20170189 Ver 1_401 Application_20170217

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Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
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
$ 8
1b. Specify Nationwide Permit (NWP) number: NWP 39 or General Permit (GP) number:
1 c. Has the NWP or GP number been verified by the Corps?
® Yes
❑ No
1d. 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
1 e. 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
1 g. 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:
WFIQ Rail Trail South
2b. County:
Forsyth
2c. Nearest municipality / town:
Winston-Salem
2d. Subdivision name:
2e. NCDOT only, T.I.P. or state
project no:
3 2Q17
101
3. Owner Information 'W
R R
3a. Name(s) on Recorded Deed:
NCDOT & WFIQ Holdings, LLC
M
3b. Deed Book and Page No.
003222/00961 & 003120/03159
3c. Responsible Party (for LLC if
applicable):
Mr. Allan Paul & Mr. Eric Tomlinson
3d. Street address:
See Attached Agent Authorizations
3e. City, state, zip:
3f. Telephone no.:
3g. Fax no.:
3h. Email address:
Page 1 of 12
PCN Form — Version 1.3 December 10, 2008 Version

4. Applicant Information (if different from owner)
4a. Applicant is:
❑ Agent ® Other, specify: One of Two LOs is Applicant
4b. Name:
Mr. Eric Tomlinson
4c. Business name
(if applicable):
WFIQ Holdings, LLC
4d. Street address:
575 North Patterson Avenue
4e. City, state, zip:
Winston -Salem, North Carolina 27101
4f. Telephone no.:
336.716.4903
4g. Fax no.:
336.777.3260
4h. Email address:
[e-mail]
5. Agent/Consultant Information (if applicable)
5a. Name:
Bradley S. Luckey
5b. Business name
(if applicable):
Pilot Environmental Inc.
5c. Street address:
PO Box 128
5d. City, state, zip:
Kernersville, NC 27285
5e. Telephone no.:
336.708.4997
5f. Fax no.:
5g. Email address:
[e-mail]
Page 2 of 12
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):
6835-36-8505 & 6835-36-7601
1b. Site coordinates (in decimal degrees):
Latitude: 36.09786 Longitude: - 80.23951
(DD.DDDDDD) (-DD.DDDDDD)
1 c. Property size:
NA -linear project 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:
Class 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:
The project area consists of a limited area of un -piped stream channel (see attached photograph). Existing 72" and 78"
CMPs accommodate stream flow. Several other storm drainage culverts discharge to the open stream. The majority of
the other storm drainage culverts discharge from perched locations, resulting in additional erosion and sedimentation to
the other stream. The project area is located in an urban and downtown area of Winston-Salem, North Carolina. The
project area is located beneath and proximate to the WFIQ Rail Trail South, commercial/industrial buildings, parking lots,
Fogle Street NW, East Third Street and pedestrian walkways/sidewalks associated with WFIQ Rail Trail and other
downtown features.
3b. List the total estimated acreage of all existing wetlands on the property:
0
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
—55
3d. Explain the purpose of the proposed project:
The purpose of the proposed project is to improve storm drainage infrastructure to reduce flooding potential and enhance
safe pedestrian travel in an urban, downtown area of Winston-Salem, North Carolina.
3e. Describe the overall project in detail, including the type of equipment to be used:
The overall project consists of the installation of 48 linear feet of box culvert and two concrete junction boxes within the
limited area of open stream channel. The junction boxes will accommodate numerous other storm drainage culverts.
The box culvert will connect to the existing 72" and 78" CMPs. Following installation of the box culvert and junction
boxes, the grade will be raised approximately 15 feet, consistent with existing topography within the vicinity of the
proposed project area. To facilitate installation of the box culvert and junction boxes, excavators, cranes and other heavy
machinery will be used. Vegetation removal is not necessary for the installation of the box culvert or junction boxes.
Page 3 of 12
PCN Form — Version 1.3 December 10, 2008 Version

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?
El Yes El No ®Unknown
Comments: We are not aware of requests for JDs. However,
it is our understanding that USACE representatives have
previously conducted a field visit to the project area.
4b. If the Corps made the jurisdictional determination, what type
El Preliminary El Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas?
Name (if known): The site has not been delineated. PEI
Agency/Consultant Company:
visited the site on 2.9.17 to document potential adjacent
Other:
wetlands. Wetlands are not located adjacent to the stream
(attached data form)
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
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.
A NWP Verification (SAW -2010-01491) was issued on 9.7.10 to permanently fill 75 linear feet of stream channel between
two existing culverts. It is our understanding that this NWP Verification was related to the WFIQ Rail Trail. We are not
aware of other permits or certifications being issued for the WFIQ Rail Trail.
6. Future Project Plans
6a. Is this a phased project?
❑ Yes ® No
6b. If yes, explain.
Future impacts to streams/wetlands, outside of those proposed in this appilication, are not anticipated as a result of the
proposed project.
Page 4 of 12
PCN Form — Version 1.3 December 10, 2008 Version

