20190145 Ver 1_PCN Form Submission_20190130

D1�VR
�irlslan af Water Resources
Initial Review
Pre-Construction Notification (PCN) Form
September 29, 2018 Ver 3
Has this project met the requirements for acceptance in to the review process?*
F Yes
C' No
Is this project a public transportation project?"
� Yes r No
Change only rf needed.
BIMS # Assigned *
20190145
Is a payment required for this project?*
f No paymentrequired
� Fee received
F Fee needed - send electronic notification
Reviewing Office *
WinstomSalem Regional Office - (336) 776-
9800
Information for Initial Review
1a. Name of project:
Springside Culvert Replacement
1a. Who is the PrimaryContact?*
Cynthia C. Lancaster
1 b. Primary Contact Email: *
clancaster@jewelleng r. com
Date Submitted
1 /30/2019
Nearest Body of Water
Muddy Creek
Basin
Yadkin-PeeDee
Water Classification
C
Site Coordinates
Latitude:
36.03713
I A. Processing Information
Longitude:
-80.37367
County (or Counties) where the project is located:
Forsyth
Is this project a public transportation project?"
� Yes r No
Is this a NCDOT Project?"
� Yes r No
1a. Type(s) of approval sought from the Corps:
CJ Section 404 Permit (�tlands, 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?
Ve rsion# *
1
What amout is owed?*
r• $zao.00
C' $570.00
Select Project Reviewer*
Dave Wanucha:eads\djwanucha
1 c. Primary Contact Phone:"
[phone]
h

�J Nationwide Permit (NWP)
r Regional General Permit (RGP)
r Standard (IP)
1c. Has the NWP or GP number been verified bythe Corps?
C' Yes r No
Nationwide Permit (NWP) Number:
14 - Linear transportation
NWP Numbers (for multiple NWPS):
1d. Type(s) of approval sought from the DWR:
�J 401 Water Quality Certification - Regular
r Non-404 Jurisdictional General Permit
r Individual Permit
1e. 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:
1f. Is this an after-the-fact permit application?"
f Yes r No
1g. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
C' Yes r No
1g. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation of impacts?
� Yes r No
Acceptance LetterAttachment
1h. Is the project located in any of NC's twenty coastal counties?
C' Yes r No
1j. Is the project located in a designated trout watershed?
l' Yes r No
B. Applicant Information
1d. Who is applying for the permit?
rJ Owner rJ Applicant (other than owner)
1e. Is there an Agent/Consultant for this project?
r Yes r No
2. Owner Information
2a. Name(s) on recorded deed:
JAMES E RHODES AND LESLIE G FRY
2b. Deed book and page no.:
LOT NO 102, BLOCK NO 4264
2c. Responsible party:
2d. Address
Street Address
0 EDGEWATER DRIVE
Address Line 2
�Y
CLEMMONS
Fbstal / Zip Code
27012
2e. Telephone Number:
[phone]
2g. Email Address:"
[e-mail]
2a. Name(s) on recorded deed:
MARVN G CREWS
r 401 Water Quality Certification - 6cpress
r Riparian Buffer Authorization
S[ate / FYwince I Region
NC
Country
US
2f. Fax Number:
*
C' Yes r No
C' Yes r No

2b. Deed book and page no.:
LOT NO 004, BLOCK NO 4264
2c. Responsible party:
2d.Address
Street Address
0 SPRINGSIDE DRIVE
Address Line 2
�Y
CLEMMONS
Fbstal / Zip Cocle
27012
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
2a. Name(s) on recorded deed:
RENEE DAVIS BROOKS
2b. Deed book and page no.:
LOT NO 005, BLOCK 4264
2c. Responsible party:
2d.Address
Street Address
3211 SPRINGSIDE DR
Address Line 2
�Y
CLEMMONS
Fbstal / Zip Code
27012
2e. Telephone Number:
[phone]
2g. Email Address:"
[e-mail]
2a. Name(s) on recorded deed:
VILLAGE OF CLEMMONS (SPRINGSIDE DRIVE ROW)
2b. Deed book and page no.:
NOT APPLICABLE
2c. Responsible party:
2d.Address
Street Address
3800 DILLON INDUSTRIAL DRIVE
Address Line 2
�Y
CLEMMONS
Fbstal / Zip Code
27012
2e. Telephone Number:
[phone]
2g. Email Address:*
[e-mail]
3. Applicant Information (if different from owner)
3a. Name:
Village of Clemmons (owns ROW/is acquiring easements)
3b. Business Name:
State / Rovince I F�gion
NC
Country
US
2f. Fax Number:
S[ate / Rwince / Region
NC
Country
US
2f. Fax Number:
State / Rovince / f�gim
NC
Country
US
2f. Fax Number:
3c.Address

