20010651 Ver 1_Complete File_20010427

OF WA TER Michael F_ Easley
\O? QC_ Governor
r William G. Ross, Jr., Secretary
j Department of Environment and Natural Resources
O Kerr T. Stevens
Division of Water Quality
April 30, 2001
Guilford County
DWQ Project No. 01651
Replacement of Pipe under SR 1128 (Winford Road)
APPROVAL of 401 Water Quality Certification with Additional Conditions
Mr. S.L. Hall, District Engineer
NCDOT District 2, Division 7
1584 Yanceyville Street
Greensboro, NC 27415
Dear Mr. Hall:
You have our approval, in accordance with the attached conditions and those listed below, to temporarily impact 40 linear
feet and permanently impact 30 linear of Hickory Creek for the purpose of replacing a 30-foot long 48" reinforced
concrete pipe under SR 1128 (Winford Road) in Guilford County. The project should be constructed in accordance with
your application dated 19 April 2001 (received 27 April 2001). After reviewing your application, we have decided that
this project is covered by General Water Quality Certification Number 3289. This certification corresponds to Regional
(General) Permit Number 198200031 issued by the Corps of Engineers. In addition, you should acquire any other federal,
state or local permits before you proceed with your project including (but not limited to) Sediment and Erosion Control,
Non-Discharge and Water Supply Watershed regulations. This approval will expire with the accompanying §404 permit,
unless otherwise specified in the Water Quality Certification. The following additional conditions will be required:
1. Stormwater should be directed to buffer areas or retention basins and should not be routed directly into streams.
2. Sediment and erosion control measures shall adhere to design standards for sensitive watersheds (15A NCAC 413
.0024) prior to any ground-disturbing activities to minimize impacts to downstream aquatic resources. Temporary or
permanent herbaceous vegetation should be planted on all bare soil within 15 days of ground-disturbing activities to
provide long term erosion control.
3. The culvert required for this project shall be installed in such a manner that the original stream profile is not altered
(i.e. the depth of the channel should not be reduced by a widening of the streambed).
4. All work shall be performed during low flow conditions.
5. All mechanized equipment operated near surface waters should be regularly inspected and maintained to prevent
contamination of stream waters from fuels, lubricants, hydraulic fluids, or other toxic materials.
6. The presence of equipment in the channels must be minimized. Under no circumstances should rock, sand or other
materials be dredged from the wetted stream channel under authori zation-of this permit, except in. the immediate
vicinity. of the culverts.
7. Mowing of existing vegetated buffers is strongly discouraged, so that they may be utilized for storm water sheet flow.
8. Use of rip-rap for bank stabilization is to be minimized; rather, native vegetation is to be planted when practical. If
necessary, rip-rap should be limited to the stream bank below'the high water mark, and vegetation should be used for
stabilization above high water.
9. Rock silt screens at culvert outlets should be removed at project completion.
This approval is valid solely for the purpose and design described in your application (unless modified below). Should t
your project change, you must notify the DWQ and submit 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 the conditions.
If the proposed fill is in excess of 150 linear feet of stream length or 1 acre of wetlands, compensatory mitigation will
North Carolina Division of Water Quality, 401 Wetlands Certification Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
919-733-1786 (phone), 919-733-6893 (fax), http://h2o.enr.state.nc.us/ncwetlands/
Page 2 of 2
required as described in 15A NCAC 2H .0506 (h) (6) and (7). For this approval to be valid, you must follow the
conditions listed in the attached certification and any additional conditions listed above.
If you do not accept any of the conditions of this certification, you may ask for an adjudicator y hearing. You must act
within 60 days of the date that you receive this letter. To ask for a hearing, send a written petition that conforms to
Chapter 150B of the North Carolina General Statutes to the Office of Administrative Hearings, 6714 Mail Service Center,
Raleigh, N.C. 27699-6714. 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.
Sincerely,
Attachment

Pc: Wilmington District Corps of Engineers
Corps of Engineers Raleigh Field Office
NCDWQ Winston-Salem Regional Office
Central Files

