20170127 Ver 2_PCN Form Submission_20180228

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 2/27/2018 10:28:52 PM (Start Event)
Accept by Carpenter,Kristi 2/28/2018 11:12:41 AM (DOT Initial Review)
• The task was assigned to Carpenter,Kristi . The due date is: March 2, 2018 5:00 PM
2/27/2018 10:29 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)
January 31, 2018 Ver 2.3
*
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.
https://edocs. deq. nc.gov/WaterResources/0/edoc/624704/PCN%20Help%20File%202018-1-30. pdf
A. Processing Information
County(or Counties) where the project is located:*
Guilford
Is this project a public transportation project? *(')
C�' Yes C' No
Is this a NCDOT Project?*
C' Yes C•' No
1a. Type(s) of approval sought from the Corps:*
fJ 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)
� Regional General Permit (RGP)
Nationwide Permit (NWP) Number: 14 - Linear transportation
NWP Number Other:
List all MNnurrbers you are applying for not on the drop down list.
1c. Type(s) of approval sought from the DWR:*
check all that apply
fJ 401 Water Quality Certification - Regular r 401 Water Quality Certification - Express
r Non-404 Jurisdictional General Permit �J 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

*
1d. Is this notification solelyfor the record because written approval is not required?
� For the record only for Corps Permit: �' Yes C�' 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
r Yes l" No
Acceptance Letter Attachment
Gick the upload button or drag and drop files here to attach docurrent
I CMRTF_Horse Pen Creek Road Widening.pdf 212.35KB
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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?*
C' Yes C� No
Link to trout information: http://w�nn�v.saw.usace.army.mil/Missions/Regulatory-Permit-PrograrrUAgency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact?*
John Jamison
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) �7 AgenUConsultant
(Check all that apply)
2. Owner I nformation
2a. Name(s) on recorded deed:
City of Greensboro
2b. Deed book and page no.:
e�asting rights-of-way and easements- recently acquired for the project
2c. Responsible party:
(for Corporations)
Guy Ingle, Construction Projects Coordinator
2d.Address
Street Address
PO Box 3136
Address Line 2
��
Greensboro
Fbstal / Zip Code
27402-3136
2e. Telephone Number:
State / R-ovince / Region
NC
Country
Guilford

(xxx)x�c-xxxx
[phone]
2f. Fax Number:
[phone]
I (xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
Michelle Podeszwa, PE
4b. Business Name:
(if applicable)
HDR Engineering
4c. Address
Street Address
440 S. Church St. Suite 1000
Address Line 2
��
Charlotte
Fbstal / Zip Code
28202
4d. Telephone Number:
[phone]
(xxx)xxx-xxxx
4e. Fax Number:
(xxx)xxx-xxxx
4f. Email Address:*
[e-mail]
State / R-ovince / F�gion
NC
Country
Mecklenburg
AgentAuthorization Letter*
Rease provide the Agent Authorization Letter if you are subrritting this docurrent.
Horse Pen Creek Road PCN signature page.pdf 74.89K6
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C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Horse Pen Creek Road Improvements
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 GPS rrapping system Rease provide directions.
the project is along Horse Pen Creek Road between New Garden Road and Battleground Avenue (US 220) in northwest Greensboro

