20061423 Ver 1_COMPLETE FILE_20060901

Triage Check List
Date: 9/05/06 Project Name: COArchdale Sewer Improvements
DWQ#: 06-1423
County: Randolph
Daryl Lamb, Winston-Salem Regional Office
To:
60-day processing time: 9/01/06 - 10/30/06
1 L_
From: Cyndi Karoly Telephone: [phone]
The file attached is being forwarded to you for your evaluation.
Please call if you need assistance.
? Stream length impacted
? Stream determination
Wetland determination and distance to blue-line surface waters on USFW topo maps
? Minimization/avoidance issues
? Buffer Rules (Meuse, Tar-Pamlico, Catawba, Randleman)
? Pond fill
Mitigation Ratios
? Ditching
? Are the stream and or wetland mitigation sites available and viable?
? Check drawings for accuracy
? Is the application consistent with pre-application meetings?
? Cumulative impact concern
Comments: As per our discussion regarding revision of the triage and delegation processes,
please review the attached file. Note that you are the first reviewer, so this file will need to be
reviewed for administrative as well as technical details. If you elect to place this project on hold,
please ask the applicant to provide your requested information to both the Central Office in
Raleigh as well as the Asheville Regional Office. As we discussed, this is an experimental, interim
procedure as we slowly transition to electronic applications. Please apprise me of any
complications you encounter, whether related to workload, processing times, or lack of a "second
reviewer" as the triage process in Central had previously provided. Also, if you think of ways to
improve this process, especially so that we can plan for the electronic applications, let me know.
Thanks!
/?E' Inc.
Charles J. Jones. IT & PI.S
Daniel W. Pritchett. IT & PLS
.IAMESTOWN ENGINEERING GROUP, INC.
CIVIL • SANITARY • SURVEYING
117 Gast Main Street • P.O. Box 365 • Jamestown, N.C. 27282
Telephone [phone] Fax [phone]
Email:.IE(.IN('Ca)AOI..('OM
20061423
Division of Water Quality
Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Dear Sir or Madam:
August 31, 2006
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9
Re: Sewer Improvements
United Furniture Industries
And Carraway Creek Area
City of Archdale
Randolph County, NC
404/401 PCN
JEG Job No. 06054
UMTE_
Copy, 2.3
With regards to the referenced site, and on behalf of The City of
Archdale, we have enclosed two (2) courtesy copies of the Pre-
Construction Notification Application for Nationwide Permit 12 for
your review. The project involves sewer outfall and force main
installations crossing Carraway Creek. We have attached copies of
the USES Topography Map for this area, an overall impact map, a
vicinity map, half-scale plan/profile drawings of the impact areas,
approval letter for the E.A., and enlarged specific impact maps.
Wetland delineation surveys were performed by Wetland and Natural
Resource Consultants, Inc.
Any questions regarding the stream or wetland delineations should
be directed to Mr. Chris Huysman at Wetland and Natural Resource
Consultants, Inc., [phone].
If there are any questions or additional information required,
please call.
Yours very truly,
JAMESTOWN ENGINEERING GROUP, INC.
E & PLS
6aniel tt, P
DWP/cp
Enclosures
Cc: Mr. Gary Parker, City Manager
Mr. Chris Huysman
lame. 13. Ste cil" ITS • Rich Glo ci. FIT • lamrs D. Terrell. PL S

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Pre-Construction Notification (PCN) Application Form
QG
f ?
For Section 404 and/or Section 10 Nationwide, Regional and General Permits, Section 401
General Water Quality Certifications, and Riparian Buffer and Watershed Buffer Rules
This form is to be used for projects qualifying for any of the U.S. Army Corps of Engineers' (USACE)
Nationwide, Regional or General Permits as required by Section 404 of the Clean Water Act and/or
Section 10 of the Rivers and Harbors Act, and for the North Carolina Division of Water Quality's
(DWQ) associated General 401 Water Quality Certifications. This form is also to be used for any
project requiring approval under any Riparian Buffer Rules implemented by the N.C. Division of Water
Quality. This form should not be used if you are requesting an Individual 404 Permit or Individual 401
Water Quality Certification. The USACE Individual Permit application form is available online at
http://www.saw.usace.at-niy.miI/wetlands/Penn app.htm.
The USACE is the lead regulatory agency. To review the requirements for the use of Nationwide,
Regional or General permits, and to determine which permit applies to your project, please go to the
USACE website at http://www.saw.usace.army.mil/wetlands/regtour.litin, or contact one of the field
offices listed on page 3 of this application. The website also lists the responsible project manager for
each county in North Carolina and provides additional information regarding the identification and
regulation of wetlands and waters of the U.S.
