20050380 Ver 1_Complete File|_20051004

Mr. J.M. Mills, P.E.
March 11, 2005
DWQ# 05-0380
Page 4
DWQ Project No.:
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County: (J-y/C_f di2 rJ
i OA-) -771-
Applicant: 61,5 4 U T- All
Project Name: CA--,Zr-i ) A? /L /0 ?rL 2?` 5 T -- /°/?'s? /L?2?°c ?t-t,2?,.? z 4,1
Date of Issuance of 401 Water Quality Certification: /4-l 2 00-;;
Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable Buffer Rules, and any
subsequent modifications, the applicant is required to return this certificate to the 401/Wetlands Unit, North Carolina
Division of Water Quality, 1621 Mail Service Center, Raleigh, NC, 27699-1621. This form may be returned to DWQ by
the applicant, the applicant's authorized agent, or the project engineer. It is not necessary to send certificates from all of
these.
Applicant's Certification
I, ??- Yr Y?N`l\ , hereby state t?iatf. to the best of my abilities, due care and diligence was
used in the observation of the construction such that the cbrtstnwtien was observed to be built within substantial
compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans and specifications, and
other supporting materials.
Signature: 7?. Date: / 0 - ?-- p s'
Agent's Certificati
hereby state that, to the best of my abilities, due care and diligence was
used in the observation of the construction such that the construction was observed to be built within substantial
compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans and specifications, and
other support' aterial q?
I-N
Signature: Date:
Engineer's C rtification
Partial Final
I, , as a duly registered Professional Engineer in the State of North
Carolina, having been authorized to observe (periodically, weekly, full time) the construction of the project,for the
Permittee hereby state that, to the best of my abilities, due care and diligence was used in the observation of the
construction such that the construction was observed to be built within substantial compliance and intent of the 401 Water
Quality Certification and Buffer Rules, the approved plans and specifications, and other supporting materials.
Signature Registration No.
Date
W AT ?9PG
? Y
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
s,??s?•?P `SOS
0
?i
APPROVAL of 401 Water Quality Certification
Mr. J.M. Mills, P.E.
Division Engineer, Division 7
North Carolina Department of Transportation
1584 Yanceyville Street
Greensboro, North Carolina, 27415
Dear Mr. Mills:
March 11, 2005
Guilford County
DWQ Project No. 05-0380
SR 2755 (Carmon Rd)
You have our approval, in accordance with the attached conditions and those listed below, to incur the following impacts
in order to replace four (4) undersized pipes on SR 2755 (Carmon Rd) in Guilford County.
• 38 linear feet of piping impacts;
• up to 80 linear feet of rip rap for bank stabilization; and
• Temporary dewatering impacts of approximately 50 linear feet at each pipe replacement.
The project shall be constructed in accordance with your application dated February 28, 2005 (received March 2, 2005).
After reviewing your application, we have decided that this fill is covered by General Water Quality Certification Nos.
3495, 3404 and 3366, corresponding to the U.S. Army Corps of Engineers Nationwide Permit Numbers 13, 14 and 33. 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 valid solely for the purpose and design described in your application (unless modified below). Should
your project change, you must notify the Division of Water Quality (Division) and submit a new application. If the
property is sold, the new owner must be given a copy of this approval letter and certifications, and is thereby responsible
for complying with all the conditions. If total wetland fills for this project (now or in the future) exceed one acre, or if
total impacts to streams (now or in the future) exceed 150 linear feet, compensatory mitigation may be required as
described in 15A NCAC 2H .0506 (h) (6) and (7). For this approval to remain valid, you must adhere to the conditions
listed in the attached certification and any additional conditions listed below.
1. Erosion and sediment control practices must be in full compliance with all specifications governing the proper
design, installation and operation and maintenance of such Best Management Practices in order to protect surface
waters standards:
a. The erosion and sediment control measures for the project must be designed, installed, operated, and
maintained in accordance with the most recent version of the North Carolina Sediment and Erosion Control
Planning and Design Manual.
North Carolina Division of Water Quality 585 Waughtown Street
Internet: h2o.encstate.nc.us Winston-Salem, NC 27107
NorhCaro ina
Naturally
Phone [phone] Customer Service
FAX [phone]
An Equal Opportunity/Affirmative Action Employer - 50% Recycled/10% Post Consumer Paper
Mr. J.M. Mills, P.E.
March 11, 2005
DWQ# 05-0380
Page 2
b. The design, installation, operation, and maintenance of the sediment and erosion control measures mug
such that they equal, or exceed, the requirements specified in the most recent version of the North Car(
Sediment and Erosion Control Manual. The devices shall be maintained on all construction sites, boi
sites, and waste pile (spoil) projects, including contractor-owned or leased borrow pits associated wits
project.
c. For borrow pit sites, the erosion and sediment control measures must be designed, installed, operated,
maintained in accordance with the most recent version of the North Carolina Surface Mining Manual.
d. The reclamation measures and implementation must comply with the reclamation in accordance with
requirements of the Sedimentation Pollution Control Act.
2. No waste, spoil, solids, or fill of any kind shall occur in wetlands, waters, or riparian areas beyond the footprr
the impacts depicted in the Preconstruction Notice Application. All construction activities, including the de;
installation, operation, and maintenance of sediment and erosion control Best Management Practices, shad
performed so that no violations of state water quality standards, statutes, or rules occur.
3. Sediment and erosion control measures shall not be placed in wetlands or waters to the maximum ea
practicable. If placement of sediment and erosion control devices in wetlands and waters is unavoidable,
shall be removed and the natural grade restored within six months of the completion of the project.
4. Riparian vegetation must be reestablished within the construction limits of the project by the end of the gro,
season following completion of construction.
5. Stormwater should be directed to vegetated buffer areas, grass lined ditches or other means appropriate to the
for the purpose of pre-treating stormwater runoff, and must not be routed directly into streams. Mowin
existing vegetated buffers is strongly discouraged, so that they may be utilized for stormwater sheet flow.
