20021880 Ver 1_Complete File_20021204

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December 11, 2002
Guilford County
DWQ Project No. 021880
Pipe Replacement on SR 2526 (Summit Avenue)
APPROVAL of 401 Water Quality Certification with Additional Conditions
Mr. J.M. Mills, P.E., Division Engineer
NCDOT Division 7
P.O. Box 14996
Greensboro, NC 27415
Dear Mr. Mills:
You have our approval, in accordance with the attached conditions and those listed below, to permanently
impact 30 linear feet and incur 20 linear feet of temporary impacts to an unnamed tributary to Jordan
Branch in order to replace a pipe on SR 2526 (Summit Avenue) in Guilford County. The project should
be constructed in accordance with your application dated November 27, 2002 (received December 4,
2002). After reviewing your application, we have decided that this fill is covered by General Water
Quality Certification Nos. 3366 and 3375 corresponding to the U.S. Army Corps of Engineers
Nationwide Permit Numbers 33 and 14. 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.
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, in writing, and 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, or if stream impacts exceed 150 linear feet, compensatory
mitigation may be 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 below.
1. The impacted waters are classified as Nutrient Sensitive Waters. Therefore, NCDOT shall use Best
Management Practices for the Protection of Surface Waters (NCDOT March 1997) to minimize
impacts to downstream aquatic resources. Additionally, storm water should be directed to buffer
areas, grass-lined swales or retention basins (or other appropriate means) and not be routed directly
into streams unless the applicant provides evidence that this is not practicable or feasible.
2. Stormwater should be directed to vegetated buffer areas, grass-lined ditches or retention basins and
must not be routed directly into streams. Mowing of existing vegetated buffers is strongly
discouraged, so that they may be utilized for storm water sheet flow.
3. Riparian vegetation must be reestablished within the construction limits of the project by the end of
the growing season following completion of construction.
4. The culverts shall be designed and installed to allow for fish and other wildlife movement as well as
prevent headcutting of the streams.
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
ry 4
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/ncwetiands/
5. NCDOT must submit a plan for written DWQ approval to address any headcutting that will occur as a
result of this project.
6. Use of rip-rap for bank stabilization is to be minimized; rather, native vegetation is to be planted
when practical. If rip-rap is necessary, it must be limited to the stream bank below the high water
mark, and vegetation must be used for stabilization above high water. Rip rap shall not be placed in
the stream bottom.
7. Upon completion of the project, the NCDOT shall complete and return the enclosed
"Certificate of Completion" form to notify NCDWQ when all work included in the §401
Certification has been completed. The responsible party shall complete the attached form
and return it to the 401/Wetlands Unit of the NC Division of Water Quality upon
completion of the project. Please include photographs upstream and downstream of the
structure to document correct installation.
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 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 Ms. Cynthia Van Der Wiele at 919.733.5715 or Ms.
Jennifer Frye of the Winston-Salem Regional Office at 336.771.4600.
Sincerely,
Alan W. Klimek, P.E.
Attachment
Pc: Wilmington District Corps of Engineers
John Thomas, USACE Raleigh Field Office
Jennifer Frye, NCDWQ Winston-Salem Regional Office
Central Files
File Copy

MICHAEL F. EASLEY
GOVERNOR
TA1(u fPIT
d ? 5
STATE OF NORTH CAROLINA fr
DEPARTMENT OF TRANSPORTATION
1584 YANCEYVILLE STREET, GREENSBORO, NC 27415
1 IL r f ? ? , November 27, 2002
MEMORANDUM TO: Ms. Cynthia Van der Wiele
Wetlands/401 Unit
FROM: Lane Hall /j 'Z'? &
District Engineer, District 2, ivlslon 7
LYNDO TIPPETT
SECRETARY