C. Proposed Impacts Inventory
1. Impacts Summary
1a. 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
W4 ❑ 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: Wetland impacts are not proposed.
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
Culvert/Fill
Unnamed
® PER
❑ INT
® Corps
❑ DWQ
8
55
S2 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S3 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S4 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S5 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S6 ❑ P ❑ T
[-IPER
E] Corps
❑ INT
❑ DWQ
3h. Total stream and tributary impacts
55
3i. Comments: The proposed project will permanently impact 55 linear feet of perennial stream channel. Temporary impacts
to streams are not proposed.
Page 5 of 12
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 ❑P❑T
02 ❑P❑T
03 ❑P❑T
04 ❑P❑T
4f. Total open water impacts
4g. Comments: Open water impacts are not proposed.
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: Construction of ponds/lakes are not proposed.
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 El 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❑T
F-1 Yes
❑ No
B2 ❑ P ❑ T
❑ Yes
❑ No
B3 ❑P❑T
El Yes
❑ No
6h. Total buffer impacts
6i. Comments: Riparian buffer impacts are not proposed.
Page 6 of 12
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.
Due to the nature of the purpose and need of the proposed project, it is not practical to avoid impact to any portion of the open
stream channel within the project area. However, the proposed impact is to a significantly degraded, impaired and urban
stream that provides little to no aquatic or hydrologic function or quality. Additionally, the proposed stream impact is likely to
reduce sedimentation, contaminants and other adverse water quality parameters from negatively contributing to down -gradient
water quality due to the elimination of several perched stormwater drainage culverts and the reduction of surface water from
nearby impervious surfaces continuing to severely erode the portion of open stream channel.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Sand bags will be placed on either end of the impact area within the existing culverts. Water will be pumped from the
construction area and up -gradient of the construction area to a down -gradient junction box/manhole. The proposed work will
be completed in the dry. Best management practices will be used.
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
ElPayment 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:
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 7 of 12
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 12
PCN Form — Version 1.3 December 10, 2008 Version

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: It is not located in an arrea with regulated riparian buffers.
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: The proposed project will not create
impervious surfaces. It is our understanding that the overall project, other portions of overall project and/or this portion of
the project either have a previously approved stormwater management plan or are exempt from stormwater management
as outlined by NCDEQ.
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?
❑ Phase II
❑ NSW
3b. Which of the following locally -implemented stormwater management programs
❑ 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 9of12
PCN Form — Version 1.3 December 10, 2008 Version

F. Supplementary Information
1.
Environmental Documentation (DWQ Requirement)
1a.
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)?
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.)
❑ Yes
® No
Comments: We are not aware of a NEPA or SEPA being required for the proposed
project.
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.
We are not aware of additional development that will impact nearby downstream water quality.
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 not be generated by the proposed project.
Page 10 of 12
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?
PEI consulted the USFWS List of Protected Species for Forsyth County, the county that contains the project. The
USFWS identifies the following protected species in Forsyth County: bog turgle, northern -long eared bat (NLEB) and
small anthered bittercress. Based on our site observations, suitable habitat of these species are not present within the
project area. Therefore, we have made a determination of no effect for these species.
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?
Based on our knowledge of the site, the site is not located in or near an area designated as essential fish habitat. Best
management practices and the use of temporary sediment and erosion control devices will prevent sediment from entering
down -gradient waterbodies which may contain fish.
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?
According to the NC SHPO Historic Properties website (attached), eligible or listed resources are not located within the
proposed project area. The Winston-Salem Tobacco District (FY3151) and S.J. Nissan Building (FY0753) are identified
as listed properties located northwest of the project area. Additionally, Patterson -Fogle Streets Durax Painting (FY3901)
is identified as a surveyed only property west of the proposed project area.
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA -designated 100 -year floodplain?
F[_1 Yes ® No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination? FEMA FIRM 3710863500J (attached)
Digitally signed by Bradley S. Luckey
DN: cn=Bradley S. Luckey, o=Pilot
Environmental, Inc., ou,
Bradley S. Luckey
email=[e-mail], c=US
2.10.17
J Date: 2017.02.1014:55:57 -05'00'
Applicant/Agent's Printed Name
Date
Applicant/Agent's Signature
(Agent's signature is valid only if an authorization letter from the applicant
isprovided.)
Page 1 1 of 12
PCN Form — Version 1.3 December 10, 2008 Version

AGENT AUTHORIZATION
This form authorizes PEI to act as our agent in stream/wetland matters including U.S. Army
Corps of Engineers and North Carolina Division of Water Resources field verification and
permitting.
Property Address:
Owner Information:
Address:
Telephone Number:
Fax Number:
412 E Third Street
Winston-Salem, NC 27101
WFIQ Holdings, LLC
575 N. Patterson Avenue, Suite 550
Winston-Salem, NC 27101
336-716-4903
336-777-3260
E-mail Address: [e-mail]
JURISDICTIONAL DETERMINATION REQUEST
SECTION D -PROPERTY OWNER CERTIFICATION
I, the undersigned, a duly authorized owner of records of the property/properties identified
herein, do authorize representatives of the Wilmington District, U.S. Army Corps of Engineers
(Corps) to enter upon the property herein described for the purpose of conducting on-site
investigations and issuing a determination associated with Waters of the U.S. subject to Federal
jurisdiction under Section 404 of the Clean Water Act and/or Section 10 of the Rivers and
Harbors Act of 1899.
Eric Tomlinson, PDs, PhD
Property Owner (please print)
Property Owner Signature
� - ► 3--1'1
Date

