20201819 Ver 1_ePCN Application_20210429

I I DWR
Division of Water Resources
Pre-Construction Notification (PCN) Form
April 4,2021 Ver 4
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#*
20201819 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:
Replacement of Bridge no.230 on SR 2250(Becks Church Road)
1a.Who is the Primary Contact?*
Amy Euliss
1b.Primary Contact Email:* 1c.Primary Contact Phone:*
[e-mail] [phone]
Date Submitted
4/29/2021
Nearest Body of Water
Pounder Fork Creek
Basin
Yadkin-PeeDee
Water Classification
WS-V,B
Site Coordinates
Latitude: Longitude:
35.920853 -80.279955
A. Processing Information
County(or Counties)where the project is located:
Davidson
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.9.R.79
Pre-Filing Meeting Information
Is this a courtesy copy notification?*
✓ Yes G No
ID# Version
Pre-fling Meeting or Request Date
11/20/2020
Attach documentation of Pre-Filing Meeting Request here:
Click the upbad button or drag and drcp files here to attach docunsnt
DWR Pre-Filing Meeting Request Form.pdf 49.58KB
File type nest be FCF
1a.Type(s)of approval sought from the Corps:
[7 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
✓ No
lb.What type(s)of permit(s)do you wish to seek authorization?
r Nationwide Permit(NWP)
f7 Regional General Permit(RGP)
r Standard(IP)
1c.Has the NWP or GP number been verified by the Corps?
✓ Yes G No
Regional General Permit(RGP)Number: 201902350-Work associated with bridge construction,widening,replacement,and
interchanges
RGP Numbers(for multiple RGPS):
ld.Type(s)of approval sought from the DWR:
fJ 401 Water Quality Certification-Regular r 401 Water Quality Certification-Express
r Non-404 Jurisdictional General Permit r Riparian Buffer Authorization
r Individual 401 Water Quality Certification
le.Is this notification solely for the record because written approval is not required? *
For the record only for DWR 401 Certification: r Yes t No
For the record only for Corps Permit: r Yes t No
If.Is this an after-the-fact permit application?*
✓ Yes (' No
1g.Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
6 Yes rNo
1g.Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
✓ Yes rNo
Acceptance Letter Attachment
1 h.Is the project located in any of NC's twenty coastal counties?
✓ Yes No
1j.Is the project located in a designated trout watershed?
0 Yes (' No
B.Applicant Information U
Id.Who is applying for the permit?
)7 Owner r Applicant(other than owner)
le.Is there an Agent/Consultant for this project?*

C Yes a No
2. Owner Information
2a.Name(s)on recorded deed:
NCDOT Division 9
2b.Deed book and page no.:
2c.Contact Person:
S.Pat Ney,PE
2d.Address
Street Address
375 Silas Creek Parkway
Address Line 2
City State/Province/legion
Winston Salem NC
Postal/Zlp Code Country
27127 USA
2e.Telephone Number: 2f.Fax Number:
[phone]
2g.Email Address:*
[e-mail]
� I
C. Project Information and Prior Project History
1. Project Information
lb.Subdivision name:
(if appropriate)
1c.Nearest municipality/town:
Lexington
2. Project Identification
2a.Property Identification Number: 2b.Property size:
2c.Project Address
Street Address
Address Line 2
CRY State/Province/legion
Postal/Zip Code Country
3.Surface Waters
3a.Name of the nearest body of water to proposed project:*
Pounder Fork Creek
3b.Water Resources Classification of nearest receiving water:*
WS-V,B
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.
030401030206
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 land surrounding the project area consists of forest and rural farmland.
4b.Have Corps permits or DWR certifications been obtained for this project(including all prior phases)in the past?*
r Yes 6. 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)
Fig 4 Topo_Map.pdf 3.24MB
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)

Fig 3 Soils_Map.pdf 1.42MB
4f.List the total estimated acreage of all existing wetlands on the property:
0.18
4g.List the total estimated linear feet of all existing streams on the property:
1190
4h.Explain the purpose of the proposed project:*
The project is to replace the existing bridge with a new bridge and to provide the associated improvements to the approach roadway.
4i.Describe the overall project in detail,including indirect impacts and the type of equipment to be used:*
Standard road and bridge construction equipment will be used including track hoes,cranes and other grading equipment.
4j.Please upload project drawings for the proposed project.
17BP9R79_HYD_PERMIT.pdf 1.47MB
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:
5b.If the Corps made a jurisdictional determination,what type of determination was made?*
r Preliminary r Approved C Not Verified r Unknown r N/A
Corps AID Number:
SAW-2019-01113
5c.If 5a is yes,who delineated the jurisdictional areas?
Name(if known): Nathan Howell,Nancy Scott
Agency/Consultant Company:
Other:
5d.List the dates of the Corp jurisdiction determination or State determination if a determination was made by the Corps or DWR
DWR:8.12.2019
USACE:8.2.2019
5d1.Jurisdictional determination upload
17BP.9.R.79_PJD_PACKAGE_06202019.pdf 4.48MB
17BP.9.R.79_NCDWR_FINAL.pdf 384.7KB
17BP.9.R.79_ThreeOaks_Aquatic_Resources_in_Review Area_REV.pdf 47.33KB
BR-79_NRTR_Fig3.pdf 1.94MB
BR-79_PJD_Fig2.pdf 762.94KB
SAW-2019-01113(signed PJD).pdf 2.78MB
DWR Determination_B_230.docxpdf 664.88KB
6. Future Project Plans
6a.Is this a phased project?*
C 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
1a.Where are the impacts associated with your project?(check all that apply):
I7 Wetlands I7 Streams-tributaries r Buffers
r Open Waters r Pond Construction
2.Wetland Impacts
2a.Site#*(?) 2a1 Reason(?) 2b.Impact type*I?) 2c.Type of W.* 2d.W.name* 2e.Forested* 2f.Type of 2g.Impact
Jurisdicition*(?) area*
1 6"Water Line P Floodplain Pool WF No Both 0.010
Excavation (acres)

