20240191 Ver 1_ePCN Application_20240129

DWR
Division of Water Resources
Pre -Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
October 2, 2023 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.
Does this project involve maintenance dredging funded by the Shallow Draft Navigation Channel Dredging and Aquatic Weed Fund or involve the distribution or transmission of energy or
fuel, including natural gas, diesel, petroleum, or electricity?
Yes No
BIMS # Assigned Version# *
20240191 1
Is a payment required for this project?*
No payment required What amount is owed?*
Fee received $240.00 $570.00
Fee needed - send electronic notification $323.00 $767.00
Reviewing Office*
Winston-Salem Regional Office - (336) 776- Select Project Reviewer*
9800 Seren Homer:Seren.Homer
Information for Initial Review
la. Name of project:
Samet Burnt Poplar Road
la. Who is the Primary Contact?*
Troy Shelton
1b. Primary Contact Email: *
[e-mail]
Date Submitted
1/29/2024
Nearest Body of Water
Long Branch
Basin
Cape Fear
Water Classification
WS-IV
Site Coordinates
Latitude:
36.07331
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
Longitude:
-79.917759
1c. Primary Contact Phone:*
[phone]
a

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: 39 - Commercial/Institutional Developments
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:
101 Chimney Rock LLC
2b. Deed book and page no.:
R 8754 3069-3072
2c. Contact Person:
Brian Hall

2d. Address
Street Address
5942 Tarleton Dr.
Address Line 2
City
Oak Ridge
Postal / Zip Code
27310
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
3a. Name:
Troy Shelton
3b. Business Name:
Dewberry Engineers Inc.
3c.Address
Street Address
551 Piney Forest Road
Address Line 2
city
Danville
Postal / Zip Code
24540
3d. Telephone Number:
[phone]
3f. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Troy Shelton
4b. Business Name:
Dewberry Engineers Inc
4c.Address
Street Address
551 Piney Forest Rd
Address Line 2
city
Danville
Postal / Zip Code
24540
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:
Guilford
2. Project Identification
State / Province / Region
North Carolina
Country
United States
2f. Fax Number:
State / Province / Region
Virginia
Country
United States
3e. Fax Number:
[phone]
State / Province / Region
Virginia
Country
United States
4e. Fax Number:
[phone]

2a. Property Identification Number:
99333
2c. Project Address
Street Address
Address Line 2
city
Postal / Zip Code
3. Surface Waters
3a. Name of the nearest body of water to proposed project:
Long Branch
3b. Water Resources Classification of nearest receiving water:"
WS-IV
3c. What river basin(s) is your project located in?
Cape Fear
3d. Please provide the 12-digit HUC in which the project is located.
0303000301
4. Project Description and History
2b. Property size:
5.25
State / Province / Region
Country
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 is currently wooded. Two wetlands WA (PFO) and WB (PSS) are located on the southern end of the project. Two streams SA (R3) and SB (R4) are also located on the
southern most part of the project area. Land use in the vicinity is heavy industrial, commercial, and residential.
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:
0.07
4g. List the total estimated linear feet of all existing streams on the property:
308
4h. Explain the purpose of the proposed project: *
Grade, fence, and landscape for an outside storage area.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:
The site will include a concrete drive apron, gravel driveway, gravel yard, perimeter fencing, and a storm -water control device.
Equipment used during construction will include a bulldozer, backhoe dumb truck and other related equipment.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
Yes No G Unknown
Comments:
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-2023-02252
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company: Dewberry Engineers Inc
Other:
5d. List the dates of the Corp jurisdiction determination or State determination if a determination was made by the Corps or DWR
1/16/2024
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 O
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
Wetlands Streams -tributaries O Buffers
Open Waters Pond Construction
3. Stream Impacts
F I
3a. Reason for impact (?)
3b.lmpact type"
3c. Type of impact"
3d. S. name* ��3e.
Stream Type*
31`. Type of
3g. S. width
3h. Impact
?)
Jurisdiction*
length*
S1
�SA
Permanent
Fill
Long Branch
ffto
Perennial
Corps
65
Averege (feet)
(linear feet)
S2
SB
Permanent
Fill ]U�to
Long Branch
Intermittent
Corps
Averege (feet)
(linear feet)
S3
SA
Temporary
Other
UT1 to long branch
Perennial
Corps
5
30
Averege (feet)
(linear feet)
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
71
31. Total stream and ditch impacts:
101
3j. Comments:
E. Impact Justification and Mitigation
1. Avoidance and Minimization
31. Total temporary stream impacts:
30
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
To access the site a stream crossing is required. The road width and culvert size were chosen to minimize the overall impact on the stream. The
entrance to the site is along an existing road.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
All work in the stream bed and all areas adjacent to the stream are to be stabilized immediately upon the completion of the work. A temporary pump and
hose are to be positioned and extended to the existing culvert for the discharge of stream water around the installation area. After culvert/pipe, wall and
rip rap installation is complete and stabilized, flow will be diverted through the culvert. Erosion control measures will be provided to control stormwater
and sediment release. Including- Silt Fence, silt fence outlets, rock inlet protection, temporary construction entrance, and limits of disturbance.
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 are below Compensatory Mitigation requirement.
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
0
V
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
2c. Does this project have a stormwater management plan (SMP) reviewed and approved under a state stormwater program or state -approved local government stormwater program?
Yes No
N/A - project disturbs < 1 acre
2d. Which of the following stormwater management program(s) apply:
Local Government State
Local Government Stormwater Programs
Phase II NSW USMP Water Supply
Please identify which local government stormwater program you are using.
City of Greensboro
Comments:
Three phase plan for erosion and sediment control. The first two phases will include the construction of a skimmer basin and temporary diversion ditches to handle off site drainage from
entering the proposed BMP. The last phase will convert the skimmer basin into a dry detention basin to detain stormwater for an extended period of time. Positive grading will be
established to help drainage throughout the site. For post -construction runoff, the dry detention basin will treat the quantity of water and there are two proprietary devices, (filtera and
stormfilter) that will be used to treat the quality of water. These devices in combination will ensure that quantity and quality requirements set by the City of Greensboro are met. The Filtera
device is being installed at the riperian buffer to treat the flow from the driveway improvements that are within this buffer.
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
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.
Not a phased project area surrounding the project are already developed.
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
What Federal Agency is involved?
USACE
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
Unknown
O

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?
U.S. Fish and Wildlife Service (USFWS) Information for Planning and Consultation (IPaC), NCDCR Natural Heritage Data Explorer
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?
National Oceanic and Atmospheric Administration (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?
North Carolina State Historic Preservation Office (NCSHPO)
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?*
Federal Emergency Management Act (FEMA) Flood Map Service Center Data
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
PCN Report for DEQ.pdf 17.71MB
Samet PJD.pdf 1.69MB
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:
Dylan Thomas Irby
Signature
Date
1/29/2024
u