20031492 Ver 1_Complete File_20031126

Certificate of Completion
DWQ Project No.: D 31 11 `1 Z County:
Applicant: N Ld o T .0 f u i g i o/-/ '7-
Project Name: G-,4-L1- IMoA 4A1 2J? L 52 ?S S ?? - P?iZ 22.Qi?i t.4H-??-?'I
Date of Issuance of 401 Water Quality Certification: M` Z" ZOO)
Upon completion of all work approved within the 401 Water Quality Certification and 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
hereby state drat, to the best of my abilities, due care and
diligence was used in the observation of the construction such tt ,ht the construction was observed to be built
Certification and Buffer Rules, the
within substantial compliance and intent of the 401 Water Qualil
ty.
approved plans and specifications, and other supporting materials...,
Signature:
Agent's Certi, fic 'on
Date: i U' 4- 03-
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 p and sp ons, and other supporting materials.
Signature. Date:
ff this project was designed by a Certified Professional
I, , as a duly registered Professional
Engineer, Landscape Architect, Surveyor, etc.) 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 withir"ubstantial compliance and intent of the 401 Water Quality
Certification and Buffet Rules, the approved plans and specifications, and other supporting materials.
Signature: Registration No.: Date:
WAT f9pG
December 2, 2003
Guilford County
DWQ Project No. 031492
Culvert Replacement on SR 1556 (Gallimore Dairy Road)
APPROVAL of 401 Water Quality Certification with Additional Conditions and Randleman Buffer
Rules AUTHORIZATION CERTIFICATE
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 18 linear feet, to incur 18 linear feet of temporary impacts, and to fill 1903 square feet of protected
riparian buffer on an unnamed tributary to the East Deep Fork River for the purpose of extending a
culvert on SR 1556 (Gallimore Dairy Road) in Guilford County. The project should be constructed in
accordance with your application dated November 21, 2003 (received November 26, 2003). After
reviewing your application, we have decided that this fill is covered by General Water Quality
Certification Nos. 3366 and 3404 corresponding to the U.S. Army Corps of Engineers Nationwide Permit
Numbers 33 and 14. This approval shall act as your Authorization Certificate as required within the
Randleman Lake Riparian Area Protection Rules (15A NCAC 2B .0205). 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. NCDOT shall comply with WS-IV Water Supply Watershed regulations, including the requirement
for a 30-foot vegetated buffer.
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.
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/
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
Coleen H. Sullins, Deputy Director
Division of Water Quality
4
NCDOT SR 1556, DWQ # 031492
Page 2
December 2, 2003
4. The culvert shall be designed and installed to allow for fish and other wildlife movement as well as to
prevent headcutting of the stream.
5. 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. 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.
b. The design, installation, operation, and maintenance of the sediment and erosion control measures
must be such that they equal, or exceed, the requirements specified in the most recent version of
the North Carolina Sediment and Erosion Control Manual. The devices shall be maintained on
all construction sites, borrow sites, and waste pile (spoil) projects, including contractor-owned or
leased borrow pits associated with the project.
c. For borrow pit sites, the erosion and sediment control measures must be designed, installed,
operated, and maintained in accordance with the most recent version of the North Carolina
Surface Mining Manual.
d. Any reclamation measures and implementation must comply with the reclamation in accordance
with the requirements of the Sedimentation Pollution Control Act.
8. No waste, spoil, solids, or fill of any kind shall occur in wetlands, waters, or riparian areas beyond the
footprint of the impacts depicted in the Preconstruction Notice Application. All construction activities,
including the design, installation, operation, and maintenance of sediment and erosion control Best
Management Practices, shall be performed so that no violations of state water quality standards,
statutes, or rules occur.
9. Sediment and erosion control measures shall not be placed in wetlands or waters to the maximum
extent practicable. If placement of sediment and erosion control devices in wetlands and waters is
unavoidable, they shall be removed and the natural grade restored within six months of the date that
the Division of Land Resources has released the project.
10. All work shall be performed during low flow (below bankfull) conditions.
11. Heavy equipment must be operated from the banks rather than in the stream channel in order to
minimize 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 prevent contamination of stream waters from fuels, lubricants, hydraulic fluids, or other toxic
materials.
13. 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.

