20060299 Ver 1_COMPLETE FILE_20060223

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Mr. P. Lee Smith
Forsyth Country Club
3101 County Club Road
Winston-Salem, NC 27104
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
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APPROVAL of 401 Water Quality Certification with Additional Conditions
Dear Mr. Smith:
Alan W. Klimek, P.E. Director
Division of Water Quality
March 13, 2006
DWQ# 06-0299
Forsyth County
Forsyth Country Club has our approval, in accordance with the attached conditions, to place permanent fill in,
or otherwise impact, 130 linear feet of perennial stream in order to construct a road crossing for a maintenance
access road on club property in Winston-Salem, Forsyth County, as described in your application received by
the Division of Water Quality (DWQ) on February 23, 2006. After reviewing your application, we have
determined that this fill is covered by General Water Quality Certification Number 3404, which can be
viewed on our web site at http://www.ncwaterquality.orWwetlands.html. This Certification allows you to use
Nationwide Permit Number 14 when it is issued by the U.S. Army Corps of Engineers. In addition, you
should secure any other applicable federal, state or local permits before you proceed with your project,
including (but not limited to) those required by Sediment and Erosion Control, Non-Discharge, and Water
Supply Watershed regulations. Also, this approval will expire when the accompanying 404 permit expires
unless otherwise specified in the General Certification.
This approval is valid only for the purpose and design that you have described in your application. If you
change your project, you must notify us in writing, and you may be required to send us a new application for a
new certification. If the property is sold, the new owner must be given a copy of the Certification and
approval letter and is thereby responsible for complying with all conditions. If total wetland fill for this
project (now or in the future) exceeds one acre, or total fill to perennial streams equals or exceeds 150 linear
feet, compensatory mitigation may be required as described in 15A NCAC 2H .0506 (h). For this approval
to be valid, you must follow the conditions listed in the attached certification, as well as the additional
conditions listed below:
1. The following impacts are hereby approved as long as all other specific and general conditions of this
Certification are met. No other impacts, including incidental impacts, are approved:
Amount Approved Plan Location or Reference
Streams 130 linear feet Buena Vista Branch at a point located - 1,150 feet upstream of its
confluence with Silas Creek on Forsyth Country Club property in
Winston-Salem, Forsyth County as depicted on the project vicinity ma

None hCarolina
Naturally
North Carolina Division of Water Quality
Wetlands Certification Unit 1650 Mail Service Center Raleigh, NC 27699-1650 Phone [phone] FAX [phone]
2321 Crabtree Blvd. Raleigh, NC 27604-2260 Internet h_t_tp//:www.ncwaterguality.orq
Customer Service Number: 1-877-623-6748
An Equal Opportunity/Affirmative Action Employer - 50% Recycled/10% Post Consumer Paper
Mr. P. Lee Smith
Page 2, DWQ# 06-0299
March 13, 2006
2. Appropriate sediment and erosion control measures which equal or exceed those outlined in the most
recent version of the North Carolina Sediment and Erosion Control Planning and Design Manual or the
North Carolina Surface Mining Manual (available from the Division of Land Resources at NCDENR
regional offices or the central office), whichever is more appropriate, shall be designed, installed and
maintained properly to assure compliance at all times with the North Carolina water quality standards
that are applicable to Class C waters as described in 15A NCAC 02B.0211 Fresh Surface Water Quality
Standards For Class C Waters. Such measures must equal or exceed the requirements specified in the
most recent version of the North Carolina Sediment and Erosion Control Manual. These measures must
be maintained on all construction sites, borrow sites, and waste pile (spoil) sites, including contractor
owned and leased borrow pits, which are associated with this project.
3. Sediment and erosion control measures shall not be placed in wetlands or waters to the maximum extent
practicable. If placement of sediment and erosion control measures in wetlands or waters is
unavoidable, they shall be removed and the natural grade restored within six months of the date that the
project is completed or, if applicable, within six months of the date that the project is released by the
North Carolina Division of Land Resources.
4. No waste, spoils, solids, or fill of any kind shall occur in wetlands, waters, or riparian areas beyond the
footprint of the impacts depicted in the Pre-Construction Notification. All construction activities,
including the design, installation, operation, and maintenance of sediment and erosion control "Best
Management Practices" shall be performed so that no violations of state water quality standards,
statutes, or rules occur.
5. Where riprap is required for energy dissipation and scour protection, it shall be limited to the minimum
dimensions specified by appropriate engineering calculations. Riprap may only be used below the
normal high water level. The original grade and elevation of the stream's cross-section must be
maintained. Riprap placed in the streambed must be inserted into the bed matrix to a depth sufficient to
provide the thickness of riprap required for scour protection. The elevation of the streambed must not be
increased by the placement of riprap. Placement of riprap must not result in destabilization of the
streambed or banks upstream or downstream of any crossing.
6. All construction activities associated with this project shall minimize built-upon surface area, direct
stormwater runoff away from surface waters, and incorporate best management practices to minimize
water quality impacts. If concrete is used with any fill material, it shall not be allowed to come in
contact with surface waters until it has cured. If any stormwater must be collected for discharge into a
stream channel, it shall not enter the stream as a point source, but shall be slowed and discharged as
sheet flow prior to entering the riparian buffer on either side of the stream.
7. Upon finishing the project, the Applicant shall fill out and return the enclosed "Certificate of
Completion" to notify NCDWQ when all work included in the §401 Certification has been completed.
This certificate should be returned to the Wetlands/401 Certification Unit of the NC Division of Water
Quality at the address listed on the form. Along with the Certificate of Completion, please send
photographs of the inflow and outflow sections of the culvert to document correct installation.

