20180007 Ver 1_PCN Form Submission_20180102

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 12/22/2017 3:28:16 PM (Start Event)
Accept by Carpenter,Kristi 1/2/2018 4:00:51 PM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: December 27, 2017 5:00 PM
12/22/2017 3:28 PM

E-PCN Submittal
���
�lulslaa af Water Resources
Pre-Construction Notification (PCN) Form
For Nationwide Permits and Regional General Permits
(along with corresponding Water Quality Certifications)
December 15, 2017 Ver 2.2
*
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.
Also, if at any point you wish to print a copy of the E-PCN, all you need to do is right-click on the document and you can print a copy of the form.
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:*
Rowan
Is this project a public transportation project? *(')
C�' Yes C' No
Is this a NCDOT Project?*
r Yes C' No
(NCDOT only) T.I.P. or state project number:
I-3804
WBS #
38708.1.1
(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?*
r Nationwide Permit (NWP)
r% Regional General Permit (RGP)
Regional General Permit (RGP) Number: 198200031 - NCDOT Bridges, Widening Projects 2015
RGP Number Other:
List all RGP nurrbers you are applying for not on the drop dow n list.
1c. Type(s) of approval sought from the DWR:*

check all that apply
ri 401 Water Quality Certification - Regular r 401 Water Quality Certification - E�ress
r Non-404 Jurisdictional General Permit 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:
For the record only for Corps Permit:
�' Yes C•' No
C' Yes �' 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 l" No
Acceptance Letter Attachment
Gick the upload button or drag and drop files here to attach docurrent
I-85 - SR 1221 Interchange - Division 9- STR - YD 105.pdf 63.68KB
FlLE TYFE MJST BE FflF
1f. Is the project located in anyof NC's twentycoastal counties?*
C' Yes �' No
1h. Is the project located in a designated trout watershed?*
C' Yes C' No
Link to trout information: http://www.saw.usace.army.mil/Missions/Regulatory-Permit-PrograrrUAgency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact?*
Amy Euliss - NCDOT Division 9 Environmental Officer
1b. Primary Contact Email:*
[e-mail]
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
rJ Owner r 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.:
Not applicable
2c. Responsible party:
(for Corporations)
Not applicable
2d.Address

Street Address
375 Silas Creek Parkway
Address Line 2
Qty
Winston-Salem
Fbstal / Zip Code
27127
2e. Telephone Number:
(xxx)xxx-xxxx
[phone]
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
State / R-ovince / I�gion
NC
Country
US
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
New Interchange at Interstate 85 (I-85) and SR 1221 (Old Beatty Ford Road
Relocation)
1b. Subdivision name:
(if appropriate)
Not applicable
1c. Nearest municipality/town:*
Kannapolis / China Grove
1d. Driving directions*
I If it is a new project and can not easily be found in a C�S rrapping system Rease provide directions.
The new interchange is located on e�sting I-85 between e�ts 63 and 68 at the location of Old Beatty Ford Relocation (W-5516).
35°32'07.0"N 80°34'26.1 "W
35.535274.-80.573926
2. Project Identification
2a. Property Identification Number:
(tax RN or parcel ID)
Not applicable
2b. Propertysize:
(in acres)
20 acres
2c. Project Address

Street Address
Not appicable - New interchange at the Old Beatty Ford Road Relocation.
Address Line 2
Not applicable
C1ty State / Rovince / f�gion
China Grove NC
Fbstal / Zip Code
28023
2d. Site coordinates in decimal degrees
Country
US
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:*
35.532093 -80.573776
ex:34208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Cold Water Creek
3b. Water Resources Classification of nearest receiving water:*
WS-IV for Cold Water Creek
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:*
Land use within the project vicinity consists mainly of forested, agricultural, and low density residential areas.
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)
C7ick the upload button or drag and drop files here to attach docurrent
I-3804 CE topo.pdf 1.79MB
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)
aick the upload button or drag and drop files here to attach docurrent
I-3804 CE soils.pdf 302.05KB
Fle type rrust be pdF
4d. List the total estimated acreage of all existing wetlands on the property:
Less than 10 acres
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
Approximately 10,500 linear feet
4f. Explain the purpose of the proposed project:*

