20121033 Ver 1_401 Application_20121112

Dewberry
DATE:
PROJECT NAME
REFERENCE:
20121033
11/6/2012 PROJECT #: 50049760
ARMC New Cancer Center and ED /OR Expansion
TO: Karen Higgins
401 Permitting Unit Supervisor y
NC Division of Water Quality -'
401 /Wetlands Unit
/f0*0 Mail Service Center
Raleigh, North Carolina 27699 -1650
PHONE:
CC:
L] As per your request
❑ Under separate cover
® By mad
❑ By messenger
❑ By pick up
❑ By overnight carrier
LJ Prints
® Copies
❑ Reports
❑ Studies
❑ Reproducible
❑ Product literature
❑ Computations
TRANSMITTAL
Z0 i2
DENR .
Wetlands WATEH QU,ylf1�,
�--R.. Star. .., ._
Lg Your approval
❑ Your review and comment
❑ Your file /use
❑ Revision and submission
❑ Distribution
5 i PCN Application Form
5 I Plan Sheets showing Stream and Wetland Impacts
5 1 USGS Maps /Soils Maas /Sketch of Pr000sed Impacts [
Karen —
Please find enclosed the above referenced documents.
Let me know if you have any questions.
Thanks.
Virginia Russell, PE, LEED AP BD +C
If enclosures are not as noted, please notify us at once Page 1 of 1

Dewberry
Dewberry & Davis, Inc.
2301 Rexwoods Drive, Suite 200
Raleigh, NC 27607 -3366
919.881.9939
919.881.9923 fax
www.dewberry.com
November 06, 2012
Karen Higgins
401 Permitting Unit Supervisor
NC Division of Water Quality
401 /Wetlands Unit
1650 Mail Service Center
Raleigh, North Carolina 27699 -1650
Reference: ARMC New Cancer Center and
ED /OR Expansion
Dewberry Project No. 50049760
Dear Ms. Higgins:
Enclosed are five copies of a Pre - Construction Notification (PCN) Permit Application Package for the
ARMC New Cancer Center and ED /OR Expansion project. For your review we have enclosed the
following:
Five copies of the PCN Application Form
Five copies of the plan sheets showing stream and wetland impacts
Five copies of USGS Maps /Soils Maps /Sketch of Proposed Impacts
Please call with any questions regarding this project.
Sincerely,
Dewbe & Davis, Inc.
Virginia Russell, PE, LEED AP BD +C
Project Manager
Enclosures

W A T�c9OG
20121033
Office Use Only:
Corps action ID no
DWQ project no.
Form Version 1.4 January 2009
Pre - Construction Notification (PCN) Form
A. Applicant Information
1. Processing
1 a. Type(s) of approval sought from the Corps:
X❑ Section 404 Permit ❑ Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number: 33 or General Permit (GP) number:
1 c. Has the NWP or GP number been verified by the Corps?
❑X Yes ❑ No
1 d. Type(s) of approval sought from the DWQ (check all that apply):
❑X 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 ❑X No
For the record only for Corps Permit:
❑ Yes Q 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 ❑X No
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below.
❑ Yes ❑X No
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes ❑X No
2. Project Information
2a. Name of project:
ARMC New Cancer Center and ED /OR Expansion
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:
Alamance Regional Medical Center ^
3b. Deed Book and Page No
BK #2871 PG #0155
i nQ
Z,[
3c. Responsible Party (for LLC if
applicable):
Bill Payne CFPS, CHFM, SASHE, MBA
3d. Street address:
1240 Huffman Mill Road I 1"I l .i 8 101
3e. City, state, zip:
Burlington, NC 27215 ML—LO-
3f. Telephone no.
336- 538 -7775 Wetlands 8, water
3g. Fax no.:
3h. Email address:
paynblll @armc.com
Page 1 of 10
PCN Form – Version 1.4 January 2009

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:
Virginia Russell
5b. Business name
(if applicable):
Dewberry
5c. Street address,
2301 Rexwoods Drive, Suite 200
5d. City, state, zip:
Raleigh, NC 27607
5e. Telephone no.:
919 -424 -3740
5f. Fax no.:
919- 881 -9923
5g. Email address:
fvrussell @dewberry.com
Page 2 of 10

B.
Project Information and Prior Project History
1.
Property Identification
1a.
Property identification no. (tax PIN or parcel ID):
8854116510 & 8854210315
1 b. Site coordinates (in decimal degrees):
I Latitude: 36.061639 Longitude: -79 502747
1 c
Property size:
69.65 acres
2.
Surface Waters
2a.
Name of nearest body of water to proposed project:
Unnamed tributary to Back Creek
2b. Water Quality Classification of nearest receiving water:
WS -V; NSW 16 -19 -5
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:
Alamance Regional Medical Center is currently in operation at the site. The surrounding land uses are commercial, residential, medical and
undeveloped woodland.
3b.
List the total estimated acreage of all existing wetlands on the property: 0.308
3c.
List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 770
3d. Explain the purpose of the proposed project:
Expansion of the existing medical facility, including new cancer center and expansion of ED /OR
3e. Describe the overall project in detail, including the type of equipment to be used:
Modification of existing parking lot, construction of stormwater BMP, construction of new buildings and installation of supporting utilities.
Conventional construction equipment will be used, including dump trucks, track and tire mounted excavating and cranes.
4.
Jurisdictional Determinations
4a
Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (including all prior phases) in the past?
❑X Yes ❑ No ❑ Unknown
Comments: SAW 20064160
4b.
If the Corps made the jurisdictional determination, what type
of determination was made?
❑ Preliminary ❑X Final
4c.
If yes, who delineated the jurisdictional areas?
Name (if known): unknown
Agency /Consultant Company: Falcon Engineering
Other:
4d If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Owner is not able to locate copies of SAW20064160 and related documentation
5.
Project History
5a.
Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
El Yes ❑ No El Unknown
5b.
If yes, explain in detail according to "help file" instructions.
6.
Future Project Plans
6a.
Is this a phased project?
❑ Yes ❑X No
6b
If yes, explain.
Page 3 of 10
PCN Form — Version 1.4 January 2009

