20230354 Ver 1_ePCN Application_20230303

DWR
Division of Water Resources
Initial Review
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
April 13, 2022 Ver 4.3
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:
10/6/2022
BIMS # Assigned * Version#*
20230354 1
Is a payment required for this project? *
No payment required
Fee received
Fee needed - send electronic notification
Reviewing Office*
Winston-Salem Regional Office - (336) 776-
9800
Information for Initial Review
What amout is owed?*
$240.00
$570.00
Select Project Reviewer*
Seren Homer:[e-mail]
la. Name of project:
Water Line Improvements along Knox and Bethel Church Road
la. Who is the Primary Contact?*
Jim Mason
1b. Primary Contact Email: * 1c. Primary Contact Phone: *
[e-mail] [phone]
Date Submitted
3/3/2023
Nearest Body of Water
Rock Creek
Basin
Cape Fear
Water Classification
WS-IV;NSW
Site Coordinates
Latitude:
36.089294
Longitude:
-79.631446
A. Processing Information
Is this project connected with ARPA funding?
Yes No
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
la. 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
1b. What type(s) of permit(s) do you wish to seek authorization?
Nationwide Permit (NWP)
Regional General Permit (RGP)
Standard (IP)
lc. Has the NWP or GP number been verified by the Corps?
Yes No
Nationwide Permit (NWP) Number: 58 - Utility Line Activities for Water and Other Substances (frequently used)
NWP Numbers (for multiple NWPS):
ld. Type(s) of approval sought from the DWR:
401 Water Quality Certification - Regular
Non-404 Jurisdictional General Permit
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:
For the record only for Corps Permit:
If. Is this an after -the -fact permit application?*
Yes No
lg. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
Yes No
lg. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
Yes No
lh. 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
Id. 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:
City of Greensboro
2b. Deed book and page no.:
2c. Contact Person:
Shane Messer
401 Water Quality Certification - Express
Riparian Buffer Authorization
Yes No
Yes No

2d. Address
Street Address
2602 S. Elm -Eugene St
Address Line 2
City
Greensboro
Postal / Zip Code
27406
State / Province / Region
NC
Country
USA
2e. Telephone Number: 2f. Fax Number:
[phone]
2g. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Jim Mason
4b. Business Name:
Three Oaks Engineering
4c. Address
Street Address
324 Blackwell Street, Suite 1200
Address Line 2
City
Durham
Postal / Zip Code
27701
4d. Telephone Number:
[phone]
4f. Email Address:*
[e-mail]
C. Project Information and Prior Project History
State / Province / Region
NC
Country
USA
4e. Fax Number:
1. Project Information
1b. Subdivision name:
(if appropriate)
lc. Nearest municipality / town:
McLeansville & Gibsonville
2. Project Identification
2a. Property Identification Number: 2b. Property size:
Multiple
2c. Project Address
Street Address
Bethel Church Rd at Peeden Drive to Knox Road at US 70
Address Line 2
City
Postal / Zip Code
3. Surface Waters
3a. Name of the nearest body of water to proposed project: *
Rock Creek
3b. Water Resources Classification of nearest receiving water: *
WS-IV;NSW
3c. What river basin(s) is your project located in?*
Cape Fear
State / Province / Region
Country
3d. Please provide the 12-digit HUC in which the project is located.
030300020303

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 project area consists of existing two-lane roads with agriculture, residential, churches, and a school in the vicinity. Most construction will take place within existing North Carolina
Department of Transportation right-of-way.
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:
0.02
4g. List the total estimated linear feet of all existing streams on the property:
68
4h. Explain the purpose of the proposed project: *
The City of Greensboro is proposing improvements to the existing waterline along Knox and Bethel Church Road between Gibsonville and McLeansville, in Guilford County, North
Carolina. This project extends from Bethel Church Road (SR 2752) from Peeden Drive to Knox Road (SR 2814) at US 70 (Burlington Road).
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used: *
The project includes improvements to an existing waterline along Knox Road from Burlington Road (US 70) to Bethel Church Road and along Bethel Church Road from Knox Road to
Peeden Drive.
Impacts will include temporary open trenching of two unnamed tributaries to Rock Creek, plus impacts to riparian buffer. Areas outside of the proposed permanent maintenance corridor
(existing maintained NCDOT ROW, plus 10-ft permanent easement) will not be impacted. Typical construction equipment, such as trucks, bulldozers, excavators, and backhoe loaders, will
be used during construction.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas? *
Yes
Comments:
No O Unknown
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-2022-00517
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
Nathan Howell, MS, PWS
Three Oaks Engineering
5d. List the dates of the Corp jurisdiction determination or State determination if a determination was made by the Corps or DWR
office verification only (see attached email)
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
la. Where are the impacts associated with your project? (check all that apply):
Wetlands
Open Waters
3. Stream Impacts
Streams -tributaries
Pond Construction
Buffers
O
3a. Reason for impact (?)
3b.lmpact type*
3c. Type of impact*
3d. S. name*
3e. Stream Type*
(?)
3f. Type of
Jurisdiction*
3g. S. width
3h. Impact
length*
Sf
Waterline Installation
Temporary
Dewatering
S2
Perennial
Both
10
Average (feet)
32
(linear feet)
S2
Waterline Installation
Temporary
Dewatering
S3
Perennial
Both
7
Average (feet)
36
(linear feet)

