20140540 Ver 1_401 Application_20140614

20 1 405 40
CK ARCADIS
Infrastructure, environment, facilities ARCADIS
1 Centerview Drive
Suite 208
VED!)INR-
. Greensbo ro
North Carolina 27407
Ms. Jennifer Burdette Tel [phone] NC DWR,-401 & Buffer Permitting Unit G 2 iu 14 Fax [phone]
51'2 North Salisbury St. www.arcadis - us.com
Raleigh, NC 27604 u�r�p ,..._
WATER DIVISION
Subject
Greensboro, North Carolina
Young's Mill Outfall — Design Phase
Date
May 23, 2014
Dear Ms. Burdette:
Contact
On behalf of the City of Greensboro we are pleased to submit the enclosed Pre- David Hamilton
Construction Notification (PCN) Form for the Young's Mill Outfall sewer extension'
project. This a pp lication and supporting information is simultaneously being P rovided Phone to Mr Craig Brown, USACE. 336.292.2271
We are submitting this application concurrently with the following for the subject YMO
project:
• NCDENR DWQ - Sewer Extension Permit
• NCDENR DLR - Erosion Control Permit
• NCDOT- R/W Encroachment Agreement
• Guilford County - Storrnwater Permit
Imagine the result
G \PROJ T \GRGRN081 D001 (Rock Creek Lift Staoon)\Regulatory\DWO -Sewer
Email
The project includes the construction of the Young's Mill Outfall (YMO) which
davld.hamilton@arcadis-
includes 11,200 linear feet of 42" and 11,870 linear feet of 36" gravity sewer pipe for
us.com
the City of Greensboro. This will allow the City to abandon the existing undersized
Young's Mill Lift Station and allow for increased flow within the system. The gravity
Our ref
sewer starts near the intersection of Young's Mill Road and the 1 -85 bypass then
GRGRN081.D001
follows along the Little Alamance Creek. The sewer outfall ends approximately 360
feet east of AT &T Drive where It will discharge into the new Stewart Mill Lift Station
(designed by others and currently being submitted for regulatory approvals).
ARCADIS G &M of North Carolina, Inc
NC Engineering License # C -1869
NC Surveying License # C -1869
An Environmental Assessment has been performed for this project and the FONSI
has been received.
We are submitting this application concurrently with the following for the subject YMO
project:
• NCDENR DWQ - Sewer Extension Permit
• NCDENR DLR - Erosion Control Permit
• NCDOT- R/W Encroachment Agreement
• Guilford County - Storrnwater Permit
Imagine the result
G \PROJ T \GRGRN081 D001 (Rock Creek Lift Staoon)\Regulatory\DWO -Sewer

Ms. Jennifer Burdette
ARCADIS May 23, 2014
It should be noted that this project necessitates that permanent maintenance
corridors disturb more than the allowable 1/10 acre of forested wetlands. Therefore,
compensatory mitigation will be made to the In -lieu Fee program which is discussed
in the attached application.
This PCN submittal package contains the following:
• A check in the amount of $570.00 made payable to N.C. Division of Water
Resources for the Major Impacts review fee.
• Five complete copies of the PCN Application with the following supporting
documents:
• 5 -PCN Application Tables (C.2, C.3, and C.6)
• 1 -EEP In -Lieu Fee Mitigation Form
• Plans
0 2 — Full size
0 3 — 11x17
• YMO Figures
• Figure 1 -Vicinity Map
• Figure 2 - USGS Map with Impact Locations
• Figure 3a & 3b - NRCS Map with Impact Locations
• Figure 4a & 4b - Aerial Map with Impact Locations and Table
We appreciate your assistance with this important project for the City of Greensboro
and look forward to your approval.
Sincerely,
ARCADIS
David A. Hamilton, PE
Project Manager
Copies
Melinda King, PE (City of Greensboro WR Dept)
Andy Larrick, PE (DMP Inc)
Phil May (Carolina Ecosystems, Inc.)
G \PROJECT\GRGRN081 D001 (Rock Creek Lift Statioo)\RegulatoryOWQ -Sewer Page
2/2

