20170151 Ver 2_PCN Form Submission_20171213

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 12/13/2017 10:28:40 AM (Start Event)
Accept by Carpenter,Kristi 12/13/2017 1:29:07 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: December 18, 2017 5:00 PM
12/13/2017 10:29 AM

�� �
6fvlslaa of Water Resources
Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
November 25, 2017 Ver 2.1
*
Please note: fields marked with a red asterisk below are required. You will not be able to submit the form until all mandatory questions are ans�red.
Below is a link to the online help file.
http://edocs.deq.nc.gov/WaterResources/0/doc/603610/Page1.aspx
A. Processing Information
County(or Counties) where the project is located:*
Guilford
Is this project a public transportation project? (?)
r Yes C' No
Is this a NCDOT Project?
C� Yes C' No
(NCDOT only) T.I.P. or state project number:
B-4960
WBS #
40153.1.1
(for NCDOT use only)
1a. Type(s) of approval sought from the Corps:
ri 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?
rJ 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: C' Yes C•' No
For the record only for Corps Permit: C' Yes r No
1e. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
If so, attach the acceptance letter from rritigation bank or in-lieu fee program
C•' Yes C' No
Acceptance Letter Attachment
qick the upload button or drag and drop files here to attach docurrent
SR 3058 - Birdge 214 B-4960 Revised Division 7 STR Buffer CF 02 Haw.pdf 96.15K6
SR 3508 - Bridge 214 (B-4960) - Division 7- CF 02 Haw Buffer Payment Request.pdf 129.78KB
SR 3508 - Bridge 214 (B-4960) - Division 7- STR - CF 02 - Guilford.pdf 140.81 KB
FlLE TYFE MJST BE FDF
1f. Is the project located in anyof NC's twentycoastal counties?*
C' Yes C•' No
1h. Is the project located in a designated trout watershed?*
r No
C' Yes
Link to trout information: http://�wwv.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Agency-Coordination/Trout.aspx
� B. Applicant Information
1a. Who is the Primary Contact?*
Mr. Jerry Parker
1b. Primary Contact Email:*
[e-mail]
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
r Owner rJ Applicant (other than owner) r Agent/Consultant
(Check all that apply)
2. Owner I nformation
2a. Name(s) on recorded deed:
North Carolina 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
Greensboro, NC 27415
a�
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)
3a. Applicant is:
C' Agent
C� Other NC DOT Highway Division 7
If other please specify.
3b. Name:
Division Engineer NC DOT Division 7, Mr. Mike Mills, PE
3c. Business Name:
(if applicable)
NC DOT
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
State / R-ovince / F�gion
NC
Country
USA
C. Project Information and Prior Project History
1. Project Information

1a. Name of project:*
Konica Drive Extension; Removal of bridge #214 over Little Alamance Creek
1b. Subdivision name:
(if appropriate)
1c. Nearest municipality/town:*
Whitsett
1d. Driving directions*
If it is a new project and can not easily be found in a GPS rrapping system Rease provide directions.
I-40 west to exit 138, NC 61 Gibsonville. Konica drive will be on the right in approxmately one mile.
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)
n/a
2b. Propertysize:
(in acres)
n/a
2c. Project Address
Street Address
Address Line 2
�Y
Fbstal / Zip Code
State / FYovince / F�gion
Country
2d. Site coordinates in decimal degrees
� Please collect site coordinates in decimal degrees. Use betv�en 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 e>cample, most mobile phones with GPS provide locational precision in decimal degrees to
map coordinates to 5 or 6 digits after the decimal place.)
i Latitude:*
36.057012
ex:34.208504
3. SurFace Waters
Longitude:*
-79.587589
-77.796371
3a. Name of the nearest body of water to proposed project:*
Little Alamance Creek (Lake Mackintosh)
3b. Water Resources Classification of nearest receiving water:*
WS-IV; NSW; CA; 16-19-3-(4.5)
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:*
There currently is a dirt road/utility easement where e�tisting Konica Drive will be extended to. The existing bridge
is a timber construction with concrete interior and end bents. Judge Adams Road, a gravel lane, accesses the
bridge from the north and south.