Mr. P. Lee Smith
Page 3, DWQ# 06-0299
March 13, 2006
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearing. You
must act within 60 days of the date that you receive this letter. To ask for a hearing, send a written petition
which conforms to Chapter 150B of the North Carolina General Statutes to the Office of Administrative
Hearings, 6714 Mail Service Center, Raleigh, N.C. 27699-6714. This certification and its conditions are final
and binding unless you ask for a hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water Act.
If you have any questions, please telephone Daryl Lamb in the DWQ Winston-Salem Regional Office at 336-
771-4959 or Ian McMillan in the Wetlands/401 Central Office in Raleigh at 919-715-4631.
Sincerely,
Alan W. Klimek, P.E.
AWK/cdl
Attachments
cc: Mr. John Thomas, U. S. Army Corps of Engineers, Raleigh Regulatory Field Office
DWQ, Winston-Salem Regional Office
Central Files
Wetlands/401 File Copy
Mr. C. Douglas Jewell, Stimmel Associates, PA, P. O. Box 2294, Kernersville, NC 27284
p o a ? `t.`;+dD
idYFR6
North Carolina Wildlife Resources Commission 0
Richard B. Hamilton, Executive Director
MEMORANDUM
TO: Cyndi B. Karoly, Supervisor
401 Oversight and Express Permits Unit
NCDWQ Wetlands and Stormwater Branch
FROM: Ron Linville, Regional Coordinator ZWW
Habitat Conservation Program
DATE: March 3, 2006
SUBJECT: Review of an application for Forsyth Country Club, Maintenance Road, DWQ No.
20060299, Forsyth County
Forsyth Country Club is requesting 401 Water Quality Certification from the North Carolina Division of
Water Quality. The NCWRC has reviewed information provided by the applicant, and field biologists on
our staff are familiar with habitat values of the project area. These comments are provided in accordance
with provisions of the Clean Water Act of 1977 (33 U.S.C. 466 et. seq.) and the Fish and Wildlife
Coordination Act (48 Stat. 401, as amended; 16 U.S.C. 661-667d).
The project is to provide a multiple barrel culvert road crossing over Buena Vista Branch, a tributary of
Silas Creek. Water quality and/or aquatic stream habitats in the Winston-Salem area are considered poor
by most biological standards. Generally, this poor quality is attributed to urban development, lack of
stormwater management, and historical anthropomorphic activities affecting headwaters and streams in
the community. The proposed project appears to indicate that a four (4) barrel culvert is proposed and
that these barrels will be placed on the same elevation. Routinely, the North Carolina Wildlife Resources
Commission recommends the following non-prioritized conditions for culverts:
Bridges are recommended for all permanent roadway crossings of streams, floodplains and
associated wetlands to eliminate the need to fill and culvert active floodplains. Bridges
should be the standard practice where significant natural resources like trout, listed species, or
site limitations like bedrock or significant flooding exist. Floodplain capacities and
floodplain functions must be maintained with bridges and culverts. If culverts must be used
for temporary or permanent crossings, culverts should be designed and installed to allow
passage of aquatic organisms. Culverts 48 inches or larger must be buried at least a foot
(12") below the streambed. Culverts less than 48 inches diameter must be buried to a depth
equal to or greater than twenty (20) percent their size to provide aquatic life passage. These
measurements must be based on natural thalweg depths. Culverts should be situated so that
Mailing Address: Division of Inland Fisheries • 1721 Mail Service Center • Raleigh, NC 27699-1721
Telephone: [phone] • Fax: [phone]
of I
Forsyth Country Club -Page 2 - March 3, 2006
no channel realignment or widening is required. Widening of the stream channel at the inlet
or outlet of structures usually causes a decrease in water depth and velocity causing
sedimentation and reduction of aquatic passage. Flat concrete aprons between wing-walls
must not be used. Riprap must not be placed in the streambed. If multiple barrels are
needed, a base flow barrel(s) must be provided and additional barrels should be placed so that
their bottoms are located on the active bankfull elevation. These bankfull barrels must be
connected to active floodplain benches to provide natural dimensions for the base flow
channel with sufficient water depth during drought and low flow conditions to accommodate
movement of aquatic species. If culverts are long and/or sufficient slopes exist, alternating
baffles should be provided in a manner that conforms to channel bends upstream and
downstream, mimics natural meanders, prevents upstream scour and downstream deposition,
contains typical bed load materials, and provides resting areas for aquatic species. If multiple
barrels are used, at least one pipe or barrel should be designed to remain dry (except for storm
or flood conditions) with a floor material that is easily used by terrestrial wildlife for passage.
2. If concrete will be used, work must be accomplished so that wet concrete does not contact
stream water. This will lessen the chance of altering the stream's water chemistry and
causing a fish kill.
3. Stringent erosion control measures should be installed where soil is disturbed and maintained
until project completion.
4. Fill within active floodplains should be avoided unless this can be accomplished in a manner
that provides a no net loss of flood storage capacities in the immediate area.
5. Only autochthonous plants should be used for stabilization. Remaining streambanks should
be revegetated with silky dogwood (Corpus amonum), silky willow (Salix sericea), tag alder
(Alnus serrulata), black willow (&dix nigra), and sycamore (Platanus occidentalis) to
provide long term bank stability and stream shading. Note that silky dogwood, silky willow
and black willow can be planted as live stakes collected during the dormant growing season.
Cuttings should be randomly planted on four (4) foot centers from the waters edge to the top
of the bank. Trees should be planted on ten (10) to twelve (12) foot centers. Stream banks in
these areas should also be seeded with an approved wetland seed mix or temporary crop of
annual wheat or rye or otherwise stabilized with erosion control matting, mulch, etc.
6. Erosion control approvals and permits are required for projects impacting an acre of land.
Erosion control measures are required for land disturbing activities involving less than an
acre.
Thank you for the opportunity to review and comment on this project. If you have any questions
regarding these comments, please contact me at 336/769-9453.
Ec: Daryl Lamb, DWQ-WSRO
John Thomas, USACOE-RRO
Triage Check List
Date: 2/27/06 Project Name: Forsyth Country Club Maint. Rd. Crossing
DWQ#: 06-0299
County: Forsyth
_ f
Daryl Lamb, Winston-Salem Regional Office
To:
60-day processing time: 2/23/06 - 4/23/06
From: Cyndi Karoly Telephone: [phone]
The file attached is being forwarded to you for your evaluation.
Please call if you need assistance.
? Stream length impacted
? Stream determination
Wetland determination and distance to blue-line surface waters on USFW topo maps
? Minimization/avoidance issues
? Buffer Rules (Meuse, Tar-Pamlico, Catawba, Randleman)
? Pond fill
Mitigation Ratios
? Ditching
? Are the stream and or wetland mitigation sites available and viable?
? Check drawings for accuracy
? Is the application consistent with pre-application meetings?
? Cumulative impact concern
Comments: As per our discussion regarding revision of the triage and delegation processes,
please review the attached file. Note that you are the first reviewer, so this file will need to be
reviewed for administrative as well as technical details. If you elect to place this project on hold,
please ask the applicant to provide your requested information to both the Central Office in
Raleigh as well as the Asheville Regional Office. As we discussed, this is an experimental, interim
procedure as we slowly transition to electronic applications. Please apprise me of any
complications you encounter, whether related to workload, processing times, or lack of a "second
reviewer" as the triage process in Central had previously provided. Also, if you think of ways to
improve this process, especially so that we can plan for the electronic applications, let me know.
Thanks!
JEWELL
ENGINEERING CONSULTANTS, PC
February 22, 2006
(0
US Army Corps of Engineers, Raleigh Regulatory Field Office
6508 Falls of the Neuse Rd., Ste. 120
Raleigh, NC 27615 FER Z006
49 3 North Carolina Division of Water Quality
Ily W
401 Wetlands Unit 17-`
1650 Mail Service Center
Raleigh, NC 27699-1650
Re: Pre-Construction Notification Application
Forsyth Country Club - Maintenance Road Crossing (Proposed)
City of Winston Salem, North Carolina - Forsyth County
JEC Project No. 05-142-016
To whom it may concern:
This submittal is an application for a Pre-Construction Notification (PCN) for the proposed maintenance road
culvert which will cross over Buena Vista Branch, a tributary to Silas Creek in Winston-Salem, NC. All
construction associated with the project will be contained on Forsyth Country Club property. Please find
enclosed the following information and data for this project:
1. PCN Application forms
2. Check for $200 made out to the NC Division of Water Quality (contained in the original package sent
to NC Division of Water Quality, only (1 of 7))
3. Exhibit #1 - Vicinity Map showing extents of Forsyth Country Club Property
4. Exhibit #2 - USGS Quadrangle showing project location
5. Exhibit #3 - Forsyth County Soils Map showing project location
6. Exhibit #4 - Plan and Profile Sheet
An application has been submitted and is currently under review by the Federal Emergency Management
Agency (FEMA) to update the Flood Insurance Rate Map flood mapping and account for the impacts of this
project. This project has been reviewed and approved by the Winston-Salem Floodplain Administrator.
If you have any questions or need additional information, please feel free to contact me or Kathy Landphair at
336-996-9974.
Sincerely yours, 6?bybilfffpp?
JEWELL gineering Consultants, PG?? C,A'PO? os?
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C. Douglas Je ell PE °
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Enclosures °d s> fq? 0 Z/tt?
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Cc: P. Lee Smith, Forsyth Country Club, LLC (w/ enclosure)
Neal Tucker, Stimmel Associates, PA (w/ enclosure)
Post Office Box 2294, Kernersville, NC 27285-2294 ¦ 311 South Main Street, Suite A, Kernersville, NC 27284
'' [phone] ¦ Fax [phone] ¦ www,jewellengr.com
Office Use Only: Form Version March 05
USACE Action ID No. DWQ No.
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
1. Processing
1. Check all of the approval(s) requested for this project:
® Section 404 Permit ? Riparian or Watershed Buffer Rules
? Section 10 Permit ? Isolated Wetland Permit from DWQ
® 401 Water Quality Certification ? Express 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: NWP 14
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts, attach the acceptance letter from NCEEP, complete section VIII,
and check here: ?
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
I' 4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here: ?
II. Applicant Information
1. Owner/Applicant Information
Name: P. Lee Smith
Mailing Address: Forsyth Country Club
3101 Country Club Road
Winston-Salem. North Carolina 27104
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: l.smith@fors?thcc.com
2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has signatory authority for the owner/applicant.)
Name: C. Douglas Jewell
Company Affiliation: JEWELL Engineering Consultants PC
Mailing Address: PO Box 2294
Kernersville North Carolina 27285-2294
Telephone Number: 336-996-9974 ext. 1 Fax Number: 336-996-9976
E-mail Address: [e-mail]
Updated 11/1/2005
Page 5 of 13
I
III. Project Information
I
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: Forsyth Country Club - Maintenance Road Crossing
2. T.I.P. Project Number or State Project Number (NCDOT Only): n/a
3. Property Identification Number (Tax PIN): 6815-67-4128
4. Location
County: Forsyth Nearest Town: Winston-Salem
Subdivision name (include phase/lot number): Forsyth Country Club
Directions to site (include road numbers/names, landmarks, etc.): Forsyth Country Club can
be reached by heading north on Knollwood St. off of Business 40, turn west onto Country
Club Road and go about 0.6 miles with the country club located on the north side of the road.
III , 5. Site coordinates (For linear projects, such as a road or utility line, attach a sheet that
separately lists the coordinates for each crossing of a distinct waterbody.)
Decimal Degrees (6 digits minimum): 36° 06.163' ON 80° 18.232' °W
I?
6. Property size (acres): 172.75 acres
7. Name of nearest receiving body of water: Buena Vista Branch of Silas Creek
8. River Basin:-Yadkin-Pee Dee River Basin
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/maps/.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: Golf course owned and operated by Forsyth Country Club.
The golf course/country club includes a club house, swimming pool and tennis courts. The
surrounding vicinity is mainly an established residential area.
'I Updated 11/1/2005
Page 6 of 13
'
I'
10. Describe the overall project in detail, including the type of equipment to be used:
Proposed project is to construct a new, private, maintenance access road to be built from
Yorkshire Road (located north of Forsyth Country Club), adjacent to Shaffner Park (owned
by City of Winston-Salem) into the Maintenance Facility. Complex which serves and is
owned by Forsyth Country Club. The proposed road is about 2,000 feet long and is proposed
to cross Buena Vista Branch, a tributary to Silas Creek, at a point about 1150 feet upstream
of the confluence of Buena Vista Branch with Silas Creek. The maintenance road culvert
crossing of Buena Vista Branch consists of four parallel 48 inch reinforced concrete pipes
' with about a foot of cover on top of the pipes. There will be vertical walls on both ends of
the system with asphalt paving on the roadway and extending to the top of the endwalls. On
either side of the endwalls, riprap will provide scour protection against overtopping flows.
' Standard earth grading and soil compaction equipment as required will be used to construct
the project following installation of approved erosion and sediment control measures.

