20120254 Ver 1_401 Application_20120312

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Winston Salem
March 6 2012
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Public Works Department
Engineering Division
North Carolina Division of Water Quality
c r W s I„ Transportation Permitting Unit #
10 B 2511
W t b 1 NC )710 1650 Mail Service Center
C L k 7 7 8000 Raleigh NC 27699 1650
1 33( 748 30(4
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RE Application for Section 404 Nationwide Permit 14 and Section 401 Water
Quality Certification for the Lansing Drive Sidewalk Improvements Project
Forsyth County North Carolina City Project No 201111
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Dear Sir or Madam
The City of Winston Salem proposes to construct sidewalk improvements along an
existing portion of Lansing Drive
Please find the enclosed copies of the Pre Construction Notification (PCN) Form Project
location maps Permit drawings Stormwater management plan and Design plans for the
above referenced project A copy of this submittal has been forwarded to the Amy Euliss
with the Winston Salem Regional office
This project is scheduled for construction availability by the Summer of 2012
If you have any questions or need additional information please call me at 747 6833
Sincerely
ENGINEERING DIVISION
Todd Love P E
Project Engineer
Cc Amy Euliss NCDWQ Regional office
Cc U S Army Corps of Engineers
ctyc IM \II I \ H B k \1) I I p N I IX d1) 1) Ad N hW d1) B S 1 W I R b C(I k W IX I
M II L gh S h I IX d M h I N h IX d 1) r I M g Is \\ d J I I J\ I W d C M 6 L� 1) (
I

1 Processing
la Types) I f approval sought from the
®Section 404 Permit El Section 10 Permit
Corps
lb Specify Nationwide Permit (NWP) number 14 or General Permit (GP) number
1c Has the JNWP or GP number been verified by the Corps? ❑ Yes ® No
Id Type(s) i f approval sought from the DWQ (check all that apply)
® 401 Water Quality Certification - Regular F-1 Non 404 Jurisdictional General Permit
F-1 401 Water Quality Certification - Express ❑ Riparian Buffer Authorization
1 e
Is this notification solely for the record
For the record only for DWQ 401
For the record only for Corps Permit
Name(s) on Recorded Deed
because' written approval is not required?
Certification
Deed Book and Page No
not applicable
3c
E
❑ Yes ® No
❑ Yes
® No
if
Is payment into a mitigation bank or in lieu fee program proposed for mitigation
❑Yes
®No
3f
of impacts? If so attach the acceptance letter from mitigation bank or in lieu
[phone]
3g
Fax no !
fee program
3h
Email address
1g
Is the project located in any of NC s twenty coastal counties If yes answer 1 h
El Yes
® No
below
1h
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
El Yes
® No
2
Project Information
I Lansing Drive Sidewalk Improvements
2a Name of project City Project Number 201111
2b County ( Forsyth
2c Nearest municipality/ town Winston Salem
2d Subdivision name not applicable
2e NCDOTjonly T I P or state
3
Owner Information
3a
Name(s) on Recorded Deed
City of Winston Salem
3b
Deed Book and Page No
not applicable
3c
Responsible Party (for LLC if
applicable)
not applicable
3d
Street address
P O Box 2511
3e
City state zip
Winston Salem NC 27102
3f
Telephone no
[phone]
3g
Fax no !
[phone]
3h
Email address
toddml @cityofws org
p @00WIR
MAR 12 2012
Page 1 of 11 DENR WATERUArr,
PCN Form -Version 1 3 Dec*W16N1W0VWMW@j

4
Applicant
Information (if different from owner)
4a
Applicant
is
® Agent ❑ Other specify
4b
Name
Todd Love P E
4c
Business
(if applicable)
name
City of Winston Salem Engineering Department
4d
Street address
100 E First Street Suite 235
4e
City state zip
Winston Salem NC 27101
4f
Telephone no
336 747 6833
4g
Fax no !
336 727 2361
4h
Email address
toddml @cityofws org
5
Agent/Consultant Information (if applicable)
5a
Name
not applicable
5b
Business name
(if applicable)
5c
Street address
5d
City state zip
5e
Telephone no
5f
Fax no
5g
Email address
Page 2 of 11
PCN Form — Version 1 3 December 10 2008 Version

