20190590 Ver 1_PCN Form Submission_20190507

DWR
IDIOM n of Water Resources
Pre -Construction Notification (PCN) Form
September 29, 2018 Ver 3
21nitial Review
Has this project met the requirements for acceptance in to the review process?*
r Yes
r No
Is this project a public transportation project?*
G Yes r No
Change only if needed.
BIMS # Assigned
20190590
Is a payment required for this project?*
r No payment required
r Fee received
r Fee needed - send electronic notification
Select Project Reviewer*
April Norton:eads\arnorton
Information for Initial Review
1a. Name of project:
Replace Pipe #40 2221 on SR 3426 (Sheraton Park Rd)
1a. Who is the Primary Contact?*
Division Engineer NCDOT Division 7, Mr. Mike Mills, PE
1b. Primary Contact Email:*
[e-mail]
Date Submitted
5/7/2019
Nearest Body of Water
Unnamed Tributary of Polecat Creek
Basin
Cape Fear
Water Classification
WS-III; 17-11-2-(2); HUC 030300030107
Site Coordinates
Version# *
1
Reviewing Office*
Central Office - [phone]
1c. Primary Contact Phone:*
[phone]
Latitude: Longitude:
35.969681-79.795187
FA. Processing Information u
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?*
r Yes r No
(NCDOT only) T.I.P. or state project number:
WBS # (?)
17BP.7.C.11
1a. Type(s) of approval sought from the Corps:

W Section 404 Permit (wetlands, streams and waters, Clean Water Act)
r Section 10 Permit (navigable waters, tidal waters, Rivers and Harbors Act)
1b. What types) of permit(s) do you wish to seek authorization?
W Nationwide Permit (NWP)
r' Regional General Permit (RGP)
r' Standard (IP)
1c. Has the NWP or GP number been verified by the Corps?
r 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
F Non-404 Jurisdictional General Permit
F Individual Permit
le. 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:
r 401 Water Quality Certification - Express
F Riparian Buffer Authorization
1f. Is this an after -the -fact permit application?*
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
1g. Is payment into a mitigation bank or in -lieu fee program proposed for mitigation of impacts?
r Yes r No
Acceptance Letter Attachment
1h. Is the project located in any of NC's twenty coastal counties?
r Yes r No
1j. Is the project located in a designated trout watershed?
C Yes r No
FB. Applicant Information
1d. Who is applying for the permit?
r- Owner rJ Applicant (other than owner)
le. Is there an Agent/Consultant for this project?
r Yes r No
2. Owner Information
2a. Name(s) on recorded deed:
North Carolina Department of Transportation
2b. Deed book and page no.:
NA
2c. Responsible party:
Division Engineer NCDOT Division 7, Mr. Mike Mills, PE
2d.Address
Street Address
PO Box14996
Address Line 2
City
State / Frwinre / R�gion
Greensboro
NC
Fbstal / Zip Code
Q�untry
27415
USA
2e. Telephone Number:
2f. Fax Number:
[phone]
[phone]
2g. Email Address:*
*
r Yes r No
r Yes r 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
City
Greensboro
F stal / Zip Code
27415
3d. Telephone Number:
[phone]
3f. Email Address:*
[e-mail]
C. Project Information and Prior Project History
1. Project Information
1b. Subdivision name:
(if appropriate)
N/A
1c. Nearest municipality/town:
Greensboro
2. Project Identification
State / Province / Pagion
NC
Country
USA
3e. Fax Number:
[phone]
2a. Property Identification Number:
2b. Property size:
N/A
N/A
2c. Project Address
Street Address
Address Line 2
aty
State / Province / Pagion
Postal / Zip Cade
Country
3. Surface Waters
3a. Name of the nearest body of water to proposed project:*
Unnamed Tributary of Polecat Creek
3b. Water Resources Classification of nearest receiving water:*
WS-III; 17-11-2-(2); HUC 030300030107
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.
030300030107
4. Project Description and History
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, commercial land, and active farm land. Also note, Wood Lake is immediately upstream of our
project site.
4b. Have Corps permits or DWR certifications been obtained for this project (including all prior phases) in the past?*
r Yes 6 No r 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 2221 Guilford USGS Map.pdf 2.75MB
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 2221 Guilford Soil Map.pdf 1.83MB
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
-200 LF of channel within the project area
4h. Explain the purpose of the proposed project:*
The proposed project is to replace two failing, existing 84-inch corrugated metal pipe (CMP) culverts.
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 Wil be installed. The proposed structure vdll be replaced on its existing alignment, the two existing 84-inch
CMPs will be replaced by two proposed 102-inch concrete arch pipes (CAPs) with headwalls, endwalls, and sills. The project proposes 49 linear feet (-0.02 acres) of permanent stream
impact and 48 linear feet (-0.04 acres) of temporary stream impact associated with the impervious dikes to devoter the channel so that construction activities take place in the dry (to
run concurrently with the permanent impacts). The pipe inlets and outlets will consist of Class II rip rap embankment at the stream to prevent erosion as well as a Class II rip rap
dissipator pad at the pipe outlets. Please note the existing pipes are perched approximately 4.5 feet and the new proposed pipe outlet inverts will be lowered to reduce perching.
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_C11_Permit Drawings_20180807.pdf 1.38MB
5. Jurisdictional Determinations
5a. Have the wetlands or streams been delineated on the property or proposed impact areas?*
r Yes r No r Unknown
Comments:
HDR/ICA conducted field reconnaissance for the subject site in 2016
5b. If the Corps made a jurisdictional determination, what type of determination was made?*
r Preliminary r Approved r Not Verified r Unknown r N/A
Corps AID Number:
5c. If 5a is yes, who delineated the jurisdictional areas?
Name (if known): Ben Furr
Agency/Consultant Company: HDR
Other:
5d1. Jurisdictional determination upload
6. Future Project Plans
6a. Is this a phased project?*
r 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
la. Where are the impacts associated with your project? (check all that apply):
r Wetlands W Streams -tributaries r Buffers
r- Open Waters r Pond Construction
3. Stream Impacts
F 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*
FIL- 12+71 to 13+60 LT/RT Permanent Bank Stabilisation UT
to Polecat Creek
Perennial
Both
25
Average (feet)
49
(linear feet)
S2
12+71 to 13+60 (LT/RT)
Temporary
Dewatering
UT to Polecat Creek
Perennial
Both
25
Average (feet)
48
(linear feet)
3i. Total jurisdictional ditch impact in square feet:
0