11. Explain the purpose of the proposed work: The proposed road will be private and used
primarily by maintenance and delivery vehicles for access into and out of the golf course
maintenance complex.
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer imPacts along with associated mitigation (where applicable). If this is a NCDOT ProJect
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules. No prior applications have been made to the USACOE/NC DWQ for the
Forsyth Country Club site in Winston-Salem to the best of the applicant's knowledge.
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.
No future permit requests are anticipated for this project.
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. Each impact must be
listed separately in the tables below (e.g., culvert installation should be listed separately from
riprap dissipater pads). Be sure to indicate if an impact is temporary. All proposed impacts,
permanent and temporary, must be listed, and must be labeled and clearly identifiable on an
111
Ili' Updated 11/1/2005
Page 7 of 13
' accompanying site plan. All wetlands and waters, and all streams (intermittent and perennial)
should be shown on a delineation map, whether or not impacts are proposed to these systems.
Wetland and stream evaluation and delineation forms should be included as appropriate.
Photographs may be included at the applicant's discretion. If this proposed impact is strictly for
wetland or stream mitigation, list and describe the impact in Section VIII below. If additional
space is needed for listing or description, please attach a separate sheet.
1. Provide a written description of the proposed impacts: The proposed road crossing
will impact 130 linear feet of the Buena Vista Branch, a perennial stream which is a tributary to
Silas Creek. The nominal width (top-of-bank to top-of-bank) of the Buena Vista Branch along
this particular section of the stream is 49 feet. The nominal bottom width is 29 feet along this
point of crossing.
2. Individually list wetland impacts. Types of impacts include, but are not limited to
mechanized clearing, grading, fill, excavation, flooding, ditching/drainage, etc. For dams,
separately list impacts due to both structure and flooding.
Wetland Impact
Site Number
(indicate on map)
Type of Impact Type of Wetland
(e.g., forested, marsh,
herbaceous, bog, etc.) Located within
100-year
Floodplain
( es/no) Distance to
Nearest
Stream
(linear feet) Area of
Impact
(acres)
n/a

