20000461 Ver 1_COMPLETE FILE_20000405

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
AN ;W'A
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
April 14, 2000
Forsyth County
DWQ Project # 000461
APPROVAL of 401 Water Quality Certification
Tom Prince
PO Box 1054
Kernersville, NC 27285
Dear Mr. Prince:
You have our approval, in accordance with the attached conditions, to excavate 0.01 acres of wetlands in
Warren County to install a sewer main, as you described in your application received by the Division of Water
Quality on April 5, 2000. After reviewing your application, we have determined that this action is covered by
General Water Quality Certification Number 3101. This Certification allows you to use Nationwide Permit
Number 12 when issued by the U.S. Army Corps of Engineers. In addition, you should get any other federal, state
or local permits before you go ahead with your project including (but not limited to) Sediment and Erosion Control,
Non-Discharge and Water Supply Watershed regulations. Also this approval will expire when the accompanying
404 permit expires unless otherwise specified in the General Certification.
This approval is only valid for the purpose and design that you described in your application except as modified
below. If you change your project, you must notify us and you may be required to send us a new application. If the
property is sold, the new owner must be given a copy of this Certification and approval letter and is thereby responsible for
complying with all conditions. If total wetland fills for this project (now or in the future) exceed one acre, compensatory
mitigation may be required as described in 15A NCAC 2H.0506 (h) (6) and (7). This approval shall expire when the
corresponding Nationwide Permit expires or as otherwise provided in the General Certification. For this approval to be
valid, you must follow the conditions listed in the attached certification.
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearing. You must
act within 60 days of the date that you receive this letter. To ask for a hearing, send a written petition, which conforms to
Chapter 150B of the North Carolina General Statutes to the Office of Administrative Hearings, P.O. Box 27447, Raleigh.
N.C. 276 1 1-7447. This certification and its conditions are final and binding unless you ask for a hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water Act. if you
have any questions, please telephone John Dorney at 919-733-9646.
Sine 13R
rrTi. Stevens -?
Attachment
cc: Corps of Engineers Raleigh Field Office
Winston-Salem DWQ Regional Office
File Copy
Central Files 000461
Division of Water Quality • Nor.-Discharge Branch
,621 Mail Service Center, Raleigh; NC 27699-1621 -elephone 919-733-1786 FAX # [phone]
An Equal Opportunity Affirmative Action Employer - 50% recyder%10% post cot isurner paper
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PAYMENT ?d??T r},'?%5 RC ? '
DEM ID: O ®O 4 6 1 CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #):
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
1) NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATION FOR SECTION 401 CERTIFICATION
3) COORDINATION WITH THE NC DIVISION OF COASTAL MANAGEMENT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE FIELD OFFICE
OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN (7) COPIES SHOULD BE
SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT (SEE AGENCY ADDRESSES SHEET).
PLEASE PRINT.
1. OWNERS NAME : T„ ?,,, Prince.
2. MAILING ADDRESS: Box toS4
SUBDIVISION NAME:
CITY: K2r4 2rSvjl e. STATE: _A;c ZIP CODE:-17Z85-
PROJECT LOCATION ADDRESS, INCLUDING UBDIVISIO NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE) : Ta„J?r GtTse Sub
3. TELEPHONE NUMBER (HOME) : 33lc- 0117 - 3 SS- (WORK) :
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL,
ADDRESS, PHONE NUMBER:
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP OR
AERIAL PHOTOGRAPH WITH SCALE):
COUNTY: For ss4LY
o rss,tl NEAREST TOWN OR CITY: N?-
erners+.
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ETC.)
-700 Fee' .50 of Bqs?ne.rj 77'40 -r mdet 1204 13
tlh FterrN,o- Creek
6. IMPACTED OR NEAREST STREAM/RIVER: 1_6r' ion Ml Creek C Sjn,?? ?ree?C Or1 USCS)
RIVER BASIN: la d kl^
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER
(SA), HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER SUPPLY
i
f
(WS-I OR WS-II)? YES [ ] NO [V] IF YES, EXPLAIN:
7b. IF THE PROJECT IS LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL MANAGEMENT
ARE OF ENVIRONMENTAL CONCERN (AEC)? YES [ I NO [V-11
7c. IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF COASTAL
COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION:
8a. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS PROPERTY?
YES [ ] NO [ ?] IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND ANY
ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401 CERTIFICATION):
8b. ARE ADDITIONAL PERMIT,REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE?
YES [ ] NO [\/] IF YES, DESCRIBE ANTICIPATED WORK:
9A. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND: 126. 5-9
9B. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE: .0
10A. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: EXCAVATION: 40r x gfW,le Creek = #01
FLOODING: OTHER:
DRAINAGE: TOTAL ACRES TO BE IMPACTED: 01
10B. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED, PROVIDE
DISTANCE BOTH BEFORE AND AFTER RELOCATION):
LENGTH BEFORE: !qo FT AFTER: -40 FT
WIDTH BEFORE (based on normal high water contours): g FT
WIDTH AFTER: g FT
,
AVERAGE DEPTH BEFORE: , S FT AFTER: t SFT
(2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION: PLACEMENT OF PIPE IN CHANNEL:
z- xcgi+rtIon/
CHANNEL E;;3EWA N: CONSTRUCTION OF A DAM/FLOODING:
OTHER:
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED DRAINING
TO THE POND?
WHAT IS THE EXPECTED POND SURFACE AREA?
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL EQUIPMENT
TO BE USED (ATTACH PLANS: 81-?" x 11" DRAWINGS ONLY):
on cfc.roz S S+r'ec
Dmckhoe . loader
FP
13. PURPOSE OF PROPOSED WORK: o C_0 v? hec? e Y?Dose Se ?
S?wed' ma?.tr
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS. (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS):
.SLlrA CP1.ip? jlnaIr. 1S or% 4A Q vOIIaS,Te r, -I
i're e -
e
15. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER (SHPO) (SEE
AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE
PERMIT AREA WHICH MAY BE AFFECTED BY THE PROPOSED PROJECT.
DATE CONTACTED: /A pQr ?So?r Thor,ci COE-
16. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF PUBLIC

