20191469 Ver 2_Submitted PCN Form_20200813

DWR
MOM— of Ware, Resources
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
September 29, 2018 Ver 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://ed oes.deq. ne.g ov/WaterReso u rces/0/edoe/624704/PCN % 2OHelp / 20F i le / 202018-1-30. pdf
A. Processing Information 6
............................................................................................................................................................................................................................................................................................................................................................................
County (or Counties) where the project is located:*
Forsyth
Is this project a public transportation project? *
C' Yes C-' No
This is any publicly funded by mnicipai,state a federal funds road, rail, airport transportation project.
la. Type(s) of approval sought from the Corps:*
W Section 404 Permit (wetlands, streams and waters, Clean Water Act)
rI Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1 b. What type(s) of permit(s) do you wish to seek authorization?*
P Nationwide Permit (NWP)
❑ Regional General Permit (RGP)
❑ Standard (IP)
This form may be used to initiate the standard/individual permit process with the Corps. Please contact your Corps representative concerning submittals for standard permits. All required items that
are not provided in the E-PCN can be added to the miscellaneous upload area located at the bottom of this form.
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):
List all MNnurbers you are applying for not on the drop down list.
1d. Type(s) of approval sought from the DWR:*
check ail that apply
401 Water Quality Certification - Regular
❑ Non-404 Jurisdictional General Permit
❑ Individual Permit
39 - Commercial/Institutional Developments
le. Is this notification solelyfor the record because written approval is not required?
❑ 401 Water Quality Certification - E)press
❑ Riparian Buffer Authorization
*
For the record only for DWR401 Certification: Q Yes O No
Forthe record onlyfor Corps Permit: Q Yes O No
1f. Is this an after -the -fact permit application?*
I- Yes 6 No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
If so, attach the acceptance letter from rritgatm bark a in -lieu fee program
C- Yes r No
Acceptance Letter Attachment
Oickthe upload bdtm a drag and drop files here to attach document
FILETYFEMJSTBEFCF
1h. Is the project located in anyof NC's twentycoastal counties?*

r Yes
R No
1j. Is the project located in a designated trout watershed?*
r Yes 6 No
Link to trout information: http://www.saw.usace.army.miI/Missions/Regulatory-Permit-ProgranVAgeney-Coordination/Trout.aspx
B. Applicant Information V
la. Who isthe Primary Contact?*
Walter Cole
1c. Primary Contact Phone:*
1b. Primary Contact Email:* (xxx)xxx-xxxx
[e-mail] [phone]
1d. Who is applying for the permit?*
rJ Owner ❑ Applicant (other than owner)
(Check all that apply)
1e. Is there an Agent/Consultant for this project?
OYes 0No
2. Owner Information
2a. Name(s) on recorded deed:*
Winston- Salem Forsyth County Schools
2b. Deed book and page no.:
2c. Responsible party:
(for Corporatons)
Colon Moore
2d. Address*
SIreet Address
475 Corporate Square Drive
Address Line 2
Oty
Slate / province / Pegcn
Winston-Salem
NC
Postal / Zip Code
Country
27105
USA
2e. Telephone Number:*
(xxx)xxx-xxxx
[phone]
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
wcmoore@wsfcs. k12. nc. us
4. Agent/Consultant (if applicable)
4a. Name:*
Walter Cole
4b. Business Name:
(d applicable)
SRME, Inc
4c. Address*
Street Address
3201 Spring Forest Road
Address Line 2
Oty
Slate / province / Pegcn
Raleigh
NC
Postal / Zip Code
Country
27616
USA
4d. Telephone Number:*
[phone] 4e. Fax Number:
(xxx)xxx-xxxx (xxx)xxx-xxxx
4f. Email Address:*
[e-mail]

Agent Authorization Letter*
Rease provide the Agent Authorization Letter if you are srbrnthng this doament.
Agent Authorization_SIGNED.pdf
FiLETYFE MJST BE RDF
393.87KB
C. Project Information and Prior Project History C�
1. Project Information L}
la. Name of project:*
Lewisville Middle School
1b. Subdivision name:
(d appropriate)
1c. Nearest municipality/town:*
Lewisville
2. Project Identification �}
2a. Property Identification Number:
(tax RN a parcel ID)
2b. Property size:
5886-75-4031, 5886-75-1433, 5886-54-9930,
(in acres)
5886-75-3433, 5886-75-4443, 5886-54-2433
79.17
2c. Project Address
SIreet Address
1115 Lewisvile-Vienna Road
Address Line 2
city
State / province / Pegm
Lewisville
NC
Postal / Zip Code
Country
27023
US
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 howthe 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:*
36.11918-80.39688
ex: 34.208504-77.796371
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
Surface Water Lookup
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
River Basin Lookup
4. Project Description and History
4a. Describe the existing conditions on the site and the general land use in the vicinityof the project at the time of this application:*
The existing site is primarily wooded with some rural residential structures. The vicinity is primarily residential, undeveloped, or agricultural.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
r Yes F 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)
ciickthe upload bdtm a drag and drop files here to attach dmurrent
USGS.pdf 1.32MB
File type must be pdF

