20170220 Ver 1_Cover letter and PCN signed_20170221

STATE OF NORTH CAROLINA
DEPART�NT OF T`RANSPORTATION
ROY COOPER
GOVERNOR
US Army Corps of Engineers
Raleigh Regulatory Field Ofiice
Attn: Mr. David Bailey
3331 Heritage Trade Dr., Ste, 105
Wake Forest, NC 27587
7AMES H. TROGDON, III
SECRETARY
February 21, 2017
NC Division of Water Resources
Winston-Salem Regional Office
Attn: Mr. Dave Wanucha
450 W. Hanes Mill Rd, Ste. 103
Winston-Salem, NC 27105
Subject: Nationwide 14 Pernut and Jordan Lake Riparian Buffer Application for the
replacement of Bridge No. 379 on SR 2715 (Busick Quarry Road) over UT to Reedy
Fork, Guilford County, North Carolina, WBS Element No. 17BP.7.R.87
Dear Mr. Bailey and Mr. Wanucha:
The North Carolina Department of Transportation (NCDOT) is proposing to replace a
functionally obsolete 35' timber bridge with a new, three-barrel 11' x 8' reinforced concrete box
culvert (RCBC). An off-site detour will be used to convey traffic during construction. The
project will also include minor approach work on the existing roadway.
Please find enclosed a PCN application, USGS and Soil Survey vicinity maps, Stormwater
Management Plan, permit drawings, buffer drawings, SHPO Concurrence Forms and site
photographs.
The North Carolina Natural Heritage Database was checked for records of threatened and
endangered species. The database lists two species for Guilford County that have federal status.
Bald eagle (Haliaeetus leucocephalus) is protected in every county in North Carolina under the
Bald and Golden Eagle Protection Act. Small whorled pogonia (Isotria naedeoloides) is listed as
threatened.
Habitat for bald eagle primarily consists of mature forest in proximity to large bodies of open
water for foraging. Large dominant trees are utilized for nesting sites, typically within 1.0 mile
of open water. A desktop-GIS assessment of the project study area, as well as the area within a
1.13-mile radius (1.0 mile plus 660 feet) of the project limits, was performed on January 13,
2016 using 2014 color aerials. Several impoundments were identified as water bodies large
enough and sufficiently open to be considered a potential feeding source. At the field scoping
meeting on February 20, 2014, it was determined that the subject project would have no effect on
bald eagle. Additionally, a review of the NCNHP database on January 13, 2016 revealed no
lcnown occurrences of this species within 1.0 mile of the project study area. The closest known
occurrence is approximately 17.0 miles west of the project. Due to the lack of known
Mailing Address:
NC DEPARTMENT OF TRANSPORTATION
DIVISION OF HIGHWAYS
DIVISION 7 OFFICE
P.O. BOX 14996
GREENSBORO, NC 27415-4996
Telephone: [phone]
Customer Service: 1-877-368-4968
Website: www.ncdot.gov
Location:
1584 YANCEVILLE STREET
GREENSBORO, NC 27415-4996

