20211721 Ver 2_ePCN Application_20221101

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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:
11/29/2021
BIMS # Assigned"
20211721
Is a payment required for this project?
No payment required
Fee received
Fee needed - send electronic notification
Select Project Reviewer*
Ryan Conchilla:eads\rjconchilla
Information for Initial Review
1a. Name of project:
U-4015A Proposed Improvements to Gallimore Dairy Road
1a. Who is the Primary Contact?*
Jerry Parker
1 b. Primary Contact Email:
[e-mail]
Date Submitted
11 /1 /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
Version#*
2
Reviewing Office*
Central Office - [phone]
1c. Primary Contact Phone:*
[phone]
Is this a NCDOT Project?*
Yes No

(NCDOT only) T.I.P. or state project number:
U-4015A
WBS#M
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
Please provide the date of the previous submission.*
8/29/2022
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:
RGP Numbers (for multiple RGPS):
1d. Type(s) of approval sought from the DWR:
401 Water Quality Certification - Regular
Non-404 Jurisdictional General Permit
Individual 401 Water Quality Certification
201902350 - Work associated with bridge construction, widening, replacement, and
interchanges
le. Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification:
For the record only for Corps Permit:
1f. Is this an after -the -fact permit application?*
Yes No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
Yes No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
Yes No
1 h. Is the project located in any of NC's twenty coastal counties?
Yes No
1j. Is the project located in a designated trout watershed?
Yes No
B. Applicant Information
1d. Who is applying for the permit?
Owner Applicant (other than owner)
le. Is there an Agent/Consultant for this project?
Yes No
2. Owner Information
2a. Name(s) on recorded deed:
NCDOT Division 7
2b. Deed book and page no.:
2c. Contact Person:
Jerry Parker
401 Water Quality Certification - Express
Riparian Buffer Authorization
Yes No
Yes No

2d.Address
Street Address
1584 Yanceyville Stret
Address Line 2
PO Box14996
City
Greensboro
Postal / Zip Code
27415
2e. Telephone 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:
2. Project Identification
State / Province / Region
NC
Country
USA
2f. Fax Number:
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. The equipment used on this project will be typical roadway construction equipment.
5. Jurisdictional Determinations

5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
Yes No Unknown
Comments:
'Parcel 14 was impacted by adjacent development. They are still shown on drawings at the request of
USACE.
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*
Type of Jurisdicition*
rm
2g.impact
area *
Fill
L
Headwater Forest
WB
Yes
]
Both
]
0.010
(acres)
2g. Total Temporary Wetland Impact
0.000
2g. Total Wetland Impact
0.010
21. Comments:
3. Stream Impacts
2g. Total Permanent Wetland Impact
0.010
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: Fill
Permanent
Fill
SA
Intermittent
Both
153
Average (feet)
(linear feet)
S2
Site 1: Culvert
Permanent
Culvert
SA
Intermittent
Both
3
49
Average (feet)
Qinear feet)
S3
Site 1: Bank Stabilization
Permanent
Bank Stabilization J
SB
Perennial
Both
20
98
Average (feet)
(linear feet)
S4
Site 3: RCP
Permanent
Culvert
SC
Perennial
Both
36
Average (feet)
Qinear feet)
S�
Site 3: RCP
Temporary
Culvert
SC
Perennial
Both
—]
Average (feet)
Qinear feeQ

S6
Site 1: Bank Stablization
Temporary
Bank Stabilization
—]
SB
Perennial
Both
20
Average (feet)
11
(linear (eet)
S7
Site 1: Culvert
Tem ora
P rY
Culvert
SA
Intermittent
Both
3
Average (feet)
11
(linear feet)
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts: 3i. Total temporary stream impacts:
336 31
31. Total stream and ditch impacts:
367
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 1A: Parallel Impact
P
East Fork Deep River / SA
Yes
2,890
3,044
Site 16: Road Crossing Perpendicular
P
East Fork Deep River
No
11,748
6,993
Site 3: Road Crossing Perpendicular
P
UT East Fork Deep River / SC
No
2,226 11
1,533
6h. Total buffer impacts:
Zone 1
Total Temporary impacts: 0.00
Zone 1
Total Permanent impacts: 16,864.00
Zone 1
Total combined buffer impacts: 16,864.00
61. Comments:
E. Impact Justification and Mitigation
1. Avoidance and Minimization
Zone 2
0.00
Zone 2
11,570.00
Zone 2
11,570.00
1a. 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 ouffall.
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:
Silt fencing will be utilized to control sediment from entering stream and wetland features
on site. All staging areas and pre -fabrication of materials will occur on high ground
outside of the riparian buffer.
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
t^�

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:
(linear feet)
476
4d. Buffer mitigation requested (DWR only):
(square feet)
Zone 1: 2,806: Zone 2: 1,616
4f. Non -riparian wetland mitigation requested
NA
4h. Comments
4c. If using stream mitigation, what is the stream temperature:
warm
4e. Riparian wetland mitigation requested:
(acres)
0.02
4g. Coastal (tidal) wetland mitigation requested:
(acres)
NA
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
feet)
Multiplier
6e. Required mitigation
(square feet)
Zone 1
Parallel Impact
2,890
2
5,780
Zone 2 Parallel
3,044 2 6,088
6f. Total buffer mitigation required
11868
6g. If buffer mitigation is required, is payment to a mitigation bank or NC Division of Mitigation Services proposed?
Yes No
6j. Comments:
F. Stormwater Management and Diffuse Flow Plan (required by DWR) n,
1. Diffuse Flow Plan
la. 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

1a. Does the project involve an expenditure of public (federallstatellocal) 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 includes 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, the 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
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?
USFWS IPaC. See cover letter for survey dates.
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?
Review of online mapping
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?*
Included archaeology form/letter and historic properties and landscapes form/letter.
8. Flood Zone Designation (Corps Requirement)
Sa. Will this project occur in a FEMA-designated 100-year floodplain?*
Yes No

8b. If yes, explain how project meets FEMA requirements:
Hydrologic model. MOA Program
8c. What source(s) did you use to make the floociplain determination?*
FEMA floodmaps
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 Permit Drawings.pdf
6.39MB
U-4015A Sunflower Survey.pdf
675.82KB
U-4015A Mitigation Letter 2.pdf
233.43KB
U-4015 Cultural Resource Info.pdf
1.01 MB
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
11/1/2022
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