20140624 Ver 1_401 Application_20140614

i
June 16, 2014
3040 NC Hwy 42 West; Clayton, NC 27520
P:919- 606 -1065 — F:919 -585 -5570
Ms. Amy Chapman
NC DWR, Transportation Permitting Unit
1617 Mail Service Center 2 0 1 4 0 6 2
Raleigh, NC 27699 -1617
RE: Pre - Construction Notification: General Certification No. 3886
�0/
TIP B -5004
Bridge No. 87 over Brushy Fork and No. 86 over Salem Creek on Reynolds Park Road
Winston- Salem, Forsyth County, North Carolina
Dear Ms. Chapman;
The City of Winston -Salem proposes to replace bridge No. 87 over Brushy Fork and bridge No.
86 over Salem Creek in their existing locations (TIP B- 5004). The purpose of this project is to
replace two structurally deficient bridges to allow the continued safe use of Reynolds Park Road
by passenger vehicles. Enclosed is an application for a Section 401 Water Quality Certification
No. 3886 for Bridge No. 87. Bridge No. 87 does not require notification to the US Army Corps
of Engineers under Nationwide Permit 14. Bridge No. 86 does not require pre- construction
notification to either agency, as no stream or wetland impacts are anticipated. Therefore, the
attached PCN form relates to Bridge 87 only. Plans for Bridge No. 86 are included with this
PCN for record purposes only as B -5004 includes both bridges.
For bridge No. 87, the only impacts to waters of the U.S. are 12 linear feet of permanent stream
impacts due to upgrading an existing rip rap outlet and 28 linear feet of temporary stream
impacts for channel stabilization. No wetland impacts are anticipated for this project. No
impacts to waters of the US are anticipated for utility relocation.
The preceding information, along with the enclosed project information sheet, Pre - Construction
Notification, Vicinity Map, USGS Map, Jurisdictional Features Map, and wetland and stream
impact drawings are being submitted for your review of this project.

Ms. Amy Chapman
June 16, 2014
Page 2 of 2
If you have any questions or need additional information please contact me at your earliest
convenience at (919) 606 -1065 or phil.may @carolinaeco.com.
Sincerely,
Carolina Ecosystems, Inc.
�J6 4
Philip May
Senior Environmental Scientist
cc: Mr. John Thomas, USACE Raleigh Regulatory Office
Greg Purvis, P.E., Wetherill Engineering, Inc.

CAROLINA
ECOSYSTEMS9 INC.
Project Information Sheet
3040 NC Hwy 42 West; Clayton, NC 27520
P:919-606-1065—F:919-585-5570
Date: 6/16/14
Project Name: TIP B -5004 Bridge No. 87 over Brushy Fork and Bridge No. 86 over Salem Creek on
Reynolds Park Road
Name of Property Owner /Applicant: City of Winston -Salem
Consultant/Agent: Carolina Ecosystems, Inc.
Related /Previous Action IDs: 200900969, City of Winston -Salem Water Line EA
Site Address: N/A
Subdivision Name (if applicable): N/A
City: Winston - Salem, NC
County: Forsyth County
Lat: See Table Long: See Table
USGS Quadrangle(s): Winston -Salem East
River Basin(s): Yadkin
8 -Digit HUC(s): 03040101
Nearest Stream(s): Brushy Fork (Bridge 87) and Salem Creek (Bridge 86)
Directions to Site: From Raleigh take 1 -40 West into Winston - Salem, take US 52 North to exit 108B
Vargrave Street turn right onto Vargrave Street, take the next left onto Diggs Blvd, turn left at T
intersection and remain on Diggs Blvd, turn left onto Martin Luther King Dr., then first right on
Reynolds Park Road to project locations.
Requested Action:
❑ Pre - application Request
❑ Jurisdictional Determination Request ❑ Final ❑ Preliminary
® Permit Application: ® Nationwide 14 ❑ General ❑ Individual