?? 3
401 ISSUED
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY 1584 YANCEYVILLE STREET, GREENSBORO, NC 27415 LYNDO TIPPETT
GOVERNOR SECRETARY
April 19, 2001
NC DENR Division of Water Quality
1650 Mail Service Center ®1®V
Raleigh, NC 27699
ATTN: Ms. Cynthia Van der Wiele
Wetlands/401 Unit
Dear Ms. Van Der Wiele:
SUBJECT: Guilford County, Replacement of one line of 30-feet long 48-inch Reinforced
Concrete Pipe (RCP) under Winford Road (SR 1128).
Please find seven (7) copies a Pre-Construction Notification Application package attached for you
review. If you have any questions or need any additional information, please contact Len Smith
[phone] or Paul Ingram at [phone]. Thank you for your time and assistance.
Sincerely,
S. L. Hall
District Engineer, District 2, Division 7
cc: Mr. Eric Alsmeyer, USACE
Mr. Lenwood Smith, 11, PWS, NCDOT

PHONE [phone] FAX [phone]
L

STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY
GOVERNOR
April 19, 2001
U.S. Army Corps of Engineers
Regulatory Field Office
6508 Falls of the Neuse Road, Suite 105
Raleigh, North Carolina 27615
ATTN: Mr. Eric Alsmeyer..
NCDOT Coordinator
Dear Mr. Alsmeyer:
LYNDO TIPPETT
SECRETARY
SUBJECT: Guilford County, Replacement of one line.of 30-feet long 48-inch Reinforced
Concrete Pipe (RCP) under Winford Road (SR 1128).
The North Carolina Department of Transportation (NCDOT) proposes to one (1) line of 30-feet long
48-inch RCP with one (1) line of 73 by 55-inch Corrugated Metal Pipe Arch 60-feet long as part of
secondary road improvement. The existing travel lane and shoulders must be widened to increase
safety and flow. The pipe will be buried at least one foot below streambed to facilitate aquatic life
movement. No Wetlands, High Quality Waters, or Outstanding Resource Waters occur in the
project area. Records from the NCDOT Historic Architect indicate compliance with the National
Historic Preservation Act.
The NCDOT anticipates that this activity will be authorized under General Permit 198200031.
Enclosed please find the project site map and the pre-construction notification form for the above
referenced projects. By copy of this letter we are also requesting a General Water Quality
Certification #3289 from the NC Division of Water Quality. Construction is anticipated to begin in
December and take five weeks to complete.
P. O. Box 14996 Greensboro, NC 27415-4996 Telephone [phone]
Fax No. [phone]

