20180576 Ver 1_401 Application_20180430

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Anonymous User 4/30/2018 5:27:49 PM (Message Start Event)
Accept by Carpenter,Kristi 4/30/2018 5:28:46 PM (DOT project)
. The task was assigned to Carpenter,Kristi. The due date is: May 3, 2018 5:00 PM 4/30/2018 5:27 PM

Water Resources
ENVIRONMENTAL �UPLITV
Staff Review
ID#* Version* �
20180576
Is this project a public transportation project? * �' Yes
�' No
Reviewer List:* Dave Wanucha:eads\djwanucha
Select Reviewing Office:* Winston-Salem Regional Office -[phone]
Submittal Type:*
401 Application
Does this project require a request for payment to be sent? *
l'
Yes
r•
No

Project Submittal Dated 4/30/2018
*
Please note: fields marked with a red asterisk beloware required. You will not be able to submit the form until all
mandatory questions are ans�red.
Project Type:* �' New Project
C' Pre-Application Submittal
C' More Information Response
r Other Agency Comments
l•' For the Record Only (Courtesy Copy)
New Project - Please check the new project type if you are trying to submit a new project that needs an official approval
decision.
Pre-Application Submittal - Please check the pre-application submittal if you just want feedback on your submittal and
do not have the e�ectation that your submittal will be considered a complete application requiring a formal decision.
More Information Response - Please check this type if you are responding to a request for information from staff and
you have and ID# and version for this response.
Other Agency Comments - Please check this if you are submitting comments on an ebsting project.
Project Contact Information
Name: Glenn I. Martin
Who is subrritting the irrforrration?
Email Address:* [e-mail]
Project Information
Project Name:* Line 326 DOT Pipeline Relocation
Is this a public transportation project? *
C•' Yes
C' No
Is the project located within a NC DCM Area of Environmental Concern (AEC)?*
C' Ye�" No �' Unknown
TI P#: WBS#:
(Applies to DOT projects only)
County (ies) *
Forsyth
Please upload all files that need to be submited.
Qick the upload button or drag and drop files here to attach docurrent
Application Only Line 326 DOT Pipeline
308.79KB
Relocation.pdf
Only pdf or Ivrz files are accepted.
Describe the attachments:
File sent through electronic process by Kristi Lynn Carpenter, NCDEQ Admin with Glenn I. Martin listed as
contact per paper copy PCN.
* fJ By checking the box and signing box below, I certify that:

o I have given true, accurate, and complete information on this form;
o I agree that submission of this form is a"transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the
"Uniform Electronic Transactions AcY')
o I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes
(the "Uniform Electronic Transactions AcY');
o I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
o I intend to electronically sign and submit the online form."
Signature:
f�rJrr �j�s'N [ }l���f-r�9Ylixt�
Submittal Date:

Office Use Only:
Corps adion ID no.
DWQ projed no.
Form Version 1.4 January 2009
Pre-Construction Notification (PCN) Form
A. Applicant InfortnaUon
1. Pracessing
1a. Type(s) of appraval sought from the Corps: � Sedion 404 Permit ❑ Section 10 Permit
1b. Specify Natlonwide Permit (NWP) number: 1z or General Permit (GP) number:
tc. Has the NWP or GP number been verified by the Corps? ❑ Yes � No
1 d. Type(s) of approval sought fram the DWQ (check all that apply):
0 401 Water Quality Cert�cation — Regular ❑ Non-404 Jurisdidional General Pertnit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
1 e. Is this natificatian solely for the record For the record only for DWQ For the record only for Corps Pertnit:
because written approval is not required? 401 Certification:
❑ Yes ❑x No ❑ Yes � No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for
mitigation of impads7 If so, attach the acceptance letter from mitigation bank ❑ Yes ❑X No
or in-lieu fee program.
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h � yes � No
below.
1 h. Is the project located within a NC DCM Area of Environmental Concem (AEC)? ❑ Yes � No
2. Project InformaUon
2a. Name of projed: Line 326 DOT Relocation
2b. County: Forsyth
2c. Nearest municipality / tawn: Stanleyville
2d. Subdivision name: NA
2e. NCDOT only, T.I.P. or state projed no: NA
3. Ownerinfortnatian
3a. Name(s) on Recorded Deed: See PCN supplemental information
3b. Deed Book and Page No. See PCN supplemental information
3c. Responsible Party (for LLC if qaron Weldon
appliqble):
3d. Street address: 4720 Piedmont Row Drive
3e. City, state, zip: Charlotte, NC 28233
3f. Telephone no.: 704364-3120
3g. Fax no.:
3h. Email address: [e-mail]
Page 1 of 10
PCN Form — Version 1.4 January 2009

