20040186 Ver 1_Complete File_20040209

OF W A r?? Michael F. Easley, Governor
q
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North Carolina William G. Ross Jr., Secretary
Department of Environment and Natural Resources

Alan W. Klimek, P.E. Director
Division of Water Quality
August 23, 2005
DWQ # 20040186
Guilford County
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
Ms. Paula McCoy
Kavanagh Associates, Inc
1810 Pembroke Road
Greensboro, NC 27408
Subject Property: High Gate Condominiums
Bull Run Creek, Greensboro, NC
NOTICE OF WITHDRAWL
Dear Ms. McCoy:
On February 9, 2004, you requested a 401 Water Quality Certification from the Division of Water
Quality (DWQ) for your project. We wrote to you on March 31, 2004 discussing concerns that we
have regarding the design of the project and stating that it would be placed on hold for three weeks
giving you time to address DWQ's concerns. As of today, DWQ has not received a response to this
request. Therefore, your file is hereby considered withdrawn and will not be reviewed until DWQ's
earlier concerns are addressed. Once you have collected sufficient information to have a complete
application (please see our March 31, 2004 letter for the missing information), you will need to
reapply for DWQ approval. This includes submitting a complete application package with the
appropriate fee.
Please be aware that you have no authorization under Section 401 of the Clear Water Act for this
activity and any work done within waters of the state would be a violation of North Carolina General
Statutes and Administrative Code. Please call Mr. Ian McMillan at 919-715-4631 if you have any
questions or concerns.
Sincerely,
;vie Permitting Unit
cc:
Daryl Lamb, Winston-Salem DWQ Regibhal Office
Raleigh Corps of Engineers
Central Files
File Copy
Anthony Lester, Evans Engineering, Inc., 4609 Dundas Drive, Greensboro, NC 27407
Filename: S:\2005 CorrespondenceVW0186 High Gate Condo (Guilford) Withdrawal.doc
JhCarolina
t1lCQ«y
401 Oversight/Express Review Permitting Unit
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / Internet: hn://h2o.enr.state.nc.us/ncwetlands
An Equal Opportunity/Affirmative Action Employer - 50% Recycled/10% Post Consumer Paper
?OF W A r49Q
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o -c
Michael F. Easley
Governor
William G. Ross, Jr., Secretary
Department of Environment and Natural Resources
Alan W. Klimek, P.E., Acting Director
Division of Water Quality
CERTIFIED MAIL: 7002 2030 0002 7223 7496
RETURN RECEIPT REQUESTED
Ms. Paula McCoy
Kavanagh Associates, Inc.
1810 Pembroke Road
Greensboro, NC, 27408
Dear Ms. McCoy:
WEnANDS 1401 GROUP
APR 0 7 2004
WATER QUALITY SECTION
March 31, 2004
Guilford County
DWQ# 04-0186
On February 9, 2004, the NC Division of Water Quality (DWQ) received your application for a General 401
Water Quality Certification to impact 235 linear feet of an unnamed tributary to Bull Run Creek, Greensboro,
Guilford County. In accordance with 15A NCAC 2H.0506, an inspection of the site was conducted on October
7, 2003 by Mr. Daryl Lamb and Mr. Bob Zarzecki of the Division of Water Quality (DWQ), Winston-Salem
Regional Office. The proposed impact to the unnamed tributary consists of excavation and dam construction
for a permanent wet detention pond. The site plan included with your application shows that the proposed wet
detention pond will be located along a reach of stream that is protected by riparian buffers under 15A NCAC 2B
.0250, Randleman Lake Water Supply Watershed: Protection and Maintenance of Riparian Areas.
Consequently, this proposed stream impact cannot be approved because its planned location violates the State's
water quality regulations, specifically 15A NCAC 2B .0250 (2)(e)(ii).
You may amend your application by submitting an alternative proposal that relocates the wet detention pond to
an area which will not result in violation of the State's water quality regulations, or you may withdraw your
application. Please provide notice to DWQ, in writing, of your intentions with regard to this matter. If you
choose to amend your application, please send seven copies of the amended Pre-Construction Notification
Application to Ms. Cyndi Karoly, N. C. Division of Water Quality, 401 Wetlands Certification Unit, 1650 Mail
Service Center, Raleigh, NC 27699-1650.
Until the information requested in this letter is provided, I will request (by copy of this letter) that the U.S.
Army Corps of Engineers place this project on hold. The processing of this application will begin when the
requested information is received.
Please send the requested information to Ms. Cyndi Karoly, N. C. Division of Water Quality, 401 Wetlands
