19990667 Ver 1_Complete File_19990709 (2)

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Hugh Creed Associates, Inc., P.A.
Consulting Engineers & Land Surveyors
1306 W. WENDOVER AVE. P.O. BOX 9623
GREENSBORO, NC 27408 GREENSBORO, NC 27429
TELE: [phone] OR [phone]
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? YVATER UAU
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PROJECT/CLIENT.
FAX: [phone]
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ORIGINAL(S) OTHER
TO BE DELIVERED n TO BE MAILED TO BE PICKED UP
DIRECT EXPRESS F1 FEDERAL EXPRESS EXPRESS MAIL
OTHER.
FOR REVIEW/COMMENT [:] FOR APPROVAL M FOR SUBMITTAL
FOR YOUR USE n AS REOUESTED
COMMENTS. ,Sais" Q ?i%L /c o'7 ^-S
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WETLAND, STREAM, AND BUFFER INSPECTION FORM
compliance Evaluation Inspection: (pull down
menu: 101 CEI, Buffer CEI)
? Complaint (pull down menu: wetland, stream,
wetland & stream, buffer)
? Follow-up inspection: (pull down menu: Number
of visits 2"d, 3`d, etc.)
? Other types of investigations
-Date of Inspection:
-Regional Office: (Pull do 4n men ARO, FRO, MRO, WaRO,
WiRO, ?RO)
Regional Office rackin0 No.
-Project Name:_
County: Z? .? 2 to
River Basin (pull down :
Nearest Stream Name:
Lat.- _ - Long.
Project Name:
DWQ #:
Project Type: (pull down menu: Commercial, Industrial,
Subdivision (residential), Single Family, DOT, Road Project (non-
DOT), Utility Lines, Forestry, Agriculture, CAMA, Military, Other
OWNER REPRESENTATIVE
Name:
Name:
Address:
Address:

Phone No. - - Phone No.: - -
INSPECTION FORM TYPES (Note: hishlighting one or combinations of the following will bring a new screen)
? =101/Water Quality Certification - CEI
? Stream/Wetland Compliant - NO WQ Certification
? Riparian Buffer Complaint and CEls
RIPARIAN BUFFER COMPLAINTS AND CEIs
Stream Information:
Stream Name:
Stream Classification:
Buffer Rules: (pull down menu: Neuse, Tar-Pam, Randleman, Water Supply Watershed)
Inspection Conditions:
? Confirmation that the stream is subject to the rule by DWQ staff. (e.g. for Neuse and Tar-Pam the stream
must be depicted on either a USGS map or Soil Survey. If the buffer rule is in a Water Supply the stream
must be depicted on the most recent versions of the U.S.G.S. 1:24000 (7.5Minute) scale topographic maps or
as determined by local government studies map.
Confirmation description:
Linear feet of buffer impact
Linear width of buffer impact
Estimate acreage of buffer impact
Estimate acreage of Zone I
Estimate acrea =e of Zone 2
Buffer Use Observed: (Pull down menu: Airport, Archaeological activities, Bridges. Da in maintenance, Drainage of a pond, Driveway
crossing, Forestry. Fertilizer application, Greenway trails, Mining activities, Non-electric utility. on-site sanitary sewer systems, Overhead
electric utility lines, modified natural stream maintenance, play ground equipment, protection of excising structures. Railroads, Scientific
studies and gauging stations. Stormwater Management. Stream restoration. Temporary Sedimentation and Erosion Control. Underground
electric lines, vegetation management, Water dependent structures, Water Supply, Water Wells, Wetland Restoration, other )
? Buffer Use Designation: (pull down menu: Exempt, Allowable, Allowable w/ Mitigation, Prohibited)
? DWQ Authorization needed
? DWQ Authorization received (pull down menu: compliant, non-compliant)
Comments:
Resolution:
? Compliant - NO Further Action Required
Non-Compliant
? Notification to Local Delegated Authority
? Notice of Violation
? Notice of Violation - Recommendation for Enforcement
? Other

STREAM/WE'T'LAND COMPLAINT - NO wQ CERTIFICATION ISSUED
Inspection Conditions: NO 401 Certiticati Linear Feet
? Estimate Stream Impacts: - Acres
? Estimate Wetland Impacts:
? Description of Activity:
Resolution: URIED/COMPLIANT
? NO ACTION REQ
Non-Compliant
? Notification to USACE
? Notice of Violation
? Notice of Violation - Recommendation for Enforcement
? Other
N

401 WQ C ER 11PtUA 1 IUN - k-r-1
401 WQ Certification Issued and Containing the following Stipulated Conditions:
.2' Stream Impacts (LF):
? Wetland Impacts (acres):
? Stormwater Management: Y/N
? Mitigation: (Pull clown menu: WRP, on-site, off site (non-WRP), mitigation hank)
? Special Conditions:

Inspection Conditions:
,,P??II'O?'ect Status:
waer Mar?a?een - -
Special Conditions:
Estimate Non-compliant Stream Impacts:
Estimate Non-compliant Wetland Impacts:
Completed _? nder ConstrucSiQn? Not Started
C -mplianNon compliant Not applicable
Compliant Non-compliant Not applicable
Linear Feet
Acres
Notes:

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DEM IV: CORPS ACTION ID:'
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #):
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:

