20170988 Ver 1_PCN Form Submission_20170808

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 8/8/2017 11:57:05 AM (Start Event)
Accept by Carpenter,Kristi 8/8/2017 12:20:11 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: August 11, 2017 5:00 PM
8/8/2017 11:57 AM

�� �
6fvlslaa of Water Resources
Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
June 28, 2017 Ver 1.8
*
Please note: fields marked with a red asterisk below are required. You will not be ab/e to submit the form until all mandatory questions are ans�red.
Below is a link to the DRAFT online help file. http://edocs.deq.nc.gov/WaterResources/0/doc/549884/Page1.aspx
A. Processing Information
County (or Counties) where the project is located:*
Guilford
Is this a NCDOT Project?*
C� Yes �' No
(NCDOT only) T.I.P. or state project number:
B-5726
WBS #
45682.1.1
(for NCDOT use only)
� 1a. Type(s) of approval sought from the Corps:*
rJ Section 404 Permit (wetlands, streams and waters, Clean Water Act)
r Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What type(s) of permit(s) do you wish to seek authorization?*
fJ Nationwide Permit (NWP)
r Regional General Permit (RGP)
Nationwide Permit (NWP) Number:
NWP Number Other:
List all MN nurrbers you are applying for not on the drop dow n list.
14 - Linear transportation
1c. Type(s) of approval sought from the DWR:*
check all that apply
� 401 Water Quality Certification - Regular
� Non-404 Jurisdictional General Permit
r 401 Water Quality Certification - Express
�7 Riparian Buffer Authorization
1d. Is this notification solelyfor the record because written approval is not required?
For the record only for DWR 401 Certification:
I For the record only for Corps Permit:
1e. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
*
l" Yes C•' No
C' Yes C•' No

If so, attach the acceptance letter from rritigation bank or in-lieu fee program
�' Yes C' No
Acceptance Letter Attachment
Qick the upload button or drag and drop files here to attach docurrent
i SR 1001 - Bridge 135 (B-5726) - Dvision 7- STR - CF 02.pdf 59.82KB
FlLE IYFE MJST BE FDF
1f. Is the project located in any of NC's twenty coastal counties?*
C' Yes �' No
B. Applicant Information
1a. Who is the Primary Contact?*
Mr. Jerry Parker
1b. PrimaryContact Email:*
[e-mail]
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
� Owner rJ Applicant (other than owner) r AgenUConsultant
(Check all that apply)
2. Owner I nformation
2a. Name(s) on recorded deed:
NC Department of Transportation
2b. Deed book and page no.:
2c. Responsible party:
(for Corporations)
Division Engineer NC DOT Division 7, Mr. Mike Mills, PE
2d.Address
Street Address
PO Box14996
Address Line 2
�Y
Greensboro
Fbstal / Zip Code
27415
2e. Telephone Number:
(xxx)xxx-xxxx
[phone]
2f. Fax Number:
[phone]
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
State / R-ovince / F�gion
NC
Country
USA

3a. Applicant is:
C' Agent
C' Other
If other please specify.
3b. Name:
Mr. Jerry Parker
3c. Business Name:
(if applicable)
NC Department of Transporation
3d. Address
Street Address
PO Box14996
Address Line 2
��
Greensboro
Fbstal / Zip Code
27415
3e. Telephone Number:
[phone]
(xxx)xxx-xxxx
3f. Fax Number:
[phone]
(xxx)xxx-xxxx
3g. Email Address:*
[e-mail]
State / Rovince / F�gion
NC
Country
USA
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
� Bridge No. 135 over Squirrel Creek on SR 1001 (North Church St)
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Greensboro
1d. Driving directions*
If it is a new project and can not easily be found in a G� rrapping system Rease provide directions.
I-40/I-85 W to ebt 227 (I-840) to US 70 West; continue on US 70/Wendover Ave. for approx. 5 miles; take right onto N. Church St and go
about 7.5 miles
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)
i N/A - Bridge replacement
2b. Propertysize:
(in acres)
f�UA - Bridge replacement

