20051994 Ver 1_Complete File_20051031

TOWN OF KERNERSVILLE
PUBLIC WORKS DEPARTMENT

Randy E. McCaslin, Town Manager
Timothy G. Shields, Director

P.O. Box 728
Kernersville, N.C. 27285-0728

720 McKaughan Street
Telephone [phone]
Fax [phone]

CERTIFIED MAIL
RETURN RECEIPT REQUESTED
7004 0550 0000 5620 0329

October 26, 2005

Division of Water Quality
401 Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650

RE: Pre-Construction Notification Courtesy Copies
Century Blvd. Dam Repair
Kernersville, NC
Forsyth County

Dear Review Engineer:

Please find attached two courtesy copies of the Pre-Construction Notification (PCN) Application
Forms and supporting documents. I have submitted this PCN to the Army Corps of Engineers
with the intent of obtaining a Nationwide Permit #3 for a dam repair project located in the Town
of Kernersville, in Forsyth County.

If you have any questions or need additional information, call me at [phone], or email me
at: aderliiJici. kcrncrsvillc.nc .lIS

Sincerely,

~&J?~

Franz Ader, PE
Stormwater Administrator

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Attachments

Office Use Only:

Form Version March 05

USACE Action ID No. D'VQ No.
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)

I. Processing

1. Che9k all of the approval(s) requested for this project:
~Section 404 Permit 0 Riparian or .Watershed Buffer Rules
o Section 10 Permit D Isolated Wetland Permit from DWQ
D 401 Water Quality Certification 0 Express 401 Water Quality Certification

2. Nationwide, Regional or General Permit Number(s) Requested: ;t,b..I/,?/)u/((Jc/ f('r/W'i; 4ti3
.. ---..

3. Ifthis notification is solely a~y.rtesy copy because written approval for the 401 Certification
is not required, check here: Lr6'

4. If payment into the North Carolina Ecosystem Enhancement Prograrn (NCEEP) is proposed
IV! It for mitigation of impacts, attach the acceptance letter from NCEEP, complete section VIII,
/- and check here: 0

II.

rt.!t'1 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~, [i@h~eDW~

Applicant Information ~ . ~
DCl 3 1 Z005

1. Owner/Applicant Information
Name: 70"';'1 or ker/?t?;~.vjI0
Mailing Address: ~ 0, &>c- 7;;"{/
f(er/lc'/-svr'I(.v,/ NC/ :;o:/...&S

DENR - WATER QUALITY
WElWlDS NW S I lJj{lfo MTERtlRN lei I

Telephone Number: 33& --?'l/;~ &Lf6:.r- Fax Number: 336.- <;"}6- ~5/
E-mail Address: o.d/!'.-Fa r:;~"( K.r?r'/le,::5/,//'//r.:-_ !'1r::... ''is"

2. AgenUConsultant 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: ;V//!
Company Affiliation:
Mailing Address: .

Telephone Number:
E-mail Address:

Fax Number:

Page 5 of 12

III. Project Information

Attach a vicinity map clearly showing the location of the property with respect to local
lan~marks 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 rnust 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 yersion 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 ofproject: {!r:;.NWi<-7J- BLL/.D, 0 rJlJ?

2. T.I.P. Project Number or State Project Number (NCDOT Only): /'Ill/-
c;f1'7.s- -79,- 15.//9.;>-

3. Property Identification Number (Tax PIN):

4. Location
County: FOr<.,:;;y 771 Nearest Town: kc~I'V;~;;UVIL~
Subdivision name (include phase/lot number): /1// /J
Directions to site (include road numbers/names, landmarks, etc.):,F~ /21lt:.r-~ r-14 //1 /c.E-;;
:t:.-Jjo 13\11'.155 W~..:;;T /0 1<r:;I!NC'~ihL '0 -rAke:- cr/,v,'C'.v Cf?t7SS lcD, /VaR.;l/ /-}"P?ft20)c.
,8' MIL- ,S' r, L ~NTD CClv'il//2.- <!. /' . t/::: O. 2-'I'J
(!ENWIZY aL.vD, jHjtJ> S) To I.. O,.;?, /JJ/!,f25 C',.; a/61ft.

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): ON OW

6. Property size (acres):

/0 c..c.re,5

7. Name of nearest receiving body of water: oPllTIt C.f<e,l3~,I::..

8. River Basin: Yllp/Oil)
(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/adminlmaps/.)

9. Describe the existing conditions on the site and general land use in the vicinity ofthe project
at the time ofthis application: TlI6 SITG CIa SrS (,v ,..Jt1/ ,q~;tPJ of /II (:r eO usE:
511v'iLC - r=;.'7,;?IC-Y {~E5108~/r'fL- C='?1"~ICI':'C II'/L. ;J-IL-/fl,::/.;nJIJ...01116f./tuAr.-; /?,USllvC;.:;;<.. E7c,.
, I ~, -.."
77i[;" PO,l/,? Lcc/l 01l~/TC '5 Ct/,2./Gb7Vl{ ,'//<:.:D /1(O.-1/,v6 :>. ,.:{; Q

Page 6 of 12

10. Describe the overall project in detail, including the type of equipment to be used: TJ-{&2e: 1<.5
C!...(,/iZ-r2-c:wrt,.-,'I A F/lIt.-t;.D OOt/&L~ () Hte~ CLL- sP/'u-w/fy 771--1I/,vb7.;;?J.5 /<-t::i;.?/f/tc-.
s;-tJNO!fIU) Co/lls77:!.(';c-llcw0 a(/tt2mb'~tJJLt.- Se; VS5"o: Ot..y,?p,-;:,?",(/cl<-.S, DDcQU/
Tile DO tI;J LC M/2..,L {;:lL- 101 /....-{./ S ~ ~ E3Pt.-.4c.-GD 13 Y ON c;;- 6 . erG.

11. Explain the purpose of the proposed work: xC; lt1/n:~O To ~ C;PI...I"}C,,E;:' OL D-CJ;7?/16CO
ovrPril.-t- 0(2/11;.)5 "oj,TH D'-'/o- (7.y~ 0 cJ/PT-Jtc- PII"" c:-z

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 ill 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. 7/1C?'4/J? /lalla... /1/4<,' C'l:C16././l/A-t'J'f/ ;;',c;r',e.u~ BY ~/// .s./f'/2:ry q
fl~5~ /)r/C/19td!bclJc:cf ),ut5i1t:E" IJI"f7tZ~?J We- /',zoJ7;:2::( c>;Vrrut.y 6" /<199 10/Z /7 #..-17l0Ul.}/Vb'pc-;1!./hfr3.J..;;:6
(tjrfr;c../fc!J), Od,s ....,.. -- ~ n/c - ('2-7/"1 mi. D. ~C?~ /I--. c /'c'.cI ,. C-t9,(;{;) ~1{.f ')I
;<f/?('/Z..Cv:..OJ 11ft:: 6/2C8 V uW77Z.t"L- PL4,v 0/)/ Fall6 300if {?t fpc/'eo?.-J,. me rlc-/tC'tv ID::. I? 9 fj';}'07 J b
O;:}/>1 t<..e7Yli/z; FW/]tS O./2.J6:(tVtl:l.?0/ OR./.)CJZGO t3u' 0/10 5A.PG7V Of/} SE}::)1;30/ /996.-
v. ~ u ure proJec Plans T " I' . / ' ,

Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of tins work from the current application.
Ill/A

VI. Proposed Impacts to 'Vaters of the United States/\Vaters 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
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.

