20090573 Ver 2_401 Application_20100210

P
C 1247 So. Martin Luther King Jr. Dr.
® Winston-Salem, INC 27107
a l l i
i z z a T: 336.788.2764
p
g F: 336.788.2768
construction company
Transmittal 280
Thomas WTP Improvements
Winston-Salem, NC 27107
Project No. 12806
0q_ Ds 13 V a
Subject Amendment to Permit #09-0573
Date 24-Feb-10

Sent To Sent By
Sue Homewood Nicholas Nadolski
NC DWQ, 401/Wetlands Unit Pizzagalli Const. Co.
1650 Mail Service Center 1247 S. MLK Jr. Dr.
Raleigh, NC 27699-1650 Winston-Salem, NC 27107
T: 336-771-4964
F: 336-771-4630
We Are Sending Submitted For Action Taken
? Shop Drawings ® Approval ? Approved As Submitted
? Letter ? Your Use ? Approved As Noted
? Prints ? As Requested ? Returned After Loan
? Change Order ? Review and Comment ? Resubmit
? Plans Sent Via ? Submit
? Samples ? Attached ? Returned
? Specifications ? Separate Cover ? Returned For Corrections
® Other: Permit# 09-0573
amendment L_J `"`"" "`"" .
? Other:
Attachments
Copies Ref Title Comment
5 Amendment to Permit #09-0573 see attached
P AZORlMVATE6t MWCH
Notes
Distribution
Cc Contact
Notes
File

Transmittal Page 1
Project 12806 Form PM1000 100
RE: RA Thomas - NWP 33 (Temporary Stream relocation) - DWQ project # 09-0573 Page 1 of 2
RE: RA Thomas - NWP 33 (Temporary Stream relocation) DWQ project #
09-0573
Homewood, Sue
Sent: Friday, February 19, 2010 2:59 PM
To: Nadolski, Nicholas [[e-mail]]
Cc: Walker, Brian [[e-mail]]; Thomas, John T JR SAW [[e-mail]]
n..... ...... .n?o
. ,, . . . ...... .
Nick,
Thanks for hunting this down and for your time today.
The USACE does not always copy DWQ when they issue permits. Technically, since the WTP already had a
permit from DWQ, Pizzagalli should have also submitted this to the DWQ for amendment to the existing permit.
Even though it's for a separate nationwide permit, it is still within the same project covered by the existing
permit.
So, the bottom line is this: Will you please submit all this documentation to the DWQ for formal review and
approval. We will need 5 copies, sent to the DWQ Raleigh address found in the PCN instructions. Please put a
cover letter on it that indicates this is an amendment to permit # 09-0573. Attach a copy of the USACE permit
too.
The one thing I noted in a quick review of these documents that you copied to me is that I will require more
specific details about the restored/final channel. We need to see plans that show what dimensions it will be
built to, what side slopes it will have, what type of material will be in the bed and slopes. If you need more
explanation, please feel free to email or call. The letter submitted to the USACE sounds like the restored
channel will be similar to the temporary channel that I saw today. We will not approve that type of design for a
permanent channel
Sue Homewood
NC DENR Winston-Salem Regional Office
Division of Water Quality
585 Waughtown Street
Winston-Salem, NC 27107
Voice: [phone]
FAX: [phone]
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and
may be disclosed to third parties.
From: Nadolski, Nicholas [mailto:[e-mail]]
Sent: Friday, February 19, 2010 12:17 PM
To: Homewood, Sue
Cc: Walker, Brian
Subject: RA Thomas - NWP 33 (Temporary Stream relocation)
Sue,
https://mail.ne.gov/owa/?ae=Item&t=IPM.Note&id=RgAAAACChSeOTRSCT5TN0706x... 2/22/2010
RE: RA Thomas - NWP 33 (Temporary Stream relocation) - DWQ project # 09-0573 Page 2 of 2
Thank you for taking the time to talk with me during your site visit today. After you left I talked with the Project
manager Brian Walker regarding your concerns/comments regarding the temporary stream relocation that we
have done on site. Attached you will find the PCN we completed and sent into The Army Corps of Engineers
regarding this work. It was our understand that NCDENR would receive a copy of this PCN and Nationwide
Permit Number NW 33.
I believe that the attached information should end any concerns that NCDENR might have regarding the stream
relocation that you saw today. If you could please contact me or Brian so that we can make sure that we are all
in agreement that there are no remaining issues it would be greatly appreciated.
Thank you.
Nick
Nicholas J. Nadolski
Pizzagalli Construction Company
RA Thomas WTP Improvements
P: 336-788-2764 x-13
F: 336-788-2768
https://mail.nc.gov/owa/?ae=Item&t=IPM.Note&id=RgAAAACChSeOTRSCT5TN0706x... 2/22/2010
PC
pizzagalli
construction company
1247 S. Martin Luther King Jr. Drive
Winston Salem, North Carolina 27107
Telephone [phone]
Fax [phone]
February 23, 2010
Sue Homewood
NC DWQ, 401/Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Re: RA Thomas Water Treatment Plant Improvements
Winston-Salem, NC
PC Project # 12806
Subject: Amendment to Permit 409-0573 (Temporary Creek Re-location)
To Whom It May Concern:
FEB 2,,5 2010
DENR • WATER QUALITY
WETL M AND STORMWATER ARANW
This letter is in regard to DWQ Permit #09-0573. After a site visit by Sue Homewood with NC DENR Division of Water
Quality on February 19, 2010, it was brought to our attention that the attached documents should be sent to you for review
and consideration of possible amendment to DWQ Permit #09-0573.
Pizzagalli Construction Company is under contract with City / County Utilities of Winston-Salem for the RA Thomas Water
Treatment Plant Improvements project. Part of our work involves constructing a wash water equalization basin This structure
is located next to a branch of the Salem Creek. In May, 2009, the USACE issued a Nationwide Permit Number: NW33 for
the temporary creek bypass in the area mentioned above.
Pizzagalli Construction offers the following additional information regarding the proposed restoration of the stream after the
temporary by-pass is no longer needed. In order to create the by-pass an earthen dam was placed in the existing stream after
the bypass was created, diverting flow to the temporary by-pass. The location of this dam is in the same area as Stream
Impact #3 and #5 as identified in Black & Veatch letter dated July 21, 2009 and NCDENR approval letter dated September 1,
2009 (See attached). Since the earthen dam in is in the same location as these stream impacts we will use the approved
method of restoration for this area. The remainder of the existing stream bed was left unchanged except for where the
existing stream bed and by-pass met. A stone check dam was installed to catch any sediment that may have washed
downstream from residual flow. This stone check dam will be removed by use of equipment and Detail CS on Contract
Drawing Sheet B36 will be used to stabilize the replaced stream bank the stream bottom and will match original bottom in
width of approximately 3'-0" wide with bank slope not greater than 2:1.

