20052017 Ver 1_Complete File_20050113

A
o -r
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
November 16, 2005
DWQ# 05-2017
Rockingham County
Mr. Richard Vaughn
City of Reidsville
230 West Morehead Street
Reidsville, NC 27320
APPROVAL of 401 Water Quality Certification with Additional Conditions
Dear Mr. Vaughn:
The City of Reidsville has our approval, in accordance with the attached conditions, to place fill in 30 linear feet
of perennial stream in order to install a gravity sewer line in Reidsville, Rockingham County, as described in
your application received by the Division of Water Quality (DWQ) on November 3, 2005. After reviewing
your application, we have determined that this fill is covered by General Water Quality Certification Number
3374, which can be viewed on our web site at http://h2o.enr.state.nc.us/ncwetlands. This Certification allows
you to use Nationwide Permit Number 12 when it is issued by the U.S. Army Corps of Engineers. In addition,
you should secure any other applicable federal, state or local permits before you proceed with your project,
including (but not limited to) those required by Sediment and Erosion Control, Non-Discharge, and Water
Supply Watershed regulations. Also, this approval will expire when the accompanying 404 permit expires
unless otherwise specified in the General Certification.
This approval is valid only for the purpose and design that you have described in your application. If you
change your project, you must notify us in writing and you may be required to send us a new application for a
new certification. If the property is sold, the new owner must be given a copy of the Certification and approval
letter and is thereby responsible for complying with all conditions. If total wetland fills for this project (now or
in the future) exceed one acre, compensatory mitigation may be required as described in 15A NCAC 2H .0506
(h). For this approval to be valid, you must follow the conditions listed in the attached certification, as
well as the additional conditions listed below:
1. The following impacts are hereby approved as long as all other specific and general conditions of the
Certification are met. No other impacts, including incidental impacts, are approved:
Amount Approved Plan Location or Reference
Streams 30 linear feet Wolf Island Creek, just north of its intersection with Gibbs Road in
Reidsville, Rockingham County, as depicted on the Vicinity and
Site Map for Harrison Street Sanitary Sewer included with the Pre-
Construction Notification

NorthCarolina
Naturally
North Carolina Division of Water Quality
Wetlands Certification Unit 1650 Mail Service Center Raleigh, NC 27699-1650 Phone [phone] FAX [phone]
2321 Crabtree Blvd. Raleigh, NC 27604-2260 Internet httpll h2o enr.state.no us/ncwetlands
Customer Service Number: 1-877-623-6748
An Equal Opportunity/Affirmative Action Employer - 50% Recycled1109% Post Consumer Paper
Mr. Richard Vaughn
Page 2, DWQ# 05-2017
November 16, 2005
2. Soft bank stabilization methods, such as the use of erosion control matting and the planting of
appropriate ground cover, shall be utilized to the maximum extent practicable. Riprap may only be used
below the normal high water level. The original grade and elevation of the stream's cross-section must
be maintained. Riprap placed in the stream bottom must be inserted into the bottom matrix to a depth
sufficient to provide the thickness of riprap required for scour protection. The elevation of the stream
bottom must not be increased by the placement of riprap. Placement of riprap must not result in
destabilization of the streambed or banks upstream or downstream of any crossing.
3. Appropriate sediment and erosion control measures, which equal or exceed those outlined in the most
recent version of the North Carolina Sediment and Erosion Control Planning and Design Manual or the
North Carolina Surface Mining Manual (available from the Division of Land Resources at NCDENR
regional offices or the central office), whichever is more appropriate, shall be designed, installed and
maintained properly to assure compliance at all times with the North Carolina water quality standards
that are applicable to Class C waters as described in 15A NCAC 02B.0211 Fresh Surface Water Quality
Standards For Class C Waters. Such measures must equal or exceed the requirements specified in the
most recent version of the North Carolina Sediment and Erosion Control Manual. These measures must
be maintained on all construction sites, borrow sites, and waste pile (spoil) sites, including contractor
owned and leased borrow pits, which are associated with this project.
4. Sediment and erosion control measures shall not be placed in wetlands or waters to the maximum extent
practicable. If placement of sediment and erosion control measures in wetlands or waters is
unavoidable, they shall be removed and the natural grade restored within six months of the date that the
project is completed or, if applicable, within six months of the date that the project is released by the
North Carolina Division of Land Resources.
5. No waste, spoil, solids, or fill of any kind shall occur in wetlands, waters, or riparian areas beyond the
footprint of the impacts depicted in the Pre-Construction Notification. All construction activities,
including the design, installation, operation, and maintenance of sediment and erosion control "Best
Management Practices" shall be performed so that no violations of state water quality standards,
statutes, or rules occur.
6. Permanent, maintained access corridors shall be restricted to a maximum width of 20 feet, including
manhole locations and vehicle turnaround areas.
7. Where joints must be placed in sewer lines within the foot print of the stream channel at crossings
having topographic and bedrock constraints, the jointed section shall either be completely enclosed in a
steel encasement pipe sealed at both ends, for aerial crossings, or encased in concrete from bank to bank,
for buried crossings. At its discretion, the City of Reidsville may use ductile iron pipe with
mechanically restrained joints in lieu of concrete encasement.
8. If concrete is used with any fill material, it shall not be allowed to come in contact with surface waters
until it has cured.
9. Upon completion of the project, the Applicant shall complete and return the enclosed "Certificate of
Completion" form to notify NCDWQ when all work included in the §401 Certification has been
completed. The responsible party shall complete the attached form and return it to the 401/Wetlands

Mr. Richard Vaughn
Page 3, DWQ# 05-2017
November 16, 2005
Unit of the NC Division of Water Quality upon completion of the project. Along with the Certificate of
Completion form, please send photographs upstream and downstream of each strewn-crossing site to
document correct installation.
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearing. You
must act within 60 days of the date that you receive this letter. To ask for a hearing, send a written petition
which conforms to Chapter 150B of the North Carolina General Statutes to the Office of Administrative
Hearings, 6714 Mail Service Center, Raleigh, N.C. 27699-6714. This certification and its conditions are final
and binding unless you ask for a hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water Act. If
you have any questions, please telephone Daryl Lamb in the DWQ Winston-Salem Regional Office at 336-771-
4600 or Ian McMillan in the Central Office in Raleigh 919-715-4631.
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NOV 2 1 2005
I;Ci7?ti: Sty
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AWK/cdl
Attachments
Sincerely,
Alan W. Klimek, P.E.
cc: Mr. Todd Tugwell, U. S. Army Corps of Engineers, Raleigh Regulatory Field Office
Winston-Salem DWQ Regional Office
Central Files
Wetlands/401 File Copy
O?O? W A T ?qpG
r
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimck, P.E. Director
Division of Water Quality
November 16, 2005
DWQ# 05-2017
Rockingham County
Mr. Richard Vaughn
City of Reidsville
230 West Morehead Street
Reidsville, NC 27320
APPROVAL of 401 Water Quality Certification with Additional Conditions
Dear Mr. Vaughn:
The City of Reidsville has our approval, in accordance with the attached conditions, to place fill in 30 linear feet
of perennial stream in order to install a gravity sewer line in Reidsville, Rockingham County, as described in
your application received by the Division of Water Quality (DWQ) on November 3, 2005. After reviewing
your application, we have determined that this fill is covered by General Water Quality Certification Number
3374, which can be viewed on our web site at http://h2o.enr.state.nc.us/ncwetlands. This Certification allows
you to use Nationwide Permit Number 12 when it is issued by the U.S. Army Corps of Engineers. In addition,
you should secure any other applicable federal, state or local permits before you proceed with your project,
including (but not limited to) those required by Sediment and Erosion Control, Non-Discharge, and Water
Supply Watershed regulations. Also, this approval will expire when the accompanying 404 permit expires
unless otherwise specified in the General Certification.
This approval is valid only for the purpose and design that you have described in your application. If you
change your project, you must notify us in writing and you may be required to send us a new application for a
new certification. If the property is sold, the new owner must be given a copy of the Certification and approval
letter and is thereby responsible for complying with all conditions. If total wetland fills for this project (now or
in the future) exceed one acre, compensatory mitigation may be required as described in 15A NCAC 2H .0506
(h). For this approval to be valid, you must follow the conditions listed in the attached certification, as
well as the additional conditions listed below:
1. The following impacts are hereby approved as long as all other specific and general conditions of the
Certification are met. No other impacts, including incidental impacts, are approved:
Amount Approved Plan Location or Reference
Streams 30 linear feet Wolf Island Creek, just north of its intersection with Gibbs Road in
Reidsville, Rockingham County, as depicted on the Vicinity and
Site Map for Harrison Street Sanitary Sewer included with the Pre-
Construction Notification