2c. Project Address
Street Address
Address Line 2
�'
Fbstal / Zip Code
2d. Site coordinates in decimal degrees
State / Rovince / F�gion
Country
Please collect site coordinates in decimal degrees. Use between 4-6 digits (unless you are using a survey-grade GPS device) after the decimal place as
appropriate, based on howthe location was determined. (For example, most mobile phones with GPS provide locational precision in decimal degrees to
map coordinates to 5 or 6 digits after the decimal place.)
� Latitude:* Longitude:*
36.188168 -79.785657
ex:34.208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Squirrel Creek
3b. Water Resources Classification of nearest receiving water:*
16-11-8-(1); WS-III; NSW; 03-06-02; 03030002
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Cape Fear
RiverBasin Lookup
4. Project Description
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 study area is comprised of ebsting maintained right of way, forested land and residential properties.
4b. Attach an 8 1/2 X 11 excerpt from the most recent version of the USGS topographic map indicating the location of the project site. (for
DWR)
aick the upload button or drag and drop files here to attach docurrent
135_USGS Map.pdf 2.88M6
Fle type rrust be pdF
4c. Attach an 8 1/2 X 11 excerpt from the most recent version of the published County NRCS Soil Survey map depicting the project site.
(for DWR)
C7ick the upload button or drag and drop files here to attach docurrent
135_Soil_Map.pdf 2.12M6
Fle type rrust be pdF
4d. List the total estimated acreage of all existing wetlands on the property:
There is approx. 1 acre of wetlands within the project study area, but less
than 0.05 acres within the project limits.
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
Approx 200 LF
4f. Explain the purpose of the proposed project:

The project proposes to replace a functionally obsolete, two span bridge (1 @18', 1@17'6") with timber deck on I-
Beams supported by timber caps on timber piles. Interior bent is steel cap on steel piles. The
proposed structure is a 2@ 11' X6' Reinforced Concrete Box Culvert (RCBC)
4g. Describe the overall project in detail, including the type of equipment to be used:
The proposed structure has been designed to have as little environmental and surface water impacts as
possible. 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, geotextile and rip-rap were utilized for bank
stabili�ation in an attempt to reduce stream bank erosion. A lowflow barrel on the north side of the culvert was
designed to match the stream width to maintain the normal flowwidth, depth and velocity of the stream. This will
maintain sediment transport to provide a stable stream during bankfull discharge. The barrel invert will be a
minimum of 1' below the stream bed to consider fish passage. A high flow barrel on the south side of the culvert
will provide flood conveyance during high flow storm events. This will reduce shear stress on the stream bottom.
This road is a major collector with current ADT over 5000. Tv�ro offsite detours v�re considered by NCDOT. The
high ADT and concerns by the Schools, Fire, and EMS nullify the viability of an offsite detour. An onsite detour is
required during construction to maintain traffic. The temporary crossing structures are 3@48" CSPs under the
detour. There are e�sting ditches located at all four quadrants of the bridge. The ditch at the northwest and
southeast quadrants daylight and become diffuse flow before entering the buffer. Both of the ditches will be
retained and lined with toe protection along the fill slope. The ditch at SW quadrant will be retained and lined with
toe protection along the fill slope. This ditch will outlet to bank stabilization with class II rip rap to dissipate energy
to provide a non-erosive outlet velocity to the stream. At the NE quadrant, a proposed lateral 'V' ditch will be
installed from 16+30 to 17+g0 RT to replace the ebsting ditch. This newditch has outlet to bank stabilization with
class II rip rap to dissipate energy to provide to non-erosive outlet velocity to the stream. As the proposed
replacement structure is within the same general area and location of the existing bridge, the increases in
stormwater discharges (post vs pre condition) are insignificant and the e�sting ditches do not need to be modified.
Therefore, additional stormwater measures are not required.
4h. Please upload project drawins for the proposed project.
aick the upload button or drag and drop files here to attach docurrent
B-5726_Permit Drawings_20170601.pdf 4.56M6
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5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
�' Yes C' No f Unknown
Comments:
USACE and DWR staff visited the project site on 2/22/2017; v�tlands and
streams were delineated by Ecosystem Planning & Restoration (EPR) staff.
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
C' Preliminary C' Approved C' Unknown
Corps AID Number:
6carrple: SAVw2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:
Robert Lepsic
EPR
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
The USACE and DWR concurred with the delineation as presented by EPR. The USACE will issue the JD with the permit as discussed in the
field.
5d1. Jurisdictional determination upload