April 19, 2001
Mr. Eric Alsmeyer, USACE
Page 2
If you have any questions or need any additional information, please contact Len Smith (336) 375-
5589 or Paul Ingram at [phone]. Thank you for your time and assistance.
Sincerely,
?L?allj?
S. L. Hall
District Engineer, District 2, Division 7
cc: Ms. Cynthia Van der Wiele, NCDWQ
Mr. Lenwood Smith, II, PWS, NCDOT
P. 0. Box 14996 Greensboro, NC 27415-4996 Telephone [phone] Fax No. [phone]
Y
31
C-3
Pre-Construction Notification (PCN) Application Form
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.army.mil/wetlands/Perm 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 littp://www.saw.uszice.army.mil/wetl.ands/regtour.htm, or contact one of the field
offices listed at the end 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 some 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 also 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 the last page of this application).
Page 1 of 12
CAMA Coordination - If the project occurs in any of North Carolina's twenty coastal counties (listed on
the last page of this application) the applicant should also contact the North Carolina Division of Coastal
Management (DCM) at [phone]. DCM will determine whether or not the project involves a
designated Area of Environmental Concern, in which case DCM will act as the lead permitting agency.
In such cases, DCM will require a Coastal Area Management Act (LAMA) Permit and will coordinate
the 404/401 Permits.
USACE Permits - Submit one copy of this form, along with supporting narratives, maps, data forms,
photos, etc. to the applicable USACE Regulatory Field Office (addresses are listed at the end of this
application). 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 httT)://www.saw.usice.army.mil/wetlands/nw-pfinalFedReg.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 htt-p://h2o.ehnr.state.nc.us/ncwetlands/fees.htm.l. 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
Office Use Only: Form Version April 2001
USACE Action ID No. DWQ No. 010651
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
I. Processing
1. Check all of the approval(s) requested for this project:
® Section 404 Permit
? Section 10 Permit
® 401 Water Quality Certification
? Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested:
31
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here:
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here: ?
H. Applicant Information
1. Owner/Applicant Information
Name: Mr. J.M. Mills PE. Division Engineer - Division 7
Mailing Address: 1584 Yancevville Street
Greensboro NC 27415
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: [e-mail]
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: Mr. S. L. Hall
Company Affiliation: NCDOT Division 7
Mailing Address:_ 1584 Yancevville Street
Greensboro NC 27415
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: [e-mail]
Page 3 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: Winford Road (SR 1128)
2. T.I.P. Project Number (NCDOT Only): 6.492731
3. Property Identification Number (Tax PIN):
4. Location
County: Guilford Nearest Town: Greensboro
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.): Approximately 1300 feet from
end of existing pavement
5. Site coordinates, if available (UTM or Lat/Long): 35° 59' 13.07" N 79° 51'49.93" W
(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:
Residential
7. Property size (acres): N/A
8. Nearest body of water (stream/river/sound/ocean/lake):_ Hickory Creek
9. River Basin: Cape Fear
Page 4 of 12
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at htti)://h2o.enr.state.nc.us/admin/maps/.)
10. Describe the purpose of the proposed work:- Upgrade of an unpaved secondary road to a
paved secondary road.
11. List the type of equipment to be used to construct the project: Road construction
equipment
12. Describe the land use in the vicinity of this project: Forested
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.
V. Future Project Plans
Are any additional permit requests anticipated for this project in the future? If so, describe the
anticipated work, and provide justification for the exclusion of this work from the current
application: N/A
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
Page 5 of 12
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.
1. Wetland Impacts
Wetland Impact
Site Number
(indicate on ma)
Type of Impact* Area of
Impact
(acres) Located within
100-year Floodplain**
(yes/no) Distance to
Nearest Stream
(linear feet)
Type of Wetland***
N/A

* List each im acts f_1 d 'd
F epara y an t enttfy 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 http://www.fema.gov.
*** 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 existing wetlands on the property: N/A
Total area of wetland impact proposed: N/A
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact
Site Number
(indicate on ma)

A
Type of Impact*

Placement of
pipe in channel Length of
Impact
(linear feet)

30(pm)
40(tmp)
Stream Name**

T to Hickory Creek Average Width
of Stream
Before Impact-

2 Feet Perennial or
Intermittent?

(please secif )

Perennial

* T : _L
LISL each Impact separately and identity 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.
Page 6 of 12
** 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.uszs.gov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.coin,
www.mapnuest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 30-permanet(pm)
40-temporary (tmp)
Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S.
Open Water Impact
Site Number

(indicate on ma)
Type of Impact* Area of
Impact

(acres)
Name p Waterbody
(if a ltcable
pp ) Type of Waterbody

(lake, pond, estuary, sound,
bay, ocean, etc.)
N/A

is eac impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
4. Pond Creation
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 F-1 stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.): N/A
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.
Expanding shoulder width in order to increase stability. Pipe will be buried one foot below
streambed elevation to facilitate aquatic life movement
Page 7 of 12
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
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
1-ittp://h2o.enr.state.iic.us/ncwetlands/str.m.2ide.html.
1. 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.
Pipe will be buried one foot below streambed elevation to facilitate aquatic life movement
Page 8 of 12
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 httn://h2o.enr.state.ne.tis/wm/index.htm. 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 funds or the use of public (federal/state/local)
land?
Yes ® No ?
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
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 ?
X. 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
Page 9 of 12
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
(Neuse), 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
feet
(square )
Multiplier
Required
Mitigation
1 3
2 1.5
Total
u? ?u? p--yuuuicuiar irom near oanx or ctnannet; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
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 2B .0242 or .0260.
N/A
XI. Stormwater (DWQ Only
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.
In accordance with February 25 1991 delegation agreement one copy of the sediment and erosion
control plan will be submitted to DENR-Division of Land Ouaility and NCDOT Roadside
Environmental prior to construction
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.
Page 10 of 12
XIII. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No ?
Is this an after-the-fact permit application?
Yes ? 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 time 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).