�reet Address
3800 DILLON INDUSTRIAL DRIVE
Address Line 2
�Y
CLEMMONS
Fbstal / Zip Code
27012
3d. Telephone Number:
[phone]
3f. Email llddress:*
[e-mail]
State / Rovince I f�gion
NC
Cauntry
US
3e. Fax Number:
[phone]
C. Project Information and Prior Project History �
1. Project Information
1b. Subdivision name:
(rf appropriate)
1 c. Nearest municipality / town:
Village of Clemmons
2. Project Identification
2a. Propertyldentification Number:
2c. Project Address
Street Address
Springside Drive
Address Line 2
�Y
Clemmons
Postal / Zip Code
27012
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Muddy Creek
3b. Water Resources Classification of nearest receiving water:*
C
3c. What river basin(s) is your project located in?*
Yadkin-PeeDee
3d. Please provide the 12-digit HUC in which the project is located.
030401011306
4. Project Description and History
2b. Property size:
State / Rovince / f�gion
NC
Country
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 location of the proposed culvert replacement is on Springside Drive, which is a dead-end Village of Clemmons street within a residential area. On the upstream side is a privately-
owned pond. The original outlet for the pond failed long ago and the pond has for many years been drained by 4-18" CMP's with inverts roughly only 2.5 ft belowthe top of the road.
Approximately 183 acres of watershed is drained to Springside pond, including 90 acres north of I-40. Due to the hydraulic inadequacy of the ebsting outlets, the road may be
overtopped multiple times within a year. The downstream side of the roadway embankment is very steeply sloped and has been subjected to substantial erosion over time, requiring the
Village to heavily reinforce the slopes in order to protect the roadway. The outlet discharges to private property, but the stream then flows through a neighborhood park to the neM
crossing at Greendale Way. Geotechnical investigation indicated that the existing roadway embankment construction for Springside Drive was not done in a manner adequate to
function as a dam and vwuld require significant improvements if the Village wanted to maintain the pond.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
C' Yes r No C' Unknown
4d. 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)
Springside_PCN_USGS_Map.pdf 666.49KB
4e. Attach an 8 7/2 X 11 excerpt from the most recent version of the published County NRCS Soil Survey map depicting the project site. (for DWR)
Springside_PCN_Soil Map. pdf 9776KB
4f. List the total estimated acreage of all existing wetlands on the property:
0
4g. List the total estimated linear feet of all existing streams on the property:

�a
4h. Explain the purpose of the proposed project:*
The purpose of the proposed project is to improve flood conveyance under Springdale Drive so that the road is protected from overtopping and to rebuild the eroded embankment on a
stable and safe slope. The project is a public safety measure because the current conditions threaten the integriry of the roadway embankment.
4i. Describe the overall project in detail, including indirect impacts and the type of equipment to be used:*
The pond will be permanently drained as part of the culvert replacement. The contractor �nnll be required to place some temporary pipe to convey flood flows and protect the roadway
and project from flooding. Contractor will likely also excavate 1 or 2-10' x 10' areas to be lined and surrounded wth filter stone riprap such that a pump can be operated to partially
dewater the sediment. The proposed construction sequence will close off the upstream side of the road so the contractor can proceed with installing the downstream portion of the
precast box culvert, pouring the downstream wingwalls, rebuilding the downstream embankment on a stable slope, and modifying the downstream channel for appropriate energy
dissipation and transition to the natural stream. Shoring and physical barriers will be required to facilitate the excavation for the culvert and protect the vehicles using the upstream side
of the roadway. When the downstream conshuction is completed, the haffic will be moved to the downstream side. A coffer dam or slide rail system will be used to create a work area
which can be dewatered and is protected from accumulated sediments sliding in. The culvert installation will be completed and the upstream concrete control structure poured. The
gabion walls will be built and filter stone placed betv�en the gabions and the coffer dam. Then the slide rail or coffer will be rerrwved. All e�sting drainage pipe culverts will be removed
as part of the project and the areas backfilled per recommendations from the geotechnical engineer. See project narrative for additional information.
It is expected that the contractor will use an excavator, bulldozer, backhoe, crane, and dump trucks to accomplish the excavation wnrk and installation of the culvert.
4j. Please upload project drawings for the proposed project.
SpringsideCulvert_Jan30_PCN.pdf 5.56MB
5. Jurisdictional Determinations
Sa. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
F Yes �' No �' Unknown
Comments:
See attached report from Piedmont Environmental
Sb. If the Corps made a jurisdictional determination, what type of determination was made?*
f' Preliminary (' Approved r Not Verified r Unknown 6' WA
Corps AID Number:
Sc. If Sa is yes, who delineated the jurisdictional areas?
Name (if known): Brad Luckey
Agency/Consultant Company: Piedmont Environmental, Inc.
Other:
5d1. Jurisdictional determination upload
Pilot Project 3880 - Springside Dr - Wet Report_8.22.18.pdf
3.48MB
6. Future Project Plans
6a. 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?
D. Proposed Impacts Inventory
1. Impacts Summary
1a. Where are the impacts associated with your project? (check all that apply):
r Wetlands IIJ Streams-tributaries r Buffers
,rJ Open Waters I� Pond Construction
3. Stream Impacts
�.
❑ 3a. Reason for impact (') 3b.lmpact type * 3a Type of impact* 3d. S. name * 3e. Stream Type * 3f. Type of 3g. S. width* 3h. Impact
(?) Jurisdiction" length"
S1
Culvert extension Permanent Culvert unnamed trib Perennial Both 15 20
Average (feet) (linear feet)
gy Energy dissipation Permanent Rip Rap Fill unnamed trib Perennial Both 15 54
Average (feet) Qinear feet)
3i. Total jurisdictional ditch impact in square feet:
0