C7ick the upload button or drag and drop files here to attach docurrent
DWR Determinations.pdf
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6. Project History
2.25MB
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past?*
C' Yes C� No C' Unknown
7. Future Project Plans
7a. Is this a phased project?*
C' 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 activit�/? This includes other separate and distant crossing for linear projects that require Department of the
Army authorization but don't require pre-construction notification.
D. Proposed I m pacts I nventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
rJ Wetlands rJ Streams-tributaries rJ Buffers
r Open Waters r Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. Site # - Reason for
impact
1 From 15+46 to 16+46 -
L- (Fill)
N�p label (e.g. Road Qassing 1)
1 From 15+46 to 16+46 -
L- (Mechanzied
Clearing)
N�p label (e.g. F�ad Qossing 1)
15+46 to 16+46 -L-
(Hand Clearing)
N�p label (e.g. Road Qassing 1)
1 From 15+89 to 16+30 -
L- (6ccavation)
N�p label (e.g. F�ad Qassing 1)
From 15+2g to 16+35 -L-
(Temporary Detour -
Temp. Fill)
N�p label (e.g. Finad Qossing 1)
From 15+28 to 16+35 -L-
(Temporary Detour -
Hand Clearing)
N�p label (e.g. Finad Qossing 1)
2b. Impact type * 2c. Type of wetland
P Seep
F�rrranent (P� or Terrporary
��
P Seep
F�rrranent (P� or Terrporary
i�
T Seep
F�rrranent (P) or Terrporary
��
P Seep
F�rrranent (P� or Terrporary
i�
T Bottomland Hardwood
�rrrenent (� or Terrporary Forest
��
T Bottomland Hardwood
F�rrranerd (P� or Terrporary FOrest
��
2g. Temporary Wetland Impact
0.030
2d. Wetland name 2e. Forested 2f. 2g. Impact
Jurisdiction area
type
No Both 0.010
(404, 10) or d�NR (acres)
(401, other)
No Both 0.010
(404, 10) or D�NR (acres)
(401, other)
No Both 0.010
(404, 10) or GNR (acres)
(401, other)
No Both 0.010
(404, 10) or CANR (acres)
(401, other)
Yes Both 0.010
(404, 10) or DJVR (acres)
(401, other)
Yes Both 0.010
(404, 10) or D�NR (acres)
(401, other)

2g. Permanent Wetland Impact
0.030
2g. Total Wetland Impact
0.060
2h. Comments:
Please note, the above impacts are less than 0.01 acres (in each case) however that cannot be represented
within the fillable fields.
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this question for all stream sites
impacted.
Row 1
Row 2
Row 3
Row 4
3a. Site # - 3b.lmpact
Reason for type
impact
1 From P
15+46 to F2rrrenent (Fj or
16+46 -L- Terrporary (�
N�p label (e.g.
Raad Q'ossing 1)
1 From T
15+46 to F2rrranent (Fj or
16+46 -L- Terrporary (�
N�p label (e.g.
Finad Qossing 1)
3c. Type of 3d. Stream 3e. Stream 3f. 3g. Stream 3h. Impact
impact name Type Jurisdiction width length
type
Culvert Squirrel Perennial Both Average 53
Cree k F2rennial (FB� or � 0 (linear feet)
interrrittent (IN�
(feet)
Other Squirrel Perennial Both Average 13
Cree k F2rennial (FB� or � 0 (linear feet)
interrrittent (If� (feet)
1 From P Bank Squirrel
15+89to F�rrranent(P�or Stabilizatio Creek
16+30 -L- Terrporary (� n
fv�p label (e.g.
Finad Qassing 1)
From 15+28 T Other Squirrel
to16+35-L- F�rrranent(P�or Creek
N�p label (e.g. Terrporary (�
Rnad Qossing 1)
Perennial Both Average
F�rennial (Fff� or 10
interrrittent (IfV�
(feet)
Perennial Both Average
F�rennial (� or 10
interrrittent (IfVn
(feet)
'� All Perennial or Intermittent streams must be verified by DWR or delegated local government.
3i. Total jurisdictional ditch impact in square feet:
0
3i. Total permanent stream impacts:
113
3i. Total temporary stream impacts:
61
3i. Total stream and tributary impacts:
174
3j. Comments:
Of the 174 linear feet of proposed impacts, 13 LF of temporary stream impact is associated with construction and
dewatering activities, another 48 LF of temporary impact is associated with the onsite detour. The stream will be
returned to its original pattern, dimension and profile post construction in the area of the detour. As previously
discussed, this road is a major collector with current ADT of over 5000. Two offsite detours were considered by
NCDOT. The high ADT and concerns by the Schools, Fire, and EMS nullify the viability of an offsite detour. An
onsite detour is required during construction to maintain traffic. The temporary crossing structures are 3@48"
CSPs under the detour.
60
(linear feet)
48
(linear feet)

