20190404 Ver 1_PCN Form Submission_20190402

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 *
20190404
Is a payment required for this project?*
f No paymentrequired
� Fee received
f Fee needed - send electronic notification
Select Project Reviewer"
April Norton:eads\arnorton
Information for Initial Review
1a. Name of project:
Replace Pipe #40 2226 on SR 2930 (Bethel Church Rd)
1a. Who is the PrimaryContact?*
Division Engineer NCDOT Division 7, Mr. Mike Mills, PE
1b. PrimaryContact Email:*
[e-mail]
Date Submitted
4/2/2019
Nearest Body of Water
UT to Little Alamance Creek
Basin
Cape Fear
Water Classification
WS-IV; NSW; 16-19-3-(0.5); HUC 030300020303
Site Coordinates
Latitude:
36.098354
A. Processing Information
County (or Counties) where the project is located:
Guilford
Is this project a public transportation project?*
r Yes r No
Is this a NCDOT Project?*
G Yes r No
(NCDOT only) T.I.P. or state project number:
Ve rsion# *
1
Reviewing Office *
Central Office - [phone]
1c. PrimaryContact Phone:*
[phone]
Longitude:
-79.648399
::
WBS # (�)
17BP7.C.9
1a. Type(s) of approval sought from the Corps:

�J 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)
1c. Has the NWP or GP number been verified bythe Corps?
F Yes r No
Nationwide Permit (NWP) Number:
03 - Maintenance
NWP Numbers (for multiple NWPS):
1d. Type(s) of approval sought from the DWR:
fJ 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?
Forthe record onlyfor DWR401 Certification:
For the record onlyfor Corps Permit:
1f. Is this an after-the-fact permit application?*
� 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?
� Yes r No
B. Applicant Information
1d. Who is applying for the permit?
r Owner fJ Applicant (other than owner)
1e. Is there an Agent/Consultant for this project?
f Yes r No
2. Owner Information
2a. Name(s) on recorded deed:
North Carolina Department of Transportation
2b. Deed book and page no.:
IWA
2c. Responsible party:
Division Engineer NCDOT Division 7, Mr. Mike Mills, PE
2d. Address
Street Address
PO Box 14996
Address Line 2
�Y
Greensboro
Fbstal / Zip Code
27415
2e. Telephone Number:
[phone]
2g. Email Address:*
r 401 Water Quality Certification - E�ress
rJ Riparian Buffer Authorization
State / Aovince I F�gion
NC
Country
USA
2f. Fax Number:
[phone]
x
C' Yes R No
G Yes C' No

[e-mail]
3. Applicant Information (if different from owner)
3a. Name:
Division Engineer NCDOT Division 7, Mr. Mike Mills, PE
3b. Business Name:
NC DOT
3c.Address
Street Address
PO Box14996
Address Line 2
�ty
Greensboro
Postal / Zip Code
27415
3d. Telephone Number:
[phone]
3f. Email Address:"
mmil [e-mail]
S[ate / Awince I Region
NC
Country
USA
3e. Fax Number:
[phone]
C. Project Information and Prior Project History �
1. Project Information �
1b. Subdivision name:
(rf appropriate)
wn
1 c. Nearest municipality / town:
Greensboro
2. Project Identification
2a. Propertyldentification Number:
WA
2c. Project Address
Street Address
Address Line 2
�Y
Postal / Zip Code
3. SurFace Waters
3a. Name of the nearest body of water to proposed project:"
UT to Little Alamance Creek
3b. Water Resources Classification of nearest receiving water:*
WS-IV; NSW; 16-19-3-(0.5); HUC 030300020303
3c. What river basin(s) is your project located in?*
Cape Fear
3d. Please provide the 12-digit HUC in which the project is located.
030300020303
4. Project Description and History
2b. Property size:
WA
S[ate / FYovince I Region
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 project area is a mix of undisturbed, forested areas, maintained lawns and residences, and active farm land.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
C' Yes r No � 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)
Pipe 40 2226 Guilford USGS Map.pdf 224MB
4e. 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)
Pipe 40 2226 Guilford Soil Map.pdf 2.09MB