Total Wetland Impact (acres)
3. List the total acreage (estimated) of all existing wetlands on the property: 0.0 acres
4. Individually list all intermittent and perennial stream impacts. Be sure to identify temporary
impacts. Stream impacts include, but are not limited to placement of fill or culverts, dam
construction, flooding, relocation, stabilization activities (e.g., cement walls, rip-rap, crib
walls, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is proposed,
plans and profiles showing the linear footprint for both the original and relocated streams
must be included. To calculate acreage. multiDly length X width. then divide by 43.560.

Stream Impact
Number
(indicate on ma)
Stream Name
Type of Impact Perennial or
Intermittent? Average
Stream Width
Before Impact Impact
Length
(linear feet) Area of
Impact
(acres)
I Buena Vista
Branch Placement of
culvert Perennial
29 feet 130 feet 0.09

Total Stream Impact (by length and acreage) 130 feet 0.09
Updated 11/1/2005
Page 8 of 13

1
5. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.). Open water impacts include, but are not limited to
fill- excavation- dre.dvinQ_ flondinv_ drainage. bulkheads. etc.
Open Water Impact
Site Number
(indicate on ma) Name of Waterbody
(if applicable)
Type of Impact Type of Waterbody
(lake, pond, estuary, sound, bay,
ocean, etc.) Area of
Impact
(acres)
n/a

Total Open Water Impact (acres)
6. List the cumulative imvact to all Waters of the U.S. resulting from the project:
Stream Impact (acres): 0.09 ac
Wetland Impact (acres): 0.0
Open Water Impact (acres): 0.0
Total Impact to Waters of the U.S. (acres) 0.09ac
Total Stream Impact (linear feet): 1301f
' 7. Isolated Waters
Do any isolated waters exist on the property? ? Yes ® No
Describe all impacts to isolated waters, and include the type of water (wetland or stream) and
the size of the proposed impact (acres or linear feet). Please note that this section only
' applies to waters that have specifically been determined to be isolated by the USACE.
i
8. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included.with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Current land use in the vicinity of the pond:
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
Updated 11/1/2005
1 1 Page 9 of 13