None h Caroli na
,latura!!if
North Carolina Division of Water Quality
Wetlands Certification Unit 1650 Mail Service Center Raleigh, NC 27699-1650 Phone [phone] FAX [phone]
2321 Crabtree Blvd. Raleigh, NC 27604-2260 Internet hffp//:h2o.encstate.nc.us/ncwetlands
Customer Service Number: 1-877-623-6748
An Equal Opportunity/Affirmative Action Employer - 50% Recycled/10% Post Consumer Paper
Mr. Richard Vaughn
Page 2, DWQ# 05-2017
November 16, 2005
2. Soft bank stabilization methods, such as the use of erosion control matting and the planting of
appropriate ground cover, shall be utilized to the maximum extent practicable. Riprap may only be used
below the normal high water level. The original grade and elevation of the stream's cross-section must
be maintained. Riprap placed in the stream bottom must be inserted into the bottom matrix to a depth
sufficient to provide the thickness of riprap required for scour protection. The elevation of the stream
bottom must not be increased by the placement of riprap. Placement of riprap must not result in
destabilization of the streambed or banks upstream or downstream of any crossing.
3. Appropriate sediment and erosion control measures, which equal or exceed those outlined in the most
recent version of the North Carolina Sediment and Erosion Control Planning and Design Manual or the
North Carolina Surface Mining Manual (available from the Division of Land Resources at NCDENR
regional offices or the central office), whichever is more appropriate, shall be designed, installed and
maintained properly to assure compliance at all times with the North Carolina water quality standards
that are applicable to Class C waters as described in 15A NCAC 02B.0211 Fresh Surface Water Quality
Standards For Class C Waters. Such measures must equal or exceed the requirements specified in the
most recent version of the North Carolina Sediment and Erosion Control Manual. These measures must
be maintained on all construction sites, borrow sites, and waste pile (spoil) sites, including contractor
owned and leased borrow pits, which are associated with this project.
4. Sediment and erosion control measures shall not be placed in wetlands or waters to the maximum extent
practicable. If placement of sediment and erosion control measures in wetlands or waters is
unavoidable, they shall be removed and the natural grade restored within six months of the date that the
project is completed or, if applicable, within six months of the date that the project is released by the
North Carolina Division of Land Resources.
5. No waste, spoil, solids, or fill of any kind shall occur in wetlands, waters, or riparian areas beyond the
footprint of the impacts depicted in the Pre-Construction Notification. All construction activities,
including the design, installation, operation, and maintenance of sediment and erosion control "Best
Management Practices" shall be performed so that no violations of state water quality standards,
statutes, or rules occur.
6. Permanent, maintained access corridors shall be restricted to a maximum width of 20 feet, including
manhole locations and vehicle turnaround areas.
7. Where joints must be placed in sewer lines within the foot print of the stream channel at crossings
having topographic and bedrock constraints, the jointed section shall either be completely enclosed in a
steel encasement pipe sealed at both ends, for aerial crossings, or encased in concrete from bank to bank,
for buried crossings. At its discretion, the City of Reidsville may use ductile iron pipe with
mechanically restrained joints in lieu of concrete encasement.
8. If concrete is used with any fill material, it shall not be allowed to come in contact with surface waters
until it has cured.
9. Upon completion of the project, the Applicant shall complete and return the enclosed "Certificate of
Completion" form to notify NCDWQ when all work included in the §401 Certification has been
completed. The responsible party shall complete the attached form and return it to the 401 /Wetlands
Mr. Richard Vaughn
Page 3, DWQ# 05-2017
November 16, 2005
Unit of the NC Division of Water Quality upon completion of the project. Along with the Certificate of
Completion form, please send photographs upstream and downstream of each stream-crossing site to
document correct installation.
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearing. You
must act within 60 days of the date that you receive this letter. To ask for a hearing, send a written petition
which conforms to Chapter 150B of the North Carolina General Statutes to the Office of Administrative
Hearings, 6714 Mail Service Center, Raleigh, N.C. 27699-6714. This certification and its conditions are final
and binding unless you ask for a hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water Act. If
you have any questions, please telephone Daryl Lamb in the DWQ Winston-Salem Regional Office at 336-771-
4600 or Ian McMillan in the Wetlands/401 Unit Central Office in Raleigh at 919-715-4631.
Sincerely,
Alan W. Klimek, P.E.
AWK/cdl
Attachments
cc: Mr. Todd Tugwell, U. S. Army Corps of Engineers, Raleigh Regulatory Field Office
Winston-Salem DWQ Regional Office
Central Files
Wetlands/401 File Copy
Triage Check List
Date: 11/07/05 Project Name: City of Reidsville-Harrison St. Sewer
DWQ#: 05-2017
County: Rockingham
Daryl Lamb, Winston-Salem Regional Office
To:
60-day processing time: 11/03/05 - 1101105
From: Cyndi Karoly Telephone: [phone]
The file attached is being forwarded to you for your evaluation.
Please call if you need assistance.
? Stream length impacted
? Stream determination
Wetland determination and distance to blue-line surface waters on USFW topo maps
? Minimization/avoidance issues
? Buffer Rules (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: As per our discussion regarding revision of the triage and delegation processes,
please review the attached file. Note that you are the first reviewer, so this file will need to be
reviewed for administrative as well as technical details. If you elect to place this project on hold,
please ask the applicant to provide your requested information to both the Central Office in
Raleigh as well as the Asheville Regional Office. As we discussed, this is an experimental, interim
procedure as we slowly transition to electronic applications. Please apprise me of any
complications you encounter, whether related to workload, processing times, or lack of a "second
reviewer" as the triage process in Central had previously provided. Also, if you think of ways to
improve this process, especially so that we can plan for the electronic applications, let me know.
Thanks!
City of Reidsville 230 West Morehead Street, Reidsville, North Carolina 27320 • [phone] Fax [phone]
DEPARTMENT OF
COMMUNITY DEVELOPMENT
October 21, 2005
Ms. Laurie Dennison
NCDENR/Division of Water Quality
Wetlands Unit
1621 Mail Service Center
Raleigh, N.C. 27699-1621
Dear Ms. Dennison,
RE: Harrison Street Sanitary Sewer
Reidsville, N.C.
I am writing to inform you of our desire to construct an 8" gravity sanitary sewer from
Gibbs Road to Mark Road in the City of Reidsville North Carolina. This sewer will
commence at an existing manhole 75ft west of Wolf Island Creek and proceed east along
Gibbs road. The sewer will cross under Wolf Island Creek and then under Gibbs Road by
boring method and will continue up a slope to parallel the northern side of Harrison
Street to terminate at a manhole at the intersection of Mark Road and Harrison
Street for a total of 3,260 LF. Attached is a Vicinity Map, a Plan & Profile Design Sheet,
and a Temporary creek crossing detail for your review.
This package is being submitted along with the stream crossing permit to obtain your
authorization to proceed with the stream crossing. Seven copies of this package along
with the $200.00 application fee are attached and this information is also concurrently
being sent to the U.S. Army Corps of Engineers for their approval also. If you have any
questions feel free to contact myself at [phone] or Steve Moran, City Engineer at
[phone].
Sincerely,
Richard G. Vaughn
Cc: Steve Moran, P.E., Reidsville City Engineer
Bill Penn, Reidsville Engineering Coordinator
Nov 3 -.2005
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Paper "Planning for Tomorrow Today"

