20100819 Ver 1_Application_20101004

STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
BEVERLY EAVES PERDUE
GOVERNOR
Mr. Brian Wrenn
September 29, 2010
Division of Water Quality 100819
4011Transportation Permitting Unit 1650 Mail Service Center
Raleigh, NC 27699-1650
SUBJECT: Pipe Replacement on SR 1413 (Bess Road), Gaston County
Dear Mr. Wrenn:
EUGENE A. CONTI, JR.
SECRETARY
p@036wop
OCT - 4 2010
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The North Carolina Department of Transportation requests written authorization for the
replacement of a deteriorating 67-foot long, 48" CMP with a 64-foot long, 48" RCP on SR
1413 (Bess Road) in Gaston County. The pipe was installed under the NW 3 (GC 3687) permit
with the intent of burying the pipe inverts as required by regulation. However, due to contractor
error, the replacement pipe was installed in a perched condition. A --5-foot rock ladder was
constructed at the outlet to alleviate the perched condition. Five feet of riprap stabilization was
utilized at the inlet and outlet for structure stabilization. Please note that the previous pipe was
perched also. The scope of the work resulted 10 feet of permanent impacts to an unnamed
tributary to Little Beaverdam Creek, which is classified as Class C waters by the Division of
Water Quality.
The project area is not located within '/, mile of any critical watershed area nor is SR 1413 a rural
or urban arterial; therefore, hazardous spill basins are not required. Enclosed is the hazardous
spill basin checklist. This office has conducted a GIS and field survey for the project for
historical sites and threatened/endangered species sites. No sites listed on the National Register
of Historic Places are located in the vicinity of the project nor did there appear to be any eligible
structures. The federally listed species for Gaston County (USFSW listed date January 31, 2008)
include Schweinitz's sunflower (Helianthus schweinitzii) - Endangered (E) and the Bog turtle
(Glyptenrys muhlenbergii)- Threatened due to Similarity of Appearance (T S/A). National
Heritage Program records document the nearest Schweinitz's Sunflower location approximately
14 miles east of the proposed project area. The sunflower is usually found in upland open areas
protected from shade or excessive competition. There is no potential habitat within the proposed
project area; however, no species were observed during the site visit. No impact on the species is
anticipated. National Heritage Program records document the nearest bog turtle location
approximately 2.4 miles southeast of the proposed project area. Bog turtles are usually found in
bogs, marshes, and wet pastures. There is no suitable habitat located within the project area and
no species were observed. T/SA species are not subject to Section 7 consultation; however, no
impact on this species is anticipated.
Post Office Box 47 Shelby, North Carolina 28151-0047

SR 1413 (Bess Road)
Page 2
September 29, 2010
I have enclosed a pre-construction notification for a WGC93687, a sketch of planned activities
and location map relative to the project.
Project information for the 401 Automated Payment Procedure is as follows:
• Work order number: 150456-55120005-12.203611-3126
Project Category: $240.00 Fee
i If you have any questions or concerns please feel free to contact me at [phone]. Thank you for
you r.time and consideration on this matter.
s hr. yrjra n. b . h 1 j t.
Respectfully yours,
M.L. Holder, P.E.
Division Engineer
Twelfth Division
BY:
Trish Simon
Division 12 Environmental Supervisor
Enclosures
o2oF W A 7F9OG
Y
i t o?? T
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notificaiion PCN Form
A. Applicant Information
1i. Processing
1 a . Type(s) of approval sought from the
Corps:
? Section 404 Permit ? Section 10 Permit
1 b . Specify Nationwide Permit (NWP) number: or General Permit (GP) number:
1c. Has the N WP or GP number been verified by the Corps? ? Yes ® No
111. Type(s) of approval sought from the DWQ (check all that apply):
® 401 Water Quality Certification - Regular. ? Non-404 Jurisdictional General Permit
? 401 Water Quality Certification - Express ? Riparian Buffer Authorization
1e. Is this notification solely for the record J
because written approval is not required? E he record only for DWQ 401
fica tion:
El Yes ® No For the record only for Corps Permit:

