20230553 Ver 1_ePCN Application_20230417

DWR
Division of Water Resources
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:
1/27/2023
BIMS # Assigned
20230553
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
la. Name of project:
Ashcroft Dam Repair
la. Who is the Primary Contact?*
Amy Black, PC
1b. Primary Contact Email: *
[e-mail]
Date Submitted
4/17/2023
Nearest Body of Water
Troublesome Creek (Lake Reidsville)
Basin
Cape Fear
Water Classification
WS-III:NSW,CA
Site Coordinates
Latitude:
36.32611
A. Processing Information
Is this project connected with ARPA funding?
Yes No
County (or Counties) where the project is located:
Rockingham
Is this a NCDMS Project
Yes No
Longitude:
-79.69389
Version#*
1
What amout is owed?*
$240.00
$570.00
Select Project Reviewer*
Seren Homer:[e-mail]
1c. Primary Contact Phone: *
[phone]
O

Is this project a public transportation project?*
Yes No
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
1b. What type(s) of permit(s) do you wish to seek authorization?
Nationwide Permit (NWP)
Regional General Permit (RGP)
Standard (IP)
1c. Has the NWP or GP number been verified by the Corps?
Yes No
Nationwide Permit (NWP) Number: 03 - Maintenance
NWP Numbers (for multiple NWPS):
1d. Type(s) of approval sought from the DWR:
401 Water Quality Certification - Regular
Non-404 Jurisdictional General Permit
Individual 401 Water Quality Certification
401 Water Quality Certification - Express
Riparian Buffer Authorization
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
1h. 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:
Ashcroft Lake Association, Inc.
2b. Deed book and page no.:
0971/2251
2c. Contact Person:
Larry Huffman, Association President

2d. Address
Street Address
1318 Winterberry Drive
Address Line 2
City
Reidsville
Postal / Zip Code
27320
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Amy Black, PE
4b. Business Name:
LJB Engineering PC
4c.Address
Street Address
311-A South Main Street
Address Line 2
city
Kernersville
Postal / Zip Code
27284
4d. Telephone Number:
[phone]
4f. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality / town:
Reidsville, NC
2. Project Identification
2a. Property Identification Number:
799307586585
2c. Project Address
Street Address
1318 Winterberry Drive
Address Line 2
city
Reidsville
Postal / Zip Code
27320
3. Surface Waters
3a. Name of the nearest body of water to proposed project:
Troublesome Creek (Lake Reidsville)
3b. Water Resources Classification of nearest receiving water:
WS-III:NSW,CA
3c. What river basins) is your project located it *
Cape Fear
State / Province / Region
NC
Country
Rockingham
2f. Fax Number:
State / Province / Region
NC
Country
Forsyth
4e. Fax Number:
2b. Property size:
10.31
State / Province / Region
NC
Country
Rockingham

3d. Please provide the 12-digit HUC in which the project is located.
030300020203
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:
This lake and dam are located in a residential area and is maintained by Ashcroft Lake Association, Inc. The dam is a small, earthen dam and the owner has been issued a Notice of
Violation from NC Dam Safety. The lake has been drained well over a year in response to a Dam Safety Order and will not be filled until Dam Safety has approved the repair. The dam and
areas downstream of the dam are maintained by the Lake Association.
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
4g. List the total estimated linear feet of all existing streams on the property:
375
4h. Explain the purpose of the proposed project:"
This project will replace a non -compliant CMP riser/barrel with a RCP riser/barrel and add a riprap apron at the discharge location for energy dissipation to reduce erosion downstream.
The crest elevation of the emergency spillway will also be adjusted so it won't activate in less than the 50 year event in order to allow it to remain a grassed spillway.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used: *
The 12" barrel through the dam will have to be excavated and replaced. The new pipe will be set on a concrete cradle and include a constructed two -stage filter diaphragm. A riprap apron
will be added at the discharge location to prevent erosion during high velocity discharge. The new riprap apron will be a permanent impact. All other impacts will be temporary to allow for
construction.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?
Yes No G Unknown
Comments:
All work, with the exception of the riprap apron, will be performed in the upland areas. There does not
appear to be any wetland areas within the project site.
5b. If the Corps made a jurisdictional determination, what type of determination was made?
Preliminary Approved Not Verified Unknown N/A
Corps AID Number:
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
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?
No
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
3. Stream Impacts
L
F
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*
fl
Riprap apron at discharge
Permanent
Stabilization
Unnamed trib to Troublesome
Creek
ff::]
Both
Average (feel)
14
(linear feet)
31. Total jurisdictional ditch impact in square feet:
0

3i. Total permanent stream impacts:
14
3i. Total temporary stream impacts:
0
3i. Total stream and ditch impacts:
14
3j. Comments:
4. Open Water Impacts
4a. Site #
4a1. Impact Reason 714b.
Impact type
4c. Name of waterbody
4d. Activity type
4e. Waterbody type
4f. Impact area
Upstream of
Lmer'placement and
sediment
T
Ashcroft Lake
Excavation
PondDam
4g. Total temporary open water Impacts: 4g. Total permanent open water impacts:
0.80 0.00
4g. Total open water impacts:
0.80
4h. Comments:
This acreage includes everything within the LOD in the pond. Much of this is just access. No disturbance is intended on the upstream slope except for
the excavation area over the pipe. The pond bed is dry since the pond has been drained for over a year. There is an existing access path that was used
during the last repair project that will be used again. The riser/barrel replacement includes the same size but different material - so no additional
permanent impacts.
E. Impact Justification and Mitigation O
1. Avoidance and Minimization
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
The proposed outlet is located in the same area as the existing outlet to avoid additional disturbance in removing the existing infrastructure. Access into
the lake bed will be from the northern bank - an area that was previously used and is much less steep than the dam embankment. All impacts are
directly related to the dam repair and improvements.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
The lake has already been drained and the lake bed is dry. All work will be completed in dry conditions. An Erosion & Sediment Control plan is included
in the project documents.
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 will provide erosion protection for the downstream outlet. There will be no loss of open water.
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
If no, explain why:
This project will not add impervious area and does not require a diffuse flow plan.
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

1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?
Yes No
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.
Repair of this existing dam will not result in additional development in the area.
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?
Fish & Wildlife iPaC service
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?
Searched the GIS spatial data from National Register of Historic Places at NPS.gov. Additionally, this project is in a residential subdivision on private
property.
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?"
fris.nc.gov
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
Ashcroft_Agent_Auth_Form.pdf 171.01KB
PCN_Soils_Map.pdf 1.64MB
PCN_USGS_Map.pdf 1.37MB
ROCKI-162_Ashcroft Plans 2023-04-07.pdf 7.39MB
Species List_ Raleigh Ecological Services Field Office.pdf 617.6KB
File must be PDF or KMZ
Comments
The construction plans, Agent Authorization, Soils Map, USGS Map, and Species List from iPaC are included as attachments.
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:
Amy Black
Signature
Date
4/17/2023
a