I. Provide a written description of the proposed impacts: 7//1<.5 IS ;4 I2GPrJ 1)<.. Pv2r.XFEcr;

'f1f E12 C /f A ~ ,.;; /7 0 D /17 eN r::; L- I rn P /1 c:. T"'; /7:;) S v;Z..F /I-c., C '(;0117'& K,., , R. E*'IT I ,e,s t...V I t...L--
13C I r\1 ;tCC.C.2" ,1r.1ct3 (,u/Th 77t--~C SJ;3;7'J;.trGO 7() 4ttJfJ f}/-?,:JdcvCo .<S Y
,
O(}fl1 S.-1FC'j'1

Page 7 of 12

{rJ I f+ 2,

separate y IS Impacts ue to ot structure an 00 mg.
Wetland Impact Type of Wetland Located within Distance to Area of
Site Number Type of Impact (e.g., forested, marsh, IOO-year Nearest Impact
(indicate on map) herbaceous, bog, etc.) Floodplain Stream (acres)
(yes/no) (linear feet)
Total Wetland Impact (acres)

Individually list wetland impacts. Types of impacts include, but are not limited to
mechanized clearing, grading, fill, excavation, flooding, ditching/drainage, etc. For dams,
I r t . d b h d fl d'

rv Iff

3. List the total acreage (estimated) of all existing wetlands on the property:

rJ/fI

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.), excayation, ditching/straightening, etc. If stream relocation is proposed,
plans and profiles showing the linear footprint for both the original and relocated streams
t b . I d d T I I t If I I th X 'dth th d' 'd b 43 560

mus e mc u e . o ca cu a e acreage, mu IP y eng WI , en IVI e y ,
Stream Impact Perennial or Average Impact Area of
Number Stream Name Type ofImpact Intermittent? Stream Width Length Impact
(indicate on map) Before Impact (linear feet) (acres)
Total Stream Impact (by length and acreage)

IV III 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, dredging, flooding, drainage, bulkheads, etc.

Open Water Impact Name of Water body Type of Waterbody Area of
Site Number Type of Impact (lake, pond, estuary, sound, bay, Impact
(indicate on map) (if applicable) ocean, etc.) (acres)
Total Open Water Impact (acres)

Page 8 of 12

6. List th

I .

llW

f h US

I' fr

e cumu atIve Impact to a aters 0 t e . . resu tmg om t Ie pro] ect:
Stream Impact (acres): li/fl
Wetland Impact (acres): /]/11'
Open Water Impact (acres): /V'IJ
Total Impact to Waters of the U.S. (acres) /t/ 1/1
Total Stream Impact (linear feet): 1~9

7. Isolated Waters
Do any isolated waters exist on the property? ~ Yes D 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.
/'r? F<.?/I ..:r ..51--'--".,?J w;i/ be ,;1J~~(.fcd by i-IJG r-er-c;,-;'--

~\~ 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): \ D uplands D stre nl D wetlands
Describe the method of construction (e.g., am/embankment, avation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock w
local stormwater requirement, etc.):
Current land use in the vicinity ofthe pond:
Size of watershed draining to pond:

VII. Impact Justification (Avoidance and Minimization)

Specifically describe rneasures 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. 1m y/} CT5 TO Tlte: STt2 E:1)1?f
()J i~v de /'11/1//1')]; c; eo p()f<.t.t)c, <!o,J:5T~UC.Tl{?rJ~ Q2CSi'CN CD1/nUL- ())C11SV;2.&S JI,UC
f3alV ,4;:JP/2.0l,/6!:) f!> V LIII'v'O Q()lJ-tAry ANt) wI L-t., &(3.. A/) Jr(:'::./:.?El::> 7l/ Dv/.!-I tV 6-
~/)/.sr;ei/47o;J. {

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

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
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://h20.enr.state.nc. us/ncwetlands/ strmgide.html.

rJ(l11.

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 yiew,
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 shee . f more space is needed.

N 1ft 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://h20.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):

Page 10 of 12

IX. Environmental Documentation (required by D\VQ)

1. Does the project involve an expenditure of public (federal/state/local) funds or the use of
public (federal/state) land? Yes ~ No D

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 (NEPAlSEPA)?
Note: If you are not sure whether a NEP AlSEP A document is required, call the SEP A
coordinator at [phone] to review current thresholds for environmental documentation.
Yes D No ~

,V {IP. If yes, has the document review been finalized by the State Clearinghouse? If so, please
attach a copy ofthe NEPA or SEPA final approval letter. Yes D No D

x. Proposed Impacts on Riparian and \Vatershed Buffers (required by D\VQ)

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 - )'1 Yes D 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 multi liers.

1
2

Multiplier

3 (2 for Catawba)
1.5

Zone*

Total

* Zone I extends out 30 feet perpendicular from the top of the near bank of channcl; Zone 2 extends an
additional 20 feet from the cdge of Zone I.

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. ;VI A

Page 11 of 12

XI. Stormwater (required by D'VQ)

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
the property. If percent impervious surface exceeds 20%, please provide calculations
demonstrating total proposed impervious level. -mC/U5"' 0' a % r0Pc/?'L//C'U5; /Jc,z,c796C
eN 71/5 totf?-OP~I?-'7- lliE:1Zb /6 rVo /;vCl2e7/sG 1M ///JPv<_.v;ov!.s /jiZ.Cl.J P/2.;;PO.scb
O(,.I,({(n) 6 7716 te6i9tlf2- C]P 'THe;;..- (;),.;,~ ,

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.
rllel2C tpl"l-& pC:; /I/o S;=UrJ6C. cA- tJ.'1.5rz;;:(...,)4n~l2.~ ,c)5Scc:.../.'-;--/CO tulTI-t
lifE (?IZ.O~DS'EP /f~11 ~-

XIII. Violations (required by DWQ)

Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes D No [g

Is this an after-the-fact permit application? Yes D

No 0

XIV. Cumulative Impacts (required by D'VQ)

Will this project (based on past and reasonably anticipated future impacts) result in additional
development, which could impact nearby downstream water quality? Yes D No (g/
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://h20.enr.state.nc.us/ncwetlands. If no, please provide a short narrative description: T/ff...5
f<EPlff(( Tt:. Tlf6 DH/11 /6 S::/tJM (c,vD&'cTr:;-f) BY 7nC ~KD8',e c,:: /lA-PE/L//2-...-
O,Lj,)1 s:t9F~;;/ ~N ~//99,6_ 77/c72c u..'I'Lt_ 1St: A~'D (//j P4CT5 Tr> /I/r=I'9,~t3 V
(:bWNS7(;(G. '.7) fL)41 CYV4CJry- (
Other Circumstances (Optional):

xv.

