20230167 Ver 1_401 Application_20230127

Staff Review Form
NORTH CAROLINA
Ertrlmnmertlrtl Quality
Updated September 4, 2020
Staff Review
Does this application have all the attachments needed to accept it into the review process?*
Yes No
ID# *
20230167
Version* 1
Is this project a public transportation project?*
Reviewer List:*
Select Reviewing Office: *
Submittal Type:*
Yes
No
Sue Homewood:eads\slhomewood:[e-mail]
Winston-Salem Regional Office - [phone]
401 Application
Does this project require a request for payment to be sent?*
Yes
No
How much is owed?* $240.00
$570.00

Project Submittal Form
Please note: fields marked with a red asterisk * below are required. You will not be able to submit the form until all
mandatory questions are answered.
Project Type: *
For the Record Only (Courtesy Copy)
New Project
Modification/New Project with Existing ID
More Information Response
Other Agency Comments
Pre -Application Submittal
Re-Issuance\Renewal Request
Stream or Buffer Appeal
Pre -Filing Meeting Date Request was submitted on:
9/22/2022
Project Contact Information
Name:
Michael Barfield
Who is submitting the information?
Email Address: [e-mail]
Project Information
Project Name: Colonial Pipeline Company Line 1 Shallow Cover 401 WQC Davidson Co. NC
Is this a public transportation project?
Yes
No
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
Yes No Unknown
County (ies)
Davidson
Please upload all files that need to be submited.
Click the upload button or drag and drop files here to attach document
Colonial Pipeline Company LN 1 Shallow Cover 401
WQC Davidson Co. NC.pdf
Only pdf or kmz files are accepted.
Describe the attachments or
comments:
401 water quality certification submittal
Sign and Submit
20.27MB
By checking the box and signing box below, I certify that:
• I, the project proponent, hereby certifies that all information contained herein is true, accurate, and complete to the
best of my knowledge and belief.

• I, 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.
• I agree that submission of this online form is a "transaction" subject to Chapter 66, Article 40 of the NC General
Statutes (the "Uniform Electronic Transactions Act");
• I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General
Statutes (the "Uniform Electronic Transactions Act");
• I understand that an electronic signature has the same legal effect and can be enforced in the same way as a
written signature; AND
• I intend to electronically sign and submit the online form.
Signature:
Submittal Date: 1/27/2023
Is filled in automatically.

/4#A . ;
corblu
ECOLOGY GROUP
January 27, 2023
NC DWR, 401 & Buffer Permitting Branch
512 North Salisbury Street
Raleigh, NC 27604
Subject: Section 401 Water Quality Pre -Construction Notification
Colonial Pipeline Company Maintenance
Davidson County, North Carolina
Corblu Project No. 02-041901-122 Line 1 Shallow Cover
To whom it may concern:
On behalf of our client, Colonial Pipeline Company (CPC), Corblu Ecology Group, LLC (Corblu) is pleased
to submit this Section 401 water quality Pre -Construction Notification (PCN) for preventative maintenance
on their Line 1. Specifically, insufficient protective pipeline cover over CPC's Line 1 has been detected
which requires restoration within an unnamed perennial stream in CPC's right-of-way (ROW). The
pipeline shallow cover area is located within CPC's existing ROW southwest of the Simmerson Road and
Hannah Ferry Road intersection in Davidson County, North Carolina (35.744653,-80.445949; Figure 1).
Based on our evaluation of the subject site, we believe that the temporary and permanent disturbances
to waters of the U.S. associated with this maintenance activity are authorized by the U.S. Army Corps of
Engineers (USACE) under Nationwide Permit (NWP) No. 3 (a) and (c) — Maintenance. The required
pipeline maintenance does not require notification to the USACE prior to initiation of the work; however,
it has been determined that written approval is required from the North Carolina Department of
Environmental Quality (DEQ) for Section 401 Water Quality Certification prior to the initiation of work.
Background
Corblu inspected the above referenced pipeline exposure location for the presence of jurisdictional waters
of the U.S. on October 14, 2022. Specifically, Corblu surveyed the above maintenance location in
J

Section 401 Water Quality Pre -Construction Notification
Colonial Pipeline Company — Line 1 Shallow Cover
January 27, 2023
Corblu Project No. 02-041901-122 — Davidson Co. NC
accordance with the 1987 Corps of Engineers Wetlands Delineation Manual', "Rapanos" guidance 2, and
the appropriate U.S. Army Corps of Engineers (USACE) Regional Supplement3. Streams were assessed
using the North Carolina Division of Water Quality (NCDWQ) Identification Methods for the Origins of
Intermittent and Perennial streams4 (Appendix A). Jurisdictional features [one unnamed perennial stream
and an adjacent emergent wetland (W1)] were observed within the maintenance area (Photograph Nos.
1-7; Figure 2).
Due to recent high flow events bed/bank erosion has occurred within the unnamed perennial stream
resulting in a culvert failure and displacement of an existing revetment mat within CPC's ROW. The
streambank and bed erosion has damaged the existing in -stream structures (culvert and revetment mats)
displacing the required protective cover over Line 1 resulting in "shallow cover". The lack of pipeline
protection at the maintenance location has resulted in conditions where the pipeline is vulnerable to
potential damages. Further, these conditions are not consistent with CPC's or the U.S. Department of
Transportation's (USDOT) regulatory requirements for pipeline protection.
CPC is committed to operating their pipelines and support facilities in a manner that protects the safety
of the public, the environment, and its workforce. The proposed preventative pipeline maintenance is a
component of CPC's ongoing Integrity Management Program (IMP) as required by the USDOT
requirements [49 CFR Part 195 — "Pipeline Safety: Pipeline Integrity in High Consequence Areas
(Hazardous Liquid Operators with 500 or More Miles of Pipeline); Final Rule"]. The IMP provides an
important means of achieving spill -free, error -free operations. The purpose of the IMP is to
improve/maintain the integrity of CPC's system — including CPC's pipelines, facilities, equipment, tanks,
and delivery lines.
CPC's IMP and the referenced USDOT regulations include prescriptive requirements for inspection of
pipeline systems and requires excavation and repair of certain pipeline defects according to specific
schedules and regulatory guidelines. It should be noted that USDOT has completed an Environmental
Assessment (EA) under the National Environmental Policy Act (NEPA) concerning repairs that an
operator would have to make to its pipeline following an integrity assessment. The EA and corresponding
' Environmental Laboratory. Corps of Engineers Wetlands Delineation Manual. U.S. Army Corps of Engineers, Washington, D.C. 100 pp.
plus appendices. 1987.
z U.S. Army Corps of Engineers and U.S. Environmental Protection Agency. Clean Water Act Jurisdiction Following the U.S. Supreme
Court's Decision in Rapanos v. United States and Carabell v. United States. December 2, 2008.
s U.S. Army Corps of Engineers. 2012. Regional Supplement to the Corps of Engineers Wetland Delineation Manual: Eastern Mountains
and Piedmont Region Version 2.0, ed. J.F. Berkowitz, J.S. Wakeley, R.W. Lichvar, C.V. Noble. ERDC/EL TR-12-9. Vicksburg, MS: U.S.
Army Engineer Research and Development Center.
4 North Carolina Division of Water Quality. 2010. NC DWQ Stream Identification Form Version 4.11. North Carolina Division of Water
Quality.
2

Section 401 Water Quality Pre -Construction Notification
Colonial Pipeline Company — Line 1 Shallow Cover
January 27, 2023
Corblu Project No. 02-041901-122 — Davidson Co. NC
Finding of No Significant Impact concluded that these actions would not significantly affect the quality of
the human environment (Docket No. RSPA-00-6355).
In accordance with 49 CFR § 195.401 and CPC's IMP, CPC must take prompt action to address
anomalous conditions, to include pipeline exposures and shallow cover areas that are discovered through
the integrity assessment process. CPC must, in maintaining its pipeline systems, ensure that repairs are
made in a safe and timely manner and are conducted to prevent damage to persons, property, and the
environment. Additionally, CPC's IMP follows USDOT's requirements with respect to addressing possible
unsafe conditions; specifically, the USDOT - Pipeline and Hazardous Materials Safety Administration's
(PHMSA) Interpretation Response No. PI-84-0103 which explains with respect to the regulatory
provisions of 49 CFR Part 192, Subpart M and Part 195, Subpart F, whenever an operator discovers any
condition that could adversely affect the safe operation of its pipeline system, the operator must correct
the condition within a reasonable time.
Proposed Activities in Jurisdictional Waters
The maintenance location will be accessed from Hannah Ferry Road onto an existing single track gravel
road that crosses CPC's existing, mowed, and maintained ROW (Figure 3). Prefabricated mats will be
used to temporarily cross the emergent wetland area and stream to access the maintenance location
(Appendix B). CPC intends to inspect Line 1 and replace the required minimal protective cover over the
pipeline using Submar pre -cast revetment mats and rip rap to remediate the perennial streambed/bank
erosion. To re-establish the minimal pipeline protective cover, CPC intends to conduct the following: 1)
remove the existing failed culvert and revetment mat from the stream system; 2) excavate the eroded
area on Line 1; 3) inspect and make repairs to Line 1 as necessary; 4) backfill the excavation area; and
5) restore the streambed to approximate pre -erosion contours and elevations over Line 1 using Submar
mats. These pre -cast mats and rip rap will be keyed/imbedded into the stream bed and banks in a manner
that maintains grade and normal stream flow conditions (Appendix C). Please note: CPC proposes to use
rip rap for stabilization in lieu of re -installing the failed culvert.
To minimize sedimentation to the unnamed perennial stream during the above -mentioned maintenance
activity, dams constructed of sandbags, steel plates, or water -inflatable plastic dams will be temporarily
placed upstream of the maintenance area to conduct maintenance activities "in -the -dry". The stream flow
will be pumped around the maintenance area, discharging immediately downstream via an energy
dissipater to prevent stream scour. The pump(s) used will be sufficiently sized to accommodate the
anticipated stream flow (Appendix D). The excavated soils will be ordered (ordered; top 12 inches and
subsoil) temporarily stored separately in the adjacent upland area on geotextile fabric or similar material
within the CPC ROW.
3

Section 401 Water Quality Pre -Construction Notification
Colonial Pipeline Company — Line 1 Shallow Cover
January 27, 2023
Corblu Project No. 02-041901-122 — Davidson Co. NC
Rip rap will be used above and below the mat system within the streambed for additional stabilization.
Further, the rip rap will be placed on an erosion control blanket (geotextile fabric) in a manner where the
finished top elevation of the rip rap does not exceed that of the original stream bed elevation. Once the
required minimal protective pipeline cover (pre -cast revetment mats) is keyed into the streambed in a
manner that maintains existing grade and flow conditions of the stream, the temporary dams will be
removed, and normal streamflow will be restored.
The proposed maintenance activity will require unavoidable permanent and temporary impacts to an
unnamed perennial stream and an adjacent emergent wetland (Appendix E). Initially, CPC proposes to
remove the existing failed structures within the stream to include: 83 linear feet (LF; 0.0082-acre)
articulated revetment mat and 24 LF (0.0011-acre) of culvert totaling 107 LF (0.0093-acre) which
represent existing fill in jurisdictional waters. CPC will then place 139 LF of Submar mat and 34 LF of rip
rap in the stream channel. Additional permanent impacts include approximately 66 LF (0.0138-acre) of
stream (56 LF of Submar mats and 10 LF of rip rap), and 0.0007-acre of wetland (Submar mats). Please
note the exiting 24 LF of culvert will be replaced with 24 LF of rip rap and therefore is accounted for as
existing stream impact and is not included in the total impact calculation. Temporary impacts include
approximately 20 LF (0.0014-acre) of the unnamed perennial stream and 0.0502-acre of wetland for
workspace/grading.
Permanent Impact Table
Existing Impacts (X)
St rea m
Proposed Additonal Permanent Impacts (Y)
St rea m
Wetland
Overall Site Pipeline Protection (X+Y) = Z
St rea m
Wetland
Total Additional Permanent Impacts (X - Z) = Y
St rea m
Wetland
83 LF (0.0082-acre) revetment mats
24 LF (0.0011-acre) Culvert
56 LF (0.0129-acre) Submar matting
10 LF (0.0009-acre) riprap
0.0007-acre Submar matting
139 LF (0.0211-acre) Submar matting
34 LF (0.0020-acre) Riprap
0.0007-acre Submar matting
66 LF (0.0138-acre)
0.0007-acre
CPC's standard erosion control practices will be employed (Appendix F). Specifically, the disturbed areas
along the stream bank and disturbance within the adjacent emergent wetland area will be reseeded with
a native wetland seed mix and strawed. No monofilament erosion control matting will be used.
El