AGENT AUTHORIZATION
This form authorizes PEI to act as our agent in stream/wetland matters including U.S. Army
Corps of Engineers and North Carolina Division of Water Resources field verification and
permitting.
Property Address: +Is E. YI+i�_7 S-TziA�.j
w,P57oN—s^L..eM dNc 2i to
Owner Information: N(; pep" &(ftS ti OfRAi1L, 7���4ti5i�t�i
Address: S WiL►MlkjG V-1
1553 MAIL 5ERJit.E GE0-rf;'i-
VA L61'6,14 ,ML 1_1"Ot 1653
Telephone Number: (R (q } 0"7 t_1 i 2
Fax Number: (IlR� -115 — 658
E-mail Address: kctip"( Q. AC80+. �od
JURISDICTIONAL DETERMINATION REQUEST
SECTION D -PROPERTY OWNER CERTIFICATION
I, the undersigned, a duly authorized owner of records of the property/properties identified
herein, do authorize representatives of the Wilmington District, U.S. Army Corps of Engineers
(Corps) to enter upon the property herein described for the purpose of conducting on-site
investigations and issuing a determination associated with Waters of the U.S. subject to Federal
jurisdiction under Section 404 of the Clean Water Act and/or Section 10 of the Rivers and
Harbors Act of 1899.
Cu
ProperZ00wnerple int)
P operty Owner Signature
� /-/.7
Date

rv� 601 N. TRADE STREET, SUITE 200 date: 1/31/2017 job #: 12-085
S ti� I e WINSTON-SALEM, N 27101 ro ect: WFIQ RAIL TRAIL SOUTH
www.stimmelpa.com 336.723.1067 p
LANDSCAPE ARCHITECTURE CIVIL ENGINEERING LAND PLANNING scale: 1°=20' sheet 1 of 1
description: STREAM IMPACT EXHIBIT
EXHIBIT
�
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12'X11' CONCRETE I.D.
JUNCTION BOX
WITH 5' MANHOLE RISER,
RING AND COVER 1
RIM 854.81
\ 5
INV: 834.07
50 659 _
STREAM IMPACT: 55'
Z99 _
860
855
850
12'X11' CONCRETE
845 JUNCTION BOX
WITH 5' MANHOLE
RISER
RIM 854.8±
INV: 834.07
840
EXISTING 72" CMP
835
830
\�
9
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84 9
6
PROPOSED
GRADE
i
Tom) 6'(H) Box \
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4.17% \\ \
/ \
\ _
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X11 CONCR
UNCTION BOX WITH 5' MANHOLE
MISER, RING AND COVER,
AND USF 3220 RING AND 5660
RATE OR APPROVED EQUAL.
RIM 852.4±
91 INV: 832.07
\PROVIDE BLOCKOUT FOR
FUTURE 84"0 RCP
860
PROFILE SCALE
HORIZ. V=40'
VERT. 1"=5' 1 855
850
EX. GRADE
845
8'X11' CONCRETE
JUNCTION BOX
WITH 5'
MANHOLE RISER
RIM 852.4± 840
INV: 832.07
EXISTING'78" CI MP
1+00 1
835
830

SITE PHOTOGRAPHS
Photograph 1 - View of Project Area.

WETLAND DETERMINATION DATA FORM — Eastern Mountains and Piedmont
Project/Site: WFIQ City/County: WS/Forstyh Sampling Date: 2.9.17
Applicant/Owner: State: North Carolina Sampling Point:_
Investigator(s): Luckey, PEI Section, Township, Range:
Landform (hillslope, terrace, etc.) Swale Local relief (concave, convex, none):
Slope (%): 2 Lat: Long: Datum:
Soil Map Unit Name: NWI Classification:
Are climatic / hydrologic conditions on the site typical for this time of year? Yes X No (If no, explain in Remarks.)
Are Vegetation X , Soil , or Hydrology significantly disturbed? Are "Normal Circumstances' present? Yes X
Are Vegetation , Soil , or Hydrology naturally problematic? (If needed, explain any answers in Remarks.)
No
,UMMAKT OF FIIVumub — Attacn site map snowing sampling point locations, Transects, Important Teatures, etc.
Hydrophytic Vegetation Present? Yes No X
Is the Sampled Area
Hydric Soil Present? Yes No X within a Wetland? Yes No X
Wetland Hydrology Present? Yes No X
Remarks:
Vegetation is absent within the data point area due to recent construction activities
HYDROLOGY
Wetland Hydrology Indicators:
Secondary Indicators (minimum of two reguired)
Primary Indicators (minimum of one is required: check all that apply)
Surface Soil Cracks (136)
_ Surface Water (Al)
_
True Aquatic Plants (614)
Sparsely Vegetated Concave Surface (BB)
_ High Water Table (A2)
_ Hydrogen Sulfide Odor (Cl) _
Drainage Patterns (810)
_ Saturation (A3)
Oxidized Rhizospheres on Living Roots (C3)
Moss Trim Lines (B16)
_ Water Marks (B1)
_ Presence of Reduced Iron (C4) _
Dry -Season Water Table (C2)
_ Sediment Deposits (132)
_ Recent Iron Reduction in Tilled Soils (C6) _
Crayfish Burrows (C8)
_ Drift Deposits (133)
Thin Muck Surface (C7) _
Saturation Visible on Aerial Imagery (C9)
_ Algal Mat or Crust (134)
_ Other (Explain in Remarks) _
Stunted or Stressed Plants (D1)
_ Iron Deposits (135)
Geomorphic Position (D2)
_ Inundation Visible on Aerial Imagery (137)
_
Shallow Aquitard (D3)
_ Water -Stained Leaves (139)
_
Microtopographic Relief (D4)
Aquatic Fauna (1313)
_
FAC -Neutral Test (D5)
Field Observations:
Surface Water Present? Yes No X
Depth (inches):
Water Table Present? Yes No X
Depth (inches):
Wetland Hydrology
Present? Yes No X
Saturation Present? Yes No X
Depth (inches):
_
(includes capillary fringe)
Describe Recorded Data (stream gauge, monitoring well, aerial photos, previous inspections), if available:
Remarks:

VEGETATION (Four Strata) - Use scientific names of plants.
Sampling Point
Remarks: (Include photo numbers here or on a separate sheet.)
Vegetation is absent due to construction activities.
Dominance Test worksheet:
Absolute Dominant Indicator
Tree Stratum
(Plot size: 30' )
% Cover Species? Status
Number of Dominant Species
1. None Observed
That Are OBL, FACW, or FAC: (A)
2.
3
Total Number of Dominant
Species Across All Strata: (B)
4
5.
Percent of Dominant Species
6
That Are OBL, FACW, or FAC: (A/B)
7.
8.
Prevalence Index worksheet:
= Total Cover
Total % Cover of: Multiply by:
OBL species x 1 =
Sapling/Shrub Stratum
(Plot size: 30' )
FACW species X2=
1. None Observed
FAC species X3=
2.
FACU species X4=
3
4
UPL species X5=
5
Column Totals: (A) (B)
6.
7.
Prevalence Index = B/A =
8.
Hydrophytic Vegetation Indicators:
9•
_ 1 - Rapid Test for Hydrophytic Vegetation
2 - Dominance Test is > 50%
10.
= Total Cover
_
3 - Prevalence Test is <— 3.0'
- Morphological Adaptations' (Provide supporting
Herb Stratum
(Plot size: 30' )
_4
data in Remarks or on a separate sheet)
1. None Observed
Problematic Hydrophytic Vegetation' (Explain)
2
_
3.
'Indicators of hydric soil and wetland hydrology must
4
be present, unless disturbed or problematic.
5.
Definitions of Vegetation Strata:
6.
7.
8,
Tree — Woody plants, excluding vines, 3 in. (7.6 cm)
g
or more in diameter at breast height (DBH),
regardless of height.
10.
11.
Sapling/Shrub — Woody plants, excluding vines, less
12.
than 3 in. DBH and greater than 3.28 ft (1 m) tall.
= Total Cover
Herb — All herbaceous (non -woody) plants, regardless
of size, and woody plants less than 3.28 ft tall.
Woody Vine Stratum
(Plot size: 30' )
1. None Observed
Woody vine — All woody vines greater than 3.28 ft in
height.
2.
3.
4.
Hydrophytic
5•
Vegetation
6.
Present? Yes No X
Remarks: (Include photo numbers here or on a separate sheet.)
Vegetation is absent due to construction activities.

SOIL
Sampling Point:
Profile Description: (Describe to the depth needed to document the indicator or confirm the absence of indicators.)
Depth Matrix
Redox Features
inches Color (moist) %
Color (moist) % Type' Loc' Texture Remarks
0-18 7.5YR 5/8 100
SCL
'Type: C=Concentration, D=De letion, RM=Reduced Matrix, CS=Covered or Coated Sand Grains.
'Location: PL=Pore Lining, M=Matrix.
Hydric Soil Indicators:
Indicators for Problematic Hydric Soils':
Histosol (Al)
Dark Surface (S7)
2 cm Muck (A10) (MLRA 147)
_ Histic Epipedon (A2)
Polyvalue Below Surface (S8) (MLRA 147, 148)
Coast Prairie Redox (A16)
Black Histic (A3)
Thin Dark Suface (S9) (MLRA 147, 148)
(MLRA 147, 148)
Hydrogen Sulfide (A4)
Loamy Gleyed Matrix (F2)
Piedmont Floodplain Soils (F19)
_ Stratified Layers (A5)
Depleted Matrix (F3)
(MLRA 136, 147)
2 cm Muck (A10) (LRR N)
Redox Dark Surface (F6)
Red Parent Material (TF2)
Depleted Below Dark Surface (A11)
Depleted Dark Surface (F7)
Very Shallow Dark Surface (TF12)
Thick Dark Surface (Al2)
Redox Depressions (F8)
Other (Explain in Remarks)
_ Sandy Mucky Mineral (S1) (LRR N,
Iron Manganese Masses (F12) (LRR N,
MLRA 147, 148)
MLRA 136)
— Sandy Gleyed Matrix (s4)
Umbric Surface (F13) (MLRA 136, 122)
3 Indicators of Hydrophytic vegetation and
Sandy Redox (S5)
Piedmont Floodplain Soils (F19) (MLRA 148)
wetland hydrology must be present, unless
Stripped Matrix (S6)
disturbed or problematic.
Restrictive Layer (if observed):
Type:
Hydric Soil Present? Yes No X
Depth (inches):
Remarks:

STATE OF NORTH CAROLINA FIRM PANEL LOCATOR DIAGRAM
SURRY I STOKES
YADKIN
DAVIE u
DAV1030N
I I_
r \0 RAND
\ r
DATUM INFORMATION
The projection Iced n Opt preparinon of this map won the Nath Gamete State
Plane TIPSZONE 3200) The horizontal Whim won the N«M AmeNan Dal of
1NO, GRSSO H[Pa d. Daesrences in damn ellipsoid, plljadon, « Univemal
T--Meruh z«s vse4 n Ute production d
roFIRMS for adj-1
I.-.- may -u' In
-gm
psilional tliflerenom In map fens".. a«
funao.lonal boundmies. Thea dlhe- do rM aflsd Ma accuracy d .1
FIRM. All cooldilaas on sols mep are Survey Feel, whre
1 U.S. Sumy Fad = 1200/1937 Mems.
Fmoa abvalions on this map Ma reeareneW to Vee Non, Ammon Venice'
U.- d 1938 (NAND 8S) These flood abandons must be compared m sm,elun
and ground e" ­see 3,0,4 m me seine vllytlW dasum An avenge Met
bate,al NAVD 88 aro INNM'lo-I Geolan, Vertical Datum d 1929 (NGVD 29)
has been c P.`d fa a- Nam" Caroae coa ty The Msec was dmn split -
m Me NGVD 29 hood elevMlona thin wen rpt -sed! during Me aeaMn d this
sWawids banal FIRM. The oases f« county ty shown on this FIRM psoas we
shown in 11I vemeal tlelun Mae! table below When,a eamn, b«eYdery art a
flooding _os wiM unrevised bvm
NGVD 29 flood eims ere mmdaem. an
no -I MSM NS been cgwated are eppleed d -W the «salon d this
slanwke format FIRM See Sachn 61 d is Accompanying Flood Inewance
SWdy repel to dein hums, infmmmom on Ore can pas of alevetim.
bMween NAVD 88 are NGVD 29. To often burred --on. dss«Wuon. andmr
IocNWn em.mas- I« bemh mark. shown on me map, plasm opnmd Me
NI Cano. Geodetic Survey MIN s00roas shown slow. You may also
oomad Me Imd�Mron SeMcss Branch d ma National Ce . Survey M (301)
713.3242. a - 9S website at Mea lh-no%
Nonh CMolins Gooddiic S, -ay Courcy Average Vami Datum Oaeal Table
121 M. J-Street=4.7rS31eL
ReIM4e, NC 276(H
(9191,333836
mm'.l/wvYw.rms.Meb.M us
M streams listed 'm Me Flood Hazard DMa Tabb b wen asWled by detesed
methods '" hW wnsy OIhw lead heard date shown on his mep may
N. been dmived usl ame, a -.,I amaly.s p I.- detailed! Rina
analyse. More imdm"an on is flooding solus studied by I- eNlyses a
eonteined in IN Flood limain oa Study rapt.
FLOOD HAZARD DATA TABLE M d m Mdna.Ml
1A1t4Nyn DMeRm
1%"new. Drape an pMerdSkepnm
Ones Stream floc ss, -E) DFsoectD- EO em)
slam, Barone Denrgs wbnsarau ee,askm (Ladnln Dowretr.MN«
(cl¢I (faro N"VD9M TdN Fbodwe WloYl
BRUSHY FORK CREEK
MAP NUMBER
JANUARY 2r 2009
37106835001
006 550
NA
787 EP
485
014 1,410
NA
774.3
125
o20 2,000
NA
776.3
60
024 2,400
NA
780.5
125
034 3,360
NA
781.6
4753
063 6.270
NA
789.0
110
067 8300
NA
789.6
20D
069 6,890
NA
789.8
200
CLOVERLEAF BRANCH
005 530
NA
784.3
711
012 1,243
NA
771.1
50
015 1,477
NA
774.9
50
022 2,190
NA
791.4
SALEM CREEK
440 "Doo
NA
751.4
390
455 45,500
NA
754.0
146
461 46,123
NA
so
485 48,500
NA
758.6
370
502 50.200
NA
761.7
720
511 51,700
t4A
763.9
219
533 53,300
NA
768.3
175
STADIUM BRANCH
011 1,110
NA
765.7
SO
021 2.110
N4
789.5
' Feil Neva nwM' Fboup calmcNd M Seem Desk' eevasbrl klckpM Ncbv ase emacs
,Deas SaWnCreek ' Va4e k IlleccwM eF row Ibodx y leu been a'}nW n tib meero
nemn mpoepfkp-bMW IloottiMn, r.4we.mr
a
(.p„)a II _ Ice IDI 10.' ..Y
This diglial Flood Inassranu Rale Map (FIRM) wan p Kh,osd .rough a unique
boopmen. PSnmmahm beNaerl Me State of NOM Canal- and the Federal
Emergency Management Agency (FEMA). The Stale of North Carolina las
1110-mented a long term approach of floodplain management to decease me
mass assodMed was flooding demonstratedm
This is monstrated by the State•. mmemenl to
map 600dplan areas at Me baai level. As a pal of Sea Mfmt, the stele d North
Carina has Idlwd in a Cooperating Technkal State agreement was FEMA to
produce and maintain INS dl9dai FIRM.
www.ncfloodmaps.com
This map Is Iso use n soness anne Me Nes- Fbaa IMwama Proem. tt 4[ea rad neuuaYY,derlbtY
NI .- subI- m floo N Pmoi hone low --enoyl d mase Mia. The Iwlmllmny map
lapoe.ay-d be conwaedb Poe.deup.. alllAamd Moo nsm idamfam.
I pian rope Oasailed inMmak«I m crow amen Bem Flood EMveHans (9FEe) eIl«« flpodweye
Nva been dlN,miM4 lugs m am'au,e'4ad m oMIN Me Pbod ft- Fo-" Dasa. !mead
OefAad Food Heald DIN. ane« SYmne y of Stanal EMVadons .dee oamens l v the -
wa Sl IRS) upon M accmpnbs Na RRM. Usha -W - MM EFEs .lawn m
Me FIRM ,present Impu sHsdedaot Mevaslorl9. These BFB an'aNrWW br Mod ea«allu rslVlp
purpoeu any end andAd ra b Iced u Ma same [wu d flsotl ebvam IM«metlm. A-Nf,,,
aced elevelbn deb prefareea m an FlS lePo,I .IOW a IAYbed In ImnAslmll w1th oMe FIRM r
plepoa> dpNtradpn.w« nobdpen meNmmem
B.eoabe d,agIIIMPn' lbotlwge inpan m Me FIRM b flooMp fdvm stee�ed� �by d�e,el d IneMos
werecempe.MM«ua seraolnaltdm'llserpdalW baesaN esus I -n Frei wee Neom
IwanWlc cm.tlesekara h rOes, rodNelNnb d tll. Normal by .utero Prspas Rasdwe,
-aro per pllmiem tldp 1" dab tar Modng y I eaabd by defiled melhos n wee a rcry
e,IweCMnMa widllb M floating ¢au'cu eerlliatl IN ISN P detailed llleands w seas did n do flood
In rmu Study (FlSI mpda for Ne µna41[aon. TM FI6 ,open Ned promMa irmC L«u b dNmmirmp
a P,voawaY Inns mnleluoedmrlvAdn M11ooM0 favus InldW by IkrelW 41agW meMoe.
Cenein Moa¢ sot . SpadN Mod Hurn Mu may u pabcied by abed epnaal ebuamnf. qeM ro
5aoon
..-.s in
.1. ip Pnleceon Meuuna' d tlw Foal weuro«.e Study nlpm I. infermabn a Mood convol
ls mud n.
NOTES TO USERS
FEMA noon -M MM a Food Inaeane Pokey be N -ad br sm- e¢. Mua -a buses are
sewn as povidiro paleeten from are 1% annul m.va Poon. -V b not [ovaeed by aland.o
popMyA MrN M " e,mmos pdose nal is it covMM by HomePwTre m , Ponves In.aMlca
C -Z
DaM ft O.ae Irwaa or C titl swm,ce Vow Iniwaeb m and
P,opny ape
ocM floodpa -Ix na runny" lama Y A mm' nvww lame Rdayn aW odf 1[r
Inl.mebm b ere lea k d floa4mp n .-= uiro pdedea @/ bvue