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
Bridge 214 USGS 24000.pdf
Fle type rrust be pdF
867.81 KB
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)
Gick the upload button or drag and drop files here to attach docurrent
I Bridge 214 Guildford Soils.pdf
Fle type rrust be pdf
4d. List the total estimated acreage of all existing wetlands on the property:
0.19
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
— 285 LF of stream within the project boundaries
2.21 MB
4f. Explain the purpose of the proposed project:
i The purpose of the proposed project is to remove a functionally obsolete bridge and to provide appropriate
access to properties and utilities, located north of Bridge No. 214, by extending SR 3224 (Konica Drive).
Please note that this project was previously authorized in February 2017; however, NCDOT will not be able to
complete the project prior to the authorization expiration on March 18, 2018. Therefore, NCDOT is respectfully
requesting a re-issuance of the project authorizations. The plans have not changed.
4g. Describe the overall project in detail, including the type of equipment to be used:
The project proposes to remove Bridge No. 214 on SR 3058 (Judge Adams Road) over Little Alamance Creek in
Guilford County. A new bridge will not be constructed. A service road will be constructed to provide continued
access to the properties north of Bridge No. 214. The proposed service road will tie into existing SR 3224 (Konica
Drive), which runs south of and parallel to I-40/85, will be extended west to the existing utility easement north of
Bridge No. 214 to tie into the northern limit of Judge Adams Road. The e�sting portion of SR 3224 (Konica Drive)
will remain open during construction of the service road. Bridge No. 214 along SR 3058 (Judge Adams Road) will
also remain open during construction of the service road and will be removed after the completion of the service
road. NCDOT will implement sedimentation, erosion control, and storm water drainage BMPs during construction.
NCDOT will adhere to Design Standards in Sensitive Watersheds within the project area. Equipment to be used
includes a track hoe, dump truck, paving equipment, crane, pumps and various hand tools.
4h. Please upload project drawings for the proposed project.
qick the upload button or drag and drop files here to attach docurrent
B-4960 PERMIT PACKAGE 2017 01 23.pdf 4.15M6
B-4960 Wetland Impact Summary Sheet 2017 01 23.pdf 58.61 KB
Fle type rrust be pdf
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
�' Yes �' No �' Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
r Preliminary l" Approved f Unknown f' N/A
Corps AID Number:

6carrple: SAV�2017-99999
SAW-2016-02209
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:
B. Barrett, J. Mason, J. Hemphill
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
The USACE issued the Preliminary JD with the 404 Authorization
5d1. Jurisdictional determination upload
aick the upload button or drag and drop files here to attach docurrent
2016-02209 NWP 14 Verification.pdf
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6. Project History
219.8KB
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past?*
C�' Yes C' No [" Unknown
6b. If yes, please give the DWR Certification number or the Corps Action ID (exp. SAW-0000-00000).
SAW 2016-02209 (issued 02/07/2017); DWR project No. 20170151 (issued 02/17/17)
Project History Upload
aick the upload button or drag and drop files here to attach docurrent
2016-02209 NWP 14 Verification.pdf 219.8KB
Konica Drive Extension SR-3224 and Removal of Bridge 214 on SR 3058.pdf 1.69M6
SR 3508 - Bridge 214 (B-4960) - Division 7- CF 02 Haw Buffer Payment Request.pdf 129.78KB
SR 3508 - Bridge 214 (B-4960) - Division 7- STR - CF 02 - Guilford.pdf 140.81 KB
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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 activity? 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 Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
r% Wetlands r% Streams-tributaries rJ Buffers
fJ 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 *
S2
N�p label (e.g. Fd�ad Qossing 1)
S2
N�p label (e.g. I�ad Qossing 1)
2b. Impact type * 2c. Type of wetland *
P Non-Tidal Freshwater
F2rrranent (F'� or Terrporary M arsh
��
T Non-Tidal Freshwater
F2rrrenent (Pj or Terrporary M aPsh
��
2d. Wetland name * 2e. 2f. 2g. Impact
Forested* Jurisdiction area*
type *
S2 No Corps 0.010
(404, 10) or d�NR (acres)
(401, other)
S2 No Corps 0.040
(404, 10) or CTJVR (acres)
(401, other)
2g. Total Temporary Wetland Impact
0.040
2g. Total Permanent Wetland Impact
0.010
2g. Total Wetland Impact
0.050
2h. Comments:
I Proposed permanent fill in the wetland is actually <0.01 acres; the remaining impact will be hand clearing only
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.
