20201640 Ver 1_401 Application_20201202

Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
April 11, 2020 Ver 3.1
1a. Name of proje ct:
1a. Who is the Primary Contact?
1b. Primary Contact Email:1c. Primary Contact Phone :
Site Coordinates
Latitude :Longitude :
County (or Countie s) where the proje ct is locate d:
Ne are st Body of Wate r
Is this a NCDM S Proje ct *
Is this project a public transportation project?
Is this a NCDOT Proje ct?
(NCDOT only) T.I.P. or state proje ct numbe r:
WBS #(?)
1a. Type (s) of approv al sought from the Corps:
1b. What type (s) of pe rmit(s) do you wish to se e k authorization?
1c. Has the NWP or GP numbe r be e n v e rifie d by the Corps?
Nationwide Pe rmit (NWP) Numbe r:
NWP Numbe rs (for multiple NWPS):
1d. Type (s) of approv al sought from the DWR:
1e . Is this notification sole ly for the re cord be cause writte n approv al is not re quire d?
Structure 40 2112 over UT to Reedy Fork on SR 2735 (Sockwell Rd)
NCDOT Division 7 Division Engineer, Mr. Wright R. Archer III, PE
[e-mail] [phone]
36.174176 -79.551361
A. Processing Information
Guilford
Yes No
Yes No
Yes No
17BP.7.C.17
Section 404 Permit (wetlands, streams and waters, Clean Water Act)
Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
Nationwide Permit (NWP)
Regional General Permit (RGP)
Standard (IP)
Yes No
14 - Linear transportation
401 Water Quality Certification - Regular 401 Water Quality Certification - Express
Non-404 Jurisdictional General Permit Riparian Buffer Authorization
Individual Permit
For the re cord only for DWR 401 Ce rtification:
For the re cord only for Corps Pe rmit:
1f. Is this an afte r-the -fact pe rmit application?
1g. Is payme nt into a mitigation bank or in-lie u fe e program propose d for mitigation of impacts?
Acce ptance Le tte r Attachme nt
1h. Is the proje ct locate d in any of NC's twe nty coastal countie s?
1j. Is the proje ct locate d in a de signate d trout wate rshe d?
1d. Who is applying for the pe rmit?
1e . Is the re an Age nt/Consultant for this proje ct?*
2. Owner Information
3. Applicant Information (if different from owner)
Yes No
Yes No
Yes No
Yes No
SR 2735 - Bridge 40 Revised - Division 7 - STR - Buffer (Haw) - CF 02 (Agony Acres).pdf 81.53KB
Yes No
Yes No
B. Applicant Information
Owner Applicant (other than
owner)
Yes No
2a. Name (s) on re corde d de e d:
2b. De e d book and page no.:
2c. Re sponsible party:
2d. Addre ss
2e . Te le phone Numbe r:2f. Fax Numbe r:
2g. Email Addre ss:*
NC Department of Transportation
N/A
City
Greensboro
State / Province / Region
NC
Postal / Zip Code
27415
Country
USA
Street Address
PO Box 14996
Address Line 2
[phone] [phone]
[e-mail]
3a. Name :
3b. Business Name :
3c. Addre ss
3d. Te le phone Numbe r:3e . Fax Numbe r:
3f. Email Addre ss:
NCDOT Division 7 Division Engineer, Mr. Mike Mills, PE
City
Greensboro
State / Province / Region
NC
Postal / Zip Code
27415
Country
USA
Street Address
PO Box 14996
Address Line 2
[phone] [phone]
[e-mail]
1b. Subdivision name :
1c. Ne are st municipality / town:
2a. Prope rty Identification Numbe r:2b. Prope rty size :
2c. Proje ct Addre ss
3. Surface Waters
3a. Name of the ne are st body of wate r to propose d proje ct:
3b. Wate r Re source s Classification of ne are st re ce iv ing wate r:*
3d. Ple ase prov ide the 12-digit HUC in which the proje ct is locate d.
