HomeMy WebLinkAbout20181227 Ver 1_PCN Form Submission_20180905Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 9/5/2018 10:04:41 AM (Start Event)
Accept by Carpenter,Kristi 9/5/2018 4:08:06 PM (DOT Initial Review)
. The task was assigned to Carpenter,Kristi. The due date is: September 10, 2018 5:00 PM
9/5/2018 10:06 AM
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�ivislan af Water Resour�es
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 beloware required. You will not be able 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 l' No
lhis is any publicly funded by rrunicipal,state or federal funds road, rail, airport transportation project.
Is this a NCDOT Project?*
f• Yes r No
(NCDOT only) T.I.P. or state project number:
WBS #
17BP.7.R.113
(for �ICDOT use only)
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?*
fJ 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: 03 - Maintenance
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
r% 401 Water Quality Certification - Regular r 401 Water Quality Certification - Express
r Non-404 Jurisdictional General Permit �rJ Riparian Buffer Authorization
r Individual Permit
*
1d. Is this notification solelyfor the record because written approval is not required?
For the record onlyfor DWR 401 Certification:
For the record onlyfor Corps Permit:
f Yes C' No
C' Yes f' 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 a- in-lieu fee program
l" Yes f' No
1f. Is the project located in anyof NC's twentycoastal counties?*
f Yes C•' No
1h. Is the project located in a designated trout watershed?*
C' Yes C No
Link to trout information: http://�wvw.saw.usace.army.mil/Missions/Regulatory-Permit-Program/Agency-Coordination/Trout.aspx
B. Applicant Information
1a. Who is the Primary Contact?*
Division Engineer NCDOT Division 7, Mr. Mike Mills, PE
1b. PrimaryContact Email:*
mmills@ncdot.gov
1c. PrimaryContact Phone:*
(xxx)xxx-xxxx
(336)334-3297
1d. Who is applying for the permit?
r Owner r7 Applicant (other than owner) r Agent/Consultant
(Check all that apply)
2. Owner Information
2a. Name(s) on recorded deed:
North Carolina Department of Transportation
2b. Deed book and page no.:
NA
2c. Responsible party:
(for Corporations)
Division Engineer NCDOT Division 7, Mr. Mike Mills, PE
2d. Address
Street Address
PO Box 14996
Address Line 2
aty
Greensboro
Fbstal / Zip Code
27415
2e. Telephone Number:
(xxx)xxx-xxxx
(336)334-3297
State / Rovince / Region
NC
Cauntry
USA
2f. Fax Number:
(336)334-3637
(xxx)xxx-xxxx
2g. Email Address:*
mmills@ncdot.gov
3. Applicant Information (if different from owner)
3a. Applicant is:
C' Agent
r Other , L,v � Highway vivision 7
IF other please spec'rfy.
3b. Name:
Division Engineer NCDOT Division 7, Mr. Mike Mills, PE
3c. Business Name:
(if applicable)
NC DOT
3d. Address
Street Address
PO Box 14996
Address Line 2
a�y
Greensboro
Fbstal / Zip Code
27415
3e. Telephone Number:
(336)334-3297
(xxx)xxx-xxxx
3f. Fax Number:
(336)334-3637
(xxx)xxx-xxxx
3g. Email Address:*
mmills@ncdot.gov
State / Rovince / f�gion
NC
Country
USA
C. Project Information and Prior Project History
1. Project Information
1a. Name of project:*
Bridge No. 240 over Little Alamance Creek on SR 3285 (Causey Lake Rd)
1b. Subdivision name:
(if appropriate)
wa
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.
From Raleigh, follow I-40 West to the I-85 South split; continue toward I-73f�UUS 421/Thomasville/High Point; take exit 128 for Alamance
Church Rd; turn right onto Alamance Church Rd; take the first right onto Causey Lake Rd; bridge will be in 1/2 mile
2. Project Identification
2a. Propertyldentification Number:
(tax RN or parcel ID)
wa
2b. Propertysize:
(in acres)
f�UA
2c. Project Address
Street Address
Address Line 2
aiy
Fbstal / Zip Code
2d. Site coordinates in decimal degrees
State / FYovince / F�gion
Country
Please collect site coordinates in decimal degrees. Use bet�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�mple, 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:*
36.037 340 -79.729665
ex:34.208504 -77.796371
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Little Alamance Creek
3b. Water Resources Classification of nearest receiving water:*
WS-IV; NSW; 16-19-3-(0.5); HUC 03030002
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 project area is a mix of undisturbed, forested areas, maintained lawns and residences and active farm land.