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)
Click the upload b ltm a drag and drop files here to attach dmurrent
SOILS.pdf 1.89MB
File type must be pdr
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:
(intermittent and perennial)
5650
4h. Explain the purpose of the proposed project:*
The purpose of the proposed project is to accommodate the overflow of students within the epsting local school district. These epsting facilties are currently using pods and mobile
classrooms to expand their capacity. As of August 2016, the county had nearly 3,000 more middle school students than they had available seats in brick and mortar school buildings.
The proposed school has a planned capacity of approximately 800 students and is being constructed to help alleviate the overflow of students currently being served in pods and
mobile classrooms.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
The overall project will involve the construction of a school (approx. 65,760 square feet) and its associated athletic fields, site access and parking areas, landscaping, lighting,
stormwater management facilities, and utilities. There will be no specialized equipment not commonly seen on construction sites used for the construction of this project.
4j. Please upload project drawings for the proposed project.
Oickthe upload b ltm a drag and drop files hereto attach dmurrent
2019-09-19 Lewisville MS Plans.pdf 17.45MB
File type must be pdr
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:
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:
Exanple: SAW-2017-99999
SAW-2018-01516
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Michael Brame
Agency/Consultant Company: Pilot Environmental
Other:
5d. List the dates of the Corp jurisdiction determination or State determination if a determination was made bythe Corps or DWR.
Site visit conducted on Dec. 7, 2017 with Michael Brame (Pilot Environmental), Bryan Roden -Reynolds (USACE), and Sue Homewood (NCDWR). Preliminary Jurisdictional Determination
issued by Bryan Roden -Reynolds on August 1, 2018.
5d1. Jurisdictional determination upload
Oickthe upload b ltm a drag and drop files here to attach dmurrent
Pilot 3059 - Robin hood Rd USACE JD_08-01-18 .pdf 7.06MB
File type must be FLF
6. Future Project Plans
6a. Is this a phased project?*
r Yes No
Are anyother 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.
No
D. Proposed Impacts Inventory
1. Impacts Summary
la. Where are the impacts associated with your project? (check all that apply):
r Wetlands r Streams -tributaries F 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.

