20211721 Ver 1_U-4015A_Permit_Application_v3_20220829

STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
Roy COOPER
GOVERNOR
February 2, 2022
3331 Heritage Trade Dr. Suite 105
Wake Forest, NC 27587
[e-mail]
ATTN: Mr. David Bailey, NCDOT Regulatory Coordinator
J. ERIC BOYETTE
SECRETARY
SUBJECT: Application for Section 404 Regional General, Permit, Section
401 Water Quality Certification, and Randleman Buffer
Authorization for the Proposed improvements to Gallimore Dairy
Road (SR 1556) from NC 68 to Airpark Drive in Guilford County,
TIP U-4015A, Division 7, Debit $570 from WBS Element 35013.1.1
Dear Mr. Bailey:
The North Carolina Department of Transportation (NCDOT) proposes improvements to
Gallimore Dairy Road (SR 1556) from NC 68 to Airpark Drive in Guilford County. This
section of road is currently two to three lanes and will be widened to five lanes. This action
will result in 95 LF of permanent (loss of waters) impacts to streams, 98 LF of permanent
impacts resulting from bank stabilization and I 1 LF of temporary impacts resulting from
bank stabilization. There will be 153 LF of permanent impacts resulting from stream
relocation and 15 LF of temporary impacts to streams from temporary construction
impacts. There will be < 0.01 acre of permanent impacts to wetlands and < 0.01 acre of
temporary impacts to wetlands from temporary construction impacts. Mitigation will be
required from NCDMS for 248 LF of permanent stream impacts from this project.
There will be 27,515 square feet of allowable impacts and 1,086 square feet of mitigable
impacts to the Randleman Lake Buffer from roadway fill. Mitigation will be required from
NCDMS for the mitigable buffer impacts from this project.
Please see enclosed copies of the Pre -Construction Notification (PCN), NCDMS
Acceptance Letter, NCDWR Pre Filing Meeting Request, Stormwater Management Plan,
Permit Drawings, and Buffer Drawings. A Minimum Criteria Determination Checklist
(MCDC) was completed in March 2020 and is included in the ePCN.
This project calls for a letting date of May 16, 2023, and a review date of March 28, 2023.
Mailing Address: Telephone: [phone] Location:
NC DEPARTMENT OF TRANSPORTATION Fax: [phone] YANCEYVILLE STREET
DIVISION 7 Customer Service: 1-877-368-4968 GREENSBORO, 27415-4996
PO BOX 14996
1584 YANCEYVILLE STREET Website: www.ncdot.gov
GREENSBORO, 27415-4996

A copy of this permit application and its distribution list will be posted on the NCDOT
Website at: hlt2s://xfer.services.ncdot.gov/pdea/PennApps/. If you have any questions or
need additional information, please contact Jerry Parker at [phone].
Sincerely,
Jerry Parker
NCDOT Division 7 Environmental Supervisor
cc: NCDOT Permit Application Standard Distribution List

