20090907 Ver 1_401 Application_20090809

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_9? "PracticalEnghwering &
Enviromwntal Solutions"
August 14, 2009
Mr. John Thomas
Raleigh Regulatory Field Office
US Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27586
Telephone [phone] (Ext. 25)
RE: Preconstruction Notification Application
Southpark Boulevard Headwall Repair
Winston-Salem, Forsyth County, NC
Our Project #09.203
Dear Mr. Thomas:
2050 Northpoint Drive • Suite A
Winston-Salem, NC 27106
Phone: [phone]
Fax: [phone]
[e-mail]
www.geotec.com
QFg@NGVT2'= D
AUG 1 7 2009
DENR - WATER QUALITY
WETLANDS AND STORKWATER BRANCH
By email we sent you a copy of the enclosed PCN for a project to repair the headwall. The headwall
is at a 60 in. RCP that is in a creek, at Southpark Boulevard. The damage was the result of erosion
caused by misalignment of the pipe with the stream.
The project involves:
1) Placing a temporary cofferdam for diversion.
2) Removal of debris from the collapsed wall.
3) Placing a 30 ft. section of 48 in. CMP in the stream. Construction of a temporary work
platform. This will involve straightening the stream alignment, which will shorten the steam by 5
ft. The new alignment will become permanent, to reduce likelihood of a recurrence of the failure.
4) Placing soil nails in the road embankment, attaching reinforcement, applying Shotcrete.
5) Replacing the segmental block retaining wall.
6) Removal of the work platform and CMP.
7) Dressing and seeding the banks of the stream, placing riprap on the banks for 10 ft. upstream
of the headwall. The riprap will also help reduce the likelihood of recurrence of the failure.
Ms. Sue Homewood of DWQ Winston-Salem Regional Office has visited the site with the writer.
She determined that the stream is jurisdictional. A copy of the determination letter is enclosed. She
stated that if this project fits under NW Permit #3, and if the impact can be kept to less that 40 ft.,
then no DWQ permit is required. You stated that the project qualifies for Permit #3. We have
planned the work to keep the impact below 40 ft.
Please let us know if you have any questions or require further information with regard to this
application.
With best regards,
GEOSCIE E AND TECHNOLQ ?YJ P.A.
Carl von Is rg, P. E_,'
Senior Civil Engineer EX;- 09
enclosures: PCN
cc: Robby Stone, PE, Streets Director, City of Winston-Salem
Ms Cyndi Karoly, Supervisor
401 Oversight/Express Review Permitting Unit
NCDENR
2321 Crabtree Boulevard
Raleigh, North Carolina 27604
Telephone [phone]
Sue Homewood, Winston-Salem Regional Office, NC DWQ
o?0F 101A(rFR?Qc

Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification (PCN) Form
A. Applicant Information
1. Processing
1 a. Type(s) of approval sought from the

Corps:
®Section 404 Permit El Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: 3 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps? ? Yes ? No
1 d. Type(s) of approval sought from the DWQ (check all that apply):
? 401 Water Quality Certification - Regular ? Non-404 Jurisdictional General Permit
? 401 Water Quality Certification - Express ? Riparian Buffer Authorization
1 e. Is this notification solely for the record
because written approval is not required? For the record only for DWQ 401
Certification:
? Yes ? No For the record only for Corps Permit:

? Yes ? No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program. ? Yes ? No
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below. ? Yes ? No
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ? Yes ? No
2. Project Information
2a. Name of project: Repair of Headwall, Southpark Boulevard
2b. County: Forsyth
2c. Nearest municipality / town: Winston-Salem, NC
2d. Subdivision name:
2e. NCDOT only, T.I.P. or state
project no:
3. Owner Information
3a. Name(s) on Recorded Deed: Morgan Ridge Rs Llc Et Al City of Winston-Salem
3b. Deed Book and Page No. 2653-1349 Public Right of Way
3c. Responsible Party (for LLC if
applicable): Greg Turner, Asst. City Manager
3d. Street address: 2089 Fort Union Blvd E 100 E Main Street
3e. City, state, zip: Salt Lake City, UT 84121 Winston-Salem, NC 27101
3f. Telephone no.: 725-2545
3g. Fax no.: 748-3060
3h. Email address:
Page I of 10
PCN Form - Version 1.3 December 10, 2008 Version
4. Applicant Information (if different from owner)
4a. Applicant is: ® Agent ? Other, specify:
4b. Name: Carl von Isenburg
4c. Business name
(if applicable): GeoScience & Technology, PA
4d. Street address: 2050 Northpoint Drive
4e. City, state, zip: Winston-Salem, NC 27106
4f. Telephone no.: 336-896-1300
4g. Fax no.: 336-896-1020
4h. Email address: [e-mail]
5. Agent/Consultant Information (if applicable)
5a. Name:
5b. Business name
(if applicable):
5c. Street address:
5d. City, state, zip:
5e. Telephone no.:
5f. Fax no.:
5g. Email address:
Page 2 of 10
PCN Form - Version 1.3 December 10, 2008 Version
B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
1b. Site coordinates (in decimal degrees): Latitude: Longitude: -
(DD.DDDDDD) (-DD.DDDDDD)
1c. Property size: 25.17 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to Unnamed tributary to Salem Creek
proposed project:
2b. Water Quality Classification of nearest receiving water:
2c. River basin: Yadkin-Peedee
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
Incised watercourse in common area of apartment complex.
3b. List the total estimated acreage of all existing wetlands on the property:
0.25
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
<200 ft
3d. Explain the purpose of the proposed project:
Repair damaged headwall
3e. Describe the overall project in detail, including the type of equipment to be used:
Install temporary coffer dam for diversion (pump-around); prepare bed, including straightening alignment; install
temporary CMP in stream; fill to provide working platform; install soil nails, repair wall; remove fill and pipe, dress stream
banks, place riprap. Equipment in stream: track hoe. Equipment on project: drill, concrete pump.
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
? Yes ? No X® Unknown
project (including all prior phases) in the past?
Comments:
4b. If the Corps made the jurisdictional determination, what type
? Preliminary ? Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company:
Name (if known): Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5. Project History
5a. Have permits or certifications been requested or obtained for El Yes El No ®Unknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
There is the possibility of litigation. Prior consultants and contractors are not providing information.
6. Future Project Plans
6a. Is this a phased project? ? Yes X® No
6b. If yes, explain.
Page 3 of 10
PCN Form - Version 1.3 December 10, 2008 Version
C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
? Wetlands ® Streams - tributaries ? Buffers
? Open Waters ? Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type of jurisdiction
number - Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWQ - non-404, other) (acres)
Temporary T
W 1 ? P ? T ? Yes ? Corps
? No ? DWQ
W2 ? P ? T ? Yes ? Corps
? No ? DWQ
W3 ? P ? T ? Yes ? Corps
? No ? DWQ
W4 ? P ? T ? Yes ? Corps
? No ? DWQ
W5 ? P ? T ? Yes ? Corps
? No ? DWQ
W6 ? P ? T ? Yes ? Corps
? No ? DWQ
2g. Total wetland impacts
2h. Comments:
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a. 3b. 3c. 3d. 3e. 3f. 3g.
Stream impact Type of impact Stream name Perennial Type of jurisdiction Average Impact
number - (PER) or (Corps - 404, 10 stream length
Permanent (P) or intermittent DWQ - non-404 width (linear
Temporary (T) (INT)? ,
other) (feet) feet)
S1 ®P ? T alignment, riprap unnamed ® PER ® Corps 6 15
on bank ? INT ? DWQ
S2 ? P ? T ? PER ? Corps
? INT ? DWQ
S3 ? P ? T ? PER ? Corps
? INT ? DWQ
S4 ? P ? T ? PER ? Corps
? INT ? DWQ
S5 ? P ? T ? PER ? Corps
? INT ? DWQ
S6 ? P ? T ? PER ? Corps
? INT ? DWQ
3h. Total stream and tributary impacts 15
3i. Comments:
Page 4 of 10
PCN Form - Version 1.3 December 10, 2008 Version
4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individually list all open water impacts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number - (if applicable) Type of impact Waterbody type Area of impact (acres)
Permanent (P)
or Temporary T
01 ?P?T
02 ?P?T
03 ?P?T
04 ?P?T
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If and or lake construction proposed, then complete the chart below.
5a. 5b. 5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or purpose (acres)
number of pond
Flooded Filled Excavated Flooded Filled Excavated Flooded
P1
P2
5f. Total
5g. Comments:
5h. Is a dam high hazard permit required?
? Yes ? No if yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below . If yes, then individually list all buffer impacts
below. If an impacts require mitigation, then you MUST fill out Section D of this form.
6a.
? Neuse
? Tar-Pamlico ? Other:
Project is in which protected basin? ? Catawba ? Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number - Reason Buffer Zone 1 impact Zone 2 impact
Permanent (P) for Stream name mitigation (square feet
(square feet)
or Temporary T impact required?
B1 ?P?T ?Yes
? No
B2 ? P ? T ? Yes
? No
B3 ?P?T ?Yes
? No
6h. Total buffer impacts
6i. Comments:
Page 5 of 10
PCN Form - Version 1.3 December 10, 2008 Version
D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Unavoidable. Need access to repair washed out headwall.
1b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
Limit length of pipe to minimum
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for
impacts to Waters of the U.S. or Waters of the State? ? Yes ® No
2b. If yes, mitigation is required by (check all that apply): ? DWQ ? Corps