� WAt Q
A
0 r
2 0 1 4 0 5 4 0
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.4 January 2009
Page 1 of 10
PCN 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
1b. Specify Nationwide Permit (NWP) number: 12 or General Permit (GP) number:
1c.
Has the•NWP or GP number been verified by the Corps?
❑X Yes ❑ No
1d. Type(s) of approval sought from the DWQ (check all that apply):
E9 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 ❑X 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.
❑X Yes ❑ 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 Q No
2.
Project Information
2a. Name of project:
Young's Mill Outfall
2b. County:
Guilford s�
2c.
Nearest municipality / town:
Greensboro
p, F
2d. Subdivision name:
NA d °
2e.
NCDOT only, T.I.P. or state project no:
3.
Owner Information
3a.
Name(s) on Recorded Deed:
City of Greensboro
3b.
Deed Book and Page No.
NA
3c.
Responsible Party (for LLC if
applicable):
City of Greensboro, Melinda King
3d. Street address:
2602 S. Elm- Eugene Street
3e.
City, state, zip:
Greensboro, NC 27406
3f.
Telephone no.:
336- 412 -6314
3g.
Fax no.:
336- 412 -6305
3h. Email address:
Melinda. King @greensboro - nc.gov
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:
4f. Telephone no.:
4g. Fax no.:
4h. Email address:
5. Agent /Consultant Information (if applicable)
5a. Name:
David A. Hamilton
5b. Business name
(if applicable):
ARCADIS
5c. Street address:
1 Centerview Dr., Suite 208
5d. City, state, zip:
Greensboro, NC 27407
5e. Telephone no.:
336- 292 -2271
5f. Fax no.:
336- 855 -5648
5g. Email address:
David.Hamilton @arcadis - us.com
Page 2 of 10

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
Multiple parcels - see attached plan set
1 b. Site coordinates (in decimal degrees):
Latitude: 36.037197 Longitude: 79.695197
1 c. Property size:
26.3 acres
2. Surface Waters
2a. Name of nearest body of water to proposed project:
Little Alamance Creek
2b. Water Quality Classification of nearest receiving water:
WS -IV, 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:
Existing conditions consist of undeveloped wooded land and wetlands, rural residential land, and existing roadway rights -of -way. Land use is mostly
undeveloped areas with scattered residential development.
3b. List the total estimated acreage of all existing wetlands on the property: 2.9
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 10,400
3d. Explain the purpose of the proposed project:
Proposed project replaces a sewer lift station that's reaching capacity. New outfall will allow for increased flow within the system through the year 2050.
D
3e. Describe the overall project in detail, including the type of equipment to be used:
Installation of — 11,200 LF of 42" & 11,870 LF of 36" sewer pipe. Track hoe used for excavation and loader and /or grader to return site to original grade..
D
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?
Z Yes ❑ No ❑ Unknown
Comments: JD request submitted October 2012
4b. If the Corps made the jurisdictional determination, what type
of determination was made?
0 Preliminary ❑ Final
4c. If yes, who delineated the jurisdictional areas?
Name (if known): Phil May, Brian Smith
Agency /Consultant Company: Carolina Ecosystems, Inc.
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
Field verification with Andy Williams & Sue Homewood on 12/18/2012. Sites 16, 17, and 18 have been delineated since that verification.
5. Project History
5a. Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
El Yes ❑X No ❑ 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 ❑X Streams — tributaries ❑X 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
Choose one
Choose one
Yes /No
-
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:
1.35
2h. Comments:
See attached Table C.2. Wetland Impacts. Upon completion of the pipe installation, the wetland areas will be returned to original grade and seeded
with wetlands seed mix. All Nationwide 12 conditions will be implemented during construction. Directional drill or bore technology is not practical due
to the size of the line and depth of bedrock found during geotechnical investigations. Open cut construction will be accomplished when flow is minimal.
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
Choose one
S2
Choose one
S3
Choose one
S4
Choose one
S5
Choose one
S6
Choose one
3h. Total stream and tributary impacts
548
3i. Comments:
See attached Table C 3. Stream Impacts. Coffer dams and culverts will be installed prior to pipe installation. Upon completion of the pipe installation,
the stream will be restored to pre- construction grades and the stream banks will be stabilized.
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 indivii ually list all open water impacts below.
4a.
Open water
impact number
Permanent (P) or
Temporary T
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: NA
5. 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: NA
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 ZX Other:Jordan
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:
40,420
62,413
6i. Comments:
See attached Table C.6. Outfall will have 10' permanent maintenance corridor. Buffers will be returned to original grade & seeded.
Page 5 of 10

