20130169 Ver 1_401 Application_20130213

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Environmental Engineers & Scientists
February 20, 2013
North Carolina Division of Water Quality II j
WBSCP Unit
1650 Mail Service Center a
Raleigh, North Carolina 27699 -1650 -
Hazen and Sawyer, P.C.
4011 WestChase Blvd.
Raleigh, NC 27607
919 -833 -7152
Fax: [phone]
Re: Pre - Construction Notification, Kingston Road Culvert Replacement, City of Winston -
Salem, Winston - Salem, Forsyth County, North Carolina
To Whom It May Concern,
Please find attached the Pre - Construction Notification (PCN) Application for the above
referenced project. The City of Winston -Salem (City) is proposing to replace an existing 36°
culvert with a new 5 -foot high, 25 -foot wide, bottomless culvert. The purpose of the project is to
address deficiencies in the ability of the existing culvert to handle flows associated with storm
events. Significant development has occurred since the culvert was installed prior to 1960,
resulting in a significant increase in stormwater runoff and localized flooding that has damaged
private property. In order to remove and replace the existing culvert, the underground sewer
and water pipelines that are located above the culvert will be relocated in order to comply with
current North Carolina and City requirements for minimum cover over underground utilities.
Additionally, modifications of and repair to reaches of the stream channel are proposed in order
to accommodate the proposed culvert and wingwalls and to address past sedimentation issues.
Two roadside drainageways will be modified as well.
R�
Impacts associated with the proposed activities are 131 feet of permanent impact to
jurisdictional Section 401 stream and 30 feet of temporary impacts to a jurisdictional Section
401 stream.
If you have any questions or require additional information, please contact me at 919.833.7152.
Thank you for your assistance.
Sincerely,
HAZEN AND SAWYER, P.C.
Keven Arrance
Scientist
Attachment
New York, NY . Armonk, NY • Woodbury, NY • Detroit, MI • Raleigh, NC • Charlotte, NC • Atlanta, GA. Fairfax, VA • Hollywood, FL • Boca Raton, FL. Fort Pierce, FL • Sarasota, FL • Miami, FL • Philadelphia, PA

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`0 pG Office Use Only:
20 3 0 g g Corps action ID no.
° DWQ project no.
Form Version 1.3 Dec 10 2008
Pre - Construction Notification C Form 0
cd
A . AppHcant Information
1. Processing
1 a. Type(s) of approval sought from the
Corps: ®Section 404 Permit El Section 10 Permi
1b. Specify Nationwide Permit (NWP) number: 3 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 ❑ Non404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
M
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 1h
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:
Kingston Road Culvert Replacement
2b. County:
Forsyth
2c. Nearest municipality / town:
Winston -Salem
2d. Subdivision name:
N/A
2e. NCDOT only, T.I.P. or state
project no:
3. Owner Information
3a. Name(s) on Recorded Deed:
See attached.
3b. Deed Book and Page No.
3c. Responsible Party (for LLC if
applicable):
3d. Street address:
3e. City, state, zip:
3f. Telephone no.:
3g. Fax no.:
3h. Email address:
Page 1 of 14
PCN Form — Version 1.3 December 10, 2008 Version

4. Applicant Information (if different from owner)
4a. Applicant is:
❑ Agent ® Other, specify: municipality
4b. Name:
Mr. Keith Huff
4c. Business name
(if applicable):
City of Winston -Salem
4d. Street address:
101 N. Main Street
4e. City, state, zip:
Winston - Salem, NC 27101
4f. Telephone no.:
336.747.6962
4g. Fax no.:
336.748.3173
4h. Email address:
Keithh1 @cityofws.org
5. Agent/Consultant Information (if applicable)
5a. Name:
Ms. Keven Arrance
5b. Business name
(if applicable):
Hazen and Sawyer, P.C.
5c. Street address:
4011 WestChase Blvd, Suite 500
5d. City, state, zip:
Raleigh, NC 27607
5e. Telephone no.:
919.863.9350
5f. Fax no.:
919.833.1828
5g. Email address: I
karrance @hazenandsawyer.com
Page 2 of 14
PCN Form — Version 1.3 December 10, 2008 Version

