20110780 Ver 1_401 Application_20110811

TIMMONS GROUP
YOUR VISION ACHIEVED THROUGH OURS.
August 17, 2011
N.C. Division of Water Quality
WeBSCaPe Unit
Attn: Karen Higgins
1650 Mail Service Center
Raleigh, NC 27699-1650
Re: LETTER OF TRANSMITTAL
Pre-Construction Notification Application
Alamance House (Approx. 5.6 acres)
City of Burlington, North Carolina
Dear Ms. Higgins:
RALRD
On behalf of Alamance AL Investors, LLC, please find the attached Pre-Construction
Notification Application and supplemental information requesting written confirmation that the
activities proposed for the Alamance House sewer line construction project in Burlington,
North Carolina, may proceed under Nationwide Permit 12 and N.C. Division of Water
Quality General Water Quality Certification 3819.
Should you have questions or require additional information, please contact Josh
Witherspoon at [phone] or josh.witherspoonatimmons.com.
Sincerely,
Timmons Group
Posh itherspoon, LSS
Senior Environmental Project Manager
Attachments:
PCN Application Form
Agent Authorization
Jurisdictional Delineation Map
USGS Topographic Map & NRCS Soil Survey Map
Overall Site Plans and Impact Figures
PCN Checklist
Letter of Stormwater Approval
$240.00 DWQ Application Fee
AUG? 2011
DEW - WATER 4UALITY
nANOS AND STORMWATER BRANCH
5410 Trinity Road, Suite 112 Raleigh, North Carolina 27607 919-866-4951 www.timmons.com
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0000 0 •
TIMMONS GROUP
YOUR VISION ACHIEVED THROUGH OURS.
TRANSMITTAL
TO: NCDWQ - WeBSCaPe Unit
Attn: Karen Higgins
1650 Mail Service Center
Raleigh, NC 27699-1650
Date: 8-17-11
201 10780
EDA I ID
Job #: 30787
Project: Alamance House
Reference:
Copies Sent To:
® ENCLOSED PLEASE FIND: Nationwide Permit 12 Pre-Construction Notification application package
? WE ARE SENDING UNDER SEPARATE COVER:
COMMENTS: If you have any questions, please contact me at 919-866-4940 or josh.witherspoon(u)_timmons.com.
Thank you,
Josh Witherspoon
Senior Environmental Project Manager
SIGNED: ?_ , /_ "V .
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AUG i s 2011
DENR - WATER QUALITY
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THESE ITEMS ARE TRANSMITTED:
If enclosures are not as noted, please notify us at once.
Version 1.4
January 9, 2009
401 Oversight/Express Permitting PCN Submittal Checklist
® The application fee (Checks may be made out to "N.C. Division of Water Quality"
- $240.00 for 401 Water Quality Certification with minor impacts
- $570.00 for 401 Water Quality Certification with major impacts
- Express Review Fee (Amount requested on Acceptance Letter)
® Five (5) complete and collated copies of the PCN Application and supporting
documentation (instead of providing 5 copies of the full size plans you may provide two
copies of full size plans along with three copies of 11 X 17 plans)
? Stormwater Management Plan (if applicable - see PCN Form Help File Section E)
1) Please provide three (3) copies of the stormwater management plans along with all
supporting information pertaining to this project including the following:
a. Entire site development/layout plans delineating all drainage areas;
b. Design calculation sheets for all proposed BMPs) sized for both on-site and
off-site drainage;
c. BMP supplements for each proposed BMP and Required Items Check List
(http://h2o.enr.state.nc.us/su/bmp forms.htm) along with all required
items;
d. A Notarized Operation & Maintenance Agreement for each stormwater
management facility;
e. Detailed construction drawing sheets shall include
(i) Erosion and sediment control plans;
(ii) Installation and planting schedules for the proposed BMPs;
(iii) Appropriately scaled plan views and cross sectional details of all
BMPs and associated components - inlet and outlet structures,
forebay, respective zones and pertinent elevations.
? If your project is located within a State implemented Riparian Buffer Rule Area, submit the
following along with site plans and PCN form:
1) Three (3) copies of the details for on-site diffuse flow provisions, (refer to
http://h2o.enr.state.nc.us/su/bmp_jorms.htm).
? DWQ Stream Determination Forms for streams on property and DWQ determination
letter for wetlands or streams (if applicable).
The following is the most critical of all the information that you must provide. The quality and
detail of the information will often determine the expeditiousness of the review. The following is
a checklist of the types of pertinent information required at a minimum:
Maps and Plans:
® The most recent version of the 1:24,000 USGS Topographic Map - Please cleanly draw or
delineate the site boundaries on the topographic map.
® The most recent version of the bound and published County NRCS Soil Survey Map -
(required for projects within the Neuse River Basin, Tar-Pamlico River Basin, Randleman
Lake Watershed and the Catawba River Basin, also recommended for all projects) -
Please clearly delineate the site boundaries, etc. on the map. If the delineation obscures
any of the features, it is recommended that a clean copy be provided. Copies of the
Version 1.4
January 9, 2009
current soil survey and/or soil survey map sheets can be obtained from the local NRCS
County Office (http://www.nc.nres.usda.gov/). GIS soil layers are not acceptable.
® Vicinity map - Please clearly mark the location and approximate boundaries of the property
and project on the map. Please indicate north arrow and scale. Please include applicable
road names or State Road numbers.
® The Site Plan - The most critical map to be provided is the site plan. You must provide full
sized plans. The following is the minimum list of plans that are typically needed.
