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Home My WebLink About20130453 Ver 1_More Info Received_20130710WFi3 -o',s3 THE July 9, 2013 WOOTEN COMPANYMrs. Sue Homewood NCDENR Winston Salem Regional Office ENGINEERING 585 Waughtown Street PLANNING Winston -Salem NC 27107 A R C H I T E C T U R E Re: Preconstruction Notification - DWQ No. 13 -0453 Winston -Salem Forsyth County Utility Commissioners (CCUC) Janita Lakes Outfall Rehabilitation TWC No.: 2810 -K ED Dear Mrs. Homewood: In response of your letter dated June 3, 2013 regarding the above referenced project, we are submitting a new PCN form for the Section 404 Permit application for the Janita Lakes Outfall Rehabilitation project and this letter to request 401 Water Quality Certification. For your information, we received verification from US Army Corps of Engineers on April 30, 2013 the project is approved under NW 12. Enclosed are the following items: ■ PCN Application Form: 5 copies • Application Fee Check: $240.00 The project will rehabilitate and /or replace the CCUC's sanitary sewer utilities along the South Fork Sewer Discharge, Ebert Road Outfall, Janita Lakes Outfall and Thompson Drive Sewer. The existing infrastructure associated with these lines is deteriorated and poses a risk of failure. We are asking for a variance on this project from General Certification #3884 Condition #10. This project involves replacing an existing interceptor in place to utilize the existing trench and easements as much as possible. In following the existing interceptor there are a few locations where disturbance will be less than 10 feet from the top of bank of a class C stream. The locations are as follows: 1- Sheet 3 of 6, Janita Lakes Outfall Replacement, Sta 18+30,60 feet 2- Sheet 3 of 6, Janita Lakes Outfall Replacement, Sta 20+30, 16 feet 3- Sheet 4 of 6, Janita Lakes Outfall Replacement, Sta 26 +50, 35 feet 350 North Cox Street Suite 26 4- Sheet 4 of 6, Janita Lakes Outfall Replacement, Sta 27 +22, 110 feet Asheboro NC 27203 5- Sheet 5 of 6, Janita Lakes Outfall Replacement, Sta 39 +10, [ga V 336.626.5322 fax 336.626.5722 JUL 1 0 2013 1 " Mrs. Homewood NCDENR W -S Regional Office 7/9/13 Page 2 All of these locations involve erosion control items being within 10 feet from the top of bank of the stream. These areas will be monitored closely in construction and stabilized as soon as possible. Use of the existing trench area is important on this interceptor to minimize rock excavation and forested clearing. Please review the submittal and contact us with your approval, or if you have questions, comments or require additional information. Sincerely, THE WOOTEN COMPANY Jahn C. Grey, PE Project Manager /rsf Enclosures cc w /enclosures (5): John Domey, The Wetlands /401 Water Quality Certification Unit cc: Scott Jones, CCUC wr THE WOOTEN COMPANY ENGINEERING PLANNING ARCHITECTURE 350 North Cox Street Suite 26 Asheboro NC 27203 336.626.5322 fax 336.626.5722 July 9, 2013 Mrs. Sue Homewood NCDENR Winston Salem Regional Office 585 Waughtown Street Winston -Salem NC 27107 Re: Preconstruction Notification - DWQ No. 13 -0453 Winston -Salem Forsyth County Utility Commissioners (CCUC) Janita Lakes Outfall Rehabilitation TWC No.: 2810 -K Dear Mrs. Homewood: In response of your letter dated June 3, 2013 regarding the above referenced project, we are submitting a new PCN form for the Section 404 Permit application for the Janita Lakes Outfall Rehabilitation project and this letter to request 401 Water Quality Certification. For your information, we received verification from US Army Corps of Engineers on April 30, 2013 the project is approved under NW 12. Enclosed are the following items: ■ PCN Application Form: 5 copies ■ Application Fee Check: $240.00 The project will rehabilitate and /or replace the CCUC's sanitary sewer utilities along the South Fork Sewer Discharge, Ebert Road Outfall, Janita Lakes Outfall and Thompson Drive Sewer. The existing infrastructure associated with these lines is deteriorated and poses a risk of failure. We are asking for a variance on this project from General Certification #3884 Condition #10. This project involves replacing an existing interceptor in place to utilize the existing trench and easements as much as possible. In following the existing interceptor there are a few locations where disturbance will be less than 10 feet from the top of bank of a class C