"S." will be used in the table below to represent the word "stream".
F I
3a. Reason for impact*(?)
3b.lmpact type *
3c. Type of impact*
3d. S. name *
3e. Stream Type *
(?)
3f. Type of
Jurisdiction*
3g. S. width *
3h. Impact
length*
S1
Road crossing
9
Permanent
Culvert
S1
Perennial
Corps
p
16
87
Average (feet)
(linear fee[)
gp
Road crossing
Permanent
Rip Rap Fill
S1
Perennial
Corps
16
36
Average (feet)
(linear fee[)
S3
Road Crossing
Temporary
Other
S1
Perennial
Corps
16
10
Average (feet)
(linear fee[)
S4
Road CrossingTem
orar
p Y
Other
S1
Perennial
Corps16
10
Average (feet)
(linear fee[)
** All Perennial or Intermittent streams must be verified by DWR or delegated local government.
3i. Total jurisdictional ditch impact in square feet:
3i. Total permanent stream impacts:
123
3i. Total temporary stream impacts:
20
3i. Total stream and ditch impacts:
143
3j. Comments:
Impacts to the stream are limited to a single stream crossing in which a culvert will be installed. These impacts will cumulatively result in 87 linear feet
of impact by culvert fill, 36 linear feet of keyed -in rip rap fill, and temporarily impact 20 feet by dewatering/pump around during construction. Areas of
temporary impact will be restored to similar pre -construction conditions.
E. Impact Justification and Mitigation CJ
1. Avoidance and Minimization
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
The site was designed to avoid impacts to streams on site with the exception of a single stream crossing required for site access. The access road
was designed to cross the stream at a near perpendicular angle to avoid unnecessary impacts and the crossing was designed in compliance with local
and state regulations regarding school site access.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Specific attention will be paid to ensure grading is only performed to the extent needed for the proposed project and all grading not required will be
avoided. Additional impacts to the jurisdictional stream will be avoided through the use of appropriate sediment and erosion control devices.
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?
C Yes (-- No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
Impacts do not meet thresholds normally required for mitigation.
NC Stream Temperature Classification Maps can be found under the Mitigation Concepts tab on the Wilmington District's RIBITS website.
F. Stormwater Management and Diffuse Flow Plan (required by DWR) C^�
*** Recent changes to the stormwater rules have required updates to this section .***
1. Diffuse Flow Plan
la. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
r Yes c No
For a list of options to meet the diffuse flow requirements, click here.
If no, explain why:
Project is not located within a buffered 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)? *
r Yes 6 No
To lookup low density requirement click here 15A NCAC 02H .1003(2).
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?*
0Yes 0No
Hnt: projects that have vested rights, exerrptions, a grandrathering franstate a locally irgderrented stormater prograrrs a projects that satsfy state a locally-inplerrented stanwater programs 9vwgh use of camurrty in -lieu programs shodd answer no
to this question.
2d. Which of the following stormwater management program(s) apply (check all that apply):*
P Local Government rJ State
If you have a kcal governrrent appro al please include the SlvPon their o erall irrpact rrep.
Local Government Stormwater Programs*
rJ Phase II r NSW
r USMP r Water Supply
Please identifywhich local government stormwater program you are using.*
Town of Lewisville
State Stormwater Programs*
rJ Phase II
r" HWQ or ORW
r Coastal Counties
r Other
Comments:
The stormwater plan will be submitted to the Town of Lewisville and NC DEC for approval. The proposed stormwater control measure locations are depicted on the included site plans.
G. Supplementary Information U
1. Environmental Documentation
la. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
I- 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)?*
r Yes (-- 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.
The proposed project is anticipated to relieve the overpopulation of existing school facilities and additional development is not anticipated as a result
of this project.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
r Yes f No r N/A
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.
Sewage generated by this project will be treated by existing infrastructure by the Winston-SalerrdForsyth County utilities.
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?*
0- 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 F 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?*
0Yes ONo
Link to the NLEB SLOPES document: http://saw-reg.usace.army.mil/NLEB/1�30-17-signed_ NLEBSLOPESRapps.pdf
5h. Does this project involve the construction/installation of a wind turbine(s)?'*
C Yes C 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.?*
0Yes 0No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
The USFWS Information for Planning and Consultation (IPaC) online tool (https://ecos.fvs.gov/ipac/) and the NC Natural Heritage Program's Data
E)plorer environmental review (https://nenhde.natureserve.org/).
Consultation Documentation Upload
Oickthe upload b ttm a drag and drop files here to attach dccurrent
IPaC Report.pdf 412.62KB
NCNHP Report.pdf 913.8KB
File type must be FCF
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?
C- Yes 6 No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
The USFWS website http:mm.fas.gov/Raleigh including IPaC, NC Natural Heritage Program's online database (https://nenhde.natureserve.org/) and
the Essential Fish Habitat Mapper on the NOAA Habitat Conservation Website.
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data: http://gis.neder.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)?*
r Yes r• No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
Reviewofthe historic properties on the North Carolina State Historic Preservation Office Geographic Information Systems (GIS) Virtual Workroom
(Fktp://gis.neder.gov/hpoweb/) did not reveal any historic properties in the project area.
7c. Historic or Prehistoric Information Upload
Click the upload b ttm a drag and drop files here to attach dmurrent
SHPO.pdf 2.5MB
File crust be FDF
8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https://rrse.ferna.gov/portal/search
8a. Will this project occur in a FEMA-designated 100-year floodplain?
r Yes 6 No
8c. What source(s) did you use to make the floodplain determination?*
The eastern portion of the property is located within the 100-year floodplain. However, all construction within the floodplain will be avoided and no
impacts to the floodplain are anticipated as a result of this project. Sources include the project engineer and the site specific FEMAfirmette.
Miscellaneous tV
Comments
Miscellaneous attachments not previously requested.
Oickthe upload b ttm a drag and drop files here to attach dmurrent
2019-09-19 Lewisville MS Plans.pdf
17.45MB
Impact Exhibits.pdf 30.12MB
File crust be FDF a KvI7
Signature
By checking the boxand 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
Date
10/25/2019