occurrences and minimal impact anticipated for this project, it has been determined that the
subject project will not affect this species.
Small whorled pogonia generally occurs in open, dry, deciduous woods with acid soil, according
to the U.S. Fish and Wildlife Service. However, it is also known to occur in a variety of habitats
in North Carolina, including along streams. The project site is maintained road right of way,
with some forest area consisting of deciduous trees and the invasive multiflora rose. The bridge
site appears to have a very low potential to support small whorled pogonia. Surveys conducted
by NCDOT in 2013 as well as at the field scoping meeting on February 20, 2014 determined that
there was no habitat for small whorled pogonia and the subject project would have no effect on
the species. Records indicate the nearest known occurrence of small whorled pogonia is
approximately 4.1 miles south of the project area. Therefore, the subject project will not affect
this species.
This project was reviewed by NCDOT's Human Environment Unit in 2013 for potential affects
to historical architecture and archaeology. It was determined that no survey was required for
historical architecture or archaeological resources. Therefore, no historic or archaeological
resources will be affected by this project.
The project study area is comprised mostly of maintained/residential land with hardwood forest
along the stream banks. There are no additional jurisdictional features associated with Bridge
379 other than UT to Reedy Fork.
NCDOT best management practices (BMPs) will be used to minimize and control sedimentation
and erosion. The construction foreman will review the BMPs daily to ensure erosion and
sedimentation is being effectively controlled. If the foreman determines the devices are not
functioning as intended, they will be replaced immediately with better devices.
Impacts to Waters of the United States
UT to Reedy Fork (DWR Class: 16-11-(9); WS-V; NSW) is shown on the USGS topographic
map as a perennial stream. The channel is well defined with a substrate primarily composed of
sand, silt, gravel, cobble, and boulder and is approximately 6-12 feet wide. From the project site,
UT to Reedy Fork flows approximately 0.3 mile to its confluence with Reedy Fork. Reedy Fork
then flows approximately 3.6 miles to its confluence with the Haw River, The Haw River meets
the definition of a Traditional Navigable Water. For these reasons, we believe UT to Reedy Fork
is a Relatively Permanent Water and is under the jurisdiction of the U.S. Army Corps of
Engineers. In order to construct the project, it will be necessary to impact waters of the United
States in the Cape Fear River Basin (HUC 03030002). Specifically, NCDOT is requesting to
replace Bridge No. 379 with a reinforced concrete box culvert. The impacts are listed in the
table below:

Jurisdictional Impact Summary
Perm. Temp. perm. Temp.
Existing Existing
Station Structure Size / Type SW SW Channel Channel
Impacts Impacts Impacts Impacts
(ac) ( ac) 1 1
12+59 to 13+32 3@ 11'X8' RCBC 0.01 0 63 0
12+59 to 13+32 Bank Stabilization 0.01 0 82 0
12+59 to 13+32 Impervious Dikes/Construction 0 <0.01 0 10
Jordan Lalce Buffer Impact Summary
Station Type Zone 1(ftZ) Zone 2(ft2)
11+95 to 14+02 Roadway Crossing 3,670 1,147
Total 3,670 1,147
Permits Requested
NCDOT is hereby requesting authorization under Section 404 of the Clean Water Act to proceed
with the construction project outlined above. We are also requesting a 401 Water Quality
Certification and Jordan Lake Riparian Buffer Authorization from the North Carolina
Department of Environmental Quality (DEQ), Division of Water Resources (DWR).
If you have any questions or need additional information, please contact Jerry Parker at (336)
256-2063 or j�arker e,ncdot.gov. Your review and consideration are greatly appreciated.
Sincerely,
. Mills, PE
ision Engineer, Division 7
Enclosures
cc: Travis Wilson, Wildlife Resources Commission (electronic copy)
Gary Jordan, US Fish & Wildlife Service (electronic copy)
Tim Powers, NCDOT (electronic copy)
Aaron Harper, Field Operations Engineer, Div. 7&8 Roadside Environmental Unit, NCDOT
Jeremy Warren, NCDOT
Chuck Edwards, District 1, District Engineer

�,oFWArF9Q Office Use Only:
�� �� ° � Corps action ID no.
p � DWQ project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Noti�cation (PCl� Form
A Applicant Information
1. Processing
1 a. Type(s) of approval sought from the
� Section 404 Permit ❑ Section 10 Permit
Corps:
1 b. Specify Nationwide Permit (NWP) number: 14 or General Permit (GP) number:
1 c. Has the NWP or GP number been verified by the Corps? � Yes
1 d. Type(s) of approval sought from the DWQ (check all that apply):
� 401 Water Quality Certification — Regular ❑ Non-404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express � Riparian Buffer Authorization
1 e. Is this notification solely for the record For the record only for DWQ 401
because written approval is not required? Certification:
❑ Yes � No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program.
� •
For the record only for Corps Permit:
❑ Yes � No
� Yes ❑ No
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h ❑ Yes
below.
1 h. Is the project located within a NC DCM Are� of Environmental Concern (AEC)? ❑ Yes
2. Project Information
►1 .
►/ .
2a. Name of project: Replace Bridge No. 379 on SR 2715 (Busick Quarry Rd) over UT to Reedy Fork
2b. County: Guilford
2c. Nearest municipality / town: Ossipee
2d. Subdivision name: N/A
2e. NCDOT only, T.I.P. or state 17BP.7.R.87
project no:
3. Owner Information
3a. Name(s) on Recorded Deed: North Carolina Department of Transportation
3b. Deed Book and Page No. N/A
3c. Responsible Party (for LLC if Division Engineer NC DOT Division 7, Mr. Mike Miils, PE
applicable):
3d. Street address: PO Box 14996
3e. City, state, zip: Greensboro, NC 27415
3f. Telephone no.: [phone]
3g. Fax no.: [phone]
3h. Email address: [e-mail]
Page 1 of 11
PCN Form — Version 1.3 December 10, 2008 Version