The primary purpose of the proposed project is to improve system connectivity to employment centers and access
to planned developments in southern Rowan County. The project is needed to support economic prosperity
across southern Rowan County, improve access to I-85 for regional, statewide and national markets, and to
support long-range planning and land use initiatives.
4g. Describe the overall project in detail, including indirect imapacts and the type of equipment to be used:*
The North Carolina Department of Transportation (NCDOT) proposes to provide a new interchange at I-85 and SR
1221 (Old Beatty Ford Road relocation) in Rowan County (see Figure 1). The project is included in the NCDOT
2016-2025 State Transportation Improvement Program (STIP) as Project No. I-3804. The proposed project v�rould
convert the I-85 crossing of the Old Beatty Ford Road relocation project, currently under construction as STIP W-
5516, from a grade separation to an interchange. Standard road building equipment will be used. In addition, a
roundabout will be added at the intersection of Old Beatty Ford Road relocation and China Grove Road v�st of
the new interchange.
4h. Please upload project drawings for the proposed project.
Gick the upload button or drag and drop files here to attach docurrent
13804_HYD_PRM_SET.pdf 6.17M6
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5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
C' Yes C' No f" Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
C•' Preliminary C' Approved C' Unknown C' fWA
Corps AID Number:
6carrple: SAV�2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:
Mark Mickley
Mulkey (now Caylx)
HDR reverified 2017
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
The jurisdictional determination was completed for the I-3802B project on 6/23/2014. The impacts for this project are located within the area
covered by that jurisdictional determination.
Sd1. Jurisdictional determination upload
qick the upload button or drag and drop files here to attach docurrent
Fle type rrust be FDF
6. Project History
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 C•' 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 I m pacts I nventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
r Wetlands �J Streams-tributaries r Buffers
� Open Waters r Pond Construction
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
I impacted.
3a. Site #- Reason for 3b.lmpact 3c. Type of impact* 3d. Stream name * 3e. Stream 3f. Type of 3g. Stream 3h. Impact
impact* type* Type* Jurisdiction* width* length*
1 P Bank Stabilization Cold Water Creek Perennial Corps 25 10
N�p label (e.g. f3�ad Q'ossing 1) F2rrrenent (P'j or (SJ) F�rennial (FH�) or Average (feet) (linear feet)
Terrporary (� interrrdtent (If�
1 T Bank Stabilization Cold Water Creek Perennial Corps 25 10
N�p label (e.g. Id�ad Qossing 1) F�rrranent (P� or (SJ) F�rennial (�2) or Average (feet) (linearfeet)
Terrporary (� interrrittent (IfVn
2 P Bank Stabilization Cold Water Creek Perennial Corps 25 43
N�p label (e.g. Fd�ad Qassing 1) F2rrranent (Fj or (SJ) F�rennial (F�Z) or Average (feet) (linear feet)
Terrporary (� interrrittent (IfV�
2 T Bank Stabilization Cold Water Creek Perennial Corps 25 40
N�p label (e.g. I�ad CYossing 1) F2rrrenent (�j or (SJ) F�rennial (�) or Average (feet) (linear feet)
Terrporary (� interrrdtent (If�
3 P Fill Cold Water Creek Perennial Corps 25 303
N�p label (e.g. I�ad Qossing 1) F�rrranent (� or (SJ) F�rennial (�) or Average (feet) (linearfeet)
Terrporary (� interrrittent (IfVn
3 T Fill Cold Water Creek Perennial Corps 25 20
N�p label (e.g. Road Qassing 1) F2rrranent (Fj or (SJ) F�rennial (F�2) or Average (feet) (linear feet)
Terrporary (� interrrittent (IfV�
4 P Fill UTto Cold Water Perennial Corps 10 56
N�p label (e.g. Finad Q'ossing 1) F2rrrenent (Pj or CPee k(SJB) F2rennial (FH�) or Average (feet) (linear feet)
Terrporary (� interrrittent (If�
4 T Fill UTto Cold Water Perennial Corps 10 10
N�p label (e.g. f�ad Qossing 1) F�rrranent (Fj or Creek (SJB) F�rennial (�) or Average (feet) (linearfeet)
Terrporary (� interrrittent (IfVn
5 P Bank Stabilization Cold Water Creek Perennial Corps 25 20
N�p label (e.g. F�ad Qassing 1) F2rrranent (Fj or (SJ) F�rennial (F�2) or Average (feet) (linear feet)
Terrporary (� interrrittent (IfV�
5 T Bank Stabilization Cold Water Creek Perennial Corps 25 10
fv�ip label (e.g. R�ad Qossing 1) F2rrranent (Pj or (SJ) F2rennial (Fffl) or Average (feet) (linearfeet)
Terrporary (� interrrittent (If�
"" 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:
432