2. Project Identification
2a. Property Identification Number:
(t�vc RN or parcel ID)
Existing ROW - see attached plansheets
2b. Propertysize:
(in acres)
47
2c. Project Address
Street Address
Address Line 2
��
F�stal / 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.)
I Latitude:* Longitude:*
36.13408 -79.88683
ex:34.208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Horsepen Creek
3b. Water Resources Classification of nearest receiving water:*
WS III; NSW ( Horsepen Creek)
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 site is the e�asting Horse Pen Creek Road alignment, a 2- lane suburban roadway maintained by the City of
Greensboro through a residential district in the northwest portion of the City. Land uses along the corridor are
primarily residential, with areas of limited commercial/ institutional development and recreation lands. A number of
public and private schools and park facilities are located along the corridor.
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
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4c. Attach an 8 1/2 X 11 ezcerpt 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
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4d. List the total estimated acreage of all existing wetlands on the property:
2
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
1000
4f. Explain the purpose of the proposed project:*
To serve future volumes, relieve congestion, address past/current growth in the area, improve safety, and improve
pedestrian and bicycle mobility.
4g. Describe the overall project in detail, including indirect imapacts and the type of equipment to be used:*
i Horse Pen Creek Road is 3.2 miles long with 25 intersections ( 5 signalized). It is a minor thoroughfare with current
daily traffic volumes up to 18,700.
4h. Please upload project drawings for the proposed project.
C7ick the upload button or drag and drop files here to attach docurrent
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5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
�' Yes �' No �' Unknown
Comments:
See attached correspondence from Amy Euliss, DWQ
5b. If the Corps made a jurisdictional determination, what type of determination was made? *
r Preliminary l" Approved f Unknown C' N/A
Corps AID Number:
6carrple: SAV�2017-99999
SAW-2013-01953
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other
HDR Engineering
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
February 8, 2012 verification site visit with Thomas Brown (USACE) and Amy Euliss (NCDWQ); July 15, 2016 site visit with David Bailey
(USACE) (Brian Wrenn (NCDWR) reviewed on his own on July 12, 2016)
5d1. Jurisdictional determination upload
Gick the upload button or drag and drop files here to attach docurrent
Fig3_JurisdictionalFeatures_Horsepen_NRTR_11x17P.pdf 3.81 MB
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6. Project History
6a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past?*
�' Yes C' No f" Unknown
6b. If yes, please give the DWR Certification number or the Corps Action ID (exp. SAW-0000-00000).