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.
5. Pond or Lake Construction
If pond or lake construction is proposed, then complete the chart below.
6. Buffer Impacts (for DWR)
If project will impact a protected riparian buffer, then complete the chart below. Individually list all buffer impacts below.
6a. Project is in which protect basin(s)?*
Check all that apply.
r Neuse r Tar-Pamlico
I � Catawba r Randleman
� Goose Creek rJ Jordan Lake
r Other
6b. Impact Type
6c. Per or 6d. Stream name
Te mp
1-L- 15+46 to 16+77 "Allowable" P Squirrel Creek
Road Crossing F2rrranent (Fj or
Location and 6cerrpt, Allowable, allowable w/ rritigation Terrporary (�
1-L- 15+63 to 16+87 "Allowable" T Squirrel Creek
Road Crossing (Onsite Detour) F2rrranent(�jor
Location and 6cerrpt, Allowable, allowable w/ rritigffiion Terrporary (�
6h. Total buffer impacts:
Temporary impacts
Permanent impacts:
Total buffer impacts
6i. Comments:
Zone 1
4,009.00
Zone 1
2,838.00
Zone 1
6,847.00
Zone 2
2,636.00
Zone 2
1,196.00
Zone 2
3,832.00
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
C7ick the upload button or drag and drop files here to attach docurrent
B-5726_Permit Drawings_20170601.pdf
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E. Impact Justification and Mitigation
1. Avoidance and Minimization
6e. Buffer 6f. Zone 1 6g. Zone 2
mitigation impact impact
required?
No 2,838 1,196
(squarefeet) (squarefeet)
No
4.56MB
4,009 2,636
(squarefeet) (squarefeet)

1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
This structure has been designed to have as little environmental and surface water impacts as
possible. 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, geotextile and rip-rap will be utilized for bank
stabilization in an attempt to reduce stream bank erosion. A low flow barrel on the north side of the culvert was
designed to match the stream width to maintain the normal flowwidth, depth and velocity of the stream. This will
maintain sediment transport to provide a stable stream during bankfull discharge. The barrel invert will be a
minimum of 1' below the stream bed to consider fish passage. A high flow barrel on the south side of the culvert
will provide flood conveyance during high flow storm events. This will reduce shear stress on the stream bottom.
There are existing ditches located at all four quadrants of the bridge. The ditch at the
northwest and southeast quadrants daylight and become diffuse flow before entering the buffer. Both of the
ditches will be retained and lined with toe protection along the fill slope. The ditch at SW quadrant will be retained
and lined with toe protection along the fill slope. This ditch will outlet to bank stabilization with class II rip rap to
dissipate energy to provide a non-erosive outlet velocity to the stream. At the NE quadrant, a proposed lateral 'V'
ditch will be installed from 16+30 to 17+80 RT to replace the e�sting ditch. This
new ditch has outlet to bank stabilization with class II rip rap to dissipate energy to provide to non-erosive outlet
velocity to the stream. As the proposed replacement structure is within the same general area and location of the
e�asting bridge, the increases in stormwater discharges (post vs pre condition) are insignificant and the existing
ditches do not need to be modified. Therefore, additional stormwater measures are not required.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Erosion and sedimentation BMPs will be installed prior to construction. 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 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):
r DWR �J Corps
2d. If yes, which mitigation option(s) will be used for this project?
r Mitigation bank rJ Payment to in-lieu fee program r 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
4b. Stream mitigation requested:
(linear feet)
53
4c. If using stream mitigation, stream temperature:
warm
4d. Buffer mitigation requested (DWR 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

F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1a. Does this project require a Stormwater Management Plan?
C� Yes �' No
1b. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
Plan is attached
1c. What is the overall percent imperviousness of this project?
0
%
1d. Who will be responsible for the review of the Stormwater Management Plan?*
� Certified Local Government
r% DWR 401 & Buffer Permitting Branch
2. Diffuse Flow Plan
r DEMLR Stormwater Review
r DWR Transportation Permitting Branch
2a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection
Rules?
C� Yes �' No
2b. All buffer impacts and high ground impacts require diffuse flow or other form of stormwater treatment. Include a plan that fully
documents how diffuse flow will be maintained.
If, due to site constraints, a BMP other than a level spreader is proposed, please provide a plan for stormwater treatment as outlined
in Chapter 8 of the NC Stormwater BMP Manual and attach a BMP Supplement Form
What documentation are you providing?
r Level Spreader
rJ Other BMP
(check all that apply)
Diffused Flow Documentation
aick the upload button or drag and drop files here to attach docurrerrt
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5. DWR 401 Stormwater Review
5a. Is the Stormwater Management Plan (including BMP Supplemental Forms and Operation and Maintenance Agreements) attached?
C� Yes
l" No
Stormwater Management Plan Upload
C7ick the upload button or drag and drop files here to attach docurrent
file type rrust be pdf
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?*
C•' 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 PolicyAct (NEPA/SEPA)?*
C' Yes C•' No
Comments:*