4. Applicant Information (if different from owner)
4a. Applicant is: OX Agent ❑ Other, specify:
4b. Name:
4c. Business name
(if applicable):
4d. Street address:
4e. City, state, zip:
4f. Telephone no.:
4g. Fax no.:
4h. Email address:
5. Agent/Consultant Information (if applicable)
5a. Name: Glenn I. Martin
5b. Business name Pond & Co
(if applicable):
5c. Street address: 3500 Parkway Lane Suite 500
5d. City, state, zip: Peachtree Corners, GA 30092
5e. Telephone no.: 678-336-7720
5f. Fax no.:
5g. Email address: [e-mail]
Page 2 of 10

B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): See PCN supplemental information
1b. Site coordinates (in decimal degrees): Latitude: 36.217 Longitude: -80.309
1c. Property size: 9.500000� acres
2. Surface Waters
2a. Name of nearest body of water to proposed project: Beaver Dam Creek
2b. Water Quality Classification of nearest receiving water: C
2c. River basin: Upper Yadkin - 03040101
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
This proposed natural gas pipeline project is located adjacent to proposed NCDOT rights-of-ways (ROWs) within a predominately mixed pine-
hardwood forest.
3b. List the total estimated acreage of all existing wetlands on the property: 0.72
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 1,325
3d. Explain the purpose of the proposed project:
See PCN supplemental information
3e. Describe the overall project in detail, including the type of equipment to be used:
See PCN supplemental information
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the � Yes ❑X No ❑ Unknown
Corps or State been requested or obtained for this property /
ro'ect includin all rior hases in the ast? Comments:
4b. If the Corps made the jurisdictional determination, what type
of determination was made? ❑ Preliminary ❑ Final
4c. If yes, who delineated the jurisdictional areas? Agency/Consultant Company:
Name (if known): Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5. Project History
5a. Have permits or certifications been requested or obtained for �Yes ❑X No ❑ Unknown
this project (including all prior phases) in the past?
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project? ❑ Yes �X No
6b. If yes, explain.
Page 3 of 10
PCN Form — Version 1.4 January 2009

C. Proposed Impacts Inventory
1. Impacts Summary
1 a. Which sections were completed below for your project (check all that apply):
�X Wetlands ❑X Streams — tributaries ❑ Buffers ❑ Open Waters ❑ Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. 2b. 2c. 2d. 2e. 2f.
Wetland impact Type of impact Type of wetland Forested Type ofjurisdiction Area of
number Corps (404,10) or impact
Permanent (P) or DWQ (401, other) (acres)
Tem ora
W2 P Land Clearing Non-Riverine Swamp,Forest Yes Corps 0.08
- Choose one Choose one Yes/No -
- Choose one Choose one Yes/No -
- Choose one Choose one Yes/No -
- Choose one Choose one Yes/No -
- Choose one Choose one Yes/No -
2g. Total Wetland Impacts: 0.08
2h. Comments:
The pipeline ROW will be cleared and maintained at 50-feet wide in perpetuity for structural integrity and safety except where it crosses water
resources in which cases it will not exceed 40 feet. Mechanical clearing will be utilized in the forested wetiand crossing.
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a. 3b. 3c. 3d. 3e. 3f. 3g.
Stream impact Type of impact Stream name Perennial (PER) or Type of Average Impact
number intermittent (INT)? jurisdiction stream length
Permanent (P) or width (linear
Temporary (T) (feet) feet)
S1 T Excavation Unnamed Trib PER Corps 2 52
S3 T Excavation Unnamed Trib PER Corps 5 41
S4 T Excavation Unnamed Trib INT Corps 5 64
- Choose one - -
- Choose one - -
- Choose one - -
3h. Total stream and tributary impacts �57.00000�
3i. Comments:
Open cut methods will be utilized to construct this proposed pipeline. Average trench width will be 4 feet wide. Construction corridor will be no more
than 40 feet wide at waters.
Page 4 of 10
PCN Form — Version 1.4 January 2009