N-1 4?4
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'mo`t S y„ s r a

12806 DWQ Creek Relocation 02-22-10.doc
-Prior to Stone Check Dam installation -Location of Stone Check Dam
Showing existing conditions
Page 2
2/23/2010
Any vegetation that has grown while the stream has been by-passed will be cleared using hand tools so that it will not impact
the flow of the stream when it is placed back into service. The existing stream banks will not be required to be resloped as
they are at a slope of less the 2:1, if resloping is required in the areas where the stream bank has been disturbed by
construction they will be sloped not greater than 2:1. Any area where natural vegetation has not regrown naturally or requires
resloping we will properly stabilize and reseed the banks in accordance with typical sedimentation control protocol (with the
exception of using native seed, not fescue).This work shall be complete by the end of June 2010. We will perform all of our
work as to not allow any erosion or harm to the environment. We apologize for inadvertently not notifying the North
Carolina Department of Environment and Natural Resources about this work and we look forward to resolving this issue as
soon as possible.
Please let me know if we need to submit any other information or if you need any changes made to our plan. Thank you again
for your time and assistance with this issue.
Sincerely,

Nicholas Nadoiski
Project Engineer
cc: PC Correspondence File
Enclosed: USACE NW33 permit Signed 5/19/09
PCC Letter dated 5/13/09 including original PCN Form
B&V Letter Dated 7/21/09
NCDENR Letter Dated 9/1/09
U.S. ARMY CORPS OF ENGINEERS cmi-,r!hxr
2 ao 76069 WILMINGTON DISTRICT Ov- T
Action ID. 20090091969 County: Forsyth USGS Quad: Winston-Salem East
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION /
Property Owner / Authorized Agent: City of Winston-Salem / RA Thomas Water Treatment Plant 11i
Address: 1201 S. Martin Luther King Jr Drive
Winston-Salem, North Carolina 27107
Telephone No.: 336 747-7309
Size and location of property (water body, road name/number, town, etc.): RA Thomas Water Treatment Plant
located off of 1201 S. Martin Luther King Jr Drive, in Winston-Salem, Forsyth County, North Carolina. Property
is adiacent to a tributary of Salem Creek which is a tributary of the Yadkin River.
Description of projects area and activity: Mechanized landclearing, excavation and the discharge of fill material
associated with the proposed wash water equalization basin construction resulting in temporary impacts (i.e.
temporary stream channel relocation) to approximately 150 linear feet of stream channel to the iurisdictional
waters of Salem Creek.
Applicable Law: ® Section 404 (Clean Water Act, 33 USC 1344)
? Section 10 (Rivers and Harbors Act, 33 USC 403)
Authorization: Regional General Permit Number:
Nationwide Permit Number: NW 33
Your work is authorized by the above referenced permit provided it is accomplished in strict accordance with the attached
conditions and your submitted plans. Any violation of the attached conditions or deviation from your submitted plans may subject the
permittee to a stop work order, a restoration order and/or appropriate legal action.
This verification will remain valid until the expiration date identified below unless the nationwide authorization is modified,
suspended or revoked. If, prior to the expiration date identified below, the nationwide permit authorization is reissued and/or
modified, this verification will remain valid until the expiration date identified below, provided it complies with all requirements of
the modified nationwide permit. If the nationwide permit authorization expires or is suspended, revoked, or is modified, such that the
activity would no longer comply with the terms and conditions of the nationwide permit, activities which have commenced (i.e., are
under construction) or are under contract to commence in reliance upon the nationwide permit, will remain authorized provided the
activity is completed within twelve months of the date of the nationwide permit's expiration, modification or revocation, unless
discretionary authority has been exercised on a case-by-case basis to modify, suspend or revoke the authorization.
Activities subject to Section 404 (as indicated above) may also require an individual Section 401 Water Quality Certification. You
should contact the NC Division of Water Quality (telephone [phone]) to determine Section 401 requirements.
For activities occurring within the twenty coastal counties subject to regulation under the Coastal'Area Management Act (CAMA),
prior to beginning work you must contact the N.C. Division of Coastal Management.
This Department of the Army verification does not relieve the permittee of the responsibility to obtain any other required Federal,
State or local approvals/permits.
If there are any questions regardin s verification, any of the conditions of the Permit, or the Corps of Engineers regulatory
program, please contact John Thomad @ 919 554-404 ext. 25.
Corps Regulatory Official
Date: 05/19/2009
Expiration Date of Verification: 05/19/2011
The Wilmington District is committed to providing the highest level of support to the public. To help us ensure we continue to do so,
please complete the attached customer Satisfaction Surveyor visit http://www.saw.usace.army.mil/WETLANDS/index.html to
complete the survey online.
Page 1 of 2
Determination of Jurisdiction:
? Based on preliminary information, there appear to be waters of the US including wetlands within the above described project area.
This preliminary determination is not an appealable action under the Regulatory Program Administrative Appeal Process
( Reference 33 CFR Part 331).
? There are Navigable Waters of the United States within the above described project area subject to the permit requirements of
Section 10 of the Rivers and Harbors Act and Section 404 of the Clean Water Act. Unless there is a change in the law or our
published regulations, this determination may be relied upon for a period not to exceed five years from the date of this
notification.
® There are waters of the US and/or wetlands within the above described project area subject to the permit requirements of Section
404 of the Clean Water Act (CWA)(33 USC § 1344). Unless there is a change in the law or our published regulations, this
determination may be relied upon for a period not to exceed five years from the date of this notification.
? The jurisdictional areas within the above described project area have been identified under a previous action. Please reference
jurisdictional determination issued . Action ID
Basis of Jurisdictional Determination: Property has tributary to Salem Creek which flows to the Yadkin River and the Atlantic
Ocean.
Appeals Information (This information applies only to approved jurisdictional determinations.)
Attached to this verification is an approved jurisdictional determination. If you are not in agreement with that approved jurisdictional
determination, you can make an administrative appeal under 33 CFR 331. Enclosed you will find a Notification of Appeal Process
(NAP) fact sheet and request for appeal (RFA) form. If you request to appeal this determination you must submit a completed RFA
form to the following address:
District Engineer, Wilmington Regulatory Division
Attn:Jean Manuele, Project Manager,
Raleigh Regulatory Field Office
3331 Hweitage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
In order for an RFA to be accepted by the Corps, the Corps must determine that it is complete, that it meets the criteria for appeal
under 33 CFR part 331.5, and that it has been received by the District Office within 60 days of the date of the NAP. Should you
decide to submit an RFA form, it must b eceived at the above address by July 19, 2009.
**It is not necessary to submit an form to the Officpf you do not object to the determination in this correspondence.**
Corps Regulatory Official:
Date 05/19/2009 Expiration Date 05/19/2011
SURVEY PLATS, FIELD SKETCH, WETLAND DELINEATION FORMS, PROJECT PLANS, ETC., MUST BE
ATTACHED TO THE FILE COPY OF THIS FORM, IF REQUIRED OR AVAILABLE.
Copy Furnished:
Brian Walker, Pizzagalli Construction Company, 1247 S. Martin Luther King Jr Drive, Winston-Salem NC 27107
Page 2 of 2
e; *0.
pizzage Ii
construction company
May 13, 2009
1247 S. Martin Luther King Jr. Drive
Winston Salem. North Carolina 27107
Telephone [phone]
Fax [phone]
Mr. John Thomas
US Army Corp of Engineers
Raleigh Regulatory Field Office
3331 Heritage Trade Drive, Suite 105
Wake Forest, NC 27587
(919)-554-4884
(919)-562-0421 fax
Re: RA Thomas Water Treatment Plant Improvements
Winston-Salem, NC
PC Project # 12806
Subject: Temporary Creek Re-location
Dear Mr. Thomas:
This letter is in regards to the above noted project and in reference to our telephone conversation on May 1, 2009 and then
again on May 7. 2009. After this conversation on May 7'', 2009 you directed us to submit to you a PCN and a Nationwide
Permit Number 33. We have filled out these forms as completely as possible however please let me know if we missed
something or need to make any changes.
Pizzagalli Construction Company is under contract with City / County Utilities of Winston-Salem for the RA Thomas Water
Treatment Plant Improvements project. Part of our work involves constructing a wash water equalization basin. This structure
is located next to a branch of the Salem Creek. See below for a section of the USGS Map of this area and the red arrow
showing the specific spot we are describing. The sites physical address is the same as our field office which is located onsite
at the above address.
12806 Anny Corp Creek Relocation 5 -13-09.doe
Page 2 5/13/2009
As we discussed Pizzagalli Construction Company inadvertently failed to properly notify the Army Corp of Engineers of its
plan for the construction of the wash water equalization basin located along a branch of the Salem Creek. The work that we
performed was to temporarily move the branch of this creek over approximately 20 feet in order for it to avoid our
excavation. The excavation of the equalization basin is approximately 16 feet deep and is located along this branch of the
creek. The top of slope for this excavation put it right into the edge of the creeks banks. In an effort to limit erosion and to
keep the creek flowing we excavated a temporary channel that was three feet wide and sloped the sides. In the bottom and
sides of the new channel we installed rip rap and woven filter fabric to help prevent erosion and to stabilize this area. This
creek has varying flows and we felt this provided more protection to the soils. After constructing the new channel we
diverted flow from the old channel and sent flow to the new channel. We installed a stone and earth check dam to allow the
flow to go to the new channel. Our intention is to when complete with the construction of the equalization basin to restore the
old creek to it original location and properly stabilize the banks and creek bottom from erosion. We would then divert flow
back to the old creek route and remove the temporary creek. We felt this was the best option to ensure that no erosion
happened and to ensure proper flow down this creek. The following picture shows the area before any construction activities
started. Note the green arrow shows the area where the creek was originally before our temporary relocation. Before
construction this creek bed had very limited flow due to being clogged up with dead vegetation and trees and also clogged
with existing deposited silt. Before construction water did not flow well but now we have cleaned the area up to allow better
drainage and flow through this branch of the creek.
Below are pictures of the area before we removed the old creek bed location and showing the new temporary creek that we
installed. Note the red arrow shows the new temporary creek location and green arrows show the old creek bed location. Note
the aerial photo shows the overall area as well as our silt fence for the sediment protection.
Page 3
5/13/2009
The next picture shows the area now after we have excavated for the equalization basin. Note that we have tried to leave as
much of the old creek bed un-disturbed as possible. The dimensions of the rip rap area where we relocated the creek to be are
approximately 150 feet long and distance from old centerline of the creek to the new temporary centerline of the creek is
approximately 20 feet at the widest point. The major area of our concern was where the middle green arrow is located. For
this reason and knowing the flooding potential of this creek we thought that the risk of losing this old creek bed was too high
to progress with construction without relocating the creek.
We have also enclosed copies of the contract drawings showing the grading, structure location, and structure drawings for
your use. We also included a scales drawing showing the area and our temporary channel with elevations. We plan to restore
the area back to what it looked like before our construction upon completion of our construction of the equalization basin.
This construction work shall be complete by the end of September 2009. We will perform all of our work as to not allow any
erosion or harm to the environment to happen. We apologize for inadvertently not notifying the Army Corp of Engineers
about this work and we look forward to resolving this issue as soon as possible.
Please let me know if we need to submit any other information or if you need any changes made to our plan. Thank you again
for your time and assistance with this issue.
Sincerely,