NCDOT SR 1556, DWQ # 031492
Page 3
December 2, 2003
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. Beth Barnes at 919.715.8394 or Mr. Daryl Lamb of
the Winston-Salem Regional Office at 336.771.4600.
Sincerely,
Attachment
Pc:
Wilmington District Corps of Engineers
John Thomas, USACE Raleigh Field Office
NCDWQ Winston-Salem Regional Office
Central Files
File Copy

eM?o?
STATE OF NORTH CAROLI& E COPY
?,D Icld-
C ` ,0
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY
GOVERNOR
LYNDO TIPPETT
SECRETARY
November 21, 2003
Ms. Beth Barnes
Wetlands/401 Unit
NC DENR Division of Water Quality
1650 Mail Service Center
Raleigh, NC 27699
(Seven Copies)
01492
WETIAN[?),q
Mr. John Thomas
US Army Corps of Engineers
6508 Falls of the Neuse Suite 120
Raleigh, NC 27615-6814
(Two Copies)
WATER QUALITY SECT101V
Subject: Guilford County, Emergency Culvert Replacement on Gallimore Dairy Road (SR 1556)
Project Number # 35013
To Whom It May Concern:
The North Carolina Department of Transportation (NCDOT) proposes to extend a culvert on
Gallimore Dairy Road (SR1556) in Guilford County in order increase lane width and improve traffic
safety. This activity will result in impacts to an unnamed tributary of East Fork Deep River. In an
effort to obtain the necessary permits for the subject culvert extension, we are providing a pre-
construction notification application with supporting documentation. We believe this project can be
permitted under the Nationwide Permit number 14. This application is intended as a request for
formal written authorization from the USCOE for NWP 14. This application is also intended as a
request for written authorization from the NC Division of Water Quality for minor road crossing
under General Water Quality Certificate #3404. It is also intended as notification of proposed
dewatering activity under General Water Quality Certificate #3366.
This project is in the Randleman Lake Water Supply Watershed as determined by a DWQ on-site
field determination on January 11, 2002 (see attached letter). However, the work is proposed on an
existing road crossing and will utilize a perpendicular extension. All fill material is proposed to be
kept out of the stream by the utilization of a headwall at the pipe inlet end and utilization of silt
screens along the road embankment. Also, NCDOT will maintain sheetflow to the maximum extent
practical through dispersing concentrated flow and re-establishing vegetation to maintain the
effectiveness of the riparian area. It is the department's opinion that this project can be exempted
from the riparian area protection requirements as according to NCAC T15A:02B.0250 (2) (e) (i).
NCDOT is requesting a "No Practical Alternative" exemption for the proposed project.
The following information is being provided to satisfy conditions of General Water Quality
Certification.
P. O. Box 14996 Greensboro. NC 27415-4996 Telephone No. [phone] Fax No. (3361334-3637
PROJECT INFORMATION
Road Name SR Number Project Length
miles Classification
Gallimore Dairy
Rd SR 1556 N/A Urban
River Basin: DWQ
ID Water Quality
Designation % Impervious
Surface
Cape Fear 17-2-(0.3) WS-IV;* N/A
Buffer Rulesa Buffer Rule Conditions where applicable)
Yes Request Exemption
Protected Species
Presentb Mapped Historic
Pro erties' CAMA
AEC Essential Fishery
Habitat
No No No No
a Separate documentation attached as needed: b See the attached Endangered
Species Review Sheet for further information: c When Applicable - See the attached
Historic Review Letter for further information
PIPE EXTENSION INFORMATION
Site Stream Type Intermittent
Station
Existing Pie 48 inch X 120 feet Extension 48 inch X 14 linear feet
Construction Pump around through existing Dewatering N/A
Method pipe Device*
Burial Depth One foot E/C Plan
Date
Construction As soon as practicable Duration One week
Date
Impacts (ft.) 14 ft-enclosure;4 X 4 ft junction box; 50 sf -temporary sandbags and rock silt
dam
Special
Conditions
Restoration Within 15 working days of the pipe extension the natural stream contours will
Plan be 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]
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 Tim Jackson at [phone] or Jerry Parker at [phone]. Your time and effort are
appreciated.
Sincerely,
/v--22'4/
(jDiv;*ion . Mills, P.E.
Engineer, Division 7
Enclosures
CC: Tim Jackson, NCDOT
Barry Harrington, NCDOT
S. Lane Hall, NCDOT
J. Paul Ingram, NCDOT
Paul Shepard, NCDOT
Jerry Parker, NCDOT
P. O. Box 14996 Greensboro, NC 27415-4996 Telephone No. [phone] Fax No. [phone]
'Office Use Only' 0 31 Dorm Version May 2002
492
USACE Action ID No. DWQ No.
(if anv particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
1. Processing
I . 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: ?