3a. Site #- Reason 3b.lmpact 3c. Type of 3d. Stream name *
for impact* type* impact*
S1 P Culvert UTto Little Alamance
N�p label (e.g. Fd�ad F�rrranent (Fj Cre e k
Qossing 1) or Terrporary
��
S1 T Dewaterin UTto Little Alamance
N�p label (e.g. Id�ad F�rrranent (f'� g Cre e k
Qossing 1) or Terrporary
��
3e. Stream Type * 3f. 3g. Stream 3h. Impact
Jurisdictior�idth* length*
type *
Perennial Both 20 135
F�rennial (�) or interrrittent Average (feet) (linear feet)
(If�
Perennial Both 20 25
F�rennial (�) or interrrittent Average (feet) (linear feet)
Qf�
"" 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:
135
3i. Total temporarystream impacts:
25
3i. Total stream and tributary impacts:
160
3j. Comments:
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 4b. Impact 4c. Name of waterbody* 4d. Activity 4e. Waterbody4f. Impact
impact * type * type * type * area *
01 T Little Alamance Creek/Lake Other Lake 0.10
N�p label (e.g. Id�ad Qossing 1) F�rrranent (P� or M ackintosh (acres)
Terrporary (� (if applicable)
4g. Total temporary open water Impacts:
0.10
4g. Total permanent open water impacts:
0.00
4g. Total open water impacts:
0.10
4h. Comments:
The impact is associated with bridge bent removal.
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 Catawba
r Goose Creek
r Other
6b. Impact Type *
r Tar-Pamlico
r Randleman
�J Jordan Lake
6c. Per or 6d. Stream name *
Te mp *
B1 Roadway fill/culvert Allowable P UT to Little Alamance
Location and C errpt, Allowable, allowable w/ rritigation F2rrranent (P) or CPee k
Terrporary (�
6h. Total buffer impacts:
Temporary impacts
Permanent impacts:
Total buffer impacts:
6i. Comments:
Zone 1
0.00
Zone 1
9,129.00
Zone 1
9,129.00
Zone 2
0.00
Zone 2
5,852.00
Zone 2
5,852.00
6e. Buffer 6f. Zone 1 6g. Zone 2
mitigation impact* impact*
required?*
Yes 9,129 5,852
(squarefeet) (squarefeet)

: Please note that within the riparian buffer area is also a small, non-tidal, non-forested, riparian wetland. A small
amount of wetland within the buffer will be impacted (123 sq. ft. in Zone 1 and 675 sq. ft. in Zone 2). This is only for
reporting purposes as wetland mitigation is not triggered by this proposed project; however, riparian buffer
compensatory mitigation will be required as the proposed impacts are greater than 1/3 acre.
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
C7ick the upload button or drag and drop files here to attach docurrent
SR 3058 - Birdge 214 B-4960 Revised Division 7 STR Buffer CF 02 Haw.pdf 96.15K6
SR 3508 - Bridge 214 (B-4960) - Division 7- CF 02 Haw Buffer Payment Request.pdf 129.78KB
SR 3508 - Bridge 214 (B-4960) - Division 7- STR - CF 02 - Guilford.pdf 140.81 KB
Fle rrust be F�F
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 proposed project includes the removal of Bridge No. 214 in Guilford County and constructing a service road
to provide access to properties and utilities who currently have access via SR 3058 (Judge Adams Road) north of
Bridge No. 214. The proposed service road will be an 18-foot aggregate base road and will be constructed starting
at the ewsting SR 3224 (Konica Drive) west appro�mately 2,925 feet to tie into the northern limit of Judge Adams
Road. The proposed typical section of the service road will be two nine-foot wide lanes. The embankment will be
graded for two 12-foot lanes with 6-foot shoulders per NCDOT standard practice. The elevation of the extended
new road with its associated fill slopes over the e�asting stream elevation account for the proposed impacts for this
project. Due to a projected traffic volume of 100 vehicles per day (vpd) on Konica Drive, NCDOT will be
constructing a two-lane roadway typical section for the extension of Konica Drive, but will be placing an 18-foot
wide stone surface at this time. Two cul-de-sacs will be constructed on either side of the Bridge No. 214 location,
one at the westernmost terminus of the proposed service road extending from existing SR 3224 (Konica Drive) and
one south of Bridge No. 214 along SR 3058 (Judge Adams Road).