31. Total permanent stream impacts:
49
31. Total temporary stream impacts:
48
31. Total stream and ditch impacts:
97
3j. Comments:
Of the 97 linear feet of stream impact, only 49 linear feet are permanent which will occur mostly in the form of stream bank stabilization, except for the
small amount of rip rap in the thalweg at the outlet of the new, proposed CAP pipes.
E. Impact Justification and Mitigation u
1. Avoidance and Minimization
la. Specifically describe measures taken to avoid or minimize the proposed impacts in designing the project:
The proposed project is to remove and replace two existing, failing 84-inch CMPs with two, 102-inch CAPS with headwalls, endwalls, and sills. Roadway
approach work was minimized as much as possible to reduce the overall project footprint. Impacts to the associated stream have also been reduced
by protecting the inlet and outlet of the proposed pipes with Class II rip rap bank stabilization. An off -site detour will be employed to avoid the need for
a temporary crossing.
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 BMPs for the protection of surface waters, restrictions against
staging 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?
r Yes r No
2b. If this project DOES NOT require Compensatory Mitigation, explain why:
The permanent stream impacts proposed with this replacement are for bank stabilization which historically has not required mitigation. The small amount of rip rap placed in the channel
at the outlet of the CAPs is well below the compensatory mitigation thresholds.
F. Stormwater Management and Diffuse Flow Plan (required by DWR)
1. Diffuse Flow Plan
la. 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
If no, explain why:
The proposed project is located within the Cape Fear River Basin, outside of the Randleman Lake and Jordan Lake watersheds and therefore does not have associated riparian buffer
areas.
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
la. Does the project involve an expenditure of public (federallstate/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:*
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 (15A NCAC 2H .1300), or DWR Surface Water or Wetland Standards or
Riparian Buffer Rules (15A NCAC 2B .0200)? *
r Yes r No

3. Cumulative Impacts (DWR Requirement)
3a. Will this project 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.
Per the NC DWQ April 2004 Version 2.1 Cumulative Impacts policy, small scale public transportation projects — such as widening projects, bridge
replacements (including culvert 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. existing 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 a UT Polecat Creek, which is Class WS-III, (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?*
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? *
r Yes r No
5b. Have you checked with the USFWS concerning Endangered Species Act impacts?*
r Yes r No
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. Is another Federal agency involved?*
r Yes r No r Unknown
5e. Is this a DOT project located within Division's 1-8?
r Yes r No
5j. 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, Helianthus schweinitai
(Schweinitts sunflower) and Myotis septentrionalis (Northern long-eared bat, NLEB) as endangered in Guilford County. HDRJICA conducted field
investigations on 6/16/16. The project site provides marginal habitat for Small whorled pogonia & Schweinitts sunflower on the south side of E.
Sheraton Park Road in the form of a mature bottomland hardwood forest with 75 percent canopy coverage and a moderately dense understory and
herbaceous layer. The area surrounding this forested community is predominately residential development. Survey transects were walked within the
marginal habitat but neither species was observed during field investigations. The biological conclusion for Small whorled pogonia & SchweinitZs
sunflower is no effect. Effects of NCDOT projects on NLEB in Guilford County have been addressed through a Programmatic Biological Opinion which
took effect on May 4, 2015.
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?*
r 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?*
r Yes r No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?*
Letters provided by NCDOT Architectural Historian (dated 10/25/17) and NCDOT Archaeologist (dated 10/31/17), see attached.
7c. Historic or Prehistoric Information Upload
HA-17-10-0008NoSurveyReq.pdf 2.78MB
SR 3426 Pipe 402221 Guilford No Archaeological Survey Required Form.pdf 1.25MB
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain?*
r Yes r No
8b. If yes, explain how project meets FEMA requirements:
NCDOT MCA
8c. What source(s) did you use to make the floodplain determination?*
https://fris.nc.gov/fris/indexaspx?FIPS=081&ST=NC&user=General Public

Miscellaneous
U
Comments
Miscellaneous attachments not previously requested.
CA 1—EC and Construction Seq.pdf
1.49MB
Signature u
m 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:
P. D. Wilson, PE
Signature
Date
5/7/2019