20180931 Ver 1_401 Application_20180718

Action History (UTC -05:00) Eastern Time (US & Canada)
Submit by Anonymous User 7/3/2018 4:58:07 PM (Start Event)
Accept by Montalvo, Sheri A 7/9/2018 9:00:17 AM (Non DOT Initial Review)
• The task was assigned to Montalvo, Sheri A. The due date is: July 6, 2018 5:00 PM 7/3/2018 5:00 PM

DWR
Division of 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 W11 not be able to submit the form until all mandatory questions are answered.
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.govMaterResources/0/edocl6247041PCN%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?*
f Yes f• No
This is any publicly funded by nunicipal,state or federal funds road, rail, airport transportation project.
1a. Type (s) of approval sought from the Corps:*
V Section 404 Permit (wetlands, streams and waters, Clean Water Act)
F Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What type(s) of permit(s) do you wish to seek authorization?*
IJ Nationwide Permit (NWP)
r Regional General Permit (RGP)
r Standard (IP)
This form may be Corps to initiate the standard/individual permit process. Please contact your Corps representative for submittal of standard permits.
All required items that are not provided in the E -PCN and be added to the miscellaneous upload located at the bottom of this form.
Nationwide Permit (NWP) Number: 18 - Minor Discharges
Nationwide Permit (NWP) Number: OTHER NWP #:(specify)
NWP Number Other:
27
List all WV nunbers you are applying for not on the drop down list.
1c. Type(s) of approval sought from the DWR:*
check all that apply
IJ 401 Water Quality Certification - Regular ❑ 401 Water Quality Certification - Express
r Non -404 Jurisdictional General Permit ❑ Riparian Buffer Authorization
r- Individual Permit
*
1d. Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification: r Yes r No

For the record only for Corps Permit:
r 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 n itigation bank or in -lieu fee program
f Yes r No
1f. Is the project located in anyof NC's twenty coastal counties?*
O Yes r No
1h. Is the project located in a designated trout watershed?*
f Yes r No
Link to trout information: http://wvvw.saw.usace.army.mil/Missions/Regulatory-Permit-ProgranVAgency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact?*
David Hamilton
1b. Primary Contact Email:*
[e-mail]
1c. Primary Contact Phone:*
(xxx)xxx-xxxx
[phone]
1d. Who is applying for the permit?
r Owner V Applicant (other than owner) rJ Agent/Consultant
(Check all that apply)
2. Owner Information
2a. Name(s) on recorded deed:
See Cover Letter
2b. Deed book and page no.:
2c. Responsible party:
(for Corporations)
2d. Address
Street Address
Address Line 2
City
Rbstal / Zip Code
2e. Telephone Number:
(XXX)XXX-XXXX
2f. Fax Number:
(xxx)xxx-xxxx
2g. Email Address:*
[e-mail]
..... .... ...........
3. Applicant Information (if different from owner)
3a. Applicant is:
State / Province / F egion
Country

0 Agent
f• Other Applicant Owner
If other please specify.
3b. Name:
Johnnie Hill
3c. Business Name:
(if applicable)
City of Greensboro
3d. Address
State/ Province/ Fbgion
Street Address
NC
2602 S Elm -Eugene Street
Country
Address Line 2
USA
CSty
State / Province / Fbgion
Greensboro
NC
Fbstal / Zip (ode
Country
24706
USA
3e. Telephone Number:
[phone]
(XXX)XXX-XXXX
Fax Number:
[phone]
(XXX)XXX-)D=
3g. Email Address:*
[e-mail]
4. Agent/Consultant (if applicable)
4a. Name:
David Hamilton
4b. Business Name:
ff applicable)
Arcadis
4c. Address
Street Address
1 Centerview Drive
Address Line 2
Suite 208
CSty
State/ Province/ Fbgion
Greensboro
NC
F bstal / Zip (ode
Country
27407
USA
4d. Telephone Number:
[phone]
(XXX)XXX-XXXX
4e. Fax Number:
(xxx)xxx-xxxx
M. Email Address:*
[e-mail]
Agent Authorization Letter*

Please provide the Agent Authorization Letter if you are subn ilting this docunent.
Western Trail Agent Authorization Form.pdf
FILE TYPE M ET BE PDF
b'SYM451
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Western Trail Stream Restoration
1b. Subdivision name:
(if appropriate)
NA
1c. Nearest municipality / town:
*
Greensboro
1d. Driving directions*
If it is a new project and can not easily be found in a GPS napping system Please provide directions.
Located behind 5934 Western Trail, Greensboro, NC 27410
2. Project Identification
2a. Property Identification Number:
(tax PIN or parcel ID)
7826851055,7826759007
2b. Property size:
(in acres)
2c. Project Address
Street Address
5934 Western Trail
Address Line 2
City
Greensboro
Pbstal / Zip Code
27410
State/ Province/ Region
NC
Country
USA
2d. Site coordinates in decimal degrees
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 how the location was determined. (For example, most mobile phones with GPS provide locational precision in decimal degrees to
map coordinates to 5 or 6 digits after the decimal place.)
Latitude:* Longitude:*
36.1235 -79.9207
ex: 34.208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Brush Creek
3b. Water Resources Classification of nearest receiving water:*
WS -III, NSW
Surface Water Lookup

