20220184 Ver 1_ePCN Application_20220128

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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*
20220184
Is a payment required for this project?
No payment required
Fee received
Fee needed - send electronic notification
Select Project Reviewer*
Sue Homewood:eads\slhomewood
Information for Initial Review
1a. Name of project:
COURTESY COPY Stokes County Water Improvement Project
la. Who is the Primary Contact?*
Mark Lacy
1 b. Primary Contact Email:
[e-mail]
Date Submitted
1 /28/2022
Nearest Body of Water
Dan River
Basin
Roanoke
Water Classification
WS-V
Site Coordinates
Latitude:
36.385279
A. Processing Information
County (or Counties) where the project is located:
Stokes
Is this a NCDMS Project
Yes No
Longitude:
-80.188658
Is this project a public transportation project?*
Yes No
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)
Version#*
1
Reviewing Office*
Winston-Salem Regional Office - (336) 776-
9800
1c. Primary Contact Phone:*
[phone]

Has this PCN previously been submitted?*
Yes
No
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:
NWP Numbers (for multiple NWPS):
1d. Type(s) of approval sought from the DWR:
401 Water Quality Certification - Regular
Non-404 Jurisdictional General Permit
Individual 401 Water Quality Certification
58 - Utility Line Activities for Water and Other Substances (frequently used)
le. Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification:
For the record only for Corps Permit:
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:
Stokes County
2b. Deed book and page no.:
ROW for NC 8 and 89 Highway South and County Home Road
2c. Contact Person:
Stuart Easter
2d.Address
Street Address
1014 Main Street
Address Line 2
City
Danbury
Postal / Zip Code
27016
2e. Telephone Number:
[phone]
2g. Email Address:
[e-mail]
401 Water Quality Certification - Express
Riparian Buffer Authorization
State / Province / Region
North Carolina
Country
USA
2f. Fax Number:
Yes No
Yes No
U

3. Applicant Information (if different from owner)
3a. Name:
Mark Lacy, P.E.
3b. Business Name:
LKC Engineering
3c.Address
Street Address
140 Aqua Shed Court
Address Line 2
City
Aberdeen
Postal / Zip Code
28315
3d. Telephone Number:
[phone]
3f. Email Address:"
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Michelle Measday
4b. Business Name:
ECS Southeast LLP
4c.Address
Street Address
5260 Greens Dairy Road
Address Line 2
City
Raleigh
Postal / Zip Code
27616
4d. Telephone Number:
[phone]
4f. Email Address:"
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality / town:
Danbury
2. Project Identification
2a. Property Identification Number:
Roadway ROW
2c. Project Address
Street Address
NC Highway 8 and 89 and County Line Road
Address Line 2
City
Danbury
Postal / Zip Code
27016
3. Surface Waters
State / Province / Region
North Carolina
Country
USA
3e. Fax Number
State / Province / Region
North Carolina
Country
USA
4e. Fax Number
2b. Property size:
58
State / Province / Region
North Carolina
Country
USA
3a. Name of the nearest body of water to proposed project:
Dan River

3b. Water Resources Classification of nearest receiving water:*
WS-V
3c. What river basin(s) is your project located in?*
Roanoke
3d. Please provide the 12-digit HUC in which the project is located.
030101030109
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 PSA is located within roadway right-of-way for NC 8 Highway South, Dodgetown Road and County Home Road as shown on the attached figures included with this assessment. In
addition to the water line installation, there are additional features associated with the project, including a water tank, development well, and pressure reducing valve areas. The project is
located within Meadows and Danbury in Stokes County. The PSA includes the roadway, roadway right-of-way, mowed turf, and wooded lands. Based on the United States Geological
Survey (USGS) Topographic Map, unnamed tributaries to Flat Shoals Creek, Flat Shoals Creek, an unnamed tributary to Dan River and Mill Creek.
The PSA consists predominantly of roadway, maintained right-of-way, and wooded lands. The majority of the right-of-way is mowed turf to the tree line. Steep sections along the right-of-
way that are unable to be mowed consist of Virginia creeper (Parthenocissus quinquefolia), poison ivy (Toxicodendron radicans), Japanese honeysuckle (Lonicera japonica), and violet
(Viola, spp.). Forested areas along the right-of-way include yellow poplar (Liriodendron tulipifera), oaks (Quercus alba, Quercus rubra, Quercus stellate), hickory (Carya spp.) and cherry
(Prunus serotina, Prunus virginiana) and pines (Pinus spp.) with an open understory of the mature species mixed with ironwood (Carpinus caroliniana), flowering dogwood (Corpus florida)
mountain laurel (Kalmia latifolia) and rhododendron (Rhododendron maximum).
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:
0.002
4g. List the total estimated linear feet of all existing streams on the property:
820
4h. Explain the purpose of the proposed project:
The proposed project entails improvements to an existing well, installation of a new storage tank, new pressure reducing station, a new booster pump station and approximately 25,500
linear feet of water main. The proposed work is located in close proximity to tributaries to the Dan River.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:
The 25,500-LF of water main proposed for installation within the right-of-way for NC Highway 8 and 89 requires crossing of six tributaries. No permanent impacts are proposed with the
installation of the water main. See below for details of each tributary.
Tributary 1 is an unnamed tributary of Flat Shoals Creek that carries stream flow under County Home Road near NC Highway 8 and 89. The channel flows under County Home Road by
way of an arch culvert. An open cut is proposed to the streambed for installation of the water main. The disturbance is temporary and will be backfilled to existing elevations with native
material. Backfill in the stream channel shall be material that shall not readily erode. Refer to Sheet W-1.8 for details regarding the stream crossing.
Tributary 2 is an unnamed tributary to Flat Shoals Creek. No disturbance is proposed to this tributary. The proposed water main will be installed above the culvert.
Tributary 3 is Flat Shoals Creek. Flat Shoals Creek is conveyed under NC Highway 8 and 89 through a double box culvert. An open cut is proposed to the streambed for installation of the
water main. The disturbance is temporary and will be backfilled to existing elevations with native material. Backfill in the stream channel shall be material that shall not readily erode. Refer
to Sheet W-1.7 for details regarding the stream crossing.
Tributary 4 is an unnamed tributary to Flat Shoals Creek. The tributary is conveyed under NC Highway 8 and 89 through an 18-inch reinforced concrete pipe (RCP). No disturbance is
proposed to this tributary. The water main installation is proposed below the existing RCP using a Jack and Bore Method of installation.
Tributary 5 is an unnamed tributary to Flat Shoals Creek. The tributary is conveyed under NC Highway 8 and 89 through double box culvert. No disturbance is proposed to this tributary.
The water main is proposed above the existing culvert.
Tributary 6 is Mill Creek and drains into the Dan River. Mill Creek is conveyed under NC Highway 8 and 89 through double box culvert. No disturbance is proposed to this tributary. The
water main is proposed above the existing culvert.
Project related impacts include 15-LF (559-SF) of temporary impacts to Tributary 1 and 15-LF (304-SF) of temporary impacts to Tributary 3 for installation of the water main. All
construction related impacts will be restored upon construction completion to pre -disturbance elevations and replanted with a native seed mix.
A hydrologic connection will be maintained during construction of the water main and following construction
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
Yes
Comments:
No
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?
Unknown

