20160822 Ver 1_401 Application_20160816

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ENGINEERING
August 15, 2016
NC Division of Water Resources p 1 6 Q 8 2 2
401 & Buffer Permitting Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Re: Request for Section 401 Approval
Brushy Branch Sewer Project
City of Winston-Salem, Forsyth County, North Carolina
Karen Higgins:
1151 SE Cary Parkway, Suite 101
Cary, North Carolina 27518
[phone]
www.ecologicaleng.com
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D Q -WATER RESOURCES
401 & BUFFER PERMITTING
Ecological Engineering, LLP (Ecological Engineering), on behalf of Highfill Infrastructure, Inc. and the City
of Winston-Salem, respectfully requests project approval per Section 401 of the Clean Water Act for
impacts associated with the Brushy Branch Sewer Project. In accordance with environmental permitting
requirements, we have attached the following information to assist in your review of the project:
• Five copies of the completed Pre -Construction Notification;
• Five copies of the approved USACE Pre -JD;
• Five copies of the permit drawing denoting impacts to jurisdictional resources;
• Five copies of associated mapping with regards to the project area;
• Five copies of stream determination data forms;
• Five copies of the Agent Authorization Form;
• Check for Minor Water Quality Application Fee ($240.00).
Based on the limited permanent impacts from this project, one permanent stream impact (13LF) will
occur as part of the installation in the stream bed; no stream mitigation is being proposed. This stream is
perennial. Two areas of temporary impacts will occur from the removal of existing sewer pipes crossing
Brushy Branch.
If you have any questions or concerns regarding this submittal, please do not hesitate to contact me at
919.557.0929 or via email at [e-mail].
Sincerely,
Heather Smith
cc: Eddie Sasser, P.E., Highfill Infrastructure

O�'0,F NNNA�ATE9oG
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Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
R1[1@[R0W1MP
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Page 1 of 10
Pre -Construction Notification PCN Form
A. Applicant Information
1.
Processing
1 a.
Type(s) of approval sought from the
Corps:
Section 404 Permit Section 10 Permit
FEI ❑
1 b.
Specify Nationwide Permit (NWP) number: N/A or General Permit (GP) number: N/A
1 c.
Has the NWP or GP number been verified by the Corps?
® Yes
❑ No
1 d.
Type(s) of approval sought from the DWQ (check all that apply):
❑ 401 Water Quality Certification — Regular ❑ Non -404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
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 in -lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in -lieu
fee program.
❑ Yes
® No
1g.
Is the project located in any of NC's twenty coastal counties. If yes, answer 1h
below.
❑ Yes
® No
1 h.
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
® No
2.
Project Information
2a.
Name of project:
Upgrade of sewer line along Brushy Branch
2b.
County:
Forsyth
2c.
Nearest municipality / town:
Winston-Salem
2d.
Subdivision name:
not applicable
2e.
NCDOT only, T.I.P. or state
project no:
N/A
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).-
pplicable):3d.
Ron Hargrove Director City/County Utilities
3d.
Street address:
100 East First St.
3e.
City, state, zip:
Winston-Salem, NC 27101
3f.
Telephone no.:
[phone]
3g.
Fax no.:
N/A
3h.
Email address:
[e-mail]
R1[1@[R0W1MP
AM) 2z2016
Page 1 of 10

4.
Applicant Information (if different from owner)
4a.
Applicant is:
® Agent ❑ Other, specify:
4b.
Name:
Eddie Sasser
4c.
Business name
(if applicable):
Highfill Infrastructure Engineering, P.C.
4d.
Street address:
2703 Jones Franklin Rd. Suite 201
4e. City, state, zip:
Cary, NC 27518
4f.
Telephone no.:
[phone]
4g.
Fax no.:
n/a
4h.
Email address:
[e-mail]
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..-
o.:5f.
5f.
Fax no.:
5g.
Email address:
Page 2 of 10