B Projectllnformation
and Prior Project History
1 Property Identification
1a Property identification no (tax PIN or parcel ID)
n/a
1b Site coordinates (in decimal degrees)
Latitude 36 0906 Longitude 801247
(DD DDDDDD) ( DD DDDDDD)
1 c Property size
n/a acres
2 Surface Waters
2a Name of nearest body of water (stream river etc ) to
Unnamed Tributary to Brushy Fork Branch
proposed project
2b Water Quality Classification of nearest receiving water
C
2c River basin
Yadkin
3 ProjectiDescnption
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
Lansing Drive is a local collector street and the existing land use in the project area is a mix of residential and institutional
developk ent Two private schools and several churches are located near or within the protect limits
3b List the
total estimated acreage of all existing wetlands on the property
0 acres
I
3c List the t1
tal estimated linear feet of all existing streams (intermittent and perennial) on the property
n/a
3d Explain I he purpose of the proposed protect
The project will provide sidewalk along Lansing Drive It will connect 2 existing sidewalks that are not currently connected
Students and staff at 2 schools will benefit from the project
3e Describe the overall project in detail including the type of equipment to be used
The project involves approximately 1/4 mile of widening Lansing Drive from east of Carver School road to west of Lasley
Drive This will involve grading paving drainage improvements pipe culverts and curb and gutter Equipment used will
be a broad range of paving equipment backhoes and wheel loaders motor graders and trucks used in road construction
4 Jurisdictional Determinations
4a Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
protect (including all prior phases) in the past?
❑ Yes ® No ❑ Unknown
Comments Met with DWQ at the project site and stream was
deemedijurisdictional
4b If the Corps made the jurisdictional determination what type
of determination was made?
El Preliminary E] Final
4c If yes who delineated the jurisdictional areas?
Agency /Consultant Company
Name (if known)
Other
4d If yes lift
the dates of the Corps jurisdictional determinations or State determinations and attach documentation
5 Project
CHistory
5a Have permits
this project
or certifications been requested or obtained for
(including all prior phases) in the past?
❑ Yes ® No ❑ Unknown
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 alphased projects —711—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 Isummary
la Which sections were completed below for your project (check all that apply)
❑ Wetlandsl ® Streams tributaries ❑ Buffers
❑ Open Waters ❑ Pond Construction
2 Wetlandllmpacts
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 1P) or
(if known)
DWQ — non 404 other)
(acres)
Temporary T
El Yes
[:1 Corps
W1 ❑ P ❑I
T
❑ No
❑ DWQ
T
❑ Yes
❑ Corps
W2 ❑ P ❑
❑ No
❑ DWQ
W3 ❑ P ❑jT
44
❑ Yes
❑ Corps
No
❑ DWQ
❑ Yes
❑ Corps
W4 ❑ P ❑T
I❑
❑ No
❑ DWQ
W5 ❑ P ❑T
I
❑ Yes
❑ Corps
❑ No
❑ DWQ
❑ Yes
❑ Corps
W6 ❑ P ❑T
❑ 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
fP) or
intermittent
DWQ — non 404
width
(linear
Temporary
(T)
(INT)?
other)
(feet)
feet)
S1 ®PST
I
Culvert Extension
Tributary to
Brushy Fork
® PER
® Corps
25
32 (perm)
Branch
❑ INT
®DWQ
22 (temp)
T
❑ PER
❑ Corps
S2 ❑ P [:1
❑ INT
❑ DWQ
S3 ❑ P ❑
T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S4 ❑ P ❑
T
❑ PER
❑ Corps
f
❑ INT
❑ DWQ
S5 [:1 PT
E] PER
❑ Corps
I❑ INT
❑ DWQ
S6 El P ❑
T
❑ PER
[:1 Corps
❑ INT
❑ DWQ
3h Total stream
and tributary impacts
32 (perm)
1
22 (temp)
31 Comment's
Total Impacts = 32 LF (perm) 22 LF (temp) Temporary impacts are due to temporary dewatenng of the stream
during culvert
installation (12 LF upstream 10 LF downstream) Permanent impacts are due to proposed culvert extension
Page 5 of 11
PCN Form — Version 1 3 December 10 2008 Version

4 Open Water
P
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 ❑ PEE] T
02 ❑P ❑T
03 ❑P❑P T
04 ❑PST
4f Total open water impacts
4g Comments
Construction
5 Pond or, Lake
If pond or lake construction proposed then complete the chart below
5a
5b
5c
5d
5e
IWetland
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)
51 Size of pond
watershed (acres)
5k Method
of construction
d
6 Buffer Impacts
(for DWQ)
If project will1impact
a protected riparian buffer then complete the chart below If yes then individually list all buffer impacts
below If
any impacts re quire mitigation then you MUST fill out Section D of this form
6a
❑ Neuse El Tar Pamlico El Other
Project is in
which protected basin?
❑ Catawba ❑ Randleman
6b
I
6d
6e
6f
6g
Buffer impact
number
o
EReason
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P)
or
Stream name
mitigation
(square feet)
(square feet)
Tem ora
f T
required?
B1 ❑P "T
❑Yes
I
❑ No
B2 ❑P ©T
El Yes
I
❑ No
B3 ❑ P ❑1
T
El
I
❑ No
f6h Total buffer impacts
61 Comments
Page 6 of 11
PCN Form — Version 1 3 December 10 2008 Version

