20110622 Ver 1_More Info Received_20120125

J celled 17-5 2
MESTOWN
ORTH CAROLINA
January 20 2012
Ms Sonia Carillo
North Carolina Department of Environment and Natural Resources
Transportation Permitting Unit
1650 Mail Service Center
Raleigh NC 27699 1650
Dear Ms Carillo
0
if
l I- G(, zz
RE Proposed Connector to Bicentennial Greenway
East Fork Road in Guilford County
Project No 11118431
DWQ Project no 2011 0622
Enclosed please find one set of revised plans Categorical Exclusion Form and PCN for the
Connector to the Bicentennial Greenway project on East Fork Road in Guilford County
Changes have been made and forwarded to Amy Euliss in the Winston Salem Regional Office
pursuant to her previous comments Those comments and our responses are as follows
• Comment Please account for impacts to Zone 1 and Zone 2 of the Randleman
Buffers on the impact table in the PCN Response The impact table on sheet 7 of
the PCN has been revised treating all of the area within the NCDOT right of way as
permanent impacts The area outside of the greenway trail to be impacted is to be
vegetated however it will be maintained to prevent excessive growth and noxious
vegetation
• Comment Please delineate Zone 1 and Zone 2 of the Randleman buffers in the
project area and show the buffers including the impacted area on the plan sheets
Response The buffer zones have been shown on the plan sheets
• Comment Provide a stormwater plan for the greenway including how you will
achieve diffuse flow prior to entering the buffer Response Plunge pools are to be
used at each end of the greenway to achieve diffuse flow
• Comment Include the width of the greenway Response The width of the
greenway has been included on the plans
• Comment Update the PCN to reflect that you are only applying for a buffer
authorization Response The PCN has been revised to indicate it is for buffer
authorization
• Comment Delineate the existing transportation facility on the plan sheet if it
overlaps any buffer impacts for the greenway project Response The
transportation facility has been delineated as requested
Please feel free to contact Matt Johnson or myself at 336 454 1 138 should you have any
questions or comments
Respectfully
L�
Paul R Blanchard PE
Director of Public Services
P 0 Box 848 http / /www Jamestown nc us Tel (336) 45¢1138
Jamestown, NC 27282 Fax [phone]..)04

December 27 2011
Ms Amy Euliss
North Carolina Department of Environment and Natural Resources
585 Waughtown Street
Winston Salem NC 27107
RE Proposed Connector to Bicentennial Greenway
East Fork Road in Guilford County
Project No 118431
DWQ Project no 2011 0622
Dear Ms Euliss
Enclosed please find one set of revised plans Categorical Exclusion Form and PCN for
the Connector to the Bicentennial Greenway project on East Fork Road in Guilford
County Pursuant to your previous review and comment letter dated July 18 2011 we
have made the following changes
• Comment Please account for impacts to Zone 1 and Zone 2 of the Randleman
Buffers on the impact table in the PCN Response The impact table on sheet 7
of the PCN has been revised treating all of the area within the NCDOT right of
way as permanent impacts The area outside of the greenway trail to be
impacted is to be vegetated however it will be maintained to prevent excessive
growth and noxious vegetation
• Comment Please delineate Zone 1 and Zone 2 of the Randleman buffers in the
project area and show the buffers including the impacted area on the plan
sheets Response The buffer zones have been shown on the plan sheets
• Comment Provide a stormwater plan for the greenway including how you will
achieve diffuse flow prior to entering the buffer Response Plunge pools are to
be used at each end of the greenway to achieve diffuse flow
• Comment Include the width of the greenway Response The width of the
greenway has been included on the plans
• Comment Update the PCN to reflect that you are only applying for a buffer
authorization Response The PCN has been revised to indicate it is for buffer
authorization
• Comment Delineate the existing transportation facility on the plan sheet if it
overlaps any buffer impacts for the greenway project Response The
transportation facility has been delineated as requested
Please feel free to contact Matt Johnson or myself at 336 454 1 138 should you have any
questions or comments
Respectfully oL &,,
Paul R Blanchard PE
Director of Public Services

