20200859 Ver 2_YRWSP_PCN_ApplicationForm_20211027_20211028

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NORTH CAROLINA
Environmental Quality
Water Resources
Office Use Only
Corps Action ID no. SAW-2018-01144 Date received: [Click to enter.]
DWR project no. DWR# 20-0859 Date received: [Click to
enter.]
Site Coordinates:
Latitude (DD.DDDDDD): 35.14193
Longitude (DD.DDDDDD):-80.35764
Form Version 4, April 4, 2021
Pre -Construction Notification (PCN) Form
(Ver. 4, April 4, 2021))
For Nationwide Permits and Regional General Permits and corresponding Water Quality Certifications
Please note: fields marked with a red asterisk are required. The form is not considered complete until all
mandatory questions are answered.
The online help file may be found at this link:
https:Hedocs. deg. nc. gov/WaterResources/0/edoc/624704/PCN %2OHelp%2OFile%202018-1-30. pdf
The help document may be found at this link:
http://www.saw.usace.army.miI/Missions/Regulatory-Permit-Program/Permits/2017-Nationwide-
Permits/Pre-construction-Notification/
Before submitting this form, please ensure you have submitted the Pre -Filing Meeting Request Form as
DWR will not be able to accept your application without this important first step. The Pre -Filing Meeting
Request Form is used to satisfy 40 C. F. R. Section 121.4(a) which states "At least 30 days prior to
submitting a certification request, the project proponent shall request a pre -filing meeting with the certifying
agency." In accordance with 40 C.F.R. Section 121.5(b)(7), and (c)(5), all certification requests must
include documentation that a pre -filing meeting request was submitted to the certifying authority at least 30
days prior to submitting the certification request.
Attach documentation of Pre -Filing Meeting Request to this Application.
Date of Pre -filing Meeting Request (MM/DD/YYYY) : 6/29/20220
DWR ID # 20-0859 Version 2 (If applicable)
Page 1 of 23 PCN Form - Version 1.5, September 2020

A. Processing Information
County (counties) where project is located:
Union Stanly
Is this a NCDMS project?
(Click yes only if NCDMS is the applicant or co-
❑ Yes 0 No
applicant)
Is this a public transportation project?
(Publicly funded municipal, state, or federal road, rail,
❑ Yes 0 No
or airport project)
Is this a NCDOT project?
❑ Yes 0 No
If yes, NCDOT TIP or state project number:
Click to enter.
If yes, NCDOT WBS number:
Click to enter.
0 Section 404 Permit (wetlands, streams, waters,
Clean Water Act)
la. Type(s) of approval sought from the Corps:
❑ Section 10 Permit (navigable waters, tidal
waters, Rivers and Harbors Act)
Has this PCN previously been submitted?
0 Yes ❑ No
Please provide the date of the previous submission.
6/29/2020
0 Nationwide Permit (NWP)
1 b. What type(s) of permit(s) do you wish to seek
El Regional General Permit (RGP)
authorization?
❑ Standard (IP)
This form may be used to initiate the standard/ individual permit process with the USACE. Please contact your Corps
representative concerning submittals for standard permits. All required items can be included as attachments and
submitted with this form.
1 c. Has the NWP or GP number been verified by the Corps?
0 Yes ❑ No
NWP number(s) (list all numbers ):
12
RGP number(s) (list all numbers ):
Click to enter.
Are you a federal applicant?
❑ Yes 0 No
If yes, please provide a statement concerning compliance with
the Coastal Zone Management Act
Click to enter text.
1d. Type(s) of approval sought from DWR (check all that apply):
0 401 Water Quality Certification — Regular
❑ 401 Water Quality Certification— Express
❑ Non-404 Jurisdictional General Permit
❑ Riparian Buffer Authorization
❑ Individual 401 Water Quality Certification
Page 2 of 23 PCN Form - Version 1.5, September 2020

Pre -Filing Meeting Information
Before submitting this form please ensure you have submitted the Pre -Filing Meeting Request Form as we will not be
able to accept your application without this important first step. The Pre -Filing Meeting Request Form is used in
accordance with 40 C.F.R. Section 121.4(a) "At least 30 days prior to submitting a certification request, the project
proponent shall request a pre -filing meeting with the certifying agency" and in accordance with 40 C.F.R. Section
121.5(b)(7), and (c)(5) all certification requests shall include documentation that a pre -filing meeting request was
submitted to the certifying authority at least 30 days prior to submitting the certification request.
To read more information on when this form is needed prior to application submission:
https://www.epa.gov/sites/production/files/2020-07/documents/clean water act section 401 certification rule.pdf
To view the form: https:Hedocs.deg.nc.gov/Forms/DWR-Pre-Filing-Meeting-Request
Is this a courtesy copy notification
❑ Yes
X No
1 e.
Is this notification solely for the record because written approval is not required?
For the record only for DWR 401 Certification:
❑ Yes
❑x No
For the record only for Corps Permit:
❑ Yes
❑x No
1f.
Is this an after -the -fact permit/certification application?
❑ Yes
❑x No
1g.
Is payment into a mitigation bank or in -lieu fee program proposed for
mitigation of impacts?
M Yes
❑ No
If yes, attach the acceptance letter from mitigation bank or in -lieu fee program.
1 h.
Is the project located in any of NC's twenty coastal counties?
❑ Yes
❑x No
1 i.
Is the project located within an NC DCM Area of Environmental
Concern (AEC)?
❑ Yes
❑x No ❑ Unknown
1j.
Is the project located in a designated trout watershed?
❑ Yes
❑x No
If yes, you must attach a copy of the approval letter from the appropriate Wildlife Resource Commission Office.
Trout information may be found at this link: http://www.saw.usace.army.miI/Missions/Regulatory-Permit-
Program/Agency-Coordination/Trout.aspx
Page 3 of 23 PCN Form - Version 1.5, September 2020