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NOV 3 -.2005
DENR - WATER QUA" FY
V;ETW,pSAND ST1??ATER ERAtZH
Pre-Construction Notification (PCN) Application Form
For Section 404 and/or Section 10 Nationwide, Regional and General Permits, Section 401
General Water Quality Certifications, and Riparian Buffer and Watershed Buffer Rules
This form is to be used for projects qualifying for any of the U.S. Army Corps of Engineers' (USACE)
Nationwide, Regional or General Permits as required by Section 404 of the Clean Water Act and/or
Section 10 of the Rivers and Harbors Act, and for the North Carolina Division of Water Quality's
(DWQ) associated General 401 Water Quality Certifications. This form is also to be used for any
project requiring approval under any Riparian Buffer Rules implemented by the N.C. Division of Water
Quality. This form should not be used if you are requesting an Individual 404 Permit or Individual 401
Water Quality Certification. The USACE Individual Permit application form is available online at
www.saw.usace.army.rail/hvetlands/Permits.html.
The USACE is the lead regulatory agency. To review the requirements for the use of Nationwide,
Regional or General permits, and to determine which permit applies to your project, please go to the
USACE website at www.saw.usace.aniiy.mil/wetlands/index.htnil, or contact one of the field offices
listed on page 3 of this application. The website also lists the responsible project manager for each
county in North Carolina and provides additional information regarding the identification and regulation
of wetlands and waters of the U.S.
The DWQ issues a corresponding Certification (General or Individual), and cannot tell the applicant
which 401 Certification will apply until the 404 Permit type has been determined by the USACE.
Applicants are encouraged to visit DWQ's 401/Wetlands Unit website at
http://l12o.enr.state.nc.us/newetlands to read about current requirements for the 401 Water Quality
Certification Program and to determine whether or not Riparian Buffer Rules are applicable. The
applicant is also advised to read the full text of the General Certification (GC) matching the specific 404
Permit requested. In some cases, written approval for General Certifications is not required, provided
that the applicant adheres to all conditions of the GC. Applicants lacking access to the intemet should
contact DWQ's Central Office in Raleigh at [phone].
Trout Waters Coordination - Special coordination with the North Carolina Wildlife Resources
Commission (NCWRC) is required for projects occurring in any of North Carolina's twenty-five
counties that contain trout waters. In such cases, the applicant should contact the appropriate NCWRC
regional coordinator (listed by county on page 4 of this application) prior to submittal of the application.
UK D,
?r
Page 1 of 12
Coastal Area Management Act (CAMA) Coordination - If the project occurs in any of North Carolina's
twenty coastal counties (listed on page 4) the applicant should contact the North Carolina Division of
Coastal Management (DCM). DCM will determine whether or not the project is within a designated
Area of Environmental Concern, in which case DCM will act as the lead permitting agency. In such
cases, DCM will require a CAMA Permit and will coordinate the 404/401 Permits.
The applicant may also choose to coordinate with the United States Fish- and Wildlife Service to ensure
that the proposed project will have no impact upon any endangered or threatened species or critical
habitat as regulated by the Endangered Species Act, and the State Historic Preservation Office, North
Carolina Department of Cultural Resources to ensure that the proposed project will have no impact upon
any properties listed or eligible for listing on the National Register of Historic Places. Compliance with
these regulations is required to be eligible for any Department of the Army permit. The addresses for
both agencies are listed on page 3 of this application.
USACE Permits - Submit one copy of this form, along with supporting narratives, maps, data forms,
photos, etc- to the applicable USACE Regulatory Field Office. Upon receipt of an application, the
USACE will determine if the application is complete as soon as possible, not to exceed 30 days. This
PCN form is designed for the convenience of the applicant to address information needs for all USACE
Nationwide, Regional or General permits, as well as information required for State authorizations,
certifications, and coordination. Fully providing the information requested on this form will result in a
complete application for any of the USACE Nationwide, Regional or General permits. To review the
minimum amount of information that must be provided for a complete PCN for each USACE
Nationwide permit, see Condition 13, 67 Fed. Reg. 2090 (Jan. 15, 2002), available at
http://Nvww.usace.army.mil/inet/functions/cw/cecwo/rea/2002nwps.pdf. Processing times vary by
permit and begin once the application has been determined to be complete. Please contact the
appropriate regulatory field office for specific answers to permit processing periods.
401 Water Quality Certification or Buffer Rules - All information is required unless otherwise stated
as optional. Incomplete applications will be returned. Submit seven collated copies of all USACE
Permit materials to the Division of Water Quality, 401/Wetlands Unit, 1650 Mail Service Center,
Raleigh, NC, 27699-1650. If written approval is required or specifically requested for a 401
Certification, then a non-refundable application fee is required. In brief, if project impacts include less
than one acre of cumulative wetland/water impacts and less than 150 feet cumulative impacts to
streams, then a fee of $200 is required. If either of these thresholds is exceeded, then a fee of $475 is
required. A check made out to the North Carolina Division of Water Quality, with the specific name of
the project or applicant identified, should be stapled to the front of the application package. For more
information, see the DWQ website at littp:Hli2o.elinr.state.nc.us/ncxvetlands/fees.litml. The fee must be
attached with the application unless the applicant is a federal agency in which case the check may be
issued from a separate office. In such cases, the project must be identifiable on the U.S. Treasury check
so that it can be credited to the appropriate project. If written approval is sought solely for Buffer Rules,
the application fee does not apply, and the applicant should clearly state (in a cover letter) that only
Buffer Rule approval is sought in writing. Wetlands or waters of the U.S. may not be impacted prior to
issuance or waiver of a Section 401 Water Quality Certification. Upon receipt of a complete application
for a 401 Certification, the Division of Water Quality has 60 days to prepare a written response to the
applicant. This may include a 401 Certification, an on-hold letter pending receipt of additional
requested information, or denial.
Page 2 of 12
US Army Corps Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Caldwell Haywood McDowell Swain
US Army Corps of Engineers Alleghany Catawba Henderson Mecklenburg Transylvania
151 Patton Avenue Ashe Cherokee Iredell Mitchell Union
Room 208 Avery Clay Jackson Polk Watauga
Asheville, NC 28801-5006 Buncombe Cleveland Lincoln Rowan Yancey
Telephone: [phone] Burke Gaston Macon Rutherford
Fax: [phone] Cabarrus Graham Madison Stanley
Raleigh Regulatory Field Office Alamance Franklin Nash Surry
US Army Corps Of Engineers Caswell Forsyth Northampton Vance
6508 Falls of the Neuse Road Chatham Granville Orange Wake
Suite 120 Davidson Guilford Person Warren
Raleigh, NC 27615 Davie Halifax Randolph Wilkes
Telephone: [phone] Durham Johnston Rockingham Wilson
Fax: [phone] Edgecombe Lee Stokes Yadkin
Washington Regulatory Field Office Beaufort Currituck Jones Pitt
US Army Corps Of Engineers Bettie Dare Lenoir Tyrrell
Post Office Box 1000 Camden Gates Martin Washington
Washington, NC 27889-1000 Carteret' Green Pamlico Wayne
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perquimans •Croatan National Forest Only
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pender
Post Office Box 1890 Brunswick Hoke Richmond
Wilmington, NC 28402-1890 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Fax: [phone] Cumberland New Hanover Scotland
North Carolina State Agencies
Division of Water Quality
401 Wetlands Unit Division of Water Quality State Historic Preservation Office

1650 Mail Service Center Ecosystem Enhancement Program
1652 Mail Service Cente Department Of Cultural Resources

Raleigh, NC 27699-1650 r
Raleigh, NC 27699-1652 4617 Mail Service Center
Raleigh
NC 276994617
Telephone: [phone] Telephone: [phone] ,
Telephone: [phone]
Fax: [phone] Fax: [phone] Fax: [phone]
US Fish and Wildlife Service / National Marine Fisheries Service
US Fish and Wildlife Service
Raleigh Field Office US Fish and Wildlife Service National Marine Fisheries Service

Post Office Box 33726 Asheville Field Office
160 Zillicoa Str
t Habitat Conservation Division