B. Project Information and Prior Project History
I. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
See attached information.
1 b. Site coordinates (in decimal degrees):
Latitude: 36.13977 Longitude: - 80.30709
(DD.DDDDDD) (- DD.DDDDDD)
1c. Property size:
See attached information. acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
proposed project:
Unnamed Tributary (UT) to Mill Creek
2b. Water Quality Classification of nearest receiving water:
C
2c. River basin:
Yadkin
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PCN Form — Version 1.3 December 10, 2008 Version

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 project site is located in a primarily residential neighborhood in the northwestern portion of Winston - Salem. Kingston
Road is a local, two -lane street and bisects the site in a north -south direction. An unnamed tributary (UT) to Mill Creek
flows from east to west through the site. The northeastern portion of the site includes a portion of a property that contains
a community recreation facility. The facility includes an outdoor pool, tennis courts, a clubhouse, and a gravel parking lot.
The remaining portions of the site are residential properties with some trees present and some maintained lawn areas.
The existing culvert under Kingston Road is a 36" reinforced concrete pipe (RCP). There are existing underground
utilities that parallel Kingston Road and cross above the culvert. There is an 8" vitrified clay pipe (VCP) for sewer
collection and gravity conveyance along the west side of the road and a 6" ductile iron pipe (DIP) conveying drinking
water along the east side of the road. Upstream of the existing culvert, the channel has eroded the banks to a nearly
vertical condition. Downstream of the existing culvert, a roadside drainage ditch has eroded and washed the riprap lining
thereof into the stream.
3b. List the total estimated- acreage of all existing wetlands on the property:
No jurisdictional wetlands were identified within the project limits.
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
227 feet
3d. Explain the purpose of the proposed project:
The purpose of the project is to address local flooding, which has caused property damage at the recreation facility and
limited vehicular access to the recreation facility and residences in recent years. The culvert under Kingston Road is
shown on utility as -built drawings that are dated 1960. Due to development within the watershed and the subsequent
increase in stormwater runoff discharging to the stream, the existing culvert is no longer of adequate size to handle flows
associated with storm events. The proposed project involves removing the existing 61 -foot long, 36" diameter culvert and
installing a new,approximately 41 -foot long, 5 -foot high, 23 -foot wide, corrugated aluminum, flat -bottom culvert with
headwalls and wingwalls to protect against erosion upstream and downstream of the proposed new culvert. The State of
North Carolina's and the City of Winston - Salem's requirements relative to minimum cover over utility pipes (per 15A
NCAC 02T.0305 and Winston -Salem Public Works Technical Specifications) will require that either the road be elevated
or the existing sewer and water pipes be relocated.
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PCN Form — Version 1.3 December 10, 2008 Version

