19941165 Ver 1_COMPLETE FILE_19941222

State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Environmental Management
James B. Hunt, Jr., Governor
Jonathan B, Howes, Secretary
A. Preston Howard, Jr., P.E., Director
[D FE F1
December 27, 1994
Forsyth County
DEM Project # 941165
APPROVAL of 401 Water Quality Certification
City of Winston-Salem
Public Works/Engineering Division
P.O. Box 2511
Winston-Salem, N.C. 27102
FIL ?w
Dcar Sirs:
You have our approval to place fill material in .03 acres of wetlands or waters for the purpose of
sewer line construction at NC Highway 65, as you described in your application dated 21 December
1994. After reviewing your application, we have decided that this fill is covered by General Water
Quality Certification Number 2664. This certification allows you to use Nationwide Permit Number 12
when it is issued by the Corps of Engineers.
This approval is only valid for the purpose and design that you described in your application. If
you change your project, you must notify us and you may be required to send us a new application.
For this approval to be valid, you must follow the conditions listed in the attached certification. In
addition, you should get any other federal, state or local permits before you go ahead with your
project.
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory
hearing. You must act within 30 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. 27611-7447. This certification and
its conditions are final and binding unless you ask for a hearing.
This letter completes the review of the Division of Environmental Management under Section 401
of the Clean Water Act. If you have any questions, please telephone John Dorney at 919-733-1786.
Sincerell
P eston Howard, Jr. P
Attachment
cc: Wilmington District Corps of Engineers
Corps of Engineers Raleigh Field Office
Winston-Salem DEM Regional Office
Mr. John Domey
Central Files
941165.1tr
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal opportunity Affirmative Action Employer 50% recycled/ 10% post-consumer paper
DEM ACTION ID:
Nation ride Permit Requested (Provide Nationwide Permit #): NWP12
JOINT FORM FOR
Nationwide permits that require notification to the Corps of Engineers
Nationwide permits that require application for Section 401 certification
WILMINGTON DISTRICT ENGINEER
CORPS OF ENGINEERS
DEPARTMENT OF THE ARMY
P.O. Box 1890
Wilmington, NC 28402-1890
ATTN: CESAW CO-E
Telephone [phone]
WATER QUALITY PLANNING
DIVISION OF ENVIRONMENTAL MANAGEMENT
NC DEPARTMENT OF ENVIRONMErt7TH, -RN
AND NATURAL RESOURCES
P.O. Box 29535
Raleigh, NC 27626-0535 )/
ATTN: MR JOHN DORNEY
Telephone [phone]
ONE (1) COPY OF THIS COMPLETED APPLICATION SHOULD BE SENT TO THE %SAPS OF ENGINEERS.
SEVEN (7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT.
PLEASE PRINT.
1. Owners Name: City of Winston-Salem
2. Owners Address: Public Works/Engineering Div. P.O. Box 2511, Winston-Salem, NC 27102
3. Owners Phone Number (Home): 910/727-2141 (Work):
4. If Applicable: Agent's name or responsible corporate official, address, phone number.
N/A
5. Location of work (MUST ATTACH MAP). County:
Forsyth
Nearest Town or City: Bethania (Wins -nn-Sal ern)
Specific Location (Include road numbers, landmarks, etc.): Along NC HW 65 @ Muddy Creek between
Bethania Road (SR 1688) and North Causeway Drive
6. Name of Closest Stream/River. Muddy Creek
7. River Basin: Yadkin
8. Is this project located in a watershed classified as Trout, SA, HQW, ORW, WS I, or WS II? YES [ ] NO [A
9. Have any Section 404 permits been previously requested for use on this property? YES [ ] NO [A
If yes, explain. .08 Acres
10. Estimated total number of acres of waters of the U.S., including wetlan ds, located on project site: 3,500 scr. ft.
11. Number of acres of waters of the U.S., including wetlands, impacted by the proposed project:
Filled:
Drained:
Flooded:
Excavated: • 03

Total Impacted: .03 Acres
12. Description of proposed work (Attach PLANS-8 1/2" X 11" drawings only): Installation of 8"
V.C. & D.I. Pipe Sanitary Sewer .Lines.
13. Purpose of proposed work: Provide sanitary sewer service to the town of Bethania and
areas along NC HW 65.
14. State reasons why the applicant believes that this activity must be carried out in wetlands. Also, note measures
taken to minimize wetland impacts. The Proposed sewer line must cross wetlands to tie to an
existing interceptor. Erosion & sediment control practices will be installed
-and maintain-a as recpiir 4 by. DEU=
15. You are required to contact the U.S. Fish and Wildlife Service (USFWS) and/or National'Marine Fisheries Service
(NMFS) regarding the presence or any Federally listed or proposed for listing endangered or threatened species or critical
habitat in the permit area that may be affected by the proposed project. Have you done so? YES[ ] NO ( )q
RESPONSES FROM THE USFWS AND/OR NMFS SHOULD BE FORWARDED TO CORPS.
16. You are required to contact the State Historic Preservation Officer (SHPO) regarding the presence of histo
properties in the permit area which may be affected by the proposed project? Have you done so? YES [ 1 NO []
RESPONSE FROM THE SHPO SHOULD BE FORWARDED TO CORPS.
17. Additional information required by; DEM:
A. Wetland delineation map showing all wetlands, streams, and lakes on the property.
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. If a stormwater management plan is required for this project, attach copy. N/A
E. What is land use of surrounding property? Commercial and residential development
F. If applicable, what is proposed method of sewage disposal? This -project provides sewage disT)osal
to existing buildings.
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