The DWQ issues a corresponding Certification (General or Individual), and cannot tell the applicant
which 401 Certification will apply until the 404 Permit type has been determined by the USACE.
Applicants are encouraged to visit DWQ's 401/Wetlands Unit website at
http://h2o.enr.state.nc.us/ncwetlands to read about current requirements for the 401 Water Quality
Certification Program and to determine whether or not Riparian Buffer Rules are applicable. The
applicant is also advised to read the full text of the General Certification (GC) matching the specific 404
Permit requested. In some cases, written approval for General Certifications is not required, provided
that the applicant adheres to all conditions of the GC. Applicants lacking access to the Internet should
contact DWQ's Central Office in Raleigh at [phone].
Trout Waters Coordination - Special coordination with the North Carolina Wildlife Resources
Commission (NCWRC) is required for projects occurring in any of North Carolina's twenty-five
counties that contain trout waters. In such cases, the applicant should contact the appropriate NCWRC
regional coordinator (listed by county on page 4 of this application).
Page 1 of 12
Coastal Area Management Act (LAMA) Coordination - If the project occurs in any of North Carolina's
twenty coastal counties (listed on page 4) the applicant should contact the North Carolina Division of
Coastal Management (DCM). DCM will determine whether or not the project is within a designated
Area of Environmental Concern, in which case DCM will act as the lead permitting agency. In such
eases, DCM will require a CAMA Permit and will coordinate the 404/401 Permits.
The applicant may also choose to coordinate with the United States Fish and Wildlife Service to ensure
that the proposed project will have no impact upon any endangered or threatened species or critical
habitat as regulated by the Endangered Species Act, and the State Historic Preservation Office, North
Carolina Department of Cultural Resources to ensure that the proposed project will have no impact upon
any properties listed or eligible for listing on the National Register of Historic Places. Compliance with
these regulations is required to be eligible for any Department of the Army permit. The addresses for
both agencies are listed on page 3 of this application.
USACE Permits - Submit one copy of this form, along with supporting narratives, maps, data forms,
photos, etc. to the applicable USACE Regulatory Field Office. Upon receipt of an application, the
USACE will determine if the application is complete as soon as possible, not to exceed 30 days. This
PCN form is designed for the convenience of the applicant to address information needs for all USACE
Nationwide, Regional or General permits, as well as information required for State authorizations,
certifications, and coordination. Fully providing the information requested on this form will result in a
complete application for any of the USACE Nationwide, Regional or General permits. To review the
minimum amount of information that must be provided for a complete PCN for each USACE
Nationwide permit, see Condition 13, 65 Fed. Reg. 12893 (March 9, 2000), available at
],ittp://www.saw.usace.army.miI/wet]ands/nwpfinalFedReg.pdf. Processing times vary by permit and
begin once the application has been determined to be complete. Please contact the appropriate
regulatory field office for specific answers to permit processing periods.
401 Water Quality Certification or Buffer Rules - All information is required unless otherwise stated
as optional. Incomplete applications will be returned. Submit seven collated copies of all USACE
Permit materials to the Division of Water Quality, 401/Wetlands Unit, 1650 Mail Service Center,
Raleigh, NC, 27699-1650. If written approval is required or specifically requested for a 401
Certification, then a non-refundable application fee is required. In brief, if project impacts include less
than one acre of cumulative wetland/water impacts and less than 150 feet cumulative impacts to
streams, then a fee of $200 is required. If either of these thresholds is exceeded, then a fee of $475 is
required. A check made out to the North Carolina Division of Water Quality, with the specific name of
the project or applicant identified, should be stapled to the front of the application package. For more
information, see the DWQ website at littp://li2o.ehnr.state.nc.us/ncwctIands/fces.litin1. The fee must be
attached with the application unless the applicant is a federal agency in which case the check may be
issued from a separate office. In such cases, the project must be identifiable on the U.S. Treasury check
so that it can be credited to the appropriate project. If written approval is sought solely for Buffer Rules,
the application fee does not apply, and the applicant should clearly state (in a cover letter) that only
Buffer Rule approval is sought in writing. Wetlands or waters of the U.S. may not be impacted prior to
issuance or waiver of a Section 401 Water Quality Certification. Upon receipt of a complete application
for a 401 Certification, the Division of Water Quality has 60 days to prepare a written response to the
applicant. This may include a 401 Certification, an on-hold letter pending receipt of additional
requested information, or denial.