I
CATEGORICAL EXCLUSION FORM
ENHANCEMENT PROJECTS
While this form represents the most common level of environmental documentation required for
Enhancement projects the environment -il impacts may be greater than those typicallj associated with this
lez el of an ilysis Aln ays have a qual f ed professional determine the scope of environmental impacts and
complete the environmental documentation
General Information
Project Name Connector to Bicentennial Greenway
TIP Number (E XXXX) EB 5517
Federal Aid Number
Project Sponsor Town of Jamestown
Protect Contact
Name Mr Matthew Johnson
Telephone [phone]
E mail mjohnson @lamestown nc gov
Protect Descnotion
(Include project scope and location with map)
See Attachment A
Purpose And Need
See Attachment A
Proposed Improvements
(Provide details attach exhibits as necessary)
See Attachment A
Special Information
(Include environmental comrmtments permits)
See Attachment B
Note This document will be reviewed by the NCDOT and by FHWA
incorrect or incomplete information could delay or disqualify a project
Revised Fom t — Mauch 2006

Threshold Criteria
Instructions Please answer each question If a correct response falls witlun an enlarged box then
supporting documentation of the impact must be included
No
ECOLOGICAL
YES
NO
1
Will the project have a substantial impact on any unique or important natural resource?
❑
P/
2
Does the project invoh e habitat where federally listed endangered or threatened
F-1
0
species may occur?
3
Will the project affect anadromous fish?
F-1
✓0
If the project involves wetlands is the amount of permanent and /or temporary
4
wetland taking less than one third (1 /3) of an acre and hat e all practicable measures to
avoid and muirruze wetland takings been eN aluated?
If no wetlands are involved write N/A '0" N/A
5
Will the project require the use of U S Forest Service lands?
F�
El
Will the quality of adjacent water resources be adverselv Impacted by proposed
F
�✓
6
construction activities?
Does the project involve waters classified as Outstanding Water Resources and /or
High Waters?
El
Q✓
7
Quality
Will the project require fill in waters of the United States in any of the designated
8
mountain trout counties?
❑
9
Does the project nn-v olve any known underground storage tanks (UST's) or hazardous
❑
materials sites?
PERMITS and COORDINATION
If the project is located within a CANIA county will the Project significantly affect the
10
coastal zone and /or any "Area of Environmental Concern' (AEC)?
❑
11
Does the project involve Coastal Banner Resources Act Resources?
E
a
12
Will a U S Coast Guaid permit be required?
F-1
O
13
Will the project result in the modification of any existing regulators floodwm?
14
Will the project require any stream relocations or channel changes?
❑
Z

Threshold Criteria
Instructions Please answer each question If a correct response falls within an enlarged box then
su000rtinigy documentation of the iimoact must be included
No
SOCIAL, ECONOMIC, AND CULTURAL RESOURCES
YES
NO
15
Will the project induce substantial impacts to planned growth or lznd use for the area?
❑
0✓
16
Will the project require the relocation of any family or business?
❑
M✓
17
Will the project have a disproportionately high and adverse human health and
❑
environmental effect on any minority or low income population?
18
If the project in% olves the acquisition of Right of Way is the amount of Right of Was
©
❑
acquisition considered minor?
19
Will the project in-, olve anj changes in access control?
❑
20
Will the project substantially alter the usefulness and /or land use of zdjacent property?
❑
21
Will d-ie project have an adN erse effect on permanent
local
❑
❑✓
traffic patterns or community cohesiveness?
22
Is the project included in an approved thoroughfare plan and /or Transportation
Improvement Program (and is therefore in conformince with the Clean Air Act of
©
❑
1990)?
23
Is the project anticipated to cause an increase in traffic volumes?
❑
24
Will traffic be maintained during construction using existing roads staged construction
9
❑
or on site detours?
25
If the project is a bridge replacement project will the bridge be replaced at its existing
location (along the existing facility) and will all construction proposed in association with
❑
the bridge replacement project be contained on the existing facility?
26
Is d-iere substantial controversy on social economic or environmental grounds
❑
m
concerning the project?
27
Is the project consistent with all Federal State and local laws relating to the
the
�✓
F-1
aspects of project?
28
28
Will the project have an "effect" on structures /properties eligible for or listed on the
❑
National Register of Historic Places?
29
Will the project affect anv archaeological remains that are important to history or pre
❑
m
history?
30
Will the project require the use of Section 4(o resources (public parks recreation lands
wildlife and waterfowl Refuges historic sites or historic bridges as defined in Section
❑
0✓
4(f) of the U S DOT Act of 1966)?
31
Will the project result in any conversion of assisted public recreation sites or facilities to
non recreation uses as defined by Section 6(f) of the Land and Water Consen ation Act
❑
of 1965 as amended?
32
Will the project involve construction in across or adjacent to a ri-, er designated as a
component of or proposed For inclusion in the Natural S) stem of Wild and Scenic
❑
❑✓
Rivers?