2c. If yes, which mitigation option will be used for this
project? ? Mitigation bank

El Payment to in-lieu fee program
? Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter) Type Quantity
3c. Comments:
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached. ? Yes
4b. Stream mitigation requested: linear feet
4c. If using stream mitigation, stream temperature: ? warm ? cool ?cold
4d. Buffer mitigation requested (DWQ only): square feet
4e. Riparian wetland mitigation requested: acres
4f. Non-riparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requested: acres
4h. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 6 of 10
PCN Form - Version 1.3 December 10, 2008 Version
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) - required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires
buffer mitigation? ? Yes ? No
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.

Zone 6c.
Reason for impact 6d.
Total impact
(square feet)
Multiplier 6e.
Required mitigation
(square feet)
Zone 1 3 (2 for Catawba)
Zone 2 1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund).
6h. Comments:
Page 7 of 10
PCN Form - Version 1.3 December 10, 2008 Version
E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1a. Does the project include or is it adjacent to protected riparian buffers identified ? Yes ® No
within one of the NC Riparian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
? Yes ? No
Comments: stormwater flow unchanged.
2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project? %
2b. Does this project require a Stormwater Management Plan? ? Yes ® No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: Repair of existing structure
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
? Certified Local Government
2e. Who will be responsible for the review of the Stormwater Management Plan? ? DWQ Stormwater Program
? DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project? City of Winston-Salem
? Phase II
? NSW
3b. Which of the following locally-implemented stormwater management programs ? USMP
apply (check all that apply): ? Water Supply Watershed
? Other:
3c. Has the approved Stormwater Management Plan with proof of approval been ? Yes ? No
attached?
4. DWQ Stormwater Program Review
? Coastal counties
? HQW
4a. Which of the following state-implemented stormwater management programs apply ? ORW
(check all that apply): ? Session Law 2006-246
? Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
? Yes ? No
attached?
5. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements? ? Yes ? No
5b. Have all of the 401 Unit submittal requirements been met? ? Yes ? No
Page 8 of 10
PCN Form - Version 1.3 December 10, 2008 Version
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the project involve an expenditure of public (federal/state/local) funds or the ? Yes ? No
use of public (federal/state) land?
1 b. If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State ? Yes ? No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1c. If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
? Yes ? No
letter.)
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards, ? Yes ? No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after-the-fact permit application? ? Yes ? No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in ? Yes ® No
additional development, which could impact nearby downstream water quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
Page 9 of 10
PCN Form - Version 1.3 December 10, 2008 Version
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or
habitat? ? Yes ? No
5b. Have you checked with the USFWS concerning Endangered Species Act
impacts? ? Yes ? No
5c. If yes, indicate the USFWS Field Office you have contacted. El Raleigh
? Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? ? Yes ? No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
? Yes ? No
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? ? Yes ® No
8b. If yes, explain how project meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?
Carl von Isenburg, PE
* 8/12/09
Applicant/Agent's Printed Name valid /AgeVSig re