B. Applicant Information
1 a.
Who is the primary contact?
John Shutak, PE
1 b.
Primary Contact Email:
[e-mail]
1 c.
Primary Contact Phone: (###)###-####
[phone]
1 d.
Who is applying for the permit/certification? (check
all that apply)
® Owner ❑ Applicant (other than owner)
1 e.
Is there an agent/consultant for this project?
® Yes ❑ No
2.
Landowner Information
2a.
Name s On Recorded Deed:
()
Union County — Union County; Stanly County — Town of Norwood;
permanent and temporary
easements will be owned by Union County and Town of Norwood (Stanly
County). Additional
adjacent property owner information is detailed on attached impact
drawings.
2b.
Deed Book and Page No.:
Click to enter.
2c.
Contact Person (for corporations):
Click to enter.
2d.
Address
Street Address:
500 N. Main Street
Address line 2:
Suite 500
City:
Monroe
State/ Province/ Region:
NC
Postal/ Zip Code:
28112
Country:
USA
2e.
Telephone Number: * (###)###-####
[phone]
2f.
Fax Number: (###)###-####
Click to enter.
2g.
Email Address: *
[e-mail]
3.
Applicant Information (if different from owner)
3a.
Name:
Click to enter.
3b.
Business Name (if applicable):
Click to enter.
3c.
Address:
Street Address:
Click to enter.
Address line 2:
Click to enter.
City:
Click to enter.
State/ Province/ Region:
Click to enter.
Postal/ Zip Code:
Click to enter.
Country
Click to enter.
3d.
Telephone Number: (###)###-####
Click to enter.
Page 4 of 23 PCN Form - Version 1.5, September 2020

3e
Fax Number: (###)###-####
Click to enter.
3f.
Email Address:
Click to enter.
4. Agent/ Consultant (if applicable)
4a. Name: *
Eric Mularski
4b. Business Name:
HDR
4c. Address: *
Street Address:
440 S. Church Street
Address line 2:
Suite 900
City:
Charlotte
State/ Province/ Region:
NC
Postal/ Zip Code:
28202
Country:
USA
4d. Telephone Number: (###)###-####
[phone]
4e Fax Number: (###)###-####
Click to enter.
4f. Email Address:
[e-mail]
Agent Authorization Letter:*
Attach a completed/signed agent authorization form or letter. A sample form may be found at this link:
https://www.saw. usace.army.mil/Missions/Regulatory-Permit-Program/Permits/2017-Nationwide-Permits/Pre-
construction-Notification/
Page 5 of 23 PCN Form - Version 1.5, September 2020

C. Project Information and Prior Project History
1. Project Information
1 a. Name of project: *
Yadkin Regional Water Supply Project
1 b. Subdivision name (if appropriate):
Click to enter.
1 c. Nearest municipality/town: *
Linear— Monroe, New Salem, Oakboro, Norwood
2.
Project Identification
2a.
Property identification number (tax PIN or parcel ID):
Linear project traversing through many properties.
Property owners lists were including in the orginal
PCN application will not change as result of the
modificatiojn.
2b.
Property size (in acres):
1,875
2c.
Project Address:
Street Address:
Click to enter.
Address line 2:
Click to enter.
City:
Click to enter.
State/ Province/ Region:
Click to enter.
Postal/ Zip Code:
Click to enter.
Country:
Click to enter.
2d.
Site coordinates in decimal degrees (using 4-6 digits
after the decimal point):
Latitude (DD.DDDDDD): * 35.14193
Longitude (-DD.DDDDDD): *--80.35764
3.
Surface Waters
3a.
Name of nearest body of water to proposed project: *
multiple — refer to table D in the original application
3b.
Water Resources Classification of nearest receiving
multiple — refer to table D in the original application
water:
The Surface Water Classification map may be found at this
link:
htti)s:Hncdenr. mai)s.arcciis.com/apes/webappviewer/index. html?id=6el 25ad7628f494694e259c8Odd64265
Yadkin-PeeDee
3c.
In what river basin(s) is your project located?
Choose additional (if needed)
3d.
Please provide the 12-digit HUC in which the project is
030401040203; 030401050405; 030401050406; 030401050503;
located:
030401050506; 030401050507;030401050702; 030401050705;
030401050707; 030401050708
The Find Your HUC map may be found at this link:
https:Hncdenr.maps.arcciis.com/apps/Publiclnformation/index.html?appid=ad3a85aOc6d644aOb97cdO69db238ac3
Page 6 of 23 PCN Form - Version 1.5, September 2020