® Yes ? No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program. ? Yes ® No
1 cl. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below. -] Yes ® No
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ? Yes ® No
2. Project Information
2a. Name of project: SR 1413 (Bess Road)
2b. County: Gaston
2c. Nearest municipality / town: Cherryville
2d. Subdivision name: NA
2e. NCDOT only, T.I.P. or state
project no: 12 203611
3. Owner Information
3a. Name(s) on Recorded Deed: NCDOT Right of Way
3b. Deed Book and Page No.
3c. Responsible Party (for LLC i f
applicable):
3dr Street address:
3e. City, state, zip:
3f. 1 Telephone no.:
3g.1 Fax no.:
3h.1 Email address:
Page j of 11
PCN Form - Version 1.3 December 10, 2008 Version
4. Applicant Information (if different from owner)
4a. Applicant is: ? Agent ? Other, specify:
4b. Name: Mike Holder
4c. Business name
(if applicable):
N.C. Department of Transportation, Division 12
4d. Street address: 1710 East Marion Street
4e. City, state, zip: Shelby, NC 28151
4f. Telephone no.: 704-480-9020
4g. Fax no.: 704-480-5401
4h. Email address: [e-mail]
5. Agent/Consultant Information (if applicable)
5a. Name: Trish Simon
Sb. Business name
(if applicable):
N.C. Department of Transportation, Division 12
5c. Street address: 1710 East Marion Street
5d. City, state, zip: Shelby, NC 28151
5e. Telephone no.: 704-480-9044
5f. Fax no.: 704-480-5401
5g. Email address: [e-mail]
Page 2 of 11
PCN Form - Version 1.3 December 10, 2008 Version
B. Project Information and Prior Project History
1. Property Identification
la. Property identification no. (tax PIN or parcel ID): NA
Latitude: 35.2071484 Longitude: -
1b. Site coordinates (in decimal degrees): 81.0589074
(DD.DDDDDD) (-DD.DDDDDD)
1c. Property size: <.10 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
proposed project: UT to Little Beaverdam Creek
215. Water Quality Classification of nearest receiving water: Class C
2c. River basin: Catawba
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
Existing pipe on paved secondary road. Surrounding landuse is designated forested and cropland.
3b. List the total estimated acreage of all existing wetlands on the property:
0
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
80
3d. Explain the purpose of the proposed project:
The purpose of the proposed work is to replace a deteriorating pipe for the safety of the travelling public.
3e. Describe the overall project in detail, including the type of equipment to be used:
Replacement of a 67-foot long, 48" CMP with a 64-foot long, 48" RCP. Riprap used at the pipe inlet and outlet for
structure stabilization. A five foot rock ladder installed to relieve perched condition. Project constructed using typical
heavy equipment (trackhoe, backhoe, etc.).
4. Jurisdictional Determinations
4a: Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (including all prior phases) in the past? ? Yes ® No ? Unknown
Comments: Jurisdictional evaluation made by Div 12 DEC.
4b: If the Corps made the jurisdictional determination, what type
? Preliminary ? Final
of determination was made?
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company:
Name (if known): Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5. Project History
5a. Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
? Yes No ? Unknown
51b.1 If yes, explain in detail according to "help file" instructions.
I
Page 3 of 11
PCN Form - Version 1.3 December 10, 2008 Version
6. Future Project Plans
6a. Is this a phased project? ? Yes ® No
6b. If yes, explain.
Page 4 of 11
PCN Form - Version 1.3 December 10, 2008 Version
r:. Proposed Impacts Inventory
'l. Impacts Summary
1 a. Which sections were completed below for your project (check all that ap ply):
El Wetlands ? Streams - tributaries ® Buffers
[] Open Waters ? Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. 2b. 2c.
Wetland impact 2d. 2e. 2f.

number - Type of impact Type of wetland
Permanent (P) or
i
Forested Type of jurisdiction
(Corps - 404, 10 Ar
ea of impact
(
f known)
Temporary T DWQ - non-404, other) (acres)
W1 ? P ? T ? Yes ? Corps
? No ? DWQ
W2 ? P ? T ? Yes ? Corps
? No ? DWQ
W3 ? P ? T ? Yes ? Corps
? No ? DWQ
W4 ? P ? T ? Yes ? Corps
? No ? DWQ
W5 ? P ? T ? Yes ? Corps
? No ? DWQ
W6 ? P ? T ? Yes ? Corps
? No ?DWQ
2g. Total wetland impacts
2h. Comments:
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site
then comp lete this
question for all stream sites impacted. ,
3a.
Stream impact 3b.
Type of impact 3c.
Stream name 3d.
Perennial 3e.
Type of jurisdiction 3f.
Average 3g.
Impact
number -
Permanent (P) or (PER) or (Corps - 404, 10 stream length

