20151012 Ver 2_401 Application_20180418

DWR
Division of water Resources
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
January 31, 2018 Ver 2.3
Please note: fields marked with a red asterisk below are required. You will not be able to submit the form until all mandatory questions are answered.
Also, if at any point you wish to print a copy of the E -PCN, all you need to do is right -click on the document and you can print a copy of the form.
Below is a link to the online help file.
https://edocs.deq.nc.govMaterResources/0/edocl6247041PCN%20Help%20File%202018-1-30.pdf
A. Processing Information
County (or Counties) where the project is located:*
Forsyth
Is this project a public transportation project?*
f Yes f• No
This is any publicly funded by nunicipal,state or federal funds road, rail, airport transportation project.
1a. Type (s) of approval sought from the Corps:*
V Section 404 Permit (wetlands, streams and waters, Clean Water Act)
F Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What type(s) of permit(s) do you wish to seek authorization?*
IJ Nationwide Permit (NWP)
r Regional General Permit (RGP)
r Standard (IP)
This form may be Corps to initiate the standard/individual permit process. Please contact your Corps representative for submittal of standard permits
All required items that are not provided in the E -PCN and be added to the miscellaneous upload located at the bottom of this form.
Nationwide Permit (NWP) Number: 12 - Utility Lines
Nationwide Permit (NWP) Number: 13 - Bank Stabilization
Nationwide Permit (NWP) Number: 18 - Minor Discharges
NWP Number Other:
NWPs listed above were discussed with Jean Gibby during 2017 field visit.
List all NN nunbers you are applying for not on the drop down list.
1c. Type(s) of approval sought from the DWR:*
check all that apply
rJ 401 Water Quality Certification - Regular r 401 Water Quality Certification - Express
F- Non -404 Jurisdictional General Permit r Riparian Buffer Authorization
r Individual Permit
*
1d. 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:
b Yes O No
b Yes O No
1e. 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
r Yes r No
1f. Is the project located in anyof NC's twenty coastal counties?*
f Yes r No
1h. Is the project located in a designated trout watershed?*
f Yes r No
Link to trout information: http://www.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Agency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact?*
Philip May
1b. Primary Contact Email:*
[e-mail]
1c. Primary Contact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
r Owner V Applicant (other than owner) V Agent/Consultant
(Check all that apply)
2. Owner Information
......... ....................
2a. Name(s) on recorded deed:
Multiple owners - see attached plans. City to acquire easements.
2b. Deed book and page no.:
30000-13,429-101,2020-3334
2c. Responsible party:
(for Corporations)
2d. Address
Street Address
Address Line 2
City
Fbstal / Zip Code
2e. Telephone Number:
(XXX)XXX-)D=
2f. Fax Number:
(XXX)XXX-XXXX Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
3a. Applicant is:
State / Province / legion
Cbuntry

O Agent
f• Other Local Municipality acquiring utitiliy easements
ff other please specify.
3b. Name:
Mike Patton
3c. Business Name:
(if applicable)
Winston Salem/Forsyth City County utilities
3d. Address
Street Address
PO Box 2511
Address Line 2
qty
State / Province / Fbgion
Winston Salem
NC
Postal / Zip Code
Country
27102
us
3e. Telephone Number:
[phone]
(xxx)xxx-xxxx
Fax Number:
[phone]
(xxx)xxx-xxxx
3g. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Philip May
4b. Business Name:
(if applicable)
Carolina Ecosystems Inc
4c. Address
Street Address
3040 Nc 42 West
Address Line 2
qty
State / Province / F egion
Clayton
NC
Postal / Zip Code
Country
27520
us
4d. Telephone Number:
[phone]
(xxx)xxx-xxxx
4e. Fax Number:
(mx)xxx-xxxx
4f. Email Address:*
[e-mail]
Agent Authorization Letter*
Please provide the Agent Authorization Letter if you are subnitting this docunent.
Agent_ authorization_form.pdf 557.3KB
FILE TYPE "T BE PDF

C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Water Transmission System Improvements
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/ town:*
Winston Salem
1d. Driving directions*
If it is a new project and can not easily be found in a (PS napping system Please provide directions.
Adjacent to Winston Salem State University on Reynolds Park Road. See Vicinity Map.
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)
See attached plans
2b. Property size:
(in acres)
2c. Project Address
Street Address
Reynolds Park Road
Address Line 2
city State / Province / fbgion
Winston Salem NC
Rbstal / Zip Code Country
2d. Site coordinates in decimal degrees
Please collect site coordinates in decimal degrees. Use between 4-6 digits (unless you are using a survey -grade GPS device) after the decimal place as
appropriate, based on how the location was determined. (For example, most mobile phones with GPS provide locational precision in decimal degrees to
map coordinates to 5 or 6 digits after the decimal place.)
Latitude:* Longitude:*
36.09165 -80.22136
ex: 34.208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Brushy Fork and Salem Creek
3b. Water Resources Classification of nearest receiving water:*
C
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Yadkin-PeeDee