'
techniques to be followed during construction to reduce impacts. Three alternatives were
considered as minimization of the impact this project has on the stream, floodway, and
' floodplain in the vicinity of the crossing. Each will be presented and discussed herein.
1. Construct the maintenance road at a location where a stream crossing would not be
necessary. This alternative was considered and discarded for the following reasons: Access
i' into the Country Club property is limited to the main entrance area where members and
guests enter and leave the site; and a secondary access drive for the maintenance compound
which meanders through the golf course and practice tee area. This access to the golf
t maintenance compound through the public portion of the conflicts with member/guest
activities. The large maintenance compound has been constructed over the years in a

II' secluded portion of the property and is in very good condition. A new facility would cost in
excess of $1,000,000. The proposed access route is the only possible access route that
avoids the public portions of the property. The proposed maintenance road will provide an
entrance where deliveries can be made, and heavy trucks and maintenance vehicles can enter
the site without disrupting member/guest activities. The proposed maintenance road must
cross the stream since the public street to which it connects and the maintenance compound
are on opposite sides of the stream. Note that re-routing the access to the maintenance
compound will also enable the Country Club to achieve needed, long-term development
goals which include re-routing a current golf hole and expanding the practice area, none of
which will involve additional stream crossings.
' 2. Construct the crossing clear-spanning the floodway. A bridge was considered that would
span the floodway and would be set above the 100-year flood elevation. The costs

I associated with such a structure are orders of magnitude greater than the proposed crossing
II' and would exceed what is reasonable for the project. Additionally, local regulations limiting
a rise in the 100-year water surface elevation to no more than 0.5 feet, would necessitate that

I such a structure span significantly more than the floodway, which in turn would drive the
I' cost even higher.
3. Construct the crossing as proposed herein. The proposed crossing configuration is designed
to provide a natural streambed for passage of aquatic biota with the invert of each 48-inch
diameter RCP being placed below stream invert by 10 inches (>20% of the pipe diameter so
that the pipe invert will fill with sediment.
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on January 15, 2002, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
'
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
Updated 11/1/2005
,' Page 10 of 13
1I
' and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
' for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCEEP concurrence shall be placed on hold as incomplete.
An applicant may also choose to review the current guidelines for stream restoration in DWQ's
II' Draft Technical Guide for Stream Work in North Carolina, available at
http://h2o.enr.state.nc.us/ncwetlands/strmgide.html.
Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
n/a
2. Mitigation may also be made by payment into the North Carolina Ecosystem Enhancement
Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at
[phone] to determine availability, and written approval from the NCEEP indicating
that they are will to accept payment for the mitigation must be attached to this form. For
additional information regarding the application process for the NCEEP, check the NCEEP
website at http://h2o.enr.state.nc.us/wrp/index.htm. If use of the NCEEP is proposed, please
check the appropriate box on page five and provide the following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
IX. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federal/state/local) funds or the use of
public (federal/state) land? Yes ? No
2. If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?

Updated 11/1/2005
Page 11 of 13

' Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No ?
3. If yes, has the document review been finalized by the State Clearinghouse? If so, please
attach a copy of the NEPA or SEPA final approval letter. Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
1. Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 02B .0243 (Catawba) 15A NCAC
2B .0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please
identify V Yes ? No
2. If "yes", identify the square feet and acreage of impact to each zone of the riparian buffers.
If buffer mitigation is required calculate the required amount of mitigation by applying the
buffer multipliers.
Zone* Impact Multiplier Required
(square feet) Mitigation
1 3 (2 for Catawba)
2 1.5
I' Total
* Zone 1 extends out 30 feet perpendicular from the top of the near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
3. If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e.,
Donation of Property, Riparian Buffer Restoration / Enhancement, or Payment into the
Riparian Buffer Restoration Fund). Please attach all appropriate information as identified
within 15A NCAC 2B .0242 or .0244, or .0260.
XI. Stormwater (required by DWQ)
Describe impervious acreage (existing and proposed) versus total acreage on the site. Discuss
I' stormwater controls proposed in order to protect surface waters and wetlands downstream from
the property. If percent impervious surface exceeds 20%, please provide calculations
demonstrating total proposed impervious level. N/A
Updated 11/1/2005
Page 12 of 13
n
XII. Sewage Disposal (required by DWQ)
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.
XIII. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (I 5A NCAC 2H .0500) or any Buffer Rules?
Yes ? No
Is this an after-the-fact permit application? Yes ? No
XIV. Cumulative Impacts (required by DWQ)
I' Will this project (based on past and reasonably anticipated future impacts) result in additional
development, which could impact nearby downstream water quality? Yes ? No
If yes, please submit a qualitative or quantitative cumulative impact analysis in accordance with
the most recent North Carolina Division of Water Quality policy posted on our website at
http://h2o.enr.state.nc.us/ncwetlands. If no, please provide a short narrative description:
I,
XV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
I' Applicant/A
(Agent's signature is

422-1yo
Signature Date
only if an authorization letter from the applicant is provided.)
Updated 11/1/2005
Page 13 of 13
Exhibit # 1 -Vicinity Map -Forsyth Country Club and
Proposed Buena Vista Branch Maintenance Road Crossing