Base mp'nldmeon, eed,,so osea des sedn,oaaaMa FIRM rale obWned hon velbue
ori aneabans, -.v he pabdyaep law c«nmwkFylbe), sone +ro kaerW egandaa, wp/pr doer
MMus. The on sry ben h. he FIRM is same Imegely engWrea fY F«rym Courcy Th lone peso
al -.n e. Nle maga a TORS Ina.mekon aro gsomakN aeb w{pN l by tlV row
c«nenweh(e. lel mat FEMA base mep [«a- Me palened aosu M
d..opnent ase tlls low mp. Sea pao¢paael ma -M the .,-W 4lpael FIRM M edptimN
kyormallon about Na mep pepwekon.
Base sop mumu spawn on nes mp, sell m ob orees lhahe.e be- on Me moat uptpdMa Dab
aaibble M es timedchemises'.mN m Nw oscM,M
iakm I Y n aM[e tlW
serolth [ rob
oro
sop ala pudNnedI Mp lues anouW u and an ePPmPman commune ONdN «web¢. m ,ra,UY
d meWnMli ve -.
dudbmNsomil a -n o1 stem wane Iso IewN nyarpkc mooN wa aaeted
ro Me In- of alis eblam4o FIRM.
This map needs mon asse. and 4-ro-0ala afro. [Nasal edmpuralloe man dpi ehpwn on
the pnviow FIRM f. Me jun Winton. The flm4pnanf ala Aoodwayn tial wma trensenea ham IN,
to Innbm m e Ae a
pnwoue FIRM nave been uate4 meas IMM roam channel mnagurar
_ Y ala
borne PrdYu ars People Os tabas in Ian Foo Innosel th Sd M1tidl
shownalNpnb IrydreWo Mb) may reRm aiream hyenal diem,a'es till 4ifler Irorll vrnal II
en«xn one p.
Renu lakyto sap.., peed sap- br anaverNew map d the room'/ -n,, Ma layoutd
Nm Flood IruwenuY Plea one sato c«n- some -1 and a e aina- d l lain lNu Pe pnlNepSanumrp
gym ry a waa u Coa n-
aem-M.. tyle -a.
It you nava ass, og I - Mia map. MA M AP 14" -ala Nelson) it I I FEMA Pl.. le
peer-. pease sap 1 _ aT -FEMA MAP (1-07)-3]6292]1 . son es FEMA v.ewb M
iNolFx✓w k'^i.g4Y
M sobampanYng Fend Insurance Stoy ,apron Lamer t lap Ft- (LOMB) « Lege d Map
Ame-nem (LOM") -"g potions d Mia Tend. p Oslo vemmns d this FIRM they W e,eYebb.
Visa tie Nemo Cam." Floodpi MspoN Pnpnm website M htlo-IANHv nrJloo «
caned tie FEMA alSalad Cade, M 1-900.3568516 id- an NI ,aM4O .on-
ua«JNM wan Me FIRM. The FEMA MV Sema Carle me, mew a learned by Fax M 131D1356
9520 sold as wrOwb M Mel fern
MAP REPOSITORY
-1. knee of Map Repw4olbs u Map sou. vee blabaW ma
EFFECTIVE DATE OF FLOOD INSURANCE RATEM AP PANEL
JANUARY 2,2009
EFFECTIVE DATES) OF REVISIONS) TO THIS PANEL
I FRC
:EEK
:CTS
IEEK
asMrctla nMbap Mp IepabnNedn
swn nip ^'ePFi^Y DamnnneY Hato')
mmawnfysop w
ary Per ro
r bekaHMdMb'.
IM FIom rmu mudy ,erode
Onblon of F a.slvwl« a softie n tna � � Clem M Mb+ilW qpM Ive'Aen w
Ilagena« a aw Naebnel N I
N�CspNsion of Emegency Mellaenen tasaaaab IlstlniM Fbad lnm.vx Aoyem
LEGEND
SPECIAL FLOOD HAZARD AREAS (SFHAs) SUMECT TO
INUNDATION BY THE 1% ANNUAL CHANCE FLOOD EVENT
mu
Th t%aal mel¢ flood (106ysM food), also knoevn as the base flood, k Is (load that
Al s a I chmsm d baro er-I « She 1 e. " char food.
Spleen Fkpd yeard
Also
k IN arm sNs k m fbok0 try R. t% a, and A. T e Ea Area El Special Me
FfrMa kldWe Imes h M. Al A0, AR A99, V, and A. The ease flood EkrAlm k Ole
wdM. moa elen,abn dole I% anmsN demon flood.
ZONEA No Ease Flood Ekvadon dal merle!.
ZONE AE ease Rood Fenton, deNrMnN.
ZONE AN Flood depths of i m 3 feet (INuasb areas of porAap); ease Mod EICroMrN
da"T"d.
ZONE AO Flood depths of 1 m 3 feet (-ally shed flmv on ship terayd; avenge
0ISM. d -timed. For ens of aNrfl fan f abOU vwlocldm Man
demmmad.
ZONE AR Spe1N Floud Haaatd Arm folmeny WolszbM hen tle 1% amWl n,anbe
od «ad
flood M a flomMat was s Mae",* desxrt ted. Tone AR
Bede -a Met the mane Mod caned ImMe, Is being ,!atoned To PrOvWs
prdecmn ham Ole1%annual dance « - flood.
20NE A99 Arms m N protected hem 1% -L a arae Mod by a Federal Mod
Pah don s,e- wee canasmdlan; no ease Flood Eeeatbns tleterdrlad.
'0" VE Casal Mad sone wtth vemdty Wren (wave action), Se se Rood Elevators,
det.mYled.
FLOODWAY AREAS IN ZONE AE
Time flmtlway a the enamel of a learn pars am adlaceet Doodplam meas the rtpN N kept
has of egmctm ant to the ft I% anneal beano, Mad can be carred wabdn subNaesl
esOesss in Mod hJppnb.
OTHER FLOOD AREAS
ZONE It A,ns at 0.2% mi dunce Mad; ons of 1% Mmol dfnce Mod wee
amaSe depths of les tlen i foot or with MaRNe ares ess Man 1 square
MIs; and area imbensC by levees 11% a.bill ctflce Mod.
OTHER AREAS
zON!% Alda 4lAermlN ma.bWe an 0.2%emwi mance-own.
MME Anu.wikcn MO MmMert l.laasen.no, W[ postide.
® COASTAL BARRIER RESOURCES SYSTEM (CBRS) AREAS
OOTHERWISE PROTECTED AREAS (OPAS)
CERS anis and OP4 me nomlash, abated, wM a or adlacmK m 5pasal Mod Hazard Arai.
1%a- - moose. bi e
a- a- ons Mopain O.IIM1
--- noodle,-na.Y
--- Zprc DpouMery
..................... le5 ae OPA k[I.IMry
9ouowy -. 51aMi Fbo Hua. Arta Zonas ao nvmaalr
C.' ' - "�J dHd.O SMdal fbo waN Alga d UYleene fiat Fboo
�..- ' ���J limwtkns. Moo d6aa w Moo Mocala.
-513-
St.
513^^ -^'St. 9971 gas Mod Ebvatbn vNw wtiee Ixllrann wan. m; elevadan .
lea'
• easamcel rode r1pM Anlerkan VMral Damm d 19x5
�. Clot 5ec9m 011e
ee-ot, cvordnasa INewaN m IN N.N Amakan Durum d
e. arm. tt Rsrc gar (� Al)
Iodg.Me UnAMSYlyens<rse elelcnmr goo tiro, naw t)
1371503 FEET 250D1[d Sao vNlns: Noftb 01- Rine Pee dosrOkMM sial,
(RPSMfE 3200, Sfb Rwn xAo 93 het)
BM5510 ramkna 0epdeac S, -lawn mark I. "role i,e«aamn
BMS5100 "'11°lae Taddmc S"Iwr a°ed' '"en' lr°r "pas .ro""er.n aka
Nm;//mm'.ms.roM.NN)
IIGS58 CIP$x.sN VemolCmwas«CmVm«F bYSIiN
BM5510® � ) (to, Imre IllfwmNla viae
e M1.5 .va was
GRID NORTH
MAP SCALE 1" a :0'(1: 5,000)
as ase
In
I IINNII�-IIIJII PANEL 6836) I
FIRM
FLOOD INSURANCE RATE MAP
NORTH CAROLINA
PANEL 6835
ISEEATOR-AAN m MAPekDaa FDR FIRM PAREE
CANTALHS.
cDMMUNITv SBD.NY. �tlEl SIJFfIx
r Sx9
yon mdHa ON an D Maas
van TM
.tun P bas mep �me�n �Camnudry feelker lnwm anew
wpNaoane •Mea
<.wnwln
EFFECTIVE DATE
MAP NUMBER
JANUARY 2r 2009
37106835001
^�
9
f
State of North
Carolina
Federal Emcn- Managk:me tt APenbv