1/31/22, 3:28 PM Resume Submission
DWR
i)Svislon of Water Resources
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
December 6, 2021 Ver 4.2
Please note: fields marked with a red asterisk below are required. You will not be able to submit the form until all mandatory questions are answered.
Also, if at any point you wish to print a copy of the E-PCN, all you need to do is right -click on the document and you can print a copy of the form.
Below is a link to the online help file.
https://edocs.deq.nc.govMlaterResources/O/edoc/624704/PCN%2OHelp%20File%202018-1-30.pdf (https://edocs.deq.nc.gov/WaterResources/0/doc/603610/Pagel.aspx)
A. Processing Information
County (or Counties) where the project is located:*
Guilford v
Add additional county
Is this a NCDMS Project*
p Yes ) No
Click Yes, only if NCDMS is the applicant or co -applicant.
Is this project a public transportation project?*
QQ Yes p No
This is any publicly funded by municipal,state or federal funds road, rail, airport transportation project.
Is this a NCDOT Project?*
Yes No
(NCDOT only) T.I.P. or state project number:
U-4015A
WBS #*
35013.1.1
(for NCDOT use only)
1 a. Type(s) of approval sought from the Corps:*
Q 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?*
0 Yes
(g No
1 b. What type(s) of permit(s) do you wish to seek authorization?*
p Nationwide Permit (NWP)
Q Regional General Permit (RGP)
p Standard (IP)
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1 c. Has the NWP or GP number been verified by the Corps?
Q Yes (4 No
Regional General Permit (RGP) Number:
Add additional RGP
RGP Numbers (for multiple RGPS):
List all RGP numbers you are applying for not on the drop down list.
1 d. Type(s) of approval sought from the DWR:
check all that apply
Q 401 Water Quality Certification - Regular
❑ Non-404 Jurisdictional General Permit
❑ Individual 401 Water Quality Certification
201902350 - Work associated with bridge construction, widening, replaceme v
1 e. Is this notification solely for the record because written approval is not required?
❑ 401 Water Quality Certification - Express
❑ Riparian Buffer Authorization
For the record only for DWR 401 Certification: p Yes 0 No
For the record only for Corps Permit: p Yes * No
1f. Is this an after -the -fact permit application?*
0Yes )No
1 g. 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.
(j) Yes p No
Acceptance Letter Attachment
Click the upload button or drag and drop files here to attach document
Upload
FILE TYPE MUST BE PDF
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?*
p Yes ) No
Link to trout information: http://www.saw.usace.army.miI/Missions/Regulatory-Permit-Program/Agency-Coordination/Trout.aspx (http://www.saw.usace.army.miI/Missions/Regulatory-
Permit-P rog ram/Age ncy-Coord i nation/Trout. aspx)
B. Applicant Information
1a. Who is the Primary Contact?*
Jerry Parker
1 b. Primary Contact Email:*
[e-mail]
1d. Who is applying for the permit?*
Q Owner
(Check all that apply)
1c. Primary Contact Phone:*
(xxx)xxx-xxxx
[phone]
Applicant (other than owner)
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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
(for Corporations)
Jerry Parker
2d. Address*
Street Address
1584 Yanceyville Street
Address Line 2
PO Box 14996
City
State / Province / Region
Greensboro
NC
Postal /Zip Code
Country
27415
USA
2e. Telephone Number:*
(xxx)xxx-xxxx
[phone]
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
owner
4. Agent/Consultant (if applicable)
4a. Name:*
Matt Martin
4b. Business Name:
(if applicable)
RK&K
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4c. Address*
Street Address
8601 Six Forks Road
Address Line 2
Forum 1, Suite 700
"Y
Raleigh
Postal /Zip Code
27615
State / Province / Region
NC
Country
USA
4d. Telephone Number:* 4e. Fax Number:
[phone]
(xxx)xxx-xxxx (xxx)xxx-xxxx
4f. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1 a. Name of project:*
U-4015A Proposed improvements to Gallimore Dairy Road (SR
1 b. Subdivision name:
1 c. Nearest municipality / town:
Greensboro
2. Project Identification
2a. Property Identification Number:
(tax PIN or parcel ID)
2b. Property size:
(in acres)
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
2d. Site coordinates in decimal degrees
Please collect site coordinates in decimal degrees. Use between 4-6 digits (unless you are using a survey -grade GPS device) after the decimal place as appropriate, based on how
the location was determined. (For example, most mobile phones with GPS provide locational precision in decimal degrees to map coordinates to 5 or 6 digits after the decimal place.)
Latitude: *
Longitude:*
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36.066186-79.954417
ex: 34.208504-77.796371
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:*
Surface Water Lookup (https://ncdenr.maps.arcgis.com/apps/webappviewer/index.html?id=6el25ad7628f494694e259c8Odd64265)
3c. What river basin(s) is your project located in?*
Cape Fear v
Add another river basin
3d. Please provide the 12-digit HUC in which the project is located.*
030300030102
River Basin Lookup (http://ncdenr.maps.arcgis.com/apps/Publicinformation/index.html?appid=ad3a85aOc6d6"aOb97cdO69db238ac3)
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?*
0 Yes No 0 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:
(intermittent and perennial)
1,354
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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 p Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
QQ Preliminary p Approved p Not Verified p Unknown p N/A
Corps AID Number:
Example: SAW-2017-99999
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
Ga. Is this a phased project?*
p Yes No
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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?
This includes other separate and distant crossing for linear projects that require Department of the Army authorization but don't require pre -construction notification.
D. Proposed Impacts Inventory
1. Impacts Summary
1 a. Where are the impacts associated with your project? (check all that apply):
Wetlands Q 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.
"W." will be used in the table below to represent the word "wetland".
1
2a1 Reason*(?)
Fill
2b. Impact type* (')
P v
2c. Type of W.*
Headwater Forest V1
2d. W. name*
:1
WC
2e. Forested*
Yes v
2f. Type of
Jurisdicition* M
Both v
2g. Impact
area*
0.010
(acres)
=tT
nized CI
T v
Headwater Forest v
WB
Yes v
Both v
0.010
(acres)
Add
2g. Total Temporary Wetland Impact
0.010
2g. Total Permanent Wetland Impact
0.010
2g. Total Wetland Impact
0.020
2i. Comments:
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.
Reason for impact* M
*
"S." will be used in the table below to represent the word "stream".
Type of impact* II3d. S. name*
Stream 3f. Type of 3g. S. width* 3h. Impact
e* M Jurisdiction* length*
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S1
Site 1: Stream Re
Permanent v
Relocation v
Sri
Perennial v
Both v
3
153
Average (feet)
Qinear feet)
s2
Site 1: Culvert
Permanent v
Culvert V
Ski
Perennial v
Both v
3
49
Average (feet)
Qinear feet)
�]L
1: Bank Stabi
Permanent v
Bank Stabilization
East Fork Deep R
Perennial v
Both v
25
9$
Average (feet)
Qinear feet)
�]�iteTemporary
1: Bank Stab
v
Bank Stabilization
East Fork Deep R
Perennial v
Both v
25
11
Average (feet)
Qinear feet)
S5
Site 2: Culvert
Permanent v
Culvert v
SD
Intermittent v
Both v
2
10
Average (feet)
Qinear feet)
S6
Site 2: Culvert
Temporary v
Culvert v
$D
Intermittent v
Both v
2
6
Average (feet)
Qinear feet)
E!!
3: Culvert
Permanent v
Culvert v
SC:
Intermittent v
Both v
3
36
Average (feet)
Qinear feet)
fl
Site 3: Culvert
Temporary v
Culvert v
SC
Intermittent v
Both v
3
9
Average (feet)
Qinear feet)
Add another impact
** All Perennial or Intermittent streams must be verified by DWR or delegated local government.
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
346
3i. Total temporary stream impacts:
26
3i. Total stream and ditch impacts:
372
3j. Comments:
6. Buffer Impacts (for DWR)
