20151086 Ver 1_401 Application_20151019

Innovation Done Right ...We Make a Difference
I N T E R N A T 1 0 N A L
October 16, 2015
Jennifer Burdette
401 /Buffer Coordinator
NC DWR, 401 & Buffer Permitting Unit
1617 Mail Service Center
Raleigh, North Carolina 27699 -1617
Subject: Pre - Construction Notification/401 Certification Package
Silas Creek Bank Stabilization Project
Forsyth County, North Carolina
Dear Ms. Burdette:
Please find enclosed five (5) copies of our PCN package for the Silas Creek Bank Stabilization Project. As
part of this submittal, we have included the following supporting data on the project and a check of $240.00
for the permit fee. We have also included five copies of the following supporting data on the project:
• PCN form,
• Supporting Information: Letters & Maps,
• Agent Authorization Form
• Permit Fee ($240.00),
• (5) half -size copies of the Plan Set, and
• Digital CD submittal (PDF format)
The purpose of the project is to stabilize stream banks along Silas Creek within the Lake Katharine Wetland
in the vicinity of Reynolda Walking Trail and the Lake Katharine dam. The project will implement
bioengineering measures such as geo -lifts on the upstream face of the dam and use an herbaceous vegetation
mix to avoid woody roots compromising the dam.
In addition to this submittal for 401 Certification, Baker has submitted a request to the US Army Corps of
Engineers (Raleigh Field Office) for 404 Permit approval of a NW -13. If you have any questions, please call
me at (828) 350 -1408 Ext. 2001.
Sincerely,
Jacob Byers, PE
Project Manager
Enclosures
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Corps Submittal Cover Sheet
Please provide the following info:
1. Project Name Silas Creek Stream Bank Stabilization Proiect
2. Name of Property Owner /Applicant: wake Forest Universitv
3. Name of Consultant /Agent: Michael Baker Engineering, Inc. /Jake Bvers, P.E./828.350.1408
*Agent authorization needs to be attached.
4. Related/Previous Action ID number(s): N/A
5. Site Address: Between 114 and 128 Revnolda Village, Winston - Salem, NC 27106
6. Subdivision Name: N/A
7. City: Winston -Salem
8. County: Forsvth
9. Lat: 36.1286760 Long: - 80.2840850 (Decimal Degrees Please
10. Quadrangle Name: Rural Hall, NC
11. Waterway: Silas Creek
12. Watershed: Yadkin
13. Requested Action: Attachments:
❑
Nationwide Permit # 13 Agent Authorization; Completed PCN (10 pages);
❑ General Permit # Permit Drawings (10 pages);
$240 DWR Application Fee;
® Jurisdictional Determination Request USGS 7.5' Topo. Quad.; NRCS Soils Survey Map;
❑ Pre - Application Request Preliminary Jurisdictional Determination Form;
Vicinity Map; NWI Map; DFIRM Map; Aerial; Letter of
Explanation
The following information will be completed by Corps office:
h D
Prepare File Folder Assign number in ORM Begin Date
Authorization: Section 10 Section 404
Project Description/ Nature of Activity/ Project Purpose:
Site/Waters Name:
Keywords:

AGENT AUTHORIZATION FORM
PROPERTY LEGAL DESCRIPTION:
LOT NO. 105` EE PLAN NO. PARCEL ID: 6862- 07a995.00; 6826 -08- 9642.00
STREET ADDRESS: Between 114 and 128 Reynolda Village, Winston- Salem, NC 27108
Please print: Wake Forest University
Property Owner:
Property Owner:
The undersigned, registered property owners of the above noted property, do hereby authorize
Jake Byers, PE of Baker Engineering
(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):
1834 Wake Forest Rd Winston Salem NC 27109
Telephone: [phone]
We hereby certify the above information submitted in this application is true and accurate to the
best of our knowledge.
L)� I l -A L-_ ev'e 5��--
Authorized Signature Authorized
Date:
Signa7,,�//,
Date: /d