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 ofthe applicant's control).
#/11

..~:r/Lc-',?~ C2L)..:"--"/, ..:Jicrrn k-'~1 Qd'1) ij 1ra.to,-
I=r"'",nz. ~) 7!D(..iwoF KE/GrVG:.t<Sv; L-L.-C

Applicant/Agent's Signature Dat
(Agent's signature is valid only if an authorization letter from the applicant is provided.)

Page 12 of 12

Vicinity
Map

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Century Bid. Dam
l~mersville. NC

360 061 2311N, 800 051 2911W (WGS84jNAD83)
USGS Kernersville Quad .
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North Carolina Department of Environment and Natural Resources
Division of Land Resources
Land Quality Section

James D. Simons, P.G., P.E.
Director and State Geologist

Michael F. Easley, Governor
William G. Ross Jr., Secretary

Fcbruary 4, 2005

Mr. Franz Adcr
Town of Kernersville
Post Office Box 728
Kcrnersvillc, North Carolina 27285

RE: Approval to Repair
Ccntury Park Dam
FORSY-202

Dear Mr. Ader:

This is in responsc to your submission dated Decembcr 23, 2004 of plans, specifications and
design data for the repair of the subject dam in compliance with the Dam Safety Law of 1967.
These plans, specifications and design data werc prepared under the supervision of Mr. John T.
Grimes, PE. This letter constitutes approval of the proposal to repair the subject dam according
to the plans and specifications received by this Division on December 29,2004 with the
following stipulations:

1. Projcct construction shall bc supervised by Mr. Jolm T. Grimes, PE.

2. During construction, the Division of Land Resources may require such progress reports
as are decmcd necessary.

3. Per G.S. S 143-215.26 & .30, upon completion of the project, Mr. John T. Grimes, PE
shall inspect the completed work. Upon finding that the work has bcen done as specified
and the dam is safe, Mr. Grimes shall file with the Division of Land Resources two sets
of record drawings and a certificate stating that the work has been completed in
accordance with approved plans, specifications, and other requirements, and that the dam
is safc and adequatc.

4. No water shall be impounded behind the dam until final approval is issued by the
Division of Land Resources for operation of this dam.

Geological Survey. Land Quality. Geodetic Survey
Division of Land Resources. 1612 Mail Service Center, Raleigh, North Carolina 27699-1612
512 North Salisbury Street, Raleigh, North Carolina 27604
919.733-3833 \ FAX: [phone] \ Internet: \w/w.dlr.enr. state.nc,us/dlr.htm
An Equal Opportunity \ Affirmatve Action Employer - 50% Recycled \ 10% Post Consumer Paper

Mr. Franz Ader
February 4,2005
Page 2 of2

5. Prior to impoundment, an Emergency Action Plan and Operation and Maintenance Plan
shall be submitted.

6. You must notify Mr. Matthew E. Gantt, PE, Regional Engineer, Land Quality Section,
585 Waugh town Street, Winston-Salem, North Carolina 27107, [phone] ten days
before the start of construction.

The Army Corps of Engineers and the Water Quality Section of this Department should be
contacted to determine if additional permits are required. Also, the erosion and sediment control
program having jurisdiction should be contacted to determine permit requirements. In any case,
sediment must be prevented from entering the waters of the state or flowing onto neighboring
property.

Construction of the repairs must begin by February 4,2006 or this approval is void. For
assistance you may contact Mr. Matthew E. Gantt, PE in the Winston-Salem Regional Office at
telephone number [phone] or Mr. Maxwell Fowler, PE in the Raleigh Central Office at
telephone number [phone].

Sin/relY, L'~
/ / --
. /
:OC}/;[(J4" l> . ~ '{,;lLtr-<---:J

/ lames D. Simons, PG, PE
t/ Director and State Geologist

JDS/mrf/whd

cc: Mr. Jolm T. Grimes, PE, Jewell Engineering Consultants
Mr. Steve Tedder, Regional Water Quality Supervisor
Mr. Matthew E. Gantt, PE

<CElRTKFJI<CATE OF PLAN APPlROVAL

The posting of this certificate certifies that an erosion and sedimentation control plan
has been approved for this project by the North Carolina Department of Environluent
and I\Iablloal Resources in accordance with North Carolina General Statute 113A - 57 (4) and
113A - 54 (d) (4) and North Carolina Administrative Code, Title 15A, Chapter 4B.OI07 (c).
This certificate nIust be posted at the primary entrance of the job site before construction
begins and until establishment of permanent groundcover as required by North Carolina
AduIinistrative Code, Title 15A, Chapter 4B.0127 (b).

/Y\) II
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~ e p"Q I (j!Jt?;y
~

; at p A !J~t><J Il ~ /J~:fJ / t? S
Project Nanle and Location
;r:of?S!/ Co e 009- ~ ~ a>>

17 /) 7,,- <.')/?
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JC:::,...;~.... t,...-.~-~ ~...:..:.....:.
Regional Engineer

Date of Plan Approval

!,L

ij'c~

r-~h

-/'" Department of Environment and Natural

l\lichacl F. Easley, Governor
William G. Ross Jr., Secretary

James D. Simons, P.G., P.E., Director
and State Geologist

~ .';).... .....~.......~.~'o......~. ..J\...
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D\f]~lQ)~M~

February 16,2004

WINSTON-SALEM REGIONAL OFFICE
DIVISION OF LAND RESOURCES
LAND QUALITY SECTION

LETTER OF APPROVAL

Town of Kernersville
Attention: Franz Ader
P.O. Box 728
Kernersville, NC 27285

Dear Mr. Ader:

This office has reviewed the subject erosion and sedimentation control plan. We find the plan to be
acceptable and hereby issue this Letter of Approval. The enclosed Certificate of Approval must be
posted at the job site. This plan approval shall expire three (3) years following the date of approval, if no
land-disturbing activity has been undertaken, as is required by Title I 5A NCAC 4B .0029.

Please be advised that Title 15 NCAC 4B.0018 (a) requires that a copy of the approved erosion control
plan be on file at the job site. Also, you should consider this letter to give the notice required by GS
I 13A-61.1 (a) of our right of periodic inspection to insure compliance with the approved plan.

North Carolina's Sedimentation Pollution Control Program is performance-oriented, requiring protection
of existing natural resources and adjoining properties. If, following the commencement of this project, it
is determined that the erosion and sedimentation control plan is inadequate to meet the requirements of
the Sedimentation and Pollution Control Act of 1973 (North Carolina General Statute 113A-51 through
66), this office may require revisions to the plan and implementation of the revisions to insure
compliance with the Act.

Acceptance and approval of this plan is conditioned upon your compliance with Federal
and State water quality laws, regulations, and rules. In addition, local city or county
ordinances or rules may also apply to this land-disturbing activity. This approval does
not supersede any other permit or approval.

Please note that this approval is based in part on the accuracy of the information provided in the
Financial Responsibility Form, which you have provided. You are requested to file an amended form if
there is any change in the information included on the form. In addition, it would be helpful if you notify
this office of the proposed starting date for this project. Please notify us if you plan to have a
preconstruction conference, and we will plan to attend.