'temporary (T) intermittent

(INT)? DWQ - non-404, width (linear
other) (feet) feet)
S1 ®P ? T Rock ladder for UT to Little El PER ® Corps
perched condition Beaverdam Creek ® INT ® DWQ 3 5
S2 ®P ? T Inlet rock ? PER ® Corps
stabilization ® INT ® DWQ 3 5
S3 ? P ? T ? PER ? Corps
[J INT ? DWQ
S4 ? P ? T ? PER ? Corps
? INT ? DWQ
SS ; ? P F1 T ? PER E] Corps
? INT ? DWQ
S6 I? P ? T R
? NT ?DWQ
3h. Total stream and tributary impacts
10
3i. 6
I omments:
Page 5 of 11
PCN Form - Version 1.3 December 10, 2008 Version
4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds,
the U.S. then individually list all open water impacts below. the Atlantic Ocean, or any other open water of
4a. 4b. 4c. 4d. 4e

Open water
Name of waterbody .
impact number -
Permanent (P) or (if applicable) Type of impact Waterbody type Area of impact (acres)
Temporary T
01 ?P?T
02 ?P?T
03 ?P?T
04 ?P?T
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If and or lake construction proposed, the n complete the chart below.
5a. 5b. 5c. 5d. 5e.

Pond ID
Proposed use or purpose Wetland Impacts (acres) Stream Impacts (feet) Upland

number
of pond (acres)
Flooded Filled Excavated Flooded Filled Excavated Flooded
P1
P2
5f. Total
5g. Comments:
5h. Is a dam high hazard permit required?
? Yes ? No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Meth od of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian bu ffer, then complete the chart below . If yes, then individually list all buffer impacts
below. If an impacts require mitigation, then you MUST fill out Section D of this form.
6a.
?
Neuse EEII Tar-Pamlico ? Other:
Projectis in which protected basin? ? ? Randleman
6b 6c. 6d i
6e 6g.
Buffer impact
number-
Permanent (P) or Reason
for
Stream name Bu
miti Zone 1 impact
(square feet) Zone 2 impact

Tem ora T
im act
re (square feet)
B1 ?P?T ?Yes
? No
B2 ?P?T ?Yes
? No
B3 ?P?T ?Yes
? No
6h. Total buffer impacts
6i. Comments:
Page 6 of 11
PCN Form - Version 1.3 December 10, 2008 Version
u. nnpact jusancation ana mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
Replacement of previous pipe with pipe of lesser or same length. Rock ladder construction to facilitate some aquatic passage.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for
impacts to Waters of the U.S. or Waters of the State? ? Yes ® No
2b. If yes, mitigation is required by (check all that apply): ? DWQ ? Corps

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

? Payment to in-lieu fee program
? Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3¢. Credits Purchased (attach receipt and letter) Type Quantity
3c:. Comments:
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached. ? Yes
4b. Stream mitigation requested: linear feet
4c. If using stream mitigation, stream temperature: ? warm ? cool ?cold
4d. Buffer mitigation requested (DWQ only): square feet
4e. Riparian wetland mitigation requested: acres
4f. Non-riparian wetland mitigation requested: acres
4g Coastal (tidal) wetland mitigation requested: acres
41h. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 7 of 11
PCN Form -Version 1.3 December 10, 2008 Version
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) - required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires ? Yes ®No
buffer mitigation?
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.

Zone 6c.
Reason for impact 6d.
Total impact
Multiplier 6e.
Required mitigation
(square feet) (square feet)
Zone 1 3 (2 for Catawba)
Zone 2
1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration
i
, payment
nto an approved in-lieu fee fund).
6h. Comments:
Page 8 of 11
PCN Form - Version 1.3 December 10, 2008 Version
IE. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
ta. Does the project include or is it adjacent to protected riparian buffers identified
within one of the NC Riparian Buffer Protection Rules? ? Yes No
Ii b. If yes, then is a diffuse flow plan included? If no, explain why.
Comments: ? Yes ? No
:2. Stormwater Management Plan
2a. What is the overall percent imperviousness of this project? 0 ova
2b. Does this project require a Stormwater Management Plan? ? Yes ® No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: Complies with NCDOT's individual
NPDES permit NCS000250. (Implementation, management, and inspection of erosion control devices and control of
discharge sources (ie. construction equipment).
-A. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:

2e. Who will be responsible for the review of the Stormwater Management Plan? ? Certified Local Government
? DWQ Stormwater Program
? DWQ 401 Unit
3. Certified Local Government Stormwater Review
3a. In which local government's jurisdiction is this project? NA
? Phase II
313. Which of the following locally-implemented stormwater management programs ? NSW
apply (check all that apply): ? USMP
? Water Supply Watershed
? Other:
3c. Has the approved Stormwater Management Plan with proof of approval been ? Yes ? No
attached?
4. DWQ Stormwater Program Review
? Coastal counties
4a. Which of the following state-implemented stormwater management programs apply ? HQW
? ORW
(check all that apply): ? Session Law 2006-246
? Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
attached? ? Yes
? No
5. jDWQ 401 Unit Stormwater Review
5a' Does the Stormwater Management Plan meet the appropriate requirements? ® Yes ? No
5bi
Have all of the 401 Unit submittal requirements been met?
I ® Yes ? No
Page 9 of 11
PCN Form - Version 1.3 December 10, 2008 Version
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
la. Does the project involve an expenditure of public (federal/state/local) funds or the
use of public (federal/state) land? ® Yes ? No
1 b. If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State ? Yes ® No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1c. If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval
letter.) ? Yes ? No
Comments: NA
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards, ? Yes ® No
or Riparian Buffer Rules (15A NCAC 26 .0200)?
2b. Is this an after-the-fact permit application? ® Yes ? No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s): Initial pipe
replacement proposal was to bury pipe as required by regulation. Due to contractor issues, the pipe was not buried and was
perched at outlet. Permit application submittal after the fact since GC3687 "permit conditions were not met".
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in
additional development, which could impact nearby downstream water quality? ? Yes ® No
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
The project is a minimum criteria project which has low potential for cumulative/indirect impacts and will not result in
additional development which could impact water quality.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
Page 10 of 11
PCN Form - Version 1.3 December 10, 2008 Version
o. enaangerea Species and Designated Critical Habitat (Corps Requirement)
Sa. Will this project occur in or near an area with federally protected species or
habitat? El Yes ® No
Sb. Have you checked with the USFWS concerning Endangered Species Act
impacts? ? Yes ® No
Sc. If yes, indicate the USFWS Field Office you have contacted. ? Raleigh
? Asheville
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
NC Natural Heritage Program database.
16. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? ? Yes ®No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
No salt marshes, oyster reefs, or seagrass beds in the vicinity of the project.
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation
status (e.g., National Historic Trust designation or properties significant in ? Yes No
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
The State Historic Preservation office resources and the National Register of Historic Places were reviewed for historic
sites in the vicinity of the project; however, the pipe replacement project occurs withi
i
n a prev
ously impacted area
(NCDOT Right of Way).
B. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? ? Yes ® No
.3b. If yes, explain how project meets FEMA requirements:
3c. What source(s) did you use to make the floodplain determination? FEMA FIRM panal number: 37103508001
M,(-.. 1401der -0 IV14166, q49 /0
Applicant/Agent's Printed Name Applicant/Agent's Signature Date
(Agent's signature is valid only a an authorization letter from the applicant
-I is rovided.
Page I 1 of 11
PCN Form - Version 1.3 December 10, 2008 Version
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Name: BESSEMER CITY Location: 035.3426553-N 081.3426004° W
Date: 9%29/2010 Caption: Pipe Replacement, SR 1413 (Bess Road), UT to Little
Scale: 1 inch equals 1000 feet Beaverdam Creek, Class C Waters, Catawba River Basin
1
NCDOT
HAZARDOUS SPILL BASIN CHECKLIST
Division: 1? County: Cinctnn Project ID: 12.203611
River Basin: Catawba Bridge No: NA
Route: SR 1413, Bess Road Stream: UT to Little
Beaverdam Creek
Water Quality Criteria:
Yes No
Stream Crossing Blue Line On USGS r r
ORW r 17
WS1 r r
WS 11,111 OR IV, Crossing Within 0.5mi of W.S. Critical Area r r
Roadway Criteria:
Route Designation-
Arterial Urban
Arterial Rural
Additional Site Information:
Is a Hazardous Spill Basin Required?
Yes No
r w
r rr
Yes No
F P
Criteria Based Upon NCDOT "Best Management Practices for the
Protection of Surface Waters" (March, 1997).