Elio
d 0� WAS �G
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.4 January 2009
Pre - Construction Notification (PCN) Form
A. Applicant Information
1. Processing
1 a. Type(s) of approval sought from the Corps:
1 b. Specify Nationwide Permit (NWP) number: 13
1c. Has the NWP or GP number been verified by the Corps?
❑X Section 404 Permit ❑ Section 10 Permit
or General Permit (GP) number: 3885
❑ Yes ❑X No
1 d. Type(s) of approval sought from the DWQ (check all that apply):
❑X 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 For the record only for DWQ
because written approval is not required? 401 Certification:
❑X 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.
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below.
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
2. Project Information
2a.
Name of project:
Silas Creek Stream Bank Stabilization Project
2b.
County:
Forsyth
2c.
Nearest municipality / town:
Winston -Salem
2d.
Subdivision name:
2e.
NCDOT only, T.I.P. or state project no:
3.
Owner Information
3a.
Name(s) on Recorded Deed:
Wake Forest University
3b.
Deed Book and Page No.
NA
3c.
Responsible Party (for LLC if
Greg Scott
applicable):
3d.
Street address:
PO Box 7201
3e.
City, state, zip:
Winston - Salem, NC 27109
3f.
Telephone no.:
336.758.4529
3g.
Fax no.:
336.758.6060
3h.
Email address:
scott @wfu.edu
For the record only for Corps Permit:
❑X Yes ❑ No
❑ Yes ❑X No
❑ Yes ❑X No
❑ Yes ❑X No
Page 1 of 10
PCN Form — Version 1.4 January 2009

4.
Applicant Information (if different from owner)
4a.
Applicant is:
❑ Agent ❑ Other, specify:
4b.
Name:
4c.
Business name
(if applicable):
4d.
Street address:
4e.
City, state, zip:
4f.
Telephone no.:
4g.
Fax no.:
4h.
Email address:
5.
Agent /Consultant Information (if applicable)
5a.
Name:
Jake Byers, PE
5b.
Business name
Michael Baker Engineering, Inc.
(if applicable):
5c.
Street address:
797 Haywood Rd., Suite 201
5d.
City, state, zip:
Asheville, NC 28806
5e.
Telephone no.:
828- 350 -1408
5f.
Fax no.:
828- 350 -1409
5g.
Email address:
jbeyers @mbakerintl.com
Page 2 of 10

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): 1 6862 -07- 7995.00; 6826 -08- 9642.00
1 b. Site coordinates (in decimal degrees): I Latitude: 36.128676 Longitude: - 80.284085
1c. Property size: 23 acres
2. Surface Waters
2a. Name of nearest body of water to proposed project: Silas Creek
2b. Water Quality Classification of nearest receiving water: C
2c. River basin: Yadkin
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 existing dam is an earthen dam built in the early 20th century on Silas Creek, which outfalls from the dam via a stone arch culvert. Siltation
upstream as resulted in current braided channels and wetland marsh configuration. Nearby landuse include include Wake Forest University, historic
Reynolda property, and residential uses.
3b. List the total estimated acreage of all existing wetlands on the property: 0.07
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 275
3d. Explain the purpose of the proposed project:
Stabilize stream banks along Silas Creek within the Lake Katharine Wetland in the vicinity of Reynolda Walking Trail and the Lake Katharine dam
3e. Describe the overall project in detail, including the type of equipment to be used:
Bio- engineered structures on the upstream face of the dam; use of herbaceous vegetation mix to avoid woody roots compromising the dam
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the ❑ Yes ❑X No ❑ Unknown
Corps or State been requested or obtained for this property /
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:
Name (if known): Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5. Project History
5a. Have permits or certifications been requested or obtained for ❑ Yes ❑X No ❑ Unknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project? ❑ Yes ❑X No
6b. If yes, explain.
Page 3 of 10
PCN Form — Version 1.4 January 2009

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply)
❑X Wetlands
❑X Streams
— tributaries ❑ Buffers
❑ Open Waters
❑ Pond Construction
2. Wetland Impacts
Stream name Perennial (PER) or Type of Average
Impact
number
intermittent (INT)? jurisdiction stream
If there are wetland impacts proposed on
the site, then complete this question
for each wetland
area impacted.
(linear
2a. 2b.
2c.
2d.
2e.
2f.
Wetland impact
Type of impact
Type of wetland
Forested
Type of jurisdiction
Area of
number
Choose one
Corps (404,10) or
impact
Permanent (P) or
S5 -
Choose one
DWQ (401, other)
(acres)
Temporary (T)
Choose one
W1 P
Excavation
Non -Tidal Freshwater Marsh
No
Corps
0.01
W2
Choose one
Choose one
Yes /No
W3
Choose one
Choose one
Yes /No
W4 -
Choose one
Choose one
Yes /No
W5 -
Choose one
Choose one
Yes /No
W6 -
Choose one
Choose one
Yes /No
2g. Total Wetland Impacts: 0.01
2h. Comments:
Pull back point bar to 4:1 (more gradual slope)
3. Stream Impacts
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 (PER) or Type of Average
Impact
number
intermittent (INT)? jurisdiction stream
length
Permanent (P) or
width
(linear
Temporary (T)
(feet)
feet)
S1 P
Stabilization
Silas Creek PER Corps
120
S2 -
Choose one
S3 -
Choose one
S4 -
Choose one
S5 -
Choose one
-
S6 -
Choose one
3h. Total stream and tributary impacts
120
3i. Comments:
Install 2 rock vane, Install
8 lift geolift up to approximate
elevation 860', Install impervious swale, Smooth out topography, Pull back point bar to 4:1
(more gradual slope)
Page 4 of 10
PCN Form — Version 1.4 January 2009