585 Waughtown Street, Winston-Salem, North Carolina 27107-2241

Phone: [phone] \ FAX: [phone] \ Internet: www.enr.statc.nc.lls/ENRJ
AN EQUAL OPPORTUf..:ITY \ AFFIRi\IA TlVE ACTION E1\!PLOYER - 50% RECYCLED / 10% POST CONSUMER PAPER

LETTER OF APPROVAL - Ccntury Park Dam Rcpairs
Fcbruary 16, 2004
Pagc 2

Please be aware that if one acre is to be disturbed by this project, you will be covered by the enclosed
general stormwater pcrmit NCGOIOOO (Construction Activities). You should first bccome familiar with
all of the requirements for compliance with the cnclosed gencral permit.

Your cooperation is appreciated, and we look forward to working with you on this project.

Sincerely,

~1~

Brooks Cole, CPESC
Assistant Regional Engineer

BC/jc
Enclosure: Certificate of Plan Approval
NPDES

cc: Jewel Engineering Consultants, P.C.
WSRO File

PROJECT NAME: Century Park Dam Repairs
COUNTY: FORSYTH
RIVER BASIN: Yadkin
WATER CLASSIFICATION: Other
FACILITY NUMBER: FORSY-2004-025
SUBMITTED BY: Jewel Engineering Consultants, P.C.
RECEIVED BY L.Q.S.: February 6, 2004
NEW SUBMITTAL (x)

0~A:
~..,;p.~
MCIDENR

\MES B. HUNTJR.

OVERNOR

IAYNE McDEVITT
ECRETARY

HARL.ES H. GARDNER

G., RE. DIRECTOR

'1D STATE: GEOL.OGIST

NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES

DIVISION OF LAND RESOURCES

May 12, 1999

CERTIFIED MAIL
RETURN RECEIPT REOUESTED

The Honorable Larry R. Brown, Mayor
Town of Kernersville
Post Office Drawer 728
Kernersville, North Carolina 27285

.j

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RE:

Approval to Repair
Century Park Lake Dam
Forsyth County
FORSY-202-H
Yadkin-Pee Dcc River Basin

Dear Mayor Brown:

This is in response to your submission dated March 10, 1999 and received on
March 12, 1999 of plans, specifications and design data for the repair of the subject dam
in Forsyth County on Smith Creek in compliance with the Dam Safety Law of 1967.
Thesc plans, specifications and design data were preparcd under the supervision of Mr.
John T. Grimes, P. E. with Jcwell Engineering Consultants.

This lctter constitutes approval of the proposal to repair the subject dam
according to the plans and spccifications submitted to this Division on March 10, 1999
with the following stipulations:

1. Project construction shall be supervised by Mr. John T. Grimes, P. E.

2. During construction the Division of Land Resources may require such progress
reports as are deemed necessary.

3. Ductile iron pipe (DIP) shall be used in lieu of corrugated aluminum pipe (CAP)
for the storm drain pipe which is to be installed through the embankment located
to the right (facing downstream) of the primary spillway. This rcquirement shall
be reflected on revised construction plans and on the "as-built" drawings.
(Reference Sheets G-8 and G-9 of the plans for Design Alternative I and Design
Alternative 2.)

L.AND QUALITY SECTION [phone] FAX [phone]
GEOLOGICAL SURVEY SECTION [phone] FAX [phone]

P.O. Box 27637, RALEIGH, NORTH CAROLINA 2761 1-7637 TELEPHONE [phone] FAX (9 t 9) 7 t 5.8801
AN EQUA.L OPPORTUNITY I AFFIRMAtiVE ACTION EMPLOYER - so~~ RECYCLED/1 OSo POST.CQNSUMER PAPER

The Honorable Larry R. Brown, Mayor
May 12, 1999
Page Two

4. Upon completion of the project, Mr. John T. Grimes, P. E. shall inspect the completed work and
upon finding (a) that the work has been done as specified, and (b) that the dam is safe, shall file
with the Division of Land Resources two sets of "as-built" drawings and a certificate stating that
the work has been completed in accordance with approved plans, specifications and other
requirements.

5. No water shall be i::;~c)Unded behind the dam until final approval is issued by the Division of
Land Resources for operation of this dam. Also, draining of the lake shall be performed in such
a manner. as to preclude off-site sedimentation.

6. You mustnotify Mr. Matthew E. Gantt, P. E., Regional Engineer, Land Quality Section, 585
\Yaughto\VI1 Street, Winston-Salem, North Carolina 27107, [phone] ten days before the
start of construction.

Sincerely,

~c/~~

Charles H. Gardner, P. G., P. E.

CHG/JKL/

cc: Mr. Matthew E. Gantt, P. E.
Ms. Anita LeVeaux-Quigless, Esq.
Mr. John T. Grimes, P. E.
Mr. Russell D. Radford, P. E.
Mr. Timothy G. Shields
Mr. John G. Wolfe, III, Esq.

.
--,

u.s. ARMY CORPS OF ENGINEERS
'Wilmington District

Action ID:

199920716 County:

F orsvth

GENERAL PERMIT REGIONAL AND NATION\VIDE VERIFICATION

Propcrty
owner:

Authorized
Town of Kernersville Allcnt: Jewell Engineering
c/o Timothy G. Shields John T. Grimes
Addrcss: P.O. Drawer 728 Addrcss: P.O. Box 2294
Kernersville, NC 27285 Kernersville, NC 27285-2294
Tclcnhonc: Tclcphonc: 336 996-9974
Sizc and Location of Propcrty (Watcrbodv. Highwav namc/numbcr. town. ctc.): Town of
Kcrncrsvillc's Ccntury Park Dam locatcd off of Ccntury Park Boulcvard, adjaccnt to Smith Crcek,
ncar Kcrncrsvillc, in Forsyth County, North Carolina.

Description of Activity: Proposcd rcpair and rchabilitation of tl~c existing dam (N\VP 3) and
extension of spillway (N\VP 26) rcsulting in impacts to ap'pfOxiIna!cly .0..063 acrcs (including 149
lincar fcct of strcam habitat) of thc jurisdictional waters'ofSinitl~ Ci.cck;.,

.'

-.LScction 4.04 (Clcan \Vater Act, 33 USC 1344) only.
_Section 1.0 (Rivcr and Harbor Act of 1899) only.
_Scction 4.04 and Section 1.0.
-.LNationwidc Pcrmit Numbcr NWP 3 & NWP 26

,~. :1

.)

".J I ~

Any violation of thc conditions of thc Rcgional Gcncral or N ationwidc Pcrmit rcfcrcnccd abovc may
subjcct thc pcrmittcc to a stop worl" ordcr, a rcstoration ordcr, and or appropriatc lcgal action.
This Dcpartmcnt of thc Army Rcgional Gcncral / Nationwidc Pcrmit verification docs not
rclicvc thc pcrmittcc of thc responsibility to obtain any othcr rcquircd Fcdcral, Statc, or local
approvals/pcrmits. Thc pcrmittcc may nccd to contact appropriatc Statc and local agcncics bcforc
bcginning work. If you havc any qucstions rcgarding thc Corps of Enginccrs rcgulatory program,
plcasc contact John Thomas at tclcphonc nUmjctf919) 8~67441, cxtcj(on 25.