If project will impact a protected riparian buffer, then complete the chart below. Individually list all buffer impacts below.
6a. Project is in which protect basin(s)?*
Check all that apply.
❑ Neuse
❑ Catawba
❑ Goose Creek
❑ Other
Impact Type* M
M
❑ Tar -Pamlico
Q Randleman
❑ Jordan Lake
Per or Temp* II6d. Stream name* 116e. Buffer mitigation required?
Zone 1 impact* 6g. Zone 2
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Parallel Impact
P V
East Fork Deep River
Yes V
0
563
(square feet)
(square feet)
Road Crossing
P V
East Fork Deep River
No V
10,384
41758
(square feet)
(square feet)
Parallel Impact
P
SA
F
3,919
1,668
(square feet)
(square feet)
Parallel Impact
P
SA
Yes V
0
522
(square feet)
(square feet)
Road Crossing
P
F
No V
2,322
705
(square feet)
(square feet)
Road Crossing
::1
P �SD
�
No V
2,226
1,533
(square feet)
(square feet)
Add another impact
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
1 a. 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.
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
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2a. Does the project require Compensatory Mitigation for impacts to Waters of the U.S. or Waters of the State?
QQ Yes No
2c. If yes, mitigation is required by (check all that apply):
Q DWR Q Corps
2d. If yes, which mitigation options) 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.
(j) Yes Q No
4b. Stream mitigation requested:
(linear feet)
248
4c. If using stream mitigation, what is the stream temperature:
warm v
NC Stream Temperature Classification Maps can be found under the Mitigation Concepts tab on the Wilmington District's RIBITS (https://ribits.usace.army.miI/ribits_apex/f?
p=107:27:2734709611497::NO:RP:P27_BUTTON_KEY:O) website.
4d. Buffer mitigation requested (DWR only):
(square feet)
1086
4f. Non -riparian wetland mitigation requested:
(acres)
0
4h. Comments
Mitigation will be secured from NCDMS
4e. Riparian wetland mitigation requested:
(acres)
0
4g. Coastal (tidal) wetland mitigation requested:
(acres)
0
6. Buffer mitigation (State Regulated Riparian Buffer Rules) - required by DWR
Ga. 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 0No
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 in the table below.
...................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
6c. Reason for impact
6d. Total impact
Multiplier
6e. Required
(square feet)
mitigation (square
feet)
Zone 1
Q
v ::K
Zone 2 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?
pQ Yes No
1,085
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6j. Comments:
Mitigation will be secured from NCDMS
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
*** Recent changes to the stormwater rules have required updates to this section .***
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection Rules?
pQ Yes p No
1 b. All buffer impacts and high ground impacts require diffuse flow or other form of stormwater treatment. If the project is subject to a state implemented riparian buffer
protection program, include a plan that fully documents how diffuse flow will be maintained.
All Stormwater Control Measures (SCM)s must be designed in accordance with the NC Stormwater Design Manual (https://deq.nc.gov/about/divisions/energy-mineral-
land-resources/energy-mineral-land-permit-guidance/stormwater-bmp-manual). Associated supplement forms and other documentation shall be provided.
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
(check all that apply)
For a list of options to meet the diffuse flow requirements, click here
(htt ps://files. nc.gov/ncdegMlate r%20Qual ity/Surface %20Water%20P rotection/401 /Buffer%20C Iarification %20M emos/Options%20for%20Meetin g %20Diff use %20Flow%20P rovisions%20c
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
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
Q 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)?*
Q Yes No
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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
letter.)*
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 (based on past and reasonably anticipated future impacts) 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 0 No p 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 QQ 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, PAC, Field Surveys. Habitat is present for Schweinitz's sunflower and 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?*
p Yes No
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6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
hftps://www.habitat.noaa.gov/apps/efhmapper/
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data: http_//gis.ncdcr.gov/hpoweb/ gov/hpowebD.
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 (e.g., National
Historic Trust designation or properties significant in North Carolina history and archaeology)?*
0Yes 0No
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)
Link to the FEMA Floodplain Maps: https://msc.fema.gov/portal/search (https://msc.fema.gov/portal/search)
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
QQ 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
https:Hmsc.fema.gov/portal/search
FEMA Maps
Miscellaneous
Comments
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
Upload
File must be PDF or KMZ
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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:*
Signature*
Sign
Date
Date will be captured on form submission
Submit Save as Draft
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ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
MARC RECKTENWALD
Director
Mr. Jerry Parker
NCDOT Division 7 Environmental Supervisor
North Carolina Department of Transportation
P. O. Box 14996
Greensboro, North Carolina 27415-4996
Dear Mr. Parker:
Subject: Mitigation Acceptance Letter:
NORTH CAROLINA
Environmental Quality
January 11, 2022
Division 7 Project — TIP Number U-4015A, Improvements to Gallimore Dairy Road, Guilford County
The purpose of this letter is to notify you that the North Carolina Department of Environmental Quality — Division
of Mitigation Services (NCDEQ-DMS) will provide the stream and buffer mitigation for the subject project. Based on the
information received from you on January 10, 2022, the impacts are located in CU 03030003 of the Cape Fear River basin
in the Central Piedmont (CP) Eco-Region, and are as follows:
Cape Fear
Stream
Wetlands
Buffer (Sq. Ft.)
03030003
Cp
Cold
Cool
Warm
Riparian
Non -Riparian
Coastal Marsh
Zone 1
Zone 2
Impacts
0
0
248.000
0
0
0
0
1,086.000
(feet/acres)
All buffer mitigation requests and approvals are administrated through the Riparian Restoration Buffer Fund. The
NCDOT will be responsible to ensure that appropriate compensation for the buffer mitigation will be provided in the agreed
upon method of fund transfer. Upon receipt of the NCDWR's Buffer Authorization Certification, DMS will transfer funds
from the NCDOT 2984 Fund into the Riparian Restoration Buffer Fund. Upon completion of the transfer payment,
NCDOT will have complete its riparian buffer mitigation responsibility for TIP Number U-4015A in Guilford County.
DMS commits to implementing sufficient compensatory mitigation credits to offset the impacts associated with
this project as determined by the regulatory agencies in accordance with the In -Lieu Fee Instrument dated July 28, 2010. If
the above referenced impact amounts are revised, then this mitigation acceptance letter will no longer be valid and a new
mitigation acceptance letter will be required from NCDEQ-DMS.
If you have any questions or need additional information, please contact Ms. Beth Harmon at 919-707-8420.
Sincerely,
Cl4a66 r1laA i? 01
James VStanfill
DMS Asset Management Supervisor
cc: Mr. Dave Bailey, USACE — Raleigh
Ms. Amy Chapman, NCDWR
Ms. Linda Fitzpatrick, NCDOT — EAU
Mr. Brad Chilton, NCDOT — EAU
File: U-4015A — Division 7
D E Q�� North Carolina Department of Environmental Quality I Division of Mitigation Services
217 West Jones Street 1 1652 Mail Service Center I Raleigh, North Carolina 27699-1652
NORTH CAROLINP,
o.P.re�.narnwromen«i0 itr 919.707.8976