Name (if known): Michelle Measday
Agency/Consultant Company: ECS Southeast LLP
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
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
❑
S7
3a. Reason for impact (?)
water line installation
3b.lmpact type*
Temporary
3c. Type of impact*
Excavation
3d. S. name*
-]
UNT Flat Shoals Creek
3e. Stream Type*
?)
Perennial
3f. Type of
Jurisdiction*
Corps
3g. S. width*
20
Average (feet)
3h. Impact
length*
15
pinear feet)
S2
water line installation :7ht::]
Excavation
UNT Flat Shoals Creek
Perennial:::]
CorpP
Average (feet)
Qinear feet)
3i. Total jurisdictional ditch impact in square feet:
0
31. Total permanent stream impacts:
0
31. Total stream and ditch impacts:
30
3j. Comments
E. Impact Justification and Mitigation
1. Avoidance and Minimization
3i. Total temporary stream impacts:
30
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
The potential alignment routes of this water main were limited due to topography, water line depth, streams, and manhole locations. The water main was
located as perpendicular to the tributaries as feasibly possible to minimize stream disturbance. Jack and bore method is being utilized to minimize
stream impacts and avoids an open cut of Tributary 4. The water main will be installed above the culvert at Tributaries 2, 5 and 6 avoiding impacts to
those streams.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Jack and bore method is being utilized to minimize stream impacts and avoids an open cut of Tributary 4. The water main will be installed above the
culvert at Tributaries 2, 5 and 6 avoiding impacts to those streams.
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:
Temporary impacts are proposed. No permanent impacts are associated with this project.
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
u

If no, explain why:
Project area tributaries are not subject to riparian buffers.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?
Yes No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?
Yes No
2c. Does this project have a stormwater management plan (SMP) reviewed and approved under a state stormwater program or state -approved local government stormwater program?
Yes No
N/A - project disturbs < 1 acre
2d. Which of the following stormwater management program(s) apply:
Local Government State
Local Government Stormwater Programs
Phasell NSW USMP Water Supply
Please identify which local government stormwater program you are using.
Danbury/Stokes County
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
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.
The project is an improvement project, not an expansion project.
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.
Asheville
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
5i. 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?
USFWS IPaC and a response letter from USFWS concurring a "no effect" determination.
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 Essential Fish Habitat Mapper.
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?*
NC HPO GIB imagery and letter of concurrence from the NC HPO
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:
Impacts are temporary. Impacted areas will be restored to pre -disturbance elevation. No fill will be introduced into the flood hazard area.
8c. What source(s) did you use to make the floodplain determination?*
FEMA FIRM Map Service GIS viewer.
Miscellaneous
u
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
ORM Form Stokes-Meadows.pdf
595.86KB
Signed Agent Authorization.pdf
830.95KB
WOUS Figure.pdf
1.65MB
Permit Impact Locations.pdf
1.65MB
Stokes County Stream Crossing Plan Sheets - Revised.pdf
1.73MB
USFWS Response Letter.pdf
324.21KB
NHP Response Letter 2021-May-19.pdf
1.54MB
SHPO Response Letter.pdf
151.22KB
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:
Michelle Measday
Signature
Michelle I(7e6sdT
U
Date
1 /28/2022