20001134 Ver 1_COMPLETE FILE_20000830

U
State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
January 4, 2001
Davidson County
DWQ Project # 001134
APPROVAL of 401 Water Quality Certification and ADDITIONAL CONDITIONS
Todd Yates
Model Home Co.
Post office Box 1259
Denton, NC 27239
Dear Mr. Yates:
You have our approval, in accordance with the attached conditions and those listed below, to place fill material in 130 linear feet of
streams for the purpose of constructing road crossings at Whispering Oaks subdivision at your development on SR 2113 as described in your
application dated October 3, 2000 as shown on December I, 2000 site plan. After reviewing your application, we have decided that this fill is
covered by General Water Quality Certification Number 3287. This certification allows you to use Nationwide Permit Number 39 whcn the
Corps of Engineers issues it. In addition, you should get any other federal, state or local permits before you go ahead with your project
including (but not limited to) Sediment and Erosion Control, Coastal Stormwater, Non-Discharge and Water Supply Water shed regulations.
This approval will expire when the accompanying 404 or CAMA permit expires unless otherwise specified in the General Certification.
This approval is only valid for the purpose and design that you described in your application except as modified below. If you chang-
your project, you must notify us and you may be required to send us a new application. If the property is sold, the new owner must be gisen a
copy of this Certification and approval letter and is thereby responsible for complying with all conditions. If total wetland fills for this project
(now or in the future) exceed one acre, compensatory mitigation may be required as described in 15A NCAC 2H .0506 (h) (6) and (7). For this
approval to be valid, you must follow the conditions listed in the attached certification and any additional conditions listed below.
1. Deed notifications or similar mechanisms shall be placed on all remaining jurisdictional wetlands and streams and on all lots within 30
feet of these streams to notify the state in order to assure compliance for future wetland and/or water impact. These mechanisms shall be
put in place within 30 days of the date of this letter or the issuance of the 404 Permit (whichever is later).
2. Any future road or driveway crossings must be bridges or bottom less culverts.
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearing. You must act within 60 days of
the date that you receive this letter. To ask for a hearing, send a written petition, which conforms to Chapter 150B of the North Carolina
General Statutes to the Office of Administrative Hearings, P.O. Box 27447, Raleigh, N.C. 276 1 1-7447. This certification and its conditions are
final and binding unless you ask for a hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water Act. If you have any questions,
please telephone John Domey at 919-733-9646.
Rcl
Attachment
Cc: Corps of Engineers Raleigh Field Office
Winston-Salem DWQ Regional Office
File copy
Central Files
Robert Russell; Associated Surveying & Engineering
Division of Water Quality • Wetlands/401 Unit
1621 Mail Service Center • Raleigh NC 27669-1621 • Telephone [phone] • FAX # [phone]
An Equal Opportunity Affirmative Action Employer
50% recycled/10% post consumer paper

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
DWQ Project No.: County: _
Applicant:
Project Name:
Date of Issuance of 401 Water Quality Certification:
Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable Buffer Rules,
and any subsequent modifications, the applicant is required to return this certificate to the 401/Wetlands Unit,
North Carolina Division of Water Quality, 1621 Mail Service Center, Raleigh, NC, 27699-1621.This form may be
returned to DWQ by the applicant, the applicant's authorized agent, or the project engineer.It is not necessary
to send certificates from all of these.
Applicant's Certification
I, , hereby state that, to the best of my abilities, due care and diligence
was used in the observation of the construction such that the construction was observed to be built within
substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans
and specifications, and other supporting materials.
Signature: Date:
Agent's Certification
I, , hereby state that, to the best of my abilities, due care and diligence
was used in the observation of the construction such that the construction was observed to be built within
substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans .
and specifications, and other supporting materials.
Signature: Date:
If this project was designed by a Certified Professional
I, , as a duly registered Professional (i.e., Engineer,
Landscape Architect, Surveyor, ect.) in the State of North Carolina, having been authorized to observe
(periodically, weekly, full time) the construction of the project, for the Permittee hereby state that, to the best of
my abilities, due care and diligence was used in the observation of the construction such that the construction
was observed to be built within substantial compliance and intent of the 401 Water Quality Certification and
Buffer Rules, the approved plans and specifications, and other supporting materials.
Signature Registration No.
Date
Division of Water Quality • Wetlands/401 Unit
1621 Mail Service Center • Raleigh NC 27669-1621 • Telephone [phone] • FAX # [phone]
An Equal Opportunity Affirmative Action Employer
50% recycled/10% post consumer paper
NC ENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
MEMORANDUM
TO: John Dorney Regional Contact: Jennifer Frye
Non-Discharge Branch WO Supervisor: 1 arry Coble
Date: ??/1 RiOp
SUBJECT: WETLAND STAFF REPORT AND RECOMMENDATIONS
Facility Name Model Home Co.
Project Number 00 1134
Recvd From APP
Received Date 8/30/00
Project Type residential
Recvd By Region 9/8/2000
County Davidson
County2
Region Winston-Salem
Certificates Stream
Permit Wetland Wetland Wetland Stream Class Acres Feet
Type Type Impact Score Index Prim. supp. Basin Req. Req.
39 Stre,im P-7 O N 13 2 1-1-1 WSIII F- 30,709. 102.00
Mitigation Wetland
MitigationType Type Acres Feet