Z -7h ? /",.- -q- /9 - D /
Applicant/Agent's Signature Date
(Agent's signature is valid onl y if an authorization letter from the applicant is provided.)
US Army C orps Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office
US Army Corps of Engineers
151 Patton Avenue
Room 208
Asheville, NC 28801-5006
Telephone: [phone]
Fax: [phone] Alexander Cherokee Iredell Mitchell Union
Avery Clay Jackson Polk Watauga
Buncombe Cleveland Lincoln Rowan Yancey
Burke Gaston Macon Rutherford
Cabarrus Graham Madison Stanley
Caldwell Haywood McDowell Swain
Catawba Henderson Mecklenburg Transylvania
Raleigh Regulatory Field Office Alamance Durham Johnston Rockingham Wilson
US Army Corps Of Engineers Alleghany Edgecombe Lee Stokes Yadkin
6508 Falls of the Neuse Road Ashe Franklin Nash Surry
Suite 120 Caswell Forsyth Northampton Vance
Raleigh, NC 27615 Chatham Granville Orange Wake
Telephone: [phone] Davidson Guilford Person Warren
Fax: [phone] Davie Halifax Randolph Wilkes
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
Page 11 of 12
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
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]
North Carolina State Agencies
Division of Water Quality
401 Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Telephone: [phone]
Fax: [phone]
Division of Water Quality
Wetlands Restoration Program
1619 Mail Service Center
Raleigh, NC 27699-1619
Telephone: [phone]
Fax: [phone]
CAMA and NC Coastal Counties
State Historic Preservation Office
Department Of Cultural Resources
4617 Mail Service Center
Raleigh, NC 27699-4617
Telephone: [phone]
Fax: [phone]
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 Ons16w 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
Kernersville, 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
Page 12 of 12
Adjoining Property Owners
Proposed Pipe Relocation for Winford Road (SR 1127)
Lottie M. Elliott
4831 Winford Rd.
Greensboro, NC 27407
James B. & Elizabeth H. Greene
4826 Winford Rd.
Greensboro, NC 27407
Donnie Joe & Pam Saintsing
4824 Winford Rd.
Greensboro, NC 27407
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$' W ' ;t
Name: PLEASANT GARDEN
Date: 4/23/2001
Scale: 1 inch equals 2000 feet
Location: 035° 58' 22.3" N 079° 50' 67.8ii W
Caption: Location of the Proposed Pipe Replacement on Winford Road
(SR 1128)
Copyright (C) 1997, Maptech, Inc.
EROSION CONTROL PLAN
County cbcu lc?aj Route
Project 3' 4(C!5^;L, Bridge
Replacement of with f,jpG
Rip Rap sediment dam required?NO
Stilling basin required? YES:- if yea show size and location
on plans!
Excavate to remove e)(15"?+,I'j
Install silt fence as needed.
Install le 73 "y SS backf ill and contact landscape for
seeding.
COMMENTS
??c w ! E 1 %te? / u o?-?I? oa.rl` Pal o
.-?'3ZSC'?' G,i1. ?3t"!)u].rC?S TX PLi?s[?? ??UbC T/l!?Gt?r?l l ? d .
a a 12/40- i s ??t lc? P w.c w,'
/\ r ieq
Prepared by Supervisor
Contacted Roadside Environmental Encineer on
Approved by D-k 94,4? on 3 .2l _() ?

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View upstream from the pipe to be replaced.
View of the pipe outlet. Note the perching.
View downstream from the pipe to be replaced.
IF INCORRECT RETURN TO
NC DEPARTMENT OF TRANSPORTATION
3363343192
WARRANT NO. J10660
DATE 04/19/2001
INVOICE NUMBER INVOICE DATE INVOICE AMOUNT „ NET AMOUNT
0419 04/19/2001 $200.00 $200.00