20120095 Ver 1_401 Application_20120212

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P
tt , mall
Associates,PLLC
20120095
Date February 2 2012
To Division of Water Quality From Victoria Waldron Small PE
NCDENR Westcott Small & Associates P Lff�
401 /Wetlands Unit 125 S Elm Street Suite 606
1650 Mail Service Center Greensboro NC 27401
Raleigh NC 27699 1650
We are sending you ® attached ❑ under separate cover the following item #&(r--,-108
LS (r--,-108
❑ Shop Drawings ❑ Estimate ❑ Disk FFp _ D
❑ Prints ❑ Specifications ® Other 201
❑ Contracts ❑ Copy of Letter hF4MORR WAFERGLJAL
AhD SrUk„iyygrER BRANCH
# COPIES
DRAWING NO
DESCRIPTION
DISPOSITION
7
Autism Classroom Building
For Approval
Pre Construction Notification
Application (1 Original + 6
Copies)
7
Copies of Impact Area
For Approval
Drawings
1
Check $240 00
For Review Fee
REMARKS
125 S Elm Street Suite 606 * Greensboro North Carolina 27401 • phone [phone] • web www wsaaeng com

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20120095
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 PC Form
A Applicant Information
1
Processing
la
Type(s) of approval sought from the
Corps
E
®Section 404 Permit El Section 10 Permit
1b Specify Nationwide Permit (NWP) number 39 or General Permit (GP) number
1 c
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 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
Autism Classroom Building
2b
County
Guilford
2c
Nearest municipality / town
Greensboro
2d
Subdivision name
n/a D
2e
NCDOT only T I P or state
project no
n/a bu FEB
DU
3
Owner Information
3a
Name(s) on Recorded Deed
Guilford County Board of Education tNETjgp�
R WATER
3b
Deed Book and Page No
DB 4941 PG 1176
3c
Responsible Party (for LLC if
applicable)
Robert J Melton
3d
Street address
712 N Eugene St
3e
City state zip
Greensboro NC 27401
3f
Telephone no
[phone]
3g
Fax no
[phone]
3h
Email address
meltonr @gcsnc com
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
4b
Name
4c
Business name
(if applicable)
4d
Street address
4e
City state zip
0
Telephone no
4g
Fax no
4h
Email address
5
Agent/Consultant Information (if applicable)
5a
Name
Victoria Waldron Small PE
5b
Business name
(if applicable)
Westcott Small & Associates PLLC
5c
Street address
125 S Elm St Suite 606
5d
City state zip
Greensboro NC 27401
5e
Telephone no
336 310 9722
5f
Fax no
n/a
5g
Email address
tsmall @wsaaeng 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)
7884294679
Latitude 36 081677 N Longitude
lb Site coordinates (in decimal degrees)
79 73421 W
(DD DDDDDD) (DD DDDDDD)
1c Property size
79 85 acres
2 Surface Waters
2a Name of nearest body of water (stream river etc ) to
UT to South Buffalo Creek
proposed project
2b Water Quality Classification of nearest receiving water
WS V NSW
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 is partially developed with on site middle and elementary schools and associated parking areas fields utilities
etc The remainder of the site is mixed with open areas and wooded areas along the stream
3b List the total estimated acreage of all existing wetlands on the property
08 ac
3c List the total estimated linear feet of all existing streams (intermittent and perennial) on the property
2200 If
3d Explain the purpose of the proposed project
The project includes the construction of anew academic budding with classrooms for the autism program There will be
associated parking lots and access drive play areas utilities and stormwater management BMPs The building is
situated to allow interaction between the students in the autism program and tradtional programs The access drive will
cross the perennial stream at two locations
3e Describe the overall project in detail including the type of equipment to be used
The project includes mechancial installation of a dual 60 RCP culvert at an intermittent stream crossing and a dual 48
RCP culvert at a perennial stream crossing for the construction of a 24 access drive for bus and automobile traffic
serving the proposed school
4 Jurisdictional Determinations
4a Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
El Yes ❑ No Unknown
project (including all prior phases) in the pasty
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
W1 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W2 ❑ P FIT
❑ 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 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
Culvert & Rip Rap
UT2 to S Buffalo
Creek
® PER
❑ INT
® Corps
® DWQ
3
60
S2 ❑ P ® T
Erosion Control
UT2 to S Buffalo
Creek
® PER
❑ INT
® Corps
® DWQ
3
14
S3 ® P ❑ T
Culvert & Rip Rap
UT3 to S Buffalo
Creek
❑ PER
® INT
® Corps
® DWQ
4
60
S4 ❑ P ® T
Erosion Control
UT3 to S Buffalo
Creek
❑ PER
® INT
® Corps
® DWQ
4
15
S5 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S6 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
3h Total stream and tributary impacts
149
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
02 ❑P ❑T
03 ❑P ❑T
04 ❑P ❑T
4f Total open water impacts
4g Comments
5 Pond or Lake Construction
If pond or lake construction proposed the 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
51 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 any 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
Stream name
mitigation
(square feet)
(square feet)
or Temporary
impact
required?
B1 ®P ❑ T
Driveway
UT2 to S Buffalo Creek
® Yes s
4428
2375
B2 ®P ❑ T
Driveway
UT3 to S Buffalo Creek
®Nos
4487
3167
B3 ❑P ❑T
El Yes
❑ No
6h Total buffer impacts
8915
5542
61 Comments
Page 6 of 11
PCN Form — Version 1 3 December 10 2008 Version

D Impact Justification and Mitigation
1 Avoidance and Minimization
la Specifically describe measures taken to avoid or minimize the proposed impacts in designing project
Roadway width at crossings is minimum allowable width for two way traffic Separate lanes for cars and busses (preferred for
student safety) begin after the crossings and shoulders at the crossings have been reduced from standard width Crossings
are perpendicular to the stream channel and head walls are proposed to reduce the impact from the fill slope Mulitple
stormwater devices are proposed throughout the site reducing the buffer impact associated with a single large pond
1 b Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
The construction sequence is written so stream impact is minimal Proper erosion control measures will be installed
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
la
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 Included with stormwater plan to be approved by the City of
❑ Yes ® No
Greenbsoro
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
2d
If this project DOES require a Stormwater Management Plan then provide a brief narrative description of the plan
The proposed built upon area drains to several bioretention cells with appropriate level spreaders placed throughout the
development area
® 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 Greensboro
® 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
El HQW El 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)
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 wastewater from the building will be treated by the City of Greensboro Existing sanitary sewer mains are on site and
are sized appropriately to accept the addtional flow generated by this project
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
habitat?
❑ Yes ❑ No
5b Have you checked with the USFWS concerning Endangered Species Act
impacts?
❑ Yes ❑ No
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?
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?
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
status (e g National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
❑ Yes ❑ No
7b What data sources did you use to determine whether your site would impact historic or archeological resources?
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? Survey
�'F01 J MeToti, ��
Applicant/Agent s Printed Name
A3 i -7d1Z
Date
ApplicanVAt6nt s Signature
(Agent s signaturalis valid onl d an authorization letter from the applicant
is provided
Page 11 of 11
PCN Form — Version 1 3 December 10 2008 Version

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