o`'o� wAr�gQc.
O <
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Page 1 of 12
PCN Form — Version 1.3 December 10, 2008 Version
Pre - Construction Notification PCN Form
A. Applicant Information
1.
Processing
1 a.
Type(s) of approval sought from the
Corps:
E] Section 404 Permit ❑Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number: 14 or General Permit (GP) number:
1 c.
Has the NWP or GP number been verified by the Corps?
❑ Yes
® No
1 d.
Type(s) of approval sought from the DWQ (check all that apply):
® 401 Water Quality Certification — Regular ❑ Non -404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
1 e.
Is this notification solely for the record
because written approval is not required?
For the record only for DWQ 401
Certification:
❑ Yes ® No
For the record only for Corps Permit:
® Yes ❑ No
1f.
Is payment into a mitigation bank or in -lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in -lieu
fee program.
❑ Yes
® No
1 g.
Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below.
❑ Yes
® No
1 h.
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
®No
2.
Project Information
2a.
Name of project:
B -5004 Bridge No. 87 over Brushy Fork and Bridge No. 86 over Salem Creek on
Reynolds Park Road
2b.
County:
Forsyth County
2c.
Nearest municipality / town:
City of Winston -Salem
2d.
Subdivision name:
2e.
NCDOT only, T.I.P. or state
project no:
B -5004
3.
Owner Information
3a.
Name(s) on Recorded Deed:
City of Winston -Salem
3b.
Deed Book and Page No.
3c.
Responsible Party (for LLC if
applicable):
Alan Temple
3d.
Street address:
100 East First Street
3e.
City, state, zip:
Winston - Salem, NC 27102
3f.
Telephone no.:
336 - 747 -6844
3g.
Fax no.:
3h.
Email address:
alant @cityofws.org
Page 1 of 12
PCN Form — Version 1.3 December 10, 2008 Version

4.
Applicant Information (if different from owner)
4a.
Applicant is:
❑ Agent ❑ Other, specify:
4b.
Name:
4c.
Business name
(if applicable):
4d.
Street address:
4e.
City, state, zip:
4f.
Telephone no.:
4g.
Fax no.:
4h.
Email address:
5.
Agent/Consultant Information (if applicable)
5a.
Name:
Phil May
5b.
Business name
(if applicable):
Carolina Ecosystems Inc.
5c.
Street address:
3040 NC Hwy 42 West
5d.
City, state, zip:
Clayton, NC 27520
5e.
Telephone no.:
(919) 606 -1065
5f.
Fax no.:
(919)- 585 -5570
5g.
Email address:
phil.may @carolinaeco.com
Page 2 of 12
PCN Form — Version 1.3 December 10, 2008 Version

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
Public ROW
1 b. Site coordinates (in decimal degrees):
Latitude: 36.088796 Longitude: - 80.21976
(DD.DDDDDD) ( -DD DDDDDD)
1 c. Property size:
0.46 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
Brushy Fork
proposed project:
2b. Water Quality Classification of nearest receiving water:
C
2c. River basin:
Yadkin
3. Project Description
3a. 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 project site is an existing two -lane bridge and roadway. Land use in the project vicinity is primarily industrial and
institutional with some forested areas along Bushy Fork and Salem Creek
3b. List the total estimated acreage of all existing wetlands on the property:
0.79 acres within the Study Area
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
1260 linear feet within the Study Area
3d. Explain the purpose of the proposed project:
Replace a structurally deficient bridge with a new 2 -lane bridge with improved vehicle and pedestrian safety.
3e. Describe the overall project in detail, including the type of equipment to be used:
Bridge 87 will be replaced in its existing location using an off -site detour. Stormwater improvements will be constructed.
The existing bridge will be removed using NCDOT Best Management Practices. Standard construction equipment such
as trucks, cranes, excavators, and bulldozers will be used.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
®Yes El No El Unknown
project (including all prior phases) in the past?
Comments: Preliminary JD requested April 2012
4b. If the Corps made the jurisdictional determination, what type
❑ Preliminary ❑ Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas?
Agency /Consultant Company: Carolina Ecosystems Inc.
Name (if known): Phil May and James Pflaum
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5. Project History
5a. Have permits or certifications been requested or obtained for
❑ Yes ® No ❑ Unknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
Page 3 of 12
PCN Form — Version 1.3 December 10, 2008 Version

6. Future Project Plans
6a. Is this a phased project? ❑ Yes ® No
6b. If yes, explain.
Page 4 of 12
PCN Form — Version 1.3 December 10, 2008 Version