Brian Walker
Project Manager
cc: PC Correspondence File
cc: Butch Bedell - PCC
Page 4
5/13/2009
Enclosed: B-11, B-14, P-1, P-2, P-3
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Office Use Only:
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 sought from the
Corps: ® Section 404 Permit ? Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number: NWP 33 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps? ® Yes ? No
1 d. 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
because written approval is not required? For the record only for DWQ 401
Certification:
® Yes ? No For the record only for Corps Permit:

? 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. ? Yes ® No
1g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1h
below. ? Yes ® No
1h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ? Yes ® No
2: Project Information
2a. Name of project: RA Thomas Water Treatment Plant Improvements Project
2b. County: Forsyth
.2c. Nearest municipality / town: Winston-Salem
2d. Subdivision name: N/A
2e. NCDOT only, T.I.P. or state
project no: N/A
3. Owner Information
3a. Name(s) on Recorded Deed: City of Winston Salem
3b. Deed Book and Page No. Municipal Project - No number needed
3c. Responsible Party (for LLC if
applicable): N/A
3d. Street address: 1201 S. Martin Luther King Jr Drive
3e. City, state, zip: Winston-Salem NC 27107
3f. Telephone no.: 336-747-7309
3g. Fax no.: 336-727-8432
3h. Email address: [e-mail]
Page I of 11
PCN Form - Version 1.3 December 10, 2008 Version
4. Applicant Information (if different from owner)
4a. Applicant is: ? Agent ® Other, specify: General Contractor
4b. Name: Pizzagalli Construction Company
4c. Business name
(if applicable):
Pizzagalli Construction Company
4d. Street address: 1247 S. Martin Luther King Jr. Drive
4e. City, state, zip: Winston-Salem NC 27107
4f. Telephone no.: 336-788-2764
4g. Fax no.: 336-788-2768
4h. Email address: [e-mail]
5. Agent/Consultant Information (if applicable)
5a. Name: N/A
5b. Business name
(if applicable):
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. Fax no.:
5g. Email address:
Page 2 of 11
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): See attached
1 b. Site coordinates (in decimal degrees): Latitude: 36.08567 Longitude: - 80.21807
(DD.DDDDDD) (-DD.DDDDDD)
1 c. Property size: 43.92 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to Unnamed tributary to Salem Creek
proposed project:
2b. Water Quality Classification of nearest receiving water: WS-III; CA
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:
311 - The existing condition is both maintained grass and un-maintained overgrowth of grass and other vegitation. Mainly
it is a grass lined stream.
3b. List the total estimated acreage of all existing wetlands on the property:
0
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
1712 feet
3d. Explain the purpose of the proposed project:
Relocate a creek in order to allow for excavation of the wash water equalization basin, this was due to the top of slope
being located in the creek.
3e. Describe the overall project in detail, including the type of equipment to be used:
We will temporarly relocate the creek to allow for the construction of the equalization basin. First we dug a tempoary
channel from the down stream side up to the tie in location. We installed rip rap and filter fabric under the entire new
channel. Next we opened flow up to the new channel and stopped flow to the old channel. The old channel will be
restored to its original location and condition following completion of the construction of the equalization basin.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
? Yes ? No Unknown
project (including all prior phases) in the past?
Comments:
4b. If the Corps made the jurisdictional determination, what type
r ? Preliminary ? Final
of dete
mination 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 ? No ® Unknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
Page 3 of 11
PCN Form - Version 1.3 December 10, 2008 Version
6. Future Project Plans
6a. Is this a phased project? ? Yes ® No
6b. If yes, explain.
Page 4 of 11
PCN Form - Version 1.3 December 10, 2008 Version
C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
? 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. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type of jurisdiction
number - Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWQ - non-404, other) (acres)
Temporary T
W1 ? P ? T ? Yes ? Corps
? No ? DWQ
W2 ? P ? T ? Yes ? Corps
? No ? DWQ
W3 ? P ? T ? Yes ? Corps
? No ? DWQ
W4 ? PEI T ? Yes ? Corps
? No ? DWQ
W5 ? P ? T ? Yes ? Corps
? No ? DWQ
W6 ? P ? T ? Yes ? Corps
? No ? DWQ
2g. Total wetland impacts
2h. Comments:
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 Type of jurisdiction Average Impact
number - (PER) or (Corps - 404, 10 stream length
Permanent (P) or intermittent DWQ - non-404, width (linear
Temporary (T) (INT)? other) (feet) feet)
S1 ? P ®T Relocation with UT1 - Salem ? PER ® Corps 3 150
Restoration Creek ® INT ? DWQ
S2 ? P ? T ? PER ? Corps
? INT ? DWQ
S3 ? P ? T ? PER ? Corps
? INT ? DWQ
S4 ? P ? T ? PER ? Corps
? INT ? DWQ
S5 ? P ? T ? PER ? Corps
? INT ? DWQ
S6 ? P ? T ? PER ? Corps
? INT ? DWQ
3h. Total stream and tributary impacts
3i. Comments: This is a temporary relocation of 150 feet of creek that will be restored to its original location and condition.
Page 5 of 11
PCN Form -Version 1.3 December 10, 2008 Version
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
impact number- (if applicable) Type of impact Waterbody type Area of impact (acres)
Permanent (P) 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, then complete the chart below.
5a. 5b. 5c. 5d. 5e.

Pond ID
Proposed use or purpose Wetland Impacts (acres) Stream Impacts (feet) Upland
(acres)
number of pond
Flooded Filled Excavated Flooded Filled Excavated Flooded
P1
P2
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 an impacts require mitigation, then you MUST fill out Section D of this form.
6a.
? Neuse ? Tar-Pamlico ? Other:
Project is in which protected basin? ? Catawba ? Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number - Reason Buffer Zone 1 impact Zone 2 impact
Permanent (P) or for Stream name mitigation (square feet) (square feet)
Temporary T impact re uired?
61 ?P?T ?Yes
? No
B2 ?p?T ?Yes
? No
B3 ?P?T ?Yes
? No
6h. Total buffer impacts
6i. Comments:
Page 6 of 11
PCN Form - Version 1.3 December 10, 2008 Version
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
The location of the Wash Water Equalization Basin is a fixed location, we did work to make our excavation slopes a minuum
safe amount in order to minimize the impacts to the creek.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
We constructed the tempoary channel first before doing any work to the existing creek, the new channel was linned with
geotextile fabric on the slopes and then covered with rip rap to stabilize the area. We then removed the check dam at the point
where the new channel starts and diverted flow into the new channel. We then stopped flow into the old channel. After this
was complete we begain excavation of the equalization basin.
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