Section 401 Water Quality Pre -Construction Notification
Colonial Pipeline Company — Line 1 Shallow Cover
January 27, 2023
Corblu Project No. 02-041901-122 — Davidson Co. NC
Corblu respectfully requests 401 Water Quality Certification for the required preventative maintenance
work and the unavoidable additional permanent impacts of 66 LF (0.0138-acre; Submar mats/rip rap)]
within the perennial stream and 0.0007-acre (Submar mats) of emergent wetland. As mentioned above,
temporary impacts include approximately 20 LF (0.0014-acre) of the unnamed perennial stream and
0.0502-acre of wetland for workspace/grading within CPC's existing, mowed, and maintained ROW
(Appendix C). Please refer to Appendix E for a detailed and tabular description of existing and proposed
impacts to jurisdictional features.
401 and Buffer Permitting PCN Submittal Checklist
We have provided the following information to document compliance with the requirements outlined in
the PCN Submittal Checklist (Appendix G). Each item is discussed below.
Application Fee
A $240.00 payment for a 401 Water Quality Certification with minor impacts will be made electronically
once the project has been assigned a project number.
Pre -filing meeting request
A prefiling meeting request was submitted to 401 [e-mail] on September 22, 2022. A copy of
the email request is attached to the USACE Wilmington District PCN Form.
PCN Application
A complete copy of the USACE Wilmington District PCN Form and supporting documentation which
includes an IPaC Official Species List have been included with this submittal (Appendix H).
Stormwater Management Plan
Not Applicable - This is a maintenance activity for an existing petroleum pipeline and does not involve the
construction of any roads or structures.
If your project is located within a State implemented Riparian Buffer Rule Area, submit the following along
with site plans and PCN form: Three (3) copies of the details for on -site diffuse flow provisions.
The proposed required maintenance activity is located within the Yadkin Pee Dee River Basin which is
not a Riparian Buffer Rule Area.
DWR Stream Determination Forms for streams on property and DWR determination letter for wetlands
or streams (if applicable)
A North Carolina DWQ Stream Identification Form Version 4.11 has been included (Appendix A).
Maps and Plans
The most recent version of the 1:24,000 USGS Topographic Map:
See Figure 1.
5

Section 401 Water Quality Pre -Construction Notification
Colonial Pipeline Company — Line 1 Shallow Cover
January 27, 2023
Corblu Project No. 02-041901-122 — Davidson Co. NC
• The most recent version of the bound and published County NRCS Soil Survey Map - (required
for projects within the Neuse River Basin, Tar -Pamlico River Basin, Randleman Lake Watershed
and the Catawba River Basin, also recommended for all projects):
See Figures 4A and 4B.
• Vicinity map:
See Figure 3.
• The Site Plan:
See Appendix C.
• Pre-construction/Pre-existing conditions:
See Appendix C.
• Proposed conditions:
See Appendix C.
• Drainage Plans:
Not Applicable.
• Proposed Impacts:
See Appendices C and E.
• Wetland Impacts:
See Appendices C and E.
• Stream Impacts:
See Appendices C and E.
Summary and Conclusion
In summary, the pipeline maintenance activity will result in additional permanent impacts of 66 LF (0.0138-
acre; Submar mats/rip rap)] within the perennial stream and 0.0007-acre (Submar mats) of emergent
wetland. The project was designed to avoid and minimize stream and wetland impacts to the maximum
extent practicable and represents the least environmentally damaging, practicable alternative that
satisfies the project purpose for preventative pipeline maintenance and protection as required by USDOT,
PHSMA and CPC's IMP.

Section 401 Water Quality Pre -Construction Notification
Colonial Pipeline Company — Line 1 Shallow Cover
January 27, 2023
Corblu Project No. 02-041901-122 — Davidson Co. NC
Based on this submittal, we respectfully request written authorization of Section 401 Water Quality
Certification. If you have any questions or comments regarding this PCN submittal, please contact the
undersigned at [phone].
Sincerely,
CORBLU ECOLOGY GROUP, LLC
Michael A. Barfield, CWB, CE Richard W. Whiteside, PhD, CWB, CSE
Project Ecologist President
Enclosures: Figure 1 — Site Location Map
Figure 2 — Jurisdictional Features and Photograph Locations
Figure 3 — Vicinity Map
Figure 4A — USDA NRCS Soils Map
Figure 4B — USDA Soils Map
Photographs (7)
Appendix A: NCDWQ Stream Form Version 4.11
Appendix B: Typical Prefabricated Mat Stream and Wetland Crossing
Appendix C: Submar Design Plans
Appendix D: Typical Dam and Pump Maintenance Dig
Appendix E: Impacts Exhibit
Appendix F: CPC Soil Erosion and Sediment Control Plan
Appendix G: 401 & Buffer Permitting PCN Submittal Checklist
Appendix H: USACE Wilmington District PCN Form
c: Ms. Jennifer Price, CPC Project Manager, via email
Mr. John Wyatt, CPC Environmental Lead-SED, via email
Mr. David Reedy, CPC Environmental Specialist, via email
7

' r
Simmerson Road �e
•
Hannah Ferry Road
l i
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Line 1 Shallow Cover
35.744653,-80,445949re
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CPC Pipeline
Base Map Source: USA Topo Maps 1:24,000 o 1,000 2,000 4,000 Feet
Colonial Pipeline Company, SE
Figure 1
Line 1 Shallow Cover
I I
Site Location Map
Davidson County, North Carolina
ECOLOGY GROUP
Project No. 02-041901-122

Base Map Source: ESRI Aerial Imagery 0 50 100 200 Feet
GPS Data Collected: 10/14/2022 1 . 000
Colonial Pipeline Company, SE
Line 1 Shallow Cover
Davidson County, North Carolina
IT
4�N.
oorllu
ECOLOGY GROUP
Figure 2
Jurisdictional Features and
Photograph Map
Project No. 02-041901-122

Base Map Source: ESRI Aerial Imagery 0 62.5 125 250 Feet
GPS Data Collected: 10/14/2022 1 : 500
Colonial Pipeline Company, SE
Line 1 Shallow Cover
Davidson County, North Carolina
oorllu
ECOLOGY GROUP
Figure 3
Vicinity Map
Project No. 02-041901-122

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1:24,000 1
Colonial Pipeline Company, SE
Line 1 Shallow Cover o I b I
Davidson County, North Carolina ECOLOGY GROUP
1,200 2,400 4,800 Feet I
Figure 4A
USDA NRCS Soils Map
Project No. 02-041901-122

Base Map Source: ESRI Aerial Imagery
Soils Data: Soil Survey Staff, Natural Resources Conservation Service, 1 :2 000
United States Department of Agriculture. Web Soil Survey. Available online ' 0 100 200 400 Feet
at the following link:
http://websoilsurvey.sc.egov.usda.gov/. Accessed [12/5/2022].
Colonial Pipeline Company, SE
Line 1 Shallow Cover
Davidson County, North Carolina
oorllu
ECOLOGY GROUP
Figure 4B
USDA Soils Map
Project No. 02-041901-122

Section 401 Water Quality Pre -Construction Notification Photos taken on 10/14/2022
Colonial Pipeline Company — Line 1 Shallow Cover Corblu Project No. 02-041901-122- Davidson Co. NC

Section 401 Water Quality Pre -Construction Notification
Colonial Pipeline Company — Line 1 Shallow Cover
Photos taken on 10/14/2022
Corblu Project No. 02-041901-122- Davidson Co. NC
SE
120 . 150
S SW W
180. '210 240 270
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Section 401 Water Quality Pre -Construction Notification
Colonial Pipeline Company — Line 1 Shallow Cover
Photos taken on 10/14/2022
Corblu Project No. 02-041901-122- Davidson Co. NC
Revetment Mat
IPhotograph No. 6: Northeast facing view of the unnamed perennial stream at the Line 1 I
Shallow Cover maintenance location within CPC's ROW.

Section 401 Water Quality Pre -Construction Notification Photos taken on 10/14/2022
Colonial Pipeline Company — Line 1 Shallow Cover Corblu Project No. 02-041901-122- Davidson Co. NC

APPENDIX A
NCDWQ STREAM FORM VERSION 4.11

NC DWQ Stream Identification Form Version 4.11
Date:1O/14/2O22
Project/Site: LN 1 Shallow Cover
Latitude: 35.744653
Evaluator: MAB
County: Davidson
Longitude: _80.445949
Total Points:
Stream Determination (circle one)
Other
Stream is at least intermittent �� ■��
if> 19 or perennial if>_ 30*
Ephemeral Intermittent Perennial
e.g. Quad Name:
A. Geomorphology (Subtotal = 15.5 )
Absent
Weak
Moderate
Strong
1' Continuity of channel bed and bank
0
1
2
3
2. Sinuosity of channel along thalweg
0
1
X
3
3. In -channel structure: ex. riffle -pool, step -pool,
ripple -pool sequence
0
X
2
3
4. Particle size of stream substrate
0
X
2
3
5. Active/relict floodplain
0
X
2
3
6. Depositional bars or benches
0
X
2
3
7. Recent alluvial deposits
0
X
2
3
8. Headcuts
0
X
2
3
9. Grade control
0
X
1
1.5
10. Natural valley
0
0.5
X
1.5
11. Second or greater order channel
No = 0
Yes = 3
a artificial ditches are not rated; see discussions in manual
B. Hvdrologv (Subtotal = )
12. Presence of Baseflow
0
1
2
A
13. Iron oxidizing bacteria
0
1
X
3
14. Leaf litter
1.5
X
0.5
0
15. Sediment on plants or debris
0
1
1.5
16. Organic debris lines or piles
0
1
1.5
17. Soil -based evidence of high water table?
No = 0
Yes)< 3
C. Biology (Subtotal = 9.25 )
18. Fibrous roots in streambed
X
2
1
0
19. Rooted upland plants in streambed
X
2
1
0
20. Macrobenthos (note diversity and abundance)
0
X
2
3
21. Aquatic Mollusks
X
1
2
3
22. Fish
0
1
1.5
23. Crayfish
0
1
1.5
24. Amphibians
0
1
1.5
25. Algae
>
0.5
1
1.5
26. Wetland plants in streambed
FACW = 0.75; OBL =
1.5 Other = 0
*perennial streams may also be identified using other methods. See p. 35 of manual.
Notes: *26 Persicaria pensylvanicum (FACW) in portion of stream due to overgrowth in right-of-way
Sketch:

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I_1»MI►1971:197
IvA:jW_lmIMkviI_1►19110J►viIJM/_11►kIMI►FilkiMAl][L7

PUMP
SUMP W/INTAKE HOSE
FILTER/SCREEN OR
SUBMERSIBLE PUMP
- WATERBODY -
SPOIL CONTAINMENT BERM
(SILT FENCE, HAY BALES
OR OTHER APPLICABLE
MATERIALS)
� All
SPOIL
II
II
- ;III III
I I I I
,II II
FILTER BAG
V/ TROW ENGINEERING CONSULTANTS INC.
T - MEOi0P0uiPN BLYO., $OIM 2W rHLN1ASSEE, R., OSP 323M
Trout PHONE: (-5 385_5441
REVISION DATE
CALE DATE DRAWN APPROVED
NTS 01-29-2004
RETAIN A MIN. 25'
VEGETATIVE BUFFER TO
THE EXTENT POSSIBLE
ENERGY DISSIPATOR/
SCOUR PROTECTION
1.7\IT, I
FLOW
MAINTAIN A MINIMUM 25' I
VEGETATIVE BUFFER TO
THE EXTENT POSSIBLE
FOR STREAM EQUIPMENT
CROSSINGS, SEE NOTE 14
SEE SHEET 2 FOR NOTES
COLONIAL PIPELINE COMPANY
ATUWA, GEORGIA
TYPICAL DAM AND PUMP
MAINTENANCE DIG
AT WATERBODY LESS THAN 15'
TROW PROJ. NO.1 DRAWING SHEET
THES0050362 COL-0003 1 OF 2