11 /29/21, 1:25 PM
Submission Completed
DWR Pre -Filing Meeting Request Form
Contact Name*
Contact Email Address*
Project Owner*
Project Name*
Project County*
Owner Address:
Is this a transportation project?*
Matthew Martin
[e-mail]
NCDOT Divison 7
+ A ..
NORTH CAROLINA
Enrlmnmenen! Quofiry
U-4015A Proposed improvements to Gallimore Diary Road (SR 1556) from
NC 68 to Airpark Drive in Guilford County
Guilford
Street Address
1584 YANCEYVILLE STREET
Address Line 2
City
GREENSBORO
Postal / Zip Code
27415
pp Yes Q No
Type(s) of approval sought from the DWR:
401 Water Quality Certification - Regular
Q Individual Permit
Q Shoreline Stabilization
Does this project have an existing project ID#?*
Yes No
Please list all existing project ID's associated with this projects.*
SAW-2019-00840
State / Province / Region
NC
Country
USA
401 Water Quality Certification - Express
Modification
Do you know the name of the staff member you would like to request a meeting with?
Ryan Conchilla
Please give a brief project description below and include location information.*
The North Carolina Department of Transportation (NCDOT) proposes improvements to Gallimore Diary Road (SR 1556)
from NC 68 to Airpark Drive in Guilford County. This section of road is currently two to three lanes and will be widened to
five lanes. Draft permit drawings are attached.
https://edocs.deq.nc.gov/Forms/Form/Submit 1 /2