Is Wetland Rating Sheet Attached? O Y *N Did you request more info? O Y ON
Have Project Changes/Conditions Been Discussed With Applicant? (0 Y O N
Is Mitigation required? O Y O N Recommendation: O Issue 0 Issue/fond O Deny
Provided by Region: Latitude (ddmmss) 354736 Longitude (ddmmss) 800803
Comments:
The WSRO recommends that this WO Gertification be issued with the followlna condlfiow
** Deed restrictions must be placed on remaining lots per WS rules (30' vegetative buffers)
and future drive ???ay cros?ina(s)These future crossings must be either bridges or bottomless
arch culverts
(The buffers and future driveway information are shown and outlined on 12/1/00 site development
plamLhowever. deed restrictions/covenants should still be req uirP )
cc: Regional Office
Central Office Page Number 1
Facility Name Model Home Co.
County Davidson
Project Number 00 1134
Regional Contact: Jennifer Frye
Date: 12/18/2000
Comments (continued from page 1):
cc: Regional Office Page Number 2
Central Office
October 16, 2000
Certified Mail 7099 3220 0006 8502 5103
Return Receint Requested
Mr. Mark Klass
116 West Center Street
P. O. Box 1343
Lexington, NC 27292
SUBJECT: Model Home Co.
DWQ Project #00 1134
Davidson County
Dear Mr. Klass:
This Office is in receipt of the additional information supplied by your engineer,
Robert Russell, concerning your plans to discharge fill material into approximately 130 linear
feet of an unnamed tributary to Brier Creek, Yadkin-Pee Dee River Basin, Class WS-III
waters, Davidson County. However, our concerns outlined in (1) and (2) of the September 8,
2000 letter have not been adequately addressed. Please provide documentation, such as
alternative designs, economic analysis, etc., which demonstrates that no practical alternative
exists. Moreover, it is still unclear whether or not the access road encroaches upon the 30 foot
vegetative buffer, required pursuant 15A NCAC 2B .0215. In addition, what is the linear
footage of impact for each of the crossings? Are the crossings identical in design and impact?
What is the length of stream impacted by the culverts? Rip-rap?
The Division appreciates your efforts to address our concerns and will continue to
place your project on hold until we receive the additional information.
If you have any questions regarding this matter, please contact Mrs. Jennifer Frye or
myself at [phone].
Sincerely,
Larry D. Coble
WQ Regional Supervisor
cc: Raleigh Field Office, US Army Corps of Engineers
Wilmington Office, US Army Corps of Engineers
Wetlands/401 Unit Central Office
Central Files
WSRO
AsuclateA SurY®lllna a Eneluearlet PC
108 State Street - Lower Level - Greensboro, N.C. 27408
Phone [phone] - Fax [phone]
Civil Engineering and Land Surveying
Lary D. Coble
WQ Regional Supervisor
Division of Water Quality
585 Waughton Street
Winston-Salem, N.C. 27107
i ?.A
n-WATT°?
Ref: Model Home Co., Davidson County
DWQ Project #00 1134
September 19, 2000
Mr. Coble,
Please find attached an additional copy of the application for the above referenced project along with a
full set of plans for the project.
We have also attached a portion of the Surveyors work map which indicates that the amount of land
acceptable for use in an onsite sewage system is very limited. The location of the usable soils has
dictated the placement of the road and has limited our flexibility in design.
You will also note that there is a second road (Lee Black Road - SR 2113) located to the east of the
property. We have investigated using this road as an entrance for the property but this was disallowed
because of the severity of the curve and the limited sight distance available.
We hope that this information will be helpful in your review of this project
Sincerely,
Robert K. Russell, PE PLS
cc: John R. Dorney
4401 Reedy Creek Road
Raleigh, NC 27607
DEM ID: CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #):
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
1) NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATION FOR SECTION 401 CERTIFICATION
3) COORDINATION WITH THE NC DIVISION OF COASTAL MANAGEMENT
SE![D THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE FIELD OFFICE
CF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN (7) COPIES SHOULD BE
:;ZNT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT (SEE AGENCY ADDRESSES SHEET)
PLEASE PRINT. M 1
OWNERS NAME : 0
MAILING ADDRESS
SUBDIVISION NAME: \j,\S C?[1 G
CITY: 0 STATE: N?L ZIP CODE:
PROJECT LOCATION ADDRESS, IVCLU}D_I `SUBDIVISION NAME ( F D?I'FF SRENT FROM
MAILING ADDRESS ABOVE) QC?\ ?
-
OME) - (WORK):
:
TELEPHONE NUMBER (H
4. IF APPLICABLE: AGENT' N OR RESPONSIBLE CORPORATE OFFICIAL,
ADDRESS, PHONE NUMBER
LOCATION OF WORK (PROVIDE ? '-f-AP,
AERIAL PH?OOTOG PHY WITH SCALE) :
Xl\?\ On
COUNTY:
SPECIFIC LOCATION (INCLUDE ROAD
?REFERABL`I A COPY OF USGS TOPOGRAPHIC MAP OR
NEAREST TOWN OR CITY