Rcgulatory Projcct Managcr Signaturc /U J rfJ:14rn.~ 1/.
! 1/
Datc 6 July, 1999 Expiration 15 September 1999

SURVEY PLATS, FIELD SKETCH, \VETLAND DELINEATION FORlYI, ETC., MUST BE
ATTACHED TO THE FILE COpy OF THIS FORlYI, IF REQUIRED OR AVAILABLE.

CF:

EXPIRATION DATE OF VERIFICATION:
UNTIL NW26 expires (currently
September 15, 1999) or two years from
date of issue, whichever come first

,4

Office Use Only:

Form Version March 05

US ACE Action ID No. D\VQ No.
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)

I. Processing

1. QIeyk all of the approval(s) requested for this project:
[0'Section 404 Permit D Riparian or Watershed Buffer Rules
D Section 10 Permit D Isolated Wetland Permit from DWQ
D 401 Water Quality Certification D Express 401 Water Quality Certification

2. ,Nationwide, Regional or General Permit Number(s) Requested: If}cd/q;;/}u/((/c/ Feo"",'-b 4ti3

3. Ifthis notification is solely a~~esy copy because written approval for the 401 Certification
is not required, check here: li2r

4. If payment into the North Carolina Ecosystem Enhancement Program (NCEEP) is proposed
/v{ It for mitigation of impacts, attach the acceptance letter from NCEEP, complete section VIII,
I' and check here: D

II.

Applicant Information

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: D

~{g@{gnw{g ~
Oel 3 1 2005

f~fft 5.

1. Owner/Applicant Information
Name: /o"''n of=- ke"v/ur..n/f/lu
Mailing Address: A 0, Boy.. 7.;>-[/
,l-(er/lc'rJ(/:'I(~" NC/ ;;J:7~s-

DEtlR \'JhTI=R QUALITY
WEMNOS mo STOOl.WATER BRANUi

Telephone Number: 33' --1 'j/;~ 0Lf6.:;)- Fax Number: 336 -- 7~6- -r:057
E-mail Address:clClt!.-Pac..{Kclr-lle.:Jv../lt:-.ru::.... c..{..s-

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: fI//17
Company Affiliation:
Mailing Address:.

Telephone Number:
E-mail Address:

Fax Number:

Page 5 of 12

"

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 yersion 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 ofproject: {!(31.J7V;Z.7J- Bi.L/Pr O/9)?/

2. T.I.P. Project Number or State Project Number (NCDOT Only): IV (If
tpf1'7S'-79.- g.lf9,p...

3. Property Identification Number (Tax PIN):

4. Location
County: ror.!.,$1j TN Nearest Town: kauvJc~vl LL.E:
Subdivision name (include phase/lot number): /l/ /19-
Directions to site (include road numbers/names, landmarks, etc.):;:'oG:-Y1:I /Z11C.r-; ('_ H "/A kr-:
...
J:--'/o t3\1P,1S:S (,.</<0:51 /e> 1<e-I!.NE:'~i.IILt.e:- //-//(.1:." 4""'-vl"t;?/v Ci'20SS /cO, /l./OR.7~1 r9,P?~o)c
/ .
,g ;1'J/L- $' T: L <J...JTD ([;/I/,VI'2..- e.'. ~/::::- ~ O. 2- '
CENiV;ZY Bt,.vj;), jN}I?> S) T8 /. o..;? /?)/L-€5 c:'-'! a/ &/1/.

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): ON oW

6. Property size (acres):

/0 AcreS

7. Name of nearest receiving body of water: S/mr!t Lf<.CGK-

8. River Basin: YAp/Oil)
(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 ofthis application: 71ft:' 5/TG C)a Sr.5 I,V .>4/1/ Aa,.a1 of,-,) l:t CI';> v.sE:
51,..'iI..C - t=;P7iLV 1).1(/II'i~H.nl/J-V/11161-1u.,.-.4(,J RU.5/lvC;:;;, E'/e-
, I 'f'
71 b PO,Vi'> LccA , . ,1/eD ,-<10"11 r1I6 'NIR-S

Page 6 of 12

10. Describe the overall project in detail, including the type of equipment to be used: Tl-(c/Ze:: 1<.5
r:!...c./tZ..r2-~r,,'j A FHIt-t50 Dot/iSLe 0 Hal< eLl.- sP;{../.-.W/Ty 7l1'-f-T fl,,'1:,7.:::7.J.S ,<..C:j?/ilt<?-.
ST/fro/ORi2-0 CodS"TIZVC-IlG,v Fli'V{Pmb,1./'ItJJL...l-- /36 VSt;O/ ou,,,?p(J2..(,.IC~ ODcclM1
Tile DOtI;JL.b GY't/Z-iZ.&7-L- tOl ~ t3c;;- .<<f3Pt...-/lc.-GZ) l3y ONe 6 Clu

11. Explain the purpose ofthe proposed work: t<)c; 1/7/n.,..--=NO To f\ G';Pf-.rJG':;;:: DL D-Cf"1'7-"9GCJ;)
Ol.JrPYiL.1.-- O(2../-tlrV5 'WI TH ode;- (7'//; 0 rJlPr-Jt,.c.- P/~CZ

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 ill 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. 7I1Ct?4~ /lm/a- [1./4< CR/6IdA-r,o/ H-/lt""rt.v~ i'2v Pr;/~ S.4~Y q
2r/C;i9t:</bdJcJ ),u5/tr:.E' f}l",q'Z~'1:J we ~2.onz:r cW ;'-uUj t/1199 10/Z 4- /vA-/;ovll.'/fJ6n-??flllr3.;..;;:6
- fe-t))~ Ort. 5, ...'" --- ZVt:.. - o.~Y} E1J.. / - D. d-C. ",;, /1-.-, c hL"C/ "C-I9,W (ivlury
I :c__"'vw me 6/2CC/ ,"./ uY1/TiZo2- PL.4,v o/'V' Falj6 .300~ U{f,bcA~c.?J me /tc--TtcnJ (D = I? '17:>1.(7) 6
Qrj/)J R..e7Y:f-//l., Fu.Yt.ts OJlI6;ltVt/'1l?W DRPCJZ.GO 8'-/ 0/10 s:..:lFG-rLI OI/.J SEP1;,30J /996"
v. 1U ureProJec 'Plans 1 '1" / ' ,

Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion ofthis work from the current application.
!I//ft

VI. Proposed Impacts to 'Vaters of the United States/\Vaters 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
accompanying site plan. All wetlands and waters, and all streams (intermittent and perennial)
should be shown on a delineation map, whether or not impacts arc 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 VllI below. If additional
space is needed for listing or dcscription, pleasc attach a separate sheet.