3e. Describe the overall project in detail, including the type of equipment to be used:
The project will involve removal of the existing 61 -foot long, 36" diameter RCP and installation of the proposed
approximately 41 -foot long, 5 -foot by 23 -foot, aluminum, flat -bottom culvert with the associated headwalls and wingwalls
to prevent erosion of the stream banks both upstream and downstream of the culvert. Approximately 12 inches of soil will
be placed in the culvert in order to minimize the potential for scour. In order to accommodate the proposed culvert and
meet the State of North Carolina and the City of Winston -Salem requirements for minimum cover over an underground
utility without raising the roadway, the existing sanitary sewer pipeline and water main will be relocated. The sewer line
will be diverted westward via a proposed new manhole located south of the stream crossing. The realigned sewer line
will extend approximately 110 feet west to a second proposed new manhole. From the second manhole, the pipe will turn
north - northwestward and cross the stream via an aerial crossing located approximately 83 feet downstream of the
proposed culvert outlet. The realigned sewer pipe will reconnect with the existing 12" VCP via a third proposed new
manhole. The water line will be diverted through a new 6° DIP that will turn eastward away from Kingston Road, cross
under the streambed approximately 40 feet upstream of the proposed culvert inlet, and turn westward toward Kingston
Road to reconnect with the existing pipe on the east side of the road. Two existing residential connections to the water
pipeline will be removed and realigned to accommodate project elements.
A roadside drainage pipe that empties into the stream from the south and immediately upstream of the culvert will be
realigned to improve the angle between the pipe and the stream bank at the pipe outlet. The pipe realignment will involve
the installation of a new manhole, regrading of the stream bank, and placement of riprap at the pipe outlet. The bank of
the stream on the north side of the stream, also upstream of the culvert, will be modified and graded in order to
accommodate the width and location of the proposed open -bottom culvert. The proposed bank repairs and modifications
will extend approximately 60 feet upstream of the proposed culvert inlet.
Downstream of the culvert, the roadside drainage ditch that flows from the north into the stream will be restored and
stabilized with geotextile underlay and riprap. The existing riprap and sediment that has been deposited in the stream
channel near and immediatiey downstream of the mouth of the roadside ditch will be dredged and removed from the
stream. A new plunge pool will be constructed in the stream channel in order to properly dissipate the energy of water
flowing through the culvert and from the roadside drainage ditch to the north. Mprap will be placed in the plunge pool and
in the apron immediately downstream thereof to minimize erosion. The dredging, plunge pool construction, and
placement of riprap in the stream will occur from the proposed culvert outlet, downstream to a point approximately 70 feet
from the proposed culvert outlet. Two stone check dams will be installed in the stream downstream of the in -stream work
area in order to prevent sediment from the work area from migrating downstream. The sediments collected behind the
check dams and the check dams will be removed upon completion of all in -stream work.
All work will be performed in dry streambed conditions. The method for achieving dry stream conditions is left to the
contractor to select and implement. It is anticipated that the stream's water will be pumped around the work area within
the limits of construction in order to achieve dry stream conditions. The equipment that is anticipated to be used to
perform the proposed project includes a dozer, trackhoe, roller compactor, dump trucks, backhoe, paving machine, and
paving roller.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (including all prior phases) in the past?
❑ Yes ® No ❑ Unknown
Comments:
4b. If the Corps made the jurisdictional determination, what type
of determination was made?
❑ Prelimina ry Final
❑
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
this project (including all prior phases) in the past?
❑ Yes ® No ❑ Unknown
5b. If yes, explain in detail according to "help file" instructions.
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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 6 of 14
PCN Form — Version 1.3 December 10, 2008 Version

C. Proposed Impacts Inventory
1. Impacts Summary
1a. Which sections were completed below for your project (check all that apply):
❑ Wetlands ® Streams - tributaries ❑ Buffers
Cl Open Waters ❑ Pond Construction
Page 7 of 14
PCN Form — Version 1.3 December 10, 2008 Version