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
B3 -
Yes /No
impact number (if applicable)
Type of impact
Waterbody Area of impact (acres)
Permanent (P) or
B6 -
type
Temporary (T)
6h. Total Buffer Impacts:
6i. Comments:
01
Choose one
Choose
02
Choose one
Choose
03
Choose one
Choose
04
Choose one
Choose
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If pond or lake construction proposed, then complete the chart below.
5a. 5b. 5c. 5d. 5e.
Pond ID number Proposed use or Wetland Impacts (acres) Stream Impacts (feet) Upland
purpose of pond (acres)
Flooded Filled Excavated Flooded Filled Excavated
P1 Choose one
P2 Choose one
5f. 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 any impacts require mitigation, then you MUST fill out Section D of this form.
6a. Project is in which protected basin? ❑ Neuse ❑ Tar - Pamlico ❑ Catawba ❑ Randleman ❑ Other:
6b. 6c. 6d. 6e. 6f. 6g.
Buffer Impact Reason for impact Stream name Buffer Zone 1 Zone 2
number — mitigation impact impact
Permanent (P) or required? (square (square
Temporary (T) feet) feet)
B1
Yes /No
B2
Yes /No
B3 -
Yes /No
B4 -
Yes /No
B5 -
Yes /No
B6 -
Yes /No
6h. Total Buffer Impacts:
6i. Comments:
Page 5 of 10

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
NA; Project is specifically designed for environmental enhancement /restoration.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
NA; Project is specifically designed for environmental enhancement /restoration.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for ❑ Yes ❑X No
impacts to Waters of the U.S. or Waters of the State?
2b. If yes, mitigation is required by (check all that apply): ❑ DWQ ❑ Corps
❑ Mitigation bank
2c. If yes, which mitigation option will be used for this
El Payment to in -lieu fee program
project?
❑ Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
Type: Choose one Quantity:
3b. Credits Purchased (attach receipt and letter) Type: Choose one Quantity:
Type: Choose one 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: Choose one
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 6 of 10
PCN Form — Version 1.4 January 2009

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 ❑ Yes ❑X No
buffer mitigation?
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.
6c. 6d. 6e.
Zone Reason for impact Total impact Multiplier Required mitigation
(square feet) (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 7 of 10

E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified ❑ Yes ❑ No
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
❑ Yes ❑ No
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 ❑X No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
Streambank stabilization only; no impervious surface
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
2e. Who will be responsible for the review of the Stormwater Management Plan?
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
apply (check all that apply): ❑ USMP
❑ 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?
5.
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 8 of 10
PCN Form — Version 1.4 January 2009

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the project involve an expenditure of public (federal /state /local) funds or the ❑ Yes ❑X 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 X❑ No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1c. 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
letter.) ❑ Yes ❑ No
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 ❑X No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after - the -fact permit application? ❑ Yes ❑X 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 ❑X 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
NA the proposed project, or available capacity of the subject facility.
Page 9 of 10
PCN Form — Version 1.4 January 2009

S. 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 El No
impacts?
5c. If yes, indicate the USFWS Field Office you have contacted. I Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
http: Nwww. fws. govt raleightspecies /cntylisUforsyth.html; https:llecos.fws.govriipact
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? I ❑ Yes Q No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
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?
http:llgis.nedcr.gov/hpoweb/
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA - designated 100 -year floodplain?
❑X Yes ❑ No
8b. If yes, explain how project meets FEMA requirements:
A hydraulic analysis was conducted within the project area to determine if any proposed work would have an affect on water surface elevation.
floodway elevations, or floodway widths. The results of the analysis showed no change in water surface elevation, floodway elevation. or floodway
width. see attached for approved floodplain development permit.
8c. What source(s) did you use to make the floodplain determination?
http:llwww.ncfloodmaps.com/
Applicant/Agent's Printed Name
App icant/Agent's Signature
(Agent's signature is valid only if an authorization
letter from the amlicant is provided.)
Page 10 of 10
a ! 5'
Date

