20090795 Ver 1_401 Application_20090709

?Il obgyq P.A.
"Practical Engineering &
Environmental Solutions"
09-0795
2050 Northpoint Drive • Suite A
Winston-Salem, NC 27106
Phone: [phone]
Fax: [phone]
[e-mail]
www.geotec.com
July 16, 2009

Mr. John Thomas
Raleigh Regulatory Field Office
US Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27586
Telephone [phone] (Ext. 25)
JUL s i 2ooe

Mr. John Dorney
' Division of Water Quality
NCDENR
4401 Reedy Creek Road
' Raleigh, North Carolina 27607
Telephone [phone]

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- WATER WEIINIDS?i ND SYMNA? NVJCH
PAI11
RE: Preconstruction Notification Application (Revised)
Nationwide Permit #3, Repair of Existing Structure to Bring it up to Current Safety Standards
Stream: Unnamed Tributary to Ellison Creek
Lewisville, Forsyth County, NC
Our Project #09.232
Dear Mr. Thomas and Mr. Dorney:
On behalf of Stan and Brenda Forester ("Forester"), Geoscience & Technology, P.A. ("GeoSci")
is pleased to submit the enclosed Preconstruction Notification Form (PCN) for impacting an 80 ft.
section of a stream in Lewisville, NC. The following text contains additional information concerning
the proposed project. Where the information pertains to specific items in the PCN, the PCN section
numbers are used.

' Background
' The Forester property on which the bulk of the dam sits is designated as Forsyth County Tax
Block 4433 Lot 031N. A part of the embankment and some of the proposed features of the project
will be on the parcel also owned by Forester, and designated Block 4433 Lot 031B. Access to the
site is through the driveway of 1098 Reynolds Road, Lewisville. The unnamed stream is marked on
the US Geodetic Survey Quadrant maps with a solid blue line. It discharges into Ellison Creek
approximately 12,000 ft. away.
' NC DENR issued a Notice of Violation in 2004, listing repairs that are required to bring the dam
into compliance with the Dam Safety Law. Among the violations listed are inadequacy of the
principal spillway, corrosion of the corrugated metal pipe ("CMP") principal spillway and failure
to maintain the embankment free of brush and trees. Forester retained GeoSci for engineering
consulting services related to design of the repairs. NC DENR has approved the repair plan.
i The approved repair plan includes installing a new principal spillway system that incorporates pre-
cast concrete manholes and reinforced concrete pipe ("RCP"), and plugging and abandoning the
existing principal CMP spillway. The alignment of the new spillway RCP is chosen to minimize
excavation in the embankment and for the tailwater discharge to be close to tangential to the stream.
Discharge will be on to a riprap dissipater pad, which is part of the permanent impact.

The existing downstream slope of the dam embankment is approximately 2H: 1V, which is not
possible to mow mechanically. Part of the plan to facilitate long term maintenance of the dam is to
reduce the severity of the slope to 3H : 1V, which is a safe slope for tractor mounted mowers. The
modification entails covering approximately 60 ft of the stream. This is also part of the permanent
impact.
In summary, our proposal is to fill approximately 60 ft. of the stream, immediately downstream
from the end of the existing CMP, and to place a riprap dissipater pad, for a total permanent impact
of 80 ft., as measured along the existing stream centerline. 30 ft. of temporary impact will be
required during construction, for placement of the dissipater and for space to place cofferdams to
enable bypass or pump around during work in the stream.
In a telephone conversation with Mr. Thomas, he advised us that NWP #3 is appropriate for this
project.
' We request the corresponding General Certification from NC DWQ. We understand that the NC
DWQ Authorization Number 3705 may apply.
' Project Description PCN §111. 10)
Proposed construction details are indicated on Sheets 1 and 2. The proposed project consists of:
1) Install erosion control measures.
2) Clear site, strip and stockpile topsoil.
3) Maintain low pool using temporary siphon.
4) Adjust grade at emergency spillway.
' 5) Excavate for and placing new principal spillway.
6) Install a temporary cofferdam to allow bypass or pump-around.
7) Repair the hole in the CMP spillway.
' 8) Grout the CMP.
9) Install permanent siphon drain.

