20231323 Ver 1_ePCN Application_20230925

DW R
DHlsloo 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:
8/24/2023
BIMS # Assigned *
20231323
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
1a. Name of project:
Cone Health MedCenter Asheboro
Ia. Who is the Primary Contact?*
Josh Hoke
1b. Primary Contact Email: *
josh. [e-mail]
Date Submitted
9/25/2023
Nearest Body of Water
McDowell Creek
Basin
Yadkin-PeeDee
Water Classification
WS-II;HQW
Site Coordinates
Latitude: Longitude:
35.74964-79.82871
A. Processing Information
Is this project connected with ARPA funding?
Yes No
County (or Counties) where the project is located:
Randolph
Is this a NCDMS Project
Yes No
Is this project a public transportation project?*
Yes No
Version#*
1
What amount is owed?*
$240.00
$323.00
Select Project Reviewer*
Soren Homer:Seren. Homer
1c. Primary Contact Phone:
[phone]
$570.00
$767.00

Ia. 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 permits) 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:
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
58 - Utility Line Activities for Water and Other Substances (frequently used)
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
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
401 Water Quality Certification - Express
Riparian Buffer Authorization
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. Nani on recorded deed:
Moses H Cone Memorial Hospital
2b. Deed book and page no.:
002830/01331
2c. Contact Person:
Adam Bricker
2d. Address
Street Address
1200 N. Elm Street
Address Line 2
City
Stale / Province / Region
Greensboro
North Carolina
Postal / Zip Code
Country
27401
United States
Yes No
Yes No

2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Josh Hoke
4b. Business Name:
Terracon
4c.Address
Street Address
1800 Reynolds Avenue
Address Line 2
city
North Charleston
Postal / Zip Code
29405
4d. Telephone Number:
[phone]
4f. Email Address:"`
josh. [e-mail]
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality / town:
Asheboro
2. Project Identification
2a. Property Identification Number:
7752481417
2c. Project Address
Street Address
1271 Spero Road
Address Line 2
City
Asheboro
Postal / Zip Code
27205
3. Surface Waters
3a. Name of the nearest body of water to proposed project: "
McDowell Creek
3b. Water Resources Classification of nearest receiving water:
WS-II;HQW
3c. What river basin(s) is your project located in?*
Yadkin-PeeDee
3d. Please provide the 12-digit HUC in which the project is located.
030401030403
4. Project Description and History
2f. Fax Number:
State / Province / Region
South Carolina
Country
United States
4e. Fax Number:
2b. Property size:
65.17
State / Province / Region
North Carolina
Country
United States
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 land to be used by the proposed Hospital and Pump Station is currently undeveloped wooded land. The eastern side of the site is bordered by Interstate Highways 73/ 74, the north
and east sides of the site are made up of single family residential properties, and south of the site is undeveloped wooded land.
a

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:
0.878
4g. List the total estimated linear feet of all existing streams on the property:
3,256
4h. Explain the purpose of the proposed project:*
The purpose of the project is to construct a single access road which will impact a portion of a wetland to provide access to a pump station on the eastern side of the site and to install a
new 6" force main water pipe which will cross McDowell Creek, one other unnamed tributary and wetland.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used: *
The proposed project consists of the development of a pump station with a 6" force main and a gravel road for access. A total of approximately 0.878 acres of jurisdictional freshwater
wetlands have been identified on the site and wetland impacts are located predominantly within the access road portion near the northeast corner of the site. Within the wetland area a
gravel road crossing is proposed to meet the proposed development requirements. The 6" force main will cross a wetland area near the southeast corner of the site. In addition to the
wetland impacts, the 6" forcemain will cross an intermittent Tributary called McDowell Creek and an unnamed intermittent tributary. The pump station area is outside of the wetlands
identified on the site.
The proposed permanent impacts include 0.013 acres (595 square feet) of fill for the construction of the access road. Additionally, 8 square feet of temporary wetland impacts are
proposed outside of the 0.013 acres of fill for installing the 6" force main. Temporary impacts to streams include a 20 linear foot impact to McDowell Creek and 20 linear foot impact to an
unnamed tributary to install the 6" force main. All three temporary impacts are a result of temporary surface excavation to install the 6" force main. Temporary impacts will be back filled
after the installation of the force main and regraded to pre -project conditions. The proposed freshwater wetland and stream impacts were unavoidable to allow for the proposed
development to meet the project purpose and need.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
Yes No O Unknown
Comments:
See attached delineation package
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: Terracon Consultants, Inc.
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
2. Wetland Impacts
O
2a1 Reason (?)
access road
2b. Impact type* (?)
P
2c. Type of W.*
Headwater Forest
2d. W. name
W3
2e. Forested*
Yes
2f. Type of Jurisdicition *
(?)
Both
2g. Impact
area *
0.013
(acres)
water line installation
T
Headwater Forest
W5 �ff:::::][B.th
0.000
(acres)
2g. Total Temporary Wetland Impact 2g. Total Permanent Wetland Impact
0.000 0.013

2g. Total Wetland Impact
0.013
2i. Comments:
The temporary wetland impact is 8 sf (0.00018-acres)
3. Stream Impacts
F1
S1
3a. Reason for impact (?)
water line installation
3b.lmpact type"
Temporary
3c. Type of impact"
Excavation
3d. S. name"
T2 (McDowell Creek)
3e. Stream Type*
(?)
Perennial
3f. Type of
Jurisdiction*
Both
3g. S. width
10
Averge (feet)
3h. Impact
length*
20
(linear feet)
S2
Water line installation
Temporary
Excavation
T3
Intermittent
Both
Average (feet)
20
(linear feet)
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
0
3i. Total stream and ditch impacts:
40
3j. Comments:
E. Impact Justification and Mitigation
1. Avoidance and Minimization
31. Total temporary stream impacts:
40
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
The project has been designed to avoid impacts to wetlands and streams on site as much as practicable. The single permanent wetland impact is
necessary to provide access to the proposed pump station and has been designed to be minimal and less than 0.1-acre. The project was designed to
minimize temporary impacts to streams and wetlands by routing the 6" force main around a number of wetlands and to cross perpendicularly to the
streams.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
All required ESC measures will be installed and monitored for compliance throughout the entire period of construction. An erosion control plan will be
submitted to NCDEQ Land Quality and approved prior to any site work. Work within the stream will be conducted during dry periods with low flow.
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 impacts incurred by the proposed project do not exceed the mitigation thresholds.
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:
The project is located in the Yadkin -Pee Dee Basin
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
L

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
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 project is not anticipated to promote further development and/or impacts to aquatic resources.
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?
NHP data from August 2023 does not report any federal protected species within a minimum of 1 miles of the project site. Terracon also prepared an
IPaC consultation package in August 2023. the project area was evaluated by Terracon biologists for the presence of habitat capable of supporting the
federal species listed for Randolph County. No potential habitat for these species was identified.
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 online 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?
NCNHP did not identify an historic or cultural resources on site. The Back Creek Mountain Natural Area is documented within one mile of the site.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?
Yes No

Sc. 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
CHMC Asheboro - NWP_Supporting_Documentation with Appendicies.pdf 5.93MB
File must be PDF or KMZ
Comments
See attached supporting documentation for additional project details.
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:
Joshua Hoke
Signature
Date
9/25/2023
Q