Page 2 of 12
US Army Corps Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Caldwell Haywood McDowell Swain
US Army Corps of Engineers Alleghany Catawba Henderson Mecklenburg Transylvania
151 Patton Avenue Ashe Cherokee Iredell Mitchell Union
Room 208 Avery Clay Jackson Polk Watauga
Asheville, NC 28801-5006 Buncombe Cleveland Lincoln Rowan Yancey
Telephone: [phone] Burke Gaston Macon Rutherford
Fax: [phone] Cabarrus Graham Madison Stanley
Raleigh Regulatory Field Office Alamance Franklin Nash Surry
US Army Corps Of Engineers Caswell Forsyth Northampton Vance
6508 Falls of the Neuse Road Chatham Granville Orange Wake
Suite 120 Davidson Guilford Person Warren
Raleigh, NC 27615 Davie Halifax Randolph Wilkes
Telephone: [phone] Durham Johnston Rockingham Wilson
Fax: [phone] Edgecombe Lee Stokes Yadkin
Washington Regulatory Field Office Beaufort Currituck Jones Pitt
US Army Corps Of Engineers Bertie Dare Lenoir Tyrrell
Post Office Box 1000 Camden Gates Martin Washington
Washington, NC 27889-1000 Carteret* Green Pamlico Wayne
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perquimans *Croatan National Forest Only
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pender
Post Office Box 1890 Brunswick Hoke Richmond
Wilmington, NC 28402-1890 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Fax: [phone] Cumberland New Hanover Scotland
North Carolina State Agencies
Division of Water Quality Division of Water Quality State Historic Preservation Office
401 Wetlands Unit Wetlands Restoration Program Department Of Cultural Resources
1650 Mail Service Center 1619 Mail Service Center 4617 Mail Service Center
Raleigh, NC 27699-1650 Raleigh, NC 27699-1619 Raleigh, NC 27699-4617
Telephone: [phone] Telephone: [phone] Telephone: [phone]
Fax: [phone] Fax: [phone] Fax: [phone]
US Fis
US Fish and Wildlife Service
Raleigh Field Office
Post Office Box 33726
Raleigh, NC 27636-3726
Telephone: [phone]
h and Wildlife Service / National N
US Fish and Wildlife Service
Asheville Field Office
160 Zillicoa Street
Asheville, NC 28801
Telephone: [phone]
[arine Fisheries Service
National Marine Fisheries Service
Habitat Conservation Division
Pivers Island
Beaufort, NC 28516
Telephone: [phone]
Page 3 of 12
CAMA and NC Coastal Counties
Division of Coastal Management Beaufort Chowan Hertford Pasquotank
1638 Mail Service Center Bertie Craven Hyde Pender
Raleigh, NC 27699-1638 Brunswick Currituck New Hanover Perquimans
Telephone: [phone] Camden Dare Onslow Tyrrell
Fax: [phone] Carteret Gates Pamlico Washington
NCWRC and NC Trout Counties
Western Piedmont Region Coordinator Alleghany Caldwell Watauga
3855 Idlewild Road Ashe Mitchell Wilkes
Kemersville, NC 27284-9180 Avery Stokes
Telephone: [phone] Burke Surry
Mountain Region Coordinator Buncombe Henderson Polk
20830 Great Smoky Mtn. Expressway Cherokee Jackson Rutherford
Waynesville, NC 28786 Clay Macon Swain
Telephone: [phone] Graham Madison Transylvania
Fax: [phone] Haywood McDowell Yancey
APPLICATION FORM BEGINS ON PAGE 5. PLEASE DO NOT SUBMIT PAGES 1 - 4.
Page 4 of 12
Office Use Only: Form Version February 2002
USACE Action ID No. DWQ No. 20061423
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
1. Processing U ? ( OW ? D
l5
1. Check all of the approval(s) requested for this project:
® Section 404 Permit jLP 2006
? Section 10 Permit DENR-WATER QUALITY
® 401 Water Quality Certification WETLANDS ANDSTORMWATERBRANCH
? Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested: NWP 12
3. If this notification is solely a courtesy coisi Wm&yproval for the 401 Certification
is not required, check here:
COPY
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here: ?
II. Applicant Information
1. Owner/Applicant Information
Name: City of Archdale
Mailing Address: P.O. Box 14068
Archdale NC 27263
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: gparker(a)archdale-nc.gov
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory authority for the owner/applicant.)
Name: Daniel W. Pritchett P.E.
Company Affiliation: Jamestown Engineering Group, Inc.