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rp
Figure 1 - Lake Katharine
Project No. 147273
7.5- minute quadrangle Rural Hall, NC
N
0 200 400 800
Feet

FORSYTH COUNTY, NORTH CAROLINA ® SHEET NUMBER 23
N
A
w
u-
0
00
ri
pp
O
O
A

Site Latitude
Longitude Cowardin
Estimated
Class of
Class
amount of
aquatic
aquatic
resource
resource in
review area
Silas 36.128676
- 80.284085 Freshwater
0.01 acres
Non- section
Creek /Lake
Emergent
10 - wetland
Katharine
Silas 36.128676
- 80.284085 Perennial
120 linear feet
Non - section
Creek /Lake
10 — non -
Katharine
wetland

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LA�J) National Wetlands Inventory
This map is for general reference only. The US Fish and Wildlife Service is not
responsible for the accuracy or currentness of the base data shown on this map. All
wetlands related data should be used in accordance with the layer metadata found on
the Wetlands Mapper web site.
User Remarks:
Silas Creek Stream Bank Stabilization Project - NWI Map
Oct 6, 2015
Wetlands
Freshwater Eniergent
- Freshwater FtrrestedJShrub
- Estuarine and Marine Deepwater
® Estuarine ana Marine
- Freshwater Pond
- Lake
- Riverine
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Katharine Figure 2 - Lake
Project No. 147273
0 200 400 800
Forsyth County Feet
N
A

A TTA CHMENT A
PRELIMINARY JURISDICTIONAL DETERMINATION FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PRELIMINARY JURISDICTIONAL
DETERMINATION (JD):
B. NAME AND ADDRESS OF PERSON REQUESTING PRELIMINARY JD:
Jake Byers, P.E.; Michael Baker Engineering; 797 Haywood Rd., Suite 201; Asheville, NC 28806
C. DISTRICT OFFICE, FILE NAME, AND NUMBER:
Raleigh,
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION:
Silas Creek Bank Stabilization Project; Lake Katharine Dam; Winston - Salem, NC
(USE THE ATTACHED TABLE TO DOCUMENT MULTIPLE WATERBODIES AT DIFFERENT
SITES)
State: NC County /parish /borough: Forsyth City: Winston -Salem
Center coordinates of site (lat /long in degree decimal format):
Lat. 36.128676 ON; Long. - 80.284085 OW.
Universal Transverse Mercator:
Name of nearest waterbody: Silas Creek and Lake Katharine
Identify (estimate) amount of waters in the review area:
Non - wetland waters:
120 linear feet: 19 -29 width (ft) and /or acres.
Cowardin Class:
Stream Flow: Perennial
Wetlands: 0.01 acres.
Cowardin Class: Freshwater Emergent
Name of any water bodies on the site that have been identified as Section 10
waters:
Tidal:
Non - Tidal:
1

E. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT
APPLY):
❑ Office (Desk) Determination. Date:
❑ Field Determination. Date(s):
SUPPORTING DATA. Data reviewed for preliminary JD
(check all that apply - checked items should be included in case file and,
where checked and requested, appropriately reference sources below):
❑ Maps, plans, plots or plat submitted by or on behalf of the
applicant /consultant:
❑ Data sheets prepared /submitted by or on behalf of the
applicant/consultant.
❑Office concurs with data sheets /delineation report.
❑ Office does not concur with data sheets /delineation report.
❑ Data sheets prepared by the Corps:
❑ Corps navigable waters' study:
❑ U.S. Geological Survey Hydrologic Atlas:
❑ USGS NHD data
❑ USGS 8 and 12 digit HUC maps
❑✓ U.S. Geological Survey map(s). Cite scale & quad name: 7.5- minute; Rural Hail ,NC
✓❑ USDA Natural Resources Conservation Service Soil Survey.
Citation: USDA, Forsyth County, NC Soil Survey, 1976
❑✓ National wetlands inventory map(s). Cite name: http: / /www.fws.gov /wetiands /data /mapper.HTML
❑ State /Local wetland inventory map(s):
❑✓ FEMA /FIRM maps: NC Panel 6826
❑ 100 -year Floodplain Elevation is:
(National Geodectic Vertical Datum of 1929)
❑✓ Photographs: ❑✓ Aerial (Name & Date): or
❑ Other (Name & Date):
❑ Previous determination(s). File no. and date of response letter:
❑ Other information (please specify):
2