SUBJECT: Payment Information - Water Quality Certificate for Guilford County,
Summit Avenue (SR 2526)
In accordance with General Statute 143-215.3D(e) the following information if being provided to
facilitate payment of fees associated with the appropriate Water Quality Certificate:
• Certificates being requested: #3375 (NWP 14) and #3366 (NWP 33)
• Work Order Number : 5.4970800
• Amount of fee: $200
PAYMENT
RECEIVED
PHONE [phone] FAX [phone]
A
f sW`°"?,
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY 1584 YANCEYV= STREET, GREENSBORO, NC 27415
GOVERNOR
November 27, 2002
Mr. John Thomas
U.S. Army Corps of Engineers
Regulatory Field Office
6508 Falls of the Neuse Road, Suite 105
Raleigh, North Carolina 2761
(Two Copies)
Ms. Cynthia Van der Wiele
Wetlands/401 Unit
NC DENR Division of Water Quality
1650 Mail Service Center
Raleigh, NC 27699
(Seven Copies)
LYNDO TIPPETT
SECRETARY
SUBJECT: Guilford County, Pipe Replacement located on Summit Avenue (SR 2526)
State Project Number: 5.4970800
To Whom It May Concern:
The North Carolina Department of Transportation (NCDOT) proposes to upgrade an existing pipe
located on Summit Avenue (SR 2526). This activity will result in impacts to a stream due to the
replacement and extension of a crossline pipe. The NCDOT anticipates that the pipe replacement
activity will be authorized under Nationwide Permit (NWP) 14 and the dewatering operation will be
authorized under NWP 33. This application is intended as a request for formal written authorization
from the USACE for dewatering activities occurring under NWP 33. This application is also
intended as request for written authorization from the NC Division of Water Quality to replace the
pipe under General Water Quality Certificate # 3375 (NWP 14). The following information is being
provided to satisfy Nationwide Permit Condition 13 (Federal Register January 15, 2002) and
Condition 1 of General Water Quality Certificate # 3375.
PHONE [phone] FAX [phone]
PROJECT INFORMATION
Road Name SR Number Project Length
(miles) Classification
Summit Avenue 2526 N/A Subdivision
River Basin: DWQ
ID Water Quality
Designation % New Impervious
Surface
Cape Fear
Buffer Rules' Buffer Rule Conditions (where applicable)
No Not Applicable
Protected Species
Present Mapped Historic
Properties' CAMA
AEC Essential Fishery
Habitat
No. No No No
"Separate documentation attached as needed: ' See the attached Endangered Species Review Sheet for further
information: 'When Applicable -Seethe attached Historic Review Letter for further information
PIPE REPLACEMENT INFORMATION
Site 1 Stream Type Perennial
(Station)
Existing 36" X 36" Box Culvert Proposed 95" X 67" Arch Pipe
Pie . Length - 50' Pie Length - 60'
Construction Pump around with off-site detour Dewatering ABC aggregate
Method Device*
Burial Depth 1' E/C Plan N/A
Date
Construction As soon as practicable Duration 2 weeks
Date
Impacts (ft. 10'-enclosure; 20'-rip-rap dissipaters;20'-temporary
Special
Conditions
Restoration Within 15 working days of the of the pipe replacement all cofferdams will be
Plan entirely removed and natural stream contours will be restored and seeded.
Temporary silt screens placed in intermittent channels will be cleaned and
removed following vegetation establishment.
RCP = reinforced concrete pipe; CMP = Corrugated metal pipe; CMPA = Corrugated metal pipe arch; E/C = Erosion
control. *A less intrusive dewatering device may be used in lieu of the one proposed.
-2-
MINIMIZATION INFORMATION
Impacts will be minimized by strict enforcement of Best Management Practices for the protection of
surface waters and wetlands, restrictions against the staging of equipment in or adjacent to waters of
the US, and coordination (including a pre-construction meeting) with the Division Environmental
Officer.
MITIGATION INFORMATION
Stream mitigation is not anticipated, as the impacts to any individual stream do not exceed 150 feet
Wetland mitigation is not anticipated, as wetland impacts do not exceed 0.10 acres and do not occur
in a unique natural wetland.
APPLICATION INFORMATION
Enclosed please find the Pre-construction Notification Form and supporting documentation for the