Raleigh, NC 27636-3726 ee
Asheville, NC 28801 Pivers Island
Beaufort
NC 28516
Telephone: [phone] Telephone: [phone] ,
Telephone: [phone]
Page 3 of 12
CAMA and NC Coastal Counties
Division of Coastal Management Beaufort Chowan Hertford Pasquotank
1638 Mail Service Center Bertie Craven Hyde Pender
Raleigh, NC 27699-1638 Brunswick Currituck New Hanover Perquimans
Telephone: [phone] Camden Dare Onslow Tyrrell
Fax: [phone] Carteret Gates Pamlico Washington
NCWRC and NC Trout Counties
Western Piedmont Region Coordinator Alleghany Caldwell Watauga
3855 Idlcwild Road Ashe Mitchell Wilkes
Kemersville, NC 27284-9180 Avery Stokes
Telephone: [phone] Burke Surry
Mountain Region Coordinator Buncombe Henderson Polk
20830 Great Smoky Mtn. Expressway Cherokee Jackson Rutherford
Waynesville, NC 28786 Clay Macon Swain
Telephone: [phone] Graham Madison Transylvania
Fax: [phone] Haywood McDowell Yancey
APPLICATION FORM BEGINS ON PAGE S. PLEASE DO NOT SUBMIT PAGES 1- 4.
Page 4 of 12
Office Use Only: Form Version March 05
USACE Action ID No. DWQ No.
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
1. Processing
1. Ch k all of the approval(s) requested for this project:
[; Section 404 Permit ? Riparian or Watershed Buffer Rules
? Section 10 Permit ? Isolated Wetland Permit from DWQ
DIM Water Quality Certification ? Express 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: N W P I2
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts, attach the acceptance letter from NCEEP, complete section VIII,
and check here: ?
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
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: ?
H. Applicant Information
?J
1. Owner/A Itcant?tforma on
Name: P, of i ' sv+ e,- NOV 3 - 2005
Mailing Addr ss: D
?ds??11p_, N.C
QUALITY
WATER ERNO
Telephone Number: 33(. -3 - 23 I [o Fax Number: 3:5 - 3q-7-.' 355
E-mail Address: ryat1n ep_ Gi. fei c-4. I I e . hC . tAs
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:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Page 5 of 12
III. Project Information
4
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 proj
2. T.I.P. Project Number or State Project Number (NCDOT Only
3. Property Identification Number (Tax PIN): 7 99.5 1 e 3 / 7 & 9 /
Location
County: 906i A 4IhA V_ Nearest Town: Fe_;JG V ;
Subdivision name (i lude phase/lot number): N /A
Directions to site (include road numbers/names, landmarks, etc.): ?Q, A/. C. A7.41_-S_-1_6,
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): 3L - Z I - 411 °N --79 - L12 - 03 °W
6. Property size (acres):_ 3, ct ,4 CA?
7. Name of nearest receiving body of water- F-,'b n pw e,,t-
8. River Basin: r"n rx nv k e- Ri \i eA-
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h 2o.enr.state.nc.us/acimininx1hs;.)
9. Describe the existing conditions on the site and general land use in the vicinity of the proj
at the time of this application: C g e?,IC deep e_-± nq a q,7ags ('oQ en
Cree.L .
Page 6 of 12
10. Describe the overall project in detail, including t e type of equip ent tq.be used:5' 1; 110,
A r W'
C1 iff OYt 87 m
MJ1- Vc "P 1 i4io-?
PV.
11. Explain the purpose of the proposed work:- Proy i &- Ge-wPR !5V V t .e. ? 0
-- _-- 1 , - - _ I _ . N n n_, _ .. .-?
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-
i
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.
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. Each impact must be
listed separately in the tables below (e.g., culvert installation should be listed separately from
riprap dissipater pads). Be sure to indicate if an impact is temporary. All proposed impacts,
permanent and temporary, must be listed, and must be labeled and clearly identifiable on an
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.
Page 7 of 12
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,
se aratel list im acts due to both structure and floodin
Wetland Impact
Site Number
(indicate on map)

-
Type of Impact Type of Wetland
(e.g., forested, marsh,
herbaceous, bog, etc.) Located within
100-year
Floodplain
es/no Distance to
Nearest
Stream
linear feet Area of
Impact
(acres)
7 NO
A5

Total Wetland Impact (acres)
3. List the total acreage (estimated) of all existing wetlands on the property: /v
4. Individually list all intermittent and perennial stream impacts. Be sure to identify temporary
impacts. Stream impacts include, but are not limited to placement of fill or culverts, dam
construction, flooding, relocation, stabilization activities (e.g., cement walls, rip-rap, crib
walls, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is proposed,
plans and profiles showing the linear footprint for both the original and relocated streams
must be included. To calculate acrea a multi 1 It-nffth X w'dth th d' 'd

Stream Impact
Number

indicate on ma
?5

Stream Name

S °?" Grcc >

Type of Impact

OtTCN INCA

Perennial or
Intermittent?

'rr,-, mar > , en
Average

Stream Width
Before Impact
20' tvt e b 43,5
Impact

Length
linear feet 60.
Area of

Impact
acres

Total Stream Impact (by length and acreage) 3o
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- flnndinn dminnap 1v,1L t,-r1q o*?

Open Water Impact
Site Number
indicate on ma - -----
Name of Waterbody

(if applicable) --- , - .. ?, vwaauaV

Type of Impact M VJ, V?V•
Type of Waterbody

(lake, pond, estuary, sound, bay,
ocean, etc.
Area of

Impact
acres

Total Open Water Impact (acres)
Page 8 of 12
6. List the cumulative impact to all Waters of the U.S. resulting from the project.
Stream Impact (acres):
Wetland Impact (acres :
Open Water Impact acres :
Total Impact to Waters of the U.S. (acres)
Total Stream Impact linear feet): 3 L.
7. Isolated Waters
Do any isolated waters exist on the property? ? Yes [j(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.
8. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Current land use in the vicinity of the pond:
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss cons ction
techniques to be followed during c nstruction to reduce impacts. ToDag r•aph ?l G,r/a
_P.?C1S?inc? SeWeJt. 1 ?L i t rtc, a 1r e 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://l12o.enr.state.nc.us/ncwetiands/strin.vide.litini.
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.
2. Mitigation may also be made by payment into the North Carolina Ecosystem Enhancement
Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at
[phone] to determine availability, and written approval from the NCEEP indicating
that they are will to accept payment for the mitigation must be attached to this form. For
additional information regarding the application process for the NCEEP, check the NCEEP
website at http://h2o.enr.state.nc.us/xvrp/index.litin. 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 DWQ)
1. Does the project involve an expenditure of pub tc (fedeml/state/loeal) funds or the use of
public (federal/state) land? Yes No E]
2. If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not ure whether a NEPA/SEPA document is required, call the SEPA
coordinator at (919) 7 -5083 to review current thresholds for environmental documentation.
Yes ? No
3. If yes, has the document review been finalized by the State Clearinghouse? If so, please
attach a copy of the NEPA or SEPA frial approval letter. Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
1. Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0243 (Catawba) 15A NCAC
2B .0250 (Randleman Rules and Water Supply Buff Requirements), or other (please
identify V Yes ? No
2. If "yes", identify the square feet and acreage of impact to each zone of the riparian buffers.
If buffer mitigation is required calculate the required amount of mitigation by applying the
buffer multipliers.
Zone* I Impact I Multiplier I Required
3 (2 for Catawba)
1.5
Total I I I i
Zone 1 extends out 30 feet perpendicular from the top of the near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
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.
Page 11 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. ap C'6AC e- In I YA DPAVi6U.c,
XII. Sewage Disposal (required by DWQ)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater gener ted from the proposed roject, or available capaci??y' of the subject facility.
-Mot 1eGulv-64 c)r 0_nn&? era- 'ton . SeALY.Lr, rlie 0In, ne I?'1tD
M s. A 1. R . . - 1 1 L \ . _ _ _ 1'_ _I 1 i __ T7 c J . . 1 1 %. 1o _ 1 . 1 __
-Frea+rno? 4 P laM .
XM. Violations (required by DWQ)
Is this site in violation of DW Wetland Rules (I 5A NCAC 2H.0500) or any Buffer Rules?
Yes ? No
Is this an after-the-fact permit application? Yes ? No Q/
XIV. Cumulative Impacts (required by DWQ)
XV.
ccnd 41scha'? e Inh C:66
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).
P
Applicabt/Agent's Signature 'Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)