DAM AND PUMP CROSSING
THE FOLLOWING IS A SEQUENCE OF CONSTRUCTION AND MITIGATION
MEASURES TO BE FOLLOWED AT ALL "DAM AND PUMP" TYPE CROSSINGS.
SEQUENCE OF ACTIVITIES
STEP 1. IMPLEMENT THE TEMPORARY EROSION AND SEDIMENT CONTROLS.
STEP 2. INSTALL DRY STREAM CROSSING MATERIALS.
STEP 3. EXCAVATE TRENCH AND INSPECT OR REPLACE PIPE.
STEP 4. BACKFILL AND RESTORE STREAM BANKS.
STEP 5. REMOVE DAMS.
STEP 6. IMPLEMENT PERMANENT EROSION AND SEDIMENTATION CONTROLS.
I►[01:4
I • SCHEDULE INSTREAM ACTIVITY FOR LOW FLOW PERIODS AND
FOR THE APPROPRIATE TIMING WINDOW.
2. MARK OUT AND MAINTAIN LIMITS OF AUTHORIZED WORK
AREAS WITH FENCING OR FLAGGING TAPE TO AVOID
UNNECESSARY DISTURBANCE OF VEGETATION. ENSURE
EQUIPMENT OPERATORS WORKING ON THE CROSSING HAVE
BEEN BRIEFED ABOUT THIS PLAN AND THE MEASURES
NEEDED TO PROTECT WATER QUALITY. INSTALL PRE —WORK
SEDIMENT CONTROL MEASURES AS SPECIFIED IN THE PLAN.
ALL NECESSARY EQUIPMENT AND MATERIALS TO BUILD THE
DAMS AND TO PUMP WATER MUST BE ON SITE OR READILY
AVAILABLE PRIOR TO COMMENCING IN —WATER CONSTRUCTION.
3. CONTRACTOR SHALL SUPPLY, INSTALL AND MAINTAIN SEDIMENT
CONTROL STRUCTURES, AS DEPICTED AND ALONG DOWN GRADIENT
SIDES OF WORK AREAS AND STAGING AREAS SUCH THAT NO
HEAVILY SILT LADEN WATER ENTERS WATERBODY.
a. NO HEAVILY SILT LADEN WATER SHALL BE DISCHARGED DIRECTLY
OR INDIRECTLY INTO THE WATERBODY.
b. EROSION AND SEDIMENT CONTROL STRUCTURE LOCATIONS AS
DEPICTED ARE APPROXIMATE AND MAY BE ADJUSTED AS DIRECTED
BY THE COMPANY INSPECTOR TO ACTUAL SITE CONDITIONS.
c. SILT FENCE OR HAY BALE INSTALLATIONS SHALL INCLUDE
REMOVABLE SECTIONS TO FACILITATE ACCESS DURING
CONSTRUCTION. UTILIZE HAY BALE BARRIERS ONLY IN LIEU
OF A SILT FENCE WHERE FREQUENT ACCESS IS REQUIRED.
d. SEDIMENT LADEN WATER FROM TRENCH DEWATERING SHALL BE
DISCHARGED TO A WELL VEGETATED UPLAND AREA, INTO A HAY
BALE DEWATERING STRUCTURE OR GEOTEXTILE FILTER BAG.
e. SEDIMENT CONTROL STRUCTURES MUST BE IN PLACE AT ALL
TIMES ACROSS THE DISTURBED PORTIONS OF THE RIGHT—OF—WAY
EXCEPT DURING EXCAVATION/INSTALLATION OF THE CROSSING PIPE.
4. TO THE EXTENT POSSIBLE, MAINTAIN A MINIMUM 25 FEET
VEGETATIVE BUFFER STRIP BETWEEN DISTURBED AREAS AND THE
WATERBODY. INSTALL AND MAINTAIN A SILT FENCE UPSLOPE
OF THE BUFFER STRIP ON EACH SIDE OF THE WATERBODY.
THE SILT FENCE SHOULD INCORPORATE REMOVABLE "GATES" AS
REQUIRED TO ALLOW ACCESS WHILE MAINTAINING EASE OF
REPLACEMENT FOR OVERNIGHT OR DURING PERIODS OF RAINFALL.
5. CONSTRUCT A TEMPORARY SUMP UPSTREAM OF THE DAM AND
LINE WITH ROCKFILL IF A NATURAL POOL DOES NOT EXIST.
INSTALL THE PUMP OR PUMP INTAKE IN THE POOL OR SUMP.
DISCHARGE WATER ONTO AN ENERGY DISSIPATOR DOWNSTREAM
OF THE WORK AREA.
6• EXCAVATED MATERIAL MUST NOT BE STOCKPILED WITHIN 10 FT.
OF THE WATERBODY. THIS MATERIAL MUST BE CONTAINED
WITHIN BERM CONTAINMENT, WITH SECONDARY SILT FENCE
PROTECTION TO PREVENT SATURATED SOIL FROM FLOWING
BACK INTO THE WATERBODY.
7. CHEMICALS, FUELS, LUBRICATING OILS SHALL NOT BE STORED
AND NOR SHALL EQUIPMENT BE REFUELED WITHIN 100 FT. OF THE
WATERBODY. PUMPS ARE TO BE REFUELED AS PER THE SPCC PLANS.
MAINTENANCE OF STREAMFLOW
IF THERE IS ANY FLOW IN THE WATERBODY, INSTALL
PUMPS TO MAINTAIN STREAMFLOW AROUND THE ISOLATED
SECTIONS OF CHANNEL. THE PUMP IS TO HAVE 1.5
TO 2 TIMES THE PUMPING CAPACITY OF ANTICIPATED FLOW.
A SECOND STANDBY PUMP OF EQUAL CAPACITY IS TO BE
READILY AVAILABLE AT ALL TIMES. AN ENERGY DISSIPATOR
IS TO BE BUILT TO ACCEPT PUMP DISCHARGE WITHOUT
STREAMBED OR STREAMBANK EROSION. IF THE WORK
IS PROLONGED BEYOND ONE DAY THE AREA NEEDS
TO BE MONITORED OVERNIGHT.
8. IF A REPLACEMENT, PIPE MAKE—UP AREAS ARE TO BE
LOCATED AT LEAST 50 FT. FROM THE WATER'S EDGE
(WHERE TOPOGRAPHIC CONDITIONS PERMIT) AND SHALL
BE THE MINIMUM AREA NEEDED.
9. DAMS ARE TO BE MADE OF STEEL PLATE, INFLATABLE PLASTIC
DAM, SAND BAGS, COBBLES, WELL GRADED COARSE GRAVEL FILL,
OR ROCK FILL. DAMS MAY NEED KEYING INTO THE BANKS AND
STREAMBED. ENSURE THAT THE DAM AND VEHICLE CROSSING (IF
NEEDED ARE LOCATED FAR ENOUGH APART TO ALLOW FOR A WIDE
EXCAVATION. CAP FLUMES USED UNDER VEHICLE CROSSING
DURING DRY CROSSING.
10. DEWATER AREA BETWEEN DAMS IF POSSIBLE. DEWATERING
SHOULD OCCUR IN A STABLE VEGETATIVE AREA A MINIMUM OF
50 FT. FROM ANY WATERBODY. THE PUMP DISCHARGE SHOULD
BE DISCHARGED ONTO A STABLE SPILL PAD, FILTER BAG OR
HAY BALE STRUCTURE TO PREVENT LOCALIZED EROSION.
THE DISCHARGE WATER SHOULD ALSO BE FORCED INTO SHEET
FLOW IMMEDIATELY BEYOND THE SPILL PAD BY USING HAY BALES
AND THE NATURAL TOPOGRAPHY. DISCHARGED WATER SHALL NOT
BE ALLOWED TO FLOW INTO ANY WATERBODY OR WETLAND. IF IT
IS NOT POSSIBLE TO DEWATER THE EXCAVATION DUE TO SOILS
WITH A HIGH HYDRAULIC CONDUCTIVITY, THE EXCAVATION IS TO BE
CARRIED OUT IN THE STANDING WATER. PUMP ANY DISPLACED WATER
AS DESCRIBED ABOVE TO PREVENT OVERTOPPING OF DAMS.
11. INSPECT/REPAIR PIPELINE AS NEEDED.
12. CONTRACTOR SHALL RESTORE THE STREAM BED AND BANKS TO
APPROXIMATE PRE —CONSTRUCTION CONTOURS, BUT NOT TO
EXCEED 2:1 SLOPE.
a. CONTRACTOR SHALL INSTALL PERMANENT EROSION AND
SEDIMENT CONTROL STRUCTURES AS INDICATED ON A SITE
SPECIFIC BASIS. IN THE ABSENCE OF SITE SPECIFIC INFOR—
MATION, A FLEXIBLE CHANNEL LINER SUCH AS NAG C125 OR
C350 WHICH IS CAPABLE OF WITHSTANDING ANTICIPATED FLOW
SHALL BE INSTALLED. ALTERNATIVELY, ROCK RIP —RAP SHALL
BE INSTALLED.
b. ANY MATERIALS PLACED IN THE STREAM TO FACILITATE
CONSTRUCTION SHALL BE REMOVED DURING RESTORATION.
BANKS SHALL BE STABILIZED AND TEMPORARY SEDIMENT
BARRIERS INSTALLED AS SOON AS POSSIBLE AFTER IN —STREAM
WORK BUT WITHIN 24 HOURS OF COMPLETING IN —STREAM WORK.
c. MAINTAIN A SILT FENCE OR HAY BALE BARRIER ALONG
THE WATERBODY UNTIL VEGETATION IS ESTABLISHED IN
ADJACENT DISTURBED AREAS.
13. WHEN THE STREAMBED HAS BEEN RESTORED, THE CREEK BANKS
ARE TO BE CONTOURED TO A STABLE ANGLE AND PROTECTED
WITH EROSION RESISTANT MATERIAL COMPATIBLE WITH FLOW
VELOCITY BETWEEN DAMS (E.G., EROSION CONTROL BLANKETS,
CRIBBING, ROCK RIP —RAP, ETC.). THE DAMS ARE TO BE REMOVED
DOWNSTREAM FIRST. KEEP PUMP RUNNING UNTIL NORMAL FLOW
IS RESUMED. COMPLETE BANK TRIMMING AND EROSION PROTECTION.
IF SANDBAGS ARE USED FOR THE DAMS, PLACE AND REMOVE BY
HAND TO AVOID EQUIPMENT BREAKING BAGS.
14. TEMPORARY EQUIPMENT CROSSING CAN BE CONSTRUCTED USING EITHER
A FLUME CROSSING OR A TEMPORARY BRIDGE. FOR BRIDGE CROSSING
DETAILS, REFER TO THE TYPICAL RAILCAR BRIDGE CROSSING OR
TYPICAL MAT CROSSING DRAWINGS.
IMO ENGINEERING CONSULTANTS INC. COLONIAL PIPELINE COMPANY
1300 MEfROP011iPN BLYa.P ONE: (850) ]85-5441 "ASSEE, R., IISP ]f308
M
ATLANTA, GEORGIA
TYPICAL DAM AND PUMP
MAINTENANCE DIG
REVISION °�'0°` ,� R. AT WATERBODY LESS THAN 15'
CALF I DATE DRAWN APPROVED TROW PROJ. NO.1 DRAWING SHEET
NTS 1 01-29-2004 ALS I — I I THES0050362 I COL-0003a 2 OF 2

Fill »ml►1971:l4
IMPACTS EXHIBIT

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APPENDIX F
CPC SOIL EROSION AND SEDIMENT CONTROL PLAN

Colonial Pipeline Company
Soil Erosion and Sediment Control Plan
For
Pipeline Maintenance Activities
Objective
Disturbed areas are to be restored as close as practical to their original contours and
conditions so that once vegetation is reestablished, erosion will be reduced to the same
or lower level that existed prior to disturbance.
Description
This section defines the soil erosion and sediment control measures that Colonial
Pipeline Company will implement during and after inspection and repairs of the pipeline
are complete. The objectives of this plan are to establish general guidelines for
controlling erosion and sedimentation and to specify criteria for sensitive orparticularly
susceptible soil areas. The plan incorporates measures to control erosion and
sedimentation, including minimizing cover removal, limiting the time of exposure,
limiting the flow of water onto the disturbed right-of-way, and filtering or settling out
sediment from water flowing from the right-of-way.
The primary objective of the soil erosion and sediment control plan is to reduce the area
and duration of soil disturbance and reestablish permanent vegetation as soon after
construction as possible, thereby minimizing long-term erosion and sedimentation.
Some erosion is inevitable during construction; however, the plan includes measures to
reduce erosion to the minimum practical.
Colonial Pipeline Company plans to reduce soil erosion and provide sediment control
during the repair of the pipeline at the project site by incorporating the following
measures:
• Water pumped from the construction area as part of the dewatering operation
from the excavation will be filtered through silt filtration bags and discharged to
a well -vegetated area.
• All work will be confined within the existing right-of-way. Staked hay bales and silt
fence will be installed around the worksite and maintained until vegetation is established.
Proper controls will be added ifnecessary during construction.
• All terms and conditions within Nationwide Permit 3 will be followed.
• Erosion control measures will be installed prior to conducting any soil disturbing
activities associated with the pipeline maintenance activity.
• Clearing of vegetation will be kept to an absolute minimum and confined to the
existing pipeline easement area. The easement area is 50 feet in width and devoid

oflarge trees. The right of way is vegetated with undergrowth grasses and other
short vegetation.
• Vegetation will be reestablished within disturbed areas and along stream banks
as soon as possible upon completion of work. Disturbed areas will be seeded
with a wetland seed mixture
• All erosion and sediment control measures will be inspected every two weeks at a
minimum and after every significant rainfall event of 0.5 inch or more until
disturbed areas have been stabilized. Identified damages to control measures
must be repaired immediately.
Refuse and Waste Disposal
Colonial's representative will not allow the Contractor to discard any litter, including
paper, bottles, cans, rags, sacks, welding rod stubs, fuel, crankcase draining, coating
materials, equipment, and junk pipe in the ditch or along the right-of-way. All refuse
must be collected and disposed in accordance with company specifications. Personnel
will be instructed regarding the correct procedure for waste disposal.
Maintenance/Inspection Procedures
The following inspection and maintenance practices will be implemented to maintain
erosion andsediment controls:
i. All control measures will be inspected every two weeks at a minimum and following
any storm event of 0.5 inch or greater.
2. All control measures will be maintained in good working order. If a repair is
necessary, it will be initiated within 24 hours of the report.
3. Built-up sediment will be removed from silt fences when it has reached one-third the
height ofthe fence.
4. Silt fences will be inspected for depth of sediment, tears, secure attachment ofthe
fabric to the fence posts, and firm placement of the fence posts in the ground.
5. Temporary and permanent seeding and planting will be inspected for bare spots,
washouts, and healthy growth.
6. Colonial Pipeline Company will select individuals to be responsible for inspections,
maintenance and repair activities, and completion of the inspection and
maintenance report. Personnel selected for inspection and maintenance
responsibilities will receive training from Colonial Pipeline Company or its
representative. Personnel must be trained in all practices necessary for maintaining
the erosion and sediment controls used on -site.