4. Project Description and History
4a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of
this application: *
The Study Area consists of single family residences, commercial, parks, schools, churches, agricultural fields, planted pines, roadside rights -of -way, and forested
areas.
4b. Have Corps permits or DWR certifications been obtained for this
® Yes Z No ❑ Unknown
project (including all prior phases) in the past?
If yes, please give the DWR Certification number and/or Corps
SAW-2018-01144
Action ID (ex. SAW-0000-00000):
DWR# 20-0859
Attach any pertinent project history documentation
4b2. Is any portion of the work already complete? *
❑ Yes ❑x No
If yes, describe the completed work.
Click to enter text.
4c. List of other certifications or approvals/denials received from other federal, state or local agencies for work
described in this application not related to the 404 or 401.
NPDES Stormwater Permits
4d. Attach an 8'/ x 11" excerpt from the most recent version of the USGS topographic map indicating the location of
the project site.
4e. Attach an 8'/ x 11" excerpt from the most recent version of the published County NRCS Soil Survey map
depicting the project site.
4f. List the total estimated acreage of all existing wetlands on the
property:
acres
4g. List the total estimated linear feet of all existing streams (intermittent
linear feet
and perennial) on the property:
4g1. List the total estimated acreage of all existing open waters on the
0.53 acres
property:
Page 7 of 23 PCN Form - Version 1.5, September 2020

4h. Explain the purpose of the proposed project:
The purpose and need for the new Yadkin Regional Water Supply Pipelines (YRWSP) are to provide a
long-term water supply to Union County's Yadkin River Basin Service Area. The project includes the
withdrawal of water from Lake Tillery, in Stanly County, for transfer to a new water treatment plant in
Union County for treatment and distribution.
Existing Infrastructure
Union County (County) has seen significant growth over the past two decades and is expected to
continue to have steady growth and development into the foreseeable future. In response to this
growth, the County has worked diligently to meet the increasing demands for public water supply and
other services. Further, the County has completed an extensive water supply planning effort, and has
identified opportunities to provide a long-term, sustainable water supply solution for its citizens and
community. The purpose and need for the YRWSP is to provide a long-term water supply to Union
County, Norwood, and surrounding areas and was fully detailed and studied in the YRWSP
Environmental Impact Statement (EIS) (HDR 2015).
Environmental Background
In 2015, Union County completed an EIS regarding the YRWSP and Interbasin Transfer (IBT)
Certificate for developing a long-term water supply for Union County. Union County obtained a Record
of Decision for this EIS on April 12, 2016 and subsequently received a Final Determination from the
North Carolina Environmental Management Commission to grant an IBT Certificate for the YRWSP on
May 11,2017.
In accordance with Duke Energy Lake Services' Conveyance Permit Application Part V, an application
for this project was prepared for FERC review and approval to be used by FERC to grant authorization
to Duke Energy (i.e., licensee of the Yadkin -Pee Dee Project) to permit a non -project use of the project
boundary (i.e., water withdrawal from Lake Tillery).
Proposed Infrastructure
The proposed design meets the project's purpose and need of delivering a safe, sustainable water
supply to meet current and future water demands, as well as the associated environmental impacts,
mitigation measures, technical feasibility, and financial impacts. The project consists of construction of
all the elements needed for the 42-inch and 54-inch diameter raw water transmission pipelines, water
treatment plant, and 36-inch diameter finished water distribution pipeline. All proposed pipes will be
made of steel.
Section 401 — Modification - The final erosion and sediment control (E&SC) design resulted in
additional impacts to jurisdictional surface waters not included in the approved permit authorization. In
addition, changes to the limits of disturbance to meet E&SC requirements resulted in reduced impacts
to jurisdictional surface waters previously authorized in the approved permit. Changes in impacts will
result in a net decrease of 112 linear feet of impacts to jurisdictional streams and net decrease of
0.005 acres of impact to jurisdictional wetlands.
Page 8 of 23 PCN Form - Version 1.5, September 2020