3i. Total temporary stream impacts:
90
3i. Total stream and tributary impacts:
522
3j. Comments:
Permanent Fill Impacts - 359 linear feet
Temporary Fill Impact - 30 linear feet
Permanent Bank Stabilization Impacts - 73 linear feet
Temporary Bank Stabilization Impacts - 60 linear feet
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:*
Two Build Alternatives were evaluated. Alternative A(Preferred) is a partial cloverleaf configuration with ramps and
loops in the northwest and southeast quadrants of the interchange. Alternative A has less stream impacts and
acquires less land from fewer properties than Alternative B. Alternative B is a half cloverleaf configuration with
ramps and loops in the southwest and southeast quadrants of the interchange. Alternative B has more stream
impacts, a culvert, and acquires more right of way than Alternative A. Alternative B also would moderately affect
active farming operations. Urban discharge equations were used to accommodate future growth in the area. Bank
stabilization has been proposed in areas to minimize future scour and sedimentation. Wetland WAQ was avoided
and a note place on the plans indicating no disturbance to this wetland .
Permit Impact Sites 1, 2, and 5 include bank stabilization impacts along Cold Water Creek. A bridge will span Cold
Water Creek at Sta. 15+24 near Permit Site 2. Permit Site 3 is installation of a triple 12x12-foot reinforced concrete
box culvert (RCBC) on Cold Water Creek. The RCBC will have a 2-foot sill in the left barrel of the culvert and the
center and right barrels will have 1-foot sills.
Native bed material shall be placed between the sills in the lowflowculvert. Native materials consists of material
that is excavated from the stream bed or floodplain at the project site during culvert construction. Rip rap may be
used to supplement the native material. If rip rap is used, native material should be placed on top to facilitate
animal passage. The top surface of the natural stream bed material shall be placed and leveled to a flat surface to
allowfor animal passage. The high flowbarrels shall be back filled with native material and/or rip rap. Native
material and rip rap are subject to approval by the engineer and may be subject to permit conditions.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
NCDOT Best Management Practices for Construction and Maintenance Activities and Best Management Practices
for the Protection of Surface Waters will be employed.
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):
� DWR �J Corps
2d. If yes, which mitigation option(s) will be used for this project?
r Mitigation bank N7 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.
�J Yes
4b. Stream mitigation requested:
(linear feet)
359' at 2:1 ratio
i 4c. If using stream mitigation, what is the stream temperature:

warm
4d. Buffer mitigation requested (DWR only):
(squarefeet)
0
4e. Riparian wetland mitigation requested:
(acres)
0
4f. Non-riparian wetland mitigation requested:
(acres)
0
4g. Coastal (tidal) wetland mitigation requested:
(acres)
0
4h. Comments
See attached DMS Letter
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
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
"` Recent changes to the stormwater rules have required updates to this section ."*
I 1. Diffuse Flow Plan
1a. 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
For a list of options to meet the diffuse flow requirements, click here.
If no, explain why:
I The project is not located within a buffered basin.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
C� Yes C' No
G. Supplementary Information
1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land?*
�' Yes 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

