20210925 Ver 1_ePCN Application_20211028

DW R
Divi.ha of ware.Resources
Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
June 1,2021 Ver 4.1
Initial Review
Has this project met the requirements for acceptance in to the review process?*
Yes
No
Is this project a public transportation project?*
Yes No
Change only if needed.
BIMS#Assigned* Version#*
20210925 1
Is a payment required for this project?*
No payment required
Fee received Reviewing Office*
Fee needed-send electronic notification Central Office-[phone]
Select Project Reviewer*
Ryan Conchilla:eads\rjconchilla
Information for Initial Review
1a.Name of project:
Tabernacle Church Road Bridge Replacement
la.Who is the Primary Contact?*
Jerry Parker
1 b.Primary Contact Email:* 1c.Primary Contact Phone:*
[e-mail] [phone]
Date Submitted
10/28/2021
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 No
Is this a NCDOT Project?*
Yes No
(NCDOT only)T.I.P.or state project number:
SF-400584

WBS#(?)
17BP.7.R.138
Pre-Filing Meeting Information
Is this a courtesy copy notification?"
Yes 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
File type must be PDF
1a.Type(s)of approval sought from the Corps:
Section 404 Permit(wetlands,streams and waters,Clean Water Act)
Section 10 Permit(navigable waters,tidal waters,Rivers and Harbors Act)
Has this PCN previously been submitted?x
Yes
No
Please provide the date of the previous submission.*
6/23/2021
1 b.What type(s)of permit(s)do you wish to seek authorization?
Nationwide Permit(NWP)
Regional General Permit(RGP)
Standard(IP)
1c.Has the NWP or GP number been verified by the Corps?
Yes No
Nationwide Permit(NWP)Number: 03-Maintenance
NWP Numbers(for multiple NWPS):
1d.Type(s)of approval sought from the DWR:
401 Water Quality Certification-Regular 401 Water Quality Certification-Express
Non-404 Jurisdictional General Permit 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: Yes No
For the record only for Corps Permit: Yes No
1f.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?
Yes No
1g.Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
Yes No
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?
Yes No
B. Applicant Information
1d.Who is applying for the permit?
Owner Applicant(other than owner)
le.Is there an Agent/Consultant for this project?"
Yes 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 Street
Address Line 2
City State/Province/Region
Greensboro NC
Postal/Zip Code 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
City State/Province/Region
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 rural residential and woodlands.This project 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 three 30'precast prestressed concrete channels with end bents made of PPG cap and timber piles;the interior
bents are made of PPG cap and steel piles.The proposed bridge will consists of a single span of 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?"
Yes No Unknown
If yes,please give the DWR Certification number or the Corps Action ID(exp.SAW-0000-00000).
SAW-2019-00875

