20240633 Ver 1_ePCN Application_20240501

DW R
Dlvlslon 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# *
20240633 1
Is a payment required for this project?*
No payment required
Fee received
Fee needed - send electronic notification
Select Project Reviewer*
Ryan Conchilla:ryan.conchilla
Information for Initial Review
1a. Name of project:
TIP U-4758
1a. Who is the Primary Contact?*
Robert Crowther
1b. Primary Contact Email:*
[e-mail]
Date Submitted
5/1 /2024
Nearest Body of Water
West Fork Deep River
Basin
Cape Fear
Water Classification
WS-IV;CA
Site Coordinates
Latitude:
36.065008
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:
-80.007620
Reviewing Office*
Central Office - [phone]
1c. Primary Contact Phone:*
[phone]
Is this project a public transportation project?*
Yes No

Is this a NCDOT Project?*
Yes No
(NCDOT only) T.I.P. or state project number:
U-4758
WBS # (1)
40251.1.1
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: 14 - Linear transportation
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
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
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:
NCDOT
2b. Deed book and page no.:
2c. Contact Person:
401 Water Quality Certification - Express
Riparian Buffer Authorization
Yes No
Yes No

2d. Address
Street Address
1598 Mail Service Center
Address Line 2
City
Raleigh
Postal / Zip Code
27699-1598
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
3a. Name:
Robert Crowther
3b. Business Name:
3c. Address
Street Address
1598 Mail Service Center
Address Line 2
city
Raleigh
Postal / Zip Code
27699-1598
3d. Telephone Number:
[phone]
3f. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality / town:
High Point
2. Project Identification
2a. Property Identification Number:
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:
West Fork Deep River
3b. Water Resources Classification of nearest receiving water:"
WS-IV;CA
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.
030300030101
4. Project Description and History
State / Province / Region
NC
Country
US
2f. Fax Number:
State / Province / Region
NC
Country
us
3e. Fax Number:
2b. Property size:
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:*
Johnson Street and Sandy Ridge Road are 2-lane roads that together serve as a connection between Greensboro and High Point. General land use within the immediate proximity of this
project is mostly residential and agriculture. There are other community resources located along these roads including churches, sports complexes, and Piedmont Triad Farmers Market.
There are also large tracts of forested lands along stream corridors that are crossed by both Johnson Street and Sandy Ridge Road.
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:
5.00
4g. List the total estimated linear feet of all existing streams on the property:
11,625
4h. Explain the purpose of the proposed project:"
The purposes of this proposed project are to improve existing and projected traffic flow and capacity on Johnson Street and Sandy Ridge Road, to provide facilities for pedestrians and
bicyclists along the corridor, and to provide a facility that conforms to NCDOT roadway design standards.
Johnson Street and Sandy Ridge Road are important north -south transportation routes in the area that experience traffic congestion and delays due to capacity deficiencies. The corridor
is locally and regionally important as a connection between High Point and Greensboro, including major destinations such as the Piedmont Triad International Airport (PTIA) and the
Piedmont Triad Farmers Market. The existing roadways also lack adequate facilities for pedestrians and bicyclists, which limits mobility for these travelers.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:"
The proposed project would widen Johnson Street and Sandy Ridge Road along the full project corridor from the current two-lane with grass shoulder facility to a four -lane median divided
facility with 4' bike lanes in each direction and 5' sidewalks on each side.
A new four -lane bridge will be built over the West Fork Deep River on the location of the existing bridge and to the east to avoid impacts to the Johnson Street Sport Complex, which is a
Section 6(f) resource. The existing bridge will be used for traffic during the construction of half of the proposed bridge, and then removed to complete bridge construction. The proposed
bridge will have the same typical section as the proposed roadway.
Standard road and bridge building equipment such as trucks, dozers, and cranes will be used.
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
Yes No O 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-2013-01044
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Matthew Thomas and Benjamin Cogdell
Agency/Consultant Company: Atkins
Other:
5d. List the dates of the Corp jurisdiction determination or State determination if a determination was made by the Corps or DWR
On -site agency meeting conducted on 08/12/2014. SAW-2013-01044 (PJD) issued on 03/11/2015.
On -site riparian buffer review conducted by NCDWR on 03/21/24 and determination issued on 03/28/24. NCDWR Project #20240225.
An on -site review of water resources was conducted by USACE (Eric Alsmeyer) on 04/23/24. No changes were made to jurisdictional boundaries, but one note was added to the permit
drawings for Impact Site 2.
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