6. Where practicable, culverts that are less than 48-inch in diameter should be buried to a depth equal to or gn
than 20% of their size to allow for aquatic life passage. Culverts that are 48-inch in diameter or larger shoul
buried at least 12 inches below the stream bottom to allow natural stream bottom material to become establi
in the culvert following installation and to provide aquatic life passage during periods of low flow. T
measurements must be based on natural thalweg depths. This may require increasing the size of the culve
meet flow conveyance requirements. If any of the existing pipes are perched, they shall be removed and reply
and re-installed correctly, unless demonstrated that this is topographically unfeasible. All waters must
through without freefalling or damming on either end of the culverts during low flow conditions, to mail
aquatic life and/or fish passage.
7. The dimension, pattern and profile of the stream above and below the crossing should not be modifie
widening the stream channel or reducing the depth of the stream.
8. Disturbed floodplains and streams should be restored to natural geomorphic conditions.
9. Use of rip-rap for bank stabilization is to be minimized; rather, native vegetation is to be planted when praci
If rip-rap is necessary, it must be limited to the stream bank below the high water mark, and vegetation mu
used for stabilization above high water. Any rip-rap used must not interfere with aquatic life passage during
flow conditions.
10. If concrete is used, work must be accomplished so the wet concrete does not contact the stream water. This w
lessen the chance of altering the stream's water chemistry and causing a fish kill.
11. Heavy equipment must be operated from the banks rather than in the stream channel in order to mini
sedimentation and reduce the likelihood of introducing other pollutants into the stream.
12. All mechanized equipment operated near surface waters must be regularly inspected and maintained to pre
contamination of stream waters from fuels, lubricants, hydraulic fluids, or other toxic materials.
13. The presence of equipment in the channels must be minimized. Under no circumstances must rock, sand or i
materials be dredged from the wetted stream channel under authorization of this permit, except in the imme
vicinity of the culverts.
14. Temporary dewatering sites must be restored to preexisting conditions unless more natural geomorphic condi
can be provided.
F
Mr. J.M. Mills, P.E.
March 11, 2005
DWQ# 05-0380
Page 3
15. All work shall be performed during low flow conditions.
16. Upon completion of the project, the NCDOT shall complete and return the enclosed "Certification of Completion
Form" to notify DWQ 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 Division of Water Quality upon
completion of the project.
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearing. You must act
within 60 days of the date that you receive this letter. To ask for a hearing, send a written petition, which conforms to
Chapter 150B of the North Carolina General Statutes to the Office of Administrative Hearings, 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 contact Sue Homewood at 336-771-4600 extension 287 or at [e-mail].
Sincerely,
Alan W. Klimek, P.E.
Attachment
cc: Wilmington District Corps of Engineers
John Thomas, USACE Raleigh Field Office
Jerry Parker, Division 7, Division Environmental Officer
AN, 0
Winston Salem Regional Office
Central Files
Mr. J.M. Mills, P.E.
March 11, 2005
DWQ# 05-0380
Page 4
DWQ Project No.:
County:
Applicant:
Project Name:
Date of Issuance of 401 Water Quality Certification:
Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable Buffer Rules, and any
subsequent modifications, the applicant is required to return this certificate to the 401/Wetlands Unit, North Carolina
Division of Water Quality, 1621 Mail Service Center, Raleigh, NC, 27699-1621. This form may be returned to DWQ by
the applicant, the applicant's authorized agent, or the project engineer. It is not necessary to send certificates from all of
these.
Applicant's Certification
I, , hereby state that; to the best of my abilities, due care and diligence was
used in the observation of the construction such that tho cbArbtruotiov was observed to be built within substantial
compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans and specifications, and
other supporting materials. +
Signature:
Agent's Certification
Date:
I, , hereby state that, to the best of my abilities, due care and diligence was
used in the observation of the construction such that the construction was observed to be built within substantial
compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans and specifications, and
other supporting materials.
Signature:
Engineer's Certification
Date:
Partial Final
1, , as a duly registered Professional Engineer in the State of North
Carolina, having been authorized to observe (periodically, weekly, full time) the construction of the project,for the
Permittee hereby state that, to the best of my abilities, due care and diligence was used in the observation of the
construction such that the construction was observed to be built within substantial compliance and intent of the 401 Water
Quality Certification and Buffer Rules, the approved plans and specifications, and other supporting materials.
Signature
Registration No.
Date
F
job , `sT'to a?` V
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATI
MICHAEL F. EASLEY LYNDO TIPP=
GOVERNOR SECRETARY
February 28, 2005
Ms. Beth Barnes
Wetlands/401 Unit
NC DENR Division of Water Quality 0 7 0 3 0 0
1650 Mail Service Center
Raleigh, NC 27699
(Seven Copies) Written Authorization Required
Mr. John Thomas
US Army Corps of Engineers
6508 Falls of the Neuse Suite 120
Raleigh, NC 27615-6814
(Two Copies)
Subject: Carmon Road (SR 2755) Guilford County, replacement of four undersized pipes with four larger
pipes. State Project Number 39280
To Whom It May Concern:
The North Carolina Department of Transportation (NCDOT) proposes to replace four separate undersized pipes
on Carmon Road (SR 2755) in Guilford County near Gibsonville with four larger pipes. This activity will result
in impacts to UTs to Rock Creek and Back Creek. The road will be closed during construction with offsite,
detours. The NCDOT anticipates that the pipe replacement activity and extension will be authorized under'
Nationwide Permit (NWP) 14 and 33. This application is intended as a request for written authorization from
the US Army Corps of Engineers for the Nationwides 13, 14 and 33. This package is also being forwarded to'
the NC Division of Water Quality notification as prescribed under General Water Quality Certifications #3399
(NW 13), #3404 (NW 14) and #3366 (NW 33). The following information is being provided to satisfy
conditions of the Nationwide Permits and General Water Quality Certifications.
I ?_1aLl `rr'?,_i1
P. O. Box 14996 Greensboro, NC 27415-4996 Telephone No. [phone] Fax No. [phone]