4b. Attach an 8 7/2 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
Bridge_240_Guilford_USGS.pdf 2.02MB
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)
Qick the upload button or drag and drop files here to attach docurrent
Bridge_240_Guilford_soil.pdf 2.44MB
Fle type rrust be pdF
4d. List the total estimated acreage of all existing wetlands on the property:
< 0.25
4e. List the total estimated linear feet of all existing streams on the property:
(interrrittent and perennial)
—100 LF
4f. Explain the purpose of the proposed project:*
The proposed project is to replace a functionally obsolete bridge.
4g. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
Traffic will be detoured off-site. Erosion and sedimentation control measures will be installed. The proposed
structure will be replaced on its existing alignment. The project proposes 25 linear feet of stream impact
associated with an existing roadside ditch which transitions into a 2-foot base ditch with Class B rip rap which
outlets to a rip rap embankment at the stream to prevent erosion. Two wetland pockets exst on the north east and
west quadrants of the project resulting in a minor amount of wetland fill (<0.01 ac) of wetland fill associated with
the new approaches to the bridge. The project also requires 0.02 acres of inechanized clearing and 0.03 acres of
hand clearing within the wetland area. 2:1 fill slopes were utilized to reduce the overall wetland impacts to the
eMent practicable. Equipment to be used includes a track hoe, dump truck, paving equipment, and various hand
tools, possibly a crane to move construction material such as reinforced bars of steel and concrete buckets to
place concrete.
4h. Please upload project drawings for the proposed project.
aick the upload button or drag and drop files here to attach docurrent
400240_Permit Drawings_20180801.pdf 3.57MB
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5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
C•' Yes f" No C' Unknown
Comme nts:
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
C' Preliminary f Approved C' Unknown l•' f�UA
Corps AID Number:
Exarrple:SAVw2017-99999
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Othe r:
Bob Lepsic/AmyJames
EPR
5d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
DWR visited the site in May 2018 and issued an onsite determination in July 2018.
5d1. Jurisdictional determination upload
aick the upload button or drag and drop files here to attach docurrent
NCDWR Stream Determination_Bridge 240_Guilford.pdf 1.06MB
NCDOT Guilford 240 Revised 7-10-18.pdf 831.02KB
Bridge 240_Division 7 packet.pdf 5.18MB
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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?*
C' Yes C•' No C' Unknown
7. Future Project Plans
7a. Is this a phased project?'�
f 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 Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
r% Wetlands rJ Streams-tributaries �T 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*
1 -L- 16+05 to 77+74 (fill)
Nbp label (e.g. Fd�ad Qossing 1- CLlvert,
dewatering, etc)
1 -L- 16+05 to 17+14
(mechanized clearing)
N�p label (e.g. Fd�ad Qossing 1- Qalvert,
dewatering, etc)
1 -L- 16+05 to 77+74 (hand
clearing)
fvl�p label (e.g. Fd�ad Qossing 1- Qalvert,
dewatering, etc)
P
F2rrranent (� or
Terrporary (�
P
F2rrranent (� or
Terrporary (�
T
F2rrranent (� or
Terrporary (l j
2g. Total Temporary Wetland Impact
0.030
2g. Total Permanent Wetland Impact
0.030
Small-Basin Wetland
Small-Basin Wetland
2d. Wetland name *Ze. 2f. Type of
Forested* Jurisdicition*
WC Yes Corps
(404, 10) or C�NR(401
other)
WC Yes Corps
(404, 10) or C!✓�R (401
other)
2g. Impact
area*
0.010
(acres)
0.020
(acres)
Small-Basin Wetland WD Yes Corps 0.030
(404, 10) or C!✓�R(401, (acres)
other)
2g. Total Wetland Impact
0.060
2h. Comments:
The proposed wetland fill is actually less than 0.01 acres; the mechanized clearing was reduced to hand clearing
where possible.
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 sqfe�
type * Type * Jurisdiction * width * length *
S7 -L- 15+27 to 15+40 P Bank Little Alamance Perennial Both 20 25 5
N�p label (e.g. Fd�ad Qossing �rrranent (� or Stabilization Cree k �rennial (Fff2) or Average (linearfeet) 0
1) Terrporary (lj interrrittent (If� (feet) 0
*' 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:
25
3i. Total temporary stream impacts:
0
3i. Total stream and tributary impacts:
25
3j. Comments:
The stream impact is associated with an exsting ditch which will be realigned and repaired to prevent future
erosion and/or scour at the outlet of the stream channel.
6. Buffer Impacts (for DWR)
ff 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
r Goose Creek fJ Jordan Lake
r Other
6b. Impact Type * 6c. Per or
Temp*
Allowable P
Location and 6cerrpt, Allowable, allowable w/ F2rrranem (Fj or
rritigation Terrporary (�
6h. Total buffer impacts:
zone 1
Temporary impacts: 0.00
Permanent impacts:
Total buffer impacts:
Zone 1
3,537.00
Zone 1
3,537.00
6d. Stream name * 6e. Buffer mitigation
required?*
Little Alamance Creek No
Zone 2
0.00
Zone 2
1,867.00
Zone 2
1,867.00
6i. Comments:
The impacts associated with the roadway crossing and bridge fall under the "potentially allowable" category per
the Jordan Water Supply Buffer Rules Table of Uses {15A NCAC 02B .0267 (9)}
Supporting Documentation - i.e. Impact Maps, Plan Sheet, etc.