2a1 Reason (?)
2b. Impact type* (?)
2c. Type of W. *
2d. W. name
2e. Forested *
2f. Type of Jurisdicition *
?)
2g• Impact
area
Hand Clearing
T
__]
Headwater Forest
WAA
Yes
Corps
0.004
(acres)
2g. Total Temporary Wetland Impact
0.004
2g. Total Wetland Impact
0.004
2i. Comments:
3. Stream Impacts
2g. Total Permanent Wetland Impact
0.000
3a. Reason for impact (?)
3b.lmpact type*
3c. Type of impact*
3d. S. name* ��3e.
Stream Type* �[3f.
Type ofh.Impact
❑
(?)
urisdiction*
length*
g1
Site 1 - Construction Access
Temporary
Culvert
UT to West Fork Deep River
Perennial
Both
38
(SW)
Averege (feet)
(linear feet)
S2
Site 2 - Construction Access
Temporary
Other
fest Fork Deep River
Perennial
Both
25
34
Averege (feet)
(linear feet)
S3
Site 2 - Construction Access
Temporary
Workpad/Causeway J
West Fork Deep River
Perennial
Both
25
49
Averege (feet)
(linear feet)
S4
Site 2 -Culvert Construction
fff:]
Culvert
West Fork Deep River
Perennial
Both
25
15
Average (feel)
(linear feet)
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts: 3i. Total temporary stream impacts:
15 121
3i. Total stream and ditch impacts:
136
3j. Comments:
There are no bents proposed to be placed within the streambed of West Fork Deep River with the new bridge at Impact Site 2. Please see attached
cover letter for further description of these stream impacts.
6. Buffer Impacts (for DWR)
6a. Project is in which protect basirl
Check all that apply.
Neuse Tar -Pamlico
Catawba Randleman
Goose Creek Jordan Lake
Other
6b. Impact Type
6c. Per or Temp
6d. Stream name
6e. Buffer mitigation required?
6f. Zone 1 impact
6g. Zone 2 impact
Site 1 Road Crossing - Allowable
P
UT to West Fork Deep River
No
807
1,245
Site 2 Road Crossing - Allowable
P
West Fork Deep River
No
0
1,247
Site 2 Bridge - Allowable
P
West Fork Deep River
No
9,215
3,869
Site 3 Road Crossing - Allowable
P
UT to West Fork Deep River
No
32
2,255
Site 4 Outlet Channel -Allowable
P
UT to West Fork Deep River
No
1,272
1,177
Site 5 Roadway Fill - Allowable w/ Mitigation
P
UT to West Fork Deep River
Yes
1,057
9,765
6h. Total buffer impacts:
Zone 1 Zone 2
Total Temporary impacts: 0.00 0.00
Zone 1 Zone 2
Total Permanent impacts: 12,383.00 19,558.00