1 6"Waterline P Floodplain Pool WF No Both 0.010
Mechanized Clearing (acres)
3 Aerial Power lines T Seep WC No Both 0.010
(acres)
6 Fill Slope T Bottomland Hardwood Forest WE Yes Both 0.010
(acres)
2g.Total Temporary Wetland Impact 2g.Total Permanent Wetland Impact
0.020 0.020
2g.Total Wetland Impact
0.040
2i.Comments:
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*
SI Relocation of stream due to Permanent Fill UT to Pounder Fork Creek Intermittent Both 2 300
fill slope(site 4) (SB) Average(feet) (linear feet)
32 Bank Stabilization(site 5) Permanent Bank Stabilization Pounder Fork Creek Perennial Both 10 84
Average(feet) (linear feet)
S3 6"Water line(site 2-falls Temporary Other Pounder Fork Creek Perennial Both 10 8
within permanent bank Average(feet) (linear feet)
stabilization impacts at site 5)
3i.Total jurisdictional ditch impact in square feet:
0
3i.Total permanent stream impacts: 3i.Total temporary stream impacts:
384 8
3i.Total stream and ditch impacts:
392
3j.Comments:
Temporary impacts from the waterline relocation fall within the bank stabilization impacts.
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:
The proposed bridge crossing has been widened compared to the existing bridge.Banks of Pounder Fork Creek have been permanently stabilized
with rip rap.The designer investigated steepening the fill slopes at the UT to Pounder Fork Creek from 2:1 to 1:1:5 in attempt to reduce impacts to the
stream.The steeper fill slopes did not reduce the impacts.The channel has been relocated into a rip rap lined channel which will provide long term
stability to both the road slope and the stream.
lb.Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
The erosion control plan has been designed in accordance with NCDOT Sediment and Erosion Control Manual.
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?
6' Yes rNo
2c.If yes,mitigation is required by(check all that apply):
r 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.
r Yes r No

4b.Stream mitigation requested:
(linear feet) 4c.If using stream mitigation,what is the stream temperature:
300 warm
4d.Buffer mitigation requested(DWR only): 4e.Riparian wetland mitigation requested:
(square feet) (acres)
4f.Non-riparian wetland mitigation requested: 4g.Coastal(tidal)wetland mitigation requested:
(acres) (acres)
4h.Comments
DMS letter is attached under the miscellaneous tab.
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 ( No
If no,explain why:
The project is not in a riparian buffer basin.
2.Stormwater Management Plan
2a.Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
✓ Yes r No
Comments:
The Stormwater Management Plan is included in the permit drawings.
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)?*
rYes rNo
Comments:*
The project meets the State Minimum Criteria Rules.A MCDC has been prepared for the project.
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 result in additional development,which could impact nearby downstream water quality?*
(' Yes ( No
3b.If you answered"no,"provide a short narrative description.
The project involves replacing a bridge on the same location in a rural setting.
4.Sewage Disposal(DWR Requirement)
4a.Is sewage disposal required by DWR for this project?*
✓ Yes 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?*
✓ Yes (' No
5b.Have you checked with the USFWS concerning Endangered Species Act impacts?*
(' Yes ( No
5d.Is another Federal agency involved?*

✓ Yes 6- No f Unknown
5e.Is this a DOT project located within Division's 1-8?
✓ Yes ( No
5f.Will you cut any trees in order to conduct the work in waters of the U.S.?
✓ Yes r No
5g.Does this project involve bridge maintenance or removal?
6 Yes r No
5g(1).If yes,have you inspected the bridge for signs of bat use such as staining,guano,bats,etc.?
✓ Yes r No
If you answered"Yes"to 5g(1),did you discover any signs of bat use?
✓ Yes r No r Unknown
5h.Does this project involve the construction/installation of a wind turbine(s)?*
✓ Yes 0. 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.?
6 Yes r No
If yes,please provide details to include type of percussive activity,purpose,duration,and specific location of this activity on the property.
5j.What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
Site surveys and NC Natural Heritage program database.
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?*
✓ Yes f• No
6b.What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
NOAA Fisheries,Essential Fish Habitat Mapper
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 f No
7b.What data sources did you use to determine whether your site would impact historic or archeological resources?*
NCDOT Cultural Resource staff reviews
7c.Historic or Prehistoric Information Upload
AR17-05-0049NoSurvey.pdf 1.21MB
Tribal Coordination Br 230 Davidson.pdf 589.39KB
17-05-0049NoSurvey.pdf 3.05MB
8. Flood Zone Designation(Corps Requirement)
8a.Will this project occur in a FEMA-designated 100-year floodplain?*
✓ Yes r No
8b.If yes,explain how project meets FEMA requirements:
The project is a Type Ilb MOA.
8c.What source(s)did you use to make the floodplain determination?*
FEMA DFIRM 3710672900J
Miscellaneous
Comments
Regarding the blasting and percussive sounds,standard bridge building practices may apply.This may involve blasting,pile driving and/or drilling.
Miscellaneous attachments not previously requested.
SR 2250-Bridge 230-Division 9_STR_YD 103.pdf 419.33KB
Signature
*
17 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:
Amy Euliss
Signature
eve/cif-6
Date
4/29/2021