stream. The locations are as follows: 1- Sheet 3 of 6, Janita Lakes Outfall Replacement, Sta 18+30,60 feet 2- Sheet 3 of 6, Janita Lakes Outfall Replacement, Sta 20+30, 16 feet 3- Sheet 4 of 6, Janita Lakes Outfall Replacement, Sta 26 +50, 35 feet 4- Sheet 4 of 6, Janita Lakes Outfall Replacement, Sta 27 +22, 110 feet 5- Sheet 5 of 6, Janita Lakes Outfall Replacement, Sta 39 +10, 216 feet Mrs. Homewood NCDENR W -S Regional Office 7/9/13 Page 2 All of these locations involve erosion control items being within 10 feet from the top of bank of the stream. These areas will be monitored closely in construction and stabilized as soon as possible. Use of the existing trench area is important on this interceptor to minimize rock excavation and forested clearing. Please review the submittal and contact us with your approval, or if you have questions, comments or require additional information. Sincerely, THE WOOTEN COMPANY John C. Grey, PE Project Manager /rsf Enclosures cc w /enclosures (5): John Dorney, The Wetlands /401 Water Quality Certification Unit cc: Scott Jones, CCUC W1 THE WOOTEN COMPANY ENGINEERING PLANNING ARCHITECTURE 350 North Cox Street Suite 26 Asheboro NC 27203 336.626.5322 fax 336.626.5722 July 9, 2013 Mrs. Sue Homewood NCDENR Winston Salem Regional Office 585 Waughtown Street Winston -Salem NC 27107 Re: Preconstruction Notification - DWQ No. 13 -0453 Winston -Salem Forsyth County Utility Commissioners (CCUC) Janita Lakes Outfall Rehabilitation TWC No.: 2810 -K Dear Mrs. Homewood: In response of your letter dated June 3, 2013 regarding the above referenced project, we are submitting a new PCN form for the Section 404 Permit application for the Janita Lakes Outfall Rehabilitation project and this letter to request 401 Water Quality Certification. For your information, we received verification from US Army Corps of Engineers on April 30, 2013 the project is approved under NW 12. Enclosed are the following items: ■ PCN Application Form: 5 copies ■ Application Fee Check: $240.00 The project will rehabilitate and /or replace the CCUC's sanitary sewer utilities along the South Fork Sewer Discharge, Ebert Road Outfall, Janita Lakes Outfall and Thompson Drive Sewer. The existing infrastructure associated with these lines is deteriorated and poses a risk of failure. We are asking for a variance on this project from General Certification #3884 Condition #10. This project involves replacing an existing interceptor in place to utilize the existing trench and easements as much as possible. In following the existing interceptor there are a few locations where disturbance will be less than 10 feet from the top of bank of a class C stream. The locations are as follows: 1- Sheet 3 of 6, Janita Lakes Outfall Replacement, Sta 18+30,60 feet 2- Sheet 3 of 6, Janita Lakes Outfall Replacement, Sta 20+30, 16 feet 3- Sheet 4 of 6, Janita Lakes Outfall Replacement, Sta 26 +50, 35 feet 4- Sheet 4 of 6, Janita Lakes Outfall Replacement, Sta 27 +22, 110 feet 5- Sheet 5 of 6, Janita Lakes Outfall Replacement, Sta 39 +10, 216 feet Mrs. Homewood NCDENR W -S Regional Office 7/9/13 Page 2 All of these locations involve erosion control items being within 10 feet from the top of bank of the stream. These areas will be monitored closely in construction and stabilized as soon as possible. Use of the existing trench area is important on this interceptor to minimize rock excavation and forested clearing. Please review the submittal and contact us with your approval, or if you have questions, comments or require additional information. Sincerely, THE WOOTEN COMPANY John C. Grey, PE Project Manager /rsf Enclosures cc w /enclosures (5): John Dorney, The Wetlands /401 Water Quality Certification Unit cc: Scott Jones, CCUC ot W ArF9OG y O t 13 -b4S3 Office Use Only: Corps action ID no. DWQ project no. Form Version 1.3 Dec 10 2008 Pre- Construction Notification C Form A. AppKcant Information <' rn to 1. Processing 1a. Type(s) of approval sought from the Corps: ®Section 404 Permit [:1 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? N Yes ❑ No 1d. Type(s) of approval sought from the DWQ (check all that apply): ® 401 Water Quality Certification — Regular ❑ Non404 Jurisdictional General Permit ❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization 1e. 