20070346 Ver 1_Individual_20070308

APPLICATION FOR DEPARTMENT OF THE ARMY PERMIT vane rarrnvvNr. nv. vi .w.....,
~ /33 CFR 3251 ~1 r ~~ 1~ ~ Expires December 31, 2004
,'The Public burden for thN coNsction of infomnation is sestimated to average 70 hours per response, ahhough the majority of spplications should require
5 hours or Isss. This includes the time for reviewing ustructions, searching existing data sources. gsthering and maintaining the data needed, and
computing and reviswirp the collection of irrfarmation. Send comments regsrding this burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden. to Department of Defame. Washington Headquarters Service Directorate of Information
Operatiom and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlkigtcn. VA 22202-4302; and to the Office of Management and Budget,
paperwork Reduction Project (0710-0003). Wsdrngton, DC 20503. Respondents should bs aware that notwithstanding any other provision of uw,
rro person shall ~ ~ any ppralty for faiirrg to corrrply with a collection of information if it does not display a currently valid OMB control
number. Please DO NOT RETURN yore form to either of those add. Computed appNcatiom must be submitted to the District Engineer having
jurisdiction over the location of the proposed activity
PRIVACY ACT STATEMENT
Authorities: Rivers and Harbors Act. Section 10, 33 USC 403; Clean Water Ad. Section 404, 33 USC 1344; Marine Protection . Rsseareh and
Ssrretuerus Act, 33 USC 1413, Ssctiorr 103. Principal Propose: Irrtorrrtation Provided on this form wiM be used in svaktating the application for a
permit. Route Usss: This information may be shared with the Department of Justice end other federal, st+roe, and local goverrrrnant agencies.
5ubmssion of rsgrrssbsd information is voltstrtary, however, $ information is not provided the permit applkeation cannot be evakrsted tar can a permit
~ ususcl• must be attacirsd to this
Ona set of original drarrirgs or good rsproduouls copies which show the location and clrsraciaer of the proposed activity
application (sac sample drawings and imtruations) and be submitted to the District Engineer hsvirrg jurisdiction over the location of the proposed
activity An application that is not computed in full wiN ba returned.
n'rFa.e s THR1/ s TO BE FIJ 1 FA BY THE ~^DOei
1. APPUCATION NO.
LO T F Y
APPLICANT'S NAME
5 8. AUTHORIZED AGENT'S NAME AND TITLE !.o aperK a nor req~dredl
.
Joseph P. Talnneberger Matthew O'Brien, ice President
8. APPLICANT'S ADDRESS 9. AGENT'S ADDRESS
Environmental Services, Inc.
101 West Worthington Ave., Suite 204 3661 Alamance Road
Charlotxe, NC.28203 Burlington, NC 27215
7.. APPUCANT'S PHONE NOS. WIAREA CODE 10. AGENT`S PHONE NOS. W AR CODE
a. Residence 704.551.2202 a. Residence 336.570.3002
b. Business 704.551.2202 b. Business 336.382.4356
_ sraTEMENT of AUTHOfnzAnoN
1 hereby authorize, Environmental Services, IilC. to act in my bshatf as my agent in the processing this application and to
iurniatr, upon request, supplemsrrtal ir-formation in support of this permit applicston. ~ / ,~ ~~'
~F~EI~~u~
See attached "Agent Authorization", dated January 8, 2007.
APPLICANT'S SIGNATURE DATE
NAME. LOCATION AND DESCRIPTION OF PROJECT OR ACTIVITY
12. PROJECT NAME OR TITLE raeesatieationar
Clemmons Town Center
13. NAME OF WATERBODY, IF KNOWN r~rBp~
N/A
7b. LOCATION OF PROJECT
Forsyth North Carolina
COUNTY STATE
14. PROJECT STREET ADDRESS ptagorosb/el
2400 Lewisville-Clemmons Rd.
Clelnmons, NC 27012
16. OTHER LOCATION DESCRIPTIONS, IF KNOWN, raeelnaon.rxcnsl
17. DIRECTIONS TO THE SITE
From I-40 exit at Lewisville-Clemmons Road. The tract is northwest of the interchange (see Figure 1).
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2. FIELD OFFICE CODE 3. DATE RECEIVED ! 4. DATE APPLICATION COMPLETED
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8. tseture of Activity (o~;n~ ~ t>~• su ~
See attached "Block 18".
i 9. Project Purpose ro *~ a w•~ ~ u+~ • e~ ~ This Project proposes development of flue tract Ior COIIInlercl.al
retail operations. The site is located at a major interchange in an area of rapid demographic growth and is zoned
appropriately for the proposed purpose. Alternative sites which were not selected are attached ("Site Alternatives
Analysis") and confer those sites' environmental and/or developmental constraints.
USE BLOCKS 20-22 IF Q"a"-""~" ""'JOit RLL MATERIAL IS TO BE ~SCHARGED
t0. Reason(s) for Discharge The proposed discharge activities are entirely related to development of this tract for
commercial retail purposes. Specific impact descriptions are given in Block 18 (attached) and include
placement of roads, building pads, parking areas, sewer access, and stormwater management.
21. Typelsj of Material Being Discharged and ihs Amount of Each Type in Cubic Yards
See attached "Block 21".
22. Surface Area in Acres of Wetlands or Other Waters FiNsd lase asrn,cnonsl
See attached "Block 22".
23. is Any Portion of the Work Already Complete? Yes No X IF YES, DESCRIBE THE COMPLETED WORK
24. Ad~esses of Adjoining Property Owners, Lessees, Etc., Whose Property Adpins the Watsrbody (lf more than can be entered here,
please attach a supplemental (ist).
See attached "Block 24".
25. List of Oilier Certifications or ApprovalslDsnials Readwd from other Federal, State or Local Agendas for Work Described in This Application.
AGENCY TYPE APPROVAL• IDENTIFICATION NUMBER DATE APPLIED DATE APPROVED DATE DENIED
•Would induda but is not restricted to zoning, building and flood plain permits
2B. Application is hereby made for a permit or permits to suthorize the work described in this application. 1 certify that the aiformation in this
application is complete and accurate. 1 further certify that 1 possess the authority to undertake the work descnbed herein or am acting as the
duly authorized agent of the applicant. /
(See attached Agent Authorization dated January 8, 2007) ' ;~w~~~~.lr~./~Dv/~ f ~t G
SIGNATURE OF APPLICANT DATE SIGNATURE OF AGENT DATE
The application must be signed by the person who desires to undertake the proposed activity lapplicant) or it may be signed by a duty
authorized agent if the statement in block 11 has bean filled out and signed.
18 U.S.C, Section 1001 provides that: Whoever, in any manner within the jurisdiction of arty department or agency of the United Steles
knowingly and willfully falsifies, conceals, or covers up any trick, scheme, or disguises a material fact or makes any false, fictitious or
fraudulent satsments or representations or makes or uses any false writing or document knowing same to contain any false, fictitious or
fraudulent statements or entry, shall be fined not moro than 510,000 or imprisoned not more than five yeas or both.