above referenced project. If you have any questions or need any additional information, please
contact Lane Hall at [phone] or Len Smith at [phone]. Your time and effort are
appreciated.
Sincerely,
Mr. J,! Mills, P.E.
Did sion Engineer, Division 7
cc: Mr. S. Lane Hall, District 2 Engineer PM
Mr. Paul Ingram, P.E., County Maintenance Engineer, Guilford
Mr. Donald Pearson, Area Roadside Field Operations Engineer
Mr. Barry Kizziah, Bridge Maintenance Supervisor
-3-
Office Use Only: Form Version May 2002
USACE Action ID No. DWQ No.
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
I. Processing
1. Check all of the approval(s) requested for this project:
® Section 404 Permit ? Riparian or Watershed Buffer Rules
? Section 10 Permit ? Isolated Wetland Permit from DWQ
® 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: NWP 14 and 33
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 (verify availability with NCWRP prior to submittal of PCN), complete
section VIII and check here: ?
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here:' ?
H. Applicant Information
1. Owner/Applicant Information
Name: Mr. J.M. Mills, RE, Division Engineer - Division 7
Mailing Address: P.O. Box 14996
Greensboro, NC
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: [e-mail]
2. Agent/Consultant 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: Not Applicable
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
Fax Number:
Page 1 of 8
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: SR 2526 - Summit Avenue
2. T.I.P. Project Number or State Project Number (NCDOT Only): 5.4970800 (Non-TIP)
3. Property Identification Number (Tax PIN): Not Applicable
4. Location
County: Guilford Nearest Town: Greensboro
Subdivision name (include phase/lot number): Not Applicable
Directions to site (include road numbers, landmarks, etc.):
The project is north of Greensboro. The pipe is located under Summit Avenue
approximately 100' north of Yarbrough Road which is still in the city limits.
5. Site coordinates, if available (UTM or Lat/Long): See the attached USGS map.
(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. Property size (acres): Not Applicable
7. Nearest body of water (stream/river/sound/ocean/lake): UT To Jorden Branch
8. River Basin: Cape Fear
(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.ne.us/admin/maps/.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
. at the time of this application: Residential
Page 2 of 8
10. Describe the overall project in detail, including the type of equipment to be used:
The project will involve replacing the existing outdated culvert with an updated, properly
sized arched pipe. Equipment used will be standard pipe replacement equipment (trackhoe,
and backhoe).
11. Explain the purpose of the proposed work: To upgrade an existing Pipe to improve the
water flow at that location.
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.
Not Applicable
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.
Not Applicable
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 3 of 8
1. Provide a written description of the proposed impacts: Permanent stream impacts will
result from channel enclosure and placement of rip-rap energy dissipaters. Temporary stream
impacts will result from placement of cofferdams (perennial streams) and siltscreens. Silt
screens placed in intermittent channels will be cleaned and removed following vegetation
establishment.
2. Individually list wetland impacts below:
Wetland Impact
Site Number
(indicate on ma)
Type of Impact* Area of
Impact
(acres) Located within
100-year 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 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.) Indicate if wetland is isolated (determination of isolation to be made by USACE only).
List the total acreage (estimated) of all existing wetlands on the property: Not Applicable
Total area of wetland impact proposed: Not Applicable
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact
Site Number
(indicate on ma
Type of Impact* Length of
Impact
linear feet
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
(please secif