c
PROJECT INFORMATION
Road Name SR Number Project Length
(miles) Classification
Carmon Road SR 2755 N/A Rural
River Basin: DWQ
ID Water Quality
Designation % Impervious Surface
Cape Fear 16-19-3.5
16-19-5 WS IV;NSW&
C;NS W N/A
Buffer Rules' Buffer Rule Conditions (where applicable)
No Request Exemption
Protected Species
Presentb 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 - See the attached Historic Review Letter for further information
PIPE REPLACEMENT INFORMATION (SITE A)
Site (Station) Carmon Road Stream Type Perennial
Existing Pipe 50' X 24" RCP Proposed 60' X 42" CMP
Pipe
Construction Pump around with offsite detour Dewatering Cofferdams & Pump Around
Method Device*
Burial Depth 1 foot E/C Plan See Attached
Date
Construction As soon as practicable Duration Four weeks
Date
Impacts 10 ft-enclosure; 20 if ft-rip-rap for bank stabilization; 501f -temporary sandbags and
(ft.) rock silt dam for dewaterin
Special
Conditions
Restoration Within 15 working days of the pipe replacement the natural stream contours will be
Plan restored-and seeded. Temporary silt screens 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.
P. O. Box 14996 Greensboro, NC, 27415-4996 Telephone No. [phone] Fax No. [phone]