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

? 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.
Page 7 of 11
PCN Form - Version 1.3 December 10, 2008 Version
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 8 of 11
PCN Form - Version 1.3 December 10, 2008 Version
E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1 a. 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? Currently about 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: Site is already covered under existing
plan obtained by owner / engineer
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? Covered under separate plan
? Phase II
3b. Which of the following locally-implemented stormwater management programs ? NSW
? USMP
apply (check all that apply): ? 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
? 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
5b. Have all of the 401 Unit submittal requirements been met? ® Yes ? No
Page 9 of 11
PCN Form - Version 1.3 December 10, 2008 Version
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1a. 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
environmental 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): We inadvertently
did not apply for the permit for the tempoary relocation of the creek in adance.
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in
dd ? Yes ® No
a
itional 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.
There is no sewage disposal in this area of the project. All sewage disposal is by public sewer system and is not covered
under this permit / work.
Page 10 of 11
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 ? No
impacts?
E:1 Raleigh
5c. If yes, indicate the USFWS Field Office you have contacted.
® Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
Verified with Bryan Tompkins of USFWS that this project will have no effect and does not require any permitting.
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?
http://ocean.floddamadne.org/efh-coralAms/viewer.htm
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?
hftp://www.hpo.ncdcr.gov/ndist.htm
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? ® Yes ? No
8b. If yes, explain how project meets FEMA requirements: This is a tempoary relocation of the existing creek.
8c. What source(s) did you use to make the floodplain determination? Floodplain was shown on Contract documents for
constuction project.
1 l Z.ZG(pU t 1 ? GO?J?ruGT?vu ?p
Far l ?? (,?JLr s/ 3/o
Applicant/Agent's Printed Name icant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant
is provided.)
Page 11 of 11
PCN Form - Version 1.3 December 10, 2008 Version
APPLICATION FOR DEPARTMENT OF THE ARMY PERMIT OMB APPROVAL NO. 0710-0003
(33 CFR 325) Expires December 31, 2004
The Public burden for this collection of information is estimated to average 10 hours per response, although the majority of applications should require
5 hours or less. This includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Service Directorate of Information
Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302; and to the Office of Management and Budget,
Paperwork Reduction Project (0710-0003), Washington, DC 20503. Respondents should be aware that notwithstanding any other provision of law, no
person shall be subject to any penalty for failing to comply with a collection of.information if it does not display a currently valid OMB control
number. Please DO NOT RETURN your form to either of those addresses. Completed applications 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 Act, Section 404, 33 USC 1344; Marine Protection, Research and
Sanctuaries Act, 33 USC 1413, Section 103. Principal Purpose: Information provided on this form will be used in evaluating the application for a
permit. Routine Uses: This information may be shared with the Department of Justice and other federal, state, and local government agencies.
Submission of requested information is voluntary, however, if information is not provided the permit application cannot be evaluated nor can a permit
be issued.
One set of original drawings or good reproducible copies which show the location and character of the proposed activity must be attached to this
application (see sample drawings and instructions) and be submitted to the District Engineer having jurisdiction over the location of the proposed
activity. An application that is not completed in full will be returned.
(ITEMS I THR U 4 TO BE FILLED BY THE CORPS)
1. APPLICATION NO. 2. FIELD OFFICE CODE 3. DATE RECEIVED 4. DATE APPLICATION COMPLETED
(ITEMS BELOW TO BE FILLED BYAPPLICANT)
5. APPLICANT'S NAME 8. AUTHORIZED AGENT'S NAME AND TITLE (an agent is not required)
Pizzagalli Construction Company N/A
6. APPLICANT'S ADDRESS 7. AGENT'S ADDRESS
1247 S. Martin Luther King Jr. Drive N/A
Winston-Salem, NC 27107
7. APPLICANT'S PHONE NOS. W/AREA CODE 10. AGENT'S PHONE NOS. W/AREA CODE
a. Residence a. Residence N/A
b. Business 336-788-2764 ext 11 b. Business N/A
11. STATEMENT OF AUTHORIZATION
I hereby authorize P1 /'a to act in my behalf as my agent in the processing of this application and to
furnish, upon request, supplem tal information in support of this permit application.
d" 5// 7/O 9
LICANT'S SIGNATURE DATE
NAME, LOCATION AND DESCRIPTION OF PROJECT OR ACTIVITY
12. PROJECT NAME OR TITLE (see instructions)
RA Thomas Water Treatment Plant Improvements Project
13. NAME OF WATERBODY, IF KNOWN (if applicable) 14. PROJECT STREET ADDRESS (fapplicable)
A branch of the Salem Creek 1201 S. Martin Luther King Jr. Drive
Winston-Salem NC 27107
15. LOCATION OF PROJECT
Forsyth NC
COUNTY STATE
16. OTHER LOCATION DESCRIPTIONS, IF KNOWN (see instructions)
17. DIRECTIONS TO THE SITE
Take Hwy 52 North to Stadium Drive, turn right onto Stadium Drive, next turn right onto South Martin Luther King Jr. Drive. Arrive at jobsite after
third light, it is located on the left hand side.
I I
ENG FORM 4345, Jul 97 EDITION OF FEB 94 IS OBSELETE (Proponent: CECW-OR)
18. Nature of Activity (Description ofproject, include all features) Temporary relocated of a branch of the Salem Creek. The relocated channel is
approximately 150 feet long. The temporary channel is rip-rap lined and also contains a geo textile fabric. The new channel was constructed and then
flow was allowed to go into the new channel and then the old channel was blocked off. This temporary channel will be removed and flow restored to
the old channel upon completion of the construction of the Wash Water Equalization Basin.
19. Project Purpose (Describe the reason or purpose of the project, see instructions)
The purpose of the re-location is to allow proper room to excavate for the construction of the wash water equalization basin adjacent to this creek. The
creek was moved over to accommodate this excavation and will be restored to it original location and condition following construction.
USE BLOCKS 20-22 IF DREDGED AND/OR FILL MATERIAL IS TO BE DISCHARGED
20. Reason(s) for Discharge
N/A
21. Type(s) of Material Being Discharged and the Amount of Each Type in Cubic Yards
N/A
22. Surface Area in Acres of Wetlands or Other Waters Filled (see instructions)
N/A
23. Is Any Portion of the Work Already Complete? Yes XX No IF YES, DESCRIBE THE COMPLETED WORK
We inadvertently did not apply for the permit for this work before doing our creek relocation. The creek has been relocated and we are underway with
construction of the equalization basin.
24. Addresses of Adjoining Property Owners, Lessees, Etc., Whose Property Adjoins the Waterbody (if more than can be entered here,
please attach a supplemental list).
The City of Winston Salem - City / County Utilities Commission is the property owner.
101 N. Main Street, Suite 357
Winston-Salem NC 27107
25. List of Other Certifications or Approvals/Denials Received from other Federal, State, or Local Agencies for Work Described in This Application
AGENCY TYPE APPROVAL* IDENTIFICATION NUMBER DATE APPLIED DATE APPROVED DATE DENIED
none
*Would include but is not restricted to zoning, building and flood plain permits
26. Application is hereby made for a permit or permits to authorize the work described in this application. I certify that the information in this
application is complete and accurate. I further certify that I possess the authority to undertake the work described herein or am acting as the
duly authorized agent of the applicant.

