20211405 Ver 1_ePCN Application_20220427

DW R
mrlsloa of ware.Besourcrs
Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
April 13,2022 Ver 4.3
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.
Pre-Filing Meeting Date Request was submitted on:
9/20/2021
BIMS#Assigned" Version#*
20211405 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:
Coble Church Rd Bridge Replacement
1a.Who is the Primary Contact?*
Jerry Parker
1 b.Primary Contact Email:* 1c.Primary Contact Phone:*
[e-mail] [phone]
Date Submitted
4/27/2022
Nearest Body of Water
Climax Creek
Basin
Cape Fear
Water Classification
WS-IV NSW 16-19-2
Site Coordinates
Latitude: Longitude:
35.964973 79.650700
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:
WBS#(1)
17BP.7.R.136
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:
NCDOT
2b.Deed book and page no.:
2c.Contact Person:

2d.Address
Street Address
1584 Yanceyville Street
Address Line 2
P.O.Box 14996
City State/Province/Region
Greensboro NC
Postal/Zip Code Country
27415-4996 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:
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:
Climax Creek
3b.Water Resources Classification of nearest receiving water:*
WS-IV NSW 16-19-2
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:
Project site is a rural residential area with agricultural fields and forest land.
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:
0.2 acres
4g.List the total estimated linear feet of all existing streams on the property:
100 If
4h.Explain the purpose of the proposed project:
The purpose of the project is to replace a structurally deficient bridge with a new bridge.
4i.Describe the overall project in detail,including indirect impacts and the type of equipment to be used:
The project involves replacement of Bridge#267 on Coble Church Rd.Traffic will be detoured offsite during construction.Two stormwater outalls are proposed which will be placed at a
distance to minimize impacts to the nearby stream and adjacent buffers.All stormwater will outlet outside of the buffers.Riprap pads will be placed at the ouffalls to dissipate energy.No
deck drains are proposed.Standard road building equipment will be used,such as trucks,dozers,tamps and cranes.
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 Sa is yes,who delineated the jurisdictional areas?
Name(if known): Reid Robul
Agency/Consultant Company: VHB
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
2.Wetland Impacts
2a1 Reason M 2b.Impact type*(?) 2c.Type of W. 2d.W.name 2e.Forested" 2f.Type of Jurisdicition"2g.Impact
(?) area"
__]
Site 1 hand clearing&fill T Bottomland Hardwood Forest Site 1 No Corps 0.040
(acres)
Site 2 Hand clearing and fill T Bottomland Hardwood Forest Site 2 No Corps 0.090
(acres)
Site 4 hand clearing&fill T Bottomland Hardwood Forest Site 4 No Corps 0.030
(acres)
Site 5 Hand Clearing T Bottomland Hardwood Forest Site 5 No Corps 0.010
(acres)
Site 6 Fill P Bottomland Hardwood Forest Site 6 No Corps 0.030
(acres)
_]
2g.Total Temporary Wetland Impact 2g.Total Permanent Wetland Impact
0.170 0.030
2g.Total Wetland Impact
0.200
2i.Comments:
Wetland impacts from Site 1,2 and 4 show combined impacts from hand clearing and fill.Please see Wetland and Surface Water Impacts Summary and
permit drawing for more detailed breakdown of impacts.
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
(?) urisdiction* length*
S1 Bank Stabilization Permanent Bank Stabilization Climax Creek Perennial Both 17 39
Average(feet) (linear feet)
S2 Bank Stabilization Temporary Dewatering Climax Creek Perennial Both 17
Average(feet) Qinear feet)

H
Toe Protection at Site 6 Permanent Fill UT to Climax Creek Perennial Both 3 7
Average(feet) (linear feet)
H
P rY
Toe Protection at Site 6 Tem ora Fill UT to Climax Creek Perennial Both 3 31
Average(feet) (linear feet)
3i.Total jurisdictional ditch impact in square feet:
0
3i.Total permanent stream impacts: 3i.Total temporary stream impacts:
46 37
31.Total stream and ditch impacts:
83
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
Site 1 Allowable P Climax Creek No 3,215 2,106
Site 2 Allowable P Climax Creek No 2,032 1,353
Site 3 Allowable with mitigation P Climax Creek Yes 5,688 2,359
6h. Total buffer impacts:
Zone 1 Zone 2
Total Temporary impacts: 0.00 0.00
Zone 1 Zone 2
Total Permanent impacts: 10,935.00 5,818.00
Zone 1 Zone 2
Total combined buffer impacts: 10,935.00 5,818.00
61.Comments:
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:
Roadway approach work was minimized as much as possible and an offsite detour will be utilized to avoid temporary construction.Outlets will discharge
outside of the buffer and dissipator pads will be used to decrease energy.
1 b.Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
NCDOT Best Management Practices will be utilized.Erosion and sedimentation devices will be installed prior to commencing construction.Buffer areas
will be identified and fenced off prior to construction.Dewatering will occur during construction to prevent impacts to the stream and downstream aquatic
resources.
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:
Impacts to surface waters will not exceed the thresholds that would require compensatory mitigation.
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
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:*
This project does not meet the threshold for NEPA/SEPA.
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 impact associated with project,stimulated growth or influence in nearby land use is not anticipated.
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?
IPaCs Website and T&E survey performed by consultants

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?*
NCDOT Cultural Resource personnel
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 Flood 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
Coble Church Rd(Bridge#267)Topo Map.pdf 696.69KB
Coble Church Rd Buffer Impacts Summary.pdf 1.2MB
Coble Church Rd No Archaeology Survey Regd.pdf 1.12MB
Coble Church Rd Permit Drawings.pdf 2.45MB
Coble Church Rd Pre-Filing Request.pdf 57.43KB
Coble Church Rd Signed Effects Form.pdf 1.04MB
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,PE
Signature
Date
4/27/2022