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 in4ieu fee program proposed for mitigation of impacts? If so, attach the acceptance letter from mitigation bank or in4ieu 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: Janita Lakes Outfall Rehabilitation 2b. County: Forsyth 2c. Nearest municipality / town: Winston Salem 2d. Subdivision name: NA 1 Q 2e. NCDOT only, T.I.P. or state project no: NA 3. Owner Information mar 3a. Name(s) on Recorded Deed: Winston Salem/Forsyth County Utility Commission 3b. Deed Book and Page No. 3c. Responsible Party (for LLC if applicable): 3d. Street address: Suite 357, City Hall, 101 North Main Street 3e. City, state, zip: Winston Salem, NC, 27101 3f. Telephone no.: 336- 727 -8000 3g. Fax no.: 336- 727 -8432 3h. Email address: Page 1 of 11 PCN Form — Version 1.3 December 10, 2008 Version ,''l ~ � .-`�'�"�__- �' �-_._-~�.^_~ '\` 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: 4f. Telephone no.: 4g. Fax no.: 4h. Email address: 5. Agent/Consultant Information (if applicable) 5a. Name: John C. Grey, P.E. 5b. Business name (if applicable): The Wooten Company 5c. Street address: 350 N. Cox Street, Suite 26 5d. City, state, zip: Asheboro, NC, 27203 5e. Telephone no.: 336 - 626 -5322 5f. Fax no.: 336 -626 -5722 5g. Email address: jgrey @thewootencompany.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): NA 1b. Site coordinates (in decimal degrees): Latitude: 36.0386 Longitude: - 80.2922 (DD.DDDDDD) (- DD.DDDDDD) 1c. Property size: 7.8 acres 2. Surface Waters 2a. Name of nearest body of water (stream, river, etc.) to Salem Creek proposed project: 2b. Water Quality Classification of nearest receiving water: C 2c. River basin: Yadkin - Pee Dee 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: Forest and cleared land. Land uses include residential, undeveloped and municipal. Majority of work will take place in existing sewer right -of -way 3b. List the total estimated acreage of all existing wetlands on the property: 0.402 3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 110 linear feet 3d. Explain the purpose of the proposed project: To replace an existing oversized deficient sewer line with a new smaller sewer line. 3e. Describe the overall project in detail, including the type of equipment to be used: Approximately 1,800 linear feet of CIPP lining at WWTP site. Existing manholes and bends will be removed and replaced with new manholes. From the WWTP to Landfill Rd approximately 640 linear feet of 27 "gravity wastewater sewer will be installed parallel to existing line. Approximately 3,435 linear feet of 12" gravity wastewater sewer and 3,560 linear feet of 8" gravity wastewater sewer will be replace existing larger deficient sewer in place from Landfill Rd to Thompson Drive. Manholes will be constructed along the gravity interceptor at approximate existing manhole locations. Trackhoes will be used to perform the excavation and backfilling required to install the utilities. Construction corridors will be limited to 40 feet in width where wetlands and streams are crossed. Backfill will be placed to match original grade. Disturbed areas will be seeded with a wetlands seed mixture where wetlands are disturbed. 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: The Wooten Company Name (if known): Mark Hussey Other: 4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation. Page 3 of 11 PCN Form — Version 1.3 December 10, 2008 Version 5. Project History 5a. Have permits or certifications been requested or obtained for this project (including all prior phases) in the past? ❑ Yes ® No ❑ Unknown 5b. If yes, explain in detail according to "help file' instructions. 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 1 a. 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 Excavation, ® Yes ❑ Corps 0.07 clearing, grubbing ❑ No ❑ DWQ W2 ®P ❑ T Excavation, ❑ Yes ❑ Corps 0.153 clearing, grubbing ® No [I DWQ W3 []POT Clearing, grubbing ® Yes ❑ No ❑ Corps ❑ DWQ 0.169 W4 []POT Clearing, grubbing ❑ Yes ® No ❑ Corps ❑ DWQ 0.01 W5 ❑ P ❑ T ❑ Yes ❑ Corps ❑ No ❑ DWQ W6 ❑ P ❑ T ❑ Yes ❑ Corps ❑ No ❑ DWQ 2g. Total wetland impacts 0.402 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 excavation UT to Salem Creek ® PER ❑ INT ❑ Corps ❑ DWQ 31.5 20 S2 ❑ P ®T excavation UT to Salem Creek ® PER ❑ INT ❑ Corps ❑ DWQ 8.1 10 S3 ❑ P ®T excavation UT to Salem Creek ® PER ❑ INT ❑ Corps ❑ DWQ 20.28 20 S4 ❑ POT excavation UT to Salem Creek ® PER ❑ INT ❑ Corps ❑ DWQ 22.7 24 S5 ❑ P ®T excavation UT to Salem Creek ® PER ❑ INT ❑ Corps ❑ DWQ 22.1 36 S6 ❑ P ❑ T ❑ PER ❑ Corps ❑ INT ❑ DWQ 3h. Total stream and tributary impacts 110 3i. 