20201640 Ver 1_401 Application_20201202

I I DWR
Division 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?*
6 Yes
✓ No
Is this project a public transportation project?*
0 Yes r No
Change only if needed.
BIMS#Assigned* Version#*
20201640 1
Is a payment required for this project?*
✓ No payment required Reviewing Office*
6 Fee received Winston-Salem Regional Office-(336)776-
✓ Fee needed-send electronic notification 9800
Select Project Reviewer*
Dave Wanucha:eads\djwanucha
Information for Initial Review
1a.Name of project:
Structure 40 2112 over UT to Reedy Fork on SR 2735(Sockwell Rd)
1a.Who is the Primary Contact?*
NCDOT Division 7 Division Engineer,Mr.Wright R.Archer III,PE
lb.Primary Contact Email:* 1c.Primary Contact Phone:*
[e-mail] [phone]
Date Submitted
12/2/2020
Nearest Body of Water
UT to Reedy Fork
Basin
Cape Fear
Water Classification
16-11-(9);WS-V;NSW;HUC 030300020108
Site Coordinates
Latitude: Longitude:
36.174176 -79.551361
A. Processing Information U
County(or Counties)where the project is located:
Guilford
Is this a NCDMS Project
✓ Yes G No
Is this project a public transportation project?*
6 Yes r No
Is this a NCDOT Project?*
6 Yes r No
(NCDOT only)T.I.P.or state project number:

WBS#(?)
17BP.7.C.17
1a.Type(s)of approval sought from the Corps:
I7 Section 404 Permit(wetlands,streams and waters,Clean Water Act)
r Section 10 Permit(navigable waters,tidal waters,Rivers and Harbors Act)
lb.What type(s)of permit(s)do you wish to seek authorization?
I7 Nationwide Permit(NWP)
r Regional General Permit(RGP)
r Standard(IP)
1c.Has the NWP or GP number been verified by the Corps?
s Yes r No
Nationwide Permit(NWP)Number: 14-Linear transportation
NWP Numbers(for multiple NWPS):
Id.Type(s)of approval sought from the DWR:
fJ 401 Water Quality Certification-Regular r 401 Water Quality Certification-Express
✓Non-404 Jurisdictional General Permit 17 Riparian Buffer Authorization
✓ Individual Permit
le.Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification: r Yes 6 No
For the record only for Corps Permit: r Yes R No
1f.Is this an after-the-fact permit application?*
✓ Yes 0No
1g.Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
✓ Yes r No
1g.Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
✓ Yes rNo
Acceptance Letter Attachment
SR 2735-Bridge 40 Revised-Division 7-STR-Buffer(Haw)-CF 02(Agony Acres).pdf 81.53KB
Ih.Is the project located in any of NC's twenty coastal counties?
✓ Yes 0' No
1j.Is the project located in a designated trout watershed?
✓ Yes f No
B. Applicant Information U
1d.Who is applying for the permit?
r Owner fJ Applicant(other than owner)
1e.Is there an Agent/Consultant for this project?*
✓ Yes G No
2.Owner Information
2a.Name(s)on recorded deed:
NC Department of Transportation
2b.Deed book and page no.:
N/A
2c.Responsible party:
2d.Address
Street Address
PO Box 14996
Address Line 2
qty State/Bovine/F?rggion
Greensboro NC
Postal/Zip axle Country
27415 USA