PIPE REPLACEMENT INFORMATION (SITE B)
Site Station Carmon Road Stream Type Perennial
Existing Pipe 52'X 36" RCP Proposed 60' X 48" RCP
Pipe
Construction Pump around with offsite detour Dewatering Cofferdams & Pump Around
Method Device*
Burial Depth 1 foot E/C Plan See Attached
Date
Construction As soon as practicable Duration Four weeks
Date
Impacts (ft.) 8 ]f-enclosure; 201f ft-rip-rap for bank stabilization; 501f -temporary sandbags and rock silt
dam for dewaterin
Special
Conditions
Restoration Within 15 working days of the pipe replacement the natural stream contours will be
Plan restored and seeded. Temporary silt screens 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.
PIPE REPLACEMENT INFORMATION (SITE Q
Site Station Carmon Road Stream Type Perennial
Existing Pipe 58' X 36" RCP Proposed 60' X 54" CMP
Pipe
Construction Pump around with offsite detour Dewatering Cofferdams & Pump Around
Method Device*
Burial Depth 1 foot E/C Plan See Attached
Date
Construction As soon as practicable Duration Four weeks
Date
Impacts (ft.) 2 ft-enclosure; 20 if ft-rip-rap for bank stabilization; 501f -temporary sandbags and rock silt
dam for dewaterin
Special
Conditions
Restoration Within 15 working days of the pipe replacement the natural stream contours will be
Plan restored and seeded. Temporary silt screens 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.
P. O. Box 14996 Greensboro, NC 27415-4996 Telephone No. [phone] Fax No. [phone]

PIPE REPLACEMENT INFORMATION (SITE D)
Site Station Cannon Road Stream Type Perennial
Existing Pipe 42' X 84" CMP Proposed 60' X 84" CMP
Pipe
Construction Pump around with offsite detour Dewatering Cofferdams & Pump Around
Method Device*
Burial Depth 1 foot E/C Plan See Attached
Date
Construction As soon as practicable Duration Four weeks
Date
Impacts (ft.) 18 ft-enclosure; 201f ft-rip-rap for bank stabilization; 50 if -temporary sandbags and rock
silt dam for dewaterin
Special
Conditions
Restoration Within 15 working days of the pipe replacement the natural stream contours will be
Plan restored and seeded. Temporary silt screens 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.
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.
P. 0. Box 14996 Greensboro, NC 27415-4996 Telephone No. [phone] Fax No. [phone]

l
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 Jerry Parker at
[phone]. Your time and effort are appreciated.
Sincerely,
Mills, P.E.
Engineer, Division 7
Enclosures
CC: Jerry Parker. NCDOT
Lane Hall, NCDOT
Barry Harrington, NCDOT
Joshua Purkett, NCDOT
Sue Homewood, NCDWQ
Jeremy Delapp, NCDOT
P. O. Box 14996 Greensboro, NC 27415-4996 Telephone No. [phone] Fax No. [phone]
Office Use Only: Form Version May 2002
0
USACE Action ID No. DWQ No.
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
1. 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: NWPs 13, 14 & 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: ?
II. Applicant Information
1. Owner/Applicant Information
Name: Mr. J.M. Mills, RE, Division Engineer- Division 7
Mailing Address: P.O. Box 14996
Greensboro, NC 27415-4996
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: Jerry A. Parker
Company Affiliation: NCDOT
Mailing Address: P.O. Box 14996
Greensboro. NC 27415-4996
Telephone Number: [phone] Fax Number: [phone]
Page 1 of 9