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 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W2 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W3 ❑ P ❑ 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
Aerial sewer
Unnamed tributary
® PER
® Corps
15
1
crossing
(UT) to Mill Creek
❑ INT
❑ DWQ
S2 ❑ P ®T
Excavation for
pipeline
UT to Mill Creek
® PER
® Corps
15
10
installation
❑ INT
❑ DWQ
Culvert
S3 ®P ❑ T
replacement;
installation of
UT to Mill Creek
® PER
❑ INT
® Corps
❑ DWQ
15
0*
wingwalls and
headwalls
Channel repair
S4 ®P ❑ T
bank lay -back,
construct plunge
UT to Mill Creek
® PER
❑ INT
® Corps
❑ DWQ
15
130
pool, line with
riprap
S5 []PST
Two stone check
dams
UT to Mill Creek
® PER
❑ INT
® Corps
❑ DWQ
15
20 **
S6 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
3h. Total stream and tributary impacts
161
3i. Comments: *S3 - The proposed culvert is 20 feet shorter than the existing culvert. Therefore, no new stream length will be
impacted by the culvert replacement. The length of stream immediately upstream and downstream of the existing culvert that
may be impacted by the removal of the culvert is included in the stream length stated in S4. * *S5 - The impact associated with
each stone check dam is 10 feet. For the two proposed check dams, the total impact is 20 feet.
Page 8 of 14
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
01 ❑P ❑T
02 ❑P
03 ❑P
04 ❑P ❑T
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If Pond or lake construction proposed, then complete the chart below.
5a.
5b.
5c.
5d.
5e.
Pond ID
Proposed use or purpose
Wetland Impacts (acres)
Stream Impacts (feet)
Upland
number
of pond
(acres)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
K Total
5g. Comments:
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWO)
If project will impact a protected riparian buffer, then complete the chart below. if yes, then individually list all buffer impacts
below. If any impacts 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.
6e.
6f.
6g.
Buffer impact
number —
Reason
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P) or
for
Stream name
mitigation
(square feet)
(square feet)
Temporary
impact
required?
131 ❑P [IT
El Yes
❑ No
B2 ❑P ❑T
❑Yes
❑ No
B3 ❑P ❑T
[I Yes
❑ No
6h. Total buffer impacts
-
6i. Comments:
Page 9 of 14
PCN Form — Version 1.3 December 10, 2008 Version

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Avoidance of impacts is possibly only with a no -build scenario. However, the future flooding of private property and financial
loss to private property owners and to those providing recreational facilities to the community cannot be addressed and
prevented with the no -build option. Impacts to the stream have been minimized by shortening the culvert and by installing
wingwalis and headwalls to protect the stream from further erosion at the inlet and outlet of the culvert. Additionally, the flat -
bottom nature of the proposed culvert and the 12 -inch depth of soil in the culvert will provide a more natural stream bottom
under the roadway, which will minimize the potential for scour, allow fish passage, and present other biological benefits to the
stream. The realigned portion of the sewer pipeline will cross the stream as an aerial crossing with no support structures or
piers in the stream, thereby avoiding the placement of fill in the channel and the disturbance of the streambed. Modifications
of and repair to the roadside drainage ditches in the project area are anticipated to improve water quality by reducing erosion
and sedimentation into the stream. All work will be performed using Best Management Practices.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Impacts to the stream during construction will be limited to the extent feasible by performing as much work as is feasible from
the banks of the stream. The footprint and period of time over which the streambed and other areas below the Ordinary High
Water Mark are disturbed will be minimized to the extent feasible. All in- stream work will be performed in dry stream
conditions (in- the -dry). The disturbed areas will be returned to original grade and elevation and will be seeded with a native
seed mix within 90 days of the completion 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
❑ 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
❑ Mitigation bank
2c. If yes, which mitigation option will be used for this
project?
❑ Payment to in-lieu fee program
❑ Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter)
Type
Quantity
3c. Comments:
4. Complete if Making a Payment to In -lieu Fee Program
4a. Approval letter from in -lieu fee program is attached.
❑ Yes
4b. Stream mitigation requested:
linear feet
4c. If using stream mitigation, stream temperature:
❑ warm ❑ cool []cold
4d. 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.
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PCN Form — Version 1.3 December 10, 2008 Version

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 11 of 14
PCN Form — Version 1.3 December 10, 2008 Version

E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified
❑Yes No
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
Comments:
El Yes El No
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project?
<1 %
2b. Does this project require a Stormwater Management Plan?
❑ Yes ® No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: There is no adverse impact to water
quantity or quality. The project improves an existing conveyance.
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative 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 II
3b. Which of the following locally-implemented stormwater management programs
❑ NSW
❑ 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
4a. Which of the following state-implemented stormwater management programs apply
❑ HQW
❑ ORW
(check all that apply):
❑ Session Law 2006 -246
❑ Other.
4b. Has the approved Stormwater Management Plan with proof of approval been
attached?
❑ Yes ❑ No
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 12 of 14
PCN Form — Version 1.3 December 10, 2008 Version