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10) Place fill on downstream slope of embankment.
11) Remove temporary measures.
12) Apply a layer of topsoil, turf reinforcement mat and seed.
The project is described on the enclosed drawings. Sheet SP-1 contains a small-scale plan of the
surrounding area, showing topography and physical features, downloaded from the Forsyth County
GIS.
Schedule
The contractor has been selected. Once permits are in hand, construction will be complete within 14
weeks.
Stream Impacts (§V1.3)
Under the proposed construction, approximately 80 linear ft. of the stream will be permanently
impacted and approximately 30 additional ft. will be temporarily impacted during construction. The
80 ft. of permanent impact consists placing fill and a dissipater pad in the existing stream. These
lengths are measured along the mapped centerline of the stream.
Impact Justification (Avoidance and Minimization) §Vll:
The impacts are necessary to bring the dam into compliance and to make possible the continuation
of compliance with dam safety law. The ability to maintain the embankment mechanically is
essential to keeping the dam in compliance.
l The 80 ft. impact just allows the 3H : 1V slope that can be maintained mechanically and the
placement of a dissipater pad. Reduced impact could only be achieved with a steeper slope that
would not be safe to maintain mechanically.
Submittal
1

The original and one (1) copy of this application are enclosed for the Corps of Engineers. Five (5)
copies are enclosed for the Division of Water Quality. A check made payable to the NC Division of
Water Quality for the application fee of $240.00 is attached to the cover page of one copy of the
application sent to the NC DWQ.
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Please let us know if you have any questions or require further information with regards to this
application.
With best regards,
GEOS E AND TECI•F
Carl von burg ,. 02407
Senior Civil Engineer
enclosures: PCN forms%< iro° R
Original and otte4d, pia eYo John Thomas, COE
Five (5) copies to John Dorney, DWQ
attachments: A check for $240.00 application fee attached to one copy sent to NC DWQ
cc: w/att. Steve Tedder, Winston-Salem Regional Office, NC DWQ
Jeff Kopf, Erosion Control, Flood Plain Manager, Winston-Salem/Forsyth Co.
Stan Forester

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FIGURES

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Subject Site
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Tide: Project
Forester Parker Lake #2 Dam Scale:
NTS Date:
1/9/200-5
VeI.&-hen? F,
Site Location Map T?r'hidbgy
P. A.
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NC Fig. No.:

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on No.: Iy rZr ic• ngneenng
Enuronmemal Solationc"
04.376 ew
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e, 0 Winston-Salem, NC [phone]
PCN APPLICATION FORM
0-9-0 3 5
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Office Use Only:
' ci 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 sou
ht from the
.
g
Corps: ®Section 404 Permit ? Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: 3 (Repair existing structure to bring it up to current safety stanards) or
General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps? ® Yes ? No

1d. 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 For the record only for DWQ 401 For the record only for Corps Permit:
because written approval is not required? Certification:
? Yes ® No
? Yes N No
If. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation ? Yes ® No
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program.
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1h ? Yes ® No
below.
1 h
Is the
roject locat
d
ithi
NC DCM
.
p
e
w
n a
Area of Environmental Concern (AEC)? ? Yes ® No
2. Project Information
2a. Name of project: REPAIR OF PARKER LAKE #2 DAM (FORSY - 040)
2b. County: FORSYTH
' 2c. Nearest municipality / town: LEWISVILLE
2d. Subdivision name: NONE JUL 2
2009
2e. NC DOT only, T.I.P. or state NONE
project no: ENR-WATER g0AEI7Y
3. Owner Information
3a. Name(s) on Recorded Deed: FORESTER, STANLEY F., JR. & BRENDA I.
3b. Deed Book and Page No. 1581-375, 1673-3291
7 3c. Responsible Party (for LLC if
applicable): STANLEY F. FORESTER, JR.
3d. Street address: 1098 REYNOLDS ROAD
3e. City, state, zip: LEWISVILLE, NC 27023
Ef. Telephone no.: 336-760-6500
Fax no.: 336-760-6521
3h. Email address: [e-mail]

