20210925 Ver 1_ePCN Application_20210623

DWR
Division of Water Resources
Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
June 1,2021 Ver4.1
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?*
R Yes r No
Change only if needed.
BIMS#Assigned* Version#*
20210925 1
Is a payment required for this project?*
✓ No payment required
6' Fee received Reviewing Office*
✓ Fee needed-send electronic notification Central Office-[phone]
Select Project Reviewer*
Ryan Conchilla:eads\rjconchilla
Information for Initial Review
la.Name of project:
Tabernacle Church Road Bridge Replacement
1a.Who is the Primary Contact?*
Della Moore
lb.Primary Contact Email:* 1c.Primary Contact Phone:*
[e-mail] [phone]
Date Submitted
6/23/2021
Nearest Body of Water
Big Alamance Creek
Basin
Cape Fear
Water Classification
Big Alamance Creek
Site Coordinates
Latitude: Longitude:
35.962690 -79.715119
A. Processing Information
County(or Counties)where the project is located:
Guilford
Is this a NCDMS Project
✓ Yes ( 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:
SF-400584

WBS#(9)
17BP.7.R.138
Pre-Filing Meeting Information
Is this a courtesy copy notification?*
✓ Yes G No
ID# Version
20210925 1
Pre-fling Meeting or Request Date
5/4/2021
Attach documentation of Pre-Filing Meeting Request here:
Click the upload button or drag and drop files here to attach document
DWR Pre-Filing Meeting Request Form(2).pdf 53KB
Re type mast 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?
f7 Nationwide Permit(NWP)
✓Regional General Permit(RGP)
✓Standard(IP)
1c.Has the NWP or GP number been verified by the Corps?
✓ Yes 6 No
Nationwide Permit(NWP)Number: 14-Linear transportation
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
✓Non-404 Jurisdictional General Permit 17 Riparian Buffer Authorization
✓ 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 6' No
For the record only for Corps Permit: r Yes 6 No
If.Is this an after-the-fact permit application?*
✓ Yes f No
1g.Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
✓ Yes ( No
1g.Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
✓ Yes rNo
lh.Is the project located in any of NC's twenty coastal counties?
✓ Yes 6 No
1j.Is the project located in a designated trout watershed?
✓ Yes f No
B. Applicant Information
1d.Who is applying for the permit?
17 Owner r Applicant(other than owner)
le.Is there an Agent/Consultant for this project?*
✓ Yes f No
2.Owner Information

2a.Name(s)on recorded deed:
NCDOT
2b.Deed book and page no.:
2c.Contact Person:
2d.Address
Street Address
1584 Yanceyville St
Address Line 2
atY State/Bovine/Region
Greensboro NC
Postal/Zip Cork Country
27405 Guilford
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)
Pleasant Garden
1c.Nearest municipality/town:
Climax
2. Project Identification
2a.Property Identification Number: 2b.Property size:
N/A
2c.Project Address
Street Address
Address Line 2
Clly Slate/Rovince/Fagion
Postal/Zip Code Country
3.Surface Waters
3a.Name of the nearest body of water to proposed project:*
Big Alamance Creek
3b.Water Resources Classification of nearest receiving water:*
Big Alamance Creek
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.
030300020301
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 surrounding land use consists of forest,rural residential,and woodlands.TIP project SF-400584 involves the replacement of the existing NCDOT Bridge#400584 on SR 3412
(Tabernacle Church Road)over Big Alamance Creek in Guilford County.
Bridge#400584 consists of 3 @ 30'precast prestressed concrete channels with end bents made of PPC cap and timber piles with interior bents made of PPC cap and steel piles.The
proposed bridge will consists of 1 @ 100'-39"box beam with 4'-0"caps.
4b.Have Corps permits or DWR certifications been obtained for this project(including all prior phases)in the past?*
r Yes f• No C Unknown
4f.List the total estimated acreage of all existing wetlands on the property:
0.055
4g.List the total estimated linear feet of all existing streams on the property:
100

