20110251 Ver 1_401 Application_20110311

46
MqKIN4 &CREED
TO: NCDENR - DWQ 401
1650 Mail Service Center
Raleigh, NC 27699-1650
ATTENTION:
WE ARE SENDING: ? Originals ® Prints
? Specifications ? Calculations
201 1025 1
i
LETTER OF TRANSMITTAL
DATE: March 12, 2011
PROJECT NO: 5466,0003 TASK NO:
RE: PCN
TRANSMITTAL NO: PAGE 1 OF 1
? Shop Drawings ? Samples
? Other -
Quantity Drawing No. Rev. Description Status
2 24x36 Plan Sets - ... _..____.._..W_._._..e. _ .._._. G
3 11x17 Plan Sets` ?- G
5 PCN + G
L?
????

Issue Status Code: A. Preliminary B. Fabrication Only C. For Information D. Bid
E. Construction F. For Review & Comments G. For Approval H. See Remarks
Action Status Code: 1. No Exceptions Taken 2. Make Corrections Noted
4. Amend & Resubmit 5. Rejected - See Remarks
REMARKS: Please feel free to contact me if you have any questions.
3. Other
8020 Tower Point Drive, Charlotte, NC 28227 Tel: [phone] Fax: [phone]
cc:
McKIM & CREED, PA
Signed
Jason E. Marshall, El
201 1025 1
O?0F- ATF9QG
>b
O liii? -c
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification PCN Form
A. Applicant Information
1. Processing
1 a. Type(s) of approval sought from the
Corps:
® Section 404 Permit ? Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number: 3, 13, 27 or General Permit (GP) number: Water Quality
Certification Nos. 3689 and 3688
1 c. Has the NWP or GP number been verified by the Corps? ? Yes ® No
1 d. Type(s) of approval sought from the DWQ (check all that apply):
® 401 Water Quality Certification - Regular ? Non-404 Jurisdictional General Permit
? 401 Water Quality Certification - Express ? Riparian Buffer Authorization
1 e. Is this notification solely for the record
because written approval is not required? For the record only for DWQ 401
Certification:
? Yes ® No For the record only for Corps Permit:

? Yes ® No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program. ? Yes ® No
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below. ? Yes ® No
1h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ? Yes ® No
2. Project Information
2a. Name of project: Phase 1 & Phase 2 Distribution & Collection Infrastructure Improvements & Stream Restoration/Bank
Stabilization Improvents
2b. County: Forsyth County
2c. Nearest municipality / town: Winston-Salem (Phase 1) and Kernersville (Phase 2)
2d. Subdivision name: N/A
2e. NCDOT only, T.I.P. or state

project no:
...........
.
N/AR ,.....Y- 1?