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
The sewer alignment was designed to avoid or minimize impacts to jurisdictional areas, and where feasible, manholes were placed outside of
jurisdictional areas All MHs on project will be water tight and MHs within 50' of streams and wetlands will have sealed joints and interior water proofing
to minimize leaks. At Site 5, the maintenance corridor was located at an area with more stable banks to avoid excessive stabilization measures being
necessary at the crossing. Stream crossings have been minimized to those required due to steep topography and other unavoidable constraints.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Best management practices and sedimentation and erosion control methods will be used during all construction techniques No equipment refueling or
maintenance activities will occur adjacent to jurisdictional areas. All temporary impacts to jurisdictional wetlands during construction activities will be
returned to their original configuration and seeded in a timely manner for stabilization. Stream crossings will be stabilized with riprap and fabric, and
permanent maintenance crossings will be at bed elevation, and will not block flow or aquatic passage.
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?
❑X Yes ❑ No
2b. If yes, mitigation is required by (check all that apply):
❑ DWQ ❑X Corps
2c. If yes, which mitigation option will be used for this
project?
❑ Mitigation bank
❑X 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.
❑X Yes
4b. Stream mitigation requested:
0 linear feet
4c. If using stream mitigation, stream temperature:
Choose one
4d. Buffer mitigation requested (DWQ only):
18,243 square feet
4e. Riparian wetland mitigation requested:
0.23 acres
4f. Non - riparian wetland mitigation requested:
0 acres
4g. Coastal (tidal) wetland mitigation requested:
0 acres
4h. Comments: Refer to Table C.2 Wetland Impacts (forested wetlands in permanent maintenance) and C.6. Buffer Impacts
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
❑X Yes ❑ No
buffer mitigation?
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.
6c.
6d.
6e.
Zone
Reason for impact
Total impact
Multiplier
Required mitigation
(square feet)
(square feet)
Zone 1
Non - perpendicular crossing
6,081
3 (2 for Catawba)
18,243
Zone 2
0
1.5
0
6f. Total buffer mitigation required:
40,671
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).
[AWAITING EEP RESPONSE BEFORE COMPLETING THIS ITEM]
Mitigation is proposed for non - perpendicular impacts to Zone 1 buffers at Sites 13, 14, 16, and 21 These impacts are unavoidable
6h. Comments: due to steep slopes and other constraints (houses and infrastructure) Site 16 is a non - perpendicular stream crossing, and the
angle is designed to minimize impacts to the adjacent wetland. B23b is associated with a sewer replacement with no change in use.
Page 7 of 10