Additional Documentation reQUIred for Unfavorable Responses
Checked ENLARGED boxes indicate UNFAVORABLE responses
Checked smaller boxes indicate favorable responses
For Official NCDOT Use Only
Reviewed by
Date Reviewer s Signature
Project Development & En-, ironrnental Analysis Branch
North Carolina Department of Transportation
Approved by
Date
Di-, ision Administrator s Signature
Federal Highway Administrltion
Consultants should submit this completed form to the munrc,ipalrty or organization that engaged their sen ice
The Municipality or organuzation should submit to their assigned Transportation Program Consultant
Please submit completed form within 90 day of the holding of your scopung meeting

("KLEINrELDER
Bright People Right Solutions
313 GALLIMORE DAIRY ROAD
GREENSBORO NORTH CAROLINA
PHONE [phone]
FIGURE 1
SITE LOCATION MAP
CONNECTOR TO BICENTENNIAL GREENWAY
EAST FORK ROAD
JAMESTOWN, NORTH CAROLINA
DATE 4/2812011 1 APPROVED BY SCALE 1 =2 000
SOURCE USGS Topographic
Orthophoto Map Guilford 1994 High CV) PROJECT NO 118431
Point 1993

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ATTACHMENT A
PURPOSE AND NEED
This proposed project will connect the trails and walkways south of town all the
way through town to the mayor existing Bicentennial Greenway on the north side
of town
PROJECT DESCRIPTION
The project is a connector from the existing walkway system in the Town of
Jamestown on Main Street along East Fork Road to the existing Bicentennial
Greenway The proposed walkway must bridge an arm of High Point City Lake,
the east fork of Deep River
The bridge and a portion of the walkway will be on City of High Point property
The remainder of the walkway will be on the right or -way of the East Fork Road
(S R 1545 )

ATTACHMENT B

O�O� w AT FR
IG
>_ =4
O T
Office Use Only
Corps action ID no
DWQ project no
Form Version 1 3 Dec 10 2008
Page 1 of 11
PCN Form — Version 1 3 December 10 2008 Version
Pre - Construction Notification PCN Form
A Applicant Information
1
Processing
1 a
Type(s) of approval sought from the
Corps
®Section 404 Permit El Section 10 Permit
1b
Specify Nationwide Permit (NWP) number 42 or General Permit (GP) number
1 c
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
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
Connector to Bicentennial Greenway
2b
County
Guilford
2c
Nearest municipality / town
Jamestown
2d
Subdivision name
2e
NCDOT only T I P or state
project no
TIP No EB 5517
3
Owner Information
3a
Name(s) on Recorded Deed
City of High Point
3b
Deed Book and Page No
PB 72 PG 402
3c
Responsible Party (for LLC if
applicable)
High Point Register of Deeds
3d
Street address
325 East Russell Avenue Room 155
3e
City state zip
High Point NC 27261
3f
Telephone no
[phone]
3g
Fax no
3h
Email address
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 Local Municipality
4b
Name
Matthew Johnson
4c
Business name
(if applicable)
Town of Jamestown
4d
Street address
Town Hall PO Box 848
4e
City state zip
Jamestown NC 27282
4f
Telephone no
[phone]
4g
Fax no
4h
Email address
mjohnson @jamestown nc gov
5
Agent/Consultant Information (if applicable)
5a
Name
Christopher W Hay
5b
Business name
(if applicable)
Kleinfelder Southeast Inc
5c
Street address
313 Gallimore Dairy Road
5d
City state zip
Greensboro NC 27409
5e
Telephone no
[phone]
5f
Fax no
[phone]
5g
Email address
chay @kleinfelder com
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)
The property does not have a PIN
1 b Site coordinates (in decimal degrees)
Latitude 36 009707 Longitude 7994118
(DD DDDDDD) (DD DDDDDD)
1 c Property size
unknown acres
2 Surface Waters
2a Name of nearest body of water (stream river etc ) to
High Point City Lake (East Fork Deep River)
proposed project
2b Water Quality Classification of nearest receiving water
WS IV CA
2c River basin
Cape Fear
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 includes DOT right of way within the buffer area of High Point City Lake Land use to the east is residential Land
use to the west includes a golf course and residential property North and south of the project are undeveloped wooded
areas buffering the lake
3b List the total estimated acreage of all existing wetlands on the property
Only open water is located within the project area The area around the lake and the East Fork of the Deep River
entering and exiting the lake is not defined by parcels
3c List the total estimated linear feet of all existing streams (intermittent and perennial) on the property
The project area only includes open water
3d Explain the purpose of the proposed project
To construct a pedestrian bridge to connect sidewalks in town to the Bicentennial Trail west of the lake
3e Describe the overall project in detail including the type of equipment to be used
The project includes construction of walkway pavements and a pedestrian bridge The sidewalk and bridge approach will
be graded with skid steer and track hoe equipment Timber piles will be driven approximately 14 feet Construction lifts
will be used to place structural beams and assist in construction
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
❑ 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
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
la 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 [:IT
❑ Yes
❑ Corps
❑ No
❑ DWQ
W4 ❑ P [IT
❑ 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 FIT
❑ PER
❑ Corps
❑ 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
31 Comments
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
High Point City
Thirty six 12 inch diameter timber
lake
00007
Lake
piles
02 ®P ❑ T
High Point City
Area of bridge deck
lake
005
Lake
03 ❑P ❑T
04 ❑P ❑T
4f Total open water impacts
00507
4g Comments The total footprint of the 36 timber piles is 28 square feet No temporary construction impacts are anticipated
The portion of the bridge deck over open water will be 390 feet in length and 6 feet in width (2 340 square feet)
5 Pond or Lake Construction
If pond 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)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
number
of pond
P1
P2
5f Total
5g Comments
5h Is a dam high hazard permit required
❑ Yes ❑ No If yes permit ID no
51 Expected pond surface area (acres)
5j Size of pond watershed (acres)
5k Method of construction
Page 6 of 11
PC Form —Version 1 3 December 10 2008 Version