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement) -
1 a. Does the project involve an expenditure of public (federal /state/local) funds or the
® Yes ❑ No
use of public (federal /state) land?
1 b. 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
letter.)
❑ Yes ❑ No
Comments:
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 213 .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.
The project will not induce future growth or development. The purpose of the proped activities is to replace a deficient
structure and repair adjacent drainageways in order to improve the handling of stormwater drainage.
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.
No wastewater will be generated as a result of the proposed project.
Page 13 of 14
PCN Form — Version 1.3 December 10, 2008 Version

5. Endangered Species and Designated Ct(titai Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or
❑ Yes ® No
habitat?
5b. Have you chedced.wkh the USFWS,c onteming Endangered Species Act
❑
Yes 0 N
impacts?
:5c. If yes, Indicate the USFWS Field Office you have contacted.
❑ Raleigh
❑ Asheville
5d: What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
USFWS list of protected species -ft Forsyth bounty was reviewed. No habitat forthe threatened or endangered species
listed was observed In the vicinity of'theptroject.
6. Essential Fish Habitat (Corps Requirement)
6a. MMI, this project amour- irtor near an area 0,signated as essential fish habitat?
❑ Yes ® No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
NOAA, Essential Fish Habitat online mapper was used to determine that no EFH or Habitat Areas of Particular Concern
have teen identified at the pproject- location (Nov 15, 2012).
7. Historic dr 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 14 No
status (eg., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to detennine.,whether your site would impact historic or archeological resources?
Historic resources were researched via the NC SHPO web GIS service (Nov 15, 2012). Cultural resources were
researched by staff with the Office of State Archaeology in November 2012. The staff member stated that the proposed
project is not anticipated to affect significant archaeological resources.
8. Flood Zone `Designation (Corps Requirement)
U. Will this project Occur in a FEMA- designated 100 -year floodplain?
❑ Yes ® No
8b. If yes, explain how project meets'FEMA requirements:
8c. What source(s) did you use to make the floodplain determination? Reviewed the project vicinity on the FEMA Mapping
Information Platform online viewer (Nov 15, 2012).
Keith D. Huff
r
2/19/2013
ApplioanU/1gents Printed Name
Applicant/Agents Sfneure
Date
f wft signature Is valid only if an autrmriza-tian letter from the applicant
Is WovidedJ
Page 14 of 14
PCN Form — Version 1.3 December 10, 2008 Version

Additional Information for Pre - Construction Notification ADalication
Kingston Road Culvert Upgrade, City of Winston -Salem
Section A. Questions 3a -3h. Owner Information and Section B. Question 1a & 1c. Property
Identification No. and Property Size (acres).
John Stephen and Sehr Belle
Deed Book and Page: 2578 -4177
104 Belvedere Dr
Morganton, NC 28655
PIN: 6817 -23- 5914.00
0.51 acre
Richard and Joan Pacula
Deed Book and Page: 3056 -1302
2941 Bennington Ct
Winston - Salem, NC 27106
PIN: 6817 -23- 4886.00
0.81 acre
Norman Solomon Revocable Trust
Deed Book and Page: 2997 -2452
3622 Kingston Rd
Winston - Salem, NC 27106
PIN: 6817 -23- 5754.00
0.45 acre
James Bryan and Tamela R. Byrd
Deed Book and Page: 2529 -898
3625 Kingston Rd
Winston - Salem, NC 27106
PIN: 6817 -23- 8837.00
0.64 acre
Town & Country Belvedere
Deed Book and Page: 870 -440
3330 Briarcliffe Rd
Winston - Salem, NC 27106
PIN: 6817 -24- 8130.00
1.96 acres
Please note that the project also occurs within the City of Winston -Salem right -of -way for Kingston Road.

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