20211721 Ver 1_ePCN Application_20220829

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:
4/29/2022
BIMS#Assigned" Version#*
20211721 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:
U-4015A Proposed improvements to Gallimore Dairy Road(SR 1556)from NC 68 to Airpark Drive in Guilford County
1a.Who is the Primary Contact?*
Jerry Parker
1 b.Primary Contact Email:* 1c.Primary Contact Phone:*
[e-mail] [phone]
Date Submitted
8/29/2022
Nearest Body of Water
East Fork Deep River
Basin
Cape Fear
Water Classification
WS-IV:*
Site Coordinates
Latitude: Longitude:
36.066186 -79.954417
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:
U-4015A
WBS#r)
35013.1.1
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 Division 7
2b.Deed book and page no.:
2c.Contact Person:
Jerry Parker

2d.Address
Street Address
1584 Yanceyville Street
Address Line 2
PO Box14996
City State/Province/Region
Greensboro NC
Postal/Zip Code Country
27415 USA
2e.Telephone Number: 2f.Fax Number:
[phone]
2g.Email Address:*
[e-mail]
4.Agent/Consultant(if applicable)
4a.Name:
Matt Martin
4b.Business Name:
RK&K
4c.Address
Street Address
8601 Six Forks Road
Address Line 2
Forum 1,Suite 700
City State I Province/Region
Raleigh NC
Postal/Zip Code Country
27615 USA
4d.Telephone Number: 4e.Fax Number:
[phone]
4f.Email Address:*
[e-mail]
C. Project Information and Prior Project History
1.Project Information
1 b.Subdivision name:
(if appropriate)
1c.Nearest municipality/town:
Greensboro
2.Project Identification
2a.Property Identification Number: 2b.Property size:
2c.Project Address
Street Address
Gallimore Dairy Road(SR 1556)from NC 68 to Airpark Drive
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:
East Fork Deep River
3b.Water Resources Classification of nearest receiving water:*
WS-IV:*
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.
030300030102
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 general land use in the vicinity of the project is industrial with development on all sides of the project.
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:
0.09
4g.List the total estimated linear feet of all existing streams on the property:
1,354
4h.Explain the purpose of the proposed project:"
The purpose of the project is to increase capacity and reduce congestion on Gallimore Dairy Road(SR 1556).
4i.Describe the overall project in detail,including indirect impacts and the type of equipment to be used:
Widen and improve Gallimore Dairy Road(SR 1556)from NC 68 to Airpark Drive(approximately 1.1 miles long).This section of road is currently two to three lanes and will be widened to
five lanes.The typical section includes five 12'lanes with a center turn lane along the corridor.
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:
SAW-2019-00840
5c.If 5a is yes,who delineated the jurisdictional areas?
Name(if known): Matt Martin/Gordon Marsh
Agency/Consultant Company: RK&K
Other:
5d.List the dates of the Corp jurisdiction determination or State determination if a determination was made by the Corps or DWR
April 25th,2019.David Bailey USACE and April Norton NCDWR
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* �12f.Type of Jurisdicition*2g•Impact
area
Fill P Headwater Forest WC Yes Both 0.010
(acm
(acres)
Mechanized Clearing T Headwater Forest WB ��A
Both 0.010
�777� acres)
2g.Total Temporary Wetland Impact 2g.Total Permanent Wetland Impact
0.010 0.010

2g.Total Wetland Impact
0.020
2i.Comments:
3. Stream Impacts
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 Site 1:Stream Relocation Permanent Relocation SA Perennial Both 153
Average(feet) (linear feet)
S2 Site 1:Culvert Permanent Culvert SA Perennial Both 49
Average(feet) (linear feet)
S3 Site 1:Bank Stabilization Permanent Bank Stabilization East Fork Deep River Perennial Both 25 98
Average(feet) pinear feet)
S4 Site 1:Bank Stabilization Temporary Bank Stabilization J
East Fork Deep River Perennial Both 25 11
Average(feet) (linear feet)
S5
Site 2:Culvert Permanent Culvert SD Intermittent Both 2 10
Average(feet) (linear feet)
S6 Site 2:Culvert Temporary Culvert SD Intermittent Both 2 6
Average(feet) (linear feet)
S7 Site 3:Culvert Permanent Culvert SC Intermittent Both 3 36
Average(feet) (linear feet)
gg Site 3:Culvert Temporary Culvert SC 7Intermittent Both �i
Average(feet) (linear feet)
--]
31.Total jurisdictional ditch impact in square feet:
0
3i.Total permanent stream impacts: 3i.Total temporary stream impacts:
346 26
3i.Total stream and ditch impacts:
372
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
Parallel Impact P East Fork Deep River Yes 0 563
Road Crossing P East Fork Deep River No 10,384 4,758
Parallel Impact P I SA No 3,919 11 1,668
Parallel Impact P SA Yes 0 522
Road Crossing P SC No 2,322 705
Road Crossing P SD No 2,226 1,533
6h. Total buffer impacts:
Zone 1 Zone 2
Total Temporary impacts: 0.00 0.00
Zone 1 Zone 2
Total Permanent impacts: 18,851.00 9,749.00