® Pre-construction/Pre-existing conditions - This sheet (or sheets) must include:
• All jurisdictional and non-jurisdictional wetland, stream, water features, State regulated
buffers (delineated into Zones 1 and 2)
• Topographic contours with elevations
• Any existing structures and impervious areas
• Existing utility lines and easements
• Existing roads, culverts, and other pertinent features
• North arrow and the scale (1":50' scale is recommended).
® Proposed conditions - This sheet (or sheets) must include:
• All jurisdictional and non-jurisdictional wetland, stream, water features, State regulated
buffers (delineated into Zones 1 and 2)
• Lot layout (if a subdivision or commercial development is proposed) - lots must be
developable without further impacts to jurisdictional and non-jurisdictional wetlands
streams, water features, and State regulated buffers. Building envelopes must be
provided when streams, wetlands, riparian buffers, or water features exist on a lot
• All built-out structures and impervious cover
• Final grading contours with elevations
• All utilities and easements (including septic fields on all lots within 100 feet of stream,
wetland, or water features - if applicable)
• Impacted areas - these should correspond with the Impact numbers listed on your PCN
form.
® Drainage Plans - Final drainage plans must include the following:
• Locations and pertinent elevations and sizes of the stormwater collection system and
drainage ways
• All inlets and outlets must also be shown with pertinent elevations (All outlets to
wetlands must be at a non-erosive velocity, generally less than 2 ft/sec during the peak
flow from the 10-vr storm)
• Scaled stormwater BMPs must also be indicated as required by DWQ rules and policies
• In certain cases (see Section E of PCN form), final stormwater management plans must
also be provided (see Stormwater Management Plan Checklist)
® Proposed Impacts - All impacts to jurisdictional and non-jurisdictional wetland, stream,
water features, and State regulated buffers must be shown and labeled on the site plans at
a scale no smaller than 1" = 50'. All excavation, fill, flooding, stabilization, and other impacts
that will be conducted in or near jurisdictional and non-jurisdictional wetland, stream, water
features, and State regulated buffers must be indicated. Please provide cross sectional
details showing the provisions for aquatic life passage (burial of culvert 20% for culverts s 48
inches, and 1-foot for culverts > 48 inches).
Version 1.4
January 9, 2009
Wetland Impacts:
? Precise grading and final elevation contours must be provided. Existing
vegetation and any clearing must be specified.
? All subsurface utility lines must indicate the location of anti-seep collars.
Construction detail for anti-seep collars must be provided.
? Roadway or other crossings of riparian wetlands may require floodway culverts to
maintain existing hydrological conditions.
? Plans should show that the hydrology of remaining wetlands on the site will be
maintained.
Stream Impacts:
® Stream impacts must be clearly shown on the plans. The centerline as well as
the banks of the stream must be surveyed or located by GPS for the portion of
the stream to be impacted.
? The inlet and the outlet of all culverts should be aligned with the stream as
much as possible. Inlet and outlet elevations and streambed elevations should
be indicated. Any inlet or outlet protection must be shown and enumerated on
the impact map(s).
? For bottomless culverts or other spans, a vertical cross section should be
provided that shows the minimum distance from each span to each stream bank,
the stream cross section, the height of the span above the stream and the
minimum distance from the edge of each footer to each stream bank.
Additionally, please provide a signed and sealed geotechnical report of
subsurface soils at the proposed bottomless culvert location. The report must
comply with the Division of Highways - Guidelines for Drainage Studies and
Hydraulic Design, prepared by A.L. Hankins, Jr., State Hydraulics Engineer -
1999.
? Multiple culverts or sectioned box culverts typically require the use of sills, off-
setting or other means to match the cross section of the existing stream (in order
to maintain stream stability and provide aquatic life passage). A vertical cross
section of the culverts should be shown overlain with the up and downstream
stream cross section including the stream flood-prone area.
? Impacts associated with dam construction must indicate and enumerate all fill
associated with the dam footprint, spillway and any bank stream bank
stabilization. The length of stream impounded must also be indicated and
enumerated.
20110780
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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 & "A IF 0)
1 a. Type(s) of approval sought from the
Corps:
® Section 404 Permit ? 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
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
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below. ? Yes ® No
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ? Yes ® No
2. Project Information
2a. Name of project: Alamance House
2b. County: Alamance
2c. Nearest municipality / town: Burlington
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: Debra D. Isley
3b. Deed Book and Page No. Deed Book: 2787 Page No: 0563
3c. Responsible Party (for LLC if
applicable): Alamance AL Investors, LLC
3d. Street address:
C
4409 Harmony Church Road ZP; em
3e. City, state, zip: Effland, NC 27243 %
3f. Telephone no.:
3g. Fax no.: FIE- '11:?;