3. JR/
Owner Information
3a. Name(s) on Recorded Deed: N/A
3b. Deed Book and Page No. N/A!actarr n ;....
ter..

3c.
Responsible Party (for LLC if
applicable): `??
?a
N/Ar6re?ci?
3d. Street address: N/A
3e. City, state, zip: N/A
3f. Telephone no.: N/A
3g. Fax no.: N/A
3h. Email address: N/A
Page I of 12
PCN Form - Version 1.3 December 10, 2008 Version
4. Applicant Information (if different from owner)
4a. Applicant is: ? Agent ® Other, specify: Winston-Salem/Forsyth County, NC
4b. Name: Courtney Driver, PE
4c. Business name
(if applicable): City/County Utility Commission
4d. Street address: 101 N Main Street, Suite 357
4e. City, state, zip: Winston-Salem, NC 27102-2511
4f. Telephone no.: [phone]
4g. Fax no.: [phone]
4h. Email address: [e-mail]
5. Agent/Consultant Information (if applicable)
5a. Name: J. Michael Osborne, PE
5b. Business name
(if applicable): McKim & Creed, PA
5c. Street address: 8020 Tower Point Drive
5d. City, state, zip: Charlotte, NC 28227
5e. Telephone no.: 704 841 2588
5f. Fax no.: 704 841 2567
5g. Email address: [e-mail]
Page 2 of 12
PCN Form - Version 1.3 December 10, 2008 Version
B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): Multiple Sites
Latitude: 36.1597 Longitude: - 80.08570
1b. Site coordinates (in decimal degrees): (DD.DDDDDD) (-DD.DDDDDD)
1c. Property size: 10.3 Acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to Multiple - see attached list
proposed project:
2b. Water Quality Classification of nearest receiving water:
2c. River basin:
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
The current land use within the project limits consists primarily of vacant wooded and mowed lot with adjacent
residential areas and mowed lawns
3b. List the total estimated acreage of all existing wetlands on the property:
NIA
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
2750 ft
3d. Explain the purpose of the proposed project:
The primary purpose of this project is to conduct stream restoration and enhancement on eighteen sites in Forsyth
County and perform maintenance on areas of sewer and water main where integrity has been compromised due to
stream erosion. The primary goal of the project is to protect the streams from compromised water and sewer main
by reestablishing the cover and protection of the pipe and creating more geomorphologically stable channels while
improving and restoring their hydrologic connection to the flood plains. In addition, the project will restore aquatic
and terrestrial habitat and enhance recreational opportunities as well as provide flood water storage and create
mitigation credits.
3e. Describe the overall project in detail, including the type of equipment to be used:
18 sites located on 10 streams (see list) will be relocated to new geomorphically stable channels to provide proper cover
and prevent further erosion that has exposed water and sewer utilities. The channels will have improved channel
dimensions and profiles and will exhibit improved floodplain access and sinuosity. The new channels will have in-stream
structures and constructed riffles to increase stream habitat diversity and improve channel stability.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property / ? Yes ® No ? Unknown
project (including all prior phases) in the past?
Comments:
4b. If the Corps made the jurisdictional determination, what type
? Preliminary ? Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company: N/A
Name (if known): N/A Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
N/A
Page 3 of 12
PCN Form -Version 1.3 December 10, 2008 Version
5. Project History
5a. Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past? ? Yes ® No ? Unknown
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project? ? Yes ® No
6b. If yes, explain.
Page 4 of 12
PCN Form - Version 1.3 December 10, 2008 Version
C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
? Wetlands ® Streams - tributaries ? Buffers
? Open Waters ? Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type of jurisdiction
number - Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWQ - non-404, other) (acres)
Temporary
W1 ? P ? T ? Yes ? Corps
? No ? DWQ
W2 ? P ? T ? Yes ? Corps
? No ? DWQ
W3 ? P ? T ? Yes ? Corps
? No ? DWQ
W4 ? P ? T ? Yes ? Corps
? No ? DWQ
W5 ? P ? T ? Yes ? Corps
? No ? DWQ
W6 ? P ? T ? Yes ? Corps
? No ? DWQ
2g. Total wetland impacts
2h. Comments:
3. Stream Impacts - SEE ATTACHED LIST
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a. 3b. 3c. 3d. 3e. 3f. 3g.
Stream impact Type of impact Stream name Perennial Type of jurisdiction Average Impact
number - (PER) or (Corps - 404, 10 stream length
Permanent (P) or intermittent DWQ - non-404, width (linear
Temporary (T) (INT)? other) (feet) feet)
S1 ? P ? T ? PER ? Corps
? INT ? DWQ
S2 ? P ? T ? PER ? Corps
? INT ? DWQ
S3 ? P ? T ? PER ? Corps
? INT ? DWQ
S4 ? P ? T ? PER ? Corps
? INT ? DWQ
S5 ? P ? T ? PER ? Corps
? INT ? DWQ
S6 ? P ? T ? PER ? Corps
? INT ? DWQ
3h. Total stream and tributary impacts 2750
3i. Comments:
Page 5 of 12
PCN Form - Version 1.3 December 10, 2008 Version
4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list all open water impacts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number - (if applicable) Type of impact Waterbody type Area of impact (acres)
Permanent (P) or
Temporary
01 ?P?T
02 ?P?T
03 ?P?T
04 ?P?T
4E Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If and or lake construction proposed, then complete the chart below.
5a. 5b. 5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or purpose (acres)
number of pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
5L Total
5g. Comments:
5h. Is a dam high hazard permit required?
? Yes ? No if yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If an impacts require mitigation, then you MUST fill out Section D of this form.
6a.
? Neuse ? Tar-Pamlico ? Other:
Project is in which protected basin? ? Catawba ? Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number - Reason Buffer Zone 1 impact Zone 2 impact
Permanent (P) or for Stream name mitigation (square feet) (square feet)
Temporary T impact required?
B1 ?PQT ?Yes
? No
B2 ?P?T ?Yes
Q No
B3 QP?T ?Yes
? No
6h. Total buffer impacts
6i. Comments:
Page 6 of 12
PCN Form - Version 1.3 December 10, 2008 Version
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Impacts to on-site jurisdictional waters of the US have been reduced to the maximum extent practicable. Restoration
work will result in an improvement in stream stability and ecological function.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Proper sediment and erosion control measures will be used to minimize disturbances to downstream waters. All construction
activities will be constructed in the dry in accordance with Water Quality Certification No. 3689.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for
impacts to Waters of the U.S. or Waters of the State? ? Yes ® No
2b. If yes, mitigation is required by (check all that apply): ? DWQ ? Corps

2c. If yes, which mitigation option will be used for this
project? ? Mitigation bank

El Payment to in-lieu fee program
? Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter) Type Quantity
3c. Comments:
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached. ? Yes
4b. Stream mitigation requested: linear feet
4c. If using stream mitigation, stream temperature: ? warm ? cool ?cold
4d. Buffer mitigation requested (DWQ only): square feet
4e. Riparian wetland mitigation requested: acres
4f. Non-riparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requested: acres
4h. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 7 of 12
PCN Form - Version 1.3 December 10, 2008 Version
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) - required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation? ? Yes ® No
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.

