20100934 Ver 1_401 Application_20101110

ADAMS - HEATH ENGINEERING, INC.
CIVIL - ENVIRONWFNTAL.
?pAID
November 3, 2010
Raleigh Regulatory Field Office NOV 5 2010
US Army Corps of Engineers
6512 Falls of the Neuse Road, Suite 105 DENR WATER QOwTy
Raleigh, North Carolina 27615 WEILAhFS MD STORVOTERBR#Cn
Re: Mount Airy/ Pilot Mountain Water System Interconnection Project
Surry County, North Carolina
Dear Sir/ Madam:
Please find enclosed the original and one copy of the Pre-Construction Notification for the above
referenced project. The project involves water line extensions from the City's existing water system to the
Town of Pilot Mountain's water system. Proposed construction includes water line stream crossings at ten
(10) locations. By copy of this letter, we are also forwarding five (5) copies to the NC Division of Water
Quality and one copy to the NC Wildlife Resources Commission. We included a $240.00 fee payment to
NCDWQ for a Minor Water Quality Certification as less than 150 LF of stream will be impacted and we
believe that Nationwide Permit 12 would apply and a 401 Certification is not required. The NCWRC is
copied due to Surry County's listing as a Trout County.
If you have any questions, feel free to call.
Sincerely,
ADAMS-HEATH ENGINEERING, INC.
V?U` [.U
Kevin Heath, P.E.
cc: NC Division of Water Quality
4401 Reedy Creek Road
Raleigh, North Carolina 27607
w/ 5 attachments & $240.00 check
North Carolina Wildlife Resources Commission
Western Piedmont Regional Coordinator
3855 Idlewild Road
Kemersville, North Carolina 27284-9180
w/ 1 attachment
Mitch Williams, P.E., City of Mount Airy w/ 1 attachment
KH/sct
TEL: [phone] NORTH MAIN STREET FAX: [phone]
GALAX, VIRGINIA 24333
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Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 13 Dec 10 2008
Pre-Construction Notification PC Form
A. Applicant Information
1. Processing
1a. Type(s) of approval sought from the
Corps:
El Section 404 Permit El Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number: 12 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps? ? Yes ® No
1d. Type(s) of approval sought from the DWQ (check all that apply):
® 401 Water Quality Certification - Regular ? Non-404 Jurisdictional General Permit
? 401 Water Quality Certification - Express ? Riparian Buffer Authorization
1 e. Is this notification solely for the record
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
If. 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 1 h
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: Mount Airy / Pilot Mountain Water System Interconnection
2b. County: Surry
2c. Nearest municipality / town: Town of Pilot Mountain
2d. Subdivision name: N/A
2e. NCDOT only, T.I.P. or state
project no: N/A J
3. Owner Information ? 2 t
3a. Name(s) on Recorded Deed: City of Mount Airy
3b. Deed Book and Page No. N/A S1>;ybq
3c. Responsible Party (for LLC if
applicable): Barbara Jones, City Manager
3d. Street address: 300 South Main Street
3e. City, state, zip: Mount Airy, North Carolina 27030
3f. Telephone no.: 336-786-3501
3g. Fax no.: 336-719-7506
3h. Email address: [e-mail]
Page 1 of 10
PCN Form - Version 1.3 December 10, 2008 Version
4. Applicant Information (if different from owner)
4a. Applicant is: ? Agent ? Other, specify:
4b. Name:
4c. Business name
(if applicable):
4d. Street address:
4e. City, state, zip:
4f. Telephone no.:
4g. Fax no.:
4h. Email address:
5. Agent/Consultant Information (if applicable)
5a. Name: Kevin Heath, P.E.
5b. Business name
(if applicable): Adams-Heath Engineering, Inc.
5c. Street address: 119 North Main Street
5d. City, state, zip: Galax, Virginia 24333
5e. Telephone no.: 276-236-4588
5f. Fax no.: 276-236-0458
5g. Email address: [e-mail]
B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): N/A
1 b. Site coordinates (in decimal degrees): Latitude: 36.257858 Longitude: 80.317274
(DD.DDDDDD) (-DD.DDDDDD)
1 c. Property size: N/A acres - linear water line project
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
proposed project: Stoney Creek, Flat Shoal Creek, Toms Creek, and
tributaries
2b. Water Quality Classification of nearest receiving water: Class C
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:
All ten (10) sites are water line stream crossings, all of which are adjacent to NCDOT highways. Adjacent
properties include highway r/w, farm land, and undeveloped property - all with herbaceous cover.
3b. List the total estimated acreage of all existing wetlands on the property:
N/A - linear water line extension adjacent to NCDOT r/w
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
N/A - linear water line extension adjacent to NCDOT r/w
3d. Explain the purpose of the proposed project:
Water line stream crossings included in project for interconnection of the City of Mount Airy and Town of Pilot Mountain
water systems
Page 2 of 10
PCN Form - Version 1.3 December 10, 2008 Version
3e. Describe the overall project in detail, including the type of equipment to be used:
The project involves water line extensions for interconnection of two public water systems. The overall project
includes construction of approximately 38,000 LF of 12" and smaller water line and related improvements. Included
in the construction will be ten (10) water line stream crossings. Of those crossings, one (1) is to be directionally
drilled below streambed without stream encroachment and nine (9) are to be excavated and steel encased below
streambed elevation.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property / ? Yes ® No El Unknown
project (including all prior phases) in the past'.
Comments:
4b. If the Corps made the jurisdictional determination, what type ? Preliminary ? Final
of determination 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.
6. Future Project Plans
6a. Is this a phased project? ? Yes ® No
6b. If yes, explain.
