20220222 Ver 1_ePCN Application_20220207

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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,f needed.
BIMS # Assigned*
20220222
Is a payment required for this project?
No payment required
Fee received
Fee needed - send electronic notification
Reviewing Office*
Mooresville Regional Office - [phone]
Information for Initial Review
1a. Name of project:
Country Club Dr. Culvert Replacement
la. Who is the Primary Contact?*
Carolina Garcia Zaragoza Villa, PE
1 b. Primary Contact Email:
[e-mail]
Date Submitted
2/7/2022
Nearest Body of Water
Threemile Branch
Basin
Yadkin-PeeDee
Water Classification
C
Site Coordinates
Latitude:
35.444064
A. Processing Information
County (or Counties) where the project is located:
Cabarrus
Is this a NCDMS Project
Yes No
Longitude:
-80.603902
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
What amout is owed?*
$240.00
$570.00
Select Project Reviewer*
Doug Perez:eads\djperez
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: 03 - Maintenance
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
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:
City of Concord
2b. Deed book and page no.:
Deed Book 500, Page 746
2c. Contact Person:
2d.Address
Street Address
35 Cabarrus Ave. W
Address Line 2
City
Concord
Postal / Zip Code
28025
2e. Telephone Number:
[phone]
2g. Email Address:
[e-mail]
401 Water Quality Certification - Express
Riparian Buffer Authorization
State / Province / Region
NC
Country
us
2f. Fax Number:
Yes No
Yes No
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C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality / town:
Concord
2. Project Identification
2a. Property Identification Number:
n/a
2c. Project Address
Street Address
Country Club Dr. NE
Address Line 2
City
Concord
Postal / Zip Code
28025
3. Surface Waters
3a. Name of the nearest body of water to proposed project:'
Threemile Branch
3b. Water Resources Classification of nearest receiving water:*
C
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.
030401050202
4. Project Description and History
2b. Property size:
n/a
State / Province / Region
NC
Country
Us
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 existing culvert at Country Club Dr. consists of 3 - 72" corrugated metal pipes. The pipes lengths' are 70.8', 71.3', 75.5'. Culvert skew is 130-degrees. All three pipes are in very poor
condition.The pipes' hydraulic capacity does not comply with the current City of Concord ordinances and technical standards.
The project vicinity is in a "General Commercial District".
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:
287 LF
4h. Explain the purpose of the proposed project:
The purpose of this project is to replace the existing structures, which are in bad condition and don't have enough hydraulic capacity, with 2 - 12' wide x 11high box precast concrete
culvert.

4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used: *
The project consists of the removal of the existing corrugated metal pipes and the installation of 78 linear feet of 2-12'x11' precast concrete box culverts and associated services that
include the relocation of the existing 6" and 8" water line, new 18" and 24" storm sewer pipe system, roadway pavement reconstruction and other appurtenances along Country Club Dr. in
Concord NC.
The following steps will be taken:
1. Install erosion control measures.
2. Install proposed water line west of the creek.
3. Temporary dam will be constructed upstream of the project and set up pump around operations using excavator with hydraulic thumb.
4. Install proposed water line across the creek.
5. Remove existing pavement and structures using excavator.
6. Clear vegetation from stream banks within the construction limits.
7. Prepare subgrade with excavator and soil compactor.
8. Install double barrel precast culvert boxes with excavator/crane.
9. Add 12-in of natural stream bed fill inside the base flow barrel and 24-in inside the overflow barrel using dump truck, excavator, Bob Cat and walk behind soil compactor.
10. Install modular block wingwalls with an excavator.
11. Backfill behind wingwalls and on top of culvert, using dump truck, excavator and walk behind soil compactor.
12. Install 15", 24" and 30" storm sewer pipe.
13. Re -construct banks at a 2 Horizontal to 1 Vertical, using dump truck, excavator and walk behind soil compactor.
14. Fine grade slope of banks with a Bob Cat, install rip rap, erosion control mats, and plant vegetation.
15. Remove dam and discontinue pumping.
16. Construct pavement, curb and gutter and other roadway appurtenances over the culvert.
17. Remove erosion control measures after site is stabilized.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
Yes No Unknown
Comments:
The Threemile Branch is a FEMA regulated perennial stream.
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):
Agency/Consultant Company:
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
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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*
S7
Country Club Culvert
Temporary
Dewatering
Threemile Branch
Perennial
Both
33
20
Average (feet)
(linear feet)
S2
Country
Count Club Culvert
Permanent
Fill
Threemile Branch
Perennial
Both
35
5
Average (feet)
(linear feet)
S3
Country Club Culvert
Permanent
-]
Rip Rap Fill
Threemile Branch
Perennial
Both
42
63
Average (feet)
(linear feet)
S4
Country Club Culvert
Temporary
Culvert
Threemile Branch
Perennial
Both
Average (feet)
(linear feet)
S5
Country Club Culvert
Permanent
Rip Rap Fill
Threemile Branch
Perennial
Both �Fv
�111
ge(feet)
nearfeet)