4f.List the total estimated acreage of all existing wetlands on the property:
0.06
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.
41.Describe the overall project in detail,including indirect impacts and the type of equipment to be used:"
The project includes removal of the existing NCDOT Bridge#400584 on SR 3412(Tabernacle Church Road)over Big Alamance Creek in 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 PPG cap and
timber piles whose interior bents made of PPG cap and steel piles,2-10'lanes with 0.5'paved shoulders.The proposed typical cross section will consist of 2-11'lanes with 4'paved
shoulders and 2'grass shoulders(off-road);whereas 4'-Y paved shoulders will transition approaching the bridge.The proposed structure is to include one 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 is 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 may 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 No Unknown
Comments:
5b.If the Corps made a jurisdictional determination,what type of determination was made?*
Preliminary Approved Not Verified Unknown N/A
Corps AID Number:
SAW-2019-00875
5c.If 5a is yes,who delineated the jurisdictional areas?
Name(if known): Simpson Engineers Associates
Agency/Consultant Company: VHB Engineering
Other:
5d.List the dates of the Corp jurisdiction determination or State determination if a determination was made by the Corps or DWR
July 29,2021
6.Future Project Plans
6a.Is this a phased project?*
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?
N/A
D. Proposed Impacts Inventory
1. Impacts Summary
1a.Where are the impacts associated with your project?(check all that apply):
Wetlands Streams-tributaries Buffers
Open Waters Pond Construction
2.Wetland Impacts
2a1 Reason(?) 2b.Impact type*(?) 2c.Type of W.* 2d.W.name* 2e.Forested* 2f.Type of Jurisdicition*2g.impact
area
L-14+20 to Fill in Wetland P Bottomland Hardwood Forest t
Yes Both 0.020
16+14-LT (acres)
L-14+20 to Hand-clearing in P Bottomland Hardwood Forest WLC Yes Both 0.009
16+14-LT Wetland (acres)
2g.Total Temporary Wetland Impact 2g.Total Permanent Wetland Impact
0.000 0.029
2g.Total Wetland Impact
0.029
21.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
(?) urisdiction* length*
L-14+20 to 16+14 Permanent Fill f�Alrnance Creek Perennial BothS1
Average(feet) (linear feet)
S2
L-14+20 to 16+14 Tem ora Fill Bi Alamance Creek Perennial Both 17 10 P rY 9
Average(feet) (linear feet)
31.Total jurisdictional ditch impact in square feet:
0
31.Total permanent stream impacts: 3i.Total temporary stream impacts:
5 10
31.Total stream and ditch impacts:
15
3j.Comments:
6. Buffer Impacts (for DWR)
6a.Project is in which protect basin(s)?
Check all that apply.
Neuse Tar-Pamlico
Catawba Randleman
Goose Creek Jordan Lake
Other
6b.Impact Type 6c.Per or Temp 6d.Stream name 6e.Buffer mitigation required? 6f.Zone 1 impact 6g.Zone 2 impact
Road Crossing P Big Alamance Creek No 809 416
Road Crossing P Big Alamance Creek No 3,051 1,907
6h. Total buffer impacts:
Zone 1 Zone 2
Total Temporary impacts: 0.00 0.00
Zone 1 Zone 2
Total Permanent impacts: 3,860.00 2,323.00
Zone 1 Zone 2
Total combined buffer impacts: 3,860.00 2,323.00
6i.Comments:
E. Impact Justification and Mitigation
1.Avoidance and Minimization
la.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.
1 b.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?
Yes 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?
Yes No
What type of SCM are you providing?
Level Spreader
Vegetated Conveyance(lower SHWT)
Wetland Swale(higher SHWT)
Other SCM that removes minimum 30%nitrogen
Proposed project will not create concentrated Stormwater flow through the buffer
2. Stormwater Management Plan
2a.Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?
Yes No
Comments:
G. Supplementary Information
1. Environmental Documentation
la.Does the project involve an expenditure of public(federal/state/local)funds or the use of public(federal/state)land?
Yes No
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(North Carolina)
Environmental Policy Act(NEPA/SEPA)?*
Yes No
Comments:"
N/A
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 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.
4. Sewage Disposal (DWR Requirement)
4a.Is sewage disposal required by DWR for this project?*
Yes No 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
5c.If yes,indicate the USFWS Field Office you have contacted.
Raleigh

5d.Is another Federal agency involved?*
Yes No Unknown
5e.Is this a DOT project located within Division's 1-8?
Yes No
5j.What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
VHB Consultants conducted this survey with the outcome being No Effect to present habitat or endangered species.
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?*
N/A
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?*
Tribal Historic Preservation Offices were notified and issued letters of concurrence and an Archeological Survey and filed with OSA who accepted the
project.
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:
NCDOT Hydraulics Unit coordination with FEMA
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 document
Tabernacle Rd Plant Survey.pdf 126.73KB
Tabernacle Rd No Archaeological Survey.pdf 1.83MB
Tabernacle Church Rd Soil Map.pdf 908.51 KB
Tabernacle Church Rd Topo.pdf 764.13KB
TCR Plans.pdf 3.36MB
File must be PDF or KMZ
Comments
Signature
*
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
Signature
W-�FOA IR—
Date
10/28/2021