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
Utility easement
1 b. Site coordinates (in decimal degrees):
Latitude: 36.113271 Longitude: - 80.210529
(DD.DDDDDD) (-DD.DDDDDD)
1 c. Property size:
3 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
Brushy Fork
proposed project:
2b. Water Quality Classification of nearest receiving water:
C
2c. River basin:
Yadkin
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 at the Project Site include maintained/ disturbed sewer easement. Land use in the Project Vicinity is
urban with some forested areas along stream corridor and housing surrounding the road frontage.
3b. List the total estimated acreage of all existing wetlands on the property:
Approximately 0 acres
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
Approximately 100 linear feet
3d. Explain the purpose of the proposed project:
To install a new sewer parallel to the existing one. The new alignment will be further from Brushy Fork than the existing
alignment.
3e. Describe the overall project in detail, including the type of equipment to be used:
Install new 20" pipe sewer parallel to the existing alignment. The new sewer will be further from Brushy Fork and will
have one stream crossing. Standard equipment, such as trucks, dozers and cranes will be used.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
®Yes El No El Unknown
project (including all prior phases) in the past?
Comments:
4b. If the Corps made the jurisdictional determination, what type
®Preliminary El Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas?
Agency/Consultant Company:
Name (if known): Heather Smith
Other: Ecological Engineering
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
SAW -2016-00369 2/23/2016
5. Project History
5a. Have permits or certifications been requested or obtained for
❑ Yes ® No ❑ Unknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project?
❑ Yes ® No
6b. If yes, explain.
Page 3 of 10

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
❑ Yes
❑ Corps
❑ No
❑ DWQ
W2 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W3 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W5 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W6 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
2g. Total wetland impacts
2h. Comments: N/A
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 F1 T
Sewer pipe
installation
Brushy Fork
® PER
❑ INT
® Corps
® DWQ
15
13
S2 ❑ P ® T
Sewer pipe
removal
Brushy Fork
® PER
❑ INT
® Corps
® DWQ
15
13
S3 ❑ P ® T
Sewer pipe
removal
Brushy Fork
® PER
❑ INT
® Corps
® DWQ
15
13
S4 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S5 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S6 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
3h. Total stream and tributary impacts
39
3i. Comments: Permanent impacts are the result of boring the sewer pipe under the stream but due to elevation requirements
a portion of the pipe will be visible within the stream bed. The temporary impacts are from the removal of two existing sewer
pipes. The stream will put back to existing surrounding elevation.
Page 4 of 10

4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list all open water impacts below.
4a.
4b.
4c.
4d.
4e.
Open water
Name of waterbody
impact number —
(if applicable)
Type of impact
Waterbody type
Area of impact (acres)
Permanent (P) or
Temporary T
01 ❑P❑T
02 ❑P❑T
03 ❑P❑T
04 ❑P❑T
4E Total open water impacts
4g. Comments:
5. 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
5E Total
5g. Comments:
5h. Is a dam high hazard permit required?
❑ Yes No If yes, permit ID no:
5i. Expected pond surface area (acres):
N/A
5j. Size of pond watershed (acres):
N/A
5k. Method of construction:
N/A
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? No (Yadkin)
❑ 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
im act
required?
B1 ❑P❑T
El Yes
❑ No
B2 ❑P❑T
El Yes
❑ No
B3 ❑P❑T
El 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.
The sewer alignment has been placed further from the jurisdictional resources and is only crossing the stream once in order to
connect into an existing sewer line that crosses over Bowen Blvd.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Best Management Practices for Protection of Surface Waters and sediment and erosion control measures will be
implemented.
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
E:1 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:
4c. If using stream mitigation, stream temperature:
❑ warm ❑ cool ❑cold
4d. Buffer mitigation requested (DWQ only):
square feet
4e. Riparian wetland mitigation requested:
acres
4f. Non -riparian wetland mitigation requested:
acres
4g. Coastal (tidal) wetland mitigation requested:
acres
4h. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 6 of 10

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 ® 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
Comments:
2.
Stormwater Management Plan
2a.
What is the overall percent imperviousness of this project?
0 acres
2b. Does this project require a Stormwater Management Plan?
❑ Yes ® No
2c.
If this project DOES NOT require a Stormwater Management Plan, explain why:
There is no additional impervious area associated with this project and the disturbed area will be brought back to original
grade once the sewer pipe has been buried.
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?
❑ DWQ Stormwater Program
❑ DWQ 401 Unit
3.
Certified Local Government Stormwater Review
3a.
In which local government's jurisdiction is this project?
Not applicable
❑ Phase II
3b.
Which of the following locally -implemented stormwater management programs
❑ NSW
El 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