In determining the preferred alternative, NCDOT examined replacing the existing bridge in place as well as the
proposed Konica Drive extension. From a cost perspective, Konica Drive Extension alternative (KDE) is estimated
at $1,643,303 compared to the Judge Adams Bridge alternative (JAB) estimated at $1,523,903. NCDOT analyzed
both alternatives with the same typical sections, matching KDE's 2, 12 foot lanes with 6 foot shoulders to JAB's 2, 9
foot lanes with 4 foot shoulders (a 36 foot width to a 26 foot width) and vice versa. When bringing up JAB's typical
section to KDE's typical section for comparison purposes, NCDOT v�rould have to construct a 10 foot wider bridge
and roadway on Judge Adams Road that would transition down to and tie into the e�sting 2, 9-foot lanes with 4
foot shoulders. This would result in the cost of JAB increasing beyond what is presented above as well as incurring
additional jurisdictional impacts. Further, Judge Adams Road has an 11 % grade along the roadway down to the
bridge; if NCDOT were to improve JA up to the KDE design parameters, that 11 % grade on Judge Adams Road
would need to be improved which �nrould result in a higher and longer bridge, a higher and wider roadway, potential
hydraulic backwater issues, and substantial increase in costs and environmental impacts higher than the KDE. As
the purpose of the proposed project is to maintain access to properties and prevent them from becoming
landlocked, the extension of Konica Drive was determined to be the preferred alternative based upon the above
discussed concerns and circumstances related to cost, design, structures and proposed environmental impacts.
The proposed 2, 12-foot lanes with 6-foot shoulders roadway typical is proposed as it matches the typical section
of Konica Drive which is NCDOT policy. The cost estimates above reflect this proposed typical section for KDE,
and the 2, 9-foot lanes with 4-foot shoulders typical section proposed for JAB which matches the ebsting typical
section for Judge Adams Road.
During construction of the service road, the existing portion of SR 3224 (Konica Drive) will remain open. Bridge No.
214 along SR 3058 (Judge Adams Road) will remain open during construction of the service road to provide
access to properties and utilities located north of the bridge. The bridge will be removed after the completion of
the service road.
Runoff from the roadway runs across grass shoulders, and is collected in ditches, most of which are grass lined.
Runoff that finds its way to storm sewer inlets is first conveyed through grass lined ditches. This promotes
infiltration and filtration. The steepness of the project terrain is the main factor that precludes using filter strips,
and precludes ditches from meeting water quality swale criteria. The storm sewer near buffers and wetlands is
discharged to a preformed scour hole. Storm sewer was minimized on the project in favor of ditches. Cross pipes
outlet to riprap pads to prevent erosion. Several measures such as a drop junction box, oversized culvert
e�hension pipe, and riprap dissipator basin are used to reduce energy of the large culvert e�ension.
NCDOT will implement sedimentation, erosion control, and storm water drainage BMPs during construction.
NCDOT will adhere to Design Standards in Sensitive Watersheds within the project area.
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. 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 impacts to Waters of the U.S. or Waters of the State?
C•' Yes C' No
2c. If yes, mitigation is required by (check all that apply):
rJ DWR r7 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.
fJ Yes
4b. Stream mitigation requested:
IQinearfeet)
135 LF @ 2:1 ratio
4c. If using stream mitigation, what is the stream temperature:
warm
4d. Buffer mitigation requested (DWR only):
(squarefeet)
27,387 sq. ft. Zone 1; 8,778 sq. ft. Zone 2(these totals reflect the
appropriate multipliers)
4e. Riparian wetland mitigation requested:
(acres)
4f. Non-riparian wetland mitigation requested:
(acres)
4g. Coastal (tidal) wetland mitigation requested:
(acres)
4h. Comments
6. Buffer mitigation (State Regulated Riparian Buffer Rules) - required by DWR
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.
C� Yes C' No
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 in the table below.
Zone 1
Zone 2
6c. Reason for impact
Roadway fill & Culvert
Roadway fill 8� Culvert
6f. Total buffer mitigation required
36165
6d. Total impact Multiplier
(square feet)
9,129 3
5,852 1.5
6e. Required
mitigation (square
fe e t)
27,387
8,778
6g. If buffer mitigation is required, is payment to a mitigation bank or NC Division of Mitigation Services proposed?