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
❑ Wetlands ® Streams - tributaries ❑ Buffers
❑ Open Waters ❑ Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a.
2b.
2c.
2d.
2e.
2f.
Wetland impact
Type of jurisdiction
number —
Type of impact
Type of wetland
Forested
(Corps - 404, 10
Area of impact
Permanent (P) or
(if known)
DWQ — non -404, other)
(acres)
Temporary T
W1 LIP ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W2 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W3 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W4 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W5 ❑ P FIT
❑ Yes
❑ Corps
❑ No
❑ DWQ
W6 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
2g. Total wetland impacts
0.0
2h. Comments: No wetland impacts are anticipated for this project.
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a.
3b.
3c.
3d.
3e.
3f.
3g.
Stream impact
Type of impact
Stream name
Perennial
Type of jurisdiction
Average
Impact
number -
(PER) or
(Corps - 404, 10
stream
length
Permanent (P) or
intermittent
DWQ — non -404,
width
(linear
Temporary (T)
(INT)?
,other)
(feet)
feet)
S1 ❑ P ®T
Bank Stabilization
Brushy Fork
® PER
❑ INT
® Corps
❑ DWQ
20
28
S2 ® P ❑ T
Rip Rap Outlet
Brushy Fork
® PER
❑ INT
® Corps
❑ DWQ
20
12
❑ PER
❑ Corps
S3 ❑ P ❑ T
❑ INT
❑ DWQ
S4 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
❑ PER
❑ Corps
S5 ❑ P ❑ T
❑ INT
❑ DWQ
❑ PER
❑ Corps
S6 ❑ P ❑ T
❑ INT
❑ DWQ
3h. Total stream and tributary impacts
40
3i. Comments: An existing rip rap outlet pad will be upgraded and relocated. Temporary stream impacts will be limited to
channel stabilization above the ordinary high water line.
Page 5 of 12
PCN Form —Version 1.3 December 10, 2008 Version

4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list all open water impacts below.
4a.
4b.
4c.
4d.
4e.
Open water
Name of waterbody
impact number -
(if applicable)
Type of impact
Waterbody type
Area of impact (acres)
Permanent (P) or
Temporary T
01 ❑P ❑T
02 ❑P ❑T
03 ❑P ❑T
04 ❑ PEI T
4f. Total open water impacts
0.0
4g. Comments:
5. Pond or Lake Construction
If pond or lake construction proposed, the complete the chart below.
5a.
5b.
5c.
5d.
5e.
Wetland Impacts (acres)
Stream Impacts (feet)
Upland
Pond ID
Proposed use or purpose
(acres)
number
of pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
5f. Total
5g. Comments:
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If any impacts require mitigation, then you MUST fill out Section D of this form.
6a.
❑ Neuse ❑Tar- Pamlico ❑Other-
Project is in which protected basin?
❑ Catawba ❑ Randleman
6b.
6c.
6d.
6e.
6f.
6g.
Buffer impact
number-
Reason
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P) or
for
Stream name
mitigation
(square feet)
(square feet)
Temporary T
impact
required?
El Yes
131 ❑P ❑T
❑ No
El Yes
B2 ❑P ❑T
❑ No
El Yes
B3 ❑P ❑T
❑ No
6h. Total buffer impacts
6i. Comments:
Page 6 of 12
PCN Form - Version 1.3 December 10, 2008 Version

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
The proposed bridge will completely span Brushy Fork. No bents will be placed in the water. An off site detour will be used
to route traffic during construction to avoid additional temporary impacts. Wetlands have been completely avoided during
design.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
NCDOT BMP's for bridge construction and demolition as well as erosion control measures will be strictly enforced throughout
project 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 yes, mitigation is required by (check all that apply):
❑ DWQ ❑ Corps
2c. If yes, which mitigation option will be used for this
project?
❑ Mitigation bank
❑ Payment to in -lieu fee program
❑ Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter)
Type
Quantity
3c. Comments:
4. Complete if Making a Payment to In -lieu Fee Program
4a. Approval letter from in -lieu fee program is attached.
❑ Yes
4b. Stream mitigation requested.
linear feet
4c. If using stream mitigation, stream temperature:
❑ warm ❑ cool ❑cold
4d. Buffer mitigation requested (DWQ only):
square feet
4e. Riparian wetland mitigation requested:
acres
4f. Non - riparian wetland mitigation requested:
acres
4g. Coastal (tidal) wetland mitigation requested:
acres
4h. Comments:
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.
Page 7 of 12
PCN Form — Version 1.3 December 10, 2008 Version

6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation?
❑ Yes ® No
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.
Zone
6c.
Reason for impact
6d.
Total impact
(square feet)
Multiplier
6e.
Required mitigation
(square feet)
Zone 1
3 (2 for Catawba)
Zone 2
1.5
6f. Total buffer mitigation required:
0
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in -lieu fee fund).
6h. Comments:
Page 8 of 12
PCN Form —Version 1.3 December 10, 2008 Version