4i. Describe the overall project in detail, including the type of equipment to be used: *
The Project will consist of a raw water transmission pipeline (RWTP), a water treatment plant (WTP), and a finished water
distribution pipeline (FWDP). The RWTP will consist of approximately 24.9 miles of 42-inch pipeline that will be pumped
to the Hydraulic Control Structure, at approximately STA 1314+00. From there it will be gravity fed through a 54-inch
pipeline to the water treatment plant approximately 5.1 miles away. The 36-inch FWDP will then continue from the WTP in
a westerly direction to the terminus near the intersection of N. Rocky River Road and Secrest Shortcut Rd approximately 10
miles away.
The Project is proposed to be installed within permanent easements to be purchased by Union County Public Works.
Temporary easements necessary for construction of the proposed pipeline will be acquired to provide equipment staging
areas, and material storage areas and access to permanent easement areas during construction. The permanent easement
width for the RWTP is 60 feet in most areas. The RTWP construction corridor width and permanent, maintained easement
width are both proposed to be larger than the easement widths recommended by the North Carolina Division of Water
Resources (NCDWR). The construction corridor width is proposed to be larger because of the size of pipe and associated
excavation, the need for temporary stream crossings and the size of equipment required for pipe installation. The RWTP
permanent easement width is proposed to be larger because a second, parallel raw water pipeline is expected to be required
in the future to meet projected future water demands. Acquisition of the larger RWTP 60-foot permanent easements allows
the burden of the complex, lengthy and expensive real estate process to be reduced for both Union County and property
owners. The permanent easement for the FWDP is 25 feet wide with a temporary construction easement width of 15 feet.
Installation of the Project will require temporary and permanent impacts to streams, wetlands and open waters. Temporary
impacts are associated with temporary construction access and installation of the raw water pipeline and associated
infrastructure such as blow -off valves and relief valves. Permanent impacts to open waters are associated with moving the
existing dam to a location outside the permanent easement and filling to create uplands within open water OW 1C.
All stream and wetland crossings are proposed to be constructed using open -cut installation methods. Open cut installation
methods are proposed because the large diameter of pipe which limits the use of trenchless technologies (e.g., horizontal
directional drilling) to smaller pipes or longer installations. The use of open -cut installation methods also reduces the risk of
damage to surface waters associated with the release of drilling fluid used in horizontal directional drilling. Where the
proposed raw water pipeline is installed within roadway embankments, a jack -and -bore auger machine will be used to install
a steel casing and raw water pipeline within the embankment.
Dewatering to install the Project below the streambed will allow the contractor to work in dry conditions and minimize
downstream sedimentation. Temporary vehicle stream crossings will utilize the design noted in Detail C-35-0704/D3. The
use of a temporary impervious dike and bypass pumping system shall be employed for smaller streams and a temporary
impervious coffer dam flow diversion system shall be employed for larger streams. Excavated material will be temporarily
stockpiled adjacent to the dewatered construction area and be replaced following pipe installation. Dewatering of streams
using an impervious dike and bypass pumping system shall last no longer than 24 hours. Dewatering systems will be
completely removed, and pre -construction contours will be restored, as soon as possible after pipe installation is complete.
Streams impacted by temporary construction activities will be restored to pre -construction contours as soon as possible after
construction activity in each stream is complete. Stream banks that are disturbed as part of the proposed pipelines
installation will be stabilized with erosion control matting, straw mulch, temporary cover seed, and a permanent native seed
mix. Erosion control matting that includes plastic twine or mesh shall not be used on stream banks. Live stakes shall be used
within temporary construction easements and within permanent easements where they can be installed at least 20 feet away
from the proposed pipe centerline.
Wetlands impacted by temporary construction activities will be restored to pre -construction contours as soon as possible
after construction activity in each wetland is complete. During excavation, topsoil will be removed separately and re-
deposited on top of backfill material. Anti -seep collars will be installed downstream of wetland crossings and every 150 feet
up the gradient until the pipe exits the wetland. A temporary cover seed mix and a native wetland seed mix will be applied to
all wetland areas impacted during construction. Straw mulch will be applied over seed mixes to temporarily control erosion
and provide conditions conducive to seed establishment.
Temporary erosion and sediment control measures shall be installed to reduce sediment loss from disturbed areas.
Temporary measures proposed for this site include silt fence, tree protection fence, stabilized construction entrances/exits,
erosion control matting, inlet and outlet protection measures, fiber filtration tubes, temporary stream crossings and
temporary seeding. Temporary and permanent vegetative cover for disturbed areas will consist of a native seed mix and
temporary cover species as recommended by North Carolina Department of Environmental Quality (NCDEQ) Land Quality
and the Natural Resources Conservation Service. Erosion control measures, including temporary stream crossings, shall be
Page 9 of 23 PCN Form - Version 1.5, September 2020

removed once the site is stable and construction access is no longer needed.
Construction equipment anticipated to be used includes wheeled backhoes and loaders, tracked excavators, bulldozers, dump
trucks, flatbed trucks, compaction equipment, skid steer loaders, dewatering pumps, hand tools and j ack-and-bore auger
machine.
4j. Attach project drawings/site diagrams/depictions of impact areas for the proposed project.
4k. Will this activity involve dredging in wetlands or waters?
® Yes ❑ No
If yes, describe the type of dredging, the composition of the dredged material, and the locations of disposal area.
Excavation required for the pipe installation.
Page 10 of 23 PCN Form - Version 1.5, September 2020

5.
Jurisdictional Determinations
5a.
Have the wetlands or streams been delineated on the property or in
® Yes ❑ No ❑ Unknown
proposed impact areas?
Comments:
UICK to enter text.
5b.
If the Corps made a jurisdictional determination,
x❑ Preliminary ❑ Approved ❑ Emailed concurrence
what type of determination was made? *
❑ Not Verified ❑ Unknown ❑ n/a
Corps AID number (ex. SAW-0000-00000):
SAW-2019-01144
Name (if known): Multiple
5c.
If 5a is yes, who delineated the jurisdictional
Agency/Consultant Company: HDR
areas?
Other: Click to enter.
5d.
List the dates of the Corps jurisdictional determination or State determination if a determination was made by
either agency.
10/22/2019.The PJD was submitted as part of the originally submitted PCN application.
5d1.
Attach jurisdictional determinations.
6.
Future Project Plans
6a.
Is this a phased project?
® Yes ❑ No
6b.
If yes, explain.
The RWTP is a phased portion of the Project to meet future projected water supply demands. A 36-
inch pipeline will be installed parallel to the approximate 24.9 miles of 42-inch pipeline. This 36-inch
pipeline will be installed from the pump station on Lake Tillery to the hydraulic control structure at STA
1314+00. Based on future water demand projections the additional 36-inch pipeline will be able to
supply the WTP with the additional raw water to meet the future demand. This in turn is the reason for
the 60-foot wide maintained RWTP easement from Lake Tillery to STA 1314+00.
Are any other NWP(s), regional general permit(s), or individual permit(s) used, or intended to be used, to
authorize any part of the proposed project or related activity? This includes other separate and distant crossings
for linear projects that require Department of the Army authorization but don't require pre -construction
notification.
No
7.
Addresses of adjoining property owners, lessees, etc. whose property adjoins the waterbody (if more than can be
entered here, please attach a supplemental list)
Included in the original PCN application
8.
Scheduling of activity:
UICK to enter.
Page 11 of 23 PCN Form - Version 1.5, September 2020