C7ick the upload button or drag and drop files here to attach document
400240_Permit Drawings_20180801.pdf 3.57MB
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E. Impact Justification and Mitigation
1. Avoidance and Minimization
6f. Zone 1
impact*
3,537
(square feet)
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:*
6g. Zone 2
impact*
7,867
(squarefeet)
The proposed project is to remove and replace a structurally deficient, three span bridge with a single span,
precast concrete box beam bridge on the same alignment. Roadway approach work was minimized as much as
possible to reduce the overall project footprint and slopes were reduced to 2:1 to avoid additional wetland impacts.
Impacts to the associated riparian buffers have also been educed by promoting sheet flowwhere possible and
stabiliang ebsting ditches. Two newdrop inlets will carry stormwater off the bridge and discharge at non erosive
velocities outside the buffer area. There are no changes to e�asting ditch lines. An off-site detour will be employed
to avoid the need for a temporary parallel structure.
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 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?
f Yes �' No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
The impacts associated with the roadway crossing and bridge fall under the "potentially allowable" category per the Jordan Water Supply
Buffer Rules Table of Uses {15A NCAC 02B .0267 (9)} and therefore, do not require mitigation.
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 SHWT)
r Wetland Swale (higher SMNT)
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
(7ick the upload button or drag and drop files here to attach docurrent
Fle type rrust be F�F
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
C Yes r 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?*
l•' 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 (NEPAISEPA)?*
C' Yes C•' No
Comme nts: *
While this project involves an e�enditure of public funds, it does not exceed the thresholds that require
NEPA/SEPA documentation preparation.
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15A NCAC 2H .0500), Isolated Wetland Rules (75A NCAC 2H .7300), or
DWR Surface Water or Wetland Standards or Riparian Buffer Rules (75A NCAC 2B .0200)?*
l" Yes f' No
2b. Is this an after-the-fact permit application?*
f 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 qualit�/?*
f Yes C•' 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. e�asting residences in
the vicinity), this is not a road on a new location (i.e. there is an existing road and bridge structure and thus, the
area already contains impervious surfaces) and the project drains to Little Alamance Creek, which is Class WS-IV;
Nutrient Sensitive Waters (NSW). We anticipate the NC DWR will advise us if a qualitative or quantitative analysis
is needed.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
f Yes C No C' 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?*
C•' Yes C' No
Sc. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. Is another Federal agency involved?*
l' Yes C No
5e. Is this a DOT project located within Division's 1-8?*
C Yes C' No
C' Unknown
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
IPaC, NCNHP record review and onsite reconnaissance. Mr. Lepsic conducted a survey for smooth coneflower at
the subject site on July 27, 2017. Roadside habitat ewsts on the hillslopes above the stream floodplain at the
bridge but no specimens �re found. The biological conclusion for smooth coneflower at the Bridge 240 site is No
Effect; Habitat Present.
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 wtiich 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 history and archaeology)?*
f Yes b' No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources? *
See attached letters from NCDOT Architectural Historian and NCDOT Archaeologist dated 2016.
7c. Historic or Prehistoric Information Upload
C7ick the upload button or drag and drop files here to attach docurrent
176P.7.R.113_No Archaeological Survey Required Form 400240.pdf 5.5MB
17BP.7.R.113_No Survey Required Form Historic Archictecture 400240.pdf 4.24MB
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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?*
l•' Yes l" No
8b. If yes, explain how project meets FEMArequirements:
NCDOT MOA
8c. What source(s) did you use to make the floodplain determination?*
NC Floodplain Mapping Program (Flood Risk Information System)
Miscellaneous
Miscellaneous attachments not previously requested.
Qick the upload button or drag and drop files here to attach docurrent
Guilford_Pogonia_TE_Lttr.pdf 92.24K6
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Signature
�7 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:*
J. M. Mills
Signature
/I%�'" ��
1�
Date Submitted:
9/3/2018
Initial Review
Is this project a public transportation project?* (?)
f• Yes r No
Change only rf needed.
Has this project met the requirements for acceptance in to the review process? *
C Yes
f No
BIMS # Assigned *
20181227
Version#*
Reviewing Office *
Central Office - (919) 707-9000
Select Project Reviewer*
April Norton:eads\arnorton
Is a payment required for this project?*
C' No payment required
C•' Fee received
f Fee needed - send electronic notification