4f. List the total estimated acreage of all existing wetlands on the property:
-0.00
4g. List the total estimated linear feet of all existing streams on the property:
-125 LF
4h. Explain the purpose of the proposed project:*
The proposed project is to replace two failing, e�sting corrugated metal pipe (CMP) culverts (84-inch and 66-inch).
4i. 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 existing 84-inch CMP
and e�tisting 66-inch CMP will be replaced by a 12-foot 11-inch x 7-foot 6-inch Corrugated Aluminum Structural Plate Pipe Arch (CASPPA) pipe with headwalls, endwalls & sills. The
project proposes 40 linear feet (-0.02 acres) of permanent stream impact (30 LF for bank stabilization and 10 LF of additional culvert length) and 36 linear feet (0.01 acres) of
temporary stream impact associated with the impervious dikes to dewater the channel so that construction activities take place in the dry (to run concurrently with the permanent
impacts). The pipe inlet and outlet will consist of Class I rip rap embankment at the stream to prevent erosion. Equipment to be used includes a track hoe, dump truck, paving
equipment, various hand tools, and crane to move construction material, including the existing and proposed pipes.
4j. Please upload project drawings for the proposed project.
G2_C09_permit drawings_20181016.pdf 2.46MB
5. Jurisdictional Determinations
Sa. Have the wetlands or streams been delineated on the propertyor proposed impact areas?*
F Yes r No
Comments:
HDR/ICA conducted field reconnaissance for the subject site in 2016.
Sb. If the Corps made a jurisdictional determination, what type of determination was made?*
f Preliminary f Approved f Not Verified f Unknown G WA
Corps AID Number:
Sc. If 5a is yes, who delineated the jurisdictional areas?
Name (if known):
Agency/Consultant Company:
Other:
Sd1. Jurisdictional determination upload
6. Future Project Plans
Ben Furr
HDR/ICA
�' Unknown
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):
� Wetlands I17 Streams-tributaries
� Open Waters I� Pond Construction
3. Stream Impacts
fJ Buffers
�, I
❑ 3a. Reason for impact (') 3b.lmpact type * 3c. Type of impact* 3d. S. name * 3e. Stream Type * 3f. Type of 3g. S. width* 3h. Impact
(�) Jurisdiction" length"
S1 12+28 LT/RT Permanent Culvert
82 -L- 11+25 to 13+50 LT/RT Permanent Bank Stabilization
S3 -L- 11+25 to 13+50 LT/RT Temporary Dewatering
3i. Total jurisdictional ditch impact in square feet:
0
to Little Alamance Creek ��Perennial
to Little Alamance Creek ��Perennial
to Little Alamance Creek ��Perennial
1� 10
Average (feet) Qinear feet)
1� 30
Average(feet) Qinearfeet)
1� 36
Average (feet) Qinear feet)