3h.
Email address: UUA

Page 1 of 11
PCN Form -Version 1.3 December 10, 2008 Version
4. Applicant Information (if different from owner)
4a. Applicant is: ? Agent ® Other, specify: Developer
4b. Name: Hunter D. Smith
4c. Business name
(if applicable): Alamance AL Investors, LLC
4d. Street address: 4423 Pheasant Ridge Road, Suite 301
4e. City, state, zip: Roanoke, VA 24014
4f. Telephone no.: 540-774-7762
4g. Fax no.:
4h. Email address:
5. Agent/Consultant Information (if applicable)
5a. Name: Josh Witherspoon
5b. Business name
(if applicable): Timmons Group
5c. Street address: 5410 Trinity Road, Suite112
5d. City, state, zip: Raleigh, NC 27607
5e. Telephone no.: 919-866-4940
5f. Fax no.: 919-859-5663
5g. Email address: [e-mail]
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): Parcel ID: 170181
1 b. Site coordinates (in decimal degrees): Latitude: 36.03555 Longitude: - 79.29361
(DD.DDDDDD) (-DD.DDDDDD)
1 c. Property size: --5.64 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to Gum Creek
proposed project:
2b. Water Quality Classification of nearest receiving water: WS-V; NSW
2c. River basin: Cape Fear HUC 03030002
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:
The site is currently undeveloped forested land. General land use in the vicinity includes forested, undeveloped areas
and residential development. Gum Creek is along the northern boundary of the project site. Jurisdictional wetlands are
not present within the project site.
3b. List the total estimated acreage of all existing wetlands on the property:
0 acres
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
400 If
3d. Explain the purpose of the proposed project:
To construct a new 8-inch vitrified clay pipe (VCP) sanitary sewer line and connect the new sewer line to the existing 21-
inch sanitary sewerline on the northeast side of Gum Creek. The new 8-inch sanitary sewer will service the proposed
Alamance House assisted living facility to be constructed south of Grand Oaks Boulevard.
3e. Describe the overall project in detail, including the type of equipment to be used:
The project will include installing the new sewerline in a trench a minimum of one foot below the existing bed of Gum
Creek. The new sewer line will installed beneath Grand Oaks Boulevard using the bore and jack method. The pipe will
be encased in concrete within the limits of the Gum Creek crossing. Equipment to be used will likely include tracked or
wheeled excavators and dump trucks and other equipment used for construction.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
®Yes [-I 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: Timmons Group
Name (if known): James Hatcher Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Awaiting final Jurisdictional Determination from the USACE.
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
1a. 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 ? 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: No wetlands are present within the project site.
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 Open-cut Sanitary
Sewer Gum Creek ® PER
? INT ® Corps
® DWQ 20 5
S2 ? P ®T Open-cut Sanitary Gum Creek ® PER ® Corps 20 20
Sewer ? 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 25 If
3i. Comments: Permanent impacts to the stream will result in a post construction loss or change in stream morphology and
function.
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.
Open water
impact number -
Permanent (P)
or Temporary
T 4b.
Name of waterbody
(if applicable) 4c.