Mailing Address: P.O. Box 365, 117 E. Main Street
Jamestown NC 27282
Telephone Number: [phone] Fax Number: [phone]
E-mail Address dan(a)iamestownen ing eering.com
Page 5 of 12
III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: city of Archdale - Sewer Improvements -Southern Growth Area-United Furniture
Industries- Contract 05-054
2. T.I.P. Project Number or State Project Number (NCDOT Only): N/A
3. Property Identification Number (Tax PIN): Parcel Numbers: 7727429149, 7727518642, 7727638444,
7727532375,7727327425,7727324532,7727244993
4. Location
County: Randolph Nearest Town: Archdale
Subdivision name (include phase/lot number): N/A - Archdale Sewer Improvements
Directions to site (include road numbers, landmarks, etc.): Take I-85 (Bypass) south from
Greensboro. Take NC 311 exit for Archdale. Make left turn onto Hwy 311 1.5 miles to Tom Hill Road. (See
detailed project area map attached for project limits.)
5. Site coordinates, if available (UTM or Lat/Long): Approximately from N35°52.49' W79°55.52',
N35°52.12' W79°55.63', N35°52.17' W79°56.04', N35°52.42' W79°56.23', N35°53.00' W79°56.22',
N35°53.40' W79°56.12', N35°53.45' W79°56.16', N35°53.35' W79°56.29', (Note - If project is linear, such as
a road or utility line, attach a sheet that separately lists the coordinates for each crossing of a distinct
waterbody.)
6. Describe the existing land use or condition of the site at the time of this application:
Sites exist within wooded, and pasture areas, and roadway shoulders.
7. Property size (acres): 7.8 Acres +/- (total area for construction & permanent easements along Caraway
Creek and road rights-of-way.
8. Nearest body of water (stream/river/sound/ocean/lake): Caraway Creek
9. River Basin: Yadkin River
Page 6 of 12
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/adniin/maps/.)
10. Describe the purpose of the proposed work: To extend public sewer service for Cif of Archdale to
United Furniture Industries and residents in the area.
11. List the type of equipment to be used to construct the project: Bulldozer, Trackhoe, Loader,
Timber clearing equipment
12. Describe the land use in the vicinity of this project: Primarily undeveloped tracts of land
with some industrial and residential users.
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
None Requested
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.
None Anticipated
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
Page 7 of 12
Provide a brief written description of the proposed impacts: Sewer outfall extension to the United
Furniture Industries site will impact 75 linear feet of streams.
1. Individually list wetland impacts below:
Wetland Impact
Site Number
(indicate on map)
Type of Impact* Area of
Impact
(acres) Located within
100-ear
Floodplain**
es/no
Distance to Nearest
Stream (linear feet)
Type of Wetland***
N/A

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at htip://www.f'ema,? .
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated) of all existing wetlands on the property: N/A
Total area of wetland impact proposed: N/A
2. Individually list all intermittent and perennial stream impacts below:
Stream Impact Length of Average Width Perennial or
Site Number Type of Impact* Impact Stream Name** of Stream Intermittent?
indicate on ma linear feet Before Impact leasespecify)
S-1 Temp. Stream 25' Caraway Creek 20' ± Perennial
Crossing
S-2 Temp. Stream 25' Tributary to Caraway 61 ± Perennial
Crossing Creek
S-3 Temp. Stream 25' Tributary to Caraway 30' + Perennial
Crossing Creek

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.usgs.gov. Several intemet sites also allow direct download and printing of USGS maps (e.g., ??w%topomne.com,
www.niapquest.coni, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 75' ±
Page 8 of 12
Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below: N/A
Open Water Impact
Site Number
(indicate on ma)
Type of Impact* Area of
Impact
(acres) Name Waterbody
)
(if applicable) Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean, etc.)
N/A

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
4. Pond Creation (N/A)
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): N/A
Size of watershed draining to pond: N/A Expected pond surface area: N/A
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts. The purpose of the sewer outfall
installation is to extend sewer service to United Furniture_ Industries, allowing the current wound absorption sytem
to be abandoned Soils within the area are not conducive to ground absorption systems. The proposed outfall
location was chosen because it will have reduced impacts to the adjacent streams. The outfall following the
Caraway Creek is located on the east side of the creek to eliminate additional stream crossings in the future.
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
Page 9 of 12
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http://h2o.enr.state.nc.us/ncwetlands/strmgide.litml.
Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP) with the NCWRP's written agreement. Check the box indicating that
you would like to pay into the NCWRP. Please note that payment into the NCWRP must be
reviewed and approved before it can be used to satisfy mitigation requirements. Applicants
will be notified early in the review process by the 401/Wetlands Unit if payment into the
NCWRP is available as an option. For additional information regarding the application
process for the NCWRP, check the NCWRP website at http://h20.enr.state. nc.LIS!Wrp%indmlitm. If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following information:
Amount of stream mitigation requested (linear feet): N/A
Amount of buffer mitigation requested (square feet): N/A
Amount of Riparian wetland mitigation requested (acres): N/A
Amount of Non-riparian wetland mitigation requested (acres): N/A
Amount of Coastal wetland mitigation requested (acres): N/A
IX. Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public (federal/state) funds or the use of public
(federal/state) land?