E-mail Address: [e-mail]
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 Carmon Road (SR 2755) Pipe Replacements (4 Sites)
2. T.I.P. Project Number or State Project Number (NCDOT Only): 39280
3. Property Identification Number (Tax PIN): Not Applicable
4. Location
County: Guilford Nearest Town: Gibsonville
Subdivision name (include phase/lot number): Not Applicable
Directions to site (include road numbers, landmarks, etc.):
The project is located west of Gibsonville in Guilford County. From 140 West; Take exit
138 and turn right (north) on NC 61 and proceed for approximately 3 miles into Gibsonville
and turn left on Carmon Road (SR 2755). Site A is located near House ## 5926; Site B is
located 1000' east of Wagoner Road (SR 2724); Site C is located to the east of House #5953
and Site D is located to the east of House It 6421.
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): UTs to Rock Creek & Back Creek
8. River Basin: Cape Fear
Page 2 of 9
(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/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:_ Paved secondary road in low density rural neighborhood
10. Describe the overall project in detail, including the type of equipment to be used: The
project will involve replacing four culverts at four sites on Carmon Road. The SITE A
culvert is a 50' X 24" RCP (reinforced concrete pie) that will be replaced with 60' X 42"
CMP (corrugated metal pipe). The SITE B culvert is a 52' X 36" RCP that will be replaced
with a 60' X 48" CMP. The SITE C culvert is a 58' X 36" RCP that will be replaced with a
60' X 54" CMP. The SITE D culvert is a 42' X 60" CMP that will be replaced with a 60' X
84" CMP. The pipe replacements are necessary in order to bring the proposed paved road up
to current DOT standards. Traffic will be diverted to offsite detours. The new pipes will be
buried one foot below the stream bed. Right-of-way width is illustrated on the attached site
plan. Equipment used will be standard road construction equipment (trackhoe, grader,
backhoe, and bulldozer).
11. Explain the purpose of the proposed work: To maintain traffic safety and to reduce future
maintenance costs.
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
Page 3 of 9
r
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. Provide a written description of the proposed impacts: Permanent stream impacts will
result from channel enclosure and placement of riprap. Temporary stream impacts will result
from placement of cofferdams and siltscreens..
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.femi.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 Length of Average Width Perennial or
Site Number Type of Impact* Impact Stream Name** of Stream Intermittent?
(indicate on ma linear feet Before Impact (please secif
Carmon Rd Pipe (en) 10 if
tmp) 501f UT to Rock Creek
1-2 feet
Intermittent
SITE A Replacement ( ) 201f

SITE B pipe (en) 8 if
tmp) 501f UT to Back Creek
1-2 feet
Intermittent
Replacement r 201f

SITE C
Pipe (en) 10 if
tmp) 501f
UT to Rock Creek
1-2 feet
Intermittent
Replacement ( 201f

SITE D (en) 101f
tmp) 501f
to Rock Creek
'
1-2 feet
Intermittent
placement
Replacement ( ) 201f
* 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
Page 4 of 9
www.uses.QOv. Several internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.coni,
www.mapquest.coni, etc.).
*Cumulative impacts (linear distance in feet) to all streams on site:
SITE A project should involve an increase of 10 linear feet of stream impacts - enclosure
(en) 10 linear feet. Impacts from temporary (tmp) sandbags and riprap in streams at SITE A
should not exceed 50 linear feet. Approximately 20 linear feet of riprap (m) will be utilized
for bank stabilization.
SITE B project should involve an increase of 18 linear feet of stream impacts - enclosure
(en) 8 linear feet. Impacts from temporary (tmp) sandbags and riprap in streams at SITE B
should not exceed 50 linear feet. Approximately 20 linear feet of riprap (rp) will be utilized
for bank stabilization.
SITE C project should involve an increase of 2 linear feet of stream impacts - enclosure (en),
2 linear feet. Impacts from temporary (tmp) sandbags and riprap in streams at SITE C should
not exceed 50 linear feet. Approximately 20 linear feet of riprap (ID) will be utilized-for bank
stabilization.
SITE D project should involve an increase of 18 linear feet of stream impacts - enclosure
(en) 18 linear feet. Impacts from temporary (tmp) sandbags and riprap in streams at SITE D
should not exceed 50 linear feet. Approximately 20 linear feet of riprap (rp) will be utilized
for bank stabilization.
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 Area of
Name Wat Type of Waterbody
Site Number Type of Impact* Impact )
plicabblele)
(if applicable) (lake, pond, estuary, sound,
indicate on ma acres bay, ocean, etc.

* 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
Page 5 of 9
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.
Pipe replacement activities are necessary to maintain travel safety. Impacts will be minimized
by strict enforcement of Best Management Practices for the protection of wetland and surface
waters, 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.
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
http://h2o.enr.state.nc.us/ncwetlands/strtngide.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
Page 6 of 9
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 approximately 18 linear feet. No Outstanding Resource Waters, federally protected
species or their habitats, or essential fishery habitats occur in the project area. .
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.ne.us/wrp/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
IX. 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
X. 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
Page 7 of 9
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 X_ 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 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.
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.
Not Applicable
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
XIII. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes_ No X
Page 8 of 9
Is this an after-the-fact permit application?
. Yes No X
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).

y plicant/Agent's Signature / Dale
signature is valid only if an authorization letter from the applicant is provided.)
Page 9 of 9