3c. What river basin(s) is your project located in?*
Cape Fear
River Basin Lookup
4. Project Description
4a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this application:*
The project area is in a residential development in the suburbs of Greensboro, NC. The area is predominately
wooded and includes an intermittent waterbody - a tributary to Brush Creek.
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 document
WesternTrail_PCN_Fig2.pdf 2.03MB
File type must 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)
Click the upload button or drag and drop files here to attach docurrent
WesternTrail_PCN_Fig3.pdf 1.94MB
File type mast be pdf
4d. List the total estimated acreage of all existing wetlands on the property:
0
4e. List the total estimated linear feet of all existing streams on the property:
(internittent and perennial)
150
4f. Explain the purpose of the proposed project:*
The purpose of the project is to remove 45 LF of existing road culvert and replace it with a step pool channel and
control stream bank erosion/migration.
4g. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
The project entails the removal of an existing 30" rcp culvert along with the restoration of approximately 150 linear
feet of stream bank. The restoration techniques proposed include concrete block toe walls, step pools, root wads
and log j -hook vanes. Since this is private property and the stream bisects the property, the City has agreed to put
a concrete toe wall so a bridge can be built in the future by the landowner to access that portion of their property.
The project area will be accessed by a 15' wide construction entrance. Equipment used for this project will include
but not limited to full sized passenger trucks, dump trucks, mini excavators and various gas powered pumps and
generators.
4h. Please upload project drawings for the proposed project.
Qick the upload button or drag and drop files here to attach docurrent
20180622 Western Trail 100% Submittal.pdf 19.68MB
File type mast be pdf
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
f• Yes r No r Unknown
Comments:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
r Preliminary r Approved F Unknown r N/A
Corps AID Number:
Exarrple: SAW -2017-99999

5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Ron Johnson
Agency/Consultant Company: Arcadis
Other:
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Arcadis delineated wetlands on Feb 6, 2018
5d1. Jurisdictional determination upload
dick the upload button or drag and drop files here to attach docurrent
Wetlands and Waterbody Delineation Memo & PJD.pdf 5.44MB
File 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?
r Yes G No r Unknown
7. Future Project Plans
7a. Is this a phased project?*
r^ Yes F 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):
F Wetlands W Streams -tributaries rJ Buffers
F 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
impacted.
3a. Reason for impact*3b.lmpact 3c. Type of impact*3d. Stream name* 3e. Stream 3f. Type of 3g. Stream 3h. Impact sgfe
type * Type * Jurisdiction * width * length*
S1 Tributary. T Bank Tributary to Brush Perennial Corps 5 150 7
Restoration F2rrranent(P)or Stabilization Creek Perennial (FI3:�or Average (linear feet) 5
Ivbp label (e.g. Fbad Crossing Terrporary (T) interrrittent (INT) (feet) 0
1)
** 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:
0
3i. Total temporary stream impacts:
150
3i. Total stream and tributary impacts:

150
3j. Comments:
45 LF of piped tributary will be removed and replaced with step pools. J -hooks and root wads will be added to help
stabilize the tributary. Since this is private property and the stream bisects the property, the City has agreed to put
a concrete toe wall so a bridge can be built in the future by the landowner to access that portion of their property.
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.
Neuse
r7 Catawba
r- Goose Creek
r- Other
6b. Impact Type *
6c. Per or
Permanent impacts: 0.00
Temp*
B1, Allowable
T
Location and Exerrpt, Allowable, allowable w/
Permanent (F� or
mitigation
Temporary (T)
B2, Allowable
T
Location and Exempt, Allowable, allowable w/
Fern anent (F� or
mitigation
Temporary (T)
r- Tar -Pamlico
r- Randleman
V Jordan Lake
6d. Stream name * 6e. Buffer mitigation
required?*
Tributary to Brush No
Creek
Tributary to Brush No
Creek
6h. Total buffer impacts:
Zone 1 Zone 2
Temporary impacts: 5,668.00 0.00
Zone 1
Zone 2
Permanent impacts: 0.00
0.00
Zone 1
Zone 2
Total buffer impacts: 5,668.00
0.00
6i. Comments:
45 LF of piped tributary will be removed and replaced with step pools. In order for the City to stabilize the stream
banks, correct the scour pool and remove the culvert, there is no practical alternative, as per regulations stated in
15A NCAC 02B.0267 regarding the Jordan watershed. The Project Site will be planted with native vegetation to
restore the riparian buffer.
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
Click the upload button or drag and drop files here to attach document
WesternTrail_PCN_Fig4.pdf 1.98MB
File mast be FDF
E. Impact Justification and Mitigation
1. Avoidance and Minimization
6f. Zone 1 6g. Zone 2
impact* impact*
1,639 0
(square feet) (square feet)
4,029 0
(square feet) (square feet)
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
The restoration techniques proposed reduced the footprint of the project area and it's limits of disturbance. Waste
is reduced by the proposal of structures that utilize demolished onsite materials.