Type of impact 4d.

Waterbody type 4e.

Area of impact (acres)
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.

Pond ID 5b.

Proposed use or purpose of 5c.
Wetland Impacts (acres) 5d.
Stream Impacts (feet) 5e.
Upland
(acres)
number 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:
Page 6 of 11
PCN Form - Version 1.3 December 10, 2008 Version
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: Jordan Lake
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) for impact Stream name mitigation (square feet) (square feet)
or Temporary required?
T
B1 ®P ? T EasSewer ement Gum Creek ®Neos 2,300 838
B2 ?P?T ?Yes
? No
B3 ?P?T ?Yes
? No
6h. Total buffer impacts 2,300 838
6i. Comments: An existing maintained sewer easement is present within Zone 2 of the buffer on the northeast side of Gum
Creek.
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 sewerline will be installed as perpendicular to Gum Creek as possible with a 30-foot permanent easement. The sewer
line and easement crossing of Gum Creek at a 125-degree angle is necessary because of the easment acquisition minimizing
impacts to the adjacent property and the alignment of the existing sewer easement on the northeast side of Gum Creek. The
permanent 30-foot easement is required by the City of Burlington's Engineering Specifications and Standard Details manual
dated November, 2004. Impacts to Gum Creek will be temporary in nature due to the placement of the pipe below the existing
stream bed.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Erosion and sedimentation control measures will be implemented during the construction of the sewer line. Erosion control
measures will be placed to prevent sediment from leaving the easment construction corridor and entering Gum Creek. All
construction shall be per the City of Burlington and NCDENR standards and specifications. The contractor will provide any
additional erosion control measures as necessary to prevent sediment runoff.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for ? Yes ® No
impacts to Waters of the U.S. or Waters of the State?
2b. If yes, mitigation is required by (check all that apply): ? DWQ ? Corps
? Mitigation bank
2c. If yes, which mitigation option will be used for this project? ? 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
Page 7 of 11
PCN Form - Version 1.3 December 10, 2008 Version
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.
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
1a. 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.
Comments: No impervious surfaces or structures will be constructed as part of the
sewer line construction project. The stormwater BMP for the Alamance House ? Yes ® No
assisted living facility will discharge into the existing stormwater system for Grand
Oaks Boulevard.
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project? 46%
2b. Does this project require a Stormwater Management Plan? ® Yes ? No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: No impervious surfaces are part of the
sewer line construction project. Additionally, a SMP is not required by NWP 12 or the corresponding WQC 3819. A
Stormwater Management Plan has been submitted to the City of Burlington for the Alamance House assisted living facility
project. This plan is currently under review.
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
Stormwater for the Alamance House will be treated on-site with a wet pond BMP to be located in the eastern portion of
the assisted living facility site located south of Grand Oaks Blvd. This BMP will discharge to the existing stormwater
system for Grand Oaks Blvd.
® 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? City of Burlington
® 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
Page 9 of 11
PCN Form - Version 1.3 December 10, 2008 Version
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
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)?
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:
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.
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 project includes the construction of a new 8-inch sanitary sewer that will service the new assisted living facility. The
new sewer line will connect to the City of Burlington's sanitary sewer system.
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?