Zone 1 Zone 2
Total combined buffer impacts: 18,851.00 9,749.00
6i.Comments:
E. Impact Justification and Mitigation
1.Avoidance and Minimization
la.Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
1.Steepening of roadway fill slopes within jurisdictional areas.
2.Stormwater was designed to avoid direct discharge into jurisdictional features to maximum extent practicable.
3.Stormwater design velocities entering jurisdictional features have beem mitigated to be non-erosive(less than 2 fps).
4.Open shoulder sections were maximized to promote sheet flow from the roadway.
5.Diffuse flow provided at outlets that do not have a well defined outfall.
6.Dissipater pads are provided in buffers at pipe outlets where channel change occurs.
1 b.Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Best construction practices will be adhered to.
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
4. Complete if Making a Payment to In-lieu Fee Program
4a.Approval letter from in-lieu fee program is attached.
Yes No
4b.Stream mitigation requested:
(iinearfeet) 4c.If using stream mitigation,what is the stream temperature:
248 warm
4d.Buffer mitigation requested(DWR only): 4e.Riparian wetland mitigation requested:
(square feet) (acres)
1086 0
4f.Non-riparian wetland mitigation requested: 4g.Coastal(tidal)wetland mitigation requested:
(acres) (acres)
0 0
4h.Comments
Mitigation will be secured from NCDMS
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
6b.If yes,then identify the square feet of impact.
6c.Reason for impact 6d.Total impact(square Multiplier 6e.Required mitigation
feet) (square feet)
IF
Zone 1 0 0
Zone 2 1,085 1,085
6f.Total buffer mitigation required
1085
6g.If buffer mitigation is required,is payment to a mitigation bank or NC Division of Mitigation Services proposed?
Yes No
6j.Comments:
Mitigation will be secured from NCDMS

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:
A stormwater management plan is attached.
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
Comments:*
This project included a Minimum Criteria Determination Checklist(MCDC).Review by the state clearing house is no longer a requirement.
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 project,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

5j.What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
NRTR,FAC,Field Surveys.Habitat is present for Schweinitz's sunflower and small-whorled pogonia.
Schweinitz's sunflower habitat is present on site in the form of disturbed roadside
rights-of-way.Habitat was surveyed on September 11,2019 by RK&K biologists,one species of Helianthus was observed onsite and determinded to be
Helianthus maximiliani.A review of the NCNHP database,updated April 2019,revealed no occurrences within 1.0 mile of the study area.This project
will have no effect on the species.
Small whorled pogonia habitat in the form of dry deciduous woods and moist slopes are present on the site A review of NHP records on or updated
January 22,2019 indicates no known occurrences within 1.0 mile of the study area.A survey was conducted,and no specimens were observed.This
project will have no effect on small whorled pogonia.
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?"
https://www.habitat.noaa.gov/apps/efhmapper/
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?*
Minimum Criteria Determination Checklist(MCDC)
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:
Hydrologic model.MCA program.
8c.What source(s)did you use to make the floodplain determination?*
Hydrologic modeling HEC-RAS
hftps://msc.fema.gov/portal/search
FEMA 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
U-4015A_Permit_Application_v3.pdf 15.96MB
PRE_app_request.pdf 124.57KB
U-4015A_MCDC_FINAL.pdf 8.91 MB
U-4015A-Permit_Drawings.pdf 6.37MB
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
8/29/2022