Certification Unit, 1650 Mail Service Center, Raleigh, NC 27699-1650. If you have any questions, please
contact Mr. Daryl Lamb, DWQ, Winston-Salem Regional Office, at [phone] extension 272.
Sincerely,
01? / reo6, ?e,-
Steve W. Tedder
Regional Supervisor
Division of Water Quality
North Carolina Division of Water Quality, 401 Wetlands Certification Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
919-733-1786 (phone), 919-733-6893 (fax), http://h2o.enr.state.nc.us/nowetiands/
Page 2 of 2
SWT/cdl
cc: Ms. Andrea Wade, U. S. Army Corps of Engineers, Raleigh Regulatory Field Office
DWQ, Winston-Salem Regional Office
401/Wetlands Unit File Copy
Central Files
Anthony D. Lester, Evans Engineering, Inc. 4609 Dundas Drive, Greensboro, NC 27407
O?0 W AT ?RQG
Cj 7,
Michael F. Easley
Governor
William G. Ross, Jr., Secretary
Department of Environment and Natural Resources
Alan W. Klimek, P.E., Acting Director
Division of Water Quality
March 31, 2004
Guilford County
DWQ# 04-0186
CERTIFIED MAIL: 7002 2030 0002 7223 7496
RETURN RECEIPT REQUESTED
Ms. Paula McCoy
Kavanagh Associates, Inc.
1810 Pembroke Road
Greensboro, NC, 27408
Dear Ms. McCoy:
On February 9, 2004, the NC Division of Water Quality (DWQ) received your application for a General 401
Water Quality Certification to impact 235 linear feet of an unnamed tributary to Bull Run Creek, Greensboro,
Guilford County. In accordance with 15A NCAC 2H.0506, an inspection of the site was conducted on October
7, 2003 by Mr. Daryl Lamb and Mr. Bob Zarzecki of the Division of Water Quality (DWQ), Winston-Salem
Regional Office. The proposed impact to the unnamed tributary consists of excavation and dam construction
for a permanent wet detention pond. The site plan included with your application shows that the proposed wet
detention pond will be located along a reach of stream that is protected by riparian buffers under 15A NCAC 2B
.0250, Randleman Lake Water Supply Watershed: Protection and Maintenance of Riparian Areas.
Consequently, this proposed stream impact cannot be approved because its planned location violates the State's
water quality regulations, specifically 15A NCAC 2B .0250 (2)(e)(ii).
You may amend your application by submitting an alternative proposal that relocates the wet detention pond to
an area which will not result in violation of the State's water quality regulations, or you may withdraw your
application. Please provide notice to DWQ, in writing, of your intentions with regard to this matter. If you
choose to amend your application, please send seven copies of the amended Pre-Construction Notification
Application to Ms. Cyndi Karoly, N. C. Division of Water Quality, 401 Wetlands Certification Unit, 1650 Mail
Service Center, Raleigh, NC 27699-1650.
Until the information requested in this letter is provided, I will request (by copy of this letter) that the U.S.
Army Corps of Engineers place this project on hold. The processing of this application will begin when the
requested information is received.
Please send the requested information to Ms. Cyndi Karoly, N. C. Division of Water Quality, 401 Wetlands
Certification Unit, 1650 Mail Service Center, Raleigh, NC 27699-1650. If you have any questions, please
contact Mr. Daryl Lamb, DWQ, Winston-Salem Regional Office, at [phone] extension 272.
Sincerely,
Steve W. Tedder
Regional Supervisor
Division of Water Quality
North Carolina Division of Water Quality, 401 Wetlands Certification Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
919-733-1786 (phone), 919-733-6893 (fax), hftp://h2o.enr.state.nc.us/ncwetiands/
Page 2 of 2
SWT/cdl
cc: Ms. Andrea Wade, U. S. Army Corps of Engineers, Raleigh Regulatory Field Office
DWQ, Winston-Salem Regional Office
401/Wetlands Unit File Copy
Central Files
Anthony D. Lester, Evans Engineering, Inc. 4609 Dundas Drive, Greensboro, NC 27407
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Michael F. Easley, Governor
William G. Ross Jr.. Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E., Director
Division of Water Quality
Coleen IL Sullins, Deputy Director
Division of Water Quality
Division of Water Quality
Department of Environmental and Natural Resources
Wetlands/401 Unit
Street Address: 2321 Crabtree Boulevard, Suit e 250
Raleigh, NC 27604-2260
Mailing Address: 1650 Mail Service Center
Raleigh, NC 27699-1650
Contact Information: Phone #: [phone]
Fax #: [phone]
Fax #:
Fax To: 0(
Company:
Number of pages including cover sheet:
Notes or special instructions:
Date: r,- "/ =
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N. C. Division of Water Quality, 401 Wetlands Certification Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crtbtree Blvd., Raleigh, NC 27604-2260 (Location)
[phone] (phone), 919-733-6893 (fax), (httpdih2o.enr.statenc.uVncwetlands