4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individuall list all o en water im acts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number (if applicable) Type of impact Waterbody Area of impact (acres)
Permanent (P) or type
Tem ora
- Choose one Choose
- Choose one Choose
- Choose one Choose
- Choose one Choose
4f. Total open water impacts
4g. Comments:
5. Pond or Lake Construction
If ond or lake construction ro osed, then com lete the chart below.
5a. 5b. 5c. 5d. 5e.
Pond ID number Proposed use or Wetland Impacts (acres) Stream Impacts (feet) Upland
purpose of pond (acres)
Flooded Filled Excavated Flooded Filled Excavated
Choose one
Choose one
5f. Total:
5g. Comments:
5h. Is a dam high hazard permit required? ❑ Yes OX No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If an im acts re uire miti ation, then ou MUST fill out Section D of this form.
6a. Project is in which protected basin? ❑ Neuse ❑ Tar-Pamlico ❑ Catawba ❑ Randleman ❑ Other:
6b. 6c. 6d. 6e. 6f. 6g.
Buffer Impact Reason for impact Stream name Buffer Zone 1 Zone 2
number — mitigation impact impact
Permanent (P) or required? (square (square
Tem ora feet feet
- Yes/No
- Yes/No
- Yes/No
- Yes/No
- Yes/No
- Yes/No
6h. Total Buffer Impacts:
6i. Comments:
Page 5 of 10

D. Impact Justification and Mitigation
1. Avoidance and Minimization
1a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
See PCN supplemental information
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
See PCN supplemental information
2. Com ensato Miti ation for Im acts to Waters of the U.S. or Waters of the State
2a. Does the project require Compensatory Mitigation for � Yes ❑X No
impacts to Waters of the U.S. or Waters of the State?
2b. If yes, mitigation is required by (check all that apply): ❑ DWQ ❑ Corps
❑ Mitigation bank
2c. If yes, which mitigation option will be used for this
project? ❑ Payment to in-lieu fee program
❑ Permittee Responsible Mitigation
3. Com lete if Usin a Miti ation Bank
3a. Name of Mitigation Bank:
Type: Choose one Quantity:
3b. Credits Purchased (attach receipt and letter) Type: Choose one Quantity:
Type: Choose one Quantity:
3c. Comments:
4. Com lete if Makin a Pa ment to In-lieu Fee Pro ram
4a. Approval letter from in-lieu fee program is attached. ❑ Yes
4b. Stream mitigation requested: linear feet
4c. If using stream mitigation, stream temperature: Choose one
4d. Buffer mitigation requested (DWQ only): square feet
4e. Riparian wetland mitigation requested: acres
4f. Non-riparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requested: acres
4h. Comments:
5. Complete if Using a Permittee Responsible Mitigation Plan
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
Page 6 of 10
PCN Form — Version 1.4 January 2009

6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires � Yes ❑X No
buffer mitigation?
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.
6c. 6d. 6e.
Zone Reason for impact Total impact Multiplier Required mitigation
(square feet) (square feet)
Zone 1 3(2 for Catawba)
Zone 2 1.5
6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund).
6h. Comments:
Page 7 of 10