D Impact Jpstification and Mitigation
1 Avoidance and Minimization
la Specifically describe measures taken to avoid or minimize the proposed impacts in designing project
In extreme fill locations 2 1 fill slopes have been utilized Rip rap pre formed scour holes will be used to reduce erosion at pipe
outlets The road widening section will be minimal and consist of grass fill slopes
1 b Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
Best Management Practices (BMP s) for construction activities will be used during the culvert installation Sediment and
erosion control measures will be used during the construction The no build alternative to this project would not address the
core purpose and need for the project which is to provide a safe pedestrian pathway between two schools
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 ito Waters of the U S or Waters of the State?
❑ Yes ® No
2b If y `s mitigation is required by (check all that apply)
❑ DWQ ❑ Corps
2c If yes which
project?
mitigation option will be used for this
`
jj
❑ Mitigation bank
❑ Payment to in lieu fee program
❑ Permittee Responsible Mitigation
3 Complete
if Using a Mitigation Bank
3a Name ofIMitigation
Bank
3b Credits Purchased
(attach receipt and letter)
Type
Quantity
3c Comments
l
4 Complete
I
if Making a Payment to In lieu Fee Program
4a Approvall
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
6
requested (DWQ only)
square feet
4e Riparian
wetland mitigation requested
acres
4f Non npanan
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
I
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
buffer mitigation?
result in an impact within a protected riparian buffer that requires
❑ Yes ® No
6b If yes then
amount
identify the square feet of impact to each zone of the riparian buffer that requires mitigation Calculate the
'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
permittee
mitigation is required discuss what type of mitigation is proposed (e g payment to private mitigation bank
responsible riparian buffer restoration payment into an approved in lieu fee fund)
6h Comments
Page 8 of 11
PCN Form — Version 1 3 December 10 2008 Version

E Stormwater
Management and Diffuse Flow Plan (required by DWQ)
1 Diffuse
Flow Plan
1 a Does the
protect include or is it adjacent to protected riparian buffers identified
within one
of the NC Riparian Buffer Protection Rules?
❑Yes ®No
1 b If yes then is a diffuse flow plan included? If no explain why
El Yes El No
Comments
I
2 Stormwater Management Plan
2a What is I he overall percent imperviousness of this project?
n/a %
I
2b Does this protect require a Stormwater Management Plan?
® Yes ❑ No
2c If this protect
DOES NOT require a Stormwater Management Plan explain why
2d If this p�tect
DOES require a Stormwater Management Plan then provide a brief narrative description of the plan
See aft
ched
® Certified Local Government
2e Who will
be responsible for the review of the Stormwater Management Plan?
p!
❑ DWQ Stormwater Program
❑ DWQ 401 Unit
3 Certified
Local Government Stormwater Review
3a In which
local government s jurisdiction is this protect?
City of Winston Salem
® Phase II
3b Which of
the following locally implemented stormwater management programs
❑ NSW
❑ USMP
apply (check
all that apply)
{
❑Water Supply Watershed
€I
❑ Other
3c Has the approved
attached?
Stormwater Management Plan with proof of approval been
❑ Yes ® No
4 DWQ Stormwater
Program Review
❑ Coastal counties
4a Which of
(check all
the following state implemented stormwater management programs apply
that apply)
❑ HQW
❑ ORW
❑ Session Law 2006 246
❑ Other
4b Has the approved Stormwater Management Plan with proof of approval been
attached?
I
❑ Yes ❑ No
f
5 DWQ 401 Unit Stormwater Review
5a Does the
Stormwater Management Plan meet the appropriate requirements?
El Yes ❑ No
5b Have all
of the 401 Unit submittal requirements been met?
El Yes ❑ No
Page 9 of 11
PCN Form — Version 1 3 December 10 2008 Version