A prior NWP 14 (SAW-2013-01953) and GC 3886 (project # 20170127) was issued under the old program that
e�ired in March 2017. This is a request for a re-issuance of the permit/GC.
I Project History Upload
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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 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):
fJ 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* 2b. Impact type * 2c. Type of wetland*
W1- Land Clearing
N�p label (e.g. f�ad Qossing 1- Qalvert,
dewatering, etc)
W2- Fill
N�p label (e.g. F�ad Qassing 1- Qalvert,
dewatering, etc)
W3- Land Clearing
N�p label (e.g. Fd�ad Qossing 1- QiNert,
dewatering, etc)
W4- Excavation
N�p label (e.g. I�ad Qossing 1- Qalvert,
dewatering, etc)
T
F2rrranent (P� or
Terrporary (�
P
F2rrranent (P'j or
Terrporary (�
T
F2rrrenent (P� or
Terrporary (�
P
F2rrranent (P� or
Terrporary (�
2g. Total Temporary Wetland Impact
0.070
i 2g. Total Permanent Wetland Impact
0.120
2g. Total Wetland Impact
0.190
2h. Comments:
Bottomland Hardwood
Forest
Bottomland Hardwood
Forest
Bottomland Hardwood
Forest
Bottomland Hardwood
Forest
2d. Wetland name *Ze. 2f. Type of 2g. Impact
Forested* Jurisdicition* area*
W1 Yes Corps 0.050
(404, 10) or C7�NR(401, (acres)
other)
W2 Yes Corps 0.100
(404, 10) or GNF2(401, (acres)
other)
W3 Yes Corps 0.020
(404, 10) or CMR(401, (acres)
other)
W4 Yes Corps 0.020
(404, 10) or C7�NR(401, (acres)
other)
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 for 3b.lmpact 3c. Type of impact* 3d. Stream name * 3e. Stream 3f. Type of
impact* type* Type* Jurisdiction*
S1- Culvert removal T Culvert Horse Pen Creek Perennial Corps
N�p label (e.g. Fd�ad Q-ossing 1) F2rrranent (P� or F2rennial (F�2) or
Terrporary (� interrrittent (IfV�
S2 P Relocation Stream 4 Intermittent Corps
N�p label (e.g. I�ad Qossing 1) F2rrrenent (P'j or F2rennial (�) or
Terrporary (� interrrittent (If�
S3 T Stabilization Stream 4 Intermittent Corps
N�p label (e.g. f�ad Qossing 1) F2rrranent (Fj or F�rennial (�2) or
Terrporary (� interrrittent (IfVn
S4 T Other Stream 5 Intermittent Corps
N�p label (e.g. Fd�ad Q-ossing 1) F2rrranent (Fj or F2rennial (F�2) or
Terrporary (� irderrrittent (IfV�
S5 P Culvert Stream 6 Perennial Corps
N�p label (e.g. Id�ad Qossing 1) F2rrrenent (Pj or F2rennial (FB�) or
Terrporary (� interrrittent (If�
S6 T Stabilization Stream 6 Perennial Corps
fv�ip label (e.g. R�ad Qossing 1) F2rrranent (Fj or F�rennial (FH�) or
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:
91
3i. Total temporarystream impacts:
69
3i. Total stream and tributary impacts:
160
3j. Comments:
Horse Pen Creek culvert is being removed and replaced with a bridge; Stream 4 is being relocated; Stream 5 is
temp impacts for stormwater outlet tie-in, per Corps request to minimize erosion; Stream 6 is fill/ pipe in erosional
gulley beginning at E/ P stream origin point.
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
r Catawba r Randleman
� Goose Creek �J Jordan Lake
� Other
6b. Impact Type * 6c. Per or
Temp*
B1 P
Location and 6cerrpt, Allowable, allowable w/ F�rrranent (P� or
rritigation Terrporary (�
62 T
Location and 5cerrpt, Allowable, allowable w/ F�rrranerrt (P� or
rritigation Terrporary (�
6d. Stream name *
Horse Pen Creek
Horse Pen Creek
6e. Buffer mitigation
required? *
No
No
3g. Stream 3h. Impact
width* length*
30 41
Average (feet) (linear feet)
3 50
Average(feet) (linearfeet)
3 10
Average (feet) (linear feet)
3 8
Average (feet) (linear feet)
5 41
Average (feet) (linear feet)
5 10
Average(feet) (linearfeet)
6f. Zone 1
impact*
5,529
(square feet)
1,702
(square feet)
6g. Zone 2
impact*
3,958
(square feet)
789
(squarefeet)

6b. Impact Type *
63
I Location and Exerrpt, Allowable, allowable w/
rritigation
B4
Location and C errpt, Allowable, allowable w/
rritigation
6h. Total buffer impacts:
i Temporary impacts
Permanent impacts:
Total buffer impacts
6c. Per or 6d. Stream name *
Temp*
P Stream 5
F�rrranerd (P� or
Terrporary (�
P Stream 6
F2rrranerd (P) or
Terrporary (�
Zone 1
1,702.00
Zone 1
10,477.00
Zone 1
12,179.00
Zone 2
789.00
Zone 2
7,576.00
Zone 2
8,365.00
6e. Buffer mitigation
required?*
No
No
6i. Comments:
I B1 and 62 impacts are on either side of the existing culvert/ proposed bridge location; B5 and B6 are at other
locations along the project
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
Gick the upload button or drag and drop files here to attach docurrent
Fig 1_Vicin ity_Horsepen_NRTR. pdf 1.55M6
Fig2_ProjectStudyArea_Horsepen_NRTR_11 x17P. pdf 2.68M6
174268_HORSEPEN_EC_ALL_092115.pdf 47.4M6
I HORSEPEN_Permit_Set_24x36_091916.pdf 13.92MB
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E. Impact Justification and Mitigation
1. Avoidance and Minimization
6f. Zone 1 6g. Zone 2
impact* impact*
745 409
(square feet) (square feet)
4,203 3,209
(squarefeet) (squarefeet)
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
The Horse Pen Creek crossing could have been a culvert extension, but to minimize impacts and increase
floodplain capacity a bridge was chosen to replace the exsting culvert. The widening was shifted away from
streams where feasible to minimize the required fills and piping. Wetland A, a much higher quality v�tland
downgradient of the road widening, was avoided entirely.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
As described above, the primary avoidance measure is the bridge construction in lieu of a culvert extension. Fill
slopes were reviewed to minimize the overall footprint as well.
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 �' No
2c. If yes, mitigation is required by (check all that apply):
r DWR N,7 Corps
2d. If yes, which mitigation option(s) will be used for this project?