4. Applicant Information (if different from owner)
4a. Applicant is: ❑ Agent � Other, specify: NC DOT Highway Division 7
4b. Name: Division Engineer NC DOT Division 7, Mr. Mike Milis, PE
4c. Business name
(if applicable):
4d. Street address:
NC DOT
PO Box 14996
4e. City, state, zip: Greensboro, NC 27415
4f. Telephone no.: [phone]
4g. Fax no.: [phone]
4h. Email address: [e-mail] *note: please a/so copy Mr. Jerry Parker, Highway Division 7 Environmenfal
Supervisor on all correspondence — [e-mail]
5. AgentlConsultant Information (if applicable)
5a. Name: Mr. Jerry Parker
5b. Business name NC DOT Highway Division 7, Division Environmental Supervisor
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. Fax no.:
5g. Email address:
�
PO Box 14996
Greensboro, NC 27415
[phone]
[phone]
[e-mail]
3
Page 2 of 11
PCN Form — Version 1.3 December 10, 2008 Version

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): N/A
1 b. Site coordinates (in decimal degrees): Latitude 36.190840 Longitude: -79.551665
(DD.DDDDDD) (-DD.DDDDDD)
1 c. Property size: N/A acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to UT to Reedy Fork
proposed project:
2b. Water Quality Classification of nearest receiving water: WS-V; NSW; 16-11-(9)
2c. River basin: Cape Fear (HUC 03030002)
3. Project Description
3a. 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 study area is comprised of mostly maintained roadway with hardwood forest along the stream banks and
nearby agricultural fields and residences. There are no additional jurisdictional features associated with Bridge 379 other
than UT to Reedy Fork.
3b. List the total estimated acreage of all existing wetlands on the property:
N/A
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
� 145 LF of stream within the project boundaries
3d. Explain the purpose of the proposed project:
To replace a structurally deficient and functionally obsolete timber bridge.
3e. Describe the overall project in detail, including the type of equipment to be used:
Traffic will be detoured off-site. Erosion and sedimentation control measures will be installed. Water will be diverted around the
construction area. The old bridge will be removed. The proposed stucture will be replaced on its existing alignment. The new
culvert structure will be a three barrell 11' x 8' reinforced concrete box culvert. The channel will be excavated and realigned for
low flow shaping. Water will gravity flow through a 36" pipe around the work area during construction by installed impervious
dikes upstream and downstream of the existing bridge. Special stilling basins will be utilized on an as needed basis to pump
water trapped between the impervious dikes if a storm event overtops the dikes. Equipment to be used includes a track hoe,
dump truck, paving equipment, pumps, and various hand tools, possibiy a crane to move construction material such as
reinforced bars of steel, and concrete buckets to place concrete. `
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (including all prior phases) in the past? ❑ Yes � No ❑ Unknown
Comments: N/A
4b. If the Corps made the jurisdictional determination, what type
of determination was made? ❑ Preliminary ❑ Final
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company: N/A
Name (if known): N/A Other: N/A
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
N/A
5. Project History
5a. Have permits or certifications been requested or obtained for � Yes � No ❑ Unknown
this project (including aii prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
N/A
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PCN Form — Version 1.3 December 10, 2008 Version

