20171354 Ver 1_PCN Form Submission_20171024

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 10/24/2017 10:28:16 AM (Start Event)
Accept by Carpenter,Kristi 10/24/2017 12:14:46 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: October 27, 2017 5:00 PM
10/24/2017 10:28 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:*
Rowan
Is this a NCDOT Project?*
C� Yes �' No
(NCDOT only) T.I.P. or state project number:
U-5820A
WBS #
44392.1.1
(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
r 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
C' Yes C•' No
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?*
Amy Euliss-NCDOT Division 9
1b. Primary Contact Email:*
[e-mail]
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
r% Owner r Applicant (other than owner) r AgenUConsultant
(Check all that apply)
2. Owner I nformation
2a. Name(s) on recorded deed:
I North Carolina Department of Transportation
i 2b. Deed book and page no.:
f�UA
2c. Responsible party:
(for Corporations)
wa
2d.Address
Street Address
375 Silas Creek Parkway
Address Line 2
��
Winston-Salem
Fbstal / Zip Code
27127
2e. Telephone Number:
(xxx)xxx-xxxx
[phone]
2f. Fax Number:
[phone]
(xxx)xxx-xxxx
� 2g. Email Address:*
[e-mail]
State / FYovince / F�gion
NC
Country
USA
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*

U-5820A Innes Street Market Dr. E�ension
1b. Subdivision name:
(if appropriate)
wa
1c. Nearest municipality/town:*
Salisbury
1d. Driving directions*
If it is a new project and can not easily be found in a G� rrapping system Rease provide directions.
Located at the end of Innes Street Market Dr. in Salisbury.
2. Project Identification
2a. Property Identification Number:
(tac RN or parcel ID)
wa
2b. Propertysize:
(in acres)
10 acres
2c. Project Address
Street Address
Innes Street Market Dr.
Address Line 2
aty
Salisbury
Fbstal / Zip Code
28146
2d. Site coordinates in decimal degrees
State / FYovince / F�gion
NC
Country
USA
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:*
35.652878
ex:34.208504
3. Surface Waters
Longitude:*
-80.463351
-77.796371
3a. Name of the nearest body of water to proposed project:*
Town Creek
3b. Water Resources Classification of nearest receiving water:*
C
Surface Water Lookup
3c. What river basin(s) is your project located in?*
Yadkin-PeeDee
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:*
Existing conditions at the Project Site include disturbed areas along roadways, ponds, and wetlands.
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)
Qick the upload button or drag and drop files here to attach docurrent
Fig1_Vicinity Map_U5820A Rowan PCN.pdf 314.34KB
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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
Fig2_Soil Survey_U5820A Rowan.pdf 587.03KB
Fle type rrust be pdf
4d. List the total estimated acreage of all existing wetlands on the property:
0.82 acres wetlands, 0.27 acres open water
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
i wa
4f. Explain the purpose of the proposed project:
To accommodate the through movement from Bendix Drive, this project proposes improvements along existing
Innes Street Market Drive which includes pavement reconstruction throughout its e�sting length and access
management improvements on Faith Road. Furthermore, this project improves traffic flowand accessibility to
numerous commercial areas along this roadway, Faith Road, and portions of Bendix Drive.
4g. Describe the overall project in detail, including the type of equipment to be used:
� Extend the two lane road, Innes Street Market Dr. to SR 2576 (Bendix Dr.). Standard road building equipment,
such as trucks, bulldozers, and cranes will be used.
4h. Please upload project drawins for the proposed project.
C7ick the upload button or drag and drop files here to attach docurrent
i U5820A Permit_Drawings.pdf 1.81M6
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5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
C� Yes �' No �' Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
�' Preliminary C' Approved C' Unknown
Corps AID Number:
6carrple: SAV�2017-99999
SAW-2017-00500
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other
Heather Smith and David Cooper
Ecological Engineering, LLP