NUMBERS, LA1I1DM.=R.KS, ETC
T
cs)
IMPACTED OR NEAREST STREAM, I'?E. l (\(\?(?\?l 't ?? A co-(Ck? R'. t\ rtC,nc?]
RIVER BASIN:
/q. IS PROJECT LOCATED NEAR WA-ER CLASSIFIED AS TROUT, TIDAL SALTWATER
(SA) , HIGH QUALITY WATERS =QiW) , OUTSTANDING RESOURCE WA- _-'RS (ORW) , WATER SUPPLY
(WS-I OR WS-II)? YES ( ] NO (X] IF YES, EXPLAIN:
7b. IF THE PROJECT IS LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL MANAGEMENT
ARE OF ENVIRONMENTAL CONCERN (AEC) ? YES ( ] NO ( Xl
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:
8a. HAVE A.ti! SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS PROPERTY?
YES ( ; NO (X1 IF YES, PROVIDE ACTION I. D. NUMBER OF PREVIOUS PERMIT AND ANY
ADDIT:C`fAL INFORMATION (INCL=,E PHOTOCOPY OF 401 CERTIFICATION) :
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE?
YES ( j NO (x) IF YES, DESCRIBE ANTICIPATED WORK: 9A. EST:M:,- D TOTAL NUMBER OF ACRES IN TRACT OF LAND: zo -