2e.Telephone Number: 2f.Fax Number:
[phone] [phone]
2g.Email Address:*
[e-mail]
3.Applicant Information(if different from owner)
3a.Name:
NCDOT Division 7 Division Engineer,Mr.Mike Mills,PE
3b.Business Name:
3c.Address
Street Address
PO Box 14996
Address Line 2
Oty State/Bovine/Ragion
Greensboro NC
Postal/Zip Code Country
27415 USA
3d.Telephone Number: 3e.Fax Number:
[phone] [phone]
3f.Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
lb.Subdivision name:
(if appropriate)
1c.Nearest municipality/town:
Altamahaw
2. Project Identification
2a.Property Identification Number: 2b.Property size:
N/A N/A
2c.Project Address
Street Address
Address Line 2
(Sty State/Bovine/Region
Foetal/Zip Code Country
3.Surface Waters
3a.Name of the nearest body of water to proposed project:*
UT to Reedy Fork
3b.Water Resources Classification of nearest receiving water:*
16-11-(9);WS-V;NSW;HUC 030300020108
3c. What river basin(s)is your project located in?*
Cape Fear
3d.Please provide the 12-digit HUC in which the project is located.
030300020108
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 area is a mix of undisturbed forested areas,maintained lawns and residences,pasture,and agricultural land.Additionally,the northern portion of the project encroaches
onto an existing Department of Mitigation Services(DMS)conservation easement.
4b.Have Corps permits or DWR certifications been obtained for this project(including all prior phases)in the past?*
r Yes G 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)

Pipe 40 2112 Guilford USGS Map.pdf 2.4MB
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)
Pipe 40 2112 Guilford Soil Map.pdf 2.16MB
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:
-120 LF in the project area
4h.Explain the purpose of the proposed project:*
The proposed project is to replace an existing,failing tile arch culvert.
4i.Describe the overall project in detail,including indirect impacts and the type of equipment to be used:*
Traffic will be detoured off-site.Erosion and sedimentation control measures will be installed.The proposed structure will be replaced on its existing alignment.The project proposes 39
linear feet of permanent stream impact associated with bank stabilization and the culvert and 21 linear feet of temporary impact associated with construction activities.Impervious dikes
will be utilized to remove the existing tile arch culvert,install the proposed culvert,and install the bank stabilization in the dry.Equipment to be used includes a track hoe,dump truck,
paving equipment and various hand tools.
4j.Please upload project drawings for the proposed project.
C.17_Permit Drawings_20180515.pdf 1.82MB
C.17_EC and Construction Seq.pdf 1.56MB
5.Jurisdictional Determinations
5a.Have the wetlands or streams been delineated on the property or proposed impact areas?*
6 Yes r No C Unknown
Comments:
5b.If the Corps made a jurisdictional determination,what type of determination was made?*
r Preliminary r Approved r Not Verified a Unknown r N/A
Corps AID Number:
5c.If 5a is yes,who delineated the jurisdictional areas?
...............
Name(if known):
Agency/Consultant Company:
Other:
5d1.Jurisdictional determination upload
6. Future Project Plans
6a.Is this a phased project?*
r 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
la.Where are the impacts associated with your project?(check all that apply):
7 Wetlands 17 Streams-tributaries 17 Buffers
I— Open Waters (` 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
(?) Jurisdiction* length*
S1 -L-11+50 to 13+25 Permanent Bank Stabilization UT to Reedy Fork Perennial Both 10 23
Average(feet) (linear feet)
S2 -L-12+50 Permanent Culvert UT to Reedy Fork Perennial Both 10 16
Average(feet) (linear feet)
S3 -L-11+50 to 13+25 Temporary Dewatering UT to Reedy Fork Perennial Both 10 21
Average(feet) (linear feet)