Page 12 of 12
Will this project (based on past and reasonably anticipated future impacts) result in add*
development, which could impact nearby downstream water quality? Yes ? No
If yes, please submit a qualitative or quantitative cumulative impact analysis in accordance with
the most recent North Carolina Division of Water Quality policy posted on our website at

i ?
i
Q
?DENR WATER?Q FRB RCN ??
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VICINITY & SITE MAP FOR
HARRISON STREET SANITARY
SEWER
REIDSVILLE, N.C. - SEPTEMBER,
SCALE: 1" = 1000'
2005
l= a
ti
YQ W
3
\ \ a?5E?9N/??I ?I a G???
CITY OF REIDSVILLE
DEPARTMENT OF COMMUNITY DEVELOPMENT
230 NEST MOREHEAD STREET
REIDSVILLE, N.C. 27320
PHONE: [phone]
HARRISON STREET SANITARY SEWER
PARKLAND TO MARK ROAD
ti?}
Y Q?
N ?
65 87
E413
1
j
ClrY<
ref
r
HgRR1SQN 'Dp9?
? r
IMPACT AREA

? J
iA
ao
N
ST.
JEFFERSON ST
FULTON T 1 D
Ofd
D 4pR0 STR
e
STREET r 57R1N ?E ZENN
BLVD, r LANE
K
STRT T =? 9gR8
ST,
ON r i BUSTETT ??..
YLE STREET m
N
ilk ? w
v STREET ti
C C3 Z N
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qRR/SQ PIEDMONT Z
158 LLEET STREET a 2004 OINVE.m PQAG ST. 65 Z
n STf
7 STAT?? E, A e
14 -A A I I-;i A F= QTRES
2470 2464
2465
2413
N
PL. z
= a
JEFFREY ~
COURT ?
. t1 °
1A?
A .tea
NOTE STREAM CROSS-SECTION SHALL BE
RESTORED TO ITS ORIGINAL GRADE AND ELEVATION.
4
LEVY C. J. 80SMLL
7995-18-31-7691
00
CENTER DI ON CREEK WITH IMECHAN CAL J
TO BE ENCASED IN 24' CONCRETE,
(CONCRETE STA. 0+65 TO STA. 0+93)
2 JOINTS 8' DUCTILE IRON PIPE
CENTERED ON CREEK WTH MECHANICAL JI
TO BE ENCASED IN 24' CONCRETE.
(CONCRETE STA. 0+65 TO STA. 0+93)
DATUM E
680.01
IMPACT AREA LEVY C. J•31O76 u P" SVED 3 J2 25 LF. BE
6.51 PLACEDMN THNE DITCAH LINE
7995-18 I \ / (SEE DETAIL ON SHEET 4.)
TESPORCHECKROCK
ROAD TO BE BORED PIPE
d STA. 1+161.97 E, erlM ?' ?WI 0.25' WALENC.L THICKNESS
pp - ? ?tIIB?7 r r
,+ 1+
/ R D
60 LF. MATTING SHALL BE
PLACED IN THE DITCH LINE
(SEE DETAIL ON SHEET 4.) CITY OF REIDSVILLE
_ 7995-18-31-8392
CITY OF REIDSVILLE
7995-18-31-8392
4 ,wa
NC
87
t
h
. a r ^ K ? `(11\)1 ,.' i
fi 1 "n`
?t'• ?,?Zt??l?. ?!
%
MAP SHOWING
STREAM CROSSING DETAIL
HARRISON STREET SANITARY SEWER
REIDSVILLE, N.C. - SEPTEMBER, 2005
SCALE: I" = 60'
WEST HARRISON STREET
n?
n?
PUMP PROPOSED
EARTH BERM
O O (TYP.)
TEMP. CONSTRUCTION
STREAM CROSSING 10' _
CLASS 'l" MIN.
FLOW --?? RIP RAP
12 5'
MIN. W. \-L..

STREAM
FLOW
24 TO
42 " CMP
CLASS "I "
RIP RAP
PROPOSED
EARTH BERM
(TYP.)
POL YETHYLENE FABRIC
ON FACE (8 ML. THICK)
TO
'UMP
STREAM
FL OW
i
I
W?
0
I
MIN.
- ------- ? -- 2' CLASS 'A" /
CROSSING EROSION CONTROL
PIPE STONE wE?R
20'
[ 40' CONSTRUCTION EASEMENT

1,= :l
l? 10
?? MIN.
.
FROM
10' x 10'
SEDIMENT TRAP
/ 0 Z• 1 SIDE SLOPE
OR SIL T BA G.
I
EX. IN V. TEMPORARY-)
CREEK STONE DAM
EAR TH BERM
(TYP.)
12' TOP OF
[ MIN. BANK
- - - ---- - - - - - - - - - - - - -
TEMP.
24 " TO
-42 " CUP
o
MIN.
POL YETHYLENE FABRIC
ON FACE (8 ML. THICK)
CROSSING
PIPE
10' x 10'
DEWA TERING BASIN
'© 2.• 1 SIDE SLOPE
OR SIL T BAG.
INSTALL SANDBAGS IN PIPE INVERT & FABRIC WHILE PUMPING
AROUND DURING CONSTRUCT/ON IN STREAM.
POL YETHYLENE FABRIC
ON FACE (8 ML. THICK) REMOVE SANDBAGS & FABRIC TO ALLOW FLOW THROUGH
PIPE WHEN NOT PUMPING AROUND.
r'7 7'Y 0 %, ?J I DS "1I 7 L ??
F

NO TES:
1) EROSION STONE TO BE "CLASS I" RIP-RAP UNLESS DESIGNA TED DIFFERENTL Y ON
CONSTRUCTION PLAN.
2) PIPE SIZE AND AMOUNT NEEDED TO BE DETERMINED BY ENGINEER ON CONSTRUCTION
PLAN.
3) PUMP AND LINE SIZE TO BE DETERMINED BY THE CONTRACTOR USING THE BASE FLOW
SHOWN ON THE CONSTRUCTION PLANS.
4) WIDTH OF CONSTRUCTION EASEMENT SHALL BE MINIMIZED BASED UPON FIELD CONDITIONS.
ANY DISTURBANCE(S) EXCEEDING 40' MA Y REQUIRE ADDITIONAL WA TER QUALITY PERMITTING
OR MI T/GA TION.
1) INSTALL PUMP AND LINE TO PUMP FLOW FROM AREA UPSTREAM OF TEMPORARY STREAM
CROSSING TO AREA DOWNSTREAM OF CONSTRUCTION AREA. BEGIN PUMPING AND
CONTINUING PUMPING WHILE WORKING WITHIN THE STREAM.
2) INSTALL UPSTREAM DAM, FIL TER FABRIC, AND TEMPORARY CUP. COVER PIPE INLET
WITH FABRIC AND SAND BAGS AS SHOWN IN INSET "A " WHILE WORKING IN THE STREAM.
ALLOW STREAM FLOW THROUGH CUP AS SHOWN IN INSET B" WHEN NOT WORKING WITHIN
THE STREAM.
3) INSTALL DOWNSTREAM TEMPORARY STONE DAM AND FILTER FABRIC TO PREVENT
BACK FLOW INTO CONSTRUCTION AREA.
4) INSTALL PROPOSED EARTH BERMS ALONG TOP OF BANK ON EACH SIDE OF THE
CONSTRUCTION AREA.
5) INSTALL DEWA TERING SA SIN OR S/L T BA G A T TOP OF BANK. DEkYA TER CONSTRUCTION
AREA BETWEEN TEMPORARY DAM USING THIS BASIN.
6) INSTALL THE 10' X 10' SEDIMENT TRAP OR S/L T BAG.
7) UPON CONSTRUCTION COMPLETION, REMOVE TEMPORARY DAMS, FIL TER FABRIC, AND
TEMPORARY CUP. DEPRESS TEMPORARY DAM BOTTOMS INTO STREAM BED UNTIL TOP OF
RIP RAP IS LEVEL WITH STREAM BOTTOM.
8) UPON STABILIZATION OF CLEARED AREAS, REMOVE TEMPORARY EARTH BERM, SEDIMENT
RAP. AND DEWA TERING BASIN.
2 OF 2
C-11' 1'I
1 1? _S' VIL L c