5c. If yes, indicate the USFWS Field Office you have contacted. ?
Raleigh
® Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
The US Fish and Wildlife Service website was accessed on 7-13-2011. The listing for Alamance County was last
updated on 9-22-2010. Federally threatened or endangered species are not listed for Alamance County.
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?
The South Atlantic Habitat and Ecoysystem IMS website, accessed on 7-13-11, does not identify essential fish habitat on
or adjacent to the project site.
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?
The North Carolina State Historic Preservation Office HPOWEB GIS Service website, accessed on 7-13-11, did not
identify historic or archaeological resources within or adjacent to the project site.
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: The sewerline bill be buried a minimum of one foot below the
existing grade. The only structures above the existing grade will be a new doghouse manhole on the existing sewer line.
8c. What source(s) did you use to make the floodplain determination? FEMA Map No. 3710885400J Panel 8854
Josh Witherspoon ?I - I

Timmons Group ( t
l
Applicant/Agenvs Signature Date
Applicant/Agent's Printed Name (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

TIMMONS GROUP
YOUR VISION ACHIEVED THROUGH OURS.
July 13, 2011
Mr. Andrew Williams
Raleigh Regulatory Field Office
US Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
Subject: US Army Corps of Engineers
Agent Authorization Letter
Alamance House
Burlington, North Carolina
The undersigned hereby authorizes Timmons Group to proceed on behalf of Alamance AL Investors,
LLC, as the agent for regulatory permitting issues pertaining to the above-referenced project site. This
agent authorization letter supersedes any previous agent authorizations. From this day forward,
Alamance AL Investors, LLC, authorizes the US Army Corps of Engineers to contact Timmons Group
for regulatory permitting issues associated with this project.
Sincerely,
Timmons Group
J erspoon, LSS
Senior Scientist
Alamance AL Investors, LLC
By:__
Printed Name: Hunter D. Smith Vice Chairman/Manager
Date:
Date: 07/15/2011
5410 Trinity Road, Suite 112 Raleigh, North Carolina 27607 919-866-4951 www.timmons.com
Josh Witherspoon
From: Williams, Andrew E SAW <[e-mail]>
Sent: Monday, August 01, 20116:04 PM
To: Josh Witherspoon
Subject: RE: Alamance House delineation (UNCLASSIFIED)
Classification: UNCLASSIFIED
Caveats: NONE
Josh,
If that is the only impact then a NWP 12 would be appropriate. If there are other impacts related to the development,
then a NWP 39 would be the appropriate NWP. Please give me a call if you have any questions. Thanks.
Andrew Williams
Regulatory Project Manager
U.S. Army Corps of Engineers
Wilmington District, Raleigh Field Office
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
919-554-4884 ext. 26
The Wilmington District is commited to providing the highest level of support to the public. To help us ensure we
continue to do so, please complete the Customer Satisifaction Survey located at our website at
http://pert.nwp.usace.army.mil/survey.htmi to complete the survey online.
-----Original Message----
From: Josh Witherspoon [mailto:[e-mail]]
Sent: Monday, August 01, 20119:19 AM
To: Williams, Andrew E SAW
Subject: RE: Alamance House delineation (UNCLASSIFIED)
Andy - I wanted to verify that a NWP 12 is the appropriate permit for this project. The project will include one crossing
of Gum Creek to install an 8"
sewer line. Thanks.
Josh Witherspoon, LSS
Senior Environmental Project Manager
TIMMONS GROUP I www.timmons.com
5410 Trinity Road, Suite 112 1 Raleigh, NC 27607
Office: 919.866.4940 1 Fax: [phone]
Mobile: [phone] [e-mail] Your Vision Achieved Through Ours
-----Original Message-----