1c. 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
NEPAor SEPAfinal approval letter.)*
�' Yes l" No
NEPAor SEPAFinal Approval Letter
C7ick the upload button or drag and drop files here to attach docurrent
I-3804 CE signature and commitments.pdf 502.07KB
FlLE TYFE MJST BE FflF
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 �' No
2b. Is this an after-the-fact permit application?*
C' Yes C•' No
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.
The following is the Cumulative Effects Statement from the Categorical Exclusion (April 2017): Qualitative analyses
of the probable development patterns in the FLUSA, based on the information and data available at the time of
this report, suggest that future development resulting from STIP I-3804 would have a minimal effect on the
watershed. It is anticipated that the project would not notably contribute to cumulative impacts to environmental
resources in the FLUSA.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project? *
C' Yes C' No r f�/A
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or habitat?*
C� Yes �' No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
G Yes C' No
5c. If yes, indicate the USFWS Field Office you have contacted.
Asheville
Sd. Is another Federal agency involved?*
C' Yes �' No
5e. Is this a DOT project located within Division's 1-8?*
C' Yes r No
5f. Will you cut anytrees in order to conduct the work in waters of the U.S.?*
�' Yes �' No
Sg. Does this project involve bridge maintenance or removal?*
C' Yes C' No
C' Unknown

Link to the NLEB SLOPES document: http://sav�reg.usace.army.mil/NLEB/1-30-17-signed_NLEB-SLOPES&apps.pdf
5h. Does this project involve the construction/installation of a wind turbine(s)?"*
C' Yes G No
5i. 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.?*
C' Yes r No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
The USFWS county list and NCNHP database were consulted for Rowan County. Schweinitz's sunflower, northern
long-eared bat (NLEB), and the bald eagle are federally protected species noted for the county. A No Effect
Biological Conclusion was rendered for the Schweinit�s sunflower. The last survey for Schweinitz's sunflower was
on October 18, 2016. The Biological Conclusion for the NLEB is May Affect. NCDOT has determined that the
proposed action does not require separate consultation on the grounds that the proposed action is consistent with
the final Section 4(d) rule, codified at 50 C.F.R. § 17.40(0) and effective February 16, 2016. NCDOT may presume
its determination is informed by best available information and consider Section 7 responsibilities fulfilled for NLEB.
It has been determined that this project would not affect the bald eagle species due to the lack of habitat, the lack
of known occurrences, and based on completed past surveys as detailed in the November 2016.
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?*
NMFS County Index
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? *
NEPA Categorical Exclusion Documentation approved April 2017.
7c. Historic or Prehistoric Information Upload
aick the upload button or drag and drop files here to attach docurrent
I-3804 CE historic_cultural.pdf
I-3804_Cover Letter_12_20_2017.doc.pdf
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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:
NCDOT Hydraulics Unit coordination with FEMA
8c. What source(s) did you use to make the floodplain determination?*
FEMA Maps
6.64M6
140.7K6

Miscellaneous
Miscellaneous attachments not previously requested.
C7ick the upload button or drag and drop files here to attach docurrent
790000 2017 13802B COLD WATER CREEK I-85SB EXIT RAMP Y115RPA.PDF 1.61 MB
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Signature
rJ 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
�fr�[j.rl./r.ctr�
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?*
C� Yes
C' No
BIMS # Assigned*
20180007
Version#*
1
Reviewing Office*
Winston-Salem Regional Office - [phone]
Select Project Reviewer*
I Dave Wanucha:eads\djwanucha
Is a payment required for this project?*
C� No payment required
f Fee received
C' Fee needed - send electronic notification