C� Yes C' No
6h. Attach the acceptance letter from the mitigation bank or NC Division of Mitigation Services.

SR 3058 - Birdge 214 B-4960 Revised Division 7 STR Buffer CF 02 Haw.pdf 96.15KB
SR 3508 - Bridge 214 (B-4960) - Division 7- CF 02 Haw Buffer Payment Request.pdf 129.78KB
SR 3508 - Bridge 214 (B-4960) - Division 7- STR - CF 02 - Guilford.pdf 140.81 KB
(FDF only)
6i. If no, then discuss what type of mitigation is proposed.
6j. Comments:
The mitigation for stream and buffer impacts has already been debited from the DMS ledger
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:
� Plan is attached
1c. What is the overall percent imperviousness of this project?
%
1d. Who will be responsible for the review of the Stormwater Management Plan?*
r Certified Local Government r DEMLR Stormwater Review
r DWR 401 & Buffer Permitting Branch �J DWR Transportation Permitting Branch
2. Diffuse Flow Plan
2a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection
Rules?
G Yes C' No
2b. All buffer impacts and high ground impacts require diffuse flow or other form of stormwater treatment. Include a plan that fully
documents howdiffuse flowwill 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
I in Chapter 8 of the NC Stormwater BMP Manual and attach a BMP Supplement Form
What documentation are you providing?
r Level Spreader
r Other BMP
(check all that apply)
Diffused Flow Documentation
C7ick the upload button or drag and drop files here to attach docurrent
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5. DWR 401 Stormwater Review
Sa. Is the Stormwater Management Plan (including BMP Supplemental Forms and Operation and Maintenance Agreements) attached?
C' Yes C' No
Stormwater Management Plan Upload
aick the upload button or drag and drop files here to attach docurrerrt
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 C' 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 does involve an e�enditure of public funds, it falls belowthe NEPA/SEPA documentation
thresholds.
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 qualit�i?*
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 (i.e. project site is adjacent
to I-40 corridor, existing businesses and industrial buildings in the vicinity), this is not a road on a new location (i.e.
there is an e�sting road and there used to be a bridge structure and thus, the area already contains impervious
surfaces) and the project drains to Little Alamance Creek, which is Class WS-IV; NSW; CA (i.e. not HWQ or ORW).
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? *
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.
Raleigh
5d. Is another Federal agency involved?*
C' Yes C•' No �' Unknown

5e. Is this a DOT project located within Division's 1-8?*
C' Yes C' No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
An onsite investigation for Isotria medeoloides was conducted in 2013 and included in the project NRTR. No
habitat or species were found within the project area. A review of the NCNHP records indicated no known
occurrences within 1.0 mile of the study area. Therefore, this project will have "no effecY' on the small whorled
pogonia. Additionally, previous communication with Mr. Gary Jordan (USFWS) determined that a resurvey for the
small whorled pogonia was not needed. Also, Mr. Gary Jordan (USFWS) recently released the Programmatic
Conference Opinion (PCO) for the recently listed Northern Long Eared Bat (NLEB). This opinion, states in part,
that "...it is the Service's conference opinion that NCDOT activities in eastern North Carolina (Divisions 1-8), as
proposed, are not likely to jeopardize the continued e�stence of the NLEB."
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 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)
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? *
North Carolina State Historic Preservation HPOWEB GIS Service was reviewed to determine that the project did
not take place in or near an area designated as having a historic or cultural preservation status. Also, a review
was conducted in 2013; see attached letters.
7c. Historic or Prehistoric Information Upload
qick the upload button or drag and drop files here to attach docurrent
13-05-0038 No Survey.pdf 2.61 MB
B-4960 Guilford No Survey Required For.pdf 4.23MB
Fle rrust be FDF
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?*
G 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?*
North Carolina Floodplain Mapping Program
Miscellaneous attachments not previously requested.
aick the upload button or drag and drop files here to attach docurrent
Fle rrust be FDF

Signature
*
fJ 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:*
James Michael Mills
Signature
4.f ►����
Date :
current_date
Initial Review
Is this project a public transportation project? *(')
C� Yes C' No
Change only if needed.
Has this project met the requirements for acceptance in to the review process?*
�' Yes
C' No
BIMS # Assigned*
20170151
Version#*
2
Reviewing Office*
Central Office - [phone]
Select Project Reviewer*
April Norton:eads\arnorton