River Basin Lookup
4. Project Description
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:*
The site and general vicinity are highly developed, comprised of urban institutional (University), industrial, railroad,
roadway, power transmission lines and landfill. Some forested areas remain along Brushy Fork and Salem Creek
in various stages of succession.
4b. 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)
Click the upload button or drag and drop files here to attach docurrent
WS_ PCN_Fig3_USGS. pdf
File type mist be pdf
803.19KB
4c. Attach an 8 1/2X11 excerpt from the most recent version of the published County NRCS Soil Survey map depicting the project site.
(for DWR)
Click the upload button or drag and drop files here to attach docurrent
File type mist be pdf
4d. List the total estimated acreage of all existing wetlands on the property:
4e. List the total estimated linear feet of all existing streams on the property:
(intermttent and perennial)
712
4f. Explain the purpose of the proposed project:*
The City is planning to replace and relocate two water transmission lines (20 -inch and 24 -inch) with a new 30 -inch
transmission line to serve the downtown areas and other interconnections. The actual installation date of the
current water system in the project area is not known, but based on plans for other infrastructure, the lines are at
least 50 years old, and could be as old as 60-80 years. Some of these lines have been repaired multiple times and
continue to cause maintenance issues. On multiple occasions in the past, the existing City water mains have been
relocated due to conflicts with Winston Salem State University infrastructure expansion or improvements.
Relocations involve temporary interruptions in water service, increased incremental costs of relocation to the City,
and potential delays in project schedules. In order to avoid further conflicts with planned University infrastructure
and to address the aging infrastructure issue, the proposed project would relocate the transmission line beyond
the future expansion area of the University. The campus has grown in size and developed all around these existing
water mains. Any problems, such as a break in the water main, could pose a danger to the buildings and students
on campus. It would also be more difficult and more disruptive to the entire campus to repair or maintain these
water mains in their present location.
4g. Describe the overall project in detail, including indirect imapacts and the type of equipment to be used:*
The line replacement would involve several stream crossings as detailed below in order to avoid conflicts with
existing infrastructure, unstable stream banks and existing high tension transmission lines. The proposed line
would run approximately 3,000 linear feet from the WTP north to tie into existing City infrastructure (Figure 2). The
construction corridor would be approximately 40 feet wide, resulting in a total disturbance area of approximately
2.75 acres. No new service areas and no increase in water supply are associated with this project. Construction
equipment will include, but not be limited to, excavators, track hoes, and dump trucks.
Construction within the Brushy Fork culvert under the railroad will be completed in the dry and is designed to
prevent future impacts being required for greenway construction planned in the same (western) barrel. The
existing water infrastructure will be removed from the eastern barrel, which currently does not contain jurisdictional
waters and sediment will be removed from that barrel. Flow will be diverted into the eastern barrel and the new
water main installed in the western barrel, to align it with the future planned greenway. Stream banks up and
downstream will be stabilized as shown on the attached plans. The water main will be secured and protected within
the culvert. Vegetative bank stabilization was considered but due to the current instability of the bank, presence of
significant invasive species outside the project area (and control of the City) including kudzu, and the highly
variable flow regime of Brushy Fork due to its urban watershed, hardened stabilization measures were deemed the
most appropriate method.
4h. Please upload project drawings for the proposed project.
Click the upload button or drag and drop files here to attach docurrent
WSSU 30 -inch Water Main_2018-03-27.pdf 9.52MB
File type mist be pdf
5. Jurisdictional Determinations

