19950488 Ver 1_COMPLETE FILE_19950516

State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Environmental Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
A IL
[D F= F1
May 16, 1995
Forsyth County
DEM Project # 95488
APPROVAL of 401 Water Quality Certification
Mr. Rick Longworth
LCDX Corporation
232 Heathcliff Place
Winston-Salem, N.C. 27104
F I L I
Dear Mr. Longworth:
You have our approval to place fill material in 0.17 acres of wetlands or waters for the purpose
of installing a 12" Sanitary Sewer along Blanket Bottom Creek to serve Waterford Subdivision,
Section 5 and other upstream areas from this project, as you described in your application dated 6 May
1995. After reviewing your application, we have decided that this fill is covered by General Water
Quality Certification Number 2664. This certification allows you to use Nationwide Permit Number 12
when it is issued by the Corps of Engineers.
This approval is only valid for the purpose and design that you described in your application. If
you change your project, you must notify us and you may be required to send us a new application.
For this approval to be valid, you must follow the conditions listed in the attached certification. In
addition, you should get any other federal, state or local permits before you go ahead with your
project.
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory
hearing. You must act within 30 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, P.O. Box 27447, Raleigh, N.C. 27611-7447. This certification and
its conditions are final and binding unless you ask for a hearing.
This letter completes the review of the Division of Environmental Management under Section 401
of tae Clean Water Act. If you have any questions, please telephone John Domey at 919-733-1786.
Attachment
cc: Wilmington District Corps of Engineers
Corps of Engineers Raleigh Field Office
Winston-Salem DEM Regional Office
Mr. John Dorney
Central Files
Phillip R. Ball; The Phillip R. Ball Company
95488.1tr
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal opportunity Affirmative Action Employer 50% recycled/ 10% post-consumer paper

