20120180 Ver 1_Application_20120216

STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
BEVERLY EAVES PERDUE
GoVERNOR
February 13 2012
Ms Liz Hair
US Army Corp of Engineers
Asheville Regulatory Field Office
151 Patton Avenue Room 208
Asheville N C 28801 5006
EUGENE A CONTI, JR
SECRETARY
FEB 16 2012
5 dR WP 7TF—r O JALI r Y
POINT SOURLC BP NCH
SUBJECT Pipe Extension NC Highway 150 (East College Avenue) Cleveland County
Dear Ms Hair
The North Carolina Department of Transportation requests authorization to extend an existing
45 foot long 4 ft x 5 ft box culvert to provide an adequate road shoulder at this location on NC
Highway 150 (East College Avenue) in Cleveland County NCDOT proposes to extend the
culvert 15 equilaterally at both inlet and outlet The culvert extension results in the inlet invert
being perched approximately one foot Streambed material excavated during construction of the
15 ft inlet extension will be utilized to build the streambed up to grade at the inlet Additionally
the extension results in the culvert outlet being perched approximately one foot A five foot rock
ladder will be constructed at the pipe outlet to connect the pipe outlet elevation to the
downstream bed elevation and to allow for some aquatic passage There is an existing 25 foot
pipe located downstream of the culvert extension The pipe will be removed and the steep banks
will be stabilized with Class II riprap Due to the existing conditions, NCDOT requests a
waiver from the Regional Condition 2(b)(e) permit depth specification, for the construction
of this project A temporary cofferdam pumping system will be used to divert the stream around
the construction site as needed Areas affected by temporary cofferdam system will be restored
to pre project conditions The scope of the work will result in a total of 35 feet of permanent
impacts to Poplar Branch which is classified as Class C Waters by the Division of Water
Quality
The project is located on an urban arterial, however it is not located within '/2 mile of a critical
watershed 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 Cleveland County (USFWS listed date September 21 2010) include
the dwarf flowered heartleaf (Hexastylis naniora) National Heritage Program records
document the nearest dwarf flowered heartleaf location approximately 2 1 miles southwest of the
Post Office Box 47 Shelby North Carolina 28151 -0047

Hwy 150
Page 2
February 13 2012
proposed project area The heartleaf is usually found on dry to moist ravine slopes (usually north
facing and of the oak hickory pine forest type) and in boggy areas near sprmgheads There is no
suitable habitat within the proposed project area and no species were observed No impact on
this species is anticipated
I have enclosed a pre construction notification for a NW #14 sketches of planned activities and
location maps relative to the project
Project information for the 401 Automated Payment Procedure is as follows
• Work order number 150464 55120005 12C 023023 3300
• TIP# NA
• Project Category $240 00 Fee
If you have any questions or concerns please feel free to contact me at [phone] Thank
you for your time and consideration on this matter
Respectfully yours
M L Holder P E
Division Engineer
Twelfth Division
BY ,
Trish Simon
Division 12 Environmental Supervisor
Enclosures
cc
Brian Wrenn Division of Water Quality 401 /Transportation Permitting Unit
Polly Lespmasse Division of Water Quality Mooresville Regional Office

W A 7F9QG
LE. 1i o Y
Office Use Only
Corps action ID no
DWQ project no
Form Version 13 Dec 10 2008
Page 1 of 11
PCN Form — Version 1 3 December 10 2008 Version
Pre - Construction Notification PCN Form
A Applicant Information
1
Processing
la
Type(s) of approval sought from the
Corps
®Section 404 Permit ❑Section 10 Permit
1 b
Specify Nationwide Permit (NWP) number 14 or General Permit (GP) number
1c
Has the N WP or GP number been verified by the Corpse
FEI Yes
® No
1 d
Type(s) of approval sought from the DWQ (check all that apply)
® 401 Water Quality Certification — Regular ❑ Non 404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
1 e
Is this notification solely for the record
because written approval is not required?
For the record only for DWQ 401
Certification
❑ Yes ® No
For the record only for Corps Permit
❑ Yes ® No
1f
Is payment into a mitigation bank or in lieu fee program proposed for mitigation
of impacts? If so attach the acceptance letter from mitigation bank or in lieu
fee program
❑ Yes
® No
1g
Is the project located in any of NC s twenty coastal counties If yes answer 1 h
below
❑ Yes
® No
1h
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
® No
2
Project Information
2a
Name of project
NC Highway 150 (East College Avenue)
2b
County
Cleveland
2c Nearest municipality / town
Boling Springs
2d
Subdivision name
2e
NCDOT only T I P or state
project no
12c 023023
3
Owner Information
3a
Name(s) on Recorded Deed
NC DOT Right of Way
3b
Deed Book and Page No
3c
Responsible Party (for LLC i f
applicable)
3d
Street address
3e
City state zip
3f
Telephone no
3g
Fax no
3h
Email address
Page 1 of 11
PCN Form — Version 1 3 December 10 2008 Version