S6
Country Club Culvert
Permanent
Fill ]Fe-ile
Branch
Perennial
Both
48
Average (feet)
18
(linear feet)
S7
Country Club Culvert
Temporary
Dewatering
Threemile Branch
Perennial
Both
28
Average(feet)
20
(linear feet)
31. Total jurisdictional ditch impact in square feet
0
31. Total permanent stream impacts: 31. Total temporary stream impacts:
141 40
31. Total stream and ditch impacts:
181
3j. Comments:
Refer to Surface Water Impacts exhibit in the Miscellaneous section.
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:
Headwalls are designed to minimize the culvert footprint. Wingwalls are designed to minimize grading. Banks are transitioned back to existing as close
as possible to the proposed culvert.
The proposed low flow barrel width is comparable to the width of the stream channel. The proposed low flow barrel will be buried 12in by using natural
stream bed material. The overflow barrel will be buried 24in and will receive flows exceeding base flow.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Precast concrete culvert and headwalls, and modular block wingwalls will be used, minimizing concrete placement in the creek and achieving a faster
construction.
Appropriate erosion control and installation measures will be also used. A pump around will be utilized to route flow around the construction area during
construction.
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:
The purpose of this project is to replace aging structures in the public ROW. The overall impact has been minimized as much as possible. Permanent impacts to the stream bed are less
than 150 linear feet.
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:
The project is in the Yadkin PeeDee Basin and it is not located in or adjacent in any of the Riparian Protection Buffer Program areas.
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
N/A - project disturbs < 1 acre
3. Stormwater Requirements
No
3a. Select whether a completed stormwater management plan (SMP) is included for review and approval or if calculations are provided to document the project will not cause degradation of
downstream surface waters.*
Stormwater Management Plan Antidegradation Calculations
Comments:
N/A, this is culvert replacement project.
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?*
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: *
This is a project funded 100 % by the City of Concord.
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 purpose of this project is to replace aging structures.
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
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?
Critical Habitat for Threatened & Endangered Species [USFWS] Online Mapper and the Red HUC maps by the Asheville Ecological Services Field
Office.
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?
The NOAA Essential Fish Habitat (EFH) 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 State Historic Preservation Office GIS information for advanced users.

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:
A no -rise certificate letter will be submitted to the City of Concord Floodplain Manager for approval before the project construction.
In addition, a Letter Of Map Revision (LOMR) will be submitted to FEMA within six months of completion of the project.
8c. What source(s) did you use to make the floodplain determination?*
FEMA Flood Insurance Rate Map (FIRM) number 3710562200K, dated November 16, 2018.
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
2021-043 Country Club Culvert - PERMIT APPLICATION_signed.pdf 34.24MB
2021-043 Culvert-IMPACTS.pdf 532.07KB
DWR Pre -Filing Meeting Request Form.pdf 112.73KB
File must be PDF or KMZ
Comments
A DWR pre -Fling meeting request was submitted on 12/16/2021
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:
Carolina Garcia Zaragoza Villa
Signature
Pwkd(U;1— Zpi - if -
Date
2/7/2022
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