F
Supplementary
Information
1
Enviro Imental
Documentation (DWQ Requirement)
la
Does the
project involve an expenditure of public (federal /state /local) funds or the
use of public
blic (federal /state) land?
®Yes El No
lb
If you answered
environmental
yes to the above does the project require preparation of an
document pursuant to the requirements of the National or State
❑ Yes ® No
(North Carolina)
Environmental Policy Act (NEPA/SEPA)?
1c
If you answered
State Clearing
yes to the above has the document review been finalized by the
House? (If so attach a copy of the NEPA or SEPA final approval
letter )
❑ Yes ❑ No
Comme,
its
f
2
Violations
(DWQ Requirement)
2a
Is the site in violation of DWQ Wetland Rules (15A NCAC 2H 0500) Isolated
Wetlands Rules (15A NCAC 2H 1300) DWQ Surface Water or Wetland Standards
❑ Yes ® No
or Riparian Buffer Rules (15A NCAC 26 0200)?
2b
Is this a( 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 Iproject (based on past and reasonably anticipated future impacts) result in
additional development which could impact nearby downstream water quality?
❑ Yes ® No
3b
If you answered yes to the above submit a qualitative or quantitative cumulative impact analysis in accordance with the
description
most recent DWQ policy If you answered no provide a short narrative
Based I the small size of this project it is unlikely that this project will trigger development This project is to construct
sidewalks in an already developed area The primary purpose of this project is to provide connectivity between existing
sidewalks
l
4
Sewage! Disposal (DWQ Requirement)
4a
Clearly dIetail 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
Page 10 of 11
PCN Form — Version 1 3 December 10 2008 Version

5 Endang�
red 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
impacts?
❑ Yes ® No
5c If yes indicate the USFWS Field Office you have contacted
E] Raleigh
❑ Asheville
5d What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat ?,
North Carolina Heritage Database
6 Essential
l 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 AtIlantic
Habitat and Ecosystem IMS
7 Historic
or Prehistoric Cultural Resources (Corps Requirement)
7a Will this
project occur in or near an area that the state federal or tribal
govern
I ents have designated as having historic or cultural preservation
❑ Yes ® No
status (e
North Carolina
g National Historic Trust designation or properties significant in
history and archaeology)?
7b What data
sources did you use to determine whether your site would impact historic or archeological resources?
City of Winston
Salem Forsyth County information NCHPO records
8 Flood Zone
Designation (Corps Requirement)
8a Will this
project occur in a FEMA designated 100 year floodplain?
i
❑Yes ® No
8b If yes explain
how project meets FEMA requirements
8c What so
l rce(s) did you use to make the floodplain determination? NC flood maps
odd M Love
35 12
Applicant/Agent s Signature
Applicant/Agent
s Printed Name
Date
I
(Agents signature is valid only rf an authorization letter from the applicant
is provided
Page 11 of 11
PCN Form — Version 1 3 December 10 2008 Version

STORMWATER MANAGEMENT PLAN
,ity of Winston Salem Project No 201111
1orsyth County, North Carolina
,ansmg Drive Sidewalk Improvements from Carver School Road to Lasley Drive
;ity Project Engineer Todd Love P E
DESCRIPTION
e City of Winston Salem proposes to construct curb and gutter with sidewalks along
existing portion of Lansing Drive Some minimal road widening will be constructed to
istruct the sidewalks The scope of the work includes grading, drainage pipe culvert
ension curb and gutter and paving improvements Drainage systems consist of grated
-ts with pipe networks and preformed scour holes at the pipe outlets
-se roadway improvements will result in additional impervious area of approximately
60 SF) 0 22 acres
he project is located near the divide between the Yadkin Pee Dee and the Roanoke
.aver basin in Forsyth County North Carolina Water resources in the area include
rushy Fork Branch and Unnamed Tributaries to Brushy Fork Branch Brushy Fork
ranch is a perennial stream that flows south to north east of the project boundaries and
as a best usage classification of C All waters within the project flow into the Brushy
ork Branch and do not have an assigned Stream Index Number by the N C Division of
later Quality The surrounding area is rolling piedmont with natural ground elevations
etween approximately 950 and 1000 feet Existing land use varies from forested land
development and residential development along the project
either High Quality Waters (HQW), Water Supplies (WS I WS II or WS III) are
,cated within 1 0 mile of the project area
MANAGEMENT PRACTICES
primary goal of Best management practices (BMP's) is to prevent degradation of the
s surface waters by the location construction and operation of roadway system The
measures used on this project to reduce stormwater impacts are
The hydraulic design minimizes water quality impacts by using pre formed scour
holes at pipe outlets Pipe Outlets #3 and #7 drain to a proposed preformed scour
hole with level spreader
Rip rap was used where warranted to reduce erosion at pipe outlets
In steep fill locations 2 1 fill slopes were used to minimize stream buffer impacts

PROJECT LOCATION MAP
PROPOSED PROJECT 201111 NOT TO I DATE
SCALE 3 -1 -12
LANSING DRIVE SIDEWALK IMPROVEMENTS

PROJECT: 20111 7 LANSING DRIVE
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AERIAL MAP
CITY ROADWAY PROD. N0. 201111 NOT TO DATE SCALE 2 -28 -12
LANSING DRIVE SIDEWALK AERIAL MAP

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CITY ROADWAY PROD. N0. 201111 NOT TO DATE SCALE 2-28-12
USGS MAP - WALKERTOWN QUADRANGLE