SIGNATURE OF APPLICANT DATE SIGNATURE OF AGENT DATE
The application must be signed by the person who desires to undertake the proposed activity (applicant) or it may be signed by a duly
authorized agent if the statement in block 11 has been filled out and signed.
18 U.S.C. Section 1001 provides that: Whoever, in any manner within the jurisdiction of any department or agency of the United States
knowingly and willfully falsifies, conceals, or covers up any trick, scheme, or disguises a material fact or makes any false, fictitious or
fraudulent statements 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 more than $10,000 or imprisoned not more than five years or both.
Step-by-Step Instructions for Completing ENG Form 4345
Blocks 1 through 4. To be completed by the Corps of Engineers. When the Corps receives your completed application, it
will be assigned a number for identification. You will be notified of the number in an acknowledgment letter. Please refer to
this number in any correspondence or inquiry concerning your application.
Block 5. Applicant's Name. Enter the name of.the permit applicant. If the permit applicant is an agency, company,
corporation or other organization, indicate the responsible officer and his or her title. If more than one applicant is
associated with the application, please list the other applicants in the supporting documentation submitted with the
application.
Block 6. Address of Applicant. Please provide the full mailing address of the permit applicant. If there are additional
applicants associated with the application, please provide their mailing addresses in the supporting documentation
submitted with the application.
Block 7. Applicant Telephone Number(s). Please provide the telephone number where the permit applicant can usually
be reached during normal business hours.
Blocks 8 through 11. To be completed if the permit applicant chooses to have an agent act on his or her behalf during
the permit application process.
Block 8. Authorized Agent's Name and Title. Indicate the name of the individual or agent, designated by the permit
applicant, to represent the permit applicant in the permit process. An agent can be an attorney, builder, contractor,
engineer or any other person or organization.
Note: An agent is not required.
Block 9 and 10. Agent's Address and Telephone Number. Please provide the complete mailing address of the agent,
along with the telephone number where he or she can be reached during normal business hours.
Block 11. Statement of Authorization. To be completed by the permit applicant, if he or she has employed an agent.
Block 12. Proposed Project Name or Title. Please provide a name that is to be used to identify the proposed project
(e.g., Mill Creek Plaza, Oak subdivision, Smith Industrial Park).
Block 13. Name of Waterbody. Please provide the name of the stream, lake, marsh, or other waterbody to be directly
impacted by the activity (if the waterbody or wetland has a name). If it is a minor stream with no name, identify the
waterbody the minor stream enters.
Block 14. Proposed Project Address. If the proposed project is located at a site that has a street address (not a box
number), please enter that address here.
Block 15. Location of Proposed Project. Enter the borough (if applicable) and state where the proposed project is
located. If more space is required, please provide that information in the supporting documentation submitted with the
application.
Block 16. Other Location Descriptions. If available, please provide the Section, Township and Range and/or the latitude
and longitude of the site. You may also provide a description of the proposed project location, such as lot numbers or tract
numbers, or you may choose to indicate the location of the proposed project site from a known point (such as the right
descending bank of Smith Creek, one mile down from the Highway 14 bridge). If the project is located at a large river or
stream, include the river mile of the proposed project site if known.
Block 17. Directions to the Site. Provide directions to the site from a known location or landmark. Include highway and
street numbers as well as names. Also provide distances from known locations and any other information that would assist
in locating the site.
Block 18. Nature of the Activity. Describe the overall activity or project, including all features. Give appropriate
dimensions (length, width, and height) of structures (such as piers or bulkheads), fills, or excavations. Identify the
materials to be used in construction, as well as the methods by which the work is to be done. Also, identify any structure(s)
to be constructed on fills, piles, or float-supported platforms. Include the locations of all disposal sites for dredged or
excavated materials. If the activity involves dredging, state if the dredging activity is new or maintenance dredging. If
maintenance dredging is proposed, please provide the name and number of the previous Corps of Engineers permit for
dredging that area.
The written descriptions and illustrations are an important part of the application. Please describe, in detail, what the permit
applicant wishes to do. If more space is required, please provide that information in the supporting documentation
submitted with the application.
Block 19. Project Purpose. Describe the purpose and need for the proposed project. What will it be used for and why?
Also include a brief description of any related activities to be developed as the result of the proposed project. Please
provide the approximate dates the permit applicant plans to begin and complete all work.
Block 20. Reason(s) for the Discharge. If the proposed activity involves the discharge of dredged or fill material into
wetlands or other waters of the United States, including the temporary placement of material, explain the specific purpose
of the placement of the material (such as erosion control).
Block 21. Type(s) of Material Being Discharged and the Amount of Each Type in Cubic Yards. Describe the material
to be discharged and amount of each material to be discharged in waters of the United States. Examples of materials
include rock, sand, clay, concrete, etc.
Block 22. Surface Areas of Wetlands or Other Waters Filled. Describe the area to be filled at each location. Specifically
identify the surface areas, or parts thereof, to be filled. Also include the means by which the discharge is to be done
(backhoe, dragline, etc.). If dredged material is to be deposited at an upland site, identify the site and the steps to be taken
(if necessary) to prevent runoff from the dredged material back into a waterbody. If more space is required, please provide
that information in the supporting documentation submitted with the application.
Block 23. Is Any Portion of the Work Already Complete? Provide background on any part of the activity that is already
completed. Describe the area already developed, structures completed, any dredged or fill material already discharged,
the type of material, the volume in cubic yards, and the amount of waters of the United States filled (acres or linear feet). If
the work was done under an existing Corps permit, identify the authorization, if possible. Also indicate when the completed
work was initiated and completed.
