20200404 Ver 1_PCN Form Submission_20200324

DWR
Division of Water Resources
Pre -Construction Notification (PCN) Form
September 29, 2018 Ver 3
Initial Review
Has this project met the requirements for acceptance in to the review process?*
6 Yes
r No
Is this project a public transportation project?*
C Yes 6 No
Change only if needed.
BIMS # Assigned * Version#*
20200404 1
Is a payment required for this project?*
r No payment required What amout is owed?*
r Fee received 6 $240.00
6 Fee needed - send electronic notification r $570.00
Reviewing Office *
Winston-Salem Regional Office - (336) 776- Select Project Reviewer*
9800 Sue Homewood:eads\slhomewood
Information for Initial Review
1a. Name of project:
Guinevere Sewer Rehabilitation
1a. Who is the Primary Contact?*
Vickie Miller
1b. Primary Contact Email:*
[e-mail]
Date Submitted
3/24/2020
Nearest Body of Water
Silas Creek
Basin
Yadkin -Pee Dee
Water Classification
C
Site Coordinates
Latitude: Longitude:
36.095664-80.311211
A. Processing Information
County (or Counties) where the project is located:
Forsyth
Is this project a public transportation project?*
r Yes r No
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 type(s) of permit(s) do you wish to seek authorization?
W Nationwide Permit (NWP)
r Regional General Permit (RGP)
r Standard (IP)
1c. Primary Contact Phone:*
[phone]

1c. Has the NWP or GP number been verified by the Corps?
r Yes r- No
Nationwide Permit (NWP) Number:
NWP Numbers (for multiple NWPS):
1d. Type(s) of approval sought from the DWR:
W 401 Water Quality Certification - Regular
r Non-404 Jurisdictional General Permit
r Individual Permit
03 - Maintenance
le. Is this notification solely for the record because written approval is not required?
For the record only for DWR401 Certification:
For the record only for Corps Permit:
r 401 Water Quality Certification - E)press
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
B. Applicant Information
1d. Who is applying for the permit?
r Owner W Applicant (other than owner)
le. Is there an Agent/Consultant for this project?*
r Yes r- No
2. Owner Information
2a. Name(s) on recorded deed:
Winston-Salem / Forsyth County Utilities Easement
2b. Deed book and page no.:
2c. Responsible party:
Ms. Hsiang -Yu Chou-Hoofman, P.E.
2d.Address
Street Address
101 N. Main St.
Address Line 2
CKY
Winston-Salem
Postal / Zip Code
27101
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
3a. Name:
Ms. Hsiang -Yu Chou-Hoofman, P.E.
State / Province / I;Lgion
NC
Country
United States
2f. Fax Number:
r Yes r No
r Yes r No

3b. Business Name:
Winston-Salem/Forsyth County Utilities
3c.Address
Street Address
101 N. Main St.
Address tine 2
City
Winston-Salem
Postal / Zip Code
27101
3d. Telephone Number:
[phone]
3f. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Vickie Miller
4b. Business Name:
HDR
4c.Address
Street Address
555 Fayetteville St. Suite 900
Address tine 2
City
Raleigh
Postal / Zip Code
27601
4d. Telephone Number:
[phone]
4f. Email Address:*
[e-mail]
Agent Authorization Letter*
03_Agent Authorization Form Guinevere Lane_signed.pdf
State / Province / legion
NC
Country
United States
3e. Fax Number:
State / Province / legion
NC
Country
United States
4e. Fax Number:
230.44KB
C. Project Information and Prior Project History C^U
1. Project Information
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/ town:
Winston-Salem
2. Project Identification
2a. Property Identification Number:
6815-26-7211.00 / 6815-26-5117.00
2c. Project Address
Street Address
3765 / 3795 Guinevere Ln
Address tine 2
city
Winston-Salem
Postal / Zip Code
27104
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Silas Creek
2b. Property size:
1.74
State / Province / Region
NC
Country
United States
3b. Water Resources Classification of nearest receiving water:*
C

3c. What river basin(s) is your project located in?*
Yadkin-PeeDee
3d. Please provide the 12-digit HUC in which the project is located.
030401011306
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:*
The project is located in a residential neighborhood on the nest side of Winston-Salem. Currently, the existing sewer aerial crossing and manhole have been undermined due to the
stream system and storm drainage. The drainage is located between two residential parcels. Land use is maintained lawn with trees along the edges of the yards. It is piped upstream of
the project area through a 48" RCP and downstream by a 48" CMP. The existing stream in incised and actively eroding in the area between the two existing pipes.
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)
Guinevere_usgs_topo.pdf 1.34MB
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)
Guinevere_soils.pdf 1.98MB
4f. List the total estimated acreage of all existing wetlands on the property:
0
4g. List the total estimated linear feet of all existing streams on the property:
58
4h. Explain the purpose of the proposed project:*
The purpose of the project is to replace the existing sewer aerial crossing and manhole that's been undermined due to the stream and storm drainage system. The open section of the
stream has major erosion issues, is extremely incised, appears to be actively downcutting and has put the existing sewer system in danger of failing and the existing aerial sewer
crossing pipe is currently holding the manhole up since the stream has scoured out the area around and underneath the manhole.
41. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
The proposed project includes converting the 58' section of the stream to a piped system to minimize future erosion, downcutting, sedimentation of the stream and potential failure of
the sewer system in this area. Following installation of the pipe in the stream, the manhole will be replaced and the aerial crossing will be buried. The design incorporates a junction box
to help dissipate energy at the outlet of the 48" RCP where there is currently a significant drop and then the pipe will be at a flattened slope to tie to the existing downstream 48" CMP.
Standard construction equipment will be used, such as excavators, backhoes, hauling trucks, etc.
4j. Please upload project drawings for the proposed project.
2020-02-13_Guienevere_Sewer_Rehab_Plans_Progress.pdf 6.73MB
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes r No r Unknown
Comments:
Corp field reviewed the stream on March 13, 2020.
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
r Preliminary r Approved r Not Verified r Unknown r N/A
Corps AID Number:
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Vickie Miller
Agency/Consultant Company: HDR
Other:
5d1. Jurisdictional determination upload
USACE_Approval_Email_ from _BRR.pdf 387.6KB
6. Future Project Plans
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?
D. Proposed Impacts Inventory