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PCN Form - Version 1.3 December 10, 2008 Version
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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: Carl von Isenburg, PE
5b. Business name
(if applicable): GoeScience & Technology, PA
5c. Street address: 2050 Nortpoint Drive
5d. City, state, zip: Winston-Salem, NC 27106
5e. Telephone no.: 336-896-1300
5f. Fax no.: 336-896-1020
5g. Email address: [e-mail]
Page 2 of 10
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): 5885-30-7678.00 & 5885-40-0142.00
1b. Site coordinates (in decimal degrees): Latitude: 36.079684 Longitude: - 80.409915
(DD.DDDDDD) (-DD.DDDDDD)
1 c. Property size: 37.22 & 6.58 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
proposed project:
Unnamed tributary to Ellison Creek
2b. Water Quality Classification of nearest receiving water: C
2c. River basin: YADKIN-PEEDEE
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:
Site is an eathen dam, 50=/- years old, requiring repair of principal spillway. Surrounding land is lightly wooded.
3b. List the total estimated acreage of all existing wetlands on the property:
2,404 Ft. Riverine Wetland, 4.61 Ac Lacustrine Wetland
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
2
404
he purpose of the proposed project:
eplace spillway of existing earthen dam.
P
' Describe
the overall project in detail, incl uding the type of equipment to be used:
CMP barrel. Installl new princ. spillway and drain. Add fill to downstream face. Use heavy earth moving equip.

' 4. Jurisdictional Determinations
4a. Have jurisdictional wetland
t
or s
ream determinations by the
r.nrnc nr Cfnfn I-- , a a . _?a_:_ _
. _ ?-.......,.. ... ......... .? wi a Iw `.ll V?JGI ly ' project (including all prior phases) in the past? ? Yes ®No El Unknown
Comments:
4b. If the Corps made the jurisdictional determination, what type
of determination was made? ? Preliminary ? Final
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
this project (including all prior phases) in the past? ? Yes ® No El Unknown
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project? El Yes ® No
6b. If yes, explain.
Page 3 of 10
' PCN Form - Version 1.3 December 10, 2008 Version

V. rroposed Impacts Inventory
1. Impacts Summary
1a. Which sections were completed below for your project (check all that apply):
1 ? 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.
Wetland impact 2b. 2c. 2d. 2e.
Type of jurisdiction 2f.
number -
Permanent (P) or Type of impact Type of wetland
(if known) Forested (Corps - 404, 10
DWQ Area of impact

Temporary T - non-404, other) (acres)
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
? P ? T ? Yes ? Corps
E ? No ?DWQ
W6
? P ? T ? Yes ? Corps
El No ?DWQ
2g. Total wetland impacts
GII. vVI11111G11 W.
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.
Stream impact Type of impact Stream name 3d.
Perennial 3e. 3f.
Type of jurisdiction Average 3g.
Impact
number -
Permanent (P) or (PER) or (Corps - 404, 10 stream length

Temporary (T) intermittent
(INT)? DWQ - non-404, width (linear
f
other) (feet) eet)
S1 ® P ? T Fill None PER ® Corps

? INT 10
® DWQ 80
S2 ? P ® T Temp. Work None ® PER ® Corps 10

? INT
® DWQ 30
S3 ? P ? T ? PER ? Corps
? INT ? DWQ
S4 ? P ? T ? PER ? Corps
? INT ? DWQ
S5 ? P ? T ? PER ? Corps
? INT ? DWQ
S6 ? P ? T F1 PER El Corps
? INT ? pWQ
3h. Total stream and tributary impacts
110

3i. Comments: The fill is to decrease the slope of the downst ream face of the dam to facilitate maintenance.