E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1 a. 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.
No diffuse plan included since there is a negligible change to the impervious area during construction.
Manholes for less than 0 01% impervious increase. Stormwater be
❑ Yes ❑X No
will account area outfalls will not
constructed as part of this project and flow will be diffused through the forested areas adjacent to the
sewer corridor.
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project?
0.01%
2b. Does this project require a Stormwater Management Plan?
❑ Yes ❑X No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
Minimal impervious area is proposed General Certification 3884 does not require a SMP.
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
2e. Who will be responsible for the review of the Stormwater Management Plan?
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project?
❑ 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
❑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
❑X 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
❑X Yes ❑ No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
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
letter.)
❑X Yes ❑ No
Comments: FONSI Attached
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,
E] Yes ❑X No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after - the -fact permit application?
El Yes ❑X 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 ❑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.
Development within the service area is anticipated, however numerous mitigation measures are in place to protect water quality The potential
impacts of future development were described in the November 2013 EA for this project, as well as the EA for the TZ Osborne Water Reclamation
Facility. A complete analysis of the multiple federal, state, and local ordinances that are implemented in the service area was provided in the TZ
Osborne WRF EA and FONSI.
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.
Treatment will occur at the T.Z Osborne Water Reclamation Facility (TZO WRF) The facility is rated for 40 MGD with an average daily influent flow of
20 MGD. The Young's Mill Outfall (YMO) project will generate no additional flow to the TZO WRF initially, since the YMO is simply replacing a pump
station. However, year 2050 average flows from YMO are expected to approach 5 MGD. The TZO WRF is also expected to be expanded before
Y2050.
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
Yes X No
❑ ❑
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act
X Yes ❑ No
❑
impacts?
5c. If yes, indicate the USFWS Field Office you have contacted.
Raleigh
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
USFWS Website http. / /www.fws.gov /raleigh /species /cntylisVguilford.html, for Guilford County.
North Carolina Natural Heritage Program GIS data, and on -site habitat review and surveys for small whorled pogonia
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat?
❑ Yes ❑X No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
NOAA EFH mapper
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?
SHPO GIS database & consultation with SHPO. SHPO concurrence on the project is attached.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA- designated 100 -year floodplain?
❑X Yes ❑ No
8b. If yes, explain how project meets FEMA requirements:
Upon completion of the installation of the gravity sewer line, the project corridor will be returned to its original grade, therefore, no decrease in
floodplain capacity will occur from the proposed project Project will be reviewed by the local flood plain adminstrator.
8c. What source(s) did you use to make the floodplain determination?
2012 FEMA Map -
Applicant/Agent's Printed Name
Date
plicant/Agent's ignature
(Agent's nature is valid only if an authorization
I om the applicant is provided.)
Page 10 of 10

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Statement of Compliance with Session Law 2009 -337 An Act to Promote
the Use of Compensatory Mitigation Banks and SL 2011 -343.
(link to SL 2009- 337)"�' (link to SL 2011 -343)
Prior to accessing the Ecosystem Enhancement Program (EEP) In -Lieu Fee Mitigation
Program, all applicants requesting wetlands, stream and /or riparian buffer mitigation are now
required by law to comply with Session Law 2009 -337 An Act to Promote the Use of
Compensatory Mitigation Banks and Session Law 2011 -343. All requests submitted on or
after June 27, 2011 MUST include this form signed and dated by the permit applicant or an
authorized agent. Please refer to DENR's Implementation Policy for more detailed guidance.
Compliance Statement:
I have read and understand SL- 2009 -337 and SL- 2011 -343 and have, to the best of my
knowledge, complied with their requirements. I understand that participation in the
NCEEP is voluntary and subject to approval by permitting agencies.
Please check all that apply:
Applicant is a Federal or State Government Entity or a unit of local government
meeting the requirements set forth in G.S. 143 - 214.11 (as amended by SL 2011-
343) and is not required to purchase credits from a mitigation bank.
There are no listed mitigation banks with the credit type I need located in the
hydrologic unit where this impact will take place (link to DWR list)'
x Mitigation bank(s) in the hydrologic unit where the impacts will occur have been
contacted and credits are not currently available.
The DWR or the Corps of Engineers did not approve of the use of a mitigation
bank for the required compensatory mitigation for this project.
This is a renewal request and the permit application is under review. Bank
credits were not available at the time the application was submitted.
Enter date permit application was submitted for review:
Note: It is the applicant's responsibility to document any inquiries made to private mitigation
banks regarding credit availability.
I have read and understand EEP's refund policies (attached)
initial h e,
). )L_(O r(
Sign a re of Applica (r�Age Printed Name
Date
Young's Mill Outfall Guilford County
Project Name Location