D. Proposed Impacts Inventory
Impacts Summary
0 Wetlands 0 Streams - tributaries
la. Where are the impacts associated with your project ❑ Buffers 0 Open Waters
(check all that apply):
❑ Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, complete this table for each wetland area impacted.
2a.
Site #
2a1.
Impact
Reason/Type
2b.
Impact
Duration*
2c.
Wetland Type
2d.
Wetland Name
2e.
Forested
?*
2f.
Jurisdiction
Type*
2g.
Impact Area
(ac)*
W1
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W2
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W3
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W4
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W5
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W6
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W7
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W8
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W9
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W10
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W11
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W12
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W13
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W14
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
W15
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
Choose one
Click to enter
2g1. Total temporary wetland impacts
2.35 ac
2g2. Total permanent wetland impacts
0 ac
2g3. Total wetland impacts
2.35 ac
2h. Type(s) of material being discharged and the amount of each type in cubic yards:
Click to enter text.
2i. Comments:
See attached spreadsheet and pdf with listed individual wetland impacts
Page 12 of 23 PCN Form - Version 1.5, September 2020

3. Stream Impacts
If there are perennial or intermittent stream/ tributary impacts (including temporary impacts) proposed on the site,
complete this table for all stream/ tributary sites impacted.
** All Perennial or Intermittent streams must be verified by DWR or delegated local government
Site #
3a
Impact
Reason*
3b.
Impact
Duration
3c.
Impact Type
3d.
Stream Name
3e.
Stream
Type
3f.
Jurisdiction
Type
3g.
Stream Width
(avg ft)
3h.
Impact length
(linear ft) *
S1
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S2
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S3
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S4
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S5
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S6
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S7
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S8
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S9
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S10
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S11
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S12
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S13
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S14
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S15
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S16
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S17
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S18
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S19
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
S20
Click to enter
Temp/ Perm
Choose one
Click to enter
Per/Int
Choose one
Click to enter
Click to enter
3i1. Total jurisdictional ditch
impact:
0 linear ft
3i2. Total permanent stream
impacts:
0 linear ft
M. Total temporary stream
impacts:
5,217 linear ft
3i4. Total stream and ditch
impacts:
5,217 linear ft
3j. Comments:
See attached spreadsheet and pdf with listed individual stream impacts
Page 13 of 23 PCN Form - Version 1.5, September 2020

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., individually list all open water impacts in the table below.
4a.
Site #
4a1.
Impact Reason
4b.
Impact
Duration
4c.
Waterbody Name
4b.
Activity Type*
4e.
Waterbody
Type
4f.
Impact area
(ac)
01
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
02
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
03
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
04
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
05
Click to enter.
Temp/ Perm
Click to enter.
Choose one
Choose one
Click to enter.
4g.
Total temporary open water impacts
0.019 ac
4g.
Total permanent open water impacts
0.263 ac
4g.
Total open water impacts
0.282 ac
4h.
Comments:
See attached spreadsheet and pdf with listed individual open water impacts
5.
Pond or Lake Construction
If pond or lake construction is proposed, complete
the table
below. (*This
does NOT include offline stormwater
management ponds.)
5a.
5b.
5c.
5d.
5e.
Pond ID
Proposed use or
Wetland Impacts
(ac)
Stream
Impacts (ft)
Upland
#
purpose of pond
Impacts (ac)
Flooded
Filled
Excavated
Flooded
Filled
Excavated
P1
Choose one
Click tc
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
P2
Choose one
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
P3
Choose one
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
5f.
Total
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
enter.
5g.
Comments:
Click to enter.
5h.
Is a dam high hazard permit required?
❑ Yes ❑ No
If yes, permit ID no.:
Click to enter.
5i.
Expected pond surface area (acres):
Click to enter.
5j.
Size of pond watershed (acres):
Click to enter.
5k.
Method of construction:
Click to enter.
Page 14 of 23 PCN Form - Version 1.5, September 2020

6. Buffer Impacts (DWR requirement)
If project will impact a protected riparian buffer, then complete the chart below. Individually list all buffer impacts.
6a. Project is in which protected basin(s)?
(Check all that apply.)
❑ Neuse ❑ Tar -Pamlico ❑ Catawba
❑ Jordan ❑ Goose Creek ❑ Randleman
❑ Other: Click to enter.
Site #*
6b.
Impact Type*
6c.
Impact Duration*
6d.
Stream Name*
6e.
Buffer
Mitigation
Required?*
6f.
Zone 1 Impact*
(sq ft)
6g.
Zone 2 Impact*
(sq ft)
131
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
132
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
133
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
134
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
135
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
136
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
137
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
138
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
139
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B10
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
1311
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B12
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B13
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B14
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B15
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B16
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B17
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B18
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B19
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
B20
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter.
6h. Total temporary impacts:
Zone 1: Click to enter. sq ft
Zone 2: Click to enter. sq ft
6h. Total permanent impacts:
Zone 1: Click to enter. sq ft
Zone 2: Click to enter. sq ft
6h. Total combined buffer impacts:
Zone 1: Click to enter. sq ft
Zone 2: Click to enter. sq ft
6i. Comments:
Click to enter.
Please attach supporting documentation (impact maps, plan sheets, etc.) for the proposed project.
Page 15 of 23 PCN Form - Version 1.5, September 2020

E. Impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts through project design:
Complete avoidance of proposed impacts is only possible with the no -build alternative due to the length of the proposed raw water and finished water
pipelines, existing land uses within the Project Area and the number of streams, wetlands and open waters present in the North Carolina Piedmont.
The no -build alternative was not considered because it would not meet the project goal of providing Union County with a safe and reliable water
supply. Prior to and during design of the project, evaluations of streams, wetlands and open waters were performed by HDR to assess the presence of
jurisdictional waters within the proposed project corridor. A jurisdictional determination was made by the USACE to confirm locations of jurisdictional
waters and provide a basis for adjustments to the alignment of the proposed raw water and finished water pipelines. Multiple alignment adjustments
were made to avoid impacts to jurisdictional waters. The proposed alignment generally parallels existing roadways which are constructed on high
ground, away from water resources. Temporary access easements have been minimized because of the availability of access via existing roadways
and driveways. No permanent stream crossings are proposed. Unavoidable stream crossings have been designed at perpendicular angles (between
75 and 105 degrees) to reduce impacts to streams and adjacent riparian areas.
1 b. Specifically describe measures taken to avoid or minimize proposed impacts through construction techniques:
Avoidance of impacts during construction may be possible if the contractor does not require use of the full extents of the proposed limits of
disturbance. Portions of streams, wetlands and open waters may be completely avoided if they are near the edge of the easement. Work within waters
of the U.S. will be minimized to the amount necessary to install the pipe and related structures (e.g., anti -seep collars) and restore pre-existing
contours. An impervious dike and bypass pumping system or impervious coffer dams will be installed to dewater work areas during construction to
allow the contractor to work in dry conditions and minimize downstream sedimentation. Due to the size of the pipe and limitations of technology,
trenchless installation methods are not practicable for the majority of installation areas. However, a jack -and -bore augering techniques will be used to
install casing and raw water pipes below public roads due to the large size of the road embankments. No equipment refueling or maintenance activities
will occur adjacent to the jurisdictional areas. Equipment leaking fuel, hydraulic oil or other fluids will not be allowed to work within jurisdictional waters.
Leaks will be repaired as soon as possible after discovery of the leak. Best management practices for construction and sediment and erosion control
will be used during all construction activities and routinely inspected and maintained throughout the duration of the project. All non-turfgrass areas will
be stabilized using a native seed mix to stabilize disturbed soils and improve pollinator habitat within the proposed permanent easement area.
Disturbed stream banks will be returned to pre -construction contours and will be stabilized with erosion control matting and live stakes of native
species as soon as possible after construction activities. Disturbed wetland areas will be returned to pre -construction contours as soon as possible
after construction activities. Anti -seep collars will be installed on the pipe through wetland areas. A temporary cover seed mix and a native wetland
seed mix will be applied to all wetland areas impacted during construction. Straw mulch will be applied over seed mixes to temporarily control erosion
and provide conditions conducive to seed establishment.
2. Compensatory Mitigation for Impacts to Waters of the U.S., Waters of the State, or Riparian Buffers
2a. If compensatory mitigation is required, by whom is it required? * ❑ DWR 0 Corps
(check all that apply)
2b. If yes, which mitigation option(s) will be used for this ❑ Mitigation Bank
project? (check all that apply) 0 In Lieu Fee Program
❑ Permittee Responsible Mitigation
3. Complete if using a Mitigation Bank
(Must satisfy NC General Statute143-214.11 (d1).)
3a. Name of mitigation bank:
Click to enter.
3b. Credits purchased/requested:
Type: Choose one
Quantity Click to enter.
Type: Choose one
Quantity Click to enter.
Type: Choose one
Quantity Click to enter.
Attach receipt and/or approval letter.
3c. Comments:
Click to enter.
4. Complete if Using an In Lieu Fee Program
4a. Attach approval letter from in lieu fee program.
4b. Stream mitigation requested: Click to enter. linear feet
Page 16 of 23 PCN Form - Version 1.5, September 2020