1
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Proposed Maintenance Road Crossing Location
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Legend A 4,000 2,000 0 4,000 Feet
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FORSYTH COUNTY, NORTH CAROLINA - SHEET NUMBER 29 FORSYTH COUNTY, NC
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AGGREGATE BASE COURSE PATH FACE OF REINFORCED CONCRETE HEADWALL
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F_ -
EWELL 9
II' ENGINEERING CONSULTANTS, PC
February 22, 2006
US Army Corps of Engineers, Raleigh Regulatory Field Office D
6508 Falls of the Neuse Rd., Ste. 120
Raleigh, NC 27615 FEB 2 2006
OENR - WATER QUALITY
N
401 orth Carolina
Wetlands Unit Division of Water Quality ANDnftj;y??BRANCy
1650 Mail Service Center
Raleigh, NC 27699-1650
Re: Pre-Construction Notification Application
Forsyth Country Club - Maintenance Road Crossing (Proposed)
City of Winston Salem, North Carolina - Forsyth County K?'
JEC Project No. 05-142-016
To whom it may concern:
This submittal is an application for a Pre-Construction Notification (PCN) for the proposed maintenance road
culvert which will cross over Buena Vista Branch, a tributary to Silas Creek in Winston-Salem, NC. All
construction associated with the project will be contained on Forsyth Country Club property. Please find
enclosed the following information and data for this project:
1. PCN Application forms
2. Check for $200 made out to the NC Division of Water Quality (contained in the original package sent
to NC Division of Water Quality, only (1 of 7))
3. Exhibit #1 - Vicinity Map showing extents of Forsyth Country Club Property
4. Exhibit #2 - USGS Quadrangle showing project location
5. Exhibit #3 - Forsyth County Soils Map showing project location
6. Exhibit #4 - Plan and Profile Sheet
An application has been submitted and is currently under review by the Federal Emergency Management
Agency (FEMA) to update the Flood Insurance Rate Map flood mapping and account for the impacts of this
project. This project has been reviewed and approved by the Winston-Salem Floodplain Administrator.
If you have any questions or need additional information, please feel free to contact me or Kathy Landphair at
336-996-9974.
Sincerely yours,
' JEWELL Faigineering Consultants, PC-."
_ .• l i
S E A L i
C. Douglas Je ell PE
11934
President ti
w ^ ?. ?o
f, I L1
Enclosures J:.,• tt?oC
'?dG2kGat6Gt40h
Cc: P. Lee Smith, Forsyth Country Club, LLC (w/ enclosure)
l' Neal Tucker, Stimmel Associates, PA (w/ enclosure)
Post Office Box 2294, Kernersville, NC 27285-2294 ¦ 311 South Main Street, Suite A, Kernersville, NC 27284
II' [phone] ¦ Fax [phone] ¦ www.jewellengr.com
I
Office Use Only: Form Version March 05
USACE Action ID No. DWQ No. -
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
I. Processing
Check all of the approval(s) requested for this project:
N Section 404 Permit ? Riparian or Watershed Buffer Rules
? Section 10 Permit ? Isolated Wetland Permit from DWQ
® 401 Water Quality Certification ? Express 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: NWP 14
If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts, attach the acceptance letter from NCEEP, complete section VIII,
and check here: ?
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here: ?
II. Applicant Information
Owner/Applicant Information
Name: P. Lee
Mailing Address: Forsyth Country Club
3101 Country Club Road
Winston-Salem, North Carolina 27104
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: [e-mail]
2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has signatory authority for the owner/applicant.)
Name: C. Douglas Jewell
Company Affiliation: JEWELL Engineering Consultants PC
Mailing Address: PO Box 2294
Kernersville, North Carolina 27285-2294
Telephone Number: 336-996-9974 ext. 1 Fax Number: 336-996-9976
E-mail Address: [e-mail]
I'I updated 11/1/2005
Page 5 of 13
III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
' boundaries outlined. Plan drawings, or other maps may be included at the applicants discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: Forsyth Country Club - Maintenance Road Crossing
2. T.I.P. Project Number or State Project Number (NCDOT Only): n/a
' 3. Property Identification Number (Tax PIN): 6815-67-4128
4. Location
County: Forsyth Nearest Town: Winston-Salem
Subdivision name (include phase/lot number): Forsyth Country Club
Directions to site (include road numbers/names, landmarks, etc.): Forsyth Country Club can
be reached by heading north on Knollwood St. off of Business 40, turn west onto Country
Club Road and go about 0.6 miles with the country club located on the north side of the road.
' 5. Site coordinates (For linear projects, such as a road or utility line, attach a sheet that
separately lists the coordinates for each crossing of a distinct waterbody.)
' Decimal Degrees (6 digits minimum): 36° 06.163' ON 80° 18.232' °W
6. Property size (acres): 172.75 acres
' 7. Name of nearest receiving body of water: Buena Vista Branch of Silas Creek
' 8. River Basin: Yadkin-Pee Dee River Basin
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/maps/.)
' 9. Describe the existing conditions on the site and general land use in the vicinity of the project
' at the time of this application: Golf course owned and operated by Forth Country Club.
The golf course/country club includes a club house, swimming pool and tennis courts. The
surrounding vicinity is mainly an established residential area.
Updated 11/1/2005
Page 6 of 13
10. Describe the overall project in detail, including the type of equipment to be used:
Proposed project is to construct a new, private, maintenance access road to be built from
Yorkshire Road (located north of Forsyth Country Club), adjacent to Shaffner Park (owned
by City of Winston-Salem) into the Maintenance Facility Complex which serves and is
owned by Forsyth Country Club. The proposed road is about 2,000 feet long and is proposed
to cross Buena Vista Branch, a tributary to Silas Creek, at a point about 1150 feet upstream
of the confluence of Buena Vista Branch with Silas Creek. The maintenance road culvert
crossing of Buena Vista Branch consists of four parallel 48 inch reinforced concrete pipes
with about a foot of cover on top of the pipes. There will be vertical walls on both ends of
the system with asphalt paving on the roadway and extending to the top of the endwalls. On
either side of the endwalls, riprap will provide scour protection against overtopping flows.
Standard earth grading and soil compaction equipment as required will be used to construct
the project, following installation of approved erosion and sediment control measures.
i,I
11. Explain the purpose of the proposed work: The proposed road will be private and used
primarily by maintenance and delivery vehicles for access into and out of the golf course
I' maintenance complex.
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
II' project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules. No prior applications have been made to the USACOE/NC DWQ for the
Forsyth Country Club site in Winston-Salem to the best of the applicant's knowledge.
V. Future Project Plans
' Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.
No future permit requests are anticipated for this project.
VI. Proposed Impacts to Waters of the United States/Waters of the State
'
It is the applicant's (or responsibility to determine delineate and map all impacts to agent's) wetlands, open water, and stream channels associated with the project. Each impact must be
listed separately in the tables below (e.g., culvert installation should be listed separately from
riprap dissipater pads). Be sure to indicate if an impact is temporary. All proposed impacts,
permanent and temporary, must be listed, and must be labeled and clearly identifiable on an
I Updated 11/1/2005
Page 7 of 13
accompanying site plan. All wetlands and waters, and all streams (intermittent and perennial)
should be shown on a delineation map, whether or not impacts are proposed to these systems.
Wetland and stream evaluation and delineation forms should be included as appropriate.
Photographs may be included at the applicant's discretion. If this proposed impact is strictly for
wetland or stream mitigation, list and describe the impact in Section VIII below. If additional
space is needed for listing or description, please attach a separate sheet.
1. Provide a written description of the proposed impacts: The proposed road crossing
will impact 130 linear feet of the Buena Vista Branch, a perennial stream which is a tributary
Silas Creek. The nominal width (top-of-bank to top-of-bank) of the Buena Vista Branch along
this particular section of the stream is 49 feet. The nominal bottom width is 29 feet along this
point of crossing.
2. Individually list wetland impacts. Types of impacts include, but are not limited to
mechanized clearing, grading, fill, excavation, flooding, ditching/drainage, etc. For dams,
separately list impacts due to both structure and flooding.
Wetland Impact
Site Number
(indicate on map)
Type of Impact Type of Wetland
(e.g., forested, marsh,
herbaceous, bog, etc.
) Located within
100-year
Floodplain
(es/no) Distance to
Nearest
Stream
(linear feet) Area of
Impact
(acres)
n/a

