20211570 Ver 1_ePCN Application_20211206

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#*
20211570 1
Is a payment required for this project?*
No payment required Reviewing Office*
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:
Surry pipe 2266 replacement
la.Who is the Primary Contact?*
Kevin Fining-NCDOT
1 b.Primary Contact Email:* 1c.Primary Contact Phone:*
[e-mail] [phone]
Date Submitted
12/6/2021
Nearest Body of Water
UT to Lovills Creek
Basin
Yadkin-PeeDee
Water Classification
WS-Iv
Site Coordinates
Latitude: Longitude:
36.535963 -80.614830
A. Processing Information u
County(or Counties)where the project is located:
Surry
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:

WBS#(,
17BP.11.C.4
Pre-Filing Meeting Information
Is this a courtesy copy notification?"
Yes No
ID# Version
Pre-fling Meeting or Request Date
Attach documentation of Pre-Filing Meeting Request here:
Click the upload button or drag and drop files here to attach document
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?"
Yes
No
1 b.What type(s)of permit(s)do you wish to seek authorization?
Nationwide Permit(N W P)
Regional General Permit(RGP)
Standard(IP)
1c.Has the NWP or GP number been verified by the Corps?
Yes No
Regional General Permit(RGP)Number: 201902350-Work associated with bridge construction,widening,replacement,and
interchanges
RGP Numbers(for multiple RGPS):
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 It.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
801 Statesville Rd
Address Line 2
City State/Province/Region
North Wilkesboro NC
Postal/Zip Code Country
28659 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:
Mt.Airy
2.Project Identification
2a.Property Identification Number: 2b.Property size:
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:
UT to Lovills Creek
3b.Water Resources Classification of nearest receiving water:
WS-Iv
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.
030401010803
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:
Land use in the area is fairly developed and includes a high number of residential houses and a golf course.Existing pipe is a 72"x 106'CMP that is in poor condition.Other than the
stream that flows through the pipe(UT of Lovills Creek),there are no other jurisdictional resources within the project area.
4b.Have Corps permits or DWR certifications been obtained for this project(including all prior phases)in the past?
Yes No Unknown
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:
200-perennial,only one stream-UT of Lovills Creek

4h.Explain the purpose of the proposed project:'
Replace a failing/poor condition 72"x 106'CMP that carries a UT of Lovills Creek under Greenhill Rd(SR 1701).The new pipe(78"x 144'RCP)will be 38'longer(144'compared to 106'),
to better align the inlet of the pipe with the stream and allow the road to be widened.This will also allow us to improve the road shoulder width and slope back the road shoulder,improving
motorist safety.The streambanks at the inlet and outlet of the pipe have been armored in the past,but much of the rip rap has been washed away.As a result,new armoring with rip rap
will occur along with the pipe replacement.
41.Describe the overall project in detail,including indirect impacts and the type of equipment to be used:
Replace a failing/poor condition pipe that carries a UT of Lovills creek under Greenhill Rd.(SR 1701).The new pipe will be 38'longer(144'compared to 106'),to better align the inlet of the
pipe with the stream and allow the road to be widened.This will also allow us to improve the road shoulder width and slope back the road shoulder,improving motorist safety.The
streambanks at the inlet and outlet of the pipe have been armored in the past,but much of the rip rap has been washed away.As a result,new armoring with rip rap will occur along with
the pipe replacement.Standard road building equipment will be used.
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:
5c.If 5a is yes,who delineated the jurisdictional areas?
Name(if known): Kevin Hining
Agency/Consultant Company: NCDOT
Other:
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?
No
D. Proposed Impacts Inventory U
1. Impacts Summary
1a.Where are the impacts associated with your project?(check all that apply):
Wetlands Streams-tributaries Buffers
Open Waters 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
urisdiction* length*
S1 pipe replacement Permanent Culvert IF
Lovills Perennial Both 38
Average(feet) pinear feet)
gy rip rap on banks Permanent Bank Stabilization UT to Lovills Perennial Both 30
Average(feet) pinear feet)
S3 temporary dewatering Temporary Dewatering UT to Lovills Perennial Both 81
Average(feet) pinear feet)
3i.Total jurisdictional ditch impact in square feet:
0
3i.Total permanent stream impacts: 3i.Total temporary stream impacts:
68 81
3i.Total stream and ditch impacts:
149
3j.Comments:
Much of the stream has already been armored with rip rap,so only showing the new footage of rip rap(30')
E. Impact Justification and Mitigation U

1.Avoidance and Minimization
1a.Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
All work will be done in the dry,and no direct discharge of sediment will occur into the stream.NPDES forms will be completed weekly or after any rain
event>1 inch.
1 b.Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
All Best Management Practices will be adhered to.
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:
New pipe length is necessary to allow for the road to be widened and to lessen the steepness of the road shoulders.This will help improve motorist safety and lessen potential erosion
impacts to the road shoulder.The new pipe will also be better aligned with the stream,which should help reduce stream bank erosion within the project area.However,if USACE
determines that mitigation is necessary then the required mitigation will be obtained.
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:
NC Riparian Buffer Protection Rules do not apply to this area
2. Stormwater Management Plan
2a.Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?
Yes No
Comments:
NPDES forms will be completed weekly or after any rain event=to>1 inch
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
1c.If you answered"yes"to the above,has the document review been finalized by the State Clearing House?*
Yes No
Comments:*
An MCDC will be completed and signed prior to the project starting
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
5d.Is another Federal agency involved?*
Yes No 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 No
5g.Does this project involve bridge maintenance or removal?
Yes No
5h.Does this project involve the construction/installation of a wind turbine(s)?*
Yes No
51.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.?
Yes No
5j.What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
NC Natural Heritage Program and USFWS IPaC
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?
NOAA
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?*
SHPO GIS map and NCDOT Human Environment Staff
8. Flood Zone Designation (Corps Requirement)
8a.Will this project occur in a FEMA-designated 100-year floodplain?*
Yes No
8c.What source(s)did you use to make the floodplain determination?*
FRIS website and GIS
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
Catawba response-NCDOT Culvert 2266,Surry County.pdf 95.31 KB
Archaeology PA 16-02-0106 No Survey Required.pdf 7.93MB
Architecture 16-02-0106_NoSurveyReq.pdf 1.96MB
Surry pipe 2266 PCN letter.pdf 120.52KB
852266_Permit_Drawings_Package Final.pdf 2.67MB
File must be PDF or KMZ
Comments
Attached below are Sec 106 materials(Catawba Tribe response,and NCDOT Architecture and Archaeology Reviews).
I have also attached permit drawings and an PCN/application letter.
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:
Kevin Hining
Signature W
Date
12/6/2021