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
❑X 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 impact
Type of wetland
Forested
Type of jurisdiction
Area of
number
Corps (404,10) or
impact
Permanent (P) or
DWQ (401, other)
(acres)
Temporary T
W1 T
Land Clearing
Unknown
Yes
Corps
0 006
W2 -
Choose one
Choose one
Yes /No
W3 -
Choose one
Choose one
Yes /No
-
W4 -
Choose one
Choose one
Yes /No
-
W5 -
Choose one
Choose one
Yes /No
-
W6 -
Choose one
Choose one
Yes /No
2g. Total Wetland Impacts:
0.006
2h. Comments:
It is anticipated that approximately 270 square feet of the delineated wetlands will be disturbed during construction of a nearby retaining wall The
disturbed area will be revegetated with a wetland seeding mix after completion of construction.
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 (PER) or
Type of
Average
Impact
number
intermittent (INT)?
jurisdiction
stream
length
Permanent (P) or
width
(linear
Temporary (T)
(feet)
feet)
S1 P
Fill
INT
Corps
4.5
32
S2 -
Choose one
S3 -
Choose one
S4 -
Choose one
S5 -
Choose one
S6 -
Choose one
-
3h. Total stream and tributary impacts
32
3i. Comments:
Approximately 32 linear feet of stream at the top of the drainageway will be filled during construction of a retaining wall. Flow upstream of the
abandoned stream segment will be routed into the stormwater management system.
Page 4 of 10
PCN Form — Version 1.4 January 2009

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
4b.
Name of waterbody
(if applicable)
4c.
Type of impact
4d.
Waterbody
type
4e.
Area of impact (acres)
01 -
Choose one
Choose
02 -
Choose one
Choose
03 -
Choose one
Choose
04 -
Choose one
Choose
4f. Total open water impacts
4g. Comments:
S. Pond or Lake Construction
If pond or lake construction proposed, the complete the chart below.
5a.
Pond ID number
5b.
Proposed use or
purpose of pond
5c.
Wetland Impacts (acres)
5d.
Stream Impacts (feet)
5e.
Upland
(acres)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
P1
Choose one
P2
Choose one
5f. Total:
5g. Comments:
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no:
5i Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. 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. Project is in which protected basin?
❑ Neuse ❑ Tar - Pamlico ❑ Catawba ❑ Randleman ❑ Other:
6b.
Buffer Impact
number—
Permanent (P) or
Temporary T
6c.
Reason for impact
6d.
Stream name
6e.
Buffer
mitigation
required?
6f.
Zone 1
impact
(square
feet )
6g.
Zone 2
impact
(square
feet
B1 -
Yes /No
B2 -
Yes /No
B3 -
Yes /No
B4 -
Yes/No
B5 -
Yes /No
B6 -
Yes /No
6h. Total Buffer Impacts:
6i. Comments:
Page 5 of 10

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Project layout minimized impact to on -site streams and wetlands. The construction of a retaining wall was added to the project in order to provide
sufficient cover over required buried utilities without filling wetlands
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Erosion control measures will be in place prior to construction activities Construction limits will be clearly defined and no disturbance will occur outside
the construction limits Wetland and stream impacts, installation of erosion control measures, and adherence to construction limits will be reviewed
with contractor during pre - construction meetings.
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 Q 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: Choose one
Type: Choose one
Type: Choose one
Quantity:
Quantity:
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:
Choose one
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 6 of 10
PCN Form — Version 1.4 January 2009

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 7 of 10

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 ❑X 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
2.
Stormwater Management Plan
2a. What is the overall percent imperviousness of this project?
60
2b
Does this project require a Stormwater Management Plan?
❑Q 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
new Cancer Center portion of the project will result in a net decrease in built -upon area. The ED /OR portion
of the project will result in a net
increase in built -upon area The increase has been addressed by incorporating a bioretention area, which
is under review by the city of Burlington.
2e.
Who will be responsible for the review of the Stormwater Management Plan?
City of Burlington
3.
Certified Local Government Stormwater Review
3a.
In which local government's jurisdiction is this r6ect?
City of Burlington
0 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
El Yes ❑X No
attached? Plan is under review.
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 8 of 10
PCN Form — Version 1.4 January 2009

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the project involve an expenditure of public (federal /state /local) funds or the
❑ Yes ❑X 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 Q No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after - the -fact permit application?
El 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
El Yes ❑X 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.
Wastewater generated from the medical center will increase as a result of the facility expansion Wastewater is discharged into the City of Burlington
municipal wastewater system. The City of Burlington has indicated that they have adequate wastewater system capacity to accommodate the facility
expansion A sanitary sewer permit for this project has been submitted to the City of Burlington for their review
Page 9 of 10
PCN Form — Version 1.4 January 2009

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.
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
8. 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)?
El 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 floodpiain?
❑ Yes ❑X No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodpiain determination?
FIRM map no. 3710685400J, dated September 6, 2006, Panel 8864J
' Ay/y
Applicant/Agent's Printed Name
A plicant//j ent's Signature
(Agent's signature is valid only if an authorization
letter from the applicant is provided.)
Date
Page 10 of 10

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