Triage Check List
Date: ?& -F0 Project Name: Z4,
DWQ#: D ?//??•
County: ?G ?l?,c cC
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To: ? ARO Mike Parker ? WaRO
? FRO Ken Averitte ? WiRO
? MRO Mike Parker _-QWSRO
? RRO Steve Mitchell
From: Z2?
Deborah Sawyer
Joanne Steenhuis

Telephone : (919) ?/ S--
file attached is being forwarded to your for your evaluation.
The
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 (Neuse, 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: S7:;-e t1i c.? ? % v, .:

EVANS ENGINEERING INC.
ENGINEERS
PLANNERS
SURVEYORS
SINCE 1974
r r r G,
WETLANDS/ 401 GROUP
February 5, 2004
FEB 0 9 2004
N.C. Division of Water Quality
401 Wetlands Unit 8 WATER QUALITY SECTION
1650 Mail Service Center
Raleigh, NC 27699-1650
Re: 401 Water Quality Certification Application for High Gate Condominiums, Greensboro, NC
Dear Sirs:
Please find attached the following items:
1. 7 copies of the application
2. Fee check
Please process for review and approval. If you have any questions, please don't hesitate to call.
Sincerely,
i
Anthony D. Lest r, . E.
Vice President
EVANS ENGINEERING, INC.
ADL/mlc
605-360 Water Quality CeNadl
Phone: [phone] * E-mail: ([e-mail]) * Fax: [phone]
4609 Dundas Drive, Greensboro, NC 27407 - P.O. Box 10285, Greensboro,,NC 27404
PCNFORM 605-360.doc
Office Use Only:i E? Form Version October 2001
016
USACE Action ID No. DWQ No. 0 p
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
1. Processing
1. Check all of the approval(s) requested for this project:
Section 404 Permit
Section 10 Permit
401 Water Quality Certification
Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested: NWP 39
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 Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), 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: F]
II. Applicant Information WETLANDS/ 401 GROUP
1. Owner/Applicant Information FEB 0 9 2004
Name: Kavanagh Associates, Inc.
Mailing Address: 1810 Pembroke Road
Greensboro, NC 27408 VWER QUALITY SECTION
Telephone Number: 336-272-9904 Fax Number: 336-370-4137
E-mail Address:
2. Agent 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:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Page 5 of 12
PCNFORM 605-360.doc
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 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: High Gate Condominiums
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): 11-684-A-867-14, 30-33
4. Location
County: Guilford Nearest Town: Greensboro
Subdivision name (include phase/lot number): High Gate Condominiums
Directions to site (include road numbers, landmarks, etc.): I-85 to Groometown Road North.
Groometown Road to Hilltop Road, Hilltop Road to Penoak Road, site is across the road
opposite Penoak Road.
5. Site coordinates, if available (UTM or Lat/Long): N/A
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Property size (acres): 10.658 Acres
7. Nearest body of water (stream/river/sound/ocean/lake): _ UT to Bull Run Creek (Sedaef eld
8. River Basin: Cape Fear
(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.ne.us/admin/maps/.)
9. Describe the existing land use or condition of the site at the time of this application:
Site is generally wooded except for an old abandoned house and driveway.
Page 6 of 12
PCNFORM 605-360.doc
10. Describe the overall project in detail, including the type of equipment to be used:
The overall project shall consist of clearing, grading, utility installation and paving for 120
residential condominium units. Equipment used shall be pans, dozers, trackhoes. compaction
equipment, etc.
11. Explain the purpose of the proposed work: The purpose of the work shall be to install a
permanent wet detention pond for watershed purposes.
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.
N/A
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:
None anticipated.
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. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must 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.
Page 7 of 12
PCNFORM 605-360.doc
1. Provide a written description of the proposed impacts: The proposed impact shall be the
construction of a permanent stormwater wet detention pond on about 235 LF of intermittent
2. Individually list wetland impacts below:
Wetland Impact
Site Number
(indicate on map)
Type of Impact* Area of
Impact
(acres) Located within
100-year Floodplain**
(yes/no) Distance to
Nearest Stream
(linear feet)
Type of Wetland***