1. Provide a written description of the propos cd impacts: IfI~..s IS rt .tZ6Pr; II<- Pv20J'e:::::(;

'rHc-rzr;: /fAr;, ";;/10,0 /17CN t9L- I rnP~C;T~ ID S vr1-Frt-c.-C .{;tJA -r!;R." R(;:P/r/'e.s' ().JIf..L_
6C I'V ;tcu;:!.tJ ,wee tAJr71-r Tlj7,iS6 SJI3;r>rtrCO 77J ;:{;0f) f};?,:JdD.JG:o .cs y
,
Olt/')! s/t Felt I

Page 7 of 12

p) I (t 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,
t 1 r t' t d t b h d fl d'

separa e y IS Impac s ue 0 ot structure an 00 mg.
Wetland Impact Type of Wetland Located within Distance to Area of
Site Number Type ofImpact (e.g., forested, marsh, lOG-year Nearest Impact
(indicate on map) herbaceous, bog, etc.) Floodplain Stream (acres)
(yes/no) (linear feet)
Total Wetland Impact (acres)

IV 1ft

3. List the total acreage (estimated) of all existing wetlands on the property:

rJ/t1

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
t b . 1 d d T lit It' 11th X 'dth th d"d b 43 560

mus e mc u e . o ca cu a e acreage, mu Ip. y eng WI , en IVI e y ,
Stream Impact Perennial or Average Impact Area of
Number Stream Name Type of Impact Intermittent? Stream Width Length Impact
(indicate on map) Before Impact (linear feet) (acres)
Total Stream Impact (by length and acreage)

iV/It 5.

Indiyidually 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, dredging, flooding, drainage, bulkheads, etc.

Open Water Impact Name of Water body Type of Waterbody Area of
Site Number (if applicable) Type of Impact (lake, pond, estuary, sound, bay, Impact
(indicate on map) ocean, etc.) (acres)
Total Open Water Impact (acres)

Page 8 of 12

6. List th

I .

11 V

f h US

I' fr

h

e cumu atIve Impact to a \ aters 0 t e . . resu tmg om t e project:
Stream Impact (acres): li/If-
Wetland Impact (acres): /Vir
Open Water Impact (acres): /J/ II
Total Impact to Waters of the U.S. (acres) /1/1';1
Total Stream Impact (linear feet): 1~9

7. Isolated Waters
Do any isolated waters exist on the property? 0 Yes D 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 US ACE.
/lt9 r<.?;1 <.Jr .s7-,<'.r"7 &.:./;11 be ,;lJrt;cri::cL btf H1G. r-e/,a,-;'--

~\~ 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): \ D uplands D stre nl D wetlands
Describe the method of construction (e.g., amJembankment, , avation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock w
local stormwater requirement, etc.):
Current land use in the vicinity ofthe pond:
Size of watershed draining to pond:

VII. Impact Justification (Avoidance and Minimization)

Specifically describe rneasures 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 ofthe 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. 1m pq crs- TO Tlte STt20)/r)
(,P it-v i3c- ;?IIN{f"Ji Co cO P{/~/.vG (!O,J:5Tt<.ltcr1c>~~ Q2aSiON CClvnZCJ.., /hCf)S-t-';2.&$ IlrUb
t3anJ ,4tOPt20iJ6!.) p V UNO QUi1-tAry ArVO (/UI f...-.L-- &e At') Jre-/2EJ:;> 71/ Di/,t:../N6-
(!p/\l'Sj7e i/c.:r7 oM {

VIII. Mitigation

DWQ - In accordance with 15A NCAC 2H .0500, rnitigation 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

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
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
htto:/ /h20. enr. state.nc. us/ncwetlands/ strmgide.html.

(1)(111.

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 shee . f more space is needed.

(lJ 1ft 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://h20.enr.state.nc.us/wrp/index.htm. Ifuse 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):

Page 10 of12

IX. Environmental Documentation (required by D\VQ)

1. Does the project involve an expenditure of public (federal/state/local) funds or the use of
public (federal/state) land? Yes ~ No D

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 (NEPAlSEPA)?
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 D No ~

,v lIP. If yes, has the document review been finalized by the State Clearinghouse? If so, please
attach a copy ofthe NEP A or SEP A final approval letter. Yes D No D

X. Proposed Impacts on Riparian and \Vatershed Buffers (required by D\VQ)

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 - )'? Yes D 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 multi liers.

Zone*

Multiplier

1

2

Total

* Zone I extends out 30 feet perpendicular from the top of the near bank of channcl; Zone 2 extends an
addilional20 feet from the edge of Zone 1.

3 (2 for Catawba)

1.5

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. ;VI f)

Page II of 12

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
the property. If percent impervious surface exceeds 20%, please provide calculations
demonstrating total proposed impervious level. 77j.c9<...C' 1..5 0 % .:C0Pe'<./.hCUS ACtZcqr;~
Ottll'lle: P!?-OPC:-I!.:rr- 717E:RC;- /6 rYe) 1,vC-t2e..77SG IN ///lPo<...l1ous /7k!.ClJ P !2VPO.sED
OCt/Un) 6 7716 ~6j9t/t2- C)P (He- (/1'1,71 ,

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 ofthe subject facility.
rlle;/Zc tpl'L-& i?c: /1/,/ s;=u;~6& oA-. ti.)/J.5r&"L.,),t'}T6't2- /}550C-/.1-'TCO /..v1T17
77fE: f?1ZOt?DSEP/?CP.1/~.

XIII. Violations (required by DWQ)

Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes D No 0

Is this an after-the-fact permit application? Yes D

No 0

XIV. Cumulative Impacts (required by D\VQ)

Will this project (based on past and reasonably anticipated future impacts) result in additional
development, which could impact nearby downstream water quality? Yes D No (g/
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://h20.enr.state.nc.us/ncwetlands. Ifno, please provide a short narrative description: rIllS
f<EPI1/{<. It:' Tlfe Dftl71 16 6a,v~1 (c,u':X'cTr-:;-D BI/ 77-IC (""J,<Dt..'7-fG c':: /lA:'PENrL--
D~/n S:I1F5;J/ r:('N ~/IY96. 7JI~72c; "'1Lt, /3€- /LD 1//1 P-+C7S TO /1/E'I9~t3 V
Pot,.VN~G. ~ /1.)4/ Cpv4t../ry. (
Other Circumstances (Optional):

XV.

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).
#/17

..q>LL"?};:.---T (2tJv-'".,I dicrm k..'~t CLcI,~) 01ta.W'-
F/~(,IIIZ. A:J:&) 7!D{..IwoF !<Et€.rV6!eSV; '-~
Applicant/Agent's Signature Dat
(Agent's signature is valid only if an authorization letter from the applicant is provided.)