F 1
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??DSFJ9+SSOc?(]A???ICN
D UJGL?
Pre-Construction Notification (PCN) Application Form
For Section 404 and/or Section 10 Nationwide, Regional and General Permits, Section 401
General Water Quality Certifications, and Riparian Buffer and Watershed Buffer Rules
This form is to be used for projects qualifying for any of the U.S. Army Corps of Engineers' (USACE)
Nationwide, Regional or General Permits as required by Section 404 of the Clean Water Act and/or
Section 10 of the Rivers and Harbors Act, and for the North Carolina Division of Water Quality's
(DWQ) associated General 401 Water Quality Certifications. This form is also to be used for any
project requiring approval under any Riparian Buffer Rules implemented by the N.C. Division of Water
Quality. This form should not be used if you are requesting an Individual 404 Permit or Individual 401.
Water Quality Certification. The USACE Individual Permit application form is available online at
wNvw.saw. usace.army.mi I/wetlands/Permits.html.
The USACE is the lead regulatory agency. To review the requirements for the use of Nationwide,
Regional or General permits, and to determine which permit applies to your project, please go to the
USACE website at www.saw.usace.arnny.milhvetlands/index.html, or contact one of the field offices
listed on page 3 of this application. The website also lists the responsible project manager for each
county in North Carolina and provides additional information regarding the identification and regulation
of wetlands and waters of the U.S.
The DWQ issues a corresponding Certification (General or Individual), and cannot tell the applicant
which 401 Certification will apply until the 404 Permit type has been determined by the USACE.
Applicants are encouraged to visit DWQ's 401/Wetlands Unit website at
http://l12o.enr.state.nc.us/ncwetiands to read about current requirements for the 401 Water Quality
Certification Program and to determine whether or not Riparian Buffer Rules are applicable. The
applicant is also advised to read the full text of the General Certification (GC) matching the specific 404
Permit requested. In some cases, written approval for General Certifications is not required, provided
that the applicant adheres to all conditions of the GC. Applicants lacking access to the internet should
contact DWQ's Central Office in Raleigh at [phone].
Trout Waters Coordination - Special coordination with the North Carolina Wildlife Resources
Commission (NCWRC) is required for projects occurring in any of North Carolina's twenty-five
counties that contain trout waters. In such cases, the applicant should contact the appropriate NCWRC
regional coordinator (listed by county on page 4 of this application) prior to submittal of the application.
Page 1 of 12
Coastal Area Management Act (CAMA) Coordination - If the project occurs in any of North Carolina's
twenty coastal counties (listed on page 4) the applicant should contact the North Carolina Division of
Coastal Management (DCM). DCM will determine whether or not the project is within a designated
Area of Environmental Concern, in which case DCM will act as the lead permitting agency. In such
cases, DCM will require a CAMA Permit and will coordinate the 404/401 Permits.
The applicant may also choose to coordinate with the United States Fish and Wildlife Service to ensure
that the proposed project will have no impact upon any endangered or threatened species or critical
habitat as regulated by the Endangered Species Act, and the State Historic Preservation Office, North
Carolina Department of Cultural Resources to ensure that the proposed project will have no impact upon
any properties listed or eligible for listing on the National Register of Historic Places. Compliance with
these regulations is required to be eligible for any Department of the Army permit. The addresses for
both agencies are listed on page 3 of this application.
USACE Permits - Submit one copy of this form, along with supporting narratives, maps, data forms,
photos, etc.. to the applicable. USACE Regulatory Field Office. Upon receipt of an application, the
USACE will determine if the application is complete as soon as possible, not to exceed 30 days. This
PCN form is designed for the convenience of the applicant to address information needs for all USACE
Nationwide, Regional or General permits, as well as information required for State authorizations,
certifications, and coordination. Fully providing the information requested on this form will result in a
complete application for any of the USACE Nationwide, Regional or General permits. To review the
minimum amount of information that must be provided for a complete PCN for each USACE
Nationwide permit, see Condition 13, 67 Fed. Reg. 2090 (Jan. 15, 2002), available at
httn://www.usace.army.mil/inct/functions/cw/cecwo/re 2002nwps.pdf. Processing times vary by
permit and begin once the application has been determined to be complete. Please contact the
appropriate regulatory field office for specific answers to permit processing periods.
401 Water Quality Certification or Buffer Rules - All information is required unless otherwise stated
as optional. Incomplete applications will be returned. Submit seven collated copies of all USACE
Permit materials to the Division of Water Quality, 401/Wetlands Unit, 1650 Mail Service Center,
Raleigh, NC, 27699-1650. If written approval is required or specifically requested for a 401
Certification, then a non-refundable application fee is required. In brief, if project impacts include less
than one acre of cumulative wetland/water impacts and less than 150 feet cumulative impacts to
streams, then a fee of $200 is required. If either of these thresholds is exceeded, then a fee of $475 is
required. A check made out to the North Carolina Division of Water Quality, with the specific name of
the project or applicant identified, should be stapled to the front of the application package. For more
information, see the DWQ website at 11ttp:Hf12o.chnr.state.nc.us/ncwetIands/fees.iitml. The fee must be
attached with the application unless the applicant is a federal agency in which case the check may be
issued from a separate office. In such cases, the project must be identifiable on the U.S. Treasury check
so that it can be credited to the appropriate project. If written approval is sought solely for Buffer Rules,
the application fee does not apply, and the applicant should clearly state (in a cover letter) that only
Buffer Rule approval is sought in writing. Wetlands or waters of the U.S. may not be impacted prior to
issuance or waiver of a Section 401 Water Quality Certification. Upon receipt of a complete application
for a 401 Certification, the Division of Water Quality has 60 days to prepare a written response to the
applicant. This may include a 401 Certification, an on-hold letter pending receipt of additional
requested information, or denial.
Page 2 of 12
US Army Corps Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Caldwell Haywood McDowell Swain
US Army Corps of Engineers Alleghany Catawba Henderson Mecklenburg Transylvania
151 Patton Avenue Ashe Cherokee Ircdell Mitchell Union
Room 208 Avery Clay Jackson Polk Watauga
Asheville, NC 28801-5006 Buncombe Cleveland Lincoln Rowan Yancey
Telephone: [phone] Burke Gaston Macon Rutherford
Fax: [phone] Cabarrus Graham Madison Stanley
Raleigh Regulatory Field Office Alamance Franklin Nash Suny
US Army Corps Of Engineers Caswell Forsyth Northampton Vance
6508 Falls of the Neuse Road Chatham Granville Orange Wake
Suite 120 Davidson Guilford Person Warren
Raleigh, NC 27615 Davie Halifax Randolph Wilkes
Telephone: [phone] Durham Johnston Rockingham Wilson
Fax: [phone] Edgecombe Lee Stokes Yadkin
Washington Regulatory Field Office Beaufort Currituck Jones Pitt
US Army Corps Of Engineers Bertie Dare Lenoir Tyrrell
Post Office Box 1000 Camden Gates Martin Washington
Washington, NC 27889-1000 Carteret* Green Pamlico Wayne
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perquimans *Croatan Natio nal Forest Only
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pender
Post Office Box 1890 Brunswick Hoke Richmond
Wilmington, NC 28402-1890 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Fax: [phone] Cumberland New Hanover Scotland
North Carolina State Agencies
Division of Water Quality
401 Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Telephone: [phone]
Fax: [phone]
US Fisl
US Fish and Wildlife Service
Raleigh Field Office
Post Office Box 33726
Raleigh, NC 27636-3726
Telephone: [phone]
Division of Water Quality
Ecosystem Enhancement Program
1652 Mail Service Center
Raleigh, NC 27699-1652
Telephone: [phone]
Fax: [phone]
i and Wildlife Service /National M
US Fish and Wildlife Service
Asheville Field Office
160 Zillicoa Street
Asheville, NC 28801
Telephone: [phone]
State Historic Preservation Office
Department Of Cultural Resources
4617 Mail Service Center
Raleigh, NC 276994617
Telephone: [phone]
Fax: [phone]
[arine Fisheries Service
National Marine Fisheries Service
Habitat Conservation Division
Pivers Island
Beaufort, NC 28516
Telephone: [phone]
Page 3 of 12
CAMA and NC Coastal Counties
Division of Coastal Management Beaufort Chowan Hertford Pasquotank
1638 Mail Service Center Bertie Craven Hyde Ponder
Raleigh, NC 27699-1638 Brunswick Currituck New Hanover Pcrquimans
Telephone: [phone] Camden Dare Onslow Tyrrcll
Fax: [phone] Carteret Gates Pamlico Washington
NCWRC and NC Trout Counties
Western Piedmont Region Coordinator Alleghany Caldwell Watauga
3855 Idlewild Road Ashe Mitchell Wilkes
Kernersville, NC 27284-9180 Avery Stokes
Telephone: [phone] Burke Surry
Mountain Region Coordinator Buncombe Henderson Polk
20830 Great Smoky Mtn. Expressway Cherokee Jackson Rutherford
Waynesville, NC 28786 Clay Macon Swain
Telephone: [phone] Graham Madison Transylvania
Fax: [phone] Haywood McDowell Yancey
APPLICATION FORM BEGINS ON PAGE 5. PLEASE DO NOT SUBMIT PAGES 1- 4.
Page 4 of 12
Office Use Only: Form Version March 05
USACE Action ID No. DWQ No.
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
1. Processing
1. Ch k all of the approval(s) requested for this project:
9 Section 404 Permit ? Riparian or Watershed Buffer Rules
? Section 10 Permit ? Isolated Wetland Permit from DWQ
W401 Water Quality Certification ? Express 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested:_ I Y W P I
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts, attach the acceptance letter from NCEEP, complete section VIII,
and check here: ?
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
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: ? M
U Q9 [2 0 "
II. Applicant Information LS
1. Owner/A plicant forma 'on NOV 3 - 2005
Name: 0 ALITY
MailingAddr ss: 0 1IvTJANDSAND STGRViVATERBRA14CH
sJ'.t N.C. 7Z7 a
Telephone Number: 331, -34 - 23 I (v Fax Number: 33L - 3g-7-- -2355
E-mail Address: r'Ve:LtA cp- c. fei cVe . MC . (As
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:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Page 5 of 12
M. 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. Nameofproject: H(1rr?son b -ree t man
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): 7 99S ! e 3 / 7 & 9 /
4. Location
County: Town: Re i s V. 1
Subdivision name (' Jude phase/lot number):
Directions to site (include road numbers/na es, landmarks, etc.): 7Zke, Al C. rrZ l/. S. S
9N g. o ; hbs oa T /' e -u Cr
a? ?.. On i u S n?! S ? r
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): 3&-- 21- 411 ON -79 - q;? -03 °W
6. Property size (acres): ?. cl A c
7. Name of nearest receiving body of water:1-xn P,.I e/t-
8. River Basin:_ 0,n0 k e-- Rt y e-q-
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at httn:iih2o.cnr.state.nc.Lis/adminimalis.)
9. Describe the existing conditions on the site and general land use in the vicinity of the
at the time of this application: Cg ee_k b; ASP r ?; n? Q?, (4,10 S.S Cc
C,r,ee.L .
Page 6 of 12
10. Desc?pibe the overall project in detail, inclurdJing t e type of equiplL7lent tg be used: 6 l i n a,
I? ,i r A l O n Gl ?? ArtJ1 n 1 tYn m 1' l a r K n n .?n / r, ri n ?Jl 1. : i to n . . ' ; . , e n.. v r?
eA-
11. Explain the purpose of the proposed work: VroV i Cie. Se wek SefV I .L ? O
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
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.
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. Each impact must be
listed separately in the tables below (e.g., culvert installation should be listed separately from
riprap dissipater pads). Be sure to indicate if an impact is temporary. All proposed impacts,
permanent and temporary, must be listed, and must be labeled and clearly identifiable on an
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.
Page 7 of 12
2. Individually list wetland impacts. Types of impacts include, but are not limited to
mechanized clearing, grading, fill, excavation, flooding, ditching/drainage, etc. For dams,
separately list impacts due to both structure and flooding.
Wetland Impact
Site Number
(indicate on map)
Type of Impact Type of Wetland
(e.g., forested, marsh,
herbaceous, bog, etc.) Located within
100-year
Floodplain
es/no Distance to
Nearest
Stream
linear feet Area of
Impact
(acres)
A lo a e,