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
❑ 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
F1 Yes
❑ No
letter.)
Comments: Not applicable
2.
Violations (DWQ Requirement)
2a.
Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards,
❑ Yes
® No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b.
Is this an after -the -fact permit application?
❑ Yes
® No
2c.
If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3.
Cumulative Impacts (DWQ Requirement)
3a.
Will this project (based on past and reasonably anticipated future impacts) result in
❑ Yes
® No
additional development, which could impact nearby downstream water quality?
3b.
If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
4.
Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non -discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
Not applicable
Page 9 of 10

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species
® Yes ❑ No
or habitat?
5b. Have you checked with the USFWS concerning Endangered Species
❑ Yes ® No
Act impacts?
El 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?
NC Natural Heritage Program, USFWS website, and field surveys during the optimal survey window. The Cardamine
micranthera (Small-anthered bittercress) was determined to have no effect so no concurrence is required from USFWS
and an effect determination is not required for the Glyptemys muhlenbergii (Bog turtle). Please find attached NLEB 4(d)
Rule Streamlined Consultation Form for the northern long-eared bat compliance.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish
❑ Yes ® No
habitat?
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
NOAA Essential Fish Habitat 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?
State Historic Preservation Office, see attached letter.
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: A No -Rise determination was submitted to Matthew Osborne of
City of Winston Salem in August 2016.
8c. What source(s) did you use to make the floodplain determination? FEMA Maps/ NC Floodplain Mapping Program and No -
Rise study conducted by Ecological Engineering and submitted to the City of Winston Salem in August 2016.
Heather Smith
[A--
2016-8-15
Date
Applicant/Agent's Printed Name
Applicant/Agent's Signature
(Agent's signature is valid only if an authorization letter from the applicant is
provided.)
Page 10 of 10

U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id. SAW -2016-00369 County: Forsyth U.S.G.S. Quad: NC -WINSTON-SALEM EAST
Property Owner:
Address:
Telephone Number:
NOTIFICATION OF JURISDICTIONAL DETERMINATION
Winston-Salem /Forsyth County Utilities
Ron Hararoye
100 East 1st Street, Suite 407
Winston-Salem, NC, 27101
336 747-7312
Size (acres) 3
Nearest Waterway Brushy Fork
USGS HUC 03040101
Nearest Town Winston-Salem
River Basin Upper Yadkin
Coordinates Latitude: 36.11672
Longitude: -80.21122
Location description: Brushy Fork Branch sewer easement located off of New Walkertown Road (US 311), adjacent to
Brushy Fork Branch, in Winston-Salem, Forsyth County, North Carolina.
Indicate Which of the Following Apply:
A. Preliminary Determination
X Based on preliminary information, there may be waters of the U.S. including wetlands on the above described project area
. We strongly suggest you have this property inspected to determine the extent of Department of the Army (DA)
Jurisdiction. To be considered final, a jurisdictional determination must be verified by the Corps. This preliminary
determination is not an appealable action under the Regulatory Program Administrative Appeal Process (Reference 33
CFR Part 331). ff you wish, you may request an approved JD (which may be appealed), by contacting the Corps district
for further instruction. Also, you may provide new infonnation for further consideration by the Corps to reevaluate the
JD.
B. Approved Determination
There are Navigable Waters of the United States within the above described project area subject to the permit requirements
of Section 10 of the Rivers and Harbors Act and Section 404 of the Clean Water Act. Unless there is a change in the law
or our published regulations, this determination may be relied upon for a period not to exceed five years from the date of
this notification.
There are waters of the U.S. including wetlands on the above described project area subject to the permit requirements of
Section 404 of the Clean Water Act (CWA)(33 USC § 1344). Unless there is a change in the law or our published
regulations, this determination may be relied upon for a period not to exceed five years from the date of this notification.
_ We strongly suggest you have the waters of the U.S. including wetlands on your project area delineated. Due to the
size of your property and/or our present workload, the Corps may not be able to accomplish this wetland delineation in a
timely manner. For a more timely delineation, you may wish to obtain a consultant. To be considered final, any
delineation must be verified by the Corps.
_ The waters of the U:S. including wetlands on your project area have been delineated and the delineation has been
verified by the Corps. We strongly suggest you have this delineation surveyed. Upon completion, this survey should be
reviewed and verified by the Corps. Once verified, this survey will provide an accurate depiction of all areas subject to
CWA jurisdiction on your property which, provided there is no change in the law or our published regulations, may be
relied upon for a period not to exceed five years.
Page 1 of 2