6. Future Project Plans
6a. Is this a phased project?
6b. If yes, explain.
N/A
� ►1 .
C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
❑ Wetlands � Streams - tributaries � Buffers
❑ Open Waters ❑ Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type of jurisdiction
number — Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWQ — non-404, other) (acres)
Tem orar T
W1 ❑ P � T ❑ Yes ❑ Corps �
❑ No ❑ DWQ
2g. Total wetland impacts �
2h. Comments: N/A
3. Stream Impacts
lf there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then compiete this
question for all stream sites impacted.
3a. 3b. 3c. 3d. 3e. 3f. 39�
Stream impact Type of impact Stream name Perennial Type of jurisdiction Average Impact
number - (PER) or (Corps - 404, ^r� stream length
Permanent (P) or intermittent DWQ — non-404, width (linear
Temporary (T) i�NT)? other) (feet) feet)
S1 � P � T 3@ 11'X8' RCBC UT to Reedy Fork � PER � Corps 6-12 63
❑ INT � DWQ
� PER � Corps 6-12 82
S1 � P 0 T Bank Stabilization UT to Reedy Fork � �NT � DWQ
� PER � Corps 6-12 10
S1 ❑ P� T Impervious Dikes UT to Reedy Fork � �NT � DWQ
3h. Total Permanent Stream and Tributary Impacts 155'
3i. Comments: Of the 155 LF of stream impacts, 63 LF are associated with permanent impacts to the stream due to the
RCBC installation. There are 82 LF of permanent impacts associated with bank stabilization, however it should be noted that
the rip rap will remain solely on the banks (i.e. will not encroach into the thalweg of the channei). The 10 LF of temporary
impacts are associated with the impervious dikes that will be used upstream and downstream of the proposed crossing. The
dewatering of the stream will run concurrently with the construction activities (i.e. the temporary impacts associated with
dewatering are within the permanent stream impact footprint location).
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PCN Form — Version 1.3 December 10, 2008 Version

4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list all open water impacts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number - (if applicable) Type of impact Waterbody type Area of impact (acres)
Permanent (P)
or Tem ora T
01 ❑P�T
4f. Total open water impacts
4g. Comments: No open water impacts
5. Pond or Lake Construction
If ond or lake construction ro osed, then com lete the chart below.
5a. 5b. 5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or purpose of (acres)
number pond Flooded Filled Excavated Flooded Filled Excavated Flooded
P1
P2
5f. Total
5g. Comments: There are no ponds created for this project
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If an impacts require miti ation, then ou MUST fiil out Section D of this form.
6a. ❑ Neuse ❑ Tar-Pamlico � Other: Jordan Lake
Project is in which protected basin? ❑ Catawba ❑ Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number - Reason Buffer Zone 1 impact Zone 2 impact
Permanent (P) for Stream name mitigation (square feet) (square feet)
or Tem ora T im act re uired?
Road fill ❑ Yes
B1 � P[] T and UTto Reedy Fork � No 3,670 1,147
clearing
6h. Total buffer impacts 3,670 1,147
6i. Comments: The impacts associated with the roadway crossing and culvert installation fall under the "potentially allowable"
category per the Jordan Water Supply Buffer Rules Table of Uses {15A NCAC 02B .0267 (9)}
Page 5 of 1 �
PCN Form - Version 1.3 December 10, 2008 Version