11 /29/21, 1:25 PM
Submission Completed
Please attach the documentation you would like to have the meeting about.
U-4015A-Permit.pdf 6.37MB
pdf only
By digitally signing below, I certify that I have read and understood that per the Federal Clean Water Act Section
401 Certification Rule the following statements:
This form completes the requirement of the Pre -Filing Meeting Request in the Clean Water Act Section 401
Certification Rule.
I understand by signing this form that I cannot submit my application until 30 calendar days after this pre -filing
meeting request.
I also understand that DWR is not required to respond or grant the meeting request.
Your project's thirty -day clock started upon receipt of this application. You will receive notification regarding meeting
location and time if a meeting is necessary. You will receive notification when the thirty -day clock has expired, and you
can submit an application.
Signature*
Submittal Date 11/29/2021
https://edocs.deq.nc.gov/Forms/Form/Submit 2/2

Highway North Carolina Department of Transportation
StOYYYteY., Highway Stormwater Program
STORMWATER MANAGEMENT PLAN'^ `
(Version 2.08; Released April 2018) FOR NCDOT PROJECTS
WBS Element: 35013.1.1 TIP No.: U-4015A County(ies): Guilford Page 1 of 1
General Project Information
WBS Element:
35013.1.1 ITIP Number: U-4015A Project Type: Roadway Widening Date: 4/22/2021
NCDOT Contact:
Erik Seiler, PE
Contractor / Desi ner:
Trent Cormier, PE
Address:
1202 Birch Ridge Drive
Raleigh, NC 27610
Address:
8601 Six Forks Road Forum 1, Suite 700
Raleigh, NC 27615
Phone:
919 707-6757
Phone:
984 238-7226
Email:
[e-mail]
Email:
[e-mail]
City/Town:
Greensboro/High Point
Count ies :
Guilford
River Basins :
Ca a Fear I
ICAMA Count
No
Wetlands within Project Limits?
Yes
Project Descri tion
Project Length (lin. miles or feet):
1.057 MI Surrounding Land Use: lindustrial, Farmland
Proposed Project
Existing Site
Project Built -Upon Area ac.
9.5 ac.
12.6 ac.
Typical Cross Section Description:
Typical cross-section consists of five 12' lanes with a center turn lane along the corridor
and varing locations of sidewalks and shoulders.
Typical cross-section is currently two to three lanes - U.S. Concrete median island -
13'+/- towards the end of the project.
Annual Avg Daily Traffic (veh/hr/day):
Design/Future: 18,800 Year: 2024
Existing: 15,900 Year: 2018
General Project Narrative:
(Description of Minimization of Water
Quality Impacts)
Widen and improve Gallimore Diary Road (SR 1556) from NC 68 to Airpark Drive. 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. The shoulders and sidewalks will vary along the corridor. The jurisdictional streams within the
study area have biological impairments (benthos) and are listed on the draft 2020 303d list.
Design Mitigations for streams include:
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. Dissipator pads are provided in buffers at pipe outlets where channel change occurs.
Waterbody Information
Surface Water Body (1):
East Fork Deep River
NCDWR Stream Index No.:
17-2-(0.3)
NCDWR Surface Water Classification for Water Body
Primary Classification:
Water Supply IV (WS-IV)
Supplemental Classification:
None
Other Stream Classification:
None
Impairments:
biological impairment
Aquatic T&E Species?
No Comments:
NRTR Stream ID:
East Fork Deep River
Buffer Rules in Effect: Randleman Lake
Project Includes Bridge Spanning Water Body?
No
Deck Drains Discharge Over Buffer? INo
Dissipator Pads Provided in Buffer? iYes
Deck Drains Discharge Over Water Body?
N/A
(If yes, provide justification in the General Project Narrative)
(If yes, describe in the General Project Narrative; if no, justify in the
General Project Narrative)
(If yes, provide justification in the General Project Narrative)

0
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VICINITY MAP (NTS)
NOTES:
1. A PORTION
2. CLEARING ON THIS PROJECT SHALL BE PERFORMED TO THE LIMITS ESTABLISHED BY
STATE OF NORTH CAROLINA
DIVISION OF HIGHWAYS
GUILFORD COUNTY
LOCATION: SR 1556 (GALLIMORE DAIRY RD.) FROM NC 68
(LYNWOOD SMITH EXPY.) TO AIRPARK RD.IN GREENSBORO
TYPE OF WORK: GRADING, PAVING, WIDENING, DRAINAGE,
CULVERT, SIGNING, RETAINING WALLS,
AND SIGNALS
WETLAND & STREAM IMPACTS
PERMIT DRAWINGS
STATH
RTATH PROlHCT RHPHRHNCH N0.
HEE
U-4015A
I
STATB PROI.NQ
P. A. PROl.N0.
OHPCRIPTION
35013.1.1
WA
PE
GRAPHIC SCALES
DESIGN DPATA
PROJECT LENGTH
PLANS PREPARED BY:
8601 Six Pork, Road, Forum 1 Sai,e 700
HYDRAULICS ENGINEER
ADT 2018=15,900RALEIGH,
NORTH CAROLINA 27615�960
NC LICENSE NO. F-0112
R;fp
50 25 0 50 100
ADT 2040=18,800
1-888-521-4455 OR 919-82761560
MfC
NOR?
V=50 MPH
DHV =10%
D = 65%
LENGTH ROADWAY TIP PROJECT U-4015A.... ........1.045 miles
LENGTH STRUCTURE TIP PROJECT U-4015A ........... 0.011 miles
FOR NORTH CAROLINA DEPARTMENT OF TRANSPORTATION
PE.
SIGNATURE:
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2078 STANDARD SPECIFICATIONS
SCOTT D. BLEVINS, PE
PLANS
PROJECT ENGINEER
ZAC WILSON, EIT
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TTST=2% DUAL=4%
TOTAL LENGTH OF PROJECT U-4015A................... 1.056 miles
RIGHT OF WAY DATE.
05-21-2021
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Site
No.
it
2
3
Station
(From/To)
24+03 to 25+45 -L- LT
25+30 to 25+89 -L-
25+15 to 26+46 -L-
26+84 to 26+96 -L- LT
35+65 to 35+75 -L- RT
39+93 to 40+08 -L- RT
Structure
Size / Type
Stream Relocation
Culvert
Bank Stabilization
Ditch Construction
42" RCP -IV
6611/2 @ 48" RCP -IV
Permanent
Fill In
Wetlands
(ac)
< 0.01
WETLAND AND SURACE WATER IMPACTS SUMMARY
Temp.
Fill In
Wetlands
(ac)
Excavation
in
Wetlands
(ac)
Mechanized
Clearing
in Wetlands
(ac)
< 0.01
Hand
Clearing
in
Wetlands
(ac)
Permanent
SW
impacts
(ac)
Temp.
SW
impacts
(ac)
Existing
Channel
Impacts
Permanent
(ft)
153
49
98
10
36
Existing
Channel
Impacts
Temp.
(ft)
11
Natural
Stream
Design
(ft)
(TOTALS*. I < 0.01 1 < 0.01 1 1 346 1 26 1 0 1
*Rounded totals are sum of actual impacts
NOTES:
Site 1: Wetland WC will be a total take.
Revised 2018 Feb