B Project Information and Prior Project History
1 Property Identification
1a Property identification no (tax PIN or parcel ID)
NA
Latitude 35 250404 Longitude
lb Site coordinates (in decimal degrees)
81 661855
(DD DDDDDD) (DD DDDDDD)
1c Property size
< 10 acres
2 Surface Waters
2a Name of nearest body of water (stream river etc ) to
Poplar Creek
proposed project
2b Water Quality Classification of nearest receiving water
C
2c River basin
Broad
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 45 foot long 4 x 5 Concrete Box Culvert on paved primary road Landuse is mostly urban
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
100 feet
3d Explain the purpose of the proposed project
The purpose of the proposed work is to extend a concrete box culvert to increase shoulder width for the safety of the
travelling public
3e Describe the overall project in detail including the type of equipment to be used
The North Carolina Department of Transportation requests authorization to extend an existing 45 foot long 4 ft x 5 ft box
culvert to provide an adequate road shoulder at this location on NC Highway 150 (East College Avenue) in Cleveland
County NCDOT proposes to extend the culvert 15 equilaterally at both inlet and outlet The culvert extension results in
the inlet invert being perched approximately one foot Streambed material excavated during construction of the 15 ft inlet
extension will be utilized to build the streambed up to grade at the inlet Additionally the extension results in the culvert
outlet being perched approximately one foot A five foot rock ladder will be constructed at the pipe outlet to connect the
pipe outlet elevation to the downstream bed elevation and to allow for some aquatic passage A 25 foot pipe located
downstream of the extension will be removed and the steep streambanks stabilized with Class II nprap The Project will
be 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 stream determination made by
Division 12 DEO
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
Page 3 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
Busmes s 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
7044 80 9020
4g
Fax no
704 480 5401
4h
Email address
mholder @ncdot gov
5
Agent/Consultant Information (if applicable)
5a
Name
Trish Simon
5b
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
tsiimon @ncdot gov
Page 2 of 11
PCN Form —Version 1 3 December 10 2008 Version

5 Project History
5a Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past
El Yes ®No El Unknown
5b If yes explain in detail according to help file instructions
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

C Proposed Impacts Inventory
1 Impacts Summary
la Which sections were completed below for your project (check all that apply)
❑ Wetlands ® Streams tributaries ❑ Buffers
❑ Open Waters ❑ Pond Construction
2 Wetland Impacts
If there are wetland impacts proposed on the site then complete this question for each wetland area impacted
2a
2b
2c
2d
2e
2f
Wetland impact
Type of jurisdiction
number —
Type of impact
Type of wetland
Forested
(Corps 404 10
Area of impact
Permanent (P) or
(if known)
DWQ — non 404 other)
(acres)
Temporary T
W1 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W2 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W3 ❑ P ❑ T
❑ Yes
❑ No
❑ Corps
❑ DWQ
W4 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W5 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
W6 ❑ P ❑ T
❑ Yes
❑ Corps
❑ No
❑ DWQ
2g Total wetland impacts
2h Comments
3 Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site then complete this
question for all stream sites impacted
3a
3b
3c
3d
3e
3f
3g
Stream impact
Type of impact
Stream name
Perennial
Type of jurisdiction
Average
Impact
number
(PER) or
(Corps 404 10
stream
length
Permanent (P) or
intermittent
DWQ — non 404
width
(linear
Temporary (T)
(INT)?
other)
(feet)
feet)
S1 ®P ❑ T
Culvert extension
Poplar Creek
® PER
❑ INT
❑ Corps
® DWQ
2
30
S2 ®P ❑ T
Rock Ladder
Poplar Creek
® PER
❑ INT
❑ Corps
® DWQ
2
5
S3 ❑ POT
Cofferdam bypass
poplar Creek
® PER
❑ INT
❑ Corps
® DWQ
2
50
pumping
S4 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
S5 ❑ P ❑ T
❑ PER
❑ INT
❑ Corps
❑ DWQ
S6 ❑ P ❑ T
❑ PER
❑ Corps
❑ INT
❑ DWQ
3h Total stream and tributary impacts
'35
31 Comments Total permanent impacts
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 Atlantic Ocean or any other open water of
the U S then individually list all open water impacts below
4a
4b
4c
4d
4e
Open water
Name of waterbody
impact number —
(if applicable)
Type of impact
Waterbody type
Area of impact (acres)
Permanent (P) or
Temporary T
01 ❑P ❑T
02 ❑P ❑T
03 ❑P ❑T
04 ❑ PEI T
4f Total open water impacts
4g Comments
5 Pond or Lake Construction
If pond or lake construction proposed then complete the chart below
5a
5b
5c
5d
5e
Wetland Impacts (acres)
Stream Impacts (feet)
Upland
Pond ID
Proposed use or purpose
(acres)
number
of pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
5f Total
5g Comments
5h Is a dam high hazard permit required
❑ Yes ❑ No If yes permit ID no
51 Expected pond surface area (acres)
51 Size of pond watershed (acres)
5k Method of construction
6 Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer then complete the chart below If yes then individually list all buffer impacts
below If any impacts require mitigation then you MUST fill out Section D of this form
6a
❑ Neuse ❑ Tar Pamlico ❑ Other
Project is in which protected basin?
❑ Catawba ❑ Randleman
6b
6c
6d
6e
6f
6g
Buffer impact
number—
Reason
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P) or
for
Stream name
mitigation
(square feet)
(square feet)
Temporary T
impact
re uired�
B1 ❑P ❑T
F] Yes
❑ No
B2 ❑P ❑T
El Yes
❑ No
B3 ❑P ❑T
El Yes
❑ No
6h Total buffer impacts
61 Comments
Page 6 of 11
PCN Form — Version 1 3 December 10 2008 Version