0
NORTH CAROLINA ECOSYSTEM ENHANCEMENT PROGRAM, NCEEP
IN -LIEU FEE REQUEST FORM Revised 8/22/2013
Complete requested information, sign and date, email to kelly.williams ()ncdenr.gov . Attachments are acceptable for clarification
purposes (location map or lat long is required). Information submitted is subject to NC Public Records Law and may be requested
by third parties. Review meetings are held on Tuesday afternoons.
CONTACT INFORMATION APPLICANT'S AGENT APPLICANT
1. Business /Company Name ARCADIS City of Greensboro
2. Contact Person David A. Hamilton ,Melinda King
3. Street Address or P O Box 1 Centerview Dr., Suite 208 2602 S. Elm- Eugene Street
4. City, State, Zip Greensboro, NC 27407 Greensboro, NC 27406
5. Telephone Number .336- 292 -2271 336- 412 -6314 _
6.E -Mail Address uavid.Hamilton @arcadis - us.com Melinda.King @greensboro - nc.gov
PROJECT INFORMATION
7. Project Name Young's Mill Outfall
8. Project Location (nearest town, city) Greensboro
9. Lat -Long Coordinates or attach a map 36.037197 79.695197
10. County I Guilford
11. River Basin & Cataloging Unit (8- digit)
(See Note 1)
12. Project Type **specify owner type and
write in project type (e.g. school, church, retail,
residential SD, apartments, road, utilities,
military, etc.) * *__
13. Riparian Wetland Impact (ac.) (e.g., 0.13)
14. Non - Riparian Wetland Impact (ac.)
15. Coastal Marsh Impact (ac.)
16. Stream Impact (ft.) (e.g. 1,234)
17. Riparian Buffer Impact (sq. ft.)
Include subwatershed if Jordan or Falls Lake:
18. Regulatory Agency Staff Contacts
USA CE: Craig Brown
Check (4) below if this request is for a
revision to a current acceptance
renewal of an expired acceptance
Cape Fear 03030002
Owner Type: x Government
Project Type: utility
Private
0.23 acres
0
0
Warm Cool Cold _
0 0 0
Zone 1: 18, 243 Zone 2: 0
NCDWR: Sue Homewood
Other:
By signing below, the applicant is confirming they have'
read and understand EEP's r and p licy_posted_ at
i nceep.net_and tt ched to is _
Signat a pli ant o Aut orized Agent:
extension of unexpired acceptance —
D te: v
Note 1: For help in determining the Cataloging Unit, visit: www.nceeo.net or contact EEP
Direct questions to Kelly Williams at 919 - 707 -8915 or kellv.williamsno.ncdenr.gov or to EEP's front desk at 919 - 707 -8976

Refund Policv for Fees Paid to EEP's In -Lieu Fee Proqrams (9/21/2009
Purpose: The purpose of this policy is to make clear the circumstances and process under which a
permittee can obtain a refund while simultaneously balancing customer service and responsible
business practices. This policy applies to all refund requests made on or after the publication date of
this policy.
1. All refund requests must be made in writing to EEP's In -Lieu Fee Program Coordinator at
kelly.williams(a_ncdenr.gov.
2. All refund requests are subject to fund availability. EEP does not guarantee fund availability for
any request.
3. The request must either come from the entity that made the payment or from an authorized agent.
Third parties requesting refunds must provide written authorization from the entity that made the
payment specifying the name and address of the authorized refund recipient.
4. Refund requests related to unintended overpayments, typographical errors or incorrect invoices
should be brought the attention of the In -Lieu Fee Program Coordinator as soon as possible. Such
requests are typically approved without delay.
5. Payments made under EEP's incremental payment procedure are not eligible for refunds.
6. Refund requests made within nine months of payment to EEP will only be considered for requests
associated with projects that have been terminated or modified where the permittee's mitigation
requirements have been reduced. Such requests must be accompanied by written verification from the
permitting agency that the project has been cancelled, the permits have been rescinded or have been
modified, or the mitigation requirements have been reduced.
7. Refund requests made more than nine months from the payment date will only be considered for
permits that were terminated or modified to not require any mitigation. Such requests must be
accompanied by written verification from the permitting agency that the project has been cancelled, the
permits have been rescinded and /or mitigation is no longer required.
8. Refund requests not meeting the criteria specified above are not eligible for a refund.
9. Refund requests that meet the criteria above will be elevated to EEP Senior Management for
review. The following considerations apply to all refund requests:
a. availability of funds after consideration of all existing project and regulatory obligations
b. the date the payment was made
c. the likelihood EEP can use the mitigation procured using the payment to meet other
mitigation requirements
10. Once a refund has been approved, the refund recipient must provide a completed W -9 form to
EEP's In -Lieu fee Program Coordinator within two weeks in order to process the refund though the
State Controller's Office.
11. All decisions shall be final.

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