TRANSMITTAL
Fa7
Telephone: [phone]
TO-
Corps of Engineers
Department of the Army
P 0. Box 1890
Wilmington, N. C. 28402-1890
ATTN: CESAW-CO-E
7 THE 0HILLIP R. BALL COMPANY; INC.
Con3uiNng Engineers and Land Surveyors
305 Doub Road
Lewisville, North Carolina 27023
Wilmington District Engineer
<Walt,
RE,
RECEIVED
MAY 1 1995
ENVIRON?NTAL SCIENCES
RfZ NG4
Date May 6, 1995
er Quality Planning
sion of Environmental Management
NC Department of Environment, Health
and Natural Resources
P. 0. Box 29535
Raleigh, N. C. 27625-0535
ATTN: Mr. John Dorney
Blanket Bottom Creek Outfall
Between Peace Haven Road and Harper Road
Near Clemmonss Forsyth Co., N. C.
GENTLEMEN,
We are torwording the following Items in regards to the above referenced project.
tx) PLANS 1-Corps of Engrs. I SHOP DRAWINGS (X) PRINTS
f ) CONTRACT 7-DEM ( ) CALCULATIONS I ) MYLARS
( l DETAILS ( ) SPECIFICATIONS ( ) SEPIAS
t SKETCHES ( ) CHANGE ORDER ( ) OTHER
(K) FOR YOUR USE (X) FOR YOUR APPROVAL i ) FOR YOUR REVIEW
t ) FOR YOUR FILE ( ) FOR YOUR COMMENTS t ) PER YOUR REQUEST
COMMENTS:
Mr. John Thomas has visited the site and sent me the enclosed forms and
instructions to complete them.
Please note I have included an 8" X 14'' drawing showing the location of
the work in relation to the aforementioned roads.
SINCERELY,
Phillip R. 11
THE PHILLIP R. BALL COMPANY, INC.
cc: hCDX Corp.
File: E377-2
DEM TD: ??t U ACTION ID:
Nationwide Perm t Requested (Provide Nationwide Permit #):
JOINT FORM FOR 401 1UU
Nationwide permits that require notification to the Corps of Engineers
Nationwide permits that require application for Section. 401 certification
RRLM INGTON DISTRICT ENGINEM WATER QUALITY PLANNING
CORPS OF ENGINEERS DIVISION OF ENVIRONMENTAL MANAGEKEN T
DEPARTMENT OF THE ARMY NC DEPARTMENT OF ENVIRON1ytE
P.O. Box 1890 AND NATURAL RESOURCES i
Wilmington. NC 28402-1890 P.O. Box 29535 w i
AM: CESAW-CO-B Raleiah, NC 27626-0535
Telephone [phone] A1'TN: MR. JOHN DORNEY 10 199
Telephone [phone]
ONE (1) COPY OF THIS COMPLETED APPLICATION SHOULD BE SENT TO
SEVEN (7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF EENVIR Tim CORP 6,
PLEASE PRINT. NMtrlvf'!T..
1. Owners Name; LCQ X C
2. Owners Address: Z3Z dAffye4-1AX PuteE . WiWILP v.14LEM Z7?043. Owners Phone Number (Home): 1- 9/D_765 1798 (Work): 1- V O- 7lS -1778
4. If Applicable: Agent's name or responsible corporate ofcial, address, phone number.
R/ G I,[ 1-QA1e51d0 r14
J`Twr; ?io?/LD Y 1770 'hlE W 1PZ4CZ WUA0440 AMAMIAG
6.. Nano of Closest StrcamlRivcr: •?/?N,?C?7" 80777-OAA L4ggE&
7. River Basin; Yi4 b K lIV
8. IS this project located in a watershed classified as Trout, SA, HQW, ORW, WS I, or WS H? YES j NO Nf
9. Have any Section 404 permits bean prt~viously requested for use on this property? YES NO '[vf
If yes, axplain.
14. FsdmzzdtaW number of acres of waters of the U.S., including wetlands, located on project site:
0-_17.4e. ( .67"59AI E ddeEAK 0,2055/N6S
11. Number of acres of waters of the U.S., including wetlands, impacted by the proposed project:
Filled: _ -D
Drained: - a-
Floodcd: -'0 -
Excayated: 0.17 A c
Total Impacted: 0 • / 7 A c
5: Location of work (MUST ATTACH MAP). County: A0,45 oerA C -41N Z Y
Nearest Town or City; UI L LA C2E OF ?G,s•M An?aU S __ _
Specific Location (Include toad numbers, landmarks, etc.): Pd0a-5- D &J&&T. f3eTrQM /S locArEn
rauri N4.11.1995 14944 NO. 6 P. 5
12. Description of proposed work (Attach PLANS-8 112" A 11" drawings only):
V
• u t,4cc
E M _E '
13. Purpose of proposed work: IJAIg rO 1fA9VE P-APAOSED 41A MAM .0 &90teLs gd, Sze.
r`?? --
}4iV o , 09AY 02r A" 1Ca o-,W P2AMCT.
14. State reasons why the applicant believes that this activity must be carried out in wetlands. Also, note measures
taken to minimize wetland Impacts. 720Aoua 4y' _AF 9ovAlo 64TAxIS le rioA/ mf 0&rF4LL . k11 9y
li 'Vou are required to contact the U.S. Fish and Wildlife Service (USFWS) and/or National Marine Fisheries Service
(NMFS)) regarding the presence or any Federally listed or proposed for fisting endangered or threatened specie or critical
habitat In the permit area that may be affected by the proposed project. Have you done so? YES [??e NO [ j
RESPONSES FROM THE USFWS AND/OR NMFS SHOULD BE FORWARDED TO CORPS.
16. You are required to contact the State Historic Preservation Officer (SHPO) regarding the presence f historic
properties In the permit area which maybe affected by the proposed project? Have you done go?. YES (q No[
RESPONSE FROM THE SHPO SHOULD BE FORWARDED TO CORPS.
17. Additional information required by DEM:
A. Wetland delineation map showing all wetlands, streams, and lakes on the property.
B. If available, representative photograph of wetlands to be impacted by project.
C. If delineation was performed by a consultant, include all data sheets relevant to the placement of the
delineation line.
D. If it stormwater management plan Is required for this project, attach copy.
E. What is land use of surrounding property? . 99VD A DAi
F. If applicable, what Is proposed method of sewage disposal? It
a,()\, -
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Owner's Signature v Date

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