let» A►1971:( 7
El III E_A *II aaA:7»Nkv,IkaIIki10161►Mll ]kv,Ikafe1IWO]:IMMr1l1 .11

Version 4.3
Updated April 20, 2022
401 & Buffer Permitting PCN Submittal Checklist
❑✓ The application fee (Checks may be made out to "N.C. Division of Water Resources"
- $240.00 for 401 Water Quality Certification with minor impacts
- $570.00 for 401 Water Quality Certification with major impacts
- Express Review Fee (Amount requested on Acceptance Letter)
❑✓ Pre -filing meeting request documentation or receipt demonstrating that at least 30 days
prior to submitting a certification request, a pre -filing meeting was requested with the
certifying agency.
❑✓ One complete copy of the PCN Application and supporting documentation (no larger than
11 X 17 plans if submitting paper copies)
❑ Stormwater Management Plan (if applicable — see PCN Form Help File Section F)
1) Please provide the stormwater management plan along with all supporting information
pertaining to this project including the following:
a. Entire site development/layout plans delineating all drainage areas;
b. Design calculation sheets for all proposed SCM(s) sized for both on -site and
off -site drainage;
C. Application form SWU-101, the $505 application fee and last two signature
pages may be omitted;
d. Supplemental form for each proposed SCM and Required Items Check List
(https:Hdeg. nc.gov/about/divisions/energy-mineral-and-land-
resources/stormwater/stormwater-program/stormwater-design) along with all
required items;
e. A Notarized Operation & Maintenance Agreement for each proposed SCM ;
f. Detailed construction drawing sheets shall include
(i) Erosion and sediment control plans;
(ii) Installation and planting schedules for the proposed SCMs;
(iii) Appropriately scaled plan views and cross sectional details of all
SCMs and associated components — inlet and outlet structures,
forebay, respective zones and pertinent elevations;
(iv) Collection system routing stormwater to the proposed SCMs;
(v) Any energy dissipator and vegetated area (if provided);
(vi) Maintenance access/easement for the proposed SCMs.
❑ If your project is located within a State implemented Riparian Buffer Rule Area, submit the
following along with site plans and PCN form:
1) Details for on -site diffuse/dispersed flow provisions, (refer to
https:Hdeg.nc.gov/about/divisions/energy-mineral-and-land-
resources/stormwater/stormwater-prop ram/stormwate r-design) .
DWR Stream Determination Forms for streams on property and DWR determination
letter for wetlands or streams (if applicable).
The following is the most critical of all the information that you must provide. The quality and
detail of the information will often determine the expeditiousness of the review. The following is
a checklist of the types of pertinent information required at a minimum:

Version 4.3
Updated April 20, 2022
Maps and Plans:
The most recent version of the 1:24,000 USGS Topographic Map - Please cleanly draw or
delineate the site boundaries on the topographic map.
❑✓ The most recent version of the bound and published County NRCS Soil Survey Map -
(required for projects within the Neuse River Basin, Tar -Pamlico River Basin, Randleman
Lake Watershed and the Catawba River Basin, also recommended for all projects) - Please
clearly delineate the site boundaries, etc. on the map. If the delineation obscures any of the
features, it is recommended that a clean copy be provided. Copies of the current soil survey
and/or soil survey map sheets can be obtained from the local NRCS County Office
(http://www.nc.nres.usda.gov/). GIS soil layers are not acceptable.
❑✓ Vicinity map - Please clearly mark the location and approximate boundaries of the property
and project on the map. Please indicate north arrow and scale. Please include applicable road
names or State Road numbers.
The Site Plan - The most critical map to be provided is the site plan. The following is the
minimum list of plans that are typically needed.
Pre-construction/Pre-existing conditions - This sheet (or sheets) must include:
• All jurisdictional and non -jurisdictional wetland, stream, water features, State regulated
buffers (delineated into Zones 1 and 2)
• Topographic contours with elevations
• Any existing structures and impervious areas
• Existing utility lines and easements
• Existing roads, culverts, and other pertinent features
• North arrow and the scale (1 ":50' scale is recommended).
❑✓ Proposed conditions - This sheet (or sheets) must include:
• All jurisdictional and non -jurisdictional wetland, stream, water features, State regulated
buffers (delineated into Zones 1 and 2)
• Lot layout (if a subdivision or commercial development is proposed) - lots must be
developable without further impacts to jurisdictional and non -jurisdictional wetlands,
streams, water features, and State regulated buffers. Building envelopes must be provided
when streams, wetlands, riparian buffers, or water features exist on a lot
• All built -out structures and impervious cover
• Final grading contours with elevations
• All utilities and easements (including septic fields on all lots within 100 feet of stream,
wetland, or water features - if applicable)
• Impacted areas — these should correspond with the Impact numbers listed on your PCN
form.
❑ Drainage Plans - Final drainage plans must include the following:
• Locations and pertinent elevations and sizes of the stormwater collection system and
drainage ways
• All inlets and outlets must also be shown with pertinent elevations (All outlets to wetlands
must be at a non -erosive velocity, generally less than 2 ft/sec during the peak flow from
the 10-yr storm)
• Scaled stormwater BMPs must also be indicated as required by DWR rules and policies

Version 4.3
Updated April 20, 2022
• In certain cases (see Section F of PCN form), final stormwater management plan must
also be provided (see Stormwater Management Plan Checklist)
❑✓ Proposed Impacts - All impacts to jurisdictional and non -jurisdictional wetland, stream, water
features, and State regulated buffers must be shown and labeled on the site plans at a scale
no smaller than 1" = 50'. All excavation, fill, flooding, stabilization, and other impacts that will
be conducted in or near jurisdictional and non -jurisdictional wetland, stream, water features,
and State regulated buffers must be indicated. Please provide cross sectional details showing
the provisions for aquatic life passage (burial of culvert 20% for culverts <_ 48 inches, and 1-
foot for culverts > 48 inches).
Wetland Impacts:
❑✓ Precise grading and final elevation contours must be provided. Existing vegetation
and any clearing must be specified.
❑ All subsurface utility lines must indicate the location of anti -seep collars.
Construction detail for anti -seep collars must be provided.
❑ Roadway or other crossings of riparian wetlands may require floodway culverts to
maintain existing hydrological conditions.
❑✓ Plans should show that the hydrology of remaining wetlands on the site will be
maintained.
Stream Impacts:
❑✓ Stream impacts must be clearly shown on the plans. The centerline as well as the
banks of the stream must be surveyed or located by GPS for the portion of the
stream to be impacted.
❑ The inlet and the outlet of all culverts should be aligned with the stream as much
as possible. Inlet and outlet elevations and streambed elevations should be
indicated. Any inlet or outlet protection must be shown and enumerated on the
impact map(s).
❑ For bottomless culverts or other spans, a vertical cross section should be
provided that shows the minimum distance from each span to each stream bank,
the stream cross section, the height of the span above the stream and the
minimum distance from the edge of each footer to each stream bank.
Additionally, please provide a signed and sealed geotechnical report of
subsurface soils at the proposed bottomless culvert location. The report must
comply with the Division of Highways — Guidelines for Drainage Studies and
Hydraulic Design, prepared by A.L. Hankins, Jr., State Hydraulics Engineer -
1999.

Version 4.3
Updated April 20, 2022
❑ Multiple culverts or sectioned box culverts typically require the use of sills, off-
setting or other means to match the cross section of the existing stream (in order
to maintain stream stability and provide aquatic life passage). A vertical cross
section of the culverts should be shown overlain with the up and downstream
stream cross section including the stream flood -prone area.
❑ Impacts associated with dam construction must indicate and enumerate all fill
associated with the dam footprint, spillway and any bank stream bank stabilization.
The length of stream impounded must also be indicated and enumerated.

I_1»A►1971:l:I
1119_CelMaTiVAIIkv,II►Eel to] ►191&.11N109161►IMolN►vi

NORTH CARCLINA
Environmental Quality
Water Resources
Office Use Only
Corps Action ID no. [Click to enter.] Date received: [Click to enter.]
DWR project no. Dlick enter.] Date received: [Click to enter.]
Site Coordinates:
Latitude (DD.DDDDDD): 35.744653
Longitude (DD.DDDDDD): 80.445949
Form Version 4.3, April 20, 2022
Pre -Construction Notification (PCN) Form
(Ver. 4.2, January 31, 2022))
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 PCN help document may be found at this link:
https://edocs.deg. nc.gov/WaterResources/DocView.aspx?dbid=0&id=2196924&cr=1
Please ensure you have submitted a pre -filing meeting request at least 30 days prior to submitting this
form, as DWR will not be able to accept your application without documentation of this important first step.
The Division has developed a Pre -filing Meeting Request email address 401 PreFile(a)ncdenr.gov to accept
the federally required pre -filing meeting request and provide confirmation receipt of submittal . This receipt
or similar documentation will 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) : 9/22/2022
Page 1 of 22 PCN Form Version 4.3- April 20, 2022

A. Processing Information
County (counties) where project is located: *
Davidson Additional (if needed).
Is this a NCDMS project? *
(Click yes only if NCDMS is the applicant or co-
applicant)
❑ Yes ❑x No
Is this a public transportation project?
(Publicly funded municipal, state, or federal road, rail,
or airport project)
❑ Yes ❑x No
Is this a NCDOT project? *
❑ Yes ❑x No
If yes, NCDOT TIP or state project number:
Click to enter.
If yes, NCDOT WBS number: *
Click to enter.
1 a. Type(s) of approval sought from the Corps: *
❑ Section 404 Permit (wetlands, streams, waters,
Clean Water Act)
❑ Section 10 Permit (navigable waters, tidal
waters, Rivers and Harbors Act)
Has this PCN previously been submitted? *
❑ Yes ❑x No
Please provide the date of the previous submission. *
Click to enter a date.
1 b. What type(s) of permit(s) do you wish to seek
authorization?
❑ Nationwide Permit (NWP)
❑ Regional General Permit (RGP)
❑ 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? *
❑ Yes ❑x No
NWP number(s) (list all numbers ):
3 (a) and (c)
RGP number(s) (list all numbers ):
Click to enter.
Are you a federal applicant?
❑ Yes ❑x No
If yes, please provide a statement concerning compliance with the Coastal Zone Management Act
1d. Type(s) of approval sought from DWR (check all that apply):
❑x 401 Water Quality Certification — Regular
❑ Non-404 Jurisdictional General Permit
❑ Individual 401 Water Quality Certification
*
❑ 401 Water Quality Certification— Express
❑ Riparian Buffer Authorization
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 ❑ No
1f. Is this an after -the -fact permit/certification application? *
❑ Yes ❑x No
Page 2 of 22 PCN Form Version 4.3- April 20, 2022

1g.
Is payment into a mitigation bank or in -lieu fee program proposed for
❑ Yes
❑x No
mitigation of impacts?
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
❑ Yes
❑x No ❑ Unknown
Concern (AEC)? *
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.mil/Missions/Regulatory-Permit-
Program/Agency-Coordination/Trout.aspx
Page 3 of 22 PCN Form Version 4.3- April 20, 2022

B. Applicant Information
1a.
Who is the primary contact?
Jennifer Price
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 ❑x 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:
See attached easements
2b.
Deed Book and Page No.:
DICK to ent�
2c.
Contact Person (for corporations):
Click to enter.
2d.
Address
Street Address:
Click to ente.
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.
2e.
Telephone Number: (###)###-####
Click to enter.
2f.
Fax Number: (###)###-####
Click to enter.
2g.
Email Address:
Click to enter.
3.
Applicant Information (if different from owner)
3a.
Name:
Jennifer Price
3b.
Business Name (if applicable):
Colonial Pipeline Company (CPC)
3c.
Address:
Street Address:
7524 Kenstead Circle
Address line 2:
Click to entE
City:
Charlotte
State/ Province/ Region:
North Carolina
Postal/ Zip Code:
28214
Country
USA
3d.
Telephone Number: (###)###-####
[phone]
3e
Fax Number: (###)###-####
Click to entr
3f.
Email Address:
[e-mail]
Page 4 of 22 PCN Form Version 4.3- April 20, 2022

4. Agent/ Consultant (if applicable)
4a. Name:
Michael Barfield
4b. Business Name:
Corblu Ecology Group, LLC
4c. Address:
Street Address:
3225 South Cherokee Lane
Address line 2:
Click to entr
City:
Woodstock
State/ Province/ Region:
Georgia
Postal/ Zip Code:
30188
Country:
USA
4d. Telephone Number: (###)###-####
[phone]
4e Fax Number: (###)###-####
Click to entc
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 22 PCN Form Version 4.3- April 20, 2022