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 []POT 02 ❑P ❑T 03 ❑P ❑T 04 ❑P ❑T 4E Total open water impacts 0 4g. Comments: S. 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) number of pond Flooded Filled Excavated Flooded Filled Excavated Flooded P1 P2 5f. Total 0 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. ❑ Neuse ❑ Tar - Pamlico ❑ Other: 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) or for Stream name mitigation (square feet) (square feet) Temporary T Impact required? B1 ❑P [IT ❑Yes ❑ No B2 ❑P ❑T ❑Yes ❑ No B3 ❑ P ❑ T ❑ Yes ❑ No 6h. Total buffer impacts 0 6i. Comments: Page 6 of 11 PCN Form — Version 1.3 December 10, 2008 Version D. Impact Justification and Mitigation 1. Avoidance and Minimization 1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project. Limited creek crossings. Relocated new sewer line further away from creek to eliminate parallel stream bank impacts. Only crossed creek as required by existing sewer location. 1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques. Stream crossings were kept shallow to minimize the areas of impact. 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: S. 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 DWuse Flow Plan (required by DWO) 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? 1b. If yes, then is a diffuse flow plan included? If no, explain why. ❑ Yes ❑ No Comments: This procect is not adjacent to a protected riparian buffer. 2. Stormwater Management Plan 2a. What is the overall percent imperviousness of this project? 0% 2b. Does this project require a Stormwater Management Plan? ❑ Yes ® No 2c. If this project DOES NOT require a Stormwater Management Plan, explain why: This project does not require a Stormwater management Plan because it qualifies as a Low Densiy project. It meets all requiements for low density projects. 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? ❑ DWO Stormwater Program ❑ DWO 401 Unit 3. Certified Local Government Stormwater Review 3a. In which local government's jurisdiction is this project? Forsyth ® Phase 11 3b. Which of the following locally4mplemented 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. DWO Stormwater Program Review ❑ Coastal counties ❑ HOW 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 attached? ❑ Yes ® No 5. DWO 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) la. Does the project involve an expenditure of public (federal/state/local) funds or the ® Yes ❑ No use of public (federal/state) land? 1b. 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 (NEPAISEPA)? 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 ❑ Yes ❑ No letter.) Comments: 2. Violations (DWQ Requirement) 2a. Is the site in violation of DWQ Welland Rules (15A NCAC 2H .0500), Isolated Wetiand 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. Existing sanitary sewer service is available. The proposed improvements will not support additional future development beyond that which is supported by the existing utilities. 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 will ultimately be received at the Archie Elledge WWTP 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? ❑ 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 identifies the following as threatened and endangered species in Forsyth County, North Carolina: Red - cockaded woodpecker, Bog Turtle. 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? http: //www. habitat. noaa. gov / protection /efh /newlnv /index.html 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 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? NCDCR historic preservation website, google earth, Forysth County GIS 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 project will be replacing existing sewer lines and manholes. Structures that are below the 100 -year flood height will be watertight. The portion of the project in the floodplain is located at the WWTP and is owned by Winston Salem. 8c. What source(s) did you use to make the floodplain determination? NC Flood Maps i,,I� Ron Hargrove a'r��- 611-71,3 Applicalkgent's Signature Applicant/Agent's Printed Name (Agent's signature is valid oniyis if an aut o )zation letter from the applicant Date Page 11 of 11 PCN Form — Version 1.3 December 10, 2008 Version