_ The waters of the U.S. including wetlands have been delineated and surveyed and are accurately depicted on the plat
signed by the Corps Regulatory Official identified below on . Unless there is a change in the law or our published
regulations, this determination may be relied upon for a period not to exceed five years from the date of this notification.
There are no waters of the U.S., to include wetlands, present on the above described project area which are subject to the
permit requirements of Section 404 of the Clean Water Act (33 USC 1344). Unless there is a change in the law or our
published regulations, this determination may be relied upon for a period not to exceed five years from the date of this
notification.
The property is located in one of the 20 Coastal Counties subject to regulation under the Coastal Area Management Act
(CAMA). You should contact the Division of Coastal Management in Morehead City, NC, at [phone] to
determine their requirements.
Placement of dredged or fill material within waters of the US and/or wetlands without a Department of the Army permit may
constitute a violation of Section 301 of the Clean Water Act (33 USC § 1311). If you have any questions regarding this
detennination and/or the Corps regulatory program, please contact John Thomas at 919-554-4884 x25 or
John.T.Tho mas.JRQusace.a rmy. mil.
C. Basis For Determination: site includes tributaries of Brushy Fork Branch which flows to the Yadkin River and
on to the Atlantic Ocean.
D. Remarks:
E. Attention USDA Program Participants
This delineation/determination has been conducted to identify the limits of Corps' Clean Water Act jurisdiction for the
particular site identified in this request. The delineation/determination may not be valid for the wetland conservation
provisions of the Food Security Act of 1985. If you or your tenant are USDA Program participants, or anticipate participation
in USDA programs, you should request a certified wetland determination from the local office of the Natural Resources
Conservation Service, prior to starting work.
F. Appeals Information (This information applies only to approved jurisdictional determinations as indicated in
B. above)
This correspondence constitutes an approved jurisdictional determination for the above described site. If you object to this
determination, you may request an administrative appeal under Corps regulations at 33 CFR Part 331. Enclosed you will find a
Notification of Appeal Process (NAP) fact sheet and request for appeal (RFA) form. If you request to appeal this
determination you must submit a completed RFA form to the following address:
US Army Corps of Engineers
South Atlantic Division
Attn: Jason Steele, Review Officer
60 Forsyth Street SW, Room i OM 15
Atlanta, Georgia 30303-8801
In order for an RFA to be accepted by the Corps, the Corps must determine that it is complete, that it meets the criteria for
appeal under 33 CFR part 331.5, and that it has been received by the Division Office within 60 days of the date of the NAP.
Should you decide to submit an RFA form/it must be received at the above address by 4/23/2016.
**It is not necessary to submit an R on
correspondence.* *
Cotes Regulatory Official:
Date: Fel
NC 27518
to the Divoion Office i4ou do not object to the determination in this

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Project Area
X17. 4 ' S Qj •�''.� R -43A 40
Prepared By:
USGS Vicinty Map
Brushy Fork- Sewer Upgrade N
Highfill Infrastructure ° �rc 1,000 E
&OG
WG /r, Forsyth County -,,000�1�.•�jV 2013 Winston-Salem East S
USGS Quadrangle