C. Project Information and Prior Project History
1. Project Information
1 a. Name of project: *
Line 1 Shallow Cover Davidson County, North
Carolina
1 b. Subdivision name (if appropriate):
Click to enter.
1c. Nearest municipality/town: *
Linwood
2.
Project Identification
2a.
Property identification number (tax PIN or parcel ID):
5762-03-98-0675
2b.
Property size (in acres):
Click to enter
2c.
Project Address:
Street Address:
Click to enter.
Address line 2:
Click to enter.
City:
Linwood
State/ Province/ Region:
North Carolina
Postal/ Zip Code:
27299
Country:
USA
2d.
Site coordinates in decimal degrees (using 4-6 digits
after the decimal point): *
Latitude (DD.DDDDDD): * 35.744653
Longitude (-DD.DDDDDD): *-80.445949
3. Surface Waters
3a. Name of nearest body of water to proposed project: *
Yadkin River
3b. Water Resources Classification of nearest receiving
WS-V
water: *
The Surface Water Classification map may be found at this link:
https:Hncdenr.maps.arcqis.com/apps/webappviewer/index.html?id=6e125ad7628f494694e259c80dd64265
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
030401030105
located:
The Find Your HUC map may be found at this link:
https:Hncdenr.maps.arcgis.com/apps/Publiclnformation/index.html?appid=ad3a85aOc6d644aOb97cdO69db238ac3
Page 6 of 22 PCN Form Version 4.3- April 20, 2022

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:
Mowed and maintained petroleum pipeline right-of-way (ROW). The streambed/bank erosion, culvert failure, and
revetment mat system failure within the unnamed perennial stream appears to be the result of storm flows, which
has removed/displaced the required protective cover over CPC's Line 1.
4b.
Have Corps permits or DWR certifications been obtained for this
❑ Yes ❑ No ❑x Unknown
project (including all prior phases) in the past?
If yes, please give the DWR Certification number and/or Corps
[Click to enter.]
Action ID (ex. SAW-0000-00000):
jClick to enter.]
Attach any pertinent project history documentation
4b2.
Is any portion of the work already complete?
❑ Yes ❑x No
If yes, describe the completed work.
Clink to PntPr 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.
Click to enter text.
4d.
Attach an 8'h x 11" excerpt from the most recent version of the USGS topographic map indicating the location of
the project site.
4e.
Attach an 8'h 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
0.06 acres
property:
4g.
List the total estimated linear feet of all existing streams (intermittent
175 linear feet
and perennial) on the property:
4g1.
List the total estimated acreage of all existing open waters on the
Click to enter. acres
property:
4h.
Explain the purpose of the proposed project:
Due to recent high flow stream events bed/bank erosion has occurred within the unnamed perennial stream
resulting in a culvert faiure and displacement of an existing revetment mat within CPC's ROW. The erosion
around and damage to the existing in -stream structures (culvert and revetment mats) has displaced the required
protective cover over Line 1 resulting in "shallow cover". The lack of pipeline protection at the maintenance
Icoation has resulted in condions where the pipeline is vulnerable to potential damages. Further, these conditions
are not consistent with CPC's or U.S. Department of Transportation requlatory requirements for pipeline
protection. CPC proposes to replaced the protective cover over the line using Submar articulating revetment
mats and rip rap. The culvert will be removed from the stream and not replaced. These actions serve to replace
the required protective cover over the exiting pipeline and prevent future conditions from occurring within the
unnamed perennial stream that may leave Line 1 vulnerable to potential damages.
Page 7 of 22 PCN Form Version 4.3- April 20, 2022

4i. Describe the overall project in detail, including the type of equipment to be used: *
The maintenance location will be accessed from Hannah Ferry Road onto an existing single track gravel road
that crosses CPC's existing, mowed, and maintained ROW (Figure 3). Prefabricated mats will be used to
temporarily cross the emergent wetland area and stream to access the maintenance location (Appendix B). CPC
intends to inspect Line 1 and replace the required minimal protective cover over the pipeline using Submar pre-
cast revetment mats and rip rap to remediate the perennial streambed/bank erosion. To re-establish the minimal
pipeline protective cover, CPC intends to conduct the following: 1) remove the existing failed culvert and
revetment mat from the stream system; 2) excavate the eroded area on Line 1; 3) inspect and make repairs to
Line 1 as necessary; 4) backfill the excavation area; and 5) restore the streambed to approximate pre -erosion
contours and elevations over Line 1 using Submar mats. These pre -cast mats and rip rap will be
keyed/imbedded into the stream bed and banks in a manner that maintains grade and normal stream flow
conditions (Appendix C). Please note: CPC proposes to use rip rap for stabilization in lieu of re -installing the
culvert.
To minimize sedimentation to the unnamed perennial stream during the above -mentioned maintenance activity,
dams constructed of sandbags, steel plates, or water -inflatable plastic dams will be temporarily placed upstream
of the maintenance area to conduct maintenance activities "in -the -dry". The stream flow will be pumped around
the maintenance area, discharging immediately downstream via an energy dissipater to prevent stream scour.
The pump(s) used will be sufficiently sized to accommodate the anticipated stream flow (Appendix D). The
excavated soils will be ordered (ordered; top 12 inches and subsoil) temporarily stored separately in the adjacent
upland area on geotextile fabric or similar material within the CPC ROW.
Rip rap will be used above and below the mat system within the streambed for additional stabilization. Further,
the rip rap will be placed on an erosion control blanket (geotextile fabric) in a manner where the finished top
elevation of the rip rap does not exceed that of the original stream bed elevation. Once the required minimal
protective pipeline cover (pre -cast revetment mats) is keyed into the streambed in a manner that maintains
existing grade and flow conditions of the stream, the temporary dams will be removed, and normal streamflow
will be restored.
CPC's standard erosion control practices will be employed (Appendix F). Specifically, the disturbed areas along
the stream bank and disturbance within the adjacent emergent wetland area will be reseeded with a native
wetland seed mix and strawed. No monofilament erosion control matting will be used.
Equipment will include: an excavator, rock truck (for material transport), properly sized pumps, and a welding
truck (to conduct pipe repairs as necessary).
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 ❑x No
If yes, describe the type of dredging, the composition of the dredged material, and the locations of disposal area.
Click to enter text.
Page 8 of 22 PCN Form Version 4.3- April 20, 2022

5.
Jurisdictional Determinations
5a.
Have the wetlands or streams been delineated on the property or in
® Yes ❑ No ❑ Unknown
proposed impact areas?
Comments:
See Figure 2 for the project area and Figure 3 for site access
5b.
If the Corps made a jurisdictional determination,
❑ Preliminary ❑ Approved ❑ Emailed concurrence
what type of determination was made?
❑x Not Verified ❑ Unknown ❑ n/a
Corps AID number (ex. SAW-0000-00000):
r iit-k +n nntA
Name (if known): Michael Barfield
5c.
If 5a is yes, who delineated the jurisdictional
Agency/Consultant Company: Corblu Ecology Group, LLC.
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.
'link to PntPr
5d1.
Attach jurisdictional determinations.
6. Future Project Plans
6a. Is this a phased project?
❑ Yes ❑x No
6b. If yes, explain.
Click to enter.
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.
Click to enter.
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)
John F. & Betty W. Parnell
1626 Hannah Ferry Road
Linwood, NC 27299 (adjoinds waterbody)
Thomas F. Jones
3016 Simerson Road
Linewood, NC 27299 (property to the Northeast of Parnell)
8. Scheduling of activity:
Activity will be scheduled after approval of this certification and is not expected to exceed 20 days.
Page 9 of 22 PCN Form Version 4.3- April 20, 2022

D. Proposed Impacts Inventory
Impacts Summary
❑x Wetlands
1 a. Where are the impacts associated with your project ❑ Buffers
(check all that apply):
❑ Pond Construction
❑x Streams - tributaries
❑ Open Waters
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
Fill (Incl.
Riprap)
Permanent
Unknown
W1
No
Both
0.0007
W2
Grading
Temporary
Unknown
W1
No
Both
0.0502
W3
Choose one
Temp/ Perm
Choose one
Click to enter
Y/N
choose one
Click to enter
W4
Choose one
Temp/ Perm
Choose one
:,lick 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/I
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
Mick to enter
Y/N
Choose one
Click to enter
W15
Choose one
Temp/ Perm
Choose onE
Click to enter
Y/1
'>oose one
Click to enter
2g1. Total temporary wetland impacts
0.0502 ac
2g2. Total permanent wetland impacts
0.0007 ac
2g3. Total wetland impacts
0.0509 ac
2h. Type(s) of material being discharged and the amount of each type in cubic yards:
.lick to enter text.
2i. Comments:
'lick to enter text.
Page 10 of 22 PCN Form Version 4.3- April 20, 2022

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
3a
3b.
3c.
3d.
3e.
3f.
3g.
3h.
Site #*
Impact Reason*
Impact
Impact
Stream Name*
Stream
Jurisdiction
Stream
Impact length
Duration*
Type*
Type*
Type*
Width (avg
(linear ft)
ft)
S1
Fill
Permanent
Fill (Incl.
P1
Perennial
Both
8
66
Riprap)
S2
Grading/Workspace
Temporary
Other
P1
Perennial
Both
8
20
S3
Click to enter
Temp/
Choose
Click to enter
Per/Int
Choose
Click to enter
Click to enter
Perm
one
one
S4
Click to enter
Temp/
Choose
Click to enter
Per/Int
Choose
Click to enter
Click to enter
Perm
one
one
S5
Click to enter
Temp/
Choose
Click to enter
Per/Int
Choose
Click to enter
Click to enter
Perm
one
one
S6
Click to enter
Temp/
Choose
Click to enter
Per/Int
Choose
Click to enter
Click to enter
Perm
one
one
S7
Click to enter
Temp/
Choose
Click to enter
Per/Int
Choose
Click to enter
Click to enter
Perm
one
one
S8
Click to enter
Temp/
Choose
Click to enter
Per/Int
Choose
Click to enter
Click to enter
Perm
one
one
S9
Click to enter
Temp/
Choose
Click to enter
Per/Int
Choose
lick to enter
Click to enter
Perm
one
one
S10
Click to enter
Temp/
Choose
Click to enter
Per/Int
Choose
Click to enter
Click to enter
Perm
one
one
S11
Click to enter
Temp/
Choose
Click to enter
Per/Int
Choose
Click to enter
Click to enter
Perm
one
one
S12
Click to enter
Temp/
Choose
Click to enter
Per/Int
Choose
Click to enter
Click to enter
Perm
one
one
S13
Click to enter
Temp/
Choose
Click to enter
Per/Int
Choose
Click to enter
Click to enter
Perm
one
one
S14
Click to enter
Temp/
Choose
Click to enter
Per/Int
Choose
Click to enter
Click to enter
Perm
one
one
S15
Click to enter
Temp/
Choose
Click to enter
Per/Int
Choose
Click to enter
Click to enter
Perm
one
one
S16
Click to enter
Temp/
Choose
Click to enter
Per/Int
Choose
Click to enter
Click to enter
Perm
one
one
S17
Click to enter
Temp/
Choose
Click to enter
Per/Int
Choose
Click to enter
Click to enter
Perm
one
one
S18
Click to enter
Temp/
Choose
Click to enter
Per/Int
Choose
Click to enter
Click to enter
Perm
one
one
S19
Click to enter
Temp/
Choose
Click to enter
Per/Int
Choose
Click to enter
Click to enter
Perm
one
one
Page 11 of 22 PCN Form Version 4.3- April 20, 2022

S20
Click to enter
Temp/
Choose
Fickto enter
Per/Int
Choose
Click to enter
Click to enter
Perm
one
one
3i1.
Total jurisdictional ditch
Click to enter. linear ft
impact:
3i2. Total permanent stream
66 linear ft
impacts:
M. Total temporary stream
20 linear ft
impacts:
34. Total stream and ditch
86 linear ft
impacts:
3j.
Comments:
66 LF of additional stream impacts
Page 12 of 22 PCN Form Version 4.3- April 20, 2022

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*
4d.
Activity Type*
4e.
Waterbody
Type*
4f.
Impact area
(ac)*
01
dick to ent(
Temp/ Perm
Click to enter.
Choose one
:hoose one
Click to enter.
02
Click to enter.
Temp/ Perm
Click to enter.
Choose one
-hoose one
Click to enter.
03
dick 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
Click to enter. ac
4g.
Total permanent open water impacts
Click to enter. ac
4g.
Total open water impacts
Click to enter. ac
4h.
Comments:
Click to enter.
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 to
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.
ente
P3
Choose one
Click to
Click to
Click to
Click to
Click to
Click to
Click to
enter.
enter.
enter.
enter.
enter.
enter.
ente,
5f.
Total
Click to
Click to
Click to
Click to
Click to
Click to
Clicl
enter.
enter.
enter.
enter.
enter.
enter.
ent
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 13 of 22 PCN Form Version 4.3- April 20, 2022

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
❑x Other: Yadkin Pee Dee
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
B2
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter
B3
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter
B4
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter.
Click to enter
B5
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter
Click to enter.
B6
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter
Click to enter.
B7
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter
Click to enter.
B8
Choose one
Temp/ Perm
Click to enter.
Y/N
Click to enter
Click to enter.
B9
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:
No riparian buffer rules, project is located in the Yadkin Pee Dee River Basin.
Please attach supporting documentation (impact maps, plan sheets, etc.) for the proposed project.
Page 14 of 22 PCN Form Version 4.3- April 20, 2022

E. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts through project design:
The Submar mat system was designed to minimize disturbances to aquatic resources, while achieving the
required protective coverage.
1 b. Specifically describe measures taken to avoid or minimize proposed impacts through construction techniques:
The area will be temporarily de -watered with a dam and pump, which will allow for the project to take place
without contacting flowing water, thus reducing downstream sedimentation. Further, the articulating revetment
mats are pre -cast, which eliminates the need to bring live concrete on -site.
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 ❑ Corps
(check all that apply)
2b. If yes, which mitigation option(s) will be used for this ❑ Mitigation Bank
project? (check all that apply) ❑ 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 io enter.
3b. Credits purchased/requested:
Type: Choose one
Quantity Click to ente
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 ente. linear feet
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://ribits.usace.army.mil/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:
Click to enter. acres
4f.
Non -riparian wetland mitigation requested:
Click to enter. acres
4g.
Coastal (tidal) wetland mitigation requested:
Click to enter. acres
Page 15 of 22 PCN Form Version 4.3- April 20, 2022

4h. Comments:
lick to enter.
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.
,lick 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
that requires buffer mitigation?
❑ Yes ❑ No
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.
Zone
6c.
Reason for impact
6d.
Total impact
(square feet)
Multiplier
6e.
Required mitigation
(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
NC Division of Mitigation Services proposed?
Fpyes El No
6h.
If yes, attach the acceptance letter from the mitigation bank or NC Division of Mitigation Services.
6i.
Comments:
No riparian buffer protection rules, project is located in the Yadkin Pee Dee River Basin.
Page 16 of 22 PCN Form Version 4.3- April 20, 2022

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 ❑x 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.,qov/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 ❑ No
2b.
Does this project meet the requirements for low density projects as
defined in 15A NCAC 02H .1003(2)?
❑ Yes ❑ No
To look up low density requirements, click here:
http://reports.oah.state. nc.us/ncac/title%2015a%20-%20environmental%20guaIity/chapter%2002%20-
%20environmental%20manage ment/subchapter%20h/15a%20ncac%2002h%20.1003.pdf
2c.
Does this project have a stormwater management plan (SMP)
❑ 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?
❑ Local Government
(Check all that apply.)
❑ State
If you have local government approval, please include the SMP on their overall impact map.
❑ Phase II ❑ USMP
Local Government Stormwater Programs
❑ NSW ❑ Water Supply
Page 17 of 22 PCN Form Version 4.3- April 20, 2022

Please identify which local government stormwater program you are using.
Click to enter.
State Stormwater Programs * ❑ Phase II ❑ HQW or ORW
❑ Coastal Counties ❑ Other
Comments:
Project does not require a stormwater management plan.
Page 18 of 22 PCN Form Version 4.3- April 20, 2022

G. Supplementary Information
1. Environmental Documentation
1 a. Does the project involve an expenditure of public (federal/state/local)
❑ Yes ❑x 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 ❑ 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:
Click to enter.
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):
UllCK 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 ❑x No
downstream water quality? *
3b. If you answered "no", provide a short narrative description:
The Submar articulating revetment mat system has been designed to provide the required protective cover over
the pipeline and remain stable in the stream syste. Additional repairs to the area are not anticipated.
3c. If yes, provide a qualitative or quantitative cumulative impact analysis in accordance with the most recent DWR
policy. (Attach .pdf)
4. Sewage Disposal (DWR Requirement)
4a. Is sewage disposal required by DWR for this project?* I ❑ Yes ❑ No ❑x 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 19 of 22 PCN Form Version 4.3- April 20, 2022

5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected
❑ Yes ❑x No
species or habitat? (IPAC weblink: https://www.fws.gov/ipac/ ffws.govl) *
5b. Have you checked with the USFWS concerning Endangered Species
® Yes ❑ No
Act impacts? *
5c. If yes, indicate the USFWS Field Office you have contacted.
Asheville
5d. Is another federal agency involved? *
❑ Yes ❑x No ❑ Unknown
If yes, which federal agency?
Click to enter.
5e. Is this a DOT project located within Divisions 1-8? *
❑ Yes ❑x No
5f. Will you cut any trees in order to conduct the work in waters of the
U.S.? *
❑ Yes ❑x No
5g. Does this project involve bridge maintenance or removal? *
❑ Yes ❑x 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 ❑ 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://saw-reg.usace.army.mil/NLEB/1-30-17-signed NLEB-SLOPES&apps.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 ❑x No
If yes, please show the location of the wind turbine(s) on the permit drawings/ project plans (attach .pdf)
5i. Does this project involve blasting and /or other percussive activities
that will be conducted by machines, such as jackhammers,
❑ Yes ❑x 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 .pdf)
5j. What data sources did you use to determine whether your site would impact Endangered Species or Designated
Critical Habitat? *
The USFWS IPaC website was used to generate a species list. Available habitat for the IPaC listed species was
not available within the project area. Further project is not located within a RED HUC regarding the Northern
Iongeared bat.
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 ❑x No
Page 20 of 22 PCN Form Version 4.3- April 20, 2022

Is there submerged aquatic vegetation (SAV) around
the project vicinity? *
El Yes ❑x No El Unknown
Will this project affect submerged aquatic vegetation? *
❑ Yes ❑x No ❑ Unknown
Explain: Click to enter.
6b. What data source(s) did you use to determine whether your site would impact Essential Fish Habitat?
NOAA
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
Link to the State Historic Preservation Office Historic Properties Map (does not include archaeological data):
http://gis. ncdcr.,qov/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? *
The North Carolina State Historic Preservation Office GIS Download.
7c. Attach historic or prehistoric documentation.
8. Flood Zone Designation (Corps Requirement)
Link to the FEMA Floodplain Maps: https:Hmsc.fema.,qov/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.
Spoke with the Davidson County Floodplain manager. A floodplain permit will be submitted and approved prior to
initiation of work.
8c. What source(s) did you use to make the floodplain determination?
The FEMA ArcGIS base layer.
H. Miscellaneous
Comments:
Click to enter.
Attach pertinent documentation or attachments not previously requested
Page 21 of 22 PCN Form Version 4.3- April 20, 2022

I. Signature *
❑x 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 INC 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 INC 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: Michael Barfield
Signature: Click to enter.
Date: Click to enter. 1 /27/2023
Page 22 of 22 PCN Form Version 4.3- April 20, 2022

Michael Barfield
From:
Michael Barfield
Sent:
Thursday, September 22, 2022 4:12 PM
To:
401 [e-mail]
Cc:
Michael Barfield
Subject:
CPC Line 1 Shallow Cover Davidson Co. NC
Attachments:
LN1_ShalCov_DavidsonCo_NC.pdf, topo_LN1_ShalCov_DavidsonCo_NC.pdf
To whom it may concern,
This email is to serve as the Pre -filing Request for a Colonial Pipeline Company Line 1 Shallow Cover Maintenance Project
located in Davidson County, North Carolina. Site plans are still being developed for the project. I have attached a figure
depicting the location of the project.
Thank you,
Michael A. Barfield, CWB, CE
Project Ecologist
Corblu Ecology Group, LLu
3225 S. Cherokee Lane, Bldg. 800
Woodstock, GA 30188
0: 770-591-9990 Ext. 23
F: 770-591-9993
M: 678-215-2742
.1
corblu
ECOLOGY GROUP
Confidentiality Notice: The information contained in this transmission is confidential, proprietary and privileged and may be subject
to protection under various state and Federal laws and regulations regarding non-public personal health and financial information.
This information is for the use of the individual or entity to whom it is addressed for the sole purpose of performing the intended
function. All recipients are hereby notified that any improper use, distribution or copying of this information is strictly prohibited and
may subject you to criminal and/or civil penalties. If you are not the intended recipient(s), please contact the sender by replying to
this e-mail and destroy/delete all copies of this e-mail message.

UZ
John M. Wyatt
Southeast District
Environmental Program Manager
March 20, 2020
US Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
NC DWR, 401 & Buffer Permitting Branch
1617 Mail Service Center,
Raleigh, NC 27699-1617
Subject: Authorization Letter
To Whom It May Concern:
Colonial Pipeline Company
Tel: [phone]
Colonial Pipeline Company (CPC) gives authorization to Corblu Ecology Group to serve as our agent
regarding North Carolina Division of Water Quality (DWQ)/U.S. Army Corps of Engineers (USACE) Pre -
Construction Notification (PCN) Application Forms. Should you have any questions or concerns please
contact me at the letterhead address or telephone number.
Sincerely,
��L
John M. Wyatt
Southeast District
Environmental Program Manager
Colonial Pipeline Company 5251 Hwy 153 Suite C #365 Hixson, TN 37343

PCN FORM ATTACHMENT A — Easement Agreement

40 LL# 11:1. 2
Map # 148
RIGHT OF WAY EASEMENT
FOR AND IN CONSIDERATION OF One Hundred Eighty Three and No/100--------- nOLLARS,
the receipt of which is hereby acknowledged, Betty W.Parnell & Frank Parnell, her husband,;
Ona M. Wilson, A Widow, _
hereinafter referred to as Grantors (whether one or more), do hereby grant and convey unto COLONIAL PIPELINE COMPANY,.
Delaware corporation, its successors and assigns, hereinafter referred to as Grantee, an easement for a pipeline right of way with the
right to construct, maintain, inspect, operate, protect, repair, replace, change the size of, and remove a pipeline for the transportation of
liquids and/or gases on, over, and through the following described lands, of which Grantors warrant they are the owners in fee simple,
situated in Davidson County, State ofNOrth Carolina to -wit:
343-- acres, more or less, described in a Deed from Ora M. Wilson, Widow
to Better Parnell & htlsband Frank Parnell dated April 1.9 1952, recorded
in Book 229, Page 140, in the offi e of the Pee_ster of Duds of
___D^v; dsan Conn+y, Nrrti: Carol a,
together with the right of unimpaired access to said pipeline and the right of ingress and egress on, over, and through the above -described
land for any and all purposes necessary and incident to the exercise by said Grantee of the rights granted hereunder.
The said Grantors shall have the right to use and enjoy the above -described land except as the same may be necessary for the
purposes herein granted to the said Grantee. Grantors agree not to build, create, or construct any obstructions, engineering works, or other
structures over said pipe line nor permit the same to be done by others.
In addition to the above consideration, Grantee agrees to repair or to pay for any actual damage which may be done to growing
crops,' timber, fences, buildings, or other structures directly caused by Grantee exercising any rights herein granted.
Any pipe line constructed by Grantee across any portion of the above -described land which is under cultivation shall, at the time
of the construction thereof, be buried to such depth as will not interfere with Grantors' use of said land for normal cultivation required
for the planting and tending of crops; except that Grantee, at its option, may construct its pipe line above the channel of any natural or
man-made stream, ravine, ditch, or other water course.
As a part of the consideration hereinabove set forth, Grantors hereby grant unto said Grantee, its successors and assigns, the right at
any time to construct, operate, and maintain an additional pipeline or pipelines substantially parallel to the first pipeline constructed
by Grantee on Grantors' land, above described and Grantee agrees to pay Grantors the sum of $ 1 83 - QQ for each additional
pipeline constructed, said payment to be made before construction commences. Said additional pipeline or pipelines shall be subject to
the same rights, privileges, and conditions as set forth in this Right of Way Easement.
It is agreed that any payment hereunder may be made direct to said Grantors, or any one of them, or by depositing such payment to
the credit of said Grantors, or any one of them, in the UXINGTON STATE Bank of LeXiMton, N.C.
and payment so madw shall be deimed'and 'twaidef&"i*iynthtlo'each of. iafd'Grantors.
The rights herein granted may be assigned in whole or in part.
The terms, conditions, and provisions of this right of way easement shall extend to and be binding upon the heirs, executors,
administrators, personal representatives, successors, and assigns of the parties hereto.
This Right-of-way is limited to Seventy Five feet in width along the
route as now surve d Grantee is limited to the la_71ng two Pipe Lines
under the terms of this agreement.
IN WITNESS WHEREOF, the Grantors herein have hereunto set their hands and seals this,30th day of June , 1962 .
Signed, sealed, and
delivqred in the presence o€ .
i ZZ r
M.B.Sm�t
N oy Parnell.
1
7
(Seal)
a
(Seal)
erne . ^ r
Ona M. Wilson
(Seal)
Grantors