IP Submittal, Clemmons Town Center, 22 January 2007
BLOCK 18: Nature of Activity
This project proposed development of this tract for commercial and retail purposes (Figure 1). The
locations of proposed impacts are shown in Figure 2 (topography) and Figure 3 (aerial photo); the
overall site plan view is given in Sheet 1. The ponds which appear in the center of the tract have been
breached and drained; per subsequent USACE field review, these areas are have largely reestablished
as either streams with associated riparian wetlands or linear wetlands. The perennial stream
originating just above the former pond bottom flows southward at the base of the steep western slope
before entering a private lake. Two draws to the east have intermittent streams and/or linear wetlands
which confluence with the primary stream. The southernmost tip of the tract has a perennial stream
flowing from the lake.
Stream Impact #1 and Wetland Impact #4 aze shown on Sheet S. These impacts are fill and
grading activity necessary for parking azeas and building pads.
Stream Impact #2 is shown on Sheet 6. This impact involves culvert installation and grading for a
road crossing necessary to access the southern portion of the tract. The proposed design incorporates
headwalls, both upstream and down stream, and a riprap energy dissipator to minimize impact and
erosion potential.
Stream Impact #3 and Wetland Impact #3 are depicted on Sheet 7 and Sheet 4, respectively. This
impact proposes culvert installation and grading for a road crossing necessary to access the western
side of the tract. A downstream headwall and energy dissipator are used to minimize the impact and
control erosion.
Stream Impact #4 and Wetland Impact #5 are shown on Sheet 8. This is a temporary impact
necessary to install a sewer line which will connect the site to the municipal wastewater system.
Wetland Impact #1 is depicted on Sheet 2; it proposes fill and grading impacts needed for parking
areas and building pads.
Wetland Impact #2 is depicted on Sheet 3; it proposes excavation and grading impacts needed for
construction of a stormwater management pond.
BLOCK 21: Type of Material Being Discharged and Amount of Each Type in Cubic Yards
Wetland Impact #3 and Stream Impact #3 (depicted on Sheet 4 and Sheet ~ aze related to a road
crossing and propose approximately 10,263 cubic yards of fill using compacted clay and asphalt.
Wetland Impact #4 and Stream Impact #1 (depicted on Sheet S and Sheet 10) are grading-and-fill
for pazking areas which propose approximately 1,787 cubic yards of clay and asphalt fill.
Stream Impact #2 (depicted on Sheet 6 and Sheet 9) are related to a road crossing and pazking
areas which propose approximately 36,556 cubic yards of clay and asphalt fill.
BLOCK 22: Surface Areas of Wetlands or Other Waters Being Filled
Wetland Impact #1 (Sheet 2) encompasses 1.51 acres of depressional wetlands.
Wetland Impact #2 (Sheet 3) encompasses 0.70 acres oflow-quality wetlands.
Wetland Impact #3 (Sheet 4) encompasses 0.48 acres of riparian wetlands.
Wetland Impact #4 and Stream Impact #1 (Sheet S) encompass 0.08 acres of riparian wetlands
and 0.01 acres of stream (531 LF x 1.5 ft average width).
Stream Impact #2 (Sheet ~ encompasses < 0.01 acres of stream (139 LF x 1 ft average width).
Stream Impact #3 (Sheet ~ encompasses < 0.01 acres of stream (103 LF x 1 ft average width).
Stream Impact #4 and Wetland Impact #5 (depicted on Sheet 8) are temporary impacts which
encompass 0.07 acres of wetlands.