1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques:*
The techniques proposed are constructible via smaller equipment and hand tools. This limits the environmental
impact of heavy construction equipment damaging the area surrounding the project limits.
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?
f Yes r No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
The intent is for the Project is to restore the tributary to natural conditions and increase safety by reducing storm flooding on the properties.
This Project will remove the existing culvert and replace it with a stable step pool channel through the road bed/embankment and reconstruct
the stream banks in the vicinity of the scour pool. Impacts to the stream due to construction are temporary.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
*** Recent changes to the stormwater rules have required updates to this section .***
filA�130=2 oC mi NIFI i
1a. Does the project include or is it adjacent to protected riparian buffers identified within one of the NC Riparian Buffer Protection
Rules?
r Yes r 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 SHWT)
r- 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
Qick the upload button or drag and drop files here to attach docurrent
File type mast be FDF
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?
r Yes r No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?*
r Yes
r No
To look up low density requirement click here 15A NCAC 02H.1003(2)
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? *
r Yes r 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 Policy Act (NEPA/SEPA)?*
r Yes r No
Comments: *
It does not meet all three criteria to require an environmental document.
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)?
f Yes r No
2b. Is this an after -the -fact permit application?*
t' Yes r 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?*
f Yes r No
3b. If you answered "no," provide a short narrative description.
The intent of this project is to restore the tributary to a more natural condition. Further work beyond this stream
restoration project will not be completed at this site.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
r Yes r Nor N/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?
f Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
f Yes r No
5d. Is another Federal agency involved?*
r Yes r No r Unknown
5e. Is this a DOT project located within Division's 1-8?*
f Yes r No
5f. Will you cut any trees in order to conduct the work in waters of the U.S.?
r Yes f No
5g. Does this project involve bridge maintenance or removal?
f Yes r No
Link to the NLEB SLOPES document: http://saw-reg.usace.army.mil/NLEB/1-30-17-signed_NLEB-SLOPES&apps.pctf
5h. Does this project involve the construction/installation of a wind turbine(s)?*
f Yes r 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.?
r Yes r No
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?

A letter was forwarded to the North Carolina Natural Heritage Program (NCNHP) on June 27, 2018 to determine the
presence of any federally -listed, candidate endangered, threatened species or critical habitat located within the
proposed Project area. As of the date of this submittal, a response has not yet been received. A response will be
sent once it has been received.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
r Yes F No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
NOAA Fisheries
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 history and archaeology)?*
f Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
An electronic letter was forwarded to the NC State Historic Preservation Office (SHPO) on June 27, 2018 to
determine the presence of architectural, historic, or archaeological significant areas that would be affected by the
Project. s of the date of this submittal, a response has not yet been received. A response will be sent once it has
been received.
7c. Historic or Prehistoric Information Upload
Click the upload button or drag and drop files here to attach document
File must 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?*
f Yes C No
8c. What source(s) did you use to make the floodplain determination?*
FEMA Flood Mapper
Miscellaneous
Miscellaneous attachments not previously requested.
nick the upload button or drag and drop files here to attach docurrent
WesternTrail_PCN_Fig 1. pdf 2.64MB
Letter to DWR Western Trail.pdf 49.47KB
Letter to USACE Western Trail.pdf 100.76KB
File must be FDF or IWQ
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 Act');
• I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic
Transactions Act');

■ 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:*
David A. Hamilton
Signature rr77��
eE�itlfi�� �5yclt�e-
Date Submitted:
7/3/2018
Initial Review
.. ...... .... ......... ......... ........ ......... ......... ......... ..................
Is this project a public transportation project?*(?)
r Yes r No
Change only if needed.
Has this project met the requirements for acceptance in to the review process?
r Yes
f No
BIMS # Assigned *
20180931
Version#*
Reviewing Office*
Winston-Salem Regional Office - [phone]
Select Project Reviewer*
Sue Homewood:eads\slhomewood
Is a payment required for this project?*
f No payment required
f Fee received
r Fee needed - send electronic notification
What amout is owed?*
r $240.00
f $570.00