Total Wetland Impact (acres)
3. List the total acreage (estimated) of all existing wetlands on the property: /V
4. Individually list all intermittent and perennial stream impacts. Be sure to identify temporary
impacts. Stream impacts include, but are not limited to placement of fill or culverts, dam
construction, flooding, relocation, stabilization activities (e.g., cement walls, rip-rap, crib
walls, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is proposed,
plans and profiles showing the linear footprint for both the original and relocated streams
must be included. To calculate acreage. multinly lenvrh X width th#-n il;x,M, h., n1 c4n

Stream Impact
Number

indicate on ma

Stream Name - -

Type of Impact - ---- ?- -

Perennial or
Intermittent? - ......aa, -aavaa -
Average

Stream Width
Before Impact ?- V -rJ,..
Impact

Length
linear feet , VV.
Area of

Impact
acres
`75 s 41^ G??? pttcEt t ISFi T"c•?• rar 2 O' 3 Dr 0.41

Total Stream Impact (by length and acreage) 3o d. QI
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. drainnge hn1khPq.Ic ntr-
Open Water Impact
Site Number
indicate on ma Name of Waterbody
(if applicable)
Type of Impact Type of Waterbody
(lake, pond, estuary, sound, bay,
ocean, etc. Area of
Impact
acres

Total Open Water Impact (acres)
Page 8 of 12
6. List the cumulative impact to all Waters of the U_S_ res ihinn frnm the nrniect-
Stream Imp act acres : p
Wetland Impact (acres :
Open Water Impact acres :
Total Impact to Waters of the U.S. (acres)
Total Stream Impact (linear feet): 3 L.
7. Isolated Waters
Do any isolated waters exist on the property? ? Yes [R(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.
8. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Current land use in the vicinity of the pond:
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss cons ction
techniques to be followed during construction to reduce impacts. 'roQ9 ?i q G?
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://Ii2o.enr.state.ne.us/newetIands/stringide.iitm1.
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.
2. Mitigation may also be made by payment into the North Carolina Ecosystem Enhancement
Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at
[phone] to determine availability, and written approval from the NCEEP indicating
that they are will to accept payment for the mitigation must be attached to this form. For
additional information regarding the application process for the NCEEP, check the NCEEP
website at http://h2o.enr.state.nC.us/wrp/index.litm. 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.
X.
Environmental Documentation (required by DWQ)
1. Does the project involve an expenditure of pub is (federal/state/local) funds or the use of
public (federal/state) land? Yes No E]
2. If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not ure whether a NEPA/SEPA document is required, call the SEPA
coordinator at (919) 7 -5083 to review current thresholds for environmental documentation.
Yes ? No
3. If yes, has the document review been finalized by the State Clearinghouse? If so, please
attach a copy of the NEPA or SEPA final approval letter. Yes ? No ?
Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
1. Will the project impact protected riparian buffers identified within 15A NCAC 213 .0233
(Neuse), 15A NCAC 213 .0259 (Tar-Pamlico), 15A NCAC 2B .0243 (Catawba) 15A NCAC
213 .0250 (Randleman Rules and Water Supply Buff Requirements), or other (please
identify )? Yes ? No
2. If "yes", identify the square feet and acreage of impact to each zone of the riparian buffers.
If buffer mitigation is required calculate the required amount of mitigation by applying the
buffer multipliers.
Zone* Impact Multiplier Required
(square feet Mitigation
1 3 (2 for Catawba)
2 1.5
Total
* Zone 1 extends out 30 feet perpendicular from the top of the near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
3. If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e.,
Donation of Property, Riparian Buffer Restoration / Enhancement, or Payment into the
Riparian Buffer Restoration Fund). Please attach all appropriate information as identified
within 15A NCAC 213 .0242 or.0244, or .0260.
Page 11 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. 0 nC'e. in I YA OFAV I s
CAre-a..
XH. Sewage Disposal (required by DWQ)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater gener ted from the proposed project, or available capacity of the subject facility.
Mot 1eGuire, a -'nr 0e) n&4 ,ruLcA nn . SP Y'clwP. toi , eIn rA triI-n
:M,e- 5e_\MVL \0'41 be
XIII. Violations (required by DWQ)
Is this site in violation of DM Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No [Rr
Is this an after-the-fact permit application? Yes ? No 12/
XIV. Cumulative Impacts (required by DWQ)
XV.
a/? dlscha'
, C, /nb c:lv
111
Other Circumstances (Optional):
C.-I Lwl w vtl !r-we' ^
:14nd
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).
1411,0/P
-Applica$t/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 12 of 12
Will this project (based on past and reasonably anticipated future impacts) result in ad onal
development, which could impact nearby downstream water quality? Yes El No
If yes, please submit a qualitative or quantitative cumulative impact analysis in accordance with
the most recent North Carolina Division of Water Quality policy posted on our website at