Page 12 of 12

Vicinity
Map

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360 06' 23"N, 800 05' 29"W (WGS84/NAD83)
USGS Kernersville Quad
View TopoZone Pro aerial photos, shaded relief, street maps, interactive coordinate display, and

Century Bid. Dam 0 0.7 1.4 2.1 2.8 3.5 krn
Kernersville, NC 0 0.4 0.8 1.2 1.6 2 rni
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North Carolina Department of Environment and Natural Resources
Division of Land Resources
Land Quality Section

James D. Simons, P.G., P.E.
Director and State Geologist

Michael F. Easley, Governor
William G. Ross Jr., Secretary

February 4, 2005

Mr. Franz Ader
Town of Kemersville
Post Office Box 728
Kernersville, North Carolina 27285

RE: Approval to Repair
Century Park Dam
FORSY -202

Dear Mr. Ader:

This is in rcsponse to your submission dated Dcccmbcr 23,2004 of plans, spccifications and
design data for the repair ofthe subject dam in compliance with the Dam Safety Law of 1967.
These plans, specifications and design data were preparcd under the supervision ofMr. Jolm T.
Grimes, PE. This letter constitutes approval of the proposal to repair the subject dam according
to the plans and specifications received by this Division on Dccember 29, 2004 with the
following stipulations:

1. Project construction shall be supervised by Mr. John T. Grimes, PE.

2. During construction, the Division of Land Resourccs may require such progress reports
as are dccmcd necessary.

3. Pcr G.S. S 143-215.26 & .30, upon completion of the project, Mr. John T. Grimcs, PE
shall inspect the completed work. Upon finding that thc work has been done as specified
and the dam is safe, Mr. Grimes shall file with the Division of Land Resources two scts
of record drawings and a certificate stating that thc work has bcen complctcd in
accordancc with approved plans, specifications, and other requiremcnts, and that the dam
is safc and adequatc.

4. No water shall be impounded behind the dam until final approval is issued by the
Division of Land Resources for operation of this dam.

Geological Survey. Land Quality. Geodetic Survey
Division of Land Resources. 1612 Mail Service Center, Raleigh, North Carolina 27699-1612
512 North Salisbury Street, Raleigh, North Carolina 27604
919-733-3833 \ FAX: [phone] \ Internet: IV\vw.dlr.enr. state.nc.us/dlrhtm
An Equal Opportunity \ Affirmative Action Employer - 50% Recycled \ 10% Post Consumer Paper

Mr. Franz Ader
'February 4, 2005
Page 2 of2

5. Prior to impoundment, an Emergency Action Plan and Operation and Maintenance Plan
shall be submitted.

6. You must notify Mr. Matthew E. Gantt, PE, Regional Engineer, Land Quality Section,
585 Waughtown Street, Winston-Salem, North Carolina 27107, [phone] ten days
before the start of construction.

The Anny Corps of Engineers and the Water Quality Section of this Department should be
contacted to determine if additional permits are required. Also, the erosion and sediment control
program having jurisdiction should be contacted to determine permit requirements. In any case,
sediment must be prevented from entering the waters of the state or flowing onto neighboring
property.

Construction of the repairs must begin by February 4,2006 or this approval is void. For
assistance you may contact Mr. Matthew E. Gantt, PE in the Winston-Salem Regional Office at
telephone number [phone] or Mr. Maxwell Fowler, PE in the Raleigh Central Office at
telephone number [phone].

Sinjr.elY, L-./7
/ / -
, /
./7 /
/'j' ~
L;()tll(v/ l> . / ,t,'fLtr"--?

/~mes D. Simons, PG, PE
~Director and State Geologist

JDS/mrf/whd

cc: Mr. John T. Grimes, PE, Jewell Engineering Consultants
Mr. Steve Tedder, Regional Water Quality Supervisor
Mr. Matthew E. Gantt, PE

<CE~1LKIFJI<CA1LE OIF PLAN APPROVAL

The posting of this certificate certifies that an erosion and sedimentation control plan
has been approved for this project by the North Carolina Department of Environlllent
and. Natural Resources in accordance \vith North Carolina General Statute 113A - 57 (4) and
113A - 54 (d) (4) and North Carolina AdnIinistrative Code, Title 15A, Chapter 4B.OI07 (c).
This certificate nIust be posted at the primary entrance of the job site before construction
begins and until establishment of permanent groundcover as required by North Carolina
Adnlinistrative Code, Title 15A, Chapter 4B.0127 (b).

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Project Nanle and Location
j':OP~p c. [1 OQ91 ~ 6 a f)

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Regional Engineer

Date of Plan Approval

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Carolina
Department of Environment and Natural

Michael F. Easley, Governor
William G. Ross Jr., Secretary

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~~I___~ _.
~~[Q)~&~rr<<

James D. Simons, P.G., P.E., Director
and State Geologist

WINSTON-SALEM REGIONAL OFFICE
DIVISION OF LAND RESOURCES
LAND QUALITY SECTION

February 16, 2004

LETTER OF APPROVAL

Town of Kernersville
Attention: Franz Ader
P.O. Box 728
Kernersville, NC 27285

Dear Mr. Ader:

This office has reviewed the subject erosion and sedimentation control plan. We find the plan to be
acceptable and hereby issue this Letter of Approval. The enclosed Certificate of Approval must be
posted at the job site. This plan approval shall expire three (3) years following the date of approval, if no
land-disturbing activity has been undertaken, as is required by Title 15A NCAC 4B .0029.

Please be advised that Title 15 NCAC 48.0018 (a) requires that a copy of the approved erosion control
plan be on file at the job site. Also, you should consider this letter to give the notice required by GS
113A-61.1 (a) of our right of periodic inspection to insure compliance with the approved plan.

North Carolina's Sedimentation Pollution Control Program is performance-oriented, requiring protection
of existing natural resources and adjoining properties. If, following the commencement of this project, it
is detennined that the erosion and sedimentation control plan is inadequate to meet the requirements of
the Sedimentation and Pollution Control Act of 1973 (North Carolina General Statute 113A-51 through
66), this office may require revisions to the plan and implementation of the revisions to insure
compliance with the Act.

Acceptance and approval of this plan is conditioned upon your compliance with Federal
and State water quality laws, regulations, and rules. In addition, local city or county
ordinances or rules may also apply to this land-disturbing activity. This approval does
not supersede any other permit or approval.

Please note that this approval is based in part on the accuracy of the information provided in the
Financial Responsibility Form, which you have provided. You are requested to file an amended form if
there is any change in the information included on the form. In addition, it would be helpful if you notify
this office of the proposed starting date for this project. Please notify us if you plan to have a
preconstruction conference, and we will plan to attend.

585 Waughtown Street, Winston-Salem, North Carolina 27107-2241

Phone: [phone] \ FAX: [phone] \ Internet: www.enr.statc.nc.Lls/ENRJ
AN EQUAL OPPORTUNITY \ AFFIRMATIVE ACTION ErvlPLOYER - 50% RECYCLED /10% POST CONSUMER PAPER

~~-

\~~~

LETTER OF APPROVAL - CentUlJ' Park Dam Repairs
FebrualJ' 16, 2004
Page 2

Please be aware that if one acre is to be disturbed by this project, you will be covered by the enclosed
general stormwater permit NCGOIOOO (Construction Activities). You should first become familiar with
all of the requirements for compliance with the enclosed general permit.