0
N
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W
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VICINITY MAP (NTS)
NOTES:
1. A PORTION
2. CLEARING ON THIS PROJECT SHALL BE PERFORMED TO THE LIMITS ESTABLISHED BY
STATE OF NORTH CAROLINA
DIVISION OF HIGHWAYS
GUILFORD COUNTY
LOCATION: SR 1556 (GALLIMORE DAIRY RD.) FROM NC 68
(LYNWOOD SMITH EXPY.) TO AIRPARK RD.IN GREENSBORO
TYPE OF WORK: GRADING, PAVING, WIDENING, DRAINAGE,
CULVERT, SIGNING, RETAINING WALLS,
AND SIGNALS
BUFFER IMPACTS
PERMIT DRAWINGS
STATH
RTATH PROlHCT RHPHRHNCH N0.
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U-4015A
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DESIGN DPATA
PROJECT LENGTH
PLANS PREPARED BY:
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HYDRAULICS ENGINEER
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LENGTH ROADWAY TIP PROJECT U-4015A.... ........1.045 miles
LENGTH STRUCTURE TIP PROJECT U-4015A ........... 0.011 miles
FOR NORTH CAROLINA DEPARTMENT OF TRANSPORTATION
PE.
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TOTAL LENGTH OF PROJECT U-4015A................... 1.056 miles
RIGHT OF WAY DATE.
05-21-2021
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RIPARIAN BUFFER IMPACTS SUMMARY
IMPACTS
BUFFER
TYPE ALLOWABLE MITIGABLE REPLACEMENT
Site Station Structure ROAD PARALLEL
No. (From/To) Size / Type BRIDGE ZONE 1 ZONE 2 TOTAL ZONE 1 ZONE 2 TOTAL ZONE 1 ZONE 2
CROSSING IMPACT
(ft) (ft) (ft2) (ft) (ft) (ft) (ft) (ft)
1
-L- 20+21 to 21 +03 RT
X
563
563
1
-L- 25+45 to 26+92
Culvert Extension & Improvements -East
X
10384
4758
15142
Deep Fork River
1
-L- 22+66 to 25+45
JBwMH & 54" RCP-III/Channel Relocation
X
3919
1668
5587
522
522
2
-L- 35+08 to 36+33 RT
42" RCP -IV
X
2322
705
3027
3
-L- 39+38 to 40+52 RT
66" /2 @ 48" RCP -IV
X
2226
1533
3759
TOTALS*:
18851
8663
27515
0
1086
1086
0
0
NOTES
2018 Feb

WETLANDS IN BUFFER IMPACTS SUMMARY
WETLANDS IN
BUFFERS
SITE ZONE 1 ZONE 2
NO. STATION (FROM/TO) (ft) (ft)
1 -L- 26+35 to 26+96 LT 96 177
2 -L- 35+78 to 35+93 RT 16
TOTAL: 113 177
NC DEPARTMENT OF TRANSPORTATION
DIVISION OF HIGHWAYS
FEBRUARY 2021
GUILFORD COUNTY
U-4015A
Revised 2018 Feb I SHEET 5 OF 5
Rev.Jan 2009