Block 24. Names and Addresses of Adjacent Property Owners, Lessees, etc., Whose Property Adjoins the Project
Site. List complete names and mailing addresses of the adjacent property owners, lessees, etc., whose property adjoins
the waterbody or wetland where the work is being proposed so that they may be notified of the proposed activity (usually
through a public notice or a letter of permission coordination notice). If more space is needed, please list the other
adjoining property owners, lessees, etc. in the supporting documentation submitted with the application. Information
regarding adjacent landowners is usually available through the office of the tax assessor in the city or borough where the
project is to be located.
Block 25. Information about Approvals or Denials by Other Agencies. The permit applicant may need the approval of
other Federal, state, or local agencies for the project. Identify any applications for those approvals that have submitted and
the status (pending, approved or denied), if known, of each application. You need not have obtained all other permits
before applying for a Corps permit.
Block 26. Signature of Applicant or Agent. The application must be signed by the owner or other authorized party (such
as an authorized agent). This signature shall be an affirmation that the permit applicant possesses the requisite property
rights to undertake the proposed activity (including compliance with special conditions, mitigation, requirements, etc.).
What Supporting Documentation Should I Provide With My Permit Application?
Three types of illustrations are required to accurately depict proposed activities: vicinity maps, plan views, and
elevation/cross-section views. Each illustration should identify the project, the applicant, and the type of illustration (vicinity
map, plan view, cross-section view). The illustrations do not have to be professionally drawn, but they should be clear,
accurate, and contain all necessary information.
The vicinity map will be used by the Corps to locate the site of the proposed activity. The vicinity map will also be included
in any public notice that is issued to solicit comments on the proposed work. You may use an existing road map or a U.S.
Geological Survey topographic map (scale 1:24,000) as the vicinity map. Please include sufficient details to simplify
locating the site from the waterbody and from land. Identify the source of the map or chart from which the vicinity map was
taken. The vicinity map should include, as appropriate:
• Location of the site of the proposed activity (draw an arrow indicating the exact location of the site on the map).
• Latitude/longitude, river mile, or other information that coincides with Block 16 on the application form.
• Name of the waterbody, and the name of the larger creek, river, bay, etc., to which the waterbody is an immediate
tributary.
• Names, descriptions, and locations of landmarks.
• Names of all applicable political (county, parish, borough, town, city, etc.) jurisdictions.
• Name of, and distance to, the nearest town, community, or other identifying location.
• Names or numbers of all roads in the vicinity of the site.
• North arrow.
• Scale.
The plan view shows the proposed activity as if you were looking straight down on it from above. The plan view should
include, as appropriate:
• Name of the waterbody (river, creek, lake, wetland, etc.) and river mile (if known) at the location of the proposed
activity.
• Existing shorelines.
• Mean high and mean low water marks and the maximum (spring) high tide line, if the proposed activity is located
in a tidal waterbody.
• Ordinary high and ordinary low water marks, if the proposed activity is located in a non-tidal waterbody.
• Average water depths around the proposed activity.
• Existing and proposed ground contours or spot elevations.
• Vertical datum (reference elevation).
• All property lines and all project elements, such as buildings, access roads, parking areas, utility lines, and
detention ponds.
• Dimensions of the proposed activity and the distance it extends from the mean high water mark into tidal waters or
the ordinary high water mark in non-tidal waters.
• Distances to any nearby Federal projects and anchorages, if applicable.
• Distance between the proposed activity and any navigation channel, where applicable.
• Locations of structures, if any, in navigable waters immediately adjacent to the proposed activity.
• Locations of any waters (rivers, streams, lakes, ponds) and wetlands (marshes, swamps, bogs, tidal flats).
Wetland boundaries must be delineated using the three parameter approach described in the 1987 Corps of
Engineers Wetlands Delineation Manual (Technical Report Y-87-1, dated January 1987).
• The locations of the boundaries of the 100-year and 500-year floodplains and the boundary of the regulatory
floodway, as shown on the current National Flood Insurance Program map, if applicable.
• North arrow.
• Scale.
• If the proposed activity involves dredging, describe the type of material to be dredged, number of cubic yards,
method of handling, and the location and dimensions of the dredged material disposal area. The drawing should
show proposed retention levees, weirs, and/or other means of retaining hydraulically-placed materials. The
capacity of the dredged material disposal area should also be indicated on the drawing.
• Mark the drawing to indicate previously completed portions of the activity.
The elevation and/or cross-section view is a scale drawing that shows the side, front, or rear of the proposed activity. In
a section view, show the proposed structure or fill as it would look if it were sliced for display. The elevation view should
include, as appropriate:
• Vertical datum (reference elevation).
• Water elevations as shown in the plan view (including the 100-year flood elevation and the floodway, if available).
• Water depth at the channelward limit of the proposed activity or, if dredging is proposed, the depth of dredging and
estimated disposal grades.
• Dimensions from the mean high water mark (in tidal waters) or the ordinary high water mark (in non-tidal waters)
for the proposed fill or structure. Dimensions from the high tide line for pile supported platforms, including the
dimensions for any structures to be built on the platform.
• Cross-section of the dredging, excavation, or fill, including approximate side slopes.
• Graphic or numeric scale.
• Principal dimensions of the activity.
Drawings should be as clear and simple as possible. Drawings may also include:
• Names of adjoining property owners who may be affected by the proposed work. Complete names and addresses
should be shown in Block 24 on ENG Form 4345.
• Legal property description: Number, name of subdivision, block and lot number. Section, Township, and Range (if
applicable) from plot, deed, or tax assessment.
• Photographs of the site of the proposed activity are not required. However, photos are helpful and may be
submitted as part of any application.
BLACK & VEATCH
Building a world of differencd
Winston-Salem/ Forsyth County Utility Commission
R.A. Thomas Water Treatment Plant Improvements
Sue Homewood
NC DWQ, Winston-Salem Regional Office
585 Waughtown Street
Winston-Salem, NC 27107
Subject: 401 Water Quality Certification
Dear Sue Homewood,