Total Wetland Impact (acres)
3. List the total acreage (estimated) of all existing wetlands on the property: 0.0 acres
4. Individually list all intermittent and perennial stream impacts. Be sure to identify temporary
impacts. Stream impacts include, but are not limited to placement of fill or culverts, dam
construction, flooding, relocation, stabilization activities (e.g., cement walls, rip-rap, crib
walls, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is proposed,
plans and profiles showing the linear footprint for both the original and relocated streams
must be included. To calculate acreage, multi 1 length X width, then divide b 43,560.
Stream Impact
Number
(indicate on ma)
Stream Name
Type of Impact Perennial or
Intermittent? Average
Stream Width
Before Impact Impact
Length
(linear feet) Area of
Impact
(acres)
I Buena Vista
Branch Placement of
culvert Perennial
29 feet 130 feet 0.09

Total Stream Impact (by length and acreage) 130 feet 0.09
Updated 11/1/2005
Page 8 of 13
5. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
I' Ocean and any other water of the U.S.). Open water impacts include, but are not limited to
fill, excavation, dredging, flooding, drainage, bulkheads, etc.
Open Water Impact
Site Number
(indicate on ma) Name of Waterbody
(if applicable)
Type of Impact Type of Waterbody
(lake, pond, estuary, sound, bay,
ocean, etc.) Area of
Impact
(acres)
n/a

Total Open Water Impact (acres)
6. List the cumulative impact to all Waters of the U.S. resulting from the project:
Stream Impact (acres): 0.09 ac
Wetland Impact (acres): 0.0
Open Water Impact (acres): 0.0
Total Impact to Waters of the U.S. (acres) 0.09ac
Total Stream Impact (linear feet): 1301f
' 7. Isolated Waters
Do any isolated waters exist on the property? ? Yes ® No
Describe all impacts to isolated waters, and include the type of water (wetland or stream) and
the size of the proposed impact (acres or linear feet). Please note that this section only
applies to waters that have specifically been determined to be isolated by the USAGE.
I?
8. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included.with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Current land use in the vicinity of the pond:
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
Updated 11/1/2005
i ? Page 9 of 13
techniques to be followed during construction to reduce impacts. Three alternatives were
considered as minimization of the impact this project has on the stream, floodway, and
floodplain in the vicinity of the crossing. Each will be presented and discussed herein.
1. Construct the maintenance road at a location where a stream crossing would not be
necessary. This alternative was considered and discarded for the following reasons: Access
into the Country Club property is limited to the main entrance area where members and
guests enter and leave the site; and a secondary access drive for the maintenance compound
which meanders through the golf course and practice tee area. This access to the golf
maintenance compound through the public portion of the conflicts with member/guest
activities. The large maintenance compound has been constructed over the years in a
secluded portion of the property and is in very good condition. A new facility would cost in
excess of $1,000,000. The proposed access route is the only possible access route that
avoids the public portions of the property. The proposed maintenance road will provide an
entrance where deliveries can be made, and heavy trucks and maintenance vehicles can enter
the site without disrupting member/guest activities. The proposed maintenance road must
cross the stream since the public street to which it connects and the maintenance compound
are on opposite sides of the stream. Note that re-routing the access to the maintenance
compound will also enable the Country Club to achieve needed, long-term development
goals which include re-routing a current golf hole and expanding the practice area, none of
which will involve additional stream crossings.
2. Construct the crossing clear-spanning the floodway. A bridge was considered that would
span the floodway and would be set above the 100-year flood elevation. The costs
associated with such a structure are orders of magnitude greater than the proposed crossing
and would exceed what is reasonable for the project. Additionally, local regulations limiting
a rise in the 100-year water surface elevation to no more than 0.5 feet, would necessitate that
such a structure span significantly more than the floodway, which in turn would drive the
cost even higher.
3. Construct the crossing as proposed herein. The proposed crossing configuration is designed
to provide a natural streambed for passage of aquatic biota with the invert of each 48-inch
diameter RCP being placed below stream invert by 10 inches (>20% of the pipe diameter) so
that the pipe invert will fill with sediment.
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on January 15, 2002, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
Updated 11/1/2005
Page 10 of 13
' and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
' for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCEEP concurrence shall be placed on hold as incomplete.
An applicant may also choose to review the current guidelines for stream restoration in DWQ's
' Draft Technical Guide for Stream Work in North Carolina, available at
http://h2o.enr.state.nc.us/n,cwetlands/strmgide.html.
Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
n/a
2. Mitigation may also be made by payment into the North Carolina Ecosystem Enhancement
Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at
[phone] to determine availability, and written approval from the NCEEP indicating
that they are will to accept payment for the mitigation must be attached to this form. For
additional information regarding the application process for the NCEEP, check the NCEEP
website at http://h2o.enr.state.nc.us/wm/index.htm. If use of the NCEEP is proposed, please
check the appropriate box on page five and provide the following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
' Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
IX. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federal/state/local) funds or the use of
public (federal/state) land? Yes ? No
2. If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?