CPC-96
`5
STATE OF NORTH CAROLINA
COUNTY OF Dn`*1dSOn_
a
Parm
personally appeared before
Witness my hand
INDIVIDUAL ACKNOWLEDGMENT
I SS
do heroby certify
Ona M. :Jilson
y and acknowledgedK..cutionof the
seal this, the of 'JIL
a
My term of of;ica'expires o the 10 _dY of
October is 62.
STATE OF NORTH CAROLINA-Davidson County
The foregoing certificate o
a Notary Public of,,q?!1-� �-� County. is adjudged to be correct. Let the instrtupgnt and the certificate be registered.
Witness my hand anti , Zsd.,e -this /-Z-- day 4 ,T"' Z 2
Filed for registration on the —i ig- ay of
duly recorded in the office of the Register of Deeds of
ec 19fi2-, at '41 Quo'clk and
re
o N. C., in B r Etc.
Register of Deeds
FROP' BY, SUBSCRIBING WITNESS
STATE OF NORTH CAROLINA
SS
COUNTY OF Davidson
I Donnie 11 Curry of nasri rlson County, state of—N'S�Yt,h rlarol ina
certify that M. D. Smith _
personally appeared before me this day, and being duly sworn, state that in his presence Pt.tYParnp I � .}.-�= Parm�l l
and Ona 1°1. 'Jilsori signed the foregoing instrument.
Witness my hand and -official seal, this - Sri - day of— 1951� .
My term of office expires on the 10 day off q-
otary
October 196 Donnie M. Curry
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285
LL # 11:4
map if 148
RIGHT OF WAY EASEMENT
FOR AND IN CONSIDERATION OF Seventy Two & N01100--------------------- DOLLARS,
the receipt of which is hereby acknowledged, R.A.Williams and Wife, Evelyn Williams.
hereinafter referred to as Grantors (whether one or more), do hereby grant and convey unto COLONIAL PIPELINE COMPANY,a
Delaware corporation, its successors and assigns, hereinafter referred to as Grantee, an easement for a pipeline right of way with the
right to construct, maintain, inspect, operate, protect, repair, replace, change the size of, and remove a pipeline for the transportation of
liquids and/or gases on, over, and through the following described lands, of which Grantors warrant they are the owners in fee simple,
situated in Davidson County, State of North Carolina to -wit:
1 acres, more or less, described in a Deed from W.P.Williams,Sr.,
et al to R.A.Williams dated December 20, 1948, recorded in Book 189
Page 77, in the office of the Register_ of Deeds of Davidson County,
North Carolina,
together with the right of unimpaired access to said pipeline and the right of ingress and egress on, over, and through the above -described
land for any and all purposes necessary and incident to the exercise by said Grantee of the rights granted hereunder.
The said Grantors shall have the right to use and enjoy the above -described land except as the same may be necessary for the
purposes herein granted to the said Grantee. Grantors agree not to build, create, or construct any obstructions, engineering works, or other
structures over said pipe line nor permit the same to be done by others.
In addition to the above consideration, Grantee agrees to repair or to pay for any actual damage which may be done to growing
crops, timber, fences, buildings, or other structures directly caused by Grantee exercising any rights herein granted.
Any pipe line constructed by Grantee across any portion of the above -described land which is under cultivation shall, at the time
of the construction thereof, be buried to such depth as will not interfere with Grantors' use of said land for normal cultivation required
for the planting and tending of crops; except that Grantee, at its option, may construct its pipe line above the channel of any natural or
man-made stream, ravine, ditch, or other water course.
As a part of the consideration hereinabove set forth, Grantors hereby grant unto said Grantee, its successors and assigns, the right at
any time to construct, operate, and maintain an additional pipeline or pipelines substantially parallel to the first pipeline constructed
by Grantee on Grantors' land, above described and Grantee agrees to pay Grantors the sum of $ 72.00 for each additional
pipeline constructed, said payment to be made before construction commences. Said additional pipeline or pipelines shall be subject to
the same rights, privileges, and conditions as set forth in this Right of Way Easement.
It is agreed that any payment hereunder may be made direct to said Grantors, or any one of them, or by depositing such payment to
the credit of said Grantors, or any one of them, in theSeeuritY Bk & Tr Co, Rank of SpemCer, N,Ce
and payment so made shall be deemed and considered as payment to each of said Grantors.
The rights herein granted may be assigned in whole or in part.
The terms, conditions, and provisions of this right of way easement shall extend to and be binding upon the heirs, executors,
administrators, personal representatives, successors, and assigns of the parties hereto.
This Right of way is limited to seventy five feet in width along the route
surveyed. Grantee is limited to the laying of two pipe lines under the terms
of this agreement.
IN WITNESS WHEREOF, the Grantors herein have hereunto set their hands and seals this lSt day of August , 1962 .
.WiJ._Lla 19,' c (Seal)
Signed, sealed, and
delivered in the presence (Seal)
rB Smith // �E've1s11Williams. ✓xa/ (Seal)
ltCY_ f _ Z�_ (Seal)
Donald R.Williams. Grantors
boa.

CPC-96
INDIVIDUAL ACKNOWLEDGMENT
STATE OF NORTH CAROLINA l
SS
COUNTY OF J}
do hereby certify
personally appeared before me this day and acknowledged the due execution of the foregoing instrument.
Witness my hand and official seal this, the day of 19.
My term of office expires on the day of
Notary Public
• is.
286
STATE OF NORTH CAROLINA
COUNTY OF
INDIVIDUAL ACKNOWLEDGMENT
ss
do hereby certify that
personally appeared before me this day and acknowledged the due execution of the foregoing instrument.
Witness my hand and official seal this, the day of , 19_.
My term of office expires on
of
19
PROOF BY SUBSCRIBING WITNESS
Notary Public
STATE OF NORTH CAROLINA
SS
COUNTY OF
I , of Davidson County, state of North Carol i nA
certify that M B SMI-th a -
personally appeared before me this day, and being duly sworn, state that in his presence R - A .Will 'T A S Anti
Eveln Wi11149g.
` signed the foregoing instrument.
Witness. my hand and official seal, this—(2—day of— All St 19 62
My term of
ooff b>fiee` expires on the `w day of
/� Notary is
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NORTYI CAROLINA 1 In 9�par Cart
Z DAVIDSON COUNTY j
n The fotegoiag certifkate
County artocd v
a N. P. of ../-. ct
his ojficirl sal is aljudgr4l to be in due k—A and
accordina to law.
u m Let the instrument snd E'ertiftcxac be regism d.
$° Witness nay hand this �?1--day ofu}-- 19
U O
o r Clerk Superior* rt
uperior Court
p �tf 2
Z Filed for Registration at.l.-gte��QoJt-TM
and registered in Book....--..-).--..-.U.-....-.Page.-
�� 2
O W. E. Tomlinson, Dav;dso County Re ister of Deeds
p i
BY----- "'""" _pp,7N REG. OF,DEEDS
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PCN FORM ATTACHMENT B — IPaC Official Species List
and Red HUC Map

United States Department of the Interior
FISH AND WILDLIFE SERVICE
Asheville Ecological Services Field Office
160 Zillicoa Street
Asheville, NC 28801-1082
Phone: [phone] Fax: [phone]
In Reply Refer To:
Project Code: 2023-0022126
Project Name: CPC Line 1 Shallow Cover
December 06, 2022
Subject: List of threatened and endangered species that may occur in your proposed project
location or may be affected by your proposed project
To Whom It May Concern:
The enclosed species list identifies threatened, endangered, proposed and candidate species, as
well as proposed and designated critical habitat, that may occur within the boundary of your
proposed project and/or may be affected by your proposed project. The enclosed species list
fulfills the requirements of the U.S. Fish and Wildlife Service (Service) under section 7(c) of the
Endangered Species Act (Act) of 1973, as amended (16 U.S.C. 1531 et seq.).
Please note that new species information can change your official species list. Under 50 CFR
402.12(e) of the regulations implementing section 7 of the Act, the accuracy of this species list
should be verified after 90 days. The Service recommends you visit the ECOS-IPaC website at
regular intervals during project planning and implementation to ensure your species list is
accurate or obtain an updated species list.
The purpose of the Act is to provide a means whereby threatened and endangered species and the
ecosystems upon which they depend may be conserved. Under sections 7(a)(1) and 7(a)(2) of the
Act and its implementing regulations (50 CFR 402 et seq.), Federal agencies are required to
utilize their authorities to carry out programs for the conservation of threatened and endangered
species and to determine whether projects may affect threatened and endangered species and/or
designated critical habitat.
A biological assessment (BA) or biological evaluation (BE) should be completed for your
project. A BA is required for major construction activities (or other undertakings having similar
physical impacts) considered to be Federal actions significantly affecting the quality of the
human environment as defined in the National Environmental Policy Act (42 U.S.C. 4332(2) (c))
(NEPA). For projects other than major construction activities, the Service suggests that a BE be
prepared to determine effects of the action and whether those effects may affect listed species
and/or designated critical habitat. E?ects of the action are all consequences to listed species or
critical habitat that are caused by the proposed action, including the consequences of other

12/06/2022
activities that are caused by the proposed action. A consequence is caused by the proposed action
if it is reasonably certain to occur and would not occur "but for" the proposed action..
Recommended contents of a BA/BE are described at 50 CFR 402.12. More information and
resources about project review and preparing a BA/BE can be found at the following web link:
https://www.fws. gov/office/asheville-ecological-services/asheville-field-office-online-review-
process-overview.
If a Federal agency determines listed species and/or designated critical habitat may be affected
by the proposed project, the agency is required to consult with the Service pursuant to 50 CFR
402. The Service is not required to concur with "no effect" determinations from Federal action
agencies. If consultation is required, the Service recommends that candidate species, proposed
species, proposed critical habitat, and at -risk species be addressed within the consultation. More
information on the regulations and procedures for section 7 consultation, including the role of
permit or licensed applicants, can be found in the "Endangered Species Consultation Handbook"
at the following web link: https://www.fws.gov/media/endangered-species-consultation-
handbook.
Migratory Birds: In addition to responsibilities to protect threatened and endangered species
under the Act, there are additional responsibilities under the Migratory Bird Treaty Act (MBTA)
and the Bald and Golden Eagle Protection Act (BGEPA) to protect native birds from project -
related impacts. Any activity, intentional or unintentional, resulting in take of migratory birds,
including eagles, is prohibited unless otherwise permitted by the Service (50 C.F.R. Sec. 10.12
and 16 U.S.C. Sec. 668(a)). More information about MBTA and BGEPA can be found at the
following web link: https://www.fws.gov/program/migratory-birds.
We appreciate your consideration of Federally listed species. The Service encourages Federal
agencies to include conservation of threatened and endangered species in their project planning
to further the purposes of the Act. Please contact our staff at 828-258-3939, if you have any
questions. In any future correspondence concerning this project, please reference the
Consultation Code which can be found in the header of this letter.
Attachment(s):
• Official Species List
• USFWS National Wildlife Refuges and Fish Hatcheries
• Migratory Birds
• Wetlands

12/06/2022
Official Species List
This list is provided pursuant to Section 7 of the Endangered Species Act, and fulfills the
requirement for Federal agencies to "request of the Secretary of the Interior information whether
any species which is listed or proposed to be listed may be present in the area of a proposed
action".
This species list is provided by:
Asheville Ecological Services Field Office
160 Zillicoa Street
Asheville, NC 28801-1082
[phone]

12/06/2022
Project Summary
Project Code: 2023-0022126
Project Name: CPC Line 1 Shallow Cover
Project Type: Pipeline - Onshore - Maintenance / Modification - Above Ground
Project Description: Shallow cover maintenance project Davison Co. NC
Project Location:
Approximate location of the project can be viewed in Google Maps: https:
www. google.com/maps/(a)35.744583500000005,-80.44633156157388,14z
O
Counties: Davidson County, North Carolina

12/06/2022 3
Endangered Species Act Species
There is a total of 3 threatened, endangered, or candidate species on this species list.
Species on this list should be considered in an effects analysis for your project and could include
species that exist in another geographic area. For example, certain fish may appear on the species
list because a project could affect downstream species.
IPaC does not display listed species or critical habitats under the sole jurisdiction of NOAA
Fisheriesi, as USFWS does not have the authority to speak on behalf of NOAA and the
Department of Commerce.
See the "Critical habitats" section below for those critical habitats that lie wholly or partially
within your project area under this office's jurisdiction. Please contact the designated FWS office
if you have questions.
1. NOAA Fisheries, also known as the National Marine Fisheries Service (NMFS), is an
office of the National Oceanic and Atmospheric Administration within the Department of
Commerce.
Mammals
NAME STATUS
Tricolored Bat Perimyotis subflavus Proposed
No critical habitat has been designated for this species. Endangered
Species profile: https:Hecos.fws.gov/ecp/species/10515
Insects
NAME
STATUS
Monarch Butterfly Danaus plexippus
Candidate
No critical habitat has been designated for this species.
Species profile: https:Hecos.fws.gov/ecp/species/9743
Flowering Plants
NAME
STATUS
Schweinitz's Sunflower Helianthus schweinitzii
Endangered
No critical habitat has been designated for this species.
Species profile: https:Hecos.fws.gov/ecp/species/3849
Critical habitats
THERE ARE NO CRITICAL HABITATS WITHIN YOUR PROJECT AREA UNDER THIS OFFICE'S
JURISDICTION.

12/06/2022
USFWS National Wildlife Refuge Lands And Fish
Hatcheries
Any activity proposed on lands managed by the National Wildlife Refuge system must undergo a
'Compatibility Determination' conducted by the Refuge. Please contact the individual Refuges to
discuss any questions or concerns.
THERE ARE NO REFUGE LANDS OR FISH HATCHERIES WITHIN YOUR PROJECT AREA.