Yes N No ?
Page 10 of 12
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ® No ?
X.
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ® No ?
Proposed Impacts on Riparian and Watershed Buffers (DWQ Only)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ? No ® If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet) Multiplier Required
Mitigation
1 N/A N/A
2 N/A N/A
Total N/A N/A
* Zone I extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
XI.
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 213.0242 or.0260. N/A
Stormwater (DWQ Only)
Page 11 of 12
0811612005 09:11 33688b5478 JAMESTOWNENGINEERING PAGE 05/05
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
XII. Sewage Disposal (DWQ Only)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
Wastewater will be treated by the City of Hight Point Municipal Treatment Facilities
XIII. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Suffer Rules?
Yes ? No
Is this an after-the-fact permit application?
Yes [a No
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application. sufficiently .in advance of desired
construction dates to allow processing tune for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
Applicant/Agen
(Agent's signature is valid only,

r( G - to
p/Signahxre Date
an authorization. letter from the applicant is provided.)
Pagc 12 of 12
IMPACT S-3
FOR
SEWER SYSTEM IMPROVEMENTS
8" SEWER FORCE MAIN
TO SERVICE
UNITED FURNITURE INDUSTRIES
CITY OF ARCHDALE
RANDOLPH COUNTY, NORTH CAROLINA
AUGUST, 2006
OWNER: JOB No. 2006-054
CITY OF ARCHDALE
P.O. BOX 14068
40' 30' 20'
10' 0 40' 80'
ARCHDALE, NC 27263
[phone]
SCALE: 1"=40'
--------------
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IMPACT S-1
FOR
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10" SEWER OUTFALL
TO SERVICE
UNITED FURNITURE IINNDUSTRIES
CITY OF AR D
RANDOLPH COUNTY, NORTH CAROLINA
AUGUST, 2006
JOB No. 2006-054
OWNER: 40• 80'
CITY OF ARCHDALE 40' 30' 20' 10' 0
p.0. BOX 14068
ARCHDALE, NC 27263 40?
[phone] SCALE. 1"_
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MH" OF-11
UNITED FURNITURE
INDUSTRIES
SITE
IMPACT S-2
SEWER SYSTEM FOR IMPROVEMENTS
10" SEWER OUTFALL
TO SERVICE
UNITED FURNITURE INDUSTRIES
CITY OF ARCHDALE
RANDOLPH COUNTY, NORTH CAROLINA
AUGUST, 2006
JOB No. 2006-054
OWNER:
CITY OF ARCHDALE 40' 30' 40' 10' 0 40' 80'
P.O. BOX 14068
ARCHDALE, NC 27263
[phone] SCALE: 1"=40'
? ' X20
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North Carolina
Department of Administration
Michael F. Easley, Governor Britt Cobb, Secretary
June 9, 2006
Mr. George Sherr ill
NC Department of Commerce
Commercial Financial Center
4318 Mail Service Center
Raleigh, NC 27699-4313
Dear Mr. Sherrill:
Re: SCH File # 06-E-4600-0324; CDBG-ED; sewer extension along Old Glenola Road to United
Furniture Industries in the City of Archdale consists: 2,250 FL of 10' gravity influent sewer
lines, one pumping station, and 8,000 LF of 8' sewerage force main
The above referenced environmental impact information has been submitted to the State Clearinghouse
under the provisions of the National Environmental Policy Act. According to G.S. I I3A-10, when a
state agency is required to prepare an environmental document under the provisions of federal law, the
environmental document meets the provisions of the State Environmental Policy Act. Attached to this
letter for your consideration are the comments made by agencies in the course of this review.
If any further environmental review documents are prepared for this project, they should be forwarded to
this office for intergovernmental review.
Should you have any questions, please do not hesitate to call.
Sincerely,
Gk / ? 4P ? /?1&7
Ms. Chrys Baggett
Environmental Policy Act Coordinator
Attachments
cc: Region G
V. Stephen Player, The Wooten Company
Mailing Address: Telephone: [phone] Location Address:
1301 Mail Service Center Fax [phone] West Jones Street
Raleigh, NC 27699-1301 State Courier #51-01-00 Raleiah, Norch Carolina
e-marl Chrys.Baggett@)ncmail.net
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