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
The proposed project is to remove and replace a structurally deficient bridge and replace it with a box cuivert. Roadway
approach work is minimized as much as is practical to reduce the overall project footprint. Channel improvements were made
for the proposed RCBC design. Excavation was kept to a minimum to produce as little impact as possible. Where excavation
is necessary, geo-textile and rip-rap were utilized for bank stabilization in an attempt to reduce stream bank erosion. Low flow
barrels on the east and west sides of the culvert were designed to match the stream width to maintain the normal flow width,
depth and velocity of the stream. This will maintain sediment transport to provide a stable stream during bankfull discharge.
The low flow barrel invert will be a minimum of 1' below the stream bed to consider fish passage. 1' high sills will be installed
at upstream and downstream face of the low flow barrel. High flow barrels on the east and west sides of the culvert will
provide flood conveyance during high flow storm events. This will reduce shear stress on the stream bottom. 2' high sills will
be installed at upstream and downstream faces of the high flow barrels. Floodplain benches with coir fiber matting will be
installed at upstream and downstream of the culvert. Impacts to the associated protected riparian bufFers have also been
reduced by promoting sheet flow as well as providing grass shoulders to promote infiltration. As indicated on the permit
drawings the proposed pavement nearly matches the existing with only slight widening for safety (with no guardrail - this will
allow for overtopping during highflows) which this small amount of new pavement it will contribute very little to the existing
drainage area and the ditch velocities. Riprap was added to protect and stabilize the stream banks and the old bridge which
crosses at 90 degrees has been replaced with a culvert that better matches the stream alignment. Bank stabilization will be
minimized to those areas where deemed necessary. An off-site detour will be employed to avoid the need for a temporary
parallel structure. Please see the attached Bridge to Culvert justification letter from NCDOT Division 7 Bridge Program
Manager.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Erosion and sedimentation BMPs will be installed prior to construction. Water will be diverted around the work area to prevent
sedimentation of downstream aquatic resources. Impacts will be minimized by strict enforcement of Best Management
Practices for the protection of surface waters, restrictions against the staging of equipment in or adjacent to waters of the US
and coordination (including a pre-construction meeting) with the Division Environmental Supervisor.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for � Yes ❑ No
impacts to Waters of the U.S. or Waters of the State?
2b. If yes, mitigation is required by (check all that apply): ❑ DWQ � Corps
❑ Mitigation bank
2c. If yes, which mitigation option will be used for this project? � Payment to in-lieu fee program
❑ Permittee Responsible Mitigation
3. Compiete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter) Type Quantity
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PCN Form — Version 1.3 December 10, 2008 Version

3c. Comments:
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached. � Yes
4b. Stream mitigation requested: 63 LF @ 2:1 ratio
4c. If using stream mitigation, stream temperature: � warm ❑ cool ❑cold
4d. Buffer mitigation requested (DWQ only): square feet
4e. Riparian wetland mitigation requested: acres
4f. Non-riparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requested: acres
4h. Comments: see attached DMS acceptance letter
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation? ❑ Yes � No
While there are impacts to the protected Jordan Riparian area, these impacts are
"allowable" per the Table of Uses {15A NCAC 02B.0267(9)}
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.
6c. 6d. 6e.
Zone Reason for impact Total impact Multiplier Required mitigation
(square feet) (square feet)
Zone 1 3(2 for Catawba)
Zone 2 � ��
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund).
6h. Comments:
E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers identified � Yes ❑ No
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
Comments: The proposed structure will be 3@ 11' by 8' box culvert. There is a ❑ Yes � No
slight increase in impervious surface but treatment is not required.
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PCN Form — Version 1.3 December 10, 2008 Version

2 Stormwater Management Plan �
2a. What is the overall percent imperviousness of this project?
2b. Does this project require a Stormwater Management Plan?
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
N/A %
�/ - ■ •
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
Plan is attached.
2e. Who wili be responsible for the review of the Stormwater Management Plan?
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project?
3b. Which of the following locally-implemented stormwater management programs
apply (check all that apply):
3c. Has the approved Stormwater Management Plan with proof of approval been
attached?
4. DWQ Stormwater Program Review
4a. Which of the following state-implemented stormwater management programs apply
(check all that apply):
4b. Has the approved Stormwater Management Plan with proof of approval been
attached?
5. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements?
5b. Have all of the 401 Unit submittal requirements been met?
❑ Certified Locai Government
❑ DWQ Stormwater Program
� DWQ 401 Unit
❑ Phase il
❑ NSW
❑ USMP
❑ Water Supply Watershed
❑ Other:
❑ Yes ❑ No
❑ Coastal counties
❑ HQW
❑ ORW
❑ Session Law 2006-246
❑ Other:
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
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PCN Form — Version 1.3 December 10, 2008 Version