12/06/2022
Migratory Birds
Certain birds are protected under the Migratory Bird Treaty Act! and the Bald and Golden Eagle
Protection Actz.
Any person or organization who plans or conducts activities that may result in impacts to
migratory birds, eagles, and their habitats should follow appropriate regulations and consider
implementing appropriate conservation measures, as described below.
1. The Migratory Birds Treat. Act of 1918.
2. The Bald and Golden Eagle Protection Act of 1940.
3. 50 C.F.R. Sec. 10.12 and 16 U.S.C. Sec. 668(a)
The birds listed below are birds of particular concern either because they occur on the
USFWS Birds of Conservation Concern (BCC) list or warrant special attention in your
project location. To learn more about the levels of concern for birds on your list and how this
list is generated, see the FAQ below. This is not a list of every bird you may find in this location,
nor a guarantee that every bird on this list will be found in your project area. To see exact
locations of where birders and the general public have sighted birds in and around your project
area, visit the E-bird data mapping tool (Tip: enter your location, desired date range and a species
on your list). For projects that occur off the Atlantic Coast, additional maps and models detailing
the relative occurrence and abundance of bird species on your list are available. Links to
additional information about Atlantic Coast birds, and other important information about your
migratory bird list, including how to properly interpret and use your migratory bird report, can be
found below.
For guidance on when to schedule activities or implement avoidance and minimization measures
to reduce impacts to migratory birds on your list, click on the PROBABILITY OF PRESENCE
SUMMARY at the top of your list to see when these birds are most likely to be present and
breeding in your project area.
BREEDING
NAME SEASON
Bald Eagle Haliaeetus leucocephalus Breeds Sep 1 to
This is not a Bird of Conservation Concern (BCC) in this area, but warrants attention Jul 31
because of the Eagle Act or for potential susceptibilities in offshore areas from certain types
of development or activities.
Chimney Swift Chaetura pelagica Breeds Mar 15
This is a Bird of Conservation Concern (BCC) throughout its range in the continental USA t0 Aug 25
and Alaska.
Kentucky Warbler Oporornis formosus Breeds Apr 20
This is a Bird of Conservation Concern (BCC) throughout its range in the continental USA t0 Aug 20
and Alaska.

12/06/2022
BREEDING
NAME
SEASON
Prairie Warbler Dendroica discolor
Breeds May 1
This is a Bird of Conservation Concern (BCC) throughout its range in the continental USA
to Jul 31
and Alaska.
Prothonotary Warbler Protonotaria citrea
Breeds Apr 1 to
This is a Bird of Conservation Concern (BCC) throughout its range in the continental USA
Jul 31
and Alaska.
Red-headed Woodpecker Melanerpes erythrocephalus Breeds May 10
This is a Bird of Conservation Concern (BCC) throughout its range in the continental USA to Sep 10
and Alaska.
Rusty Blackbird Euphagus carolinus Breeds
This is a Bird of Conservation Concern (BCC) only in particular Bird Conservation Regions elsewhere
(BCRs) in the continental USA
Wood Thrush Hylocichla mustelina Breeds May 10
This is a Bird of Conservation Concern (BCC) throughout its range in the continental USA to Aug 31
and Alaska.
Probability Of Presence Summary
The graphs below provide our best understanding of when birds of concern are most likely to be
present in your project area. This information can be used to tailor and schedule your project
activities to avoid or minimize impacts to birds. Please make sure you read and understand the
FAQ "Proper Interpretation and Use of Your Migratory Bird Report" before using or attempting
to interpret this report.
Probability of Presence (■)
Each green bar represents the bird's relative probability of presence in the 10km grid cell(s) your
project overlaps during a particular week of the year. (A year is represented as 12 4-week
months.) A taller bar indicates a higher probability of species presence. The survey effort (see
below) can be used to establish a level of confidence in the presence score. One can have higher
confidence in the presence score if the corresponding survey effort is also high.
How is the probability of presence score calculated? The calculation is done in three steps:
The probability of presence for each week is calculated as the number of survey events in
the week where the species was detected divided by the total number of survey events for
that week. For example, if in week 12 there were 20 survey events and the Spotted Towhee
was found in 5 of them, the probability of presence of the Spotted Towhee in week 12 is
0.25.
2. To properly present the pattern of presence across the year, the relative probability of
presence is calculated. This is the probability of presence divided by the maximum
probability of presence across all weeks. For example, imagine the probability of presence
in week 20 for the Spotted Towhee is 0.05, and that the probability of presence at week 12

12/06/2022
3
(0.25) is the maximum of any week of the year. The relative probability of presence on
week 12 is 0.25/0.25 = 1; at week 20 it is 0.05/0.25 = 0.2.
3. The relative probability of presence calculated in the previous step undergoes a statistical
conversion so that all possible values fall between 0 and 10, inclusive. This is the
probability of presence score.
Breeding Season( )
Yellow bars denote a very liberal estimate of the time -frame inside which the bird breeds across
its entire range. If there are no yellow bars shown for a bird, it does not breed in your project
area.
Survey Effort (1)
Vertical black lines superimposed on probability of presence bars indicate the number of surveys
performed for that species in the 10km grid cell(s) your project area overlaps. The number of
surveys is expressed as a range, for example, 33 to 64 surveys.
No Data (—)
A week is marked as having no data if there were no survey events for that week.
Survey Timeframe
Surveys from only the last 10 years are used in order to ensure delivery of currently relevant
information. The exception to this is areas off the Atlantic coast, where bird returns are based on
all years of available data, since data in these areas is currently much more sparse.
■ probability of presence breeding season I survey effort — no data
SPECIES JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
Bald Eagle
Non Berab e 11C ++ +11+ +No +11 AF !�jI Jill Jill -- Jill Jill JillVulMiL
Chimney gwift ++++ ++++ ++++'+'"'���,'�r'—
BCC Rangewide
(CON) J
Kentucky Warbler
Rangewide� Jill III —
BCC (CON)
Prairie Prairie Warbler ���� +�
BCC Rangewide ++++ ++++ ++++ ++++ ++++ ;++ --- —+++ +—+— +—+—
(CON)
Prothonotary
Warbler ++++ ++++ ++++ "esBCC Rangewide Rangewide EMME
(CON)
Red-headed ++++ + I +J ++++ 1 +,+ ++++ ++++ �""""''+ +—+— —+-- +—+—
Woodpecker

12/06/2022
4
BCC Rangewide
(CON)
Rusty Blackbird ++1+ ++++ +"' ++++ ++++ ++-4--4- —+++ +—+— —+-- +—+—
BCC-BCR
Wood Thrush +++ ++ + + +++ + Jill Jill—+—�+-- +—+—
BCC Rangewide
(CON) -- ---�
Additional information can be found using the following links:
• Birds of Conservation Concern https://www.fws.gov/program/migratory-birds/species
• Measures for avoiding and minimizing impacts to birds https://www.fws.gov/library
collections/avoiding-and-minimizing-incidental-take-migratory-birds
• Nationwide conservation measures for birds https://www.fws.gov/sites/default/files/
documents/nationwide-standard-conservation-measures.pdf
Migratory Birds FAQ
Tell me more about conservation measures I can implement to avoid or minimize impacts
to migratory birds.
Nationwide Conservation Measures describes measures that can help avoid and minimize
impacts to all birds at any location year round. Implementation of these measures is particularly
important when birds are most likely to occur in the project area. When birds may be breeding in
the area, identifying the locations of any active nests and avoiding their destruction is a very
helpful impact minimization measure. To see when birds are most likely to occur and be breeding
in your project area, view the Probability of Presence Summary. Additional measures or permits
may be advisable depending on the type of activity you are conducting and the type of
infrastructure or bird species present on your project site.
What does IPaC use to generate the list of migratory birds that potentially occur in my
specified location?
The Migratory Bird Resource List is comprised of USFWS Birds of Conservation Concern
(BCQ and other species that may warrant special attention in your project location.
The migratory bird list generated for your project is derived from data provided by the Avian
Knowledge Network (AKN). The AKN data is based on a growing collection of survey, banding_,
and citizen science datasets and is queried and filtered to return a list of those birds reported as
occurring in the 10km grid cell(s) which your project intersects, and that have been identified as
warranting special attention because they are a BCC species in that area, an eagle (Eagle Act
requirements may apply), or a species that has a particular vulnerability to offshore activities or
development.
Again, the Migratory Bird Resource list includes only a subset of birds that may occur in your
project area. It is not representative of all birds that may occur in your project area. To get a list
of all birds potentially present in your project area, please visit the Rapid Avian Information
Locator RAIL, Tool.

12/06/2022
What does IPaC use to generate the probability of presence graphs for the migratory birds
potentially occurring in my specified location?
The probability of presence graphs associated with your migratory bird list are based on data
provided by the Avian Knowledge Network (AKN). This data is derived from a growing
collection of survey, banding, and citizen science datasets.
Probability of presence data is continuously being updated as new and better information
becomes available. To learn more about how the probability of presence graphs are produced and
how to interpret them, go the Probability of Presence Summary and then click on the "Tell me
about these graphs" link.
How do I know if a bird is breeding, wintering or migrating in my area?
To see what part of a particular bird's range your project area falls within (i.e. breeding,
wintering, migrating or year-round), you may query your location using the RAIL Tool and look
at the range maps provided for birds in your area at the bottom of the profiles provided for each
bird in your results. If a bird on your migratory bird species list has a breeding season associated
with it, if that bird does occur in your project area, there may be nests present at some point
within the timeframe specified. If "Breeds elsewhere" is indicated, then the bird likely does not
breed in your project area.
What are the levels of concern for migratory birds?
Migratory birds delivered through IPaC fall into the following distinct categories of concern:
1. "BCC Rangewide" birds are Birds of Conservation Concern (BCC) that are of concern
throughout their range anywhere within the USA (including Hawaii, the Pacific Islands,
Puerto Rico, and the Virgin Islands);
2. "BCC - BCR" birds are BCCs that are of concern only in particular Bird Conservation
Regions (BCRs) in the continental USA; and
3. "Non -BCC - Vulnerable" birds are not BCC species in your project area, but appear on
your list either because of the Eagle Act requirements (for eagles) or (for non -eagles)
potential susceptibilities in offshore areas from certain types of development or activities
(e.g. offshore energy development or longline fishing).
Although it is important to try to avoid and minimize impacts to all birds, efforts should be made,
in particular, to avoid and minimize impacts to the birds on this list, especially eagles and BCC
species of rangewide concern. For more information on conservation measures you can
implement to help avoid and minimize migratory bird impacts and requirements for eagles,
please see the FAQs for these topics.
Details about birds that are potentially affected by offshore projects
For additional details about the relative occurrence and abundance of both individual bird species
and groups of bird species within your project area off the Atlantic Coast, please visit the
Northeast Ocean Data Portal. The Portal also offers data and information about other taxa besides
birds that may be helpful to you in your project review. Alternately, you may download the bird
model results files underlying the portal maps through the NOAA NCCOS Integrative Statistical
Modeling and Predictive Mapping of Marine Bird Distributions and Abundance on the Atlantic
Outer Continental Shelf project webpage.

12/06/2022 6
Bird tracking data can also provide additional details about occurrence and habitat use
throughout the year, including migration. Models relying on survey data may not include this
information. For additional information on marine bird tracking data, see the Diving Bird Study
and the nanotag studies or contact Caleb Spiegel or Pam Lorin.
What if I have eagles on my list?
If your project has the potential to disturb or kill eagles, you may need to obtain a permit to avoid
violating the Eagle Act should such impacts occur.
Proper Interpretation and Use of Your Migratory Bird Report
The migratory bird list generated is not a list of all birds in your project area, only a subset of
birds of priority concern. To learn more about how your list is generated, and see options for
identifying what other birds may be in your project area, please see the FAQ "What does IPaC
use to generate the migratory birds potentially occurring in my specified location". Please be
aware this report provides the "probability of presence" of birds within the 10 km grid cell(s) that
overlap your project; not your exact project footprint. On the graphs provided, please also look
carefully at the survey effort (indicated by the black vertical bar) and for the existence of the "no
data" indicator (a red horizontal bar). A high survey effort is the key component. If the survey
effort is high, then the probability of presence score can be viewed as more dependable. In
contrast, a low survey effort bar or no data bar means a lack of data and, therefore, a lack of
certainty about presence of the species. This list is not perfect; it is simply a starting point for
identifying what birds of concern have the potential to be in your project area, when they might
be there, and if they might be breeding (which means nests might be present). The list helps you
know what to look for to confirm presence, and helps guide you in knowing when to implement
conservation measures to avoid or minimize potential impacts from your project activities,
should presence be confirmed. To learn more about conservation measures, visit the FAQ "Tell
me about conservation measures I can implement to avoid or minimize impacts to migratory
birds" at the bottom of your migratory bird trust resources page.

12/06/2022
Wetlands
Impacts to NWI wetlands and other aquatic habitats may be subject to regulation under Section
404 of the Clean Water Act, or other State/Federal statutes.
For more information please contact the Regulatory Program of the local U.S. Army Corps of
Engineers District.
Please note that the NWI data being shown may be out of date. We are currently working to
update our NWI data set. We recommend you verify these results with a site visit to determine
the actual extent of wetlands on site.
FRESHWATER FORESTED/SHRUB WETLAND
• PF01A

12/06/2022
IPaC User Contact Information
Agency: Corblu Ecology Group
Name: Michael Barfield
Address: 3225 South Cherokee Lane, Bldg. 800
City:
WOODSTOCK
State:
GA
Zip:
30188
Email
[e-mail]
Phone:
6782152742

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