20191469 Ver 2_401 Application_20200813

DWR
mrlslon of Water Resources
Pre -Construction Notification (PCN) Form
April 11, 2020 Ver 3.1
Initial Review
Has this project met the requirements for acceptance in to the review process?*
r Yes
r No
Is this project a public transportation project?*
G Yes r No
Change only if needed.
BIMS # Assigned * Version#*
20191469 2
Is a payment required for this project?*
r No payment required What amout is owed?*
r Fee received r $240.00
r Fee needed - send electronic notification IT $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:
Lewisville Middle School
1a. Who is the Primary Contact?*
Ashley Bentz
1b. Primary Contact Email:*
[e-mail]
Date Submitted
8/13/2020
Nearest Body of Water
UT- Tomahawk Creek
Basin
Yadkin -Pee Dee
Water Classification
C
Site Coordinates
Latitude: Longitude:
36.11918-80.39688
A. Processing Information
County (or Counties) where the project is located:
Forsyth
Is this a NCDMS Project
r Yes IT No
Is this project a public transportation project?*
r Yes IT 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)
1c. Primary Contact Phone:*
[phone]
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. 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
39 - Commercial/Institutional Developments
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:
F- 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 r 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 Schools
2b. Deed book and page no.:
2c. Responsible party:
Colon Moore
2d.Address
Street Address
475 Corporate Square Drive
Address Line 2
city
Winston Salem
Postal / Zip Code
27105
2e. Telephone Number:
[phone]
2g. Email Address:*
v,[e-mail]
State / Rovince / Iagion
NC
Country
USA
2f. Fax Number:
r- Yes r No
r Yes r No
4. Agent/Consultant (if applicable)

4a. Name:
Ashley Bentz
4b. Business Name:
S&ME, Inc
4c.Address
Street Address
3201 Spring Forest Road
Address Line 2
City
Raleigh
Postal / Zip Code
27616
4d. Telephone Number:
[phone]
4f. Email Address:*
[e-mail]
Agent Authorization Letter*
Agent Authorization_SIGNED.pdf
State / Province / F bgion
NC
Country
USA
4e. Fax Number:
393.87KB
C. Project Information and Prior Project History C^U
1. Project Information
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/ town:
Lewisville
Project Identification
2a. Property Identification Number:
5886-75-4031, 5886-75-1433, 5886-54-9930,
5886-75-3433, 5886-75-4443, 5886-75-2433
2c. Project Address
Street Address
1115 Lewisville -Vienna Road
Address Line 2
City
Lewisville
Postal / Zip Code
27023
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
UT- Tomahawk Creek
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.
030401011303
4. Project Description and History
2b. Property size:
79.17
State / Province / Region
NC
Country
USA
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:*
See attached for original PCN.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
F Yes f No F Unknown
4c. If yes, please give the DWR Certification number or the Corps Action ID (exp. SAW-0000-00000).
Attached below.
SAW-2018-01516, DWR # 20191469
Project History Upload

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)
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)
4f. List the total estimated acreage of all existing wetlands on the property:
See attached PCN
4g. List the total estimated linear feet of all existing streams on the property:
See attached PCN
4h. Explain the purpose of the proposed project:*
See attached PCN
41. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
See attached PCN
4j. Please upload project drawings for the proposed project
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:
See attached previous PCN
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:
SAW-2018-01516
Sc. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): See attached previous PCN
Agency/Consultant Company:
Other:
5d. List the dates of the Corp jurisdiction determination or State determination if a determination was made bythe Corps or DWR
See attached previous PCN
5d1. Jurisdictional determination upload
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 Buffers
r Open Waters r Pond Construction
3. Stream Impacts
3a. Reason for impact (?)
3b.lmpact type *
3c. Type of impact*
3d. S. name *
3e. Stream Type *
3f. Type of
3g. S. width *
3h. Impact
❑
11 (?)
Jurisdiction*
length*
S1
road crossing
9
Permanent
Culvert
S1
Perennial
Corps
p
16
97
Average (feet)
(lin�rfeet)
$2
road crossing
Permanent
Rip Rap Fill
S1
Perennial
Corps
16
36
Average (feet)
(lirearfeet)
S3
road crossing
Temporary
Other
S1
Perennial
Corps
16
10
Average (feet)
(lin�rfeet)

3i. Total jurisdictional ditch impact in square feet:
0
31. Total permanent stream impacts:
133
3i. Total stream and ditch impacts:
153
31. Total temporary stream impacts:
20
3j. Comments:
Impact S1 for the culvert impact needed to be revised due to an omission by the project engineer to account for the ten feet of permanent impact that
will be required to properly install headwall for the culvert. The length of the culvert is not changing, nor are the 36 linear feet of keyed -in rip rap fill, or
the 20 feet necessary for dewatering and pumping around during constrction.
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:
See attached previous PCN
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
See attached previous PCN
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:
Impacts do not meet thresholds normally required for mitigation.
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:
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
2c. Does this project have a stormwater management plan (SMP) reviewed and approved under a state stormwater program or state -approved local government stormwater
program?
r Yes r No
r NIA- project disturbs < 1 acre
2d. Which of the following stormwater management program(s) apply:
V Local Government R State
Local Government Stormwater Programs
W Phase II C NSW r USMP r Water Supply
Please identify which local government stormwater program you are using.
Town of Lewisville
State Stormwater Programs
W Phase II
r HWQ or ORW
r Coastal Counties
r Other
Comments:
Stormwater plan has been approved by the Town of Lewisville and the NC DEQ. The proposed stormwater control measures are depicted on the previously included site plans.
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)? *
r Yes r No
Comments:*
Project does not meet thresholds for NEPA/ SEPA.
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15ANCAC 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.
See previously written PCN
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
r Yes r Nor WA
4b. Describe, in detail, the treatment methods and dispositions (non -discharge or discharge) of wastewater generated from the proposed project. If the wastewater will be treated
at a treatment plant, list the capacity available at that plant.
See previously written PCN
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
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 anytrees 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
51. 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?
See previously written PCN
Consultation Documentation Upload
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?*
See previously written PCN