6 Buffer Impacts (for DWQ)
If protect will impact a protected riparian buffer then complete the chart below If yes then individually list all buffer impacts
below If any impacts require mitigation then you MUST fill out Section D of this form
6a
❑ Neuse ❑Tar Pamlico E] Other
Protect is in which protected basin?
❑ Catawba 9 Randleman
6b
c
6d
6e
6f
6g
Buffer impact
number —
Reason
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P) or
for
It
Stream name
mitigation
(square feet)
(square feet)
Temporary T
impact
required?
B1 ®P ❑ T
rCCA%0
1415h I?o►n� C4 b.) LQV-e
❑ Yes
x,191
b`,3
west
(East Fork - of De V.Jer)
® No
B2 ®P ❑ T
(arton•+�
on:trWr
li P Po nt Cihr Lake
El Yes
1,136
523
lEast)
Cl: as4- Fork , or of p ��
®No
B3 ❑P ❑T
❑Yes
❑ No
6h Total buffer impacts
20 q33
1,376
61 Comments
D Impact Justification and Mitigation
1 Avoidance and Minimization
1a Specifically describe measures taken to avoid or minimize the proposed impacts in designing protect
Alternative designs were investigated however no feasible designs were identified with lesser impacts
1 b Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
With the exception of driving the timber piles construction will have no impacts on the surface water
2 Compensatory Mitigation for Impacts to Waters of the U S or Waters of the State
2a Does the protect 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
❑Payment to in lieu fee program
protect?
❑ 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
❑ Yes No
Comments The project does not require a stormwater management plan
2
Stormwater Management Plan
2a
What is the overall percent imperviousness of this project?
%
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 consists of the construction
of brick and concrete sidewalk and a timber pedestrian bridge
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?
❑ Phase II
❑ NSW
3b
Which of the following locally implemented stormwater management programs
❑ 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
❑ Yes ❑ No
attached?
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?
lb
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
❑ Yes
® No
letter )
Comments A Categorical Exclusion has been prepared and submitted
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 213 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
not applicable
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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?
USFWS website
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?
South Atlantic Fishery Management Council website
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?
Department of Cultural Resources website
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 eastern bridge approach is in zone AE The bridge deck
elevation is outside the 100 year floodplain
8c What source(s) did you use to make the floodplain determination? Guilford County GIS website
Matthew Johnson
6/29/11
Applicant/Agent s Printed Name
Date
Applicant/Agent s Signature
(Agents signature is valid only if an authorization letter from the applicant
is provided
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