E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1.
Diffuse Flow Plan
1 a.
Does the project include or is it adjacent to protected riparian buffers identified
❑ Yes ® No
within one of the NC Riparian Buffer Protection Rules?
1 b.
If yes, then is a diffuse flow plan included? If no, explain why.
Comments: Project is not located within NCDWQ protected riparian buffer
❑ Yes ❑ No
watershed.
2.
Stormwater Management Plan
2a.
What is the overall percent imperviousness of this project?
98%
2b.
Does this project require a Stormwater Management Plan?
❑ Yes ® No
2c.
If this project DOES NOT require a Stormwater Management Plan, explain why: Percent impervious based on limited
area of disturbance for the project. There will be an overall increase of 5% impervious surface from existing conditions.
The project will be designed and constructed in compliance with NCDOT's Individual NPDES permit NCS000250.
Existing stormwater management has been improved through upgrade of an existing
outlet on the west side of the bridge
and a pre- formed scour hole on the east side at a second outlet.
2d.
If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
❑ Certified Local Government
2e.
Who will be responsible for the review of the Stormwater Management Plan?
❑ DWQ Stormwater Program
❑ DWQ 401 Unit
3.
Certified Local Government Stormwater Review
3a.
In which local government's jurisdiction is this project?
❑ Phase II
❑ NSW
3b.
Which of the following locally - implemented stormwater management programs
❑ USMP
apply (check all that apply):
❑ Water Supply Watershed
❑ Other:
3c.
Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
4.
DWQ Stormwater Program Review
❑ Coastal counties
❑ HQW
4a.
Which of the following state - implemented stormwater management programs apply
❑ ORW
(check all that apply):
❑ Session Law 2006 -246
❑ Other:
4b.
Has the approved Stormwater Management Plan with proof of approval been
❑Yes El
attached?
5.
DWQ 401 Unit Stormwater Review
5a.
Does the Stormwater Management Plan meet the appropriate requirements?
❑ Yes ❑ No
Page 9 of 12
PCN Form — Version 1.3 December 10, 2008 Version

5b. Have all of the 401 Unit submittal requirements been met?
❑ Yes ❑ No
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the project involve an expenditure of public (federal /state /local) funds or the
® Yes ❑ No
use of public (federal /state) land?
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
® Yes ❑ No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1 c. If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
❑ Yes ® No
letter)
Comments: PCE does not require Clearinghouse review
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards,
❑ Yes ® No
or Riparian Buffer Rules (15A NCAC 213 .0200)?
2b. Is this an after - the -fact permit application?
❑ Yes ® No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in
❑ Yes ® No
additional development, which could impact nearby downstream water quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
The project is a replacement of existing infrastructure; therefore, additional development is not likely to occur as a result
of the project. The replacement will neither influence nearby land use or stimulate growth as no new travel lanes are
proposed.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non - discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
No wastewater will be generated from this project
Page 10 of 12
PCN Form — Version 1.3 December 10, 2008 Version

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or
❑ Yes ® No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act
® Yes ❑ No
impacts?
® Raleigh
5c. If yes, indicate the USFWS Field Office you have contacted.
❑ Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
USFWS Websitehttp : / /www.fws.gov /raleigh /species /cntylist/forsyth.html, for Forsynth County, North Carolina Natural
Heritage
Program GIS data updated January 2012, and onsite habitat review.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat?
❑ Yes ® No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
NOAA 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
❑ Yes ® No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
HPOWEB Map Service http: / /gis.ncdcr.gov /hpoweb/
National Register of Historic Places http: / /www.nps.gov /nr /research/
Project does not involve new location construction, it is a repicement of existing infrastructure.
S. Flood Zone Designation (Corps Requirement)
Ba. 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 Certification has been approved by the NC Flood
Mapping Program.
8c. What source(s) did you use to make the floodplain determination? North Carolina Floodplain Mapping Program
http: / /www.ncfloodmaps.com/
Ai AA e Wipte
(0/10/14
Applicant/Agent's Printed Name
Date
Applicant/Agent's Sig ature
(Agent's signature is valid only if an authorization letter from the applicant
is provided.)
Page 11 of 12
PCN Form — Version 1.3 December 10, 2008 Version

Page 12 of 12
PCN Form —Version 1.3 December 10, 2008 Version

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PLANS PREPARED FOR
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Bus 919 8518077 NO.
Fox 919 8518107
DATE
DESCRIPTION
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