3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
0
3i. Total stream and ditch impacts:
68
3i. Total temporary stream impacts:
68
3j. Comments:
Streams S2 and S3 will be temporarily de -watered to allow for installation of the waterline. Streambed material will be sidecast, the line installed, and the
streambed returned to its pre -construction elevation and contours.
6. Buffer Impacts (for DWR)
6a. Project is in which protect basin(s)?
Check all that apply.
Neuse
Catawba
Goose Creek
Other
Tar -Pamlico
Randleman
Jordan Lake
6b. Impact Type
6c. Per or Temp
6d. Stream name
6e. Buffer mitigation required?
6f. Zone 1 impact
6g. Zone 2 impact
Utility, non -electric, perpendicular crossing of
stream -Allowable
P
S2
No
1,050
421
Utility, non -electric, perpendicular crossing of
stream
T
S2
No
659
119
Utility, non -electric, perpendicular crossing of
stream -Allowable
P
S3
No
1,534
753
Utility, non -electric, perpendicular crossing of
stream
T
S3
No
668
193
6h. Total buffer impacts:
Total Temporary impacts:
Total Permanent impacts:
Total combined buffer impacts:
6i. Comments:
Zone 1
1,327.00
Zone 1
2,584.00
Zone 2
312.00
Zone 2
1,174.00
Zone 1 Zone 2
3,911.00 1,486.00
The temporary impacts are vegetated areas that are within the existing easement, but do not contain trees; these areas will be re -seeded with a similar
species composition once construction in the area is completed. Impact length for both sites is very close to 40 linear feet with a 10-foot easement, so
considered Allowable rather than Exempt.
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:
The existing waterline is currently in existing road ROW. The proposed waterline will be installed as close to the existing maintenance corridor/NCDOT
ROW as possible, thereby minimizing riparian buffer impacts. The project has also been designed to avoid permanent wetland and stream impacts.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Best Management Practices for the Protection of Surface Waters will be employed. Silt fencing will be installed along the entire project. Rock check
dams will also be used where appropriate to minimize flow velocity and stormwater runoff into tributaries to Rock Creek. Additional erosion control
measures will be employed as needed during construction. Disturbed areas will be seeded, fertilized and mulched within required timeframes.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for impacts to Waters of the U.S. or Waters of the State?
Yes No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
This project avoids as many impacts as possible and will result in minimal impacts to jurisdictional features and riparian areas. Additionally, no permanent wetland or stream impacts will
occur and all riparian buffer impacts are Allowable.

F. Stormwater Management and Diffuse Flow Plan (required by DWR)
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
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?
Yes No
Comments:
G. Supplementary Information
1. Environmental Documentation
la. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land? *
Yes No
1b. If you answered "yes" to the above, does the project require preparation of an environmental document pursuant to the requirements of the National or State (North Carolina)
Environmental Policy Act (NEPA/SEPA)?*
Yes No
Comments: *
Local funding only (City of Greensboro)
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.
The proposed project is the improvement of an existing waterline, so no additional development is anticipated as a result of the project.
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
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?
Yes No
5g. Does this project involve bridge maintenance or removal?
Yes No
5h. Does this project involve the construction/installation of a wind turbine(s)?*
Yes No
5i. Does this project involve (1) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhammers, mechanized pile drivers, etc.?
Yes No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
IPaC - checked 2/27/2023; tricolored bat, small -whorled pogonia, and bald eagle are listed. Tricolored bat is currently proposed for listing as Endangered
but is not listed at the time of this application. Therefore, no action has been taken yet. If the species is listed during the life of the project and tree
clearing or impacts near existing structures still needs to be completed, this species will be addressed accordingly. No bald eagle nests were observed
during field visits to the site. For small -whorled pogonia, the project is along existing roadside, which is heavily maintained. The project also crosses
several fields, which do not possess habitat. The wooded areas that will be impacted are on the edge of the woodline adjacent to maintained ROW and
are either too open/sunlit or covered in ground cover to be considered habitat. A review of the NCNHP Winter (January) dataset identified no known
occurrences of any species within 1.0 mile of the project.
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? *
NOAA Essential Fish Habitat 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 status? *
Yes No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources? *
NC Historic Preservation Office's HPOWEB 2.0 - General Audience
Determine Eligible - Reece House (GF8209) off US 70 near Knox Rd. - No impacts will occur to this property.
Surveyed Only - GF0370 Bethel Presbyterian Church, GF1862 Wharton -Painter House (6041 Bethel Church Road), and GF1697 Shepard -Brown House
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? *
Yes No
8c. What source(s) did you use to make the floodplain determination?*
FEMA Flood Map Service Center
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
City of Greensboro_Knox_BethelChurchRd_AGENT_AUTHORIZATION_FORM_Flat.pdf
Impact Maps 01-09-2023.pdf
KNOX ROAD WATERLINE.pdf
City of Greensboro_Knox_BethelChurch_PJD_Package_03022022.pdf
USACE_PJD Acknowledgement.pdf
Knox Road_Bethel Church Road Water Line Project_Pre-Filing Request.pdf
Species List_ Raleigh Ecological Services Field Office_02272023.pdf
File must be PDF or KMZ
Comments
Signature
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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:
James Mason
Signature
Q.RArdtl Watt r
Date
3/3/2023