DocuSign Envelope ID: D6AA8133-FO4A-447F-83FC-F921 FOC921 F5
MINIMUM CRITERIA DETERMINATION CHECKLIST
The following questions provide direction in determining when the Department is
required to prepare environmental documents for state -funded construction and
maintenance activities. Answer questions for Parts A through C by checking either
"Yes" or "No". Complete Part D of the checklist when Minimum Criteria Rule
categories 98, 12(i) or 915 are used.
TIP Project No.: U-4015A
State Project No.: 35013.1.1
Project Location: Greensboro/High Point, North Carolina (see attached vicinity
map)
Project Description: Widen and improve Gallimore Diary 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. The shoulders and sidewalks vary along the
corridor as follows:
Section
Left Side
Right Side
Shoulder
Sidewalk
Shoulder
Sidewalk
NC 68 to Culvert
10,
5'
10,
5'
Culvert to Green Point Dr
9'
6'
10,
5'
Green Point Dr to Chimney Rock Rd
9'
6'
4'
None'
Chimney Rock to Driveway Sta 54+50)
9'
6'
10,
None
Driveway (Sta 54+50) to End of Project
9'
6'
04'
None
'This section of the project will utilize a section of the existing greenway instead of a sidewalk.
Portions of this section of greenway will need minor shifting to maintain a desirable space between
the roadway and the greenway.
The project will utilize retaining walls to minimize impacts to adjoining businesses.
Anticipated Permit or Consultation Requirements: A Nationwide Permit is
anticipated for the crossing of the East Fork Deep River.
Special Project Information:
Public Involvement
A local officials meeting was held 3-7-19. At the meeting there was discussion of how
the greenway at the river would be tied in along with related discussion of sidewalks
and shared use paths.
03/05/20 1 of 5

DocuSign Envelope ID: D6AA8133-FO4A-447F-83FC-F921 FOC921 F5
A public meeting was held 3-21-19 from 5 p.m. to 7 p.m. The meeting was advertised
three weeks in advance via newspapers and 175 invitations were sent via U.S. Mail.
There were seven local officials and eight citizens in attendance. A total of four
comments were received and only one person opposed the project.
The Public Meeting Map is attached as Figures 2A, 213, and 2C. The impacts to
parking for businesses along the east side have been reduced substantially by the
inclusion of retain walls.
Bicycle and Pedestrian Facilities
During the planning stages of the project, the City of Greensboro expressed a desire to
accommodate bicycle and pedestrian facilities along this section of Gallimore Diary
Road. There is general agreement that a sidewalk will be included on the east side of
the road. On the west side, there was evaluation of both a 5 ft. wide sidewalk and a
10 ft. wide shared use path.
Both scenarios would require retaining walls on the west side with the size of the wall
for the 10 ft wide path being larger, costlier and impacting more parking area for the
industrial facilities.
NCDOT met with the Greensboro Urban Area MPO to weigh the costs and impacts.
They agreed upon a compromise of a 6-foot-wide sidewalk along the western side of
Gallimore Dairy and a 5-foot wide sidewalk along the eastern side as illustrated in the
table found in the project description above.
PART A: MINIMUM CRITERIA
Item 1 to be completed by the Engineer. YES NO
I. Is the proposed project listed as a type and class of activity allowed under
the Minimum Criteria Rule in which environmental documentation is not
required?
If the answer to number 1 is "no", then the project does not qualify as a
minimum criteria project. A state environmental assessment is required.
If yes, under which category? (26) Implementation of any project which
qualifies as a "categorical exclusion" under the
National Environmental Policy Act by one of
the Agencies of the U.S. Department of
Transportation
If either category 98, #12(1) or 915 is used complete Part D of this checklist.
03/05/20 2 of 5

DocuSign Envelope ID: D6AA8133-FO4A-447F-83FC-F921 FOC921 F5
PART B: MINIMUM CRITERIA EXCEPTIONS
Items 2 — 4 to be completed by the Engineer: B
YES NO
2. Could the proposed activity cause significant changes in land use
❑
concentrations that would be expected to create adverse air quality
impacts? Development is already zoned and in progress along Gallimore
Dairy Road. The improvements will better serve the traffic that would occur
whether the road was improved or not.
3. Will the proposed activity have secondary impacts or cumulative
❑
impacts that may result in a significant adverse impact to human health
or the environment? The proposed improvements are not anticipated to
generate any traffic that was not already coming.
4_ Is the proposed activity of such an unusual nature or does the proposed
❑
activity have such widespread implications, that an uncommon concern
for its environmental effects has been expressed to the Department? No
concerns have been expressed.
Item 5-8 to be completed by Division Environmental Officer.
5. Does the proposed activity have a significant adverse effect on wetlands; ❑
surface waters such as rivers, streams, and estuaries; parklands; prime or
unique agricultural lands; or areas of recognized scenic, recreational,
archaeological, or historical value? There are no significant effects in any of
these categories. There are very few wetlands within the area and less than 400
square feet impacted by the anticipated footprint of the project. Stream impacts
total to less than 300 linear feet. The greenway will be slightly realigned but
will experience a net benefit from connectivity to the additional proposed
sidewalks. There are no other described resources within the project area.
6. Will the proposed activity endanger the existence of a species on the ❑
Department of Interior's threatened and endangered species list?
Source: NRTR
7. Could the proposed activity cause significant changes in land use ❑
concentrations that would be expected to create adverse water quality or
ground water impacts?
Land use is already designated for industrial development. The proposed action
will not change the land use.
YES NO
8. Is the proposed activity expected to have a significant adverse effect on ❑
long-term recreational benefits or shellfish, finfish, wildlife, or their
natural habitats.
The overall impacts of the project will be neutral as it relates to the natural
environment and beneficial for the recreational environment.
03/05/20 3 of 5