93. ES'CI:1.","ED TOTAL NUMBER OF AC?.ES C' WETLANDS LOCATED ON PROJEC'" SITE:
10A. NUM's :;'. OF ACRES OF WETLAND BY THE PROPOSED PROJECT BY:
L' [ L IG : E:CC A'jAT I ON :
['LOc' D1G: -_THER:
O
-'OTAL ACRES TO BE IMPACTED:
10B. ( L) :",REAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED, PROVIDE
0[3`. %JCE BOTH BEFORE AND A-7--ER RELOCATION) 4 ?
L I:NG A BEFORE: ?m'? = AFTER: 1 , (` (,(Ge `,??e? FT
'WILDBEFORE (based on nor-al high water contours) : <_1 U(11 It- FT
'WI CD'"" AFTER: y-l& C``(- ,'G'nkO,( FT
L
AVERAGE DEPTH BEFORE: ?aCY12 FT AFTER: (tom ` FT
(2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION: PLACEMENT OF PIPE IN CHANNEL:
CHANNEL ELEVATION: 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?
WHAT IS THE EXPECTED POND SURFACE AREA?
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL EQUIPMENT
TO BE USED (ATTACH PLANS: 8?" x 11" DRAWINGS ONLY) : N A
13. PURPOSE OF PROPOSED WORK: T?`\\0.?0<1 G? ?1?'\\? ?? \G(
\v? \,A- ?l??o C?1v 1 S1 O
14. STATE RT-AXNS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT /IN
WETLADIDS . (INCLUDE ANY MEASURES TAKEN TO MIN::4:ZE WETLAND IMPACTS) : oj1 fv
lc YOU NLZ2 -?EQUIRED TO CONTACT E STATE HISTORIC PRESERVATION OFFICER (SHPO) (SEE
AGEN(:'C V?DRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE
PER:44.'" :-\ EA WHICH MAY BE AFFECTED BY THE PROPOSED PROJECT.
DATE k:C*V'ACTED: `V\ C,
16. DOES 'Mi" PROJECT :?v-OL-;E A?I E::PE=1D:T'JRE prJELIC FUNDS OR THE USE OF PUBLIC
(STATE) LAND? YES [ ] NO ( ? ] (IF NO, GO TO 18)
a. IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL DOC,.?LENT
PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA ENVIRONMENTAL PO:;."Y AC--?
YES ( ] NO ( l
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA DEfAS'rMENT
OF ADMINISTRATION STATE CLEARINGHOUSE? YES [ ] NO [ l
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT REGARDING COMPLIANCE X:T11 THEE
NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE DIRE :3.
CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH CAROLINA DEPARTMENT OF
ADMINISTRATION, 1302 Marl Service Center, RALEIGH, NORTH? CAROLINA 27699-
TELEPHONE [phone].
17. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF PROPOE': ACTIVITY
INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL INTO WETLANDS:
a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES AND PGN.S 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, 1F AVAILABLE, REPRESENTATIVE PHOTCGRAPH OF iETL LVDS TO BE IMPACTEL 31: PROJECT.
c. IF DELINEATION WAS PERFORMED BY A CONSULT :VT, INCLUDE ALL DATA SHEI- :2EL AVT
TO THE PLACEMENT OF THE ^F-.=`1°?.'T_^N LIN .
d. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN TF REQUIRED.
e. WHAT IS LAND USE OF SURROUNDING PROPERTY?
f. IF APPLICABLE, THAT IS PROPOSED METHOD OF SE:-iAGE DISPOSAL?
g. SIGNED AND DATED BY 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, AND
2) EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF ENVIRONMENTAL MANAGEMENT
(WATER QUALITY) CERTIFICATION.
O R'S/AGENT' IGNATURE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED (18G.))
U
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DATE