3i. Total permanent stream impacts: 3i. Total temporary stream impacts:
40 36
3i. Total stream and ditch impacts:
76
3j. Comments:
Of the 76 linear feet of stream impact, only 40 linear feet are permanent which will occur mostly in the form of stream bank stabilization. The remaining
36 LF of temporary impact are associated with concurrent dewatering activities.
6. Buffer Impacts (for DWR)
6a. Project is in which protect basin�s)?
Check all that apply.
r Neuse
� Catawba
� Goose Creek
r Other
r Tar-Pamlico
r Randleman
fJ Jordan Lake
Impact Type ��6c. Per or Temp Il6d. Stream name I�6e. Buffer mitigation required9 I�6f. Zone 1 impact �I6g. Zone 2 impact
to Little Alamance Creek IINo I 1,939
6h. Total buffer impacts:
Zone 1 Zone 2
Total Temporary impacts: 0.00 0.00
Zone 1 Zone 2
Total Permanent impacts: 1,939.00 424.00
Zone 1 Zone 2
Total combined buffer impacts: 1,939.00 424.00
6i. Comments:
The impacts associated with the pipe replacement fall under the "allowable" category per the Jordan Water Supply Buffer Rules Table of Uses {15A
NCAC 02B .0267 (9)}.
Supporting Documentation
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:
The proposed project is to remove and replace an existing 84-inch CMP and an ewsting 66-inch CMP with one 12-foot 11-inch x 7-foot 6-inch CASPPA
pipe with headwall, endwall, and sills. Roadway approach work was minimized as much as possible to reduce the overall project footprint and slopes
were reduced to 1.5:1 to minimize impacts. Impacts to the associated riparian buffers have also been reduced by promoting sheet flowwhere possible
and stabilizing existing banks. An off-site detour will be employed to avoid the need for a temporary crossing.
1b. Specificallydescribe measures taken to avoid or minimize the proposed impacts through construction techniques:
Erosion and sedimentation BMPs will be installed prior to construction. The stream and riparian areas will be noted with highly visible fencing. Water
will be diverted around the �,wrk area to prevent sedimentation of downstream aquatic resources. Impacts will be minimized by strict enforcement of
BMPs 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?
C' Yes r No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
The impacts associated with the pipe replacement fall under the "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) "
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?
r Yes r No
What type of SCM are you providing?
r Level Spreader
r Vegetated Conveyance (lower SHWT)
r Wetland Swale (higher SM/VT)
� Other SCM that removes minimum 30 % nitrogen
CJ Proposed project will not create concentrated stormwater flow through the buffer
Diffuse Flow Documentation
2. Stormwater Management Plan
2a. Is this a NCDOT project subject to compliance with NCDOT's Individual NPDES permit NCS000250?*
r Yes r No
Comments:
This project does not add any new impervious surface, therefore, there is no need to provide stormwater treatment.
G. Supplementary Information
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)
Environmental PolicyAct (NEPAISEPA)?"
� Yes r No
Comments:"
While this project involves an expenditure 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 (15ANCAC 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.
Per the NC DWQ April 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 already in developed locales." This proposed project is within a somewhat developed landscape (i.e. ebsting residences in the
vicinity), this is not a road on a new location (i.e. there is an existing road and culvert structure and thus, the area already contains impervious
surfaces), and the project drains to a UT to Little Alamance Creek which is Class WS-IV; Nutrient Sensitive Waters (NSW) (i.e. not HQW or ORW). We
anticipate the NCDWR 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?*
C' Yes r No r fWA
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?*
F Yes r No
Sc. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
Sd. Is another Federal agency involved?"
� Yes r No
� Unknown
Se. Is this a DOT project located within Division's 1-8?
r Yes r No

S. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical Habitat?
The United States Fish and Wildlife Service (USFWS) lists Isotria medeoloides (Small whorled pogonia) as threatened and Helianthus schweinitai
(Schwainitts sunflower) as endangered in Guilford County. HDR�ICA conducted field investigations on 6/16/16. The project site provides habitat for
small whorled pogonia on the south side of Bethel Church Road in the form of a mature bottomland hardwood forest that transitions to oak-hickory
forest on the side slopes. These areas e�ibited 65 percent canopy coverage, a moderately dense to open understory, and a sparse herbaceous
layer. The area surrounding this forested community is predominately residential development and agriculture. Survey transects were walked within
this habitat but neither small whorled pogonia nor Schweinitzs sunflower were observed during field investigations, therefore, there is No Effect.
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?*
The project is located in Guildford County which 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)
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?*
This project was submitted to the NC Department of Transportation's Human Environment Unit for review in 2017. It was determined that no survey
was required for historical architecture or archaeological resources and that no cultural resources will be affected by this project. See attached
concurrence letters.
7c. Historic or Prehistoric Information Upload
C9_17-10-0016_NoSurvey.pdf 2.OSMB
C9_SR 2930 Pipe 402226 Guilford No Archaeological Survey Required Form.pdf 1.27MB
8. Flood Zone Designation (Corps Requirement)
Sa. Will this project occur in a FEMA-designated 100-year floodplain?"
� Yes r No
Sc. What source(s) did you use to make the floodplain determination?"
NC Flood Risk Information System
Miscellaneous
Comments
Miscellaneous attachments not previouslyrequested.
C.9_EC and Construction seq.pdf
Pb p7. C.9_HYD_SMP_10022018. pdf
Signature
*
fJ By checking the box and signing below, I certify that:
1.76 MB
166.78KB
. 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 AcP');
• 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:
James Michael Mills
Signature
�' �.�G.(✓�;u
^ �
.
Date
4/1 /2019