DocuSign Envelope ID: D6AA8133-FO4A-447F-83FC-F921 FOC921 F5
If any questions 2 through 8 are answered "yes", the proposed project may not qualify as a
Minimum Criteria project. A state environmental assessment (EA) may be required. For
assistance, contact:
PART C: COMPLIANCE WITH STATE AND FEDERAL REGULATIONS
Items 9-12 to be completer) by Division Environmental Officer. YES NO
9. Is a federally protected threatened or endangered species, or its ❑
habitat, likely to be impacted by the proposed action?
Source: NRTR
10. Does the action require the placement of temporary or permanent ® ❑
fill in waters of the United States? Some fill will result in extending the
culvert to carry the wider cross section.
11. Does the project require the placement of a significant amount of
fill in high quality or relatively rare wetland ecosystems, such as
mountain bogs or pine savannahs?
Source: NRTR
12. Is the proposed action located in an Area of Environmental
Concern, as defined in the coastal Area Management Act?
Sc-,rce: Not in the 20 CAMA counties
Items 13 —15 to be completer) by the Engineer.
13. Does the project require stream relocation or channel changes?
Approximately 153 feet of Stream SA will be placed in a pipe under fill.
Cultural Resources
14. Will the project have an "effect" on a property or site listed on the
National Register of Historic Places?
There are no historic architectural or archaeological resources within the study
are of the project. See attached forms.
15. Will the proposed action require acquisition of additional right of
way from publicly owned parkland or recreational areas?
A few hundred feet of greenway will be shifted but the overall area of the
relocated greenway will remain approximately the same.
Questions in Part "C" are designed to assist the Engineer and the Division Environmental
Officer in determining whether a permit or consultation with a state or federal resource
agency may be required. If any questions in Part "C" are answered "yes", follow the
appropriate permitting procedures prior to beginning project construction.
03/05/20 4 of 5

DocuSign Envelope ID: D6AA8133-FO4A-447F-83FC-F921 FOC921 F5
PART D:( To be completed when either cate2ory #8, 120) or #15 of the rules are
MUD
Answers are not required in this section as it does not meet any of the three categories but
given the nature of the project, the numbers are provided as relevant information.
16.
Project length:
1.1 miles
17.
Right of Way width:
120 feet
18.
Project completion date:
2024
19.
Total acres of newly disturbed ground
8.26 acres
surface:
20.
Total acres of wetland impacts:
0.01
21.
Total linear feet of stream impacts:
295
22.
Project purpose:
To provide better
connectivity and access,
to improve multi -modal
transportation, and to
improve safety at
intersections.
`rDocuSigned by:
Fr
U In. Wt�dmsPrepared by:p� Date:
FP
John Williams, P.E.
RK&K Project Manager
DocuSigned by:
Reviewed by. E�6RICJ f11R69F540B
Jerry Parker
Division Environmental Officer
DocuSigned by:
and by: F 5tA_�^5011
tep en o irison, P.E.
Division Planning Engineer
DocuSigned by:
Approved by:
rFffK ii&, P.E.
Project Manager
NCDOT Division 7
3/5/2020
3/6/2020
Date:
3/9/2020
Date:
Date: 3/9/2020
03/05/20 5 of 5

DocuSign Envelope ID: D6AA8133-FO4A-447F-83FC-F921 FOC921 F5
PROJECT COMMITMENTS:
Guilford County
Widen and Improve Gallimore Diary Road
From NC 68 to Airpark Drive
W.B.S. No. 35013.1.4
T.I.P. No. U-4015A
Buffer Rules - Division Environmental Officer
This project is subject to the Riparian Buffer Rules for Randleman Lake
Watershed.
303(d) Waters — Erosion Control Plans, Division Environmental Officer
Design Standards for Sensitive Watersheds will be implemented with this project.
U-4015 Page 1 of 1
Green Sheet
Feb 2020

DocuSign Envelope ID: D6AA8133-FO4A-447F-83FC-F921 FOC921 F5
Piedmont Triad
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1 STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
` DIVISION 7
U-4015A
Widen Gallimore Dairy Road
From NC 68 (Eastchester Drive) to
Just south of Airpark Drive
Project Location Map Figure I

DocuSign Envelope ID: D6AA8133-FO4A-447F-83FC-F921 FOC921 F5
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DocuSign Envelope ID: D6AA8133-F04A-447F-83FC-F921 FOC921 F5
DESIGN BUILD PUBLIC MEETING MAP
PUBLIC MEETING MAP
PROJECT U-4015A
GUILFORD FIGURE 2B
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DocuSign Envelope ID: D6AA8133-FO4A-447F-83FC-F921 FOC921 F5
A
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TO PROVIDE GREATER VISUAL CLARITY, EXISITING AND PROPOSED UTILITIES
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SHOWN ON THIS MAP IS LIMITED TO LOCATIONS OF MAJOR EXISTING AND
100' 50, 0 100' 200• POTENTIAL UTILITY EASEMENTS. THE DESIGN SHOWN ON THIS MAP, INCLUDING
HORIZONTAL SCALE 100' UTILITY EASEMENTS, IS PRELIMINARY AND IS SUBJECT TO CHANGE.
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