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
Page 3 of 10
PCN Form - Version 1.3 December 10, 2008 Version
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 ? P ? T ? Yes ? Corps
? No ? DWQ
WS ? 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. 30. 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 Stream Crossing U.T to Stoney
Creek ® PER
? INT ? Corps
® DWQ < 5 10+/-
S2 ? P ®T Stream Crossing Stoney Creek ® PER
0 INT ? Corps
® DWQ 15+/- 10+/-
S3 ? P ®T Stream Crossing U.T. to Flat Shoal
Creek ® PER
? INT ? Corps
® DWQ < 5 10+/-
S4 ? P ®T Stream Crossing U.T. to Flat Shoal ® PER ? Corps < 5 10+1
Creek ? INT ® DWQ
S5 ? P ®T Stream Crossing U.T. to Flat Shoal ® PER ? Corps 10+/- 10+/
Creek ? INT ® DWQ
S6 ? P ® T Stream Crossing U.T. to Flat Shoal ® PER ? Corps < 5 5+/
Creek ? INT ® DWQ
S7 ? POT Stream Crossing Flat Shoal Creek ® PER
? INT ? Corps
® DWQ 15+1- 10+/
S8 ? P ® T Stream Crossing U.T. to Toms ® PER ? Corps 10+1- 10+/
Creek ? INT ® DWQ
S9 ? P ® T Stream Crossing U.T. to Toms ® PER ? Corps 5+/- 10+/
Creek ? INT ® DWQ
S10 ? POT Stream Crossing Toms Creek ® PER
? INT ? Corps
® DWQ 45+/- N/A-0
3h. Total stream and tributary impacts 85 LF +/-
31. Comments: Impact lengths estimated by using a typical 10' width disturbed when crossing streams
Page 4 of 10
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.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or purpose (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. Suffer 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 miti ation, 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 impact required?
131 ?P?T ?Yes
? No
B2 ?P?T ?Yes
? No
B3 ?P?T ?Yes
? No
6h. Total buffer impacts
61. Comments:
Page 5 of 10
PCN Form -Version 1.3 December 10, 2008 Version
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
The number of stream crossings required has been reduced to the fewest possible.
1 b. Specifcally describe measures taken to avoid or minimize the proposed impacts through construction techniques.
The impacts have been minimized by requiring the longest crossing to be directionally drilled with no stream impacts. At the
open cut crossings, the Contractor shall use temporary pipe flumes or cofferdams to maintain stream flow during
construction, pipe is to be installed inside a steel casing below streambed level, and streambed is to be restored to original
contour.
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

El Payment to in-lieu fee program
? Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter) Type Quantity
3c. Comments:
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached. ? Yes
4b. Stream mitigation requested: linear feet
4c. If using stream mitigation, stream temperature: ? warm ? cool ?cold
4d. Buffer mitigation requested (DWQ only): square feet
4e. Riparian wetland mitigation requested: acres
4f. Non-riparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requested: acres
4h. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
NIA
Page 6 of 10
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 Z 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:
E. Stormwater Management and Diffuse Flow Man (required by DWQ)
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers identified
within one of the NC Riparian Buffer Protection Rules? 0 Yes Z No
1b. If yes, then is a diffuse flow plan included? If no, explain why.
Comments:
? Yes ? No
Page 7 of 10
PCN Form - Version 1.3 December 10, 2008 Version
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project? 0%
2b. Does this project require a Stormwater Management Plan? ? Yes ® No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: The project involves water lines installed
below grade, so there will be no impact to stormwater volume. Short-term impacts due to construction disturbance to be
addressed by implementation of an E& S Control Plan.
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 govemmenVs jurisdiction is this project?
? Phase 11
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
? HQW
4a. Which of the following state-implemented stormwater management programs apply ? 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 8 of 10
PCN Form -Version 1.3 December 10, 2008 Version
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the project involve an expenditure of public (federal/state/local) funds or the ® Yes ? No
use of public (federal/state) land?
1b. 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)?
1c. 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: Scoping document has been circulated through SCH, comments
received, and final EA is being prepared. No responses received that were of
significant concern to the project.
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards, ? Yes ® No
or Riparian Buffer Rules (15A NCAC 2B.0200)?
2b. Is this an after-the-fact permit application? ? Yes ® No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in ? Yes ® No
additional development, which could impact nearby downstream water quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
The project will interconnect the two public water systems. Water service will be made available to potential customers
along the transmission line route, but no significant additional development is anticipated.
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.
The proposed water project area is unsewered, so individual on-site septic systems are used. There are no plans to extend
public sewer service to the project area.
Page 9 of 10
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?
?
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?
NCDENR Division of Natural Resources Planning and Conservation was asked to comment on the project. They
indicated three rare species within one mile, but none in the project corridor and none Endangered.
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?
NOAA Web Page for Essential Fish Habitat Mapper
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?
NC Dept of Cultural Resources was contacted, asked to review project, and responded with "No Comment".
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:
8c. What source(s) did you use to make the floodplain determination?
&-bawc, A ,)a&e.S
1d. '
Applicant/Agent's Printed Name Applicant/Agent' Signature Date
(Agent's signature is valid only if an authorization letter from the applicant 9 ?ac r c
is provided.)
Page 10 of 10
PCN Form -Version 1.3 December 10, 2008 Version
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ADAMS—HEATH ENGINEERING, INC.
MOUNT AIRY/PILOT MOUNTAIN
STREAM
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CIVIL — ENVIRONMENTAL
WATER SYSTEM INTERCONNECTION
118 North Mein Street
LOCATION
Tel: [phone] Fax: [phone] Galax, Virginia 24333
SURRY COUNTY,
NORTH CAROLINA
MAP