E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan
1 a. Does the project include or is it adjacent to protected riparian buffers identified � Yes �X No
within one of the NC Ri arian Buffer Protection Rules?
1 b. If yes, then is a diffuse flow plan included? If no, explain why.
❑ Yes OX No
2. Stormwater Mana ement Plan
2a. What is the overall percent imperviousness of this project? p o�o
2b. Does this ro'ect re uire a Stormwater Mana ement Plan? ❑ Yes 0 No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why:
No impervious surfaces or stromwater infrastructure will be constructed as part of this project. Other than permanent clearing of the ROW, all
disturbances are temporary and will be restored to pre-construction conditions. No non-404 Jurisdictional General Permits are required for this project
as this project will not result in greater than 24% impervious surtace, and does not contain drainage areas with greater than 24% impervious surFace.
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
2e. Who will be responsible for the review of the Stormwater Management Plan?
3. Certified Local Government Stormwater Review
3a. In which local overnmenYs 'urisdiction is this ro'ect? Forsyth County
❑ Phase II
3b. Which of the following locally-implemented stormwater management programs ❑ NSW
apply (check all that apply): � USMP
� Water Supply Watershed
0 Other: None
3c. Has the approved Stormwater Management Plan with proof of approval been ❑ Yes ❑X No
attached?
4. DWQ Stormwater Pro ram Review
�Coastal counties
❑HQW
4a. Which of the following state-implemented stormwater management programs apply �ORW
(check all that apply):
❑Session Law 2006-246
X�Other: NCG 010000
4b. Has the approved Stormwater Management Plan with proof of approval been � Yes ❑X No
attached?
5. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements? ❑X Yes ❑ No
5b. Have all of the 401 Unit submittal requirements been met? �X Yes ❑ No
Page 8 of 10
PCN Form — Version 1.4 January 2009

F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the project involve an expenditure of public (federal/state/local) funds or the � Yes �X No
use of public (federal/state) land?
1 b. If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State ❑ Yes ❑ No
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
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 NEPA or SEPA final approval
letter.) ❑ Yes ❑ No
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland Standards, ❑ Yes OX No
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after-the-fact permit application? ❑Yes OX No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s):
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in �Yes OX No
additional development, which could impact nearby downstream water quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
The pipeline is classified as a transmission line which will not result in additional development following its completion. The installation of this proposed
line is to relocate an existing pipeline as a result of NCDOT expanding a highway interchange. Therefore, a cumulative impact analysis has not been
implemented for this project as this project is not anticipated to contribute to future impacts.
4. Sewage Disposal (DWQ Requirement)
4a. Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of wastewater generated from
the proposed project, or available capacity of the subject facility.
During construction, portable sanitary units will be provided. Waste will be coliected a minimum of one time per week by a licensed portable facility
provided in complete compliance with local and state regulations. All sanitary waste units will be located in upland areas and be easily accessible. this
project does not require sanitary sewer or septic tank service. No sanitary waste maintenance will be necessary post construction.
Page 9 of 10
PCN Form — Version 1.4 January 2009

5. Endangered Species and Designated CriUcal Habitat (Corps Requirement)
5a. VYII this projed occur in or near an area with federally proteded species or 0 Yes ❑ No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Ad � Yes 0 No
impads?
5c. If yes, indicate the USFWS Field Oifice you have contaded. -
5d. What data sources did you use to detertnine whether your site would impad Endangered Species or Designated Critical
Habitat?
USFWS, Infortnadon for Planning and Consultadon (IPaC): USFlNS Forsyth Counry Endanpered Spedes, Threatened Spedes, Federal Spedes of
Concem, and Candidate Speaes; NC Natural Herifsge Program. See PCN supplementel infortnation.
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? ❑ Yes � No
6b. What data sources did you use to detertnine whether your ske would impad Essential Fish Habitat?
NOAA Habkat Conservation Nationai Marine Fisheries Service, Essential Fish Habitat Mapper Jd.O
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project axur in or near an area that the state, federal or tribal
govemments have designated as having historic or cuRural preservation � Yes � No
status (e.g., National Historic Trust designation or properties signfipnt in
North Carolina history and archaeology)?
7b. What data sources did you use to detertnine whether your site would impad historic or archeological resources?
Norih Carolina State Historic Preservalion Otfice (SHPO) Historic Property flles, and National Register of Historic Place (NRHP). See PCN
supplemental infortnation.
6. Flood Zone Designation (Corps Requirement)
8a. Will this projed occur in a FEMA-designated 100.year floodplain? ❑ Yes � No
8b. If yes, explain how projed meets FEMA requirements:
8c. What source(s) did you use to make the floodplain determination?
FEMA Nation Flood Hazard Layer (GIS geodatabase)
Glenn I. Martin �°'�'r^ � 4-20-2018
ApplicanUAgenYs Printed Name ApplicanUAgenYs Signature Date
(Agent's signature is valid only if an authorization
letter irom the a IicaM is rovided.
Page 10 of 10