-41
71.
SBB 31 (END)
Legend
$ower B�V� 5
I 50 -foot Wide Study Corridor
r m Streams
Intermittent
Perennial
Brushy Branch runs outside the
k. iSBB-1 6v% N_ eastern edge of the study corridor.
Stream was flagged in areas it
r ,h
• � ►� �intersected t study corridor.
I AK
414 =4
-t
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i" — �!' � r wr>� �v F -M� s, t'•� 1 +R' � • -may S - .
SEE_ I ( ;
_
40
7.
gy
Prepared By:
Streams Map
Brushy Fork- Sewer Upgrade 0 400 800
Highfill Infrastructure
ECOLOGICAL Forsyth County V=409
ENGINEERING Aerial NC OneMap

NC DWO Stream Identification Form Verstn„ A 11
Date:
ProlectlSife: �r
Latttude: M I 1 1
Evaluator: - l
Strong
County- a
Longitude: - so ern
Points:
Total If-
Stream is et lnfermlttenf 0?m�
Stream Determination (circle one)
Ephemeral I ent Perennial
Qthers-p -Cq
e.g. Quad Name:
i9 or erennialfPz 3d
Perennial
.
17. Soil -based evidence of high water table?
A. Geomorphology Subtotal = (
Absent
Weak
Moderate
Strong
18, Continuity of channel bed and bank
0
1 0.5
2
15. Sediment on plants pr debris
16. Organic debris lines or piles
2. Sinuosity of channel along thalweg
0
17. Soil -based evidence of high water table?
2
3
3. In -channel structure: ex. riffle -pool, step -pool,
12 le- of sequence
0
1
1
3
4. Particle size of stream substrate
1 0
1
1.5
3
5. Active/rellct floodplain
1
1
2
3
6. Deposit<orial bars or benches
0
26. Wetland plants In streambed
2
3
7. Recent alluvial deposfts
0
2
3
8. Headcu s
0
2
3
9. Grade control
0
0.5
Sketch:
1.5
10. Natural valley
0
0.5
1.5
11. Second or greater order channel
NO
Yes = 3
artMcial ditches are not rated; see discussions In manual
B. Hvdroloav !Subtotal = !;a Cl }
12. Presence of Baseflow
0 1 2
a>
13. Iron oxidizing bacteria
1 2
3
14. Leaf litter
1 0.5
0
15. Sediment on plants pr debris
16. Organic debris lines or piles
0 0. 1
0 1
1.5
1.5
17. Soil -based evidence of high water table?
No Yes = 3
2
U. MOIOCIV {Subtotal = I`n }
18. Fibrous roots In streambed
2
1
0
19. Rooted upland plants In streambed
2
1
0
20. Macrobenthos (note diversity and abundance) ®
1
2
3
21. Aquatic Mollusks 0
1
2
3
22. Fish
0.5
1
1.5
23. Crayfish
0.5
1
1.5
24. Amphibians
0.5
1
1.5
25. Algae Qt>
0.5
1
1.5
26. Wetland plants In streambed
FACW - 0.75; OBL =1.5
Other
*perennial streams may also be Identilled using other methods. See p. 35 aF manual.
Notes:
Sketch:
,