Zone 6c.
Reason for impact 6d.
Total impact
(square feet)
Multiplier 6e.
Required mitigation
(square feet)
Zone 1 3 (2 for Catawba)
Zone 2 1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund).
6h. Comments:
Page 8 of 12
PCN Form - Version 1.3 December 10, 2008 Version
E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers identified ? Yes ® No
within one of the NC Riparian Buffer Protection Rules?
1b. If yes, then is a diffuse flow plan included? If no, explain why.
? Yes ? No
Comments:
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project? 0%
2b. Does this project require a Stormwater Management Plan? ? Yes ® No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: Not subject to Non-404 Jurisdictional
permit or NWP 14, 18, 29, 39, 41, 42, 44, 46, or GP31
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
? Certified Local Government
2e. Who will be responsible for the review of the Stormwater Management Plan? ? DWQ Stormwater Program
? DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project?
? Phase II
3b. Which of the following locally-implemented stormwater management programs ? NSW
? USMP
apply (check all that apply): ? Water Supply Watershed
? Other:
3c. Has the approved Stormwater Management Plan with proof of approval been ? Yes ? No
attached?
4. DWQ Stormwater Program Review
? Coastal counties
? HQW
4a. Which of the following state-implemented stormwater management programs apply ? ORW
(check all that apply):
? Session Law 2006-246
? Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
? Yes ? No
attached?
6. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements? ? Yes ? No
5b. Have all of the 401 Unit submittal requirements been met? ? Yes ? No
Page 9 of 12
PCN Form - Version 1.3 December 10, 2008 Version
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1a. Does the project involve an expenditure of public (federal/state/local) funds or the ® Yes ? No
use of public (federal/state) land?
1 b. If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State ? Yes ® No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1 c. If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
? Yes ? No
letter.)
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards, ? Yes ® No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after-the-fact permit application? ? Yes ® No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in ? Yes ® No
additional development, which could impact nearby downstream water quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
Page 10 of 12
PCN Form -Version 1.3 December 10, 2008 Version
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or ? Yes ® No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act ? Yes ® No
impacts?

Raleigh
?
5c. If yes, indicate the USFWS Field Office you have contacted. ? Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
NC Natural Heritage Database
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? ? Yes ® No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
South Atlantic Habitat and Ecosystem IMS: http://ocean.floridamarine.org/efh-coral/ims/viewer.hm
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation ? Yes ® No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
A letter has been forwarded to the State Historic Preservation Office to determine if the project sites would impact any
resources. No reply has been received as of yet.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? ® Yes ? No
8b. If yes, explain how project meets FEMA requirements: The project is designed for a no-net rise in flood level
8c. What source(s) did you use to make the floodplain determination? FIRM panels

Page 11 of 12
PCN Form - Version 1.3 December 10, 2008 Version

f
3- 7- 1
Applicant/Agent's Printed Name Applicant/Agent's Signature
(Agent's signature is valid only if an authorization letter from the applicant Date
is provided.)
Page 12 of 12
PCN Form - Version 1.3 December 10, 2008 Version
SAMPLE AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:vJ a?? 5 cW U { ` l + G s ?, 3?`t - ?- W y
LOT NO. _ AA PLAN NO. PARCEL ID:
STREET ADDRESS: bryr e, A, 9v.ari 9yY11c1'pA1
10 O t• f S? St. U? +vt s to v, Z 7 10 Z
Ma-l AdaQre.s s ; P 0. l3ox 2 51 f
Please print:
Property Owner: 54u ?I --1s'p. I it, w, ?? r s
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
Y" 1l C.l?lq:C,l OS?o ? ?l F.;? { ?, Of I? (. ! N/1 ?' ? II?(???!?,1 i ?'
(Contractor / Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, Issuance and acceptance of
this permit or certification and any and all standard and special conditions attached.
Property Owner's Address (if different than property above):
Telephone: 3 3(- - 'N-7- G 9 9 Z
We hereby certify the above Information submitted in this application Is true and accurate to the
best of our knowledge.
Authorized Signature
Date: Z-1-11
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