20110622 Ver 1_401 Application_20110711

KLE/NFELOER
Bright People. Right Solutions.
June 29, 2011
File No. 118431 1 GS011 L082
Mr: Andrew Williams 210622
Raleigh.Regulatory Field Office U.S. Army Corps of Engineers
3331 Heritage Trade Drive I Suite 105 r?C1/r
Wake Forest, NC 27587
RE: Connector to Bicentennial Greenway JUL 0 1 2011
NCDOT TIP No. EB-5517 oENR - vyq H
East Fork Road and High Point City Lake s Bn
Jamestown, North Carolina
Dear Mr. Williams:
Kleinfelder Southeast, Inc. prepared the attached PCN for a NWP42 and Categorical
Exclusion of the Town of Jamestown, North Carolina. The proposed project includes
construction of a timber pedestrian bridge across the East Fork of the Deep River (High
Point City Lake) adjacent to the NCDOT bridge on East Fork Road and additional
walkway pavement to connect pedestrian ways in town to the Bicentennial Trail.
Impacts to surface waters include thirty-six 12-inch diameter timber piles driven into the
lakebed for structural support at bents 2 through 17. The bridge will span approximately
390 feet of surface water. (station 2+30 to 6+20) with a bridge deck width of 6 feet.
Alternative designs were investigated including a floating, deck, support cantilevered
from the existing roadway bridge, and alternative locations. None of the alternative
design allowed for lesser surface water impacts, except providing structural support
from the existing roadway bridge. Unfortunately, the NCDOT will not approve the
additional loads since the structure was not originally designed for this purpose.
Following review of this submittal, please contact Chris Hay, 336.668.0093, if you have
questions or require additional information.
Sincerely,
KLEINFELLDEER S UTHEAST, INC.
Q3VV"IVY
W. Hay, E.I.
C
Environmental Program
CWH:cas
Attachments: Pre-Construction Notification
Categorical Exclusion
Cc: Matthew Johnson, Town of Jamestown w/att.
NCDENR, DWQ, w/att.
313 Gallimore Dairy Road, Greensboro, NC 27409 p 1336.668.0093 f 1336.668 3868
? j 0622

To complete elec"nically - CLICK box of correct answer.
Use "tab" key to move forward and "shift (ab" to move backward
CATEGORICAL EXCLUSION FORM
ENHANCEMENT PROJECTS
While th s form represents the most common level of environmental documentation required for
Enhancement projects, the environmental impacts may be greater than those typically associated Nvith this
level of analysis. Always bare a gtialrfied professional deterrrne the scope of environmental impacts and
complete the environmental documentation.
General Information
Project Name: Connector to Bicentennial Greenway
TIP Number (E-XXXX): EB-5517
Federal Aid Number:
Project Sponsor: Town of Jamestown
Project Contact
Name: Mr. Matthew Johnson
Telephone: [phone]
E-mail: [e-mail]
iclude project scope and location with map)
See Attachment A
Purpose And Need
See Attachment A
Proposed Improvements
(Provide details attach exhibits as necessary)
See Attachment A
Special Information
(Include environmental commitments permits)
See Attachment B
Note: This document will be reviewed by the NCDOT and by FHlf1A
incorrect or incomplete information could delay or disqual f, a project
Rnise Fo.t - Dludt 2006
Threshold Criteria
Instructions: Please answer each question. If a correct response falls within an enlarged box then
supporting documentation of the impact must be included.
No. ECOLOGICAL YES NO.
1 Will the project have a substantial impact on any unique or important natural resource? ? ??

Z Does the project involve habitat where federally listed endangered or threatened
i
?
El
??
es may occur
spec
3 Will the project affect anadromous fish? ?,
If the project involves wetlands, is the amount of permanent and/or temporary
4 wetland taking less than one-third (1/3) of an acre and have all practicable measures to ?
avoid and minimize wetland takings been evaluated?
If no wetlands are involved, write "N/A" 'V_ N/A
5 Will the project require the use of U. S. Forest Service lands? ?