3c. What riv e r basin(s) is your proje ct locate d in?*
4. Project Description and History
4a. De scribe the e xisting conditions on the site and the ge ne ral land use in the v icinity of the proje ct at the time of this application:*
4b. Hav e Corps pe rmits or DWR ce rtifications be e n obtained for this project (including all prior phase s) in the past?*
4d. Attach an 8 1/2 X 11 e xce rpt from the most re ce nt v e rsion of the USGS topographic map indicating the location of the proje ct site . (for DWR)
4e . Attach an 8 1/2 X 11 e xce rpt from the most re ce nt v e rsion of the publishe d County NRCS Soil Surv e y map de picting the proje ct site . (for DWR)
4f. List the total e stimate d acre age of all e xisting we tlands on the prope rty:
4g. List the total e stimate d line ar fe e t of all e xisting stre ams on the prope rty:
4h. Explain the purpose of the propose d proje ct:*
4i. De scribe the ov e rall proje ct in de tail, including indirect impacts and the type of e quipme nt to be use d:*
4j. Ple ase upload proje ct drawings for the propose d proje ct.
5. Jurisdictional Determinations
5a. Hav e the we tlands or streams be e n de line ate d on the prope rty or propose d impact are as?*
Comme nts:
C. Project I nformation and Prior Project History
1. Project Information
(if appropriate)
Altamahaw
2. Project Identification
N/A N/A
City State / Province / Region
Postal / Zip Code Country
Street Address
Address Line 2
UT to Reedy Fork
16-11-(9); WS-V; NSW; HUC 030300020108
030300020108
Cape Fear
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.
Yes No Unknown
Pipe 40 2112 Guilford USGS Map.pdf 2.4MB
Pipe 40 2112 Guilford Soil Map.pdf 2.16MB
0.0
~ 120 LF in the project area
The proposed project is to replace an existing, failing tile arch culvert.
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.
C.17_Permit Drawings_20180515.pdf 1.82MB
C.17_EC and Construction Seq.pdf 1.56MB
Yes No Unknown
5b. If the Corps made a jurisdictional de te rmination, what type of de te rmination was made ?*
Corps AID Numbe r:
5c. If 5a is ye s, who de line ate d the jurisdictional are as?
Name (if known):
Age ncy/Consultant Company:
Othe r:
5d1. Jurisdictional de te rmination upload
6. Future Project Plans
6a. Is this a phase d proje ct?*
Are any othe r NWP(s), re gional ge ne ral pe rmit(s), or indiv idual pe rmits(s) use d, or intende d to be use d, to authorize any part of the propose d project or re lated activ ity?
1. Impacts Summary
1a. Whe re are the impacts associate d with your proje ct? (che ck all that apply):
3. Stream Impacts
3a. Reason for impact *(?)3b.Impact type *3c. Type of impact *3d. S. name *3e . Stre am Type *
(?)
3f. Type of
Jurisdiction *
3g. S. width *3h. Impact
le ngth *
S1
S2
S3
3i. Total jurisdictional ditch impact in square fe e t:
3i. Total pe rmane nt stre am impacts:3i. Total te mporary stre am impacts:
3i. Total stre am and ditch impacts:
3j. Comme nts:
6. Buffer Impacts (for DWR)
6a. Proje ct is in which prote ct basin(s)?
6b. Impact Type 6c. Pe r or Te mp 6d. Stre am name 6e . Buffer mitigation re quire d?6f. Zone 1 impact 6g. Zone 2 impact
6h. Total buffe r impacts:
Preliminary Approved Not Verified Unknown N/A
Yes No
D. Proposed Impacts Inventory
Wetlands Streams-tributaries Buffers
Open Waters Pond Construction
-L- 11+50 to 13+25 Permanent Bank Stabilization UT to Reedy Fork Perennial Both 10
Average (feet)
23
(linear feet)
-L- 12+50 Permanent Culvert UT to Reedy Fork Perennial Both 10
Average (feet)
16
(linear feet)
-L- 11+50 to 13+25 Temporary Dewatering UT to Reedy Fork Perennial Both 10
Average (feet)
21
(linear feet)
0
39 21
60
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.
