20210554 Ver 1_ePCN Application_20220128

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)
December 6,2021 Ver 4.2
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#*
20210554 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:
Replacement of Bridges 109 and 121 on East Gate City Boulevard/E.Lee Street(SR 4240)over South Buffalo Creek.
la.Who is the Primary Contact?*
NCDOT
1 b.Primary Contact Email:* 1c.Primary Contact Phone:*
[e-mail] [phone]
Date Submitted
1/28/2022
Nearest Body of Water
South Buffalo Creek
Basin
Cape Fear
Water Classification
WS-V;NSW
Site Coordinates
Latitude: Longitude:
36.052850 -79.739360
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:
B-5717

WBS#(')
45673.1.2
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 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:
n/a
2b.Deed book and page no.:
2c.Contact Person:

2d.Address
Street Address
1598 Mail Service Center
Address Line 2
City State/Province/Region
Raleigh NO
Postal/Zip Code Country
27699 US
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 I town:
Greensboro
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:
South Buffalo Creek
3b.Water Resources Classification of nearest receiving water:*
WS-V;NSW
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.
030300020104
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:*
wooded,low density commercial.
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:
0.92
4g.List the total estimated linear feet of all existing streams on the property:
391
4h.Explain the purpose of the proposed project:
The purpose of the project is to replace Bridge 109(SR 4240 Eastbound)and Bridge 121(SR 2420 Westbound).Bridge 109 was built in 1957 and was previously structurally deficient.
Maintenance activities have improved the structurally deficient designation,and now the structure is only considered functionally obsolete.Bridge 121 was built in 1964 and is structurally
deficient due to a superstructure and substructure rating of 4 out of 9.
4i.Describe the overall project in detail,including indirect impacts and the type of equipment to be used:
NCDOT proposes to replace Bridges 109 and 121 over East Gate City Boulevard/E.Lee Street(SR 4240)over South Buffalo Creek in Guilford County.Bridge 109 is 200 feet long with a
deck width of 32.25 feet.Bridge 121 is 200 feet long with a deck width of 33.3 feet.
NCDOT proposes to construct two 215-foot long three-span structures,each with a minimum roadway width of 33 feet.The new structures will include two lanes at 12 feet wide,as well as
bike lanes and sidewalks,each at 5.5 feet wide.The bridges will be replaced-in-place sequentially while maintaining two-way traffic on one bridge during construction.
Temporary causeways will be utilized to provide the contractor with a working area for the demolition of existing bridges.

5. Jurisdictional Determinations
5a.Have the wetlands or streams been delineated on the property or proposed impact areas?*
Yes No Unknown
Comments:
PJD Application attached.
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): T.Shelton,B.Bill
Agency/Consultant Company: Dewberry Engineers,Inc.
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?
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*
Utility relocation P Seep WF No Corps 0.001
(acres)
Roadway Fill P Non-Tidal Freshwater Marsh WD No Corps 0.087
(acres)
Roadway Fill/Utilities P Non-Tidal Freshwater Marsh WG No Corps 0.053
(acres)
Bridge P Bottomland Hardwood Forest WB No Corps 0.004
(acres)
Bridge P Bottomland Hardwood Forest WA No Corps 0.003
(acres)
[77]
Bridge JL
Bottomland Hardwood 7tJ
WC Yes Corps 0.018
(acres)
2g.Total Temporary Wetland Impact 2g.Total Permanent Wetland Impact
0.000 0.166
2g.Total Wetland Impact
0.166
2i.Comments:
3.Stream Impacts
11
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*
S1 Temp.Causeways =Tmporary Workpad/Causeway ]Fhffalo Creek Perennial Both 55 ��]
Average(feet)