6 Will the quality of adjacent water resources be adversely Impacted by proposed
i
i
i
?
i
F
??
construct
on act
v
t
es

7 Does the project involve waters classified as Outstanding Water Resources and/or
Hi
h Qualit
Waters?
F
Q? '
g
y
Will the project require fill in waters of the United States in any.of the designated
$ mountain trout counties? ? MY(
Does the project involve any known underground storage tanks (UST's) or hazardous ?
materials sites?
. PERMITS and COORDINATION
If the project is located within a CAYIA county, will the Project significantly affect the
"
"
10 coastal zone and/or any
Area of Environmental Concern
(AEC)? F
11 Does the project involve Coastal Barrier Resources Act Resources? Q
12 Will a U. S Coast Guard permit be required? ?
13 Will the project result in the modification of any existing regulatory floodway? ?
14 Will the project require any stream relocations or channel changes? ? ? .
Threshold Criteria
Instructions: Please answer each question. If a correct response falls within an enlarged box then
supporting documentation of the impact must be included.
No. SOCIAL, ECONOMIC, AND CULTURAL RESOURCES YES NO
15 Will the project induce substantial impacts to planned growth or land use for the area? O 0?
16 Will the project require the relocation of any family or business? ? Q
17 Will the project have a disproportionately high and adverse human health and El ?
environmental effect on an minority or low-income population?
18 If the project involves the acquisition of Right-of-Wav, is the amount of Right-of-Way © ?
acquisition considered minor?
19 Will the project involve any changes in access control? ? 121
20 Will the project substantially alter the usefulness and/or land use of adjacent property? ? ?
21 Will the project have an adverse effect on permanent
l
l
ff
i
h
i
?
?
?
tra
ic patterns or commun
veness
oca
ty co
es
22 Is the project included in an approved thoroughfare plan and/or Transportation
Improvement Program (and is therefore, in conformance with the Clean Air Act of
0
El
1990)?
23 Is the project anticipated to cause an increase in traffic volumes? ? Q
24 Will traffic be maintained during construction using existing roads, staged construction,

or on-site detours?
?? ?
25 If the project is a bridge replacement project, will the bridge be replaced at its existing
location (along the existing facility) and will all construction proposed in association with m
the bridge replacement project be contained on the existing facility?
26 Is there substantial controversy on social, economic, or environmental grounds
i
h
? ?
m
concern
ng t
e project
27 Is the project consistent with all Federal, State, and local laws relating to the
f
i
l
h
?
??
e project
env
ronmenta
aspects o
t
28 Will the project have an "effect" on structures/properties eligible for or listed on the
f Hi
N
ti
l R
i
t
t
i
Pl
? O
Q
a
ona
eg
s
er o
s
or
c
aces
29 Will the project affect any archaeological remains that are important to history or pre-
hi
? ?
story
30 Will the project require the use of Section 4(0 resources (public parks, recreation lands,
wildlife and waterfowl Refuges, historic sites, or historic bridges, as defined in Section ? Q
4(f) of the U. S. DOT Act of 1966)?
31 Will the project result in any conversion of assisted public recreation sites or facilities to
non-recreation uses, as defined by Section 6(0 of the Land and Water Conservation Act
of 1965, as amended?
32 Will the project involve construction in, across, or adjacent to a river designated as a
component of or proposed For inclusion in the Natural System of Wild and Scenic
El
??
Rivers?
Additional Documentation required for unfavorable Responses:
"Checked" ENLARGED boxes indicate UNFAVORABLE responses.
"Checked" smaller boxes indicate favorable responses.
. Categorical Exclusion Approval
(Note: Qualified Professional may be required to complete)
Prepared by:
Christopher W. Hay, E.I. Environmental Program Manager
Name (print or rype)
Signature ?r
J
06/27/11
Date
License Number
For Official NCDOT Use Only
Reviewed by:
Date Reviewer's Signature
Project Development & Environmental Analysis Branc
North Carolina Department of Transportation
Approved by:
Date Division Administrator's Signature
Federal Highway Administration
.................................................................................................................................
Title
Kleinfelder Southeast, Inc.
Company'/Agency
Firm License No. F-1143
Consultants should submit this completed form to the municipality- or organization that engaged their service.
The Municipality or organization should submit to their assigned Transportation Program Consultant..
Please submit completed form within 90 days of die holding of your scoping meeting.
ATTACHMENT A
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FIGURE 1
SITE LOCATION
AP
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DER CONNECTOR TO BICENTENNIAL GREENWAY
Bright People. Right Solutions. EAST FORK ROAD
JAMESTOWN, NORTH CAROLINA
313 GALLIMORE DAIRY ROAD
GREENSBORO, NORTH CAROLINA DATE: 4/28/2011 APPROVED BY: SCALE: 1" =2,000'
PHONE: [phone] SOURCE: USGS Topographic
Orthophoto Map, Guilford 1994, Hig
h.
PROJECT NO: 118431
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ATTACHMENT A
PURPOSE AND NEED
This proposed project will connect the trails and walkways south of town all the
way through town to the major existing Bicentennial Greenway on the north side
of town.
PROJECT DESCRIPTION
The project is a connector from the existing walkway system in the Town of
Jamestown on Main Street along East Fork Road to the existing Bicentennial
Greenway. The proposed walkway must bridge an arm of High Point City Lake,
the east fork of Deep River.
The bridge and a portion of the walkway will be on City of High Point property.
The remainder of the walkway will be on the right-or-way of the East Fork Road
(S. R. 1545).
ATTACHMENT B
0 W AT e9OC 1 1 O V 2 2
o ?
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification PCN Form
A. Applicant Information
1. Processing
la. Type(s) of approval sought from the
Corps:
®Section 404 Permit El Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: 42 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps? ? Yes ® No
1d. Type(s) of approval sought from the DWQ (check all that apply):
® 401 Water Quality Certification - Regular ? Non-404 Jurisdictional General Permit
? 401 Water Quality Certification - Express ? Riparian Buffer Authorization
le. Is this notification solely for the record
because written approval is not required? For the record only for DWQ 401
Certification:
? Yes ® No For the record only for Corps Permit:

? Yes ® No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program. ? Yes ®No
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below. ? Yes ® No
1h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ? Yes ® No
2. Project Information
2a. Name of project: Connector to Bicentennial Greenway
2b. County: Guilford
2c. Nearest municipality/ town: Jamestown D
2d. Subdivision name:
2e. NCDOT only, T.I.P. or state
project no: TIP No. EB-5517
l(JI
)
3. Owner Information p f
3a. Name(s) on Recorded Deed: City of High Point d A1?k?
3b. Deed Book and Page No. PB 72 PG 402 8rarp?
3c. Responsible Party (for LLC if
applicable): High Point Register of Deeds
3d. Street address: 325 East Russell Avenue, Room 155
3e. City, state, zip: High Point, NC 27261
3f. Telephone no.: [phone]
3g. Fax no.: .
3h. Email address:
Page I of 11
PCN Form - Version 1.3 December 10, 2008 Version
4. Applicant Information (if different from owner)
4a. Applicant is: ? Agent ® Other, specify: Local Municipality
4b. Name: Matthew Johnson
4c. Business name
(if applicable):
Town of Jamestown
4d. Street address: Town Hall, PO Box 848
4e. City, state, zip: Jamestown, NC 27282
4f. Telephone no.: [phone]
4g. Fax no.
4h. Email address: [e-mail]
5. Agent/Consultant Information (if applicable)
5a. Name: Christopher W. Hay
5b. Business name
(if applicable):
Kleinfelder Southeast, Inc.
5c. Street address: 313 Gallimore Dairy Road
5d. City, state, zip: Greensboro, NC 27409
5e. Telephone no.: (336)668=0093
5f. Fax no.: [phone]
5g. Email address: [e-mail]
Page 2 of 11
PCN Form -Version 1.3 December 10, 2008 Version
B. Project Information and Prior Project History
1. Property Identification
la. Property identification no. (tax PIN or parcel ID): The property does not have a PIN
1 b. Site coordinates (in decimal degrees): Latitude: 36.009707 Longitude: - 79.94118
(DD.DDDDDD) (-DD.DDDDDD)
1 c. Property size: unknown acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to High Point City Lake (East Fork Deep River)
proposed project:
2b. Water Quality. Classification of nearest receiving water: WS-IV CA
2c. River basin: Cape Fear
3. Project Description
3a. 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 site includes DOT right-of-way within the buffer area of High Point City Lake. Land use to the east is residential. Land
use to the west includes a golf course and residential property. North and south of the project are undeveloped wooded
areas buffering the lake.
3b. List the total estimated acreage of all existing wetlands on the property:
Only open water is located within the project area. The area around the lake and the East Fork of the Deep River
entering and exiting the lake is not defined by parcels.
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
The project area only includes open water.
3d. Explain the purpose of the proposed project:
To construct a pedestrian bridge to connect sidewalks in town to the Bicentennial Trail west of the lake.
3e. Describe the overall project in detail, including the type of equipment to be used: .
The project includes construction of walkway pavements and a pedestrian bridge. The sidewalk and bridge approach will
be graded with skid-steer and track-hoe equipment. Timber piles will be driven approximately 14 feet. Construction lifts
will be used to place structural beams and assist in construction.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
? Yes ? No Unknown
project (including all prior phases) in the past?
Comments:
4b. If the Corps made the jurisdictional determination, what type