4c. If using stream mitigation, what is the stream temperature:
Choose one
NC Stream Temperature Classification Maps can be found under the Mitigation Concepts tab on the Wilmington
District's RIBITS website: (Please use the filter and select Wilmington district)
https:Hribits.usace.army.miI/ribits apex/f?p=107:27:2734709611497::NO:RP:P27 BUTTON KEY:O
4d. Buffer mitigation requested (DWR only):
Click to enter. square feet
4e. Riparian wetland mitigation requested:
1.73 acres
4f. Non -riparian wetland mitigation requested:
Click to enter. acres
4g. Coastal (tidal) wetland mitigation requested:
Click to enter. acres
4h. Comments:
Compensatory Mitigation Responsibility Transfer Form and NCDMS receipt of payment was included in original
PCN application
5. Complete if Providing a Permittee Responsible Mitigation Plan
5a. If proposing a permittee responsible mitigation plan, provide a description of the proposed mitigation plan,
including mitigation credits generated.
Click to enter.
5b. Attach mitigation plan/documentation.
6.
Buffer Mitigation (State Regulated Riparian Buffer Rules) — DWR requirement
6a.
Will the project result in an impact within a protected riparian buffer
❑ Yes ❑ No
that requires buffer mitigation?
If yes, please complete this entire section — please contact DWR for more information.
6b.
If yes, identify the square feet of impact to each zone of the riparian buffer that requires
mitigation. Calculate the
amount of mitigation required in the table below.
6c.
6d.
6e.
Zone
Reason for impact
Total impact
Multiplier
Required mitigation
(square feet)
(square feet)
Zone 1
Click to enter.
Click to enter.
Choose one
Click to enter.
Zone 2
Click to enter.
Click to enter.
Choose one
Click to enter.
6f. Total buffer mitigation required
Click to enter.
6g.
If buffer mitigation is required, is payment to a mitigation bank or
❑ Yes ❑ No
NC Division of Mitigation Services proposed?
6h.
If yes, attach the acceptance letter from the mitigation bank or NC Division of Mitigation Services.
6i.
Comments:
Click to enter.
Page 17 of 23 PCN Form - Version 1.5, September 2020

F. Stormwater Management and Diffuse Flow Plan (DWR requirement)
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers
❑ Yes 0 No
identified within one of the NC Riparian Buffer Protection Rules?
1 b. All buffer impacts and high ground impacts require diffuse flow or other form of stormwater treatment. If the
project is subject to a state implemented riparian buffer protection program, include a plan that fully documents
how diffuse/dispersed flow will be maintained.
All Stormwater Control Measures (SCM) must be designed in accordance with the NC Stormwater Design
Manual (https://deg.nc.gov/about/divisions/energy-mineral-land-resources/energy-mineral-land-permit-
guidance/stormwater-bmp-manual).
Associated supplement forms and other documentation must be provided.
❑ Level Spreader
What Type of SCM are you
❑ Vegetated Conveyance (lower seasonal high water table- SHWT)
providing?
❑ Wetland Swale (higher SHWT)
(Check all that apply)
❑ Other SCM that removes minimum 30% nitrogen
❑ Proposed project will not create concentrated stormwater flow through the
buffer
For a list of options to meet the diffuse flow requirements, click here.
Attach diffuse flow documentation.
2.
Stormwater Management Plan
2a.
Is this an NCDOT project subject to compliance with NCDOT's
Individual NPDES permit NCS000250?
❑ Yes 0 No
2b.
Does this project meet the requirements for low density projects as
defined in 15A NCAC 02H .1003(2)?
❑ Yes 0 No
To look up low density requirements, click here:
http://reports.oah.state.nc. us/ncac/title%2015a%20-%20environmental%20guality/chapter%2002%20-
%20environmental%20management/subchapter%20h/15a%20ncac%2002h%20.1003.pdf
2c.
Does this project have a stormwater management plan (SMP)
0 Yes ❑ No
reviewed and approved under a state stormwater program or state -
approved local government stormwater program?
❑ n/a — project disturbs < 1 acre
Note: Projects that have vested rights, exemptions, or grandfathering from state or locally implemented
stormwater programs or projects that satisfy state or locally -implemented stormwater programs through use of
community in -lieu programs should answer "no" to this question.
2d.
Which of the following stormwater management program(s) apply? _F
El Local Government
(Check all that apply.)
0 State
If you have local government approval, please include the SMP on their overall impact map.
Local Government Stormwater Programs
❑ Phase II ❑ USMP
❑ NSW ❑ Water Supply
Page 18 of 23 PCN Form - Version 1.5, September 2020

Please identify which local government stormwater program you are using.
Click to enter.
State Stormwater Programs 0 Phase II ❑ HQW or ORW
❑ Coastal Counties ❑ Other
Comments:
Click to enter.
Page 19 of 23 PCN Form - Version 1.5, September 2020

G. Supplementary Information
1. Environmental Documentation
1 a. Does the project involve an expenditure of public (federal/state/local)
® Yes ❑ No
funds or the 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 (North Carolina) Environmental
®Yes El No
Policy Act (NEPA/SEPA)?
1 c. 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
® Yes ❑ No
NEPA or SEPA final approval letter.)
Comments:
Record of Decision for the Environmental Impact Statement was included in the original PCN submittal/approval.
2. Violations (DWR Requirement)
2a. Is the site in violation of DWR Water Quality Certification Rules (15A
NCAC 2H .0500), Isolated Wetland Rules (15A NCAC 2H .1300),
Federally Non -Jurisdictional Wetlands /Classified Surface Waters
❑ Yes ❑x No
(15A NCAC 2H. 1400) DWR Surface Water or Wetland Standards or
Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. If you answered "yes" to the above question, provide an explanation of the violation(s):
LACK to enter.
3. Cumulative Impacts (DWR Requirement)
3a. Will this project (based on past and reasonably anticipated future
impacts) result in additional development, which could impact nearby
® Yes ❑ No
downstream water quality?
3b. If you answered "no", provide a short narrative description:
Click to enter.
3c. If yes, provide a qualitative or quantitative cumulative impact analysis in accordance with the most recent DWR
policy. (Attach .pdo
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project? I ❑ Yes ❑x No ❑ N/A
4b. If yes, describe in detail the treatment methods and dispositions (non -discharge or discharge) of wastewater
generated from the proposed project. If the wastewater will be treated at a treatment plant, list the capacity
available at that plant.
Click to enter.
Page 20 of 23 PCN Form - Version 1.5, September 2020