fJ Mitigation bank r Payment to in-lieu fee program r Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
Cripple Creek
3b. Credits Purchased/Requested (attach receipt and letter)
Type: Quantity:
Riparian wetland 0.38
Attach Receipt and/or letter
aick the upload button or drag and drop files here to attach docurrent
CMRTF_Horse Pen Creek Road Widening.pdf 212.35KB
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3c. Comments
The bank has confirmed these credits are available. Payment is pending.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
�"� Recent changes to the stormwater rules have required updates to this section .*'�
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 C' No
1b. All buffer impacts and high ground impacts require diffuse flow or other form of stormwater treatment. If the project is subject to a
state implemented riparian buffer protection program, include a plan that fully documents how diffuse flow will be maintained.
All Stormwater Control Measures (SCM)s must be designed in accordance with the NC Stormwater Design Manual. Associated
supplement forms and other documentation shall be provided.
What type of SCM are you providing?
r Level Spreader
r Vegetated Conveyance (lower SI-NVf)
� Wetland Swale (higher SHWT)
r Other SCM that removes minimum 30% nitrogen
(check all that apply)
For a list of options to meet the diffuse flow requirements, click here.
Diffus Flow Documentation
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2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
�' Yes �' 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?*
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:*
locally funded project; received written concurrence from DWQ's SEPA coordinator
(Hannah Headrick at the time) that no SEPA document was required
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?*
!' 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 C•' No
3b. If you answered "no," provide a short narrative description.
� Please see cover letter.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project? *
C' Yes C•' No C' rUA
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?*
r Yes l" No
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. Is another Federal agency involved?*
C' Yes C' No
5e. Is this a DOT project located within Division's 1-8?*
C' Yes C•' No
5f. Will you cut anytrees in order to conduct the work in waters of the U.S.?*
C' Yes C' No
5g. Does this project involve bridge maintenance or removal?*
C' Yes r No
c' Unknown
Link to the NLEB SLOPES document: http://saw-reg.usace.army.mil/NLEB/1-30-17-signed_NLEBSLOPES&apps.pdf

5h. Does this project involve the construction/installation of a wind turbine(s)?**
�' Yes �' 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 C' No
If yes, please provide details to include type of percussive activity, purpose, duration, and specific location of this activity on the
prope rty.
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5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?*
on-site habitat review, including a small whorled pogonia survey in areas of potential habitat during the optimal
survey window, as well as Natural Heritage Program NHEO database
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?*
NOAA EFH 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 �' No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
NC SHPO website at http://gis.ncdcr.gov/hpoweb/
7c. Historic or Prehistoric Information Upload
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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?*
�' Yes C' No
8b. If yes, explain how project meets FEMA requirements:
The one FEMA crossing is being converted from a box culvert to a bridge crossing. The analysis of the design
concluded it would be a no-rise, with local floodplain administrator coordination for a post-construction LOMR.
8c. What source(s) did you use to make the floodplain determination?*
local floodplain administrator coordination
Miscellaneous
Miscellaneous attachments not previously requested.

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Horsepen PCN signature 2018.pdf 1002.47K6
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Signature Page
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:*
John Jamison
Signature
[��ld�6i [�/llh7Gif�l6/

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*
20170127
Version#*
2
Reviewing Office*
Central Office - [phone]
Select Project Reviewer*
April Norton:eads\arnorton
Is a payment required for this project?*
C' No payment required
�' Fee received
C' Fee needed - send electronic notification