Page 4 of 10
' PCN Form - Version 1.3 December 10, 2008 Version

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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.
Open water 4b.
Name of waterbody 4c. 4d. 4e.
impact number -
Permanent (P) (if applicable) Type of impact Waterbody type Area of impact (acres)
or Temporary T
01 ?P?T
02 ?P?T
03 ?P?T
04 ?P?T
4f. Total open water impacts

4g. Comments:
5. Pond or Lake Construction
If and or lake construction proposed, the n complete the chart below.
5a. 5b. 5c. 5d. 5e.
Pond ID
Proposed use or purpose Wetland Impacts (acres) Stream Impacts (feet) Upland
'
number of pond (acres)
Flooded Filled Excavated Flooded Filled Excavated Flooded
P1
P2

5f. Total
' Sg. 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
B
ff
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.
u
er
mpacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
b
l
e
ow. If an impacts require mitigation, then you MUST fill out Section D of this form.
6a.

Project is in which protected basin? ? Neuse ? Tar-Pamlico ? Other:
? Catawba ? Randleman
6b. 6c. 6d.
Buffer impact 6e. 6f.
6g
number - Reason Buffer Zone 1 impact Zone 2 impact
Permanent (P) for Stream name mitigation (square feet
)
or Tern ora T im act (square feet)
re uired?
B1 ?P?T ?Yes
? No
B2 ?P?T ?Yes
? No
B3 ?P?T ?Yes
? No
6h. Total buffer impacts
6i. Comments:
1
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PCN Form - Version 1.3 December 10, 2008 Version
1
D. Impact Justification and Mitigation
' 1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Permanent impact is result of repair to bring dam into compliance with Dam Safety Act and to facilitate maintenance.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Temp. coffer dam and pump around. Where possible, equipment will be on bank.
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

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

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PCN Form - Version 1.3 December 10, 2008 Version
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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 7 of 10
PCN Form - Version 1.3 December 10, 2008 Version

' 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
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: No increase in impervious area
' 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? Forsyth County/Lewisville
' ? 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

4a. Which of the following state-implemented stormwater management programs apply ? HQW
El ORW
(check all that apply): ? Session Law 2006-246
? Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
attached? ? Yes ® No
5. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements? ? Yes ? No
; !b. Have all of the 401 Unit submittal requirements been met? ? Yes ? No
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' PCN Form - Version 1.3 December 10, 2008 Version

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 ® No
use of public (federal/state) land?
1 b. If you answered "yes" to the above, does the project require preparation of an
t
environmen
al 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
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 ® 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.
None

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' 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 ® N

impacts? o

'

5c. If yes, indicate the USFWS Field Office you have contacted ?
Raleigh
. ? Asheville
5d
Wh
t d
.
a
ata sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
' USFWS website list of endangered species. t4G KID Id 11 f e ePhOwt'Ce,5 COGS PM (S S!O 17 <iQ. Li? v r lie .
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?
Same q
5 Sa(
,
.
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7
Will
a.
this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation
status (e.g., National Historic Trust designation or properties significant in ? Yes
No
' North Carolina history and archaeology)?

' 7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
State Historic Preservation Office (awaitin
re
g
sponse)
8. Flood Zone Designation (Corps Requirement)
8a
Will thi
t
.
s projec
occur in a FEMA-designated 100-year floodplain? ? Yes ® No
' 8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination? FEMA Maps

Stanley F. Forester
1
Applicant/Agent's Printed Name Appl'c t/ ens Signature
' 7
Wae
(Agent
s si re is valid ly if n thorization letter from the applicant
is ovided.

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' PCN Form - Version 1.3 December 10, 2008 Version

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DRAWINGS
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