20210111 Ver 1_ePCN Application_20210305

I I DWR
Division of Water Resources
Pre-Construction Notification (PCN) Form
October 26,2020 Ver 3.3
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#*
20210111 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:
Steeplechase Rd Bridge Replacement
1a.Who is the Primary Contact?*
Jerry Parker
lb.Primary Contact Email:* 1c.Primary Contact Phone:*
[e-mail] [phone]
Date Submitted
3/5/2021
Nearest Body of Water
Polecat Creek
Basin
Cape Fear
Water Classification
WS-Ill 17-11(1)
Site Coordinates
Latitude: Longitude:
35.953208 79.811818
Pre-Filing Meeting Information
ID# Version
20210111 1
Pre-fling Meeting or Request Date*
1/26/2021
Attach documentation of Pre-Filing Meeting Request here:*
Steeplechase Rd Pre-filing App.pdf 57.66KB
A. Processing Information C^U
County(or Counties)where the project is located:
Guilford

Is this a NCDMS Project
✓ Yes r No
Is this project a public transportation project?*
✓ Yes r No
Is this a NCDOT Project?*
✓ Yes r No
(NCDOT only)T.I.P.or state project number:
WBS#(7)
17BP.7.R.128
1a.Type(s)of approval sought from the Corps:
fJ Section 404 Permit(wetlands,streams and waters,Clean Water Act)
r Section 10 Permit(navigable waters,tidal waters,Rivers and Harbors Act)
Has this PCN previously been submitted?*
✓ Yes
r No
lb.What type(s)of permit(s)do you wish to seek authorization?
fJ Nationwide Permit(NWP)
r Regional General Permit(RGP)
r Standard(IP)
1c.Has the NWP or GP number been verified by the Corps?
C Yes rNo
Nationwide Permit(NWP)Number: 03-Maintenance
NWP Numbers(for multiple NWPS):
Id.Type(s)of approval sought from the DWR:
17 401 Water Quality Certification-Regular r 401 Water Quality Certification-Express
r Non-404 Jurisdictional General Permit r Riparian Buffer Authorization
r 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 r No
For the record only for Corps Permit: r Yes r No
If.Is this an after-the-fact permit application?*
✓ Yes r No
1g.Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
CYes rNo
1g.Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
✓ Yes rNo
Acceptance Letter Attachment
lh.Is the project located in any of NC's twenty coastal counties?
CYes rNo
1j.Is the project located in a designated trout watershed?
✓ Yes r No
B. Applicant Information
Id.Who is applying for the permit?
7 Owner r Applicant(other than owner)
le.Is there an Agent/Consultant for this project?*
✓ Yes r No
2.Owner Information
2a.Name(s)on recorded deed:
NCDOT

2b.Deed book and page no.:
2c.Responsible party:
Wright Archer
2d.Address
Street Address
1584 Yanceyville Street
Address Line 2
P.O.Box 14996
aty State/Bovine/legion
Greensboro NC
Postal/Zip Code Country
27415-4996 USA
2e.Telephone Number: 2f.Fax Number:
[phone]
2g.Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1b.Subdivision name:
(if appropriate)
1c.Nearest municipality/town:
Greensboro
2. Project Identification
2a.Property Identification Number: 2b.Property size:
2c.Project Address
Street Address
Address Line 2
Criy State/Province/legion
Postal/Zlp Code Country
3.Surface Waters
3a.Name of the nearest body of water to proposed project:*
Polecat Creek
3b.Water Resources Classification of nearest receiving water:*
WS-Ill 17-11(1)
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.
030300030107
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:*
Site is a rural area with sparse residences interspersed with agricultural fields and pastures.
4b.Have Corps permits or DWR certifications been obtained for this project(including all prior phases)in the past?*
r Yes r' 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)
Steeplechase Topo Map.pdf 1.78MB
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)
Steeplechase Soil Survey.pdf 1.69MB
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:

170
4h.Explain the purpose of the proposed project:*
Purpose of project is to replace a structurally deficient bridge with a new bridge in approximately the same alignment.
4i.Describe the overall project in detail,including indirect impacts and the type of equipment to be used:*
Project will involve replacing an old bridge on Steeplechase Rd with a new bridge.An offsite detour will be utilized during construction.Project is designed to have minimal impacts on
the environment.New bridge will span entire width of stream with no proposed bents in the stream.There will be no deck drains.Stormwater will be directed to grated inlets that will then
outlet to riprap pads that will dissipate energy to provide a non-erosive flow into the stream.Riprap will also be utilized for bank stabilization to prevent erosion of banks into stream.
Standard road building equipment such as trucks,cranes,dozers and tamps will be used.
4j.Please upload project drawings for the proposed project.
Steeplechase Permit Drawings.pdf 1.74MB
5.Jurisdictional Determinations
5a.Have the wetlands or streams been delineated on the property or proposed impact areas?*
6' Yes r No r Unknown
Comments:
There are no wetlands on the project site
5b.If the Corps made a jurisdictional determination,what type of determination was made?*
6' Preliminary C Approved C Not Verified f Unknown C N/A
Corps AID Number:
5c.If 5a is yes,who delineated the jurisdictional areas?
Name(if known): Perkinson
Agency/Consultant Company: Axiom
Other:
5d.List the dates of the Corp jurisdiction determination or State determination if a determination was made by the Corps or DWR
5d1.Jurisdictional determination upload
Steeplechase Rd PJD.pdf 1.98MB
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 U
1. Impacts Summary
1a.Where are the impacts associated with your project?(check all that apply):
r Wetlands 17 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
(?) Jurisdiction* length*
S1 Bank Stabilization Permanent Bank Stabilization Polecat Creek Perennial Both 9 10
Average(feet) (linear feet)
S2 Bank Stabilization Permanent Bank Stabilization Polecat Creek Perennial Both 9 22
Average(feet) (linear feet)
S3 Bank Stabilization Permanent Bank Stabilization Polecat Creek Perennial Both 9 66
Average(feet) (linear feet)
S4 Bank Stabilization Temporary Bank Stabilization Polecat Creek Perennial Both 9 30
Average(feet) (linear feet)
3i.Total jurisdictional ditch impact in square feet:
0

3i.Total permanent stream impacts: 3i.Total temporary stream impacts:
98 30
3i.Total stream and ditch impacts:
128
3j.Comments:
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:
Project was designed to span entire width of stream with no bents in the stream and no deck drains.
lb.Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Best management practices will be utilized throughout construction of the project.An offsite detour will be utilized during construction of the project.
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 6 No
2b.If this project DOES NOT require Compensatory Mitigation,explain why:
Project does not meet the thresholds that would require 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?
✓ Yes tz No
If no,explain why:
Polecat Creek does not drain to buffered watershed.
2.Stormwater Management Plan
2a.Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
IT Yes r No
Comments:
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?*
✓ Yes r 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 6' No
Comments:*
Project qualifies as a Categorical Exclusion and is therefore exempt from a NEPA/SEPA document
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 f No
3. Cumulative Impacts(DWR Requirement)
3a.Will this project result in additional development,which could impact nearby downstream water quality?*
✓ Yes ( No
3b.If you answered"no,"provide a short narrative description.
Due to the minimal impacts anticipated,project will not influence nearby land use nor stimulate growth.

4.Sewage Disposal(DWR Requirement)
4a.Is sewage disposal required by DWR for this project?*
✓ Yes 6 No r 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?*
6 Yes rNo
5b.Have you checked with the USFWS concerning Endangered Species Act impacts?*
6 Yes rNo
5c.If yes,indicate the USFWS Field Office you have contacted.
5d.Is another Federal agency involved?*
✓ Yes (7 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?
USFWS Website and utilization of environmental consultants
Consultation Documentation Upload
Steepleshase Plant Survey.pdf 1.17MB
6. Essential Fish Habitat(Corps Requirement)
6a.Will this project occur in or near an area designated as an Essential Fish Habitat?*
✓ Yes ( No
6b.What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
NMFS County Index
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?*
✓ Yes ( No
7b.What data sources did you use to determine whether your site would impact historic or archeological resources?*
NCDOT Cultural Resource Personnel
7c.Historic or Prehistoric Information Upload
Steeplechase Archeological No Survey.pdf 1016.11KB
Steeplechase Archictectural No Survey.pdf 3.59MB
8. Flood Zone Designation(Corps Requirement)
8a.Will this project occur in a FEMA-designated 100-year floodplain?*
(' Yes rNo
8b.If yes,explain how project meets FEMA requirements:
Coordination with NCDOT Hydraulics Unit
8c.What source(s)did you use to make the floodplain determination?*
FEMA Maps
Miscellaneous
Comments
Miscellaneous attachments not previously requested.
Signature
*
I7 By checking the box and signing below,I certify that:
• The project proponent hereby certifies that all information contained herein is true,accurate,and complete to the best of my knowledge and belief;and
• The project proponent hereby requests that the certifying authority review and take action on this CWA 401 certification request within the applicable reasonable period of time.
• 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:
W.R.Archer III,PE
Signature
Date
3/5/2021