II. Applicant Information
1. Owner/Applicant Information
Name: Mr. J M Mills P E Division Engineer - Division 7
Mailing Address: P.O. Box 14996
Greensboro NC 27415-4996
Telephone Number: (336) 334-3 1 92 Fax Number: (336 334-3673
E-mail Address: mmills@dot state nc us
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 Parker
Company Affiliation: Division Environmental Officer
Mailing Address: P.O. Box 14996
Greensboro NC 27415-4996
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: iparker a dot state nc us
Page] of 9
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: Gallimore Dairy Road (SR 1556) Culvert Extension
2. T.I.P. Project Number or State Project Number (NCDOT Only): #35013
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 near the Piedmont Triad Airport on the west side of Greensboro. From 1-40
take Exit 211 onto Gallimore Dairy Rd and head north towards airport. Project is
approximately 0.35 miles after entering onto Gallimore Dairy Road.
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): East Fork Deep River
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.nc.us/admin/maps/.)
Page 2 of 9
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application. Pipe in need of extension in heavy industrial use area.
I O.Describe the overall project in detail, including the type of equipment to be used: The
p_roiect will involve attaching a 4 X 4 foot junction box and an additional 14 feet X 48 inch
culvert to the east side of an existing 120 foot X 48 inch culvert. The purpose is to allow for
widening of the existing road. Ripht-of-way width is illustrated on the attached site plan. This
project is in the Randleman Lake Water Supply Watershed as determined by a DWQ on-site
field determination on January 11, 2002 (see attached letter). However, the work is proposed
on an existing road crossing and will utilize a perpendicular extension The project will also
involve the placement of approximately 1903.12 sfof fill. All fill material is proposed to be
kept out of the stream by the utilization of a headwall at the pipe inlet end and utilization of
silt screens along the road embankment No work is proposed at the pipe outlet. Also
NCDOT will maintain sheetflow to the maximum extent practical through dispersing
concentrated flow and re-establishing vegetation to maintain the effectiveness of the riparian
area An existing pipe within the NCDOT right of way currently carries treated stormwater
and untreated roadway runoff directly to the stream NCDOT is proposing to install another
pipe that will carry the untreated roadway runoff to a preformed scour hole that is located
outside of the 50 foot buffer where it will be allowed to sheetflow. Since the two pipes will
be separated the overall amount of runoff going directly to the stream should be lessened and
the only direct water the stream will receive afterwards will be treated stormwater. It is the
department's opinion that this project can be exempted from the riparian area protection
requirements as according to NCAC T15A•02B 0250 (2) (e) (i). NCDOT is requesting a "No
Practical Alternative" exemption for the proposed project All proposed fill will be in a
highground area with no fill proposed to be in wetlands nor streams Equipment used will be
standard road construction equipment (trackhoe grader, backhoe and bulldozer).
I I.Explain the purpose of the proposed work: To increase road width to help increase 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
Page 3 of 9
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 Anplicable
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.
1. Provide a written description of the proposed impacts: Permanent stream impacts will
result from channel enclosure Temporal stream impacts will result from the placement of rock
silt dams and sandbags necessary for the diversion of water flow during construction of the
project.
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 identity temporary impacts. impacts mciuae, out are not mmitca to: rnccnuin wu uVamig, giau?n9,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year tloodplains 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 FF,MA Map Service Center at 1-800-358-9616, or
online at httl)://www.lema.gov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, liorested wetland, beaver pond,
Carolina Bay, bog, etc.) Indicate il'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:
Page 4 of 9
Stream Impact
Site Number
(indicate on map)
Type of Impact* Length of
Impact
(linear feet)
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
(please specify)
Gallimore Dairy
Road Culvert
extension (en) 18 ft
(tmp)20 sf UT to East Fork Deep
River Approx. five
feet
Perennial
See below-