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A I ail (FAIR GROVE)
4055 1 _
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August 25, 2000
Dear Sir:
I am writing on behalf of Model Home Co. This project that we are in the process of
working on involves fourteen lots in a subdivision, and as you see from the maps
enclosed, we need to cross a creek with a road in order to be able to complete this project.
In order to be able to afford to put the road in, we need each and every lot. Also, we have
received our permit from the Soil and Erosion Control on this matter.
If you have any questions regarding this matter, please do not hesitate to contact me.
Sincerely,
Touu -i u«?
10/01/2000 20:53 3364766185 JP YA1t5 LUN51 rria? ui
w, 1..,A1ltMV CORPS OF ENGINEERS
Wilmington District
Action ID: 2b0021893 ` '"•.' County: yidson _
GENERAL I REGIONAL AND NATIONWIDE VERIFICATION
v r•
Property Authorized
Yates Age:
owm: Model Home. Todd
VVhispcrinB.O?, 'vision
.
Address'
P.O. Box 1259 >
Denton, NC 2'.'•
Telegho : 336 476-3929 1': ?&Lld bQ?: 336
.;;
y?, a r , : Model Home Co.
? subdivision access road, located off of Bryant Road , adjacent
property proposed WhV...4
to an unnamed tributt?reek, near Holly Grove, in Davidson County, North Carolina.
i:. d construction for Whispering Oaks subdivision resulting in
Descripjion 4 Alt
approximately 0.01 acre ? to the jurisdictional waters of an unnamed tributary of Brier
Creek.
_„_Section 404 (Clean' t, 33 USC 1344) only.
Section 10 (River a Act of 1894) only.
Section 404 and S
__2LNstionwide Permit,, 14
Any violation of the con --the Regional General or Nationwide Permit referenced above may
subject the permittee to•a:. „ uric order, a restoration order, and or appropriate legal action.
This Department a4rmy Regional General I Nationwide Permit verification does not
relieve the permittee of 4 ` nsibility to obtain any other required Federal, State, or local
approvals/permits. The may need to contact appropriate State and local agencies before
beginning work. If you questions regarding the Corps of Engineers regulatory program,
please contact John Thom ephone number MI 876-8441 Axtensi 25.
c '41
Regulatory Project
Da
SURVEY PLATS, F1
ATTACHED TO THE
CF:
V
-
' Y Expiration Feb am 11, 2002
r TobH, WETLAND DELINEATION FORM, ETC., MUST BE
PY OF THIS FORM, IF REQUIRED OR AVAILABLE.
7?y??
September 8, 2000
Certified Mail 7099 3220 0006 8502 5097
Return Receipt Requested
Mr. Mark Klass
116 West Center Street
P. O. Box 1343
Lexington, NC 27292

SUBJECT: Request for Additional Information
Model Home Co.
DWQ Project #00 1134
Davidson County
Dear Mr. Klass:

0 q
?V?
Imo'
C ?(
The Division of Water Quality has reviewed your plans for the discharge of fill
material into approximately 130 linear feet of an unnamed tributary to Brier Creek,
Yadkin-Pee Dee River Basin, Class WS-III waters, Davidson County, for the purpose
of residential development. Insufficient evidence is present in our files to conclude
that your project must be built as planned in waters and/or wetlands in accordance
with 15A NCAC 2H.0506. Therefore, unless modifications of the proposal are made
as described below, we will have to move toward denial of your 401 Certification as
required by 15A NCAC 2H .0507(e) and will place this project on hold as incomplete
until we receive this additional information. We are requesting (by copy of this letter)
that the U. S. Army Corps of Engineers place your project on administrative hold.
(1) Because the proposed project is to be conducted in water supply waters,
you are required to maintain compliance with the Fresh Surface Water
Quality Standards for Class WS-III Waters, 15A NCAC 213 .0215.
Specifically, "...a minimum 30 foot vegetative buffer for (low density)
development is required along all perennial waters indicated on the
most recent version of the USGS 1:24,000 scale topographic map."
Road crossings are allowed in WS-III waters, however, you must
demonstrate that no practicable alternative exists. These allowable
activities must also minimize built-upon surface area, direct run-off
away from surface waters and maximize the utilization of BMPs. In
addition, it appears that the access road and associated un-vegetated fill
material may encroach into the 30 feet buffer, which is not allowable.
Please address these issues in detail.
(2) We are able to determine from you application the exact linear footage
of stream impact proposed. Please supply plans and specifications for
the three road crossings, showing impacts due to culverting, rip-rap,
headwalls, etc.
Please respond within three weeks of the date of this letter by sending one
copy of this information to me and one copy to John R. Dorney, 4401 Reedy
Creek Road, Raleigh, NC 27607. If we do not hear from you in three weeks, we will
assume that you no longer want to pursue this project and we will consider the project
as withdrawn. If you have any questions regarding this matter, please contact Mrs.
Jennifer Frye or myself at [phone].
Sincerely,
Larry D. Coble
WQ Regional Supervisor
cc: Raleigh Field Office, US Army Corps of Engineers
Wilmington Office, US Army Corps of Engineers
Wetlands/401 Unit Central Office
Central Files
WSRO
a
PAYMENT
RECEIVED
i
DEM ID: 0 0 1 1 3 4 CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #):
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
1) NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATION FOR SECTION 401 CERTIFICATION
3) COORDINATION WITH THE NC DIVISION OF COASTAL MANAGEMENT

SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE FIELD OFFICE
OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN (7) COPIES SHOULD BE
SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT (SEE AGENCY ADDRESSES SHEET).
PLEASE PRINT. 1 ?\rp
1. OWNERS NAME: 'MU ??\ ROMQ l0
2. MAILING ADDRESS: y?r-3
SUBDIVISION NAME:
?SR?n?r G
CITY: O(l STATE: ?- ZIP CODE: PROJECT LOCATION ADDRESS, INCLUDI SUBDIVISION NAM ( F\\ DIFr.? RENT FROM
MAILING ADDRESS ABOVE) : ?i?QCt ? ?Clo S? ,h a c?Y?QSS l
3. TELEPHONE NUMBER (HOME) : - - (WORK): - aLkO 'k 6'k t)
4. IF APPLICABLE: AGENT' NAME, OR, RESPONSIBLE CORPORATE OFFICIAL,
ADDRESS, PHONE NUMBER:0o4 ?S_,
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP OR
AERIAL PHOTOG`IA?PHY WITH SCALE) :
COUNTY: M\l\(?SOn NEAREST TOWN OR CITY:
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ETC.)

R:.`+? ??,\11?? ?? Q? \l% ?Un? C?C??1 C?CC??UI
6. IMPACTED OR NEAREST STREAM/ RIVE
RIVER BASIN: i?????c?[?t? `fie ???
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER
(SA), HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER SUPPLY

(WS-I OR WS-II)? YES [ ] NO [X1 IF YES, EXPLAIN:
7b. IF THE PROJECT IS LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL MANAGEMENT
ARE OF ENVIRONMENTAL CONCERN (AEC)? YES [ ] NO [)6
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:
8a. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS PROPERTY?
YES [ ] NO [ X ] 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 FOR THIS PROPERTY IN THE FUTURE?
??Q?\QF 1l(? (DSO
YES ( ] NO (X ] IF YES, DESCRIBE ANTICIPATED WORK:

9A. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND: -?o -
C?
98. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE: ,
10A. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: EXCAVATION:
FLOODING: OTHER:
DRAINAGE: TOTAL ACRES TO BE IMPACTED:
10B. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED, PROVIDE
DISTANCE BOTH BEFORE AND AFTER RELOCATION): \?lU -k 1
r? u? Cv Cyr `*?L FT
LENGTH BEFORE: ?1 FT AFTER:
WIDTH BEFORE (based on normal high water contours): FT
WIDTH AFTER: (10t &^`?"n A FT
AVERAGE DEPTH BEFORE: ?O?CYI? FT AFTER: Oo LbO?r? '?++ FT
(2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION: PLACEMENT OF PIPE IN CHANNEL:
CHANNEL ELEVATION: 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?
WHAT IS THE EXPECTED POND SURFACE AREA? NIT
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL EQUIPMENT
TO BE USED (ATTACH PLANS: 8'h" x 11" DRAWINGS ONLY) : 00
13. PURPOSE OF PROPOSED WORK: ?(1? \\A??C1 ?j\ ?1QS) ? \o? A k Yo0 ?G(
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED 0 IN
WETLANDS. (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS): 04 -
15. 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: rl`Pr
16. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF PUBLIC
(STATE) LAND? YES [ ] NO [? ] (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 [ l
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 :-IS.
CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH CAROLINA DEPARTMENT OF
ADMINISTRATION, 1302 Marl Service Center, RALEIGH, NORTH CAROLINA 27699-1302,
TELEPHONE [phone].
17. 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 CONSUL7ANT, 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?
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF Sn:JAGE DISPOSAL?
9. SIGNED AND DATED BY 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, AND
2) EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF ENVIRONMENTAL MANAGEMENT
(WATER QUALITY) CERTIFICATION.
J
OWNER' S/AGE`NT' 7GNATURE
(AGENT'S SIGNAT E VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED (18G.))
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DEM ID: CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #):
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
1) NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATION FOR SECTION 401 CERTIFICATION
3) COORDINATION WITH THE NC DIVISION OF COASTAL MANAGEMENT
C"7
ME:
rn
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SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE FIELD OFFICE
OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN (7) COPIES SHOULD BE
SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT (SEE AGENCY ADDRESSES SHEET)
PLEASE PRINT. 1 11 1\ /.
1. OWNERS NAME : mo ??l ?toMQ l 0
2. MAILING ADDRESS: u 32