-lent e=19NR
JUL Z Z 20
L r ter.-Salem
R g r.al (Wtce
B&V Project 145730
B&V File D-1.4
July 21, 2009
In response to your additional information request for the Section 401 Water Quality Certification
Application for the R.A. Thomas Water Treatment Plant Improvements, please find the following:
• Revised pages 6, 7, and 8 of the Pre-Construction Notification Form enumerating the temporary
impacts of stream impacts S2 and S3 which result in 110 linear feet of temporary impacts increasing
the total impact to 239 linear feet.
• Letter from Brian Walker of Pizzagalli Construction Company describing how they plan to construct
the pipelines and structures associated with these stream impacts.
• Revised Location Map illustrating the locations of the enumerated stream impacts.
• Contract Drawing Sheet B36 which includes construction detail CS for stream stabilization. Note
that the detail shows the riprap installed below the stream bed with the top of riprap matching the top
of stream bed elevation.
Sincerely,
?L;? r
Kurtis Proffit, P.E.
Enclosure[s]
cc: Ian McMillan, NC DWQ, Wetlands/401 Certification Unit (w/ enclosures)
John Thomas, U.S. Army Corps of Engineers (w/ enclosures)
David Saunders, CCUC (w/o enclosures)
Terry Cornett, B&V (w/o enclosures)
Jeff Davis, B&V (w/o enclosures)
BLACK & VEATCH INTERNATIONAL COMPANY - 9000 Regency Parkway, Suite 200 - Cary, NC 27518 - 919-462-7501 - Fax [phone]

2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. 2c. 2d. 2e. 2f.
Wetland impact Type of jurisdiction
number - Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWQ - non-404, other) (acres)
Temporary T
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
W5 ? P ? T ? Yes ? Corps
? No ? DWQ
W6 ? P ? T (] Yes ? Corps
? No ? DWQ
2g. Total wetland impacts
2h. Comments:
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then comp lete this
question for all stream sites impacted.
3a. 3b. 3c. 3d. 3e. 3f. 3g.
Stream impact Type of impact Stream name Perennial Type of jurisdiction Average Impact
number - (PER) or (Corps - 404, 10 stream length
Permanent (P) or intermittent
DWQ -non-404
width
(linear
Temporary (T) ?
(tNl') • ,
other) (feet) feet)
Demolition of the
existing and
construction of a
S1 O P ? T new Plant Outlet Unnamed ® PER Corps 20 51
Structure in the.
' Tributary ? INT ? DWQ
same location in
a
dead end branch
off the stream
Culvert extension
and construction
S2 P ? T of a concrete Unnamed 0 PER Corps 13 40
endwall with rip- Tributary ? INT ? DWQ
rap outlet
stabilziation
12" Lagoon

S3 ® P ? T Decant creek
crossing with rip- Unnamed ® PER 0 Corps
10
38
rap stream Tributary ? INT ? DwQ
stabilization
Temporary stream
bypass for Stream
Impact No. S2
S4 ? P ® T with bypass Unnamed ® PER Corps

pumping and
Tributary
? INT
? DWQ 13 90
cofferdams
located 80'
upstream and 10'
Page 6 of 12
PCN Form - Version 1.3 December 10, 2008 Version
10 downstream .

Duration of
approximately 6
weeks.
Temporary stream
bypass for Stream
Impact No. S3
with bypass
pumping and
S5 ? POT cofferdams Unnamed PER ED Corps 10 20
located 10' Tributary ? INT ? DWQ
upstream and
downstream.
Duration of
approximately 1
week.
S6 ? P ? T ? PER ? Corps
? INT ? DWQ
3h. Total stream and tributary impacts 239
3i. Comments: Note that stream impact No. S1 is actually a dead end branch off the unnamed tributary and will not impact the
flow through the tributary. Temporary bypassing is therefore not required for this impact.
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
impact number - (if applicable) Type of impact Waterbody type Area of impact (acres)
Permanent (P) or
Temporary M
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, then complete the chart below.
5a. 5b. 5c. 5d. 5e.

Pond ID
Proposed use or purpose Wetland Impacts (acres) Stream'impacts (feet) l lahd

b (acres)
num
er of pond
Flooded Filled Excavated Flooded Filled Excavated Flooded
P1
P2
K 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):
% Method of construction:
Page 7 of 12
PCN Form - Version 1.3 December 10, 2008 Version