4h.Explain the purpose of the proposed project:*
The purpose of this project is to replace a structurally deficient and aged bridge with a new structurally sound bridge.
4i.Describe the overall project in detail,including indirect impacts and the type of equipment to be used:*
The project includes removal of the existing bridge NCDOT Bridge#400584 on SR 3412(Tabernacle Church Road)over Big Alamance Creek at Guilford County.The project is
approximately 0.12 miles long surrounded by forest and rural residential areas within 0.3 acres.This bridge consists of 3 @ 30'precast prestressed concrete channels with end bents
made of PPC cap and timber piles with interior bents made of PPC cap and steel piles,2 @ 10'lanes with 0.5'paved shoulders.The proposed typical cross section will be two 11'lanes
with 4'paved shoulders and 2'grass shoulders(off-road);4'-3"paved shoulders approaching the(bridge).The proposed structure is to include 1 @ 100'-39"box beam with 4'-0"caps.
Rip-rap pads will be utilized to dissipate energy and to reduce velocity at all proposed outfalls.No deck drains are required for the proposed bridge.The bridge subject to the Jordan
Lake Buffer Rules.An offsite detour will be utilized during removal and placement of the existing and proposed bridges.Construction equipment utilized will consists of(but not limited to)
cranes,excavators,backhoes,dumb trucks,hand tools,compactors,and erosion control&safety equipment/materials that will serve as barriers for compliance and BMP
implementation.
5.Jurisdictional Determinations
5a.Have the wetlands or streams been delineated on the property or proposed impact areas?*
✓ Yes C No C Unknown
Comments:
Please see permit plans.
5b.If the Corps made a jurisdictional determination,what type of determination was made?*
✓ Preliminary r Approved r Not Verified C Unknown F N/A
Corps AID Number:
N/A
5c.If 5a is yes,who delineated the jurisdictional areas?
Name(if known):
Agency/Consultant Company: Simpson Engineers and Associates
Other: VHB Engineering
6. Future Project Plans
6a.Is this a phased project?*
✓ Yes (7 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?
N/A
D. Proposed Impacts Inventory
1. Impacts Summary
la.Where are the impacts associated with your project?(check all that apply):
17 Wetlands fJ Streams-tributaries fJ Buffers
r Open Waters 1 Pond Construction
2.Wetland Impacts
2a.Site#*(?) 2a1 Reason(?) 2b.Impact type*(?) 2c.Type of W.* 2d.W.name* 2e.Forested* 2f.Type of 2g.Impact
Jurisdicition*(?) area*
L-14+20 to Fill in Wetlands P Bottomland Hardwood Forest WLB Yes DWR 0.019
16+14 (acres)
L-14+20 to Mechanized Clearing in P Bottomland Hardwood Forest WLB Yes DWR 0.036
16+14 Wetlands (acres)
2g.Total Temporary Wetland Impact 2g.Total Permanent Wetland Impact
0.000 0.055
2g.Total Wetland Impact
0.055
2i.Comments:
N/A
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 L-14+20 to 16+14 Temporary Other Big Alamance Creek Perennial Both 5 10
Average(feet) (linear feet)
31.Total jurisdictional ditch impact in square feet:
0
3i.Total permanent stream impacts: 3i.Total temporary stream impacts:
0 10
3i.Total stream and ditch impacts:
10
3j.Comments:
N/A
6. Buffer Impacts(for DWR)
6a.Project is in which protect basin(s)?
Check all that apply.
C Neuse r Tar-Pamlico
C Catawba r Randleman
E Goose Creek 17 Jordan Lake
r Other
6b.Impact Type 6c.Per or Temp 6d.Stream name 6e.Buffer mitigation required? 6f.Zone 1 impact 6g.Zone 2 impact
L-13+65 to 15+08-LT(Bridge) P Big Alamance Creek No 684 114
L-13+68 to 15+08-LT(Parallel Impacts) P Big Alamance Creek No 125 303
L-13+62 to 15+04-RT(Bridge) P Big Alamance Creek No 2,815 756
L��-13+62 to 15+04-RT(Parallel Impacts) P Big Alamance Creek No 236 1,150
L-14+61 to 15+08-LT(Wetlands in Buffer) T Big Alamance Creek Yes 165 212
6h. Total buffer impacts:
Zone 1 Zone 2
Total Temporary impacts: 165.00 212.00
Zone 1 Zone 2
Total Permanent impacts: 3,860.00 2,323.00
Zone 1 Zone 2
Total combined buffer impacts: 4,025.00 2,535.00
6i.Comments:
N/A
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:
Rip-rap pads will be utilized to dissipate energy and to reduce velocity at all proposed outfalls.BMP's alongside erosion control measures will be
installed as per plan and the site will be continuously monitored during rain events and throughout the duration of construction.
lb.Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
An off-site detour will be implemented to control traffic for this area.Concrete footers will be retained,the embankments will be stabilized with Class II
Riprap and geotextile fabric,standard base ditches and toe protection will be utilized to manage flow as well as erosion control measures to direct flow
and maintain compliance.
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?
r Yes m No
2b.If this project DOES NOT require Compensatory Mitigation,explain why:
In accordance with 15A NCAC 02H.0506(h),15A NCAC 02H.1305(g),the Division of Water Resources(DWR)requires compensatory mitigation for permanent impacts(sometimes
referred to as losses or fill)of streams,and wetlands.DWR requires compensatory mitigation for impacts equal to or greater than 300 linear feet of perennial stream and equal to or
greater than 0.10 acre of wetland.Mitigation is only required if stream impacts on a single reach of stream,or multiple crossings of the same stream added together exceed 300 linear
feet.DWR requires that all impacts exceeding these thresholds be mitigated at a 1:1 ratio.This project will not exceed the quantified standards for mitigation.