List each impact separately and identily temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to berth 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 fixrtprint 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.usRs.i ov. Several Internet sites also allow direct download and printing of USGS maps (e.g., www.k>pozone.unn,
www.m-1a )(Lcstcom, etc.).
- -- --..
*Cumulative impacts (linear distance in feet) to all streams on site: Project should involve
increase of eighteen linear feet impacts. - enclosure (en), 18
temporary (tmp) sandbags and rock silt dams in streams---approximately 20 sf,
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 of Waterbody
(if applicable) Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean, etc.
N/A

List each impact separately and identity temporary impacts. Impacts include, but are not limited to: till, 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)
Page 5 of 9
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.
Culvert extension activities are necessary to improve traffic 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 USACF, 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_ncus/ncwetlands/strma;ide.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.
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 70 linear feet No Outstanding Resource Waters, federally protected
Page 6 of 9
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.ne.us/wrD/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
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Page 7 of 9
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 Randleman )?
Yes X No If you answered "yes", provide the following information:
*Requesting a "No Practical Alternative" option as described in 15A NCAC 0213.0250 (2)
(e) (i). Please see cover letter and or III (10) of this application
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
Miti ation
1 N/A 3
2 N/A 1.5
Total N/A
• Zone I extends out 30 teet perpenaictuar Irom near nam of cnannei; /.one z extends an
additional 20 feet from the edge of'Zone I.
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 213.0242 or.0260.
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?
Page 8 of 9
Yes No X
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).
//-Zq-O
Ap scant/Agent's Signature Date
(A nt's gnature is valid only if an authorization letter from the applicant is provided.)
Page 9 of 9

