure3_NS_Topo.pdf
1.08MB
Figure4_NS_Soils.pdf
1.95MB
NS K35.2 Project History.pdf
1.9MB
NS K-35.2 Rural Hall Impact Drawing.pdf
73.92KB
NS K-35.2 Rural Hall, NC Box Culvert 100 % Plan Submittal 2.23.24.pdf
2.04MB
project_report _norfolk_ southern _ emergency_51877_51878.pdf
832.34KB
USFWS_Species List_ Asheville Ecological Services Field Office.pdf
220.05KB
NS K35.2 AGENT_ AUTHORIZATION_FORM.pdf
140.42KB
File must be PDF or KMZ
Comments
Signature
By checking the box and signing below, I certify that:
• The project proponent hereby certifies that all information contained herein is true, accurate, and complete to the best of my knowledge and belief'; and
• The project proponent hereby requests that the certifying authority review and take action on this CWA 401 certification request within the applicable reasonable period of time.
• 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:
Ronald G. Johnson
Signature
400c0ICi �. PhOSON
Date
3/8/2024
a