D Impact Justification and Mitigation
1 Avoidance and Minimization
la Specifically describe measures taken to avoid or minimize the proposed impacts in designing project
lb Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
Minimization of impacts by installing appropriate erosion control measures
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
3b Credits Purchased (attach receipt and letter)
Type
Quantity
3c Comments
4 Complete if Making a Payment to In lieu Fee Program
4a Approval letter from in lieu fee program is attached
❑ Yes
4b Stream mitigation requested
linear feet
4c If using stream mitigation stream temperature
❑ warm ❑ cool ❑cold
4d Buffer mitigation requested (DWQ only)
square feet
4e Riparian wetland mitigation requested
acres
4f Non riparian wetland mitigation requested
acres
4g Coastal (tidal) wetland mitigation requested
acres
4h Comments
5 Complete if Using a Permittee Responsible Mitigation Plan
5a If using a permittee responsible mitigation plan provide a description of the proposed mitigation plan
Page 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
buffer mitigation?
❑ Yes ® No
6b If yes then identify the square feet of impact to each zone of the riparian buffer that requires mitigation Calculate the
amount of mitigation required
Zone
6c
Reason for impact
6d
Total impact
(square feet)
Multiplier
6e
Required mitigation
(square feet)
Zone 1
3 (2 for Catawba)
Zone 2
1 5
6f Total buffer mitigation required
6g If buffer mitigation is required discuss what type of mitigation is proposed (e g payment to private mitigation bank
permittee responsible riparian buffer restoration payment into an approved in lieu fee fund)
6h Comments
Page 8 of 11
PCN Form —Version 1 3 December 10 2008 Version