(STATE) LAND? YES [ ] NO [,,/(IF NO, GO TO 18)
a. IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL DOCUMENT
PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT?
YES [ ] NO [ ]
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA DEPARTMENT
OF ADMINISTRATION STATE CLEARINGHOUSE? YES [ ] NO [ ]
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE STATE
CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT REGARDING COMPLIANCE WITH THE
NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE DIRECTED TO MS.
CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH CAROLINA DEPARTMENT OF
ADMINISTRATION, 116 WEST JONES STREET, RALEIGH, NORTH CAROLINA 27603-8003, TELEPHONE
[phone].
17. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF PROPOSED ACTIVITY
INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL INTO WETLANDS:
a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES AND PONDS ON THE
PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26, 29, AND 38). ALL
STREAMS (INTERMITTENT AND PERMANENT) ON THE PROPERTY MUST BE SHOWN ON THE MAP.
MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET OR 1 INCH EQUALS 100 FEET OR THEIR
EQUIVALENT.
b. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE IMPACTED BY PROJECT.
c. IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA SHEETS RELEVANT
TO THE PLACEMENT OF THE DELINEATION LINE.
d. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
e. WHAT IS LAND USE OF SURROUNDING PROPERTY?
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
q. SIGNED AND DATED BY AGENT AUTHORIZATION LETTER, IF APPLICABLE.

NOTE: WETLANDS OR WATERS OF THE U.S. MAY NOT BE IMPACTED PRIOR TO:
1) ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT, AND
2) EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF ENVIRONMENTAL MANAGEMENT
(WATER QUALITY) CERTIFICATION.
OWN 'S/AGEN 'S S NATURE
(AGENT'S SIGNATU VALID ONLY
IF AUTHORIZATIO LETTER FROM
THE OWNER IS PR VIDED (18G.))
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DATE
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Consulting Engineers
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Greensboro, NC 27409
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WE ARE SENDING YOU ? Attached ? Under separate cover via
? Shop drawings O Prints ? Plans O Samples
O Copy of letter O Change order ?
the following items:
O Specifications
COMES DATE NO. DESCRIPTION
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THESE ARE TRANSMITTED as checked below:
Zloor approval ? Approved as submitted
? For your use O Approved as noted
O As requested ? Returned for corrections
O For review and comment
O FOR BIDS DUE
REMARKS
O
O Resubmit copies for approval
? Submit copies for distribution
? Return corrected prints
19 O PRINTS RETURNED AFTER LOAN TO US
COPY TO
SIGNED:
II 6MCLOGVRCS AMU NOT As NOTao. NIMOLT MOTIIT V• AT ONC/
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Consulting Engineers
8642 W. Market Street
Suite 136
Greensboro, NC 27409
[phone]
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WE ARE SENDING YOU ? Attached ? Under separate cover via the following items:
? Shop drawings O Prints ? Plans ? Samples Q Specifications
? Copy of letter 0-Change order ?
COMES DATE- NO. DESCRIPTION
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THESE ARE TRANSMITTED as checked below:
or approval O Approved as submitted ? Resubmit copies for approval
? For your use O Approved as noted O Submit copies for distribution
? As requested O Returned for corrections O Return corrected prints
O for review and comment ?
? FOR BIDS DUE 19 O PRINTS RETURNED AFTER LOAN TO US
REMARKS
COPY TO
SIGNED:
11 InMCLOsYAe/ AKK MOT AS NOTKO. K/MOLT NOT/IT V• AT ONC¦
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