From: Williams, Andrew E SAW [mailto:[e-mail]]
Sent: Tuesday, July 12, 20113:54 PM
To: Josh Witherspoon
These plans and associated documents are thee= lusive property of TIMMONS GROUP and may rot be reproduced in whole or in part and shall not be used for any purpose whatsoever. inclusive, but not
limited to construction. bddma andbr cnnam,, nn -k,nn wit-t - >.nroec wrieun -.1 of TIKA&A nic Pone 11
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CITY of BUR- UUON
North Carolina
Alamance County
August 15, 2011
LETTER OF APPROVAL
Mr. Smith Packelt
4423 Pleasant Ridge Road SW Suite 301
Roanoke. VA 24014
Subject: The Alamance House
Grand Oaks Boulevard
Burlington. NC
Dear Mr. Paekett:
The Stonmvater Division has reviewed the subject Stormwater Management plans dated 8/1/2011. The Stonmvater Division
finds the plans acceptable and the hereby issues this "Letter of Approval" and the enclosed Stornm ater Management Permit. 1he
permit is issued with "modifications- and will require the submittal of the requested BMP access and maintenance easement prior
to issuance of the certificate of occupancy or recording of plats.
Please have your contractor notify the Stornm Ater Division, phone number (336-222-5140). when a preconstruction conference
has been scheduled so that we ntay attend and discuss the Stornmater Management Plan.
The C itv's Stonmvater Ordinance is a performance-oriented program requiring protection of the natural resources and adjoining
properties. Follo%%ing commencement of this project if it is determined that the plan is not meeting the requirements of the
ordinance. then this office will require that the plan be modified to comply with the Citv's ordinance. Also. please he advised
that the ordinance requires that a copy of the approved stornmater management plan be on file at the job site.
Per City Ordinance Appendix D. Section 5-503 notice is hereby given that agents, officials. or other qualified persons authorized
by the Cite will periodical!) inspect any land. building. structure or premises to ensure compliance with the ordinances. or rules
or orders adopted or issued pursuant to the ordinance. and to determine whether the measures required in the Plan are effective in
controlling stornmater runoff resulting from development or redevelopment. Compliance %%ith the City's Erosion and
Sedimentation Control Ordinance is a requirement of this permit also.
The land-disturbing activity described in this plan may be subject to the approval of other local. state or federal agencies. -['his
could include the Division of Water Quality under storm water or water quality regulations: the U.S. Arm Corps of Engineers
under Article 404 jurisdiction: county, city or town agencies under other local ordinances: or other approvals that ma}' be
required. This approval cannot supersede any other permit or approval. nor shall it exempt the applicant from obtaining other
applicable approvals front local. state. or federal authorities.
Your cooperation is appreciated and we look forward to working wilt you on is project.
stn . odnic . CPESCtv'C.
Environmental . pecialist
Enclosure
c: k1r. Joseph R. Vilscck 111. PE
Timmons Group
1001 Boulders Parkway
Richmond. VA 23225
Modifications for Approval
PROJECT NAIME: Alamance House
LOCATION: Grand Oaks Boulevard
Burlington. N.C.
SUBMI I I f.1) BY: Joseph R. Vilseck 111. PE.
Timmons Group
DATE. RECEIVED: 8/1/2011 & 08/11/2011 (revised)
Provide an access and maintenance casement for the approved storm water management basin prior to
completion of the proicct and final certificate of occupancy or plat recording.
NOTE: Be advised that the above "Modifications" are considered to be part of the approved plan and part of the conditions of
the stormwater permit.

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