Preliminary ? Final
El
of determination was made?
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company:
Name (if known): Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5. Project History
5a. Have permits or certifications been requested or obtained for ? Yes ? No ® Unknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
Page 3 of 11
PCN Form -Version 1.3 December 10, 2008 Version
6.. Future Project Plans
6a. Is this a phased project? ? Yes ® No
6b. If yes. explain.
Page 4 of 11
PCN Form -Version 1.3 December 10. 2008 Version
C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
? Wetlands ? Streams - tributaries ? Buffers
® Open Waters ? Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type of jurisdiction
number - Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWQ - non-404, other) (acres)
Temporary T
W1 ? PM T ? Yes ? Corps
? No ? DWQ
W2 ? P M T ? Yes ? Corps
? No ? DWQ
W3 ? P F1 T ? Yes ? Corps
? No ? DWQ
W4 ? P ? T ? Yes ? Corps
? No ? DWQ
W5 ? P ? T ? Yes ? Corps
? No ? DWQ
W6 ? P ? T ? Yes ? Corps
? No ? DWQ
2g. Total wetland impacts
2h. Comments:
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.
3a. 3b. 3c. 3d. 3e. 3f. 3g.
Stream impact Type of impact Stream name Perennial Type of jurisdiction Average Impact
number - (PER) or (Corps - 404, 10 stream length
Permanent (P) or intermittent DWQ - non-404, width (linear
Temporary (T) (INT)? other) (feet) feet)
S1 ? P ? T ? PER ? Corps
? INT ? DWQ
S2 ? P ? T ? PER ? Corps
? INT ? DWQ
S3 ? P ? T ? PER ? Corps
? INT ? DWQ
S4 ? P ? T ? PER ? Corps
? MIT ? DWQ
S5 ? P ? T ? PER ? Corps
? INT ? DWQ
S6 ? P ? T ? PER ? Corps
? INT ? DWQ
3h. Total stream and tributary impacts
3i. Comments:
Page 5 of 11
PCN Form -Version 1.3 December 10, 2008 Version
4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list all open water impacts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number - (if applicable) Type of impact Waterbody type Area of impact (acres)
Permanent (P) or
Temporary T
01 ®P ? T High Point City Thirty-six 12 inch diameter timber lake 0.0007
Lake piles
02 ® PEI T High Point City Area of bridge deck lake 0.05
Lake
03 ?P?T
04 ?P?T
4f. Total open water impacts 0.0507
4g. Comments: The total footprint of the 36 timber piles is 28 square feet. No temporary construction impacts are anticipated.
The portion of the bridge deck over open water will be 390 feet in length and 6 feet in width (2,340 square feet).
5. Pond or Lake Construction
If and or lake construction proposed, then complete the chart below.
5a. 5b. 5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or purpose (acres)
number of pond
Flooded Filled Excavated Flooded Filled Excavated Flooded
P1
P2
5L Total
5g. Comments:
5h. Is a dam high hazard permit required?
? Yes ? No If yes, permit ID no:
5i. Expected pond surface area (acres):
51. Size of pond watershed (acres):
5k. Method of construction:
Page 6 of 11
PCN Form -Version 1.3 December 10, 2008 Version

6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
b
l
If
i
e
ow.
an
mpacts require mitigation, then you MUST fill out Section D of this form.
6a.
? Neuse ? Tar-Pamlico ? Other:
Project is in which protected basin? ? Catawba ? Randleman
6b. 6c. 6d.
Buffer impact 6e. 6f. 6g.
number - Reason
Permanent (P) or for Stream name
T Buffer Zone 1 impact Zone 2 impact
mitigation (square feet) (square feet)
emporal/ T impact required?
B1 ?P?T ?Yes
? No
B2 ?P?T ?Yes
? No
B3 ?P?T ?Yes
? No
6h. Total buffer impacts
6i. Comments:
D. Impact Justification and Mitigation
1. Avoidance and Minimization
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Alternative designs were investigated, however, no feasible designs were identified with lesser impacts.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techni
ue
q
s.
With the exception of driving the timber piles, construction will have no impacts on the surface water.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for El Yes ® No
impacts to Waters of the U.S. or Waters of the State?
2b. If yes, mitigation is required by (check all that apply): ? DWQ ? Corps