a9@[mw4
NOV 3 -.2005
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VICINITY & SITE MAP FOR REGAL ROAD
HARRISON STREET SANITARY SEWER
REIDSVILLE, N.C. - SEPTEMBER, 2005
SCALE: 1" = 1000'
E41Q
O
?qd
NOTE STREAM CROSS-SECTION SHALL BE
RESTORED TO ITS ORIGINAL GRADE AND ELEVATION. ? IMPACT AREA LEVY 8J, 6c)5%LL r STA. 3 36.51 2PLACED I DITCH 5 LF. MN TINE SHALL
LINE
r '7995-1 / (SEE DETAIL ON SHEET 4.)
LEVY C. J. BOSWELL N /,/
LT CHECK I N ROAD TO BE BORED
•? ?.
7995-18-31'7691 MH # 1 45 LF-18" STL. ENC. PIPE
d STA. 1+61.97 WITH 0.25" WALL THICKNESS
0+00 >T - - 8100
1 ? 1i00 ?
2 JOINTS 8" DUCTILE IRON PIPES / OIBAD ?? 5?
CENTERED ON CREEK WITH MECHANICAL JOINTT\ 60 LF. MATTING SHALL BE / ?'0
TO BE ENCASED IN 24" CONCRETE. PLACED IN THE DITCH LINE /
(CONCRETE STA. 0+65 TO STA. 0+93) (SEE DETAIL ON SHEET 4.) CITY OF REIDSVILLE
7995-18-31-8392
CITY OF REIDSVILLE
7995-18-31-8392
11001'
MH?J3
STA. 5+17.03
NC WEST HARRISON STREET
87
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704 n °
700
696
692
688
2 JOINTS 8" DUCTILE IRON PIPE
CENTERED ON CREEK WITH MECHANICAL JOINTS
TO BE ENCASED IN 24" CONCRETE
(CONCRETE STA. 0+65 TO STA. 0+93)
684
DATUM ELEV
680.00
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MAP SHOWING
STREAM CROSSING DETAIL
HARRISON STREET SANITARY SEWER
REIDSVILLE, N.C. - SEPTEMBER, 2005
SCALE: 1" = 60'
t
PUMP
=LO-Q I TEMP. CONSTRUCTION
STREAM CROSSING
FL OW -?

- - - -
12' - - - - - - - ?-
_5,. .
MIN. MIN.
PROPOSED
EAR TH BERM
(TYP.)
10' _
CLASS MIN.
RIP RAP
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FLOW i /
24"TO E
42 CUP
CLASS
RIP RAP
PROPOSED
EARTH BERM
(TYP.)
POL YETHYLENE FABRIC
ON FACE (8 ML. THICK)
TO
'UMP
STREAM
FLOW
/ 5,. .
------- IN.
T I 2' CLASS ':4
/ CROSSING EROSION CONTROL
PIPE STONE k"EIR
20'
40' CONSTRUCTION EASEMENT
xl 10' x 10'
SEDIMENT TRAP
0 2.• 1 SIDE SLOPE
OR SILT BAG.
i
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/- 10' x 10'
DEWA TERING BASIN
0 2.• 1 SIDE SLOPE
10, OR SlL T BAG
MIN.
FROM
EX. IN V. TEMPORARY)
CREEK STONE DAM
-PROPOSED
EARTH BERM
(TYP.)
12' TOP OF
MIN. BANK
----------- -------
TEMP.
24 " TO
42 " CMP
J 18" ?
? L MIN.
POL YETHYLENE FABRIC
ON FA CE (8 ML. THICK)
? CROSSING
PIPE
POL YETHYLENE FABRIC
ON FACE (8 ML. THICK)
INSTALL SANDBAGS IN PIPE INVERT & FABRIC WHILE PUMPING
AROUND DURING CONSTRUCTION IN STREAM.
REMOVE SANDBAGS & FABRIC TO ALLOW FLOW THROUGH
PIPE WHEN NOT PUMPING AROUND.
C I 1 ?' c? F-f 1? E 1 D` S' V11 L L L'

NO TES.-
1) EROSION STONE TO BE "CLASS I" RlP-RAP UNLESS DESIGNA TED DIFFERENTL Y ON
CONSTRUCT/ON PLAN.
2) PIPE SIZE AND AMOUNT NEEDED TO BE DETERMINED BY ENGINEER ON CONSTRUCTION
PLAN.
3) PUMP AND LINE SIZE TO BE DETERMINED BY THE CONTRACTOR USING THE BASE FLOW
SHOWN ON THE CONSTRUCTION PLANS.
4) WIDTH OF CONSTRUCTION EASEMENT SHALL BE MINIMIZED BASED UPON FIELD CONDITIONS.
ANY DISTURBANCE(S) EXCEEDING 40' MA Y REQUIRE ADDITIONAL WA TER QUALITY PERMITTING
OR Ml TIGA TION.
1) INSTALL PUMP AND LINE TO PUMP FLOW FROM AREA UPSTREAM OF TEMPORARY STREAM
CROSSING TO AREA DOWNSTREAM OF CONSTRUCTION AREA. BEGIN PUMPING AND
CONTINUING PUMPING WHILE WORKING WITHIN THE STREAM.
2) INSTALL UPSTREAM DAM, FIL TER FABRIC, AND TEMPORARY CUP. COVER PIPE INLET
WITH FABRIC AND SAND BAGS AS SHOWN IN INSET ';4 " WHILE WORKING IN THE STREAM.
ALLOW STREAM FLOW THROUGH COP AS SHOWN IN INSET 'B" WHEN NOT WORKING WITHIN
THE STREAM.
3) INSTALL DOWNSTREAM TEMPORARY STONE DAM AND F/L TER FABRIC TO PREVENT
BACK FLOW INTO CONSTRUCTION AREA.
4) INSTALL PROPOSED EARTH BERMS ALONG TOP OF BANK ON EACH SIDE OF THE
CONSTRUCTION AREA.
5)
6)
INSTALL DEWA TERING BASIN OR SlL T BAG A T TOP OF BANK. DEWA TER CONSTRUCTION
AREA BETWEEN TEMPORARY DAM USING THIS BASIN.
INSTALL THE 10' X 10' SEDIMEN T TRAP OR SIL T BA G.
7) UPON CONSTRUCTION COMPLETION, REMOVE TEMPORARY DAMS, FIL TER FABRIC, AND
TEMPORARY CUP. DEPRESS TEMPORARY DAM BOTTOMS INTO STREAM BED UNTIL TOP OF
RIP RAP IS LEVEL WITH STREAM BOTTOM.
8) UPON STABILIZA TION OF CLEARED AREAS, REMOVE TEMPORARY EARTH BERM, SEDIMENT
- = 7-7-FIN G BA SIN.
2 OF 2
77 -" f
( 7 ? F/
/ Dig V I L L HL4
T' T
CITY OF REIDSVILLE * 230 WEST M_OREHEAD ST. * REIDSVILLE, NC 27320 ACCOUNTS PAYABLE 336-349-105(
DATE Oct 20, 2005VENDOR NO.12672 .CHECK NO .1 162092
DESCRIPTION INVOICE DATE I INVOICE NUMBER I PO NUMBER INVOICE AMOUNT
i.:rrison Sanitary Sew
Oct 18, 2005
101705 $200.00'
TOTAL CHEC
$200.00
*See Reverse Side For Easy Opening Instructions*
"" CITY OF REIDSVILLE
*' 230 WEST MOREHEAD STREET
la E
` REIDSVILLE, NC 27320
NC DIVISION OF WATER QUALITY
Q9 rr,,,-" 1 R 0 ec0
NOV 3 - 2005
DENk . 41'ATER QUALITY