3i. Total permanent stream impacts:
74
3i. Total stream and ditch impacts:
74
3i. Total temporary stream impacts:
0
3j. Comments:
Assumes jurisdictional stream is from end of 18" CMPs to project limits, even though the upper 20 feet where the culvert extension will impact is really
more part of the embankment than part of a stream. Riprap will not extend for the entire 54 feet, but the intent is to re-use some of the onsite
stone/rubble in the initial pool area. Bed stabili�ation/energy dissipation will transition to boulders and smaller stone.
4. Open Water Impacts
4g. Total open water impacts:
0.09
4h. Comments:
Pond impact areas are shown on Figure 1 of attached narrative.
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:
(1) The stream immediately downstream of the ewsting culverts has been impacted by the riprap placed on the banks to provide protection against
erosion, and over time has been transported down to the stream bed. The plans propose to re-use that riprap for an energy dissipation area
downstream of the new culvert in order to protect the natural stream from degradation. (2) Originally the new culvert was proposed as a double 54"
pipe, but a 6'x6' box is instead planned for installation to be more consistent with the downstream channel width. (3) A gabion wall, fronted by a layer
of #5 stone, will be constructed to prevent mass downstream migration of the heavy accumulation of sediments in the pond.
1b. Specificallydescribe measures taken to avoid or minimize the proposed impacts through construction techniques:
A coffer dam or slide rall system is proposed to be used to facilitate the construction on the upstream side of the crossing, which will protect the
remainder of the pond bottom area from impacts.
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:
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
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?
� Yes r No
If no, explain why:
Not within a watershed where NC Riparian Buffer Protection Rules are applicable.
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
� Yes r No
2b. Does this project meet the requirements for low density projects as defined in 15A NCAC 02H .1003(2)?
r Yes �' No
Comments:
No new impervious area associated with the project.
h
I G. Supplementary Information --
4g. Total temporary open water Impacts: 4g. Total permanent open water impacts:
0.07 0.02

1. Environmental Documentation
1a. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federallstate) 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)
Environme ntal Policy Act (NEPAISEPA)? *
� Yes r No
Comments:"
Village of Clemmons will spend local public funds for the culvert replacemenL No state or federal funds or lands will be used.
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 (15ANCAC 2B .0200)? *
C' Yes r No
3. Cumulative Impacts (DWR Requirement)
3a. Will this project result in additional development, which could impact nearby downstream water quality? *
� Yes r No
3b. If you answered "no," provide a short narrative description.
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?*
C' Yes r No r �UA
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
Sa. Will this project occur in or near an area with federally protected species or habitat? *
f Yes r No
Sb. Have you checked with the USFWS concerning Endangered Species Act impacts?*
� Yes r No
Sd. Is another Federal agency involved?"
� Yes r No
Se. Is this a DOT project located within Division's 1-8?
C' Yes r No
Sf. Will you cut anytrees in order to conduct the work in waters of the U.S.?
� Yes r No
Sg. Does this project involve bridge maintenance or removal?
C' Yes r No
Sh. Does this project involve the construction/installation of a wind turbine(s)?*
� Yes r No
� Unknown
Si. Does this project involve (7) blasting, and/or (2) other percussive activities that will be conducted by machines, such as jackhammers, mechanized pile drivers, etc.?
C' Yes r No
Sj. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
Reviewed habitat information for threatened/endangered species list received from iPAC website on V29/2019 and completed their onsite review
process. No critical habitat is within the project area.
Consultation Documentation Upload
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as an Essential Fish Habitat?*
C' Yes r No
6b. What data sources did you use to determine whether your site would impact an Essential Fish Habitat?*
Essential Fish Mapper website
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
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?*

C' Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
accessed and checked website link to SHPO map on 1/22/2019
7c. Historic or Prehistoric Information Upload
8. Flood Zone Designation (Corps Requirement)
Sa. Will this project occur in a FEMA-designated 100-year floodplain?*
C' Yes r No
8c. What source(s) did you use to make the floodplain determination?*
Accessed and checked FEMA website listed above on 1/22/2019. Project area is not within a FEMA-designated 100-year floodplain.
Miscellaneous
Comments
see attached project narrative
Miscellaneous attachments not previouslyrequested.
Springside Pond_PCN_Narrative.pdf
Signature
*
rJ By checking the box and signing below, I certify that:
1.66 MB
• 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 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:
Cynthia C. Lancaster
Signature
Cyr�ir, C- LaRca<rtc�f,
�
�
Date
1 /30/2019