F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
la.Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
6 Yes f No
What type of SCM are you providing?
1 Level Spreader
1 Vegetated Conveyance(lower SHWT)
f-Wetland Swale(higher SHWT)
fJ Other SCM that removes minimum 30%nitrogen
f-Proposed project will not create concentrated storm titer flow through the buffer
2.Stormwater Management Plan
2a.Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
C Yes f No
2b.Does this project meet the requirements for low density projects as defined in 15A NCAC 02H.1003(2)?
s Yes r No
Comments:
Vegetated conveyances shall meet the following requirements for:
(i)Side slopes
(ii)Shoulders
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?*
6 Yes rNo
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 (• No
Comments:*
N/A
2.Violations(DWR Requirement)
2a.Is the site in violation of DWR Water Quality Certification Rules(15ANCAC 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 6- No
3. Cumulative Impacts(DWR Requirement)
3a.Will this project result in additional development,which could impact nearby downstream water quality?*
C Yes R No
3b.If you answered"no,"provide a short narrative description.
No this is a simple bridge replacement to accommodate future traffic/travel demands within a residential area.No future projects or extension thereof
in lieu of this project is warranted at this time.The purpose for this bridge replacement is to secure a structurally sound bridge and to remove the
existing deficient structure that is well beyond repairing.
4.Sewage Disposal(DWR Requirement)
4a.Is sewage disposal required by DWR for this project?*
✓ Yes r No C 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?*
G Yes CNo
5b.Have you checked with the USFWS concerning Endangered Species Act impacts?*
( Yes C No
5c.If yes,indicate the USFWS Field Office you have contacted.
Raleigh

5d.Is another Federal agency involved?*
r Yes r No r Unknown
5e.Is this a DOT project located within Division's 1-8?
6 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,Aquatic Survey Performed
6. Essential Fish Habitat(Corps Requirement)
6a.Will this project occur in or near an area designated as an Essential Fish Habitat?*
r Yes 6 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?*
6 Yes rNo
7b.What data sources did you use to determine whether your site would impact historic or archeological resources?*
SHPO
8. Flood Zone Designation(Corps Requirement)
8a.Will this project occur in a FEMA-designated 100-yearfloodplain?*
6 Yes r No
8b.If yes,explain how project meets FEMA requirements:
According to FEMA Floodplain Maps this site is situated in an area of minimal flood hazard and with 0.2%annual chances of flooding.
Political Jurisdictions:TOWN OF PLEASANT GARDEN
DFIRM_ID 37081C
VERSION_ID 2.3.3.3
SOURCE_CIT 37081C BASE7
GFID 2040f948-0c16-468c-91fc-9be99ec65131
SHAPE.LEN
8c.What source(s)did you use to make the floodplain determination?*
FEMA Maps
Miscellaneous
Please use the space below to attach all required documentation or any additional information you feel is helpful for application review.Documents should be combined into one
file when possible,with a Cover Letter,Table of Contents,and a Cover Sheet for each Section preferred.
Click the upload button or drag and drop files here to attach docunant
Tabernacle Church Rd Permit Drawings(1).pdf 1.91MB
Tabernacle Church Rd Topo.pdf 764.13KB
Tabernacle Rd No Archaeological Survey.pdf 1.83MB
Tabernacle Rd Plant Survey.pdf 126.73KB
Tabernacle Church Rd Buffer Drawings(2).pdf 1008.56KB
Tabernacle Church Rd Soil Map.pdf 908.51KB
Catawba Indian Nation Tribal Coordination Notification.pdf 44.26KB
Rle nest be HT or ffW
Comments
N/A
Signature
*
H7 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

,G1r7tnt '
Date
6/23/2021