(Agent's signatuif an tter from t he applicant
is provided.) Date
Page 10 of 10
PCN Form - Version 1.3 December 10, 2008 Version
organ
August 12, 2009
RE: Deed book & page # 2653-1349
To whom it may concern;
Morgan Ridge RS LLC authorizes Carl van Isenburg PE, of GeoScience
Technology PA to act as agent for the purpose of applying for permits (PCN) for
the construction work required to repair a headwall on or near Morgan Ridge
property.
If you have any questions, please feel free to contact me.
Warm regards,
{U' -
&e"
Peggy B. Bolens
Community Manager
100 Morgin Way - Wjn:ton-Salem, NIC 27127 - Ph 336-784.9242 - Fax [phone]
MAT
A NCDE
NR
North Carolina Department of Environment and
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
Natural Resources
Dee Freeman
Secretary
August 7, 2009
Mr. Carl von Isenburg, PE
GeoScience & Technology PA
2050 Northpoint Dr
Winston-Salem, NC 27106
Subject Property: Southpark Blvd culvert crossing, Forsyth County
On-Site Determination for Applicability to the Mitigation Rules (15A NCAC 2H.0506(h)
Dear Mr. von Isenburg:
On August 7, 2009, at your request and in your attendance, Sue Homewood conducted an on-site determination
to review features located on the subject property for intermittent/perennial determinations with regards to the
above noted state regulations. The features that were reviewed are identified on the attached map.
The feature identified as Stream A was found to be perennial from the stormwater pond outlet upstream of the
culvert under Southpoint Blvd to downstream of the culvert beyond the road right-of-way.
Please note that all perennial stream channels and jurisdictional wetlands found on the property are subject to
the mitigation rules cited above.
The owner (or future owners) should notify the DWQ (and other relevant agencies) of this decision in any
future correspondences concerning this property. This on-site determination shall expire five (5) years from the
date of this letter.
Landowners or affected parties that dispute a determination made by the DWQ or Delegated Local Authority
that a surface water exists and that it is subject to the buffer rule may request a determination by the Director. A
request for a determination by the Director shall be referred to the Director in writing c/o Cyndi Karoly, DWQ,
401 Oversight/Express Review Permitting Unit, 2321 Crabtree Blvd., Suite 250, Raleigh, NC 27604-2260.
Individuals that dispute a determination by the DWQ or Delegated Local Authority that "exempts" surface
water from the buffer rule may ask for an adjudicatory hearing. You must act within 60 days of the date that
you receive this letter. Applicants are hereby notified that the 60-day statutory appeal time does not start until
the affected party (including downstream and adjacent landowners) is notified of this decision. DWQ
recommends that the applicant conduct this notification in order to be certain that third party appeals are made
in a timely manner. To ask for a hearing, send a written petition, which conforms to Chapter 150B of the North
North Carolina Division of Water Quality, Winston-Salem Regional Office
Location. 585 Waughtown St. Winston-Salem. North Carolina 27107
Phone: [phone]! FAX: [phone]'•. Customer Service: 1-877-623-6748
Internet wm,*w.ncwaterquelity.org
An Equal Opportunity ; Affirmative Action Employer
One
NoahCarolina
?Ivaturallrf
Carl von Isenburg
August 7, 2009
Page 2 of 2
Carolina General Statutes to the Office of Administrative Hearings, 6714 Mail Service Center, Raleigh, N.C.
27699-6714. This determination is final and binding unless you ask for a hearing within 60 days.
This letter only addresses the applicability to the mitigation rules and the buffer rules and does not approve any
activity within Waters of the United States or Waters of the State or their associated buffers. If you have any
additional questions or require additional information please call me at 336-771-4964
Sincerely,
c
Sue Homewood
DWQ Winston-Salem Regional Office
Enclosures: USGS Topo Map
cc: John Thomas, USACE Raleigh Regulatory Office
DWQ, Winston-Salem Regional Office