2c. If yes, which mitigation
ooptioo
nn will be used for this ? Mitigation bank
;
project? Payment to in-lieu fee program
? Permittee Responsible Mitigation
t
3. Complete if Using a aion Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter) Type Quantity
Page 7 of 11
PCN Form - Version 1.3 December 10, 2008 Version
Comments:
Complete if Making a Payment to In-lieu Fee Program
Approval letter from in-lieu fee program is attached. ? Yes
. Stream mitigation requested: linear feet
If using stream mitigation, stream temperature: ? warm ? cool ?cold
_. Buffer mitigation requested (DWQ only): square feet
4e. Riparian wetland mitigation requested: acres
4f. Non-riparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requested: acres
4h. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) - required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation? ? Yes ®No
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.

Zone 6c..
Reason for impact 6d.
Total impact
(square feet)
Multiplier 6e.
Required mitigation
(square feet)
Zone 1 3 (2 for Catawba)
Zone 2 1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund).
6h. Comments:
Page 8 of 11
PCN Form - Version 1.3 December 10, 2008 Version
Stormwater Management and Diffuse Flow Plan (required by DWQ)
Diffuse Flow Plan
. Does the project include or is it adjacent to protected riparian buffers identified ® Yes ? No
within one of the NC Riparian Buffer Protection Rules?
. If yes, then is a diffuse flow plan included? If no, explain why.
El Yes ®No
Comments: The project does not require a Stormwater management plan.
2. Stormwater Management Plan
2a . What is the overall percent imperviousness of this project? %
2b . Does this project require a Stormwater Management Plan? ? Yes ®No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: The project consists of the construction
of brick and concrete sidewalk and a timber pedestrian bridge.
2d . If this project DOES require a Stormwater Management Plan, then provide a brief, na rrative description of the plan:
? Certified Local Government
2e. Who will be responsible for the review of the Stormwater Management Plan? ? DWQ Stormwater Program
? DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project?
? Phase 11
? NSW
3b. Which of the following locally-implemented stormwater management programs ? USMP
apply (check all that apply): ? Water Supply Watershed
? Other:
3c. Has the approved Stormwater Management Plan with proof of approval been ? Yes ? No
attached?
4. DWQ Stormwater Program Review
? Coastal counties
? HQW
4a. Which of the following state-implemented stormwater management programs apply ? ORW
(check all that apply): ? Session Law 2006-246
? Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
? Yes ? No
attached?
5. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements? ? Yes ? No
5b. Have all of the 401 Unit submittal requirements been met? ? Yes ? No
Page 9 of 11
PCN Form -Version 1.3 December 10, 2008 Version
I'
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1a. Does the project involve an expenditure of public (federal/state/local) funds or the ® Yes ? No
use of public (federal/state) land?
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 ® Yes ? No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1c. If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
? Yes
® No
letter.)
Comments: A Categorical Exclusion has been prepared and submitted .
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards, ? Yes ® No
or Riparian Buffer Rules (15A NCAC 2B.0200)? ,
2b. Is this an after-the-fact permit application? ? Yes ® No
2c. If you answered "yes" to one or both of.the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in ? Yes ® No
additional development, which could impact nearby downstream water quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
not applicable
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5. Endangered Species and Designated Critical Habitat (Corps Requirement),
5a. Will this project occur in or near an area with federally protected species or El Yes ®No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act ® Yes ? No
impacts?

Raleigh
®
5c. If yes, indicate the USFWS Field Office you have contacted. ? Asheville
5d . What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat? ,
USFWS website
6. Essential Fish Habitat (Corps Requirement)
6a . Will this project occur in or near an area designated as essential fish habitat? ? Yes ® No
6b . What data sources did you use to determine whether your site would impact Essential Fish Habitat?
South Atlantic Fishery Management Council website
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 ? Yes No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b . What data sources did you use to determine whether your site would impact historic or archeological resources?
Department of Cultural Resources website
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? ® Yes ? No
8b . If yes, explain how project meets FEMA requirements: The eastern bridge approach is in zone AE. The bridge deck
elevation is outside the 100 year floodplain.
8c. What source(s) did you use to make the floodplain determination? Guilford County GIS website
Matthew Johnson 6/29/11
Applicant/Agent's Printed Name Appt antl
Signature Date

(Agent's signature is valid only if an aration letter from the applicant
7t
?
is rov
d.) U

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PCN Form - Version 1.3 December 10,.2008 Version