Check all that apply.
Neuse Tar-Pamlico
Catawba Randleman
Goose Creek Jordan Lake
Other
Road Crossing P UT to Reedy Fork No 2,874 826
Zone 1 Zone 2
Total Te mporary impacts:
Zone 1 Zone 2
Total Pe rmane nt impacts:
Zone 1 Zone 2
Total combine d buffe r impacts:
6i. Comme nts:
Supporting Docume ntation
1. Avoidance and Minimization
1a. Spe cifically de scribe me asure s take n to av oid or minimize the propose d impacts in de signing the proje ct:
1b. Spe cifically de scribe me asure s take n to av oid or minimize the propose d impacts through construction te chnique s:
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Doe s the proje ct re quire Compe nsatory M itigation for impacts to Wate rs of the U.S. or Wate rs of the State ?
2c. If ye s, mitigation is re quire d by (che ck all that apply):
2d. If ye s, which mitigation option(s) will be use d for this proje ct?
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approv al le tte r from in-lie u fe e program is attache d.
4b. Stre am mitigation re que ste d:
4c. If using stre am mitigation, what is the stre am te mpe rature :
4d. Buffe r mitigation re que ste d (DWR only):4e . Riparian we tland mitigation re que ste d:
4f. Non-riparian we tland mitigation re que ste d:4g. Coastal (tidal) we tland mitigation re que ste d:
4h. Comme nts
6. Buffer mitigation (State Regulated Riparian Buffer Rules) - required by DWR
6a. Will the proje ct re sult in an impact within a prote cte d riparian buffe r that re quire s buffe r mitigation? If ye s, you must fill out this e ntire form - ple ase contact DWR for more
information.
0.00 0.00
2,874.00 826.00
2,874.00 826.00
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)}
C.17_Permit Drawings_20180515.pdf 1.82MB
E. Impact Justification and Mitigation
The proposed project is to remove and replace an existing 6' x 4.3' 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.
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 pre-construction meeting) with the Division Environmental Office Supervisor.
Yes No
DWR Corps
Mitigation bank Payment to in-lieu fee
program
Permittee Responsible
Mitigation
Yes No
(linear feet)
26 warm
(square feet)
1397
(acres)
0
(acres)
0
(acres)
0
The proposed project encroaches onto an existing 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.
Yes No
6b. If ye s, the n ide ntify the square fe e t of impact.
6c. Re ason for impact 6d. Total impact
(square fe e t)
M ultiplie r 6e . Re quire d mitigation
(square fe e t)
Zone 1
Zone 2
6f. Total buffe r mitigation re quire d
6g. If buffe r mitigation is re quire d, is payme nt to a mitigation bank or NC Div ision of M itigation Se rv ice s propose d?
6h. Attach the acce ptance le tte r from the mitigation bank or NC Div ision of M itigation Se rv ice s.
6j. Comme nts:
1. Diffuse Flow Plan
1a. Doe s the proje ct include or is it adjace nt to prote cte d riparian buffers ide ntifie d within one of the NC Riparian Buffe r Prote ction Rule s?
What type of SCM are you prov iding?