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Vicinity Depiction
Clemmons Tract
__ _ ; . Plemmons, Forsyth County, North Carolina
MAR 8 2001
iJRA•,tfW

Q Tract Boundaries
(Extent and Boundaries Approximate)
0 2500 5000
Feet
Source: www.mapquest.com,
IaimerThe information depicted on This fpure are for
cation purposes ony and was not prepared tor, and is
of suaable for legal or engineering purposes. The
motion presentetl Is not for regulatory review arM is
bed for use only by a professional licensed surveyor
ENVIRONMENTAL
SERVICES, INC.
3601 Alarnance Road
Burlington, North Carelina 27215
[phone]
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Project: BUR06052
Date: January 2007
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ENVIRONMENTAL Project: BUR06052
SERVICES, INC. Topographic Depiction Date: January 2007
3887 Alamance Roao Clemmons Tract
Bunington, NoM Carolina 27215 Drwn/Chkd: vbh/mhob
c33°'S'a3o82 Clemmons, Forsyth County, North Carolina
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ITEMIZE-LIST OF IMPACTS

SHEET INQEX WETLAND IMPACT-S
SURFACE AREA STREAM IMPACTS VOLI~ME IMPACT
SHEET 2 OF 11 65,945 SF ~A
SHEET 3 OF 11 30,289 SF NIA
SKEET 4 OF 11 20,736 SF SEE SHEET #7
SHEET 5 OF 11 3,509 SF 531 LF SEE SWEET #11
SHEET 6 OF 11 139 LF SEE SHEET #9
SHEET 7 OF 11 103 LF 277.101 CF
SHEET 6 OF 11 3,088 SF TEMPORARY 12 LF TEMPORARY NIA
SHEET 9 ©F 11 978.021 CF
SHEET 10 OF 11 48,249 CF
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