20230606 Ver 1_ePCN Application_20230425

i 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:
2/2/2023
BIMS # Assigned
20230606
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:
0 Lantern Ridge Drive (Muddy Creek)
la. Who is the Primary Contact?*
Jessica Tisdale
1b. Primary Contact Email: *
[e-mail]
Date Submitted
4/25/2023
Nearest Body of Water
Muddy Creek
Basin
Yadkin-PeeDee
Water Classification
C
Site Coordinates
Latitude:
Longitude:
36.092561
-80.361167
A. Processing Information
Is this project connected with ARPA funding?
Yes No
County (or Counties) where the project is located:
Forsyth
Is this a NCDMS Project
Yes No
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: 58 - Utility Line Activities for Water and Other Substances (frequently used)
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:
Lantern Ridge Association Inc
2b. Deed book and page no.:
BK1644 P1532
2c. Contact Person:

2d. Address
Street Address
2200 Silas Creek Parkway STE 2A
Address Line 2
city
Winston-Salem
Postal / Zip Code
27103
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
2a. Narri on recorded deed:
Brookberry Park Apartments LLC
2b. Deed book and page no.:
BK1989 P3670-3671
2c. Contact Person:
2d.Address
Street Address
311 X Gramercy St
Address Line 2
City
Greensboro
Postal / Zip Code
27408
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
3a. Name:
Michael Stover, Deputy Director Operations
3b. Business Name:
City of Winston-Salem/Forsyth County
3c.Address
Street Address
Bryce A. Stuart Municipal Building
Address Line 2
100 East First Street
city
Winston-Salem
Postal / Zip Code
27101
3d. Telephone Number:
[phone]
3f. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Jessica Tisdale
4b. Business Name:
HDR Engineering of the Carolinas
State / Province / Region
North Carolina
Country
us
2f. Fax Number:
State / Province / Region
NC
Country
us
2f. Fax Number:
State / Province / Region
NC
Country
us
3e. Fax Number:

4c.Address
Street Address
555 Fayetteville Street
Address Line 2
Suite 400
city
Raleigh
Postal / Zip Code
27601
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:
Winston-Salem
2. Project Identification
2a. Property Identification Number:
2c. Project Address
Street Address
0 Lantern Ridge Drive
Address Line 2
city
Winston-Salem
Postal / Zip Code
27103
3. Surface Waters
3a. Name of the nearest body of water to proposed project:"
Muddy Creek
3b. Water Resources Classification of nearest receiving water:'
C
3c. What river basins) is your project located in?*
Yadkin-PeeDee
3d. Please provide the 12-digit HUC in which the project is located.
030401011303
4. Project Description and History
State / Province / Region
North Carolina
Country
us
4e. Fax Number:
[phone]
2b. Property size:
State / Province / Region
North Carolina
Country
us
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 site is located within a WSFC Utilities sewer easement in which the system perpendicularly crosses Muddy Creek, a perennial stream. Muddy Creek greenway and the Mountains -to -
Sea Trail are adjacent to the site. The surrounding land use is residential and patchy forested exist along riparian corridors.
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:
None
4g. List the total estimated linear feet of all existing streams on the property:
20
4h. Explain the purpose of the proposed project: *
The purpose of this emergency project was to replace a compromised 80-foot section of sanitary sewer 12" ductile iron restrained pipe (DIP) with a 12" DIP encased in a 24" encasement.
A sanitary overflow was reported on December 24th, 2022 and a sanitary bypass pump was installed from upstream to downstream manholes on the same day. Woody debris in Muddy
Creek was piled up on the aerial sanitary sewer crossing which created enough pressure to compromise the DIP. Repair work on the sanitary sewer line commenced the week of January
3rd.
a

4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used: *
The project permanently impacted 20 feet of stream bank on each side of Muddy Creek where the pipe crosses. The project is located along Muddy Creek at 36.092561,-80.361167
decimal degrees.
Work entailed the removal/excavation of a damaged 50-foot, aerial pipe segment over Muddy Creek, replacement with an 80-foot 24" encasement DIP section, constructing a stable bank
using rock/geotextile, coir matting and establishing a stable segment of stream bed at the base of the bank. Repair work was completed from both sides of the stream bank, no work was
performed within the stream bed except for tree debris clearing. The site was accessed from the existing greenway system at Lantern Ridge Drive and existing sewer easements. Erosion
control measures were installed prior to work.
Stone was placed to establish a stable work area within the easement. Disturbed areas were reseeded and mulched when work was completed in late January. An excavator, a skid steer
loader and a dump truck were used to stabilize the streambank. Please see the five attached details; steel casing pipe detail, temporary silt fence, temporary construction entrance, bank
stabilization, and seeding details.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
Yes No O Unknown
Comments:
perennial stream; no wetlands on 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?
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
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
Bank stabilization
Permanent
Bank Stabilization
S1
Perennial::]
Both
h;;J�]
3i. Total jurisdictional ditch impact in square feet:
0
31. Total permanent stream impacts: 3i. Total temporary stream impacts:
20 0
3i. Total stream and ditch impacts:
20
3j. Comments
E. Impact Justification and Mitigation
1. Avoidance and Minimization
0
`1
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
See project description in Section C4.i.

1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
See attached details referenced in Section C4.i.
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:
Impacts to waters are below mitigation threshold.
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:
The Project is located in the Yadkin Pee Dee River Basin which is not included in the NC Riparian Buffer Protection Rules.
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:
Sanitary sewer line replacement
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: *
This is a small sanitary sewer replacement project.
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
2b Provide an explanation of the violation(s):
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.
This project was solely to repair an existing sewer system and no additional development is planned.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?
Yes No N/A
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or habitat?
Yes No

5b. Have you checked with the USFWS concerning Endangered Species Act impacts?
Yes No
5d. Is another Federal agency involved?*
Yes No
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
Unknown
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?
USFWS IPaC NCNHP Database report
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 Fish Map
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?
https://nc.maps.arcgis.com/home/item.html?id=79ea671 ebdcc45639f0860257d5f5ed7
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?
Yes No
8b. If yes, explain how project meets FEMA requirements:
An after the fact local jurisdictional Floodway Development permit is being prepared with an expected approval based on a No -rise determination.
8c. What source(s) did you use to make the floodplain determination?*
DFIRM no. 3710589500J which is attached to the submittal.
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
Muddy_Creek_ Permit _Package_Review_4242023_Final.pdf 4.83MB
File must be PDF or KMZ
Comments
Please review the attached upload (Attachment A) which includes project description; figures, photographs; construction details; IPAC&NHP Reports; pre -filing email request; and a signed
agent authorization.
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:
Jessica Tisdale
6

Signature
Date
4/25/2023