1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
r Wetlands W Streams -tributaries
r Open Waters r Pond Construction
3. Stream Impacts
r Buffers
3a. Reason for impact (?) 3b.lmpact type * 3c. Type of impact* 3d. S. name * 3e. Stream Type* :1 3f. Type ofwidth * 3h. Impact
(?) Jurisdiction* length*
" S1
48RCP Permanent Culvert UT to Silas Creek Perennial Both 8 58 Average (feet) (lir�rfeel)
31. Total jurisdictional ditch impact in square feet:
0
31. Total permanent stream impacts:
58
31. Total stream and ditch impacts:
58
3j. Comments:
31. Total temporary stream impacts:
0
E. Impact Justification and Mitigation U
1. Avoidance and Minimization
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
Options such as bank stabilization, laying back slopes, and gabion walls were considered for the project but were not feasible due to the current
conditions and significant impacts to adjacent landowners. The high velocity of the system would likely render any option temporary, apart from piping.
To reduce the flow velocity, a junction box will also be installed at the outlet of the existing pipe and the new pipe will be flattened to join the existing
downstream pipe.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
During construction, a pump around will be used to avoid working in the channel. Also, BMPs like temporary fabric drop inlets, silt fences, a temporary
gravel construction exit pad, and tree protection will also be used to avoid impacts.
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 r No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
Mitigation for the project was not required by Bryan Roden -Reynolds (USAGE) as he stated that piping the stream will provide functional uplift due to the amount of erosion and
sedimentation currently occurring and the condition of the existing stream.
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?
r Yes r No
If no, explain why:
The project is replacement of an underground utility and will not create any concentrated flows.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
r' Yes r No
2b. Does this project meet the requirements for low density projects as defined in 15ANCAC 02H .1003(2)?
r Yes r No
Comments:
G. Supplementary Information
U
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)? *
r Yes r No
Comments:
The project is funded by revenue collected for utility service and does not exceed SEPA thresholds for preparation of an environmental document.
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)? *
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.
Land surrounding the project has already been developed.
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 any trees 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
5h. Does this project involve the construction/installation of a wind turbine(s)?*
r Yes r No
Si. 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?
A site visit was conducted to survey for federally protected species habitat. HDR consulted USFWS's IPaC site for an Official Species List (attached).
No suitable habitat for the bald eagle, bog turtle, or small-anthered bittercress occurs in the project area. Northern Long-eared Bat habitat is present
in the form of trees for roosting. However, the project complies with the Endangered Species Act 4(d) rule. Forsyth County contains no watershed
Mere hibernacula and maternity roost trees are known to occur.
Consultation Documentation Upload
Species List Asheville Ecological Services Field Office.pdf 706.13KB
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 Fisheries Essential Fish Habitat Mapper
hftps://wmAf.habitat.noaa.gov/application/efhniapper/indexhtml

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? *
HDR reviewed the North Carolina State Historic Preservation Office (HPO) GIS database (http://gis.ncdcr.gov/hpoweb/) and found no known historic
structures located within the project area, however, the Westview Historic District is approximately 0.75 miles away. The Westview Historic District is on
the NC HPO Study List.
7c. Historic or Prehistoric Information Upload
Guinevere_historic.pdf 1.03MB
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?*
North Carolina Flood Risk Information System (FRIS)
https://fris. nc.gov/fris/HDme.aspx?ST=NC
Miscellaneous
Comments
Photos of the site are also attached to illustrate the existing pipe outlet, existing inlet and the erosion and undercutting of the existing manhole.
Miscellaneous attachments not previously requested.
G u i n eve re_p i ctu re s_fo r_PC N. p d f
Signature
W By checking the box and signing below, I certify that:
540.35KB
• 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 AGC);
• 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:
Vickie Miller
Signature
Date
3/24/2020
v

AGENT CERTIFICATION OF AUTHORIZATION
I, Hsiang-Yu Chou-Hoofman, representing Winston-Salem/Forsyth County Utilities
hereby certify that I have authorized Vickie Miller of HDR to act on my behalf and take
all actions necessary to the processing, issuance, and acceptance of this request for
wetlands and stream determination / permitting and any and all standard and special
conditions attached.
We hereby certify that the above information submitted in this application is true and
accurate to the best of our knowledge.
________________________
Applicant’s signature Agent’s signature
________________________
Date Date
Completion of this form will allow the agent to sign all future application correspondence.
Copyright:© 2013 National Geographic Society, i-cubed
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Study List

Existing Pipe Outlet

Existing Inlet

Undercutting of Existing Manhole