5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
3/8/2017 the site was reviewed by James Lastinger (USACE) and Dave Wanucha (NCDWR).
5d1. Jurisdictional determination upload
C7ick the upload button or drag and drop files here to attach docurrent
Approved signed PJD.pdf
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6. Project History
702K6
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 r 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 r Streams-tributaries r Buffers
rJ 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 2b. Impact type * 2c. Type of wetland
impact
Site 1
N�p label (e.g. I�ad Qassing 1)
Site 1
N�p label (e.g. Finad Qassing 1)
Site 1
fv�p label (e.g. I�ad CYossing 1)
Site 2
N�p label (e.g. f�ad Qossing 1)
Site 2
I N�p label (e.g. Fd�ad Qossing 1)
Site 2
N�p label (e.g. I�ad Qossing 1)
P Headwater Forest
F�rrranent (P� or Terrporary
(�
P Headwater Forest
F2rrranent (F) or Terrporary
��
T Headwater Forest
F2rrranent (� or Terrporary
��
P Headwater Forest
F�rrranent (P� or Terrporary
i�
P Headwater Forest
F2rrranent (P� or Terrporary
��
T Headwater Forest
F2rrrenent (P� or Terrporary
��
2d. Wetland name 2e. Forested 2f. 2g. Impact
Jurisdiction area
type
Wetland A Yes Both 0.037
(404, 10) or CANR (acres)
(401, other)
Wetland A Yes Both 0.008
(404, 10) or DdVR (acres)
(401, other)
Wetland A Yes Both 0.012
(404, 10) or C7�NR (acres)
(401, other)
Wetland B Yes Both 0.003
(404, 10) or CANR (acres)
(401, other)
Wetland B Yes Both 0.011
(404, 10) or d�NR (acres)
(401, other)
Wetland B Yes Both 0.034
(404, 10) or CTJVR (acres)
(401, other)

2a. Site #- Reason for 2b. Impact type * 2c. Type of wetland
impact
Site 3 P Headwater Forest
N�p label (e.g. I�ad Q'ossing 1) F2rrranent (Pj or Terrporary
��
Site 3 P Headwater Forest
I N�p label (e.g. I�ad Qossing 1) F�rrranent (P� or Terrporary
i�
2g. Temporary Wetland Impact
0.046
2g. Permanent Wetland Impact
0.064
2g. Total Wetland Impact
0.110
2d. Wetland name 2e. Forested 2f. 2g. Impact
Jurisdiction area
type
Wetland A Yes Both 0.003
(404, 10) or D�NR (acres)
(401, other)
Wetland A Yes Both 0.002
(404, 10) or C7�NR (acres)
(401, other)
2h. Comments:
Permanent impacts (0.06 acres) are due to road construction and installation of erosion control devices.
Temporary impacts (0.05 acres) are due to hand clearing.
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.
"" All Perennial or Intermittent streams must be verified by DWR or delegated local government.
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. Site # - Reason for
i impact
Site 3
I N�p label (e.g. Fd�ad Qossing 1)
4b. Impact
type
P
F2rrranent (P� or
Terrporary (�
4c. Name of waterbody
Pond B
(if applicable)
4d. Activity 4e. Waterbody4f. Impact area
type type
Fill Pond 0.01
(acres)
4g. Total temporary open water Impacts:
0.00
4g. Total permanent open water impacts:
0.01
4g. Total open water impacts:
0.01
4h. Comments:
The permanent impacts to open water are 0.0046 ac due to fill. There are no temporary impacts to surface waters.
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.