U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action 11). 201001 391 County: Forsyth USGS Quad: Winston-Salem East
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Property Owner / Authorized Agent: PTRP Holdings III LLC / Douglas L. Edgeton
Address: Medical Center Blvd.
Winston-Salem North Carolina 27157-1035
Telephone No.: 336 716-2828
Size and location of property (water body, road name/number, town, etc.): PTRP Holdings III LLC property located
off of the intersection of E. Fourth Street and N. Patterson Avenue, in Winston-Salem, Forsyth Countv, North
Carolina. Property is adjacent to a tributary of Salem Creek a tributary of the Dan River.
Description of projects area and activity: Fill associated with construction to connect two existing culverts resulting
in 75 linear feet of stream channel impacts to the iurisdictional waters of a tributary of Salem Creek.
Applicable Law: ® Section 404 (Clean Water Act, 33 USC 1344)
❑ Section 10 (Rivers and Harbors Act, 33 USC 403)
Authorization: Regional General Permit Number:
Nationwide Permit Number: NW 39
Your work is authorized by the above referenced permit provided it is accomplished in strict accordance with the attached
conditions and your submitted plans. Any violation of the attached conditions or deviation from your submitted plans may subject the
permittee to a stop work order, a restoration order and/or appropriate legal action.
This verification will remain valid until the expiration date identified below unless the nationwide authorization is modified,
suspended or revoked. All of the existing NWPs are scheduled to be modified, reissued, or revoked prior to March 18, 2012. If, prior
to the expiration date identified below, the nationwide permit authorization is reissued and/or modified, this verification will remain
valid until the expiration date identified below, provided it complies with all requirements of the modified nationwide permit. If the
nationwide permit authorization expires or is suspended, revoked, or is modified, such that the activity would no longer comply with
the terms and conditions of the nationwide permit, activities which have commenced (i.e., are under construction) or are under
contract to continence in reliance upon the nationwide permit, will remain authorized provided the activity is completed within twelve
tnontlts of the date of the nationwide permit's expiration, modification or revocation, unless discretionary authority has been exercised
on a case-by-case basis to modify, suspend or revoke the authorization.
Activities subject to Section 404 (as indicated above) may also require an individual Section 401 Water Quality Certification. You
should contact the NC Division of Water Quality (telephone [phone]) to determine Section 401 requirements.
For activities occurring within the twenty coastal counties subject to regulation under the Coastal Area Management Act (CAMA),
prior to beginning work you Hurst contact the N.C. Division of Coastal Management.
This Department of the Army verification does not relieve the permittee of the responsibility to obtain any other required Federal,
State or local approvals/permits.
If there are any questions regarding this verification, any of the conditions of the Permit, or the Corps of Engineers regulatory
program, please contact John Thomas 919 554-4884 ext. 25.
L_
Corps Regulatory Official Date: 09/07/2010
Expiration Date of Verificatioh: 03/18/2012
The Wilmington District is committed to providing the highest level of support to the public. To help us ensure we continue to do so,
please complete the attached customer Satisfaction Survey or visit http:i/www.saw.usace.army.miVWETLA\IDS/index.html to
complete the survey online.
Page I of 2