Zone 1 Zone 2
Total combined buffer impacts: 12,383.00 19,558.00
6i. Comments:
Please see attached cover letter for further description of these riparian buffer impacts.
E. Impact Justification and Mitigation
1. Avoidance and Minimization
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
The proposed widening project does not result in any sections of newly located roadway. The replacement of the existing bridge over the West Fork
Deep River will maintain the approximately perpendicular crossing and not result in any wetland impacts. The existing bridge has 2 interior bents, 1 of
which is within the banks of the West Fork Deep River. The proposed bridge will also have 2 interior bents, but both will be located outside of the river
The new bridge will not discharge deck water directly into the West Fork Deep River.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:
Best management practices and sedimentation and erosion control measures will be used during construction of the proposed project. No more than
50 % of the width of the West Fork Deep River shall be blocked at any one time during bridge demolition and construction. Temporary causeways will be
removed using the least impacttul measures possible.
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
2c. If yes, mitigation is required by (check all that apply):
DWR Corps
2d. If yes, which mitigation option(s) will be used for this project?
Mitigation bank Payment to in -lieu fee program Permittee Responsible Mitigation
4. Complete if Making a Payment to In -lieu Fee Program
4a. Approval letter from in -lieu fee program is attached.
Yes No
4b. Stream mitigation requested:
(linear feet)
15
4d. Buffer mitigation requested (DWR only):
(square feet)
10,822
4f. Non -riparian wetland mitigation requested:
(acres)
4c. If using stream mitigation, what is the stream temperature:
warm
4e. Riparian wetland mitigation requested:
(acres)
4g. Coastal (tidal) wetland mitigation requested:
(acres)
4h. Comments
NC DMS commits to implementing sufficient compensatory mitigation credits to offset the impacts associated with this project as determined by the
regulatory agencies in accordance with the In -Lieu Fee Instrument dated July 28, 2010. Please see attached Mitigation Acceptance Letter for further
information.
6. Buffer mitigation (State Regulated Riparian Buffer Rules) - required by DWR
O
6a. Will the project result in an impact within a protected riparian buffer that requires buffer mitigation? If yes, you must fill out this entire form - please contact DWR for more information.
Yes No
6b. If yes, then identify the square feet of impact.
6c. Reason for impact 6d. Total impact (square Multiplier 6e. Required mitigation
feet) (square feet)
done 1 Roadway Fill 1,057
Zone 2 Roadway Fill
6f. Total buffer mitigation required
9,765
6g. If buffer mitigation is required, is payment to a mitigation bank or NC Division of Mitigation Services proposed?
Yes No

6j. Comments:
NC DIMS commits to implementing sufficient compensatory mitigation credits to offset the impacts associated with this project as determined by the
regulatory agencies in accordance with the In -Lieu Fee Instrument dated July 28, 2010. Please see attached Mitigation Acceptance Letter for further
information.
F. Stormwater Management and Diffuse Flow Plan (required by DWR) O
1. Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified within one of the INC 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
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250? *
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
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
1c. If you answered "yes" to the above, has the document review been finalized by the State Clearing House?
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 proposed action is a widening of an existing roadway that would improve projected traffic flow and provide facilities for pedestrians and bicyclists.
Additional future development would be subject to local and state ordinances, but is not anticipated to occur as a result of this project.
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.

5d. Is another Federal agency involved?
Yes No O Unknown
What Federal Agency is involved?
FHWA
5e. Is this a DOT project located within Division's 1-8?
Yes No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
Review of USFWS Information for Planning and Consultation (IPaC) database. Please see attached cover letter for additional information regarding
protected species.
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?
Review of NOAA Fisheries 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?
Please see attached Archaeology Form and Historic Architecture and Landscapes Form.
8. Flood Zone Designation (Corps Requirement)
Be. Will this project occur in a FEMA-designated 100-year floodplain? *
Yes No
8b. If yes, explain how project meets FEMA requirements:
This proposed project meets FEMA requirements by obtaining State Floodplain Compliance (SFC) approval through the Hydraulic Unit's Highway
Floodplain Program.
8c. What source(s) did you use to make the floodplain determination?
FEMA National Flood Hazard Layer and the North Carolina Flood Risk Information System.
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
U-4758 PCN Attachment Package-compressed.pdf 39.22MB
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:
Erin K. Cheely
Signature
61,0 k Cheel
Date
5/1/2024
O