1. The Corps of Engineers believes that there may be jurisdictional waters of the
United States on the subject site, and the permit applicant or other affected party
who requested this preliminary JD is hereby advised of his or her option to
request and obtain an approved jurisdictional determination (JD) for that site.
Nevertheless, the permit applicant or other person who requested this
preliminary JD has declined to exercise the option to obtain an approved JD in
this instance and at this time.
2. In any circumstance where a permit applicant obtains an individual permit, or
a Nationwide General Permit (NWP) or other general permit verification requiring
"pre- construction notification" (PCN), or requests verification for a non - reporting
NWP or other general permit, and the permit applicant has not requested an
approved JD for the activity, the permit applicant is hereby made aware of the
following: (1) the permit applicant has elected to seek a permit authorization
based on a preliminary JD, which does not make an official determination of
jurisdictional waters; (2) that the applicant has the option to request an approved
JD before accepting the terms and conditions of the permit authorization, and
that basing a permit authorization on an approved JD could possibly result in less
compensatory mitigation being required or different special conditions; (3) that
the applicant has the right to request an individual permit rather than accepting
the terms and conditions of the NWP or other general permit authorization; (4)
that the applicant can accept a permit authorization and thereby agree to comply
with all the terms and conditions of that permit, including whatever mitigation
requirements the Corps has determined to be necessary; (5) that undertaking
any activity in reliance upon the subject permit authorization without requesting
an approved JD constitutes the applicant's acceptance of the use of the
preliminary JD, but that either form of JD will be processed as soon as is
practicable; (6) accepting a permit authorization (e.g., signing a proffered
individual permit) or undertaking any activity in reliance on any form of Corps
permit authorization based on a preliminary JD constitutes agreement that all
wetlands and other water bodies on the site affected in any way by that activity
are jurisdictional waters of the United States, and precludes any challenge to
such jurisdiction in any administrative or judicial compliance or enforcement
action, or in any administrative appeal or in any Federal court; and (7) whether
the applicant elects to use either an approved JD or a preliminary JD, that JD
will be processed as soon as is practicable. Further, an approved JD, a proffered
individual permit (and all terms and conditions contained therein), or individual
permit denial can be administratively appealed pursuant to 33 C.F.R. Part 331,
and that in any administrative appeal, jurisdictional issues can be raised (see 33
C.F.R. 331.5(a)(2)). If, during that administrative appeal, it becomes necessary
to make an official determination whether CWA jurisdiction exists over a site, or
to provide an official delineation of jurisdictional waters on the site, the Corps will
provide an approved JD to accomplish that result, as soon as is practicable.

This preliminary JD finds that there "maybe" waters of the United States on the
subject project site, and identifies all aquatic features on the site that could be
affected by the proposed activity, based on the following information:
IMPORTANT NOTE: The information recorded on this form has not
necessarily been verified by the Corps and should not be relied upon for
later iurisdictional determinations.
Signature and date of
Regulatory Project Manager
(REQUIRED)
E
Signature and date of
person requesting preliminary JD
(REQUIRED, unless obtaining
the signature is impracticable)

SAMPLE
Estimated
Site Cowardin amount of
number Latitude Longitude Class aquatic
resource in
review area
1 0.1 acre
2
3
RI
k,
100 linear feet
15 square feet
0.01 acre
Class of
aquatic
resource
Non - section 10
— non - wetland
Non- section10
— wetland
Non - section 10
— wetland
Non - section 10
— non - wetland

WAKE FOREST
U N I V E R S I T Y
Facilities and Campus Services
October 12, 2015
SUBJECT: Reynolda Village Dam Repair
To whom it may concern:
The reason this project was initiated was for the sole purpose of maintenance
and repair to the eroded areas at the culvert in question.
Our concern is that further erosion will compromise the structural integrity of the
Dam creating the possibility of a liability and/or hazardous issue downstream.
Regards, sA
Greg Scott
Senior Project Manager
Wake Forest University
Facilities & Campus Services
PH: 336 - 758 -4529
Fax: [phone]
scott @wfu.edu
GS /cjt
PO Box 7286, Winston - Salem, North Carolina 27109 -7286 phone [phone] / fax [phone]