3i.Total jurisdictional ditch impact in square feet:
0
3i.Total permanent stream impacts: 3i.Total temporary stream impacts:
0 145
3i.Total stream and ditch impacts:
145
3j.Comments:
The lone stream impact site is listed on the Impact summary Sheet as"Site 7"(not able to edit ePCN).
No more than one temporary causeway will be in place at any give time and will cover no more than half the stream width.
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
Bridge-Allowable T South Buffalo Creek No 8,450 5,892
6h. Total buffer impacts:
Zone 1 Zone 2
Total Temporary impacts: 8,450.00 5,892.00
Zone 1 Zone 2
Total Permanent impacts: 0.00 0.00
Zone 1 Zone 2
Total combined buffer impacts: 8,450.00 5,892.00
61.Comments:
E. Impact Justification and Mitigation v
1.Avoidance and Minimization
1a.Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
The existing structures are 5-span structures with 2 bent rows in the water.The proposed structures will have 3-spans and will completely span the
waterway.The proposed bridge will not contain deck drains.Roadway drainage on the east and west side of the bridge are collected by catch basins
along concrete median and shoulders,out-letting at the bottom of the roadway fill slope.
Velocities are dissipated by riprap aprons.
Temporary causeways will be utilized to provide the contractor with working area for demolition of existing bridges.
Existing bridge columns will be cut down one-foot below the current ground elevation.
No more than one temporary rock causeway will be in place at any give time and will cover no more than half the stream width.
In efforts to reduce wetland impacts,roadway fill slopes in regions near wetlands will be constructed at 1.5:1 slope,reinforced with rock plating.
1 b.Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
NCDOT standards for ground cover,vegetation,and slope stabilization will be adhered to during the life of this project and will be specified in the
NCDOT Erosion and Sediment Control Plan for 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 impacts to Waters of the U.S.or Waters of the State?
Yes No
2c.If yes,mitigation is required by(check all that apply):
DWR Corps
2d.If yes,which mitigation option(s)will be used for this project?
Mitigation bank Payment to in-lieu fee program Permittee Responsible Mitigation
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 including mitigation credits generated.
See attached information for South Buffalo Creek Mitigation Site.
6. Buffer mitigation (State Regulated Riparian Buffer Rules)- required by DWR
6a.Will the project result in an impact within a protected riparian buffer that requires buffer mitigation?If yes,you must fill out this entire form-please contact DWR for more information.
Yes No
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
1c.If you answered"yes"to the above,has the document review been finalized by the State Clearing House?*
Yes No
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.
Due to the minimal transportation impact resulting from this bridge replacement,this project will neither influence nearby land uses nor stimulate growth.
Therefore,a detailed indirect or cumulative effects study will not be necessary.
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
5g(1).If yes,have you inspected the bridge for signs of bat use such as staining,guano,bats,etc.?
Yes No
If you answered"Yes"to 5g(1),did you discover any signs of bat use?
Yes No Unknown
5j.What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
IPaC identifies 2 species within the project area:Schweinitz's sunflower,habitat present,but none found(last survey 10/21/2021)and small whorled
pogonia(no habitat present).
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?"
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?*
Yes No
7b.What data sources did you use to determine whether your site would impact historic or archeological resources?*
NEPA documentation.
8. Flood Zone Designation (Corps Requirement)
8a.Will this project occur in a FEMA-designated 100-year floodplairi
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:Zone AE.
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
B-5717 Cover Letter.pdf 299.45KB
B-5717 Hist Properties.pdf 2.81 MB
B-5717 PJD Application.pdf 7.7MB
B-5717 No Archaeological Survey Required Form.pdf 2.12MB
B-5717 CE.pdf 6.6MB
B-5717 Buffer Drawings.pdf 1.15MB
B-5717 Permit Drawings.pdf 5.7MB
B-5717 Tribal Coordination.pdf 1.18MB
File must be PDF or KMZ
Comments
Attached are the following:Cover Letter,Historic Architecture Form,Archaeological Form,Tribal Letter to Catawba Nation(No response received),NCDOT On-site Debit Ledger letter,
PJD Application,a Stormwater Management Plan,Permit Drawings,and Buffer Drawings.
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:
Michael Turchy

Signature
T"
Date
1/28/2022