E
Stormwater Management and Diffuse Flow Plan (required by DWQ)
1
Diffuse Flow Plan
1a
Does the project include or is it adjacent to protected riparian buffers identified
❑ Yes ® No
within one of the NC Riparian Buffer Protection Rules?
1 b
If yes then is a diffuse flow plan included? If no explain why
❑ Yes ❑ No
Comments
2
Stormwater Management Plan
2a
What is the overall percent imperviousness of this project?
0%
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
2d
If this project DOES require a Stormwater Management Plan then provide a brief narrative description of the plan
❑ Certified Local Government
2e
Who will be responsible for the review of the Stormwater Management Plan?
❑ DWQ Stormwater Program
❑ DWQ 401 Unit
3
Certified Local Government Stormwater Review
3a
In which local government s jurisdiction is this project?
NA
❑ Phase II
❑ NSW
3b
Which of the following locally implemented stormwater management programs
❑ USMP
apply (check all that apply)
❑ Water Supply Watershed
❑ Other
3c
Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
4
DWQ Stormwater Program Review
❑ Coastal counties
❑ HQW
4a
Which of the following state implemented stormwater management programs apply
❑ ORW
(check all that apply)
❑ Session Law 2006 246
❑ Other
4b
Has the approved Stormwater Management Plan with proof of approval been
❑ Yes No
❑
attached?
5
DWQ 401 Unit Stormwater Review
5a
Does the Stormwater Management Plan meet the appropriate requirements?
❑ Yes ❑ No
5b
Have all of the 401 Unit submittal requirements been met?
❑ Yes ❑ No
Page 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
® Yes ❑ No
use of public (federal /state) land?
1 b If you answered yes to the above does the project require preparation of an
environmental document pursuant to the requirements of the National or State
❑ Yes ® No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1c If you answered yes to the above has the document review been finalized by the
State Clearing House? (If so attach a copy of the NEPA or SEPA final approval
letter )
❑ Yes ❑ No
Comments
2 Violations (DWQ Requirement)
2a Is the site in violation of DWQ Wetland Rules (15A NCAC 2H 0500) Isolated
Wetland Rules (15A NCAC 2H 1300) DWQ Surface Water or Wetland Standards
❑ Yes ® No
or Riparian Buffer Rules (15A NCAC 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)
3 Cumulative Impacts (DWQ Requirement)
3a Will this project (based on past and reasonably anticipated future impacts) result in
❑ Yes ® No
additional development which could impact nearby downstream water quality?
3b If you answered yes to the above submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy If you answered no provide a short narrative description
The project is classified as a minimum crntiena 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

5
Endangered Species and Designated Critical Habitat (Corps Requirement)
5a
Will this project occur in or near an area with federally protected species or
❑ Yes ® No
habitat
5b
Have you checked with the USFWS concerning Endangered Species Act
❑ Yes ® No
impacts
❑ Raleigh
5c
If yes ind icate the USFWS Field Office you have contacted
❑ Asheville
5d
What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat9
NC Natural Heritage Program database and on site survey
6
Essential Fish Habitat (Corps Requirement)
6a Will this project occur in or near an area designated as essential fish habitat?
❑ Yes ® No
6b
What data sources did you use to determine whether your site would impact Essential Fish Habitat
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
❑ Yes ® No
status (e g National Historic Trust designation or properties significant in
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 culvert extension project occurs within a previously impacted area
(NCDOT Right of Way)
8
Flood Zone Designation (Corps Requirement)
8a WIII this project occur in a FEMA designated 100 year floodplain?
❑ Yes ® No
8b
If yes explain how project meets FEMA requirements
8c
What source(s) did you use to make the floodplain determination? FEMA FIRM panal number 3710250500J
14, L l �ve, 'r /
; le z
February 13
2012
f-\ C-4
Applicant/Agents Signature
Applicant/Agents Printed Name
Date
(Agents signature is valid only if an authorization letter from the applicant
is provided
Page 11 of 11
PCN Form —Version 1 3 December 10 2008 Version

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Culvert Extension
Hwy 150 (East College Avenue
Cleveland County
Upstream
Inlet
Outlet Downstream

PROPOSED
C
z
0
4x5 BOX CULVERT WILL BE EXTENDED
15' ON EACH SIDE FOR A TOTAL OF 75'
n
15
T �-
o Bo'l�rjng -� 1-
Tie in Prainage 1
appro4 8 to 9 fe
from Box Culvert
0
c
ti
U
_ -x-
-h � \\
)utlet
TIE IN DRAINAGE DITCH
APPROX 5 FEET UPSTREAM
FROM NEW BOX CULVERT INLET
Adjust Drainage Ditch to tie
into new location
1
9x5 � _
BOX Culvert.
� ete -�
_ 25 00' j-o S b
>15
Reinforce both banks
where old pipe was taken
out with Class 2 rock - 25 fif
Parking Lot

NCDOT
HAZARDOUS SPILL BASIN CHECKLIST
Division 12 County Cleveland Project ID 12c 023023
River Basin Broad Bridge No NA
Route NC Highway
Water Qualily Criteria
Stream Poplar Branch
Yes No
Stream Crossing Blue Line On USGS % r
ORW r 1✓
WSI J- I
WS II,III OR IV, Crossing Within 0 5mi of W S Critical Area r we
Roadway Criteria
Route Designation-
Additional Site Information
Yes No
Arterial Urban F r
Arterial Rural f- R-
Yes No
Is a Hazardous Spill Basin Required9
Criteria Based Upon NCDOT "Best Management Practices for the
Protection of Surface Waters" (March, 1997)