E. Impact Justification and Mitigation
1. Avoidance and Minimization
� 1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
The ebsting elevated portion of the site is being used for the majority of the new road construction. The side
� slopes will be 2:1 near the wetlands to minimize the amount of fill in the wetland.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
Best Management Practices for Protection of Surface Waters will be implemented during the construction phase.
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?
C' Yes
C•' No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
The project is permanently impacting 0.06 acres of wetlands and mitigation is not usually required for permanent impacts below 0.10 acres.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1a. Does this project require a Stormwater Management Plan?
C� Yes
C' No
1b. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
See attached Stormwater Management Plan
1c. What is the overall percent imperviousness of this project?
%
1d. Who will be responsible for the review of the Stormwater Management Plan?*
� Certified Local Government
r7 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
C•' No
If no, explain why:
There are no streams within the study area and the Yadkin Pee-Dee river basin does not have NC Riparian Buffer Protection Rules.
5. DWR 401 Stormwater Review
5a. Is the Stormwater Management Plan (including BMP Supplemental Forms and Operation and Maintenance Agreements) attached?
�' Yes
l" No
Stormwater Management Plan Upload
C7ick the upload button or drag and drop files here to attach docurrent
SMP.pdf
file type rrust be pdf
G. Supplementary Information
126.64KB

1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
r Yes l" 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
Comme nts: *
A State Minimum Criteria Determination Checklist was completed and approved in March 2017.
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 r No
3b. If you answered "no," provide a short narrative description.
Overall, this project is e�ected to result in minor indirect land use effects. Given the small scope of the project,
and current growth trends in the area, this project is not e�ected to result in induced growth or a change in land
use that would not otherwise occur.
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.
Not applicable
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? *
C' Yes C•' No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
C' Yes �' No
5c. If yes, indicate the USFWS Field Office you have contacted.
5d. Is this a DOT project located within Division's 1-8?*
C' Yes
C� No
5e. Will you cut anytrees in order to conduct the work in waters of the U.S.?*
C' Yes G No

5f. Does this project involve bridge maintenance or removal?*
C' Yes C•' No
Sf(1). If yes, have you inspected the bridge for signs of bat use such as staining, guano, bats, etc.? Representative photos of signs of bat
use can be found in the NLEB SLOPES, Appendix F, pages 3-7.
C' Yes C' No
I Link to the NLEB SLOPES document: http://sav�reg.usace.army.mil/NLEB/1-30-17-signed_NLEB-SLOPES&apps.pdf
If you answered "Yes" to 5f(1), did you discover any signs of bat use?*
C' Yes r No C' Unknown
If yes, please show the location of the bridge on the permit drawings/project plans.
C7ick the upload button or drag and drop files here to attach docurrent
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5g. Does this project involve the construction/installation of a wind turbine(s)?**
C' Yes r No
If yes, please show the location of the wind turbine(s) on the permit drawings/project plans.
Gick the upload button or drag and drop files here to attach docurrent
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Sh. 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.?*
f Yes C•' No
If yes to either, please provide details to include type of percussive activity, purpose, duration, and specific location of this activity on
the property.
aick the upload button or drag and drop files here to attach docurrent
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Si. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
On-site investigation revealed no suitable habitat for Helianthus schweinitzi (SchweinitZs sunflower) or Myotis
septentrionalis (Northern long-eared bat)
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
C' Yes �' No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
NOAA Essential Fish Habitat Mapper
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)?*
C' Yes C•' No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources? *
Historic Architecture and Landscapes No Survey Required Form-signed by Shelby Reap 1/30/2017 See attached
No Archaeological Survey Required Form-signed by Scott Halvoren 1/24/2017 See attached
7c. Historic or Prehistoric Information Upload
Gick the upload button or drag and drop files here to attach docurrent
Cultural Resources Forms.pdf 6.61 MB
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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:
8c. What source(s) did you use to make the floodplain determination?*
FEMA/ NC Floodplain Mapping DFIRM 5669
Miscellaneous attachments not previously requested.
qick the upload button or drag and drop files here to attach docurrent
PCN letter U-5820A-Signed.PDF 150.14KB
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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.
Full Name:*
Amy Euliss
Signature
��FrJUr!/i.t�
Date
10/24/2017
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*
20171354
Version#*
1

Reviewing Office *
Winston-Salem Regional Office - [phone]
Select Project Reviewer*
Dave Wanucha:eads\djwanucha