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------ ? ? it ? g t
Construction Sequence and Erosion Control Plan for Pipe Extension Using a Pump
Around ----- Gallimore Dairy Road (SR 1555)
Install a rock silt dam downstream of the work area to prevent incidental sediment
loss.
2. Install sandbags or a less intrusive dewatering device to allow dewatering of the
work area.
3. Excavate to sufficient depth to allow burial of the new pipe to 1', place base stone
and pipe extension of 4ft X 4ft junction box and 14 linear feet of 48 inch
diameter pipe.
4. Backfill the new extension of pipe and place riprap only as needed.
Divert water flow through the newly installed pipe.
6. Starting from the downstream end, remove the dewatering structure and restore
the natural stream contours.
7. Site conditions and weather may alter these plans. Work will be performed in the
dry if possible.
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Michael F. Easley
Governor
William G. Ross, Jr., Secretary
Department of Environment and Natural Resources
Gregory J. Thorpe, Ph.D., Acting Director
Division of Water Quality
January 11, 2002
Guilford County
DWQ # 02-0047
NC Department of Transportation
C/o Mr. Lenwood E. Smith, II, PWS
Division Seven Environmental Officer
1584 Yanceyville Street
Greensboro, NC 27415
Subject Property: Site Determination for Applicability to the Randleman Lake Riparian Area Protection Rules (15A NCAC 2B .0250)
Gallimore Dairy Road (SR155t, Greensboro, Guilford County, NC
Unnamed tributary stream to Deep River [03-06-08, 17-(1), WS-IV CA](see attached USGS and Soil maps)
Dear Mr. Smith,
On January 10, 2002, DWQ staff met with you to conduct an on-site determination to review a drainage feature on the
subject property for applicability to the Randleman Lake Buffer Rules [15A NCAC 2B .0250]. As a result of this on-site
determination the Division of Water Quality (DWQ) has determined that the circled drainage feature on the attached USGS and Soil
Survey maps initialed by DWQ staff on 01/10/02 is at least an intermittent stream and, therefore, is subject to the Randleman Buffer
Rules (North Carolina Administrative Code T15A:02B.0250). The stream begins on the east-side of Gallimore Dairy Road at the
outlet of a small stormwater management pond.
This letter only addresses the applicability to the buffer rules and does not approve any activity within the buffers. Please be
aware that even if no direct impacts are proposed to the protected buffers, sheet flow of all stormwater as per 15A NCAC 2B .0250(5)
is required. If you have any additional questions or require additional information you can reach me at 919-733-1786.
Sincerely,
J orney, Supervisor
W , 401 Wetlands U t
Attachment: Guilford County, USDA Soil Survey, Sheet Number 26, Initialed by Bob Zarzecki on 01/10/02
Guilford USGS Topo Map (Maptech, Inc. Copy), Initialed by Bob Zarze6cn 01/10/02
Cc: Mr. Larry Coble, DWQ Winston-Salem Regional Office
Cynthia Van Der Wiele, DWQ 401/Wetlands Unit
File Copy
Central Files
DWQ 020047
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/
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mai Ibox:///CI/Documents%20and%20Seuings/bob_zarzecki/Appl icat...
Subject: Re: Randleman
From: Bob Zarzecki <bob.zarzecki @ncmail.net>
Date: Mon, 24 Nov 2003 11:51:22 -0500
To: Beth Barnes <[e-mail]>
CC: Cynthia Vanderwiele <[e-mail]>
Beth:
It looks like they are extending an existing pipe and relocating existing stormwater to it. While at the
same time, sending "new" (and some existing stormwater) to the preformed scour hole. This looks fine
to issue. I believe that they could do this under the current rules without the need to use the General
Variance. I believe that we have had a situation similar to this where we called the relocation of the
existing stormwater "exempt" as long as they provided diffuse flow of the "new" stormwater. Of course
Todd is not around to confirm, but I recommend that you issue the 401 without requiring the General
Variance. I'll put the fax and this email back in your box.
- Bob
Beth Barnes wrote:
I place a FAX on this project in your box. Jerry Parker would like to discuss the project before he
submits the application.
Bob Zarzecki wrote:
I'll be glad to help once you get the details from Jerry.
- Bob
Beth Barnes wrote:
I told Jerry I needed more"particulars" before anyone here could be much
help. This has something to do with a TIP project, and Jerry is to ask
PD&EA for more details.
Bob Zarzecki wrote:
Beth - as usual "it depends"...I'll be glad to review it if you
like... however, I'm in and out a lot this week ...if you could put some
details in my box with a sketch at least of what you're proposing, then
I should be able to get back to you tomorrow or Fri...you can also try
to catch up with me if you like ...I'll be in tomorrow most of the day,
out Weds, out Thurs, back on Fri...- Bob
Beth Barnes wrote:
Got a DOT question for you: stormwater from road project goes into a
retention pond; overflow from retention pond then flows through 200' of
pipe before reaching stream; is this adequate storemwater treatment per
Randleman rules?
1 of 2 11/24/2003 11:51 AM
mailbox:///Cl/Documents h20and%20Settings/bob_zarzeckiinpplicat...
2 of 2 11/24/2003 11:51 AM
HOV-19-2007 17:50
FAX
TO: Beth Sames
DWQ
Phone
Fax Phone [phone]
CC:
F. 01,'02
`Date 11119103
I Number of pages including cover sheet 2
FROM: Jerry Parker
Enviromental Officer
N.C. Dept. of Transportation
Phone [phone]
Fax Phone [phone]
REMARKS: [] Urgent ® For your review 0 Reply ASAP 0 Please Comment
Beth,
This is a FAX of the topview of the project on Gallimore Dairy Road in Guilford County near the
airport.
NCDQT would like to construct a 4 X 4 It junction box and extend the 48 inch pipe diagonally 14
linear feet. (See the circled area). The lower darkened line coming into the circled area from
the right is an existing pipe that is carrying treated stormwater from a nearby retention pond.
That pipe also carries untreated roadway runoff from catch basins to the stream. NCDQT is
proposing to separate the treated water from the retention pond from the untreated roadway run-
off water by installing another line of pipe (the upper darkened line). The upper pipe will carry
the untreated roadway runoff across the street to the preformed scour hole where it will be
allowed to sheet flow. The scour hole is located outside of the 50 ft buffer area. Since the two
pipes will be separated, the overall amount of runoff' going directly to the stream should be
lessened and the only water the stream will receive directly will be treated stormwater.
I would like to discuss this with you prior to the submittal of the application to address any
concerns you may have- I will call you later after you have received this FAX.
HOV-1=+-200-j 17:51
8

PREFORMED SCOUR HOLE
SEE DETAIL
+58
85'
POE
-58
wri \ I
Iw
M

F'. 012, Gil
APRON TO
EXl?N 3 SIDES
NOTE: NO EK VTIO? 50 LFR4E
1 WITHIINF 113 %R ON
TOP
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Deep River a
?1 1
/ +00
RMI
57 3 -L- ?; CD?
RAIN
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P E -

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T
OP- 803.18 GA IM R ROVE
INV- 877.
D. 6.4503 R is
--? CrL.+ 1
c 32
rNV.. en.ai? "? _ -
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?h 40.00 TOP- e7 to
IW- 873.
s,»
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1 +52.70 -L-
66.00
1 Sedfinent Pond
+34.53 -L
40.00 Q?+
1 / Q
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40.00
f14.90
66.00 j

Extend ` B" RCP I LF
Site Sta. .7,54
U -4015 a
WBS PEA`: 35013.1.1
Galimone Dairy Rood
Guilford County
SCALE: /" = 40'
TOTHL P.02'