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected
0 Yes ❑ No
species or habitat? (IPAC weblink: https://www.fws.gov/ipac/ ffws.govl)
5b. Have you checked with the USFWS concerning Endangered Species
0 Yes ❑ No
Act impacts?
5c. If yes, indicate the USFWS Field Office you have contacted.
Asheville
5d. Is another federal agency involved?
❑ Yes 0 No ❑ Unknown
If yes, which federal agency?
Click to enter.
5e. Is this a DOT project located within Divisions 1-8?
❑ Yes 0 No
5f. Will you cut any trees in order to conduct the work in waters of the
U.S.?
®Yes El No
5g. Does this project involve bridge maintenance or removal?
❑ Yes 0 No
5g1. If yes, have you inspected the bridge for signs of bat use such as
staining, guano, bats, etc.? Representative photos of signs of bat use
❑ Yes 0 No
can be found in the NLEB SLOPES, Appendix F, pages 3-7.
Representative photos of signs of bat use can be found in the NLEB SLOPES, Appendix F, pages 3-7. Link to
NLEB SLOPES document: http:Hsaw-reg.usace. army.mil/NLEB/1-30-17-signed NLEB-SLOPES&am)s.pdf
If you answered yes to 5g1, did you discover any signs of bat use? *
❑ Yes ❑ No ❑ Unknown
If yes, please show the location of the bridge on the permit drawings/ project plans
5h. Does this project involve the construction/ installation of a wind
turbine(s)?
❑ Yes 0 No
If yes, please show the location of the wind turbine(s) on the permit drawings/ project plans (attach .pdo
5i. Does this project involve blasting and /or other percussive activities
that will be conducted by machines, such as jackhammers,
0 Yes ❑ No
mechanized pile drivers, etc.?
If yes, please provide details to include type of percussive activity, purpose, duration, and specific location of this
activity on the property (attach .pdo
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated
Critical Habitat? *
USFWS IPaC and NC Natural Heritage Program Data Explorer Reports.
Attach consultation documentation.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as
an Essential Fish Habitat?
❑ Yes 0 No
Is there submerged aquatic vegetation (SAV) around
the project vicinity?
El Yes 0 No El Unknown
Will this project affect submerged aquatic vegetation?
❑ Yes 0 No ❑ Unknown
Page 21 of 23 PCN Form - Version 1.5, September 2020

Explain: Click to enter.
6b. What data source(s) did you use to determine whether your site would impact Essential Fish Habitat?
NOAA Fisheries Essential Fish Habitat Mapper https://vvww.habitat.noaa.gov/protection/efh/efhmapper/
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data):
http://qis.ncdcr.gov/hpoweb/
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
❑ Yes X No
properties significant in North Carolina history and archaeology)?
7b. What data source(s) did you use to determine whether your site would impact historic or archeological
resources?
SHPO coordination letters dated September 28, 2018 and May 4, 2020. SHPO responses were received on
October 23, 2018 and June 19, 2020. lincluded in the original PCN submittal/approval.
7c. Attach historic or prehistoric documentation.
8.
Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https:Hmsc.fema.gov/portal/search
8a.
Will this project occur in a FEMA-designated 100-year floodplain? *
® Yes ❑ No
8b.
If yes, explain how the project meets FEMA requirements.
The pipeline will be installed below grade and no aboveground appurtenances will be installed in designated floodplains. No change in base flood
elevations are anticipated due to the Project.
8c.
What source(s) did you use to make the floodplain determination?
FEMA FIRM Panels 3710542700J, 3710543700J, 3710544700J, 3710545700J, 3710546700J, 3710546800J, 3710547800J, 3710547900J,
3710548800J, 3710558000K, 3710558000K, 3710558200K, 3710558200K, 3710650200K, 3710650200K, 3710650300J, 3710651300K,
3710652300K, 3710653300J, 3710654300J, 3710654400J, 3710655300J, 3710655400J, 3710656400J, and 3710657400K
H. Miscellaneous
Comments:
Attached is the signed Nationwide 12 Verification for the plan modification (SAW-2018-01144).
Attach pertinent documentation or attachments not previously requested
Page 22 of 23 PCN Form - Version 1.5, September 2020

I. Signature *
Z By checking the box and signing below, I, as the project proponent, certify to the following:
• The project proponent hereby certifies that all information contained herein is true, accurate, and complete, to
the best of my knowledge and belief;
• The project proponent hereby requests that the certifying authority review and take action on this CWA 401
certification request within the applicable reasonable period of time;
• The project proponent hereby agrees that submission of this PCN form is a "transaction" subject to Chapter
66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• The project proponent hereby agrees to conduct this transaction by electronic means pursuant to Chapter 66,
Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• The project proponent hereby understands that an electronic signature has the same legal effect and can be
enforced in the same way as a written signature; AND
• As the project proponent, I intend to electronically sign and submit the PCN/online form.
Full Name: * Eric Mularski
Signature: * Eric Mularski
Date: 10/28/2021
Page 23 of 23 PCN Form - Version 1.5, September 2020