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?*
See previously written PCN
7c. Historic or Prehistoric Information Upload
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?*
See previously written PCN
Miscellaneous
Comments
Miscellaneous attachments not previously requested.
20191469 Ver 1_Approval Letter_20191202.pdf 2.81MB
SAW-2018-01516 (signed NWP).pdf 10.59MB
Submitted Pre -Construction Notification (PCN) Form.pdf 127.55KB
Impact Exhibits.pdf 30.32MB
Signature
*
P 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:
Ashley Bentz
Signature
����ff.
Date
8/13/2020
u

AGENT AUTHORIZATION AND RIGHT -OF -ENTRY FORM
Date: L5 I
-9
Project Information
S&ME Project Name: Proposed Lewisville Middle School Site
Type of Project: Institutional
Location: 1115 Lewisville — Vienna Road, Lewisville, Forsyth County, NC
Property Owner/Representative Information
Business Name: Winston-Salem/Forsyth County Board of Education
Mailing Address: 475 Corporate Square Drive
City, State, Zip Code: Winson-Salem, NC 27105
Telephone No. 336-727-2533 ext. 34916
Email Address: [e-mail]
Contact: Colon Moore
Agent Information
Business Name:
S&ME, Inc.
Street Address:
3201 Spring Forest Road
City, State, Zip Code:
Raleigh, NC 27616
Telephone No.
919-872-2660
Contact:
Mr. Walter Cole
Authorization: I �, on behalf
of (Contact.Signature)
Winston- Salem/Forsyth County Board of Education
(Name of Landowner or Representative)
a duly authorized owner of record of the property/ properties identified herein, hereby authorize S&ME to
act as agent with the USCAE in connection with the above -mentioned project. By signing above, I also '
authorize representatives of the Wilmington District, U.S. Army Corps of Engineers (Corps) to enter upon
the property herein described for the purposes of conducting on -site investigations, if necessary, and
issuing a jurisdictional determination pursuant to Section 404 of the Clean Water Act and/or Section 10 of
the River and Harbors Act of 1889. 1, the above signed, am either a duly authorized owner of record of
the property identified herein, or acting as the duly authorized agent of the owner of record of the
property.

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APPLICANT INFORMATION:
OWNER: WINSTON-SALEM FORSYTH COUNTY BOARD OF EDUCATION
OWNER CON TACT.• ATTN: COLON MOORE
475 CORPORATE SQUARE DRIVE
WINSTON-SALEM, NC 27105
PHONE. [phone]
EMAIL: WCMOORE®WSFCS. K12. NC. US
NOTE:
TOTAL WETLANDS ON -SITE. 0.00 ACRES
TOTAL WETLANDS IMPACTED: 0.00 ACRES
TOTAL LINEAR FEET OF STREAM ON -SITE. 3337 LF
TOTAL LINEAR FEET OF STREAM IMPACTED: 153 LF
IMPERVIOUS AREA FOR PROPOSED PROJECT- 8.63 ACRES
THIS PROPERTY IS NOT LOCATED WITHIN SPECIAL FLOOD HAZARD AREAS AS
DETERMINED BY FEMA AND DEPICTED ON FIRM MAP NUMBER 3710588600J DATED
11212009 AS BEING WITHIN ZONE "X-OTHER AREA"
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Piedmont Leaf Lofts
404 East 4th Street,
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Phone [phone] Fax [phone]
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Consultants:
Consultant Name Civil/Structural/MEP
Seal:
CLH DESIGN, P.A.
400 Regency Forest Drive
Suite 120
Cary, North Carolina 27518
Phone: [phone]
Fax: [phone]
LA: C-106, PE: C-1595
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Client:
WINSTON-SALEM FORSYTH
COUNTY SCHOOLS
LEWISVILLE MIDDLE
SCHOOL
Drawing Title:
OVERALL
PROPOSED
CONDITIONS
PLAN
Bid Documents
Issue Date
NOVEMBER 8, 2019
Project Number: Drawn by:
201 7-8 RP/I(L
Drawing Number
400

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APPLICANT INFORMATION:
OWNER: WINSTON-SALEM FORSYTH COUNTY BOARD OF EDUCATION
OWNER CON TACT.• ATTN: COLON MOORE
475 CORPORATE SQUARE DRIVE
WINSTON-SALEM, NC 27105
PHONE [phone]
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Piedmont Leaf Lofts
404 East 4th Street,
Winston-Salem, NC 27101
Phone [phone] Fax [phone]
www.mckissickassociates.com
Consultants:
Consultant Name Civil/Structural/MEP
Seal:
CLH DESIGN, P.A.
400 Regency Forest Drive
Suite 120
Cary, North Carolina 27518
Phone: [phone]
Fax: [phone]
LA: C-108, PE: C-1595
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ISSUE LOG
Distribution Date No.
Client:
WINSTON-SALEM FORSYTH
COUNTY SCHOOLS
LEWISVILLE MIDDLE
SCHOOL
Drawing Title:
OVERALL
EXISTING
CONDITIONS
PLAN
STREAM IMPACT MAPS
Issue Date
OCTOBER 23, 2019
Project Number: Drawn by:
2017-8 RP/KL
Drawing Number
C-2

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