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February 21, 2005
Pine 1 mi. marker .65
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Construction Sequence and Erosion Control Plan for Replacement of
Pipe with Pipe Using a Pump Around - Guilford County, SR 2755
Work to begin as soon as practicable following authorization.
Construction is anticipated to take 1 week
1. Install a rock silt dam downstream of the work area to prevent incidental sediment
loss.
2. Install ABC aggregate or a less intrusive dewatering device to allow dewatering of
the work area.
3. Install pumps to divert flow around the work area.
4. Remove one existing line of 50' long 24" RC pipe.
5. Excavate to sufficient depth to allow burial of the pipe to 1', place base stone, and
single line of 60' long 42" CM pipe.
6. Backfill the new line of pipe and place rip rap only as needed.
7. Starting from the downstream end, remove the dewatering device and restore the
natural stream contours.
8. Notify landscape department for final seeding.
9. Silt fences to be placed as site conditions require.
10. A 10' X 15' dirt bag will be used to remove excess water in the hole where the new
pipe is being replaced.
11. Site conditions and weather may alter these plans.
12. A method less intrusive than a pump around system may be utilized if site conditions
allow.

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February 21, 2005
Pipe #17 mi. marker 4.15
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Construction Sequence and Erosion Control Plan for Replacement of
Pipe with Pipe Using a Pump Around - Guilford County, SR 2755
Work to begin as soon as practicable following authorization.
Construction is anticipated to take 1 week
1. Install a rock silt dam downstream of the work area to prevent incidental sediment
loss.
2. Install ABC aggregate or a less intrusive dewatering device to allow dewatering of
the work area.
3. Install pumps to divert flow around the work area.
4. Remove one existing line of 52' long 36" PIPE.
5. Excavate to sufficient depth to allow burial of the pipe to 1', place base stone, and
single line of 60' long 48" CM pipe.
6. Backfill the new line of pipe and place rip rap only as needed.
7. Starting from the downstream end, remove the dewatering device and restore the
natural stream contours.
8. Notify landscape department for final seeding.
9. Silt fences to be placed as site conditions require.
10. A 10' X 15' dirt bag will be used to remove excess water in the hole where the new
pipe is being replaced.
11. Site conditions and weather may alter these plans.
12. A method less intrusive than a pump around system may be utilized if site conditions
allow.

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February 21, 2005
Pipe #3 mi. marker.97
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Construction Sequence and Erosion Control Plan for Replacement of
Pipe with Pipe Using a Pump Around - Guilford County, SR 2755
Work to begin as soon as practicable following authorization.
Construction is anticipated to take 1 week
1. Install a rock silt dam downstream of the work area to prevent incidental sediment
loss.
2. Install ABC aggregate or a less intrusive dewatering device to allow dewatering of
the work area.
3. Install pumps to divert flow around the work area.
4. Remove one existing line of 58' long 36" RC pipe.
5. Excavate to sufficient depth to allow burial of the pipe to 1', place base stone, and
single line of 60' long 54" CM pipe.
6. Backfill the new line of pipe and place rip rap only as needed.
7. Starting from the downstream end, remove the dewatering device and restore the
natural stream contours.
8. Notify landscape department for final seeding.
9. Silt fences to be placed as site conditions require.
10. A 10' X 15' dirt bag will be used to remove excess water in the hole where the new
pipe is being replaced.
11. Site conditions and weather may alter these plans.
12. A method less intrusive than a pump around system may be utilized if site conditions
allow.

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February 21, 2005
Pipe #11 mi. marker 3.28
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Construction Sequence and Erosion Control Plan for Replacement of
Pipe with Pipe Using a Pump Around - Guilford County, SR 2755
Work to begin as soon as practicable following authorization.
Construction is anticipated to take 1 week
1. Install a rock silt dam downstream of the work area to prevent incidental sediment
loss.
2. Install ABC aggregate or a less intrusive dewatering device to allow dewatering of
the work area.
3. Install pumps to divert flow around the work area.
4. Remove one existing line of 42' long 60" CM pipe
5. Excavate to sufficient depth to allow burial of the pipe to 1', place base stone, and
single line of 60' long 84" CM pipe.
6. Backfill the new line of pipe and place rip rap only as needed.
7. Starting from the downstream end, remove the dewatering device and restore the
natural stream contours.
8. Notify landscape department for final seeding.
9. Silt fences to be placed as site conditions require.
10. A 10' X 15' dirt bag will be used to remove excess water in the hole where the new
pipe is being replaced.
11. Site conditions and weather may alter these plans.
12. A method less intrusive than a pump around system may be utilized if site conditions
allow.

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