Determination of Jurisdiction:
❑ Based on preliminary information, there appear to be waters of the US including wetlands within the above described project area.
This preliminary determination is not an appealable action under the Regulatory Program Administrative Appeal Process
( Reference 33 CFR Part 331).
❑ 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 US and/or wetlands within 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.
❑ The jurisdictional areas within the above described project area have been identified under a previous action. Please reference
jurisdictional dcterrnination issued . Action ID
Basis of Jurisdictional Determination: Property has tributary which flows to the Yadkin River and the Atlantic Ocean.
Appeals Information (This information applies only to approved jurisdictional determinations.)
Attached to this verification is an approved jurisdictional determination. If you are not in agreement with that approved jurisdictional
determination, you can make an administrative appeal under 33 CPR 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 RPA
form to the following address:
District Engineer, Wilmington Regulatory Division
Attn:Jean Manuele, Project Manager,
Raleigh Regulatory Field Office
6508 Falls of the Neuse Road, Suite 120
Raleigh, North Carolina 27615
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 District Office within 60 days of the date of the NAP. Should you
decide to submit an RFA form, it mist be received at the above address by November 7, 2010.
**It is not necessary to subntit an RFAfo the District ftice if you d not object to the determination in this correspondence.**
Corps Regulatory Official: \
Date 09/07/2010 Expiration Date 03/18/2012
SURVEY PLATS, FIELD SKETCH, WETLAND DELINEATION FORMS, PROJECT PLANS, ETC., MUST BE
ATTACHED TO THE FILE COPY OF THIS FORM, IF REQUIRED OR AVAILABLE.
Copy Furnished:
Wilbur Christmas, Stimmel Associates, 601 N. Trade Street, Suite 200, Winston-Salem, NC 27101-2916
Page 2 of 2