5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes f No r Unknown
Comments:
Delineations were initially performed in 2009, and re -delineated in 2015 and
2017
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
f Preliminary r Approved r Unknown r N/A
Corps AID Number:
Exarrple: SAM2017-99999
Initial PJD request was submitted on 11/2/2009
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
Philip May
Carolina Ecosystems, Inc.
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Field verification was performed with John Thomas in 2010, and a field visit to discuss the project revisions was held with Jean Gibby and
Sue Homewood in 2017. The current proposed easement was re-evaluated based on discussions, and no wetlands are present within the
corridor. Therefore no revised PJD request is required.
5d1l. Jurisdictional determination upload
Click the upload button or drag and drop files here to attach docurrent
File type rust be FDF
6. Project History
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past?
r Yes f No r Unknown
6b. If yes, please give the DWR Certification number or the Corps Action ID (exp. SAW -0000-00000).
Prior permit applications were submitted in 2015 but a NWP was not issued as flood plain approval was not
available at that time. 2015 PCN is also attached.
Project History Upload
(lick the upload button or drag and drop files here to attach docunent
SignedPCNApp.pdf 8.49MB
File type rust be FDF
7. Future Project Plans
7a. 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? This includes other separate and distant crossing for linear projects that require Department of the
Army authorization but don't require pre -construction notification.
A NWP 14 for the proposed Brushy Fork Greenway was submitted by the
City under separate cover. While part of the greenway overlaps with this
project, the impacts at Brushy Fork and the railroad will occur as part of this
project. The other greenway impacts will not be built in the same time frame
or contract and therefore is being requested as a separate permit.
D. Proposed Impacts Inventory
1. Impacts Summary

Ia. Where are the impacts associated with your project? (check all that apply):
F Wetlands V Streams -tributaries ❑ Buffers
F- Open Waters r Pond Construction
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. Reason for impact*3b.lmpact 3c. Type of impact*3d. Stream name *
3e. Stream
3f. Type of
3g. Stream 3h. Impact s
15 7
type*
Type*
Jurisdiction*
width*
length*
S1 Utility crossing
T Excavation UT to Salem Creek
Perennial
Both
10
19 1
rvbp label (e.g. Road Grossing
Ferrmnent (F) or
Perennial (F$P) or
Average
(linear feet) 9
1)
Tenporary (T)
interni tent (INT)
Nap label (e.g. Road Grossing
(feet)
0
S2 Utilitycrossing
T Excavation Salem Creek
Perennial
Both
30
40 1
Nap label (e.g. Road Grossing
Permanent (P) or
Perennial (FEP� or
Average
(linear feet) ,
1)
Tenporary (T)
intermittent (INT)
(feet)
S3 Utilitycrossing
T Excavation
UTtoSalemCreek Jurisdictiona Both
5
15 7
Nap label (e.g. Road Grossing
Fernanent (F'1 or
I Ditch
Average
(linear feet) 5
1)
Tenporary (T)
Perennial (PEP� or
(fes)
internittent (INT)
S4 Utilitycrossing
T Excavation
Brushy Fork Perennial Both
25
40 1
Nap label (e.g. Road Grossing
Permanent (P) or
Ferennial (F8P� or
Average
(linear feet)
1)
Tenporary (T)
internittent (INT)
(feet)
n
S5 Stream stabilization T Bank Brushy Fork Perennial Both 25 246 6
Nap label (e.g. Finad Grossing Ferrranent (F9 or Stabilization Perennial (M:� or Average (linear feet)
1) Tenporary (T) internittent (INT) (feet) 1
S6 Greenway & pipe P Fill Brushy Fork Perennial Both 25 76 1
protection Pernanent(F'or Perennial (PEP)or Average (linear feet)
Nap label (e.g. Finad Grossing Tenporary (T) internittent (INT) (feet) 9
1) n
S7 Utilitycrossing T Excavation Brushy Fork Perennial Both 25 69 1
Nap label (e.g. Fbad Grossing Fernanent (F) or Perennial (REP) or Average (linear feet)
1) Ter porary (T) internittent (INT) (feet) 7
2
S6 Utilitycrossing T Excavation Brushy Fork Perennial Both 25 15
Nap label (e.g. Finad Crossing Ferrranent (P) or Perennial (Pff� or Average (linear feet)
1) Ter porary (T) internittent (INT) (feet)
** All Perennial or Intermittent streams must be verified by DWR or delegated local government
3i. Total jurisdictional ditch impact in square feet:
75
3i. Total permanent stream impacts:
76
3i. Total temporary stream impacts:
444
31. Total stream and tributary impacts:
520
3j. Comments:

One jurisdictional ditch (S3) is present (Sheet 2 Station 5+90). Stream crossings occur at Stations 3+00 and 4+25
on Sheet 2 (S1 & 2), Station 20+00 on Sheet 3 (S4), and Station 22-26 on Sheets 4 and 7 (S5-8). The ditch
crossing at Station 1+75 on Sheet 2 is a relict channel (likely replaced by the existing stream at Station 3+00).
Impacts S5-8 are detailed on Sheet 7 Stream Impacts (attached as a miscellaneous document separate from the
plans) to help exhibit the multiple Nationwide Permit activities proposed at the railroad culvert as discussed in the
2017 field visit.
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:*
Impact minimization was performed during the planning and design phases of the project and is thoroughly
documented in a SEPA Environmental Assessment and Finding of No Significant Impact in 2010. Changes since
that time have resulted in further minimization. Wetland impacts have been avoided by relocating the line further
from the one remaining wetland (Sheet 4 - Station 18+00). One jurisdictional ditch will be crossed (Sheet 2 -
Station 6+00). Stream crossings have been reduced and occur in areas necessary to avoid infrastructure and
other constraints. The crossing under the rail road over Brushy Fork Creek has been aligned along the proposed
greenway (submitted under a separate permit) alignment to avoid multiple construction impacts. The impacts
necessary to construct and protect the proposed water main will also avoid future greenway construction impacts.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Sediment and erosion control measures depicted in the attached plans will be implemented and inspected
throughout construction after NCDMLR approval. Copies of the issued permits will be provided to all contractors
and all permit conditions will be included in the contract documentation.
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?
f Yes C No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
Permanent impacts are limited to 76 linear feet of stream channel. While permanent fill is proposed at the railroad culvert in the existing
stream location, the stream will actually be tied to the eastern barrel and therefore no loss of stream function or area is likely to occur.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
*** Recent changes to the stormwater rules have required updates to this section .-
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
For a list of options to meet the diffuse flow requirements, click here.
If no, explain why:
The Yadkin River basin does not currently have NC Riparian Buffer Protection Rules.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
f Yes r No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?*
r Yes
f No
To look up low density requirement click here 15A NCAC 02H.1003(2)

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?
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)?*
f Yes r No
Comments:
SEPA no longer applies to the project since rule changes, however an EA was prepared in 2010 under the prior
SEPA rules. A FoNSI was issued for the project.
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
2b. Is this an after -the -fact permit application?*
t' Yes r No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) 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 project relocates eAsting water infrastructure but does not increase the service area or water supply.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
f Yes r NorN/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 t' No r Unknown
What Federal Agency is involved?
FEMA
5e. Is this a DOT project located within Division's 1-8?*
f Yes r No
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?

r Yes f No
5g. Does this project involve bridge maintenance or removal?
f Yes r No
Link to the NLEB SLOPES document: http://saw-reg.usace.army.mil/NLEB/1-30-17-signed_NLEB-SLOPES&apps.pdF
5h. Does this project involve the construction/installation of a wind turbine(s)?*
f 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.?
f Yes r No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
NHP Element Occurrence Data, USFWS Asheville Office Northern Long Eared Bat documentation, on-site review
of habitats, and prior SEPA document review by USFWS.
In regards to 5i, no blasting or percussive activities are planned. However, if significant rock is encountered there
is potential for minor activity to occur, but no specific locations can be identified at this time.
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?*
NOAA EFH Mapper
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data: hftp://gis.ncdcr.gov/hpoweb/
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 (e.g., National Historic Trust designation or properties significant in North Carolina history and archaeology)?*
f Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
NC SHPO review of the 2010 SEPA EA.
7c. Historic or Prehistoric Information Upload
Click the upload button or drag and drop files here to attach document
SCH CLR Winiton-Salem Replaclement Main 9-14-10.pdf 610.38KB
File must be FDF
8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https:Hmsc.fema.gov/portal/search
8a. Will this project occur in a FEMA -designated 100 -year floodplain?*
G Yes r No
8b. If yes, explain how project meets FEMA requirements:
A Conditional Letter of Map Revision was approved under FEMA for the proposed utility/greenway crossing of
Brushy Fork through the ebsting railroad crossing.
8c. What source(s) did you use to make the floodplain determination?*
NC Flood Mapping Program
Miscellaneous

Miscellaneous attachments not previously requested.
Click the upload button or drag and drop files here to attach docurrent
W -S_30 -inch water main_Sheet7_stream impacts_2018-04-19.pdf 1.59MB
File nest be FDF or KNE
Signature
fJ 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:*
Philip May
Signature
Initial Review
Is this project a public transportation project?* (?
f Yes f• No
Change only if needed.
Has this project met the requirements for acceptance in to the review process?
f• Yes
f No
BIMS # Assigned *
20151012
Version#*
2
Reviewing Office*
Winston-Salem Regional Office - [phone]
Select Project Reviewer*
Sue Homewood:eads\slhomewood
Is a payment required for this project?*
f No payment required
f Fee received
F Fee needed - send electronic notification
What amout is owed?*
r $240.00
r $570.00