3i.Total jurisdictional ditch impact in square feet:
0
3i.Total permanent stream impacts: 3i.Total temporary stream impacts:
39 21
3i.Total stream and ditch impacts:
60
3j.Comments:
Of the 60 linear feet of stream impact proposed,only 39 linear feet is permanent impact.The remaining 21 linear feet is associated with diking and
dewatering to conduct the work in the dry.
6. Buffer Impacts(for DWR)
6a.Project is in which protect basin(s)?
Check all that apply.
r Neuse r Tar-Pamlico
r Catawba r Randleman
r Goose Creek 17 Jordan Lake
I—Other
6b.Impact Type 6c.Per or Temp 6d.Stream name 6e.Buffer mitigation required? 6f.Zone 1 impact 6g.Zone 2 impact
Road Crossing P LfT to Reedy Fork No 2,874 826
6h. Total buffer impacts:
Zone 1 Zone 2
Total Temporary impacts: 0.00 0.00
Zone 1 Zone 2
Total Permanent impacts: 2,874.00 826.00
Zone 1 Zone 2
Total combined buffer impacts: 2,874.00 826.00
6i.Comments:
The impacts associated with the culvert replacement fall under the"potentially allowable"category per the Jordan Water Supply Buffer Rules Table of
Uses(15A NCAC 02B.0267(9))
Supporting Documentation
C.17_Permit Drawings_20180515.pdf 1.82MB
E. Impact Justification and Mitigation
1.Avoidance and Minimization
la.Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
The proposed project is to remove and replace an existing 6'x4.3'tile arch culvert with an 87"x 67"CAAPA with headwall and armor the stream
banks with rip rap for stabilization.The new culvert is proposed to be buried below stream bed elevation with inlet and outlet sills.Additionally,the
existing roadway fill slopes are steep and unstable.The new fills slopes with be flatter,at 2:1,and grassed.An off-site detour will be employed to avoid
the need for a temporary structure.
lb.Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Erosion and sedimentation BMPs will be installed prior to construction.The outside stream and riparian areas will be noted with highly visible fencing.
Water will be diverted around the work area to prevent sedimentation of downstream aquatic resources.Impacts will be minimized by strict
enforcement of Best Management Practices for the protection of surface waters,restrictions again staging of equipment in or adjacent to waters of the
US and coordination(including a pm-construction meeting)with the Division Environmental Office Supervisor.
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 C No
2c.If yes,mitigation is required by(check all that apply):
I7 DWR fJ Corps
2d.If yes,which mitigation option(s)will be used for this project?
r Mitigation bank fJ Payment to in-lieu fee r Permittee Responsible
program Mitigation

4. Complete if Making a Payment to In-lieu Fee Program
4a.Approval letter from in-lieu fee program is attached.
( Yes r No
4b.Stream mitigation requested:
(linear feet) 4c.If using stream mitigation,what is the stream temperature:
26 warm
4d.Buffer mitigation requested(DWR only): 4e.Riparian wetland mitigation requested:
(square feet) (acres)
1397 0
4f.Non-riparian wetland mitigation requested: 4g.Coastal(tidal)wetland mitigation requested:
(acres) (acres)
0 0
4h.Comments
The proposed project encroaches onto an eadsting DMS mitigation project-Agony Acres.The USACE determined that stream mitigation is required
and there is a loss of enhancement II stream credits from the mitigation project.DMS has committed to implementing sufficient compensatory stream
mitigation credits to offset the impacts associated with the proposed project.
6. Buffer mitigation(State Regulated Riparian Buffer Rules)-required by DWR
6a.Will the project result in an impact within a protected riparian buffer that requires buffer mitigation?If yes,you must fill out this entire form-please contact DWR for more
information.
( Yes r No
6b.If yes,then identify the square feet of impact.
6c.Reason for impact 6d.Total impact Multiplier 6e.Required mitigation
(square feet) (square feet)
Zone 1 Culvert 1,190 1,190
Zone 2 Culvert 207 207
6f.Total buffer mitigation required
1397
6g.If buffer mitigation is required,is payment to a mitigation bank or NC Division of Mitigation Services proposed?
6' Yes r No
6h.Attach the acceptance letter from the mitigation bank or NC Division of Mitigation Services.
SR 2735-Bridge 40 Revised-Division 7-STR-Buffer(Haw)-CF 02(Agony Acres).pdf 81.53KB
6j.Comments:
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
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?
( Yes r No
What type of SCM are you providing?
r Level Spreader
r Vegetated Conveyance(lower SM/Vf)
r Wetland Swale(higher SMNT)
r Other SCM that removes minimum 30%nitrogen
Pi Proposed project will not create concentrated stormwater flow through the buffer
Diffuse Flow Documentation
2.Stormwater Management Plan
2a.Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
0. Yes r No
Comments:

G. Supplementary Information
1. Environmental Documentation
la.Does the project involve an expenditure of public(federal/state/local)funds or the use of public(federal/state)land?*
( Yes No
lb.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(NEPAISEPA)?*
✓ Yes ( No
Comments:*
While this project involves an expenditure of public funds,it does not exceed the thresholds that require NEPA/SEPA documentation preparation.
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?*
r Yes ( No
3b.If you answered"no,"provide a short narrative description.
Per the NC DWQ April 2004 Version 2.1 Cumulative Impacts policy,small scale public transportation projects-such as widening projects,bridge and
culvert replacements,and intersection improvements-have a"low potential for cumulative impact since little(if any)new impervious surface is added
and the projects are usually already in developed locales."This proposed project is within a somewhat developed landscape(i.e.ebsting residences
in the vicinity),this is not a road on a new location(i.e.there is an existing road and culvert structure and thus the area already contains impervious
surfaces)and the project drains to a UT to Reedy Fork,which is Class WS-V;Nutrient Sensitive Waters(NSW),(i.e.not HQW or ORW).We anticipate
the NCDWR will advise us if a qualitative or quantitative analysis is needed.
4.Sewage Disposal(DWR Requirement)
4a.Is sewage disposal required by DWR for this project?*
✓ Yes r No ( 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?*
( Yes r No
5b.Have you checked with the USFWS concerning Endangered Species Act impacts?*
( Yes r No
5c.If yes,indicate the USFWS Field Office you have contacted.
Raleigh
5d.Is another Federal agency involved?*
✓ Yes ( No r Unknown
5e.Is this a DOT project located within Division's 1-8?
( Yes r No
5j.What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
IPaC,NCNHP record review and onsite reconnaissance.HDR/ICA conducted a survey for vegetation-including Isotria medeoloides(Small whorled
pogonia)and Schweinitts Sunflower(Helianthus schweinitai)at the subject site in August 2016.The project site does not provide habitat for either
species.The south side of Sockwell Road is a maintained cattle pasture and the north side is densely vegetated area protected by a conservation
easement related to stream mitigation.The biological conclusion for both species is No Effect.
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 ( No
6b.What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
The project takes place in Guilford County which is not near any coastal habitat that would support EFH(i.e.salt marshes,oyster reefs,etc.).
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?*

6 Yes rNo
7b.What data sources did you use to determine whether your site would impact historic or archeological resources?*
NCDOT Archaeologists reviewed the project study area and conducted file searches at the Office of State Archaeology in January 2016.NCDOT
Architectural Historians reviewed the project study area and conducted reviews of HPO's maps and the HPOWEB GIS Service in January 2016.
Further consultation with the OSA and HPO concluded that the project would have an Adverse Effect on the existing tile arch culvert.Due to the safety
concerns associated with the existing tile arch culvert,the project was approved to proceed following the Memorandum of Agreement among the
USACE,NCSHPO,and NCDOT.
7c.Historic or Prehistoric Information Upload
15-12-0009SignedEffectsConcurrenceForm.pdf 6.57MB
Archaeological ADVERSE EFFECT SR 2735 Pipe Guilford Adverse Effects F....pdf 2.02MB
20200423 ACHP Response Letter.pdf 195.51 KB
SAW-2019-01495 MOA.pdf 863.43KB
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?*
FEMA Floodplain Mapper;FRIS Maps
Miscellaneous
Comments
Due to the encroachment into the DMS Agony Acres Mitigation Site(which is a mitigation site intended for NCDOT use but has not been released for credits yet),NCDOT coordinated
with the Office of State Property and DMS to adjust the conservation easement as required.The area in question has been removed from the mitigation site,the Conservation
Easement has been re-recorded with the NCDOT PDE in place and NCDOT is proposing to mitigate for the lost stream and buffer credits from Agony Acres.Attached to this application
are the original CE,the re-recorded CE and a PDF demonstrating the lost credits.
Miscellaneous attachments not previously requested.
17bp.7.C.17_HYD_SMP_10022018.pdf 44.27KB
Agony Acres mitigation project.pdf 714.54KB
PB 202 PG 121 Conservation Easement.pdf 417.32KB
Sockwell Rd CE Overlay with DOT PDE.pdf 2.22MB
Signature
*
E,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:
Mr.Wright R.Archer III,PE
Signature
'Gt{r rPam'i
Date
5/14/2020