* List each impact separately and identify temporary impacts. 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.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http://Nkww.fema._izov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property: None.
Total area of wetland impact proposed: None.
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact
Site Number
(indicate on map)
Type of Impact* Length of
Impact
(linear feet)
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
(please specify)

I Excavation &
PermDam for anent wet
detention pond
235
UT to Bull Run Creek
0.5'
Intermittent

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, 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.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at I-800-358-9616, or online at
www.uscs.vov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
www.mapquest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 235 LF
Page 8 of 12
PCNFORM 605-360.doc
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Open Water Impact
Site Number
(indicate on map)
Type of Impact* Area of
Impact
(acres) Name of Waterbody
(if applicable) Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean, etc.)

List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
5. 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): 0 uplands F? stream F] wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.): Construction shall include excavation, dam &
embankment, installation of riser & barrell kit, and emergency spillway installation.
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): Local stormwater pond
Size of watershed draining to pond: 10.4 Acres Expected pond surface area: 8372 SF
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
techniques to be followed during construction to reduce impacts.
The pond location was considered to be where the existing pond is currently located but
NCDOT is draining this pond and restoring the original channel as part of their Wetlands
Mitigation. The impacts were also minimized due to the fact that we piped +- 29 Acres of
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.
Page 9 of 12
PCNFORM 605-360.doc
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, 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
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 NCWRP 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
htip://h2o.enr.state.nc.us/ncwetlands/stnngide.html.
1. 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 Wetlands Restoration
Program (NCWRP) with the NCWRP's written agreement. Check the box indicating that
you would like to pay into the NCWRP. Please note that payment into the NCWRP must be
reviewed and approved before it can be used to satisfy mitigation requirements. Applicants
will be notified early in the review process by the 401/Wetlands Unit if payment into the
NCWRP is available as an option. For additional information regarding the application
process for the NCWRP, check the NCWRP website at http://h2o.enr.state.nc.us/wip/index.htm. If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following information:
Amount of stream mitigation requested (linear feet): N/A
Amount of buffer mitigation requested (square feet): N/A
Amount of Riparian wetland mitigation requested (acres): N/A
Amount of Non-riparian wetland mitigation requested (acres): N/A
Amount of Coastal wetland mitigation requested (acres): N/A
Page 10 of 12
PCNFORM 605-360.doc
IX. Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
land?
Yes ? No
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)?
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 ? N/A
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 n No ? N/A
X. Proposed Impacts on Riparian and Watershed Buffers (DWQ Only)
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.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 213 .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ? No ? If you answered "yes", provide the following information:
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
(square feet) Multiplier Required
Mitigation
1 3
2 1.5
Total
Zone 1 extends out 30 teet perpendicular trom near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
Page 11 of 12
,
PCNFORM 605-360.doc
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or .0260.
XI. Stormwater (DWQ Only)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
Prop. ISA = 3.90 Acres Permanent wet detention pond is to be built on-site
Total Site Area = 10.658 Acres in order to control proposed ISAs.
XII. Sewage Disposal (DWQ Only)
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.
Sewage disposal shall be by public means. This sewer flows to the City of Greensboro
wastewater treatment plant which has adequate capacity.
XIII. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes F? No
Is this an after-the-fact permit application?
Yes El No El
XIV. 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).
N/A
4L1_J Z r, ffjc,(",C
Applicant/Agent's Signature
(Agent's signature is valid only if an
letter from the applicant is provided.)
Page 12 of 12
P.)?x 19 17, 12
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460 DUNDAS O, NORTH CARD NA 27407
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PHONE: [phone] FAX.• [phone]