Your cooperation is appreciated, and we look forward to working with you on this project.

Sincerely,

~d

Brooks Cole, CPESC
Assistant Regional Engineer

BC/jc
Enclosure: Certificate of Plan Approval
NPDES

cc: Jewel Engineering Consultants, P.C.
WSRO File

PROJECT NAME: Century Park Dam Repairs
COUNTY: FORSYTH
RIVER BASIN: Yadkin
WATER CLASSIFICATION: Other
FACILITY NUMBER: FORSY-2004-025
SUBMITTED BY: Jewel Engineering Consultants, P.C.
RECEIVED BY L.Q.S.: February 6, 2004
NEW SUBMITTAL (x)

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.....:-:-.., r. ~.
r"CIDENIR

\MES B. HUNTJR.

OVE;:RNOR

IAYNE MCDEVITT
ECRETARY

HARLES H. GARDNER

G., RE. DIRECTOR
'lD STATE GEOLOGIST

NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES

DIVISION OF LAND RESOURCES

May 12, 1999

CERTIFIED MAIL
REllJRN RECEIPT REQUESTED

The Honorable Larry R. Brown, Mayor
Town of Kernersville
Post Office Drawer 728
Kernersville, North Carolina 27285

! -)
-'

RE:

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, ,
!

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; . J

Approval to Repair
Century Park Lake Dam
Forsyth County
FORSY-202-H
Yadkin-Pee Dee River Basin

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Dear Mayor Brown:

This is in response to your submission dated March 10, 1999 and received on
March 12, 1999 of plans, specifications and design data for the repair of the subject dam
in Forsyth County on Smith Creek in compliance with the Dam Safety Law of 1967.
These plans, specifications and design data were prepared under the supervision of Nlr.
John T. Grimes, P. E. with Jewell Engineering Consultants.

This letter constitutes approval of the proposal to repair the subject dam
according to the plans and specifications submitted to this Division on March 10, 1999
with the following stipulations:

I. Project construction shall be supervised by Mr, John T, Grimes, P. E.

2. During construction the Division of Land Resources may require such progress
reports as are deemed necessary,

3. Ductile iron pipe (DIP) shall be used in lieu of corrugated aluminum pipe (CAP)
for the storm drain pipe which is to be installed through the embankment located
to the right (facing downstream) of the primary spillway. This requirement shall
be retlected on revised construction plans and on the "as-built" drawings.
(Reference Sheets G-8 and G-9 of the plans for Design Alternative I and Design
Alternative 2.)

LAND QUALITY SECTION [phone] FAX [phone]
GEOLOG ICAL SURVEY SECTION [phone] FAX [phone]

P.O. Box 27687, RALEIGH, NORTH CAROLINA 27611-7687 TELEPHONE [phone] FAX [phone]
AN EQUAl. OPPORTUNITY I AF~IRM..\ilVE ACTION EMPLOYER - 50S-0 RECYCLED/1 O~~ POST-CONSUMER PAPER

The Honorable Larry R. Brown, Mayor
May 12, 1999
Page Two

4. Upon completion of the project, Mr. John T. Grimes, P. E. shall inspect the completed work and
upon finding (a) that the work has been done as specified, and (b) that the dam is safe, shall file
with the Division of Land Resources two sets of "as-built" drawings and a certificate stating that
the work has been completed in accordance with approved plans, specifications and other
requirements.

5. No water shall be i~~8unded behind the dam until final approval is issued by the Division of
Land Resources for operation of this dam. Also, draining of the lake shall be performed in such
a manner as to preclude off-site sedimentation.

6. You must notify Mr. Matthew E. Gantt, P. E., Regional Engineer, Land Quality Section, 585
Waughtown Street, Winston-Salem, North Carolina 27107, [phone] ten days before the
st~rt of construction.

Sincerely,

~(/~.

Charles H. Gardner, P. G., P. E.

CHG/JKL/

cc: Mr. Matthew E. Gantt, P. E.
Ms. Anita LeVeaux-Quigless, Esq.
Mr. John T. Grimes, P. E.
NIr. Russell D. Radford, P. E.
Mr. Timothy G. Shields
Mr. John G. Wolfe, III, Esq.

u.s. ARMY CORPS OF ENGINEERS
\Vilmington District

Action ID:

1999207 16 County:

Forsyth

GENERAL PERMIT REGIONAL AND NATION\VIDE VERIFICATION

Propcrty Authorizcd
owncr: Town of Kcmersville Agcnt: Jewell Engineering
c/o Timothy G. Shields Jolm T. Grimes
Addrcss: P.O. Drawer 728 Addrcss: P.O. Box 2294
Kemersville, NC 27285 Kernersville, NC 27285-2294
Tclcphonc: Tclcphonc: 336 996-9974
Sizc and Location of Propcrty (Watcrbody, Highwav namc/numbcr, town, ctc.): Town of
Kcrncrsvillc's Ccntury Park Dam locatcd off of Ccntury Park Boulcvard, adjaccnt to Smith Crcck,
ncar Kcrncrsvillc, in Forsyth County, North Carolina.

Dcscrintion of Activitv: Proposcd rcpair and rchabilitat!oll of thc cxisting dam (NWP 3) and
cxtcnsion of spillway (NWP 26) rcsulting in impacts to ap'proxiri.a~cly p.063 acrcs (including 149
lincar fcct of strcam habitat) of thc jurisdictional watcrs of Sinitl.~ c;rcck::>

-LScction 404 (Clcan \Vatcr Act, 33 USC 1344) only.
_Scction 10 (Rivcr and Harbor Act of 1899) only.
_Scction 404 and Scction 10.
-LNationwidc Pcrmit Numbcr NWP 3 & NWP 26

~ ,I

Any violation of thc conditions of thc Rcgional Gcncral or Nationwidc Pcrmit rcfcrcnccd abovc may
subjcct thc pcrmittcc to a stop work ordcr, a rcstoration ordcr, and or appropriatc lcgal action.
This Dcpartmcnt of thc Army Rcgional Gcncral / Nationwidc Pcrmit vcrification docs not
rclicvc thc pcrmittcc of thc rcsponsibility to obtain any othcr rcquircd Fcdcral, Statc, or local
approvals/pcrmits. Thc pcrmittcc may nccd to contact appropriatc Statc and local agcncics bcforc
bcginning work. If you havc any qucstions rcgarding thc Corps of Enginccrs rcgulatory program,
/ J _
please eonlae! John Thomas al telephone nnmje'/,919) 8~-"41, extej'on 2,.

Rcgulatory Projcct Managcr Signaturc IU J f'jJ-1",frn.-~ )".
{ {/
Datc 6 July. 1999 Expiration 15 September 1999

SURVEY PLATS, FIELD SKETCH, \VETLAND DELINEATION FORlYI, ETC., MUST BE
ATTACHED TO THE FILE COpy OF THIS FORlYI, IF REQUIRED OR AVAILABLE.

CF:

EXPIRATION DATE OF VERIFICATION:
UNTIL NW26 expires (currently
September 15, 1999) or two years from
date of issue, whichever come first