NL D W Q Stream Identlfcation !Form Version 4.11
Date: �.� S P.roject/Site: yJ "� Latitude:,36. {)
Evaluator: .�,•� County: Longitude: -so--71.-06
YY�t
Total Points: Stream Determination (circ one) Qther 56G •-S
Sa 19 or atteast1-1f r! rlittenf � Ephemeral Intermittent . ere Ial e.g. Quad Name:
ff219 of erenntat Ifs 30`
A. Geomorphology (Subtotal - �f
Absent
Weak
Moderate
Strong
1' Continuity of channel bed and bank
p
1
2
15. Sediment on plants pr debris
2. Sinuosity of channel along thalweg
0
1
2
QV
3. In -channel structure: ex. riffle -pool, step -pool,
ri e- ool sequence
0
1
2
�'^ti
CD
4. Parade size of stream substrate
p
1
2
24. Amphibians 0
5. Active/relict iioodplaln
0
1
2
0.5
6. Depositlorial bars or benches
0
1
2
Other
7. Recent alluvial deposits
0
1
3
8. Headcuis
0
2
3
8. Grade control
0
0.5
1
1 D6
10. Natural valley
0
0.5
1
11. Second or greater order channel
No = 0
Ye =
urujICi1a1 alu rm are noT ratea; see aiscusslons In manual _
B. Hvdroloav (Atthtntal = It ri. C' 1
12. Presence of Baseflow
0 1
2 3
13. Iron oxidizing bacteria
1
2 3
14. Lest litter
1
0.5 0
15. Sediment on plants pr debris
0 0.5
1
16.4 anic debris lines or piles
0' 0.5
1
17. Soli -based evidence of high water table?
No = 0
y
U- M10I00V t51fMnta1 = x 1
18. Fibrous roots In streambed
2
1
0
19. Rooted upland plants in strearnbed
2
1
0
20. Macrobenthos (note diversity and abundance)
1
2
3
21. Aquatic Mollusks
1
2
3
22. Fish
1
1.5
23. Crayfish 0
O.V
1
1.5
24. Amphibians 0
0.5
1.5
25. Algae
0.5
1
1.5
26. Wetland plants In streambed
FACW = 0.75; OBL -1.5
Other
"perennial streams may also be identified using other methods. See p. 35 of manual.
Notes:
Sketch:

NC DWO Stream identification Form Vercin„ d 11
Date: j - .r
Praject/Site: r,)SI/ „
Latitude: 1 `
Evaluator:
County:
Lof:gitude:
Total Points:
Stream is at feast lntOAMIttent
Stream Determination (eircle one)
Ep3temeral intermittent P en ' 1
Other
e.g. Ll§C--
Name: v
ifa 19 arrennW-If 30*
.
0
A. Geomorphology (Subtotal=
Absent
Weak
Moderate
Strong
12L Confinuity of channel bed and bank
0
1
2
01 0.5 1 ' 1.
2. Sinuosity of channel along thdM
0
1
2
3
3. In -channel structure: ex riffle -pool, step -pool,
ripple -pool sequence
0
1
2
3
4. Particle size of stream substrate
0
1
2
1.5
5. Activelrelict floodplain
0
1
1
3
B. Depositiorial bars or benches
0
i
1
3
7. Recent alluvial deposits
0
1
1
3
8. Head"
0
1
Other
3
.9. Grade control
0
0,5
1
Notes:
10. Natural valley
0
0.5
1
1.
11. Second or greater order channel
No 0
Yes
Sketch:
artlflcial ditches are not rated; see dfamssfans In manual
B. Hydrolocly (Subtotal = ) C 1
12. Presence of Baseflow
0 1 2
13. Iron oxidizing bacteria
1 2 3
14. Leaf litter
1 0.5 0
15. Sediment on plants or debris
0 0.5 1.5
16.Organic debris fines or piles
01 0.5 1 ' 1.
17. Soll-based evidence of high water table?
No = 0 Yes -
C. Bioloov (Subtotal= ' + 1
18. Fibrous roots In streambed
2
1
0
19. Rooted upland.plants In streambed
2
1
0
20. Macrcbenthos (nota dfversity and abundance)
1
2
3
21. Aquatic Mollusks
QA
1
2
3
22. Fish
0
1
1.5
23. Crayffsh
0.5
1
1.5
24. Amphibians
0
1
1.5
25.8LcLae
0.5
1
1.5
26. Wetland plants in streambed
FACW = 0.75; OBI_ 1.5
Other
"perennial streams may also be Identified using other methods. See p. 35 of manual.
Notes:
Sketch:
,

AGENT AUTHORIZATION FORM
City of Winston-Salem
Project Name: Brushy Branch Sewer Replacement
Project Location: New Walkertown Rd., Winston-Salem, NC
Date: November 2015
The City of Winston-Salem, undersigned, does hereby authorize:
The Professional Engineers and Scientists Ecological Engineering, LLP
of
(Contractor / Agent)
(Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of this
permit or certification and any and all standard and special conditions attached.
City of Winston Salem
100 East First St.
Winston-Salem, NC 27101
[phone]
I hereby certify the above information submitted in this application is true and accurate to the
best of my knowledge.
116 Harg e
Director City/County Utilities
P y3 /ti
Me