Updated 11/1/2005
'? ? Page 11 of 13
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No ?
3. If yes, has the document review been finalized by the State Clearinghouse? If so, please
attach a copy of the NEPA or SEPA final approval letter. Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
1. Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 02B .0243 (Catawba) 15A NCAC
2B .0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please
identify V Yes ? No
' 2. If "yes", identify the square feet and acreage of impact to each zone of the riparian buffers.
If buffer mitigation is required calculate the required amount of mitigation by applying the
buffer multipliers.
Zone* Impact Multiplier Required
(square feet) Mitigation
1 3 (2 for Catawba)
' 2 1.5
Total
* Zone 1 extends out 30 feet perpendicular from the top of the near bank of channel; Zone 2 extends an
' additional 20 feet from the edge of Zone 1.
3. If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e.,
Donation of Property, Riparian Buffer Restoration / Enhancement, or Payment into the
' Riparian Buffer Restoration Fund). Please attach all appropriate information as identified
within 15A NCAC 2B .0242 or .0244, or .0260.
' XI. Stormwater (required by DWQ)
Describe impervious acreage (existing and proposed) versus total acreage on the site. Discuss
stormwater controls proposed in order to protect surface waters and wetlands downstream from
I' the property. If percent impervious surface exceeds 20%, please provide calculations
demonstrating total proposed impervious level. N/A
Updated 11/1/2005
I' Page 12 of 13
¦

XII. Sewage Disposal (required by DWQ)
¦ 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.
N/A
' XIII. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
' Yes ? No
Is this an after-the-fact permit application? Yes ? No
XIV. Cumulative Impacts (required by DWQ)
' Will this project (based on past and reasonably anticipated future impacts) result in additional
development, which could impact nearby downstream water quality? Yes ? No
If yes, please submit a qualitative or quantitative cumulative impact analysis in accordance with
' the most recent North Carolina Division of Water Quality policy posted on our website at
http://h2o.enr.state.nc.us/ncwetlands. If no, please provide a short narrative description:
¦
' XV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
' Threatened Species, accessibility problems, or other issues outside of the applicant's control).
¦ Zug
' Applicant/Ag 's Signature Date
(Agent's signature is va ' only if an authorization letter from the applicant is provided.)
I'
Updated 11/1/2005
¦ Page 13 of 13
Exhibit # 1 - Vicinity Map - Forsyth Country Club and
Branch Maintenance Road Crossing

Proposed Maintenance Road Crossing Location
ti
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tJ

c
Legend N 4,000 2,000 0 4,000 Feet
Forsyth Country Club Parcels A

SID RTH
© 2002 DeLorme (www.delorme.com). 3-D TopoQuads ®. Data copyright of content owner. F 1,000 ft
Scale: 1 : 24,000 Map Rotation: 0° Magnetic Declination: 7.4°W I
FORSYTH COUNTY, NORTH CAROLINA - SHEET NUMBER 29 FORSYTH COUNTY, N(
810 _
ASPHALT
PAVEMENT
. NOTE: UPSTREAM ENDS OF PIPES TO BE FLUSH j
AGGREGATE BASE COURSE WTH FACE OF REINFORCED CONCRETE HEADWALL
ASPHALT PAVED SHOULDER
SELECT EARTH BACKFILL ROADWAY CROWN ELEV: 805.54
805
TOP OF HW: 804.20- S,1. -TOP OF HW. 804.60
PIPE CROWN (INSIDE): 802.50- -PIPE CROWN (INSIDE} 802.90
XISITNG STREAM BED ELEV 799.2 EXISITNG STREAM BED ELEV 799.70

P EXISITNG STREAM BED
eoD 48
RCP -
UPSTREAM INVERT: 798.90
DOWN STREAM INVERT 798.50 (TYPICAL ALL PIPES)
(TYPICAL ALL PIPE
S)
INSTALL PIPE INVERT BELOW INSTALL PIPE INVERT BELOW
STREAM INVERT AS SHOWN STREAM INVERT AS SHOWN
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Exhibit # 4
0513EEL ossomuR PA.
023577
1004125 - N.C. Division of Water Quality Check Date: 02/22/06 Customer #:
Invoice # Invoice Description Invoice Date Amount Adjustments Net Amount
022206 Pre-Construction Notification 2/22/2006
RE' :S-T%RI O-N CROSSING
I
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FEB 2 3 2006
DENR - WATER QUALITY
WETLANDS AND STORMWATER BRANCH

Detach Before Depositing
$200.00 $0.00 $200.00