1) NOTIFICAT2oN To TFiFS CORPS OF ENGINEERS
2) APPLICATION rOR SECTION 401 CERTIrxcATzoN
3) COORDINATION WITH TEE NC bIVISXON OS COASTAL MANAOMOONT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE
FIELD OFFICE OF THE CORPS OF ENGINEERS (NEE AGENCY ADDRESSES 5REET). SEVEN
(7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT
(SEE AGENCY ADDRESSES SHEET). PLEASE PRINT.
1. OWNERS NAME: Gene T. Fales ?
2. MAILING ADDRESS: P.O. Box 19541, Greensboro, NC 27419
CITY: High Point STATE.
SUBDIVISION NAME: Piedmont Centre
NC
ZIP CODE:
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE): Lot 13, Piedmont Centre, 4259 Piedmont Parkway
High Point, NC 27265
3. TELEPHONE NUMBER (HOME): (WORK): [phone]
4. IF APPLICABLE: AGENT'S NAME OR IkESPONSIBLE CORPORATE 6FFICIAL, ADDRESS,
PHONE NUMBER: NJA

5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: _ _Guilfo,Ed NEAREST TOWN OR CITY: High Point

1
SPECIFIC LOCATION (INCLUDE ROAD
NUMBERS, LANDMARKS, ETC.): 4259 Piedmont Parkway, second lot on
north side of Piedmont Parkway just west of intersection with
Tarrant Road
w
6. IMPACTED OR NEAREST STREAM/RIVER: East Fork Deep River
RIVER BASIN: Deep River
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER
(SA), HIGH QUALITY WATERS (HOW), OUTSTANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WS-I OR WS-II)? YES [ ] NO [X] IF YES, EXPLAXN:?
7b. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES ( ] NO
7c. IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR
LIST OF COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION?
N/A
$a. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON
THIS FROPERTY? YES [ ] NO kX] IF YES, PROVIDE ACTION I.D. NUMBER OF
PREVIOUS PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
CERTIFICATION):
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED ]`OR THIS PROPERTY IN THE ,
FUTURE? YES ( ] NO [X?d IF YES, DESCRIBE ANTICIPATED WORK:
9a. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND: 4.204 Ac.
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
0.06 Ac, assume 10 along drainageway
2
10a.. NUMBER'OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: EXCAVATION:
FLOODING:
DRAINAGE: 0.06 Ac.
OTHER:
TOTAL ACRES TO BE IMPACTED:
0.06 Ac.
10b. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF
RELOCATED, PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION)
LENGTH BEFORE: /SD ? FT AFTER.' FT
WIDTH BEFORE (based on normal high water contours): PT
WIDTH AFTER: FT
AVERAGE DEPTH BEFORE: FT AFTER:
(2) BTg$,paK CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION: PLACEMENT OF PIPE IN CHANNEL: XX
CHANNEL EXCAVATION: CONSTRUCTION OF A DAM/FLOODING:
OTHER:
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE
WATERSHED DRAINING TO THE POND? N/A
WHAT IS THE EXPECTED POND SURFACE AREA? N/A
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYP,E OF
MECHANICAL EQUIPMENT TO BE USED-(ATTACH PLANS: 8 1/2" X 11" DRAWINGS
ONLY): Use pans, loaders, dozers and hackhQe Ln grade site
and install storm drain and utilities
13. PURPOSE OF PROPOSED WORK: To build 31,810 scj. ft. office/warehouse
din
3
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED
OUT IN WETLANDS. (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND
IMPACTS): .
To make use of the lot for the proposed building, parking and loading arei
1S. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SERVICE
(USFWS) AND/OR NATIONAL MARINE FISHERIES SERVICE (NMFS) (SEE AGENCY
ADDRESSES SHEET) REGARDING THE PRESENCE OF ANY FEDERALLY LISTED OR
PROPOSED FOR LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL HABITAT
IN THE PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE
CONTACTED: /Alpo' 9-3-77 (ATTACH RESPONSES
FROM THESE AGENCIES.)
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) (SEE AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC
PROPERTIES IN THE PERMIT AREA WHICH MAY BE AFFECTED BY THE PROPOSED
PROJECT. DATE CONTACTED: /NF'°. SST
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF
PUBLIC (STATE) LAND?
YES H NO [A (IF NO, GO TO 18)
a. IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA ENVIRONMENTAL
POLICY ACT?
YES [ ] NO [)
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE?
YES [ ) NO [ ]
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE
STATE CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT REGARDING
COMPLIANCE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
4
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18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF
PROPOSED ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL
INTO WETLANDS:
a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES
AND PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26,
29, AND 38). ALL STREAMS (INTERMITTENT AND PERMANENT) ON THE PROPERTY
MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET OR 1
INCH EQUALS 100 FEET OR THEIR EQUIVALENT.
b. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE
IMPACTED BY PROJECT.
c. IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA
SHEETS RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
d. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
e. WHAT IS LAND USE OF SURROUNDING PROPERTY? Th p
in an industrial park subdivision with to on each side and
across Piedmont Parkway developed with office l warehouse buildings
and an existing pond to the rear of the site
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
Public sanitary sewer
g. SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE U.S. MAY NOT BE IMPACTED PRIOR TO:
1) ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT,
2) EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF
ENVIRONMENTAL MANAGEMENT (WATER QUALITY) CERTIFICATION, AND
3) ( ZN TEE '1'i W17 COAS7''A1 COUNTIES ONLY) , A LETTER` FROM THE
NORTH CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED
ACTIVITY IS CONSISTENT WITH THE NORTH CAROLINA COASTAL MANAGEM$NT
PROGRAM.
OWNER' S /AGENT' S SIGNATURE
z 2 $ 9,.9
DATE
(AGENT'S SIGNATURE VALID ONLY
IE' AUTHORIZATION LETTER FROM
THE OWNER IS PROVXnED (18g.))
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