SUBDIVISION NAME: ??QS2(tn
CITY: O(? STATE: N-?L- ZIP CODE: 13
PROJECT LOCATION ADDRESS, INCLUDI \SUBDIVISION1N,AME ( F DIFF RENT FROM
l???SS
MAILING ADDRESS ABOVE) j? CQt1U no C

3. TELEPHONE NUMBER (HOME) : - - (WORK) : ' - U 'k
4. IF APPLICABLE: AGENT' NOR RESPONSIBnLE CORPORATE OFFICIAL,
?
`
UC 4119
ADDRESS, PHONE NUMBER : U J
?
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP OR
AERIAL PHOTOGRAPHY WITH SCALE) :
COUNTY: M?ISo? NEAREST TOWN OR CITY:
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ETC.)
\I ? M A'p- YJ Lou_ 6, IMPACTED OR NEAREST GTREAM/RIVER: \ VA \1 viin?1
RIVER BASIN: ?k"h'CC?G ?e 1)E
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER
(SA), HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER SUPPLY
(WS-I OR WS-II)? YES [ ] NO [XI IF YES, EXPLAIN:
7b. IF THE PROJECT IS LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL MANAGEMENT
ARE OF ENVIRONMENTAL CONCERN (AEC)? YES [ ] NO [ X]
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:
Ba. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS PROPERTY?
YES [ ] NO [ X ] 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 FOR THIS PROPERTY IN THE FUTURE?
YES [ ] NO [x ] IF YES, DESCRIBE ANTICIPATED WORK: S ?C???0.?C(1 Oka
t La& A-0 C `l GSS .
9A. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND: i_
9B. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT S:TE: C;
10A. NUMBER OF ACRES OF ',`IE ?a1D =?ACTED BY THE PROPOSED PROJECT BY:
FILLING:
EXCAVATION:
FLOODING: OTHER:
DRAINAGE: TOTAL ACRES TO BE IMPACTED: O
10B. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED, PROVIDE
DISTANCE BOTH BEFORE AND AFTER RELOCATION) : \:?U ?}•1-_
LENGTH BEFORE: FT AFTER: 0 o? C?! Gv?q?? FT
WIDTH BEFORE (based on normal high water contours): ?Qm FT
WIDTH AFTER: ?p? C`l'C1nA ` FT
(2)
AVERAGE DEPTH BEFORE: FT AFTER: Orj 6aX)R,g& FT
GTRSAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION
PLACEMENT OF PIPE IN CHANNEL: ?
CHANNEL ELEVATION: 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?
WHAT IS THE EXPECTED POND SURFACE AREA? M 11r
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TY?E OF MECHANICAL EQUIPMENT
TO BE USED (ATTACH PLANS: 81/2" x 11" DRAWINGS ONLY) : N
13. PURPOSE OF PROPOSED WORK: ?C? \\Q??? b? ??Q9 A \C?Ak YoaA (Gt
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS. (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS) :
15. 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: ,AV? c
16. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF PUBLIC
(STATE) LAND? YES [ ] NO [ ? ] (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 [ l NO l 1
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 ::S.
CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH CAROLINA DEPARTMENT OF
ADMINISTRATION, 1302 Marl Service Center, RALEIGH, NORTH CAROLINA 27699-1302,
TELEPHONE [phone].
17. 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. F 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?
F. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SG:4AGE DISPOSAL?
g. SIGNED AND DATED BY 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, AND
2) EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF ENVIRONMENTAL MANAGEMENT
(WATER QUALITY) CERTIFICATION.