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1a. Does the project involve an expenditure of public (federal/state/local) funds or the
use of public (federallstate) land?
1 b. 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
❑ Yes � No
1 c. If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
letter.) ❑ Yes
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards, ❑ Yes
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after-the-fact permit application?
❑ No
►/ .
■ - �� •
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in (� Yes � No
additional development, which could impact nearby downstream water quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
Per the NC DWQ April 10, 2004 Version 2.1 Cumulative Impacts policy, small scale public transportation projects — such
as widening projects, bridge replacements and intersection improvements — have a"low potential for cumulative impact
since little (if any) new impervious surface is added and the projects are usually in already developed locales." This
proposed project is within a somewhat developed landscape (i.e. existing residential homes in the vicinity), this is not a
road on a new location (i.e. there is an existing road and bridge structure and thus, the area already contains impervious
surfaces) and the project drains to UT to Reedy Fork which is Class WS-V; Nutrient Sensitive Waters (NSW) (i.e. not
ORW or HQW waters). We anticipate the NC DWR will advise us if a qualitative or quantitative analysis is needed.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
It is not anticipated that this project will generate any wastewater as it is a roadway project.
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PCN Form — Version 1.3 Decerriber 10, 2008 Version

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or � Yes � No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act � Yes ❑ No
impacts?
� Raleigh
5c. If yes, indicate the USFWS Field Office you have contacted.
❑ Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
The North Carolina Natural Heritage Database was checked for records of threatened and endangered species. The
database lists two species for Guilford County that have federal status. Bald eagle (Haliaeetus leucocephalus) is protected in
every county in North Carolina under the Bald and Golden Eagle Protection Act. Small whorled pogonia (Isotria medeoloides)
is listed as threatened.
Habitat for bald eagle primarily consists of mature forest in proximity to large bodies of open water for foraging. Large
dominant trees are utilized for nesting sites, typicaily within 1.0 mile of open water. A desktop-GIS assessment of the project
study area, as well as the area within a 1.13-mile radius (1.0 mile plus 660 feet) of the project limits, was performed on
January 13, 2016 using 2014 color aerials. Several impoundments were identified as water bodies large enough and '
sufficiently open to be considered a potential feeding source. At the field scoping meeting on February 20, 2014, it was
determined that the subject project would have no effect on bald eagle. Additionally, a review of the NCNHP database on
January 13, 2016 revealed no known occurrences of this species within 1.0 mile of the project study area. The closest known
occurrence is approximately 17.0 miles west of the project. Due to the lack of known occurrences and minimal impact
anticipated for this project, it has been determined that the subject project will not affect this species.
Small whoried pogonia generally occurs in open, dry, deciduous woods with acid soil, according to the U.S. Fish and Wildlife
Service. However, it is also known to occur in a variety of habitats in North Carolina, including along streams. The project
site is maintained road right of way, with some forest area consisting of deciduous trees and the invasive multiflora rose. The
bridge site appears to have a very low potential to support small whorled pogonia. Surveys conducted by NCDOT in 2013 as
well as at the field scoping meeting on February 20, 2014 determined that there was no habitat for small whorled pogonia and
the subject project would have no effect on the species. Records indicate the nearest known occurrence of small whorled
0 onia is a roximatel 4.1 miles south of the ro'ect area. Therefore, the sub'ect ro'ect will not affect this s ecies.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? ❑ Yes � No
6b. What data sources did you use to determine whether your site wouid impact Essential Fish Habitat?
This bridge replacement project takes place in Guilford County which is not near any coastal or tidal habitat that would
support EFH (i.e. salt marshes, oyster reefs, etc.).
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 cuitural preservation � Yes � No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
This project was submitted to the North Carolina Department of Transportation's Human Environment Unit for review in
2013. It was determined that no survey was required for historical architecture or archaeology. Therefore, no historic or
archaeological resources will be affected by this project.
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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: MOA
8c. What source(s) did you use to make the floodplain determination? North Carolina Floodplain Mapping Program
Mr. Mike Mills, PE �/J�� 2/21/2017
Applicant/Agent's Printed Name /�`� /,�s%��''—
ApplicanbAgent's Signature Date
(Agent's signature is valid only if an authorization letter from the
applicant is provided.)
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