While this project involves the expenditure of public funds, it falls below the thresholds of NEPA/SEPA
documentation.
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)? *
C' Yes C•' No
2b. Is this an after-the-fact permit application?*
C' Yes C•' No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWR Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in additional development, which could impact
nearby downstream water quality?*
C' Yes �' No
3b. 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, this is not a road on a new
location (i.e. there is an ewsting road and bridge structure and thus, the area already contains impervious
surfaces) and the project drains to Squirrel Creek which is Class WS-III; Nutrient Sensitive Waters (NSW) (i.e. not
ORW or 303(d) listed waters). We anticipate the NC DWR will advise us if a qualitative or quantitative analysis is
needed.
4. Sewage Disposal (DWR Requirement)
4a. Describe, in detail, the treatment methods and dispositions (non-discharge or discharge) of wastewater generated from the
proposed project. If the wastewater will be treated at a treatment plant, list the capacity available at that plant.
It is not anticipated that this project will generate any wastewater as it is a roadway project.
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?*
G Yes C' No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
�' Yes l" No
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. Is this a DOT project located within Division's 1-8?*
C•' Yes
C' No
5i. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
I Ecosystem Planning & Restoration (EPR) biologists conducted field studies for both Echinacea laevigata (Smooth
Coneflower) and Isotria medeoloides (Small whorled pogonia) on May 24, 2017. While habitat occurs at the project
area for these species, no individuals were observed. A review of NCNHP records (September 2016) indicates no
known occurrences within 1.0 mile of the project. Therefore, the biological conclusion is No Effect; Habitat Present.
6. Essential Fish Habitat (Corps Requirement)

6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
C' Yes C•' No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
This bridge replacement project takes place in Guilford County which is not near any coastal or tidal habitat that
i would support EFH (i.e. salt marshes, oyster reefs, etc.).
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data: http://gis.ncdcr.gov/hpoweb/
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 (e.g., National Historic Trust designation or properties significant in North Carolina historyand archaeology)?*
!' Yes C•' No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources? *
� NCDOT's Human Environment Unit reviewed the project for Historic Architecture and for Archaeological resources
in early 2016. They determined no surveys were required for either (see attached letters).
7c. Historic or Prehistoric Information Upload
aick the upload button or drag and drop files here to attach docurrent
B-5726_Architectrual NO Survey Guilford135NoSurvey.pdf 3.81 MB
I B-5726_Archaeological NO Survey.pdf 1.45MB
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8. Flood Zone Designation (Corps Requirement)
� Link to the FEMA Floodplain Maps: https://msc.fema.gov/portal/search
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
C' Yes C' No
8b. If yes, explain how project meets FEMA requirements:
MOA
8c. What source(s) did you use to make the floodplain determination?*
NC Floodplain mapping program
Miscellaneous attachments not previously requested.
C7ick the upload button or drag and drop files here to attach docurrent
Bridge to Culvert Justification BR 400135.pdf 55.75KB
onsite Detour Justification letter.pdf 19.18KB
D7_T&E_Lttr.pdf 106.17KB
temporary stream crossing.pdf 223.17KB
Fle rrust be FDF
Signature
*
r% By checking the box and signing below, I certify that:
■ 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 AcY');
■ I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic
Transactions AcY');
■ 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.
I Full Name:*
J. M. Mills
Signature
��
Date
8/8/2017
� Initial Review
Is this project a public transportation project?
�' Yes �' No
Only change this if the project has been reassigned.
Has this project met the requirements for acceptance in to the review process?*
C•' Yes
C' No
BIMS # Assigned*
20170988
Version#*
Reviewing Office *
Winston-Salem Regional Office - [phone]
Select Project Reviewer*
Dave Wanucha:eads\djwanucha