Diffuse Flow Docume ntation
2. Stormw ater Management Plan
2a. Is this a NCDOT proje ct subje ct to compliance with NCDOT’s Indiv idual NPDES pe rmit NCS000250?*
Comme nts:
1. Environmental Documentation
1a. Doe s the proje ct inv olv e an e xpe nditure of public (fe de ral/state /local) funds or the use of public (fe de ral/state ) land?*
1b. If you answe re d “ye s” to the abov e , doe s the proje ct re quire pre paration of an e nv ironme ntal docume nt pursuant to the re quireme nts of the National or State (North Carolina)
Env ironme ntal Policy Act (NEPA/SEPA)?*
Comme nts:*
2. Violations (DWR Requirement)
2a. Is the site in v iolation of DWR Wate r Quality Ce rtification Rule s (15A NCAC 2H .0500), Isolate d We tland Rule s (15A NCAC 2H .1300), or DWR Surface Wate r or We tland Standards or
Riparian Buffe r Rule s (15A NCAC 2B .0200)?*
3. Cumulative Impacts (DWR Requirement)
3a. Will this proje ct re sult in additional de v e lopme nt, which could impact ne arby downstre am wate r quality?*
Culvert 1,190 1,190
Culvert 207 207
1397
Yes No
SR 2735 - Bridge 40 Revised - Division 7 - STR - Buffer (Haw) - CF 02 (Agony Acres).pdf 81.53KB
F. Stormwater M anagement and Diffuse Flow Plan (required by DWR)
Yes No
Level Spreader
Vegetated Conveyance (lower SHWT)
Wetland Swale (higher SHWT)
Other SCM that removes minimum 30% nitrogen
Proposed project will not create concentrated stormwater flow through the buffer
Yes No
G. Supplementary Information
Yes No
Yes No
While this project involves an expenditure of public funds, it does not exceed the thresholds that require NEPA/SEPA documentation preparation.
Yes No
Yes No
3b. If you answe re d “no,” prov ide a short narrativ e de scription.
4. Sewage Disposal (DWR Requirement)
4a. Is se wage disposal re quire d by DWR for this proje ct?*
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this proje ct occur in or ne ar an are a with fe de rally prote cte d spe cie s or habitat?*
5b. Hav e you che cke d with the USFWS conce rning Endange re d Spe cie s Act impacts?*
5c. If ye s, indicate the USFWS Fie ld Office you hav e contacte d.
5d. Is anothe r Fe de ral age ncy inv olv e d?*
5e . Is this a DOT proje ct locate d within Div ision's 1-8?
5j. What data source s did you use to de te rmine whe the r your site would impact Endange re d Spe cie s or De signate d Critical Habitat?*
Consultation Docume ntation Upload
6. Essential Fish Habitat (Corps Requirement)
6a. Will this proje ct occur in or ne ar an are a de signate d as an Esse ntial Fish Habitat?*
6b. What data source s did you use to de te rmine whe the r your site would impact an Esse ntial Fish Habitat?*
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this proje ct occur in or ne ar an are a that the state , fe de ral or tribal gov e rnme nts hav e de signate d as hav ing historic or cultural pre se rv ation status?*
7b. What data source s did you use to de te rmine whe the r your site would impact historic or arche ological re source s?*
7c. Historic or Pre historic Information Upload
8. Flood Zone Designation (Corps Requirement)
8a. Will this proje ct occur in a FEM A-designate d 100-ye ar floodplain?*
8c. What source (s) did you use to make the floodplain de te rmination?*
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. existing 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.
Yes No N/A
Yes No
Yes No
Raleigh
Yes No Unknown
Yes No
IPaC, NCNHP record review and onsite reconnaissance. HDR/ICA conducted a survey for vegetation - including Isotria medeoloides (Small whorled
pogonia) and Schweinitz’s Sunflower (Helianthus schweinitzii) 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.
Yes No
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.).
Yes No
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.
15-12-0009SignedEffectsConcurrenceForm.pdf 6.57MB
Archaeological ADVERSE EFFECT SR 2735 Pipe Guilford Adverse Effects F....pdf 2.02MB
20200423 ACHP Response Letter.pdf 195.51KB
SAW-2019-01495 MOA.pdf 863.43KB
Yes No
FEMA Floodplain Mapper; FRIS Maps
M iscellaneous
Comme nts
M isce llane ous attachme nts not pre v iously re que ste d.
*
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 :*
Signature *
Date
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.
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
By checking the box and signing below, I certify that:
Mr. Wright R. Archer III, PE
5/14/2020