1
Pipe replacement 10'(en)
20'(tmp)
20' ( )
UT To Jorden Branch
3.0'
Perennial

* 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/straightcning, 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.usos.Qov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.topozone. com,
www.mapguest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 10'- enclosure (en),
20'- temporary (tmp), 20'- rip rap (rp)
Page 4 of 8
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Open Water Impact
Site Number
(indicate on ma)
Type of Impact* Area of
Impact
(acres
Name Wate)
(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.
5. 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 ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.): Not Applicable
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): Not Applicable
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.
Pine replacement activities are necessarv to increase travel lane and shoulder width to current
construction standards. Impacts will be minimized by strict enforcement of Best Management
Practices for the protection of wetland and surface waters, restrictions against the staging o
equipment in or adiacent to waters of the US, and coordination (including a pre-construction
meeting) with the Division Environmental Officer.
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.
Page 5 of 8
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
http://h2o.enr.state.nc.us/ncwetlands/strmgide.html.
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.
A finding of insignificant impact is anticipated; therefore, a mitigation plan is not provided.
Cumulative impacts are less than 150 feet. The maximum amount of impact to a single
stream is 30 linear feet. No Outstanding Resource Waters, federally protected species or
their habitats, or essential fishery habitats occur in the project area. The project is not located
in a High Quality Water.
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP). Please note it is the applicant's responsibility to contact the NCWRP at
[phone] to determine availability and to request written approval of mitigation prior
to submittal of a PCN. For additional information regarding the application process for the
NCWRP, check the NCWRP website at http://h2o.enr.state.nc.us/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): Not Applicable
Amount of buffer mitigation requested (square feet): Not Applicable
Amount of Riparian wetland mitigation requested (acres): Not Applicable
Amount of Non-riparian wetland mitigation requested (acres): Not Applicable
Amount of Coastal wetland mitigation requested (acres): Not Applicable
Page 6 of 8
IX.
X.
Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federal/state) funds or the use of public
(federal/state) 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
Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
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 213 .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* square Impact
( feet) Multiplier M tg fired
1 N/A 3
2 N/A 1.5
Total N/A
* Zone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
Page 7 of 8
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.
Not Applicable
XI. Stormwater (required by DWQ)
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.
Because the percent new impervious surface is less than 30% stormwater controls are not being
provided
XII. Sewage Disposal (required by DWQ)
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.
Not Applicable
XHL Violations (required by DWQ)
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).

:pplicant/Agent's Signature Date
signature is valid only if an authorization letter from the applicant is provided.)
Page 8 of 8
NCD OT
HAZARDOUS SPILL BASIN CHECKLIST
Division Seven County Guilford Project ID: 5.4970800
River Basin Cape Fear Bridge No:
Route 2526 Stream UT To Jorden Branch
Water Quality Criteria
Yes No
Stream Crossing Blueline on USGS Z ?
ORW ? Z
WSI ? Z
WS II, III, or IV Crossing Within 0.5 mi. of W.S. Critical Area ? Z
Roadway Criteria
Route Designation Yes No
Arterial Urban ? Z
Arterial Rural ? Z
Additional Site Information:
Yes
Is a Hazardous Spill Basin Required? ?
No
Z
Criteria Based Upon NCDOT "Best Management Practices for the
Protection of Surface Waters" (March, 1997).
N. C. D. 0. T.
BRIDGE MAINTENANCE UNIT
EROSION CONTROL SEQUENCE
AND CONSTRUCTION SEQUENCE
GUILFORD COUNTY
PIPE REPLACEMENT
S. R. NO.? l ?cwuc. T" AC-PROJECT NO.

DESCRIPTION: REMOVAL OF EXISTING PIPES OR PIPE AND REPLACE WITH it #'I
NEW PIPES OR PIPE C @ 2 6-A to 7
1. CONSTRUCT DAM AT UPSTREAM AND DOWNSTREAM ENDS OF PIPE
USING ABC STONE
2. SILT FENCE WILL BE INSTALLED AS NEEDED.
3. USE WATER PUMP TO DIVERT WATER FROM UPSTREAM TO
DOWNSTREAM
4. PUMP WATER OUT OF EXCAVATION AREA INTO SILT BAG AND BEGIN
EXCAVATING AREA FOR NEW PIPE
WITH RIP
5. INSTALL NEW PIPE OR PIPES, ?? ?L THESTABILIZE UPS BANKS ?? DAM
RAP AND REMOVE DOWNS
6. SEED AND MULCH AREAS NECESSARY
PREPARED BY 1 DATE
Z4F 6;9ERVISO
APPROVAL DATE U?s• Q Z
DIVISION MAINT. ENGINEER

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Name: LAKE BRANDT Location: 036' 08' 13.9" N 079° 45' 13.2" W
Date: 10/30/2002 Caption: SR 2526 Summitt Ave.
Scale: 1 inch equals 2000 feet Guilford County
Divi sion 7
97, IUeptech, Inc .