6. Buffer Impacts (for
If project will impact a Ordtected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
6abelow. If an Im acts require miti ation, then you MUST fill out Section D of this form.
.
Project is in which protected basin?
6b. 6c. 6d.
Buffer impact
number - Reason
Permanent (P) or for
B1OP0T
B2 OPOT
B3 OPOT
6i. Comments:
D. Impact Justification and Mitigation
Yes
No
Yes
No
Yes
No
6h. Total buffer impacts
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Stream impact No. S3 crosses the creek at an angle less than 75 degrees in order to avoid conflict with the existing 15"
sanitary sewer line on the east side of Brushy Fork Creek and connect to the proposed Wash Water Equalization Basin on the
west side of the creek.
The structures associated with stfgaln impacs S1 and S2 are essential for the water treatment plant improvements but were
designed to minimize stream impacts as much as possible.
1 b., Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
In accordance with Contract Drawing B11 Note 3, the existing creek is to be intercepted and bypassed
around stream impacts
2 and S3 such that no water flows through any distrubed area until construction of these facilities is complete. Rip-rap
stabilization per Detail CS on Sheet B16 is shown for these structures to protect the stream-bank during and after
construction. P
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?
2b. If yes, mitigation is required by (check all that apply):
12c. If yes, which mitigation option will be used for this
project?
L3. Complete if Using a Mitigation Bank
i 3a. Name of Mitigation Bank:
0 Yes 0 No
0 DWQ 0 Corps
0 Mitigation bank
[] Payment to in-lieu fee program
0 Permittee Responsible Mitigation
Jb. Credits Purchased (attach receipt and letter)
Type
0 Neuse 0 Tar-Pamlico
? Catawba ? Other:
El Randleman
6e. 6f. 69
Buffer Zone 1 impact Zone 2 impact
Stream name mitigation (s
required? (square feet) (square feet)
Quantity
Page 8 of 12
PCN Form - Version 1.3 December 10, 2008 Version
pizzagalii
construction company
l
July 7, 2009
1247 S. Martin Luther King Jr. Drive
Winston Salem, North Carolina 27107
Telephone [phone]
Fax [phone]
Mr. Jeff Davis
Black and Veatch International
8520 Cliff Cameron Drive, Suite 210
Charlotte, NC 28269
(704)-510-8440
(704)-510-0211 fax
Re: RA Thomas Water Treatment Plant Improvements
Winston-Salem, NC
PC Project # 12806
Subject: NCDENR Letter Dated June 24, 2009
Dear Mr. Davis:
This letter is in regards to the Section 401 Water Quality Certification Application and specifically how Pizzagalli
Construction Company plans to construct the pipelines and structures located in the stream channels onsite. All work
will be performed in the dry. In order to provide a dry area PCC intends to set up a temporary by-pass pump system to
divert the flow of the creek around the new construction. We intend to use both electric pumps and diesel powered dri-
prime pumps. The pumps will be sized in order to maintain the flow of the creek. Currently we plan to use a 3"
electric pump and a 4" diesel powered pump with other pumps available as needed. After the pumps are set up and
ready we will install an upstream temporary cofferdam. We will construct this by first pushing sheet piles into the
creek to completely block flow off from our construction area, next we will cover the sheet piling with dirt and rip rap
in order to help support the temporary cofferdam. Next we will set the suction lines of our dewatering pumps into the
wet side of the new cofferdam and pump this water continuously around the construction area. We will also construct
a small cofferdam on the downstream side of the construction area to prevent water from backing up in the
construction area. After the bypass pump system is operational we will set a pump to dewater the stream channel in
between our two cofferdams. After all water has been removed we will start excavating for the new pipe or structure.
Upon completion of the structure and restoration of the stream channel inside the cofferdam area we will then remove
the downstream cofferdam and there remove the upstream cofferdam. Then we will remove our temporary bypass
pumps and restore the remaining area of the stream channel. During all this work we will provide adequate erosion
control practices to prevent sediment from entering the stream or leaving the site. We will also use stone check dams
with our dewatering in order to prevent erosion also. Please let us know if you have any questions or concerns.
Sincerely,
Brian Walker
Project Manager
cc: PC Correspondence File
12806 NCDENR Letter 6-14-09.doc
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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
September 1, 2009
DWQ# 09-0573 correction
Mr. David Saunders Forsyth County
City of Winston-Salem
101 N. Main St, Suite 357
Winston-Salem, NC 27101
Re: Section 401 Water Quality Certification application
Dear Mr. Saunders:
You have our approval, in accordance with the attached conditions, to place fill and impact 264 linear feet of
two unnamed tributaries to Salem Creek to construct the R.A. Thomas Water Treatment Plant Improvements
located in Winston-Salem, NC in Forsyth County, as described in your application received by the Division
on May 19, 2009, and additional information received on July 22, 2009 and addendum submitted August 24,
2009. Please note this authorization letter replaces the letter issued on August 20, 2009. After reviewing your
modification application, we have determined that this fill is covered by General Water Quality Certification
Numbers 3705, which can be viewed on our web site at
http://h2o.enr.state.nc.us/ncwetlands/rd wetlands _certifications.htm. This Certification allows you to use
Nationwide Permit Number 39 when it is issued by the U.S. Army Corps of Engineers. In addition, you
should secure any other applicable federal, state or local permits before you proceed with your project,
including (but not limited to) those required by Sediment and Erosion Control (including trout buffer waivers
as necessary), Non-Discharge, State Stormwater, and Water Supply Watershed regulations. Also, this
approval will expire when the accompanying 404 permits expire unless otherwise specified in the General
Certification.
This approval is valid only for the purpose and design that you have described in your application. If you
change your project, you must notify us in writing, and you may be required to send us a new application for a
new certification. If the property is sold, the new owner must be given a copy of the Certification and
approval letter and is thereby responsible for complying with all conditions. If total wetland fill for this
project (now or in the future) exceeds one acre, or total fill to perennial streams equals or exceeds 150 linear
feet, additional compensatory mitigation may be required as described in 15A NCAC 2H .0506 (h). For this
approval to be valid, you must follow the conditions listed in the attached certification, as well as the
additional conditions listed below:
1. The following impacts are hereby approved as long as all other specific and general conditions of
this Certification are met. No other impacts, including incidental impacts, are approved:
Identifier Stream Impact len h.
Site S1 Unnamed Tributar #1 to Salem Creek 51. feet permanent im act
North Carolina Division of Water Quality, Winston-Salem Regional Office
Location: 585 Waughtown St. Winston-Salem, North Carolina 27107 One
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748 NorthCarol ina
Internet: www.ncwaterquality.org
An Equal Opportunity l Affirmative Action Employer
Mr. David Saunders
DWQ# 09-0573 correction
September 1, 2009
Page 2 of 3
Site S2 Unnamed Tributary #2 to Salem Creek 40 feet permanent impact
90 feet temporary impact
Site S3 Unnamed Tributary #2 to Salem Creek 38 feet permanent impact
30 feet temporary impacts
Site S4 Unnamed Tributary #2 to Salem Creek 5 feet permanent impact
20 feet temporary impacts
Total 134 linear feet permanent
130 linear feet tem orar
2. Upon finishing the project, the Applicant shall fill out and return the enclosed "Certificate of
Completion" to notify NCDWQ when all work included in the 401 Certification has been completed.
This certificate should be returned to the Winston-Salem Regional Office of the NCDWQ at the address
listed on the form.
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, 6714 Mail Service Center, Raleigh, N.C. 27699-6714. 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 contact Sue Homewood in the DWQ Winston-Salem Regional Office at
336-771-4964 or at [e-mail].
Sincerely,
(y4v/.111_e_..
Coleen H. Sullins, Director
611, Division of Water Quality
cc: John Thomas, U. S. Army Corps of Engineers, Raleigh Regulatory Field Office (via email)
Kurtis Proffit, P.E., Black & Veatch (via email)
DWQ Winston-Salem Regional Office
DWQ Wetlands/401
Mr. David Saunders
DWQ# 09-0573 correction
September 1, 2009
Page 3 of 3
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
1, , 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:
A ent 's Certi ication
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:
rnmineer's Certification
Partial Final
1, , as a duly registered Professional Engineer 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