20231166 Ver 1_ePCN Application_20230821

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:
7/12/2023
BIMS # Assigned
20231166
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:
Parkdale Culvert Replacement
la. Who is the Primary Contact?*
Amy Black, Project Manager
1b. Primary Contact Email: *
[e-mail]
Date Submitted
8/21/2023
Nearest Body of Water
Muddy Creek
Basin
Yadkin-PeeDee
Water Classification
C
Site Coordinates
Latitude:
36.03379
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
Longitude:
-80.37595
Version#*
1
What amout is owed?*
$240.00
$570.00
Select Project Reviewer*
Rebecca Chandler:[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:
Village of Clemmons
2b. Deed book and page no.:
2c. Contact Person:
Mike Gunnell, Village Manager

2d. Address
Street Address
3715 Clemmons Road
Address Line 2
city
Clemmons
Postal / Zip Code
27012
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Amy Black, Project Manager
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:
Village of Clemmons
2. Project Identification
2a. Property Identification Number:
5893-34-0290.000
2c. Project Address
Street Address
(Near) 6125 Parkdale Drive
Address Line 2
City
Clemmons
Postal / Zip Code
27012
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 it *
Yadkin-PeeDee
State / Province / Region
NC
Country
us
2f. Fax Number:
State / Province / Region
NC
Country
us
4e. Fax Number:
2b. Property size:
1.2
State / Province / Region
NC
Country
us

3d. Please provide the 12-digit HUC in which the project is located.
030401011306
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 existing culvert is located on Parkdale Drive, between Sabastian Court and Fairpoint Drive. The land use is residential. The existing culvert is an 18" RCP and is undersized, causing
localized flooding in significant rain events.
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:
85
4h. Explain the purpose of the proposed project:*
The proposed culvert replacement at Parkdale Drive in Clemmons, NC will reduce flooding and roadway overtopping in this area.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used: *
This project will replace an undersized culvert with a double 30" culvert to reduce flooding and roadway overtopping in this area. The existing pipe is an 18" RCP. We are limited in pipe
size and elevation change by an existing sewer main above the culvert and rock at depths below the culvert. We are proposing two 30" pipes at lower invert elevations to keep the top -of -
pipe elevation at the existing top -of -pipe elevation because of limited separation between culvert and sanitary sewer. The proposed pipe invert will be a foot lower than the existing invert,
which will require some grading of the upstream channel to meet the new culvert.
The existing culvert is 70 LF and the proposed culvert is 60 LF. There will be minimal grading and channel stabilization needed downstream since the existing invert is more than a foot
above the channel elevation. Grading in the upstream channel will extend approximately 20 LF in order to tie in the new grade and we will include riprap for the newly graded area to
prevent erosion.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
Yes No O Unknown
Comments:
Adjacent property owners mow the grassy upland area up to the top of bank at the upstream culvert
inlet. The culvert discharges into a natural rock pool. Property owners maintain the shoulder area as
an extension of their grassed lawn.
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
O
F I
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*
S1
Culvert Replacement
Temporary
Culvert
Unnamed tributary
Perennial
Both
10
Average (feet)
65
(linear feet)

g;2 Culvert Replacement —] Rip Rap Fill Unnamed tributary Perennial Both )Permanent T�J[L__
t
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
20
3i. Total stream and ditch impacts:
85
3j. Comments:
E. Impact Justification and Mitigation
1. Avoidance and Minimization
3i. Total temporary stream impacts:
65
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
Proposed culvert length will be less than existing to avoid excavation of the visible rock downstream. The upstream grading will be limited to that
necessary to tie into existing grades. Riprap will be installed on disturbed stream channel to reduce erosion and downstream impacts.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Erosion and sediment control practices for this project will include pump around to allow all stream work to be completed in dry conditions.
Appropriatesoil erosion and sediment controls will be used and maintained in effective operating condition during construction, and all exposed soil and
other fills, aswell as any work below the ordinary high-water mark, will be permanently stabilized at the earliest
practicable date.
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:
The proposed project is designed to avoid adverse effects to waters of the U.S. and will not impacts wetlands.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
1a. 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:
This project is a culvert replacement and will not add impervious area.
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
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: *
Project only involves environmental enhancement and replacement of existing structure. There will be no additional impervious area.
2. Violations (DWR Requirement)
O
O

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.
This project replaces an existing culvert and 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
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 Resource List for proposed project area reported no critical habitat in our project area:
iPac website: https:Hipac.ecosphere.fws.gov/
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: https://www.fisheries.noaa.gov/resource/map/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? *
The project does not propose to rehabilitate, alter, remove, or demolish any historic property within the project area and does not involve any land
acquisition or impacts to historic architecture or adverse impacts to adjacent right-of-way. No impacts to historic structures or properties are anticipated
as a result of the culvert replacement project. Project site was evaluated using http://gis.ncdcr.gov/hpoweb/
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 website: https://msc.fema.gov/portal/search
Miscellaneous O

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
Parkdale_PCN documents.pdf 13.19MB
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:
Amy Black, PE
Signature
Date
8/21 /2023
M