OWNER'S/AGENT'S\,?YGNATURE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED (18G.))
DATE
as, ccea ? ? I? ? I?
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August 25, 2000
Dear Sir:
I am writing on behalf of Model Home Co. This project that we are in the process of
working on involves fourteen lots in a subdivision, and as you see from the maps
enclosed, we need to cross a creek with a road in order to be able to complete this project.
T- cr? or «c'-° able to afford to put the read in, we need each and every lot. Also, we have
received our permit from the Soil and Erosion Control on this matter.
If you have any questions regarding this matter, please do not hesitate to contact me.
Sincerely,
Touu i u?.
v??
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Associated Surveying & Engineering, PC
108 State Street -• Lower Level - Greensboro, N.C. 27408
Phone [phone] - Fax [phone]
Civil Engineering and Land Surveying
December 1, 2000
Larry D. Coble
WQ Regional Supervisor
Division of Water Quality f
!ado„ ,?>?.
585 Waughton Street
Winston-Salem, N.C. 27107
Ref: Model Home Co., Davidson County
DWQ Project #00 1134
Mr. Coble,
Please find attached revised plans for the above referenced project. Please note that the following
dhanges that have been made to reduce the impact of this projects on the streams which flow across the
property:
1- The length of roadway has been reduced to restrict the required stream crossings to one.
2- Requirements have been added that restrict the driveway crossings to bridges or bottomless
arch culverts to allow for uninterrupted travel of aquatics life.
3- Access to Lot 5 is provided via an easement across Lot 4.
4- Requirement added to include information about the use and maintenance of vegetative buffer
to be included as part of the restrictive convenants of the subdivision. NCDENR approval is
required for the wording of the convenant.
5- Requirement to serve multiple lots from stream crossing where possible added.
By reducing the length of road we have been able to limit the impact on the stream to 102 If (71 If 60"
RCP and 31 If Rip-Rap). We are using the 60" RCP instead of a bottomless arch due to the
requirements of the NCDOT.
No feel that the changes we have made demonstrate our commitment to helping maintain the integrity of
:I•(: environment while still providing for a useful development of this property.
hope that this information will be helpful in your review of this project.
r cerely,
P^,bert K. Russell, PE PLS
John R. Dorney
4401 Reedy Creek Road
Raleigh, NC 27607
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108 State Street CONRAD HILL TOWNSHIP
A S S 0 Cl VI EI) Greensboro, N.C. 27408 t:lZ1''ING and .t- 1
336-574-0722 336-574-07'-,13 Fax < S ENGINEERING, PC - - - : E' r _ 6' WATER LINE - BRYAM ROAD
Land Surveying and Civil Ergineerin
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108 State S t DAVIDSON COUNTY
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' ' 108 State Street -`SSUCIATEU R (~AOWAY /}may cRo CHECKED BY, 4 „
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vTw+uu Z+uo +00 4+00 5+00 6+00 7+00
N~~,~` IATEll - - - - - 7+00 8+00 i 980 +00 10+00 11+00 12+00 13+00
SSOC 108 State Street REVISI014S TYPE _ CONTRACT CONTRACTOR AS-8UI AS-BUILT, AUIH, DATE BENCH MARKS Joe N
k 1 SURVEYING arid Greensboro. N.C. 27408 ROADWAY _ o. aooaz • p AV DSON ~ BOUNTY
ao~' 336-574-0722 336-574-0723 Fax DESIGNED RKR • By. CONI~A CHI LL T01NNS HIP
NGINEERING, PC SEWER r=. Land Survey in and Civil Engineering LL rr ~ s 4 .~71I +YN 11 O A r 41 DETAILED
-'M 'I"1tr~r jr,. _ - ,'4' .7 . 1. , ~ W 1 • BY RKR SHEET NQ. H WHM1;dNG,0AKES C ECK60- ~BYN1WGRr »
a:. ' SID WALK 4G 0 2 OF 6
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